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.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

Dr. Aletha 

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

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Donald Trump’s Healthcare Achievements-a review

The ACA sparked heated debate in the 2016 election with the Democratic candidate pledging to build upon it and Republican candidate vowing to dismantle it . This year the debate continues.

Due to the pandemic caused by the SARS-CoV2 virus, health has been a major topic in both world and national news this year and will continue to be so for months if not years. And health is a major issue in this year’s United States’ presidential election in November 2020.

Health care was a major issue in the 2008 election and proved to be momentous. In his campaign, the Democratic candidate, Barack Obama, promised health care reform and as President he delivered with the passage of the Affordable Care Act, (ACA) the first time Americans have had universal health care.

The ACA sparked heated debate in the 2016 election with the Democratic candidate pledging to build upon it and Republican candidate vowing to dismantle it . This year the debate continues.

Healthcare and the Presidential campaign 2020

In this and another post, I review and list what I think are some of the most important points in the health care philosophy of each major party candidate, according to information on their official websites.

I am not endorsing either of the candidates, their party ,or their healthcare plans. My intent is to present a non-partisan look at what they have done and propose. If it sounds otherwise, that is unintentional. I’ll give you the links to their sites and encourage you to read them for yourself.

You should also review a post I wrote about the Republican Party healthcare platform.

How to become President inforgraphic
The Presidential pathway from USA.gov
The incumbent candidate-Republican- Donald J. Trump

Donald J. Trump, owner and former president of The Trump Organization, was elected the 45th U.S. president in 2016. He was born June 14, 1946. Mr. Trump is married to Melania Trump and has 5 children.

 “ Making America Great Again Healthcare

President Donald J. Trump Achievements

The Trump Administration

  • expanded access to Association Health Plans (AHPs) allowing small business to pool risk across states.
  • launched a program to provide the HIV prevention drug PrEP to uninsured patients for free.
  • issued guidance expanding options for individuals with chronic conditions. High deductible plans can now cover products such as insulin, inhalers and statins pre-deductible.
  • issued a rule allowing health care workers to refuse to provide services like abortion, sterilization or assisted suicide, if they cite a religious or conscientious objection.
  • announced the launch of a new COVID-19 Uninsured Program Portal in an effort to cover testing and treatment for uninsured individuals.

As part of the landmark Tax Cuts and Jobs Act President Trump repealed the individual mandate, which forced people to buy expensive insurance and taxed those who couldn’t afford it.

The mandate disproportionately hurt the poor: 80% of those affected made less than $50,000.

As President, Mr. Trump
  • took executive action to strengthen Medicare and reform the Medicare program to stop hospitals from overcharging seniors on their drugs.
  • pressured China to close dangerous loopholes that allowed Chinese fentanyl manufacturers to legally ship the compound worldwide, much of which ended up in the U.S.
  • created a bipartisan opioid commission that issued 56 recommendations to help defeat the opioid crisis.
  • invoked the Defense Production Act, giving power to allocate health care supplies and increase production of necessary products to counter COVID-19. 
  • worked with Congress to stop surprise medical billing.
As President, Mr. Trump signed
  • the bipartisan Tobacco-Free Youth Act to raise the nationwide age for purchasing tobacco and vaping products to 21 years old.
  • the Families First Coronavirus Response Act, expanding the SNAP and WIC programs by adding $500 million, helping pregnant women and those who lost their jobs due to COVID-19.
  • an executive order to modernize flu vaccines and help protect more Americans by promoting new technologies to improve vaccine manufacturing and effectiveness.
  • a bill to extend Veterans Choice Health Care Law.
  • an executive order that increased price and quality transparency in American health care.
Oval Office replica
replica of the Oval Office at the Reagan Presidential Library, photo by Dr. Aletha
Exploring the HEART of healthcare election politics

Thanks for reviewing this overview of Mr. Trump’s health care achievements. I hope you will take the time to review his website for yourself. In another post I will review the views of the Democratic challenger, Joe Biden.

At this time there is still much uncertainty as to how we will be able to vote in November without getting exposed to the coronavirus. Whatever the situation is in your community, I hope you will find a way to participate in this important process, one of our most precious rights and privileges as United States citizens.

a group of lapel buttons, red, white and blue, saying VOTE

This photo and the cover photo of the White House are from the media site Lightstock.com, an affiliate which pays this blog a commission for purchases made from this link

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha