Add a comment February 4th, 2010 by bronxdoc
Our friends from the National Physicians Alliance (see prior postings) have passed on an invitation to their 5th annual meeting to be held March 13-15, 2010 in Long Beach, Califonia. For information and registration, please click on this link. To give readers of the Portal a sense of what some physician activists are up to, we are reprinting some of the conference schedule:
Leadership Development: Developing Skills to Lead as the Landscape of Health Care Changes
From national health care reform to community advocacy to clinical practice, physician leadership and engagement has never been more vital to the health of the nation. Recent successful examples have also demonstrated the benefits of physician leadership, advocacy, and engagement with community partners. This track will provide resources for communication, management and advocacy skills, civic engagement, community collaboration, and other tools that physicians can apply in a variety of settings. Community members are welcome to join and learn more about physician engagement. Session to include:
Advancing Health Care Through Civic Engagement
Kim Alexander, President, California Voter Foundation Carmela Castellano-Garcia, President CEO, California Primary Care Association Marc Wetherhorn, National Advocacy Director, National Association of Community Health Centers
Messaging, Media & Communications
Bob Crittenden, MD, MPH , Executive Director, The Herndon Alliance
Effectively Engaging with Your State Legislatures & Its Members
Progressive States Network – Speaker TBA
Educating State Legislators, Advancing Health Care Reform: Tools Physicians Can Use to Engage & Inform State Legislators About Federal HC Reforms
Progressive States Network – Speaker TBA
Models for Physician Leadership and Community Engagement
Bill Jordan, MD, MPH, NY Action Network – National Physicians Alliance
Aaron Fox, MD, MPH, NY Action Network – National Physicians Alliance
Issues on the Horizon: 2010 & 2012 Elections
Kim Alexander, President, California Voter Foundation
Serena Kirk, Senior Policy Advocate, California Primary Care Association
Practice Innovations: Practicing Medicine in a Changing World
What will the practice of medicine look like in ten years? How will reform change the way the average physician will practice medicine? This will be an instructive and interactive track will address these complex questions and many others by focusing on the following three areas: 1) Evidence Based Medicine (EBM), 2) Practice structure and financing, and 3) Information and Communications Technology. Sessions to include:
Evidence-based Medicine & Clinical Guidelines
Colin Kopes-Kerr, MD, JD, MPH, The Permanente Medical Group
Healthcare Planning and Strategy
Kevin Fickenscher, MD, CPE, FACPE, FAAFP, Perot Systems
Approaches in Chronic Disease Management
Susan Snyder, MD
High Quality Care for Disadvantaged Populations
L. Gordon Moore, MD
National Health Policy: Avenues for Involvement in Advocacy to Enhance our Country’s Health
With the potential passing of federal health care reform legislation a “wave of change” will alter the landscape of public health and healthcare in America. The National Health Policy Track aims to educate and mobilize physicians on the healthcare reform debate of 2009 and future directions for reform. Sessions to include:
Reforms that Reduce Costs Without Reducing Quality of Care
Thomas Rice, PhD, Professor, Department of Health Services; Vice Chancellor, Academic Personnel
UCLA School of Public Health
Political Solutions to the Obesity Epidemic
Deborah Cohen, MD, MPH, Senior Natural Scientist, Rand Corporation
Outcomes of Health Care Reform: Review of the Policy Debate
Josh Derr, Manager, Mayo Clinic Health Policy Center
Health Care Reform: Impact on Women
National Women’s Law Center – Lisa Codispoti, Senior Counsel
Federal Health Care Reform: How Physicians Can Help Their States Access Upcoming Opportunities & Resources
Progressive States Network – Speaker TBA
Global Health: Workforce Issues in an Ever-Evolving Global Health Landscape
The world has never been smaller, nor have global issues of health been more of a concern for physicians and advocates alike. With health care workers migrating to the Unites States for better opportunities, a shortage in these critical areas ensues. What can physicians do to ensure that we are thinking globally in our efforts to improve the health of our patient, our community and our world? Sessions to include:
The Global Workforce Crisis-Is US the Problem or Solution?
Richard Scheffler, PhD, University of California, Berkeley
Kate Tulenko, MD, MPH, Deputy Director at Capacity Plus/ IntraHealth
Health Policy Specialist at World Bank
International Health Workforce Issues
Amy Hagopian, MHA, PhD, Health Alliance International, University of Washington
In the Wake of the Storm: On the Ground in Haiti
Susan Partovi, MD, Professor UCLA School of Medicine
Director Homeless Healthcare Los Angeles
Trade and Health: The Impact of Health Worker Migration
Michelle Forzley, JD, MPH
Nuclear Non-Proliferation: The Physicians Role in Advocating Peace
Bob Dodge, MD, Physicians for Social Responsibility, Los Angeles
California Health Policy: Experiences & Experiments in State Policy and its Nationwide Influence
California has long been at the forefront of the ever-changing face of healthcare. Its struggles are often those of other states around the country, and the innovations and experiments in health care delivery have offered guidance to the rest of the nation, whether in success or in failure. With the ongoing budget crisis in the state and the potential impact of impending national health legislation, adding to other internal debates about border health, malpractice, medical marijuana, and disaster preparedness, now as ever, California will be watched by the nation. In the California health track we hope to stimulate learning, debate and exchange of ideas around these and other issues relevant to patients, providers, and policy-makers. Sessions to include:
Issues facing Community Health Clinics and the Underserved & Minority Populations
Michael R. Cousineau, PhD, Director Community Health and Family Medicine University of Southern California Castulo de la Rocha, JD, President & CEO AltaMed Medical Services
A ‘Reformed Single Payer’ in the Current Reform Era
E. Richard Brown, PhD, Director, UCLA Center for Health Policy Research Professor, UCLA School of Public Health, Principal Investigator, CHIS
Border States and the Uninsured: Immigration Issues for Health Care Reform
Michael Rodríguez, MD, MPH, Sr. Researcher, UCLA Center for Health Policy Research Professor, UCLA Department of Family Medicine
Krysten Sinema, MSW, Arizona State Legislator
Progressive States Network – Speaker TBA
Addressing Disparities Through Health Reform
National Women’s Law Center
Healthcare Crisis in a Bankrupt State: Can California Still Lead?
Herb Schultz, MPP, Senior Health Policy Advisor to the Governor
Sara Rogers, Health Legislative Advisor to Senator Mark Leno
Coordinating Across State Lines: Opportunities Presented by Health Care Reform
Progressive States Network – Speaker TBA
posted by Matt Anderson, MD
Add a comment January 31st, 2010 by claudio
Effective action requires not just an enthusiasm,
but calls for a close rapport with the disgruntled so
as to get them organized. (A. Robbins)
1. You may often have asked yourself as to whether your individual contribution in the field of health and/or nutrition makes or is making any difference. This, of course, depends. Alone, each of us is indeed helpless to change very much. Standing alone to-right-the-world’s-wrongs is a false ideal. We have thus plenty to learn from the lessons of mutuality or even of militancy. Individual concern (let alone compassion…) is just clearly less powerful than organized solidarity. (Tikkun) Or, to use an old adage, ‘divided we beg, united we demand’.
2. Sporadic, collective grassroots-organized acts are happening all the time –mostly the result of non-political and personal leadership initiatives. To make these acts really count and add-up to something, they need to be progressively channeled into new patterns of higher political meaning and political impact. Human rights activists are needed to lead the way in such a transition. This, because without continuity and follow-through actions, popular struggles will remain a heap of toothless words. (S. Ophir)
3. In the human rights (HR) context, two questions arise here: Are the fields of health and nutrition legitimate and good ports of entry for HR activism? And if the answer is yes: Are we ready for such a challenge?
4. If the answer is again yes, new forms of progressive HR learning and HR action are then needed in our line of work. Actually, to act effectively in the time before us, we need to first develop a more widely shared strategy that unequivocably points in the HR framework direction. When adopting such a strategy, we cannot merely denounce; we must also announce a new order –an order with more empowering-health-and-nutrition-alternative-actions. We must thus strive to become proactive, not merely reactive.
5. Today, together with the victims of health and nutrition rights violations, the inescapable challenge before us is to redefine the strategies we use in order to combat preventable ill-health, preventable malnutrition and preventable premature deaths. This invariably entails (simultaneously at the global, national and local levels) addressing and combating the social, economic and political determinants of the violations of the UN-sanctioned Right to Health and Right to Nutrition. Only thus will we be able to overcome the present crisis in overall development thinking and praxis we now are stuck-in in these two domains. (R. Boyte)
6. As an avant-garde, we not only need to reflect on new institutional ways of supporting grassroots HR initiatives, but we also need to become more proactive in organizing them, as well as helping generate new forms of HR knowledge and of practices-of-direct-democracy in local government. In the process, we also need to reassess the pertinence and the role of foreign aid and of private (non-official) international development cooperation in the fields of health and nutrition. This, to either reject both or to help redefine them so that they, once and for all, fit the demands of local communities. (S. Padron) If the latter cannot be done, yes indeed, it is high time poor countries begin considering turning down foreign aid.
7. Still proactively, we first need to help create a shared critical awareness of the immorality of the prevailing social, economic and political system responsible for the violations of the Right to Health and the Right to Nutrition we are basically left to deal with as health and nutrition professionals. For this, among other, we need to bring people both in the rich and the poor countries to a point where they become more vocal in their demands to change the mechanisms that lead to the conditions perpetuating ill-health, malnutrition, poverty and injustice. And this can only be achieved by creating a growing discontent that leads to a ‘constructive anger’ and to commensurate actions that address such injustice. Action along these lines is desirable (preferably preemptive rather than reactive), and should even be made an inescapable outcome of effective health, nutrition and development learning. The HR activist/educator thus has a key role in our midst.
8. If we are to be consequent with effective people’s empowerment, we will have to foster an authentic people-centered development (in our case using health and nutrition as a port of entry to HR issues). For this we will have to further:
i) move away from coercive or top-down practices involving any kind of ‘acceptance-as-a-fait-accompli’ (e.g., in family planning?), and move into consensus-building practices involving legitimate beneficiaries’ approval; ergo, do things departing from the-way-people-see-them in their own environment;
ii) revolutionize people’s expectations helping them to move away from fatalistic outlooks;
iii) help define a new type of collective, community sense of responsibility that replaces the prevailing individual identity;
iv) help legitimize and enforce all UN-sanctioned people’s rights;
v) increase the negotiation and bargaining capacity –or at least the defense capacity– of claim holders;
vi) as needed, aim at overcoming constraining local political structures (formal and informal);
vii) concentrate on changing the local inter-generational dynamics when required, and very specially concentrate on changing the role of women (our main contact in health and nutrition work) in overall development work;
viii) work with people towards the goal of ultimately controlling their own community resources, fighting for the resources they need from outside, and taking initiatives to shape their own future through a strengthened, militant organization;
ix) make sure people get access to relevant information, especially the type of information that will help them hold their government officials accountable; *
x) help redefine the roles and methods of so-called ‘participation’ shifting them towards methods of ‘empowerment’ –in our case in health and nutrition;
xi) constantly re-gather groups becoming marginalized, trying to make sure their special interests are accommodated in the general strategy;
xii) secure concrete short and long-term positive results for claim holders (with an initial emphasis on short-term results to foster self-confidence);
xiii) together with claim holders, monitor and evaluate said results, especially with regards to the degree of popular empowerment being achieved, as well as probing the equality of the benefits accrued; and
xiv) promote self-education with the aim of achieving faster results.
*: Information given to people for use through the fashionable ‘social marketing’ approach is definitely not the type of information conducive to any meaningful participation; social marketing simply does not bring about the needed sustainable structural changes –at best, it allows people to tolerate and cope-with an unjust situation. Social marketing tells people what to do, but not what for and why…
9. Only through the constant practice of such people-centered development activities –often through trial-and-error– will we overcome the limits of existing flawed development models and theories. (L. Padron)
10. In short, starting with/from our work in health and nutrition, we should all contribute, to the best of our abilities, to generate popular alternative development strategies with the corresponding set of tactics to implement them. But to make a difference, remember that standing alone changes little; so: Network with other like-minded activists in the HR field!
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org
Add a comment January 28th, 2010 by Claudia Chaufan
By Margaret Flowers, M.D.
January 28, 2010
President Barack Obama|
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear President Obama,
I was overjoyed to hear you say in your State of the Union address last night:
“But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”
My colleagues, fellow health advocates and I have been trying to meet with you for over a year now because we have an approach which will meet all of your goals and more.
I am a pediatrician who, like many of my primary care colleagues, left practice because it is nearly impossible to deliver high quality health care in this environment. I have been volunteering for Physicians for a National Health Program ever since. For over a year now, I have been working with the Leadership Conference for Guaranteed Health Care/ National Single Payer Alliance. This alliance represents over 20 million people nationwide from doctors to nurses to labor, faith and community groups who advocate on behalf of the majority of Americans, including doctors, who favor a national Medicare-for-All health system.
I felt very optimistic when Congress took up health care reform last January because I remember when you spoke to the Illinois AFL-CIO in June, 2003 and said:
“I happen to be a proponent of a single-payer universal health care program.” [applause] “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”
And that is why I was so surprised when the voices of those who support a national single-payer plan/Medicare for All were excluded in place of the voices of the very health insurance and pharmaceutical industries which profit off the current health care situation.
There was an opportunity this past year to create universal and financially sustainable health care reform rather than expensive health insurance reform. As you well know, the United States spends the most per capita on health care in the world yet leaves millions of people out and receives poor return on those health care dollars in terms of health outcomes and efficiency. This poor value for our health care dollar is due to the waste of having so many insurance companies. At least a third of our health care dollars go towards activities that have nothing to do with health care such as marketing, administration and high executive salaries and bonuses. This represents over $400 billion per year which could be used to pay for health care for all of those Americans who are suffering and dying from preventable causes.
The good news is that it doesn’t have to be this way. You said that you wanted to “keep what works” and that would be Medicare. Medicare is an American legacy of which we can feel proud. It has guaranteed health security to all who have it. Medicare has lifted senior citizens out of poverty. Health disparities, which are rising in this nation, begin to disappear as soon as patients reach 65 years of age. And patients and doctors prefer Medicare to private insurance. Why, our Medicare has even been used as a model by other nations which have developed and implemented universal health systems.
Mr. President, we wanted to meet with you because we have the solution to health care reform. The United States has enough money already and we have the resources, including esteemed experts in public health, health policy and health financing. Our very own Dr. William Hsiao at Harvard has designed health systems in five other countries.
I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system. We can implement it within a year of designing such a system.
What are the benefits of doing this?
* It will save tens of thousands (perhaps hundreds of thousands) of American lives each year, not to mention the prevention of unnecessary suffering.
* It will relieve families of medical debt, which is the number one cause of bankruptcy and foreclosure despite the fact that most of those who experienced bankruptcy had health insurance.
* It will relieve businesses of the growing burden of skyrocketing health insurance premiums so that they can invest in innovation, hiring, increased wages and other benefits and so they can compete in the global market.
* It will control health care costs in a rational way through global budgeting and negotiation for fair prices for pharmaceuticals and services.
* It will allow patients the freedom to choose wherever they want to go for health care and will allow patients and their caregivers to determine which care is best without denials by insurance administrators.
* It will restore the physician-patient relationship and bring satisfaction back to the practice of medicine so that more doctors will stay in or return to practice.
* It will allow our people in our nation to be healthy and productive and able to support themselves and their families.
* It will create a legacy for your administration that may someday elevate you to the same hero status as Tommy Douglas has in Canada.
Mr. President, there are more benefits, but I believe you get the point. I look forward to meeting with you and am so pleased that you are open to our ideas. The Medicare-for-All campaign is growing rapidly and is ready to support you as we move forward on health care reform that will provide America with one of the best health systems in the world. And that is something of which all Americans can be proud.
With great anticipation and deep respect,
Margaret Flowers, M.D.
Congressional Fellow, Physicians for a National Health Program
Please join Dr. Flowers in urging the President to meet with advocates of real reform (improved Medicare for all) by calling the White House at 202-456-1111.
Tell them, “I’m letting you know that improved Medicare for all (HR 676) is better than the health bill proposed by Congress. Meet with Dr. Flowers and the Leadership Conference for Guaranteed Health Care about why.”
For more information relevant to President Obama’s health care related comments in his first State of the Union:
Going Down the Same Old Tunnel, By Steffie Woolhandler and David Himmelstein
Add a comment January 28th, 2010 by Claudia Chaufan
For Immediate Release: 1/28/10
January 28, 2010
Leno’s Single Payer Health Insurance Legislation
Wins Senate Vote 22 to 14
California OneCare Campaign
Reveals Massive Netroots, Grassroots Campaign
By a vote of 22 to 14, the California Senate today passed historic reform legislation, SB 810, that calls for sweeping changes in the financing of health care.
Under the bill, authored by Senator Mark Leno (SF), all residents would be covered by a true universal health care system, which would pay for all needed health services utilizing a “single payer” insurance system. Most residents would be required to pay into the system and all would be covered, with no additional co-pays, deductibles or exclusions for pre-existing conditions.
Comprehensive reform. Under SB 810, private insurance companies would be replaced by one non-profit health insurance fund. All services, including prescription medications and equipment would be paid by the single fund – hence the term “single payer”. All California residents will be covered with comprehensive, universal coverage for all necessary health care including doctors, hospital, medications, mental health, medical equipment, dental, eye care and more. Under the SB 810 legislation, hospitals anddoctors would continue to operate privately, while insurance would be financed publicly..
SB 810 is expected to be revenue neutral to the state and cost most businesses and residents less for the most comprehensive health care reform plan ever offered Americans.
A strategic Plan to WIN. Sponsors of the bill applauded the Senators who supported this victory and outlined coalition plans for a massive multimedia grassroots educational campaign to pass the bill through the Assembly later this year.
One key component of the campaign will be an historic multimedia advertising campaign that will feature a new 30-second TV spot every day for a year starring celebrities, political leaders, health care activists and victims. Some 60 spots have already been produced, featuring Lily Tomlin, Paula Poundstone, Elliot Gould, Ed Begley, Valerie Harper, Connie Stevens, Tracy Newman, Ken Howard, Ed Asner, Sheila Kuehl and more. Supporters will be invited to submit their own versions.
Massive Grassroots Education. Kicking off on March 1, the 365-day ad and grass roots organizing campaign will gain momentum during the most tumultuous political period in decades, including a key state primary and the November election for Governor, Senate and Assembly seats. The goal of the campaign is to achieve passage and approval of the legislation by a two-thirds super majority of legislators in order to pass the financing legislation to implement the legislation. Similar single payer bills were passed twice by a 62% majority of the California legislature only to be vetoed by Governor Schwarzenegger.
Californians will be invited to get active on line or join neighborhood events to educate others about the benefits of this major reform of our health care system. Leaders expect that California’s success with a single payer system will lead other states to adopt it as well.
California OneCare and the 365 Ad Campaign are a project of Health Care for All-California and supported by single payer advocacy groups nationwide.
DONATE TO GET SINGLE PAYER, UNIVERSAL HEALTH CARE IN CALIFORNIA. Please support the California OneCare 365 Ad Campaign. Help us produce a new thirty-second ad supporting single-payer health care on websites and television throughout California every day for one year. Click here to donate.
For more information, contact:
Andrew McGuire, Executive Director,
Health Care forAllCalifornia and the California OneCare Campaign
Phone: 415.215.8980
Ali Bay (California Senate)
916 651-4003
Add a comment January 26th, 2010 by bronxdoc
Add a comment January 24th, 2010 by bronxdoc
Joanna Mae Souers, an American studying medicine at the Latin American School of Medicine (ELAM) has written several times on the portal (see here). She asked us to post the following thank you note:
David Lundquist, President and CEO of Kingston Hospital, of upstate New York, made efforts to organize supplies to donate to the students of the Latin American School of Medicine in Havana Cuba. Supplies included masks, gloves, scrubs, and several other useful items that the students can use during their time in Cuba. Because of the U.S. embargo against Cuba, supplies are limited and students are expected to bring their own. It is very helpful when hospitals can help students out by donating supplies to alleviate them from these costs.
Kingston is where I grew up, and it is wonderful to get such positive support from local hospitals. Many health care professionals don’t know about the program to study medicine in Cuba, but when they hear about the opportunity, in spite of political propaganda, they think it’s great and they look forward to anything they can do to support the students. Cuba is well renowned for their public health care and international relief efforts, but what is little known is that there are over 100 U.S. students studying medicine in Cuba for free, with one catch, the promise to return to the U.S. upon graduation and practice in underserved communities. Is that really a catch? This is a gift from the Cuban government to the American people.
I want to thank Kingston Hospital for their generous donation and I want to encourage other hospitals to donate what they can. If you would like to make a donation of medical supplies or books to the students of ELAM, please contact IFCO & Pastors for Peace via their website www.ifconews.org.
Thank you Kingston Hospital for your support!
[Editor's note: For more information about this program, readers should visit prior postings on this topic.]
Add a comment January 21st, 2010 by bronxdoc
We have received an appeal from our friends at MEDICC who are providing support to Haitian doctors in Haiti who have been trained in Cuba. This is a particularly important effort since it strengthens the local medical infrastructure; these Haitian doctors will remain in place long after the disaster relief ends. And it also breaks with the mainly paternalistic (and subtly racist) presentation of Haitians as the passive recipients of help provided by outside agents. [A link to be donate, can be found here.]
Cuban Medical Assistance in Haiti
There are currently about 400 Cuban-trained Haitian doctors working in 120 communities around Haiti, including Port-au-Prince. As graduates of the Latin American Medical School in Havana (ELAM) these doctors typically come from the poorest regions of Haiti and have studied medicine to serve Haiti, not to emigrate to the US (where the majority of Haitian-trained doctors work). They are accompanied by a 370-person Cuban medical mission which has been working in Haiti for several years.
The work of the Cubans and Haitians in the past week is described in these video feeds from CNN’s Shasta Darlington and Steve Kastenbaum. To quote from the Kastenbaum report:
“There are so few places where ordinary Haitians can turn to when they are in need of urgent medical care in the center of the city. We came across one: La Paz hospital. It is now being administered by Cuban medical personnel here in Haiti alongside crews from Spain and Latin America. And it is amazing to see. They are giving medical attention—quality medial care—to severely injured people, six to seven hundred patients a day, several dozen surgeries a day. They have three theaters going around the clock, 24-7, and it is one of the only places deep in the city where Haitians can go and be treated and have a reasonable expectation of surviving.
We saw so many traumatic injuries there. I can’t even say how many amputations we saw, compound fractures, traumatic flesh wounds. Yet, these overwhelmed medical teams were finding ways to take care of all of them, despite being very low on critical supplies—sutures, oxygen, anesthetics, water—they need all these things. Their supply lines stretch all the way back to Spain, and it’s being sent in. And it is being done in a remarkably orderly fashion.”
[The Portal has provided information about US students studying at ELAM who have also agreed to return to medically disadvantaged areas in the US.]
Providing support through MEDICC & Global Links
MEDICC, the Medical Education Cooperation with Cuba, has paired up with Global Links to organize a recovery and long-term medical assistance program for ELAM-trained Haitian doctors. Both organizations have decades of experience in regional material aid cooperation, and with Cuba and Haiti in particular. They will be working with representatives of the Haitian graduates to identify needs for medicines, medical supplies, and equipment. And they will get these supplies directly to them.
While US law does not allow Cuban doctors in Haiti to receive these essential medical materials–the US embargo is taking its toll post-disaster–MEDICC and Global Links will ensure distribution to the young Haitian physicians working in public hospitals and clinics alongside the Cuban team, seeing hundreds of patients daily.
To quote from MEDICC”s appeal:
We need your help to raise the funds for this joint effort–and to raise the policy bar by replacing hostility towards Cuba with cooperation when it comes to the health of the hemisphere–Haiti deserves nothing less. And Haiti’s young doctors need your support now.
For more information, see www.medicc.org, where you can also donate online to the HAITI EARTHQUAKE APPEAL. Or send your check to: MEDICC, PO Box 361449, Decatur, Georgia, 30036. Note at bottom: HAITI APPEAL.
MEDICC (Medical Education Cooperation with Cuba) is a 501 (c) (3), not-for-profit organization; your donation is tax-deductible.
Here is a direct link to donate.
The Political Economics of Public Health
Much has been made of the disastrous health and social conditions in Haiti. It is important to keep in mind that these conditions did not develop in a vacuum. Paul Farmer, in an April 8, 2004 article published in the New England Journal of Medicine, documented the links between political violence and the public health in Haiti.
This political violence was often the result of outside interference, most prominently by the US. Commondreams.org has published several articles discussing this from which we quote the following (written by Peter Hallward):
The noble “international community” which is currently scrambling to send its “humanitarian aid” to Haiti is largely responsible for the extent of the suffering it now aims to reduce. Ever since the US invaded and occupied the country in 1915, every serious political attempt to allow Haiti’s people to move (in former president Jean-Bertrand Aristide’s phrase) “from absolute misery to a dignified poverty” has been violently and deliberately blocked by the US government and some of its allies.
Aristide’s own government (elected by some 75% of the electorate) was the latest victim of such interference, when it was overthrown by an internationally sponsored coup in 2004 that killed several thousand people and left much of the population smouldering in resentment. The UN has subsequently maintained a large and enormously expensive stabilisation and pacification force in the country.
Haiti is now a country where, according to the best available study, around 75% of the population “lives on less than $2 per day, and 56% – four and a half million people – live on less than $1 per day”. Decades of neoliberal “adjustment” and neo-imperial intervention have robbed its government of any significant capacity to invest in its people or to regulate its economy. Punitive international trade and financial arrangements ensure that such destitution and impotence will remain a structural fact of Haitian life for the foreseeable future.
it should be noted that the 2004 coup was the second overthrow of Aristide by international forces.
A different perspective on Haiti, can be found at the Institute for Justice and Democracy in Haiti, the Haiti Information Project and – for those who read French – Haiti Liberte & Haiti Progres.
Finally, one long-lasting step towards Haitian reconstruction would be cancellation of its foreign debt (click here to sign a petition asking for this). In fact, one of Aristide’s many political sins was calling for the French to return the money that Haiti had been forced to pay the ex-slaveowners in order to gain recognition by France. For another twist on this story, see Bill Quigley’s “Why the US owes Haiti Billions: The Briefest History.”
Matt Anderson, MD
Add a comment January 18th, 2010 by Claudia Chaufan
In times when militarization is on the rise as income inequalities increase and Americans lose jobs, homes, and access to medical care, even as Wall Street bonuses reach record highs, it seems fitting to remember the speech that Martin Luther King gave at the Riverside Church in New York on 4 April 1967.
May we all find the courage to not be silent when silence is betrayal, and the inspiration to strive for a future of love, social justice, and respect for human rights.
Add a comment January 13th, 2010 by Claudia Chaufan
From California OneCareNow, Campaign for single payer bill SB810
The campaign for single payer health care reform in California got a “shot in the arm” in Sacramento Monday and a report about it became the top recommended blog on Daily Kos. Busloads of California Health Professional Student Alliance members–medical, nursing, public health and allied health students–marched to the Capitol steps and joined a crowd of about a thousand supporters for a raucous rally for single payer. Blogger “Shockwave” attended the rally and posted his report about it on Daily Kos yesterday morning. It quickly become the #1 recommended blog on the influential progressive website. Read his report on Daily Kos, “Shockwave” is a Health Care for All-California member and a California OneCare supporter.
The video featured in the blog was created by California OneCare Campaign Co-Chair, Don Schroeder. The video is available on YouTube.
Featured speaker at the rally was Senator Mark Leno, principle author of SB 810, the California Universal Health Care Act that will begin its way through the legislature later this month. The bill, dubbed California OneCare, has passed twice before, only to be vetoed by Governor Schwarzenegger. It is expected to pass again by late summer. One goal of the California OneCare Campaign is to make sure the governor signs it this time. If he doesn’t, the goal is to override a veto with a two-thirds “healthy majority” in the legislature next year.
The event organizer and MC was JB Fenix, California Physicians’ Alliance Fellow, who was joined at the podium by Chris Scannell from the USC Medical School, and Lea Rosemurgy from the UCSF School of Nursing. Additional speakers at the rally included Deborah Burger, RN, Co-President of the California Nurses Association/National Nurses Organizing Committee, James Kahn, MD, President of the California Physicians’ Alliance, Allan Clark, Alliance President of the California School Employees Association, Nan Brasmer, President, California Alliance of Retired Americans, and Andrew McGuire, Executive Director of Health Care for All-Calfifornia and the California OneCare Campaign.
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Add a comment January 7th, 2010 by Claudia Chaufan
I must confess that I was disappointed to see Dr. Gawande’s mantra that more or more expensive care is not necessarily better care go unchallenged even by the otherwise outstanding Amy Goodman’s Democracy Now! Unchallenged, that is, when this rather obvious (or at least very reasonable) observation was presented as the critical explanation for why the United States spends more in health care, per person, than any other country in the world, even as it leaves millions uninsured or underinsured, leads thousands to bankruptcy, and allows 45,000 — 15 times the number murdered in 9/11 — to die for lack of health insurance. Nor was he challenged when he presented his views on Massachusetts as a sound model for health care reform, even as he granted that the program had “failed to control costs”. In fairness to the interviewers, Dr. Steffie Woolhandler’s statement that the center of the Massachusetts program did not hold was shown briefly. Yet to the already confused listener or viewer, the showcase of “opposing expert views” must have felt like the usual “he said, she said” — not awfully enlightening and at best leading to skepticism about both positions.
So back to Dr. Gawande, it appears that he is smart enough to realize that certain forms of payments, like fee for service, lead practitioners to provide more care (which sometimes, but by no means always, may be unnecessary), whereas salaried doctors do not have that incentive (incidentally, salaried doctors are the norm in “socialized medicine” type systems). And yet, Gawande is not perspicacious enough to ask himself why is it that Canada, Taiwan, France, or Japan, where fee for service reigns supreme, still spend a fraction of even what our cheapest and best run hospitals do. While I am not arguing in favor of fee for service — quite the contrary, I, like many, agree that it is at least a very inefficient and administratively burdensome form of payment — I am just pointing out that given this rather banal observation, it is clear that fee for service cannot be the whole story of our high health care costs.
At any rate, had Gawande (or his interviewers) asked this critical question, rather than continuing in the all too American exercise of navel-gazing by comparing one (low-cost) American hospital with another (high cost) American hospital, he might have studied a well-run, or even the best run, American hospital’s costs against the costs of some hospital in other countries. And he surely would not have failed to see, as it appears he has, that even Switzerland, that comes second after the United States in health care costs (even if Swiss costs are substantially lower, by around 40%, than the U.S.’s), and has “private insurers”, bans profit making from the financing of medically necessary care. Right! It’s the financing, stupid!
The same is the case with the health care of all other industrialized economies. So even when Europeans, or the Japanese, talk about “private” insurers in health care they rarely, if ever, mean “for profit” insurers. Private insurers are essentially tightly regulated subsidiaries of government, and if they are ever caught “cherry-picking” they are forced to transfer some of their money to another insurer that covered sicker patients or, as the Swiss do, lower their premiums during subsequent months, unimaginable in the America private health insurance scenario.
Admittedly, some readers might puzzle: “Why would insurers even be in business if not to become filthy rich?” Well, at least one reason is that if they do a good job and attract many members, then they can sell for profit insurance for the “over and above” services (private hospital rooms, cosmetic surgery, etc.). And to note, when Swiss insurers, who prior to 1994 were pretty much like American insurers, failed to meet their part of the social contract (i.e. were becoming filthy rich at the expense of everybody else’s suffering), they got their lesson: price controls and mandated benefits that they had to provide at no profit if they wanted to remain in business.
And had Gawande delved into the politics of health care (and not merely the Pollyannaish version of its history), he surely would not have failed to discover that the coming into being of the National Health Services (NHS) was anything but a “historical accident” (and if it was, then anything can be, and the expression is meaningless). It is surely true that the physical structures, the public hospitals, were “already there” after WWII, a war during which hospitals had been built that provided publicly funded medical care for servicemen. Yet it is equally true, and arguably much more important, that around 1948 there was a confluence of critical political forces, not the least of which was the landslide victory of Labor over the Conservative Party.
How did this unexpected victory happen, despite the popularity won by Conservative British Prime Minister Winston Churchill as a “war leader”? It appears that as “national security” concerns subsided and hunger and unemployment began to take their toll over an impoverished population, Britons concluded that Labor, not Conservatives, would be more inclined and capable to guarantee “bread and butter” issues — what were increasingly seen as basic social rights, such as full employment, income security, public education, and health care. Popular demand for guaranteed basic rights was further strengthened by the success of socialist British Minister of Health Aneurin Bevin to secure the support of the medical establishment: in a masterful move, Bevin decided that offering well paid practitioners who agreed to join the NHS generous salaries would free them “from the necessity to drum up business from rich clients to pay for their basic income” (Glennerster 2007: 51). So if the birth of the NHS was a “historical accident”, it was certainly a very complex one.
So Gawande’s conclusion, given the glaring omission in his theory, is unsurprising: it is U.S. doctors, and their “culture”, the source of our high costs – doctors, that is, who respond to a perverse systems of incentives, which according to Gawande, is the way U.S. doctors are paid: more for doing more yet not better.
Now, while doctors may certainly be part of the problem, and while paying more for doing more, even if it is not good and frequently not necessary, is obviously a bad thing, why Gawande chooses to ignore the critical and obvious fact that no other industrialized economy, and many industrializing ones (like Taiwan) leaves over 70% of its population (even if Gawande has only counted 50%) at the mercy of profit seekers when it comes to financing medically necessary care is anybody’s guess. (Elsewhere I have laid out, and many other excellent policy analysts, like PNHP doctor Don McCanne, have, why the only way to eliminate financial barriers to medically necessary care is treating health care as a social right and financing it collectively, through a tax-based or social insurance system, incidentally the only way to allow the choices that matter – of doctors and medical establishments, not “health plans” or “preferred providers” lists).
But maybe had Gawande acknowledged the obvious, I suspect that his New Yorker article, where he insists that whether insurance is public or private (we are not told whether the profit motive matters) is not that important after all, would not have never become “required” reading in the White House. Indeed, he even might have been kicked out of the sanctuaries where our health care future is being written (or cooked!), as was the case with many brave doctors (Dr. Margaret Flowers comes to mind), who keep on insisting that our politicians do what we pay them to do: put ordinary people’s welfare before corporate interests and profits.
