World Health Chief Rips 'Profit-Driven' Healthcare Industry for Ebola Fail
Africa's infrastructure failures, WHO director-general says, include development in sectors 'that favor the elite'
Speaking before a gathering of African health ministers on Monday, the leader of the World Health Organization (WHO) said that the blame for the Ebola crisis lays largely on the "profit-driven" pharmaceutical industry, which does not invest in cures "for markets that cannot pay."
WHO director-general Dr. Margaret Chan made the comments while speaking before the Regional Committee for Africa, made up of representatives from the 47 African nations, which is meeting this week in Cotonou, Republic of Benin.
During her address, Chan said that despite Africa's recent economic and social gains, the Ebola outbreak bolsters two arguments that WHO has long made "that have fallen on deaf ears for decades [and] are now out there with consequences that all the world can see, every day, on prime-time TV news."
One, she said, is the failure to put basic public health infrastructures in place. The second argument, Chan said, is the reason that clinicians are "still empty-handed, with no vaccines and no cure," despite Ebola having emerged nearly four decades ago: "Because Ebola has historically been confined to poor African nations. The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay."
Africa's infrastructure failures, WHO director-general says, include development in sectors 'that favor the elite'
Speaking before a gathering of African health ministers on Monday, the leader of the World Health Organization (WHO) said that the blame for the Ebola crisis lays largely on the "profit-driven" pharmaceutical industry, which does not invest in cures "for markets that cannot pay."
WHO director-general Dr. Margaret Chan made the comments while speaking before the Regional Committee for Africa, made up of representatives from the 47 African nations, which is meeting this week in Cotonou, Republic of Benin.
During her address, Chan said that despite Africa's recent economic and social gains, the Ebola outbreak bolsters two arguments that WHO has long made "that have fallen on deaf ears for decades [and] are now out there with consequences that all the world can see, every day, on prime-time TV news."
One, she said, is the failure to put basic public health infrastructures in place. The second argument, Chan said, is the reason that clinicians are "still empty-handed, with no vaccines and no cure," despite Ebola having emerged nearly four decades ago: "Because Ebola has historically been confined to poor African nations. The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay."
Who Would Have Health Insurance if Medicaid Expansion Weren't Optional
By KEVIN QUEALY and MARGOT SANGER-KATZ
A new data set suggests that more than three million people would have gained health insurance across 24 states if the Supreme Court had ruled differently.
In 2012, the Supreme Court ruled that a cornerstone of the Affordable Care Act — its expansion of Medicaid to low-income people around the country — must be optional for states. But what if it had ruled differently?
More than three million people, many of them across the South, would now have health insurance through Medicaid, according to an Upshot analysis of data from Enroll America and Civis Analytics. The uninsured rate would be two percentage points lower.
Today, the odds of having health insurance are much lower for people living in Tennessee than in neighboring Kentucky, for example, and lower in Texas than in Arkansas. Sharp differences are seen outside the South, too. Maine, which didn’t expand Medicaid, has many more residents without insurance than neighboring New Hampshire. In a hypothetical world with a different Supreme Court ruling, those differences would be smoothed out.
And that was the idea behind the Affordable Care Act. Before the law passed in 2010, the country had a highly regional approach to health policy and widely disparate results in both health insurance status and measures of public health. One of the main goals of the law was to provide some national standards and reduce those inequities by using federal dollars to buy coverage for low-income people in every state.
In many ways, as the Enroll/Civis data highlights, the law has succeeded in bringing health insurance to the disadvantaged populations who have historically lacked it. Its model shows that the biggest beneficiaries of the law have been the very groups that tend to suffer in today’s economy: blacks and Hispanics; young adults; people living in rural areas; women; and those earning the lowest incomes. (For a detailed look at who was covered by the law this year, read our article on the most salient trends.)
Why CHIP matters for 25,000 of Maine’s kids
By Claire Berkowitz and Janice Pelletier, Special to the BDN
Posted Nov. 02, 2014, at 12:41 p.m.
Continuing health coverage programs for children in need is a sound investment in Maine’s economic future and in Maine’s people.
Since the enactment of the federal Children’s Health Insurance Program, or CHIP, in 1997, the rate of uninsured children in Maine has been cut by more than half — from 13 to 6 percent. CHIP provides children with access to quality, affordable health care and gives their families peace of mind about their health and financial security.
Federal funding for CHIP is set to end in September of 2015. If Congress fails to act, this affordable and comprehensive health insurance for our children will end and an estimated 2 million will lose coverage nationwide.
In Maine, low-income children gain access to health care through Medicaid and CHIP. MaineCare — Maine’s Medicaid/CHIP program — has become a vital part of the insurance landscape, covering children up to 213 percent of the federal poverty level, or $42,152 for a family of three. MaineCare also covers children with severe disabilities who would otherwise be institutionalized, children in foster care and those receiving an adoption subsidy. In 2013, the CHIP program provided more than 25,000 Maine children with critical health care coverage. Without this coverage, many families would be driven into medical debt.
Despite this success, Maine’s repeated refusal to accept additional Medicaid funds under the Affordable Care Act has only made it harder to close the insurance gap, which would involve reaching the parents and the 15,000 Maine children who still lack health insurance. Maine and New Jersey were the only two states in the U.S. in the last few years to see an increase in the uninsured rate. We can’t afford to accept this backslide for Maine kids and families, especially when we have achieved an insurance rate for Maine children of 94 percent with the help of Medicaid and CHIP.
Access to affordable coverage for kids isn’t just important for families; it is necessary for economic stability. Children with insurance are more likely to have a stable source of health care and have access to preventive care. Research demonstrates uninsured children are more likely to go without needed care and to experience worse health outcomes than children with coverage, which drives up health care costs. Investing in kids now will more than pay off in the long run.
Some folks wonder, now that we have the Affordable Care Act, do we still need CHIP? The answer is yes. The new health care law is designed to work in partnership with CHIP and Medicaid, not to replace them. If CHIP is not funded next year, children covered under the program might be able to get coverage through their family’s employer-sponsored insurance plan or by purchasing a plan on the federal exchange. But these options are likely to be unaffordable for many families that rely on CHIP, leaving children uninsured.
Guns and Public Health
Joe Nocera
Mike Weisser is my favorite gun dealer. The longtime proprietor of the Ware Gun Shop in Ware, Mass., Weisser, 70, estimates he has sold more than 40,000 guns in his career as a wholesaler and retailer. He also has a nice little business teaching a gun-safety course that Massachusetts requires of all new gun owners.
“I love guns,” he told me unabashedly when we spoke the other day. With a chuckle, he added, “I just bought one yesterday.”
There’s something else about Weisser: He strongly believes that the country needs a new approach to guns and gun violence — an approach that is more data-driven, less hyperbolic, and that emphasizes the public health aspect of gun violence. Using the pen name Mike the Gun Guy, Weisser writes a blog at The Huffington Post that encapsulates his approach. He is one of the few who has focused on suicides, which make up nearly two-thirds of all gun deaths. He has called out gun control advocates from time to time; he mainly thinks they are too often passive when confronted with the tactics of the National Rifle Association.
But he has also been relentless in taking on the N.R.A. He does not believe that the Second Amendment means that people ought to be able to take a gun anywhere they want. He includes in his emails a quote from the novelist Walter Mosley: “If you carry a gun, it’s bound to go off sooner or later.” A website called AmmoLand has described him as “basically a double agent agent [sic] working to undermine our Second [Amendment] rights with his articles.”
Of all the things Weisser advocates, the issue he is most passionate about is the need for doctors to become part of the debate over gun safety. More than that, he believes that doctors need to be talking about guns in terms of their effect on public health, both to their own patients and to the public at large. In his view, “doctors allowed themselves to get pushed out of the gun debate” during the time of the assault-weapons ban and other gun restrictions that were passed during Bill Clinton’s presidency. “When the debate was about smoking, it was always a health issue, and doctors played a central role,” he says. “But the debate over guns became about their social utility rather than the public health aspects. And that is exactly how the N.R.A. wants the issue framed.”
Thus, though he has no medical credentials himself (his wife is a pediatrician, he noted), Weisser helped organize an important conference that is scheduled to take place next month in Massachusetts. Its title is “Caring for the Patient at Risk for Gun Violence: Medical, Legal, Ethical Issues,” and it will be the first Continuing Medical Education-accredited conference held on gun violence. One of the conference’s goals, says Weisser, is to help emergency-room physicians identify at-risk patients — those who are in the E.R. because they’ve been attacked by someone else or have threatened to kill themselves — and use evidence-based strategies to intervene before it’s too late.
Some ObamaCare patients with high deductibles turning to community care centers
Jim Angle
High ObamaCare deductibles creating problems for patients
When ObamaCare patients learn their deductible is so high they’re unlikely to get any reimbursement, they often wind up in places like the Denton, Texas Community Care Center.
"There are quite a few, and I saw another one today, where their deductibles are so elevated that they can't afford them," said Dr. Flippo Masciarelli, chief physician at the center, which was designed to treat indigent patients.
Robert Laszewski of Health Policy and Strategy Associates noted, "You're going to the doctor, you're paying (a) premium, and because of this really high deductible, you're not getting any benefits."
The administration pushed insurance companies to keep premiums low, but that also created high deductibles, about $5,000 per person for the least expensive plan, as well as narrow networks of providers.
But most people buy based only on premiums.
"They don't even look at what their deductible is going to be," said Dan Mendelson, CEO of Avalere Health. "They don't look at the cost of the medications that they're on. And they don't look at the...network that they have."
Masciarelli said,"one of the ladies we saw said she called eight primary care offices before she found us..." The rest would not treat people on her plan.
Rosemary Gibson of the Hastings Center and author of "The Battle over Health Care,” said many people find themselves in the same predicament. "People are scrambling to find a doctor who will see them, who will accept their insurance, who's in their network. And if they can't, where they end up going is the safety net, which includes community health centers."
If the doctor these patients find orders additional tests or treatment, even those with ObamaCare are sometimes forced to go without.
Providing Health Insurance Still a Struggle for Small Business
By REED ABELSON
Brian Adams, who sells fireplaces in Indianapolis, is like many of the nation’s small-business owners. As the cost of providing health benefits has climbed, he has struggled to afford coverage for his employees — a problem the new health care law was designed, in part, to address.
But a year after the law’s introduction of the insurance exchanges, provisions that were supposed to help small businesses offer employee health benefits are largely seen as a failure. And Mr. Adams, like many of his fellow business owners, is sending employees to the exchanges to buy their own coverage instead.
Nancy Smith, who runs the Great Arizona Puppet Theater in Phoenix, made a similar decision. Her business employs only a handful of people who need insurance, and she was able to offer only plans with high deductibles. She and her employees decided buying individual policies made the most sense.
“Everyone wanted to do it because our costs were too high,” she said.
Most of the focus on the Affordable Care Act has been on whether individuals can find affordable coverage through the online marketplaces. But the law also had the goal of creating a robust insurance market for small businesses by making tax credits available to businesses that provide coverage and creating small-business exchanges where companies could more easily find low-cost plans.
The small-business exchanges were barely functional in most states last year, and it remains to be seen whether the Obama administration will manage to stop the steady decline in the number of employers offering coverage to their workers. The administration is poised to try again when open enrollment begins on Nov. 15.
Federal officials say they do not know how many small businesses signed up for coverage in the small-business exchanges, but the numbers are likely to be very small. In California, for example, only 12,000 people were enrolled through the state’s small-business exchange, compared with more than a million who enrolled as individuals there. To date, few businesses have availed themselves of the tax credits available for purchasing coverage for low-wage workers.
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