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Healthcare – Youth Caucus of America
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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.

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.

misdiagnosis article pic 2

The Consequences Of Medical Misdiagnosis

The Consequences Of Medical Misdiagnosis

How Sexism In The Healthcare Industry Is Hurting Women

WHAT YOU CAN DO...

  • Lobby for changes in medical school curriculums to move away from a solely diagnosis-oriented approach and teach doctors to not discount patients’ reports of pain by contacting the Association of American Medical Colleges https://www.aamc.org/

  • Spread awareness of this bias among healthcare providers by calling for more scrutiny from healthcare quality and ethical reviewers by contacting the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) https://www.jointcommission.org/report_a_complaint.aspx

  • Contact your Representative about including women in tests conducted by all healthcare organizations and expanding the NIH 1993 Act to ensure that female and male results are studied separately to allow for proper scrutiny and differentiation

By Josette Barrans

In America, there is an epidemic of women being systematically misdiagnosed by healthcare providers. Women are consistently not given strong enough medication or urgent enough care for their true conditions. Their pain is not taken as seriously as men’s, even being reduced to “female hysteria.'' Not only is this sexist, it forces women to endure more unnecessary pain or face even worse consequences. The last policy which attempted to address this issue was a section in the NIH Revitalization Act of 1993 in which Congress ordered the National Institute of Health to include women in all of its clinical trials[1]. But this did not solve the knowledge gap in women’s medicine. Most studies lump data from all participants together and fail to compare women’s and men’s results separately[2]. As a result, doctors are not focusing in on how women specifically are affected by certain diseases and conditions. Consequently, there are no current policies actively working to prevent the misdiagnosis epidemic affecting female patients. Additionally, drug companies and medical device manufacturers are not required to follow the 1993 rule, meaning women are not accurately represented in their studies[3]To solve this issue, policies are needed that address the knowledge gap of female health starting in medical school curriculums and extending to include women in studies conducted by all healthcare providers.

        In a recent report, a woman underwent eight rounds of electroconvulsive therapy (ECT) because she was misdiagnosed with severe depression and other psychiatric issues. This ECT was essentially forced upon her, despite the woman’s consistent protests that she didn’t have depression, and made her lose around six years of her memory. After continuously begging her doctors to reexamine her, they discovered that she had myalgic encephalomyelitis (ME/CFS), an autoimmune disease that affects many bodily systems. Though it can cause up to 60 differentsymptoms, ME/CFS is often ignored by doctors, with some even believing that it is fake[4]. Consequently, this woman was put through extreme pain and suffering simply due to the inability of her doctors to take her seriously. Her story is not a one-off; countless women in our nation needlessly suffer due to sexism embedded into America’s healthcare system which prevents them from obtaining the treatment they need.

        One prominent example of this epidemic is women suffering from chronic pain. These women are much more likely than men to be given sedative prescriptions rather than pain medication[5]. In fact, research has shown that women experience and report greater and more frequent pain than men[6]. Yet women are consistently treated for pain less aggressively since doctors often hold misperceptions that women are more prone to overreacting and hysteria[7]. This attitude seeps into public discourse as well, causing people to think that women are not accurate portrayers of their pain, essentially discrediting their knowledge of both themselves and their body. It is also typical for women with chronic pain to have no clearly definable conditions, which often leads to doctors taking the easy way out by diagnosing them with a mental health disorder[8]. This indifferent approach not only continues the suffering of the women in pain but  also delegitimizes mental health disorders by making them an extraneous category that women with no clear condition can be lumped into.

        Even more serious medical emergencies are consistently misdiagnosed in women. Women are seven times more likely than men to be misdiagnosed while suffering a heart attack and be discharged from the hospital during the emergency[9]. This can lead to lifelong repercussions or even death. One of the main causes of these mistakes is doctors being taught to recognize symptoms and make diagnoses based on understandings of male physiology. Since women can have completely different symptoms than men for many conditions, including heart attacks, many healthcare providers are not equipped to recognize them. This lack of knowledge costs women dearly. Considering that women represent over half the population, doctors should be taught how to perceive diseases and health issues in both women and men.

        There are many contributing factors for this problem that must be addressed. For instance, even though 78% of healthcare professionals are women, the higher positions are usually filled by men[10]. If more women were making these important decisions, there would likely be less misdiagnoses or dismissals of female patients. This disparity is likely a product of the gender discrimination that still exists in hiring practices, so healthcare organizations need to make a concious effort to make sure women are getting a seat at the table. There also need to be sweeping changes to how medical schools teach symptom recogniziation so that lessons always include both male and female versions of symptoms. There must be more emphasis on evidence-based diagnosis and general awareness of this gender bias in the medical field. Doctors should be trained to take what their patients say into account, and consider their reports of pain seriously. Furthermore, there must be more scrutiny from healthcare quality and ethical reviewers on this issue. One organization that oversees this is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits more than 21,000 US health care organizations. JCAHO has on online form where one can report a patient safety concern or event at a hospital, which could be used as a platform to draw attention to instances where gender bias prevent a woman from receiving proper care[11]. We must also call on Congress to extend their policies to force all healthcare organizations to include women in their studies so that their needs can be properly served.

        Doctors must start believing women and be more willing to admit that they may not be an expert on female symptoms instead of pushing false diagnosis and treatment on these patients. Bringing in specialists can easily solve most of these diagnostic problems, rather than searching for the quickest and easiest solution. Additionally, policies are needed that close the knowledge gap by forcing companies in all industries to include women in their studies and focus on their results and reactions separately from men. Clearly, the idea of a one-size-fits-all solution has been hurting women, as the standard of medicine is typically designed around men. Women are suffering, and even dying, because of sexist doctors and healthcare practices; this must be put to a stop.

 

 


[1] “Including Women and Minorities in Clinical Research Background.” National Institutes of Health, U.S. Department of Health and Human Services, 2019. https://orwh.od.nih.gov/research/clinical-research-trials/nih-inclusion-policy/including-women-and-minorities-clinical

[2] Sagon, Candy. “Women's Health Issues And Medical Gender Bias.” AARP, 2017, www.aarp.org/health/conditions-treatments/info-2016/womens-health-gender-bias-cs.html.

[3] Sagon.

[4] Hirsch, Michele Lent. “9 Rounds of Electroshock Therapy. 6 Years Lost. All Because Her Doctors Got It Horribly Wrong.” Cosmopolitan, Cosmopolitan, 22 Jan. 2019, www.cosmopolitan.com/health-fitness/a25362145/electroshock-therapy-misdiagnosis/.

[5] Kiesel, Laura. “Women and Pain: Disparities in Experience and Treatment.” Harvard Health Blog, Harvard Health Publishing, 7 Oct. 2017, www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562.

[6] Hoffmann, Diane E. and Tarzian, Anita J., The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain (2001). Journal of Law, Medicine & Ethics, Vol. 29, pp. 13-27, 2001. https://ssrn.com/abstract=383803

[7] Seegert, Liz. “Women More Often Misdiagnosed Because of Gaps in Trust and Knowledge.” Association of Health Care Journalists, 16 Nov. 2018, healthjournalism.org/blog/2018/11/women-more-often-misdiagnosed-because-of-gaps-in-trust-and-knowledge/.

[8] Hirsch.

[9] Kiesel.

[10] Joyce, Trish. “Does Healthcare Have a Gender Problem?” Health ECareers, Everyday Health Group, 24 Apr. 2018, www.healthecareers.com/article/healthcare-news/does-healthcare-have-a-gender-problem.

[11] “Report a Patient Safety Concern or Event.” Jointcommission.org, www.jointcommission.org/report_a_complaint.aspx.

gag rule article 5

The “Gag Rule”: Silencing The Right To Choose

The "Gag Rule": Silencing The Right To Choose

The Trump Administration's Attempt To Limit Women's Healthcare Access And Suppress Information About Their Health

WHAT YOU CAN DO...

By Josette Barrans

Throughout his campaign and administration, President Donald Trump has shown he does not care much about women’s rights. From his trivialization of sexual assault to his goal of overturning Roe v. Wade, it was clear that women would be in trouble once he took office. As expected, he has already enacted policies that violate women’s healthcare rights and he continues to chip away at their basic freedoms. Earlier this year, President Trump proposed the reinstatement of a decades old “gag rule” that would ban federally funded clinics from discussing abortion and preventive care[1]. Based on a policy first implemented by Ronald Reagan, the “gag rule” would also prevent clinics from sharing spaces with abortion providers as well as prevent health care providers from referring patients to clinics such as Planned Parenthood for safe and legal abortions[2]. Through this policy, women’s ability to access accurate information about their healthcare would be severely limited.

On May 30th, Trump appointed Dr. Diane Foley as the Deputy Assistant Secretary of Population Affairs for the Department of Health and Human Services[3]. Foley is a long-time anti-abortion activist who believes in abstinence-only education. Her position oversees Title X, the federal grant program dedicated to family planning and preventive health services. Essentially, Foley determines recipients of Title X funding as well as managing the U.S. birth control program. Planned Parenthood clinics are one of the current prominent recipients of Title X funding, but they are not allowed to use this money to fund actual abortions. Under current US law, abortion services cannot be provided by any organization using federal funds[4]. But, Planned Parenthood uses the funding they receive to provide a wide range of healthcare services to women. Under this gag rule, however, Planned Parenthood would be exempt from receiving any Title X funding and would subsequently be unable to serve Title X patients due to the nature of their organization. Though abortion related services only constitute one aspect of what Planned Parenthood does, their existence in the organization would block any other services from receiving funding.

Planned Parenthood immediately took action to publicly oppose and fight this proposal, as this policy clearly targets progressive family planning organizations such as themselves. Though they only make up 13% of health centers funded by Title X, Planned Parenthood serves 41% of patients who receive care through Title X[5]. With this in mind, a blow to Planned Parenthood’s ability to effectively serve patients would burden a large portion of Title X beneficiaries. This policy also has a great impact on poor and uninsured women, being the ones who mainly use Title X funded services, as they can’t afford any other options. In fact, almost two-thirds of patients who use Title X are below the federal poverty line[6]. Additionally, Title X recipients are disproportionately women of color[7]. As a result, a gag rule would prevent these women from receiving information about abortions from the only clinics they can afford to visit. This rule clearly violates the relationship between a patient and doctor, as doctors are supposed to provide patients with all of their medical options and expert recommendations. Being forced to withhold certain information based on partisan preferences in unlawful and unethical. This policy hurts over four million people served by Title X[8].

One woman described the impact Title X funding had on her life. When Rhea lost her job, and health insurance with it, Title X funding at Planned Parenthood was the only way she was able to afford life saving treatment for precancerous cells found in her Pap test[9]. Rhea represents stories from millions of women that illustrate how vital Title X funding is to both people and organizations. If Planned Parenthood is cut off from this funding by the new proposal and the gag rule is implemented, patients like Rhea will be limited in their treatment options and may not even be told about many life-saving procedures. Furthermore, Planned Parenthood is the only family planning organization and birth control provider in many remote areas. Therefore, Title X patients in these locations could be left with no healthcare services[10].

As lawsuits are not permitted until the policy is finalized, Planned Parenthood cannot officially sue Trump over this proposal until its final language is released. Nevertheless, Planned Parenthood has already sued the Trump administration for several other amendments to Title X guidelines made earlier this year, stating that the amendments violated federal laws as they were arbitrary and unfair[11]. These guidelines promoted abstinence-only education and alternative methods to contraception rather than birth control. It also gave funding advantages to organizations that work with community and faith-based groups. The judge sided with Trump in this case, however, meaning that Planned Parenthood is already at a disadvantage to continue to receive Title X funding. If this new gag rule were implemented, their organization’s mission would be further damaged.

Trump’s commitment to eliminating safe and legal abortions extends beyond the scope of the nation. On his fourth day in office, Trump used an executive order to implement a global gag rule[12]. This rule prevents the US government from contributing funds to any international organizations that provide abortions, related services, or even information about abortions. The fact that this was one of his first acts as president demonstrates Trump’s explicit targeting of women’s healthcare rights.

It is easy to see what Trump is actually trying to do: limit women’s access to birth control, other methods of contraception, and safe and legal abortions. He is likely promoting this agenda to appease his conservative and religious base, as there is a large block of single issue voters whose main priority is the implementation of pro-life policy. While his previous attempt to explicitly defund Planned Parenthood was unsuccessful, this proposal is an effective back-door method of achieving his goal. Americans must not let Trump use loopholes to implement his unethical policies. By blocking access to healthcare, Trump is risking the health and lives of women around the country.

 


[1] Planned Parenthood. “What Is the Trump-Pence Administration's ‘Gag Rule?".” Planned Parenthood Action Fund, National - PPACTION, 18 May 2018. https://www.plannedparenthoodaction.org/blog/what-is-the-domestic-gag-rule

[2] Planned Parenthood.

[3] Planned Parenthood. “DIY Speak Up for Planned Parenthood Toolkit.” Planned Parenthood, 2018. https://www.plannedparenthood.org/planned-parenthood-south-texas/diy-speak-planned-parenthood-toolkit.

[4]Siddiqui, Sabrina. “Trump Administration to Revive Reagan-Era Abortion 'Gag' Rule.” The Guardian, Guardian News and Media, 18 May 2018. https://www.theguardian.com/world/2018/may/18/trump-administration-abortion-gag-rule-reagan-era

[5]Durkee, Alison. “Judge Sides with Trump Administration in Planned Parenthood Title X Funding Lawsuit.” Mic, Mic Network Inc., 18 July 2018. https://mic.com/articles/190323/judge-sides-with-trump-administration-in-planned-parenthood-title-x-funding-lawsuit#.ZLTAQPPb3

[6]Rovner, Julie. “Trump Proposes Cutting Planned Parenthood Funds. What Does That Mean?” The Washington Post, WP Company, 22 May 2018. https://www.washingtonpost.com/national/health-science/trump-proposes-cutting-planned-parenthood-funds-what-does-that-mean/2018/05/22/76a3a568-5ade-11e8-9889-07bcc1327f4b_story.html?noredirect=on&utm_term=.85ca3ea4fc82

[7]J. Steinauer, P. Darney. Proposed changes to the Title X family planning program. Lancet, 392 (2018), p. E6. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31733-1/fulltext

[8]J. Steinauer.

[9] Rhea, Planned Parenthood patient. “Trump's Gag Rule Could Have Killed Me.” Planned Parenthood Action Fund, 2018. https://www.istandwithpp.org/trumps-gag-rule-could-have-killed-me-planned-parenthood-title-x?_ga=2.170338275.276421464.1546556242-2136533510.1542323762

[10] Rovner, Julie.

[11] Durkee, Alison.

[12]Starrs, Ann M. 2017. “The Trump global gag rule: An attack on US family planning and global health aid,” The Lancet 389(10068): 485–486. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30270-2/fulltext

dickey amendment

How The Prevention of Gun Violence Research Enables A Public Health Crisis

Dickey's Folly

How The Prevention of Gun Violence Research Enables A Public Health Crisis

WHAT YOU CAN DO...

  • Call your Representatives and ask them to repeal the Dickey Amendment and support the Gun Violence Research Act to restore CDC funding

By Josette Barrans

After the devastating Sandy Hook school shooting in 2012 that left 20 children and 6 staff members dead, President Obama ordered the Center for Disease Control and Prevention (CDC) to conduct research on gun violence and its causes. The call after such a terrible tragedy was “Never Again” and gun control advocates thought this would finally be enough to swing the partisan debate in their favor. Yet, since Sandy Hook, there have been 1,897 more mass shootings and zero studies conducted by the CDC on the causes of gun violence[1].

Considering that gun violence is one of the leading causes of death in the United States, one would assume this would be a public health issue of great importance to both the government and the public. However, the partisan connotations of this issue block any significant progress. Legal roadblocks instituted by pro-gun Republicans, such as the Dickey Amendment, have prevented significant research on gun control over the past 20 years. The Dickey Amendment was introduced by Arkansas representative Jay Dickey and added to the Omnibus Consolidated Appropriations Act of 1997. This amendment states, “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control”[2]. This amendment came in response to a study conducted by the CDC in the previous year showing that having a gun in the home correlated with a higher risk of homicide by a family member[3]. Though these study results were simply factual, the NRA accused the CDC of having an anti-gun bias and convinced congressional Republicans to take action. While the amendment only restricts the CDC from advocating for a certain position on gun violence rather than blocking research on the issue, its passage had underlying implications. The bill also took $2.6 million from the CDC’s budget, which was the exact amount the agency spent on gun violence injury research in the previous year[4]. This sent a clear message to the CDC: stop any and all research on gun violence. Without proper funding, the CDC has no motivation to take that leap of faith and defy the will of Congress. Additionally, the vagueness of what kind of research is permissible combined with the halt of new studies by the CDC discouraged any other organization from funding gun violence research for most of the last 20 years.

This amendment and the CDC’s inaction have gained increasing public opposition over time. In light of many recent shootings, especially the one in Parkland, many healthcare professionals are calling for more tangible solutions to this public health crisis, such as the repeal of the Dickey Amendment. Others are turning the blame to the CDC; in 2013 more than 100 scientists signed a letter that called on the CDC to continue research on gun violence that can identify effective solutions to the crisis[5].  Jay Dickey himself regrets the chilling effect his amendment had on gun violence research, having written an article in the Washington Post discussing the importance of taking steps to reduce gun violence in 2015[6].

The CDC and other healthcare organizations are eager to conduct this research as they face both internal and external pressures to produce tangible solutions.. At least 65% of healthcare providers view gun violence as a major public health threat and wish to take action[7]. Outside advocacy groups and prominent organizations, such as the American Psychological Association and Doctors for America, are calling for gun violence research as they are well aware of the human cost of gun violence. 

Gun violence also poses an internal threat to healthcare organizations, as the cost of it alone justifies its classification as a major public health issue. According to research reported in Mother Jones, the direct and indirect costs of gun violence range from $100 billion to $229 billion dollars per year, costing each American around $700 per year[8]. These estimates don’t even take into account all the long-term costs such as continued medical issues or counselling, as they are too extensive to track.  Furthermore, the results of a 2017 study showed that gun violence research received around 1.6% of the funding you would expect considering its impact on mortality when compared to other leading causes of death[9]. With this in mind, both Americans and insurance providers continue to bear the financial burden of gun violence failing to be classified as a public health epidemic.

The lack of government funding into gun violence prevents the healthcare industry from being able to effectively promote public health and safety. Healthcare providers have seen the real cost of gun violence and know action is needed but are unable to provide Congress with accurate data on the scope of this crisis.. The primary way politicians have been convinced to change their mind on public health issues throughout history was through the presentation of scientific research[10]. Regulations were only enacted on the tobacco industry when research showing an explicit link between smoking and lung cancer was presented to lawmakers. Therefore, Congress in unlikely to do anything about gun control without clear and convincing evidence that only the healthcare industry can provide.

There has been a recent movement on both sides of the aisle to clarify that the Dickey Amendment does not actually ban research in response to outrage at the policy, which has allowed some progress to occur. The National Institute of Health has conducted gun violence studies in recent years, as their much larger budget provides them with less fear of retaliation by members of Congress[11].  While critics have insulted the CDC for their lack of political courage, the CDC has recently acknowledged that they realize they are not actually restricted from conducting research, and will conduct this research as soon as the much-needed funding is allocated to them[12]Nonetheless, President Trump still failed to provide the CDC with funds or lift the ban on advocacy despite adding a provision to the spending bill clarifying that the CDC could conduct research into the causes of gun violence, essentially changing nothing[13]. These kinds of clarifications and amendments are being used by Republicans as a guise of compromise and neutrality toward the subject when their underlying goal clearly remains to scare organizations into silence and block research that will show the danger of guns, and healthcare organizations are still feeling this pressure to stay silent. Even if research into gun violence were conducted, the studies will inherently be considered partisan by pro-gun legislators. The study that caused Republicans to create this amendment in the first place was considered biased simply for showing an obvious factual link, and current study results will likely indicate the necessity of gun control once again. Therefore, Republicans could continue to use the Dickey Amendment to block the use of these findings as evidence in Congress.

While advocating for research funding should be a top priority of Americans, the chilling effect of the Dickey Amendment is still a problem and its repeal would likely empower many organizations to conduct research without fear of backlash. By discouraging research and withholding funding, politicians with ties to the NRA are ensuring that no gun control measures will be taken, thereby allowing more mass shootings to occur. A lack of research would surely result in stagnation, resulting in more lives lost. This can no longer be a political debate - it must be a factual one.

 

 


[1] Lopez, German, and Kavya Sukumar. “Mass Shootings since Sandy Hook, in One Map.” Vox.com, Vox Media, 9 July 2018, www.vox.com/a/mass-shootings-america-sandy-hook-gun-violence.

[2] Omnibus Consolidated Appropriations Act, Pub. L. No. 104-208 (1996).

[3] Rostron A. The Dickey Amendment on federal funding for research on gun violence: a legal dissection. Am J Public Health. 2018;108(7):865–867.

[4] Kellermann AL, Rivara FP. Silencing the Science on Gun Research. JAMA. 2013;309(6):549–550. doi:10.1001/jama.2012.208207

[5] Frankel, Todd C. “Why the CDC Still Isn't Researching Gun Violence, despite the Ban Being Lifted Two Years Ago.”The Washington Post, WP Company, 14 Jan. 2015, www.washingtonpost.com/news/storyline/wp/2015/01/14/why-the-cdc-still-isnt-researching-gun-violence-despite-the-ban-being-lifted-two-years-ago/?utm_term=.facf36580a24.

[6] Dickey, Jay, and Mark Rosenberg. “How to Protect Gun Rights While Reducing the Toll of Gun Violence.” The Washington Post, WP Company, 25 Dec. 2015, www.washingtonpost.com/opinions/time-for-collaboration-on-gun-research/2015/12/25/f989cd1a-a819-11e5-bff5-905b92f5f94b_story.html?utm_term=.65454b1ee8dd.

[7] Jimenez, Sallie. “Health Professionals Declare Gun Violence Public Health Threat.” Nursing News, Stories & Articles, Nurse.com, 31 July 2018, www.nurse.com/blog/2018/03/05/health-professionals-declare-gun-violence-a-public-health-threat/.

[8] Pamela Behrman, Colleen A Redding, Sheela Raja, Tamara Newton, Nisha Beharie, Destiny Printz; Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun violence prevention research, Translational Behavioral Medicine, , ibx040, https://doi.org/10.1093/tbm/ibx040

[9] Stark DE, Shah NH. Funding and Publication of Research on Gun Violence and Other Leading Causes of Death. JAMA. 2017;317(1):84–85. doi:10.1001/jama.2016.16215

[10] Ansari, Sobia. “Why Should Health Care Professionals Care about Gun Control?” KevinMD.com, MedPage Today, 23 Apr. 2018, www.kevinmd.com/blog/2018/04/why-should-health-care-professionals-care-about-gun-control.html.

[11] Rubin R. Tale of 2 Agencies: CDC Avoids Gun Violence Research But NIH Funds It.JAMA. 2016;315(16):1689–1692. doi:10.1001/jama.2016.1707

[12] Frankel, Todd C.

[13] Greenfieldboyce, Nell. “Spending Bill Lets CDC Study Gun Violence; But Researchers Are Skeptical It Will Help.”NPR, NPR, 23 Mar. 2018.

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