Why does Baltimore have third world health outcomes, third world public health, and third world life expectancy? Because of SCHMOKE, O'MALLEY, DIXON, RAWLINGS-BLAKE, NOW PUGH all simply doing what global 1% tells them. As we shout over and again, Baltimore is filled with FREEMASONS AND GREEKS PLEDGED to do just this----one can no longer get a job without being part of that Charles Dicken's CHUZZLEWIT family gang. We need CITIZENS in Baltimore to get rid of all those global 1% players in order to rebuild our strongest in world history public health system..
We we are seeing in Baltimore in MOVING FORWARD US FOREIGN ECONOMIC ZONES WITH GLOBAL CORPORATE CAMPUSES is a farm team 5% player glad to out those CLINTON/BUSH/OBAMA as players ----while advancing the same global corporate campus SOCIALISM-----
Two things make us suspect this article is written by that same global 1% player----first they use the ONE WORLD UNITED NATIONS FAR-RIGHT WING talking point-----UNIVERSAL CARE/SINGLE-PAYER/MEDICARE FOR ALL-------having said nothing about ending Affordable Care Act and educating about why THAT policy is so bad----and second, the article makes people believe there is a goal of cleaning up brownfields when the goal is the opposite----MOVING FORWARD brings Chinese-level of toxic waste, environmental devastation that will make Baltimore's industrial waste sites look like a sandbox.
'Now his priority is cleaning up the brownfields and dumps that pockmark the city’s black neighborhoods, exposing the families living in them to a laundry list of toxins that have been linked to cancer and other diseases'.
REAL left social progressives agree that JIM CROW never left the south----the southern economies remained tied to PLANTATION ECONOMICS---this is why the south continued having a few very rich with most people being very poor. So, this article does identify the problem for our 99% of black citizens in Baltimore. Do we think the US is incapable of ending JIM CROW ---CLINTON/BUSH/OBAMA of course expanded JIM CROW to our north and western US cities capturing all US politics to FAR-RIGHT WING REAGAN/BUSH.
THIS IS WHY WE SHOUT----SHAKE THAT RACE AND CLASS BALTIMORE AND COME TOGETHER AS A 99% VS 1%---WE CANNOT DO THAT IF WE DO NOT BUILD REAL EQUAL RIGHTS AND OPPORTUNITY FOR 99% OF WE THE PEOPLE BLACK, WHITE, AND BROWN CITIZENS.
We want to remember as well here in Baltimore that a Johns Hopkins back in early 1900s built a sewage pipeline knowingly allowing it to drop waste right under SPARROW'S POINT STEEL MILL-----today's HARBOR POINT high rise was build on a brownfield filled with 99% black, white, and brown citizens----so these policies against public health have been EQUAL OPPORTUNITY but our 99% black citizens have been the bigger losers. AMERICAN PROSPECT IS A RIGHT WING MEDIA OUTLET so would not print a real left social progressive article----- Everyone having lived in Baltimore suffer from the complete ignoring of industrial cleanup of toxic waste ----MOVING FORWARD will make all that look like child's play.
It Will Take More Than Single-Payer to Make Baltimore Healthy
More than lack of access to health care, the ongoing legacies of Jim Crow diminish African Americans’ health.
November 20, 2017
“See that over there?” I pull over to the curb and Glenn Ross points to a half-acre patch of weeds and tall grass wedged between a railroad bridge and a new East Baltimore elementary school, the first to be built in the neighborhood in more than 30 years.
“You’ve got the playground there and over there’s a brownfield”—the term for the sites where factories, refineries, and other businesses closed after poisoning the land and water beneath them.
“Trains used to leave coal there,” Ross says. “Then a truck repair shop opened up. The ground there is hard and black with oil. Why would you ever build a school next to a contaminated site?”
A burly Vietnam vet and one of Baltimore’s most seasoned activists, Ross has been on the front lines of dozens of the battles facing the city’s African American community, which today makes up two-thirds of Baltimore’s 620,000 residents. Now his priority is cleaning up the brownfields and dumps that pockmark the city’s black neighborhoods, exposing the families living in them to a laundry list of toxins that have been linked to cancer and other diseases.
On the drive back to his house, we pass some of the city’s 17,000 boarded-up houses, a storefront with whitewashed windows that was once the neighborhood’s supermarket, and a building peppered with bullet holes—no particular reason why, just a calling card left by one of the city’s drug gangs.
By the latest estimates, more than 28 percent of African Americans in the city live below the poverty line.Images like these have long made Baltimore a poster child for the urban poverty that results from institutional racism—even more so after the April 2015 death of Freddie Gray and the protests that followed. By the latest estimates, more than 28 percent of African Americans in the city live below the poverty line. The poverty rate for Baltimore households headed by women—the vast majority of whom are African American—is far higher, 41 percent.
These numbers provide as much insight into the health crisis facing African American neighborhoods as MRIs or CT scans of the individuals living within them. Maybe more. Because poverty—and the racism that gave rise to it—is the overarching reason why the life expectancy in 14 of Baltimore’s predominantly African American neighborhoods is now lower than North Korea’s.
One of those neighborhoods is the one where Glenn Ross lives, Madison/Eastend, which is 90 percent African American and where the average life expectancy is not quite 69 years. Life expectancy in the nearby Baltimore neighborhood of Medfield/Hampden/Woodberry/Remington, which is 78 percent white, is 76.5 years.
The reasons for this disparity aren’t hard to find. Compared with Medfield/Hampden/Woodberry/Remington, Ross’s neighborhood of Madison/Eastend has a homicide rate nearly 12 times higher, a cancer mortality rate 66 percent higher, and an AIDS mortality rate more than 12 times higher.
The term used to describe the factors that are responsible for such disparities is “determinants of health.” Some are the ones Ross talked about: toxins, housing, access to food, violence, and drugs. But there are others, too: education, unemployment, the number and quality of neighborhood parks, the rat population, and anything else that impacts the health of the community as a whole. And, of course, there’s the availability of health insurance and access to care. The most important of all, right? Well, no. It’s complicated.
“THERE'S A DIFFERENCE between health care, which is critically important, and the array of social, economic, and environmental determinants of health,” says Dr. Brian Smedley, co-founder and executive director of the National Collaborative for Health Equity. “In fact, the health of populations is only minimally affected by health care. Some estimates are that only 20 percent [of a population’s health] can be explained by access and the quality of care.”
The Baltimore City Health Department (BCHD) estimate is less generous. In its report “Healthy Baltimore 2020: A Blueprint for Health,” BCHD points out that although 97 percent of health-care dollars are spent on the health-care system, only 10 percent of what determines life expectancy actually happens “within the four walls of a clinic.” The other 90 percent is decided upstream, where people live, work, go to school, and spend their free time.
All of this says something about having a single-payer or a Medicare-for-all system (slogans aside, they’re really not the same thing). It’s that while either would be a vast improvement over the insurance system we have now, neither would have a profound impact on the health crisis facing African Americans.
Some who “argue that we need to expand access to health insurance tend to also believe that if we achieve universal coverage, then racial, ethnic, and socioeconomic health care and status gaps will close,” Smedley says. “That’s simply not the case.”
What’s sending black people in Baltimore to an early grave isn’t that America lacks a Canadian-style health-care system. It’s the legacy of Jim Crow.
“BLACKS SHOULD BE quarantined in isolated slums in order to reduce the incidence of civil disturbance, to prevent the spread of communicable disease into the nearby White neighborhoods, and to protect property values among the White majority.” They could be words in South Africa’s Pass Laws, but they come from the text of a 1911 Baltimore city ordinance.
The ordinance was eventually overturned, but for all the difference that made, it may as well have stayed on the books. Baltimore whites had long believed segregation was fundamental to protecting themselves from the crime, “loose morals,” and illness that were presumably endemic to African Americans. City ordinance or not, Baltimore lenders, mortgage bankers, and real-estate interests conspired in plain view to keep black families from moving into white neighborhoods.
On the Front Lines: Glenn Ross is campaigning to raise awareness and clean up the brownfields that abound in black Baltimore.
There was never any ambiguity about whether African Americans could get loans to buy houses in the city’s white neighborhoods, or any doubt that anyone who attempted to sell or rent to blacks would be penalized for it. In 1934, Baltimore’s homegrown segregationists gained a powerful new ally with the creation of the Federal Housing Administration (FHA), one of the crown jewels of the New Deal, which, as a matter of policy, denied mortgage insurance to black people. The feds also established the practice of redlining, literally marking off African American neighborhoods on maps and designating those who lived within them, regardless of their income, as credit risks. At the same time, the FHA was backing loans for whites—essentially underwriting their exodus from the city.
In his 2009 book, Infectious Fear: Politics, Disease, and the Health Effects of Segregation, Samuel Kelton Roberts Jr., director of Columbia University’s Institute for Research in African American Studies, provides a chilling account of how housing discrimination hastened the spread of tuberculosis in Baltimore’s African American community beginning in the early 1900s.
Roberts points out that even though African Americans made up one-fifth of Baltimore’s population, they lived on only 2 percent of its residential property and often paid rents that averaged three times higher than what whites paid for similar homes. How could they afford it? Most couldn’t. Given the poverty wages earned by most black workers, the only way many could make the rent was to take in tenants of their own. For their part, landlords had little compunction about failing to provide even rudimentary maintenance, leaving homes damp, stifling, and reeking of decay and rot. City officials provided only mediocre public services, if any. The impact on black families was devastating. In his book Not in My Neighborhood: How Bigotry Shaped a Great American City, longtime Baltimore journalist Antero Pietila points out that when Baltimore’s citywide TB rate climbed to 132 cases per 100,000 people, in one black neighborhood it had surged to 958 cases per 100,000 people. The sight of fatigued black men, women, and children suffering from chills, fever, and coughing up blood or sputum wasn’t uncommon.
While redlining didn’t create TB, it was responsible for its phenomenal spread in Baltimore’s African American community
While redlining didn’t create TB, it was responsible for its phenomenal spread in Baltimore’s African American community, and the illness and death that followed. A century later, redlining continues to determine the health of the city’s black neighborhoods.
Today, according to a survey by the Corporation for Enterprise Development (CFED, known today as Prosperity Now), 32 percent of black Baltimore households have no household net worth at all, and 67 percent have so meager a level of liquid savings that they could meet their basic expenses for no more than three months if they had a medical emergency or suffered a job loss.
The Institute for Policy Studies (IPS) and CFED report that if current trends continue, the average black household in the United States will need 228 years to accumulate as much wealth as their white counterparts have now. Wealth inequality, rooted in segregation, has made poverty an enduring fact of life in Baltimore. It’s the common thread to the social determinants that are robbing African Americans of their health.
WHEN CNN COVERS the health impact of the criminal justice system on the African American community, it usually begins and ends with an account of the police killing a black person. If there’s video, all the better. But police violence is a piece of a much bigger story: how the justice system undermines the health of the entire African American community.
Ralikh Hayes has been an organizer since his teens in campaigns to change the city’s criminal justice system. Ask him about the health of Black Baltimoreans and he’ll tell you that the issue he’s concerned with isn’t whether something he’s exposed to now will kill him in 20 years. It’s simply not getting shot.
“It’s a public health issue that young black people don’t think they’re going to make it to 21, 23, 25. The fact that I turned 23 is considered a milestone in the community,” he says. “People don’t think their life expectancy is that long.”
Jim GrossfeldMustafa Santiago Ali: The chronic disinvestment in black communities has created literally toxic environments.
The experience of violence and degradation in black America, of course, has all too commonly come under the color of law. Police violence and abuse are a fundamental cause of the stress and trauma suffered by black people. Two-thirds of young African Americans say that they or someone they know has experienced violence or harassment at the hands of the police, according to a 2016 GenForward poll. Thirty percent of black men say they experienced it themselves. And hearing, reading, or seeing news coverage of police violence and harassment of black people can activate what psychologists call “racial trauma,” triggering memories of police harassment and other instances of racism that they and the people they know have experienced. Almost one in ten black Americans suffer from post-traumatic stress disorder, or PTSD.
“I'D GO THERE IF I had an accident, but not if I had a choice,” he says. “He” is a retired Baltimore steelworker who’s shy about being quoted by name. “There” is Baltimore’s Johns Hopkins Hospital. Together with the Mayo Clinic and the Cleveland Clinic, Hopkins is part of the trinity of top-ranked U.S. hospitals—a latter-day Lourdes to which sick people from around the world beat a path, hoping to find cures they’ll find nowhere else. But in Baltimore’s African American community, the hospital has a different reputation.
“They treat black people with disrespect,” he adds. “Whites get much better care.”
It’s a view shared by many African Americans. Many grew up having heard the story that if they played too close to Hopkins they might get snatched off the street for medical experiments. In their 2013 book Lead Wars, historians David Rosner and Gerald Markowitz revealed that as late as the 1990s researchers affiliated with Hopkins conducted a study that exposed children, most of them African American, to dangerously high amounts of lead.
One institution better able to address some health determinants than a hospital is the community health center. Today, there are 9,800 such centers (their number augmented over the past decade by the $11 billion included in the Affordable Care Act for that purpose), which provide care to 24 million low-income Americans, two-thirds of them minority. Because they’re small, located near their patients, culturally compatible, and often work with community leaders to address some of their patients’ non-clinical problems—access to healthy food, for example—they fill needs that most hospitals either don’t or can’t.
To what extent, though, does racism still affect the medical system at large? In 2015, The Journal of the American Medical Association Pediatrics reported on the findings of a study led by Dr. Monika Goyal of Children’s National Health System and Dr. Nathan Kuppermann and Sean Cleary of George Washington University. They found that “[b]lack children are less likely [than white children] to receive any pain medication for moderate pain and less likely to receive opioids for severe pain, suggesting a different threshold for treatment.”
An older study—but one that nonetheless came 36 years after the enactment of the Civil Rights Act—was published in 2000 in Social Science and Medicine. In it, Michelle van Ryn of the Mayo Clinic and Jane Burke of the University of Illinois at Chicago College of Medicine examined 842 post-angiogram encounters between physicians and their patients. They found that “lower [socioeconomic status] African Americans consulting a cardiologist are more likely than affluent Whites to be perceived as: lacking intelligence; lacking self-control; irrational; unlikely to have significant career demands; at risk for inadequate social support; unlikely to desire a physically active lifestyle; at risk for substance abuse; and likely to be noncompliant with cardiac rehabilitation.”
One change that would likely have a positive impact on the quality of health care provided to African Americans would be an increase in the number of black doctors. It’s not only a matter of African Americans feeling more comfortable having a black doctor; it’s that African American doctors may be more willing to see low-income—disproportionately minority—patients. In a 2015 New England Journal of Medicine article, Dr. David Ansell and Dr. Edwin McDonald wrote, “Black medical students are more than twice as likely as white students to express a desire to care for underserved communities of color. Our inability to recruit black men into medicine is alarming, given the urgency of racial health care disparities in the United States.”
Tracy PerkinsThe Neighborhood Vista: Industry and fuel storage bins abut a Baltimore residential street.
By some measures, only about 5 percent of practicing physicians are black, and there’s little evidence that number is going to grow. In 2004, medical school enrollment for African American students was 7.4 percent, but by 2011 it dropped to 7 percent.
The reasons why have been talked over (and over) for years: Throughout K–12, schools aren’t identifying and encouraging African American students who may have an interest in medicine; schools attended by black children don’t have the same resources to teach science that predominantly white schools do; the shortage of black physicians means there are few role models; many black college graduates are unprepared to apply to medical school; and, of course, black students and their families can’t afford the staggering price of studying medicine.
For generations, historically black colleges and universities (HBCUs) like Howard University in Washington, D.C., and Meharry Medical College in Nashville trained the lion’s share of America’s black physicians. They’ve also struggled to survive financially. Now, with Donald Trump suggesting that federal support for them may be unconstitutional, HBCUs could be facing their toughest times ever.
One group working to counteract these trends is White Coats 4 Black Lives, or WC4BL, a national organization of medical students whose mission is “to eliminate racial bias in the practice of medicine and recognize racism as a threat to the health and well-being of people of color.” With 54 active chapters at medical schools across the nation, WC4BL says its primary goal, in the spirit of Black Lives Matter, is to put medicine’s racial disparities on the front burner.
Black Lives Matter may be providing a template for dealing with all the systemic issues that threaten and thwart black lives.Indeed, Black Lives Matter may be providing a template for dealing with all the systemic issues that threaten and thwart black lives. Earlier this year, Mustafa Santiago Ali, a former EPA senior advisor for environmental justice and community revitalization, became the senior vice president of climate, environmental justice and community revitalization at the Hip Hop Caucus. He sees a coming-together of discrete movements to improve African Americans’ lives. “The environmental justice side, the public health side, and Black Lives Matter, all these various organizations are engaged in Flint [Michigan] and understand that what’s happening there and other communities is a sign of the disinvestment that’s been happening there for decades—even longer than decades,” he says.
“There’s the Band-Aid approach, which has its relevancy, which is just focusing on the pipes and the water,” he says. “And then there’s the broader construct of making sure there’s green housing, making sure that transportation routes are beneficial to the community, utilizing job training programs, creating small anchor institutions.”
And health insurance? While it’s important, it’s no substitute for creating new clinics that provide easy access to care. Pointing to the success of community health centers that today meet the needs of more than 24 million patients in poor communities, Ali says, “We could turn brownfields into health fields by cleaning up contaminated sites and placing health-care facilities there.”
SINCE IT HAD TAKEN a couple of weeks to arrange the interview, I was thrilled to finally have him on the phone. He was one of the country’s strongest advocates for single-payer—he wished to remain anonymous—but what I wanted to talk about with him that afternoon was racial health disparities. The responses I got from him didn’t say as much about the implications of, say, food deserts or the shortage of African American doctors as they did about the current politics of much of the left. The answer to all of my questions was single-payer.
It took a lot of prodding but eventually he explained why.
“The conversation always has to be broader than [racial] disparities,” he said. “When you look at America’s will to end poverty, it was highest during the Great Depression, when the images of most poor people were white.”
Despite the fact that the health crisis facing African Americans has less to do with access to insurance than with those other social determinants, the idea that health is rationed not only by class but by race hasn’t commonly been part of the current argument for universal coverage. That’s partly the result of political calculation. Talking about black people suffering poor health more and dying sooner isn’t likely the most persuasive argument for many white voters. When Republicans sought to repeal the Affordable Care Act, one reason they failed is that Medicaid had acquired so many white recipients (by virtue of both the ACA’s raising the income eligibility threshold and the downward mobility of the white working class) that it had become impossible for Republicans to get away with deriding it as a giveaway to blacks.
But progressives should be able to walk and chew gum at the same time. They can advocate universal coverage and speak out about the health crisis that’s engulfed black America. It really isn’t that heavy a lift—unless they’ve bought the argument that talking about issues that have a unique impact on minorities is “playing identity politics.”
Winning universal access to health care, as challenging as it is worthwhile, will not in itself create health equity across the country’s racial lines. That’s the more fundamental challenge—and it’s every bit as urgent as winning universal health care. By the metric of lives cut short, it’s a good deal more urgent—and high time that progressives treat it that way.
If one is not educating that MOVING FORWARD super-sizes industrial toxins---super-sizes worker exposures -----while MOVING FORWARD dismantles all US labor and justice rights, laws, won over 300 years---while talking of cleaning up brownfields----if one does not talk about a third world life expectancy in Baltimore these few decades of CLINTON/BUSH/OBAMA being tied to life of citizens in North Korea without mentioning MOVING FORWARD has the goal of far-right wing, authoritarian, militaristic, dictatorship extreme wealth extreme poverty LIBERTARIAN MARXISM-----the same right wing MARXISM as in North Korea. We see someone identifying the right problems while remaining silent that those problems will be super-sized by MOVING FORWARD pols and 5% players.
Affordable Care Act has a goal of keeping 99% of WE THE PEOPLE from accessing even ordinary health procedures knowing our life expectancy will be that of NORTH KOREA.
'These numbers provide as much insight into the health crisis facing African American neighborhoods as MRIs or CT scans of the individuals living within them. Maybe more. Because poverty—and the racism that gave rise to it—is the overarching reason why the life expectancy in 14 of Baltimore’s predominantly African American neighborhoods is now lower than North Korea’s'.
This article uses Federal Labor Stats which we have shouted loudly and strongly no longer represent real US citizen unemployment/underemployment---there are far more than 20% of black citizens below poverty line. If we do not use REAL stats surrounding poverty we are keeping JIM CROW and CHUZZLEWIT 5% in place.
'By the latest estimates, more than 28 percent of African Americans in the city live below the poverty line'.
We don't know if Baltimore Sun was a news journal before CLINTON/BUSH/OBAMA but it is one great big propaganda media machine these few decades for far-right global 1% policies and supporting those 5% players.
Here we see again SINGLE PAYER------referring to BERNIE SANDERS and the LIBERTARIAN supports what is sold in national media the Bernie Sanders SOCIALIST policy ------when it is all simply UNITED NATIONS PREVENTATIVE CARE FOR GLOBAL LABOR POOL 99%. None of this is tied to US HEALTH CARE these few centuries.
A libertarian's case for single-payer health care
Baltimore Sun Oct 25, 2017
I am a lifelong believer and supporter of the Libertarian Party. My beliefs were strongly reinforced by book written in the late 1970s called “Resorting the American Dream” by Robert Ringer. However, despite being contradictory to the libertarian philosophy, I support Bernie Sanders' single payer system for health care. I believe Bernie Sanders' idea is a place to start.
A libertarian supporting a self-described democratic socialist’s ideas for health care tells you how broken our medical health insurance system is for the average American. Our medical health insurance system is totally broken and needs to be replaced. I have come this realization after struggling with the high cost of coverage for prescription drugs, struggling with the cost of COBRA coverage, and struggling with ridiculously high deductibles, premiums, and co-pays for medical services with employer-sponsored insurance. The problem is, all parties involved in providing health care payments have different objectives. Normally in business, when all parties have totally different objectives, there is a balancing effect. Yet, within health care, there is no balancing effect; in fact, the scales are tilted against the person needing the coverage.
Here are the facts the way I see them:
1. We want the best the possible health care for ourselves and our family.
2. Our doctors want the best possible health care for each of us. But they also want to be paid the most for providing that care.
3. We want a third party to pay for that coverage, and for most of us, over the last 60 years, our employers are responsible to provide that coverage. Our employers make every decision based on profits. So your employer decides your health coverage based on what is best for their bottom line, not your best health concerns
4. The insurance companies make all of their decisions based on how much can they charge the employer for coverage and how little can they pay the medical communities for the service. So the insurance companies make their decisions about your health coverage based on their profits, not your best health interests.
5. Our political leaders make their decisions based on who gave them the most money to run for re-election. So our political leaders base their vote on health care issue based on who is donating the most money to them not on providing affordable healthcare for us.
A prime example of that is under current law, Medicare is not allowed to negotiate with the drug companies for price. So the primary interest of each party that is providing heath coverage is their own bottom line. The current system is failing Americans, and it was failing Americans prior to Obamacare.
Don Radke, Baltimore
This is how we know INTERCEPT and the UK Wikileaks journalist are 5% players-----since leaving the UK media scene Intercept has been just as captured. So, here INTERCEPT allows a BEN JEALOUS----FOR GOODNESS SAKE-----pretend he is feeling the pain of the 99% he killed as leader of NAACP during CLINTON/BUSH/OBAMA. We KNOW Ben Jealous is a great big global 1% Clinton neo-liberal player but now he is being sold in ALT RIGHT ALT LEFT CAPTURED MEDIA as a Bernie Sanders SOCIALIST.....and yes, he too loves that UNITED NATIONS GLOBAL LABOR POOR FOR 99% THIRD WORLD SINGLE-PAYER/UNIVERSAL CARE/MEDICARE FOR ALL ------
Below we see Bernie endorsing this super-duper Clinton neo-liberal for Gov of Maryland. Jealous took NAACP from being EQUAL RIGHTS AND OPPORTUNITY FOR ALL BLACK CITIZENS to being the civil right to make the rich extremely rich anyway they can-----just as happened in our women's organizations, our labor union organizations ---those 5% players across all population groups include SILICON VALLEY BENN JEALOUS.
'“We have the opportunity in this state to make sure that we don’t have any more neighbors burying loved ones because they didn’t have access to health care,” Jealous said at an event where Sen. Bernie Sanders endorsed him for governor'.
Maryland's experiment was this-----Clinton in 1990s allowed Maryland to be exempt from MEDICARE oversight----this is how Baltimore's Johns Hopkins was allowed to fleece Federal health agencies for these few decades building that global health corporation. This happened at the expense of third world health outcomes for many Maryland citizens. THE INTERCEPT is telling us that is good. What made US health care spend more than any nation with health outcomes worse than any other developed nation? MARYLAND'S EXPERIMENT
Single Payer, Meet All Payer: The Surprising State That Is Quietly Revolutionizing Health Care
July 24 2017, 11:20 a.m.
One unheralded reason for Trumpcare’s many difficulties was a sea change in public opinion. A new Associated Press poll finds that 62 percent now agree the federal government has a responsibility to provide health coverage to all Americans, up from 52 percent in March. Republicans looking to take away coverage ran headlong into this wave of support for a bigger governmental role in health care.
“Once you get something for pre-existing conditions, etc., etc. — once you get something, it’s awfully tough to take it away,” President Trump concluded.
Indeed, when Kansas Republican Jerry Moran issued the statement that effectively killed the bill’s hopes, his opposition was described in the press as having come from a conservative direction. And while it was cloaked in right-wing rhetoric around choice, the politics of the statement leaned decidedly left. “We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans,” said Moran, fully aware that protections for pre-existing conditions, couples with lower overall costs, require a robust government intervention in health care.
Capitalizing on the new politics, progressive groups have distributed a “People’s Platform” that includes a Medicare-for-All single-payer system. And in state capitols, activists have demanded single payer, hoping a demonstration project proving the concept will catch fire, the way a universal system in Saskatchewan in the 1940s migrated to the rest of Canada.
The movement has won some incremental victories, but has yet to get over the top. Vermont passed the framework legislatively and then abandoned it. Colorado’s quiet effort was crushed at the ballot box. California has spent 25 years trying to pass something without success, and this year’s effort is stalled. A Medicaid buy-in bill in Nevada this year drew a veto from its Republican governor. New York’s odd conservative control of the Senate seems to foreclose a solution there in the near term.
There is one state, however, where a combination of fewer institutional barriers and existing health care structures could make health-care-for-all an achievable reality: Maryland.
It will take a grassroots groundswell and electoral victories, especially in next year’s governor’s race. One prominent gubernatorial candidate, former NAACP president Ben Jealous, has ardently endorsed single payer.
“We have the opportunity in this state to make sure that we don’t have any more neighbors burying loved ones because they didn’t have access to health care,” Jealous said at an event where Sen. Bernie Sanders endorsed him for governor.
If elected, Jealous would face fewer procedural obstacles than those that have dogged California in its long battle to establish a single-payer system. While Maryland, like California, has robust Democratic supermajorities in the legislature, there is no two-thirds requirement to raise taxes, and no budgeting straitjacket mandating certain percentages of state spending to education or other priorities.
And while states do need federal waivers to incorporate programs like Medicare into a state-run program, Maryland is the only state to already hold a Medicare waiver. It enables a unique system known as all-payer rate setting, which serves as the basis for universal health care in several industrialized nations. In other words, while other states would have to begin from scratch to overhaul their health care systems, Maryland has a head start.
Maryland is the only state in America where all hospitals must charge the same rate for services to patients, regardless of what insurance they carry. There’s some variance between hospitals, but every patient in a particular hospital pays the same. Other states experience huge, seemingly random differences in hospital costs, depending on the insurer (or lack thereof).
Maryland’s Health Services Cost Review Commission has set hospital reimbursement rates for over 40 years. The state obtained a federal waiver to include Medicaid and Medicare in its all-payer system, with the goal of keeping cost increases below Medicare growth. And it’s worked, creating the lowest rate of growth in hospital costs in America.
In 2014, to prevent hospitals from making up profit margins through volume, Maryland tweaked the system, adding global budgeting. “The traditional way it worked, every hospital got a rate card,” said Joshua Sharfstein, an associate dean at Johns Hopkins’s Bloomberg School of Public Health, and a former head of Maryland’s Health Department. “Now you get a number, which is the total revenue for the year.”
Because the global budget doesn’t change based on the number of admissions, this creates hospital incentives toward better outcomes. “It makes the health system focused on keeping people healthy rather than just treating illnesses,” said Vincent DeMarco, president of the Maryland Citizen’s Health Initiative, a state advocacy group. That includes increased preventive treatment, using case managers to connect patients to primary care, eliminating unnecessary tests, and encouraging good health outside the hospital walls.
Three years into global budgeting, the state is “meeting or exceeding” its goals, according to a January Health Affairs study. Hospital revenue growth is well below counterparts nationwide, or the growth of Maryland’s economy. Plus, state hospitals have saved $429 million for Medicare, more in three years than it targeted for five. Most important, every state hospital (all of which are nonprofit) and every insurer in Maryland are on board with the system.
If a centralized rate-setter bands every insurer together to negotiate prices, all payer can functionally act like single payer in terms of bringing down costs. All payer reduces hospital and insurer overhead, since billing costs are known in advance. And because the Affordable Care Act caps the amounts insurers can take in as profits, lower hospital costs should flow back to the individual in the form of smaller premiums.
This is why five countries — France, Germany, Japan, Switzerland, and The Netherlands — use all-payer rate setting as the basis for their universal health care systems. These countries have been found to control costs far better than America’s fragmented system.
The system only applies to hospital payments, not primary care doctors or clinicians. However, last year Maryland submitted a “progression plan” to the Center for Medicare and Medicaid Services, with the goal of expanding the system by January 2019. That would line up with the swearing in of Maryland’s next governor.
Other states have looked to Maryland as a model. Pennsylvania has adopted global budgeting for rural hospitals. And in the wake of its single-payer failure, Vermont moved to an all-payer accountable care organization, where providers are paid based on health outcomes for the population. “In some ways it’s more radical [than single payer] if you’re able to get the incentives right,” said Joshua Sharfstein. But the true test of Maryland-style all payer is whether it can support universal coverage for every resident.
Maryland has a discouraging history with single payer. Health Care is a Human Right Maryland, an affiliate of Physicians for a National Health Program, did push a bill for several years in the state legislature. “In 2012, we had the bill in the House of Delegates, we lined up what we thought were enough votes in committee,” said Dr. Eric Naumberg, a member of the group’s leadership council. “But the leadership said you can’t bring this to the floor, and then we had seven votes instead of 12.”
Naumberg’s group has since focused on rallying support at the national level. “There are a lot of roadblocks set up for state single payer,” he said, including waivers necessary to incorporate Medicare and Medicaid and potential challenges under federal law regarding employer-based coverage.
Indeed, local politicians aren’t getting pushed yet. “I am not hearing a groundswell of support for a single-payer system or radically re-doing what we currently do,” said Shelly Hettleman, a member of the House of Delegates from Baltimore. “My constituents want to fix the system rather than totally reinvent it.”
However, with Maryland’s novel all-payer structure, you could potentially reinvent health care outcomes by merely tweaking the system. For example, expanding all payer across the health care system, along with tight regulation of insurers to keep premiums low, could mimic some benefits of single payer. Even Vincent DeMarco, who flat-out rejected the notion of state-level single payer, agreed. “If we can do that, we can achieve the same goals in a way that’s doable,” DeMarco said.
Maryland has a relatively low number of uninsured, about 6.7 percent of the population as of 2015. With a cost control mechanism already in place, getting them covered could prove cheaper and easier than other states. “I think you can combine alternative payment approaches with single payer, but you don’t hear about that much,” said Joshua Sharfstein.
Dan Morhaim, a House of Delegates member and an emergency room physician, suggested that the state could offer a benefit package he likened to tiers of coverage in education. “There’s public school, and if you are well-off you pay more to get tutored or go to private school. And you try to bring up that floor broadly and consistently.”
It would obviously still be a huge lift. Entrenched interests still see their survival attached to the status quo. While all hospitals in Maryland are not-for-profit (which is no guarantee against profit-taking), insurers, drug companies, and doctors not currently under price regulation can be expected to put up a fight. And with state balanced budget requirements, you would have to finance a state-run health plan, opening up the tax wars even though individual out-of-pocket costs could drop.
Two things work in Maryland’s favor. First, there’s the renewed support for single payer generally, particularly among progressive activists. Morhaim said that a recent op-ed he wrote for the Baltimore Sun about de-linking health insurance from employment got a wider response than he’s ever seen. “My email box flooded,” Morhaim said.
Second, there’s the promise of the Ben Jealous campaign. He can be expected to put single payer at the top of his agenda for the next year, to a public growing more open to the idea. And Jealous is not a novice at getting the seemingly unattainable done in Maryland politics, mounting lobbying campaigns that helped legalize same-sex marriage, abolish the death penalty, and pass a state version of the DREAM Act. “We are not here simply to elect me governor,” Jealous said at a recent speech. “You do not elect politicians to make change happen, you elect politicians to make it a little easier for a movement to make change happen.”
Jealous’ boldness has already moved Democratic primary opponents in his direction, of which there could be as many as seven. Alec Ross, a Hillary Clinton adviser during the 2016 campaign, who has a controversial plan to have investors loan working mothers money for child care, says he supports a state-based public option. Liberal State Sen. Rich Madaleno endorsed a public option as well, and has said he would “treat health care as a human right.”
Madaleno’s website rejects the idea that states can manage a single-payer plan alone. “One of the cornerstones of single-payer is that the government can negotiate and enforce prices. States can’t do that, only the national government,” it reads. But Maryland actually does precisely this kind of negotiation for hospitals, and could expand it.
Jealous’s nomination, followed up by the defeat of incumbent Republican Larry Hogan in November, would at least put single payer on the agenda in a state with a lot of relative advantages to getting it done. He would have a lot of policy support, with a deep well of knowledge in leadership roles at nonprofit hospitals, as well as from the many members of the part-time legislature who work in the health care system when not in session.
Would Maryland politicians be willing to fight for single payer? “I think the political system would be willing to take that on if the person who argued for it won the election,” Morhaim said. “It’s up to the voters.”
MARYLAND HEALTH CARE FOR ALL is that FAKE ALT RIGHT ALT LEFT global Wall Street Baltimore Development 'labor and justice' organization created by Johns Hopkins to sell the idea the AFFORDABLE CARE ACT was left social progressive meant to HELP THE POOR. This is why Maryland Health Care for All went with breaking GLASS STEAGALL DEREGULATION/CONSOLIDATION/MOST PRIVATE OF STATE HEALTH SYSTEMS -------rather than EXPANDED AND IMPROVED MEDICARE FOR ALL.
These several years of OBAMA killed Medicare---privatized it away handing it to that global corporate tribunal of health industry executives to fold hundreds of billions of dollars in Medicare and Medicaid into global health system budgets to send out anyway that health system wants......in Baltimore that was BLOCK GRANT PAY-TO-PLAY and MASSIVE N0N-PROFIT networks with no way to provide oversight and accountability----NO PUBLIC INTEREST PUBLIC AGENCY LEFT IN BALTIMORE because of MARYLAND'S EXCEPTION from Federal oversight during Clinton-era.
'However, with Maryland’s novel all-payer structure, you could potentially reinvent health care outcomes by merely tweaking the system. For example, expanding all payer across the health care system, along with tight regulation of insurers to keep premiums low, could mimic some benefits of single payer. Even Vincent DeMarco, who flat-out rejected the notion of state-level single payer, agreed. “If we can do that, we can achieve the same goals in a way that’s doable,” DeMarco said'.
During 2009 under an Obama Presidency and a super-majority of Democrats controlling Senate and House -----could not get a single voice in Maryland ---none in Congress----none in Maryland Assembly ---none in Baltimore to mention EXPANDED AND IMPROVED MEDICARE FOR ALL-----and VOILA----after several years of eliminating our Federal public health agencies under Affordable Care Act the 5% players and organizations are all promoting what can only be at this point ---UNITED NATIONS PREVENTATIVE CARE FOR GLOBAL LABOR POOL THIRD WORLD UNIVERSAL CARE--SINGLE PAYERS----it is far-right wing-----the opposite of REAL left social progressive EXPANDED MEDICARE......TELEMEDICINE FOR ALL.
This is our University of Maryland Baltimore---allowing a far-right wing health policy be sold as US strong left social progressive public health----
Category: Chapo Trap House--FAKE ALT RIGHT ALT LEFT GROUP folks-------we see these global 1% groups all the time at UNIVERSITY OF MARYLAND BALTIMORE----
The Right Tool for the Job - Single Payer for Healthcare Workers
· Hosted by Elyse DeLaittre
- clockWednesday, November 1 at 4 PM - 5:30 PM
about 3 weeks ago
- pinSMC Campus Center, Room 115
- app-groupsCreated for UMB SUPER
Join Students United for Policy, Education, and Research (SUPER) as we invite Tim Faust to come speak on why healthcare workers should advocate for single-payer as the tool for improving health justice, with a discussion to follow. Tim is a MPA candidate in health policy at NYU's Wagner Graduate School of Public Service, and has been speaking extensively around the US on single-payer and health justice. Food will be served.
Returning to the article in right wing
American Prospect-------we here a voice that is right on as regards Johns Hopkins----it has been the source of ZERO PUBLIC HEALTH in Baltimore last century and leads MOVING FORWARD to ZERO PUBLIC HEALTH in US Foreign Economic Zones. What we do not agree upon is the ILLUSION of what a HOWARD UNIVERSITY and by extension other HBCUs have done or were able to do-----when we know they PARTNERED WITH GLOBAL IVY LEAGUES LIKE JOHNS HOPKINS. The opportunity to be that 99% of public health our global IVY LEAGUES dismantled and fought was there ----and not taken. We know of the same BOULE in HBCU and Howard as exists in global IVY LEAGUE Hopkins, Yale, Harvard, Stanford et al------
'With 54 active chapters at medical schools across the nation, WC4BL says its primary goal, in the spirit of Black Lives Matter, is to put medicine’s racial disparities on the front burner.
Black Lives Matter may be providing a template for dealing with all the systemic issues that threaten and thwart black lives.
Indeed, Black Lives Matter may be providing a template for dealing with all the systemic issues that threaten and thwart black lives'.
It Will Take More Than Single-Payer to Make Baltimore Healthy
More than lack of access to health care, the ongoing legacies of Jim Crow diminish African Americans’ health.
November 20, 2017
We have found very few black citizens not aware of BLACK LIVES MATTER being that global 1% UNITED NATIONS movement just as OCCUPY WALL STREET was-----when we keep allowing reference to these groups as POPULIST LEADERS-----we cannot build REAL 99% movements. What we know is the BLACK BOULE formed during HARLEM RENAISSANCE was that black 1% ----they were mostly DOCTORS -----and they have worked last century to undermine EQUAL PROTECTION EQUAL OPPORTUNITY as those pesky 5% black players just as our Johns Hopkins filled mostly with our 5% white players did.
THESE ARE OUR HEALTH INSTITUTIONS HAVING BEEN ALLOWED TOTAL CONTROL OF VOICE IN PUBLIC POLICY ---MOVING FORWARD ONE WORLD ONE GOVERNANCE PREVENTATIVE CARE ONLY FOR GLOBAL 99% INCLUDING 99% OF US CITIZENS---BLACK, WHITE, AND BROWN CITIZENS.
Citizens not thinking telemedicine will not end well for 99% of WE THE PEOPLE must think to where microchipping, nanobotting, and constant data surveillance of our human bodies leaving individual citizens with no ability to control any of the above WILL LEAD-----need to WAKE UP ---and stop allowing captured 5% media give our 99% FAKE ALT RIGHT ALT LEFT TALKING POINTS----and not GORILLA-IN-THE-ROOM public policy goals---especially in health care.
Global Observatory for eHealth
Global diffusion of eHealth:
Making universal health coverage achievable
Report of the third global survey on eHealthAuthors:
World Health Organization
Publication detailsNumber of pages: 156
Publication date: December 2016
This third global survey of the WHO Global Observatory for eHealth (GOe) investigated how eHealth can support universal health coverage(UHC) in Member States. A total of 125 countries participated in the survey – a clear reflection of the growing interest in this area.
The report considers eHealth foundations built through policy development, funding approaches and capacity building in eHealth through the training of students and professionals. It then observes specific eHealth applications such as mHealth, telehealth, electronic health records systems and eLearning and how these contribute to the goals of UHC.
Of interest is the extent to which legal frameworks protect patient privacy in EHRs as health care systems move towards to delivering safer, more efficient, and more accessible health care. Finally the rapidly emerging areas of social media for health care as well as big data for research and planning are reported.
This report complements the Atlas of eHealth country profiles 2015 – the use of eHealth in support of universal health coverage
'With 80 percent of doctors in countries like Nigeria seeking work abroad and limited access to clinics in remote and rural areas'
The two MOVING FORWARD SMART CITIES nations---ESTONIA and NIGERIA----yes, they will indeed be the earliest to be tied to UNITED NATIONS UNIVERSAL TELEMEDICINE-----as 80% of REAL doctors leave NIGERIA.
Obama is proving to be that FOREIGN ECONOMIC ZONE king as was Clinton/Bush------not giving those 80% of Nigerian doctors real health facilities from which to provide developed nation quality of health care.....going, going, going in Western nations as well.
'Adebayo Alonge is a Nigerian entrepreneur and the co-founder of RxAll, an AI platform for pharmaceutical authentication and deliveries'.
What if the global labor pool human distribution system was dismantled and 99% of citizens became local business leaders building brick and mortar hospitals caring for 99% of their community's own citizens?
HOW FIRST WORLD STRONGEST IN WORLD HISTORY US PUBLIC HEALTH CARE WOULD THAT BE?
How AI Can Help Africa Get Universal Health Care Before America
By Adebayo Alonge On 10/30/17 at 11:56 AM
While American politicians quarrel over the Affordable Care Act, the United States—one of the few industrialized countries without universal health care--still spends twice as much per person per year on health expenses as the U.K. and Canada.
For all the debates over Obamacare, however, America boasts 38 MRI machines per one million people: Nigeria, a country of 180 million people, has only four. Across Africa, the ratio of doctors to patients is painfully low. The continent accounts for 25 percent of global disease cases, but has only 2-3 percent of the doctors in the world.
With 80 percent of doctors in countries like Nigeria seeking work abroad and limited access to clinics in remote and rural areas, the service gap across sub-Saharan Africa is wide. Almost one in two Africans lack access to modern health services—a figure expected to rise as the region’s population doubles by 2050.
Africa is a continent in need of universal health care. Efforts to increase coverage are underway: From Rwanda to South Africa, telemedicine and artificial intelligence have enabled health tech platforms to emerge, and allowed doctors to treat patients in under-resourced areas remotely, efficiently, and cheaply via mobile devices. Given increasing mobile penetration, low digitization costs, and few policy barriers, African markets are poised to use AI to leapfrog traditional health care infrastructure and achieve economically viable universal health coverage.
Despite a population of 1.2 billion spread across 54 countries, Africa is getting more and more interconnected. With prices falling to as little as $100, smartphone penetration more than doubled between 2014 and 2016. By 2020, smartphone adoption on the continent is expected to pass 50 percent—just shy of the global average.
A man takes a photo with his smartphone of painted artwork depicting then-President Barack Obama (L) and his Kenyan counterpart Uhuru Kenyatta at the Pre-Global Entrepreneurship Summit in Nairobi, Kenya, on July 23, 2015. SIMON MAINA/AFP/Getty
With the technology in so many hands, health tech companies have won half the battle. In Uganda, for example, tens of thousands of government health workers use MTRAC—an SMS-based technology connecting hospitals to the national drug chain—to report on local medicine stocks using their mobile phones. LifeBank uses digital supply chain technology to deliver blood when and where it is needed in Lagos, Nigeria’s biggest city with a population of over 20 million.
These tools are helping countries across sub-Saharan Africa circumvent the World Health Organization’s standard of one doctor per 5,000 citizens. Digital solutions make it easier to roll out new approaches to health care rapidly and at scale. Private companies and health care providers are seeing the business potential in health as disease patterns change and incomes rise. Pharmaceutical manufacturer Novartis partnered with Vodacom South Africa to connect community health workers to doctors through mobile technology. In Nigeria, General Electric has distributed cheap flip phone ultrasound scanners to diagnose more pregnant women.
Opportunity is boundless in Africa as mobile-fueled tech adoption flourishes. Mobile and digital is set do for health care what it has helped achieve for finance in Africa—overcome a lack of physical infrastructure.
Digitizing health records is essential to analyzing mass public health information. In 2014, the inability to capture and share data prolonged the Ebola outbreak in West Africa—but new platforms are emerging to address this. AMPIS in Nigeria, for example, turns hard copies of medical data into electronic health records for improved communication among stakeholders.
Digitized patient health records have been piloted in Ghana, Tanzania, Zambia, and elsewhere. Leveraging machine learning will help health care providers make more informed decisions about treatment and even prevent disease through data mining. Companies such as Ubenwa in Nigeria use machine learning to diagnose birth asphyxia by analyzing a baby’s cry.
As with most late 20th century focus in technology and medicine from internet to artificial intelligence ---telemedicine being installed today in MOVING FORWARD ONE WORLD UNIVERSAL HEALTH CARE FOR THE 99% OF WE THE PEOPLE had its start in meeting the health needs of space travel----and that is the goal of telemedicine in MOVING FORWARD. Once the 99% are microchipped, nanobotted, vaccined, and attached to ONE WORLD ONE TECHNOLOGY GRID-----they are indeed ready for that long space trip to MARS. We discussed the intention of placing planetary mining slaves in hibernation ----virtual reality entertainment-----all the technology being built today around telemedicine is creating the prototypes needed for this space travel.
Those nations first out of the MOVING FORWARD telemedicine race will be those global 99% ready to be that first plantetary colonizing mining slave. From the folks giving us TANG------
Each nation racing to build these telemedicine health tourism systems are also tied to space colonization and planetary mining goals.
Department of Space
Indian Space Research Organisation
Telemedicine is one of the unique applications of Space Technology for societal benefit. ISRO Telemedicine programme started in 2001 has been connecting remote/rural/medical college hospitals and Mobile Units through the Indian satellites to major specialty hospitals in cities and towns. ISRO Telemedicine network covers various states/regions including Jammu & Kashmir, Ladakh, Andaman & Nicobar Islands, Lakshadweep Islands, North Eastern States and other mainland states. Many tribal districts of Kerala, Karnataka, Chhattisgarh, Punjab, West Bengal, Orissa, Andhra Pradesh, Maharashtra, Jharkhand and Rajasthan are covered under Telemedicine Programme.
Extension of healthcare through telemedicine mobile van during Koshi river floods in Bihar.
Presently, the Telemedicine network of ISRO covers about 384 hospitals with 60 specialty hospitals connected to 306 remote/rural/district/medical college hospitals and 18 Mobile Telemedicine units. The Mobile Telemedicine units cover diverse areas of Ophthalmology, Cardiology, Radiology, Diabetology, Mammography, General medicine, Women and Child healthcare.
While DOS/ISRO provides Telemedicine systems software, hardware and communication equipment as well as satellite bandwidth, state governments and the speciality hospitals have to allocate funds for their part of infrastructure, manpower and facility support. In this regard, technology development, standards and cost effective systems have been evolved in association with various state governments, NGOs, specialty hospitals and industry. DOS interacts with state governments and specialty hospitals for bringing an understanding between the parties through MOU.
The recent activities under Telemedicine Programme involved migration and operationalisation of the nodes which were affected due to non-availability of EDUSAT (GSAT-3). Most of 190 nodes operating on EDUSAT were migrated to operational GSAT-12 satellite. Around 139 nodes are now operational on INSAT-3A and the remaining nodes on INSAT-3C and INSAT-4A satellites. ISRO is in the process of bringing in annual maintenance support for the Telemedicine systems to ensure continuity of service.
A Telemedicine monitoring node is established in DECU, Ahmedabad which is used for testing and supporting users for minor troubleshooting, etc.
A Telemedicine Users’ Meet was held at DECU, Ahmedabad to assess the utilisation and the future plans of the states/hospitals/institutions regarding the telemedicine nodes.