from 1776 to 2020-a vision for a “more perfect Union”

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction. The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

In ophthalmology, visual acuity is measured by the distance one can see compared to “normal”. 20/80 vision means at 20 feet you only see what a normal vision person can see from 80 feet. Perfect vision is labeled 20/20.

Maybe you expected 2020 to be a perfect year. I didn’t expect perfection, but I hoped it would be better than last year, when my husband and I spent 8 months mostly homebound while he recovered from a devastating ankle fracture.

But instead this year has brought

  • a contentious presidential election and an unexpected serious pandemic
  • peaceful protests and raucous riots
  • racism confrontations and reconciliation pursuits
  • health inequities battles and healthy community pursuits
Statue of Liberty
Lady Liberty lifting her torch in New York harbor
Independence Day 2020

Every year on July 4th the United States celebrates Independence Day- the day in 1776 the original 13 American colonies established an independent country.

A few years later they established a government as specified in the Constitution of the United States, to “form a more perfect Union”.

The United States Constitution

The Constitution does not specifically mention, establish, create, or endorse a healthcare system. Some phrases in the Preamble hint at it though-

  • establish Justice
  • insure domestic Tranquility
  • provide for the common defense
  • promote the general Welfare

Government sponsored health care programs

The Affordable Care Act, aka Obamacare

The  United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens.  During the last presidential campaign, President Trump vowed to “repeal and replace” this law but although it has been modified, it is still in place.

Healthcare for military service members, veterans ,and their families

During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current Department of Defense military health care system which covers service members and the Veterans’ Administration system for veterans.

a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha)
American soldiers serving in Afghanistan
American soldiers serving in Afghanistan
Medicare and Medicaid

Two other government healthcare programs- Medicare and Medicaid are over 50 years old. 

Medicaid provides insurance coverage for adults and children who are unemployed or low income.  

Medicare covers disabled children and adults  and persons 65 years and older.

ELDERLY COUPLE -189282_1280
Senior adults age 65 and older use Medicare.

Department of Health and Human Services

Most of the health care activities of the federal government fall under the agencies of the Department of Health and Human Services or HHS. The Secretary of HHS serves in the President’s Cabinet.

Due to the COVID-19 pandemic, we’ve heard more about the HHS in the news than usual; maybe you’ve never heard of these agencies. Generally, management of a pandemic or other public health emergency falls within the work of the CDC.

Centers for Disease Control and Prevention

The CDC’s mission is simple but encompasses many facets of health

“to work 24/7 to protect America from health, safety and security threats, both foreign and in the U.S.”

The CDC website devotes an entire section now to information, guidelines, and news about the SARS-CoV-2 virus and COVID-19.

illustration showing the coronavirus which causes COVID-19

The goal of public health is to avoid or prevent health threats from becoming public health emergencies, like the COVID-19 pandemic. If they accomplish the mission, we hardly notice. But when an outbreak occurs, their work suddenly becomes visible, scrutinized, and debated.

The CDC director, Dr. Robert Redfield, spoke to Congress soon after the pandemic started, and his assessment of the response and funding for it were not positive. Lack of funding hampered the federal government’s response to the coronavirus outbreak, he told lawmakers on March 10, 2020.

“The truth is we’ve underinvested in the public health labs,There’s not enough equipment, there’s not enough people, there’s not enough internal capacity, there’s no search capacity”

Dr. Robert Redfield, Director, CDC

The Trump administration subsequently enlisted private companies to help cut the difference. The CDC partnered with Integrated DNA Technologies to manufacture the tests under a CDC contract. IDT partnered with commercial labs, including LabCorp and Quest, for the testing.

This was reported at CNBC. at the following link.

Coronavirus testing delays caused by lack of funding for public health labs

National Institutes of HealthNIH

The National Institutes of Health, part of the Public Health Service,

  • supports biomedical and behavioral research with the United States and abroad,
  • conducts research in its own laboratories and clinics,
  • trains promising young researchers, and
  • promotes collecting and sharing medical knowledge.

And within the NIH is the NIAID– the National Institutes of Allergy and Infectious Diseases, which has been an invaluable source of guidance as the United States and the world works to understand and manage this new infectious disease.

Strategic Plan for COVID-19 RESEARCH

  1. Improve fundamental knowledge of SARS-CoV-2 and COVID-19
  2. Support the development of diagnostics and assays
  3. Characterize and test therapeutics
  4. Develop safe and effective vaccines against SARS-Cov-2

Read the full report at the link.

President Donald Trump Visits NIH
President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2. From left: VRC Deputy Director Dr. Barney Graham, NIH Director Dr. Francis Collins, VRC Director John Mascola, Department of Health and Human Services Secretary Alex Azar, President Trump, and VRC Research Fellow Dr. Kizzmekia Corbett.
credit NIH, public domain
Novel Coronavirus SARS-CoV-2
This scanning electron microscope image shows SARS-CoV-2 (orange)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (green) cultured in the lab.
 
Credit: National Institute of Allergy and Infectious Diseases-Rocky Mountain Laboratories, NIH

Food and Drug Administration– FDA

The FDA joins the pandemic response by

  • reviewing and approving diagnostic tests for the coronavirus
  • protecting consumers from fraudulent products for COVID-19.
  • issuing Emergency Use Authorizations (EUAs) for ventilators
  • sampling and testing of respirators for importation

As of June 26 there are 153 currently authorized tests under EUAs; these include 129 molecular tests, 23 antibody tests, and 1 antigen test.

There are currently no FDA-approved products to prevent or treat COVID-19. Consumers concerned about COVID-19 should consult with their health care provider.

COVID-19 Diagnostic Test Attire
FDA Commissioned Corps officer RADM Estella Jones, DVM, OCET Deputy Director and Co-Chair of the FDA Animal Welfare Council, oversees Commissioned Corps officers as they practice proper fitting of protective items. Healthcare workers testing patients for COVID-19 novel coronavirus infection must wear specific protective gowns, gloves, ventilation masks, and full facial shields as shown, and must replace these items after each patient is tested. credit FDA, public domain

Occupational Safety and Health administration-OSHA

OSHA is part of the United States Department of Labor. OSHA’s administrator answers to the Secretary of Labor, who is a member of the cabinet of the President of the United States.

Congress created the Occupational Safety and Health Administration (OSHA) in 1970 to

ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.

For the pandemic response, OSHA offers guidance on

  • returning to work
  • preparing workplaces for COVID-19
  • worker exposure risk to COVID-19
  • for specific industries including airlines, farms, retail, corrections
  • use of respiratory protection equipment

This page on the OSHA website explains the

key differences between cloth face coverings, surgical masks, and respirators.

important laws that administer and regulate both private and public healthcare.

The Affordable Care Act- ACA
Health Insurance Portability and Accountability Act-HIPPA
Emergency Medical Treatment and Labor Act- EMTALA
Americans with Disabilities Act-ADA
Family Medical Leave Act-FMLA
replica of the Liberty Bell at Disney World, Florida

Let Freedom Ring

In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the pursuit of Happiness” and to promote “Safety and Happiness” . 

They didn’t mention “healthcare” either, maybe because in the late 1700s medical practice was more superstition than science.

Surgery was rudimentary due to no anesthesia and infections frequently proved deadly due to no antibiotics.

No one had even imagined, much less identified the human genome, and viral DNA-what was that??

I wonder if they intended their new government to spend so much time and money providing and regulating health care –most of which was not available or even imagined at that time? 

Public vs Private-not a perfect Union

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction.

The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

But despite the lack of coordination and cooperation between all levels of government and private citizens, our health care professionals, in both public health and private medical practice stayed true to their calling. Many risked their own lives to care for COVID-19 victims. Others sacrificed time and finances to lead the pandemic response in their communities and on social media- maybe not perfectly, but definitely UNITED in resolve to lead, help, and heal their fellow citizens through this unprecedented health emergency.

Let’s celebrate!

woman holding a sprakler
Let’s celebrate ! This photo and featured image from stock photo site- Lightstock.com (affiliate)

Sharing and celebrating the HEART of health

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

I would love for you to start following Watercress Words : use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

Dr. Aletha 

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Me, a few years ago, showing my patriotic spirit by posing in red, white, and blue

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Joe Biden’s Plan to Combat Coronavirus (COVID-19)

For this and a previous post I reviewed statements about the United States’ coronavirus pandemic response from the President candidates’ official campaign websites.

The year 2020 looked to be historic even prior to the coronavirus pandemic, police involved shootings, riots, and Black Lives Matter protests. The USA will choose the next president, impacting the economy, security, defense, education, and healthcare.

In two previous posts I reviewed the healthcare plans of each candidate-Republican incumbent President Donald Trump and Democratic challenger former Vice President Joe Biden.

In this and a previous post I review statements about the United States’ coronavirus pandemic response from the candidates’ official campaign websites. I encourage you to read the entire documents yourself by follow the links provided.

This post will review Mr. Biden’s page. You may want to review the previous post now, or after reading this one.

Joe Biden’s Plan for Healthcare

The sitting President heads the Executive Branch of the U.S. Government.

The Department of Health and Human Services through the President’s cabinet member head manages the response to COVID-19. Other Cabinet members and their Departments are involved as well.

The agencies most involved in the COVID-19 response include

  • Health and Human Services-HHS
  • Federal Emergency Management Agency-FEMA
  • Centers for Disease Control-CDC
  • National Institutes of Health-NIH
  • Federal Drug Administration-FDA
  • Small Business Administration-SBA
  • Veterans Administration-VA
  • Department of Defense -DOD
  • Treasury Department
  • State Department

The President leads the Executive Branch of the government, including all of the departments and agencies headed by the Cabinet members, including the Department of Health and Human Services.
THE BIDEN PLAN TO COMBAT CORONAVIRUS (COVID-19) AND PREPARE FOR FUTURE GLOBAL HEALTH THREATS

The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak. That is why Joe Biden is outlining a plan to mount: 

  • A decisive public health response that ensures the wide availability of free testing; the elimination of all cost barriers to preventive care and treatment for COVID-19; the development of a vaccine; and the full deployment and operation of necessary supplies, personnel, and facilities.
  • A decisive economic response that starts with emergency paid leave for all those affected by the outbreak and gives all necessary help to workers, families, and small businesses that are hit hard by this crisis. 

Biden will be ready on Day One of his Administration to protect this country’s health and well-being. But he is not waiting until then to communicate his views on what must be done now to properly serve the American people. Biden believes the following steps must immediately be taken. If Trump does not take them, Biden will on Day One.

an electron microscope image of the coronavirus
the Coronavirus SARS-CoV-2, responsible for causing COVID-19- photo used with permission, CDC.GOV

December 31, 2019-China reports the coronavirus to WHO-the World Health Organization.

RESTORING TRUST, CREDIBILITY, AND COMMON PURPOSE 

We must immediately put scientists and public health leaders front and center in communication with the American people in order to provide regular guidance and deliver timely public health updates, including by immediately establishing daily, expert-led press briefings.

Ensure that public health decisions are made by public health professionals and not politicians

Immediately restore the White House National Security Council Directorate for Global Health Security and Biodefense, which was established by the Obama-Biden Administration 

MOUNTING AN EFFECTIVE NATIONAL EMERGENCY RESPONSE THAT SAVES LIVES, PROTECTS FRONTLINE WORKERS, AND MINIMIZES THE SPREAD OF COVID-19

Ensure that every person who needs a test can get one – and that testing for those who need it is free. 

Task all relevant federal agencies to take immediate action to ensure that America’s hospital capacity can meet the growing need

Prepare to stand up multi-hundred-bed temporary hospitals in any city on short notice

Expand CDC surveillance programs

Instruct the CDC to establish real-time dashboards tracking

  • (1) hospital admissions related to COVID-19, especially for ICUs and emergency departments, and
  • (2)supply chain information for essential equipment and personal protective equipment (PPE). 

Give all frontline workers high-quality and appropriate personal protective equipment . Issue guidance to states to prioritize first responders to receive PPE, and educate the public on reserving equipment for professionals. 

Ensure the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority are swiftly accelerating the development of rapid diagnostic tests, therapeutics and medicines, and vaccines. NIH must be responsible for the clinical trial networks and work closely with the U.S. Food and Drug Administration (FDA) on trial approvals.

Instruct the CDC to provide guidance and resources about containment and mitigation to schools, health care facilities, higher education, and school administrators, and the general public. 

Work with businesses to expand production of personal protective equipment, including masks and gloves, and additional products such as bleach and alcohol-based hand sanitizer.

Establish and fund a U.S. Public Health Service (PHS) Reserve Corps to expand medical and public health capacity. 

Expand staffing for the Adequate Fire and Emergency Response (SAFER) grant program for fire departments can increase staffing. As Vice President he secured an expansion of the SAFER Act. 

Increase federal resources to cover all necessary federal costs, and create a State and Local Emergency Fund to meet critical health and economic needs to combat this crisis 

ELIMINATING COST BARRIERS FOR PREVENTION OF AND CARE FOR COVID-19.

Amend the PHS Act to cover all testing, treatment, and preventive services necessary to address a public health emergency for an infectious disease. All commercial plans and public plans-Medicare, Medicaid, VA, etc- would be required to cover services. 

Fund and expand authority for the National Disaster Medical System (NDMS) to reimburse health care providers for COVID-19-related costs not covered by insurance.

Secure maximum Medicaid enrollment for currently eligible populations 

Provide explicit authority for the HHS Secretary to approve the commercial price of vaccines developed in conjunction with federally funded research

PURSUING DECISIVE ECONOMIC MEASURES TO HELP HARD-HIT WORKERS,FAMILIES, AND SMALL BUSINESSES AND TO STABILIZE THE AMERICAN ECONOMY 

The immediate economic measures in Biden’s plan include 

Comprehensive 12 weeks of paid family and medical leave envisioned in the FAMILY Act and 7 days of paid sick leave in the Healthy Families Act. The paid leave plan will cover 100% of weekly salaries or average weekly earnings up to $1400.00 weekly. 

Reimbursements to employers up to 14 days of paid sick leave, in addition to existing employer paid leave

Ensure unemployment benefits are available to those who would be denied due to rules that should not apply in a crisis 

Employment relief for reduced hours, work-sharing arrangements, domestic workers, caregivers, gig workers or independent contractors with reduced pay and hours 

Expanded food relief for hard-pressed families and children, creating a federal-state partnership to expand SNAP (Supplemental Nutrition Assistance Program) relief

Increase Federal Medical Assistance Percentage (FMAP) for the state administered Medicaid program 

Establish a temporary small and medium size loan program to address unanticipated shortfalls in revenue 

Support for child care and remote student learning by expanding assistance to federal child care enters and Title 1 schools 

Relief or forbearance of federal student loans and federally backed mortgages 

Protect union health funds

A state and local emergency fund for governors and mayors to respond to their communities’ needs including  

  • Mortgage and rental relief for impacted workers
  • Employer assistance for job maintenance
  • Interest free loans for small businesses 
  • Cash assistance or refundable tax relief

RALLYING THE WORLD TO CONFRONT THIS CRISIS WHILE LAYING THE FOUNDATION FOR THE FUTURE 

Direct the U.S. Agency for International Development (USAID) in coordination with the State Department, DOD, HHS, and the CDC, to mobilize an international response to assist vulnerable nations to address COVID-19

Empower the State Department to ensure the U.S. plays a major role in all global decisions about the outbreak

Create a Global Health Emergency Board to harmonize crisis response for vulnerable communities, ensuring a coordinated health and economic response globally

Bolster CDC and DOD’s disease detection and protections programs to protect America’s troops and deployed citizens, providing testing and treatment, and evacuation when necessary 

Expand the Global Health Security Agenda to mobilize the world against the threat of infectious diseases (established under the Obama-Biden administration)

Fully staff all federal agencies, task forces, and scientific and economic advisory groups focused on health security.

Build a global health security workforce by investing in the education of public health professionals, including the CDC’s training programs Fight climate change as a driver of health threats;  fully integrate climate change into our foreign policy and global health security

Exploring the HEART of health

I would love for you to start following Watercress Words : use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

By following this blog, you’ll know when I post the additional pieces reviewing the COVID-19 pandemic as well as other topics that explore the HEART of health.

                              Dr. Aletha 

And please, register if you need to, and don’t neglect to vote in your upcoming primaries and on November 3.

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