Health – Informed Comment

‘Hell No!’: Trump Allies’ Plan to Privatize Medicare Draws Alarm and Outrage

Common Dreams — Sat, 10 Feb 2024 05:02:20 +0000

A right-wing coalition that’s been laying the policy groundwork for another Trump presidency has developed a plan to further privatize Medicare by making fraud-riddled Medicare Advantage “the default enrollment option” for newly eligible beneficiaries.

The plan, highlighted Monday by Rolling Stone‘s Andrew Perez, is outlined about halfway through Project 2025’s 920-page playbook for the first six months of a conservative presidency.

Republican administrations and right-wing groups have long advocated funneling people who are newly eligible for Medicare into Medicare Advantage plans, which are funded by the federal government and run by for-profit insurers. During his first White House term, former President Donald Trump took steps to actively encourage seniors to choose Medicare Advantage plans over traditional Medicare and expanded the benefits that the privately run plans are allowed to offer.

Those efforts have had an impact. As Perez noted, “Last year, for the first time ever, a majority of Americans eligible for Medicare were on privatized Medicare Advantage plans.”

“If Republicans win the presidential race this year,” he wrote, “the push to fully privatize Medicare, the government health insurance program for seniors and people with disabilities, will only intensify.”

Every year, new and existing Medicare recipients have an opportunity to enroll in Medicare Advantage plans, which engage in aggressive and often highly deceptive advertising practices to lure seniors who are often seeking out benefits not currently offered by traditional Medicare, such as vision and dental care.

“Donald Trump and his MAGA Republican cronies plan to totally privatize Medicare if they win in November’s election.”

Image by Darko Stojanovic from Pixabay

Once enrolled in Medicare Advantage plans—which offer limited networks of doctors and overbill the government to the tune of $140 billion a year—patients often feel trapped and are subjected to care denials and other deep flaws in the program that have drawn growing attention from lawmakers in recent years.

If Project 2025, which is led by the right-wing Heritage Foundation, gets its way, Medicare Advantage providers would be given even greater power over the critical government insurance program. The Trump administration embraced many of the Heritage Foundation’s policy recommendations during its first year in power.

“Donald Trump and his MAGA Republican cronies plan to totally privatize Medicare if they win in November’s election,” the progressive advocacy group Social Security Works wrote in response to Rolling Stone‘s reporting. “Hell no. Hands off our earned benefits.”

Philip Verhoef, president of Physicians for a National Health Program, told Rolling Stone that Project 2025’s plan to make Medicare Advantage the default enrollment option would be “disastrous.”

“To do so would be really just a clear handout to the private insurance industry,” Verhoef said.

Project 2025 has said that it doesn’t “speak for any presidential candidate,” but Trump’s reelection campaign has relied on parts of the coalition’s proposed agenda for second-term planning.

Trump’s team has faced backlash over some of Project 2025’s work, including draft executive orders that would use the Insurrection Act to deploy the U.S. military against demonstrators. As The Washington Postreported in December, Trump campaign senior adviser Susie Wiles complained privately to Project 2025’s director and asked the coalition to “stop promoting its work to reporters.”

Seth Schuster, a spokesperson for President Joe Biden’s reelection campaign, warned in a statement Monday that “if Donald Trump wins this November, he and Republicans will continue their push to end Medicare as we know it for millions of Americans.”

“Trump will leave millions of seniors with fewer benefits and less access to doctors—all to benefit his big insurance donors,” said Schuster. “In Trump’s America, the special interests win and seniors and working families lose. Worse care, broken promises, and higher costs—that’s Trump’s plan for seniors and working families.”

In addition to making Medicare Advantage the default enrollment option for Medicare, Project 2025 is calling for the revival of the Global and Professional Direct Contracting Model, a Medicare privatization scheme that the Biden administration rebranded as ACO REACH and slightly modified—to the dismay of physicians, healthcare campaigners, and progressive lawmakers who called for the repeal of the Trump-era pilot program.

Gaza: The uncertain Fate of Patients needing Life-Saving Dialysis Treatment

The Conversation — Tue, 06 Feb 2024 05:02:19 +0000

By Ali Iqbal, McMaster University; Aliya Khan, McMaster University; and Ben Thomson, Johns Hopkins University | –

More than 100 days into the brutal assault on Gaza, over 27,000 Palestinians have been killed — of whom 60 per cent have been children and women — and 66,000 injured, according to the World Health Organization (WHO).

The destruction of Gaza’s health-care system has been catastrophic. The WHO says that, as of Jan. 5, there have been more than 600 attacks on health-care facilities, with 26 out of 36 hospitals in Gaza severely damaged and 79 ambulances targeted. Over 300 health-care workers have been killed and over 200 have been detained by Israeli forces.

In an open letter to the United Nations Security Council, Médecins Sans Frontières (MSF) president Christos Christou wrote:

“Israel has shown a blatant and total disregard for the protection of Gaza’s medical facilities. We are watching as hospitals are turned into morgues and ruins. These supposedly protected facilities are being bombed, are being shot at by tanks and guns, encircled and raided, killing patients and medical staff.”

Most of the resources within the collapsing health-care system in Gaza are directed towards treating acute trauma victims, such as the injured babies pulled from rubble, the toddlers requiring limb amputations and the civilians suffering from severe burn injuries. This leaves patients with chronic life-threatening diseases, such as cancer, heart failure and end-stage kidney disease, with severely limited access to the ongoing medical care they need to survive.

Patients unable to access care for chronic conditions

As nephrologists and internal medicine physicians, we are gravely concerned about patients in Gaza with chronic diseases who are unable to access care. There are more than 1,100 dialysis patients, including 38 children, in Gaza.

Hemodialysis is a treatment for patients with kidney failure that involves removing blood from the patient’s circulation and circulating it through a dialysis machine that clears toxins and removes excess fluid. Without adequate dialysis, fluid and toxins accumulate and patients typically die within days to weeks from respiratory failure or cardiac arrest.

Dialysis is a resource-intensive therapy that requires a dialysis facility, dialysis machines, filters, water supply and fuel, along with a team of technicians, nurses and nephrologists. Each one of these components has been severely and directly compromised since Israel’s assault on Gaza.

Israel’s complete blockade of food, fuel and water has left over 500,000 Gazans facing catastrophic hunger according to the United Nations Relief and Works Agency (UNRWA), and Gazan children face a 90 per cent reduction in access to water.

Several hospitals, including Al-Aqsa, reported being completely out of fuel, putting all patients in grave danger, particularly those on life support, babies in incubators and those requiring dialysis.

Even before the current conflict, the 16-year blockade of Gaza put the lives of kidney failure patients at risk due to chronic shortages of fuel and medical supplies. Al Jazeera reports that since Oct. 7, the number of patients at Al-Aqsa Hospital requiring dialysis has more than doubled from 143 to about 300, including 11 children, who have just 24 dialysis machines between them.

Aljazeera English Video: “Kidney patients face dialysis crisis at packed Gaza hospital”

This has forced dialysis units to significantly cut treatments, with patients receiving two-hour sessions rather than the typically prescribed 3.5-hour treatments. Treatment frequency, typically prescribed three times weekly, are now only available one or two times per week.

This decrease in treatment time and frequency is grossly insufficient to sustain life. But in a health-care system under assault, patients are fortunate to receive any dialysis at all.

Patients needing life-saving treatment

Ismail Al Tawil was a 44-year-old patient in Gaza who died of kidney failure after he was unable to access dialysis. In an interview with Al-Jazeera’s AJ+ social media arm, his widow described desperately trying to get him to dialysis at Al-Shifa hospital, but being shot at by Israeli snipers who surrounded the hospital.

She then attempted to access dialysis at Al-Awda and Kamal Adwan hospitals, but both facilities had insufficient capacity to treat him.

Since Oct. 7, 1.9 million people or 85 per cent of the population of Gaza have been internally displaced, according to Human Rights Watch. This is a tremendous challenge for dialysis patients who are faced with the uncertainty of when, where or if they will access their life-saving therapy.

Anssam, age 12, was displaced from Jabaliya in northern Gaza to seek treatment in Deir El Balah in central Gaza. She had gone 15 days without dialysis and had to leave with her mother to receive life-saving medical treatment. In an interview with The National News, Anssam said:

“I hope for this war to end and for us to go back to the way we were, happy and playing, and to go back to doing dialysis three times a week… Now, without filters, I cannot have dialysis and so I will die. My life depends on dialysis.”

Loss of medical personnel

Beyond the destruction of health-care facilities and a critical shortage of supplies, the loss of medical personnel may have the most devastating and longest-lasting impact on the health-care system in Gaza.

Dr. Hammam Alloh was one of the only nephrologists in Gaza, described as a committed physician and a beacon of light by his colleagues. He was 36 years old and a father of two young children. He had hopes to expand dialysis care in Gaza and build a nephrology educational training program.

He was killed on Nov. 12 by an Israeli airstrike to his family’s home, where he was taking a short rest after a busy shift at Al Shifa Hospital. His loss resonated far beyond his family, patients and colleagues in Gaza. Dr. Alloh’s courage and dedication has become a powerful source of inspiration for physicians and health-care workers around the world.

Multiple sources have reported the number of civilians who have been killed by the bombs and bullets during the assault on Gaza. We may never know how many cancer patients will die from lack of chemotherapy; or diabetics from lack of insulin; or kidney failure patients from inadequate dialysis. The consequences of the collapsed health-care system in Gaza will be felt for years to come.

The attempts to silence, intimidate and smear health-care workers for calling out the atrocities in Gaza have been well documented. These efforts not only attempt to rob us of our freedom of speech, but of our professional and moral duty as physicians to promote global health and protect the vulnerable.

As physicians, we will not be silent as our colleagues in Gaza are being killed, as hospitals are being targeted and attacked, and as vulnerable patients are endangered. We join the UN, the WHO, MSF and the British Medical Association, along with millions around the world, who call for an immediate ceasefire and unimpeded humanitarian aid.

We stand in solidarity with the true health-care heroes of Gaza who continue to work in harrowing conditions, and we honour the legacies of those like Dr. Alloh who lost their lives while upholding the highest values of our profession.

Ali Iqbal, Transplant Nephrologist, Assistant Professor of Medicine, McMaster University; Aliya Khan, Clinical professor, Faculty of Health Sciences, McMaster University, and Ben Thomson, Masters of Public Health student, Bloomberg School of Public Health, Johns Hopkins University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

“Helping” People by Shaming Them — and Canceling Their Civil Rights

Tomdispatch — Fri, 02 Feb 2024 05:02:42 +0000

By Mattea Kramer and Sean Fogler

( Tomdispatch.com) – Amid ongoing emergencies, including a would-be autocrat on his way to possibly regaining the American presidency and Israel’s war on Gaza (not to mention the flare-ups of global climate change), the U.S. has slipped quietly toward an assault on civil liberties as an answer to plummeting mental health. From coast to coast, state lawmakers of both parties are reaching for coercive treatment and involuntary commitment to address spiraling substance use and overdose crises — an approach that will only escalate despair and multiply otherwise preventable deaths while helping to choke the life out of America.

In December, we wrote about how loneliness has become a public-health crisis, according to the Surgeon General, and the ways in which it drives widespread substance use. We reach for substances to ease feelings of isolation and anguish — and when the two of us say “we,” we mean not just some hypothetical collective but the authors of this article. One of us, Sean, is a doctor living in long-term recovery from a substance-use disorder and the other, Mattea, is a writer who uses drugs.

And we’re anything but unique. Disconnection and loneliness aren’t just the maladies of a relatively few Americans, but the condition of the majority of us. Vast numbers of people are reaching for some tonic or other to manage difficult feelings, whether it’s weed, wine, work, television, or any mood- or mind-altering substance. These days, there’s scarcely a family in this country that’s been unscathed by problematic drug use.

Not surprisingly, under the circumstances, many elected officials feel increasing pressure to do something about this crisis — even as people who use drugs are widely considered to be social outcasts. In 2021, a survey of thousands of U.S.-based web users found that 7 in 10 Americans believed that most people view individuals who use drugs as non-community members. It matters little that the impulse to use such substances is driven by an urge to ease emotional pain or that the extremes of substance use are seen as a disease. As a society, we generally consider people who use drugs as rejects and look down on them. Curiously enough, however, such social stigma is not static. It waxes and wanes with the political currents of the moment.

“Stigma has risen its ugly head in almost every generation’s attempts to manage better these kinds of issues,” says Nancy Campbell, a historian at Rensselaer Polytechnic Institute and the author of OD: Naloxone and the Politics of Overdose. Campbell reports that she finds herself a target of what she calls “secondary stigma” in which others question why she even bothers to spend her time researching drug use.

Perhaps one reason to study such issues is to ensure that someone is paying attention when lawmakers of virtually every political stripe seek to answer a mental health crisis by forcing people into institutionalized treatment. Notably, such “treatment” can increase the odds of accidental death. Allow us to explain.

“Treatment” Can Be a Death Sentence

Across the country, the involuntary detainment and institutional commitment of people with mental illness — including those with a substance use disorder — is on the rise. Deploying the language of “helping” those in need, policymakers are reaching not for a band-aid but a club, with scant or even contradictory evidence that such an approach will benefit those who are in pain.

“The process can involve being strip-searched, restrained, secluded, having drugs forced on you, losing your credibility,” said UCLA professor of social welfare David Cohen in a 2020 statement about his research on involuntary commitment. He co-authored a study that found its use rose nationwide in the decade before the pandemic hit, even as there was a striking lack of transparency regarding when or how such coercion was used.

Buy the Book

Today, many states are expanding laws that authorize mandatory treatment for people experiencing mental-health crises, including addiction. According to the Action Lab at the Center for Health Policy and Law, 38 states currently authorize involuntary commitment for substance use. None of them require evidence-based treatment in all involuntary commitment settings and 16 of them allow facilities to engage in treatments of their choice without the individual’s consent. Nearly every state that ranked among the highest in overdose rates nationally has an involuntary commitment law in place.

In September, the California legislature passed a bill that grants police, mental healthcare providers, and crisis teams the power to detain people with “severe” substance use disorder. The Los Angeles County Board of Supervisors subsequently voted to postpone implementation of the law, with Board Chair Lindsey Hogarth noting the risk of civil rights violations as a reason for the delay. In October, Pennsylvania state legislators introduced a bill that would permit the involuntary commitment of people who have been revived following an overdose. While many mental health advocates acknowledge the good intentions of legislators, the potential for harm is incalculable.

New research shows that people who attended abstinence-based treatment programs were at least as likely, if not more likely, to die of a fatal overdose than people who had no treatment at all. By contrast, those who had access to medications like methadone or buprenorphine for opioid-use disorder were less likely to die. Those medications, however, are not considered “abstinence” and so are not uniformly provided in treatment settings. Though there is extensive evidence of the effectiveness of medications for opioid use disorder, abstinence still remains widely regarded as the morally upright and best path, even if it makes you more likely to die. The reason for the elevated risk of mortality following abstinence-based treatment is no mystery: abstinence reduces the body’s tolerance. If a person who has been abstinent resumes use, the ingestion of a typical dose is more likely to overwhelm his or her bodily system and so lead to death.

Disturbingly, both The Atlantic and the Wall Street Journal recently ran columns favoring mandatory treatment, with the Journal citing as evidence a 1960s study in which individuals fared well after 18 months of mandated residential treatment that included education and job training — a standard of care that’s virtually nonexistent today. The Atlantic referenced a study of 141 men mandated for treatment in the late 1990s whose outcomes were comparable to individuals who entered treatment voluntarily; the study’s own authors had, however, cautioned against generalizing the findings to other populations due to its limited scope — and since then, the potent opioid fentanyl has entered the drug supply and raised the risk of a fatal overdose following a period of abstinence.

Meanwhile, as policymakers turn to coerced treatment, consider this an irony of the first order: there are far too few treatment options for people who actually want help. “There is no place in this country where there is enough voluntary treatment. So why would you create involuntary commitment, involuntary treatment?” asks Campbell. The reason, she suggests, is the inclination of lawmakers not just to do something about an ongoing deadly crisis, but in no way to appear “soft on drugs.”

Just to put the strange world of drug treatment in context, imagine elected officials wanting to seem tough on constituents who have cancer or heart disease. The idea, of course, is ludicrous. But 7 in 10 Americans think society at large views addiction as “at least somewhat shameful” and people who use drugs as significantly responsible (that is, to blame) for their substance use. No surprise, then, that politicians would find it expedient to punish people who use drugs, even if such punishment only layers on still more shame, with research indicating that shame, in turn, exacerbates the pain and social isolation that drives people to use drugs in the first place. As Dr. Lewis Nelson, who directs programs in emergency medicine and toxicology at Rutgers New Jersey Medical School, pointed out to USA Today, the science of addiction and recovery is frequently overlooked because it’s inconsistent with ingrained social ideas about substance use.

“I Still Don’t Need Saving”

Punishing people for substance use worsens the pain and isolation that make drugs so appealing. So rather than punishment — and in our world today this will undoubtedly sound crazy — what if we treated people who use drugs as full and complete human beings like everyone else? Like, say, people with high blood pressure? What if we acknowledged that those who use drugs need the very same things that all people need, including love, support, and human connection, as well as stable employment and an affordable place to live?

Research on this, it turns out, suggests that human connection is particularly good medicine for the emotional pain that so often underlies substance use and addiction. Stronger social bonds — namely, having people to confide in and rely on — are associated with a positive recovery from a substance use disorder, while the absence of such social ties elevates the risk of further problematic drug use. Put another way, perhaps you won’t be surprised to learn that a powerful means of healing widespread mental distress is to connect with one another.

When people in distress have friends, attendant family, and healthcare providers who are genuinely there for them no matter what, their own self-perception improves. In other words, we help one another simply by being nonjudgmentally available.

Jordan Scott is a peer advocate for Recovery Link, which offers free digital peer support to people in Texas and Pennsylvania. She identifies as a person who uses drugs. “I felt like the message got reinforced that there was something wrong with me, that there was something broken with me,” she told us. “Anything that isn’t abstinence, or anything that doesn’t include total abstinence as a goal, is constantly positioned as less than.”

New research published in the journal Addiction draws a contrast between treatment focused exclusively on abstinence and a broader array of wellness strategies, including reducing drug use rather than eliminating it entirely. The study found that reduced use had clinical benefits and that health can distinctly improve even without total abstinence. Director of the National Institute on Drug Abuse Nora Volkow, for instance, supports a nuanced approach that includes many possible paths of recovery along with a shift away from the criminalization of drug-taking to a focus on overall health and wellbeing. And the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, has identified four dimensions critical to recovery: health, home, purpose, and community.

Most important of all, a person doesn’t necessarily need to be abstinent in order to make gains in all four areas. This makes good sense when you remember that addiction or other problematic substance use is a symptom of underlying pain. Rather than exclusively treating the symptom — the drug use — addressing the underlying loneliness, trauma, or other distress can be a very effective approach. “Family can be a valid pathway to wellness,” Scott pointed out, while adding that her own path went from 12-step meetings like Alcoholics Anonymous to active civic engagement.

For someone else, quality time with his or her kids or even exercising and eating well might be a linchpin for staying mentally healthy. In other words, healing from the pain that underlies substance use disorder can look a lot like healing from any other health challenge.

Yet policymakers continue to call for intensifying the use of coercive treatment. “I think we’re going to see more [involuntary commitment] before we see less of it,” said Campbell, who studies historical patterns in the social response to drug use. There’s nothing new, she noted, in the move to “help” people by institutionalizing them — even if such a move constitutes an erosion of basic civil rights.

“I think most of the time people are genuine in wanting to help,” said Scott, who has been a target of such “help.” The problem, she explained, is the idea that there is a group of people considered “normal” and therefore superior, who think they’re in a position to save other members of society.

“I didn’t need saving. I am a drug user now. I still don’t need saving,” Scott told us. These days she’s focused on being a part of her community through volunteerism while drawing on a support network of people who respect her path.

As for the two of us writing this article, Sean is spending time with his children, staying connected with friends, practicing meditation and yoga, and has for years facilitated a group of physicians in recovery. Mattea has started a new habit of going to the gym with her uncle to ease her loneliness, while also confiding in close friends for support. And all of that truly does make a difference.

Via Tomdispatch.com

How Trees and Forests Heal us and make for Well-Being,

H. Patricia Hynes — Mon, 29 Jan 2024 05:06:43 +0000

Greenfield, Mass. (Special to Informed Comment; Feature) – Korean scientists have confirmed that walking through forest areas improved older women’s blood pressure, lung capacity and elasticity in their arteries. Walking in an urban park with trees, or an arboretum, or a rural forest reduces blood pressure, improves cardiac-pulmonary parameters, bolsters mental health, reduces negative thoughts, lifts people’s moods, and restores our brain’s ability to focus – all findings of recent studies. Park RX America (PRA), a nonprofit founded in 2017 by the public health pediatrician Dr. Robert Zarr, has established a large network of health care professionals who use nature prescriptions as part of their health care treatment for patients. A sample prescription: “walk along a trail near a pond or in a park with a friend, without earbuds, for ½ hour, twice a week.”

As I began this piece on trees in forests, woods and parks, a friend asked, why in January in New England? Why didn’t I wait until the deciduous trees were a palette of new spring green crowning the stark brown trunks and branches of winter? The next day, January 7, nature provided the answer: a 10” snowstorm. Trees after a winter snowstorm – their upstretched dark deciduous branches shouldered with snow and their downreaching evergreen branches pillowed with snow – are a feast for the eyes.

“A forest is a sacred place…The medicines available in the forest are the second most valuable gift that nature offers us; the oxygen available there is the first.” These are the words of Irish born and educated in the ancient Celtic culture of spiritual and physical respect for trees, Diana Beresford Kroeger. This brilliant botanist went on to receive advanced degrees, culminating in a doctorate in medical biochemistry. She affirmed that simply walking in a pine forest is a balm for the body and soul, elevating our mood, thanks to their chemical gift of pinenes aerosols released by pine trees and absorbed by our bodies.

The healing potential of nature even stretches to those hospitalized. Patients recovering from surgery heal more quickly and need fewer pain killers if they have a hospital room with a window that looks out onto nature. Similarly, studies of students in classrooms with a view of nature have found that they both enjoyed learning and learned more than students without a view of nature.

Suzanne Simard worked for Canada’s minister of forests doing research on the most efficient ways to re-grow forests that had been clearcut by the logging industry. Loving forests since a child growing up in rural British Columbia, she grasped immediately that clear-cutting whole areas of a forest and applying herbicide to kill any competitor plant or tree before replanting monoculture tree seedlings was a “war on the forest.” In testing her insight, she found that clearcutting and planting single species seedling trees made no difference to speeding up the growth of the desired tree plantation and in some cases, reduced tree survival in the monoculture wood lots.

“Healing Forest,” Digital, Dream / Mystical, 2024.

In pursuing a doctorate and subsequent years of research, Simard documented that biodiverse forests are the healthiest of forests, with trees communicating with other trees of their own species and other species by an underground fungal network linking their roots with each other. Through this network, known as the wood wide web, trees provide chemical food and medicine to keep each other as healthy as possible. Her work has shown that “the fungal networks between roots of diverse trees carry the same chemicals as neurotransmitters in our brain,” strongly suggesting, she says, that trees have intelligence. She has learned from Aboriginal people that “they view trees as their people, just as they view the wolves and the bears and the salmon as their relations.” We need that back, she asserts.

Trees teach us lessons of community and cooperation through all the seasons, writes German forester Peter Wohlleben in The Hidden Life of Trees. He deems forests as “superorganisms,” sharing food with their own species and even nourishing their competitors. Together they create an ecosystem that enables them to live much longer as a community than a single living tree alone, a life lesson for us humans. Moreover, “sick trees are supported by healthy ones nearby…until they recover; and even a dead trunk is indispensable for the cycle of lifesaving as a cradle for its young.”

Trees are essential for life on earth; the older they are, the more essential they are. They remove carbon dioxide from the air, store carbon in their tissue and soil, give back oxygen into the atmosphere and slow global temperature increases. They offer cooling shade in hardscape urban neighborhoods, buffer cold winter winds, attract birds and wildlife, purify our air, prevent soil erosion during rainstorms and filter rainwater falling through their soil.

Without trees, we could not survive, whereas they have and could live without us. Older than we so-called homo sapiens (“wise men”) by a thousand times, they are wiser than many humans: they do not wage war with each other nor destroy their own habitat. They know not genocide nor ecocide. They are our ancestral model for cooperative, non-violent and sustainable communities.

I write this to honor and thank the multitude of forest protectors across our country and for those working to restore nature to their towns and cities.

We Deserve Medicare for All, But What We Get Is Medicare for Wall Street

Common Dreams — Sat, 06 Jan 2024 05:02:46 +0000

By Les Leopold | –

Creating a sane healthcare system will depend on building a massive common movement to free our economy from Wall Street’s wealth extraction.

( Commondreams.org ) – The United States health care system—more costly than any on earth—will become ever more so as Wall Street increasingly extracts money from it.

Private equity funds own approximately 9% of all private hospitals and 30% of all proprietary for-profit hospitals, including 34% that serve rural populations. They’ve also bought up nursing homes and doctors’ practices and are investing more year by year. The net impact? Medical costs to the government and to patients have gone up while patients have suffered more adverse medical results, according to two current studies.

The Journal of the American Medical Association (JAMA) recently published a paper which found:

Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line–associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections.

This should not come as a surprise. Private equity firms in general operate as follows: They raise funds from investors to purchase enterprises using as much borrowed money as possible. That debt does not fall on the private equity firm or its investors, however. Instead, all of it is placed on the books of the purchased entity. If a private equity firm borrows money and buys up a nursing home or hospital chain, the debt goes on the books of these healthcare facilities in what is called a leveraged buyout.

To service the debt, the enterprise’s management, directed by their private equity ownership, must reduce costs, and increase its cash flow. The first and easiest way to reduce costs is by reducing the number of staff and by decreasing services. Of course, the quality of care then suffers. Meanwhile, the private equity firm charges the company fees in order to secure its own profits.

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in.

An even larger study of private equity and health was completed this summer and published in the British Medical Journal (BMJ). After reviewing 1,778 studies it concluded that after private equity firms purchased healthcare facilities, health outcomes deteriorated, costs to patients or payers increased, and overall quality declined.

Photo by Towfiqu barbhuiya on Unsplash

One former executive at a private equity firm that owns an assisted-living facility near Boulder, Colorado, candidly described why the firm was refusing to hire and retain high-quality caregivers: “Their position was: We are trying to increase our profitability. Care is an ancillary part of the conversation.”

Medicare Advantage Creates Wall Street Advantages

Congress passed the Medicare Advantage program in 2003. Its proponents claimed it would encourage competition and greater efficiency in the provision of health insurance for seniors. At the time, privatization was all the rage as the Democratic and Republican parties competed to please Wall Street donors. It was argued that Medicare, which was actually much more efficient than private insurance companies, needed the iron fist of profit-making to improve its services. These new private plans were permitted to compete with Medicare Part C (Medigap) supplemental insurance.

In 2007, 19% of Medicare recipients enrolled in Medicare Advantage plans. By 2023 enrollment had risen to 51%. These heavily marketed plans are attractive because many don’t charge additional monthly premiums, and they often include dental, vision, and hearing coverage, which Medicare does not. And in some plans, other perks get thrown in, like gym memberships and preloaded over-the-counter debit cards for use in pharmacies for health items.

How is it possible for Medical Advantage to do all this and still make a profit?

According to a report by the Physicians for a National Health Program, it’s very simple—they overcharge the government, that is we, the taxpayers, “by a minimum of $88 billion per year.” The report says it could be as much as $140 billion.

In addition to inflating their bills to the government, these HMO plans don’t pay doctors outside of their networks, deny or slow needed coverage to patients, and delay legitimate payments. As Dr. Kenneth Williams, CEO of Alliance HealthCare, said of Medicare Advantage plans, “They don’t want to reimburse for anything — deny, deny, deny. They are taking over Medicare and they are taking advantage of elderly patients.”

Enter Hedge Funds

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in. They have bought large quantities of stock in the healthcare companies that are milking the government through their Medicare Advantage programs. They then insist that these healthcare companies initiate stock buybacks, inflating the price of their stock and the financial return to the hedge funds. Stock buybacks are a simple way to transfer corporate money to the largest stock-sellers.

(A stock buyback is when a corporation repurchases its own stock. The stock price invariably goes up because the company’s earnings are spread over a smaller number of shares. Until they were deregulated in 1982, stock buybacks were essentially outlawed because they were considered a form of stock price manipulation.)

United Healthcare, for example, is the largest player in the Medicare Advantage market, accounting for 29% of all enrollments in 2023. It also has handsomely rewarded its hedge fund stock-sellers to the tune of $45 billion in stock buybacks since 2007, with a third of that coming since March 2020. Cigna, another big Medicare Advantage player, just announced a $10 billion stock buyback.

These repurchases are also extremely lucrative for United Healthcare’s top executives, who receive most of their compensation through stock incentives. CEO Andrew Witty, for example, hauled in $20.9 million in 2022 compensation, of which $16.4 million came from stock and stock option awards.

Those of us fighting for Medicare for All have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks.

A look at the pharmaceutical industry shows where all this is heading. Between 2012 and 2021, fourteen of the largest publicly traded pharmaceutical companies spent $747 billion on stock buybacks and dividends, more than the $660 billion they spent on research and development, according to a report by economists William Lazonick and Öner Tulum. Little wonder that drug prices are astronomically high in the U.S.

And so, the gravy train is loaded and rolling, delivering our tax dollars via Medicare Advantage reimbursements to companies like United Healthcare and Big Pharma, which pass it on to Wall Street private equity firms and hedge funds.

It’s Not Just Healthcare

In researching my book, Wall Street’s War on Workers, we found that private equity firms and hedge funds are undermining the working class through leveraged buyouts and stock buybacks. When private equity moves in, mass layoffs (just like healthcare staff cuts and shortages) almost always follow so that the companies can service their debt and private equity can extract profits. When hedge funds insist on stock repurchases, mass layoffs are used to free up cash in order to buy back their shares. As a result, between 1996 and today, we estimate that more than 30 million workers have gone through mass layoffs.

Meanwhile, stock buybacks have metastasized throughout the economy. In 1982, before deregulation, only about 2% of all corporate profits went to stock buybacks. Today, it is nearly 70%.

Those of us fighting for Medicare for All, therefore, have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks. Every fight to stop a mass layoff is a fight against the same Wall Street forces that are attacking Medicare and trying to privatize it. Creating a sane healthcare system, therefore, will depend on building a massive common movement to free our economy from Wall Street’s wealth extraction.

To take the wind out of Medicare Advantage and Wall Street’s rapacious sail through our healthcare system, we don’t need more studies. It’s time to outlaw leveraged buyouts and stock buybacks.

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One is the Loneliest Number, especially when the One is Trump

Tomdispatch — Mon, 18 Dec 2023 05:02:14 +0000

( Tomdispatch.com) – Consider two phenomena that might seem unrelated.

This fall, the Centers for Disease Control and Prevention released new data showing a marked increase in overdose fatalities nationally. Nora Volkow, director of the National Institute on Drug Abuse, told CNN that she had expected overdose deaths to decline after a sharp spike during the pandemic. Instead, such fatalities have only gone up.

Meanwhile, by the end of November, Donald Trump was riding high with nearly 60% support in Republican primary polling. In the past 43 years, according to the Washington Post, no candidate has had such a commanding lead and failed to win his party’s nomination.

On the face of it, his astonishing poll numbers would appear to have nothing whatsoever to do with the continued rise in overdose deaths. As it happens, though, the two phenomena are horribly intertwined, connected to a fundamental question so many Americans are grappling with: In a world that feels increasingly lonely and often hopeless, how can we feel better?

Being Honest About Our Loneliness

One of us, Mattea, is a writer who currently uses drugs, and the other, Sean, is a doctor living in long-term recovery from a substance use disorder. Both of us were raised to believe that our accomplishments were the measure of our worth and that something out there — status, money, accolades — would make us whole. Both of us bagged various degrees and have admirable résumés, but neither of us found that such achievements brought any sense of wholeness. In fact, it’s often seemed as if the more impressive we appeared, the emptier we felt.

It took us about 40 years to realize that our quest to be accomplished and better than other people was, in fact, causing us despair. And today we’re writing because we remain in pain and want to be honest about it. We have come to understand that even those people who appear to be on top often feel an emptiness they try to fill with work, antidepressants, cannabis, wine, benzodiazepines, you name it.

Meanwhile, there is a nascent but growing awareness in the medical and recovery communities that loneliness is at the root of so much addiction — and that loneliness is on the rise. According to Surgeon General Vivek Murthy, loneliness in America has indeed grown into a public health crisis. Earlier this year, Murthy released a report entitled “Our Epidemic of Loneliness and Isolation,” in which he described taking a cross-country tour and hearing countless Americans of all backgrounds disclose that they feel invisible, insignificant, and isolated. That experience of loneliness coupled with trauma and a wide spectrum of mental health challenges is now tearing at the fabric of American life, driving new levels of despair and death, much of it drug-related, that are ripping through families and communities and lowering life expectancy.

In such a bleak landscape, one way to feel better is to put your hopes into a magnetic leader who makes you feel like you’re a part of something meaningful. Another way is to have a martini and any mood- or mind-altering substance — anything to numb the pain.

This is not an individual problem. This is not a moral failing or a flaw in our brain chemistry (or yours). This is a vast social problem, one that benefits The Donald immeasurably.

Disconnection ~~Nation~~ World

Bruce Alexander is a professor emeritus of psychology at Simon Fraser University in British Columbia and the author of The Globalization of Addiction. He struggled with alcohol as a young man and then left the U.S. for Canada, where he devoted his professional life to the study of addiction. He focused on the significance of “psychosocial integration,” the healthy interdependence with society an individual experiences when he or she feels both a sense of self-worth and of belonging to a larger whole. According to Alexander, psychosocial integration is what makes human life bearable and its lack is called “dislocation” or, in common parlance, disconnection.

Buy the Book

In a sense, disconnection goes hand-in-hand with our modern free-market society. Many potential sources of psychosocial integration like the sharing of food among all members of a community are today seen as incompatible with free markets or otherwise logistically implausible. Instead, each individual is meant to act in his or her own self-interest. According to Alexander, this makes a sense of disconnection not the state of a relatively few members of society, but the condition of the majority.

Such disconnection generally proves to be a psychologically painful experience that all too often leads to confusion, shame, and despair. As individuals, we tend to try to manage such feelings by numbing ourselves or reaching for a substitute for genuine connection, or both. This leads masses of people to compulsively pursue and become addicted to work, social media, material possessions, sex, alcohol, drugs, and more. Of course, simply to pursue any of these things doesn’t mean a person is addicted. It’s possible to have a healthy relationship with work or an unhealthy one — and that’s true of just about anything.

In this view of modern existence, addiction is a very human answer to the conditions in which we find ourselves. According to physician and famed childhood trauma and addiction expert Gabor Maté, addiction is so commonplace in our world that most people don’t even recognize its presence.

Yet to label people “drug addicts” is to strip them of their humanity and assign them to the lowest echelons of our society. It’s a term that implicitly undermines the validity of a person’s experience and negates their very worth. Even though different types of addictions — to drugs or money, for instance — are inherently similar, the former is stigmatized, while the latter is acceptable or even revered.

“To ostracize the drug addict as somehow different from the rest of us is arrogant and arbitrary,” writes Maté, who has been candid about his own addictions — to work and shopping — to the point of sharing his experiences with patients who were addicted to drugs. His patients, he reports, were astonished that he was “just like the rest of us.”

“The point,” Maté said in an interview with the Guardian earlier this year, “is we are all just like the rest of us.”

After more than half a century of studying addiction, Bruce Alexander no longer separates compulsive drug use from other dependencies. He categorizes addictions to alcohol, drugs, food, gambling, power, a sense of superiority, and a litany of other things as responses to the same underlying pain.

Yet he does regard one flavor of addiction as distinct from all others.

“What’s the most dangerous addiction of all in the twenty-first century?” he asked in a conversation with one of us over Zoom last year. And then he answered his own question. According to the octogenarian professor who has devoted his life to addiction psychology, the most dangerous addiction today is the rising obsession globally with cult political leaders like Donald Trump.

What Drugs and Autocracy Have in Common

Today, there is an emerging awareness among medical professionals that loneliness lies behind our addiction crisis. But political scientists have long known that loneliness can drive social decay, eroding political stability in unnerving ways.

Historian and philosopher Hannah Arendt understood isolation and loneliness as the essential conditions for the rise of an autocratic ruler. For a politician to seize absolute power, she wrote in 1951 in The Origins of Totalitarianism, people must be isolated from one another. So long ago, she referred to widespread isolation as a “pre-totalitarian” state, suggesting that totalitarian domination “bases itself on loneliness, on the experience of not belonging to the world at all, which is among the most radical and desperate experiences of man.”

In her moment, Arendt also saw political propaganda as both an art and a science that German dictator Adolf Hitler and the Soviet Union’s Joseph Stalin had developed to near perfection. She labeled it the “art of moving the masses.” Had she lived into our time, she would undoubtedly have been struck by the ways in which the science of drug chemistry and the art of political propaganda have soared to novel heights. After all, we carry in our pockets, day and night, tiny computers that all too often deliver disinformation, while the drug supply has become so potent that fatal overdoses regularly occur from both legally obtained prescription pills and a continuously shifting assortment of illicit drugs.

This should be terrifying, but we’ve also learned something significant from our own experiences and those of other people who use drugs. Every person’s drug of choice — whatever it is — deserves to be understood and respected as a strategic coping mechanism. Follow the drug to the pain underneath. Gabor Maté’s mantra is: “Don’t ask why the addiction, ask why the pain.”

No matter whether people ease or numb their suffering with drugs, alcohol, television, or by following a leader determined to be the one and only in their world, that strategy serves an important purpose in their life. And that’s true even if today’s widespread addiction to a would-be all-American dictator were to lead to the awarding of incontestable power and control over the world’s largest nuclear stockpile to a vengeful demagogue. It’s important to understand that a romance with a drug or with Donald Trump (or both) helps people tolerate their pain — very often, the pain of feeling that they don’t have a place in the world.

This molecule understands me, it doesn’t judge me. This guy understands me, he doesn’t judge me.

Arendt grasped early on that the lies of political propaganda offer an alternate reality, and when masses of people support an autocratic leader, they’re casting a vote against the world as they know it — a world marked by loneliness. It’s just such loneliness that fuels support for the iron-fisted politician, while creating a hunger for mind-numbing molecules, both impulses born of a frustrated need for connection. As a New York Times headline put it, opioids feel like love (and that’s why they’re so deadly in tough times). That one can experience love through drugs might seem fantastical to many — but such love is all too real and feels better than no love at all.

Amid endemic loneliness, drugs and autocracy each provides an escape from a reality that otherwise seems unbearable.

We Decided to Witness Each Other’s Pain

Our cultural modus operandi is to judge people who use drugs or are in the throes of addiction — to consider substance use an essential character flaw, a deep moral problem. In 2022, one of us led a national public health survey that found 69% of respondents across the U.S. believe society views people who use drugs problematically as “somewhat, very, or completely inferior.” In other words, the vast majority of us believe that people who use drugs are outcasts. Meanwhile, our legal system criminalizes certain substances (while similar or even identical molecules are legal and widely prescribed) and regards the people who use them as bad actors who must be punished and supervised in jails and prisons or through parole or probation.

But once you grasp the underlying problem — that people are lonely, traumatized, and in pain — it becomes all too clear that incarceration or other similar punishments are not the answer. They represent, in fact, just about the worst policy you could possibly bring to bear against people who are hurting and self-medicating in an attempt to feel better. The United Nations Office of the High Commissioner for Human Rights recently called on all nations to regard drug use as a public health issue and curb punitive measures to deal with it. In the U.S., even as there is a dawning awareness that the war on drugs has been a miserable failure, many elected officials (and presidential candidates) only want to double down on harsh policies.

One of us has personally experienced criminal punishment for substance use, and the shame of being judged and punished is so physically palpable that it’s the equivalent of being stabbed and then having the knife twisted in you again and again. On top of devastating repercussions that touch every dimension of your professional and civil life, it’s common to be judged badly for your substance use by friends, family, and neighbors — nearly everyone you know. That, in turn, makes recovery from a substance use disorder seem all but impossible because drugs are what numb the shame.

So, we personally decided to try something different. We’re two people who have experienced loneliness and, rather than judge each other, we’ve chosen to witness one another’s pain. That means listening to our experiences without diminishing, deflecting, or trying to fix the problem. And what we’ve found is that this makes us less lonely and provides a strong measure of healing.

Notably, research indicates that nonjudgmental peer support is a genuinely effective strategy for addressing substance use disorder. Whereas being jailed or otherwise punished or dismissed as weak or dirty is a barrier to emotional health (and all too often proves deadly), having the support of trusted peers and loved ones is associated with a reduction in the psychic pain that drives people to use drugs in the first place.

This squares with what Hannah Arendt thought, too. In The Origins of Totalitarianism, she wrote that loneliness is “the loss of one’s own self” because we are social creatures, and we confirm our very identity through “the trusting and trustworthy company of [our] equals.” That is, we need one another to be our fullest selves.

To put that another way, when it comes to addictions, whether to drugs or to a dangerous leader, the true medicine is connection to each other.

Via Tomdispatch.com

World Health Organization: Gaza faces Epidemics; 449 Israeli Attacks on Health Services in Palestine

Middle East Monitor — Mon, 11 Dec 2023 05:04:13 +0000

( Middle East Monitor ) – World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus on Sunday confirmed more than 449 attacks on health services in Gaza and the West Bank since Oct. 7, saying “now the work of the health workers is impossible.”

Speaking at a special session organised by the WHO executive board on the health situation in the occupied Palestinian territories, Tedros emphasised the catastrophic impact of conflicts on the health situation in Gaza, Anadolu Agency reports.

“More than 17,000 people are reported to have died in Gaza, including 7,000 children and we don’t know how many are buried under the rubble of their homes. More than 46,000 injuries have been reported,” he said.

World Health Organization: Dr Tedros’s remarks at the opening of the WHO #EBSpecial on the health conditions in oPt

As many as “1.9 million people have been displaced – almost the entire population of the Gaza Strip – and are looking for shelter anywhere they can find it. Nowhere and no one is safe in Gaza,” he added.

He emphasised that health should never be a target, saying on average, there is one shower unit for every 700 people and one toilet for every 150 people, and there are worrying signals of epidemic diseases including bloody diarrhoea, and jaundice. According to him, only 14 hospitals out of the original 36 are partially functional.

“As more and more people move to a smaller and smaller area, overcrowding, combined with the lack of adequate food, water, shelter and sanitation, are creating the ideal conditions for disease to spread,” he said.

The WHO chief emphasised their support for UN Secretary-General Antonio Guterres’ call for a permanent and urgent humanitarian cease-fire to ensure the delivery of critical aid to those in urgent need in the Gaza Strip.

“A cease-fire is the only way to truly protect and promote the health of the people of Gaza. I deeply regret that the Security Council was unable to adapt a resolution on such a cease-fire last Friday,” he said, referring to the US veto blocking the international calls for a truce.

Israel, in response to the Oct. 7 attack by Palestinian group Hamas, launched air and ground attacks on the besieged enclave, killing thousands of Palestinians, mostly civilians, and forced some 1.9 million people to flee their homes. Gazans also face severe shortages of food, water and other basic goods as only a trickle of aid is allowed in.

Via Middle East Monitor

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7 Questions to ask to Protect yourself from Medicare Advantage Scams

Common Dreams — Fri, 24 Nov 2023 05:02:41 +0000

To ensure you have good coverage for both current and unforeseeable health needs this open enrollment period, you should choose traditional Medicare.

Diane Archer

( Common Dreams ) – During this Medicare Open Enrollment period, ask yourself these seven questions. And, please know that you can always call the Medicare Rights Center at 1-800-333-4114 or your SHIP—State Health Insurance Assistance Program—for free, unbiased advice on any of your Medicare questions.

Q. What’s the biggest difference between traditional Medicare and a Medicare Advantage plan? To ensure you have good coverage for both current and unforeseeable health needs, you should enroll in traditional Medicare. In traditional Medicare, you and your doctor decide the care you need, with no prior approval. And, you have easy access to care from almost all doctors and hospitals in the United States with no incentive to stint on your care. In a Medicare Advantage plan, a corporate insurance company decides when you get care, often requiring you to get its approval first. Medicare Advantage plans also restrict access to physicians and too often second-guess your treating physicians, denying you needed care inappropriately. The less care the Medicare Advantage plan provides, the more the insurance company profits. You will pay more upfront in traditional Medicare if you don’t have Medicaid and need to buy supplemental coverage, but you are likely to spend a lot less out of pocket when you need costly care. Regardless of whether you stay in traditional Medicare or enroll in Medicare Advantage, you still need to pay your Part B premium.
Q. Should I trust an insurance agent’s advice about my Medicare options? No. Unfortunately, insurance agents are paid more to steer you away from traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. While some insurance agents might be good, you can’t know whom to trust. Keep in mind that while Medicare Advantage plans tell you that they offer you extra benefits, you still need to pay your Part B premium, and extra benefits are often very limited and come with high out-of-pocket costs; be aware that many Medicare Advantage plans won’t cover as much necessary medical and hospital care as traditional Medicare. For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.
Q. Why can’t I rely on my friends or the government’s star-rating system to pick a good Medicare Advantage plan? Unlike traditional Medicare, which gives you easy access to the physicians and hospitals you use from everywhere in the U.S. and allows for continuity of care, you can’t count on a Medicare Advantage plan to cover your care from the healthcare providers listed in their network or to cover the medically necessary care that traditional Medicare covers. Even if your friends say they are happy with their Medicare Advantage plan right now, they are gambling with their healthcare. The government’s five-star rating system does not consider that some Medicare Advantage plans engage in widespread inappropriate delays and denials of care, and other Medicare Advantage plans engage in different bad acts that can endanger your health. So, while you should never sign up for a Medicare Advantage plan with a one, two, or three-star rating, Medicare Advantage plans with four and five-star ratings can have very high denial and delay rates.

Image by Coombesy from Pixabay

Q. If I’m enrolled in a Medicare Advantage plan, can I count on seeing the physicians listed in the network and lower costs? Unfortunately, provider networks in Medicare Advantage plans can change at any time and your out-of-pocket costs can be as high as $8,300 this year for in-network care alone. You can study the MA plan literature, and you can know your total out-of-pocket costs for in-network care. But, you cannot know whether the MA plan will refuse to cover the care you need or delay needed care for an extended period. This year alone, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care.
Q. Doesn’t the government make sure that Medicare Advantage plans deliver the same benefits as traditional Medicare? No. The government cannot protect you from Medicare Advantage bad actors. The insurers offering Medicare Advantage plans can decide you don’t need care when you clearly do, and there’s no one stopping them; they are largely unaccountable for their bad acts. In the last few years there have been multiple government and independent reports on insurance company bad acts in Medicare Advantage plans.
Q. If I join a Medicare Advantage plan, can I disenroll and switch to traditional Medicare? You can switch to traditional Medicare each annual open enrollment period. However, depending upon your situation, where you live, your income, your age, and more, you might not be able to get supplemental coverage to pick up your out-of-pocket costs and protect you from high costs. What’s worse, you could incur thousands of dollars in out-of-pocket costs in Medicare Advantage.
Q. If I have traditional Medicare and Medicaid, what should I do? If you have both Medicare and Medicaid, traditional Medicare covers virtually all your out-of-pocket costs. You will get much easier access to physicians and inpatient services in traditional Medicare than in a Medicare Advantage plan if you need costly healthcare services or have a complex condition.

Again, for free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.

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Israel’s Sustained Bombing Created Massive Gaza Disease Risk: Overcrowded Shelters, Dirty Water and breakdown of Basic Sanitation

The Conversation — Wed, 22 Nov 2023 05:04:08 +0000

By Yara M. Asi, University of Central Florida | –

(The Conversation) – After more than a month of being subjected to sustained bombing, the besieged people of the Gaza Strip are now confronted with another threat to life: disease.

Overcrowding at shelters, a breakdown of basic sanitation, the rising number of unburied dead and a scarcity of clean drinking water have left the enclave “on the precipice of major disease outbreaks,” according to the World Health Organization.

As an expert in Palestinian public health systems who wrote about the many relationships between war and health for my forthcoming book “How War Kills: The Overlooked Threats to Our Health,” I believe that the looming crisis cannot be underestimated. The easy spread of infectious disease in wartime conditions can be just as devastating as airstrikes to health and mortality – if not more so. Health care services in Gaza – already vulnerable prior to the Israeli bombing campaign – have essentially no capacity to cope with a major outbreak.

Disease already rampant

History has proved time and again that war zones can be a breeding ground for disease. Anywhere impoverished and underresourced people crowd for shelter or access to resources – often in facilities with inadequate living conditions, sanitation services or access to clean water – is prone to the spread of disease. This can be through airborne or droplet transmission, contaminated food or water, living vectors like fleas, mosquitoes or lice, or improperly cleaned and managed wounds.

In any situation of armed conflict or mass displacement, the threat of infectious disease is among the primary concerns of public health professionals. And from the outset of the Israeli bombing campaign, experts have predicted dire health consequences for Gaza.

After all, the Gaza Strip had fragile health and water, sanitation and hygiene sectors long before the Oct. 7, 2023, Hamas attack that killed 1,200 Israelis and prompted the retaliatory airstrikes. The health system of Gaza, one of the most densely populated places in the world, has long been plagued by underfunding and the effects of the blockade imposed by Israel in 2007.

Waterborne illness was already a major cause of child mortality – the result of the contamination of most of Gaza’s water. In early 2023, an estimated 97% of water in the enclave was unfit to drink, and more than 12% of child mortality cases were caused by waterborne ailments, like typhoid fever, cholera and hepatitis A, that are very rare in areas with functional and adequate water systems.

Other forms of infectious disease spread have also been reported in recent years. Gaza had experienced several previous outbreaks of meningitis – an inflammation of the tissues surrounding the brain and spinal cord typically caused by infection – notably in 1997, 2004 and 2013.

In late 2019, a small outbreak of measles – a highly contagious, airborne virus – was reported in Gaza, with almost half of reported cases in unvaccinated people. Despite a relatively high vaccination rate in Gaza generally, these gaps in vaccination and the inability to respond quickly to outbreaks were attributed by the WHO to “the continuous socio-economic decline since 2009, conflict, and closure.”

And the COVID-19 pandemic hit the Gaza Strip hard, exacerbated by the Israeli blockade that prevented or delayed the import of vital personal protective equipment, testing kits and vaccines.

France 24: “Hunger, disease ‘inevitable’ in Gaza as fuel runs out • FRANCE 24 English”

A system overwhelmed

The vulnerability of Gaza’s health care meant that from the outset of the latest conflict, organizations such as the WHO voiced concern that the violence and deprivation could quickly overwhelm the system.

There are several ways war in general, and the conflict in Gaza in particular, accelerates and promotes infectious disease risk.

Almost concurrently with the start of the bombing campaign, Israel imposed siege conditions on Gaza. This prevented the import of fuel needed to run generators for vital infrastructure. Generators are needed because Israel shut off electricity to Gaza.

As fuel has essentially run out in recent days, this has meant no power for desalination plants or for solid waste collection. As a consequence, many people have been forced to consume contaminated water or live in conditions where living carriers of disease, like rodents and insects, thrive.

Even basic cleaning supplies are scarce, and equipment used to sterilize everything from medical equipment to baby bottles is inoperable.

These unhygienic conditions come as hundreds of thousands of Palestinians in Gaza attempt to flee the bombing to the few remaining places left to shelter. This has caused massive overcrowding, which increases the risk of an infectious disease outbreak.

Children especially vulnerable

Already, the WHO has reported worrying trends since mid-October 2023, including more than 44,000 cases of diarrhea in Gaza.

Diarrhea is a particular risk for young children who are prone to profound dehydration. It represents the second-leading cause of death worldwide in children younger than 5 years of age. Half of the diarrhea cases reported in Gaza since the Israeli bombing campaign began have been in children under 5.

Meanwhile, nearly 9,000 cases of scabies – a skin rash caused by mites – have been reported, as have more than 1,000 cases of chickenpox.

More than 70,000 cases of upper respiratory infections have been documented, far higher than what would be expected otherwise. These are just cases that were reported; undoubtedly, more people who were unable to get to a health facility for diagnosis are also sick.

Reports of the spread of chickenpox and upper respiratory infections like influenza and COVID-19 are particularly dangerous considering children’s vaccination schedules are being highly disrupted by conflict. With health services overstretched and the mass movement of families, young children and newborns are likely going without vital, lifesaving inoculations just as winter – the peak season for respiratory infections – arrives.

Upper respiratory infections are also exacerbated by the amount of dust and other pollutants in the air due to the destruction of buildings during bombing.

Then there is the direct impact of the bombing campaign. A lack of antibiotics – due to both the siege and the destruction of health facilities – means physicians are unable to adequately treat thousands of patients with open wounds or in need of medical operations, including amputations.

More death and suffering

Increasingly, doctors are even running out of wound dressings to protect injuries from exposure. Poor infection prevention controls, high casualty rates and high concentrations of toxic heavy metals, among other factors, are leading to reports of antimicrobial resistance, which occurs when bacteria and viruses evolve over time to no longer respond to antibiotics and other antimicrobial medications. This has the potential to lead to health issues long after the bombing stops. Similar trends were also seen in Iraq, where antimicrobial resistance rates remain high despite the peak of bombing campaigns ending many years ago.

And with many bodies laying under rubble, unable to be retrieved, and the necessity of digging multiple mass graves near sites where people are sheltering, there is also increased risk of disease arising from an inability to adequately dispose of the dead.

While the images and photos from Gaza of areas and people that have been bombed are devastating and have caused a massive death toll – at least 12,000 by mid-November, according to Gaza health authorities – the rapid spread of infectious disease has the ability to cause even greater mortality and suffering to a population reeling from weeks of sustained bombing.

Yara M. Asi, Assistant Professor of Global Health Management and Informatics, University of Central Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.