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The Advocate – Youth Caucus of America
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sarah yca article 1 insanity

The Insanity Defense

The Insanity Defense

How One Case Could Change The Justice System's Approach

WHAT YOU CAN DO...

By Sarah Rogers

With a number of controversial cases on the docket, the Supreme Court kicked off on October 7th receiving arguments for Kahler v. Kansas -- an accused’s rights case centered around the “insanity defense.”[1] In 2009, James Kahler was sentenced to death for the brutal killings of his wife, their teenage daughters, and his wife’s grandmother. At trial, his lawyers constructed a defense plan on the basis that Kahler suffered from severe mental illnesses -- mainly depression, as well as a number of personality disorders. [2]However, under Kansas law they were restricted to arguing that these illnesses precluded Kahler from having criminal intent -- but because he still knew he was killing another human being, he was guilty. This is a remarkable anomaly in that practically every other state considers the “insanity defense” an affirmative offense. It is broadly accepted that an individual whose mental disorder prevents them from distinguishing right from wrong cannot be held criminally liable for their actions, even if they are proven guilty. This interpretation of law dates back to the 19th century and was universally recognized throughout the U.S. until the end of the 20th century, following a series of highly-publicized cases.[3] Particularly influential was the case of John Hinckley, who in 1981 shot President Ronald Reagan and three others, but was found not guilty by reason of insanity.[4] Following Hinckley’s acquittal, the public began to doubt the legitimacy of mental-capacity defenses, and four states -- including Kansas -- eliminated the insanity defense.

 

Today, Kansas solely permits the “mental-illness defense” -- allowing evidence of mental disorders only to the extent where they impede the defendant’s ability to be aware of their actions.[5] However, mental illnesses rarely prevent people from knowing what they are doing; far more often, they give people wildly irrational reasons for unlawful activity. In drawing a distinction between these two things, and only protecting the former, Kansas law deeply misunderstands the practical wisdom on which the traditional test of insanity was founded. Justice Breyer put this perfectly during the hearing: “One defendant kills a victim he thinks is a god. The second defendant knows it’s a person but thinks the dog told him to do it. They are both crazy. And why does Kansas say one is guilty, the other is not guilty?”

 

Up until now, the Supreme Court had never been asked to consider whether states may eliminate such fundamental principles of law. Yet, despite the Court’s typical wariness of imposing restrictions on states’ governance of criminal proceedings, it has a long-established practice of fortifying traditional legal doctrines.[6] Thus, in deciding for the first time whether abolishing the insanity defense is a constitutional violation, the Supreme Court will set significant precedent on the role of the Federal government in upholding long-established legal customs in America. Moreover, it will also have a crucial stake in the fate of legal protections for the mentally ill nationwide. If the court decides in favor of Kansas, states will be given an open invitation to begin loosening legal practices that encourage non-carceral dispositions for the mentally ill. The resulting criminalization of mental illness would not only affect those suffering from personality disorders like depression, but also those suffering from addiction to drugs and other substances. Treating mental illness as though it were a crime itself is a slippery slope to using incarceration as the solution to every problem that society does not know how to solve. Even worse, it is a definitive way to ensure that those who need help the most are deprived of it.

 

Of course, Supreme Court decisions are generally founded on far more than merely “doing the right thing”. Yet, in this case the insanity defense is a morally just course of action backed by long-established and deeply embedded American legal precedent. In the vast majority of jurisdictions, legally “insane” individuals who commit even the most heinous of crimes are put in secure non-penal institutions for treatment. These patients are kept in custody or under community supervision until a court deems that they are no longer a danger to society. This system has worked for centuries providing treatment to the ill as opposed to incarcerating them for crimes they cannot possibly understand: so why should Kansas be any different?

 

         The overarching purpose of incarceration is to provide rehabilitation for those found guilty of serious offenses. Yet, if one’s reasoning for committing a crime is blurred by mental illness, which leaves them incapable of distinguishing right from wrong, then sentencing them to prison fundamentally misunderstands what the carceral system was built to do. Prisons were never intended to treat mental disorders, nor were they meant to hold people indefinitely, because of a lack of a better place to put them. Indeed, the mentally ill who commit violent crime pose a threat to public safety and should not remain in society untouched; but for them to achieve rehabilitation, they must be provided with treatment, not punishment. Thus, the insanity defense is not only morally just, but a pragmatic necessity. For if someone is truly so ill that they are incapable of basic moral judgement, then they ought to receive actual treatment, not to be put in a cell where the system locks them up and throws away the key.  

___________________________________________________________________________________________


[1] SCOTUSblog. Kahler v. Kansas

[2] Morse, Stephen and Bonnie, Richard. “Insanity and the Supreme Court.” WSJ. 6 Oct. 2019.

[3] Black, Robert. “Kahaler v. Kansas: Can States Abolish the Insanity Defense?” National Constitutional Center. 8 Oct. 2019

[4] CNN Library. “John Hinckley Jr Fast Facts.” CNN. 11 Sept. 2019.

[5] Epps, Garrett. “Does the Constitution Guarantee a Right to an Insanity Defense?” The Atlantic. 6 Oct, 2019.

[6] Bravin, Jess. “Supreme Court Opens Term with Look at Kansas’ Effort to Bar Insanity Defense.” WSJ. 7 Oct. 2019.

image1

“Tuition-Free” Medical School

"Tuition-Free" Medical School

An Effective Attempt At Reducing Student Loans Or An Unfulfilled Promise?

WHAT YOU CAN DO...

By Adelina Branescu

The U.S. is on the brink of a national student loan crisis, with Forbes reporting that this collective debt reached $1.52 trillion in 2018 and impacted 44.2 million Americans. With the upcoming presidential election in 2020, many candidates such as Senators Bernie Sanders and Elizabeth Warren are homing in on younger voters with promises of eliminating student debt. Due to a majority of high-paying jobs requiring applicants to have at least a bachelor’s degree, the scope of debt relief proposals are typically tailored to undergraduate studies. Yet, this narrowness of attention has left out a significant portion of students whom also bear what has become extremely burdensome debt: graduate students. Specifically, the path to becoming a doctor requires rigorous schooling that accumulates large sums of debt not only from undergraduate studies but also from the high price tag attached to medical schools. As a result, programs such as Cornell’s Weill Medical College are beginning to offer lowered costs and tuition-free options for students (2). To medical school applicants across the country, this development raises concerns as to whether they are eligible for the benefits of these newly implemented policies.

 

        The first institution to begin shifting debt relief efforts towards medical school was Columbia Universitywho in 2017 implemented a loan-free policy for all medical students (3). To address the notoriously high cost-of-living in New York City, Columbia also designated need-based aid to students for housing purposes. Columbia’s neighboring medical school at New York University announced a similar policy the following year, planning to cover tuition costs for all of its students. A different route has been taken at universities such as UCLA, which has introduced merit-based scholarships to ease the costs of attending their medical program. Following in the footsteps of these institutions, Cornell’s Weill program has expanded this approach by beginning to cover all costs for students deemed needy. For students looking to apply to medical schools in this upcoming cycle, the varied information per school can be overwhelming. For colleges such as Weill, applying can be nerve-wracking for prospective students who are even unsure of their own need status. Where do institutions draw the line between who qualifies for need and who doesn’t? How do they ensure the determining factors of qualification are not decided arbitrarily? To aid in answering some of these questions, below is a summaryof information for medical school applicants looking to better understand the growing debt-relief trend and how it applies to some of the country’s most popular medical schools.

 

Need-based:

 

Columbia University College of Physicians and Surgeons (4)

The program received $150 million in initial donations from Roy and Diana Vagelos and aims to receive more funding in the upcoming years. Their aid functions by replacing all loans that would have been taken out with grants, meaning that approximately 20% of students will receive entirely free tuition.

 

New York University (5)

        This initiative provides a $56,272 scholarship to each student covering the entirety of tuition. In order to continue receiving this grant, students must maintain good academic standing by NYU board standardswhich have not been specified as of late The dean stated that NYU opes to encourage students to pursue lower paying specialties in high demand, such as family medicine.

 

Cornell University (6) (7)

 

Weill recieved $160 million in donations from the Starr Foundation and Sanford I in order to offer need-based free tuition to those who qualify, which turns out to be about 52% of students per year.

 

Washington University (8)

WashU’s program utilizes over $100 million of donations to lower costs and cover full tuition for approximately half of the students attending. Similar to New York University’s Medical School, a committee determines if a student will receive a grant based on a combination of merit and need.

 

Merit Based:

 

UCLA (9)        

            UCLA provides an entirely meritbased scholarship to students who show dedication to community leadership, as decided by the UCLA admissions committee.

 

University of Pennsylvania (10) (11)

UPenn awarded approximately 30 full-tuition scholarships in a class of 150 (~20%) to students demonstrating academic performance, leadership, relevant life experiences, and other unspecified factors.

 

Conclusion:

At first glance, it appeared that some of these efforts were not entirely ambitious or beneficial. As a college student myself, I went through the process of taking out loans because the “expected parent contribution” was too high and the work-study expectation was infeasible, I wondered if these efforts to reduce student debt were actually effective and fair, or if they were a ploy for increasing university prestige, especially given the language in some of the offerings. However, based on the list of medical schools providing need-based aid, it appears that they are not allocating a portion of their already existing budget towards these programs. Instead, they arereceiving millions of dollars from donations specifically directed towards aid, resulting in less pressure for these schools to cut funding from their own endowment. In particular, New York Universityis attempting to push students towards lower-paying but highly necessary specialties through these grants. These specialties include fields such as family medicine, which has seen a shortage ofstudents pursuing this branch of medicine with primary-care physicians hovering between 14,900 and 35,600 (12) in the United States. NYU is an admirable example of a medical school attempting to create a positive societal changeby ensuring that students are specializing in their passion as opposed to a paycheck.  

 


 

1. https://www.forbes.com/sites/zackfriedman/2018/06/13/student-loan-debt-statistics-2018/#6c0a62e97310

2. http://news.cornell.edu/stories/2019/09/weill-cornell-medicine-announces-debt-free-medical-education

3. https://www.nytimes.com/2017/12/04/nyregion/columbia-medical-school-endowment-p-roy-vagelos.html?module=inline

4. https://www.columbiaspectator.com/news/2018/04/17/columbia-medical-school-first-in-nation-to-offer-new-students-debt-free-graduation/

5. https://med.nyu.edu/education/md-degree/md-affordability-financial-aid/cost-attendance

6. https://weill.cornell.edu/our-story/deans-messages/medical-school-debt-reduction

7. https://www.cnbc.com/2019/09/18/cornell-to-offer-full-rides-to-all-medical-students-who-qualify.html

8. https://medicine.wustl.edu/news/washington-university-commits-100-million-to-md-scholarships-education/

9. https://medschool.ucla.edu/geffen-scholarships-about-the-scholarship

10. https://www.med.upenn.edu/admissions/financial-aid.html

11. https://www.med.upenn.edu/admissions/entering-class-profile.html

12. https://www.nejmcareercenter.org/article/physician-shortage-spikes-demand-in-several-specialties-/

Image: https://www.pexels.com/photo/healthy-clinic-doctor-health-42273/

yca administrative healthcare

The Burden Of Inefficiency

The Burden Of Inefficiency

How Rising Administrative Burdens Have Cost U.S. Taxpayers Millions

WHAT YOU CAN DO...

    • S.B. 3434, the Reducing Administrative Costs and Burdens in Health Care Act of 2018, was killed in Committee during the 115th Congress

    • Contact Senator Bill Cassidy (R--LA) and Senator Tina Smith (D--MN) to encourage them to reintroduce this bill

By Zoe Hauser

Debates over the United States healthcare system run rampant throughout the political stage, with each party taking strict oppositional stands. Yet, healthcare should be seen through a lens that removes the party power struggle the issue has become, and as the necessity to American livelihood it truly is. The result of healthcare being posed as merely a political battleground for party quarrels is a vastly inefficient and wasteful U.S. system. If we can reduce waste and inefficiency, then we will be able to improve our system to better serve the country’s citizens and help temper the political stalemate on healthcare.

 

The United States unloads 17.8% of its GDP on healthcare, making us the world’s largest healthcare spender[1]. But this does not mean that our healthcare system uses this money efficiently and/or properly. In 2017, the National Health Expenditure Accounts (NHEA) estimated the United States spends a total of approximately $3.5 trillion each year on healthcare, rendering per capita costs of $10,739[2]. Switzerland, the second largest spender on healthcare, witnessed per capita costs at an estimated $7,317 in USD[3]. This is equal to 12.2% of Swiss GDP, a figure still substantially less than the United States. The United States’ noticeable healthcare waste can be traced to the system’s administrative costs, rooted into the inefficiency of the U.S. healthcare system. Administrative costs include medical records, insurance bills, and other hidden costs which most patients are not aware of.

 

According to a recent Journal of the American Medical Association (JAMA) study, the estimated total cost of waste in the administrative healthcare sector ranges from $760 billion to $935 billion[4]. This accounts for 25% of total healthcare spending in the United States. JAMA identified 6 domains of waste including: failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud, abuse, and administrative complexity3.

 

Administrative complexity, for instance, is the largest producer of administrative waste because the medical system requires many different departments, form duplications, and various other requirements which cause the system to become too complex to remain efficient and functional. This complexity accounts for the largest portion of administrative waste produced, but also has the potential to use innovation and reorganization to reduce its waste by the greatest portion of the six domains.

 

While some misuse of funding is inevitable in all large-scale governmental systems, the amount of administrative waste in the United States is staggering and has become an issue that must be dealt with. Researchers have proposed solutions such as digitalizing all medical records, incorporating a pay-in-advance option for services, and an array of other modifications to the system that would ultimately reduce waste by $191 billion to $282 billion.

 

In 2018, S.3434, title Reducing Administrative Costs and Burdens in Health Care Act, was introduced to Congress[5]. The Senate has referred this bill to the Committee on Health, Education, Labor, and Pensions. This bill would require the Department of Health and Human Services to allow states to implement strategies, recommendations, and actions to reduce unnecessary costs and burdens of the administrative health care system. The bill includes recommendations such as standardizing and automating administrative transactions and implementing more open application programming interfaces to improve communication between patients and their doctors.

 

For young adults, the idea of healthcare is dealt with mostly by our parents. However, as we graduate from college and transition into a lifestyle no longer supplemented by our parent’s aid, healthcare insurance costs and hospital visits will become an increasingly important part of our lives. An inefficient healthcare system handcuffed by administrative deficiencies has caused the cost of health care, and subsequently insurance rates, to increase. Since healthcare is required by law in the United States, young adults as well as other Americans will be forever plagued by these ever-increasing insurance rates.


[1] Papanicolas  I, Woskie  LR, Jha  AK.  Health care spending in the United States and other high-income countries.  JAMA. 2018;319(10):1024-1039.

 

[2] National Health Expenditures BType of Service and Source of Funds, CY 1960-2017. CMS.gov. US Centers for Medicare and Medicaid.

[3] “Health Resources - Health Spending - OECD Data.” TheOECD, data.oecd.org/healthres/health-spending.htm.

[4] Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. Published online October 07, 2019322(15):1501–1509. doi:10.1001/jama.2019.13978

 

[5] United States. Cong. Senate.  Reducing Administrative Costs and Burdens in Health Care Act of 2018. 115th Cong. 2nd sess. S3434.

latino college access yca article

Closing The Achievement Gap

Closing The Achievement Gap

Investing In The Educational Potential Of Latino Students

WHAT YOU CAN DO...

  • Support community and state organizations that provide resources and opportunities to Latino students throughout their educational journeys

  • Learn more about how you can get involved with LUCA here

    http://www.latinoucollege.org/get-involved/

By Gillian Hand

For many young adults across the country, higher education is often taken for granted. For teenagers in many underrepresented communities, however, this is not always the case. Latino students are a demographic facing a variety of obstacles to their education, often juggling numerous responsibilities while receiving minimal access to important information and resources. According to the United States Census Bureau, Latinos make up the largest minority group in the United States, expected to increase to 29% of the total population in 2060.[1] With an increase in the Latino student population correlated with this growth, high school dropout rates among Latino students are at an all-time low, with college enrollment increasing at a faster pace than any other ethnic group. However, the percentage of Latino students graduating with a college degree lags behind these otherwise encouraging figures.[2] Although one in four K-12 students is Latino, students in this demographic have produced lower records of educational attainment, indicating an uneven playing field that continues to compromise the opportunity and achievement of Latino youth.[3] 

 

A 2016 University of Minnesota study concluded that a third of the Latino student population grows up in poverty, with two-thirds coming from low-income households. This reality forces many young Latinos to play catch-up with other students around the country, embarking on their educational path already at a disadvantage.[4] Growing up in lower-income neighborhoods, these students often have to attend low-performing schools with less access to resources, support groups, and information. The skyrocketing student loan costs attributed to modern universities make it even more difficult for students to complete a degree at a post-secondary institution, often inhibiting them from pursuing higher education at all.[5]

 

In addition to these financial concerns, many Latino students are also the first in their family to seek a college education. The parents of first generation students often lack the time and knowledge needed to assist with the navigation of the college application and financial aid process, making it difficult for families to access the information and counseling needed to make informed college and career decisions.[6] Without needed support, these students struggle to find and pursue the best path toward higher education, keeping educational opportunity and achievement out of reach for far too many.

 

Another significant obstacle faced by Latino students is acculturation—the assimilation into American culture both in society and on campus. Latino youths frequently serve a far greater role in their households, often balancing responsibilities such as taking care of younger siblings and translating for parents who don’t speak English. In addition to these burdens that are uncommon among most other youth groups, many Latino young adults struggle to adjust to the new culture of the United States while they juggle the social and developmental challenges of growing up, often working to learn a new language themselves.[7] Numerous Latino students also face the psychological struggles of fearing for the safety of undocumented family members, burdens that stem from the Trump administration’s increasingly harsh policies toward immigration. In the modern political climate, Latino students often live in fear of deportation and worry that immigration services will gain information about their families, thus moving education even further out of reach.[8]

 

These obstacles to Latino students’ pursuit of higher education combine to produce the statistically disproportionate achievement gap. To even the playing field for this demographic of American society, federal and local efforts must prioritize educational services and provide these students with necessary academic opportunities and support. The National Education Association highlights an array of important steps that schools can take to improve opportunities for their Latino student population, including offering early childhood screenings for medical and social services, targeting resources on closing the gap, and providing stronger academic and social offerings such as tutors, mentors, role models, and peer support networks. Other essential changes include accessible adult education courses complemented with teachers and curriculums that “understand and capitalize on students’ culture, abilities, resilience, and effort”.[9]

 

One community organization aiming to address the achievement gap is Latino U College Access (LUCA), a non-profit agency serving first generation Latino students in Westchester County, New York. Encompassing the principles of education, advocacy, and collaboration, Latino U guides high school scholars and their families through the complicated college process, matching high-potential, low-income students with college coaches that help them navigate complex application and financial aid requirements. With opportunities such as essay and FAFSA workshops and networking with corporate partners and volunteers, LUCA exposes these promising students to educational and internship opportunities they never dreamed possible.[10] Latino U is just one example of a growing network of community-based efforts to invest in the potential of Latino students; going forward, similar organizations as well as school and state programming will be imperative in the movement to make higher education more accessible for this demographic.

 

Latino undergraduate enrollment has more than doubled in recent years, increasing from 22% to 37% between 2000 and 2015. Numerous institutions across the country have seen the development of new programs focused on broadening campus diversity such as the creation of Latino leadership programs, hiring more representative faculty, and expanding cultural programming.[11] However, there is still a long way to go until all Latino students receive the support they need to reach their educational potential. Policymakers should prioritize the creation and implementation of services that support Latino students, ensuring higher levels of college completion and educational achievement.

 


 

[1] Field, Kelly. “More Hispanics Are Going to College and Graduating, but Disparity Persists.” PBS, Public Broadcasting Service, 14 May 2018, www.pbs.org/newshour/education/more-hispanics-are-going-to-college-and-graduating-but-disparity-persists.

[2] Krogstad, Jens Manuel, and Richard Fry. “Fewer Hispanic Young Adults 'Disconnected' from School, Jobs.” Pew Research Center, Pew Research Center, 17 Aug. 2015, www.pewresearch.org/fact-tank/2015/08/17/analysis-shows-fewer-hispanic-young-adults-disconnected-from-school-jobs/.

[3] Field, “More Hispanics Are Going to College and Graduating, but Disparity Persists.”

[4] Davila, Silvia Alvarez de, and Cari Michaels . “Falling Behind: The Challenges Facing Latino Education in the U.S.” CEHD Vision 2020, Regents of the University of Minnesota, 28 Apr. 2016, cehdvision2020.umn.edu/blog/challenges-facing-latino-education/.

[5] Field, “More Hispanics Are Going to College and Graduating, but Disparity Persists.”

[6] Carnevale, Anthony P, and Megan L Fasules. “Latino Education and Economic Progress: Running Faster but Still Behind.” Executive Summary, Georgetown University Center on Education and the Workforce, 2017, cew.georgetown.edu/wp-content/uploads/Latinos-ES.pdf.

[7] Alvarez de Davila and Michaels, “Falling Behind: The Challenges Facing Latino Education in the U.S.”

[8] Field, “More Hispanics Are Going to College and Graduating, but Disparity Persists.”

[9] “Strategies for Closing the Achievement Gaps.” NEA, National Education Association , www.nea.org/home/13550.htm.

[10] “Latino U College Access.” Latino U College Access, 20 Sept. 2019, www.latinou.org/.

[11]  Field, “More Hispanics Are Going to College and Graduating, but Disparity Persists.”

candidate healthcare yca article

Healthcare In 2020 And Beyond

Healthcare In 2020 And Beyond

What Are The Candidates Really Saying?

WHAT YOU CAN DO...

By Alexander Kucherina

Plans for Candidates

Did you know that over 50 percent of Americans do not receive the proper preventative care and pre-screening that medical experts recommend? Additionally, 1 out of every 10 Americans lives without insurance? These are catastrophic problems that are somehow still not addressed with the modern-day United States healthcare system. Now that the 2020 Presidential race is up and running, an immense amount is at stake for Americans and their healthcare. The Democratic candidates, pushing and shoving their way to a party nomination, plan to enact policies that could drastically change the realm of healthcare coverage, accessibility, and costs for millions of Americans. Many of the Democratic proposals rally around a healthcare system known as “Medicare for All”, while the remaining candidates have introduced plans combining both private and universal coverage into a hybrid system. Yet, the national media tends to summarize candidates’ plans into headlining news, often failing to elaborate on how the plan would actually impact Americans on a day-to-day basis. This media shortcoming strips the public of knowing integral pieces of the proposals such as what benefits these plans would offer, the different types of healthcare providers included, insurance for non-generic drugs, etc.

 

Joe Biden

The main goal of the Affordable Care Act (ACA), otherwise known as “Obamacare”, enacted in 2010 was to reduce the number of uninsured Americans without further decimating the federal budget1. Obamacare aimed to encourage Medicaid for lower class citizens not already eligible for coverage while simultaneously subsidizing private health insurance for the middle class. Democratic frontrunner Joe Biden aims to build off of the precedents of the Affordable Care Act he and former President Barack Obama crafted almost a decade ago. Biden wants to offer Americans a “new choice” through a public health insurance option. This ACA expansion would shift power into the peoples’ hands to choose whether or not they want to buy-in to the program. The question is, would this public option work?

If he bases this option off of the previous exchange system, he might not be able to pull it off. This exchange system failed when premiums continued to rise, and enrollees’ medical costs exceeded total premiums. Additionally, if the Affordable Care Act is to be expanded as Biden’s proposal suggests, many claim it should be managed at a national level instead of under state jurisdictions. Over 14 states were able to opt out of the Affordable Care Act’s Medicaid expansion proponent after a 2012 Supreme Court ruling granted them this right. These states turned down funds that could have significantly increased coverage rates at the expense of slightly raising sales taxes per state. If the Affordable Care Act is to be expanded, Biden must tailor it in a way that would unify the states and their individual interests. A personal recommendation would be to offer each state a “safety net” plan. This would be of three options: withdrawing from the expansion if results are not visible, require cost-sharing for enrollees, or simply using the expansion funds for other areas. This would at least make sure that the funding is going through to most states. Without something like a “safety net” many underprivileged communities may once again fall victim to coverage gaps and un-insurance problems.

 

Bernie Sanders

The next plan that is currently turning heads in Washington is the Medicare for All Act proposed by Senator Bernie Sanders of Vermont. Sanders vows it will “provide comprehensive healthcare to every man, woman and child in our country without out-of-pocket expenses”. The bill will also stretch Medicare coverage to include dental, hearing and vision care. This will be pivotal, as these categories are not currently covered under our nation’s Medicare system that’s been relatively untouched since 1965. It also calls for expanded coverage to include and pay for long-term care paired with no copayments for healthcare visits.

 

            Sanders has been very vocal towards his desire to provide extensive taxes on upper classes to not only fund his healthcare bill, but to shrink the gap of income inequality in America. It must be noted that the current Medicare plan often relies on enrollees signing up for a “Part C” option which works like a supplemental insurance plan. This is likely to be eliminated under Sanders’ plan which will reduce the cost of healthcare substantially for the enrollee. Medicare is currently financed by a “pay as you go” system, where current workers pay for older Americans entering retirement. The other parts of Medicare are financed by federal tax revenues, which cover 75% of Part B (physician, outpatient care) and 75% of Part D (drug prescriptions). According to a recent study, over 40% of Medicare is financed by taxpayers. If Medicare expands into a universal system as Sanders proposes, it will likely result in an increase of medical costs that could trickle into higher payroll taxes. People would indeed pay more taxes, but likely less for their healthcare. For an individual, cost sharing is more than likely to go down under this plan, with a decrease in deductibles and copayments. Additionally, with the likelihood of physicians being paid less and crackdowns on the “Fee for Service system”, patients will not be forced into paying out of pocket for supplemental procedural needs. Quality of care will go up for most individuals, and less unnecessary, pricey x-rays will be ordered.

 

            Without this increase in taxes, components of the healthcare coverage would inevitably have to be cut. This includes public health programs, hospital spending, etc. Medicare for All seeks to eliminate the loopholes in the current healthcare system by insuring coverage to everyone. Sanders often refers to the European healthcare systems and how they are successful with their adoption of universal, single-payer coverage. He is undoubtedly right, as their healthcare spending is dramatically less, and the average individual has a multitude of affordable options in front of them when in need of medical care. On average, other wealthy countries spend about half as much per person on health than the United States spends2. It will be interesting to see how large biotech and pharmaceutical companies will respond to a Medicare for All policy. They will not be as willing to surrender their profits and allow the government to be the big single payer within the system.

 

Elizabeth Warren

                Massachusetts Senator Elizabeth Warren has also been extremely vocal about Medicare for All. Although media and news outlets tend to describe the candidate’s “Medicare for All” policy as a replication of Senator Sanders’ proposal, Warren’s plan has distinctive features. One unique driving force of Warren’s plan is a proposed bill titled “The Affordable Drug Manufacturing Act”3. This bill places responsibility on the federal government to step in and manufacture generic drugs when prices have dramatically spiked or if there is a shortage of supply. This may prove to be pivotal in regulating the price of drugs like insulin, which is currently produced by just a few companies worldwide. Nevertheless, it gives any individual a chance for receiving their necessary prescription generic or non-generic drugs if it happens to be pulled off.

                Another extremely unique component of Warren’s plan is a potential “Behavioral Health Coverage Transparency Act”, which would hold insurance companies accountable for providing adequate mental health benefits. This bill is extremely flexible and can be applied under nearly any payer system. Any insurance plan can be mandated to implement mental health coverage, which would shift the conversation of healthcare towards the individual and alleviate mental health problems that are not nearly discussed enough in current debates. Additionally, Warren’s proposed “Care Act” seeks to fight America’s opioid crisis through federal funding that would support access to medication-based treatment, public health centers, and preventative and rehabilitative care.

A lot of talk in recent months has been centered around where the funding for these acts and plans would exactly come from. Although Warren is still working on releasing an official bill outlining the budget, her proposals target highly specific and underrated elements of what healthcare means in the United States. Hitting these points would make vital differences in the day-to-day lives of individuals who are being stripped of necessary prescription drugs, mental health care, or proper rehabilitative aid.

 

Kamala Harris

Senator Kamala Harris has pledged her support of Medicare for All in the past. However, Senator Harris’ full-fledged healthcare proposal includes some noteworthy variations. For one, her bill would still include small private insurers playing a role within the Medicare for All system. Another distinction of her healthcare bill is the 10-year transition period needed to cover all Americans under this policy, while Senator Sanders’ calls for only a 4-year period. Many critics deem a 10-year plan too slow and not urgent enough in solving many of the country’s healthcare problems. Harris sticks to her claim that current Medicaid and public option enrollees will slowly transition into the Medicare for All plan she offers in order to keep the burden on American taxpayers low.

Harris ensures the government will regulate the private market that has been in the crosshairs of public scrutiny, but many analysts say this will be far more difficult than the Senator from California suggests. For instance, physicians are paid over 48% less by Medicaid than by the private insurers, on average4. This results in many providers not accepting new Medicaid or subsidized insurance plans. In 2013, only 6% of physicians accepted new Medicaid patients in Minnesota. These numbers may cause individuals currently on public options to have low belief in the plan if it takes over 10 years. On the other hand, Harris promises that at the end of the 10-year period certain beneficiaries like seniors will “see stronger Medicare benefits than they have now.” In reality, individuals may actually be forced to play succumb to the soaring prices of private insurers if they are not eligible or cannot successfully register for the public option of Medicare for All that Harris offers. Upregulating the big pharmaceutical and biotech companies would have to be essential in leveling out the playing field between them and the proposed public option.

 

References

1. https://www.politico.com/story/2019/07/15/joe-biden-health-care-plan-1415850

2. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-average-wealthy-countries-spend-half-much-per-person-health-u-s-spends

3. https://www.vox.com/policy-and-politics/2019/9/16/20869090/elizabeth-warren-2020-medicare-for-all-voxcare

4. https://www.cnn.com/2019/07/29/politics/kamala-harris-health-care-plan/index.html

yca ice article

The Healthcare Crisis In ICE Detention Facilities

The Healthcare Crisis In ICE Detention Facilities

An Inside Look Into A Rapidly Growing And Untreated Health Concern

WHAT YOU CAN DO...

By Josette Barrans

Since President Trump took office in 2016 at least 24 people, including five children[1]have died in U.S. Immigration and Customs Enforcement (ICE) detention facilities. These detention facilities are where immigrants are held after attempts to unlawfully enter the country, if they have requested asylum, and when they are in the process of being deported[2]. These facilities are not just in border towns, there are hundreds of them across the entire country. Trump has made his anti-immigration sentiment extremely clear since the onset of his campaign, which rallied around the need for a physical wall on the U.S.-Mexico border. While his plan for a border wall never came to fruition, Trump’s aggressive use of ICE to track down, detain, and deport immigrants has had a huge impact on the country. Trump’s framing of immigrants as criminals and monsterscoupled with the executive orders he has passed that have increased the amount of detention facilities and detained individuals, has allowed migrants to be treated inhumanely and detained in awful conditions for great lengths of time. As a result, there is a clear healthcare crisis in ICE migrant detention facilities across the U.S.

 

When Vice President Mike Pence visited a Texas detention facility this past July, the nation’s second-in-command praised the ICE agents and their procedures. Yet, the gruesome reality of this visit was seen through the lens of video footage taken by a reporter that uncovered detained migrants simultaneously yelling that they did not have access to showers[3]. Even more startling, it appears the extent of this issue isn’t solely limited to this one detention facility. At another Texas ICE camp, child detainees had “not been able to shower or wash their clothes since they arrived at the facility” and “have no access to toothbrushes, toothpaste or soap”[4]. Nearly all of the facilities are overcrowded, leading people to sleep in piles on the floor. These types of conditions are inhumane and lead to the facilities becoming hotbeds of disease.

 

In 2017, a US District judge found the ICE detention facilities violated the 1997 Flores agreement, which states that “immigrant children cannot be held for more than 20 days and must be provided with food, water, emergency medical care and toilets”[5]. In June of this year, a lawyer for the Trump administration argued that the government was in compliance with the Flores agreement “because it did not specifically list items such as soap or toothbrushes”[6]. By their logic, the definition of “safe and sanitary conditions” did not necessarily mean having the ability to clean yourself. Without even basic sanitary conditions, migrants with serious illnesses and pre-existing conditions face a very slim chance of ever receiving access to the medications they need while detained.

 

While detainee physical health is already a profound issue, there is a whole other side to this story: mental health. According to a Politico report, there are between 3,000 and 6,000 detainees who suffer from mental illnesses living in these facilities[7]. Typically, such a large-scale issue regarding human life would render a noticeable governmental response. Yet, an agency oversight report from 2016 concluded that “only 21 of the 230 ICE detention facilities offer any kind of in-person mental health services from the agency's medical staff”[8]. This is a clear sign that the mental health of detainees is far from a priority in this administration. While many migrants come into these facilities with prior mental health issues, the conditions inside will likely only enhance their distressing symptoms. Being trapped in an overcrowded cell is detrimental to anyone’s well-being, and this feeling can be even more catastrophic for people with schizophrenia or other serious conditions. A deteriorating mental state can lead to an inability to contribute to one’s legal proceedings and increase the likelihood of a negative outcome in their case[9]The conditions in ICE facilities have even driven some detainees to tragic lengths. In one California detention center, federal investigators found that “detainees had made nooses from bedsheets in 15 of 20 cells in the facility they visited”[10].

 

A major obstacle in combating these conditions is the centers are often out-of-sight and out-of-mind. The poor conditions were only exposed in the media through investigative reports and when big-name politicians, like Elizabeth Warren, went to visit these ICE facilities. It is in the interest of the government to keep these facilities private in order to avoid public scrutiny, so it’s essential to maintain a spotlight on this issue in the American media to reveal the truth.

 

Since ICE contracts most of its detention facilities to state and local governments, this issue can be fought on the battlegrounds of local jurisdiction. Some localities across the country are choosing to cut ties with ICE and close local facilities, while some states are “passing bills to push back against immigrant detention statewide”[11]. This method of fighting ICE has a lot of potential, because it will be much harder to maintain so many facilities if the burden is not shared with state governments. States must take a larger role in overseeing these facilities, investigating claims of poor conditions and wrongdoings, and disseminating this information to stakeholders. Furthermore, by identifying ICE detention facilities in your area, you can personally conduct research on what information is available about these facilities and their conditions through organizations like the National Immigrant Justice Center. You can even request a detention facility tour through ICE’s stakeholder access policy to investigate the conditions of a facility in your area. Then, you can lobby local representatives to shut down these institutions. This healthcare crisis is happening behind closed doors all around us, and we must take action to give detainees the physical and mental health care they deserve.

 


[1] McKenzie, Katherine C., and Homer Venters. “Policymakers, Provide Adequate Health Care in Prisons and Detention Centers.” CNN, Cable News Network, 18 July 2019, www.cnn.com/2019/07/18/opinions/medical-care-prisons-detention-centers-mckenzie-venters/index.html.

[2] “Immigration Detention in the United States.” Wikipedia, Wikimedia Foundation, 14 Oct. 2019, en.wikipedia.org/wiki/Immigration_detention_in_the_United_States.

[3] Reinicke, Carmen. “Video Shows Migrant Men Detained in an Overcrowded Texas Facility Yelling 'No Shower' as Pence Praised Agents.” Business Insider, Business Insider, 13 July 2019, www.businessinsider.com/migrant-detention-facility-video-no-shower-2019-7.

[4] Dickerson, Caitlin. “'There Is a Stench': Soiled Clothes and No Baths for Migrant Children at a Texas Center.” The New York Times, The New York Times, 21 June 2019, www.nytimes.com/2019/06/21/us/migrant-children-border-soap.html.

[5] “Are US Child Migrant Detainees Entitled to Soap and Beds?” BBC News, BBC, 20 June 2019, www.bbc.com/news/world-us-canada-48710432.

[6] “Are US Child Migrant Detainees Entitled to Soap and Beds?”

[7] Rayasam, Renuka. “Migrant Mental Health Crisis Spirals in ICE Detention Facilities.” POLITICO, 21 July 2019, www.politico.com/story/2019/07/21/migrant-health-detention-border-camps-1424114.

[8] Rayasam.

[9] Rayasam.

[10] Rayasam.

[11] Adams, Lora. “State and Local Governments Opt Out of Immigrant Detention.” Center for American Progress, 25 July 2019, www.americanprogress.org/issues/immigration/news/2019/07/25/472535/state-local-governments-opt-immigrant-detention/.

6127242068_23c80ef94f_z

Drug Prices: Is There A Better Way?

Drug Prices: Is There A Better Way?

Exploring The Airspace Of Soaring Pharmaceutical Prices

WHAT YOU CAN DO...

  • Regarding Checking Prices - You can always check with your provider to see if they cover a certain medication. This is usually on their website, or you can check with a variety of platforms like: WellRX or FamilyWize.

  • Get more informed! - Check out these latest articles:

    • Why Does Medicine Cost so Much? (TIME)
    • Why prescription drugs cost so much in the US (CNBC)
    • Patents Taking a Leading Role In War Against High Drug Prices (Kaiser)

By Alexander Kucherina

Insulin: Highly Demanded and Priced

Today, prescription drug expenditures account for nearly 20%  of the United States’ healthcare costs[1]. For instance, consider a college-aged woman who is a Type II Diabetic requiring insulin injections twice a day over an extended period of time. As Insulin injection costs have soared over the last four to five years, this woman’s insurance plan is not likely to take on this additional weight of increased drug prices, causing her to find herself under immense threat of having to pay out of pocket. As a result, the student would have to find a cheaper substitute for her injections, such as Metformin, which has many side effects, or DPP-4 inhibitors, which are not nearly as effective. What is even more troubling is that this substitution would likely not save her personal healthcare expenditures, given the prices for orally-administered drugs are similarly subject to price inflation as well as requiring more dosage and quantity. In essence, as drug prices continue to rapidly increase, individuals whose insurance plans are unable to cope with the costs will be left without proper treatment options.

This scenario represents an issue which millions of Americans face when attempting to receive recommended health care in the form of prescription drugs[2]. Given that Americans spend more than anyone else in the world on pharmaceuticals drugs, the healthcare system must be questioned when the last thing that stands between a sick patient and their prescribed medication is the price tag. More specifically, the puzzling motives of many of these large pharmaceutical industries need to be more closely examined.

Many diseases and patient problems require more constant dosages and prescriptions over time, totalling to higher healthcare expenditures via pharmaceuticals. This often leads to an over-reliance on generic drug brands, which are not as effective. For an individual still young and in college, these soaring prices result in a worsened state of health and much more trouble down the road.

 

America’s Pharma Problem

In America’s healthcare system, free market competition amongst large pharmaceutical companies combined with little government interference creates a playing field where drugs will always be subject to exponential price increases. This becomes evident as generic brands that have protected their patents for many years will further monopolize their respective drug brands. Furthermore, these high-volume, expensive generic drugs are driving up prices greater than ever, to the point where most Americans simply cannot afford them. To prevent an exponential price increase, there are a number of avenues that the United States can take on.

Firstly, making sure these drugs are available in a timely manner is crucial to fixing this nationwide problem. Many drug companies tend to spend as much time as possible in exercising their patent rights to develop drugs. In addition, further research on how cost-effective and health-effective these developing drugs are could provide some insight into whether the extra time taken by pharmaceutical companies is necessary. Lastly, it is absolutely essential to more effectively educate patients and prescribers on these issues within the pharmaceutical industry. Most recently, the “Know the Lowest Price Act” (S.2553) was passed in 2018, which mandates that pharmacists inform patients of the best possible payment option for their prescription, even if it is out of pocket. A lack of awareness regarding this legislation by millions of Americans prevented these individuals from easily saving money on their drug expenses. Another bill known as the “Empowering Medicare Seniors to Negotiate Drug Prices Act” (S.1688), which was introduced in the Senate in the 115th Congress, would allow a health services organization to directly negotiate price discounts with drug companies[3]. More bills such as these should be advocated for as opposed to legislation that further protects the abilities of big pharmaceutical industries to control prices. The lack of progressive legislation in this arena creates a setting in which big industries outnumber the smaller, leaving them more helpless.

 

Figure 1 - Source: European Medicines Agency (2016)

 

The European Way

To combat the rising costs of drugs, European nations have been successful at maximizing quality while minimizing cost. For instance, consider the cost-effectiveness scale used in Great Britain[4]. This model uses the price per Quality-Adjusted-Life-Years or (QALYs) as a basis for its price points; if the price per QALYs is greater than the set threshold amount, the respective drug is limited in its use. Essentially, this means that Britain prioritizes drugs that are low-cost and high-quality by limiting higher costing drugs to emergency situations.

In France and Belgium, drug prices are negotiated to a set point that tends to reduce the final price of the prescription drug. As seen in Figure 1, nations such as Germany and Italy set their final drug prices based on the market price set by importing countries[5]. With this in mind, both Germany and Italy tend to “free ride” on the United States’ willingness to pay high prices for pharmaceuticals. This is not to say that the majority of Americans prefer these generic drugs at higher prices. Rather, most of the American public would probably be happier with cheaper and more direct pricing styles. Additionally, most of these European nations have universal healthcare systems, meaning insurance coverage and provider availability are rarely ever issues. As long as a drug is affordable, most individuals under a single-payer system would be able to easily purchase it for low prices.

Since the United States’ healthcare system is not universal, it thus cannot enjoy the same benefits with allowing free to low price prescription drugs as those European countries. However, there are reasons as to why the European system may not be as compatible in the United States. Amongst the more important ones lies the fact that the United States has to manage both federal and state level policies. This would interfere with the extent to which the universal healthcare system would apply with regulating pharmaceutical prices in the United States. Price regulations would have to be managed both by local and federal governments, causing coordination issues that European countries would not have to manage.

 

So What?

These systems are models that suggest that there should be an increased role by the United States government to drive down drug prices. However, there is a trade off between making sure that more people are covered, maintaining access and promoting the research and development of drugs for the future. The thing is, most of these developing drugs are inevitably more expensive and primarily affordable to those who are not as likely to suffer from an exponential price increase. Additionally, the time taken for new drugs to finally release into the market is usually a minimum of 10-12 years, bringing up the popular question: Are we willing to sacrifice greater drug access today at the expense of potentially revolutionary innovation tomorrow?

The baseline healthcare system is struggling to extend coverage for many individuals and suffers from multiple coverage gaps where, for instance, individuals earn too much to be covered by Medicaid but earn too little to be covered by supplemental insurance. This gap is increasing ever so largely and continues to be an unacceptable threat to those who need improved life-saving medication. We can begin to address this issue by understanding that this problem affects every single one of us. With pharma prices set to rise by an additional 6.3% by the end of this year, more and more individuals, many of which are college-aged, will be stripped of the right to access proper healthcare in the form of necessary pharmaceuticals. Spreading the word on this issue through social media is a good start, in addition to emphasizing the urgent nature of the issue. This can be done through contacting different philanthropy groups on campuses and raising money to help reduce out of pocket costs for individuals unable to keep up with the rising pharmaceutical prices.

To address this problem at the macro policy level, policy makers should use European models as templates. This cost effectiveness scale used by Britain can be potentially be applied at a state level where, to begin with, each state utilizes some sort of regulatory mechanism to promote higher quality pharmaceuticals. To prevent rising costs of generic drugs, the United States may look to set its prices based on the set-price method that most of Europe uses. This will reduce the burden that many European countries place on the United States in free riding its willingness to pay higher prices. This is easier said than done, however, as seen by the Obama administration’s failure to advance a similar plan in 2016 due to pressure from pharmaceutical companies, doctors and patients[6].

With this in mind, it may be vital for the United States to develop cost-effectiveness scales for different classes of drugs and begin to use the European methods to “set” prices of generic drugs to market level. Lastly, it may become inevitable to push for a universal healthcare system that guarantees prescription drug coverage for all. Otherwise, patients will be forced to navigate the wide-ranging multiple payer systems available in the current market, resulting in prescription and generic drug prices continuing to rise beyond what patients and providers can afford. In the long run, a push for competition in the pharmaceutical industry as well as reform in how individuals are covered by their respective insurance companies would likely make drastic improvements.


[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf

[2] https://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained

[3] https://www.stabenow.senate.gov/news/stabenow-unveils-new-legislation-to-lower-cost-of-prescription-drugs

[4] https://www.nice.org.uk/process/pmg6/chapter/assessing-cost-effectiveness

[5] http://apps.who.int/medicinedocs/documents/s23163en/s23163en.pdf

[6] https://thehill.com/policy/healthcare/310681-obama-administration-scraps-controversial-drug-pricing-proposal

healthcare data breach yca pic

The Prevalence Of Healthcare Data Breaches

The Prevalence Of Healthcare Data Breaches

Why Vulnerabilities In Healthcare Information Technology Put Your Privacy At Risk

WHAT YOU CAN DO...

By Josette Barrans

Today, it seems like healthcare data breaches have become commonplace. Almost every week we hear a news story about records being compromised on a massive scale, but most people don’t understand what this actually means. Though these data breaches are often quickly forgotten about by the general public, their implications are much more dire than one might expect. Firstly, this data is being targeted at an alarming rate. According to the HIPAA Journal, healthcare data breaches are being reported at a rate of more than one per day[1]. Strong and effective actions are clearly needed to address such a consistent issue. Secondly, these breaches are both expensive and deadly. There is often no way to prevent fraudsters from racking up medical bills under your name and this alteration of your medical information can affect your healthcare treatment and services in the future. Lastly, these thefts are extremely hard to fight, which has caused a standstill of reform efforts for many years.

Healthcare data breaches can include a multitude of private information, including medical records, social security numbers, addresses and both employment and credit card information[2]. These breaches allow criminals to use someone’s identity to access healthcare or insurance worth hundreds of thousands of dollars, resulting in a greater impact than simply stealing credit cards[3]. If your medical insurance is breached, you may have to pay out of pocket for medical procedures or medications in the future. You may even have to cover the costs incurred by these thieves, affecting a patient’s ability to access payment during an emergency. Furthermore, if a thief uses your medical identity to incur costs, these purchases and procedures will go on your permanent medical record. So, this will affect how doctors view your alleged pre-existing conditions as they will also be scrutinizing false information. This can impact your medical treatment, which could have dangerous consequences. These breaches take twice as long to spot as credit card fraud and are much more difficult to address due to the hardship of correcting medical records and the inability of police to accept certain reports out of their jurisdiction[4]. While some private companies have developed medical identity monitoring services, these are available solely to insurance companies rather than individuals.

To address this issue, the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to protect the security of healthcare information and ensure confidentiality[5]. Yet, since 2009, data breaches have led to the theft of over 189 million healthcare records, which equates to more than 59% of the population of the United States[6]. Because of HIPAA, healthcare companies are required to pay damages for data breaches, costing the industry around $6 billion each year[7]. Though healthcare organizations don’t want to be spending this money, they seem to lack the ability to prevent breaches considering that no effective changes are being made.

There are many different causes for data breaches. Negligence is a main one, as healthcare workers often can accidentally expose records to predators either through mistakes, falling for phishing scams or partnering with shady businesses. Some organizations claim they lack the resources to fight cyber attacks, as some breaches are caused by skilled hackers. One main issue with the prevention of medical information fraud is that it takes twice as long to spot and is hard to address compared to other types of breaches[8]. If your credit card data is stolen, you can simply close your account. This is obviously not the case with your medical records, as there is no way to wipe your slate clean or easily alter the information due to the fact that they are permanently attached to your identity. While credit card companies usually have measures in place to detect fraudulent activity, insurance companies do not. Therefore, criminals can take advantage of this security flaw in three ways. First, they can steal your identity and receive medical care with your money. Secondly, they can set up fake clinics to bill your provider for fabricated procedures and services. Lastly, they can order prescription drugs through your insurance, which they resell for a higher price.

A mix of technology, education, and leadership is needed to crack down on these breaches[9]. As previously mentioned, there are already policies in place to help medical information and healthcare companies follow these guidelines. In fact, Congress enacted the HITECH Act in 2009, which sought to promote the adoption and meaningful use of healthcare information technology while also reinforcing privacy and security concerns[10].  This Actincreased the potential legal liability for non-compliance with HIPAA standards and provided for more strict enforcement[11]. While the HITECH Act has improved the use of electronic health records, it is hard to tell if it has reduced healthcare breaches, which are still happening at a high rate.

The crux of the problem is the healthcare companies’ inability to defend against and properly address these data breaches. So, more protective or advanced technology would be a great asset in this battle. Education on topics such as proper technology use, scams and proactive due diligence would also be useful to provide these organizations with tools to set their security systems up for success. Considering that 58% of all healthcare data breaches are initiated by insiders, some scholars have suggested adopting a zero-trust security policy to combat data breaches[12]. Zero Trust Security is a new security model based on the four pillars of “verifying the identity of every user, validating every device, limiting access and privilege, and learning and adapting using machine learning to analyze user behavior and gain greater insights from analytics”[13]. This would greatly improve the protection of patient records, as it is based on the idea of verifying every device or access attempt to effectively defend all potential attack surfaces.

Some organizations have started to develop technology specifically designed to allow individuals to take action to prevent medical information fraud. For example, a company called ID Experts developed the Medical Identity Alert System (MIDAS) to closely monitor their medical records and transactions so they can detect potential fraud[14]. Additionally, Blue Cross Blue Shield has made identity protection services accessible for all of its members. While these are steps in the right direction, healthcare companies must also enact more preventive measures on the technological side to block breaches, as the burden of protection cannot fall solely on the customer. More awareness must be raised regarding the impact of data breaches on individuals so that pressure can be put on healthcare organizations to prevent these breaches from occurring in the future.


[1] “Healthcare Data Breach Statistics.” HIPAA Journal, HIPAA Journal, 2019, www.hipaajournal.com/healthcare-data-breach-statistics/.

[2] “Why Data Security Is The Biggest Concern of Health Care.” Health Informatics Online, University of Illinois at Chicago, 27 Oct. 2018, healthinformatics.uic.edu/blog/why-data-security-is-the-biggest-concern-of-health-care/.

[3] Korolov, Maria. “Health Data Breaches Could Be Expensive and Deadly.” CSO Online, CSO, 9 Feb. 2015, www.csoonline.com/article/2882052/health-data-breaches-could-be-expensive-and-deadly.html.

[4] Korolov, Maria.

[5] “50 Things to Know about Healthcare Data Security & Privacy.” Becker's Hospital Review, Becker's Healthcare, 9 June 2015, www.beckershospitalreview.com/healthcare-information-technology/50-things-to-know-about-healthcare-data-security-privacy.html.

[6] “Healthcare Data Breach Statistics.”

[7] “50 Things..”

[8] Korolov, Maria.

[9] Eastwood, Brian. “How to Prevent Healthcare Data Breaches (and What to Do If You're a Victim).” CIO, CIO, 20 Dec. 2012, www.cio.com/article/2389573/how-to-prevent-healthcare-data-breaches--and-what-to-do-if-you-re-a-victim-.html.

[10] “50 Things..”

[11] “What Is the HITECH ACT?” Compliancy Group, Compliancy Group, 7 Jan. 2019, compliancy-group.com/what-is-the-hitech-act/.

[12] Columbus, Louis. “58% Of All Healthcare Breaches Are Initiated By Insiders.” Forbes, Forbes Magazine, 31 Aug. 2018, www.forbes.com/sites/louiscolumbus/2018/08/31/58-of-all-healthcare-breaches-are-initiated-by-insiders/#77864ea0601a.

[13]  Columbus, Louis.

[14] Gregg, Bob. “ID Experts: Mitigating Data Breach and Alleviating Identity Theft and Fraud.” Cyber Security, CIO REview, 2019, cybersecurity.cioreview.com/vendor/2016/id_experts.

Screen Shot 2019-05-29 at 5.25.10 PM

The Rape Kit Backlog

The Rape Kit Backlog

Why Most Assault Cases Never See The Inside Of A Courtroom

WHAT YOU CAN DO...

By Alexandra Bixler

        One in five women will be sexually assaulted in their lifetime.[1] While this is a harrowing statistic, rape remains the most underreported crime with 63 percent of incidents failing to reach law enforcement. This percentage is abysmally low and often representative of survivor’s fears, whether it be retaliation, losing employment or social ostracization. Unfortunately, the news often propagates these fears through its characterization of victims.  Justice Kavanaugh’s accuser, Christine Blasey Ford, received death threats against her family that impeded her ability to return to work. Rapper R. Kelly is facing legal ramifactions for accusations of child sexual abuse and sexual assault only after the documentary Surviving R Kelly detailed over 30 years of ignored accusations from young, low-income black women. Of the past five U.S. presidents, three have been accused of sexual misconduct (George Bush Sr, Bill Clinton, Donald Trump). Sadly, a large majority of these men resumed their careers practically unscathed.

        While external factors such as societal retaliation or indifference contribute to an unwillingness to report assaults, the legal process itself is inefficient and problematic for survivors. Rape kits are important in gathering forensic evidence for sexual assault cases as they collect identifying information on the perpetrator. However, these vital pieces of evidence are often ignored; in Jackson, Mississippi, the Jackson Police Department (JPD) has a backlog of 600 rape kits, with some being up to 10 years old. While some of these victims decided not to pursue charges, the JPD is still mandated to evaluate the evidence and determine whether to pursue prosecution to prevent further attacks from occurring. This is especially relevant in child sexual abuse cases, as Missippi holds no statue of limitations thereby allowing evidence to be used at practically any time.

        This troubling phenomenon is not specific to Mississippi; the United States has over 100,000 backlogged rape kits[2] and the average wait time for a rape kit to be tested in Washington is 14 months.[3]

        The testing of rape kits sends a very clear message to victims: “you matter and your case matters,” just as a rape kit’s neglect sends the opposite message.

        Hania Noelia Aguilar, a 13-year-old girl from North Carolina, was a victim of this indifference after she was kidnapped, raped and murdered in December 2018. Aguilar’s perpetrator, Michael Ray McLellan, committed another assault in 2016. However, the rape kit that implicated him was never investigated and thereby never made it to court. When asked about the incident, the Robeson County District Attorney Johnson Britt said:

        “I don't know what happened, if it got lost at the sheriff's department, if it got buried on somebody's desk, if it got placed in records division there and just vanished...In all likelihood, had this gone forward and we established a case against him at that time, Hania would not have died. And for that, I can't tell you how much that hurts, I can't tell you how sorry I am."

        The rape kit backlog exists for a variety of reasons. Sex crime units are commonly understaffed, often resulting in departments failing to prioritize these cases.[4] Unfortunately, inherent biases also exist against sexual assault victims, resulting in victims often being blamed or not believed. Research shows that officers suspect sex crime victims of lying more than victims of other crimes despite no evidence of such a variation. Many of these issues stem from a lack of trauma training, causing officers to disregard a victim’s credible account because of a lack of knowledge about the impact of trauma.

        In fact, James Hopper, Ph.D, an Instructor in Psychology at Harvard Medical School, wrote a piece on the impact of trauma on memory loss. The prefrontal cortex is responsible for executive functions like attention, thought processes, or impulses. The prefrontal cortex is severely inhibited in traumatic situations, which makes disorientation and memory gaps common. At some point in a very traumatic event the amygdala “takes over,” causing the brain to hyperfocus on irrelevant details like a facial expression or the designs on the ceiling. Additionally, the hippocampus can also impair a survivor’s ability to recall events in a proper sequential order.[5]  This was an especially prevalent issue when Christine Blasey Ford accused Justice Kavanaugh of attempted rape. Kavanaugh supporters looked to the fact that Blasey Ford did not remember specifics of the assault as lying, when in reality large memory gaps relating to trauma are relatively normal.

        Law enforcement can also sometimes lack knowledge in how sex criminals behave. Unfortunately, sex criminals often target individuals that are powerless or less likely to have legal support, placing these demographics at a higher risk. Some of these invidiuals may be non-English speakers (especially immigrants in the agriculture industry, or in the housekeeping industry), sex workers, drug abusers or the homeless. As a result, at-risk groups that need the most support often garner the least due to societal stigmas that tend to deprioritize the testing of kits from these social demographics.[6]

        Ultimately, stigmas that persist in social spheres against victims of sexual assault are not separate from law enforcement but rather seep into their judgements. It is important for these sex crime units to be properly funded and for all assault victims to be treated with respect. Everyone is entitled to a fair and thorough investigation.

 


[1] Black, M. C., Basile, K. C., Breiding, M. J., Smith, S .G., Walters, M. L., Merrick, M. T., Stevens, M. R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Retrieved from the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control

[2] Vicory, Justin. “JPD Has a Backlog of 600 Sexual Abuse, Rape Kits. Here's What It Means for Victims.” The Clarion Ledger, Mississippi Clarion Ledger, 21 Mar. 2019

[3] Porter, Essex. “Lawmakers Confront Price Tag for Rape Kit Backlog.” KIRO, 26 Feb. 2019

[4] Hayes, Christal. “NYPD Ignored Understaffing in Sex-Crimes Units, Told Detectives to Ignore Cases, Probe Shows.” USA Today, Gannett Satellite Information Network, 27 Mar. 2018

[5] Lisak, James Hopper and David. “Why Rape and Trauma Survivors Have Fragmented and Incomplete Memories.” Time, Time, 9 Dec. 2014

[6] Monahan, Jerald, et al. “Police Chief Magazine|Topics|Criminal Justice Reform|The Effect of Cultural Bias on the Investigation and Prosecution of Sexual Assault.” Policechiefmagazine.org

student debt yca 2

Addressing The Student Debt Crisis

Student Debt: The Costs Behind Higher Education

Examining The Financial Burden Of "The Best Four Years Of Your Life"

WHAT YOU CAN DO...

By Gillian Hand

Despite the crucial role of education in American prosperity and individual success, numerous citizens who hope to attend college are discouraged by the threat of debilitating student debt. In fact, Americans currently owe $1.5 trillion in student loans, a continuously growing number that serves as a 350% increase from the debt levels in 2003.[1] While the government grapples with its vision for the alleviation of the crisis, states are pursuing their own plans of action, such as loan forgiveness programs and other forms of financial support. However, it is essential that these efforts are supported by federal reforms that give every citizen an opportunity to pursue higher education without the pressures of lifelong debt. The 2020 presidential election will undoubtedly be a battleground for discussions of student debt reform, with a wide field of potential Democratic nominees voicing their own proposals alongside criticisms of the current administration.

It can be incredibly difficult for students to escape the trap that is a student loan. Weak job opportunities for young graduates often result in these workers frequently struggling to make enough money to pay back their loans, keeping them confined by the crushing weight of student debts. Minority communities have been found to be particularly affected by the debt crisis, with many of these students being unable to pursue a higher education due to the inevitable loans that will follow them throughout their lives.[2] The student debt crisis threatens not only the future of the United States economy but also the financial security and freedom of Americans, 44 million of whom are currently trapped in the depths of this crisis.[3] It is crucial that lawmakers invest efforts and resources in the transformation of the student loan system by offering students an achievable and debt-free path to higher education.

        According to the National Conference of State Legislatures, lawmakers across the nation have set their sights on the student debt crisis. Recent state legislation has produced nearly 200 bills with a variety of debt solutions including loan forgiveness, priority of specific professions and new tax credits. 119 of these bills would create or expand student loan forgiveness programs, with many targeting specific professions in fields such as health care and education.[4] This legislation showcases how states are now taking the initiative in the alleviation of student debt, offering their own solutions in the absence of federal efforts. Should the nation fail to address the student debt crisis as it stands, the loans will only worsen, exacerbating the debt crisis and keeping millions of Americans from financial security and possibly higher education itself.

        In addition to these state reforms, there have also been efforts at the federal level to address this crisis.  The Trump administration recently released several proposed changes to the Higher Education Act, including the reduction of federal loan repayment options as well as the capping of the amount of student loans that parents and graduate students can take on.[5] The White House claims that schools are largely responsible for the student debt crisis, as colleges tend to drive up their tuitions and are often unwilling to work to make education more affordable. The schools themselves, however, argue that they are forced to raise tuition in the wake of funding reductions from state legislatures and insufficient support from the government. This call for greater federal support of institutions of higher education is echoed by many Democrats, including Senator Patty Murray, the top Democrat on the Senate Education Committee. Murray remarked that Trump’s plan does not address the true source of the problem: the skyrocketing college prices that burden students with massive amounts of debt. Murray also noted that the proposal would likely hurt citizens in the long run by reducing the amount of federal aid allocated for students.[6] 

        The Department of Education has also been active in the realm of student loans. Secretary of Education Betsy DeVos has proposed a plan calling for the termination of a Public Service Loan Forgiveness Program and the elimination of subsidized loans for low-income students. Currently, the Public Service Loan Forgiveness Program forgives remaining student debt sums after eligible workers make ten years of on-time payments, particularly helping public service professionals such as social workers, primary care doctors, public defenders, and teachers.[7] The Department under Devos has been attempting to repeal Obama-era policies, arguing that the student loan forgiveness programs under Obama are costly to taxpayers and unfair to colleges. While Devos and other conservatives find existing policies too lenient, federal courts have rebuffed these attempts thus far, forcing the Department to continue the programs.[8] Looking ahead, Devos has requested $130 million in next year’s budget to upgrade the student loan servicing system. Democrats, however, worry that this is not a step to help students afford higher education and pay back student loans but rather a gutting of financial aid money that will worsen the debt crisis in the long run.[9] 

        As we approach the 2020 presidential election, student debt remains a popular issue in the large field of potential Democratic nominees. Senators Elizabeth Warren, Kristen Gillibrand, Kamala Harris, and Cory Booker—all Democratic candidates for 2020—recently co-sponsored the Debt-Free College Act of 2019, which aims to offer federal funding to institutions that commit to helping students pay tuition without burdening them with staggering debt. Other candidates have voiced support for developments similar to Bernie Sanders’ “College for All Act”, which supports tuition-free college for low-income students. Some potential nominees are even drawing attention to Trump’s debt policies in order to highlight their own opposition to his administration, taking advantage of a key issue that might be popular with the Democratic base’s large population of young voters.[10] It is evident that student loan reform will play an important role in 2020 campaigns as Democratic candidates address these debt issues and condemn the deficiencies of the current administration.

        While there might not yet be a clear solution to the problem, steps should certainly be taken to support affected citizens by ensuring that money is not removed from programs designed to help them. There are many faces of the student debt crisis and numerous shortcomings with the higher education system itself; while state action is undeniably important, federal reform is needed to remove this primary barrier to education and financial security. Supporting federal efforts such as Senator Elizabeth Warren’s student debt relief plan will be essential in the alleviation of these enormous burdens, and advancements such as loan forgiveness programs are both necessary and possible. The movement to combat student debt and provide affordable education requires these federal standards as a base that will inspire state efforts going forward. The reform of student loans should be a priority in modern education policy and will play a crucial role in the presidential campaigns of 2020.

 


[1] Hess, Abigail. “Trump Administration Proposes Capping Student Loans, Cutting Repayment Options-Here's What That Means for Borrowers.” CNBC, NBC Universal , 20 Mar. 2019, www.cnbc.com/2019/03/19/trump-proposes-capping-federal-student-loans-cutting-repayment-options.html.

[2] Swig, Mary Green. “A Movement Emerges to Free Former Students from Crushing Loan Debts.” Common Dreams, 23 June 2018, www.commondreams.org/views/2018/06/23/movement-emerges-free-former-students-crushing-loan-debts.

[3] “Our Story.” Our Story | Freedom to Prosper, www.freedomtoprosper.org/our-story/.

Stratford, Michael, et al. “Betsy DeVos Strikes out - in Court.” POLITICO, Politico LLC, 21 Mar. 2019, www.politico.com/story/2019/03/21/devos-roll-back-obama-policies-1288782.

[4] Stratford, Michael, et al. “Betsy DeVos Strikes out - in Court.” POLITICO, Politico LLC, 21 Mar. 2019, www.politico.com/story/2019/03/21/devos-roll-back-obama-policies-1288782.

[5] Hess, “Trump Administration Proposes Capping Student Loans, Cutting Repayment Options-Here's What That Means for Borrowers.”

[6] Binkley, Collin. “White House Proposes Caps on Student Loan Borrowing.” The Seattle Times, The Seattle Times Company, 18 Mar. 2019, www.seattletimes.com/nation-world/nation/white-house-proposes-caps-on-student-loan-borrowing/.

[7]Lobosco, Katie. “DeVos Wants to Cut Budget Funding for Student Loan Forgiveness, Again.” CNN, Cable News Network, 13 Mar. 2019, www.cnn.com/2019/03/13/politics/betsy-devos-student-loan-forgiveness-budget/index.html.

[8] Stratford, “Betsy DeVos Strikes out - in Court.”

[9] Lobosco, “DeVos Wants to Cut Budget Funding for Student Loan Forgiveness, Again.”

 

[10] Norris, Courtney. “Where 2020 Democrats Stand on Student Loans, Teacher Pay and Other Education Issues.” PBS News Hour, Public Broadcasting Service, 15 Apr. 2019, www.pbs.org/newshour/politics/where-2020-democrats-stand-on-student-loans-teacher-pay-and-other-education-issues.

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