Bernard Lown’s Political Activism and Medical Achievements are Celebrated in Maine
Counterpunch -June 13, 2024
Bernard Lown was honored June 7 in Lewiston, Maine. The place was the massive Bates Mill, the former workplace for migrants mostly from Quebec who made textiles. The minting of the “American Innovation $1 Coin” in Lown’s honor had been announced in May. It was Lown’s birthday; he was born in Lithuania in 1921 and died in 2021.
The occasion featured the unveiling of a portrait of Lown painted by Robert Shetterly. Lown joins others honored by Shetterly in the series of portraits he calls “Americans Who Speak the Truth” (AWTT).
The event, attended by the writer, offered ample recognition of Bernard Lown’s medical accomplishments and his dedication to collective struggle for justice. A prime concern here is that celebration of Lown’s successes may have obscured how and why Lown did engage with the mass social and political movements of his era. Insight on that score may contribute to an understanding of how individuals now might involve themselves in big political and social catastrophes of our own time.
Maine-resident Shetterly explained to the gathering that individuals being honored through his portraits were, or are, heroes who exemplify creativity, courage, and/or passion for justice. Exhibitions of Shetterly’s portraits and educational programs based on his subjects have circulated throughout the country.
University of Maine President Joan Ferrini-Murphy, reported that Lown participated in and provided support for programs of the University’s Honors College. Doug Rawlings, a founder of the Veterans for Peace organization and head of its Maine chapter, praised Lown as an inspiration for peace advocacy.
Lown had strong connections with Maine. He arrived in Lewiston in 1935, attended high school there – at first not speaking English – and studied at the University of Maine. City officials of Lewiston and Auburn in 1988 renamed a bridge connecting the cities as the Bernard Lown Peace Bridge. Maine VFP staged a rededication of the Peace Bridge to Bernard Lown on the 2022 anniversary of the U.S. nuclear attack on Hiroshima.
Lown’s accomplishments were many: invention and introduction of the DC cardiac defibrillator (he chose not to apply for a patent), introduction of hospital cardiac care units, establishing that sick cardiac patients remain active, and urging physicians to be caring and empathetic with patients.
He founded the group Physicians for Social Responsibility in 1961.With Soviet cardiologist Evgeni Chazov, he founded International Physicians for the Prevention of Nuclear War in 1980. In 1985 they won the Nobel Peace Prize.
Lown became politically engaged with mass movements early, on the side of working people, and against headwinds.
He and his family had confronted the Hitlerite danger in Lithuania. High-school student Lown, according to AWTT, “was outraged at the sight of policemen arresting the unconscious, bleeding striker, while allowing his strike-breaking assailant walk free. Lown jeopardized his relationship with his family and joined the striking workers …The striking French-Canadian workers were accused of being part of an international communist conspiracy.”
This was the Lewiston–Auburn shoe strike of 1937. The Maine Army National Guard was called out. There was confrontation between strikers and police on what is now the Bernard Lown Peace Bridge.
Lown was briefly expelled from Johns Hopkins Medical School for violating the rule that no sick white person would receive a Black donor’s blood. He earned a suspension for inviting a Black physician to speak at the medical school.
He belonged to the Association of Internes and Medical Students (AIMS), a U.S. organization associated with the International Union of Students (IUS). Soviet Bloc students were members of the IUS, which weighed in on post-war peace, anticolonialism and more. In 1947 Lown wrote “an effusive write-up of IUS’s founding” in the AIMS magazine The Interne.
Lown, an officer with the U.S. Army Reserve, was called up for the Korean War. He defied the requirement that he indicate political affiliations. The Army allowed him an honorable discharge and drafted him as a private. He recalled that after receiving an undesirable discharge in 1954, “I was without a job and couldn’t get a job …wherever I’d go the FBI was one jump ahead.”
Then, reports the Harvard Crimson, “[Frederick] Stare, [nutrition professor at the Harvard School of Public Health,] won notoriety for hiring … [Lown] who had been accused of holding communist sympathies.”
Lown’s attitude toward Cuba is revealing. He told an interviewer that, ““I have been to Cuba six times and learned much about doctoring in Cuba … If impoverished Cuba can provide first-class health care for its people so can other developing countries. Perhaps it is even possible for rich USA, if only it ceases viewing medicine as a marketable commodity.”
To return to the question posed at the start here: how do citizens focusing on their own lives and their own reactions to political happenings become part of mass movements the way Bernard Lown did? Do they identify as members of a social class?
New York Times columnist David Brooks, remarkably, seems qualified to explain. The U.S. mainstream media barely acknowledges the existence of social class. For a representative writer actually to examine the origins of class consciousness suggests he may know something.
Brooks stated recently that, “students at elite universities have different interests and concerns than students at less privileged places,” also that “the elite universities are places that attract and produce progressives.” Therefore, “American adults who identify as very progressive skew white, well-educated and urban and hail from relatively advantaged backgrounds.”
(We hold back on critiquing Brooks’ notion of “very progressive” and his idea that working-class and oppressed people are unlikely to identify as such.)
Brooks, continuing, cites an authority who argues that, “[J]ust as economic capitalists use their resource — wealth — to amass prestige and power, people who form the educated class and the cultural elite … use … resources — beliefs, fancy degrees, linguistic abilities — to amass prestige, power and … money.” Brooks, presuming that the excluded may be resentful, envisions “a multiracial, multiprong, right/left alliance against the educated class.”
He describes a progression: individuals experience their own political awakenings, realize their perceptions are shared, and think of themselves as a larger whole. He pictures two sets of people, two social classes, who find they are at odds with each other. He provides a roadmap of sorts showing that politically-engaged individuals, in large numbers, may well become part of mass political and social movements.
In any case, Bernard Lown, involved with struggles that continue now, lauded for achievements that were extraordinary, does matter, and not least for the model he is now of dedicated political engagement.
W.T. Whitney Jr. is a retired pediatrician and political journalist living in Maine.
Being a patient is getting harder in a strained and complex U.S. health care system
by Tom Murphy - Associated Press - June 2, 2024
Tamika Davis couldn’t nap on her couch during cancer treatment. She kept worrying one of her toddlers would wander over and pull out the needle delivering chemotherapy.
Friends and family watched her kids when they could during her treatment last year for colon cancer. But Davis had gaps with no help because she couldn’t afford child care and didn’t know where to look for assistance.
“I did not have the strength nor the energy to try to navigate these things myself,” the San Antonio, Texas, resident said.
Patients are not getting enough help dealing with a health care system that is growing increasingly complex, according to researchers and other experts in care delivery. They say more frequent insurance complications, doctor and drug shortages, and a lack of communication all make life harder for people with serious or chronic illnesses.
“Just about anything you can think of, it’s now harder to get it done, basically,” said Elisabeth Schuler, founder and president of Patient Navigator, a business that helps people get through the system.
More care providers and employers are offering help guiding people, a practice the federal Medicare program has started to cover. But that assistance has limits.
Patients with serious or chronic illnesses face a web of challenges. They include:
• Coordinating doctor appointments and tests, often while working or undergoing treatment.
• Dealing with coverage denials or care delays due to insurer pre-approval requirements.
• Figuring out how to fill a prescription if they can’t get coverage or
their medication lands on a growing list of drugs in shortage.
• Acting as a go-between for doctors and specialists who don’t talk to each other.
• Paying medical bills and getting help with rent or utilities. That
assistance has been harder to find since the COVID-19 pandemic,
according to Beth Scott of the non-profit Patient Advocate Foundation.
All of this can be compounded for patients who don’t speak English or have no experience navigating the health care system, noted Gladys Arias, a policy principal with the American Cancer Society Cancer Action Network.
Davis, the San Antonio cancer patient, said she was in the hospital when she asked for help finding community resources.
She said a case manager set a book of available resources on her bedside table and did nothing else. Davis, a nursing professor, found the book confusing. The programs it detailed had different qualifications based on things like income or diagnosis. The 44-year-old wound up losing her car and leaving her home after care bills piled up.
“I feel like there was some type of help out there for me,” Davis said. “I just didn’t know where to look.”
Ali DiGiacomo said she wishes that she learned in college how to deal with insurance companies. She often has to do that while coping with side effects from rheumatoid arthritis treatments.
The 30-year-old personal trainer said she’s spent years trying to get a diagnosis for bouts of intense chest pain, which doctors think may be tied to her condition. That requires imaging tests that insurers often decline to cover.
“Dealing with them with brain fog and fatigue and being in pain is just like the cherry on top,” DiGiacomo said.
DiGiacomo said her formulary, or list of covered drugs, has changed three times. That can force her to hunt for a place that carries the newly covered drug, which puts her behind on her medication schedule.
She figures she talks to her insurer at least four times a month.
“I have to hype myself up,” she said. “Then you talk to a million different people. I wish I just had like one person that helped me deal with all this.”
Care delays due to insurer preapproval requirements have grown more common, many experts say. More plans also have made it challenging to get coverage outside their networks of doctors and hospitals.
A typical appeal for a denial can easily involve 20 to 30 phone calls between the patient, the insurer and the doctor’s office, said Scott, director of case management for Patient Advocate Foundation, which helps people with chronic or debilitating illnesses.
She said some patients give up.
“Sometimes you are sick, and you don’t want to fight it anymore,” she said.
Case managers at hospitals are often overworked, which limits how much help they can provide, noted Schuler, who became a patient advocate about 20 years ago after her 2-year-old daughter went through cancer treatment.
Overall, help for patients is “very patchy everywhere,” according to Harvard Medical School researcher Michael Anne Kyle.
“I think we have a lot of Band-Aids that are necessary,” she said.
Many cancer centers offer patient navigators who can help coordinate appointments, get answers to coverage questions, find rides to the doctor and provide other support. Some insurers provide similar assistance.
And more employers are offering navigation or advocacy help for people on their insurance plans, according to the benefits consultant Mercer.
But these services still aren’t widespread. Alzheimer’s disease patients and their caregivers lack consistent access to such help, said Sam Fazio, a senior director with the non-profit Alzheimer’s Association.
“People are having trouble finding their way,” he said.
Making the system better for patients requires big change, said Dr. Victor Montori, a Mayo Clinic researcher who studies care delivery.
He said the system must focus more on minimally disruptive medicine, which makes care fit into patient lives. That means things like cutting unnecessary paperwork and surveys, making appointments more flexible and giving patients more time with doctors.
He noted that the burden that falls on patients is not just the time and effort they spend navigating the system. It’s also what they give up to do that.
“If you waste people’s time on silly things, you are being unkind to (their) main purpose, which is to live,” he said. “We have to stop thinking of the patient as a part-time employee of the health care system that we don’t get to pay.”
Delays, denials, debt and the growing privatization of Medicare
by Michael Sainato - The Guardian - June 3, 2024
Jenn Coffey was sick, on several medications, and in and out of the hospital around 2016 when she made a decision that she has come to regret.
Having fought off breast cancer, the former emergency medical technician faced numerous complications, and was diagnosed with two rare diseases: complex regional pain syndrome and small fiber neuropathy.
“I was terrified,” she said. “I went into the hospital as a fully functional EMT and came out in a wheelchair, to go on disability income, and I lost everything. I lost my house, I lost everything.”
Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits.
Traditional Medicare is accepted at practically every doctor’s office and hospital in the US. But it can be expensive. Most Americans will pay $679 a month just for hospital and medical coverage, with the potential for more costs if they get sick.
With monthly premiums of $18.50 per month on average, Medicare Advantage often looks like a frugal alternative. However, private insurers keep premiums low by limiting providers and using byzantine cost containment tools such as prior authorization.
For Coffey, switching proved more expensive, as her Medicare Advantage provider, UnitedHealthcare, denied requests to cover treatments, medications and infusions she required.
Coffey used to be a Republican state representative in New Hampshire. “I changed a lot over these years,” she said. “I used to think we could fix healthcare.”
Her experience with Medicare Advantage is not unusual. Private insurers now cover roughly half of the nation’s 68 million Medicare beneficiaries. Their dominance of this space has grown rapidly over the past two decades – at the expense of patient care, according to healthcare activists and patients, as corporations often deny medical care directed by doctors.
“I was stunned,” said Gloria Bent, of the first time her husband, Gary, was denied coverage for his brain surgery. It was only the start of their issues with Medicare Advantage.
Gary – a retired physicist professor in Connecticut – fought two types of cancer over six years, before passing away in March 2023. He had been put on a Medicare Advantage plan as part of his retirement health coverage, through the University of Connecticut.
Gloria, and Gary’s daughter, Megan, spent the final months and years of his life battling with NaviHealth – his Medicare Advantage plan’s software, through UnitedHealthcare – which constantly denied covering Gary’s medical care and treatment, contrary to doctor recommendations.
Each denial forced them to either cover the costs themselves – such as a wheelchair, for $2,000 – or consistently file appeal after appeal.
“You’re worried about your loved one who is in a medical crisis, you are trying to get there to support them every day, and you’re having to fight these online battles with the health insurance company to try to keep them there,” said Gloria. “It’s just a horrendous additional stress.”
She was informed by both her husband’s doctors, and other experts she contacted for assistance, that the modus operandi of Medicare Advantage private insurers was to deny medical care coverage.
“It just felt so cruel,” added Megan. “Like they weren’t thinking of my dad as a person, they were just thinking about him in terms of profit or dollars and cents.”
Gary “was really upset at the way he was being treated”, she recalled, “and “stressed about money”.
Concern about the prevalence of such cases is growing. Older adults with Medicare Advantage are significantly more likely to struggle with medical bills or debt than those under traditional Medicare plans, according to a 2023 report by the Commonwealth Fund.
On 3 June, Senator Elizabeth Warren of Massachusetts is hosting a webinar on the barriers faced by patients with Medicare Advantage plans.
The late healthcare activist Ady Barkan became concerned about Medicare Advantage in 2022, according to Carmen Rhodes, policy director for Be a Hero, the advocacy organization he founded.
The private program’s surge in enrollment “is not going to be good for the American people”, said Rhodes, “because it will be a system that consistently delays and denies people care for profit, and continues to give away billions of dollars to corporations that are actually not best positioned to decide on our healthcare”.
But the expansion of Medicare Advantage has been immensely profitable for private health insurers tied to the program, who enjoy high-gross margins compared with other plans. Over the next 10 years, Medicare Advantage insurers are expected to receive more than $7tn in payments from the federal government.
Private insurers have spent millions of dollars on advertising, marketing and hiring insurance brokers to sell Medicare Advantage plans to beneficiaries. In 2023, brokers received $601 per new enrollee for most Medicare Advantage plans, significantly higher than commissions for traditional Medicare plans.
“I don’t think when it comes down to it that most people realize the extent to which private equity and privatization is moving into Medicare and Medicare Advantage,” said Rose Roach, executive director of the Minnesota Nurses Association. “They are buying up pieces of the entire healthcare system in this country.”
Project 2025, a conservative set of policy proposals to reshape the federal government if former president Donald Trump wins November’s presidential election, includes a call to make Medicare Advantage “the default enrollment option” for Medicare.
Medicare Advantage plans were initially added to Medicare based on claims that they would provide savings for the federal government.
However, in a March 2022 report to Congress, the Medicare Payment Advisory Commission noted that “the many iterations of full-risk contracting with private plans have never yielded aggregate savings for the Medicare program. Throughout the history of Medicare managed care, the program has paid more – sometimes much more – than it would have paid for beneficiaries” otherwise.
Healthcare activists, patients and their families have claimed that the quality of Medicare Advantage plans were poor when they needed them most.
“They’re taking in more money and providing less care. That’s the formula. That’s how you make profit,” said Megan Essaheb, director of federal affairs at People’s Action, a progressive advocacy group. “As Medicare Advantage takes over the market and traps people in it, then they’re able to worsen their care.”
Some beneficiaries say they were enticed to enroll in a Medicare Advantage plan due to cheap premiums. Carly Morton of Beaver, Pennsylvania, switched through UnitedHealthcare for the additional benefits and cheap premiums. She was not able to work due to a disability.
“It was a disaster that took a really huge toll on me,” said Morton, who launched a public campaign for UnitedHealthcare to cover a lifesaving surgery to treat her rare vascular condition, neurogenic median arcuate ligament syndrome.
“Not getting the surgery would mean either dying or being very, very sick for the rest of my life,” she recalled. “I got really depressed for a while because I thought that was what was going to happen to me.”
Employers have increasingly been enrolling retirees into Medicare Advantage plans to save themselves money, too, with the federal government paying more. More than half of big employers offering retiree health benefits were estimated to do so for at least some patients through Medicare Advantage in 2023, up from 26% in 2017.
Coffey, the former emergency medical technician, does not expect to switch from Medicare Advantage for at least another decade – until she turns 65, and can requalify for traditional Medicare based on age, rather than disability.
In 2022, she decided to start rationing her treatment infusions because insurance still wasn’t covering them, along with several medications.
“The infusions make the difference for me being able to walk around, cook myself a meal, to have a semblance of dignity in life,” Coffey explained. “Spreading them out takes away that dignity. It makes it difficult to walk to the bathroom. It causes a progressive decline.
“I don’t want to die. If I can’t access my medications and treatments, if I can’t stay on top of everything, I decline and I’m not ready for that.”
In 2023, Coffey said UnitedHealthcare – her Medicare Advantage provider – reached out to her after she went public with her story. But she has still found herself pushing for insurance to cover her treatments, seeking prior authorization for care and going through appeals over denials.
According to Coffey, she has had prior authorizations accepted by UnitedHealthcare only for the insurer to not follow through with paying for the care, forcing her to regularly spend hours on the phone speaking with customer service representatives, or on hold, trying to resolve the issues.
“It’s ridiculous and disgusting that an insurance company has the power to tell my doctor: ‘No, you can’t give that patient that, no, you can’t have that drug that might help you live,’” she said. “It’s disgusting that we allow it, and insurance companies do nothing to increase positive outcomes in healthcare. Nothing. All they are is a middleman who gets to make a shit ton of money off of us.”
Medicare Advantage “works well until it doesn’t”, reflected Gloria Bent, whose husband, Gary, died last March. “And when it begins to not work well is when you most need it, when you are in a medical crisis and need advanced care.
“These companies, as I understand it, are given a certain amount of money for every client they cover who is on Medicare. What they don’t spend of that is their profit.”
https://www.blogger.com/blog/post/edit/3936036848977011940/5880168459311286180
Letter: What good are preventative screenings if you don’t have health insurance?
An opinion piece in the June 1 Press Herald celebrates increased lung cancer survival rates due to better treatment options and the relatively recent introduction of lung cancer screening. It concludes by encouraging people to talk with their physician about lung cancer prevention and screening. Although this may be sound advice, it begs the question: What about those without a physician – the 25 million Americans who still don’t have health insurance and the tens of millions more who have insurance but still can’t afford health care because their plans come with steep deductibles and copays?
The United States remains the only developed country in the world without some system of universal health care. If innovations like those cited in this opinion piece are to be widely and equitably shared, then health care must be accessible and affordable for all. We need a publicly funded system that assures everyone can benefit – from both basic health care and cutting-edge medical advances.
David Jolly
Penobscot
Letter: Time for universal health care is now
In his recent address at the University of New England, Sen. Bernie Sanders said we have the most expensive health care system in the world but not the best outcomes. To improve, we need to appreciate the social and economic costs of care not given and accept our community obligation to address the basic health care needs of all.
The costs of care not given are immeasurable. Quality prenatal and postnatal care has been shown to decrease the incidence of child abuse, increase vaccination rates, and help ensure that developmental milestones are reached. Access to mental health and substance abuse treatment for parents is critical to the health of the entire family. The cost of managing the results of substance abuse or chronic homelessness can be traced to a lack of access to treatment.
Universal access to primary care would reduce long-term costs by, for example, keeping prediabetes from developing into diabetes or controlling blood pressure before a stroke occurs or kidney disease develops. Prevention or early treatment are far less costly than dealing with a full-blown medical crisis.
A recent study conducted at Yale showed that a universal health care plan like Sen. Sanders’ Medicare for All would reduce the national health care expenditure by 13.1%, or $458 billion annually, compared with the status quo. And this does not include the savings in the social costs of care not given that I have outlined. Universal health care is affordable, and the time for it is now.
Susan Henderson, RN
South Portland
https://www.pressherald.com/2024/06/09/letter-time-for-universal-health-care-is-now/
Letter: Single-payer universal health care is the answer
A simpler system where everyone is covered has been used successfully in other countries. We should adopt it here for the well-being of all.
by Julie Pease - Portland Press Herald - June 10, 2024
I read with interest the June 3 article about the difficulties that patients face navigating our present health care system. Our system is complicated, dominated by entities for which the bottom line is financial, not patient-centered. There have been attempts to address problems with incremental modifications, but this does nothing to make the system simpler. In the story, Dr. Victor Montori said making the system better for patients requires big change. I agree. We need to change the way we pay for health care in this country, with a single-payer universal health care system.
I say this as a doctor who has practiced medicine, and as a patient who has received health care in New Zealand. New Zealand has a universal health care system that is simpler for both doctors and patients. Prior authorizations and referrals are easy to submit. Prescription drugs cost $5 per prescription. Patients receive assistance with transportation, child care, rent and groceries if necessary. Medical bankruptcy is unheard of. Yet, New Zealand accomplishes all of this for about half of the per capita cost when compared to the United States.
Economic analysis has shown that single-payer would actually reduce health expenditures while providing high-quality coverage to all U.S. residents. If our country expanded traditional Medicare to include everyone and broadened coverage to eliminate the need for supplemental plans for medical and dental services and prescription drugs, we’d have a simpler system, and everyone would be covered.
I challenge our elected officials to work for patient-centered universal health care.
Julie Keller Pease
Topsham
https://www.pressherald.com/2024/06/10/letter-single-payer-universal-health-care-is-the-answer/
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