Global Health Failure
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Routine HIV testing urged for nearly all Americans, 2/9/05

Drug 'probably killed thousands,' 1/25/05

Brazil to break Aids drug patents, 12/1/2004

Blacks dying for lack of health care- Disparities cost 886,000 lives in the U.S. in '90, 12/21/2004


Health Care Throughout the World: Inadequacies Resulting in Needless Suffering and Death

Quoting from The Health GAP Coalition White Paper: "Globalization and Unequal Access to Health Care: Resources for People with AIDS and Other Life-Threatening Illnesses,"  

"Today most of the world's people are denied access to lifesaving medications due to abuse of drug patent protection, high prices, and unfair government policies."

"About 90% of people with HIV live in developing countries, and have no access to any scientifically proven treatment for the infection. Patients with drug-resistant tuberculosis, certain cancers, and other deadly diseases also need medications that they cannot possibly obtain because of price."

See also the Washington Post Special Report: "Death Watch: AIDS in Africa," and AIDS: A Global Catastrophe

According to a September 2003 report by the World Health Organization and Medecins Sans Frontieres, only 1 percent of the millions of Africans who need anti-AIDS drugs receive them. Stephen Lewis, a U.N. AIDS expert called the crisis, “the grotesque obscenity of the modern world.”

According to the UNAIDS 2004 report on the global AIDS epidemic, "Sub-Saharan Africa has the world’s highest HIV prevalence and faces the greatest demographic impact. In the worst-affected countries of Eastern and Southern Africa, the probability of a 15-year-old dying before reaching age 60 has risen dramatically. In some countries, up to 60% of today’s 15-year-olds will not reach their 60th birthday (Timaeus and Jassen, 2003).

HIV’s impact on adult mortality is greatest on people in their twenties and thirties, and is proportionately larger for women than men. In low- and middle-income countries, mortality rates for 15–49-year-olds living with HIV are now up to 20 times greater than death rates for people living with HIV in industrialized countries. This reflects the stark differences in access to antiretroviral therapy. In low- and middle-income countries, mortality generally varies between two and five deaths per 1000 person years (PY) for people in their teens and twenties. However, HIV-infected individuals in these age groups experience death rates of 25–120 per 1000 PY, rising to 90–200 per 1000 PY for people in their forties (Porter and Zaba, 2004)."

Diseases such as polio, which should have been eradicated well before the year 2000 through global immunization, still harm the lives of children and adults throughout the world. The crushing effects of poverty, often compounded by civil war and hatred, have resulted in denial of vaccines and medical care to those most in need. Quoting from the Boston Globe article, "Ending a Scourge- a dream deferred:"

"In 1999, the number of new cases [of Polio] was estimated at 20,000 worldwide, with laboratory-confirmed cases standing at 7,143; for the first eight months of this year, the number of new confirmed cases had dropped to 1,148. Officials cautioned that the numbers could shoot up again during the next four months because of a hang-up in lab certifications, but progress has been swift in India, Pakistan, and Bangladesh, which in 1999 accounted for 53 percent of all new cases. So far this year, the three countries account for 31 percent of cases."

Children are often the silent victims of denied medical care. The organization, "Healing the Children," was started by Cris and Gary Embleton in their efforts to save the life of one child:

"Abandoned in an Asian land, sick and malnourished, her chances were not good from the start. Five dollars worth of medicine could have saved her, but it wasn’t available in her native country. In 1974, Gary and Cris Embleton fought to save her." -from "Healing the Children's History."

The global nature of the problem is underscored by the World Health Organization's, World Health Report 2000. Quoting from the overview section of this report:

"...Poorly structured, badly led, inefficiently organized and inadequately funded health systems can do more harm than good...These failings result in very large numbers of preventable deaths and disabilities in each country; in unnecessary suffering, in injustice, inequality and denial of basic rights of individuals. The impact is more severe on the poor, who are driven into deeper poverty by lack of financial protection against ill-health. In trying to buy health from their own pockets, sometimes they only succeed in lining the pockets of others. "

There are 500 million cases of Malaria in the world and 1.5 to 3 million deaths are estimated to occur annually. Malaria kills one child every 30 seconds and 3,000 children per day under the age of 5. Most children who are afflicted are African. While malaria vaccines are under development, anti-malarial drugs exist to prevent mortality and prevent morbidity from the infection. Stronger efforts are needed in prevention, prompt recognition and treatment with affordable drugs. More R&D funds are needed for vaccine development, diagnostics and development of new drugs that are not Plasmodium resistant. See: WHO: Malaria.

The World Health Organization estimates that between the years 2000 and 2020, nearly 1 billion additional people will become infected my Mycobacterium tuberculosis, 200 million will develop active disease and 35 million people will die from tuberculosis (TB). Currently one-third of the world's population is infected with TB. TB is the second leading infectious cause of death in the world, behind only HIV/AIDS, killing approximately 1.7 million people per year. Twenty percent of AIDS patients also die of TB, bringing the total deaths each year to almost 2.5 million. Greater sums of money are needed for vaccine research, low cost/rapid diagnostics and shorter, simpler therapeutic and prophylactic regimens to increase adherence.

Cataract surgery is generally a safe, uncomplicated outpatient surgical procedure performed routinely in the developed world. Yet in the developing world:

Cataracts are the leading cause of blindness worldwide, accounting for half of the world's 40 million blind. The majority of the world's 20 million cataract blind live in the developing world. About 5 million new cases of cataract blindness occur each year. Only a small percentage of persons in the Third World who develop cataracts receive cataract surgery. Cataract blindness causes severe economic and social problems in these countries. Because of increased longevity and population growth in the Third World, the number of untreated cataract cases is escalating rapidly. From: Cataract Blindness in the Developing World: Is There a Solution? by Robert Isaacs, MD, Jagat Ram, MBBS, MS, David Apple, MD page 7-19; See Also: The International Eye Foundation.

The world's poor not only do not receive health care, but some are used as guinea pigs for experimental drugs that are later approved (or not approved) in the United States and other "first world" nations. According to a Washington Post series, "The Body Hunters,"

"...The Post examines the booming, poorly- regulated system of international clinical drug testing that far too often preys on the poor and uneducated and betrays its promises to patients and consumers."

In some cases the subjects of these clinical drug tests, the so-called "control group," are given placebos, even when medicines exist that could save their lives. Human lives are being devalued to that of laboratory animals.


Health Insurance in the United States

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness." - The United States Declaration of Independence.

Yet many Americans, young and old, are essentially denied these rights by denial of access to quality health care, whether by un-insurability or inability to pay. 

Healthinsuranceinfo.net
A consumer guide for getting and keeping health insurance for each state and the District of Columbia.

Centers for Medicaid and Medicare Services

HIPPA: The Health Insurance Portability and Accountability Act of 1996: Know Your Rights!

Insure Kids Now!
Every state in the nation, has a health insurance program for infants, children and teens. For little or no cost, this insurance pays for: doctor visits, prescription medicines, hospitalizations, and much more. Kids that do not currently have health insurance are likely to be eligible, even if you are working. The states have different eligibility rules, but in most states, uninsured children 18 years old and younger, whose families earn up to $34,100 a year (for a family of four) are eligible.

Sound Partners for Community Health
Seeks to increase public awareness of specific health issues and facilitate citizens' involvement in making decisions affecting health care by fostering partnerships between public broadcasters, community organizations and additional media entities.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002)- National Academies Institute of Medicine

Healers Go for the Well-Heeled
'Concierge' Care Sparks a Debate on HMOs, Medicine and Morals

Veterans Health Administration
 

According to the document, "Key Facts About the Uninsured," from FamiliesUSA, 43 million Americans are uninsured. Eight out of ten of uninsured are in working families. The average family health plan is quite expensive, costing $6,351 annually. Lower wage earners are less likely to be offered coverage at work and even when they are offered coverage, they have to pay more to take advantage of the offer. The uninsured are more likely to be hospitalized for conditions that could have been avoided such as pneumonia and uncontrolled diabetes. Uninsured cancer patients are more likely to be diagnosed with late stage cancer. When the uninsured receive medical care they are often charged more than insured.  

Some children who are severely disabled lose critical health care benefits such as nursing coverage when they reach 21. See the case of Nicholas Dupree who lives in Alabama. According to Steve Shivers, Alabama's Commissioner of Rehabilitation Services:

The state of Alabama does not offer service of any kind in home to people who are disabled and on ventilator support. The ESPDT waiver will terminate on his [Nicholas Dupree's] 21st birthday. 

Many Americans find themselves medically uninsurable at the most inopportune times. Why this is so in one of the wealthiest countries in the world is a complex question. The following letter, which was written to Congressional and Senate representatives, is only a small example of what can happen, even to those who responsibly plan for their medical insurance needs. Certain parts of the letter were deleted to maintain the author's privacy.

This letter is to inform you of a predicament that I am in. I am writing because I believe this predicament probably effects millions of Americans. In part, it reflects a basic unfairness in American society. Further, the cause of this unfairness lies squarely in the hands of the United States Congress and the various state governments, including that of California.

I am ** years old and in good general health. I was recently laid off by my employer. One week prior to the cessation of my medical coverage, I went to see a doctor for a medical examination. The physician indicated that I had a mild *********. A second physician concurred in this diagnosis. Because the problem was minor, surgery was not indicated or recommended. In fact, surgery may not be need for many years.  In all other respects I am considered in good health.

However, as a result of this diagnosis, I am now medically uninsurable through private insurers. I will take advantage of COBRA and attempt to continue medical and vision benefits for the next 18 months under my former employer's health plan. Thereafter, if I have no breaks in medical coverage, I will be eligible for a so-called "conversion plan" that will offer me a very high deductible and correspondingly high premiums- beyond what I can afford. With this "conversion plan," I will not have to satisfy any pre-existing condition requirements. My other alternative is to seek a state sponsored medical plan alternative, offered by the Managed Risk Medical Insurance Board. This plan offers caps of up to 50,000 per year ($500,000) lifetime for medical illness. For many medical treatments, this is a proverbial "drop in the bucket." [Update 2/02: This paragraph is factually incorrect: an individual covered continuously for 18 months may be eligible under HIPAA (The Health Insurance Portability and Accountability Act), for continued coverage, without pre-existing condition exclusions, under plans that while expensive, may be of higher quality than a typical insurance company conversion plan. Further, the insured has the ability to shop plans, provided they act within 63 days of plan termination and have a Certificate of Creditable Coverage (proof of prior coverage).]

It should be noted that, if for financial reasons, I can not pay the COBRA medical premiums, my only alternative to procure coverage will be the MRMIB plans or another employer who offers a group plan (who may also have a waiting period- creating another gap in coverage). If I am merely late in paying a premium, beyond the insurer's grace period (usually 30 days), I will also lose my entitlement to guaranteed coverage. The insurer will have no inclination to reinstate my medical coverage.

In summary, if someone is deemed medically uninsurable, they are put in extreme financial and personal risk. Even someone who is in relatively good health, potentially not requiring any surgery for many years, may be unable to find and keep coverage.

The solution to this problem- if one ignores the influence of various special interest groups- is really quite simple. Provide that all individual and group medical policies must be underwritten by all insurance companies without regard to the health of an applicant. Further provide, that an insurer may not charge more for a policy, or rider out health conditions due to the ill health of an applicant. Many of these provisions already apply to small group medical insurance in California. They would not discriminate against any individual insurer or insured. In cases where individuals could not afford the insurance premiums, they might receive tax credits, loans and/or subsidies. The only alternative to this proposal under the present medical insurance system is either to effectively not provide needed medical care for uninsured sick individuals or to have "others," ultimately the taxpayer, shoulder the costs. In the latter case, medical procedures are often delayed and financially devastating- adversely effecting the long-term health of the ill person.

Is it right that employees should be afraid to lose or leave their jobs because of fears they will be uninsurable? Is this individual truly free in any meaningful sense of the term, particularly since the sick are often the least employable? Of course, preferable to our current patchwork system would be one of universal and compulsory coverage for all Americans. A system that ensures the sick will always receive needed, timely and affordable treatment. 

My life has not yet been ruined by the current laws surrounding health care in the United States and California. Can you assure me that 18 months (or less) from now- it won't be ruined? If I am unlucky or unfortunate enough to fail to continue and extend coverage, whatever savings I have would evaporate if serious medical conditions arose, my health would not be attended to, I would be unable to procure work and I would deemed "unproductive" by the society. Is this what you want to happen?

Postscript: This letter was sent to various California Congressmen and Senators over three years ago- none responded...

 

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