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Monday, August 12, 2019

Russell Ride 2019-Post and Video Clip

Excerpt from the 2019 Russell Ride Journal followed by a Utube clip
Day 1-Following a grinding work day on Friday the 21st, I opted to leave at 7:30 AM instead of 6:00. This decision proved stressful as weekend traffic was thick, post summer solstice and hitting the peak of tourist season in the Pacific Northwest. Luckily, I knew the route, slamming along Route 3 past the navy ships mothballed on shore until I exited onto “old Belfair Highway” and a bike lane. Then an easy mostly flat 10-mile ride into Belfair and a climb along the tree-lined highway towards Shelton. Past Herron Island and the northern Puget Sound outposts of Allyn and Grapeview, the route to the logging town of Shelton is preceded by a paved shoulder which is 24 inches wide at most. This seemingly adequate safety zone fails to consider the intrusion of mirrors which extend 18 inches from the passenger side of the commercial trucks, pickups, and recreational vehicles. Consequently, the cyclist must ignore the danger and ride a steady line.  
Aside from the late start I was soon pelted by rain all of the way into Mason County’s largest town. Nathan spotted me and did a quick pull over so we could take a photo to document the conditions, wet and miserable. Shelton is a 2-hour ride from Bremerton and entering the timber hub requires meandering around warehouses and various highway intersections. I am always relieved when I see the “Welcome to Shelton” sign as I leave town. There may be amenities here but they are opaque to the visitor, even someone going 15-miles-an-hour. I do not even recall a park with a restroom.
After a short highway jaunt on 108, I turn off at the McCleary casino which is my half-way rest stop. No flush toilets here, but a nice selection of porta pots and a picnic table with some historical markers. Nathan meets me here, right on schedule and we chat for 20 minutes. From here, I am now riding on smooth pavement along country roads, past farms and scaling a surprising number of hills. Once in the village of McCleary I turn left onto a beautiful bike path all the way into Elma, a sweet little town with some urban planning forethought including actual bike lanes. The land becomes flatter here, but the headwind increased to 20 MPH. I wryly observed my speed decrease on my odometer despite my best efforts. At one point I pulled into a bus shelter for a respite. Luckily, the rain had abated and it was sunny. I soldiered on to Montesano and the smiling face of my son, in the IGA parking lot. 

Nathan rode from Montesano, with a westerly crosswind and I waited for him 30 miles away in Raymond, a timber town. Weyerhaeuser owns most of the land in the region, but the town is on a river and is quite scenic with verdant hills all around. It even has sculptures along the road, a sure sign of affluence. I don’t remember much about it from last year, probably because I was so intent on getting into Astoria. South Bend is a charming town just west of Raymond with a bike path along the water and a great bike tool station with restrooms! I waited for Nathan here. He seems to be a strong rider and looks awesome in his made-in-the-US Borah gear! The goal is to camp tonight, so I need to find a site before dark and then circle back and find him. Destination-Cape Disappointment State Park on the Long Beach Peninsula.

Having plenty of time to kill, I decided to try and visit the man whom had helped me last year on the inaugural Russell Ride. I drove to his humble home and the place looked fairly deserted. I also saw a “for sale sign” off the road. I sure hope he didn’t die from his diabetes induced dialysis. Anyway, I left him the articles about the research the Russell Ride contributed to in 2018 and about this year’s ride. I also left him a brochure from Benaroya Research Institute.

Saturday, June 15, 2019

US Does Not Guarantee Healthcare To Diabetics Until Kidney Failure

If you are a diabetic in the United States, you will pay more for your insulin than anywhere else in the world and you are much less likely to have insurance pay for your required care. Presently, if a diabetic lacks private insurance, the U.S. government does not guarantee any medical care for that person until he or she is in end-stage renal failure, which means on kidney dialysis.  This provision is thanks to a 1963 act of Congress authorizing Medicare inclusion for those in end-stage kidney failure. If an individual is on Medicaid, which is for low-income folks, healthcare is provided. But working-class people without insurance are left out in the cold, unable to afford private insurance and struggling to buy their insulin.

The Trump Administration is suing the federal agency charged with administering the Patient Protection and Affordable Care Act known as Obamacare, which is one of the few methods that people can obtain affordable health insurance. In the United States only 52% of employers provide any kind of medical insurance or workplace benefits. Consequently 48% of the working population lacks access to affordable healthcare. In addition, if the Trump Administration gets its way it will rollback protections for people with pre-existing conditions and they will be unable, in many cases, to obtain any medical insurance. Keeping with current trends the Trump Administration and Senate leader, McConnell are intent to take the nation back to the fifties, not 1950, but 1850.

The US does not guarantee any access to primary healthcare for people with chronic diseases, like Type 1 Diabetes and in fact, many cannot afford to pay for their insulin, and some have died. This needs to stop.
  1.  Firstly, as a nation we need to start providing primary care to prevent kidney failure for diabetics and others. Providing care earlier will reduce problems and costs later. 
  2. Secondly, we need to reduce the manipulations of the pharmaceutical industry to continually up-sell scant changes in patent formulations which restrict access to affordable generic drugs.
  3. Thirdly, the Food and Drug Administration should represent the people of the United States and quit viewing pharmaceutical companies as its customers. A regulatory agency must maintain a separate authority from those it is policing. 
  4. Fourthly, let’s restore the application of quality science in health policy decision-making. 
  5. Finally, establishing a national healthcare policy, like Medicare-for-all would alleviate a number of these challenges, by providing a baseline of care, establishing one government authority to negotiate for pricing for health products and services, and lowering administrative costs.

 To that end, I am once-again riding the Russell Ride from Bremerton, Washington to Napa, California to promote the research Benaroya Research Institute is doing to cure Type 1 Diabetes, an auto-immune disease which took my brother at age 42. I will be speaking with people along the coast and listening to their stories about their diabetic challenges. This year, my son, Nathan will be riding with me. Join us for the Russell Ride by following me on Twitter or on the fundraising site below.

And this is the healthpolicymaven signing off encouraging you not to sign blanket medical releases, but specify that for which you consent and what you decline. And do consider making a contribution to the site, I hope to obtain 100 contributions this year.

Friday, April 12, 2019

Women's Health-The Attack on Reproductive Health

Women’s Health Revisited-Reproductive Health and Violence Towards Women

State healthcare laws impact women and should be considered by anyone thinking of relocating within the USA. Primary measures of women’s health and well-being include: access to reproductive services, availability of birth control options, maternal death rates, proportion of women covered by medical insurance, and violence against women. In order to keep this a blog-sized article, this analysis reviews; reproductive services, sex education mandates, and reported rates of rape, murder, and aggravated assault, which includes domestic violence. A subsequent issue will explore other components of women’s health.
Access to Abortion
Roe-v-Wade, the Supreme Court ruling which made abortions legal in the United States was enacted in 1973. The majority of the national population felt that abortion should be legally available to women then and still do today.  A 1979 study conducted by the Gallup Organization found 80% of the population believed abortion should be legal and 70% thought it should be available to women on Medicaid. (Public Perception on Abortion) It should be noted, the survey was commissioned by Redbook Magazine, which would have targeted a largely female population, so this acceptance of abortion rights may reflect the feminine viewpoint. A Harris Group poll at the time found 60% of Americans thought abortion should be legal in all cases. Fast forward to 2018 and Pew Research found that 58% of Americans still think abortion should be legal and only 15% were willing to say that abortion should be illegal in all cases, including rape, incest, and when the woman’s life is endangered. (Public Opinion on Abortion, 2019) The latter must view women as a host body rather than as emancipated individuals.
Table of Abortion Laws
Most Restrictive
Moderately Restrictive
Least Restrictive
Bans at 0-12 weeks gestation, which is during the first trimester of pregnancy
Allows abortion during the second trimester of pregnancy; 12-24 weeks gestation
States which permit abortion to-24-weeks and into the third trimester; depending on the circumstances
6 weeks-Louisiana* Senate Bill 184 proposes banning abortion at fetal heartbeat detection, which is during the embryonic stage (Clark, 2019)
Louisiana current law permits abortion to 15 weeks, which is 2 weeks past the 1st trimester
States permitting abortion to 24 weeks; CA, CT, DE, HI, ID, IL, MD, ME, MI, MN, MO, MT, NY, TN, WY
6 weeks fetal heartbeat law was voted unconstitutional by the North Dakota Supreme Court in 2016. ND has since voted to outlaw dilation and evacuation procedures, criminalizing doctors who perform them (Lam, 2019)

North Dakota current law permits abortion to 22 weeks
Massachusetts law allows abortion up to 27 weeks past the last period
18 weeks-Arkansas abortion ban was signed by Governor Hutchinson in March 2019. (Arkansas Governor Signs 18 Week Abortion Ban Into Law, 2019)
Arkansas current law allows abortion within the 2nd trimester
Virginia permits abortion at 25 weeks
6 weeks-Mississippi Governor Bryant signed a bill in March 2019 banning abortion at fetal heartbeat or 6 weeks past-last-period (Blinder, 2019)

Mississippi- current law permits abortion to 20 weeks, but restriction to 15 weeks is under litigation
These states permit abortion for lethal fetal anomaly: MS, GA, LA, SC, TX, DE, MD
6 weeks-Florida has a bill pending to restrict abortion once there is a fetal heartbeat, which is during the embryonic stage, so 6 weeks or less of pregnancy; and to make doctors performing abortions felons (Weiss, 2019)
Current Florida law permits abortion to 24 weeks
These states permit abortion to viability w/o restriction, leaving the decision to the clinician and patient: AK, CO,DC, NH, NJ, NM, OR, VT
Bans partial birth abortion; NH
House Bill 28 would outlaw abortion after 13 weeks in North Carolina (Cross, 2019)
North Carolina- current law allows abortion to 20 weeks
Michigan permits post viability abortion if a woman’s health is endangered
Senate Bill 1867 was signed by Arizona Governor Ducey, would require doctors to give life-saving treatment to aborted fetuses (Rau, 2019)
Arizona-has passed a law mandating a rollback to 20 weeks which is under litigation
Arizona currently allows abortion to 25 weeks
Ohio’s fetal heartbeat bill passed the legislature but was vetoed by Governor Kasich
Ohio current law allows abortion to 22 weeks
Permits abortion to viability for rape and incest: MI
Similar efforts to restrict abortion to 6 weeks also include:  Kentucky, South Carolina,Tennessee, and Texas. A Texas bill failed in April 2019 and would have included the death penalty for women who have abortions for any reason and for clinicians who perform them.
AL, AR, GA, ID, IND, IO, KS, KT, LA, NB, OK, SC, SD, TX, WV, WI all permit abortion up to 22 weeks
States permitting abortion to viability  if woman's life is endangered: RI, MI

States permitting abortion to viability for fetal abnormality: MD, DE
Utah has an 18 week ban on abortion in their 2019 legislative agenda
FL, MA, RI, NV, and PA permit abortion to 24 weeks
Utah permits abortion to viability for-rape, incest, and lethal fetal anomaly
*All first trimester bans are under review by the courts and are not currently allowed. The now conservative US Supreme Court is expected to hear some of these cases this year. Several states are trying to limit abortion from the point of fertilization or at the embryonic stage, which occurs within two weeks of the sperm penetrating the egg during intercourse, and before a woman would know she is pregnant. These folks must have skipped biology class as a fertilized egg is not a baby.

Availability of Contraceptive Services
Catholic hospitals have repeatedly been found not to comply with state laws regarding the availability of emergency contraception for women whom have been sexually assaulted. A California study found only 66% compliance among Catholic hospitals. (National Women's Law Center, 2019)
Table of Laws Governing Access to Birth Control Options
Most Restrictive for Sexual Activity
Least Restrictive for Sexual Activity
Access to Abortion Clinics (Citizen, 2019)

States with the fewest number of abortion clinics for the eligible population of females, each with only 1 clinic: MS, MO, KT, ND, SD, WV
Other states with a dearth of facilities: AL, SC, LA, WI, UT, TX
These states may have adequate abortion facilities, based on population but they are not geographically dispersed: MN, IA, ID, WY, NE, KS, OK, AR, TN, DE, RI, HI
States considered to have acceptable access to abortion clinics: CA, OR, WA, CO, MT, GA, AK, NC, VI, MD, NJ, PA, NY, NH, VT, ME, CT
Availability of Morning After Pill
This is commonly known as Plan B was approved by the FDA in 2011 (Princeton University, 2019) Because this is emergency contraception it must be administered within 120 hours of sperm exposure.
States which do not mandate information on emergency contraception even in the event of rape: MS, MO, GA, NC, LA, ND, SD (, 2019)
States permitting pharmacists to prescribe emergency contraception to women of any age: AK, WA, CA, HI, NH, NM, VT, ME, MA
States with reporting mechanisms for hospitals that do not comply with emergency contraception notification for rape victims: HI, MN, NJ, NM, IL OR, UT, WA, and WI (Washington Women's Law Center, 2019)
Birth control RX is mandated coverage for private insurance; although self-insured plans under ERISA are exempt as are religious entities (Laurie Sobel, 2019)
No mandate to cover RX contraceptives on government plans in: TX, TN, VI, OH
All other states mandate RX contraceptive coverage on private insurance plans
Birth control RX is mandated coverage for state agencies

Abortion covered by insurance
(Guttmacher Institute, 2019)
No mandate to cover RX contraceptives on government plans in: TX, TN, VI, OH

States with limited insurance mandates to cover abortion: AZ, ID, IN, KS, KY, MI, MO, NE, ND, OK, UT
These states will not allow any exemptions for state or private agencies: CO, GA, IA, MT, NH, NV, VT, WA, WI (Laurie Sobel, 2019)
Medically necessary abortions must be covered by insurance: WA, OR, NJ, NM, NY, IL, HI, CT, CA, AZ, AK
Mandated sex education in public schools (Guttmacher, 2019)
These states have no mandate for sex education in public schools: AZ, CO, FL ID, MA, VI, TX, LA,
States requiring sex education to be medically accurate and also provide education on sexually transmitted diseases: CA, DE, DOC, GA, HI, IA, KT, MN, MD, MS, MT, NV, NJ, NM, NC, ND, RI, SC, TN, UT, VT, WI
Nonprescription birth control measures (condoms) widely available at retail outlets

Some states like TX, AR, and DE have laws requiring condoms to be distributed by MD’s or Pharmacists-These laws are typically not enforced. (McDevitt, 2016)
Metropolitan areas throughout the US have condoms in grocery, drug, and convenience stores. Individuals can have condoms delivered to their home from Amazon or the Condom Super
Adequate supply of OBGYN and primary care providers (Citizen, 2019)
Inadequate supply of primary care for women in: ND, SD, MO, IO, IND, WI, KT, WV, UT, MS, TX, GA, LA
Adequate supply of primary care for women: WA, OR, CA, NY, MA, MI, IL, PA, NJ, NC, VI, MD, FL

Assault and Violence-A Statewide Analysis
Using the Federal Bureau of Investigation Crime Statistics for 2017 I analyzed rape, murder, and aggravated assault, which includes domestic violence statewide. The tables below show the safest and most dangerous states for women to live. Scores compare the variance between the national average and each state’s metrics including the Washington DC area. A negative score means these states had fewer incidents than the national average and conversely a positive score means the state had greater incidents of violence. These data are combined male and female rates, but 79% of all violent crimes were committed by men and women were victims 48% of the time. However, 93% of rapists were male and 89% of their victims were female. Likewise, for murder,78% were men and 24% of the victims were women.  (Federal Bureau of Investigation, 2019)
Safest Places
The safest places to live in the USA are the northeastern states of Maine or Vermont or the eastern seaboard states of Connecticut or Virginia. These states all tend to have good education systems and fairly high taxation. If you are a woman living in Maine you are 3 times less likely to be raped, nearly 5 times less likely to be murdered and 3 times less likely to be assaulted than for a woman in Alaska.

Table of Safest Places in the United States

Health Metrics
For Violence

Measures based on 2017 FBI data
National Incidence Rate per 100,000 people


Aggravated Assault

Combined Score


 Most Violent Places
In terms of this ranking methodology, the goal is to have fewer events than the national average for acts of violence but as you can see, these states have high rates of aggravated assault, rape, and murder, compared to the national incidence rate. It is difficult to draw conclusions from this grouping as they are so varied. Most worrisome is the rape statistic for Alaska, which I triple checked and represents 32 out of 39 agencies reporting their data for 2017.  Alaskans have 386 more incidents of these violent crimes per 100,000 people than the national average, due largely to the rape metric.  However, the assault rate was high in Alaska as well.  The highest murder rate in the nation was in Washington DC, with more than twice as many murders than the national average for 2017. The rate of assaults in DC is similar to Alaska. About the only things that Alaska and New Mexico have in common are large tribal populations, which may explain some of the violence. But Montana also has significant tribal populations and their violence metric was much lower as was North Dakota's, where the Pine Ridge Reservation is located.

 Table of Most Violent Places In the United States

Health Metrics
For Violence

Measures based on 2017 FBI data
National Incidence Rate per 100,000 people
Washington, District of Columbia
New Mexico


Aggravated Assault

Combined Score


In my 15 hours of research for this article, I decided the issue of female autonomy and reproductive rights is too complicated for one article. This analysis has attempted to show the level of vitriol lobbed against women’s constitutional rights at this moment, during the Trump Administration. Though the anti-abortionists have been relentless in their assaults on state laws governing women’s health and the clinicians whom provide these services, they have only managed to change public perception by 2%. According to a recent Pew Research poll only 2% fewer Americans believe abortion should be outlawed.  All of the harassment, personal injury, and even deaths caused by the irrational cabal of personhood-fetus-promoters has barely managed to move the dial. One can only hope that doctor patient privilege and privacy will be protected by the courts. But with the statewide and more recent federal court appointments hueing conservative, we can anticipate an increase in the rate of incarceration for women whom are merely trying to make informed decisions for their lives. At the Supreme Court we can count on newly minted Justice Kavanaugh, who doesn’t hate all women, just the ones who disagree with him, to vote against women’s autonomy at every turn. (Congressional Record, 2018) (AP, CNN, 2018)  

And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when entering an inpatient facility. Do stipulate that for which you agree and for which you decline.

This article was written by Roberta E. Winter, MHA, MPA a freelance journalist and is not subject to approval of any corporate or government agency. Winter is the author of Unraveling US Healthcare-A Personal Guide, published by Rowman and Littlefield in 2013. Research for this article will inform an update to her healthcare guide.


80% of Americans Believe Abortion Should Be Legal-70% Approve Medicaid Funding. (n.d.). Retrieved April 6, 2019, from
AP, CNN. (2018, September 28). Key Moments from the Ford and Kavanaugh Hearings Video. Retrieved from The Guardian: (2019, April 6). Retrieved from Associated Press News:
Arkansas Governor Signs 18 Week Abortion Ban Into Law. (2019, March 15). Associated Press. Retrieved April 11, 2019, from
Blinder, T. W. (2019, March 21). The New York Times. Retrieved April 11, 2019, from
Citizen (2019, April 7). Data shows unequal access to abortion clinics nationwide. Retrieved from CU-Citizen
Clark, M. (2019, April 8). Law Banning Abortion After A Fetal Heartbeat is Detected Is Set for Consideration by Louisiana Legislature. Times Picayune. Retrieved April 11, 2019, from
Congressional Record. (2018, September 27). Supreme Court Hearing Sexual Assualt Hearing. Retrieved from C-Span:
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Lam, K. (2019, April 11). North Dakota Becomes Third State to Ban Dialation and Evacuation Procedure. USA Today. Retrieved April 11, 2019, from
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McDevitt, D. J. (2016, July 22). Condom Laws. Retrieved April 7, 2019, from sex education blog: (2019, April 7). Emergency Contraception State Laws. Retrieved from National Center for State Legislation:
Princeton University. (2019, April 7). Emergency Contraception. Retrieved from
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Rau, A. B. (2019, March 14). What Arizona's Latest Abortion Law Really Does. The Republic, p. 2017. Retrieved April 11, 2019, from
National Women's Law Center. (2019, April 7). Providing Emergency Contraception to Sexual Assualt Victims. Retrieved from Washington Womens Law
Weiss, J. (2019, January 20). What is the Future of Abortion Restrictions in Florida. WLRN. Retrieved April 11, 2019, from