Easy Steps To Loose Weight

If you’re 1 of individualsthese people who nevertheless battlinggetting difficulties to shed some excess weight then you definitely might wish to consider be aware of those suggestions regarding how to free excess weight very easily and completely. It requires only 5 easy actions to adhere to that you should lastly leave behind individualsthese undesirableundesirable pounds for great.

The initial suggestion is to get sufficient relaxation every single eveningevening. Most people don’t understand the significance of acquiring sufficient relaxation which means you require to consider be aware that whenever you do not get sufficient relaxation your physique instantlyinstantly shops up extra body fatbody body fat to create certain you have sufficient energy for an additional working day. Additionally you require to create certain that you simply dont overcompensate by sleeping as well a lot simply because this may trigger some severe coronary heart issues by slowing down lower your bloodstream flow.

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Easy way to loose weight

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You’ll uncover how…

How you can function together with your metabolic processmetabolic rate to shed the excess weight quick but nevertheless Maintain Them Back! The results from the hunger/reduced calorie diet programs because they consume absent at the muscle mass tissue and deprives you of correct lengthyextended phrase excess weight reduction. How you can stay away of placing your physique into hunger manner, which boosts your urge for food and shops you areyou’re your subsequent food ratherrather of the metabolic processmetabolic rate burning via it. By consuming lessless energy you’ll shed excess weight, but when you consume much more energy you are able to shed even Much more excess weight.

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Small ALR Facility Workgroup meeting Sept. 10, 2019

To: Assisted Living Residence Providers and Stakeholders 

From: Elaine McManis, Health Facilities and Emergency Medical Services, Deputy Division Director

The next Small ALR Facility Workgroup meeting will be Sept. 10, 2019, 2:00-4:00 p.m., Building C, Room C1D on our Cherry Creek Campus. 

All non-CDPHE staff must sign in with security in Building A and get a guest badge before proceeding to Building C.

*Due to space constraints, non-workgroup members are invited to attend by phone.

To participate by telephone:

Step #1: Dial 1-712-770-8066 




Tuberculosis for Health Care Workers

To: Health care personnel who provide services for those with or at risk for tuberculosis infection and disease

From: Colorado Department of Public Health and Environment


The Colorado Department of Public Health and Environment is partnering with the Rio Grande Public Health to host a 2-day training on Tuberculosis (TB). This free training will enable you and your team to feel comfortable managing TB by providing information and skill building activities on the following topics:

– Introduction to TB
– Diagnosis and treatment for TB infection and disease
– TB case management
– TB contact investigation
– Interviewing skills

We invite nurses and other interested personnel who provide health services to patients with or at risk for tuberculosis in Colorado to attend the TB for Health Care Workers training on October 9th from 8:30 am – 4:30 pm and October 10th from 8:30am – 12:30 pm at the Alamosa Public Health Department. Address: 8900 Independence Way A-B, Alamosa, CO 81101. Please note, day one is applicable for all health care providers while day two is geared towards public health professionals.

For more details and registration, go to: www.train.org/colorado/home and search for course #1080090. Lunch will be provided, please keep your registration up to date.

Registration cost is FREE
Space is very limited so please register early.

For more information please contact Tavia Mirassou-Wolf at 303-692-2638 or Tavia.mirassou-wolf@state.co.us with any questions.

For additional training opportunities, please visit the calendar on our website: https://www.colorado.gov/pacific/cdphe/tb

Training Flyer

"Overshadowed by the Large Amount of Money in Play" – Sale of Hahnemann Residency Program as a Financial Asset Approved by Bankruptcy Judge

Introduction: the Bankruptcy of Hahnemann, the Selling of the Residency Program, Including Residents, as an Asset

As we discussed here, the storied Hahnemann University Medical Center was recently declared bankrupt by the private equity firm that bought it.  Staff were left jobless. Patients, including many who were vulnerable or chronically ill, were set adrift. Nearly 600 medical house-staff were set adrift.

The end of the medical center was a long time coming.  It had barely survived the previous bankruptcy of Allegheney Health Education and Research Foundation (AHERF), a nominally non-profit vertically integrated health system led by a charismatic, but ultimately criminal CEO (look here).  Hahnemann then became part of Tenet, a for-profit hospital system with a not always savory reputation (look here for a summary).  Tenet complained of Hahnemann’s chronic deficits, although whether these losses were due to creative accounting is unknown.  Tenet eventually sold the hospital to a private equity group, Paladin Healthcare, and made it part of their American Academic Health System LLC. It took Paladin less than two years to decide that the hospital’s continued losses were unsustainable and declare it bankrupt.  The rapidity of the hospital’s collapse raised the suspicion among some that Paladin had never intended to continue operating the hospital, but bought it only so it could sell off its valuable underlying real estate assets (look here).

The Sale of the Residency Program as an Asset Approved by a Bankruptcy Judge

The fate of the hospital’s physician trainees was then left up to a bankruptcy court.  The Paladin Healthcare plan was to auction off the residency program, apparently including its US government funding and its residents, as a financial asset (look here).  On September 5, the Philadelphia Inquirer  reported the results of that plan,

U.S. Bankruptcy Judge Kevin Gross on Thursday approved the sale of Hahnemann University Hospital’s medical residency programs to Thomas Jefferson University Hospitals Inc. for $55 million, a decision criticized as setting a dangerous legal precedent.

The decision was protested by the US government:

The federal regulator, the Centers for Medicare and Medicaid Services (CMS), considers the sale illegal and warned that the bankruptcy judge’s decision could result in residency slots at distressed hospitals being considered as valuable assets available for sale. Arguably, private equity owners could seize on the ruling as a way to increase the return on their investments.


U.S. Department of Justice Attorney Marc S. Sacks, who represented CMS, asked for a longer-term stay of the ruling, suggesting that Gross’ ruling could inspire struggling rural hospitals to sell resident slots to wealthier areas. ‘This could open the door to that nationwide,’ Sacks said. ‘This is a serious, significant issue with nationwide implications.’

While some of the Hahnemann residents had protested that in some sense, they too were being sold as assets(look here), yet the Inquirer article stressed that was likely not the primary concern of the decision maker in this case

Gross, as a bankruptcy judge primarily concerned with making sure there is as much money as possible available to pay creditors, overruled Sacks, as he did repeatedly while going over details in the order Gross will issue allowing the sale to happen. Gross called the increase in the price for the residency program from an initial $7.5 million bid to $55 million ‘a stunning success’ for Hahnemann.

It was all about the money

In response to the judge’s decision,

‘We’re very disappointed to see Jefferson and an unelected bankruptcy judge finish what Joel Freedman started and shutter an important safety-net hospital,’ said a spokesperson for the Pennsylvania Association of Staff Nurses and Allied Professionals, which represented 800 Hahnemann nurses. ‘We hope the federal government will appeal to prevent this from establishing a truly dangerous precedent.’

The judge’s decision may well be appealed by CMS.  Nevertheless, it seems that the Hahnemann residency program for years was tossed on the waves of a commercialized, financialized health care system, caught up in the financial manipulations of an empire-building CEO, sold to a commercial hospital chain, then to a private equity group, and finally sold again by the decisions of a bankruptcy judge whose biggest concern was the price.  Once again,

‘It seems that the provision of quality patient care and quality of
physician education is being over-shadowed by the large amount of money
in play
,’ said Katharine Van Tassel, a visiting professor of law at Case
Western Reserve University in Cleveland.

Summary: How Doctors Came Under the Rule of Money

We have frequently warned of the dangers of an increasingly commercialized health care system.  We noted how Dr Arnold Relman warned in 2007 of the threats arising from “the growing commercialization of the US health care system.”(1)
This has been abetted by physicians who accept “the view that medical
practice is also in essence a business.” Thus, “the vast amount of money
in the US medical care system and the manifold opportunities for
physicians to earn high incomes have made it almost impossible for many
to function as true fiduciaries for patients.”

Now “the large amount of money in play” seemingly has suceeded in turning one group of trainee physicians and their faculty into financial assets to be manipulated, like some sort of modern-day serfs.  Yet even in the face of such an outrage, the silence was deafening.  Where were the adults in the chambers of medicine?

Particularly quiet were leaders of some of the august organizations that are supposed to uphold the values of medicine and medical education.

A few did make statements sympathizing with the residents and offering them personal help, e.g., here by the AMA, and here by the ABIM.  Apparently, the American Association of Medical Colleges (AAMC) did dispatch “Lauren Macksound, a lawyer” to “advocate on behalf of the residents” in court  (per Bloomberg, July 22, 2019).

However, I could  find no evidence of any statement by such leaders deploring the larger situation, criticizing any of the responsible parties, or
more importantly suggesting changes in law, regulation, policies or
practices to address underlying causes.  In particular, I found no such statments by leaders of the
American Medical Association (AMA), or the American Association of
Medical Colleges (AAMC), or, representing my specialty, internal
medicine, by leaders of the American Board of Medicine (ABIM), the
American Board of Medical Specialties (ABMS), or the American College of
Medicine (ACP), or the American College of Cardiology (ACC).

Then again, when AHERF went bankrupt, no major professional society or other group ostensibly devoted to patient welfare, health care education, or physicians’ professional values made much of a fuss, much less pushed for new laws, regulations, policies or practices to prevent another such bankruptcy.

There may be many explanations for this silence.  One has to do with the march of neoliberalism, (or market fundamentalism) especially its dogma that:

harshly reinstated the regulatory role of the market in all aspects of
economic activity and led directly to the generalisation of the
standards and practices of management from the private to the public
sectors. The radical cost cutting and privatisation of social services
that followed the adoption of neoliberal principles became a public
policy strategy rigorously embraced by governments around the world(2)

It appears that professional societies have been cowed by neoliberal economists and lawyers who launched campaigns starting in the 1970s to restore the power of huge corporations.  They seemed to take offense at the notion that professional notions of ethics could stand in the way of corporate economic power. So neoliberal economist (and architect of the Viet Nam War body count as a measure of battlefield success) Alain Enthoven advocating breaking up physicians “guilds” to decrease their ostensible economic power, and hand power over to business managers (look here).

Particularly important in the attack on professional self-regulation was an effort to turn anti-trust law on its head.  Writing in ProMarket, Sandeep Vaheesen explained

As conservative attacks on the New Deal gained traction starting in the mid-1970s, antitrust was an early target. Corporate executives resented how antitrust law and New Deal regulations in general restricted their freedom of action. For the corporate class seeking to overthrow these public rules, Robert Bork, a law professor at Yale, would be a savior. He had been concocting the theories by which corporations would overthrow the antitrust fetters of the postwar period.

Bork offered a radical reinterpretation of antitrust law. Inventing a legislative history out of whole cloth, he argued that Congress enacted the Sherman Act only to protect ‘consumer welfare’ and not to control the broader economic and political power of corporations. Further, based on hypotheses with little or no empirical support, he asserted that mergers and trade restraints allowed businesses to lower costs and improve services and thereby benefit consumers.

Bork did believe in one antitrust prohibition. He argued that collusion among rivals should be aggressively prosecuted. His conception of collusion swept broadly and did not differentiate, for example, between pharmaceutical companies conspiring to raise prices on prescription drugs and public defenders banding together to obtain a living wage.

In the 1970s and 1980s, corporate attorneys, citing and quoting Bork on behalf of their clients, found increasingly receptive audiences in the federal courts and agencies. The Supreme Court, starting in the Nixon years, and the Department of Justice and Federal Trade Commission, beginning with Reagan, were eager to read the theories of Bork into case law and policy. (In 1982, Reagan appointed Bork as a court of appeals judge and gave him the opportunity to directly rewrite antitrust doctrine.)

So, after a 1975 Supreme Court decision that held that learned professions (like medicine) were engaged in “trade or commerce,” and hence were subject to anti-trust law, the American Medical Association abandoned its prohibition on commercial practice of medicine (look here).  Then, as discussed in Slate in 2009,

after Ronald Reagan became president, there was a paradigm shift. Where once government had sought to police the health care sector mainly to protect patients, now it sought to police it mainly to protect a competitive health care marketplace. A thriving health care bazaar, it was assumed, would serve patients’ interests.

And central to making the markets “competitive” was preventing professional organizations from upholding any standards of ethics, or principles meant to put patients ahead of market concerns.  

So now professional organizations and other non-profits supposedly devoted to patient care and medical education seem afraid to make any criticism of neoliberal or market fundamentalist dogma, those who espouse it, or the commercial firms that it enabled to run health care.

To prevent the next bankruptcy, and the next group of physicians to be sold off as assets, health care professionals will have to muster the courage to speak up against our gilded age masters.  Further, we will need to join other voices to renew the legacy of the trust busters, and disrupt the new gilded age before we all become serfs. 


1. Relman AS. Medical professionalism in a commercialized health care market. JAMA 2007; 298: 2668-2670. [link here]

 2.  Komesaroff PA, Kerridge IH, Isaacs D, Brooks PM.  The scourge of
managerialism and the Royal Australasian College of Physicians.  Med J
Aust 2015; 202: 519- 521.  Link here.

Nursing Home Innovative Grant Board – Grant Proposal Announcement

To: NH providers, owners, administrators and other interested parties

From: Jo Tansey, Section Manager, Nursing Facilities, HFEMSD

The Nursing Home Innovations Grant Board has issued a call for proposals for Grant Cycle 12. Proposals will be due on or before 5 p.m. MST on September 15, 2019. The grants are comprised of monies collected through nursing home civil monetary penalties (CMPs).

You can find the Call for Proposals, instructions, application and deliverables worksheet at




Broken Trust: the Adulteration of Ranitidine Revealed

Adulterated Ranitidine, and Before that, Valsartan, Irbesartan and Losartan

Another case of drug adulteration has just been made public.  Per the New York Times, Sept 13, 2019,

The Food and Drug Administration said on Friday that it had detected low levels of a cancer-causing contaminant in samples of heartburn medicines containing the drug commonly known as Zantac.

Zantac, the brand-name version of the drug, is sold by Sanofi, but generic versions [ranitidine] are widely sold. The F.D.A. has not identified any specific products that were affected.

The contaminant is one that has been seen before.

The contaminant, a type of nitrosamine called N-nitrosodimethylamine, or NDMA, is the same one that was found in some versions of valsartan, a blood-pressure drug carrying the brand name Diovan.

In the current case, its source is not yet apparent,

NDMA can form during manufacturing if the chemical reactions used to make the drug are not carefully controlled and monitored, the F.D.A. has said.

Jeremy Kahn, an agency spokesman, said Friday that the agency is still investigating contamination of the heartburn drugs, and that it is unclear how many companies’ products are affected and how the problem originated.

Based on the recent case of adulterated valsartan and other angiotensin receptor blocker (ARB) drugs, tt is likely that manufacturing of the drug, at least the “active pharmaceutical ingredient” in it, was outsourced.

The valsartan recalls have renewed questions about the safety of the American drug supply, particularly of generic drugs, composed of raw ingredients that are frequently manufactured in countries like China and where F.D.A. oversight has lagged.

Note that,

The source of the contaminated valsartan was a Chinese manufacturer, Zhejiang Huahai Pharmaceutical Company. Major Pharmaceuticals, Teva Pharmaceutical Industries and Solco Healthcare, which is owned by Huahai Pharmaceutical, sold it in the United States.

The same type of impurities were later found in two other blood-pressure drugs, irbesartan and losartan, in the same [ARB] class as valsartan. Two more nitrosamines — nitrosodiethylamine, or NDEA, and N-Nitroso-N-methyl-4-aminobutyric acid, or NMBA — were found in the drugs. Lists of the affected products are posted on the F.D.A. website. 

Furthermore, the FDA may not yet be on top of the problem with ranitidine:

The agency’s announcement came on the same day that an online pharmacy, Valisure, petitioned the F.D.A. to request a recall of all products containing ranitidine, because it said its own tests had revealed high levels of NDMA, above the F.D.A.’s acceptable daily limit. The Valisure petition speculated that the source of the NDMA was the result of the ‘inherent instability’ of the ranitidine molecule, which can degrade under certain conditions, such as when it is digested, to create NDMA.

‘Our feeling is that this is extremely troublesome,’ said David Light, the chief executive of Valisure, which is based in Connecticut. ‘We took it off our formulary right away.’

21st Century Cases of Drug Adulteration

Moreover, we should have been warned that these cases were coming. 
The cases of adulterated ranitidine and ARBs are not the first important
cases of drug adulteration in the 21st century.  In 2008, we wrote aabout
the case of toxic adulterated heparin from pigs in China.  We later summarized of that case was:

Baxter International imported the ‘active pharmaceutical ingredient’
(API) of heparin, that is, in plainer language, the drug itself, from
China. That API was then sold, with some minor processing, as a Baxter
International product with a Baxter International label. The drug came
from a sketchy supply chain that Baxter did not directly supervise,
apparently originating in small ‘workshops’ operating under primitive
and unsanitary conditions without any meaningful inspection or
supervision by the company, the Chinese government, or the FDA. The
heparin proved to have been adulterated with over-sulfated chondroitin
sulfate (OSCS), and many patients who received got seriously ill or
died. While there have been investigations of how the adulteration
adversely affected patients, to date, there have been no publicly
reported investigations of how the OSCS got into the heparin, and who
should have been responsible for overseeing the purity and safety of the
product. Despite the facts that clearly patients died from receiving
this adulterated drug, no individual has yet suffered any negative
consequence for what amounted to poisoning of patients with a brand-name
but adulterated pharmaceutical product.

In 2010, we noted a report by the U.S. China Economic and Security Review Commission on the perils of outsourced drug manufacturing in China.

In 2012 we documented
the continuing problems with outsourcing of drug manufacturing.  We
noted that at least 70-80% of the “active pharmaceutical ingredients”
(APIs) that made up drugs sold in the US were actually manufactured
overseas, the majority in China and India.  The regulation of
manufacturing in these countries, particularly China, is extremely lax. 
In China, APIs are considered chemicals, and the regulation of chemical
manufacture is virtually non-existent.  There is evidence that the
manufacturing processes in China, particularly at those companies that
make the cheapest drugs, are sloppy or worse.  Furthermore, US
pharmaceutical companies may buy drugs through brokers, further
obscuring who actually made them.

In 2013, we discussed adulteration of  generic drugs made in India by Ranbaxy, a subsidiary of Daiichi Sankyo, and sold in the US.

Summary: Broken Trust

The latest cases of adulterated drugs sold in the US are disgraceful.  Patients ought to be assured that  the medications they take have not been adulterated.  Patients entrust pharmaceutical corporations to  supply pure drugs in the correct dosage.  The purpose of the first major US law to regulate drugs, the US Food and Drug Act of 1906, was to assure that drugs were pure and their dosage was accurate. The presence of adulterated drugs on pharmacy shelves is a major breach of trust, and shows a major failing of the involved pharmaceutical manufacturers and US drug regulation.

If anything, the NYT article understates the problem,

 ‘I think this is another good example of how our regulations need to
change,’ said Dinesh Thakur, a drug-safety advocate who exposed
widespread quality problems as a former executive at the Indian drug
maker Ranbaxy Laboratories. He said the F.D.A.’s testing is too lax.
‘Things like this will never get caught, unless somebody is actually
actively looking for stuff.’

Since 2008 we have had warnings that outsourced drugs may be dangerous, and that foreign and US regulation is insufficient. Yet, the warning have largely been anechoic and no major action has ensued.  Will the new cases make waves?    Will there be action this time?  Who knows?

For what it’s worth, let me resurrect my thoughts from 2016:

In our rush to market fundamentalism, we seem to have deregulated, at
least de facto, most aspects of health care.  We now cannot trust the
drugs we take to have been made by the companies whose labels they bear,
or to be pure.  We now cannot trust that regulators will find that out,
or having found that out, will do anything about it in a timely

To repeatedly reiterate, as long as the leaders of health care
organizations are not held accountable for the results of their
decisions on health care quality, cost, and access (even in such extreme
quality violations as those resulting in multiple patient deaths), we
can expect continuing decisions that sacrifice quality, increase costs,
and worsen access, but that are in the self-interest of the people
making them.

To really reform health care, we must hold health care organizations and
their leaders accountable (and not blame all the problems on doctors,
other health care professionals, patients, and society at large).

Home Care Advisory Committee Membership

To: Home Care Providers and Consumers of Home Care Services

From: Steve Cox, Program Manager, Home Care Services

The next Home Care Advisory Committee meeting is scheduled for September 26th from 2-4pm at CDPHE. The agenda for the meeting is listed below. Any suggestions to the agenda must be received by September 19th, 2019 by COB.

Agenda 9/26/19

2:00 p.m. Roll Call of current members
2:10 p.m. Reading of minutes from last meeting
2:20 p.m. Old Business
2:30 p.m. New Business
– New members
– By Laws
– Propose different meeting Day/Time
3:15 p.m. Open Discussion
4:00 p.m. Adjourn

If you have questions please contact Steve Cox, Home Care Services Manager at 303-692-2981 or Steve.Cox@state.co.us or Kristi Uitich, Home Care Services Supervisor at 303-692-6328 or Kristi.uitich@state.co.us.

Debunking the Myths About National Healthcare

An analysis of the Myths of National Healthcare Constipating Real Reforms
Myth #1 A government run healthcare program eliminates your
private insurance

this is incorrect and a good example of a government run healthcare program is
Medicare, which has been around for over 50 years. Medicare is made up of several parts; Part A which is for inpatient coverage, Part B, which requires a monthly
premium provides outpatient coverage, Part C, which is the Medicare
Advantage Plan-a somewhat integrated health plan, and Part D, the prescription drug coverage added by President George
W Bush. This was back in the day when Republicans wanted to provide benefits
for people rather than take them away. Private insurance companies’ partner
with Medicare to lower cost-sharing for seniors, improve drug coverage, and increase
access to specialty care, and these are known as Medicare supplements. Though
this may seem a convoluted way to get the various components of healthcare met,
it does work. Medicare also is very effective for several reasons.

  1.  All seniors, persons age 65 and up are covered
    on Medicare, which is also a group that private insurance companies are glad to
    have the government insure. This is a demographic group that is highly likely
    to need healthcare services and whose access to healthcare would not be
    possible without government healthcare.

Myth #2 A government run health plan will cost too much

This assertion is also incorrect as
every country with a national government run health system spends far less than
the United States and boast better results in many clinical areas. For example,
according to the Petersen/Kaiser Health System Tracker in 2016 the US spent
$10,238 on average per person for healthcare.
 (Petersen/Kaiser Health System
Tracker, 2019)

But as we know, many people went without healthcare at all, so this figure,
although higher than other industrialized countries by 50% represents the skewing
of healthcare services to a much small percentage of the national population. France
spent $4,600 per person and everyone has had access to an integrated health system
for decades. Japan spent $4,519. The average spent by industrialized countries
was $5,198, less than half of what the US spends. 
Further, an integrated national
health system will be less expensive to administer and a good example of that
is Medicare and here are some reasons why:

  1.  Medicare administration expenses are 6% of total
    plan expenses as opposed to 12-18% for private sector plans, which means it is
    less expensive. 
  2. Medicare requires Medicare Advantage plans,
    which are supplemental insurance, to spend at least 80 to 85% of the premiums
    collected on actual medical claims, which mutes excess profiteering. And CMS requires
    them to issue customer rebates if they do not meet those loss ratios for
    benefits paid out. This is similar to the standards private sector insurance
    must adhere to in Europe. 
  3. Medicare already determines what services are
    approved for reimbursement, which all private sector insurance plans adopt, so
    it would be efficacious for it to set national standards.

Myth #3 You won’t be able to see your private doctor

This assumption is also incorrect
as other countries with government run health systems do have private clinics
and private doctors which their citizens enjoy. In fact, the United Kingdom
Health System which is a totally government run health system is not the norm. Other
countries with national health systems, like France the Netherlands, or Australia
use a combination of public and private programs to provide healthcare. The
difference is, a much smaller segment is provided by private insurance
companies. Of course, the behemoth insurance industry in the US is not going to
be in favor of a smaller market share. However, this does NOT mean this position
is better for you, the consumer or the patient and I state this as a former
insurance broker.

Myth #4 Most Americans have Access to Health Insurance
Through Employer Provided Plans

Again, this assertion is false as
only half of US employers provide medical plans to their workers.
(Kaiser Health Facts, 2019) And of that number,
employers are increasingly forcing more of the costs of medical care onto their
employees through higher premiums, higher co-payments, and reductions in
benefits. Ergo, people already realize they are paying for the cost of their
healthcare, and paying more than anyone else in any other nation, but we need
to move toward the discussion of value. The question needs to be, is that
$1,000 monthly insurance premium and that $5,000 co-payment for surgery less
expensive than a national healthcare plan and that answer is profoundly no. No
one in any country with a national health system is expected to pay a $5,000
co-payment for medically necessary surgery. In fact, the joint replacement
surgery to which I refer could be done for that co-payment price in many
European countries. Americans need to start discussing value-what are you
getting for that extremely high cost of care.

Further, the Republicans promote the idea that worthwhile
residents have health insurance and the others must be lacking in some social
value and this is not in keeping with current employment practices. The gig
economy includes highly specialized and educated workers from throughout
the globe and they work without benefits. It is not only farm workers who lack
healthcare, but a huge swath of the workforce. An excellent reference for the
impacts of this work force change is Mary Gray and Siddharth Suri’s Ghost
Work-How to Stop Silicon Valley from Building a New Global Underclass. (Suri, 2019)

A better approach to improving US healthcare needs to
consider who is paying for services, not just how much they are paying, because
more and more the middle-class workers are being gouged for the cost of their
healthcare. This needs to stop and the solution is to reform the US health
system into a saner, less expensive, inclusive one, that is used by all other
industrialized countries in the world (national healthcare). Some things to consider in streamlining
the US healthcare system include things that Medicare is already doing with a national

  1.  The Centers for Medicare and Medicaid (CMS) are
    part of Health and Human Services Agency and are the main fraud detection arm to
    prevent criminal activity in the healthcare system. It is in the best interest
    of all patients and tax payers to have an independent government agency monitor
    and enforce anti-fraud efforts and prevent the use of unapproved medical
    devices and products in the healthcare system.
  2.  Medicare is best suited to bargain with private
    sector entities for pricing of products and with the largest customer base,
    also in the best position to get lower prices than anywhere else. Private sector
    companies exist to make money, which means you pay more. If CMS through Health
    and Human Services has the power to bargain with pharmaceutical companies, you
    will see an immediate drop in the cost of your prescription medications. Why
    should Americans continue to pay more for medications that are sold to patients
    in Europe, with socialized health systems for significantly less?
  3.  Medicare already uses medical evidence to inform
    changes in approved treatments and these are piloted through demonstration
    projects. Medicare with its huge patient population can provide excellent data for
    future health system improvements. An example of this was the move to spend
    Medicare money to keep seniors in their homes because it was proven to reduce
    hospitalization costs and improve patient health.


A national health system for all
will eliminate some of the conflicts of health system profit making procedures
versus lower cost more efficacious health treatments that are less lucrative. The current health system
relies on up-selling of medical imaging, laboratory, and elective surgeries to generate
margins and produce financial results. Healthcare should be focused on helping
people live quality lives, not producing profits. And the health of a nation
needs to be devoted to population health measures, methods, and outcomes, not designed
to benefit a few winners of the healthcare lottery.

And this is the healthpolicymaven
signing off encouraging you not to sign blanket releases for medical procedures
which require hospitalization, do specify that for which you agree and that
which you decline. And try to bring a healthcare advocate with if you are
mystified by medical terminology.


Kaiser Health Facts. (2019, September 1). 2018
Employer Health Benefits Survey
. Retrieved from Kaiser Family
Petersen/Kaiser Health System Tracker. (2019,
September 1). How Do Healthcare Price and Use in the US Compare to Other
. Retrieved from Health System Tracker.corg:
Suri, M. L. (2019, September 1). Review of Ghosst
. Retrieved from New York Journal of Books: