Sunday, March 6, 2011

"Free" Universal Healthcare for All Americans

According the U.S Census Bureau, approximately 50.7 million U.S. residents (16.7% of Americans) have no health insurance. Additionally, more money is spent per person on healthcare in the U.S. than in any other country of the world.  Despite the fact that the U.S. pays more than than any other United Nations country (except East Timor), America lags behind other wealthy nations in infant mortality and life expectancy (48th in the world).

Physician Wages
Physician wages in the US is double that of Europe which is a major reason for the expensive health care.  Meanwhile Americans are experiencing double-digit increases to the cost of health insurance, pay more out-of-pocket costs for doctor visits and facing rising prices for prescription medicine.

Childhood obesity has tripled in the last 30 years – 16% of children are said to be obese (per the CDC).  Overweight children are being diagnosed with many obesity-related illnesses which previously were only seen in adults.  Consequently, health care costs due to obesity has risen and if allowed to go unchecked will grow to about 21% of healthcare spending by 2018.

Health Insurance
In the 2007 film “Sicko,” director, Michael Moore, described how a lady named Mychelle who had a life-threatening bacterial infection and was taken to the emergency room was told by her insurance company that she must be transferred to an approved hospital.  Three hours later after transferring hospitals, she dies.

Moore dramatizes this real-life tragedy because he wanted to highlight the problem with healthcare in the US, which he blames on “health care lobbyists and right-wing nuts.”  Furthermore, Moore calls for the country to abolish healthcare insurance and to opt for “free, universal health care for life.” (this idea will be addressed later in the paper)

Three years later, President Obama signs the Patient Protection and Affordable Care Act which aims to reform the private-health insurance market and provide better coverage for those with pre-existing conditions.
Starting in 2014, health insurance companies will no longer be able to deny coverage to anyone with a pre-existing condition.  This would seem to be beneficial to Americans in general and would impact the health insurance industry significantly.

However, all Americans will be required to purchase health insurance by 2014 or pay a fine (maximum of $695 per individual or $2,085 per family annually).  This also applies to Americans who are currently happy with their health insurance – they may be forced to switch plans and get less coverage.  Still, the penalties for not purchasing insurance may not be a bad option for some Americans.  If a person or family is not expecting any large medical expenses, they can opt not to purchase. They won’t have to worry about any emergencies, because they cannot be denied health insurance (for pre-existing conditions).

Private hospitals, which now would have to adhere to new government-determined measures of quality will be greatly affected by Obamacare.  Additionally, they will be reimbursed for Medicaid patients at a different rate and doctors may be required to perform processes not required for patients.  Now subject to more government regulation and oversight, doctors will see their jobs become more difficult.

The healthcare reform bill will also drastically change the way small businesses buy and supply health insurance. Businesses with more than 50 employees and less than 100 will be required to provide health insurance which they can buy from a pool of small businesses.  Business owners argue that that added expense may create more problems for business owners and is a large disincentive for hiring more people.

Other stakeholders affected would be the pharmaceutical industry.  Because medicine has gotten very expensive, new requirements will be imposed on their balance sheets which will surely weaken this industry and affect upcoming research. Their quest for drug and device innovation will be seriously hampered by new government regulation.

Lobbyists have driven this point home up on the Hill.  Although, they have been zealous in speaking up against taxes and fees, they failed to publicly recognize that Obamacare will hinder innovation and will cause degradation in the private sector market, a market that currently leads the world in quality and resourcefulness.

After reviewing the above list of stakeholders, just who isn’t affected by the healthcare reform bill – just about everybody is.  And you can see that there are numerous problems, loopholes, bureaucracy and costs with the healthcare reform bill -- a bill that was supposed to do just the opposite.

What’s the Alternative?

In general, there is nothing wrong with healthcare in America.  We have the best hospitals, physicians, health-care workers in the world and American medical innovation is cutting edge.  Unfortunately, the rising cost of health care is driven by the rising cost of insurance – an industry that has often times denied the public of full healthcare, an issue called revisibility – refusing to pay for countless medical services.

To lessen the burden on our healthcare system and to bring down costs, here are
some alternative steps:
1)             Let’s Move – The First Lady has launched this campaign to make fight childhood obesity by increasing physical activity and making meals more healthy.
2)             Limits on Lawsuits – Because lawyers add costs, doctors are required to purchase very expensive insurance which then drives up prices
3)             Rely on Innovation in IT – Expand web-based technologies that focuses on usability and customer experience.
4)             Offer Incentives for staying healthy and maintaining weight (This can be incorporated within the company)
5)             Eliminate tax break for employers for health insurance – this puts a chokehold on the individual market.
6)             Allow more medical workers to become healthcare providers with less schooling.  We don’t always need doctors to do routine check ups.

How about public policy?

 If these steps combined cannot reform our healthcare, then perhaps something more substantive needs to be done.  If it doesn’t appear that the health insurance system can be properly controlled, my recommendation is to do away with it completely.  Just as Michael Moore had suggested in his film “Sicko”, the U.S would be better served by incorporating a universal healthcare system where the private sector provides the care and the government ensures affordability and control.  The main difference with Obamacare is that there would be no requirement to purchase insurance, since all healthcare would be free.

The UK and Canada uses this model  (albeit complaints of substandard healthcare overseas). Socialized medicine may not be a popular concept in our country that delivered the Declaration of Independence. But in a country suffering from budget deficit and a healthcare crisis, it may be the one panacea that ensures everyone gets healthcare, while keeping costs down for the states, the hospitals, the physicians, the pharmaceuticals and ultimately the patients.


Friday, February 18, 2011

Sexual Violence: The Growing Epidemic in Egypt

It was the first day of EID.  The holy month of Ramadan had just ended and Egyptians were out in the streets en mass to reward themselves for the struggle that they endured for the last month.

After visiting the mosque to say a special prayer a special time of meet and greet provided with homemade sweets, many Egyptians went to see the debut of a new film downtown.  It was Oct 2006, and Egyptians were generally excited, but their energy was pent up and the steam valve had to be released soon or somewhere whichever came first.

But the film quickly sold out and mobs of angry men showed their disapointment by tearing down the post office.  After accomplishing this and with security not present, they decided to engage in a sexual frenzy and ran around grabbing and groping any women in sight.  It didn't matter whether the woman were wearing a hijab or uncovered.

No women was safe.  Egyptian or foreigner.  They ripped off clothes and sexually assaulted on the street in front of thousands and in front of police who seemed powerless. 

And the beatings and rape occurred for a brutal five hours from 7:30 pm to 12:30 am.  Yeah, the police was there, and the police just stared.

Sadly there was no explicit criminizing sexual harassment in Egypt.  The specific legal wording to aid in protection women exists nowhere, making prosecution extremely difficult.

Thankfully many good Samaritan Egyptians came to the aid of the women. Shopkeepers harbored women inside their stores.  Taxi drivers locked girls inside the cars, but the angry mob still tried to break the windshield and get the girls out.  It was pure pandemonium. 

And where was the news?  The event occurred with virtually no reporting on TV or in the papers.  No CNN.  It would have gotten totally unnoticed if it wasn't for the citizen journalist who through social media channels came out to document this gross injustice.  Thankfully bloggers documented and reported the incident with vigor.  They provided pictures to the police officers who blatantly refused to take action.  They were afraid that there would be negative repercussions from their peers.   

 This act led to protest on the streets by bloggers, women's rights activists and the common Egyptian who were sick and tired of the state police standing there doing nothing to quell violence.
Photo by Hossam el-Hamalawy, taken on 9 November 2006

The press would not be silenced after all, and the rest of the world needed to know about Egypt's shame and sexual violence.

Sexual abuse is rampant in Egypt.  Perhaps it has gotten progressively worse since that fall EID day in 2006.  In the past, Egyptians used to respect the women.  Now, if you are a woman living in Cairo, chances are you have been sexually harassed at some point.   It happens openly in the streets, on buses, in the workplace, in the doctor's office.  It happens in front of the police, and the government is well aware of the problem but has done little to quell it.  It would happen more in the metro train if it wasn't for the women-only trains.  And what is the glaring response by society as a whole -- it is the woman's fault for wearing something provocative, for being on the street at the wrong time, for walking alone --  Harassment happens to locals, ex-pats, even tourists.  As the Fleeting Glimpse blogger told me, "With regards to women rights, Egypt is 50 years behind the times."  I'll say that there's no comparison -- no other civilized nation in peacetime has seen sexual harassment so pervasive and ill-enforced than anytime that history books can recall or remember.

And sexual harassment by spouses can be brutally worse.  Men have been known to abuse their wives, some even burning and disfiguring them with seemingly impunity.

Why is sexual harassment so rampant in Egypt?  Some point to the spread of conservative Islam from the Gulf states.  Several million Egyptians went to work in the Gulf States.  When they returned, they brought back a more conservative view of women in the society.  But I personally it is more than that.  It is the government not doing enough, not taking a firm enough stand, and turning a blind eye to this very serious problem that is endemic in this society.

The Big Screen has Taken Notice

In the movie, "678", a man is eyeing a middle-aged woman on a jam-packed bus and sliding his hands behind her.   Though fictional, the story is inspired by true accounts from women who had to ride bus 678 daily and become helpless victims of this lewd behavior.

Lately Things are Changing, but will it Last?

Last year, the first man in Egyptian history was sentenced to jail and hard labor for groping filmmaker Noha Rushdie Saleh.  Sharif Gomaa drove a van besides her and grabbed her breasts so forcibly, she fell.

Unlike what millions of other women did before, Norah took the case to court and won.  The sentence was considered so harsh that the Egyptian Center for Women's Rights (ECWR) stated that this act would  "restore confidence in the legal system's ability to defend women subjected to such crimes."

This is a huge step in the right direction, but will it be enough to stem the tide.  Will the government call on the police to crack down, take action and not just stand on the side and watch.

Social Media Can Help

Yes, there's Twitter and Facebook and they have done a lot for victims to network and share stories.

A new site has been created for women to report sexual harassment:

The harassment covers incidents from catcalls, touching, indecent exposures and sexual invitation.

Women can now use SMS to report sexual harassment.  And they will get a response back to let them know what has been done about it.

Hopefully social media will do much to stamp out social injustice and sexual violence in Egypt.

Editor's Note: My heart goes out to Lara Logan and I commend her for her great work and courage in journalism.  

Tuesday, January 25, 2011

No Common Sense for Common Law in Chicagoland

Common sense and common law doesn't have to be mutually exclusive.  The one-year residency requirement to run for Chicago mayor, I'm sure was written eons ago to prevent outsiders from running Illinois' biggest city.  No one at that time expected a scenario where a member of Congress from Illinois' 5th district would be called to become the chief of staff for the President of the United States.  And if they did, they would probably made provisions for it.

Rahm's Chicago home
And when Emanuel was called, he did the right thing and served his President. Emanuel also took care of his family by moving them to DC and renting out his Chicago house.  As the Chief of Staff, Emanuel only made about $170,000 a year, so I'm sure he could not afford two residences.  Emanuel also wouldn't have known that Mayor Daley would be not be seeking his seventh term.  If he had known Emanuel might have decided to retain his Congress seat.
Mayor Daley
That's why it amazes me that the Illinois Appellate Court has ruled 2-1 that Emanuel cannot be on the ballot because he wasn't a resident of Chicago for one year prior to the election.

For one, everyone knew that Emanuel technically wasn't a resident of Chicago for the last year.  What do you blame him?  But sometimes, Judges should not be so narrowly confined to the law.  Judges should also consider the spirt and intent of the law, what exceptions should be considered, and what was the true intent of the person involved.

When Judges become too literal and intercede against the people they are eroding the true meaning of the Constitution and disregarding the very beginning words of this foundational document "We the People."

In short, Judges are paid to use common sense.  They are supposed to interpret the law for each situation, not just declare it.  In truth, the Chicago residency law may be quite gray.  It surely had passed  the White House vetting, if not the President would not have let him go.

When cases are gray and the requestor shows good faith, the Court should allow the benefit of the doubt and let the people of Chicago decide whether Emmanuel truly qualifies to be their mayor.

Monday, December 20, 2010

LTC Lakin's Lawful Order

The Uniformed Services University (USU) has a worldwide reputation as a center of excellence for military and public health as well as for eduction and research.

When I had the pleasure to work at the Bethesda National Naval Medical Center (2004--2005), I had the opportunity to see the great work at USU staff and students.

A lot of the initial work for advanced kevlar (fiber developed by DuPont) for the purposes of ceramic plates in body armor was conducted at USU.

Military doctors not just save lives -- they go into harm's way, defend themselves and face the enemy when necessary.  They have a tough role.  LTC Lakin was one such doctor who has gone to harm's way (Afghanistan) and performed superbly.

That is why I was very surprised to hear about the refusal of LTC Lakin,  Army doctor (Birther) who refused to deploy.  He definitely wasn't looking out for his wellbeing and his family when he chose to disobey a lawful order.

Whatever the issues and appeals of the Birthers, it wasn't up to a military doctor to bring them up.  There are many people working on this and the case has been appealed to the Supreme Court.

When you sign up, you serve your Country when ordered.  If you have conscientious issues, you bring them up through your chain of command, but that shouldn't stop you from fighting for your Country.

Kudos to Military Medicine, and let's hope LTC Lakin and others learn their lesson.

Friday, September 17, 2010

Fenty Should Run as a Republican

“I think even the mayor will admit that the schools have been so neglected that we're really talking about peanuts in terms of making them look like we want to educate children.”
The primary this week was more a referendum on Fenty's personality that on his performance.

That's why I think he deserves a second chance, as a Republican.

Why not, more than 800 Republicans wrote him in and Fenty has until 4:45 pm today to accept the Republican nomination.

Credit: J Scott Applewhite/AP Photo: Andrew Harrer/Getty Images
Fenty lost the primary by around 10,000 votes.  There are 29,000 registered Republicans in DC.   If you assume that everyone who voted for Fenty on Tuesday will vote for him again in November, then he has two months to apologize and appeal to the masses who turned up against him and significantly close the gap or possibly win.

Monday, August 9, 2010

The Taliban's Big PR Mistake

The horrible execution style murder of 10 medical personnel in a previously-safer area in Northern Afghanistan dealt a big blow to the overall medical mission in Afghanistan. Surely, I can fully understand if civilian humanitarian health care providers now feel unsafe to carry out their mission if they cannot be guaranteed protection from the insurgency.

This tragic murder was the worst assault on foreign Christians since the 2007 kidnapping of 23 South Korean missionaries. Two male hostages were slain before the South Korean government negotiated their release.

Once allowed to operate with a degree of immunity, aid workers now face a very dangerous working environment, a setback for the Obama Administration's call for a civilian surge in southern Afghanistan.

In this assault, the Taliban committed a grave mistake indiscriminately killing humanitarian aid workers from the International Aid Mission, a group that has been working in Afghanistan for over 30 years.

Medical care is one of the basic needs you can provide to people, even more for the indigent.  When you kill the medical people that are generously providing care and you deprive them of that care without an ability to replace it, you will eventually lose public support.  That is the basic law of politics and applies even to to an authoritarian regime.

Perhaps the Taliban should tear a page from the Irish Republic Army lessons learned rulebook (if there's such an animal).  In 1998, the IRA finally gave up on all military means to reach a united Ireland mostly because public opinion (with all the bloodshed and fear) over time had strongly built against them.  As a result they signed the Belfast Agreement in 1998, marking a deescalation of violence.

Just like the British did in Northern Ireland, I am a big believer that victory in Afghanistan can only be gained through both military and political negotiation with the Taliban.  In fact, earlier this year, President Hamid Kazai has expressed desires to negotiate peace with the Taliban.

Thus, ISAF and the Afghan government must receive assurances from the Taliban that they will not murder medical personnel who are exclusively providing care.  If we don't get that assurance, it would not be prudent and safe to continue providing medical care without military protection -- which in the long run could deal a lethal blow to the Taliban in the world of public opinion and support from local Afghans.

If the Taliban lose support, they will not be able to enlist the young fighters that are needed to fuel their growth and many Afghan villagers may decide to revolt against and fight the Taliban.

Medical care is a basic necessity and medical providers' security is their basic necessity.