Hillary may be beating Sanders in the primaries but Sanders trumps Trump in polls. In my opinion, and as I have posted previously, the reason for this is that voters are fed up with Washington, they are angry, really angry, with the politicians who are too busy playing politics instead of doing their job, looking out for the American people. They are seeking an alternative candidate (outsider). Clinton is viewed by young people and independents and others (non-voters) as being an insider, meaning part of the problem, not part of the solution. Older folks are more wily and figure she is the more experienced candidate or want to see a female elected President before they kick the bucket. However, she is extremely vulnerable to demonic assault. She will not be able to seriously perform the exorcism on Trump because the Trump demons will bring up every last piece of dirt they can find on her and slick Willy (aka Bill). If we send her out into the gladiatorial arena she will be devoured by the beasts. Sanders, on the other hand, is viewed by most (if not all) as an honest Abe (an outsider) who has fought the establishment his entire career. He does not speak in forked tongue. He is the only one who is qualified to perform the exorcism because he is blameless, just ask the Pope!!
Month: May 2016
Eligible to Donate but not to Receive an Organ: The Uninsured Gap Between Organ Donors and Organ Recipients
According to the National Foundation for Transplants and the United Network for Organ Sharing (UNOS), the estimated U.S. average in 2011 of billed charges per liver transplant was $577,100.00. The cost of post-transplant medical care, which includes medication to prevent rejection of the organ is estimated at $2,500.00 per month (1). This guarantees the procedure is available almost exclusively to those with some form of health care financing.
During the period 2000-2014 the death rate due to drug overdose in the United States increased by 137%. In 2014 overdose deaths reached record numbers with 47,055, primarily young people between the ages of 15-24. Furthermore, homicide is the second leading cause of death for young people also between the ages of 15-24. The victims of preventable drug and homicide deaths are increasingly becoming an important source of organs for transplantation. A Harvard study published in the International Journal of Health Services reported that 17% of organ donors but less than 1% of organ transplant recipients were uninsured. Americans without health insurance are twenty times more likely to donate a kidney for transplant than to receive one (2). Therefore, the dual epidemics of drug addiction and violent crime and the lack of universal access to health care insurance are creating unintended inequalities in the allocation of organs in the United States. For this reason it is essential to note the health care insurance gap between organ donors and organ recipients. Because as a society we are confronted with the perverse reality of the uninsured sustaining a health care service they would not be eligible to receive.
A total of 40,000 people die each year for lack of health insurance coverage (3). We have no data on how many people diagnosed with kidney or liver failure are not referred to a transplant center for evaluation for organ transplantation for lack of health insurance. If they are not evaluated they have no chance to be listed as a candidate for transplantation and their fate is continued reliance on hemodialysis (in some cases covered by Medicare) or in the case of liver failure, death.
Another stark reality is that despite the availability of Medicaid and State Health Insurance for Children (SCHIP) for the non-working poor and Medicare for the older retired population, a substantial portion of minimum or low wage earners either do not qualify for Medicaid or SCHIP and/or cannot afford health care insurance. According to the Center for Studying Health System Change, “significant gaps in access to health care affecting Latinos, Blacks and Whites persist, with Latinos and Blacks consistently reporting lower levels of access than whites” (4). In Florida over 2 million people among the working poor continue to be deprived of health insurance because the Scott administration refuses to expand Medicaid under the affordable care act (ACA). The same is happening in other States with Republican governors that refuse to expand Medicaid under ACA. These governors are playing politics at the expense of peoples’ lives.
In all fairness it remains to be seen, however, whether the ACA (Obamacare) will ensure that all people who are referred to transplant centers for evaluation will have ‘equal’ access to: 1) receive evaluation and listing, if necessary, and; 2) proceed to receive a donated organ based on need and availability, thereby narrowing unintended disparities that currently exist. Nevertheless, I believe that although more people will be insured under the ACA it is likely that the shortage of organs and not necessarily the lack of health insurance will continue to limit the overall number of future organ transplants.
In conclusion, our first priority must be to address the root causes of the epidemic of violent crime and drug addiction in our communities. In order to do so we must urgently expand access to health care insurance so as to provide on-demand mental health and drug rehabilitation services. This will help to reverse inequities in the access to health care, including organ transplants. Finally, we must redouble our efforts to address the shortage of organs in the U.S. (5). An opt-out organ donor system as in Europe rather than our opt-in system would be a step in the right direction.
References:
1. (http://www.transplants.org/faq/how-much-does-transplant-cost/ http://www.transplantliving.org/before-the-transplant/financing-a-transplant/the-costs/).
2. Herring AA, Woolhandler S, Himmelstein DU. Insurance status of U.S. organ donors and transplant recipients: the uninsured give, but rarely receive. Int J Health Serv.2008;38(4):641-52.
3. J. Lee Hargraves. Trends in Health Insurance Coverage and Access Among Black, Latino and White Americans, 2001-2003. Tracking report number 11, October 2004. Center for Studying Health System Change. (http://www.hschange.com/CONTENT/713/)
4. Andrew P. Wilper, MD, MPH, Steffie Woolhandler, MD, Karen E. Lasser, MD, MPH, Danny McCormick, MD, MPH, David H. Bor, MD, and David U. Himmelstein, MD . Health Insurance and Mortality in US Adults. Am J Public Health. 2009:99 (12);1-7.
5. United Network for Organ Sharing (UNOS). 2014. United Network for Organ Sharing: Organ donation and transplantation, Richmond, Virginia available at http://www.unos.org