Monday, March 17, 2014

AMA, 51 Other Medical Organizations, oppose Gun Violence, Duh.

Letter from AMA and 51 other Medical Organizations. PDF here.

January 8, 2013

The President
The White House
1600 Pennsylvania Avenue
Washington, DC 20500

Dear Mr. President:

The undersigned medical organizations, together representing the vast majority of practicing physicians and medical students in the United States, share the nation’s grief and sadness over the recent tragic school shootings in Connecticut. As physicians, we see first-hand the devastating consequences of gun violence to victims and their families.

We offer our experience and expertise in finding workable, common sense solutions to reduce the epidemic of gun violence—indeed the overall culture of violence—in America. We also urge the nation to strengthen its commitment and resources to comprehensive access to mental health services, including screening, prevention, and treatment.

The investigation into the Connecticut shootings is still continuing, and the issues surrounding such violence are often complex and can vary significantly from case to case. Strategies for preventing gun-related tragedies must also be complex and carefully considered. The relatively easy access to the increased firepower of assault weapons, semi-automatic firearms, high-capacity magazines, and high-velocity ammunition heightens the risk of multiple gunshot wounds and severe penetrating trauma, resulting in more critical injuries and deaths. Even for those who manage to survive gun violence involving these weapons, the severity and lasting impact of their wounds, disabilities and
treatment leads to devastating consequences for families affected and society, and contributes to high medical costs for treatment and recovery. Renewing and strengthening the assault weapons ban, including banning high-capacity magazines, would be a step in the right direction.

Many of the deaths and injuries resulting from firearms are preventable. More resources are needed for safety education programs that promote more responsible use and storage of firearms. Physicians need to be able to have frank discussions with their patients and parents of patients about firearm safety issues and risks to help them safeguard their families from accidents. While the overwhelming majority of patients with mental illness are not violent, physicians and other health professionals must be trained to respond to those who have a mental illness that might make them more prone to commit violence.

Funding needs to be available for increased research on violence prevention in general, and on the epidemiology of gun-related injuries and deaths in particular, as well as to implement available evidence-based interventions. Of equal importance is providing sufficient access to mental health services. While we strongly supported the passage of the Mental Health Parity Act of 2008, unfortunately, the promise of better access to psychiatric treatment will not be a reality absent requisite federal and state funding. This effort should be combined with an education campaign that reduces the stigma of seeking mental health services.
Newtown, Connecticut has now been added to the sad litany of recent mass shootings, including Columbine, Virginia Tech, Fort Hood, Arizona, and Aurora. As we come together as a nation to mourn the most recent victims of senseless gun violence, we must make a real and lasting commitment to work together on meaningful solutions to prevent future tragedies. We stand ready to work with Congress and the Administration to make progress in protecting our communities, especially our children, from this epidemic of violence.


American Medical Association

American Academy of Child and Adolescent Psychiatry

American Academy of Family Physicians

American Academy of Pain Medicine

American Academy of Pediatrics

American Academy of Urgent Care Medicine

American College of Emergency Physicians

American College of Mohs Surgery

American College of Occupational and Environmental Medicine

American College of Osteopathic Internists

American College of Phlebology

American College of Physicians

American College of Preventive Medicine

American College of Radiology

American College of Surgeons

American Congress of Obstetricians and Gynecologists

American Geriatrics Society

American Osteopathic Association

American Psychiatric Association

American Society for Clinical Pathology

American Society of Plastic Surgeons

Association of American Medical Colleges

College of American Pathologists

North American Spine Society

Renal Physicians Association

Society of Critical Care Medicine

The Society of Thoracic Surgeons
California Medical Association

Colorado Medical Society

Connecticut State Medical Society

Medical Society of Delaware

Medical Society of the District of Columbia

Illinois State Medical Society

Maine Medical Association

MedChi, The Maryland State Medical Society

Massachusetts Medical Society

Michigan State Medical Society

Minnesota Medical Association

Nebraska Medical Association

Nevada State Medical Association

Medical Society of New Jersey

New Mexico Medical Society

Oklahoma State Medical Association

Oregon Medical Association

Rhode Island Medical Society

South Dakota State Medical Association

Tennessee Medical Association

Texas Medical Association

Vermont Medical Society

Medical Society of Virginia

Washington State Medical Association

Wisconsin Medical Society

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Sunday, March 2, 2014

Even Critics of Safety Net Increasingly Depend on It -

It speaks for itself…

LINDSTROM, Minn. — Ki Gulbranson owns a logo apparel shop, deals in jewelry on the side and referees youth soccer games. He makes about $39,000 a year and wants you to know that he does not need any help from the federal government.

He says that too many Americans lean on taxpayers rather than living within their means. He supports politicians who promise to cut government spending. In 2010, he printed T-shirts for the Tea Party campaign of a neighbor, Chip Cravaack, who ousted this region’s long-serving Democratic congressman.

Yet this year, as in each of the past three years, Mr. Gulbranson, 57, is counting on a payment of several thousand dollars from the federal government, a subsidy for working families called the earned-income tax credit. He has signed up his three school-age children to eat free breakfast and lunch at federal expense. And Medicare paid for his mother, 88, to have hip surgery twice.

Even Critics of Safety Net Increasingly Depend on It -

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Saturday, March 1, 2014

Rand Paul Blocks Surgeon General Nominee For Saying Gun Violence Is A Public Health Threat | ThinkProgress

Rand Paul Blocks Surgeon General Nominee For Saying Gun Violence Is A Public Health Threat | ThinkProgress

Rand Paul, of course, has no concept of a physician's duty to help safeguard the health of actual people, both on an individual and population (public health) basis.

“As a physician, I am deeply concerned that he has advocated that
doctors use their position of trust to ask patients, including minors,
details about gun ownership in the home… Dr. Murthy has disqualified
himself from being Surgeon General because of his intent to use that
position to launch an attack on Americans’ right to own a firearm under
the guise of a public health and safety campaign.”

But Paul is actually out of step with most physicians. The idea that
gun violence is a danger to public health is utterly uncontroversial
among doctors’ groups, academic institutions that focus on public health, and children’s safety advocates.
Although Paul criticizes Murthy’s position that physicians and
pediatricians should ask patients about the presence of guns in their
households, the American Medical Association (AMA) adopted a resolution in 2011
officially opposing any law that bars doctors from having open
conversations about gun safety and the risks of having firearms in a
household with their patients.

In fact, just yesterday, the American Academy of Pediatrics (AAP)
issued new guidelines recommending that households with children who are
diagnosed with depression should remove guns and ammunition from their homes entirely.

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Fear Mongering With Medicare -


The Obama administration’s proposed cuts to Medicare Advantage plans — the private insurance plans that cover almost 30 percent of all Medicare beneficiaries — are fair and reasonable. As it happens, they are also mandated by law. Yet Republicans, sensing a campaign issue, are telling older and disabled Americans that the administration is “raiding Medicare Advantage to pay for Obamacare.” The health insurance industry, for its part, is warning that enrollees will suffer higher premiums, lower benefits and fewer choices among doctors if the cuts go into force.

Some of this could in fact happen, although the industry has cried wolf before and continues to thrive. But the key point is this: Over the past decade, enrollees in Medicare Advantage have received lots of extra benefits, thanks to unjustified federal subsidies to the insurance companies. Now they will have to do with somewhat less, unless the insurers are willing to absorb the cuts while maintaining benefits. Enrollment in these private plans, offered by companies like UnitedHealth and Humana, has more than doubled since 2006, in part because of lower premiums and extra benefits, like gym memberships, that are not included in traditional fee-for-service Medicare.

Fear Mongering With Medicare -

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Cabbies Hail For Health Insurance | NBC 10 Philadelphia

Getting health insurance in spite of Gov. Corbett!

About 80 percent of the nearly 5,000 taxi drivers in the city did not have insurance prior to the Affordable Care Act going into effect, said Ronald Blount, president of the Unified Taxi Workers Alliance of Pennsylvania.

"They were pretty much on their own," he said. "If a driver was hit by a drunk driver, the taxi auto insurance doesn’t cover the driver.”

"They’d be stuck with big medical bills,” added Blount, who said many drivers are plagued by “silent killers” like diabetes, high blood pressure and high cholesterol since many eat while on the go and are sitting for most of the day.

In an effort to enroll as many cabbies as possible, the TWA teamed up with two nonprofits focused on health care, Healthy Philadelphia and Get Covered America, to hold regular enrollment and information sessions.

Cabbies Hail For Health Insurance | NBC 10 Philadelphia

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Tuesday, February 18, 2014

Congressional Budget Office Report Finds Minimum Wage Lifts Wages for 16.5 Million Workers | The White House

I couldn’t understand why the CBO estimated job losses with a minimum wage hike. It’s because they seemed determine to ignore the literature on the subject:

6. CBO’s estimates of the impact of raising the minimum wage on employment does not reflect the current consensus view of economists. The bulk of academic studies, have concluded that the effects on employment of minimum wage increases in the range now under consideration are likely to be small to nonexistent. CBO also agrees that the employment effect could be essentially zero, but their central estimates are not reflective of a consensus of the economics profession. Specifically:

  • Seven Nobel Prize Winners, eight former Presidents of the American Economic Association and over 600 other economists recently summarized the literature on the employment effects of the minimum wage in this way: “In recent years there have been important developments in the academic literature on the effect of increases in the minimum wage on employment, with the weight of evidence now showing that increases in the minimum wage have had little or no negative effect on the employment of minimum-wage workers, even during times of weakness in the labor market.”
  • The pioneering research in this area was conducted by John Bates Clark Medal winner David Card and Alan Krueger, who published a study in the American Economic Review in 1994 finding that fast food restaurants in New Jersey did not cut back employment relative to Pennsylvania after the former State raised its minimum wage. They concluded, “We find no indication that the rise in the minimum wage reduced employment.”
  • The Card-Krueger research was generalized by Arindrajit Dube, T. William Lester, and Michael Reich who compared 288 pairs of contiguous U.S. counties with minimum wage differentials from 1990 to 2006. Based on this, researchers found “no adverse employment effects” from a minimum wage increase.
  • A recent literature review of the extensive published work on the minimum wage concluded: “[W]ith 64 studies containing approximately 1,500 estimates, we have reason to believe that if there is some adverse employment effect from minimum-wage raises, it must be of a small and policy-irrelevant magnitude.”
  • Another recent review of the theory and evidence on the minimum wage by John Schmitt at the Center for Economic Policy Research concluded that “The employment effects of the minimum wage are one of the most studied topics in all of economics. This report examines the most recent wave of this research – roughly since 2000 – to determine the best estimates of the impact of increases in the minimum wage on the employment prospects of low-wage workers. The weight of that evidence points to little or no employment response to modest increases in the minimum wage.”

Overall the logic for the finding that raising the minimum wage does not result in large adverse impacts on employment is that paying workers a better wage can improve productivity and thereby reduce unit labor costs. These adjustments, along with others that firms can make, help explain why the increase in the minimum wage need not lead to a reduction in employment. Higher wages lead to lower turnover, reducing the amount employers must spend recruiting and training new employees. Paying workers more can also improve motivation, morale, focus, and health, all of which can make workers more productive. In addition, by reducing absenteeism, higher wages can increase the productivity of coworkers who depend on each other or work in teams. In addition, businesses can adjust in other ways rather than reducing employment (for example, by accepting lower profit margins).  CBO’s estimates do not appear to fully reflect the increased emphasis on all of these factors from the recent economics literature.

Congressional Budget Office Report Finds Minimum Wage Lifts Wages for 16.5 Million Workers | The White House

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Monday, February 17, 2014

Bounced From Hospice -

Good piece about the dilemma faced by all hospices – is this patient going to die within 6 months?

One can sympathize with hospice organizations caught in this squeeze. Determining which patients will likely die within six months has always been difficult, especially with conditions like heart disease or dementia, whose trajectories can be unpredictable. To avoid being penalized if they guess wrong, hospices are taking no chances.

At least, that’s true of hospices operating according to the regulations and honoring the movement’s historic mission. The Post attributed much of the jump in discharges to the way for-profit hospices have come to dominate the field, enrolling ineligible seniors for long stays to bolster corporate bottom lines, then dumping them to evade Medicare sanctions. (The Times has also reported on growing hospice costs.) Whistleblowers and the Justice Department have sued several large national chains to stop these practices.

But I worry about families who have agonized about the decision and finally called for help, then feel betrayed when hospice withdraws, even though their relatives can regain hospice care when they decline further. They shouldn’t get caught in this crossfire.

Bounced From Hospice -

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