Below is that same quote from Roosevelt Institution as the goal towards global wealth inequity===the US middle-class has too much wealth. We spoke about the wages, the home-ownership, car ownership, sending kids to college as examples of that middle-class wealth. Today we look at what World Bank identifies as gross injustice for the the rest of the world's people----our US health care coverage....
AMERICANS HAVE ACCESS TO TOO MUCH HEALTH CARE SO THE BENEFITS HAVE TO GO.
So, to answer is to create the same developing nation health structure for poor here in the US basically designed to contain communicable disease and provide clinic care. With no middle-class in the US ----that will be soon 80% of Americans climbing to 90%.
'The difference is because the US middle class is much wealthier than the average global middle
class consumer'.
We have spent many days speaking to why the Affordable Care Act was simply the Clinton-era deregulation and consolidation of our financial industry to create predatory, profit-driven global health systems ending our public health structure and privatizing all Medicare and Medicaid funding to those global health systems. The ACA has always been a Republican policy to do just that. Medicaid for these few decades of CLINTON/BUSH/OBAMA was allowed to be raided with Medicaid fraud by the health industry with Medicare and Medicaid funds losing hundreds of billions of dollars each year to this corporate fraud. That money went to expanding a few global health systems overseas. Meanwhile, citizens in US cities that should have received that health funding have their lives shortened by as much as 20 years.
We have the same people in place in political office and or public agencies so what would we think will happen with the funding for EXPANDED MEDICAID? That's right---it will be more money lost to fraud with more citizens never receiving health care. So, the goal of this policy was never about giving more access to health care to the poor. It's not about more health access to ex-offenders as this article pretends. Remember what all health funding heading to mental health and addiction means----absolutely no health access to basic medical treatment/procedures/hospitalization that Medicaid USED TO COVER. I talk as well about how these mental health issues will be used in very bad ways under a far-right authoritarian government structure AND THE ROOSEVELT INSTITUTE KNOWS THIS.
THE LEFT-LEANING POLICY FOR HEALTH CARE WAS STOPPING AFFORDABLE CARE ACT AND PROTECT OUR PUBLIC HEALTH TRUSTS MEDICARE AND MEDICAID. EXPANDED AND IMPROVED MEDICARE FOR ALL WAS MEANT TO DO THIS.
What ACA did was create a gutted-of-funding global policy A MEDICAID-FOR-ALL that looks just like developing nation clinic care for the poor.
Next New Deal: The Blog of the Roosevelt Institute
Health CareRortybomb
Is Expanding Medicaid an Essential Part of Reducing Mass Incarceration? An Interview with Harold Pollack
By Mike Konczal | 03.11.15
Every policy lever available was pulled in order to create our system of mass incarceration over the past 40 years. Reformers will have to be equally clever and nimble in trying to challenge and dismantle this system. And one important lever that I hadn’t thought much about in this context is the Affordable Care Act’s (ACA, or Obamacare) expansion of Medicaid. This expansion is being blocked in 22 states, which is preventing 5.1 million Americans from getting health-care.
This came up in an excellent interview between Connor Kilpatrick and the political scientist and incarceration scholar Marie Gottschalk over at Jacobin. Commenting on the limits of the current wave of bipartisan support against incarceration, Gottschalk notes that “If you care about reentry and about keeping people out of prison in the first place, there’s no public policy that you should support more strongly now than Medicaid expansion. Medicaid expansion gives states huge infusions of federal money to expand mental health services, substance abuse treatment, and medical care for many of the people who are most likely to end up in prison. It also allows states and localities to shift a significant portion of their correctional health care costs to the federal tab.” Similar concerns were raised by Elizabeth Stoker Bruenig at The New Republic.
I immediately got Gottschalk’s new book Caught, the subject of the Jacobin interview, and though I just started the book I highly recommended it as a guide to where the prison state stands in 2015. But I wanted to know more about the relationship between Medicaid and deincarceration.
So I reached out to friend-of-the-blog Harold Pollack. Pollack is the Helen Ross Professor at the School of Social Service Administration at the University of Chicago. He is also Co-Director of The University of Chicago Crime Lab at the University of Chicago.
UNIVERSITY OF CHICAGO IS GROUND ZERO FOR WALL STREET NEO-LIBERAL POLICIES FOR DECADES AND WOULD NOT HAVE ANY POLICIES HELPING LABOR OR JUSTICE.
He has published widely at the interface between poverty policy and public health, and he also writes for a wide variety of online and print publications. He is also a thoughtful scholar on health care and crime policy and how they interact in communities.
Mike Konczal: How important is the Medicaid expansion for deincarceration?
Harold Pollack: I’m convinced that Medicaid expansion is essential for this problem. It’s essential for two different purposes. First, individuals in this population need health services, and there needs to be a clear way that individuals can get access to services from qualified providers. The Medicaid expansion does that.
Secondly, the entire ecosystem of care requires proper financing. And for historical reasons, mental health and substance abuse services have been put into their own silos. They are not properly financed, except through a patchwork of safety net funding streams that don’t particularly work well. They have also been poorly-integrated with standard medical care.
OH, SO THE SAME PEOPLE IN CONGRESS TODAY THAT WERE IN CONGRESS IN THE 1990S NOW CARE----AND THE COMING ECONOMIC CRASH FROM THE MASSIVE BOND MARKET FRAUD IS NOT TAKING ALL GOVERNMENT REVENUE THAT WOULD BUILD THIS HEALTH STRUCTURE FOR THE WORKING CLASS AND POOR?
Let’s talk about individuals first. In what ways could Medicaid benefit people who are or are likely to get caught up in the criminal justice system?
Think about who is not eligible for Medicaid before health reform. A low-income male who is not a veteran or a custodial parent, or who doesn’t qualify for Ryan-White HIV/AIDS benefits. They may have a serious substance abuse problem, but that wouldn’t qualify them for federal disability benefits. They, with the expansion, can get access to Medicaid simply because they are poor.
The criminal justice population is quite varied, but there are a couple of key areas in which Medicaid expansion would be especially beneficial for them. With the expansion, Medicaid can now cover basic outpatient substance abuse treatment. This is true for both Medicaid and private insurance after health reform. And ACA provides these services in a way that is much more integrated with people’s regular medical care.
THIS IS COMPLETELY A PHARMA-BASED HEALTH POLICY AND MUCH OF THE PHARMA IS UNTESTED AND/OR SHOWS NO EFFICACY----
One basic challenge with drug and alcohol treatment is that these services are in a separate system that people don’t want to use, and don’t use. With the Medicaid expansion, you can go to a neighborhood clinic and they can help you get Methadone or Suboxone. They can also get you the psychiatric care you need within the same umbrella of your regular care. So it is much more likely that people will use it.
There’s very good evidence that alcohol and illicit drug treatment reduces criminal offending. [Editor note: Both this study and this study, obtained via follow-up email, show treament reduces violent and property crime enough to far pass a cost-benefit test.] Both It partly reduces criminal offending by reducing the need to commit property crimes to get the substances. It also reduces offending by allowing people to be more functional, and thus more likely to stay employed. Especially in the case of alcohol, people getting their substance abuse under control makes it less likely that they’ll be intoxicated, and thus less likely to commit crimes or be victims of crime.
What about those with mental illness?
When it comes to those with serious mental illness, we end up using local jails to try and manage them. It’s important that they can get access to help and mental health treatment outside of the criminal justice itself. It’s ironic that when someone with psychiatric disorders is inside the jail, they do have access to some of these services. But those services are often unavailable or totally disconnected when they leave the jail.
We don’t really know whether, or by how much, these services can be expected to reduce offending among this group. This remains a hypothesis that depends on how well we actually implement programs. Much will depend on how effectively we can implement Medicaid expansion.
How does this element of Medicaid deal with the traditional criticisms of the program?
Medicaid has many shortcomings. It doesn’t pay a market rate for important services. But for all of its faults, Medicaid recipients are grateful to have it. The satisfaction they have is quite high compared to traditional health insurance. Medicaid gives people access to the basic health care that they need to stay healthy and improve their lives. It is also genuinely designed for people who have no money, which is really important for these indigent populations. Medicaid is inferior to private insurance in terms of reimbursement to providers, but it’s better for really poor people than any private insurance I’ve seen, because it’s been road tested for a long time in meeting the needs of indigent people.
And as I mentioned, ACA is especially important, because the ACA includes very specific components in the area of mental health and substance use.
One thing I’ve noticed is that for all the talk about ending mandatory minimums, most of the real energy is about giving judges flexibility to ignore mandatory minimums. But that put a lot of pressure on keeping recidivism down, because judges, especially elected ones, won’t ignore long records.
Deincarceration requires the puzzle pieces to fit together to be sustainable and politically tenable. That requires that we deal with the real-life problems people face when they are released. It requires monitoring and people have access to services, both to improve their quality of life and to reduce the probabilities that they will reoffend.
If we just release people without support services, my fear is that it will not go well. Then it will ultimately generate political backlash. I’m very heartened that we are reducing the mandatory minimums, in particular for older offenders who tend to be less violent. It’s essential that we address the excessive sentencing. But we also have to do what we need to do to make this effective.
Even if judges can reduce sentencing, they are ultimately dependent on the available resources to help and monitor the people that come before them. And if judges don’t see those services, then they aren’t going to use their discretion to release many of these people as early as they might.
And if property crimes are being committed by people under criminal justice supervision, and they have a history of violent offending, then they are much more likely to be sent back with a pretty serious sanctions.
Tell me more about the second issue, how the ACA rationalizes the funding stream for these services.
We’ve had a messy system in the past, and we’ll ultimately rationalize it under Medicaid. Safety net providers for substance abuse and mental illness have always been paid for by a patchwork of public funding through obscure agencies and local governments. It has always been a huge challenge where access has been inadequate, with long waiting lines, and the services provided were often quite forbidding. Given this separate funding, it’s very difficult to integrate this in with people’s overall health care. When you have these silos of places to go, with one for mental health, another silo for substance abuse, and another for safety net health care, that person isn’t going to get the integrated care they really need. The ACA is trying to bring those things together.
Many of these issues will still be in play going forward, but it will be in the context of a coherent system that at-least addresses these issues within the context of broader health care.
_________________________
So, once we know the ACA was about creating global health system structures to compete in International Economic Zones around the world--then we know our US cities deemed International Economic Zones will be built to bring foreign health corporations to cities like Baltimore while global health corporations like Johns Hopkins operate in China, Malaysia, etc. This is what is indeed happening----in BAltimore we already see global health and research corporations in our Enterprise Zone development. Let's look at what Asian billionaire family is tied to the global online health care business creating the technology products for global health tourism.
Keep in mind----any US citizen could be that small or regional business owner manufacturing products and services like this----that is what BUILDING LOCAL, SMALL BUSINESS ECONOMIES IN BALTIMORE LOOKS LIKE----but making US cities International Economic Zones means all nations tied to Trans Pacific Trade Pact brought to the US can operate in Baltimore as they do overseas. Know what third world health care looks like when it is hyper-profit-driven?
So, here we have WEN-----our Baltimore Public Health Commissioner----who works as that global health liaison for her family and Hopkins and our public health department has nothing to do with PUBLIC HEALTH----this is why Baltimore is listed by international justice organizations as third world in public health outcomes.
Leana S. Wen, M.D., MSc., FAAEM
Health Commissioner, Baltimore City
*****************************
Absolutely no one has believed for decades China was communist---these leaders have been millionaires and billionaires for decades but they work hard to keep their citizens from knowing they are getting rich. This is 1% Wall Street Libertarian Marxism. We see the 2% to the 1% of global rich Wen family partnered with the Bloomberg School of Public Health when citizens of Baltimore and Maryland have no voice in what Maryland Assembly and Baltimore City Hall push for health policy for Wall Street Baltimore Development and a very, very, very neo-conservative global Johns Hopkins.
Our Dr Wen describes what China's health care looks like after several decades of global neo-liberalism in China's International Economic Zones---she understands best that Affordable Care Act is building the same health structures here in the US as were built overseas and only the most affluent access them.
CAN CHINA'S HEALTH CARE DISTOPIA BECOME OUR FUTURE? THAT'S WHAT THESE GLOBAL PARTNERSHIPS HAVE AS A GOAL.
'The report is damaging not only to Wen, but also to the Communist party'.
China has lashed out at a US newspaper report that premier Wen Jiabao's family has amassed vast wealth worth at least $2.7bn (£1.68bn), censoring the New York Times website and questioning the paper's motivations.
Many relatives of Wen Jiabao, including his son, daughter, younger brother and brother-in-law, have become extraordinarily wealthy during his leadership, an investigation by The New York Times shows. A review of corporate and regulatory records indicates that the prime minister’s relatives — some of whom, including his wife, have a knack for aggressive deal making — have controlled assets worth at least $2.7 billion.
Can China’s Health Care Dystopia Become Our Future?
02/06/2014 04:28 pm ET | Updated Apr 08, 2014
Leana Wen, M.D. Health Commissioner of Baltimore City; Emergency Physician
What does a health care dystopia look like?
In this TED video, you are introduced to a world where people die waiting for health care, where corporate interests reign, and where doctors get paid to do more rather than to the right thing.
I’m a Chinese-born, American-trained physician. A couple of years ago, I was given an opportunity to conduct a research project on China’s health care system. I traveled to 15 cities, from Beijing to Inner Mongolia, visited over 50 hospitals, and had unprecedented access to doctors, medical students, nurses, administrators, and government officials. Given how China’s developed into a major world power, I expected to find a fair, functional system.
However, instead of this utopia, I found a dystopic world. People spoke about the 1980s, when universal health care was dismantled and 900 million people lost coverage overnight. Everyone had a story of friends and family who died in front of hospitals because they couldn’t pay.
Doctors were unhappy too. Imagine you’re a doctor, and you trained all your life to listen and heal; suddenly, overnight, you’re a businessman and you have to work your patient to get every cent.
On the other hand, if you’re a well-off patient and you hear that poor people get denied services, what do you want for yourself? You want everything to be done. Because you have the money, nobody will tell you about the risk of radiation of a CT scan. Same for expensive but untested medications, or potentially dangerous procedures. People got what they wanted, but at what cost?
No doubt, China has been very successful. The government has lifted millions out of poverty. But there is a fundamental problem, a blind spot that’s been missed in the rush towards economic reform.
This blind spot is our belief that being a consumer enables choice, and that choice is power. I’m all for empowering people to have choices. But turning patients into consumers means that healthcare is a commodity, not a right. It becomes possible to deny life-saving treatment, and to sell unnecessary, even harmful, interventions. The doctor-patient relationship becomes a transaction between salesman and client.
That blind spot, and the consequences, are not unique to China. Here in the U.S., costs of health care are escalating out of control. While millions remain uninsured, 30 percent of all tests and treatments are done are unnecessary. It’s far more profitable to peddle drugs than prevent illnesses. According to the New England Journal of Medicine, 94 percent of doctors have some affiliation with drug and medical device companies.
By no means am I romanticizing the pre-1980s Communist state. My family left on political asylum, and I am very grateful for the opportunities afforded to me by my adopted country. But capitalism doesn’t have to equate consumerism, and the beauty of a democracy is that we as citizens can decide what type of society we want to live in.
CHINA HAS THESE FEW DECADES BEEN CALLED MORE NAKED CAPITALIST THAN THE US.
To prevent further problems in our country, and to stop the rest of the world from following us down this path, we have to make a difficult decision. We must decide if it’s important to us to preserve our core tenets of liberty, democracy, equity, and justice. If not, we know what the dystopic future will look like. If so, the time is now to decide that there are some things that are not for sale, and that we must realign incentives to help people be their best selves.
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Maryland has decades of history of being the only state in the nation to OPT-OUT of Medicare and was given an exemption to do so....which was always unconstitutional as Maryland citizens were denied the level of health care citizens in states across the nation were receiving. Maryland built this POOLED FUNDING model that is now that Federal funding in Affordable Care Act that sends all Medicare and Medicaid to these consolidated health systems----ACOs. Johns Hopkins literally built their global health system and MedStar from the use of POOLED HEALTH FUNDS that should have gone to Maryland citizens and of course Baltimore has the most Medicare/Medicaid citizens in the state. We have no oversight and accountability of our health institutions----and plenty of stats generated by outside sources saying this system created huge health outcome disparity. Health industry fraud and corruption built empires----as this Roosevelt Institution identifies our very, very, very, very neo-conservative Johns Hopkins as best in health policy----it is known throughout the health and academic industry as purely profit-driven to the detriment of the working class and poor---especially black citizens.
The Affordable CAre Act simply extends this unjust system to 80% of Americans soon to be 90%. Notice how this Roosevelt Institute article brings
TAMMANY HALL O'MALLEY---AS FAR-RIGHT WALL STREET GLOBAL CORPORATE NEO-LIBERAL/NEO-CON AS A PLAYER CAN GET----AND ACTS AS THOUGH BALTIMORE DOES A GOOD JOB ON HEALTH POLICY AND RACE.
These health data are true for all ages---and the public health outcomes are third world because all revenue sources for communities are redirected to Wall Street Baltimore Development and Johns Hopkins ----they create the worst public health. There is not a more profit-driven who cares about public health empire-building city then O'Malley's Baltimore and this article suggests O'Malley should be made Department of Health and Human Services leader----after Burwell. Keeping it global corporate tribunal aren't we Richard Kirsch
Baltimore Youths Have It Worse Than Those in Nigeria
A global survey of 15- to 19-year-olds living in vulnerable cities shows that social support and outlook are driving factors in health outcomes
'The researchers found many similarities—in all five cities, adolescents were exposed to unsanitary conditions, substance abuse and violence—but the differences between each area were especially compelling. Overall, teenagers in Baltimore and Johannesburg, despite being located in comparably wealthy countries, had far worse health outcomes and tended to perceive their communities more negatively'.
'Actually, the one candidate who makes a number of serious proposals to expand coverage, improve affordability, and focus on quality, community health, and racial equity is O’Malley. As the Governor of Maryland, which has a long and ongoing history of innovation in health care delivery, O’Malley is clearly steeped in the major changes occurring in health care and how to address them. He could be a good candidate for the next Secretary of Health and Human Services'.
So, this article promotes the most global, profit-driven, predatory health structure in the US as the model. Does anyone really believe this is a step towards any public system in the midst of privatizing all that is public? REALLY???
THE ROOSEVELT INSTITUTION IS FROM WHERE ALL THE PROGRESSIVE POSING POLICIES ORIGINATE WHILE IT IS HYPER-ONE WORLD GLOBAL CORPORATE TRIBUNAL.
Next New Deal: The Blog of the Roosevelt Institute
Beyond the ACA: Toward a Health Care System That Works for All of Us
Health CarePolitics
By Richard Kirsch | 02.01.16
The Democratic presidential debates have brought welcome attention to the question of how we can build on the Affordable Care Act to realize the goal of quality, affordable health care for all. It’s a refreshing and timely break from the Republicans’ tired pledges to repeal Obamacare, a radical right stance that is supported by every Republican candidate but only one out of three voters.
In many ways, the health debate between Clinton and Sanders is really less about health policy than about the entire conception of their campaigns: Clinton the pragmatic incrementalist and Sanders the bold visionary. But neither of the two candidates is focused on measures, incremental or bold, that move our health care system to focus on promoting good health, demanding that health care providers get paid for quality care, or reducing racial inequities in health care.
I’ve just written a paper, commissioned by the Universal Health Care Foundation of Connecticut, which is all about bold incrementalism. I lay out ambitious polices, building on the ACA and the current changes taking place in health care, aimed at getting to quality affordable health care for all and promoting good health, not just good health care.
I start with the pragmatic assumption that we will not be jumping from the Affordable Care Act to a fully publicly financed health care system. But even if America rallied behind Sanders’s political revolution and enacted Medicare for All—which I would welcome!—we would still need to refocus our health care system on providing high-value care and promoting health for all instead of the wasteful treatment focus of Medicare’s current fee-for-service model.
WAS FEE-FOR-SERVICE WASTEFUL OR FULL OF FRAUD, CORRUPTION, AND PROFITEERING WHICH CAN BE CORRECTED BY REBUILDING OVERSIGHT AND ACCOUNTABILITY IN OUR MEDICARE AND MEDICAID SYSTEMS?
Medicare for All, as Sanders proposes it, would solve the two most glaring problems that remain after the ACA: the 29 million people who remain uninsured and skyrocketing out-of-pocket costs. Clinton’s “plan”—no details, just intentions—barely mentions expanding coverage to the millions who remain uninsured, focusing instead on pledges (no actual proposals) to lower deductibles and drug prices.
Actually, the one candidate who makes a number of serious proposals to expand coverage, improve affordability, and focus on quality, community health, and racial equity is O’Malley. As the Governor of Maryland, which has a long and ongoing history of innovation in health care delivery, O’Malley is clearly steeped in the major changes occurring in health care and how to address them. He could be a good candidate for the next Secretary of Health and Human Services.
While the public debate focuses on coverage and affordability, there are seismic changes happening in how we organize the delivery of health care. The visible part of the transformation, the iceberg above the surface, is mega-health insurance and hospital mergers. Like other icebergs, they look scary: bigger corporations jacking up prices to increase profits while consumers have fewer and fewer choices. People who need health care the most—those with chronic illness and disabilities, the elderly—are also likely to be hurt the most.
Ironically, though, concentration could offer the opportunity for more effective and simplified regulation. Concentration could facilitate the treatment of health care as the public good it truly is, rather than as a market good. Regulatory policies to control costs and increase quality should be easier to design and enforce if there are fewer entities to oversee and influence.
The ACA is already illustrating how government payers can have a positive impact. It is accelerating the movement of the American health care system from a focus on providing more care—needed or not—to providing quality care. By using the purchasing power of Medicare, our national health insurance program for seniors and people with disabilities, the ACA has begun paying hospitals and doctors more when they reduce costs while increasing quality, and paying them less when they provide poor quality care. In some states, Medicaid is beginning to drive the transformation with a focus on primary care and community health.
CONCENTRATION AND CONSOLIDATION STATED ABOVE WAS THE SAME CLINTON NEO-LIBERAL ARGUMENT FOR BREAKING GLASS STEAGALL BANKING WALL TO CONSOLIDATE WALL STREET INTO GLOBAL WALL STREET DOING ANYTHING IT WANTS.
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Here is the same language from the Roosevelt Institution and it is indeed the same developing nation UNIVERSAL HEALTH CARE-----simply containing communicable disease, clinic care, and preventative care but no access to much of modern health care procedures and devices....................'Some countries use incremental measures to reach the goal of'
universal health care'.
ONE WORLD HEALTH CARE------COMING TO THE US WHICH ALREADY HAD SECOND WORLD HEALTH CARE.
News / Africa
Developing Countries Strive to Provide Universal Health Care
The Jacaranda Health Clinic in Nairobi provies child and maternal health services for the poor (A. Gichigi/Results for Development)
William EagleLast updated on: September 20, 2012 7:48 PM
A new study shows progress being made by nine developing countries in Asia and Africa in creating universal health care systems. They are Ghana, Rwanda, Nigeria, Mali, Kenya, India, Indonesia, the Philippines and Vietnam.
The study is part of a series of articles on health reforms published in the scientific journal The Lancet.
Statistics help tell the story. They show how far these countries have come in extending health care to ever-widening sections of society, including the poor.
According to the study (called “Moving Towards Universal Health Coverage: Health Reforms in Nine Developing Countries in Africa and Asia”) more than three-quarters of the populations of Rwanda and the Philippines are now enrolled in health insurance programs. About half are covered in Ghana, Vietnam and Indonesia.
Countries in the early stages of reform, like Mali, Kenya, India and Nigeria, cover less than 20 percent.
The nine countries have each reached a national consensus on the need to extend health care, but their approaches vary.
Improving Revenues
Gina Lagomarsino, a managing director at the Washington-based group Results for Development, said finding a stable source of funding is essential.
Some comes from donors, which often provide funding for specific programs to fight malaria, tuberculosis and HIV/AIDS. The report says donor contributions make up about half of all health care funding in Rwanda and about a third in Kenya, but much less in other countries.
The majority of the funding in most countries comes from state revenues.
In Kenya, taxes are deducted from the paychecks of civil servants and others in the formal, or taxable, sector. Nigeria funds its health coverage for pregnant women and children in part with general revenues made available from debt relief. Some countries, including Rwanda and the Philippines, ask households to pay monthly or annual insurance premiums.
Lagomarsino said Ghana, which has one of Africa’s most successful insurance programs, has a tax devoted solely to health care.
"In 2000," she explained, Ghana instituted a new value-added or sales tax which was earmarked for the National Health Insurance Scheme, and this has provided a pretty steady stream of revenues to [the effort]. It has allowed Ghana to develop a program that’s got very comprehensive benefits and offers coverage to the whole population."
"Not that everyone is enrolled yet and the program is far from perfect, but they have been able to significantly increase government revenues and at the same time lower the amount people are paying out of pocket."
Risk pools
Some countries use incremental measures to reach the goal of universal health care. One way is to create risk pools, or programs devoted to various groups.
The programs of some countries, such as Kenya and Nigeria, began by targeting civil servants and taxable wage earners. The two countries are now working to include women, children and the poor.
Lagomarsino said the goal in many countries is to eventually replace fragmented coverage with one large pool covering everyone.
"It allows for cross-subsidies across populations so wealthier people are paying into the same pool as poorer people," she said. "It’s easier to graduate the payments so that the contributions from the wealthy are used to help subsidize the poor. Similarly, the contributions from the healthier can subsidize those of the sicker. So bigger pools means it’s more efficient; everyone pays an average cost."
Private sector support
Many of the nine countries studied in Africa and Asia are also integrating the private sector into their plans to extend health care. Advocates say private service providers can improve choice and access to care.
"We have found that in the countries that we’ve examined in this study pretty much all of them have set up an independent purchasing agency that allows them to purchase care from providers rather than just handing a budget over to a ministry of health facility," said Lagomarsino.
"And in many of the countries, they have set up a mechanism for purchasing from private sector providers. It varies by country but for example they are doing this in Ghana [and] in Kenya. They also purchase from public providers."
Lagomarsino also said that systems combining public and private health care can prevent the development of a two-tiered system – one catering to the wealthy and the other to the poor. She said with the mixed system, subsidies can be used to extend coverage to the poor. But she notes that involving private providers can create some challenges for assuring quality and preventing fraud.
Controlling fraud
Lagomarsino said the systems that work best have strong leadership, including skilled civil servants and agencies to ensure that the system functions efficiently.
In the future, technology may help improve delivery and prevent fraud. Mobile phone networks, like Kenya’s successful M-pesa, could be used to pay insurance premiums.
Technology may also help prevent fraud.
"There’s been a lot of interest," she said, "in a system that’s been widely used across India that provides health coverage to the poor, and those people who are enrolled get a SMART card that has biometric data, such as their fingerprints, on it so when they go to receive services, it can be verified that they came and got the service. And then all of the claims are submitted electronically and paid electronically."
Lagomarsino said policymakers will benefit from studying these and other cases to design programs that best fit their own countries. She said it’s not just economics, but also culture and politics, that will determine how to provide health care to everyone at an affordable cost.
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This article above identifies China's move from a social public health system to one of profit and that came because of US International Economic Zone development in China. Global corporations like Hopkins were building their health systems throughout Asia and built these policies of health tourism as well. As we see health prices are rising and access is becoming tiered and geared towards the affluent. This is the health system the Affordable Care Act is building today in the US ----and global health tourism is central to Baltimore's health policy. As this article shows-----health costs will grow higher and higher as markets compete for the most affluent and ignore anyone not able to afford private health policies.
'It involves about 50 countries in all continents and several Asian countries are clearly in the lead. In Asia, medical tourism is highest in India, Singapore and Thailand. These three countries, which combined comprised about 90% of the medical tourism market share in Asia in 2008,1 have invested heavily in their health-care infrastructures to meet the increased demand for accredited medical care through first-class facilities'
The idea that nation's with such high poverty and extreme needs in public health have focused on building these hyper-for-profit structures comes from CLINTON/BUSH/OBAMA and it created these global foreign health corporations that are now being brought to our US cities with the goal of multi-national health systems taking our local health policies.
IF YOU WANT CHEAPER HEALTH CARE ----GO TO THAILAND FOR IT-----we are already hearing this in the US.
All these nations listed in this article are the ones having signed onto TRANS PACIFIC TRADE PACT and as such will be able to operate in the US as they do overseas.
Bulletin of the World Health Organization
The effects of medical tourism: Thailand’s experience
Anchana NaRanong a & Viroj NaRanong ba. School of Public Administration, National Institute of Development Administration, 118 Sereethai Road, Klong Chan, Bangkapi, Bangkok, 10240, Thailand.
b. Thailand Development Research Institute, Bangkok, Thailand.
Correspondence to Anchana NaRanong (e-mail: anchana@gmail.com).
(Submitted: 22 September 2009 – Revised version received: 14 February 2011 – Accepted: 15 February 2011 – Published online: 28 February 2011.)
Bulletin of the World Health Organization 2011;89:336-344. doi: 10.2471/BLT.09.072249
Introduction
Unlike general tourists needing medical attention, medical tourists are people who cross international borders for the exclusive purpose of obtaining medical services. Medical tourism has increased in part because of rising health-care costs in developed countries, cross-border medical training and widespread air travel. The medical tourism industry has been growing worldwide. It involves about 50 countries in all continents and several Asian countries are clearly in the lead. In Asia, medical tourism is highest in India, Singapore and Thailand. These three countries, which combined comprised about 90% of the medical tourism market share in Asia in 2008,1 have invested heavily in their health-care infrastructures to meet the increased demand for accredited medical care through first-class facilities.
In 2007, Thailand provided medical services for as many as 1.4 million foreign patients, including medical tourists, general tourists and foreigners working or living in Thailand or its neighbouring countries. If we assume that about 30% of all foreign patients that year were medical tourists – a conservative figure by comparison with the Boston Consulting Group’s estimate of 50% in 20064 – the total number would have been about 420 000. This was more than in Singapore, formerly reputed to be the leading Asian medical tourist destination and the “medical hub of Asia”.5
Although medical tourists are still a small fraction of the 1.5 million foreigners who receive medical care in Thailand, they are the tourist group most likely to affect the country in a major way. Unlike general tourists and expatriates, medical tourists are increasing at a rapid pace – from almost none to 450 000 a year in less than a decade. Moreover, medical tourists tend to seek more intensive and costly treatments than other foreign patients, as a result of which their effect on the country is more profound.
In this paper Thailand is used as a case study to examine the main effects of medical tourism on a country’s economy and health system. The final section of the paper discusses policy implications and provides some policy recommendations.
Methods
This paper focuses on medical tourism. However, singling out data for medical tourists is difficult because Thailand breaks their data down into Thais and foreigners but not into foreigners who are medical tourists and other foreigners seeking medical care. Another reason that these two groups are usually lumped together is that most foreign patients behave similarly when seeking health care, share similar views regarding patient’s rights, and have similar health-care needs. Once they fall ill and need health care, they tend to have similar demands and requirements. It must be borne in mind, however, that the fact that the data for all foreigners are lumped together makes the mean values obtained for the average medical tourist (e.g. in terms of physician time required) usually higher than the mean values obtained for the average foreign patient.
The study is divided into three parts. The first part estimates the effects of medical tourism on the Thai economy in terms of revenues from medical services and value added gained from the activities of patients and the companions travelling with them before and after medical treatment. In general, revenues from either medical services or tourist activities include the costs of services and materials, some of which, especially new drugs and advanced equipment, are imported. Hence, the domestic value added (the revenue left after subtracting the cost of imported materials) is a better indicator of the net economic benefit of medical tourism than total revenues. Theoretically, however, the value added figures presented here are overestimated, especially with health-care providers’ income included in the calculations. This is because without foreign patients, these providers would probably spend more time with Thai patients and some positive value added would still be generated (even if lower than the value added generated from serving foreign patients) along with improvements in health status and social welfare for Thai citizens.
The estimated effects of medical tourism were partly based on data furnished by Thailand’s Ministry of Commerce, with some modifications and extrapolations to fit various scenarios and assumptions that we considered more realistic.
The estimations and projections were made in two parts:
(i) revenue and value added from medical services provided to foreign patients, and (ii) revenue and value added from the activities of medical tourists and their travelling companions, including before and after the medical treatment.
The methods (with main scenarios and assumptions) used to make estimates and projections are as follows:
THAILAND IS KNOWN FOR BEING THE WORST OF SWEAT SHOP LABOR ----PEOPLE DO NOT GET PAID AND THIS IS WHY GLOBAL HEALTH TOURISM CORPORATIONS FLOCK THERE.
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International Health justice organizations have shouted for over a decade that Trans Pacific Trade Pact will harm the world health structure that has allowed those global developing nation citizens having had access to basic health care for a century. It kills the ability to access vital PHARMA---kills funding for global communicable disease projects that have been REAL world health for people of color.....those same global people of color Roosevelt Institute says suffer under the middle-class access of Americans to their developed nation health care. CLINTON/BUSH/OBAMA has dismantled and destroyed much of this past century's world health history while doing the same in the US.
THERE IS NO PLAN FOR PUBLIC HEALTH FOR THE POOR------IT WILL BE HERE IN THE US WHAT THEY BUILD IN NIGERIA OR CAMBODIA-----AND WE ALREADY KNOW THOSE NATIONS ARE BUSY BUILDING GLOBAL NEO-LIBERAL HEALTH TOURISM.
50-Group Public Health Coalition Asks Congress To Oppose TPP
Posted: April 18, 2016
Dave Johnson Fellow, Campaign for America's Future
Saying they are “alarmed by the implications for access to medicines [created by] the Trans-Pacific Partnership (TPP)” a coalition of 50 groups concerned with public health sent a letter asking Congress to oppose the so-called “trade” agreement. The groups say that TPP provisions give giant, multinational pharmaceutical companies monopoly power as well as power to restrict decisions by sovereign governments.
The letter, dated April 12, begins:
“The intellectual property (IP), investment, and pharmaceutical and medical device reimbursement listing provisions included in the TPP would do more to undermine access to affordable medicines than any previous U.S. trade agreement. We therefore urge you to reject the TPP in its current form.”
Problems the coalition sees with TPP include:
● Procedures … that allow pharmaceutical companies to intervene in public policy deliberations on drug pricing and reimbursements.
● Measures that enable patent “evergreening” by requiring countries to grant additional 20-year patents for new uses, new methods or new processes of using existing medicines.
● Extension of patent terms beyond 20 years when the patent office review exceeds a certain period, and when patent holders allege delays in drug regulatory review of a medicine’s safety and efficacy in order to grant marketing approval.
● Rules requiring data/marketing exclusivity of at least five years for small molecule medicines plus at least three years of additional exclusivity for modifications of existing medicines or five years for combinations.
● For the first time in a U.S. trade agreement, there is a separate provision for monopoly protection for biologic medicines – such as monoclonal anti-bodies that are rapidly becoming the treatments of choice for many cancers and other illnesses.
● Provisions enabling pharmaceutical companies to sue the U.S. or other governments in unaccountable investor-state tribunals to seek taxpayer compensation by claiming that public policies have deprived them of their anticipated profits.
The letter says, “These TPP provisions significantly skew that balance away from consumer access to medicines by unduly expanding pharmaceutical industry monopoly power.”
The letter concludes, “We urge Congress to reject the TPP as long as these damaging provisions are a part of it. The stakes for public health are too high.”
The letter was signed by:
ACRIA Center on HIV & Aging
Act Up Boston
Adrian Dominican Sisters, Portfolio Advisory Board
African Services Committee
AIDS Alabama
AIDS Healthcare Foundation
Alliance for a Just Society
Alliance for Retired Americans
American Medical Student Association
Article 25
AVAC- Global Advocacy for HIV Prevention
Breast Cancer Action
Cancer Families for Affordable Medicine
Center for Policy Analysis on Trade and Health (CPATH)
Communications Workers of America (CWA)
Community Organizations in Action
Connecticut Citizen Action Group
CREDO Action
DC Fights Back
Dominican Sisters of Hope
Global Justice Institute of Metropolitan Community Churches
Health Alliance International
Health Global Access Project (GAP)
Hepatitis Education Project
Hesperian Health Guides
HIV Prevention Justice Alliance
Icahn School of Medicine at Mount Sinai
Indian People’s Action
Initiative for Medicines, Access & Knowledge (I-MAK)
Interfaith Center on Corporate Responsibility, Domestic and Global Health Leadership Teams
Main Street Alliance
Maryknoll Office for Global Concerns
Médecins Sans Frontières/Doctors Without Borders USA
National Nurses United
National Physicians Alliance
NETWORK, A National Catholic Social Justice Lobby
Northwest Coalition for Responsible Investment
Other98
Oxfam America
People’s Health Movement USA
Physicians for a National Health Program
Physicians for Social Responsibility
Project Inform
Public Citizen
RESULTS
Social Security Works
Student Global AIDS Campaign
Sum Of Us
Treatment Action Group
United Church of Christ, Justice and Witness Ministries
Universities Allied for Essential Medicines
Ursuline Sisters of Tildonk, U.S. Province
US Action
Virginia Organizing
Voices of Community Activists & Leaders (VOCAL-NY)
Washington Community Action Network
Yale Global Health Justice Partnership
Young Professionals Chronic Disease Network
___________________________________________
'Rather than sounding an alarm or considering the possibility that epochal economic decline is underway which threatens the health of the public',
The same is true with Roosevelt Institute as it simply MOVES FORWARD with the neo-liberal global corporate tribunal and US cities as International Economic Zone policies PRETENDING these global entities would really do anything socially progressive once installed in the US.
.Health systems, neoliberalism, and the end of growth: The World Health Organization in denial
by Dan Bednarz, originally published by Health after Oil | Feb 18, 2014
The WHO (World Health Organization) has released its latest in a series of reports[i] on public health in 53 European nations, and presents this assessment through a focus on the social determinants of health[ii]. Rather than sounding an alarm or considering the possibility that epochal economic decline is underway which threatens the health of the public, it serves up tepid criticism of government policies that have resulted in surging poverty[iii] and high unemployment[iv], fiscal cuts to health and other social services, increases in suicide and a host of other declining health indicators deforming people’s lives in most –possibly all- of the countries examined. Put directly, the social determinants of health are being laid to waste in several European states and endangered in others, yet the report casts this as a few dark shadows on an otherwise bright picture.
I find the report psychologically dissociative, ethically compromised, and in an intellectual malaise.
Sociologically, however, it makes sense:
it is self-destructive to analyze or challenge[v] the political/economic system that funds your work, even if it is destroying what your organization was founded to analyze, protect and ensure. As such, this report represents a conflict-ridden and unstable posture of ignorance and subservience to political power.
Revealingly, the report takes virtually no notice of the portents of socioeconomic and political[vi],[vii]upheaval[viii] –like UKip and Golden Dawn- spreading through Europe.[ix],[x] Naïvely[xi], the report calls for slight reforms –like giving health ministers a “seat at the table” of austerity[xii] budgeting to make the case for “proportionate to need” funding cuts[xiii]- as sufficient to ensure, maintain or in some conceded instances restore a portion of the underlying fundamentals of the health of European populations now being sacrificed in the name of balancing budgets and debt repayment. The authors give every indication of having no inkling that their flaccid calls for a realization that too much austerity endangers the public’s health is too little too late and, in any case, will have zero influence on neoliberal policymakers.
Politically, then, this WHO[xiv] report offers no recognition, let alone opposition, to the class-based austerity imposed by neoliberal governments[xv]. Accordingly, this report personifies developing turmoil[xvi] in organizational mission and collective identity for health professions as the divergence between the imposition of neoliberal austerity measures and the mission of public health deepens. This compromised stance, of offering mild warnings about austerity while accepting it as a legitimate policy response, is part of a cultural phenomenon of an inability to democratically address genuine problems while offering rhetoric to reassure and soothe a public that is losing economic ground and its faith in government.[xvii]
Therefore, I suggest that the report illustrates the futility of relying upon the WHO to comprehend what is occurring, let alone to lead in protecting public health. This is important because the WHO is not just another think tank or academic institute; it is the appointed champion[xviii] of world health issues. If it will not speak truth to power[xix] for the European public –which means unequivocally rejecting austerity policies and growing inequalities in income and wealth as destructive of the social determinants of health- at this critical moment, there is no reason to expect it to do so as neoliberal governments continue to cannibalize their citizens to maintain a world politically ruled by a numerically tiny financial elite[xx].
Rather than dissect the report in detail, I want to use it as a springboard to talk to those in the health sciences, especially young professionals and those close to retiring[xxi], who will read it and other such reports and conclude, “This just doesn’t fit my sense of what’s going on in Europe, my workplace, or the world, for that matter.” They will be searching for explanations containing a ring of experiential truth. They also may feel, “If the WHO is incapable of defending the social determinants of health, who will do so as conditions continue to worsen? And, how can I contribute to much needed changes?”
My comments will be unsettling to most health professions readers, but I believe that they contain a kernel of truth to explain the economic decline, which I maintain is caused by class politics and reaching the limits to economic growth.
Before presenting why health systems will continue to be bludgeoned by economic contraction, there is the intricate matter of the question of sustaining oneself while trying to contribute to the greater good. To work in medicine, public health, nursing or a related health profession means your daily bread comes from a large complex system. (And in the United States it’s even worse because most health professional work for profit-driven intensely thought-regimenting corporations.) Raising ones voice in a bureaucratic workplace to address fundamental problems of mission and strategy runs the risk of being expelled or punished by your administrative superiors.
The classic questions of those who recognize organizational decline or malfunctioning are:
Do I stay and raise my voice? Or do I leave and work for change from the outside (possibly starting my own organization?). Or, do I remain loyal? (This should not imply merely shutting up and can involve ingenious ways of sotto voce bending or subverting policies to introduce ground-level change to avert catastrophe).[xxii] So individual responses will vary with time and context and no one should be embarrassed to say, “I’m staying because I need this job and will work for change from within.”
A further note on this:
As late as the hour is, the probabilities of rationally convincing the WHO and other health leadership to challenge neoliberalism –or recognize the ecological/thermodynamic issues I will raise below- are virtually nonexistent. Nevertheless, it does not follow that it is futile to remain inside health systems articulating –as best we can for no one knows precisely what is coming- the need for vast change. The fact that the status quo of health leadership is ignorant yet powerful is a dangerous combination.
They are virtually cybernetically designed to “go down with the ship” and can be expected to make a series of rote and arrantly wrongheaded and damaging decisions as the crises in the larger society and health systems deepen. Suffice it to say that voices -or loyalists- on the inside with an ability to articulate what is happening MAY find opportunities in this volatile context to affect the course of their organizations[xxiii]. This is particularly true as the legitimacy and power of administrative leadership dwindles, which it will.
On the other hand, health professionals in austerity-eviscerated nations like Greece[xxiv], Spain, Italy, Latvia, Ireland and Portugal may find my thoughts tame, trite or passé, given the devil’s choices and steadily degrading circumstances in which they are being forced to do their work. They are past the stage of anticipating decline and need no convincing that their governments are less concerned about the health of citizens than the pocketbooks of bankers–they are deeply experiencing these realities. They are likely to provide the world with models and ideas[xxv] for how to protect the health of the public in an era of thermodynamically and ecologically induced degrowth coping –for now- with the added burden of their governments working to save the rich by plundering the rest of society.
I suggest that one major lesson of Greece, et al. for a health professional is that neoliberalism’s priorities and abandonment of citizens are on display in these nations.
After confronting the class-based nature of public policy, I ask them to rethink their taken-for-granted understanding of how health systems are sustained[xxvi]. For many this combination of requests will be much like the disorientation that occurs when viewing the world through inverted glasses[xxvii].
So what do health professionals who intuitively grasp that something is fundamentally amiss need to know?
First, they should examine the larger systems –or cultural- context that supports the delivery of health care and public health. By this I mean that the institutions upon which health systems rely for social, political and economic support are themselves caught up in a multi-layered set of ticking-clock crises, dilemmas and problems[xxviii] that spans the political/economic/financial, the ecological/thermodynamic, and the psychological/cultural/social dimensions.
To reiterate, these master institutions[xxix] as presently designed cannot respond to this set of crises in an egalitarian manner because 1) they are organized in terms of serving a) economic growth that benefits b) class-based interests; 2) they are unaware of the unfolding dynamics of ecological/thermodynamic realities bringing economic growth to a halt and 3) anthropologically, institutions in crisis automatically operate to repeat mistakes –as the only way forward- while not perceiving or merely dismissing as absurd information pointing to the necessity of taking radically alternative courses of action.
In sum, health professionals must see that austerity is a chosen policy stance of neoliberal governments serving narrow economic elite interests, not an unfortunate oversight or misguided mistake of politicians acting for the common good. Again, I stress that this will be extremely difficult and threatening for health professionals to perceive and act upon.
In tandem with this they need to understand that resource scarcity –especially the end of cheap energy[xxx]- and a host of ecological crises are coupled to –and worsened by- the inherent social, political, fiscal, and economic invidiousness of neoliberalism. This amounts to more and more of the 99% being sacrificed to preserve and further enrich the 1%. Simultaneously, the actual size of the economic pie is contracting. What is occurring in Europe, the United States and other nations is, therefore, a class-based upward redistribution of the income and wealth produced by a dwindling flow of natural capital.
These realizations require a giant leap of consciousness and will almost assuredly be accompanied by a crisis in collective and personal identity as institutions begin to fail, and possibly collapse. Preserving the social determinants of health in these dire circumstances goes beyond restoring or even increasing –which simply will not happen- funding for health services to involve building a society that shrinks energy-consumptive institutions, respects and comprehends the power of nature and, as a necessity, eliminates deeply embedded socially parasitic patterns of wealth accumulation and economic exploitation.
I am not much for prognostication, yet it appears clear to me that fissures will expand and rupture in the health professions as –probably slowly and then in a torrent- awareness spreads that the WHO and other “official” protectors of health are incapable of recognizing or responding to the crises touched upon above. This crisis of health systems, of course, will not happen in a cultural vacuum, as the master economic, financial and political institutions that health professionals take for granted also enter extreme crisis due to energy scarcities and the financial and economic chaos this will create.
Offering specific goals or detailed policy agendas beyond those cited above -shrinking energy-consumptive institutions, respect and comprehend the power of nature and eliminating deeply embedded socially parasitic patterns of wealth accumulation and economic exploitation- is, paradoxically, not likely to succeed at this moment. First comes an awakening, brought on by crisis, to the class-based nature of public policy and the thermodynamic impossibly of perpetuating economic growth[xxxi].
AMERICANS HAVE ACCESS TO TOO MUCH HEALTH CARE SO THE BENEFITS HAVE TO GO.
So, to answer is to create the same developing nation health structure for poor here in the US basically designed to contain communicable disease and provide clinic care. With no middle-class in the US ----that will be soon 80% of Americans climbing to 90%.
'The difference is because the US middle class is much wealthier than the average global middle
class consumer'.
We have spent many days speaking to why the Affordable Care Act was simply the Clinton-era deregulation and consolidation of our financial industry to create predatory, profit-driven global health systems ending our public health structure and privatizing all Medicare and Medicaid funding to those global health systems. The ACA has always been a Republican policy to do just that. Medicaid for these few decades of CLINTON/BUSH/OBAMA was allowed to be raided with Medicaid fraud by the health industry with Medicare and Medicaid funds losing hundreds of billions of dollars each year to this corporate fraud. That money went to expanding a few global health systems overseas. Meanwhile, citizens in US cities that should have received that health funding have their lives shortened by as much as 20 years.
We have the same people in place in political office and or public agencies so what would we think will happen with the funding for EXPANDED MEDICAID? That's right---it will be more money lost to fraud with more citizens never receiving health care. So, the goal of this policy was never about giving more access to health care to the poor. It's not about more health access to ex-offenders as this article pretends. Remember what all health funding heading to mental health and addiction means----absolutely no health access to basic medical treatment/procedures/hospitalization that Medicaid USED TO COVER. I talk as well about how these mental health issues will be used in very bad ways under a far-right authoritarian government structure AND THE ROOSEVELT INSTITUTE KNOWS THIS.
THE LEFT-LEANING POLICY FOR HEALTH CARE WAS STOPPING AFFORDABLE CARE ACT AND PROTECT OUR PUBLIC HEALTH TRUSTS MEDICARE AND MEDICAID. EXPANDED AND IMPROVED MEDICARE FOR ALL WAS MEANT TO DO THIS.
What ACA did was create a gutted-of-funding global policy A MEDICAID-FOR-ALL that looks just like developing nation clinic care for the poor.
Next New Deal: The Blog of the Roosevelt Institute
Health CareRortybomb
Is Expanding Medicaid an Essential Part of Reducing Mass Incarceration? An Interview with Harold Pollack
By Mike Konczal | 03.11.15
Every policy lever available was pulled in order to create our system of mass incarceration over the past 40 years. Reformers will have to be equally clever and nimble in trying to challenge and dismantle this system. And one important lever that I hadn’t thought much about in this context is the Affordable Care Act’s (ACA, or Obamacare) expansion of Medicaid. This expansion is being blocked in 22 states, which is preventing 5.1 million Americans from getting health-care.
This came up in an excellent interview between Connor Kilpatrick and the political scientist and incarceration scholar Marie Gottschalk over at Jacobin. Commenting on the limits of the current wave of bipartisan support against incarceration, Gottschalk notes that “If you care about reentry and about keeping people out of prison in the first place, there’s no public policy that you should support more strongly now than Medicaid expansion. Medicaid expansion gives states huge infusions of federal money to expand mental health services, substance abuse treatment, and medical care for many of the people who are most likely to end up in prison. It also allows states and localities to shift a significant portion of their correctional health care costs to the federal tab.” Similar concerns were raised by Elizabeth Stoker Bruenig at The New Republic.
I immediately got Gottschalk’s new book Caught, the subject of the Jacobin interview, and though I just started the book I highly recommended it as a guide to where the prison state stands in 2015. But I wanted to know more about the relationship between Medicaid and deincarceration.
So I reached out to friend-of-the-blog Harold Pollack. Pollack is the Helen Ross Professor at the School of Social Service Administration at the University of Chicago. He is also Co-Director of The University of Chicago Crime Lab at the University of Chicago.
UNIVERSITY OF CHICAGO IS GROUND ZERO FOR WALL STREET NEO-LIBERAL POLICIES FOR DECADES AND WOULD NOT HAVE ANY POLICIES HELPING LABOR OR JUSTICE.
He has published widely at the interface between poverty policy and public health, and he also writes for a wide variety of online and print publications. He is also a thoughtful scholar on health care and crime policy and how they interact in communities.
Mike Konczal: How important is the Medicaid expansion for deincarceration?
Harold Pollack: I’m convinced that Medicaid expansion is essential for this problem. It’s essential for two different purposes. First, individuals in this population need health services, and there needs to be a clear way that individuals can get access to services from qualified providers. The Medicaid expansion does that.
Secondly, the entire ecosystem of care requires proper financing. And for historical reasons, mental health and substance abuse services have been put into their own silos. They are not properly financed, except through a patchwork of safety net funding streams that don’t particularly work well. They have also been poorly-integrated with standard medical care.
OH, SO THE SAME PEOPLE IN CONGRESS TODAY THAT WERE IN CONGRESS IN THE 1990S NOW CARE----AND THE COMING ECONOMIC CRASH FROM THE MASSIVE BOND MARKET FRAUD IS NOT TAKING ALL GOVERNMENT REVENUE THAT WOULD BUILD THIS HEALTH STRUCTURE FOR THE WORKING CLASS AND POOR?
Let’s talk about individuals first. In what ways could Medicaid benefit people who are or are likely to get caught up in the criminal justice system?
Think about who is not eligible for Medicaid before health reform. A low-income male who is not a veteran or a custodial parent, or who doesn’t qualify for Ryan-White HIV/AIDS benefits. They may have a serious substance abuse problem, but that wouldn’t qualify them for federal disability benefits. They, with the expansion, can get access to Medicaid simply because they are poor.
The criminal justice population is quite varied, but there are a couple of key areas in which Medicaid expansion would be especially beneficial for them. With the expansion, Medicaid can now cover basic outpatient substance abuse treatment. This is true for both Medicaid and private insurance after health reform. And ACA provides these services in a way that is much more integrated with people’s regular medical care.
THIS IS COMPLETELY A PHARMA-BASED HEALTH POLICY AND MUCH OF THE PHARMA IS UNTESTED AND/OR SHOWS NO EFFICACY----
One basic challenge with drug and alcohol treatment is that these services are in a separate system that people don’t want to use, and don’t use. With the Medicaid expansion, you can go to a neighborhood clinic and they can help you get Methadone or Suboxone. They can also get you the psychiatric care you need within the same umbrella of your regular care. So it is much more likely that people will use it.
There’s very good evidence that alcohol and illicit drug treatment reduces criminal offending. [Editor note: Both this study and this study, obtained via follow-up email, show treament reduces violent and property crime enough to far pass a cost-benefit test.] Both It partly reduces criminal offending by reducing the need to commit property crimes to get the substances. It also reduces offending by allowing people to be more functional, and thus more likely to stay employed. Especially in the case of alcohol, people getting their substance abuse under control makes it less likely that they’ll be intoxicated, and thus less likely to commit crimes or be victims of crime.
What about those with mental illness?
When it comes to those with serious mental illness, we end up using local jails to try and manage them. It’s important that they can get access to help and mental health treatment outside of the criminal justice itself. It’s ironic that when someone with psychiatric disorders is inside the jail, they do have access to some of these services. But those services are often unavailable or totally disconnected when they leave the jail.
We don’t really know whether, or by how much, these services can be expected to reduce offending among this group. This remains a hypothesis that depends on how well we actually implement programs. Much will depend on how effectively we can implement Medicaid expansion.
How does this element of Medicaid deal with the traditional criticisms of the program?
Medicaid has many shortcomings. It doesn’t pay a market rate for important services. But for all of its faults, Medicaid recipients are grateful to have it. The satisfaction they have is quite high compared to traditional health insurance. Medicaid gives people access to the basic health care that they need to stay healthy and improve their lives. It is also genuinely designed for people who have no money, which is really important for these indigent populations. Medicaid is inferior to private insurance in terms of reimbursement to providers, but it’s better for really poor people than any private insurance I’ve seen, because it’s been road tested for a long time in meeting the needs of indigent people.
And as I mentioned, ACA is especially important, because the ACA includes very specific components in the area of mental health and substance use.
One thing I’ve noticed is that for all the talk about ending mandatory minimums, most of the real energy is about giving judges flexibility to ignore mandatory minimums. But that put a lot of pressure on keeping recidivism down, because judges, especially elected ones, won’t ignore long records.
Deincarceration requires the puzzle pieces to fit together to be sustainable and politically tenable. That requires that we deal with the real-life problems people face when they are released. It requires monitoring and people have access to services, both to improve their quality of life and to reduce the probabilities that they will reoffend.
If we just release people without support services, my fear is that it will not go well. Then it will ultimately generate political backlash. I’m very heartened that we are reducing the mandatory minimums, in particular for older offenders who tend to be less violent. It’s essential that we address the excessive sentencing. But we also have to do what we need to do to make this effective.
Even if judges can reduce sentencing, they are ultimately dependent on the available resources to help and monitor the people that come before them. And if judges don’t see those services, then they aren’t going to use their discretion to release many of these people as early as they might.
And if property crimes are being committed by people under criminal justice supervision, and they have a history of violent offending, then they are much more likely to be sent back with a pretty serious sanctions.
Tell me more about the second issue, how the ACA rationalizes the funding stream for these services.
We’ve had a messy system in the past, and we’ll ultimately rationalize it under Medicaid. Safety net providers for substance abuse and mental illness have always been paid for by a patchwork of public funding through obscure agencies and local governments. It has always been a huge challenge where access has been inadequate, with long waiting lines, and the services provided were often quite forbidding. Given this separate funding, it’s very difficult to integrate this in with people’s overall health care. When you have these silos of places to go, with one for mental health, another silo for substance abuse, and another for safety net health care, that person isn’t going to get the integrated care they really need. The ACA is trying to bring those things together.
Many of these issues will still be in play going forward, but it will be in the context of a coherent system that at-least addresses these issues within the context of broader health care.
_________________________
So, once we know the ACA was about creating global health system structures to compete in International Economic Zones around the world--then we know our US cities deemed International Economic Zones will be built to bring foreign health corporations to cities like Baltimore while global health corporations like Johns Hopkins operate in China, Malaysia, etc. This is what is indeed happening----in BAltimore we already see global health and research corporations in our Enterprise Zone development. Let's look at what Asian billionaire family is tied to the global online health care business creating the technology products for global health tourism.
Keep in mind----any US citizen could be that small or regional business owner manufacturing products and services like this----that is what BUILDING LOCAL, SMALL BUSINESS ECONOMIES IN BALTIMORE LOOKS LIKE----but making US cities International Economic Zones means all nations tied to Trans Pacific Trade Pact brought to the US can operate in Baltimore as they do overseas. Know what third world health care looks like when it is hyper-profit-driven?
So, here we have WEN-----our Baltimore Public Health Commissioner----who works as that global health liaison for her family and Hopkins and our public health department has nothing to do with PUBLIC HEALTH----this is why Baltimore is listed by international justice organizations as third world in public health outcomes.
Leana S. Wen, M.D., MSc., FAAEM
Health Commissioner, Baltimore City
*****************************
Absolutely no one has believed for decades China was communist---these leaders have been millionaires and billionaires for decades but they work hard to keep their citizens from knowing they are getting rich. This is 1% Wall Street Libertarian Marxism. We see the 2% to the 1% of global rich Wen family partnered with the Bloomberg School of Public Health when citizens of Baltimore and Maryland have no voice in what Maryland Assembly and Baltimore City Hall push for health policy for Wall Street Baltimore Development and a very, very, very neo-conservative global Johns Hopkins.
Our Dr Wen describes what China's health care looks like after several decades of global neo-liberalism in China's International Economic Zones---she understands best that Affordable Care Act is building the same health structures here in the US as were built overseas and only the most affluent access them.
CAN CHINA'S HEALTH CARE DISTOPIA BECOME OUR FUTURE? THAT'S WHAT THESE GLOBAL PARTNERSHIPS HAVE AS A GOAL.
'The report is damaging not only to Wen, but also to the Communist party'.
China has lashed out at a US newspaper report that premier Wen Jiabao's family has amassed vast wealth worth at least $2.7bn (£1.68bn), censoring the New York Times website and questioning the paper's motivations.
Many relatives of Wen Jiabao, including his son, daughter, younger brother and brother-in-law, have become extraordinarily wealthy during his leadership, an investigation by The New York Times shows. A review of corporate and regulatory records indicates that the prime minister’s relatives — some of whom, including his wife, have a knack for aggressive deal making — have controlled assets worth at least $2.7 billion.
Can China’s Health Care Dystopia Become Our Future?
02/06/2014 04:28 pm ET | Updated Apr 08, 2014
Leana Wen, M.D. Health Commissioner of Baltimore City; Emergency Physician
What does a health care dystopia look like?
In this TED video, you are introduced to a world where people die waiting for health care, where corporate interests reign, and where doctors get paid to do more rather than to the right thing.
I’m a Chinese-born, American-trained physician. A couple of years ago, I was given an opportunity to conduct a research project on China’s health care system. I traveled to 15 cities, from Beijing to Inner Mongolia, visited over 50 hospitals, and had unprecedented access to doctors, medical students, nurses, administrators, and government officials. Given how China’s developed into a major world power, I expected to find a fair, functional system.
However, instead of this utopia, I found a dystopic world. People spoke about the 1980s, when universal health care was dismantled and 900 million people lost coverage overnight. Everyone had a story of friends and family who died in front of hospitals because they couldn’t pay.
Doctors were unhappy too. Imagine you’re a doctor, and you trained all your life to listen and heal; suddenly, overnight, you’re a businessman and you have to work your patient to get every cent.
On the other hand, if you’re a well-off patient and you hear that poor people get denied services, what do you want for yourself? You want everything to be done. Because you have the money, nobody will tell you about the risk of radiation of a CT scan. Same for expensive but untested medications, or potentially dangerous procedures. People got what they wanted, but at what cost?
No doubt, China has been very successful. The government has lifted millions out of poverty. But there is a fundamental problem, a blind spot that’s been missed in the rush towards economic reform.
This blind spot is our belief that being a consumer enables choice, and that choice is power. I’m all for empowering people to have choices. But turning patients into consumers means that healthcare is a commodity, not a right. It becomes possible to deny life-saving treatment, and to sell unnecessary, even harmful, interventions. The doctor-patient relationship becomes a transaction between salesman and client.
That blind spot, and the consequences, are not unique to China. Here in the U.S., costs of health care are escalating out of control. While millions remain uninsured, 30 percent of all tests and treatments are done are unnecessary. It’s far more profitable to peddle drugs than prevent illnesses. According to the New England Journal of Medicine, 94 percent of doctors have some affiliation with drug and medical device companies.
By no means am I romanticizing the pre-1980s Communist state. My family left on political asylum, and I am very grateful for the opportunities afforded to me by my adopted country. But capitalism doesn’t have to equate consumerism, and the beauty of a democracy is that we as citizens can decide what type of society we want to live in.
CHINA HAS THESE FEW DECADES BEEN CALLED MORE NAKED CAPITALIST THAN THE US.
To prevent further problems in our country, and to stop the rest of the world from following us down this path, we have to make a difficult decision. We must decide if it’s important to us to preserve our core tenets of liberty, democracy, equity, and justice. If not, we know what the dystopic future will look like. If so, the time is now to decide that there are some things that are not for sale, and that we must realign incentives to help people be their best selves.
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Maryland has decades of history of being the only state in the nation to OPT-OUT of Medicare and was given an exemption to do so....which was always unconstitutional as Maryland citizens were denied the level of health care citizens in states across the nation were receiving. Maryland built this POOLED FUNDING model that is now that Federal funding in Affordable Care Act that sends all Medicare and Medicaid to these consolidated health systems----ACOs. Johns Hopkins literally built their global health system and MedStar from the use of POOLED HEALTH FUNDS that should have gone to Maryland citizens and of course Baltimore has the most Medicare/Medicaid citizens in the state. We have no oversight and accountability of our health institutions----and plenty of stats generated by outside sources saying this system created huge health outcome disparity. Health industry fraud and corruption built empires----as this Roosevelt Institution identifies our very, very, very, very neo-conservative Johns Hopkins as best in health policy----it is known throughout the health and academic industry as purely profit-driven to the detriment of the working class and poor---especially black citizens.
The Affordable CAre Act simply extends this unjust system to 80% of Americans soon to be 90%. Notice how this Roosevelt Institute article brings
TAMMANY HALL O'MALLEY---AS FAR-RIGHT WALL STREET GLOBAL CORPORATE NEO-LIBERAL/NEO-CON AS A PLAYER CAN GET----AND ACTS AS THOUGH BALTIMORE DOES A GOOD JOB ON HEALTH POLICY AND RACE.
These health data are true for all ages---and the public health outcomes are third world because all revenue sources for communities are redirected to Wall Street Baltimore Development and Johns Hopkins ----they create the worst public health. There is not a more profit-driven who cares about public health empire-building city then O'Malley's Baltimore and this article suggests O'Malley should be made Department of Health and Human Services leader----after Burwell. Keeping it global corporate tribunal aren't we Richard Kirsch
Baltimore Youths Have It Worse Than Those in Nigeria
A global survey of 15- to 19-year-olds living in vulnerable cities shows that social support and outlook are driving factors in health outcomes
'The researchers found many similarities—in all five cities, adolescents were exposed to unsanitary conditions, substance abuse and violence—but the differences between each area were especially compelling. Overall, teenagers in Baltimore and Johannesburg, despite being located in comparably wealthy countries, had far worse health outcomes and tended to perceive their communities more negatively'.
'Actually, the one candidate who makes a number of serious proposals to expand coverage, improve affordability, and focus on quality, community health, and racial equity is O’Malley. As the Governor of Maryland, which has a long and ongoing history of innovation in health care delivery, O’Malley is clearly steeped in the major changes occurring in health care and how to address them. He could be a good candidate for the next Secretary of Health and Human Services'.
So, this article promotes the most global, profit-driven, predatory health structure in the US as the model. Does anyone really believe this is a step towards any public system in the midst of privatizing all that is public? REALLY???
THE ROOSEVELT INSTITUTION IS FROM WHERE ALL THE PROGRESSIVE POSING POLICIES ORIGINATE WHILE IT IS HYPER-ONE WORLD GLOBAL CORPORATE TRIBUNAL.
Next New Deal: The Blog of the Roosevelt Institute
Beyond the ACA: Toward a Health Care System That Works for All of Us
Health CarePolitics
By Richard Kirsch | 02.01.16
The Democratic presidential debates have brought welcome attention to the question of how we can build on the Affordable Care Act to realize the goal of quality, affordable health care for all. It’s a refreshing and timely break from the Republicans’ tired pledges to repeal Obamacare, a radical right stance that is supported by every Republican candidate but only one out of three voters.
In many ways, the health debate between Clinton and Sanders is really less about health policy than about the entire conception of their campaigns: Clinton the pragmatic incrementalist and Sanders the bold visionary. But neither of the two candidates is focused on measures, incremental or bold, that move our health care system to focus on promoting good health, demanding that health care providers get paid for quality care, or reducing racial inequities in health care.
I’ve just written a paper, commissioned by the Universal Health Care Foundation of Connecticut, which is all about bold incrementalism. I lay out ambitious polices, building on the ACA and the current changes taking place in health care, aimed at getting to quality affordable health care for all and promoting good health, not just good health care.
I start with the pragmatic assumption that we will not be jumping from the Affordable Care Act to a fully publicly financed health care system. But even if America rallied behind Sanders’s political revolution and enacted Medicare for All—which I would welcome!—we would still need to refocus our health care system on providing high-value care and promoting health for all instead of the wasteful treatment focus of Medicare’s current fee-for-service model.
WAS FEE-FOR-SERVICE WASTEFUL OR FULL OF FRAUD, CORRUPTION, AND PROFITEERING WHICH CAN BE CORRECTED BY REBUILDING OVERSIGHT AND ACCOUNTABILITY IN OUR MEDICARE AND MEDICAID SYSTEMS?
Medicare for All, as Sanders proposes it, would solve the two most glaring problems that remain after the ACA: the 29 million people who remain uninsured and skyrocketing out-of-pocket costs. Clinton’s “plan”—no details, just intentions—barely mentions expanding coverage to the millions who remain uninsured, focusing instead on pledges (no actual proposals) to lower deductibles and drug prices.
Actually, the one candidate who makes a number of serious proposals to expand coverage, improve affordability, and focus on quality, community health, and racial equity is O’Malley. As the Governor of Maryland, which has a long and ongoing history of innovation in health care delivery, O’Malley is clearly steeped in the major changes occurring in health care and how to address them. He could be a good candidate for the next Secretary of Health and Human Services.
While the public debate focuses on coverage and affordability, there are seismic changes happening in how we organize the delivery of health care. The visible part of the transformation, the iceberg above the surface, is mega-health insurance and hospital mergers. Like other icebergs, they look scary: bigger corporations jacking up prices to increase profits while consumers have fewer and fewer choices. People who need health care the most—those with chronic illness and disabilities, the elderly—are also likely to be hurt the most.
Ironically, though, concentration could offer the opportunity for more effective and simplified regulation. Concentration could facilitate the treatment of health care as the public good it truly is, rather than as a market good. Regulatory policies to control costs and increase quality should be easier to design and enforce if there are fewer entities to oversee and influence.
The ACA is already illustrating how government payers can have a positive impact. It is accelerating the movement of the American health care system from a focus on providing more care—needed or not—to providing quality care. By using the purchasing power of Medicare, our national health insurance program for seniors and people with disabilities, the ACA has begun paying hospitals and doctors more when they reduce costs while increasing quality, and paying them less when they provide poor quality care. In some states, Medicaid is beginning to drive the transformation with a focus on primary care and community health.
CONCENTRATION AND CONSOLIDATION STATED ABOVE WAS THE SAME CLINTON NEO-LIBERAL ARGUMENT FOR BREAKING GLASS STEAGALL BANKING WALL TO CONSOLIDATE WALL STREET INTO GLOBAL WALL STREET DOING ANYTHING IT WANTS.
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Here is the same language from the Roosevelt Institution and it is indeed the same developing nation UNIVERSAL HEALTH CARE-----simply containing communicable disease, clinic care, and preventative care but no access to much of modern health care procedures and devices....................'Some countries use incremental measures to reach the goal of'
universal health care'.
ONE WORLD HEALTH CARE------COMING TO THE US WHICH ALREADY HAD SECOND WORLD HEALTH CARE.
News / Africa
Developing Countries Strive to Provide Universal Health Care
The Jacaranda Health Clinic in Nairobi provies child and maternal health services for the poor (A. Gichigi/Results for Development)
William EagleLast updated on: September 20, 2012 7:48 PM
A new study shows progress being made by nine developing countries in Asia and Africa in creating universal health care systems. They are Ghana, Rwanda, Nigeria, Mali, Kenya, India, Indonesia, the Philippines and Vietnam.
The study is part of a series of articles on health reforms published in the scientific journal The Lancet.
Statistics help tell the story. They show how far these countries have come in extending health care to ever-widening sections of society, including the poor.
According to the study (called “Moving Towards Universal Health Coverage: Health Reforms in Nine Developing Countries in Africa and Asia”) more than three-quarters of the populations of Rwanda and the Philippines are now enrolled in health insurance programs. About half are covered in Ghana, Vietnam and Indonesia.
Countries in the early stages of reform, like Mali, Kenya, India and Nigeria, cover less than 20 percent.
The nine countries have each reached a national consensus on the need to extend health care, but their approaches vary.
Improving Revenues
Gina Lagomarsino, a managing director at the Washington-based group Results for Development, said finding a stable source of funding is essential.
Some comes from donors, which often provide funding for specific programs to fight malaria, tuberculosis and HIV/AIDS. The report says donor contributions make up about half of all health care funding in Rwanda and about a third in Kenya, but much less in other countries.
The majority of the funding in most countries comes from state revenues.
In Kenya, taxes are deducted from the paychecks of civil servants and others in the formal, or taxable, sector. Nigeria funds its health coverage for pregnant women and children in part with general revenues made available from debt relief. Some countries, including Rwanda and the Philippines, ask households to pay monthly or annual insurance premiums.
Lagomarsino said Ghana, which has one of Africa’s most successful insurance programs, has a tax devoted solely to health care.
"In 2000," she explained, Ghana instituted a new value-added or sales tax which was earmarked for the National Health Insurance Scheme, and this has provided a pretty steady stream of revenues to [the effort]. It has allowed Ghana to develop a program that’s got very comprehensive benefits and offers coverage to the whole population."
"Not that everyone is enrolled yet and the program is far from perfect, but they have been able to significantly increase government revenues and at the same time lower the amount people are paying out of pocket."
Risk pools
Some countries use incremental measures to reach the goal of universal health care. One way is to create risk pools, or programs devoted to various groups.
The programs of some countries, such as Kenya and Nigeria, began by targeting civil servants and taxable wage earners. The two countries are now working to include women, children and the poor.
Lagomarsino said the goal in many countries is to eventually replace fragmented coverage with one large pool covering everyone.
"It allows for cross-subsidies across populations so wealthier people are paying into the same pool as poorer people," she said. "It’s easier to graduate the payments so that the contributions from the wealthy are used to help subsidize the poor. Similarly, the contributions from the healthier can subsidize those of the sicker. So bigger pools means it’s more efficient; everyone pays an average cost."
Private sector support
Many of the nine countries studied in Africa and Asia are also integrating the private sector into their plans to extend health care. Advocates say private service providers can improve choice and access to care.
"We have found that in the countries that we’ve examined in this study pretty much all of them have set up an independent purchasing agency that allows them to purchase care from providers rather than just handing a budget over to a ministry of health facility," said Lagomarsino.
"And in many of the countries, they have set up a mechanism for purchasing from private sector providers. It varies by country but for example they are doing this in Ghana [and] in Kenya. They also purchase from public providers."
Lagomarsino also said that systems combining public and private health care can prevent the development of a two-tiered system – one catering to the wealthy and the other to the poor. She said with the mixed system, subsidies can be used to extend coverage to the poor. But she notes that involving private providers can create some challenges for assuring quality and preventing fraud.
Controlling fraud
Lagomarsino said the systems that work best have strong leadership, including skilled civil servants and agencies to ensure that the system functions efficiently.
In the future, technology may help improve delivery and prevent fraud. Mobile phone networks, like Kenya’s successful M-pesa, could be used to pay insurance premiums.
Technology may also help prevent fraud.
"There’s been a lot of interest," she said, "in a system that’s been widely used across India that provides health coverage to the poor, and those people who are enrolled get a SMART card that has biometric data, such as their fingerprints, on it so when they go to receive services, it can be verified that they came and got the service. And then all of the claims are submitted electronically and paid electronically."
Lagomarsino said policymakers will benefit from studying these and other cases to design programs that best fit their own countries. She said it’s not just economics, but also culture and politics, that will determine how to provide health care to everyone at an affordable cost.
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This article above identifies China's move from a social public health system to one of profit and that came because of US International Economic Zone development in China. Global corporations like Hopkins were building their health systems throughout Asia and built these policies of health tourism as well. As we see health prices are rising and access is becoming tiered and geared towards the affluent. This is the health system the Affordable Care Act is building today in the US ----and global health tourism is central to Baltimore's health policy. As this article shows-----health costs will grow higher and higher as markets compete for the most affluent and ignore anyone not able to afford private health policies.
'It involves about 50 countries in all continents and several Asian countries are clearly in the lead. In Asia, medical tourism is highest in India, Singapore and Thailand. These three countries, which combined comprised about 90% of the medical tourism market share in Asia in 2008,1 have invested heavily in their health-care infrastructures to meet the increased demand for accredited medical care through first-class facilities'
The idea that nation's with such high poverty and extreme needs in public health have focused on building these hyper-for-profit structures comes from CLINTON/BUSH/OBAMA and it created these global foreign health corporations that are now being brought to our US cities with the goal of multi-national health systems taking our local health policies.
IF YOU WANT CHEAPER HEALTH CARE ----GO TO THAILAND FOR IT-----we are already hearing this in the US.
All these nations listed in this article are the ones having signed onto TRANS PACIFIC TRADE PACT and as such will be able to operate in the US as they do overseas.
Bulletin of the World Health Organization
The effects of medical tourism: Thailand’s experience
Anchana NaRanong a & Viroj NaRanong ba. School of Public Administration, National Institute of Development Administration, 118 Sereethai Road, Klong Chan, Bangkapi, Bangkok, 10240, Thailand.
b. Thailand Development Research Institute, Bangkok, Thailand.
Correspondence to Anchana NaRanong (e-mail: anchana@gmail.com).
(Submitted: 22 September 2009 – Revised version received: 14 February 2011 – Accepted: 15 February 2011 – Published online: 28 February 2011.)
Bulletin of the World Health Organization 2011;89:336-344. doi: 10.2471/BLT.09.072249
Introduction
Unlike general tourists needing medical attention, medical tourists are people who cross international borders for the exclusive purpose of obtaining medical services. Medical tourism has increased in part because of rising health-care costs in developed countries, cross-border medical training and widespread air travel. The medical tourism industry has been growing worldwide. It involves about 50 countries in all continents and several Asian countries are clearly in the lead. In Asia, medical tourism is highest in India, Singapore and Thailand. These three countries, which combined comprised about 90% of the medical tourism market share in Asia in 2008,1 have invested heavily in their health-care infrastructures to meet the increased demand for accredited medical care through first-class facilities.
In 2007, Thailand provided medical services for as many as 1.4 million foreign patients, including medical tourists, general tourists and foreigners working or living in Thailand or its neighbouring countries. If we assume that about 30% of all foreign patients that year were medical tourists – a conservative figure by comparison with the Boston Consulting Group’s estimate of 50% in 20064 – the total number would have been about 420 000. This was more than in Singapore, formerly reputed to be the leading Asian medical tourist destination and the “medical hub of Asia”.5
Although medical tourists are still a small fraction of the 1.5 million foreigners who receive medical care in Thailand, they are the tourist group most likely to affect the country in a major way. Unlike general tourists and expatriates, medical tourists are increasing at a rapid pace – from almost none to 450 000 a year in less than a decade. Moreover, medical tourists tend to seek more intensive and costly treatments than other foreign patients, as a result of which their effect on the country is more profound.
In this paper Thailand is used as a case study to examine the main effects of medical tourism on a country’s economy and health system. The final section of the paper discusses policy implications and provides some policy recommendations.
Methods
This paper focuses on medical tourism. However, singling out data for medical tourists is difficult because Thailand breaks their data down into Thais and foreigners but not into foreigners who are medical tourists and other foreigners seeking medical care. Another reason that these two groups are usually lumped together is that most foreign patients behave similarly when seeking health care, share similar views regarding patient’s rights, and have similar health-care needs. Once they fall ill and need health care, they tend to have similar demands and requirements. It must be borne in mind, however, that the fact that the data for all foreigners are lumped together makes the mean values obtained for the average medical tourist (e.g. in terms of physician time required) usually higher than the mean values obtained for the average foreign patient.
The study is divided into three parts. The first part estimates the effects of medical tourism on the Thai economy in terms of revenues from medical services and value added gained from the activities of patients and the companions travelling with them before and after medical treatment. In general, revenues from either medical services or tourist activities include the costs of services and materials, some of which, especially new drugs and advanced equipment, are imported. Hence, the domestic value added (the revenue left after subtracting the cost of imported materials) is a better indicator of the net economic benefit of medical tourism than total revenues. Theoretically, however, the value added figures presented here are overestimated, especially with health-care providers’ income included in the calculations. This is because without foreign patients, these providers would probably spend more time with Thai patients and some positive value added would still be generated (even if lower than the value added generated from serving foreign patients) along with improvements in health status and social welfare for Thai citizens.
The estimated effects of medical tourism were partly based on data furnished by Thailand’s Ministry of Commerce, with some modifications and extrapolations to fit various scenarios and assumptions that we considered more realistic.
The estimations and projections were made in two parts:
(i) revenue and value added from medical services provided to foreign patients, and (ii) revenue and value added from the activities of medical tourists and their travelling companions, including before and after the medical treatment.
The methods (with main scenarios and assumptions) used to make estimates and projections are as follows:
- The study estimates revenues and value added from medical tourism in 2008–2012 under high- and low-growth scenarios, as follows:
- High growth: The number of foreign patients grows at a yearly rate of 16%. The assumption was based on the average geometric growth rate of foreign patients in 2001–2007 (figures from the Ministry of Commerce), a period in which medical tourism in Thailand expanded rapidly.
- Low growth: The number of foreign patients grows at one half the average annual rate of 2.5% seen in 2005–2007 because of potential competition or changes in Thai government policies. This scenario rests on the assumption that the rate of growth of foreign patients will continue to fall to only half of the growth rate in 2005–2007, a period during which, according to the Ministry of Commerce, the rate was the lowest in 7 years.
- The average revenue per foreign patient in 2006 and 2007 was based on figures from the Department of Export Promotion of Thailand’s Ministry of Commerce. The revenues for 2008 and later were assumed to grow at 10% per year on average. This growth rate is slightly lower than the 16% average growth rate in medical service charges for high-end hospitals (figure obtained from interviews with hospital administrators) that resulted from the expected increase in competition in both domestic and international markets.
- The value added (including wages) of medical services was assumed to be 66.7% of the gross revenue, lower than the implied rate of 91–92% estimated for Singapore (Ministry of Trade and Industry of Singapore, The Health Care Services Working Group, n.d.). This is likely to be an overestimation since expensive medical equipment and medicines are being imported and Thai hospitals tend to charge lower medical service fees than their counterparts in Singapore. At the same time, the value added (including wages) should be greater than 50%, since labour costs for public hospitals account for approximately 50% or more of the total cost of health-care services6,7 and private hospitals, especially those attending medical tourists, should have higher labour costs than most public hospitals.
THAILAND IS KNOWN FOR BEING THE WORST OF SWEAT SHOP LABOR ----PEOPLE DO NOT GET PAID AND THIS IS WHY GLOBAL HEALTH TOURISM CORPORATIONS FLOCK THERE.
- The average revenue from hotels and tourism per foreign patient in the base year (2008) was estimated at 10% of total medical charges. This rather low figure reflects the fact that approximately 60% of all foreign patients reside in Thailand and another 10% are tourists that become sick while visiting the country. Only the remaining 30% of foreign patients are medical tourists who travel to Thailand explicitly to seek medical services and who generate extra revenue from hotel charges and tourism. For these patients, non-medical expenses, which would apply to the periods spent outside the hospital before and after treatment, were assumed to be 33.3% of their medical charges (including hospital room and meals).
- The average revenue from hotel and tourist charges for the individuals accompanying the medical tourist was assumed to be 15% of the total medical charges in 2008, other assumptions being that only three fourths of the patients would have one person accompanying them (information obtained from interviews with hospital administrators and medical tour companies) and that each travelling companion would spend twice as much on hotels and tourism as the patient. Medical tourists almost certainly spend less on hotels and tourism than the individuals accompanying them. However, these individuals are not likely to spend much more than the patients themselves, since they spend little time on their own when caring for the patients.
- Value added from tourism was assumed to be 50% of revenues (as suggested by Singapore’s estimates of 63.5–66.7%, but wages in Singapore are significantly higher than in Thailand) and to increase by 10% in 2008 (due to the high inflation rate that year) and by 6.7% per year in the following years.
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International Health justice organizations have shouted for over a decade that Trans Pacific Trade Pact will harm the world health structure that has allowed those global developing nation citizens having had access to basic health care for a century. It kills the ability to access vital PHARMA---kills funding for global communicable disease projects that have been REAL world health for people of color.....those same global people of color Roosevelt Institute says suffer under the middle-class access of Americans to their developed nation health care. CLINTON/BUSH/OBAMA has dismantled and destroyed much of this past century's world health history while doing the same in the US.
THERE IS NO PLAN FOR PUBLIC HEALTH FOR THE POOR------IT WILL BE HERE IN THE US WHAT THEY BUILD IN NIGERIA OR CAMBODIA-----AND WE ALREADY KNOW THOSE NATIONS ARE BUSY BUILDING GLOBAL NEO-LIBERAL HEALTH TOURISM.
50-Group Public Health Coalition Asks Congress To Oppose TPP
Posted: April 18, 2016
Dave Johnson Fellow, Campaign for America's Future
Saying they are “alarmed by the implications for access to medicines [created by] the Trans-Pacific Partnership (TPP)” a coalition of 50 groups concerned with public health sent a letter asking Congress to oppose the so-called “trade” agreement. The groups say that TPP provisions give giant, multinational pharmaceutical companies monopoly power as well as power to restrict decisions by sovereign governments.
The letter, dated April 12, begins:
“The intellectual property (IP), investment, and pharmaceutical and medical device reimbursement listing provisions included in the TPP would do more to undermine access to affordable medicines than any previous U.S. trade agreement. We therefore urge you to reject the TPP in its current form.”
Problems the coalition sees with TPP include:
● Procedures … that allow pharmaceutical companies to intervene in public policy deliberations on drug pricing and reimbursements.
● Measures that enable patent “evergreening” by requiring countries to grant additional 20-year patents for new uses, new methods or new processes of using existing medicines.
● Extension of patent terms beyond 20 years when the patent office review exceeds a certain period, and when patent holders allege delays in drug regulatory review of a medicine’s safety and efficacy in order to grant marketing approval.
● Rules requiring data/marketing exclusivity of at least five years for small molecule medicines plus at least three years of additional exclusivity for modifications of existing medicines or five years for combinations.
● For the first time in a U.S. trade agreement, there is a separate provision for monopoly protection for biologic medicines – such as monoclonal anti-bodies that are rapidly becoming the treatments of choice for many cancers and other illnesses.
● Provisions enabling pharmaceutical companies to sue the U.S. or other governments in unaccountable investor-state tribunals to seek taxpayer compensation by claiming that public policies have deprived them of their anticipated profits.
The letter says, “These TPP provisions significantly skew that balance away from consumer access to medicines by unduly expanding pharmaceutical industry monopoly power.”
The letter concludes, “We urge Congress to reject the TPP as long as these damaging provisions are a part of it. The stakes for public health are too high.”
The letter was signed by:
ACRIA Center on HIV & Aging
Act Up Boston
Adrian Dominican Sisters, Portfolio Advisory Board
African Services Committee
AIDS Alabama
AIDS Healthcare Foundation
Alliance for a Just Society
Alliance for Retired Americans
American Medical Student Association
Article 25
AVAC- Global Advocacy for HIV Prevention
Breast Cancer Action
Cancer Families for Affordable Medicine
Center for Policy Analysis on Trade and Health (CPATH)
Communications Workers of America (CWA)
Community Organizations in Action
Connecticut Citizen Action Group
CREDO Action
DC Fights Back
Dominican Sisters of Hope
Global Justice Institute of Metropolitan Community Churches
Health Alliance International
Health Global Access Project (GAP)
Hepatitis Education Project
Hesperian Health Guides
HIV Prevention Justice Alliance
Icahn School of Medicine at Mount Sinai
Indian People’s Action
Initiative for Medicines, Access & Knowledge (I-MAK)
Interfaith Center on Corporate Responsibility, Domestic and Global Health Leadership Teams
Main Street Alliance
Maryknoll Office for Global Concerns
Médecins Sans Frontières/Doctors Without Borders USA
National Nurses United
National Physicians Alliance
NETWORK, A National Catholic Social Justice Lobby
Northwest Coalition for Responsible Investment
Other98
Oxfam America
People’s Health Movement USA
Physicians for a National Health Program
Physicians for Social Responsibility
Project Inform
Public Citizen
RESULTS
Social Security Works
Student Global AIDS Campaign
Sum Of Us
Treatment Action Group
United Church of Christ, Justice and Witness Ministries
Universities Allied for Essential Medicines
Ursuline Sisters of Tildonk, U.S. Province
US Action
Virginia Organizing
Voices of Community Activists & Leaders (VOCAL-NY)
Washington Community Action Network
Yale Global Health Justice Partnership
Young Professionals Chronic Disease Network
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'Rather than sounding an alarm or considering the possibility that epochal economic decline is underway which threatens the health of the public',
The same is true with Roosevelt Institute as it simply MOVES FORWARD with the neo-liberal global corporate tribunal and US cities as International Economic Zone policies PRETENDING these global entities would really do anything socially progressive once installed in the US.
.Health systems, neoliberalism, and the end of growth: The World Health Organization in denial
by Dan Bednarz, originally published by Health after Oil | Feb 18, 2014
The WHO (World Health Organization) has released its latest in a series of reports[i] on public health in 53 European nations, and presents this assessment through a focus on the social determinants of health[ii]. Rather than sounding an alarm or considering the possibility that epochal economic decline is underway which threatens the health of the public, it serves up tepid criticism of government policies that have resulted in surging poverty[iii] and high unemployment[iv], fiscal cuts to health and other social services, increases in suicide and a host of other declining health indicators deforming people’s lives in most –possibly all- of the countries examined. Put directly, the social determinants of health are being laid to waste in several European states and endangered in others, yet the report casts this as a few dark shadows on an otherwise bright picture.
I find the report psychologically dissociative, ethically compromised, and in an intellectual malaise.
Sociologically, however, it makes sense:
it is self-destructive to analyze or challenge[v] the political/economic system that funds your work, even if it is destroying what your organization was founded to analyze, protect and ensure. As such, this report represents a conflict-ridden and unstable posture of ignorance and subservience to political power.
Revealingly, the report takes virtually no notice of the portents of socioeconomic and political[vi],[vii]upheaval[viii] –like UKip and Golden Dawn- spreading through Europe.[ix],[x] Naïvely[xi], the report calls for slight reforms –like giving health ministers a “seat at the table” of austerity[xii] budgeting to make the case for “proportionate to need” funding cuts[xiii]- as sufficient to ensure, maintain or in some conceded instances restore a portion of the underlying fundamentals of the health of European populations now being sacrificed in the name of balancing budgets and debt repayment. The authors give every indication of having no inkling that their flaccid calls for a realization that too much austerity endangers the public’s health is too little too late and, in any case, will have zero influence on neoliberal policymakers.
Politically, then, this WHO[xiv] report offers no recognition, let alone opposition, to the class-based austerity imposed by neoliberal governments[xv]. Accordingly, this report personifies developing turmoil[xvi] in organizational mission and collective identity for health professions as the divergence between the imposition of neoliberal austerity measures and the mission of public health deepens. This compromised stance, of offering mild warnings about austerity while accepting it as a legitimate policy response, is part of a cultural phenomenon of an inability to democratically address genuine problems while offering rhetoric to reassure and soothe a public that is losing economic ground and its faith in government.[xvii]
Therefore, I suggest that the report illustrates the futility of relying upon the WHO to comprehend what is occurring, let alone to lead in protecting public health. This is important because the WHO is not just another think tank or academic institute; it is the appointed champion[xviii] of world health issues. If it will not speak truth to power[xix] for the European public –which means unequivocally rejecting austerity policies and growing inequalities in income and wealth as destructive of the social determinants of health- at this critical moment, there is no reason to expect it to do so as neoliberal governments continue to cannibalize their citizens to maintain a world politically ruled by a numerically tiny financial elite[xx].
Rather than dissect the report in detail, I want to use it as a springboard to talk to those in the health sciences, especially young professionals and those close to retiring[xxi], who will read it and other such reports and conclude, “This just doesn’t fit my sense of what’s going on in Europe, my workplace, or the world, for that matter.” They will be searching for explanations containing a ring of experiential truth. They also may feel, “If the WHO is incapable of defending the social determinants of health, who will do so as conditions continue to worsen? And, how can I contribute to much needed changes?”
My comments will be unsettling to most health professions readers, but I believe that they contain a kernel of truth to explain the economic decline, which I maintain is caused by class politics and reaching the limits to economic growth.
Before presenting why health systems will continue to be bludgeoned by economic contraction, there is the intricate matter of the question of sustaining oneself while trying to contribute to the greater good. To work in medicine, public health, nursing or a related health profession means your daily bread comes from a large complex system. (And in the United States it’s even worse because most health professional work for profit-driven intensely thought-regimenting corporations.) Raising ones voice in a bureaucratic workplace to address fundamental problems of mission and strategy runs the risk of being expelled or punished by your administrative superiors.
The classic questions of those who recognize organizational decline or malfunctioning are:
Do I stay and raise my voice? Or do I leave and work for change from the outside (possibly starting my own organization?). Or, do I remain loyal? (This should not imply merely shutting up and can involve ingenious ways of sotto voce bending or subverting policies to introduce ground-level change to avert catastrophe).[xxii] So individual responses will vary with time and context and no one should be embarrassed to say, “I’m staying because I need this job and will work for change from within.”
A further note on this:
As late as the hour is, the probabilities of rationally convincing the WHO and other health leadership to challenge neoliberalism –or recognize the ecological/thermodynamic issues I will raise below- are virtually nonexistent. Nevertheless, it does not follow that it is futile to remain inside health systems articulating –as best we can for no one knows precisely what is coming- the need for vast change. The fact that the status quo of health leadership is ignorant yet powerful is a dangerous combination.
They are virtually cybernetically designed to “go down with the ship” and can be expected to make a series of rote and arrantly wrongheaded and damaging decisions as the crises in the larger society and health systems deepen. Suffice it to say that voices -or loyalists- on the inside with an ability to articulate what is happening MAY find opportunities in this volatile context to affect the course of their organizations[xxiii]. This is particularly true as the legitimacy and power of administrative leadership dwindles, which it will.
On the other hand, health professionals in austerity-eviscerated nations like Greece[xxiv], Spain, Italy, Latvia, Ireland and Portugal may find my thoughts tame, trite or passé, given the devil’s choices and steadily degrading circumstances in which they are being forced to do their work. They are past the stage of anticipating decline and need no convincing that their governments are less concerned about the health of citizens than the pocketbooks of bankers–they are deeply experiencing these realities. They are likely to provide the world with models and ideas[xxv] for how to protect the health of the public in an era of thermodynamically and ecologically induced degrowth coping –for now- with the added burden of their governments working to save the rich by plundering the rest of society.
I suggest that one major lesson of Greece, et al. for a health professional is that neoliberalism’s priorities and abandonment of citizens are on display in these nations.
After confronting the class-based nature of public policy, I ask them to rethink their taken-for-granted understanding of how health systems are sustained[xxvi]. For many this combination of requests will be much like the disorientation that occurs when viewing the world through inverted glasses[xxvii].
So what do health professionals who intuitively grasp that something is fundamentally amiss need to know?
First, they should examine the larger systems –or cultural- context that supports the delivery of health care and public health. By this I mean that the institutions upon which health systems rely for social, political and economic support are themselves caught up in a multi-layered set of ticking-clock crises, dilemmas and problems[xxviii] that spans the political/economic/financial, the ecological/thermodynamic, and the psychological/cultural/social dimensions.
To reiterate, these master institutions[xxix] as presently designed cannot respond to this set of crises in an egalitarian manner because 1) they are organized in terms of serving a) economic growth that benefits b) class-based interests; 2) they are unaware of the unfolding dynamics of ecological/thermodynamic realities bringing economic growth to a halt and 3) anthropologically, institutions in crisis automatically operate to repeat mistakes –as the only way forward- while not perceiving or merely dismissing as absurd information pointing to the necessity of taking radically alternative courses of action.
In sum, health professionals must see that austerity is a chosen policy stance of neoliberal governments serving narrow economic elite interests, not an unfortunate oversight or misguided mistake of politicians acting for the common good. Again, I stress that this will be extremely difficult and threatening for health professionals to perceive and act upon.
In tandem with this they need to understand that resource scarcity –especially the end of cheap energy[xxx]- and a host of ecological crises are coupled to –and worsened by- the inherent social, political, fiscal, and economic invidiousness of neoliberalism. This amounts to more and more of the 99% being sacrificed to preserve and further enrich the 1%. Simultaneously, the actual size of the economic pie is contracting. What is occurring in Europe, the United States and other nations is, therefore, a class-based upward redistribution of the income and wealth produced by a dwindling flow of natural capital.
These realizations require a giant leap of consciousness and will almost assuredly be accompanied by a crisis in collective and personal identity as institutions begin to fail, and possibly collapse. Preserving the social determinants of health in these dire circumstances goes beyond restoring or even increasing –which simply will not happen- funding for health services to involve building a society that shrinks energy-consumptive institutions, respects and comprehends the power of nature and, as a necessity, eliminates deeply embedded socially parasitic patterns of wealth accumulation and economic exploitation.
I am not much for prognostication, yet it appears clear to me that fissures will expand and rupture in the health professions as –probably slowly and then in a torrent- awareness spreads that the WHO and other “official” protectors of health are incapable of recognizing or responding to the crises touched upon above. This crisis of health systems, of course, will not happen in a cultural vacuum, as the master economic, financial and political institutions that health professionals take for granted also enter extreme crisis due to energy scarcities and the financial and economic chaos this will create.
Offering specific goals or detailed policy agendas beyond those cited above -shrinking energy-consumptive institutions, respect and comprehend the power of nature and eliminating deeply embedded socially parasitic patterns of wealth accumulation and economic exploitation- is, paradoxically, not likely to succeed at this moment. First comes an awakening, brought on by crisis, to the class-based nature of public policy and the thermodynamic impossibly of perpetuating economic growth[xxxi].
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