This forum is designed for candidates to address the 1% and their 2% global health corporations---not WE THE PEOPLE.
Clinton vs. Trump: The Future of U.S. Health Care
In the 2016 presidential election between Hillary Clinton and Donald Trump, health care has received scant attention. Yet it remains among the most urgent issues facing Americans. Insurance premiums continue their upward march, out-of-pocket costs are soaring, health insurance exchanges keep losing major insurers and every month seems to bring a fresh wave of outrage over skyrocketing prescription drug prices. What policies might address these problems, and how do the candidates’ health platforms differ? While the Democratic candidate has spelled out in great detail her health care platform, the Republican nominee has vowed to repeal Obamacare, yet has provided few policy specifics. This webinar will give an overview of each candidates’ healthcare prescriptions, forecast post-election scenarios and provide reporters with crucial context for covering one of the election’s most important, but overlooked issues.
WHEN: October 28, from 10-11 a.m. PT / 1-2 p.m. ET
TO REGISTER: Click here
Our distinguished panel includes:
Sara Collins, Ph.D., is vice president of the health care coverage and access program at the Commonwealth Fund. An economist, Collins joined Commonwealth in 2002 and has led the organization’s national program on health insurance since 2005. Collins has led several national surveys on health insurance and authored numerous reports, issue briefs and journal articles on health insurance coverage and policy. She has also provided invited testimony before several Congressional committees and subcommittees. Prior to joining Commonwealth, Collins was associate director and senior research associate at the New York Academy of Medicine, Division of Health and Science Policy. Earlier in her career, she was an associate editor at U.S. News & World Report, a senior economist at Health Economics Research, and a senior health policy analyst in the New York City Office of the Public Advocate. She holds an A.B. in economics from Washington University and a Ph.D. in economics from George Washington University.
Diana Furchtgott-Roth is a senior fellow at the Manhattan Institute, director of MI's Economics21 program, and a columnist for MarketWatch.com and Tax Notes. Furchtgott-Roth also currently serves as a volunteer adviser to Donald J. Trump's 2016 presidential campaign. During 2003–05, she was chief economist of the U.S. Department of Labor. In 2001–02, Furchtgott-Roth was chief of staff of President George W. Bush’s Council of Economic Advisers. During 1991–93, she was deputy executive director of the White House Domestic Policy Council and associate director of the Office of Policy Planning under President George H. W. Bush. Furchtgott-Roth was an economist on the staff of President Reagan’s Council of Economic Advisers in 1986–87. As an author, her titles include “Women’s Figures: An Illustrated Guide to the Economic Progress of Women in America” (2012); “Regulating to Disaster: How Green Jobs Policies Are Damaging America’s Economy” (2012); and “How Obama’s Gender Policies Undermine America (2010).” She co-coauthored “Disinherited: How Washington Is Betraying America's Young” (2015) with Jared Meyer.
Jennifer Haberkorn is a senior health care reporter for Politico and Politico Pro. She’s covered the Affordable Care Act since it was being debated in Congress in 2009. Since then, she has written about the law from Capitol Hill, the federal agencies, the courts and outside the Beltway. Before arriving at Politico, Haberkorn covered Congress and local business news for The Washington Times. A former fellow and current senior fellow for the USC Annenberg Health Journalism Fellowships, her work has also appeared in Health Affairs and The New Republic. Haberkorn is a graduate of Marquette University, where she majored in journalism and served as editor of The Marquette Tribune.
Webinars are free and made possible by the National Institute for Health Care Management Foundation.
1% Wall Street Clinton neo-liberals sold Affordable Care Act as a step towards single payer because in Republican think tanks these for-profit health corporations and insurance will lead Americans to a SINGLE-PAYER GUTTED OF FUNDING MEDICAID FOR ALL----NOT MEDICARE FOR ALL.
Annenberg Foundation and National Institutes of Health are filled with global health corporation leadership MOVING FORWARD ONE WORLD ONE GOVERNANCE GLOBAL HEALTH CARE----they are not looking to bring back our first world----developed nation, quality health care where everyone has access to ordinary health care----they are installing the same model in the US as they are in Asian or Latin American developing nations tied to Trans Pacific Trade Pact. So, US health care policy will look like Cambodian, Vietnam, Chinese, Singapore health care.
WE THE PEOPLE must remember when we allow both major political parties to be controlled by 1% Wall Street global pols----all these national organizations and our media will be filled with leadership WORKING FOR THE GLOBAL 1% AND THEIR 2%----
TRUMP AND REAL CONSERVATIVE REPUBLICANS ARE RIGHT---WE NEED TO DUMP THE AFFORDABLE CARE ACT COMPLETELY---GET RID OF CONSOLIDATED, DEREGULATED, CORPORATE HEALTH POLICY WRITING----GET RID OF PRIVATE STATE HEALTH SYSTEMS, MANDATED INSURANCE COVERAGE, MASSIVE COMPUTER TECHNOLOGY BUILD-UP--- This was Bernie Sander's left-leaning social Democratic stance.
Because our Federal Medicare program already had all of that----WE ALREADY HAD ALL THE INFRASTRUCTURE WE NEEDED-----we simply needed to stop the health industry fraud and profiteering.
Lower out-of-pocket costs
New Federal funding
Trump says repeal and replace to do these same things.
Forcing people to buy health insurance at the same time making health care global corporate predatory and profit-driven deregulated and without any of the patient protections in place IS BAD AND CONTROVERSIAL. It has nothing to do with creating conditions of access to quality care. An insurance mandate based on private state health insurance is the opposite of our Federal Medicare program and does not lead to EXPANDED AND IMPROVED MEDICARE FOR ALL.
'When campaigning against then-Senator Hillary Clinton (D-N.Y.) for the Democratic presidential nomination in 2008, Obama argued against an individual health insurance mandate'.
Obama: Forcing People to Buy Health Insurance ‘Should Not Be Controversial’
By Nicholas Ballasy | August 15, 2011 | 3:33 PM EDT
(CNSNews.com) – On his bus tour, President Barack Obama said the federal health care law’s individual mandate, which requires every American to purchase health insurance, “should not be controversial.”
To date, 26 states have sued the federal government, arguing that the individual mandate is unconstitutional because the U.S. Constitution does not grant Congress the power to require Americans to purchase a good or service.
“Here’s the problem – if an insurance company has to take you, has to insure you, even if you’re sick but you don’t have an individual mandate, then what would everybody do? They would wait until they get sick and then you’d buy health insurance, right?” Obama told an audience at the first stop of his bus tour in Cannon Falls, Minnesota on Monday.
“The basic theory is, look, everybody here at some point or another is going to need medical care and you can’t be a free rider on everybody else. You can’t not have health insurance then go to the emergency room and each of us, who have done the responsible thing and have health insurance, suddenly we have to pay the premiums for you. That’s not fair.”
Obama continued, “So if you can afford it, you should get health insurance just like you get car insurance. This should not be controversial but it has become controversial partly because of people’s view that
The Affordable Care Act policies were so popular 1% Wall Street global corporate pols had to include PENALTIES FOR NOT SIGNING UP-----and we will call that popular public support.
The Affordable CAre Act is doing just what Republican think tanks wanted when they wrote these policies----getting people needing care to be able to afford only the most basic of preventative care using deductibles and co-pays and a Hillary or any other 1% Wall Street player is not going to change this----
Lower out-of-pocket costs
New Federal funding
Trump says repeal and replace to do these same things.
The 1% Wall Street players are saying-----hurrah everyone is becoming insured knowing full well people are getting soaked with premiums and deductibles and receiving less and less care.
Lower out-of-pocket means------people cannot afford the deductibles and co-pays so they are not going for health care services----they are being forced to do without and this is seen as a health care cost savings. Remember, the problem was health industry profiteering and fraud----not patient overuse of health care. Bill Clinton defunded and dismantled public hospitals and public clinics---that sent people to hospital Emergency Rooms. Clinton allowed hospital ERs to be outsourced to private specialty services and ER rates soared. This is why US health care costs soared---NOT FROM OVER-USE BY CITIZENS.
CLINTON/BUSH/OBAMA SAY----MAKE HEALTH INSURANCE PLANS TOO EXPENSIVE FOR PEOPLE NEEDING TO ACCESS CARE----AND CALL THIS LOWERING OUT OF POCKET COSTS.
“Here’s the problem – if an insurance company has to take you, has to insure you, even if you’re sick but you don’t have an individual mandate, then what would everybody do'?
Americans Have Insurance but Can’t Afford to Use It
By Beth Braverman
March 12, 2015
Although more Americans have health insurance coverage, 25 percent of non-elderly Americans don’t have enough liquid assets to cover the deductible on their health insurance plan, according to a new report from the Kaiser Family Foundation.
The report finds that many consumers don’t have the cash on hand to cover the cost of a mid-range deductible or $1,200 for an individual or $2,400 per family. High deductible health plans require that consumers cover their health care costs out of pocket until they’ve met their deductible.
Related: High Deductible Plans Have People Delaying Treatment
The goal of such plans is to keep costs down by encouraging consumers to consider the costs and benefits of health care before purchasing it. “It’s really up to the consumer with these plans to comparison shop and look for cost savings when making medical decisions,’ says Kevin Coleman of HealthPocket.com.
For consumers, that means negotiating for any non-emergency services and evaluating medical bills for potential errors. “The big challenge is when it’s about you or someone you love, you lack objectivity, which means you lack leverage,” says Sarah O’Leary, CEO of patient advocacy company Exhale Health.
High-deductible plans, especially those paired with a funded health savings account may be a good alternative for those that are healthy or have the financial means to cover the costs of a medical emergency. However, the KFF report finds that as deductibles creep beyond the scope of savings, consumers are likely to either put off care or rack up medical debt.
A Gallup poll released last December found that one in three Americans have put off treatment for themselves or a family member because of cost—the highest rate in the history of the poll. There may be good reason: A separate report released also released in December by the Consumer Financial Protection Bureau found that about half of all debt that goes to collections agencies represents medical bills.
Such statistics suggest that while Obamacare has succeeded in expanding access to health insurance to most Americans, the law has much more work to do when it comes to the goal of making care affordable for everyday consumers.
Increasingly, consumers are turning to high deductible plans not because they’re the best option for their family, but because those are the plans with affordable premiums or the only type of plan offered by their employer. (Nearly one in five employers offers only a high-deductible plan to workers.) “High deductibles are going to continue to be a problem [for some consumers] until we can get costs under control or figure out how to get people to save more money,” says Barbara Gniewek, principal with PwC’s Human Resource Services practice.
An incredible hundreds of billions of dollars was sent to install the global health corporation system of global tourism/telemedicine technology infrastructure. None of this was about making health care more efficient---it was about building that global health system -----creating the tiered health access where the global 1% and their 2% get the health care all Americans USED TO GET AND PRE-PAID TO RECEIVE-----and placing the global 99% on telemedicine and global health tourism----
YOU WANT LOWER HEALTH COSTS SAY GLOBAL 1% WALL STREET---TRAVEL TO MEXICO OR THAILAND.
So, yes Hillary will send more Federal funding to build these global health systems------and none of it will have to do with quality care and all of it will have to do with Americans finding it more and more impossible to get the kind of health care they need LOCALLY. If they make it too hard to access----travelling outside city, state, and even nation---then people will SPEND LESS ON HEALTH CARE ESPECIALLY THE SICKEST.
Lower out-of-pocket costs
New Federal funding
Trump says repeal and replace to do these same things.
This was the Clintons goal in the 1990s----and it would be a Hillary push if allowed to office. Bernie Sander's health policies keep our US standards of care by EXPANDING AND IMPROVING MEDICARE FOR ALL.
HERE WE SEE THE COMMONWEALTH FUND SAYING THIS WILL BRING QUALITY AFFORDABLE CARE
“The Affordable Care Act gives us the opportunity to build a healthcare system that delivers affordable, high-quality care to all Americans,” said Commonwealth Fund President Karen Davis'.
Technology helps drive high cost of U.S. healthcare
By Bernie Monegain
May 03, 2012
Higher prices and greater use of technology appear to be the main factors driving the high rates of U.S. spending on healthcare, rather than greater use of physician and hospital services, according to a new study from the Commonwealth Fund. The study found the U.S. spends more on healthcare than 12 other industrialized countries, yet does not provide “notably superior” care.
The U.S. spent nearly $8,000 per person in 2009 on healthcare services, while other countries in the study spent between one-third (Japan and New Zealand) and two-thirds (Norway and Switzerland) as much. While the U.S. performs well on breast and colorectal cancer survival rates, it has among the highest rates of potentially preventable deaths from asthma and amputations due to diabetes, and rates that are no better than average for in-hospital deaths from heart attack and stroke.
The report, “Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality,” presents analysis of prices and healthcare spending in 13 industrialized countries.
U.S. healthcare spending amounted to more than 17 percent of gross domestic product (GDP) in 2009, compared with 12 percent or less in other study countries. Japan’s spending, which was the lowest, amounted to less than 9 percent of GDP, according to study author David Squires, senior research associate at The Commonwealth Fund.
All of the countries in the study, except for the U.S., provide universal healthcare, and all struggle with rising health costs. The level of healthcare spending in the U.S., however, stands apart. If the U.S. were to spend the same share of its GDP on healthcare as the Netherlands – the country spending the next-largest share of GDP – the savings would have been $750 billion in 2009.
U.S. hospital stays ‘far more’ expensive
High U.S. spending on healthcare does not seem to be explained by either greater supply or higher utilization of healthcare services. There were 2.4 physicians per 100,000 population in the U.S. in 2009, fewer than in all the countries in the study except Japan.
The U.S. also had the fewest doctor consultations (3.9 per capita) of any country except Sweden. Relative to the other countries in the study, the U.S also had few hospital beds, short lengths of stay for acute care, and few hospital discharges per 1,000 population. On the other hand, U.S. hospital stays were far more expensive than those in other countries – more than $18,000 per discharge. By comparison, the cost per discharge in Canada was about $13,000, while in Sweden, Australia, New Zealand, France and Germany, it was less than $10,000.
“It is a common assumption that Americans get more healthcare services than people in other countries, but in fact we do not go to the doctor or the hospital as often,” said Squires. “The higher prices we pay for healthcare and perhaps our greater use of expensive technology are the more likely explanations for high health spending in the U.S. Unfortunately, we do not seem to get better quality for this higher spending.”
Prices for the 30 most commonly used prescription drugs were a third higher in the U.S. compared to Canada and Germany, and more than double the amount paid for the same drugs in Australia, France, the Netherlands, New Zealand, and the United Kingdom. Magnetic imaging (MRI) and computed tomography (CT) scans were also more expensive in the U.S., and American physicians received the highest fees for primary care office visits and hip replacements.
Healthcare in the U.S. also seems to involve greater use of expensive technology than in many other countries. The U.S. performed the most MRI and CT exams among countries for which data were available (Japan had the most MRI and CT scanners, but no data was available on the number of exams performed there). Knee replacements were also performed more often in the U.S. than any country except Germany – though hip replacements were not as common as in most of the other study countries.
High spending in the U.S. might be explained, in part, by the nation’s high rates of obesity and the associated medical costs. However, at the same time, the U.S. also has a very young population and few smokers relative to the other study countries – factors that could offset higher spending linked to obesity, the report notes.
Quality varies widely in U.S.
High spending in the United States does not always translate into high-quality care. According to the report, the U.S. had the highest survival rates in the study for breast cancer, as well as the best survival rates, along with Norway, for colorectal cancer. However, cervical cancer survival rates in the U.S. were worse than average and well below those of Norway.
Compared to other countries in the study, the U.S. had high rates of asthma-related deaths among people ages 5 to 39 and, along with Germany, very high rates of amputations resulting from diabetes. U.S. rates of in-hospital deaths after heart attack and stroke were average.
Japan offers an interesting model for controlling costs, Squires says. Although its healthcare system shares certain features with the U.S., Japan is the lowest-spending nation of the group ($2,878 per capita in 2008). Japan operates a fee-for-service system, while offering unrestricted access to specialists and hospitals and a large supply of MRI and CT scanners.
Rather than containing costs by restricting access, Japan instead sets healthcare prices to keep total health spending within a budget allotted by the government.
In the U.S., individual payers negotiate prices with healthcare providers, a system that leads to complexity – and varying prices for the same goods and services, according to the report.
“The Affordable Care Act gives us the opportunity to build a healthcare system that delivers affordable, high-quality care to all Americans,” said Commonwealth Fund President Karen Davis.
“To achieve that goal, the United States must use all of the tools provided by the law – including new methods of organizing, delivering, and paying for healthcare that will help to slow the growth of healthcare costs, while improving quality.”
As we read this article we see lots of good comments and imbedded in all those comments are these two issues central to the global health system being built under AFFORDABLE CARE ACT----- hospital stays and set budgets given health systems-----------
'U.S. hospital stays were far more expensive than those in other countries – more than $18,000 per discharge'. 'Rather than containing costs by restricting access, Japan instead sets healthcare prices to keep total health spending within a budget allotted by the government'.
US citizens last century had all the access to care---all the faith in doctors and hospitals----a Medicare structure that ran smooth and effectively----WE ALREADY HAVE THE RIGHT STRUCTURE as the Commonwealth Funds says we need to bring all the tools to fix health care costs. Remember, the health industry fraud and profiteering is the cause for high prices and low quality. We see profiteering soaring now----and with more monopolies it will be far worse. Dismantling all public oversight and accountability as happens when corporations go global ----lowers our ability to create quality care conditions. Lowering employee wages and qualification standards while saying we are creating quality care----is lying....these things create maximized profits for health industry as is the goal of HILLARY/CLINTON/BUSH/OBAMA.
Guess what? Global Wall Street built this Japanese health model----that is why it is given as a model---just as with global corporate neo-liberal education saying Asian models are good----global 1% Wall Street built that Asian neo-liberal education model. What works best is our US health care model copied around the global and is that universal care. Japan has one of the most hyper-global corporate neo-liberal economy and its health care model totally private and profit-making is NOT THE MODEL WE THE PEOPLE WANT----IT IS THE MODEL A GLOBAL WALL STREET PUSHED ON JAPAN.
Working to death in Japan: health warning over 'no overtime' law
AFPMay 24, 2015
A businessman is seen napping on a bench at a Tokyo train station (AFP Photo/Yoshikazu Tsuno)
Tokyo (AFP) - Japan's push to take away overtime from high-paid workers has critics warning it will aggravate a problem synonymous with the country's notoriously long working hours -- karoshi, or death from overwork.
Teruyuki Yamashita knows the risks all too well. The now 53-year-old worked day and night in a senior sales job, made countless overseas business trips, and slept an average of just three hours a night.
Six years ago, his frantic work pace took a near fatal turn after he collapsed from a subarachnoid haemorrhage, a type of brain bleeding, leading to three weeks in intensive care -- and the loss of his sight.
"I told a nurse that it was dark -- I didn't realise that I was blind," Yamashita said, recalling when he woke up in hospital.
Hundreds of deaths related to overwork -- from strokes, heart attacks and suicide -- are reported every year in Japan, along with a host of serious health problems, sparking lawsuits and calls to tackle the problem.
But, last month, Prime Minister Shinzo Abe's cabinet approved a bill to exempt white-collar employees earning over 10.75 million yen ($88,000) a year, such as financial dealers and consultants, from work-hour rules.
His ruling Liberal Democratic Party hopes to get parliamentary approval during the current session.
Advocates, including Japan's biggest business lobby Keidanren, say the changes would reward productive workers with pay based on merit -- rather than just working hours -- and give them more flexibility in terms of how long they spend at the office.
If they get the job done quickly, they could leave early or come in later, they say.
Backers also say the reforms would not force change on workers, but rather let them choose to enter such an agreement with their employers.
- 'Accelerate deaths' -
Critics charge it would be tough for employees to refuse an offer of switching to the new model, and deride it as the "no overtime pay bill" that would force people to work longer with no extra pay beyond their agreed salary.
That could increase the number of overwork-related deaths and health problems, said Koji Morioka, professor emeritus at Kwansei Gakuin University.
"The government wants to create a system in which companies don't have to pay for overtime -- it could accelerate deaths from overwork," he said.
Morioka added that the bill seemed to run counter to the spirit of a law passed last summer aimed at preventing deaths from long working hours, which garnered wide support across party lines. Details of the bill are being worked out now.
The new law, if passed, would initially affect just four percent of private-sector employees, or about 1.8 million people.
But Keidanren already wants to expand the programme by lowering the pay threshold.
"We need to think about relaxing the income requirement and applying it to a wider scope of workers," the business lobby's chief said last month.
While the popular image of Japanese salarymen toiling long hours for the company before taking the last train home is changing, many still spend far more hours in the office than counterparts in other modern economies.
About 22.3 percent of Japanese employees work 50 hours or more each week on average, well above 12.7 percent in Britain, 11.3 percent in the United States, and 8.2 percent in France, according to the Organisation for Economic Co-operation and Development.
A Japanese government study found that 16 percent of full-time workers took no paid holidays in 2013, while others took just half their allotted vacation on average.
In that year, the official tally was 196 deaths and suicides linked to excessive working hours -- but that is just the tip of the iceberg, said Ryukoku University professor Shigeru Waki.
"There are a lot more people who died or became ill due to overwork, but it is very hard to prove," he said.
- 'State of shock' -
With more employers not required to keep track of extra hours worked under the proposed bill, it will make it even tougher to know the extent of the problem, Waki said.
The mother of a 27-year-old Tokyo man who killed himself in 2009 said his official work hours were much less than the actual extra hours spent at his printing company. She opposes the new bill.
"I was in a state of shock when his company called to tell me he was dead," said the 68-year-old woman, who asked not to be identified.
"My son will not come back, but I want to speak up for other younger people."
For Yamashita, who was blinded by his condition, burning the candle at both ends to meet the demands of a high-pressure job was hardly worth the reward.
"I didn't even get to see my kids grow up because I was too busy -- I wish I could have lived a life for my family instead."
As all the US IVY LEAGUE global Wall Street university public policy think tanks are calling Japan the health model---and yes, Hillary/Clinton neo-liberals with the Affordable Care Act are tied to this Japanese structure----this is what Japanese citizens think of what they have --------the reason Wall Street likes it----it is completely private and Japan has the same corporate control of government agencies writing these health policies.
'For the Japanese medical system to truly be considered a model for other countries, and a great service to those living here, much work remains to be done'.
We see here-----that preventative care ----annual checkups and basic care---keeping specialized health care access at bay.
'While Japan’s specialization and high-tech care may not be as advanced, the level of access, number of annual checkups and basic care for the majority of Japanese mean that specialized and technology-oriented medicine is needed less often'.
Japan’s health care as a model
- Sep 20, 2009
While the background conditions in America and in Japan are perhaps too different to compare, Japan can be said to provide a very good, if not perfect, level of health care to its citizens. With the debate raging in the States and a new government in Japan, now is a good time to take stock of lingering problems.
What many articles in the American press point out is the overall choice and general quality of services in Japan. Per capita expenditures here are lower than in the States because of so much primary and preventive care, mostly at local clinics. While Japan’s specialization and high-tech care may not be as advanced, the level of access, number of annual checkups and basic care for the majority of Japanese mean that specialized and technology-oriented medicine is needed less often.
All of that is good, but other problems remain. Local clinics and hospitals have long waits. Further consultations about rare conditions or unusual symptoms can be extremely time-consuming. A shortage of gerontologists and geriatricians is balanced, ironically, by a shortage of obstetricians and pediatricians. Many hospitals in the countryside have had to close or limit operations. Emergency rooms and services are understaffed. The number of doctors who remain at large hospitals over the course of their careers continues to diminish. These are all problems that can be solved but need urgent attention and new policies.
As the population ages, significant changes in health care will have to be instituted. Diet, tobacco and alcohol, three lifestyle issues with the largest impact on health care, deserve fresh initiatives. The health care system also needs to devote more attention to suicide and depression, leading causes of death and suffering. The new government has a lot of work ahead of it to address these problems. Any system of medical care needs ongoing development to maintain its standards.
For the Japanese medical system to truly be considered a model for other countries, and a great service to those living here, much work remains to be done.
GLOBAL HUMAN CAPITAL DISTRIBUTION LABOR POOL NEEDS TO HAVE FOREIGN ECONOMIC ZONES READY TO PROVIDE BASIC PREVENTATIVE CARE FOR ALL GLOBAL LABOR----IT WON'T BE QUALITY OR GOOD---
What did we hear Hillary had in mind for Federal health spending and it was made to sound like she was listening to FEELING THE BERN social Democrats? Building more and more preventative care and wellness businesses. This is all we are hearing in Baltimore as the Wall Street Baltimore Development 'labor and justice' organizations are out pushing just that----all small businesses that will disappear to become the only thing WE THE PEOPLE can access from a health insurance plan we can afford!
Bernie Sander's Expanded and Improved Medicare for All is not about PREVENTATIVE AND WELLNESS ONLY! It is about US citizens receiving access to quality care including hospital stays and treatments as well as continuing our HEALTHY HABITS programs.
'Per capita expenditures here are lower than in the States because of so much primary and preventive care, mostly at local clinics'.
Indeed it is just this that immigrant families are being pushed----sure, they are paying payroll taxes for Medicare and Social Security so 1%Wall Street posing progressive are trying to make our immigrant workers feel they are getting something for that payroll taxes and guess what? It is this same primary and preventative care structure our low-income citizens and immigrants have always been able to access.
'ALLOW PEOPLE TO BUY MARKET-BASED HEALTH INSURANCE PLANS REGARDLESS OF IMMIGRATION STATUS'.
Remember, the goal of ONE WORLD ONE GOVERNANCE global corporate campus filled with global human capital labor pool will require foreign workers to have access to something so we see immigrants filling the workplaces that WE THE PEOPLE used to fill----as global Wall Street prepares to send WE THE PEOPLE into this global labor pool----we will be seeking health care in Cambodia, China, Vietnam----wherever we are traded.
Hillary Clinton just backed healthcare for immigrants in the U.S. illegally
A 700-square-foot banner on the side of the California Endowment's building celebrates the budget signed by Gov. Jerry Brown, which includes healthcare for children in the country illegally.
(Katie Falkenberg / Los Angeles Times)
Soumya KarlamanglaContact Reporter
Over the last year, California politicians have been blazing a trail many doubted the rest of the country would follow:
offering free healthcare to hundreds of thousands of people in the country illegally.
But on Tuesday, presidential front-runner Hillary Rodham Clinton took a stance on the contentious issue during a televised Democratic debate, boosting it onto a prominent national stage.
Clinton said she favored efforts by states such as California to extend health benefits to these immigrants.
“First of all, I want to make sure every child gets healthcare ... and I want to support states that are expanding healthcare and including undocumented children and others,” Clinton said. “I want to open up the opportunity for immigrants to be able to buy into the exchanges under the Affordable Care Act.”
The estimated 11 million people who are in the country illegally are barred from signing up for insurance under the Affordable Care Act and make up a growing proportion of those who remain uninsured.
How much the issue will resonate in a presidential contest where immigration policy has loomed large remains to be seen. Some political experts said Clinton’s comments appeared to be part of a larger, ongoing effort to shore up support in her party’s liberal base, where her chief rival, Vermont Sen. Bernie Sanders, has been gaining ground.
“This is very much a primary issue. It’s not a general election issue,” said Jack Pitney, a professor of political science at Claremont McKenna College.
“I seriously doubt she’ll be running ads on this issue in October of next year” if she wins the Democratic nomination, he said of Clinton.
Pitney also said Clinton might be trying to gain support outside of her African American and white base. “If she can build a firewall among Hispanic voters, then it would be very hard to deny her the nomination,” he said.
Randy Capps, director of research for U.S. programs at the nonpartisan Migration Policy Institute, noted how different things were in conversations among Republicans, with candidates proposing such things as abolishing birthright citizenship and building a wall between the U.S. and Mexico.
“Certainly it sets the stage for this issue being part of the debate in the general election, where there will be a huge contrast between whoever the Democratic nominee is and whoever the Republican nominee is,” he said.
Responding to a question during the Las Vegas debate on Tuesday, Clinton generally endorsed California’s approach.
In June, Gov. Jerry Brown signed a budget that for the first time funds healthcare for children in the country illegally, making California the largest state to do so. In addition, the number of counties in the state that have committed to providing low-cost, government-run medical care to such residents jumped from 11 to 48 this year.
Some California legislators have vowed to continue expanding coverage until everyone has insurance. State Sen. Ricardo Lara (D-Bell Gardens) has introduced a bill that would allow unauthorized immigrants to purchase a medical plan through the state’s Obamacare exchange and let poorer immigrants sign up for the state’s low-income health program, known as Medi-Cal.
Lara called Clinton’s comments a “paradigm shift,” noting how quickly California’s approach entered the national political conversation.
“When I began the push for health for all, I was often told that my vision was too ambitious and needed to take a more incremental approach,” he said. “With national Democratic candidates taking note of what we’re doing in California, I’m confident that public support will continue to grow across the country.”
Lara and other advocates say it’s smart to provide coverage to unauthorized immigrants, because they often end up in emergency rooms, racking up bigger bills than if they’d received routine medical care earlier.
Critics say actions like those being taken in California on healthcare are exacerbating the problem of people coming to the U.S. illegally.
Federation for American Immigration Reform spokesman Ira Mehlman cited a 2009 Congressional Budget Office report that found expansion of preventive care generally leads to higher, not lower, spending.
In California, some proposals to extend healthcare to people who lack legal status have been priced at more than $1 billion. “It seems that sometimes they stay up late there in Sacramento dreaming up new benefits and services and protections they can provide to people who are in the country illegally even as they’re cutting all kinds of things to everybody else,” Mehlman said.
Under the Affordable Care Act, legal residents, depending on their income, can either buy insurance through new Obamacare exchanges using government-provided subsidies, or they can sign up for coverage through Medicaid, the federal health program for the poor.
Sanders has expressed broad support for extending heath coverage to people here illegally, calling it a fundamental right. Approximately 36 million U.S. residents are uninsured, 6 million of whom are here illegally, according to data from Gallup and the Migration Policy Institute.
Former Maryland Gov. Martin O’Malley, also running for the Democratic nomination, has proposed allowing approximately 5 million immigrants who are eligible for temporary immunity from deportation to either take advantage of government subsidies and purchase medical coverage through the insurance exchanges or sign up for Medicaid programs.
Clinton agreed Tuesday that undocumented immigrants should be allowed to buy coverage through the exchanges. But she stopped short of saying that they should be given taxpayer subsidies.
“It would be very difficult to administer,” Clinton said. “It needs to be part of a comprehensive immigration reform, when we finally do get to it.”
Experts said that without providing subsidies, opening up the exchanges is mostly a symbolic move, partly because many people living here illegally wouldn’t be able to afford insurance premiums on their own.
“It’s basically saying, ‘Yes, you can go into the store and you can buy things too. We won’t keep you out of the store,’” said George Washington University health policy professor Leighton Ku.
Clinton’s position is likely to be unpopular in many parts of the country, where political leaders are against Obamacare.
And that means she may have to adjust her stance during the general election — a common tactic in presidential politics, said Claremont McKenna professor Pitney.
“I think every Republican opposition researcher has noticed this statement,” he said.
This is how much the Clintons and Congressional neo-liberals love women and women's justice issues:
'In 1950, the United States ranked number five in the world for female life expectancy; by 2009, it had fallen to number forty-six'.
Here is the health care reform under Bill Clinton back in 1996----as he used Executive Order to privatize and dismantle public health for WE THE PEOPLE he used the WELFARE REFORM bill to limit what was once accessible health care for immigrants. What has changed? The installation of US cities as Foreign Economic Zones with the goal of creating huge density on global corporate campuses of global labor pool workers.
'The 1996 federal welfare reform law (Personal Responsibility and Work Opportunity Reconciliation Act, or PRWORA) restricted Medicaid eligibility of immigrants, so that those admitted to the United States after August 1996 cannot receive coverage, except for emergencies, in their first five years in the country'.
There is yet another goal to opening Medicaid to global labor pool----as California did-----sending immigrants across the border into Mexico is building global health corporation facilities overseas and in other nations using our FEDERAL MEDICARE AND MEDICAID funds. 1% Wall Street has been fleecing our Federal Trusts these few decades doing the same on a limited basis-----now they are officially including immigrant workers onto Medicaid and then sending them to facilities outside the US.
HOW DO NATIONAL HEALTH CORPORATIONS AND HEALTH SYSTEMS EXPAND GLOBALLY? USE OUR FEDERAL MEDICARE AND MEDICAID TO SEND AMERICAN WORKERS OVERSEAS FOR HEALTH TREATMENT.
'It may now be possible to harmonize longstanding U.S. foreign and domestic policies regarding health-care access for poor and middle class peoples. But perhaps it will now be possible for an HIV-infected individual in Mississippi or Alabama to have access, at taxpayers' expense, to the same level of care as the U.S. government supports for comparable individuals in Johannesburg'.
Aligning U.S. Health Care with U.S. Foreign Policy
Author: Laurie Garrett, Senior Fellow for Global Health
June 28, 2012
Millions of lives are prolonged or saved throughout the world, thanks to United States-supported health programs. But Americans aren't so lucky. For many, the best way to get affordable treatment at U.S. taxpayers' expense might be to move to a poor country that is committed to building universal coverage, backed by U.S. development aid.
The Supreme Court decision on the Affordable Care Act (PDF) opens the possibility that the United States may now begin to domestically implement policies that foreign aid agencies and the Department of Defense have long supported, both politically and economically, as elements of U.S. foreign policy. It may now be possible to harmonize longstanding U.S. foreign and domestic policies regarding health-care access for poor and middle class peoples.
Dating back to the Marshall Plan in post-WWII Europe, Gen. Douglas MacArthur's 1945-49 occupation of Japan, and then the Korean War, it has been a matter of U.S. foreign policy to invest in the creation of universal health systems. More recently, the Marshall Plan was cited by AFRICOM in support of a Department of Defense engagement in health systems construction across Africa. This year (FY2012), South Africa was the number one recipient of health aid from the United States, totaling nearly $470 million, much of which is supporting the country's fourteen-year program to build universal health coverage.
Meanwhile, on the home front, 2012 polling shows that 26 percent of Americans have faced grave financial difficulties due to medical costs, and 58 percent have delayed treatments due to their inability to pay out-of-pocket expenses or insurance co-pays. For those without health insurance or Medicare coverage, a startling 81 percent say they forego treatments, as do 72 percent of poor Americans earning less than $40,000 per year. By 2010, medical bills were the number one cause of bankruptcy in the United States, exceeding housing foreclosure as cause for limiting food, heat, and rent purchasing. Four million Americans declared bankruptcy that year, citing medical costs. A 2011 Department of Health and Human Services study found that the average American patient could only afford to cover 12 percent of their hospital bills, and that failure to gain full reimbursement on such bills accounted for $73 billion in losses for hospitals.
A lack of access to affordable health care also has real health impacts in the United States. In 1950, the United States ranked number five in the world for female life expectancy; by 2009, it had fallen to number forty-six. A 2010 Commonwealth Fund comparison (PDF) of population health in seven wealthy nations found the United States in last place. Between 1987 and 2006 the number of American women dying from pregnancy-related causes actually increased from 6.6 per 100,000 live births to 13.3--a doubling. In nearly all OECD countries, almost all which have universal coverage, the reverse trend was seen, as ever-fewer women died year by year.
Political pundits will now argue the impact of the U.S. Supreme Court decision and the likelihood that Republican opponents to the health reform law will be able to overturn it through legislation. But perhaps it will now be possible for an HIV-infected individual in Mississippi or Alabama to have access, at taxpayers' expense, to the same level of care as the U.S. government supports for comparable individuals in Johannesburg.
Here we see the deregulation of US health insurance and global health systems using health insurance plans wanting TO FIND THE CHEAPEST treatment to begin creating a global health tourism network and indeed Americans will be pushed to Mexico or overseas for health procedures they used to simply drive to their local hospital to receive. This all blends into including immigrant labor pool into our US Federal Medicare and Medicaid funding. The subsidies to expanded Medicaid simply show how far US citizens are going to fall as they enter the GUTTED OF FUNDING MEDICAID FOR ALL----
We are already seeing our Medicare and Medicaid funds being spent on travel outside of US for health care treatment. Guess who is waiting for us in Cambodia, Thailand, Mexico-----global Johns Hopkins and Kaiser----global HCA----paying global labor overseas $3-6 a day and white collar health professionals $20-30 a day.
THIS IS WHAT HILLARY AND 1% WALL STREET CLINTON/BUSH/OBAMA candidates in Congress, statehouse, and our US city halls are working towards when they shout for health technology and health care for all.
THE CITIZENS IN OVERSEAS DEVELOPING NATIONS WON'T BE AFFORDING THESE HEALTH PROCEDURES---IT IS CRAZY STUFF.
It's goal is simply to use US Federal taxpayer funds to expand these private state health systems globally
Medical tourism trips offer steep savings, but they don't pack enough financial might to play a key role in President Obama's push to lower U.S. health care costs'. 'With a low deductible and no incentives from an insurer or employer to travel, a patient may have little motivation to make a trip'.
HMMMM, AREN'T ALL BRONZE PLANS HIGH-DEDUCTIBLE?
Notice how many of the first health systems to send outside US are from Republican states? Remember, the problem with US health care costs are profiteering and fraud-----none of this addresses those problems---it allows all that to continue as global tourism brings global 1% and their 2% to US Foreign Economic Zones like Baltimore for treatment.
Insurers aim to save from overseas medical tourism
Updated 8/23/2009 7:58 AM | Comment | Recommend E-mail | By Kent Gilbert, AP
Costa Rican Dr. Luis Obando prepares to perform a root canal on Bill Jones, of Dallas, Texas, at Meza Dental Care in San Jose, Costa Rica. Jones said he elected to have the surgery in Costa Rica because he was able to save substantially compared to what he would have had to pay in the USA.
Medical tourism trips offer steep savings, but they don't pack enough financial might to play a key role in President Obama's push to lower U.S. health care costs.
Medical travel cost U.S. health care providers about $5.1 billion in business in 2007, according to estimates by Paul Keckley, executive director of the Deloitte Center for Health Solutions. While significant, that amounts to less than 1% of the $2.36 trillion spent on health care in the United States that year.
Medical tourism can yield savings of as much as 80% on some procedures compared to care in the United States. But traveling isn't for everyone and these trips are generally not an option for emergencies. A patient's willingness to travel for non-emergency care often depends on the savings at stake. With a low deductible and no incentives from an insurer or employer to travel, a patient may have little motivation to make a trip.
Any result from the Washington reform push is unlikely to affect medical tourism, Keckley said, because it won't lower costs enough to erase price gaps with foreign care providers.
Elizabeth Kunz left her dentist's office this spring with a mouth full of problems and no way to pay for them.The South Carolina resident went out of her way, literally, to find a solution, which turned out to be in Central America. Her trip to the tropics is part of a health insurance experiment for trimming medical costs: overseas care.
As Washington searches for ways to tame the country's escalating health care costs, more insurers are offering networks of surgeons and dentists in places like India and Costa Rica, where costs can be as much as 80% less than in America.
Until recently, most Americans traveling abroad for cheaper non-emergency medical care were either uninsured or wealthy. But the profile of medical tourists is changing. Now, they are more likely to be people covered by private insurers, which are looking to keep costs from spiraling out of control.
The four largest commercial U.S. health insurers — with enrollments totaling nearly 100 million people — have either launched pilot programs offering overseas travel or explored it. Several smaller insurers and brokers also have introduced travel options for hundreds of employers around the country.
Growth has been slow in part because some patients and employers have concerns about care quality and legal responsibility if something goes wrong. Plus, patients who have traditional plans with low deductibles may have little incentive to take a trip.
But a growing number of consumers with high-deductible plans, which make patients pay more out of pocket, could make these trips more inviting.
In the meantime, the insurance industry's embrace of overseas care has had a pleasant side effect at home: some U.S. care providers are offering price breaks to counter the foreign competition.
This domestic competition and the slumping economy have led to slower growth for medical tourism over the past year, as patients put off elective procedures that involve big out of pocket costs, said Paul Keckley, executive director of the Deloitte Center for Health Solutions.
Last year, the center estimated that 6 million Americans would make medical tourism trips in 2010. But Keckley has since shaved that projection to about 1.6 million people. Still, that more than doubles the roughly 750,000 Americans who traveled abroad in 2007, the last year for which Deloitte had actual numbers.
Keckley expects the medical tourism industry to recover, as more health insurers offer the option and as more people wind up with high-deductible plans.
Health care costs for employers who offer insurance to their workers were projected to rise 9.2% this year and another 9% in 2010, according to the consulting firm PricewaterhouseCoopers. That could mean double-digit percentage increases for employees through higher premiums, deductibles or copays.
Overseas care can lead to price breaks of more than $40,000, not counting travel costs, for procedures like knee replacement surgery or heart bypasses. Insurers, or employers who provide their own insurance, can save between 50% and 90% on major medical claims, said Jonathan Edelheit, president of the Florida-based Medical Tourism Association. A lower cost of living and lower prices for medical supplies and drugs help drive down care costs overseas compared to American providers.
While employers or insurers reap much of the savings, these lower costs can be the difference between a manageable expense and a bank-breaker for patients with high-deductible plans. These increasingly popular plans can lead to out-of-pocket expenses surpassing $5,000 for individual coverage and $10,000 for family plans.
High out of pocket costs also are common with dental coverage, which is one reason dental care trips have proven popular.
Kunz, 47, initially doubted the potential savings she might see from visiting a Costa Rican dentist though a program offered by her insurer, BlueCross BlueShield of South Carolina. But a little comparison shopping — with help from the insurer — persuaded her to get on a plane.
She had eight crowns replaced, a tooth filled and root canal. The work would have cost her $10,000 out of pocket back home, but she paid just $2,800 after insurance.
Ben Schreiner of Camden, S.C., would have paid the entire $10,000 deductible on his insurance policy if he had his hernia surgery done last year near home. For that reason, Schreiner, 63, had planned to wait until he turned 65 and qualified for Medicare before fixing it.
After reading about medical tourism in his insurer's annual report, the retired bank executive flew to Costa Rica and paid about $4,400, including travel expenses. Frequent flier miles covered his flight.
Schreiner said he was initially skeptical about the quality of care he might receive but reading about the doctors who could perform the surgery put him at ease.
"When you read the bios and the backgrounds of the doctors, you kind of lose your skepticism," he said.
However, apprehension about medical travel remains a high hurdle.
"People still do not understand that there could be a hospital in Thailand that can be as good as any hospital anywhere in the world or in the United States," said John Ferguson, chief marketing officer for Georgia-based BasicPlus Insurance Services.
BasicPlus, which underwrites and provides group health insurance plans to employers, started offering medical tourism as part of a benefits package last year. About 200 employers it contracts with around the country now offer that option, but no patients have used it.
Quality can be a legitimate worry, said Harvard Medical School professor Sharon Kleefield, who has worked overseas with several health care systems to establish quality measurements.
The average patient has no way of comparing hospitals worldwide on quality, which can vary widely. But, Kleefield said, insurers are helping to raise standards through careful inspections of hospitals before including them in an overseas network.
Concerns about liability also may be keeping some employers from adding overseas care options to their plans.
U.S. employers who encourage an overseas medical trip could become litigation targets. It can be difficult to sue an overseas provider in U.S. courts, said Nathan Cortez, a Southern Methodist University law school professor who studies medical tourism. And the average malpractice recovery in Thailand is about $3,000, roughly 1% of the U.S. average.
To ease this fear, medical tourism companies have started offering insurance that protects employers who send employees overseas from liability.
Some employers also have learned they don't have to send people overseas to save money.
Shortly after Hartford, Conn.-based Aetna Inc. and the Maine-based grocery chain Hannaford Bros. Co. launched a program to send patients to Singapore for hip and knee replacements, some New England hospitals countered with their own deals.
So far, three patients have benefited from the competitive pricing; Hannaford has sent no one overseas, even though the program pays travel and lodging costs.
"People travel all the time a couple hours on the interstate," said Dr. Brian Kelly, Aetna's national medical director. "That's no big deal."
Rather than build those hospital and clinic facilities in communities in US cities -----we are seeing a concerted plan to ship what will become 90% of American citizens with immigrants outside our US Foreign Economic Zones gearing global health care tourism to attract only the global 1% and their 2%----telemedicine will then keep those patients attached to overseas medical staff----
'Mexican immigrants living in California, Arizona, Texas and New Mexico have long sought health care in border cities such as Tijuana, Mexicali and Nogales. The Affordable Care Act won't change that, experts said, even though it has expanded coverage to millions of people, including many Latinos'.
"Even with insurance, it can sometimes be cheaper in Mexico," said Steven Wallace, who is associate director the UCLA center and has studied why Mexican immigrants seek care in Mexico'.
Health care, and patients, go south — to Mexico
Anna Gorman, Kaiser Health News 10:43 a.m. EDT May 7, 2014(Photo: Heidi de Marco Kaiser Health News)
TIJUANA — Irma Montalvo signed up for a health plan through California's new insurance exchange last month, getting coverage for the first time in eight years.
But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications.
Montalvo, 64, said she comes to Tijuana in part because it costs just $15 to see the doctor. She can't use her insurance for care outside California, but it's still cheaper because she doesn't have to worry about a deductible. More important, she said, is that she feels comfortable with Espinoza.
"She listens to me," said Montalvo, a U.S. citizen who was born in Mexico, said in Spanish. "I come here feeling really bad, and three days later I am better."
Mexican immigrants living in California, Arizona, Texas and New Mexico have long sought health care in border cities such as Tijuana, Mexicali and Nogales. The Affordable Care Act won't change that, experts said, even though it has expanded coverage to millions of people, including many Latinos.
Naturalized citizens and legal residents are expected to continue traveling for check-ups, minor surgeries and dental care, drawn to treatment that is less expensive and a medical culture that is less hurried. Doctors speak their language and patients often can get appointments without long waits.
In fact, it's possible even more U.S. residents may seek care with Mexican doctors, said David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at the UCLA School of Medicine. Many Latinos in the United States live in areas with a huge undersupply of providers, and as new coverage increases the demand for care, waits for appointments could grow longer and more frustrating, he said.
"If you don't have access to care, going to Tijuana may seem like a reasonable alternative," he said.
COSTS STILL TOO HIGH
Some of these patients now going to Mexico remain uninsured, or work for employers in the U.S. offering insurance plans that pay for medical care in Mexico. Others have signed up for Obamacare to cover emergencies or avoid a fine — but face high deductibles and out-of-pocket expenses.
"Even with insurance, it can sometimes be cheaper in Mexico," said Steven Wallace, who is associate director the UCLA center and has studied why Mexican immigrants seek care in Mexico.
The majority of these patients are Mexican immigrants with green cards or U.S. citizenship who can travel freely across the border. One 2009 study by Wallace found that nearly half a million Mexican immigrants living in California receive medical, dental or prescription services every year south of the border.
Lorena Villanueva, who cleans houses in Riverside County, Calif., came to Tijuana on a recent day because of a flare-up of allergies that gave her a sore throat and a rash on both arms. Villanueva bought a plan through Covered California for about $150 a month. Joining a plan that her husband has through his work as a car salesman was too expensive.
"To be honest, I like to come here better even if I have insurance," she said. "Over there it's wasting money and wasting time."
The Obamacare plan, she said, is just for emergencies. For most everything else, Villanueva said she will continue driving the 70 miles to Tijuana. "It's a long drive … but for me, it's worth it," she said.
The medical office where she sees her doctor is in an eight-story, modern building just steps from the border and across the street from a bus station. Two flags — one American and one Mexican — fly above the building owned by SIMNSA, a cross-border health plan.
Just outside, security guards monitor who enters and a line of taxis waits to give patients rides. Inside, the clinic is bustling with people seeking to get their eyes checked, lab results read, cavities filled, hearts examined, allergies treated and children immunized.
Licensed in California and overseen by the state's Department of Managed Health Care, SIMNSA offers health insurance to employees of American companies in San Diego and Imperial counties. The employer plan offers the essential benefits required under the ACA, administrators said.
Patients not on the SIMNSA employer plan can walk in to the clinic and pay out-of-pocket. Or, like Montalvo, they can pay a small membership fee allowing them to see an internist for $15 and a specialist for $25.
SIMNSA provides primary and specialty care, physical therapy, spa services and a pharmacy. "It's a one-stop shop," said Christina Suggett, chief operating officer.
Suggett said appointments typically last 30 minutes or more and the doctors don't rely heavily on nurses or medical assistants — a contrast to often more rushed encounters in the United States. Physicians develop long-term relationships with their patients, who return again and again, often bringing family members along.
Ophthalmologist Josue Delgado has been seeing Alberto Luna, 49, for several years. Luna lives just over the border in National City and has a SIMNSA policy through his job at a hotel in San Diego. Luna said he never has to wait to see Delgado and that the doctor treats him like a friend.
"We know each other by first name," Delgado said of Luna.
Irma Montalvo, 62, was diagnosed with shingles and says she doesn't mind the trip to Tijuana to be treated because she trusts her doctor. (Photo: Heidi de Marco, Kaiser Health News)
'QUALITY AND WARMTH'
On this day, Luna was seeking follow-up treatment for a complication of his diabetes — bleeding in his eye. Delgado explained it was causing blurry vision and wasn't healing. The doctor gave Luna a note for his boss so he could spend a few more weeks at home before returning to work. "Make sure you rest," Delgado told his patient, shaking his hand.
Xochitl Castaneda, director of the health initiative of the Americas at U.C. Berkeley's School of Public Health, said Mexican clinics offer something not always found in the U.S. "In Spanish, we say calidad and calidez, quality and warmth," she said. "When you are sick, you need medical support. You also need emotional support. That is something that Mexican physicians give."
The question of quality is not settled. Experts say that some hospitals, doctors and clinics are comparable to the U.S., but that quality varies widely. Some studies find that patient satisfaction with Mexican providers is generally good while others find the care needs improvement.
It is that warmth that brings Montalvo back to Tijuana, despite her new Covered California plan. After checking Montalvo's rash, Espinoza told her to continue the medication and come back in a few weeks. She also told her to call — night or day — if she had any questions.
"You are responding perfectly" to the medication, Espinoza told Montalvo. "I'm happy."
Montalvo smiled at her doctor before heading down to the pharmacy. "Que dios le bendiga," Montalvo told her. "May God bless you."