January 01, 2020
Medicaid Expansion Presentation
This is a mock campaign report that can be used to promote Medicaid Expansion in Missouri
June 08, 2017
Health Care for Inmates: a case for universal health care for all
by John Rozean
Considering the case of Demetrius Manderfield, I have found my ethics toward health care in America quite challenged.
I have generally held the view that the free market can take care of most issues of products and services – that is that the forces of supply and demand will ultimately meet in a fair exchange of goods and services that best meet in accordance with the greater good of society as a whole. Referring of course to what Adam Smith referred to as an “invisible hand” that guides the economy toward the best possible good. But considering economic theory, it is important to remember the work of John Maynard Keynes proposed that in some cases government intervention is needed (Mankiw, 1994). Perhaps health care is an area where government meddling in the economic framework is justified.
As a reminder to the reader, Manderfield was arrested and held in jail for nearly five months without the proper health care needed for his chronic, life threatening health conditions. Had Manderfield not been incarcerated, he would receive blood transfusions every three weeks along with pain management medications (Detroit Receiving Hospital, 2017) – evidently some combination of government programs and Manderfield’s own resources fitting the bill for the care. Since he was arrested last December, Manderfield has been denied that treatment by prison officials and physicians. He was simply given Ibuprofen for his life-threatening pain (Lange, 2017).
What happened with Manderfield occurs often. A study by the Department of Medicine, Cambridge Health Alliance states “Among inmates with a persistent medical problem, 13.9% of federal inmates, 20.1% of state inmates, and 68.4% of local jail inmates had received no medical examination since incarceration.” This study is a wearisome conclusion that “Many inmates with a serious chronic physical illness fail to receive care while incarcerated” (Wilper, Woolhandler, Boyd, Lasser, McCormick, Bor, & Himmelstein, 2009).
In an American Medical Association Journal of Ethics article Dr. Joseph E. Paris, uses a logical argument to contend that inmates should be given health care. Dr. Paris sums of the ethical issues. He writes;
"it makes sense from a legal, ethical, social, and public health point of view to provide health care to prisoners, but doing so creates the perceived injustice that those who behave badly are rewarded with free medical care, while those who soldier on working for low pay and resist the temptation to resort to crime are punished by not receiving free care."
(Paris, 2008)
It is an essential point, why should inmates receive free health care when the citizens who are out their “busting their humps,” and obeying the law, must pay high prices for their health care? If we are not to provide the un-incarcerated with health care, then it is certainly an 8th Amendment paradoxical obligation that we are to provide inmates with health care. Many countries around the world provide their citizens with health care, and “The fact that the U.S. lags behind riles a number of people,” writes Paris, “and especially those who understand how universal coverage applies to all U.S. prisoners.” Paris goes on, “This dilemma will persist until health insurance is available to all U.S. residents. Meanwhile, coverage of all U.S. prisoners continues and it is a good thing,” according to Paris (Paris, 2008). Again, the 8th Amendment protects prisoners from cruel and unusual punishment – such harsh punishments that do include the denial of health care while incarcerated. But if the Constitution obligates us to provide free health care to inmates, logic implies that we are also obligated to provide free, law-abiding citizens with such care as well – fairness and justice being applied here.
It is my understanding that Manderfield is currently receiving the care he needs, but this was only a result of his mother going to the media and relentlessly petitioning the system to fulfill its obligation to ensure Manderfield is provided his 8th Amendment protections. Had Manderfield not been given such protections he would have been given a death sentence even before he was ever convicted of the crime for which he is jailed for. The fight that the mother had to endure, although courageous, seems to be unnecessary since the Constitutional protections are very clear. Rabbi Joshua Levine Grater recently wrote on the ethical and moral right that individuals have to proper health care;
"we spend more on healthcare than any other industrialized nation and we are not even in the top 20 of nations in regard to health and mortality rates. We live in the wealthiest nation on Earth — the wealthiest nation in the history of the world — and millions of our citizens can’t see a doctor. 45,000 of us will die each year because of a lack of healthcare. This is a moral outrage, a moral disgrace and a moral ineptitude that is no longer tolerable."
(Grater, 2011)
After studying the case of Manderfield in great detail, I have come to the ethical conclusion that inmates deserve health care – healthcare that can only be provided by the very government that has incarcerated them. In addition, I have expanded my view on universal health care. If inmates deserve government funded health care, then so do us all.
References
Detroit Receiving Hospital (2017). RE: Demetrius Manderfield [Letter to Judge Judith Levy]. Benign Hematology Clinic, Detroit, Michigan . March 16, 2017
Grater, J. (2011) . Healthcare Is a Moral Right . blog . Huffington Post . May 25, 2011 . retrieved from http://www.huffingtonpost.com/rabbi-joshua-levine-grater/healthcare-is-a-moral-rig_b_491869.html
Lange, A. (2017) . Mom: Jailed son with deadly disease isn't being treated . Fox 2 -Detroit . March 20, 2017 . retrieved from http://www.fox2detroit.com/news/local-news/242768465-story
Mankiw, N. (1994) . Macroeconomics . 2nd Ed. New York . Worth Publishers . 1994
Paris, J. (2008) . Why Prisoners Deserve Health Care. American Medical Association Journal of Ethics . Medicine and Society. February 2008, Volume 10(2). pp 113-115. Retrieved from http://journalofethics.ama-assn.org/2008/02/msoc1-0802.html
June 04, 2017
Ask your doctor
by John Rozean
The American profit based health care system appears to be at odds with the philosophical concept of care – which is by definition some sort of balance between the cared for and the caring. Nowhere is this paradox more evident than with the pharmaceutical industry. The industry is obligated to explain the risks of medications and they do so in all of their commercials. We’ve all heard them with the fast-paced voice over that is often heard in the background of smiling, happy actors who have now been bestowed with a tremendous amount of glee– evidently after taking the advertised drug. In addition, these commercials seem to imply that one must just simply inquire with their physician about the proposed drug to get a prescription.
Saturday Night Live recently did a skit where Dwayne Johnson plays an individual with Erectile Dysfunction. “So I asked my doctor about Xentrex,” says Johnson. The doctor replies, “Xentrex! What the hell is Xentrex?” Johnson keeps insisting that the doctor prescribe the medication. The doctor replies, “Are you insane, man? You can’t put that junk in your body. It will kill you. Your heart will stop!” Johnson relies, “just write me a scrip for Xentrex and I will be on my way!”
“You could die!” replies the doctor.
“Yeah, but I still want it though,” says Johnson’s character.
According to Paula Tomkins in, Practicing Communication Ethics, a danger “occurs when caregivers think they understand the needs of the cared for, when they do not” (Tomkins, 2016). But what happens when we as the cared-for; feel we need a certain medication – based upon some sort of pharmaceutical advertisement? Doesn’t another error occur here? – that is the cared-for feel they understand their needs when in fact they do not and are not heeding the advice of our doctors. In these cases, clear communication from doctor to patient is an ethical responsibility from which physicians and other health care workers cannot give into – going to the ethics of integrity.
According to Kant, telling the truth is a universal law and human beings are always obligated to tell the truth in all cases. As I mentioned, the drug commercials are clear about communicating the risks; however, they are not so clear in their delivery as the happy-smiling video playing over the list of risks seems quite pleasant despite the background audio that appears to offer up a tremendous amount of health hazards. Pharmaceutical businesses are bound by a strict code of ethics when pitching their products to physicians (PhRMA, 2017); but this does not stop the industry from plugging their products in a shamelessness fashion to potential patients such as you and I.
While the Rock takes matters into his own hands by body slamming his doctor, this skit can serve as a reminder to patients to be mindful of the risks associated with certain medications – as well as a note to doctors to not give in to the not-so-well-informed cared-for patient.
PhRMA (2017) . Code on Interactions With Health Care Professionals . February 2, 2017 . retrieved from http://www.phrma.org/codes-and-guidelines/code-on-interactions-with-health-care-professionals
Tomkins, P. (2016) . Practicing Communication Ethics . Routledge . New York .2016
Saturday Night Live (2017). Enhancement Drug – SNL . YouTube . May 20, 2017 . retrieved from https://www.youtube.com/watch?v=5IZrYeUX3MI
Ask your doctor Ethics of Pharmaceutical commercials
May 13, 2017
Bad Blood
Labeled as “perhaps the most enduring wound in American health science,” the Tuskegee Study of Untreated Syphilis in the Negro Male has resulted in “ill effects” to “the greater whole of black culture” (Newkirk, 2016).
According to an article in The Atlantic, the scourge of Tuskegee includes a greater belief in medical conspiracies, less trust in the medical system, and less positive medical experiences in African Americans when compared to white ones.
The Atlantic article states that “These have all been connected to misgivings among black patients about Tuskegee and America’s long history of real medical exploitation of black people” (Newkirk, 2016).
A study by Marcella Alsan and Marianne Wanamaker promotes the idea that Tuskegee has reduced life expectancy among black men due to “an erosion of trust in doctors, and dampened health-seeking behavior and health-care utilization” (Newkirk, 2016).
Christened by the United States Public Health Service (USPHS) in 1932, the Tuskegee Study “is the longest nontherapeutic experiment on human beings in medical history” (Heintzelman, 2003).
After a whistle blower leaked the existence of the study to the press in 1972, the department of Health, Education and Welfare finally ended the experiment.
Much has been said about whistle blowing, leaks and fake news. Had it not been for those things the travesty of Tuskegee would have apparently went on much longer.
From the revelation of Tuskegee came the National Research Act, which begat the Belmont Report – from which patients and test subjects have gleaned protections such as informed consent concerning risks, as well as other shields (Health and Human Services, Office of, 2016) from this sort of mockery of health care occurring again.
In our current age where the apparent magic wand of deregulation seems to be tauntingly waved about, Tuskegee is an important lesson in this regard as well.
Undoing certain regulatory actions, along with a tremendous amount of negativity toward whistle blowing, leaks and the free press seem to be the order of the day.
Before we send caution to the wind with deregulation, punish whistle blowers as if they are traitors, and second guess the First Amendment; we should pause and remember the Tuskegee Study of Untreated Syphilis in the Negro Male and the betrayal that that free 40-year reign of governmental power exerted over health care options in an entire county in Alabama, which has sinse spread throughout the entire African American community and beyond.
Health and Human Services, Office of (2016) . The Belmont Report . March 15, 2016 . retrieved from https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html
Heintzelman, C. (2003) . The Tuskegee Syphilis Study and Its Implications for the 21st Century . Fall 2003 . 10(4) . retrieved from http://www.socialworker.com/feature-articles/ethics-articles/The_Tuskegee_Syphilis_Study_and_Its_Implications_for_the_21st_Century/
Newkirk, V. (2016) . A Generation of Bad Blood: New research suggests a strong link between the public revelation of the Tuskegee Study and poor health outcomes for black men. .The Atlantic . June 17, 2016 . retrieved from https://www.theatlantic.com/politics/archive/2016/06/tuskegee-study-medical-distrust-research/487439/
May 03, 2017
Moral Right to not be killed or tortured
Introduction
A tremendous stigma exist when one is imprisoned – convicted or just awaiting trial because you can’t make bail. No matter the case, once you’re behind bars; our society has stigmatized you and has a strong pull to deny your Eighth Amendment rights to remain healthy. In an American Medical Association Journal of Ethics article Dr. Joseph E. Paris makes the case that not only based upon the Constitutional rights of inmates, our society is also ethically and logically obligated to provide health care to inmates (Paris, 2008).
Consider the case of young Demetrius Manderfield, arrested and held in jail for nearly five months without the proper health care he needs for his chronic, life threatening health conditions. On the outside Manderfield would receive blood transfusions every three weeks along with pain management medications (Detroit Receiving Hospital, 2017). Since he was arrested last December, he has been denied that treatment by prison officials and physicians. He was simply given Ibuprofen for his life-threatening pain (Lange, 2017).
Manderfield’s case is not uncommon, according to a Department of Medicine, Cambridge Health Alliance study that states “Among inmates with a persistent medical problem, 13.9% of federal inmates, 20.1% of state inmates, and 68.4% of local jail inmates had received no medical examination since incarceration.” The study’s findings clearly indicate a troublesome conclusion that “Many inmates with a serious chronic physical illness fail to receive care while incarcerated” (Wilper, Woolhandler, Boyd, Lasser, McCormick, Bor, & Himmelstein, 2009).
Dr. Joseph E. Paris: Why Prisoners Deserve Healthcare
Dr. Paris sums of the ethical issues. He writes;
it makes sense from a legal, ethical, social, and public health point of view to provide health care to prisoners, but doing so creates the perceived injustice that those who behave badly are rewarded with free medical care, while those who soldier on working for low pay and resist the temptation to resort to crime are punished by not receiving free care.
(Paris, 2008)
Dr. Paris freely admits that he does not have a “solution to the apparent paradox.” I have mentioned the Eighth Amendment rights against cruel and unusual punishment that Dr. Paris cites. But Dr. Paris also makes the case from an “ethical, social, and public health point of view.” Dr. Paris grants that not all Americans “have the resources” to cover health care cost, but they do have options such as purchasing insurance, paying out of pocket, government assistance, and even free access to emergency services regardless “of a patient's health insurance status or ability to pay.” But he points out that prisoners have none of those choices (Paris, 2008). And what one can conclude from the Cambridge Health Alliance study mentioned earlier (Wilper, Woolhandler, Boyd, Lasser, McCormick, Bor, & Himmelstein, 2009); “many” inmates like Manderfield are left with the options of luck and perhaps divine intervention.
Dr. Paris points to “social reasons too.” Most inmates will get out of prison and will be back in our society. “Proper care helps to preserve their physical function.” If their health deteriorates while they are serving time, when they get out they will become a burden on the health care system. “It is in society's best interest that recently released prisoners be free of disabling diseases.” And from a public health standpoint, percentage-wise, those who have been jailed or imprisoned have a high rate of health care issues. Once again, logic implies that denying them care will only make their health worse, and when they get out that effects all us as our health care system will be further burdened (Paris, 2008).
Moreover, above the Constitution, above the ethical and social codes, and above pure logic; there are moral rights. “The idea that everyone has rights is no surprise to people living in the United States,” said Paula Tomkins in her book Practicing Communication Ethics. “For example” she writes, “there is the moral right to not be killed or tortured.” Manderfield has not even been convicted yet, but he may be getting a death sentence if he is not given the proper care that he needs.
Conclusion
There is a substantial, negative stigma that we as a society associate with those behind bars or who have served sentences. Perhaps it is this stigma that allows the health care provided to them be of such horrible quality. But we should look beyond that. We should look to the Constitution. We should look toward the ethics. We should look toward the societal and public health implications. But above all, we should look to our own morality and the fundamental belief that no one should be killed or tortured by another, especially by a powerful government entity like a prison system.
References
Detroit Receiving Hospital (2017). RE: Demetrius Manderfield [Letter to Judge Judith Levy]. Benign Hematology Clinic, Detroit, Michigan . March 16, 2017
Lange, A. (2017) . Mom: Jailed son with deadly disease isn't being treated . Fox 2 -Detroit . March 20
2017 . retrieved from http://www.fox2detroit.com/news/local-news/242768465-story
Paris, J. (2008) . Why Prisoners Deserve Health Care. American Medical Association Journal of Ethics . Medicine and Society. February 2008, Volume 10(2). pp 113-115. Retrieved from http://journalofethics.ama-assn.org/2008/02/msoc1-0802.html
Wilper, A.; Woolhandler, S.; Boyd, W.; Lasser, K.; McCormick, D.; Bor, D.; & Himmelstein, D. (2009) . The health and health care of US prisoners: results of a nationwide survey. American Journal of Public Health . April 2009 . 99(4) . pp 666-672 . doi: 10.2105/AJPH.2008.144279
January 02, 2017
Message Concepts for campaign to avoid over incarceration of the mentallly ill
Running Head: MESSAGE CONCEPTS AND GUIDLINES
Final Project Milestone 3: Message Concepts Guidelines
By John Rozean
Southern New Hampshire University
COM 575, Graduate studies
December 12, 2016
*Introduction
In the “Goals” Milestone of this Final Project, four major problems were established. This milestone requires that messaging be established for only “the most important audience segment” of my campaign. I choose to focus on major problem #1, which is included below;
*Major Problem #1: trends where those with mental health are incarcerated rather than offered the mental health care they need (MHA, 2016)(James & Glaze, 2016).
Goal #1: Use the criminal justice system to identify and initiate mental health care services for those in need.a. Initiate and design training programs for police and correction officers
b. Initiate campaigns within charity organizations, such as homeless shelters, food banks, etc..
that not only offer information but also encourage enrollment in government health care
programs.
Audience: Those employed within the criminal justice and social work fields….
*Message concepts
--1) There is a “prevalence of mental health problems among prison and jail inmates using selfreported data on recent history and symptoms of mental disorders” (James & Glaze, 2016).
--2) About 1.8 million US jail bookings are of people with serious mental illness (Fuller, 2016).
--3) Seventy percent of jails report “isolating inmates” due to some sort of “serious mental
illness” (Fuller, 2016).
--3) fourteen percent of prisoners have a “major depression or psychosis,” which coincides with
“substance abuse” (Fuller, 2016).
--4) incarceration in the criminal justice system does little for the mentally ill to adjust their antisocial behaviors, in fact it may actually “exacerbate preexisting mental health issues” making
things worse for them and the incarceration burden on society (Villines, 2013).
* Testing of message concepts with audience members
The very idea of a criminal justice system is related to Age of Enlightenment concept of
the social contract, where individuals must “consent” to surrender certain rights in order to reap the benefits of some “authority” that remains intact in order to offer protections against
stakeholders stomping on the freedoms and rights of other stakeholders (Social contract, 2016).
In my opinion, the overall goal of the criminal justice system should be designed to limit the
ways in which certain individuals stomp on the rights of others. I am certain that members of the criminal justice system believe in that concept, as they have sought out their positions as a means for the betterment of the society, and the social contract ideal.
However, mental illness seems to teeter on the realms of the criminal justice system and
the system of health care. Mental illness is perhaps one of the most misunderstood illnesses in
modern society. It has a long history of misunderstandings. The big question involves
criminality, and whether the behaviors of the mentally ill propose a danger to the other
stakeholders of the “social contract,” and should therefore be confined and have their rights
taken way because they endanger the rights of the other stakeholders of the social contract. This I believe is the core to the overincarceration of the mentally ill. Below, I cite a very important concept about the misconceptions about the mentally ill;Are people with mental illness usually dangerous?
No. This false perception underlies some of the most damaging stereotypes.
People with a mental illness are seldom dangerous. Even people with the most
severe mental illness are rarely dangerous when receiving appropriate treatment
and support.
(Health and Human Services, Department of, 2007)
The issue at hand, to me, appears to be one of health literacy. Not literacy in the sense of those who are receiving the health care, but those who are generally given the right to make the health decisions of the ones who need the care – those in the criminal justice system and the social work field. The big questions about implementing a campaign, despite the fact presented so far, is what sort of belief and perceptions exist in those fields.
Parker and Thorson in Health Communication in the New Media Landscape . propose
mechanisms to test health literacy; however, they limit the context to include only “fundamental” health literacy. Yet, they do demonstrate a model of testing to ensure that messaging is accurate and effective dealing with health literacy (Parker & Thorson, 2009).
These things being considered, I proposed the following limited question and answer sequence
that can be used not only as a means to educate, but also as a means to access the thoughts, feelings, designs and perhaps adjustments needed to test the messaging campaign to assist in the better health care offered to the mentally ill.
*Preliminary Message concept questions and answers
Q: Criminals are criminals. Right?
A: The Lakewood Police Department has outlined procedures to help police officers distinguish
from typical criminal behavior and the behavior of the mentally ill, they are included below;
1. Degree of Reactions:
Mentally ill persons may show signs of strong and unrelenting fear of persons,
places or things. For example, the fear of people or crowds may make the
person reclusive or aggressive without apparent provocation.
2. Appropriateness of Behavior:
A person may act extremely inappropriate for a given situation. For example, a
motorist who vents frustration in a traffic jam by physically attacking another
motorist may be mentally ill.
3. Extreme Rigidity or Inflexibility:
Mentally ill persons may be easily frustrated in new or unforeseen circumstances
and may exhibit inappropriate or aggressive behavior.
4. Other Specific Behaviors:
a. Abnormal memory loss such as name, address or phone number.
b. Delusions of Grandeur or Paranoia.
c. Hallucinations of any of the five senses; e.g. hearing voices, feeling one's
skin crawl.
d. Belief that the person is suffering from extraordinary physical illness that
is not possible, such as their heart has stopped beating.
e. Extreme fright or depression.
(Lakewood Police Department, 2016)
Q: what these people need is time in jail and they will change their behavior. Right?
A: Actually, time in jail is likely to make the situation for the mentally ill worse, and the
likelihood of them returning to jail increases without proper care (James & Glaze, 2016).
Q: They make choices just like the rest of us. They are in control of their bad choices. Right?
A: According to Lakewood Police Department doctrine, a mental illness is defined as a
“substantial disorder of the cognitive, volitional or emotional processes that grossly impairs
judgment, or capacity to recognize reality or to control behavior” (Lakewood Police Department,
2016). The important part of that definition is that the health condition itself makes it difficult for these individuals to control their behavior..
Q: These people are criminals. They abuse drugs and alcohol, and deserve to be in jail.
A: while drug abuse may lead to psychotic behavior, it should also be considered that mental
illness can lead to drug abuse (Drug Abuse, 2016). It is not fair to assume criminality over
mental illness, these are the decisions of train psychiatric professionals. Since police departments have mechanisms and policies designed to make this determination, they should be used.
*Conclusion
I envision these questions and concepts being included as part as some sort of training
and/or thought provoking workshop with not only designs to educate the police force on the
current trends, but also as a mechanism for the health care mechanisms to understand the current trends toward incarceration as opposed to treatment. Sessions should be videotaped and documented. The answers proposed are not proposed as absolutes but as a means to further challenge the responses to delve deeper into the problem. These sessions should be accessed to help see the alternative points of views, and so to adjust the campaign and its messaging. Those sessions could also serve as a training mechanism which is in accordance with the #1major goal assigned in this treatise, yet they can also serve as a mechanism in which to better message and accommodate the campaign to the issues where the campaign falls short.
References
Drug Abuse, National Institute on (2016) . Comorbidity: Addiction and Other Mental Illnesses .
retrieved from https://www.drugabuse.gov/publications/research-reports/comorbidityaddiction-other-mental-illnesses/why-do-drug-use-disorders-often-co-occur-other-men
Fuller, D.(2016) . Mental Illness Behind Bars – We Know, What We Don't . Treatment
Advocacy Center. July 19, 2016 . retrieved from
http://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/3589
James, D. J. & Glaze, Lauren E. (2016) Mental Health Problems Of Prison And Jail Inmates .
Bureau of Justice Statistics. September 6, 2006 . retrieved from
http://www.bjs.gov/index.cfm?ty=pbdetail&iid=789
Lakewood Police Department (2016) . 4830 Mental Health Emergency . Lakewood Police Policies
and Procedures Manual . retrieved from
http://www.lakewood.org/Police/About_Us/Policies_and_Procedures.aspx
MHA (Mental Health America) (2016). Policy . retrieved Nov. 14, 2016 from
http://www.mentalhealthamerica.net
NIH (National Institute of Health) (2016) . About . retrieved November 14, 2016 from
https://www.nih.gov/health-information.
Parker, J. & Thorson, E. (2009) . Health Communication in the New Media Landscape . Springer
Publishing Company . New York . 2009
Social contract (2016) . Wipedia . 1 December 2016 . retrieved from
https://en.wikipedia.org/wiki/Social_contract
Villines, Zawn (2013) . The Effects of Incarceration on Mental Health . goodtherapy.org . March
15, 2013 . retrieved from http://www.goodtherapy.org/blog/prison-incarceration-effectsmental-health-0315137
Health and Human Services, Department of (2007) . Myths, misunderstandings and facts about mental
illness . May 2007 . retrieved from
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-w-whatmentoc~mental-pubs-w-whatmen-myth
October 31, 2016
Two key factors for keeping health care an open system: Humility and Patient Portals
While the challenges faced by the health care industry appear to be numbersome and complicated, the area of refining the feedback mechanisms provides a great opportunity for success for the field, especially with the Web 2.0 advent of patient portals and a push for more humility from its practitioners.