Tag: Public Health

A Feature, Not a Bug

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It turns out that an algorithm used by health care providers to determine who is in need of enhanced care and monitoring discriminates against black black people.

Call me a conspiracy theorist, but I continue to think that algorithmic discrimination is actually one of the goals of this sort of AI tech, just like Airbmb listing, Facebook employment ads, etc:

A health care algorithm makes black patients substantially less likely than their white counterparts to receive important medical treatment. The major flaw affects millions of patients, and was just revealed in research published this week in the journal Science.

The study does not name the makers of the algorithm, but Ziad Obermeyer, an acting associate professor at the University of California, Berkeley, who worked on the study says “almost every large health care system” is using it, as well as institutions like insurers. Similar algorithms are produced by several different companies as well. “This is a systematic feature of the way pretty much everyone in the space approaches this problem,” he says.

The algorithm is used by health care providers to screen patients for “high-risk care management” intervention. Under this system, patients who have especially complex medical needs are automatically flagged by the algorithm. Once selected, they may receive additional care resources, like more attention from doctors. As the researchers note, the system is widely used around the United States, and for good reason. Extra benefits like dedicated nurses and more primary care appointments are costly for health care providers. The algorithm is used to predict which patients will benefit the most from extra assistance, allowing providers to focus their limited time and resources where they are most needed.

To make that prediction, the algorithm relies on data about how much it costs a care provider to treat a patient. In theory, this could act as a substitute for how sick a patient is. But by studying a dataset of patients, the authors of the Science study show that, because of unequal access to health care, black patients have much less spent on them for treatments than similarly sick white patients. The algorithm doesn’t account for this discrepancy, leading to a startlingly large racial bias against treatment for the black patients.

The effect was drastic. Currently, 17.7 percent of black patients receive the additional attention, the researchers found. If the disparity was remedied, that number would skyrocket to 46.5 percent of patients.

I really do believe that this is a deliberate business decision.  “It’s not racism, it’s just giving the cusomers what they want.”

And Yet Hickenlooper Literally Drank Fracking Fluid

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The Colorado Department of Public Health and Environment has released a long delayed study on the health impacts of fracking, and it’s pretty much as bad as anti-fracking activists have claimed:

A long-delayed public health study commissioned by Colorado regulators found that oil and gas drilling poses health risks at distances greater than current minimum “setback” distances, a development that is poised to send shockwaves through a regulatory environment already in a state of transition and uncertainty.

 “Exposure to chemicals used in oil and gas development, such as benzene, may cause short-term negative health impacts…during ‘worst-case’ conditions,” the Colorado Department of Public Health and Environment said in a press release. “The study found that there is a possibility of negative health impacts at distances from 300 feet out to 2,000 feet.

………

State toxicologist Kristy Richardson said in a press conference Thursday afternoon that the results of the study are consistent with the health impacts that have been reported by Colorado residents near oil and gas sites in recent years.

I wonder how former Colorado Governor, and current Senate candidate, John Hickenlooper will justify poisoning his own constituents.

I Heard an Ad from Doctor Patient Unity on the Radio, and Did Some Digging

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Congress is getting close to advancing one of the few significant bipartisan reforms to the health care system still on the docket: legislation to curb the practice of “surprise medical billing.”

Naturally, that progress has sparked a last-ditch, dark money blitz bent on sinking these relatively modest bills, which aim to make it harder for unsuspecting patients to get hit with exorbitant bills if they see the wrong doctor in an emergency situation.

A group called “Doctor Patient Unity,” formed in June, has bankrolled a sweeping campaign of radio and television ads to pressure senators up for re-election in 2020 to oppose proposals to reform surprise medical billing.

Now, the dark money group is going after key lawmakers with direct appeals to their constituents. A mailer paid for by Doctor Patient Unity, obtained by The Daily Beast, urges Rep. Tim Walberg’s (R-MI) constituents to call his office and tell him to “say no to rate-setting” and “to put patients first.”

………

“They’re throwing the full kitchen sink at our efforts here and seeing what will stick,” said a congressional aide, who requested anonymity to discuss the matter candidly. “It’s unclear whether or not members are seeing a huge influx of constituent calls, but it’s obvious what they’re trying to do here, which is to back members off this proposal.”

………

Those hospitals and doctors have led the charge in publicly opposing the changes Congress is mulling. But as for who exactly is pouring money into the mailers and TV ads, Doctor Patient Unity appears to have taken pains to conceal the identities of the individuals or organizations running and financing the effort. Public records provide some clues, however. Incorporation documents on file in Virginia list an address in the town of Warrenton that is shared by the prominent Republican law firm Holtzman Vogel Josefiak Torchinsky.

The group’s treasurer, according to filings with the FCC, is a woman named Janna Rutland. She serves as treasurer for a handful of other political and policy organizations, and appears to be an employee of the GOP consulting firm Crosby Ottenhoff, which counts a number of high-profile Republican candidates and party organs among its clients.

Emergency, anesthesiology, and neonatal intensive care practices are prime targets for private equity buys because the are typically involve people who are too desperate to do the deep digging required to avoid outrageous charging, which gives them almost unlimited pricing power.

Once again, there is nothing that Wall Street finance cannot get worse.

Ban Antibiotic Use on Livestock

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Meat without antibiotics is a bit more expensive, on the order of 5-10¢ a pound, (the Danes banned antibiotics, so we have good cost data( but that is a reasonable price to secure the public health:

A deadly outbreak of multi-drug resistant Salmonella that sickened 225 people across the US beginning in 2018 may have been spurred by a sharp rise in the use of certain antibiotics in cows a year earlier, infectious disease investigators reported this week.

From June 2018 to March of 2019, officials at the Centers for Disease Control and Prevention identified an outbreak of Salmonella enterica serotype Newport. The strain was resistant to several antibiotics, most notably azithromycin—a recommended treatment for Salmonella enterica infections. Before the outbreak, azithromycin-resistance in this germ was exceedingly rare. In fact, it was only first seen in the US in 2016.

Yet in the 2018-2019 outbreak, it reached at least 225 people in 32 states. Of those sickened, at least 60 were hospitalized and two died. (Researchers didn’t have complete health data on everyone sickened in the outbreak.)

………

The investigators suggest that the surge in macrolide use could have encouraged the rise and spread of the azithromycin-resistant Newport strain.

“Because use of antibiotics in livestock can cause selection of resistant strains, the reported 41% rise in macrolide use in US cattle from 2016 to 2017 might have accelerated carriage of the outbreak strain among US cattle,” they wrote.

………

In recent years, around 70% of all medically important antibiotics in the US have been sold for use in animals. Public health advocates say agricultural use of antibiotics should be reduced significantly to preserve the effectiveness of the drugs.

It is completely insane to allow farmers to destroy our public health system for a few pennies.

A Medical Myth Busted

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A study in the BMJ shows that capping interns hours at 80 per week does not adversely effect quality of care later in their careers.

Seeing as how working interns 100+ hours a week is killing patients today, and does not produce better outcomes tomorrow, it’s a good thing that accreditation authority has banned this:

When new rules by the Accreditation Council for Graduate Medical Education capped medical residents’ training hours at 80 hours per week in 2003, critics worried that the change would leave physicians-in-training unprepared for the challenges of independent practice.

Now, new research published July 11 in the journal BMJ and led by scientists in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School (HMS) says that their warnings appear largely unjustified. The team’s analysis found no evidence that reduced training hours had any impact on the quality of care delivered by new physicians.

The push to scale back residents’ hours and change other aspects of training was sparked by a series of high-profile patient injuries and deaths believed to stem from clinical errors caused by fatigue.
………

The researchers found no significant differences in 30-day mortality, 30-day readmissions, or inpatient spending between physicians who completed their residencies before and after the hour reforms.

………

The study analyzed 485,685 hospitalizations of Medicare patients before and after the reform.

The training-hour reforms were not associated with statistically significant differences in patient outcomes after the physicians left training.

I always figured that the brutal hours of medical residency were primarily about ritual scarring as a coming of age ritual, and it appears that I was right.

Interesting Data Point

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Elizabeth Warren seems to have a detailed plan for everything, with one exception she has no plan on healthcare, not even an explicit endorsement of a vague form of “Medicare for All”.

This is clearly an intentional omission, since her whole brand is about having a plan for EVERYTHING.

Considering that she has staked out a position just to the right of Bernie Sanders, I consider this to be an important tell: She will not fight for a truly universal healthcare system:

In a recent MSNBC town hall, Elizabeth Warren put her policy platform on full display. Through emotional, personal anecdotes and with a depth of understanding, Warren gave the impression of a candidate well-aware of the problems faced by working Americans and armed with the policies needed to solve them. She detailed her plans to achieve universal childcare, cancel the bulk of existing student debt, and create over a million green jobs by progressively taxing the richest Americans. She boldly criticized Joe Biden’s conservative record and decried the greed of large corporations.

The performance supported Warren’s reputation as a candidate with a “plan for everything” — a reputation emphasized repeatedly by MSNBC moderator Chris Hayes throughout the event. Taken as a whole, however, the town hall revealed an alarming gap in Warren’s policy repertoire, one that has gone mostly ignored to this point in the campaign: she has no plan for fixing the broken US health care system.

Warren had several opportunities in the town hall to address the health care crisis. Instead, she avoided the topic almost entirely. Even when discussing issues directly related to health care like repealing the Hyde Amendment and improving access to hearing aides, she neglected to propose a comprehensive policy solution.

Unfortunately, this was not a simple case of forgetfulness. In fact, it continues a disturbing trend with the Warren campaign. Check her website: in a long and thorough issues page full of bold plans to alleviate Americans’ suffering, Warren makes no mention of health care. View her campaign materials: Warren has yard signs dedicated to several of her major policy proposals, but not a single one about health care. Follow her campaign appearances: you’ll hear the usual platitudes (“health care is a human right;” “everyone deserves access to care”), but you won’t hear her endorse a specific policy.

………

Take for instance Warren’s March town hall on CNN. When asked directly whether she supports Medicare for All, Warren suggested that Medicare for All is merely a slogan for expanded public coverage, rather than a specific piece of single-payer legislation.

“When we talk about Medicare for All, there are a lot of different pathways,” she said, before listing a slew of incremental proposals without explicitly endorsing any of them, from lowering the age for Medicare eligibility to allowing employers to buy in to Medicare. “For me, what’s key is we get everyone to the table on this.”

Taking this answer at face value, it seems Warren sees herself pursuing an incremental approach that expands public coverage while preserving the private insurance industry should she be elected president. This would likely surprise many of her supporters, who might view her cosponsorship of Sanders’s Medicare for All bill as an endorsement of single-payer health care.

It’s fair to ask why Warren, who supports bold, progressive policies on a number of major issues, is avoiding the most important issue to voters. It could be a reluctance to attach herself to a rival candidate’s signature policy, or it could be a way to avoid conflict with the powerful health care corporations in her home state of Massachusetts.

Either way, it meshes well with a years-long effort by Democrats to blur the meaning of Medicare for All by gesturing goodwill toward single-payer advocates while attempting to redefine the phrase and apply it to public option proposals that preserve the private insurance industry. By following this playbook, Warren is actively supporting the corporate effort to kill the growing Medicare for All movement.

I wouldn’t go quite that far, but her reticence is unsettling.

About F%$#ing Time

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My guess is that someone has flipped on him.

Here is hoping that he spends the next few decades in jail:

Authorities investigating Flint’s water crisis have used search warrants to seize from storage the state-owned mobile devices of former Governor Rick Snyder and 65 other current or former officials, the Associated Press has learned.

………

The Solicitor general, Fadwa Hammoud, and Wayne county prosecutor Kym Worthy, who is helping with the investigation, confirmed they executed a series of search warrants related to the criminal investigation of Flint’s lead-contaminated water in 2014-15 and an outbreak of legionnaires’ disease. They declined to comment further.

One warrant, signed 19 May, lists all content from Snyder’s cellphone, iPad and computer hard drive. Similar information was sought from the devices of 33 employees who worked in his office, 11 in the department of environmental quality and 22 in the department of health and human services.

The evidence was apparently initially obtained by former special prosecutor Todd Flood with investigative subpoenas. Because it has been kept in a division of the attorney general’s office, Hammoud took the unusual step of securing a warrant to search another part of the office. She has been managing the investigation since January.

………

The warrants came after Hammoud this year reported that boxes of records were discovered in the basement of a state building, including phone extractions and a “trove” of other materials stored on hard drives that allegedly had not been turned over in response to subpoenas.

Flood was ousted as special prosecutor in April after leading the three-year investigation that led to charges against current or former government officials, including two members of Snyder’s cabinet. Nobody in Snyder’s office has been charged.

Hammoud accused Flood of mishandling the production of records and other evidence collected from state agencies. He has defended his work, saying he acted professionally.

 Looks like Flood was fired for doing a bad job, and considering that his firm was hired by Snyder ally, and former Attorney General, Bill Schuette, I would argue that his bad job was probably original reason behind hiring him.

There should be no stone unturned in this investigation, including Schuette and Flood and the people who profited from what was done to Flint.

This entire tapestry of corruption needs to be unraveled.

A Good Start

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Germany’s health minister has proposed a €2500.00 fee for people who refuse to vaccinate their children:

Germany, like the US, is facing a resurgence of measles. But the country’s health minister isn’t taking things lightly.

Health minister Jens Spahn is proposing a blanket fine for any parents of unvaccinated children. The fine runs up to €2,500 ($2,790). He also suggests banning unvaccinated children from all kindergarten and daycare facilities to protect those who are too young to vaccinate and those with medical conditions that prevent them from being vaccinated.

In an interview published over the weekend, Spahn explained that immunization is a “social responsibility,” adding that “measles vaccinations save human suffering. We protect ourselves and others.”

Fining anti-vaccine and vaccine-hesitant parents isn’t new. Officials in New York levied $1,000 fines on parents of some unvaccinated children amid ongoing measles outbreaks last month. However, the fines only applied to children in specific areas at the epicenter of the outbreak. Spahn’s proposal, on the other hand, would see fines handed down regardless of an outbreak—and the fine is even heftier.

Good.

I Approve of this Family Strife

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Members of the Kennedy family havwe publicly condemned Robert F. Kennedy, Jr’s antivaxx advocacy.

This cannot have been easy for them.

Americans have every right to be alarmed about the outbreak of measles in pockets of our country with unusually high rates of unvaccinated citizens, especially children. Right now, officials in 22 states are grappling with a resurgence of the disease, which was declared eliminated in the United States in 2000. With over 700 cases already reported and indications that more outbreaks will occur, 2019 will likely see the most recorded cases of measles in decades. And it’s not just measles. In Maine, health officials in March reported 41 new cases of whooping cough, another disease once thought to be a relic of the past—more than twice as many cases as this time last year.

………

These tragic numbers are caused by the growing fear and mistrust of vaccines—amplified by internet doomsayers. Robert F. Kennedy Jr.—Joe and Kathleen’s brother and Maeve’s uncle—is part of this campaign to attack the institutions committed to reducing the tragedy of preventable infectious diseases. He has helped to spread dangerous misinformation over social media and is complicit in sowing distrust of the science behind vaccines.

We love Bobby. He is one of the great champions of the environment. His work to clean up the Hudson River and his tireless advocacy against multinational organizations who have polluted our waterways and endangered families has positively affected the lives of countless Americans. We stand behind him in his ongoing fight to protect our environment. However, on vaccines he is wrong.

And his and others’ work against vaccines is having heartbreaking consequences. The challenge for public health officials right now is that many people are more afraid of the vaccines than the diseases, because they’ve been lucky enough to have never seen the diseases and their devastating impact. But that’s not luck; it’s the result of concerted vaccination efforts over many years. We don’t need measles outbreaks to remind us of the value of vaccination.

Good on them, and bad on RFK, Jr.

Welcome to the Third World

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Thank the anti-vaccine movement:

The US has seen more reports of measles cases in the first three months of 2019 than in the whole of last year, health officials said this week.

The US Centers for Disease Control and Prevention on Monday reported 387 measles cases so far in 2019, 15 more than the total number of cases last year. The numbers make 2019 the second-worst year for measles since the United States declared itself measles-free nearly two decades ago.

………

The number of measles cases typically declines in the summer months, but experts worry the early 2019 numbers indicate the disease is on the rise.

“My concern is that this is trending the wrong way,” said Dr Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine and author of the book Vaccines Did Not Cause Rachel’s Autism.

“It’s getting worse, it’s not getting better,” he added.

………

Dr Barbara McAneny, president of the American Medical Association, cautioned against exemptions to immunizations “solely as a matter of convenience or misinformation” because they increase the risk for vulnerable people, such as children who are too young to be vaccinated or children who cannot be vaccinated for medical reasons, such as cancer.

“Getting vaccinated not only keeps individuals from becoming ill with the measles but also helps prevent further spread to loved ones, neighbors, co-workers and others in close contact,” McAneny said.

What has happened is that a bunch of selfish idiots have been relying on herd immunity, and the inevitable has occurred:  there is now a sufficient number of unvaccinated people that herd immunity is no longer effective.

Authorities need to get seriously medieval on the anti-vaxxers.

Tweet of the Day

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During the 90s, the influencers said millions of lost jobs for the sake of free trade and globalization were worth it. Now, they tell us the loss of several hundred thousand jobs in the insurance industry for the sake of Medicare For All is intolerable. pic.twitter.com/krGH9kdHgC

— corey robin (@CoreyRobin) March 24, 2019

The reality of the situation here is that their objection is not to the loss of jobs, but the losses of the idle rich shareholders.

H/t Naked Capitalism

Any Californians Want to File a Report to the Medical Board?

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A single San Diego doctor wrote nearly a third of the area’s medical vaccination exemptions since 2015, according to an investigation by the local nonprofit news organization Voice of San Diego. The revelation follows growing concern that anti-vaccine parents are flocking to doctors willing to write dubious medical exemptions to circumvent the state’s vaccination requirements. Since California banned exemptions based on personal beliefs in 2015, medical exemptions have tripled in the state. The rise has led some areas to have vaccination rates below the levels necessary to curb the spread of vaccine-preventable illnesses. Moreover, it signals a worrying trend for other states working to crack down on exemptions and thwart outbreaks of vaccine-preventable diseases. There are currently six outbreaks of measles across the country.

Medical vaccination exemptions are intended for the relatively few people who have medical conditions that prevent them from receiving vaccines safely. That includes people who are on long-term immunosuppressive therapy or those who are immunocompromised, such as those with HIV or those who have had severe, life-threatening allergic reactions (e.g. anaphylaxis) to previous immunizations. Such patients typically receive medical exemptions incidentally during their medical care. But some doctors are providing evaluations specifically to determine if a patient qualifies for an exemption and granting exemptions using criteria not based on medical evidence. Some doctors are even charging fees for these questionable exemption evaluations—including the doctor in San Diego, Tara Zandvliet.

Zandvliet’s practice website specifically lists “Evaluation for Medical Exemption to Vaccination” as a service provided. The website also lays out the conditions and diseases she considers as qualifying for a medical exemption. The list reaches far beyond what medical experts say are acceptable reasons for exempting someone from life-saving immunizations. The list includes having a family history of bee-sting allergies, type I diabetes, or simply hives. After a reporter with the Voice of San Diego questioned some of the conditions listed, Zandvliet removed three from the list: asthma, eczema, and psoriasis.

“I have found that a few of the diseases on my list seem to invite misinterpretation more than others, and so I have deleted them,” she told the outlet in an email.

Zandvliet charges $180 for the evaluation, and her practice does not accept insurance.

Since 2015, Zandvliet has issued 141 of the 486 total medical exemptions granted in the San Diego Unified School District. After Zandvliet, the second highest number of medical exemptions granted by a single doctor was 26. The Voice of San Diego noted that Zandvliet’s practice is listed on several websites as being friendly to anti-vaccine parents.

She is renting her medical license to antivaxxers.

The solutions is to pull her medical license.

Campaign Finance Data Point

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Round up the Usual Suspects

Pharma & Insurance Gave $43M to the 129 House Democrats Not Backing Medicare for All

—Grit Post

What is distressing is not that this is corrupt as hell, but that it is all completely legal.

These folks are desperately in need of a thorough primarying:

Rep. Pramila Jayapal (D-Washington) recently rolled out House Democrats’ version of a Medicare for All proposal that would ensure all Americans have guaranteed healthcare.

 The bill (H.R. 1384) has an impressive 106 co-sponsors, and has been called “the most ambitious Medicare-for-All plan yet” by Vox, which also reported the benefits the House bill contained were even more significant than the companion bill Senator Bernie Sanders (I-Vermont) first introduced in his chamber. Under Jayapal’s plan, private, for-profit health insurance plans would be eliminated, and all Americans would be covered by a government-administered single-payer healthcare plan.

 Additionally, Rep. Jayapal’s bill — the Medicare for All Act of 2019 — calls for a two-year transition from the current system to the one she proposes, rather than a four-year transition, as Sanders proposed. The House bill would put everyone under the age of 19 and over the age of 55 on the single-payer plan after one year, and then everyone in between the following year.

 ………

However impressive 106 House Democrats co-sponsoring the bill may be, that number falls short of the 218 votes needed for a bill to pass the House of Representatives with a majority vote. Even though there are 235 House Democrats, 112 of the 129 House Democrats currently not listed as co-sponsors on Rep. Jayapal’s bill would need to come on board in order for the bill to be able to pass the chamber and go to the Senate.

………

Using campaign finance data made publicly available by the Center for Responsive Politics, Grit Post calculated that donors in the insurance and pharmaceutical industries gave a combined $43,740,947 in career campaign donations to the 130 House Democrats who have not yet signed on as co-sponsors to Rep. Jayapal’s bill. House Democrats received anywhere from $9,570 in financial support from pharma and insurance to $3.2 million, depending on the member.

Athletic Education is to Education as Athletic Supporter is to Supporter

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In a development that could only have occurred in the sports crazy state of Texas, a mandate for improved physical education has been shown to diminish educational outcomes:

It’s almost too easy to satirize physical education, better known by its eye-roll-inducing abbreviation P.E. From Clueless to Superbad to Spiderman: Homecoming, parodies of gym class are a pop-culture darling. Perhaps that’s because they speak to one of America’s fundamental truths: For many kids, P.E. is terrible.

A recent working paper focused on a massive P.E. initiative in Texas captures this reality. Analyzing data out of the state’s Texas Fitness Now program—a $37 million endeavor to improve middle schoolers’ fitness, academic achievement, and behavior by requiring them to participate in P.E. every day—the researchers concluded that the daily mandate didn’t have any positive impact on kids’ health or educational outcome. On the contrary: They found that the program, which ran from 2007 to 2011, actually had detrimental effects, correlating with an uptick in discipline and absence rates.

………

According to the study, the program resulted in a roughly 16 percent increase in the number of disciplinary actions for each student. The study also found that the proportion of misbehaving students went up by more than 7 percent.

The findings of the study, which has yet to be published in an academic journal, are limited in scope. Still, the new paper adds much-needed nuance to the body of research that has evaluated the effectiveness of various approaches to P.E., complicating the findings of studies that generally assert the importance of school policies that encourage regular opportunities for physical activity.

………

The results of Packham’s paper on the Fitness Now program support the basic takeaway that the design of P.E. courses is what’s most consequential, and they hint at two interconnected factors that experts suggest tend to undermine the impact of such curricula. For one, P.E. programs often rely on a superficial notion of gym class—conceiving of physical activity as little more than a timed run around the track, for example, or a game of kickball—and this results in worse offerings. And then, when students feel forced to take these basic offerings, they may resent the classes more than they would otherwise. “Older kids have already formed these important eating and exercising habits, and changing their daily decisions is more complicated than just providing money for jump ropes,” Packham says.

Despite greater recognition of the academic benefits of physical activities—including guidelines from agencies such as the Centers for Disease Control and Prevention stressing that kids should get at least an hour of such activities a day—schools began to deprioritize P.E. about two decades ago, and the cuts have persisted in many cases, suggests Kohl. Accompanying this shift has been a movement away from casual activities such as recess, which experts argue is one of the more effective means of promoting children’s physical health. An immense body of research demonstrates the positive benefits of increased recess time, which schools started to cut after No Child Left Behind was signed into law, because of the policy’s emphasis on academic subjects such as reading and math.

I think that many people what the real purpose of education actually is:  It’s there to give an unchallenging class major for student athletes, because those TV residuals don’t generate themselves.

The evidence is clear:  Recess is better for academics and physical fitness than gym class.

In fact, nothing is better for academics and physical fitness than gym class.

A Shande far di Goyim

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I knew that there was a major Measles outbreak in the New York City area, but I had not realized that it was almost exclusively among the ultra-Orthodox Jewish communities, where vaccination is far less common than the general population:

Through the fall, traveler after traveler arrived in the ultra-Orthodox Jewish communities of New York from areas of Israel and Europe where measles was spreading. They then spent time in homes, schools and shops in communities where too many people were unvaccinated.

Within months, New York State was facing its most severe outbreak of the disease in decades, with 182 cases confirmed by Thursday, almost exclusively among ultra-Orthodox Jews. Health officials in New Jersey have reported 33 measles cases, mostly in Ocean County, driven by similar conditions.

In 2018, New York and New Jersey accounted for more than half the measles cases in the country.

Alarmed, health officials began a systematic effort to bring up vaccination rates and halt the disease’s spread.

But while there has been progress, the outbreak is not yet over. Health officials said part of the problem has been resistance among some people in ultra-Orthodox neighborhoods to fully cooperate with health workers, get vaccinations and promptly report infections.

………

Dr. Ruppert said that health officials discovered that some religious schools, or yeshivas, in ultra-Orthodox communities in Rockland County had vaccination rates as low as 60 percent, far below the state average of 92.5 percent. Audits found that some schools were overreporting vaccination rates, she added.

Seriously.  What the F%$# is wrong with these people.

This is a danger to their community, and a danger to the surrounding community.

Measles is one of the most contagious diseases on the face of the earth, and all the rabbis would have to do is explain this to their congregants, and ten pick up the phone and get the state to set up some vaccination clinics

This has not happened..

Unleashing the Power of the Private Sector

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The price inflation in medicaid has tripled after Iowa privatized the program.

Obviously, it’s a limited sample, but when one considers that this has almost always been the case with the private sector running healthcare, it should come as not surprise:

The average cost of insuring an Iowan on Medicaid has climbed nearly three times as fast since the state hired private companies to manage the program, when compared to the previous six years, new state figures show.

Since fiscal 2017, the first full year of privatization, the per-member cost of Iowa’s Medicaid program has risen an average of 4.4 percent per year, according to the non-partisan Legislative Services Agency. In the previous six years, the per-member cost rose an average of 1.5  percent per year, the agency said.

The new cost figures come amid continuing controversy over whether Iowa should have hired private companies to run the $5 billion program. The shift’s supporters said it would slow growth in health care spending on the more than 600,000 poor or disabled Iowans covered by Medicaid.

It was never about making Medicaid working better, it was about making it worse, as well as being about shoveling money to politically connected contractors.

This is a feature, not a bug.