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4 posts from August 2020


Senate Special Committee On the Climate Crisis Releases Its Report, "The Case for Climate Action" (August 31st)

This past July 12th I made note of the House Select Committee on the Climate Crisis's publication of its June 30th report, "Solving the Climate Crisis."  This past week the (Democratic) minority staff of the Senate Special Committee on the Climate Crisis released its 260-page report titled, "The Case for Climate Action, Building a Clean Economy for the American People."  The report is at: ttps://www.democrats.senate.gov/climate-report.

I am, still, now 8 weeks later, attempting to pursue an interview with the House Select Committee Chair, Rep. Kathy Castor, or a lead report author, to discuss their report.  I attempted to solicit the Senate Special Committee Chairman, Senator Schatz, for an interview however, oddly, his office is closed - as is the Senate Minority Leader Chuck Schumer's office.   Your taxpayer dollars are work. 


Dr. Rachel Dolin Discusses the House Ways & Means Committee's Recent Report,"Under-Enforced and Over-Prescribed: The Antipsychotic Drug Epidemic Ravaging America’s Nursing Homes” (August 27th)

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In testimony before the House Energy and Commerce Committee in 2007, the FDA's Dr. David Graham stated, "15,000 elderly people in nursing homes [are] dying each year from the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn't work.  The problem has been known to the FDA for years and years.”  Eleven years later, Human Rights Watch published a report titled, “They Want Docile: How Nursing Homes in the US Over-Medicate People with Dementia."  The report found in 2016-2017 "massive use" or abuse of anti-psychotics, e.g., Seroquel, Haldol and Risperdal, that have serious side effects including sudden cardiac death.  In testimony before the Ways and Means Committee last November Nov., Richard Mollot, Executive Director of the Long Term Care Community Coalition, concluded, “the use of antipsychotics in nursing facilities is “so extensive that it puts the US in violation of . . . international conventions and covenants on torture and cruel, inhuman and degrading treatment or punishment.”  Dedicated listeners may recall I interviewed Diana Zuckerman on this topic in December 2012 and in February 2018 interviewed Hannah Flamm author of the Human Rights Watch Report. 

During this 30 minute interview, Dr. Dolin discusses report specifics including its findings regarding the extent of overuse and misuse, what explains overuse, the success of CMS' voluntary program to reduce misuse and the consequences of Trump administration's decision to place a moratorium on skilled nursing facility regulatory enforcement and decisions to reduce civil monetary penalties.  Dr. Dolin also explains why majority staff did not offer recommendations in the report and opines on whether the report will lead the Congress to, finally, address the misuse of anti-psychotics in nursing homes.   

Rachel Dolin, Ph.D., is Democratic Professional Staff with the Committee on Ways and Means, Subcommittee on Health. Dolin_head shot She is the principle author of "Under-Enforced and Over-Prescribed."   Previously, Dr. Dolin was a 2017 David A. Winston Health Policy Fellow.  Previously still, she was a National Science Foundation Graduate Research Fellow from 2013-2017.  Prior to her doctoral work she was employed as researcher for L&M Policy Research in Washington, D.C.  Her work has been featured on NPR, in Health Affairs and in other peer-reviewed journals.  Dr. Dolin received her B.A., magna cum laude, in Political Science and History from Tufts University and completed her PhD in Health Policy and Management at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. 

The Ways and Means "Under-Enforced and Over-Prescribed" report is at: https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/WMD%20Nursing%20Home%20Report_Final.pdf

Richard Mollot's November 2019 testimony before the Ways and Means Committee is at: https://waysandmeans.house.gov/legislation/hearings/caring-aging-americans.

Dr. David Graham's 2007 testimony is at: https://www.govinfo.gov/content/pkg/CHRG-110hhrg35502/html/CHRG-110hhrg35502.htm.



Dr. Charles Binkley Discusses Medical Ethics in the Time of COVID-19 (August 24th)

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From an ethical perspective our nation's response to the COVID-19 pandemic has been disastrous.  For example, as has been widely reported, our nation has failed to protect the most vulnerable among us, for example, nursing home residents have suffered approximately one-third of all COVID-19-related deaths.  As for other disenfranchised, African Americans have been were more than twice as likely as non-Hispanic Whites to die of COVID-19 complications.  Health care providers have been and continue to be inadequately protected requiring them to work in lethal environments.  Instead of providing service workers, moreover minorities, health insurance, sick leave and a livable wage, we now define them “essential workers” and give them a hand clap.  As for our the federal government's response, the president's sensitivity goes so far as his recently stating “it is what it is” - that the urban dictionary defines as a business phrase that can literally be translated as “fuck it.”  As for the Congress's response, 75% of direct and indirect CARES Act moneys went to corporations and any forthcoming or additional federal response must include COVID-related legal immunity protection for the health care industry.  The nation's response to the pandemic exposes the rift that continues to exist between medical ethics, that requires the health care industry to support the betterment of public health and a responsibility to seek policy reforms that are in the best interests of patients, and health care delivery ever-increasingly designed to generate financial profits.   

During this 30 minute discussion Dr. Binkley provides, in sum, an assessment of the extent to which the federal policy makers and the health care industry have lived up to their ethical obligations in response to the pandemic and what reforms national policy makers should take in providing health care that satisfies or at least approximates ethical norms.     

Dr. Charles Binkley is currently the Director of Bioethics at Santa Clara University's Markkula Center for Applied Ethics.   Previously, Dr. Binkley was a practicing hepatobiliary and pancreas surgeon with the Kaiser Permanente Medical Group. in San Francisco.  He also served as Chairman of the Kaiser's San Francisco Medical Center Ethics Committee, Charles-Binkley-photo-square-360x360President of the Professional Staff, and Chief of Inpatient Quality.  Dr. Binkley also served on the Committee on Ethical, Legal, and Judicial Affairs of the California Medical Association, as well as on the Board of Directors of the San Francisco Medical Society, and on the program committee of the Society for Surgery of the Alimentary Tract.  Dr. Binkley is also a Fellow of the American College of Surgeons.  Dr. Binkley has been an invited speaker at medical centers and hospitals in the United States and internationally, and acted as an ethics consultant to the American Gastroenterological Association.   His writings have appeared in the Journal of the American College of Surgeons, Annals of Surgery, Molecular and Cellular Biology, Cancer Research, Verdict, and Bioethics.net.  After completing his undergraduate degree in Classics and Philosophy at St. Meinrad Seminary, Dr. Binkley attended Georgetown University School of Medicine, graduating magna cum laude.  He completed his surgery residency at the University of Michigan, spending two years as an NIH-sponsored Gastrointestinal Surgery Fellow.

Information on the Markkula Center is at: https://www.scu.edu/ethics/

Don Berwick's "moral determinants" June JAMA essay noted during this discussion is at: https://jamanetwork.com/journals/jama/fullarticle/2767353 

Crosby and Annas's NEJM essay regarding medical ethics and human rights in immigration detention centers, also noted during this discussion, is at: https://www.nejm.org/doi/full/10.1056/NEJMp2003050?af=R&rss=currentIssue

The Alexander Cockburn's essay, "Elder Abuse, Nursing Homes, the Coronavirus, and the Bottom Line," appears in the September 2020 issue of Harper's Magazine.

Though unmentioned, see also, Osmundson and Nathan's, "COVID-19 and the Limits of American Moral Reasoning," in the July 30 issue of The New Republic, at: https://newrepublic.com/article/158660/covid-19-limits-american-moral-reasoning 

For information on the AMA's code of medical ethics go to: https://www.ama-assn.org/delivering-care/ethics  


Dr. J. Mario Molina Discusses Medicaid Program Financing in Light of the On-Going COVID-19 Pandemic (August 11th)

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Because the economy and the Medicaid program run counter cyclically or are negative correlated (when the economy falters, Medicaid enrollment increases ), to no one's surprise the COVID-19 pandemic's effect on the economy has put the Medicaid program in jeopardy.  The US is experiencing the worst unemployment rate since the Great Depression causing state budgets, heavily reliant and income and sales taxes, to crater.  (States, in sum, are looking at over $500 billion in revenue shortfalls between FY 2020 and FY 2022.)  Simultaneously, Medicare enrollment is increasing, a Kaiser Family Foundation study found enrollment could increase by as much as 24 percent by this coming January, just as state funding for it dries up.   All this explains why the Congress in March increased the federal government's Medicaid match or its funding share (termed FMAP) by 6%.  The House in May, under its HEROES Act, increased the federal government's match to 14% and in addition appropriated more than $1 trillion to state and local governments, including $915 billion in flexible aid—which can be spent for any purpose.  However, Senate Majority Leader Mitch McConnell failed to take up the HEROES Act.  The president's executive actions this past Saturday, even if they prove legal,  ignore the Medicaid program.   For FY 2021, that began July 1 for 46 states, the aggregate revenue shortfall exceeds $300 billion.   

This 27-minute interview begins with Dr. Molina's assessment of COVID-19 care under the Medicaid program and effects the pandemic is having on Medicaid and overall health care utilization.  Dr. Molina moreover discusses the federal government's response to the pandemic, whether the federal government should fund a greater portion of Medicaid spending and, alternatively, the Trump administration's proposal to block grant federal Medicaid funding.  He discusses state budget options to sustain adequate Medicaid funding.  We conclude with Dr. Molina's work with United States of Care's, specifically its OpenSafely campaign.  

Dr. J. Mario Molina is former CEO of Molina Healthcare that provides healthcare to low-income individuals, moreover BC-US-Molina-Executive-Shakeup-IMG-jpgMedicaid recipients and so called Medicaid-Medicare duals.  He is also the former founding Dean of the Keck Graduate School of Medicine in Claremont, California.  Currently, Dr. Molina work is focused on advocating for universal healthcare coverage and development next-generation medical technologies.  His volunteer experience includes serving as Founders’ Council member of the United States of Care, board trustee for Johns Hopkins Medicine, Director for Homeboy Industries, Director for Aquarium of the Pacific, visiting committee member for Harvard Medical School, board of governors’ member for the Huntington Library and inaugural board member of the Financial Solvency Standards Board of the California Department of Managed Care.  Dr. Molina is a Los Angeles native and graduate of Cal State Long Beach and the Keck School of Medicine at USC.

Information on United States of Care is at: https://unitedstatesofcare.org/.