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3 posts from December 2016

12/20/2016

Solitary Confinement: the Least Discussed & Most Unknown Public Health Crisis in America: A Conversation with Jean Casella (December 19th)

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On any given day US prisons and jails hold between 80,000 and 120,000 men, women and children in solitary confinement.   A significant percent of these individuals enter solitary with a mental disease and a similar percent of those held in isolation for extended periods of time develop severe psychiatric illnesses that include self amputation and suicidality.  (US prisons and jails constitute the largest psychiatric hospitals in the country.)  The UN Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment and Punishment, Juan E. Mendez, has concluded solitary confinement for more than 15 days constitutes torture.  In Hell is a Very Small Place, Voices from Solitary Confinement," edited by Jean Casella, James Ridgeway and Sarah Shourd, 16 former and current solitary confinement inmates discuss their experience in solitary and  two physicians and three professors (in law, political science and philosophy) discuss its physical and psychological effects and legal justification. 

During this 32 minute conversation, Ms Casella provides an overview of Hell Is a Very Small Place.  She explains why inmates are placed in solitary confinement, for how long and describes conditions under confinement.  She provides an overview of the psychological effects of solitary noted by contributing authors Dr. Stuart Grassian and Dr. Terry Kupers.  She addresses whether solitary confinement constitutes torture, explains how inmates attempt to keep their sanity, explains to what extent private sector profit making contributes to the practice and discusses what continued progress, if any, may be made under a new, incoming administration. 

Ms. Jean Casella is co-director of Solitary Watch, a web-based watchdog project that investigates, documents, and Caselladisseminated information about solitary confinement in US prisons and jails.  Prior to co-founding Solitary Watch in 2009, Ms. Casella managed several mission-driven book and magazine publishers including Thunder's Mouth Press and the Feminist Press.  Jean's writing has appeared in The Nation, Mother Jones, The Guardian, Al Jazerra, and other publications and media outlets.  The Hell is a Very Small Place anthology edited was published by The New Press in February.  For her work on solitary confinement, Jean was awarded a Soros Media Fellowship in 2012. 

For more information concerning Hell Is a Very Small Place go to: http://thenewpress.com/books/hell-very-small-place.

The UN Special Rapporteur's report is at: http://solitaryconfinement.org/uploads/SpecRapTortureAug2011.pdf

For another physician's review of solitary confinement, see, for example, Dr. Atul Gawande's essay titled,"Hellhole," in the March 30, 2009 issue of The New Yorker.  At: http://www.newyorker.com/magazine/2009/03/30/hellhole

12/06/2016

Will the Republicans Repeal the Affordable Care Act and Be Able to Replace It: A Conversation with Chris Jennings (December 5th)

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With the election of Donald Trump Congressional Republicans are poised to repeal the Affordable Care Act (ACA) within the first 100 days of the 115th Congress via the budget reconciliation process.  (At some future date they are pledging to draft ACA replacement language or legislation.)  The expectation is repeal would have an effective date of 2018 or 2019, or after the mid-term Congressional elections.  However, many if not most health policy experts agree the simple act of repeal would cause such instability state insurance marketplaces would collapse long before repeal would, legally, go into effect.  Congressional Republican leadership is also promising to move major Medicare, via premium support and major Medicaid legislation, via block grants or per capita caps, though the upcoming Congress.       

During this 23 minute conversation Chris Jennings discusses whether, and moreover how if at all, Congressional Republicans can repeal the ACA with an out-year effective date without fatally damaging state insurance marketplaces, the likely consequences of a simple repeal (without replace), when and how will Republicans will replace the ACA and whether that effort would garner any Democratic interest or support, what substantively explains Republican opposition to the current law and what might Republican leadership do to reform the Medicaid program and its likely effects.

Chris Jennings is currently Founder and President of Jennings Policy Strategies, a DC-based policy firm where he consults Jenningswith foundations, purchasers and other aligned stakeholders on policies to ensure higher quality, more affordable health care for all Americans.  Previously, Mr. Jennings served as Deputy Assistant for Health Policy to President Obama and for eight years as White House Health Care Adviser to President Clinton.   Prior still he served for a decade in the US Senate for Senators Glenn, Pryor and Melcher where he worked on Medicaid CHIP, HIPAA, PDUFA, major Medicare reforms in the 1997 Balanced Budget Act and related work concerning long term care, prescription drug coverage, rural healthcare and other related issues.  Chris has been a campaign adviser to six Democratic presidential campaigns and is a frequent contributor on health reform issues to the New England Journal of Medicine and numerous other scholarly journals, periodicals and newspapers.   

 

12/01/2016

The Pros and Cons (or Imperfections) in Rating Hospital Care Quality: A Conversation with Consumer Reports' Doris Peter (November 30th)

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Though comparatively late to adopt quality ratings, many health care products and services are today quality rated.  For example, CMS rates hospital, nursing home and home health care care quality along with Medicare Advantage insurance and prescription drug, or Part D plans.  Quality performance is a factor in calculating rewards and penalties in Medicare pay for performance agreements, for example, in scoring earned shared savings for Accountable Care Organizations.   Though today common, rating care quality is not without criticism.  For example, researchers question the validity of how component or domain scores are weighted or clustered, the absence or inadequacy of risk adjustment, meaningfulness to patients, patient literacy/numeracy limitations and unintended negative consequences.     

During this 21 minute conversation, Dr. Peter discusses why Consumer Reports rates hospital care quality, the methodology used in scoring hospital care quality, specifically types of care quality, for example prevalence of hospital-acquired infections, the response to ratings by hospitals, use by patients or consumers, the imperfections or limitations in rating hospital care quality, unintended negative consequences and how Consumer Reports intends to improve upon its work in the near term.

Dr. Doris Peter is the Director of Consumer Reports Health Ratings Center, a part of the nonprofit organization, Consumer Doris Peter Reports.   Beyond hospitals her team rates other health care services including physicians and insurance plans and as well health care products, e.g., drugs.  Dr. Peter is also the Principal Investigator of a grant from the Consumer and Prescriber Education Grant Project that helps consumers understand safety, effectiveness and the cost of prescription and over-the-counter medications.  Prior to joining Consumer Reports Dr. Peter was an editor and then publisher of the nonprofit organization, The Medical Letter, and then North American editor for an international evidence-based medicine journal.  Dr Peter is a neurobiologist by training, earning her Ph.D. at UCLA.  She completed a postdoctoral fellowship in cellular biophysics at Rockefeller University.

For more on Consumer Reports hospital quality ratings efforts go to: http://www.consumerreports.org/cro/health/doctors-and-hospitals/index.htm