Time to Take Action on Electoral Reforms

 

Now is the time to think about the distortion that dark money and huge corporations cause in the U.S. electoral system, which nullifies the will of the American people. Democracy can only survive if its people are informed and empowered with equal access to voting. Good health practices, clean air, and clean water are something we all desire, but the power of a few corporate oligarchs entrenched in outmoded industries seek and have been succeeding in ruining safeguards for us all under the Trump Administration.

Rolling back fuel efficiency standards for vehicles doesn’t provide new jobs, make the US more competitive, or provide any mitigation against cancer causing and planet warming gases. All of the other industrialized nations in the world have adopted higher fuel efficiency standards and will be capturing market share while the U.S. lags further behind, thanks to the current vacuum in leadership.[1] Failing to listen to Jimmy Carter in the 70’s the U.S. did not adopt more energy efficient building standards, unlike Europe, Scandinavia, and other nations. This too meant the nation fell behind in advancing greater efficiencies in energy usage. (Berkland, 2014) Due to the high price of oil and cheap Chinese solar batteries, the U.S. was finally catching up in the last decade, with rapid development of environmentally friendly energy production, such as wind and solar, but again the Trump Administration seeks to retard this process. The Koch brothers and others in the extraction industries are only interested in short term profits, but these companies could diversify into other sectors. Why not use their billions to improve how we access and deploy nature to create systems that will power our homes and businesses? Because we make it so easy for them to continue the same harmful practices, including burning natural gas which is occurring at oil wells because it is too inconvenient to contain and transport. The Trump Administration has also allowed the destruction of barrier islands on the coast, without creating mitigating artificial ones to at least allow bird estuaries a chance to survive. (Russell, 2020) We are already experiencing a massive extinction of many animal species, but no one in the Trump Administration seems to care, given the fact most of them will also be extinct based on life expectancies. Leaving an untenable planet for future generations doesn’t seem to bother them at all.  People that are working in the coal industry would welcome a chance to work in other sectors, including the creation of more efficient solar and batteries for electric vehicles. This anti-socialism rhetoric is false as the people of West Virginia and Kentucky would appreciate federal government investment in their communities.  Instead, they are assaulted with mere talk as their hospitals close, more people lose their jobs, and their health insurance.

Let’s create new jobs through green energy and by rebuilding our crumbling infrastructure, bring back the conservation corps that built so many of our beloved structures in national parks. Though Trump and the Republicans have controlled the Senate, for four years, they have shown no interest in rebuilding the nation. It is so much easier to offer tax breaks to huge corporations and the ultra-wealthy, who don’t need them.  Meanwhile, people like me pay higher business and personal taxes. And I don’t even mind paying my taxes, but I do mind the unfairness of our tax system, that makes the bottom 25% spend a far greater proportion of their income in taxes than the wealthy. (Picchi, 2019) And I am very concerned about the encroachment on our privacy and our liberty with the Trump Administration’s increasing militarization against its own people. This should unnerve even the most stalwart of Republicans.  When the government turns its weapons against law abiding civilians this is fascism. Yet some people still cheer because they believe they are in the right, except the unleashed militarization of our government could just as easily turn its power against them.

Denying science and criticizing those with excellent educations doesn’t make the U.S. more powerful, it makes us laughable internationally. By improving education access for all, including disenfranchised rural areas we can capture the electric brilliance of our people as we did in the 20th century. Children should not go hungry while fat cats enjoy tax breaks and the Trump Administration cuts school lunch programs. (Helen Bottemiller Evich and Juan Perez, 2020) Let’s create an incentive to go to school by offering free high-quality nutritious meals for our children and youth, because they are our future. By providing free meals for all students it would help eliminate discrimination against children from low-income households. America produces so much food that lots of it is given away, so why can’t we feed our children in public schools? Just because children don’t vote doesn’t mean we shouldn’t care.

Infants and toddlers should not be stripped from their parents, who only seek to work towards a better life. The woman who walked from Central America carrying her child 1,000 miles is exactly the kind of immigrant we need, someone with a dream, drive, and willing to put up with hardship. Yet the Trump Administration has rewritten immigration rules to make it harder for foreign students to study at our universities, for our companies to hire the best people for scientific research, and for families to reunite. Odiously the Department of Homeland Security has gone after immigrants who have lived and worked here for decades, paying taxes, with no criminal records, all because of their heritage. Trump seeks to remake this nation with the one-percenters from other countries who can buy their way in. Rich people aren’t better human beings, they may just be luckier or in many cases criminal. (McEvoy, 2020) Most of your healthcare providers are not rich, but would you seek to limit their immigration in areas of critical healthcare needs-because this is what the Trump Administration is doing.

Our nation cannot be successful if 60% of the population doesn’t embrace the administration. (Presidential Approval Ratings-Donald Trump, 2020) Bring more people to the table and we can really build something. We need to be able to tell our grandchildren and those who come after, that we did everything possible socially, emotionally, physically, and financially to assure their survival and November 3rd is the time to prove it. The survival of our democracy must be realized by liberty and opportunity for all-not just the privileged.

This is the healthpolicymaven signing off encouraging everyone to vote as our healthcare, clean air, potable water, and liberty depend on it.

Roberta Winter is an independent journalist and healthcare advocate and author of a guidebook to the US healthcare system, published by Rowman and Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

References

Berkland, S. (2014). A COMPARISON OF AMERICAN, CANADIAN, AND EUROPEAN HOME ENERGY-Performance in Heating Dominated-Moist Climates Based on Building Codes. Scholar Works. Retrieved October 21, 2020, from https://scholarworks.umass.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=2332&context=theses

Helen Bottemiller Evich and Juan Perez, J. (2020, July 21). It's Insane Millions of Kids Would Lose Access to Free Meals If This Program Expires. Politico.com. Retrieved October 21, 2020, from https://www.politico.com/news/2020/07/20/millions-of-kids-may-lose-out-on-free-meals-as-they-return-to-school-374587

McEvoy, J. (2020, August 8). Bannon Joins Long List of Trump Associates Who Have Been Charged or Imprisoned. Forbes.com. Retrieved October 21, 2020, from https://www.forbes.com/sites/jemimamcevoy/2020/08/20/bannon-joins-long-list-of-trump-associates-who-have-been-charged-or-imprisoned/#124dd8475ea4

Picchi, A. (2019, October 16). The US Tax System-New Engine of Inequality. CBS-Money Watch. Retrieved October 21, 2020, from https://www.cbsnews.com/news/u-s-tax-system-a-new-engine-of-inequality-economist-gabriel-zucman-says/

Presidential Approval Ratings-Donald Trump. (2020, October 15). Gallup Poll. Retrieved October 21, 2020, from https://news.gallup.com/poll/203198/presidential-approval-ratings-donald-trump.aspx

Russell, J. (2020, July 2). Conservation Group Sues Over Changes to Coastal Dredge Rules. Courthouse News Service. Retrieved October 21, 2020, from https://www.courthousenews.com/conservation-group-sues-over-changes-to-coastal-dredge-rules/

 

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[1] https://morningconsult.com/2019/07/31/united-states-risks-lagging-internationally-on-fuel-economy/

 

How the US Healthcare System Starves Rural Hospitals

Healthcare is the central concern in the 2020 elections in all fifty states and US territories. This article reveals more information on states with hospitals which are in danger of closing and one key finding is that most of these states (all voted Republican in 2016) chose not to expand Medicaid with the 2010 Affordable Care Act are worse off.  Of these states only Kentucky, Pennsylvania, and Arizona  have recently implemented the Medicaid expansion under the provisions of the Affordable Care Act. This provision allows low-income persons to obtain healthcare. The rest of these states are limiting federal funding for their rural hospitals even though they are required by federal law to provide care regardless of an individuals ability to pay. Here is a table which shows those states with the greatest number of hospitals likely to close: (The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability, 2020)

40% likely to close	31-39% likely to close	26-30% likely to close	21-25% likely to close
Texas	Oklahoma	Wyoming	Nebraska
Mississippi	South Carolina	Kansas	Arizona
Missouri	Alabama	Kentucky	Pennsylvania
Florida		North Carolina
		Georgia

Of these states, only Kentucky has expanded Medicaid under the Affordable Care Act. The rest of the Methodology

The Charter Center for Rural Health used regression analysis, which is a type of statistical analysis using multiple variables to assess hospital viability and those criteria included: average age of patient, length of stay, case mix index, Medicare and Medicaid discharges, size of the facility, geographic area, and the age of the facility. In terms of financial measures, operating margins, revenue, occupancy, capital efficiency, and the state level of Medicaid expansion were also evaluated. 

Though a one percent increase in funding can reduce a hospitals chance of closure by three times that investment, this is not occurring. (The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability, 2020) One of the Charter Center’s regression models showed that states which adopted the Medicaid Expansion under the Affordable Care Act reduced the likelihood of hospital closure by 62% on average. Four hundred and fifty-three hospitals were identified as vulnerable to closure in the US.

When I researched other sources on vulnerability of US hospitals the results were similar and here are the findings from the 2020 Rural Hospital Sustainability Index by Guidehouse. (The Rural Hospital Sustainability Index, 2020)

State	Vulnerable Facilities	Proportion at risk of closure
Tennessee	19 of 28 hospitals	68% of rural hospitals are at risk
Alabama	18 of 30 hospitals	60% of rural hospitals are at risk
Oklahoma	28 of 47 hospitals	50% of rural hospitals are at risk
Arkansas	18 of 34 hospitals	53% of rural hospitals are at risk
Mississippi	25 of 50 hospitals	50% of rural hospitals are at risk
West Virginia	9 of 18 hospitals	50% of rural hospitals are at risk
South Carolina	4 of 9 hospitals	44% of rural hospitals are at risk
Georgia	14 of 34 hospitals	41% of rural hospitals are at risk
Kentucky	18 of 45 hospitals	40% of rural hospitals are at risk
Louisiana	11 of 30 hospitals	37% of rural hospitals are at risk

Larger hospital corporations are driving smaller stand-alone facilities into oblivion. Further, the US healthcare system treats the health of the nation like another product and the healthcare system like a capital enterprise, which as it turns out, doesn’t deliver the most efficacious healthcare. This means we are paying more for treatments that don’t deliver a commensurate improvement in patient health. As a society we should care about this as we would not accept a lesser quality product or outcome from any other consumer good and healthcare certainly is that.

Further, the Medicaid enrollment in rural areas is higher, so states which refuse to help their residents obtain healthcare by expansion of Medicaid under the Affordable Care Act are denying people access to care. Yet, rural people elected the current president who has vowed to gut the Affordable Care Act, an existing program for individuals to obtain medical care and to keep their hospitals afloat through improved cash flows. (Estes, 2020)

The pandemic grants from the federal government are now coming due and I think we can make a good case that rural hospitals should not have to repay the grants, as they are teetering on insolvency. Perhaps this is one issue in which Republicans and Democrats can agree, however, Senate Majority leader, McConnell has scoffed at providing further to assistance municipalities, hospitals, and individuals. The people of this diverse and hardworking nation deserve better.

And this is the healthpolicymaven signing off encouraging you not to sign blanket medical releases when you have medical procedures, do consent for which you agree and that which you decline. This article was written by Roberta E. Winter an independent healthcare analyst and journalist.

References

Estes, C. (2020, October 13). 1 of 4 Rural Hospitals Are At Risk of Closure And The Problem Is Getting Worse. Retrieved from Forbes.com: https://www.forbes.com/sites/claryestes/2020/02/24/1-4-rural-hospitals-are-at-risk-of-closure-and-the-problem-is-getting-worse/#72aa1c861bc0

The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability. (2020, February 1). Retrieved from Chartis Center for Rural Health: https://www.ivantageindex.com/wp-content/uploads/2020/02/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf

The Rural Hospital Sustainability Index. (2020, October 13). Retrieved from Guidehouse.com: https://guidehouse.com/-/media/www/site/insights/healthcare/2020/ruralhospitalsustainabilityindex0420_rev01.pdf

Unintended Consequences of Pandemic Hospital Bailouts May Hasten Their Demise

This article was originally posted June 9, 2020 but was accidentally deleted and this is a repost as the article has been cited and comments are posted in various media.

We can thank the Covid pandemic for revealing the fissures in America’s healthcare system, especially how large hospital corporations continue to be focused on earnings over community healthcare. This article examines how the federal pandemic money (CARES Act) for hospitals exacerbated the problem, through distribution to the wealthiest hospital systems and not the struggling rural ones. A similar phenomenon was observed for the farm bailouts when giant agricultural corporations ended up with the money and not the small farmers. The continual winnowing of our nation’s food suppliers and healthcare resources weakens national health. Doling out money without restrictions and lacking a needs-profile for the hospitals resulted in the federal government giving billions based on how much money the hospitals already billed for services. This is like providing a sewage treatment plant to a city that already has one and leaving the neighboring community to treat its own effluent. Further, no other country spends wildly in healthcare, with fewer community health benefits. All funding for healthcare, which is largely paid for by the government through tax subsidies and government financed programs, as well as steep individual contributions in the private sector should be needs-based. We can’t expect the Trump Administration to understand these criteria since it has given billions to the wealthiest while stripping school lunch money from children. This article analyzes the fraying network of urban trauma centers and rural hospitals, with suggestions to abate the hemorrhaging.

Hospitals at Risk

Becker’s Hospital Report found that 20% of US hospitals are at risk of closure as of April 20, 2020. (Ellison, State By State Breakdown of 354 Hospitals At Risk of Closing, 2020) In real terms that means 354 hospitals are potentially unsustainable and 81% of those are considered critical to the community. In my home state, Washington, 18% of rural hospitals are in danger of failure and this isn’t as dire as many states where 50% of theirs could fail. Hospitals provide jobs, help economic development, and offer critical healthcare. Here is a list of the states where the greatest percentage of their hospitals are threatened with closure due to inadequate cash on hand:

1.       Tennessee-68%

2.       Alabama-60%

3.       Oklahoma-60%

4.       Arkansas-53%

5.       Mississippi-50%

6.       West Virginia-50%

7.       South Carolina-44%

8.       Georgia-41%

9.       Kentucky-40%

10.   Louisianna-37%

Hospitals at risk of failure in Washington State (Ellison, 2020)

Columbia County Health System in Dayton is a farming community which serves a county-wide population of 4,058. The nearest hospital is in Walla Walla which is a half-hour drive by car.

Mid-Valley Hospital in Omak (4,806) is a mountainous community in the Okanogan and serves a countywide population of 41,000

Three Rivers Hospital in Brewster is also in the Okanogan region and is in a town of 2,364 people. Seems like Mid-Valley and this one should combine forces.

Grays Harbor Community Hospital in Aberdeen is a fishing and logging community which serves a countywide population of 75,000. The next nearest hospitals would be Olympia or Shelton, both about and hours drive.

Whidbey Health Medical Center in Coupeville, the Whidbey Island County Seat has a population of 1,959 people. Since there is another hospital on the island in Oak Harbor, this wouldn’t be as critical if it succumbs.

To See How Your State Hospitals Fair

Here is the link to the statewide list: https://www.beckershospitalreview.com/finance/state-by-state-breakdown-of-354-rural-hospitals-at-high-risk-of-closing

Covid-19 Hospital Bail-out Impact

In this latest government give-a-way most of the money went to the elite health care organizations, including local, Providence Healthcare, which is technically a nonprofit by statute, but makes so much money it has its own venture capital fund (12 billion in cash reserves), generating a billion dollars annually. (Jesse Drucker, 2020) And not to be outdone, lush Cleveland and Mayo Clinics also received millions. My former employer, Ascension Health, which is a Catholic hospital chain, makes so much money it has its own venture capital fund (15.5 billion in cash reserves) and it too received federal bail-out money. This table shows cash reserves and CARES fund distribution: (Liss, 2020)

Hospital Group	Cash in Reserves	Government Bailout
Ascension Health	15,500,000,000	211,000,000
Cleveland Clinic	7,000,000,000	199,000,000
Mayo Clinic	10,600,000,000	150,000,000
Providence Health	12,000,000,000	509,000,000
HCA (for profit)	51,300,000,000	1,000,000,000
Tenet (for profit)	731,000,000	517,000,000

This government largess was despite the fact all of these mega corporations have plenty of cash in reserves, so the government funding was to ensure their profits. Worse yet, the money they were given starves small rural hospitals which may be forced to close. I can’t think of a better example of the American “winner-take-all philosophy, but is this really how we should be running our critical healthcare system? It is impossible to research this and not feel the US government is cannibalizing its own health system.  This demonstrates another systemic failure in US healthcare, which puts profits ahead of patient health. I knew it was time to leave healthcare when the hospitals preferred hiring people without a healthcare background, the easier it is to put patients out of the equation if you think of them as widgets.

This article was written by Roberta Winter, an independent journalist and health policy analyst, who has published under the healthpolicymaven trademark since 2007. Please feel free to share this article virally.

References

Ellison, A. (2020, March 6). Five Hospitals Face Imminent Closure As Covid-19 Wreaks Havoc. Beckers Hospital Review. Retrieved June 8, 2020, from https://www.beckershospitalreview.com/finance/5-washington-hospitals-face-imminent-closure-as-covid-19-wreaks-havoc.html

Ellison, A. (2020, April 9). State By State Breakdown of 354 Hospitals At Risk of Closing. Becker Hospital Report. Retrieved June 8, 2020, from https://www.beckershospitalreview.com/finance/state-by-state-breakdown-of-354-rural-hospitals-at-high-risk-of-closing.html

Jesse Drucker, J. S.-G. (2020, May 25). Wealthiest Hospitals Get Billions in Bailbouts for Struggling Providers. The New York Times. Retrieved June 8, 2020, from https://www.nytimes.com/2020/05/25/business/coronavirus-hospitals-bailout.html

Liss, S. (2020, May 26). Here's How Much For Profit Hospitals Have Received In Bailout Money So Far. Healthcare Dive.com. Retrieved June 8, 2020, from https://www.healthcaredive.com/news/heres-how-much-for-profit-hospitals-have-received-in-covid-19-bailout-fund/578378/