White Coats White Care

As we take to the streets or our screens we have to realize that systemic racism and sexism dominates most of the larger institutions established in our country. And none other is as large as the medical industrial complex, and the emphasis on complex has truly come to fruition with the Coronavirus and the exposures with regards to the failings of public health. We have for years found a lack of funding for public enterprises, from housing, to education and lastly to health care has lent itself to major disparities of equity when it comes to the working poor. And no group composes the working poor more than faces of color.

There is some roots in this vested in racsim but it is also with regards to gender and now sexuality identity. The AIDS crisis exposed again how the system failed when it came to helping those who identified as Gay and had contracted that disease. It was labeled the “Gay disease” and much like Covid today, contributed to a genocide of those who were not part of the acceptable mainstream aka White/Male/Christian. Women’s rights so fought for in the 70’s and ultimately leading to the failure of the ERA, also plays a factor as men in leadership roles found that by having women enter the workplace they may have expectations reagarding rights and privileges that were largely the domain of men. We finally saw that come to head with #MeToo and again with Covid the rights of Trans folks shows again another marginalized group shoved aside when it comes to crime, violence, and of course health care.

Below are two articles, one about the failings of the MIC to properly treat, diagnose and care for faces brown and black and that implied if not overt bias dominates the field when it comes to finding medical care. The next is on reproductive rights and how the BLM group do not see this as an issue. Well then remind me why again I am not to support you, a woman, a face of color and with the genitalia we share, with the same reproductive rights issues and needs regardless of the shade of our skin. Of all groups most affected again by denial of access to abortion it has also led to closures of clinics that do more than provide abortion and in turn provide pre and post natal care, two issues of import that again largely affect faces of color. When you take away one right you have a domino affect that leads to a reduction of rights across the spectrum. Again, we have the right to care and because of the complext needs of Trans folks the access to proper medical care is essential. Got tits? Well welcome to breast cancer and the ability to screed for that or any other cancer is again a reproductive sexual right. Safe sex is informed sex and these clinics again provide essential information and education to eliminate the transmission of sexually transmitted diseases and the necessary vaccine to prevent cervical cancer.

So agai you say you don’t have time for this? Okay then don’t ask me for any time to spend on your issue. As clearly you have one where your sexuality is not a part of your identity and your identity is more than skin color.

Racism in care leads to health disparities, doctors and other experts say as they push for change

 

The Washington Post

By Tonya Russell
July 11, 2020 at 10:00 a.m. EDT

The protests over the deaths of black men and women at the hands of police have turned attention to other American institutions, including health care, where some members of the profession are calling for transformation of a system they say results in poorer health for black Americans because of deep-rooted racism.

“Racism is a public health emergency of global concern,” a recent editorial in the Lancet said. “It is the root cause of continued disparities in death and disease between Black and white people in the USA.”

A New England Journal of Medicine editorial puts it this way: “Slavery has produced a legacy of racism, injustice, and brutality that runs from 1619 to the present, and that legacy infects medicine as it does all social institutions.”

The novel coronavirus has provided the most recent reminder of the disparities, with black Americans falling ill and dying from covid-19 at higher rates than whites. Even so, the NEJM editorial noted, “when physicians describing its manifestations have presented images of dermatologic effects, black skin has not been included. The ‘covid toes’ have all been pink and white.”

Black Americans die younger than white Americans and they have higher rates of death from a string of diseases including heart diseases, stroke, cancer, asthma and diabetes.

By one measure, they are worse off than in the time of slavery. The black infant mortality rate (babies who die before their first birthday) is more than two times higher than for whites — 11.4 deaths per 1,000 live births for blacks compared with 4.9 for whites. Historians estimate that in 1850 it was 1.6 times higher for blacks — 340 per 1,000 vs. 217 for whites.

Medical professionals describe the effects of racism across specialties and illnesses. Tina Douroudian, an optometrist in Sterling, Va., has observed differences in the severity of her patients with diabetes, as well as their management plans.

“Black folks have higher rates of diabetes and often worse outcomes. It’s universally understood that nutrition counseling is the key factor for proper control, and this goes beyond telling patients to lose weight and cut carbs,” Douroudian says.

“I ask all of my diabetic patients if they have ever seen a registered dietitian,” she says. “The answer is an overwhelming ‘yes’ from my white patients, and an overwhelming ‘no’ from my black patients. Is there any wonder why they struggle more with their blood sugar, or why some studies cite a fourfold greater risk of visual loss from diabetes complications in black people?”

Douroudian’s patients who have never met with a dietitian in most cases have also never even heard of a dietitian, she says, and she is unsure why they don’t have this information.

Her remedy is teaching her patients how to advocate for themselves:

“I tell my diabetic patients to demand a referral from their [primary care physician] or endocrinologist. If for some reason that doctor declines, I tell them to ask to see where they documented in their medical record that the patient is struggling to control their blood sugar and the doctor is declining to provide the referral. Hint: You’ll get your referral real fast.”

Black women are facing a childbirth mortality crisis. Doulas are trying to help.

Jameta Barlow, a community health psychologist at George Washington University, says that the infant mortality rate is a reflection of how black women and their pain are ignored. Brushing aside pain can mean ignoring important warning signs.

“Centering black women and their full humanity in their medical encounters should be a clinical imperative,” she says. “Instead, their humanity is often erased and replaced with stereotypes and institutionalized practices masked as medical procedure.”

Black women are more than three times as likely as white women to die of childbirth-related causes, according to the Centers for Disease Control and Prevention, (40.8 per 100,000 births vs. 12.7). Experts blame the high rate on untreated chronic conditions and lack of good health care. The CDC says that early and regular prenatal care can help prevent complications and death.

Barlow says that the high mortality rate, and many other poor health outcomes, are a result of a “failure to understand the institutionalization of racism in medicine with respect to how the medical field views patients, their needs, wants and pain thresholds. The foundation of medicine is severely cracked and it will never adequately serve black people, especially black women, until we begin to decolonize approaches and ways of doing medicine.”

Barlow’s research centers on black women’s health, and her own great-grandmother died while giving birth to her grandmother in 1924. “In the past, black women were being blamed for the maternal mortality rate, without considering the impact of living conditions due to poverty and slavery then,” she says. “The same can be said of black women today.”

Natalie DiCenzo, an OB/GYN who is set to begin her practice in New Jersey this fall, says she hopes to find ways to close the infant mortality gap. Awareness of racism is necessary for change, she says.

“I realize that fighting for health equity is often in opposition to what is valued in medicine,” she says. “As a white physician treating black patients within a racist health-care system, where only 5 percent of physicians identify as black, I recognize that I have benefited from white privilege, and I now benefit from the power inherent to the white coat. It is my responsibility to do the continuous work of dismantling both, and to check myself daily.

“That work begins with being an outspoken advocate for black patients and reproductive justice,” she says. “This means listening to black patients and centering their lived experiences — holding my patients’ expertise over their own bodies in equal or higher power to my expertise as a physician — and letting that guide my decisions and actions. This means recognizing and highlighting the strength and resilience of black birthing parents.”

DiCenzo blames the racist history of the United States for the disparities in health care. “I’m not surprised that the states with the strictest abortion laws also have the worst pregnancy-related mortality. For black LGBTQIA+ patients, all of these disparities are amplified by additional discrimination. Black, American Indian and Alaska Native women are at least two to four times more likely to die of pregnancy-related causes than white women, regardless of level of education and income,” she says.

As for covid-19, although black people are dying at a rate of 92.3 per 100,000, patients admitted to the hospital were most likely to be white, and they die at a rate of 45.2 per 100,000.

The CDC says that racial discrimination puts blacks at risk for a number of reasons, including historic practices such as redlining that segregate them in densely populated areas, where they often must travel to get food or visit a doctor.

“For many people in racial and ethnic minority groups, living conditions may contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 or to seek treatment if they do get sick,” the CDC says.

The CDC is urging health-care providers to follow a standard protocol with all patients, and to “[i]dentify and address implicit bias that could hinder patient-provider interactions and communication.”

In her 16 years in medicine, internist Jen Tang has provided care for mid- to upper-class Princeton residents as well as residents of inner city Trenton, N.J. She has seen privatization of medicine adversely affect people of color who may be insured by government-run programs that medical organizations refuse to accept. Some doctors complain that the fees they are paid are too low.

And that can make referrals to specialists difficult.

“Often my hands are tied,” says Tang, who now works part time at a federally qualified health center in California. “I try to give my patients the same level of care that I gave my patients in Princeton, but a lot of my patients have the free Los Angeles County insurance, so to get your patient to see a specialist is difficult. You have to work harder as a clinician, and it takes extremely long.”

Tang has also encountered what medical experts say is another effect of long-term racism: skepticism about the health-care system.

“Some patients don’t trust doctors because they haven’t had access to quality health care,” she says. “They are also extremely vulnerable.”

American history is rife with examples of how medicine has used people of color badly. In Puerto Rico, women were sterilized in the name of population control. From the 1930s to the 1970s, one-third of Puerto Rican mothers of childbearing age were sterilized.

As a result of the Family Planning Services and Population Research Act of 1970, close to 25 percent of Native American women were also sterilized. California, Virginia and North Carolina performed the most sterilizations.

The Tuskegee experiments from 1932 to 1972, which were government-sanctioned, also ruined the lives of many black families. Men recruited for the syphilis study were not given informed consent, and they were not given adequate treatment, despite the study leading to the discovery that penicillin was effective.

Though modern discrimination isn’t as apparent, it is still insidious, Barlow says, citing myths that lead to inadequate treatment, such as one that black people don’t feel pain.

“We must decolonize science,” Barlow says, by which she means examining practices that developed out of bias but are accepted because they have always been done that way. “For example, race is a social construct and not clinically useful in knowing a patient, understanding a patient’s disease, or creating a treatment plan,” she says, but it still informs patient treatment.

She calls upon fellow researchers to question research, data collection, methodologies and interpretations.

Like Douroudian, she recommends self-advocacy for patients. This can mean asking as many questions as needed to get clarification, and if feasible, getting a second opinion. Bring a friend along to the doctor, and record conversations with your doctor for later reflection.

“I tell every woman this when doctors recommend a drug or procedure that you have reservations about: ‘Is this drug or procedure medically necessary?’ If they answer yes, then have them put it in your medical chart,” Barlow says. “If they say it is not necessary to do that, then be sure to get another doctor’s opinion on the recommendation. Black women have always had to look out for themselves, even in the most vulnerable medical situations such as giving birth.”

Medicine’s relationship with black people has advanced beyond keeping slaves healthy enough to perform their tasks. Barlow says, however, that more work needs to be done to regain trust, and uproot the bias that runs over 400 years deep.

“This medical industrial complex will only improve,” she says, “when it is dismantled and reimagined.”

Can’t Focus on Abortion Access if My People Are Dying’

Some Gen Z and millennial women said they viewed abortion rights as important but less urgent than other social justice causes. Others said racial disparities in reproductive health must be a focus.

Emma Goldman|| The New York Times

Like many young Americans, Brea Baker experienced her first moment of political outrage after the killing of a Black man. She was 18 when Trayvon Martin was shot. When she saw his photo on the news, she thought of her younger brother, and the boundary between her politics and her sense of survival collapsed.

In college she volunteered for the N.A.A.C.P. and as a national organizer for the Women’s March. But when conversations among campus activists turned to abortion access, she didn’t feel the same sense of personal rage.

“A lot of the language I heard was about protecting Roe v. Wade,” Ms. Baker, 26, said. “It felt grounded in the ’70s feminist movement. And it felt like, I can’t focus on abortion access if my people are dying. The narrative around abortion access wasn’t made for people from the hood.”

Ms. Baker has attended protests against police brutality in Atlanta in recent weeks, but the looming Supreme Court decision on reproductive health, June Medical Services v. Russo, felt more distant. As she learned more about the case and other legal threats to abortion access, she wished that advocates would talk about the issue in a way that felt urgent to members of Generation Z and young millennials like her.

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“It’s not that young people don’t care about abortion, it’s that they don’t think it applies to them,” she said. Language about “protecting Roe” feels “antiquated,” she added. “If I’m a high school student who got activated by March for Our Lives, I’m not hip to Supreme Court cases that happened before my time.”

Her question, as she kept her eyes on the court, was: “How can we reframe it so it feels like a young woman’s fight?”

On Monday the Supreme Court ruled on the case, striking down a Louisiana law that required abortion clinics to have admitting privileges at local hospitals, four years after deciding that an effectively identical Texas requirement was unconstitutional because it placed an “undue burden” on safe abortion access. The Guttmacher Institute had estimated that 15 states could potentially put similarly restrictive laws on the books if the Supreme Court upheld the Louisiana law.

The leaders of reproductive rights organizations celebrated their victory with caution. At least 16 cases that would restrict access to legal abortion remain in lower courts, and 25 abortion bans have been enacted in more than a dozen states in the last year.

“The fight is far from over,” said Alexis McGill Johnson, the president of Planned Parenthood. “Our vigilance continues, knowing the makeup of the court as well as the federal judiciary is not in our favor.

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Interviews with more than a dozen young women who have taken to the streets for racial justice in recent weeks, though, reflected some ambivalence about their role in the movement for reproductive rights.

These young women recognized that while some American women can now gain easy access to abortion, millions more cannot; at least five states have only one abortion clinic.

But some, raised in a post-Roe world, do not feel the same urgency toward abortion as they do for other social justice causes; others want to ensure that the fight is broadly defined, with an emphasis on racial disparities in reproductive health.

Members of Gen Z and millennials are more progressive than older generations; they’ve also been politically active, whether organizing a global climate strike or mass marches against gun violence in schools.

While Gen Z women ranked abortion as very important to them in a 2019 survey from Ignite, a nonpartisan group focused on young women’s political education, mass shootings, climate change, education and racial inequality all edged it out. On the right, meanwhile, researchers say that opposition to abortion has become more central to young people’s political beliefs.

Melissa Deckman, a professor of political science at Washington College who studies young women’s political beliefs, said that Gen Z women predominantly believe in reproductive freedom but that some believe it is less pressing because they see it as a “given,” having grown up in a world of legalized abortion.

“Myself and other activists in my community are focused on issues that feel like immediate life or death, like the environment,” said Kaitlin Ahern, 19, who was raised in Scranton, Pa., in a community where air quality was low because of proximity to a landfill. “It’s easier to disassociate from abortion rights.”

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Fatimata Cham, 19, an ambassador for the anti-gun violence advocacy group Youth Over Guns, agreed that the fight for reproductive rights felt less personal. “For many activists, we have a calling, a realm of work we want to pursue because of our own personal experiences,” Ms. Cham said. “Growing up, abortion never came to mind as an issue I needed to work on.”

Some young women said that they considered reproductive rights an important factor in determining how they vote, but they struggled to see how their activism on the issue could have an effect.

When Ms. Baker helped coordinate local walkouts against gun violence, she sensed that young people no longer needed to wait for “permission” to demand change. With abortion advocacy, she said, organizers seem focused on waiting for decisions from the highest courts.

And even as those decisions move through the courts, the possibility of a future without legal abortion can feel implausible. “I know we have a lot to lose, but it’s hard to imagine us going backward,” said Alliyah Logan, 18, a recent high school graduate from the Bronx. “Is it possible to go that far back?”

Then she added: “Of course in this administration, anything is possible.”

For many women in the 1970s and ’80s, fighting for legal abortion was an essential aspect of being a feminist activist. A 1989 march for reproductive rights drew crowds larger than most protests since the Vietnam War, with more than half a million women rallying in Washington, D.C.

Today, young women who define themselves as progressive and politically active do not always consider the issue central to their identities, said Johanna Schoen, a professor of history at Rutgers and the author of “Abortion After Roe.”

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“Women in the ’70s understood very clearly that having control over reproduction is central to women’s ability to determine their own futures, to get the education they want, to have careers,” Dr. Schoen said. “As people got used to having access to abortion — and there’s a false sense that we’ve achieved a measure of equality — that radicalism women had in the early years got lost.”

Some millennial women who can easily and safely get abortions do not connect the experience to their political activism. Cynthia Gutierrez, 30, a community organizer in California, got a medication abortion in 2013. Because she did not struggle with medical access or insurance, the experience did not immediately propel her toward advocacy.

“I had no idea about the political landscape around it,” she said. “I had no idea that other people had challenges with access or finding a clinic or being able to afford an abortion.”

Around that time, Ms. Gutierrez began working at a criminal justice reform organization. “I wasn’t thinking, let me go to the next pro-choice rally,” she said. “The racial justice and criminal justice work I did felt more relevant because I had people in my life who had gone through the prison industrial complex, and I experienced discrimination.”

Other young women said they felt less drawn to reproductive rights messaging that is focused strictly on legal abortion access, and more drawn to messaging about racial and socioeconomic disparities in access to abortion, widely referred to as reproductive justice.

Deja Foxx, 20, a college student from Tucson, Ariz., became involved in reproductive justice advocacy when she confronted former Senator Jeff Flake, Republican of Arizona, at a town hall event over his push to defund Planned Parenthood.

But abortion access is not what initially drew her to the movement. She wanted to fight for coverage of contraceptives, as someone who was then homeless and uninsured, and for comprehensive sex education, since her high school’s curriculum did not mention the word consent.

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“There’s a need to protect the wins of the generation before us,” Ms. Foxx said. But she believes the conversations that engage members of her generation look different. “My story is about birth control access as a young person who didn’t have access to insurance,” she said.

The generational shift is evident at national gatherings for abortion providers. Ms. Schoen has attended the National Abortion Federation’s annual conference each year from 2003 to 2019. In recent years, she said, its attendees have grown more racially diverse and the agenda has shifted, from calls to keep abortion “safe, legal and rare” to an emphasis on racial equity in abortion access.

“The political questions and demands that the younger generation raises are very different,” she said. “There’s more of a focus on health inequalities and lack of access that Black and brown women have to abortion.”

Amid the coronavirus outbreak, even the most fundamental legal access to abortion seemed in question in some states. At least nine states took steps to temporarily ban abortions, deeming them elective or not medically necessary, although all the bans were challenged in court.

Research from the Kaiser Family Foundation found that the pandemic led to various new legal and logistical hurdles. In South Dakota, abortion providers have been unable to travel to their clinics from out of state. In Arkansas, women could receive abortions only with a negative Covid-19 swab within 72 hours of the procedure, and some have struggled to get tested.

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Alliyah Logan, a recent high school graduate, near her home in the Bronx. “I know we have a lot to lose, but it’s hard to imagine us going backward,” she said.Credit…Hiroko Masuike/The New York Times

But in spite of the threats, for some young women the calls to action feel sharpest when they go beyond defending rights they were raised with.

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“Right now, in a lot of social justice movements we’re seeing language about the future,” said Molly Brodsky, 25. “I hear ‘protect Roe v. Wade,’ and it feels like there needs to be another clause about the future we’re going to build. What other changes do we need? We can’t be complacent with past wins.”

Southern Charm

That is another anomaly along with the concept of hospitality as frankly living and traveling through the South I saw immense segregation along lines of class, color and religion.  I could not believe how bad it was as it was all masked under this false premise of hospitality which beneath the surface was a raging hate and much of self loathing.

When there are so many rungs on the ladder you assume that once you get to the top of it you are where you need to be and you climb onto the surface of said place and then let others climb aboard or some may stay and build a platform there as the view and stability is just fine but this is not the American Way/Dream/Myth.  We have a roof line and the ladder can take only so many before it can no longer serve and the roof is only so big before it collapses so we better make sure only so many can secure themselves on the top and that number seems to hover around 1% and that is good enough so pull up the ladder and let those who fall fall and they will hit the ground but its not that high right?

Well no it is getting higher as once the roof held millionaires and they became billionaires and in turn they needed a new roof so they cast a new ladder and the ones that were just holding on made sure there was no fucking way anyone was going to cast them off and so it became the new Roman Holiday, the Gladiator kind.  No scooting through the streets with a gorgeous gal along for the ride and meeting all kinds of interesting people to share a glass of wine and a bowl of pasta, no they were like the Jets, who said “stick with your own kind” and that anyone who threatened the gang they would be iced/shivved or shoved off the roof.  Clearly I have been watching way too many old movies, from the classic beauty and original rom coms of the day to the Hitchcock suspense and of course musicals that despite the melody and dance often told of underlying dark themes, Oklahoma anyone? Well they are superior to the ramblings of the crazy dopey Grandpa and his grim little Igor who threatens death around every corner.  Balance in that house is slim to non-existent, Simone Biles could not traverse it with grace.

There is no balance and it is why we all turn to Cuomo who is realizing that some type of rollout is necessary for many reasons, most of veiled in the idea of stir crazy. Yes every corner in lower Manhattan has Police stationed on it.  When I went for my walk and went into Soho and Tribeca I saw none.  I did find parks opened and people in them distancing appropriately and even a bakery open but not much else. Yes I saw the luxury retail houses boarded up anticipating the riots that have yet to occur but note I said yet.   The one thing I did not see which I do see here in Jersey City is the endless looks of suspicion and avoidance as if just looking at you would mean contagion.   They are really afraid here and that is because most of the people are Millennials who are in over their heads in every way with this crisis.   People were out doing whatever they were doing and guess what it is NONE.OF.MY.BUSINESS as long as we keep apart and have no issue that puts either at risk, the whole personal responsibility thing that millennials seem to have problems with and are the loudest SHUT IT DOWN STAY HOME crowd next to old people who well are rightfully scared and then again they all are as Fox News is a perpetual horror house.

I have never liked Millennials and frankly this only continues to validate my feelings about them and I will never give them the respect or acknowledgement they think they deserve after this as they are like wind, it passes over and some blow over and some breeze by and I just keep walking regardless, I just do up my coat more.  That generation has finally given me a free pass from being civil and polite….. to them.

But as I sit here in my home overlooking the harbor and it pours rain I think that it is truly the weather that has stopped any organization or unrest but if the weather gets warmer and the social isolation continues there will be problems. I see it here in my building with complaints about shoes in the hallway, garbage tossed indiscriminately, scooters and children playing in the halls and this is why you don’t close parks as you have a type of a prison and that is not a good thing.

And as the South rises, again, the reality is that many of the GOP Governors refused to acknowledge that this virus was serious and they took their cues from the CDG and have vacillated on restrictions and orders to reduce the spread.  They don’t like angry IGOR either and frankly Dr. Bix is a scold but she just seems more sane and rational, maybe it the scarves.  She is the one they should send to the South as they have the faux respect for Grammas and the like and that she is a Doctor would be fine as they love titles too.  I met a shitload of “Dr.”who earned them from non-secular schools with weak curriculum and even lower standards but they love having that honorarium.

With the virus came facts and truths that the religious right loath as that is science and no you cannot pray it away and so resistance is futile when trying to be rational with the irrational. Poverty and racism is as it always was in the South and you cannot rebrand that truth. And most people live very much on the fringe are at risk and the status quo prefers it that way as it is a much better way to segregate and isolate with money than with whips and chains.

‘A perfect storm’: poverty and race add to Covid-19 toll in US deep south

Whole families are falling victim as African Americans are hit disproportionately hard by the coronavirus pandemic

Oliver Laughland
Guardian
Sun 12 Apr 2020

Last weekend, at two churches in New Orleans, two pastors read from separate passages of the Bible as they buried four members of the same family. Each had died within days of each other after contracting the novel coronavirus.

At St James Methodist church, a single-storey red-brick in the city’s seventh ward, the Rev Joseph Tilly recited Luke chapter 15 as he mourned Timothy Franklin, 61, and his brothers Anthony, 58, and Herman, 71. “The three prodigal sons,” he told the small, congregation of grieving relatives sitting at a distance from each other, “have gone back to their heavenly father.”

Tilly had taught “the boys” since they were children at Sunday school. “I prayed before the service and God gave me strength,” he said.

The next day, at Ebenezer Baptist, pastor Jermaine Landrum read from Job, chapter 1 as he remembered the brothers’ mother, 86-year-old Antoinette Franklin, a lifelong worshipper at the church who, just a few weeks earlier, had embraced Landrum and thanked him for another Sunday service.

“It was devastating,” said the pastor, reflecting on the counsel he gave to Franklin’s surviving nine children. “Can you imagine losing a mother and three brothers in a matter of days? It’s a tragedy for our community.”
‘A racially disproportionate rate of death has hit America’s poorest region’

Across the city of New Orleans and throughout the state of Louisiana, in America’s deep south, similar scenes of mourning have played out among hundreds of African American families. Louisiana is among the states hardest-hit by Covid-19, with 755 deaths marking one of the highest per-capita death rates in the country. Seventy per cent of those who have died here are black, despite African Americans making up only 32% of the state population.

This racially disproportionate rate of death has begun to emerge among other states in the deep south, America’s poorest region, where a nexus of intergenerational poverty, a greater prevalence of underlying health conditions, and less access to healthcare are certain to have more pronounced consequences for the black community as the virus proliferates.

“The south has the perfect storm of characteristics to just be a tragic region in terms of the Covid outbreak,” said Thomas LaVeist, dean of public health and tropical medicine at Tulane University.
People walk to a Palm Sunday service at Life Tabernacle church in Baton Rouge, Louisiana, despite statewide stay-at-home orders due to the coronavirus pandemic.

LaVeist pointed to higher rates of diabetes, hypertension and heart disease – mostly tied to poverty – among black residents of Louisiana and other former Jim Crow states including Alabama, Mississippi, Georgia and South Carolina that make up the deep south. All conditions are suspected of elevating risk of death from Covid-19.

“African Americans not only have higher prevalence of these chronic conditions, but they also, on average, acquire these conditions at younger ages. So when we talk about people over the age of 65 being at increased risk, for African Americans, that age is probably 55, maybe even 50.”

Although the majority of deaths in Louisiana are still those over the age of 70, 31% are aged between 50 and 69, a proportion that is slightly higher than in New York City, the center of America’s Covid-19 outbreak.

The “perfect storm” LaVeist refers to, brews over a region that has almost unanimously – bar Louisiana – declined to expand Medicaid benefits offered by Barack Obama’s signature healthcare legislation, the Affordable Care Act, which would enable millions of low-income southerners access to health insurance.

In Alabama, which has seen one of the highest rates of rural hospital closures in America, and where 75% of rural hospitals operate at a financial deficit – partially due to this Republican state’s decision not to expand benefits – healthcare advocates warned the pandemic could lead to a number of hospitals closing at the height of an outbreak due to the financial pressures associated with treating uninsured people.

But, warned Michael Saag, professor of infectious diseases at the University of Alabama at Birmingham, the lack of benefits expansion here could also stop people from seeking treatment for Covid-19 until it is too late.

“A lot of people who live in poverty wait with an illness until they absolutely have to be seen, so they come in with much more severe symptoms of whatever they’re dealing with.

“It means the people who pick it up are going to typically be late to present [for treatment] and more likely to be hospitalized and therefore potentially more likely to have advanced disease and maybe need intensive care units.”

Alabama has begun to see a surge in cases in recent days with 80 people now dying from the virus – 36% of deaths were African Americans who make up only 26% of the state’s population.

‘Southern states slow to react, preferring to keep economies open’

Adding another layer to a deepening crisis in the south, is the inaction that characterized many state governors’ response to the pandemic just weeks ago, with a number attempting to keep their economies open for as long as possible.

In Georgia, the Republican governor, Brian Kemp, a close ally of Donald Trump, waited until last Thursday to issue a stay-at-home order, far behind his Democratic counterparts in other jurisdictions.

Georgia has released only partial data on the racial breakdown of its Covid-19 deaths, which have surged to 425.

The story is the same in Mississippi, where the Republican governor, Tate Reeves, issued a stay-at-home order just a day before Kemp. Two weeks earlier, as he continued to resist calls to sign the order and as neighbouring Louisiana and its Democratic governor, John Bel Edwards, declared a state or emergency – Reeves had written an op-ed in the local press, advocating the power of prayer to combat the virus and advising Mississippians not to panic.

Eighty-two people have died from Covid-19 in the state. The Mississippi department of health has declined to break the numbers down by race.

On the eve of the Easter weekend, with churches across this deeply Christian region mostly closed, the civil rights and moral revival campaigner the Rev William Barber preached a sermon online.

“Take a candle and light it in remembrance of those who have died and are dying unnecessarily,” said Barber, who has focused much of his campaigning in poor communities throughout the south. “Dying because of human negligence. Not what God has done, but, instead, what we haven’t done. Their deaths will not be in vain. Their suffering, not without a witness.”

Trumpcare, could it get worse?

I am not writing anything new here as we know that Obamacare has been allowed to quietly collapse. The mandate ends this year and then what?  I used to buy reasonable care for about 400/month and it included prescriptions vision and dental. It was a minimal care plan with a 5K deductible but I rarely used it and it was intended for catastrophic care but not one of those cheap horrific inadequate ones that are now being peddled that actually cover nothing so why they exist is beyond me.  I used one when I moved to meet the obligation of the law and I have not heard if I will be required to pay a penalty as a result. 

This year I signed up for the full monty at 700/month and 5K deductible. I would be better off with an HSA and putting that money in the savings and if I end up needing it using it and defaulting on the rest if I end up with serious costs.  Welcome to America, land of medical bankruptcy.  I am not sure what the current stats are with regards to those cases with the rise of Obamacare but I suspect it still exists it is just not reported with as much frequency as it once was.

The case studies below show the contrast of those who qualify for subsidies and those who do not and the resentment that results. Note the change of opinion when suddenly one of them qualifies for employee covered medical insurance which goes to show the old adage: I got mine so fuck you.  Okay that might be not necessarily true but close enough.

I am done paying this shit. With the end of the mandate I am finding the cheapest below that is like the one I used to have or what we call bronze.  I am done with the bullshit and the games.  I will be 62 in four years and will be signing up for Social Security and why I cannot get Medicare at that age is beyond me but that way it will allow me to sign up for at least Medicaid and as I will be out of the red and into the blue, as in State, I will have no problem qualifying.  I can still Sub and live in real city or in close proximity and that will undoubtedly improve my quality of life in many ways.  And that matters.  Again we have a fucktard in the White House a Congress full of idiots and we sit idly by complaining.  Gee once those kids are done with gun control maybe health care for all could be their next quest. 

As Some Got Free Health Care, Gwen Got Squeezed: An Obamacare Dilemma

By ABBY GOODNOUGH
THE NEW YORK TIMES
FEB. 19, 2018

MERRIMACK, N.H. — Gwen Hurd got the letter just before her shift at the outlet mall. Her health insurance company informed her that coverage for her family of three, purchased through the Affordable Care Act marketplace, would cost almost 60 percent more this year — $1,200 a month.

She and her husband, a contractor, found a less expensive plan, but at $928 a month, it meant giving up date nights and saving for their future. Worse, the new policy required them to spend more than $6,000 per person before it covered much of anything.

“It seems to me that people who earn nothing and contribute nothing get everything for free,” said Ms. Hurd, 30. “And the people who work hard and struggle for every penny barely end up surviving.”

A few miles away in another wooded suburb, Emilia DiCola, 28, an aspiring opera singer who scrapes by with gigs at churches and in local theaters, has no such complaints. She qualifies for Medicaid — free government health insurance that millions more low-income Americans have gained through an expansion of the program under the Affordable Care Act.

“I am very lucky to have the coverage I have,” said Ms. DiCola, who lives with her parents along the Merrimack River in Litchfield.

President Trump’s attempts to undermine the health law have exacerbated a tension at the heart of it — while it aims to provide health coverage for all, the law is far more generous to the poor and near poor than the middle class. By taking steps that hurt the individual insurance market, Mr. Trump has widened the gulf between people who pay full price for their coverage and those who get generous subsidies or free Medicaid. That, in turn, has deepened the resentment that has long simmered among many who do not qualify for government assistance toward those who do.

Such attitudes have helped shift white working-class voters to the right and were integral in the election of President Trump. They underlie the sharp cuts to social welfare programs in the budget proposal he released this week. They help explain why the national debate over health insurance has been so bitter, and why the only government programs with broad support are those that everyone benefits from, Social Security and Medicare.

They are also likely helping fuel the renewed Democratic push for a single-payer system, or at least one that provides broader access to government health insurance.

“Democrats have begun to recognize the political costs of playing into the narrative that they only care about the poor,” said Joan C. Williams, a professor at the University of California Hastings College of Law and author of a recent book, “White Working Class: Overcoming Class Cluelessness in America.”

Many Republican states plan to start requiring many Medicaid recipients to work, volunteer or take job-training classes. Along the same theme, Mr. Trump’s new budget proposal would make it harder for the so-called “able-bodied” poor who don’t work to receive food stamps and public housing.

Such proposals reflect a “very American” view — that only those who are severely disabled or struck by tragedy deserve government assistance, and that anyone else who gets it is shirking, said Mark Rank, a professor of social work at Washington University in St. Louis.

“Our social safety net is, in general, the weakest of any of the Western industrialized countries because we have these kinds of views,” Mr. Rank said.

Different Paths

The Affordable Care Act was supposed to help, and did, but not for those who earn too much to get financial assistance but are still on a tight budget. About 25,000 New Hampshire residents paid full freight for Obamacare plans last year, according to a legislative report, and their premiums increased by an average 52 percent this year. This group earns more than four times the poverty level — for a family of three, like the Hurds, that’s about $82,000 a year.

Another 29,000 were getting subsidized coverage through the Affordable Care Act marketplace, and many of them have seen their out-of-pocket costs drop this year. That is because when Mr. Trump forced premiums higher by cutting off a type of payment to insurers last fall that the law had guaranteed them, subsidies rose, too. About 53,000 are getting free Medicaid coverage through the health law’s optional expansion of the program.

Ms. Hurd remembers watching a documentary about people signing up for Obamacare coverage last year and bristling when someone who got a big subsidy gushed about the low price.

“I was like, ‘It’s not expensive for you because everybody else is paying for it,’” she said.

She also has problems with the Medicaid “expansion population,” made up of working-age adults who have no disability — particularly those who aren’t working as hard as she and her husband are. Cut off from the help Obamacare provided to everyone under a certain income level, as well as the contributions that employers make toward their employees’ health coverage, she was caught in what she saw as an unduly penalized subset.

“I’m totally happy to pay my fair share,” she said, “but I’m also paying someone else’s share, and that’s what makes me insane.”

Ms. Hurd finished college at the University of Massachusetts, with her parents paying for it, and has a master’s degree in communications, which she got tuition-free while working in admissions at Southern New Hampshire University. She’s been working about 30 hours a week at the outlet mall and a small remodeling firm while looking for a job with good benefits in communications or marketing.

Her husband, Matt, started his contracting business a few years ago and is finishing his undergraduate degree with the help of a loan. They bought a 1750s farmhouse just before they married; Ms. Hurd returned to work when their son, Harry, was eight weeks old.

Though roughly the same age, Ms. DiCola has followed a different course. She dropped out of the Manhattan School of Music in 2009 after her freshman year because she couldn’t keep up with the tuition. Now, to supplement the scant income she gets from singing gigs, she drives for Uber and Lyft a few nights a week, sometimes more, in Boston. She earned about $15,000 last year, making sure she stayed under the threshold to qualify for Medicaid.

“I feel like it’s no different from what corporations do all the time, taking advantage of tax breaks and that sort of thing,” Ms. DiCola, a soprano who talks animatedly about Verdi and Puccini, said of being on Medicaid. “Frankly, if they’re allowed to do it, why shouldn’t I?”

Medical care has been easy to access on Medicaid. She got physical therapy for an old injury, and when she needed to have an IUD surgically removed last year, she went to Dartmouth-Hitchcock Medical Center in Hanover, the state’s most prestigious hospital. She paid for none of it. She spends most of her income on paying off her car, a used 2012 Prius with 160,000 miles on it, and her last outstanding student loan.

“The coverage is actually really good,” she said. “I’m just kind of finding my way, so the health insurance is so helpful.”

For Ms. Hurd, health care has been something to avoid since she and her husband got the marketplace plan shortly after Harry’s birth last year. (Before that, she had a job with benefits but quit because of her difficult pregnancy.) She went to an urgent care clinic for a throat culture last fall because unlike at her primary care practice, she could find out the cost, $150, upfront. And when Harry was up all night sobbing with a fever recently, she hesitated briefly before seeking medical help, again at urgent care.

“That’s ugly,” she said. “I hate that I, even for a moment, considered waiting it out to save money.”
Constantly Close to the Edge

News stories in New Hampshire have stoked the resentment Ms. Hurd and others facing spiking premiums have felt. “Medicaid platinum, silver for the rest,” read a recent headline in The Union Leader, New Hampshire’s largest newspaper. The story was about a report that found Medicaid recipients used health care more aggressively than marketplace customers, presumably because their coverage was free.

Instead of giving its new Medicaid recipients traditional coverage through the program, New Hampshire uses Medicaid funds to buy them private plans through the Obamacare marketplace. The report, by an independent actuarial firm, found that average medical costs for the state’s expansion population were 26 percent higher than for the marketplace’s other customers in 2016.

The firm found this raised average claim costs — a proxy for premiums — for everyone by 14 percent.

One of the conditions that Gov. Chris Sununu has attached to continuing expanded Medicaid here is that most adult recipients without a disability or small children will have to work, volunteer or get job training, at least 20 hours a week. New Hampshire is among eight Republican-controlled states asking the Trump administration for approval to impose work requirements; two others, Kentucky and Indiana, already got permission last month.

Ms. Hurd — who says she thinks “work is everything, honestly” — is elated about the possibility.

“If there were actual repercussions aside from your personal self-worth — like ‘Hey, you may not be able to get the pills you need’ — people might be more inclined to work,” she said.

But research has found that most Medicaid recipients without disabilities, like Ms. DiCola, already work at least part-time.

“I know I live with my parents, but I’m not going on fancy trips or anything like that — I feel guilty when I buy a new lipstick,” she said. She worried when she had the flu in December and lost four days of income, she said, adding, “I’d like not to feel like I’m constantly so close to the edge.”

Ms. DiCola started driving for Uber and Lyft three years ago, after stints at a Panera and a train station cafe. She often shuttles customers around Boston until after midnight, making up to $25 an hour — enough to pay two or three times more than the $87.50 she owes on her student loan each month, plus buy gas. Her days include pitching in on cooking and other household duties, auditions, rehearsals and studying musical scores on her couch, a cat or two by her side. She hopes to get a college degree, find a more stable career and get access to employer health coverage. But for now, with a free place to live and with Medicaid, she said, “I’m able to throw all my money at paying off my debt.”

Anxiety and Peace of Mind

Ms. Hurd is a former Republican who volunteered for Mitt Romney’s campaign in 2012 and voted for Carly Fiorina in the 2016 primary, but now describes her politics as more libertarian. She’s pro-immigration, not least because she sees immigrants as having strong work ethics. She voted for Hillary Clinton in the general election, she said, because she finds President Trump deeply offensive, a “guy who bullied his way into power.”

Her father, a Trump voter from the Boston suburbs, sends her articles that are critical of the health law, and they resonate with her.

Even members of her own family take advantage of a flawed system, in her view, by getting Medicaid. “They don’t work because they don’t want to, and they get free health insurance.” She said. “What the heck? If my husband and I, who grew up with relatively middle-class backgrounds in wealthy states, know people that mooch off the system in our immediate families, imagine what it’s like elsewhere.”

Ms. DiCola’s father, a solo-practice lawyer, is also a Trump supporter, but she is a liberal Democrat and uneasily aware of the anger and frustration that unsubsidized Obamacare customers are feeling — so much so that at first, she worried about sharing her story with The New York Times and “being dragged through the mud on some 24-hour news channel” for being on Medicaid.

She described her state’s plan to impose work requirements on Medicaid recipients as “poor-shaming.” Her friends show more empathy, she said. When she needed a root canal and crown last year and Medicaid would not have paid for it (dental care is one area that Medicaid does not cover comprehensively, or sometimes at all), she posted about it on Facebook and her friends jumped in to help.

Ms. DiCola doesn’t expect to need much health care this year — just a physical and a new pair of glasses, which Medicaid will cover, she said. Still, she added, “You never know what could come up — my appendix could decide to burst tomorrow.” In which case, Medicaid would cover the emergency room visit, surgery and hospital stay, a huge relief to Ms. DiCola, who became so anxious as Republicans in Congress tried to repeal the Affordable Care Act last summer that she felt physically ill.

Ms. Hurd has had no such peace of mind. A burst appendix would likely cost at least her individual deductible of $6,300.

By late January, Ms. Hurd had begun to believe that the only way for her family to have any access to health care was to drop their insurance and save the $928 a month to spend on care when they need it. Harry’s recent illness had rattled her, and Matt wanted to see a chiropractor for back pain that was threatening his ability to work.

“We can’t afford to both treat his back issues and pay for insurance,” she said one morning. She was crying, and it was time to go to work.

The following week, after months of searching, Ms. Hurd got offered a full-time job with benefits, running social-media marketing for a company that sells plant nutrition products. The Hurds plan on dropping their Obamacare policy in April, when her new coverage, with a $300 monthly premium, should kick in. The deductible — $3,000 per person, up to $6,000 for the family — will still be higher than she’d like, but she didn’t complain. Her indignation seemed to be softening.

“I understand that some people cannot afford health care and shouldn’t just be left to suffer,” she said. “But there has to be a better way than asking a very small amount of people to foot that bill.”

Call Email Write

The AARP are running television ads right now asking individuals in certain regions to call their respective Senators to vote NO on repealing Obamcare.  The Senate is working in secret to change the current laws regarding the Affordable Care Act and in turn modify that piece of shit Trumpcare that the House gave them.

If you do not know how to contact your Senators ask why you don’t and even if you don’t have a nutfuck or two like we have here in Tennessee nothing is stopping you from calling as a Citizen of the United States.  And if they will take your check why not your phone call?   Besides you can look up an address of a Public Storage and give that as your address as you may well be moving here soon. Why I have no idea unless you are truly desperate. 

I was asked by a Lyft driver the other day if Nashville was everything I expected.  I informed him I had none and that my primary reason was Medical/ so while that is pretty much as expected my only true horror was the public schools and what dumps they are.  But thankfully a book came out last year to confirm I wasn’t insane and I was right so now I am good with them and care even less so that is about all I can do at this point to comment on Nashville as that is all I know.   No one wants the truth but shit I actually don’t give a flying fuck about liking or not liking Nashville. I am in a coping strategy which means I work around how I feel every day living in a city of ill educated and informed idiots.

But there is one thing I do know that most of the people here are not covered by insurance and that the State is a hot mess of problems, which I think was intentional by the right wing nut fucks to sabotage the ACA and instead got a whole new set of problems called medical debt, unhealthy sick citizens that drain the system versus the swamp.  Whoops bad call there!

The ACA as flawed as it is works for those who don’t work in conventional gigs (aka semi retired or on contract)  or are self employed.  

If you don’t know who to call here are the current Senators who are not standing by the phone but their aides are.  Call, email, write, walk into their local office.  Just help someone other than yourself just once.  You might feel good. 

Flexibility That A.C.A. Lent to Work Force Is Threatened by G.O.P. Plan

By REED ABELSON
THE NEW YORK TIMES
JUNE 11, 2017

In recent years, millions of middle- and working-class Americans have moved from job to job, some staying with one company for shorter stints or shifting careers midstream.

The Affordable Care Act has enabled many of those workers to get transitional coverage that provides a bridge to the next phase of their lives — a stopgap to get health insurance if they leave a job, are laid off, start a business or retire early.

If the Republican replacement plan approved by the House becomes law, changing jobs or careers could become much more difficult.

Across the nation, Americans in their 50s and early 60s, still too young to qualify for Medicare, could be hit hard by soaring insurance costs, especially people now eligible for generous subsidies through the existing federal health care law.
Continue reading the main story

This news scares Fern Warnat, 59. She has gotten insurance on the federal marketplace a couple of times in the last few years. When she and her husband moved from New York to Boca Raton, Fla., she bought a policy for a few months to tide her over until she got coverage from a new job. A year later, she needed to buy insurance again when she found herself unemployed. The policy was expensive — around $800 a month.

“It wasn’t easy, but it was available,” she said.

Now she worries what would happen under the Republican plan if she left her job at a home health company that provides insurance.

“I need something to be there,” she said. “I’m going to be 60 years old. All my conditions pre-exist.”

Since the Affordable Care Act was enacted, companies have become less worried about people who want to leave but feel locked into their jobs because of health insurance, said Julie Stone, who works with corporations at Willis Towers Watson, a benefits consultant. The law “removed one of the barriers to leaving your job,” she said.

Fewer employers now offer health insurance for their retirees, she said. The other alternative is Cobra, the federal law that requires companies to allow workers to remain on their employer’s plan if they pay the full monthly premiums, which are often extremely expensive and out of reach for many people. The coverage generally lasts no more than a year and a half. Cobra was a “Band-Aid on a broken market,” Ms. Stone said.

The nonpartisan Congressional Budget Office estimated in an analysis last month that states covering one-sixth of the population would take waivers that allowed insurers to charge people with pre-existing conditions more. It predicted that such consumers “would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all.”

The budget office did note that the House bill would potentially lead to lower prices, especially for younger and healthier people. In most markets, the low premiums would “attract a sufficient number of relatively healthy people to stabilize the market.”

But the budget office also warned that markets in states that allowed insurers to charge higher premiums for people with pre-existing conditions — whether high blood pressure, a one-time visit to a specialist or cancer — could become unstable. Some places are already experiencing a dearth of insurers. More companies could exit as they struggled to make money in highly uncertain conditions.

Millions of people could also wind up with little choice but to buy cheap plans that provided minimal coverage in states that opted out of requiring insurers to cover maternity care, mental health and addiction treatment or rehabilitation services, among other services required under the Affordable Care Act. Consumers who could not afford high premiums would wind up with enormous out-of-pocket medical expenses.

The individual market has always been characterized by heavy churn, and insurers struggle to meet the needs of these short-timers, particularly the young and healthy, for whom coverage can be expensive. “It’s a huge challenge, even independent of the A.C.A.,” said John Graves, a health policy expert at Vanderbilt University.

Insurers say they have had a hard time accurately estimating the medical costs of the changing pool of customers who need relatively short-term coverage and pricing their plans high enough to cover those costs. Aetna, one of the large national insurers that has decided to leave the market, said about half of its customers were new, and it blamed “high churn” as one reason the company lost money.

Older people with potentially the most expensive conditions account for almost 30 percent of those who enrolled for insurance on the exchanges this year.

David Clark wanted to retire from his job at Sam’s Club at age 62, three years before he would qualify for Medicare. He and his wife, Phyllis, who now live in Delray Beach, Fla., were not in good health. He has a heart ailment, and she has diabetes. Before passage of the Affordable Care Act, he said, he would have had to keep working.

“We wouldn’t have been able to buy insurance at any price,” he said.

But he was able to retire and get coverage on one of the marketplaces. “This has been three of the greatest years of our life,” said Mr. Clark, who spends much of his time mentoring college students. When he needed triple bypass surgery at age 64, he was covered.

Many people are keenly aware that the existing marketplaces provide a safety net, even if it is far from ideal.

Dr. Marie Valleroy was able to stop working because she could afford to buy insurance on the federal exchange for four years until she was old enough to get Medicare. She has multiple sclerosis, and her symptoms were making it harder for her to see patients in Portland, Ore. “It was time for me to retire, truthfully,” she said. Her medications cost upward of $5,000 a month.

And the law made it possible for Bobby Evans, now 35, to move to New Orleans two years ago to be with his girlfriend, now his wife. Because he was working part time until he could find a permanent position, he bought a policy through the state marketplace.

He and his wife have talked about opening their own consulting firm, but the plan is being delayed, he said, depending on what happens with the federal law providing individual insurance. “Health care is a big-time barrier for a lot of people’s professional growth,” Mr. Evans said.

D Squared

This is the new Trumpcare plan – D Squared – Die Poor Die Already.   What we have now is  the rich have access and the poor can go fuck themselves. This article contributes to the ongoing battle over medical care and why costs have become untenable. It also demonstrates that the fucktards in Silicon Valley are utter assholes and their version of saving the world means themselves. Hence they want robots as that will eliminate any need for servers and others who clean their toilets and assess, so one less drain on America. I am unclear who will buy their shit once all the poors are dead but that is not my problem.

The Doctor Is In. Co-Pay? $40,000.

By NELSON D. SCHWARTZ
THE VELVET ROPE ECONOMY
THE NEW YORK TIMES
JUNE 3, 2017

SAN FRANCISCO — When John Battelle’s teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.

“They’re taking him to a local hospital,” Mr. Battelle’s wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. “No, they’re not,” Dr. Shlain instructed them. “You don’t want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.”

Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco’s top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.

For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.

“I feel badly that I have the means to jump the line,” he said. “But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?”

Increasingly, it is a question being asked in hospitals and doctor’s offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.

Money has always made a big difference in the medical world: fancier rooms at hospitals, better food and access to the latest treatments and technology. Concierge practices, where patients pay several thousand dollars a year so they can quickly reach their primary care doctor, with guaranteed same-day appointments, have been around for decades.

But these aren’t the concierge doctors you’ve heard about — and that’s intentional.

Dr. Shlain’s Private Medical group does not advertise and has virtually no presence on the web, and new patients come strictly by word of mouth. But with annual fees that range from $40,000 to $80,000 per family (more than 10 times what conventional concierge practices charge), the suite of services goes far beyond 24-hour access or a Nespresso machine in the waiting room.

Indeed, as many Americans struggle to pay for health care — or even, with the future of the Affordable Care Act in question on Capitol Hill, face a loss of coverage — this corner of what some doctors call the medical-industrial complex is booming: boutique doctors and high-end hospital wards.

“It’s more like a family office for medicine,” Dr. Shlain said, referring to how very wealthy families can hire a team of financial professionals to manage their fortunes and assure the transmission of wealth from generation to generation.

Only in this case, they are managing health, on behalf of clients more than equipped to pay out of pocket — those for whom, as Dr. Shlain put it, “this is cheaper than the annual gardener’s bill at your mansion.”

There are rewards for the physicians themselves, of course. A successful internist in New York or San Francisco might earn $200,000 to $300,000 per year, according to Dr. Shlain, but Private Medical pays $500,000 to $700,000 annually for the right practitioner.

For patients, a limit of no more than 50 families per doctor eliminates the rushed questions and assembly-line pace of even the best primary care practices. House calls are an option for busy patients, and doctors will meet clients at their workplace or the airport if they are pressed for time.

In the event of an uncommon diagnosis, Private Medical will locate the top specialists nationally, secure appointments with them immediately and accompany the patient on the visit, even if it is on the opposite coast.

Meanwhile, for virtually everyone else, the typical wait to see a doctor is getting longer.

Waiting Longer to See a Doctor

A survey released in March by Merritt Hawkins, a Dallas medical consulting and recruiting firm, found it takes 29 days on average to secure an appointment with a family care physician, up from 19.5 days in 2014. For some specialties, the delays are similarly long, with a 32-day wait to see a dermatologist, and a 21-day delay at the typical cardiologist’s office.

And some patients are willing to pay a lot to avoid that. MD Squared, an elite practice that charges couples up to $25,000 a year, opened a Silicon Valley office in 2013 and within months had a waiting list to join.

“You have no idea how much money there is here,” said Dr. Harlan Matles, who specializes in internal medicine and joined MD Squared after working at Stanford, where he treated 20 to 25 patients a day and barely had time to talk to them. “Doctors are poor here by comparison.”

Nowhere is the velvet rope in health care rising faster than here in Northern California, where newfound tech wealth, abundant medical talent and a plethora of health-conscious patients have created a medical system that has more in common with a luxury hotel than with the local clinic.

In fact, before founding Private Medical, Dr. Shlain, 50, worked as the on-call doctor at the Mandarin Oriental hotel here, an experience he said taught him about how to provide five-star service as well as good medical care.

Private Medical started 15 years ago with a single location in San Francisco, and has since opened practices in nearby Menlo Park, in 2011, and Los Angeles, in 2015. Dr. Shlain is now eyeing an expansion into New York, Seattle and Santa Monica, Calif.

The annual fee covers the cost of visits, all tests and procedures in the office, house calls and just about anything else other than hospitalization, as well as personalized annual health plans and detailed quarterly goals for each patient.

Although Private Medical provides its patients with doctors’ cellphone numbers and same-day appointments, like more conventional concierge practices do, Dr. Shlain does not like the term “concierge care.”

“When I’m at a country club or a party and people ask me what I do, I say I’m an asset manager,” Dr. Shlain explained. “When they ask what asset, I point to their body.”

“We organize health care for the entire family,” he said, sitting in his hip-but-not-too-fancy office in a nondescript building in upscale Presidio Heights. Dr. Shlain and his team will coordinate treatment for grandparents in a nursing home and care for their middle-aged children, as well as provide adolescent or pediatric medicine for the grandchildren.

For example, when a teenage patient with a history of depression or anxiety moves across the country to Boston for college, Private Medical will line up a top psychiatrist near the school beforehand so a local professional is on call in case there is a recurrence. Or if a middle-aged patient is found to have cancer, Dr. Shlain can secure an appointment in days, not weeks or months, with a specialist at MD Anderson Cancer Center in Houston or Memorial Sloan Kettering Cancer Center in New York.

“It’s not because we pay them,” he added. “It’s because we have relationships with doctors all over the country.”

‘We Can Get You In’

As with the ever more rarefied tiers of frequent-flier programs or V.I.P. floors at hotels, the appeal of MD Squared and Private Medical is about intangibles like time, access and personal attention.

“I am able to give the time and energy each patient deserves,” said Dr. Matles, the MD Squared physician in Menlo Park. “I wish I could have offered this to everyone in my old practice, but it just wasn’t feasible.”

So in addition to providing immediate access to specialists, concierge doctors also come in handy when otherwise wealthy, powerful people find themselves flummoxed by a health care system that is opaque to outsiders.

“If you need to go to Mass General, we can get you in,” Dr. Matles said. “We are connected. I don’t know if I can get you to the front of the line, but I can make it smoother. Doctors like to help other doctors.”

But for all their confidence about the advantages of their particular brand of concierge medicine, these physicians are quick to admit they struggle with the ethical issues of providing elite treatment for a wealthy few, even as tens of millions of American struggle to afford basic care.

Dr. Shlain founded a software start-up, HealthLoop, that aims to “democratize” his boutique approach by allowing patients to communicate directly with their doctors through daily digital checklists and texts.

He sees no reason that the medical world should not respond to consumer demand like any other player in the service economy. “Whenever I bump into a bleeding-heart liberal, which I am, I mention that schools, housing and food are all tiered systems,” he said. “But health care is an island of socialism in a system of tiered capitalism? Tell me how that works.”

Dr. Howard Maron, who founded MD Squared, is similarly candid about the new reality of ultra-elite medical care.

“In my old waiting room in Seattle, the C.E.O. of a company might be sitting next to a custodian from that company,” he recalled. “While I admired that egalitarian aspect of medicine, it started to appear somewhat odd. Why would people who have all their other affairs in order — legal, financial, even groundskeepers — settle for a 15-minute slot?”

It’s a fair question — but the new approach does not sit so well with veteran practitioners like Dr. Henry Jones III, one of Silicon Valley’s original concierge doctors at the Palo Alto Medical Foundation’s Encina Practice. He charges $370 a month, a fraction of what newer entrants in the area like MD Squared and Private Medical do. “It’s priced so the average person in this ZIP code can afford it,” he said.

A third-generation doctor from Boston, Dr. Jones offers a version of concierge medicine that is a way of providing more personalized service — the way doctors did when he graduated from medical school more than four decades ago — rather than delivering a different standard of care.

“Encina is like a Unesco World Heritage site — we practice medicine the way it has been traditionally practiced,” he said. “Just because you’re an Encina patient doesn’t mean you can go to the front of the line, unless you need to because of your case.”

Plusher Quarters

Not far from Dr. Jones’s office in Palo Alto, the new wing of Stanford’s hospital is taking shape. Designed by the star architect Rafael Viñoly, it will feature a rooftop garden and a glass-paneled atrium topped with a 65-foot dome. And unlike the old wing, all of the new building’s 368 rooms will be single occupancy, a crucial amenity for hospitals competing to attract elite patients from across the United States and overseas.

Stanford raised a significant portion of the project’s $2 billion cost by cultivating wealthy patients — a funding model used by university hospitals around the country, which is especially effective among the millionaires and billionaires of Silicon Valley.

Not to be outdone, Lenox Hill Hospital in New York recently hired a veteran of Louis Vuitton and Nordstrom, Joe Leggio, to create an atmosphere that would remind V.I.P. patients of visiting a luxury boutique or hotel, not a hospital. “This is something that patients asked for, and we want to go from three-star service to five-star service,” said Mr. Leggio, the hospital’s director of patient and customer experience.

In its maternity ward, the Park Avenue Suite costs $2,400 per night, twice what a deluxe suite at the Carlyle Hotel down the street commands, but that’s not a problem for well-heeled new parents. Beyoncé and Jay Z welcomed their baby, Blue Ivy, into the world at Lenox Hill, as did Chelsea Clinton and her husband, and Simon Cowell and his girlfriend.

With a separate sitting room for family members, a kitchenette and a full wardrobe closet, the suite overlooking Park Avenue is a world away from the semiprivate experience upstairs at the hospital, where families share an old-fashioned room divided by a curtain. Slightly less exalted but still private rooms in Lenox Hill’s maternity ward range from $630 to $1,700 per night.

As the stream of celebrity couples suggests, there is plenty of demand for these upscale options, crowding out traditional maternity wards. Lenox Hill is replacing some of its shared maternity rooms with private rooms, a far more profitable offering for hospitals since patients pay for them out of pocket, not through insurance plans that can bargain down rates.

Hospital executives argue that giving the well heeled extra attention is a way of keeping the lights on and providing care for ordinary middle- and even upper-middle-class patients, as reimbursements from private insurers and the federal government shrink. “I need to succeed to pay for the children we are bringing in from all over the world and treat for free,” said Dr. Angelo Acquista, a veteran pulmonologist who leads Lenox Hill’s executive health and international outreach programs.

Then there are the red blankets that some big Stanford benefactors receive when they check in as patients. For doctors and nurses, it is a quiet sign of these donors’ special status, which is also noted in their medical records.

“You don’t get better care,” Dr. Jones said. “But maybe the dean comes by, and if it’s done well, it’s done invisibly. It’s an acknowledgment of a contribution to the organization.”

Valuing Relationships

Rex Chiu, an internist with Private Medical in Menlo Park, spent more than a decade as a doctor on Stanford’s faculty. “I loved my time at Stanford, but I was spending less and less time with patients,” he said. “Fifteen or 20 minutes a year with each patient isn’t enough.”

“We all say we should get the same care, but I got sick and tired of waiting for that to happen,” he added. “I decided to go for quality, not quantity.”

Besides more money, the calmer pace of high-end concierge medicine is also a major selling point for physicians — Dr. Matles said he never made it to an event at his children’s school until he joined MD Squared. But for Dr. Sarah Greene, it wasn’t really the money or the lifestyle that led her to Private Medical.

“I really have time to think about my patients when they’re not in front of me,” said Dr. Greene, a pediatrician who joined the company’s Los Angeles practice in October. “I may spend a morning researching and emailing specialists for one patient. Before, I had to see 10 patients in a morning, and could never spend that kind of time on one case.”

Getting in the door as a new hire isn’t easy. When it comes to credentials like college, medical school and residency, Dr. Shlain said, “at least two out of the three need to be Ivy League, or Ivy League-esque.”

In many ways, today’s elite concierge physician provides the same service as the family doctor did a half-century ago for millions of Americans, except that it is reserved for the tiny sliver of the population who can pay tens of thousands of dollars annually for it.

“I didn’t know this level of care was possible,” said Trevor Traina, a serial entrepreneur here who is a patient of Dr. Shlain’s. “I have a better relationship with my veterinarian than the doctors I went to in the past.”

What about everyone else? Mr. Traina doesn’t see much future for the conventional family doctor, except for patients who go the concierge route.

“The traditional model of having a good internist is dying,” said Mr. Traina, a scion of a prominent family here that arrived with the California Gold Rush. “Even the 25-year-olds at my company either have some form of concierge doc, or they’ll just go to an H.M.O. or a walk-in clinic. No one here has a regular doctor anymore.”

Statin Island

And once again Big Pharma shows us how big by reminding us that we are a pill away from some new disease, disorder or ailment that they can fix by a simple pill.  Drive up to the Doctor’s office get a latte to down it with and speed away.

Ironic? Coincidental? or Fortuitous? I mean the Obamageddon is just upon us and with those aging Boomers who lost their insurance as a result or because of their job loss and their ever increasing age and succubus nature that requires heavy meds to live to a ripe old age in which further bankrupt America now is a great time to ensure profits for those “shareholders.”  I use the plural but really who are these shareholders? I feel I could fit them all nicely into a reasonably sized conference room. Table for six anyone?

They are keeping us alive for perhaps food security. Soylent Green anyone? 

One Doctor is already claiming foul and and he is concerned as to what this means?

Steven L. Zweibel has been taking a statin drug to lower his cholesterol for seven years. It has worked, and he has suffered no problems or side effects.

But, like many patients taking these drugs, he is perplexed by new guidelines on preventing heart disease and stroke — despite the fact that he is the director of cardiac electrophysiology at Hartford Hospital. 

“I am very happy to be on Zocor,” said Dr. Zweibel, 47, referring to the statin he takes. “But now the real question in my head is whether I need to be on it.

 And below is another editorial decrying the decision. 

I can’t wait to leave America. No not in a coffin or a stretcher but on a plane.

Don’t Give More Patients Statins

By JOHN D. ABRAMSON and RITA F. REDBERG

Published: November 13, 2013

This announcement is not a result of a sudden epidemic of heart disease, nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else. 

The new guidelines, among other things, now recommend statins for people with a lower risk of heart disease (a 7.5 percent risk over the next 10 years, compared with the previous guidelines’ 10 to 20 percent risk), and for people with a risk of stroke. In addition, they eliminate the earlier criteria that a patient’s “bad cholesterol,” or LDL, be at or above a certain level. Although statins are no longer recommended for the small group of patients who were on the drugs only to lower their bad cholesterol, eliminating the LDL criteria will mean a vast increase in prescriptions over all. According to our calculations, it will increase the number of healthy people for whom statins are recommended by nearly 70 percent. 

This may sound like good news for patients, and it would be — if statins actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects. However, none of these are the case. 

Statins are effective for people with known heart disease. But for people who have less than a 20 percent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail even to reduce the risk of serious illness — as shown in a recent BMJ article co-written by one of us. That article shows that, based on the same data the new guidelines rely on, 140 people in this risk group would need to be treated with statins in order to prevent a single heart attack or stroke, without any overall reduction in death or serious illness. 

At the same time, 18 percent or more of this group would experience side effects, including muscle pain or weakness, decreased cognitive function, increased risk of diabetes (especially for women), cataracts or sexual dysfunction. 

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease. According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day. 

Aside from these concerns, we have more reasons to be wary about the data behind this expansion of drug therapy. 

When the last guidelines were issued by the National Heart, Lung, and Blood Institute in 2001, they nearly tripled the number of Americans for whom cholesterol-lowering drug therapy was recommended — from 13 million to 36 million. These guidelines were reportedly based strictly on results from clinical trials. But this was contradicted by the data described in the document itself.

For example, even though the guidelines recommended that women between the ages of 45 and 75 at increased risk of heart disease and with relatively high LDL levels take statins, the fine print in the 284-page document admitted, “Clinical trials of LDL lowering generally are lacking for this risk category.” The general lack of evidence for LDL level targets is why they have been dropped from the current guidelines. In fact, committee members noted that cholesterol lowered by drugs may not have the same effect as cholesterol lowered by nondrug methods, such as diet, exercise and being lucky enough to have good genes. 

The process by which these latest guidelines were developed gives rise to further skepticism. The group that wrote the recommendations was not sufficiently free of conflicts of interest; several of the experts on the panel have recent or current financial ties to drug makers. In addition, both the American Heart Association and the American College of Cardiology, while nonprofit entities, are heavily supported by drug companies. 

The American people deserve to have important medical guidelines developed by doctors and scientists on whom they can confidently rely to make judgments free from influence, conscious or unconscious, by the industries that stand to gain or lose. 

We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. Patients should be skeptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them.

Spoonful of Sugar

Frankly it would be cheaper and possibly not worse.  The high price of medicine makes no sense unless of course you realize that Big Pharma has no interest, no horse in that race, nor imperative to do so.

As the supposed saviors of America claim, the tech sector, they are saving us from well them maybe, we have all the super technology in the world which should make things run fast enough and in turn cheap enough for everyone.  That is clearly not working out.

Today the NYT had an article about the costs associated with breathing.  Good to know that in America taking a breath costs a few breaths as those who need medicine in which to do so, often save a breath in order to take one.

I may need an inhaler to cope with another frustrating example of how our Country is run ragged by the corporations that profit from greed. That is all it is – greed.  There is no other explanation as to why any company would ensure their “shareholders’ aka “executive management” wealth by simply exploiting the health of the American people.  Shame, shame on them and us for allowing it.

Breathe deeply then read the article and then the editorial below about how the Medical Industrial Complex is also ensuring their profits as the nation gears up for the next year when Obamacare kicks in.

Is this really about health care or about profits?  This is more about our fight for our civil/human rights to have health care that is equal and available to everyone.

Out of Network, Out of Luck

BY: THERESA BROWN
Published October 13, 2013

For several hundred patients at the University of Pittsburgh Medical Center, it started with a certified letter informing them that they were no longer allowed to see their physicians. The reason? They were unlucky enough to have insurance called Community Blue, which is offered by a rival hospital system. Astoundingly, they were barred even if they could pay for the care themselves.

One patient, in the middle of treatment for lung cancer, said at a hearing before a State House of Representatives committee that she was prohibited from seeing her U.P.M.C. oncologist. Another, with the debilitating autoimmune disease scleroderma, said she was dismissed from the U.P.M.C. Arthritic and Autoimmune Center. A third, a five-year breast cancer survivor who needs follow-up care every six months, was cut off from the doctor who had been with her since she was first given her diagnosis.

Community Blue is sold by a company called Highmark. Like U.P.M.C., it is both a hospital system and an insurance provider, part of a growing trend toward vertical consolidation in the two industries. These and other companies insist that such consolidation streamlines the caregiving system and thus benefits the patient. But in the short term, they are waging a vicious war over patients — and as the experience in Pittsburgh shows, it’s often the patients who are losing.

Historically, U.P.M.C. was the biggest health care provider in Pittsburgh and Highmark the largest insurer. U.P.M.C., though, has been selling its own brand of insurance for over a decade, and Highmark recently affiliated with a local multisite hospital system, now known as the Allegheny

U.P.M.C. responded to the formation of the Allegheny Health Network by labeling Highmark a competitor and a threat to its financial sustainability. It has also announced that its current contract with Highmark will not be renewed, meaning that in December 2014 almost all U.P.M.C. hospitals will be open to Highmark customers only at out-of-network rates, which are among the highest in the country.

At the same time, U.P.M.C. is running an aggressive ad campaign for its own health insurance plan, and Highmark subscribers with Community Blue have been denied access to their U.P.M.C. physicians. According to an official statement from U.P.M.C., this denial of access results from “misunderstandings” related to Community Blue’s being “a cut-rate product.” (Full disclosure: I used to work as a clinical nurse for U.P.M.C.; my insurance is not through Highmark.)

Things have gotten so bad that State Representative Dan Frankel, a Democrat, and State Representative Jim Christiana, a Republican, recently introduced legislation in the Pennsylvania House that would guarantee health system access to “any willing insurer.” I spoke at the news conference announcing the bill, sharing my concern, as a consumer and a bedside nurse, that the health care providers in Pittsburgh seem to value market share more than the needs of patients.
All of this is happening within the context of dramatic change in the health care industry. Historically, insurance companies have had more market power than hospital systems: they set reimbursement levels, determined which providers and hospitals were in or out of network and chose which patients to insure.

The Affordable Care Act, however, is changing that. By mandating that insurance companies can no longer deny coverage because of pre-existing medical conditions, or set lifetime caps on total payouts, the act curbs what some would call past insurance company abuses, and in the process cuts back some of the industry’s market power.
But while health insurance practices are becoming more regulated, the act, by offering incentives for coordinated care, has encouraged hospital mergers and the buying up of physician practices.

In line with those changes, more health systems nationally are following the lead of U.P.M.C. and Highmark, combining health insurance with the provision of care itself. The systems promise that such networks streamline care and offer lower costs and consistently good outcomes for patients.

But the worry is that integration will yield not better care but higher profits achieved through monopolistic consolidations and self-serving business practices. The cost of care for an entire geographic region could increase without making patients better off.

Further, if rural hospitals become part of large integrated systems, patients could be shut out from the only nearby hospital, as was feared recently in Altoona, Pa., when U.P.M.C. acquired Altoona Regional Health System.

Profit seeking has its place, even in some parts of health care. But the hospitals in Pittsburgh are nonprofits supported in part by community donations and public tax breaks. Profiteering is fundamentally antithetical to who they are.

And the generosity bar should be set higher for health care than for any other business. Hospitals are not selling cool new phones or marketing the latest app. We produce that most delicate and personal of products: health. Patients come to us in need, and it’s our job to either make them better or, if we can’t heal them, offer all the comfort we can.
The Affordable Care Act says that in order to justify their tax-exempt status, nonprofits must show “community benefit,” offering a possible check on aggressive business practices. However, that requirement does not specifically address provider-insurer networks or questions of access, and a lack of compassion has definitely been on display in western Pennsylvania.

Have a Heart

Well if you were a victim of unnecessary surgery by EMH Medical Centers in Ohio you might have two hearts.  Well they are better than one.

The below article discusses another settlement by the other industrial complex, no not banking, medicine.  And like all the current settlements that mark the recent laundering, fraudulent practices and other assorted indiscretions, it will be shared in higher costs and no apologies.

The players in this No Apology band would include failed Presidential aspirants, half of Wall Street, European bankers and the varying Medical Administrators, Doctors and other caregivers could go on a national No Apology tour and charge outrageous ticket fees – which we will pay. No we will pay, even if we don’t go, we will pay in some form or another.  (We will know the tour is in town by the bus, it will have an Olympic horse strapped to the top. And yes we paid for that too in the form of a tax deduction as a medical expense. And yet our wounded warriors cannot get dogs counted as PTSD treatment…hmmm)

 This settlement is about fraud and the fraud actually included actually physically harming people under the guise of “care.”  Care meaning I care about my income and how I can use/exploit/manipulate you in to agreeing to a procedure that does absolutely nothing for your long term health.

Why the Government settles and agrees what happens to the hundreds of patients who were subjected to the procedure? Will their long term health needs be met? Will their families be compensated for the lifetime of problems they could encounter as a result? Hell no.  But then looking at the recent Wall Street settlements, the expression “drop in the bucket” is appropriate; as its buckets in which they put medical waste.  Wall Street and Medicine are only concerned about the bottom line and that is how they are in the black, the red as in your blood that is spilled is really just that, a waste by product.

And in turn Medicare which is the current bargaining chip in the never ending poker game called deb ceiling, fiscal cliff, entitlement spending, is also the secondary injury. Thanks to the overwhelming fraud to get blood from a stone or you, whichever pays more,  further fuels that fire to why Medicare must be changed.  And in turn good Doctors (all three or six of them as so few take Medicare anymore) who do want to help those on this plan – Senior citizens most of them the poors – will find their payments and benefits reduced.    But you don’t see any reform with regards to the Medical Matrix Industrial Complex on the table. And it clearly needs some very necessary surgery.

If anyone thinks that these fines will not lead to a rise in costs of medical care will be needing their head examined.    The neglect, the abuse, the lack of care at the expense of the incompetence of these morons in charge of people’s lives will go on with their lives unchanged and undamaged. Their victims not so much.   Be they Bankers on Wall Street or Doctors on Main Street, the real people pay their bills and the interest is rising.

U.S. Settles Accusations That Doctors Overtreated

By REED ABELSON
Published: January 4, 2013

“A hospital in Ohio agreed to pay $3.9 million over allegations that doctors billed Medicare for unneeded heart procedures.”

A group of doctors who performed unusually high rates of heart procedures on patients at a community hospital in Ohio settled with the Justice Department over accusations that some of the procedures were medically unnecessary, federal regulators announced on Friday.

The settlement covered accusations that the doctors and the hospital, then known as the EMH Regional Medical Center, had billed Medicare for unnecessary medical care from 2001 to 2006. The hospital agreed to pay $3.9 million to settle the accusations, and the physician group, the North Ohio Heart Center, agreed to pay $541,870, according to a Justice Department statement.

Federal regulators had accused the doctors and the hospital of performing unnecessary procedures known as angioplasties, in which a clogged blood vessel is opened. The procedure often requires insertion of a device called a stent to keep the blood vessel from closing again.

Besides the cost to Medicare, “performing medically unnecessary cardiac procedures puts patients’ lives at risk,” said Steven M. Dettelbach, the United States attorney for the Northern District of Ohio, which was involved in the investigation. “Patient health and taxpayer dollars have to come before greed,” he said.

The high rate of heart procedures at the hospital was the subject of a front-page article in The New York Times in August 2006. Medicare patients in Elyria, Ohio, where the hospital is located, were receiving angioplasties at a rate nearly four times the national average, a figure that prompted questions from insurers and raised concerns about overtreatment.

The concerns included whether many patients in Ohio and elsewhere were receiving expensive and inappropriate medical treatments because of the high fees the procedures generated.

The settlement represents the latest in a series of actions brought against cardiologists and hospitals for performing questionable cardiac procedures. Patients typically have a choice of treatments, and many doctors say some individuals should be treated more conservatively with medicines rather than through costly procedures.

At the time, the Elyria cardiologists defended their high rates as a result of an aggressive style of medicine, and the doctors continued to defend the medical care they provided. They said the procedures they performed were medically warranted but might not have met the government’s guidelines for reimbursement.

“We choose to settle rather than go to court,” said Dr. John Schaeffer, the chairman of North Ohio Heart, which is now part of the hospital system, EMH Healthcare. The government did not single out any individual physicians, and neither the hospital nor the medical group said it disciplined any of the doctors.

“As the physicians on the ground when these decisions were made and the procedures were performed, we felt confident we were making the correct choices for our patients,” he said in a statement on the group’s Web site. “We still do.”

The former manager of the hospital’s catheterization lab, Kenny Loughner, filed a whistle-blower complaint in October 2006. Mr. Loughner, who will receive $660,859 from the settlement for alerting the government, described how doctors urged nurses and others to falsify complaints of chest pain to justify the unnecessary angioplasties. He also described the doctors’ technique of treating patients in stages, forcing patients to come back for multiple procedures.

The government did not include the accusations in its findings, the hospital said, and they are without merit.

In a separate statement issued by EMH Healthcare, the system’s chief executive, Dr. Donald Sheldon, said “no patients, to our knowledge, were ever at risk, and there is no question that the patients treated had heart disease and some degree of blockage.” The hospital also said it was conducting an external peer review of its cardiac care.