#physicians for a national health program

[wat3rm370n]

Value-based care is a red flag that a healthcare CEO was not thinking things through.

Everyone else notices how this “value-based care” idea will lead to grotesquely perverse incentives, right? Physicians for a National Health Program at least recognized the problem.

People - Wife of Murdered UnitedHealth CEO Brian Thompson Says He Received Threats and She's 'Trying to Console' Their Children - the wife of slain CEO Brian Thompson, said her husband did not alter his travel plans in spite of the threats. By Liam Quinn Published on December 4, 2024, 12:38 PM EST. Part of the text is highlighted with a marker, the part highlighted is “did not alter his travel plans in spite of the threats”.

I’m sorry if this seems like victim blaming, but I do think this demonstrates that people who become CEOs of giant healthcare corporations should definitely not be assumed to be particularly clever or insightful, I also think they shouldn’t be trusted with responses to disasters or “innovations” to any systems for that matter. It does seem like common sense that the CEO of a health insurance company that spends all its time and resources to avoid paying for people’s healthcare should’ve shown a little less hubris. (Of course elites always panic about the wrong things, even if it hurts their own interests, this is a known pattern.) I would’ve assumed that a person in that situation would be aware that the company is likely on the shitlist of any number of wronged and angry patients. But wait, there’s more - while some major media outlets have repeated the idea that this guy kept a “low profile” (do better, AP and PBS!), in fact in a newsletter from Payday Report, Mike Elk reported that this guy was being sued by Hollywood Firefighters union, saying “The union sued Thompson for failing to reveal that United Healthcare was under DOJ investigation. As a result, the pension fund lost $25 billion in value. Meanwhile, Thompson had cashed out over $15 million in stock while selling the stock to pension funds like those of the Hollywood Firefighters union.” and pointing to Ken Klippenstein’s report. So the list of people with axes to grind is numerous. Not what I’d describe as a low profile, but whatever.

The lack of judgement that stood out to me though was in another article which mentioned that: “At an investor meeting last year, he outlined UnitedHealth's shift to "value-based care," paying doctors and other caregivers to keep patients healthy, rather than focusing on treating them when they get sick.”

Who is Brian Thompson, the UnitedHealthcare CEO shot dead in Manhattan? By Megan Cerullo Edited By Anne Marie Lee Updated on: December 4, 2024 / 8:22 PM EST / CBS News For a top executive at a $562 billion company that affects how millions of Americans get health care, Thompson kept a relatively low profile. At an investor meeting last year, he outlined UnitedHealth's shift to "value-based care," paying doctors and other caregivers to keep patients healthy, rather than focusing on treating them when they get sick.

This “value based care” sounds quite obviously like a recipe to get doctors to fail to notice or even note any signs of serious disease. It sounds like an incentive to not document anything well, and to deliberately not notice any problems. Instead of being paid to cure and treat illness and relieve suffering, they would be incentivized to have patients with no sickness documented. Just sweep it under the rug! And if the patient dies, so be it because then they’re not a patient anymore and not covered by health insurance anymore, so they wouldn’t count in the metrics. And try to recruit mostly healthy people into your patient pools, and avoid taking on patients with chronic illness or any serious condition. Similar to the madness of “high risk pools” in privatized insurance. And already we have this problem with networks where some providers that are in-network are begrudging about it, and have their clerical staff make it as hard as possible to make an appointment if they have the “undesirable” insurance. I can’t prove this happens but it sure seems like it does since I’m not the only person who’s talked about running into this type of treatment and runaround when a specialist seems like they don’t want you as a patient even though they’re accepting new patients and supposedly are in-network.

Obviously an optimistic person might think that there would be an incentive just because not all patients die outright, and surely to mitigate downturns would be desirable. But that’s where loss aversion comes in, and also that market incentives are known for absolutely stinking at long-term goals, seemingly always favoring the short term. Andt if the patient takes a huge downturn and becomes disabled because of a preventable condition doctors failed to document, report, or treat, the patient will likely be shoved off the private healthcare insurance when they lose their job, and into Medicaid and maybe eventually Medicare, so then, again, not the problem of the private health insurance company. It’s all about socializing the losses and privatized profits.

I was astonished that this concept could be taken seriously given this glaringly obvious flaw. It’s so obvious that this would NOT be an improvement. Especially in the system we have that’s rife with perverse incentives already. I was relieved to find that Physicians for a National Health Program recognize the problem, and that there’s a published article from 2016 on the “countervailing incentives” and behavioral economics involved, and it articulates how the cognitive bias of loss aversion works so that people are more motivated to avoid loss than to seek gain. They didn’t articulate the gruesome corruption that I just envisioned. But anyone who’s worked in or adjacent to any kind of healthcare or health insurance in the trenches will know how the violence of the system plays out. It’s quite obvious this scheme would benefit the most lurid and ruthless of healthcare providers, and it would force even decent caring doctors into morally injurious situations as they would be pressured by employers to hide disease more than to prevent it or maintain health in patients. We already see how this works in these bureaucracies. If they’re looking for a solution to “upcoding”, which is a legitimate problem in the current payment system, then I suggest better oversight by patient advocacy oriented regulation makes sense. There’s no market solution here that would “naturally” benefit patients with the “invisible hand” they set up.

We need not just to let go of that idea, but to call it out, and reject it outright.

Lawsuit Against Murdered CEO - Firefighters pension accused UnitedHealthcare CEO of fraud, insider trading Ken Klippenstein Dec 04, 2024 In May, the Hollywood Firefighters’ Pension Fund had filed a lawsuit against Thompson, alleging he had sold over $15 million of UnitedHealth stock despite being aware of an active Justice Department antitrust investigation into the health insurance company that he did not disclose to investors or the public. Though UnitedHealth, the lawsuit alleges, was aware of the Justice Department investigation since at least October 2023, the public would only learn of the case when the Wall Street Journal published a story about it on February 27, 2024. When news of the investigation broke, it erased almost $25 billion in shareholder value. But by that time, Thompson had already cashed out, selling over $15 million in personally held UnitedHealth shares, per the suit. If true, the account affirms the countless internet memes’ depiction of Thompson as a rapacious health insurance executive fat cat. Literally none of the news media coverage I’ve seen about the murder has included this context, instead tugging at heart strings about the two sons he’ll be leaving behind. Members of Congress have likewise issued anguished statements about the tragic loss of life, remarks that decline to mention the allegations against him or the vast sums of money the company he oversaw has contributed to them and other politicians.

Behavioral economics and countervailing incentives in value-based payment - By Daniel R. Arnold Healthcare, May 17, 2016 But there is mounting evidence that extrinsic rewards can undermine intrinsic motivation. Of the numerous findings that relate to the crowd-out of intrinsic motivation, two seem particularly relevant to physicians: (1) negative effects of monetary rewards are strongest for complex cognitive tasks and (2) motivational crowd-out spreads to work that is not directly incentivized. With respect to complex cognitive tasks, even very large financial incentives undermine performance. For example, rural villagers in India offered half their annual money income experienced worsened performance on complex memory and puzzle-solving tasks. The spread of motivational crowd-out to work not directly incentivized has been observed in England. In 2004, the U.K. government introduced a pay-for-performance scheme with 136 indicators for family practices. By 2007, improvement for incentivized measures had plateaued, and quality deteriorated for two measures that were not incentivized.

PBS - Hacking Your Mind - Weapons of Influence Episode 102 | Marketers and politicians hack into your autopilot system — learn how to fight back. Aired 08/05/2020 | Expired 09/10/2024 | (transcript) One of the field's key insights is that gut feelings like loss aversion lead consumers to make predictable mistakes, and companies in a market economy make a lot of money by encouraging us to make those mistakes. Until then, the widely accepted view had been that markets actually protect consumers from their mistakes. “And so I would often hear something like the following -- "Yes, yes. I understand that the people in your experiments and some of the people I know do foolish things, but in markets, then -- and then I claim..." They could never quite finish this sentence without literally waving their hands, and the argument is somehow if you choose the wrong career or fail to save for retirement, that the market will somehow push you back toward being rational. There's a reason why no one can make this argument without waving their hands, and that's because the argument is just silly. You know, if you don't save enough for retirement, what happens to you? You're poor when you're old. The market doesn't discipline you. Suppose people have a weakness for gambling. What's going to happen? Will people build casinos, or will they offer programs to help people curb their gambling addiction? Well, people have made a lot more money on casinos than on programs to stop gambling.”

[sayruq]

Medical complicity in torture occurs in a number of ways. As explicated in Addameer’s 2020 comprehensive study, Cell 26, prior to the start of a detainee’s interrogation, Israeli physicians collaborate with Shin Bet interrogators to “certify” or approve that they are “fit” to undergo torture. Throughout the duration of interrogation, a physician provides a “green light” that torture can continue. But the enabling of torture extends beyond a superficial “health check.” In their examinations, healthcare professionals look for physical and psychological weaknesses to exploit in a person. These weaknesses are actively shared with interrogators to help them break a prisoner’s spiritIsraeli doctors also conceal injuries they observe during torture. Instead of fulfilling their ethical responsibilities to report abuse, physicians falsify or refrain from documenting the physical and psychological effects of torture on a detainee’s body and mind — depriving victims of using potential evidence against their torturers. Medical complicity in torture extends further beyond individual physicians to the entirety of the Israeli medical system. Palestinian detainees recount that interrogators are trained in methods of abuse that are designed to inflict maximum harm. This knowledge is not innate; rather, according to Cell 26 medical research is shared with Israeli occupation interrogators to arm them with specific techniques and programs of torture intended to cause extreme suffering to Palestinian detainees while leaving minimal physical evidence. Since October 7, investigations and testimonies from survivors of torture, advocates, human rights organizations, and even some Israeli whistleblowers have confirmed that the involvement of Israeli physicians in torture is still ongoing. On April 16, an appalling report by the United Nations Relief and Works Agency on the torture of Gazan detainees stated that when attempting to receive medical assistance to treat injuries caused by torture, Palestinian prisoners were instead beaten more by prison doctors.

[reasonsforhope]

"Growing up, Mackenzee Thompson always wanted a deeper connection with her tribe and culture.

The 26-year-old member of the Choctaw Nation said she grew up outside of her tribe’s reservation and wasn’t sure what her place within the Indigenous community would be.

Through a first-of-its-kind program, Thompson said she’s now figured out how she can best serve her people — as a doctor.

Thompson is graduating as part of the inaugural class from Oklahoma State University’s College of Osteopathic Medicine at the Cherokee Nation. It’s the first physician training program on a Native American reservation and in affiliation with a tribal government, according to school and tribal officials.

“I couldn’t even have dreamed this up,” she said. “To be able to serve my people and learn more about my culture is so exciting. I have learned so much already.”

Thompson is one of nine Native graduates, who make up more than 20 percent of the class of 46 students, said Dr. Natasha Bray, the school’s dean. There are an additional 15 Native students graduating from the school’s Tulsa campus.

The OSU-COM graduates include students from 14 different tribes, including Cherokee, Choctaw, Muscogee, Seminole, Chickasaw, Alaska Native, Caddo, and Osage.

Bray said OSU partnered with the Cherokee Nation to open the school in 2020 to help erase the shortage of Indigenous doctors nationwide. There are about 841,000 active physicians practicing in the United States. Of those, nearly 2,500 — or 0.3 percent — are Native American, according to the Association of American Medical Colleges.

When American Indian and Alaska Native people visit Indian Health Service clinics, there aren’t enough doctors or nurses to provide “quality and timely health care,” according to a 2018 report from the Government Accountability Office. On average, a quarter of IHS provider positions — from physicians to nurses and other care positions –are vacant.

“These students here are going to make a generational impact,” Cherokee Nation Principal Chief Chuck Hoskin Jr. told the students days before graduation. “There is such a need in this state and in this region for physicians and this school was created out of a concern about the pipeline of doctors into our health system.”

The Cherokee Nation spent $40 million to build the college in its capital of Tahlequah. The walls of the campus feature artifacts of Cherokee culture as well as paintings to remember important figures from Cherokee history. An oath of commitment on the wall is written in both English and Cherokee.

The physician training program was launched in the first year of the pandemic.

Bray said OSU and Cherokee leadership felt it was important to have the school in the heart of the Cherokee Nation, home to more than 141,000 people, because students would be able to get experience treating Indigenous patients. In Tahlequah, students live and study in a small town about an hour east of Tulsa with a population of less than 24,000 people.

“While many students learn about the problems facing these rural communities,” Bray said. “Our students are getting to see them firsthand and learn from those experiences.”

While students from the college are free to choose where to complete their residency after graduation, an emphasis is placed on serving rural and Indigenous areas of the country.

There’s also a severe lack of physicians in rural America, a shortage that existed before the COVID-19 pandemic. The Association of American Medical Colleges has projected that rural counties could see a shortage between 37,800 and 124,000 physicians by 2034. An additional 180,000 doctors would be needed in rural counties and other underserved populations to make up the difference.

Bray said OSU saw an opportunity to not only help correct the underrepresentation of Native physicians but also fill a workforce need to help serve and improve health care outcomes in rural populations.

“We knew we’d need to identify students who had a desire to serve these communities and also stay in these communities,” she said.

Osteopathic doctors, or DOs, have the same qualifications and training as allopathic doctors, or MDs, but the two types of doctors attend different schools. While MDs learn from traditional programs, DOs take on additional training at osteopathic schools that focus on holistic medicine, like how to reduce patient discomfort by physically manipulating muscles and bones. DOs are more likely to work in primary care and rural areas to help combat the health care shortages in those areas.

As part of the curriculum, the school invited Native elders and healers to help teach students about Indigenous science and practices...

Thompson said she was able to bring those experiences into her appointments. Instead of asking only standard doctor questions, she’s been getting curious and asking about her patient’s diets, and if they are taking any natural remedies.

“It’s our mission to be as culturally competent as we can,” she said. “Learning this is making me not only a better doctor but helping patients trust me more.”

-via PBS NewsHour, May 23, 2024

[vague-humanoid]

Evidence from over the past 30 years proves that Israeli physicians routinely fail to uphold these ethical obligations and operate in violation of international law. As detailed in reports by Human Rights Watch, Amnesty International, Physicians for Human Rights-Israel, and many, many others, Israeli medical involvement in torture is systematic — and in fact integral to Israel’s torture regime.

Medical complicity in torture occurs in a number of ways. As explicated in Addameer’s 2020 comprehensive study, Cell 26, prior to the start of a detainee’s interrogation, Israeli physicians collaborate with Shin Bet interrogators to “certify” or approve that they are “fit” to undergo torture. Throughout the duration of interrogation, a physician provides a “green light” that torture can continue. 

But the enabling of torture extends beyond a superficial “health check.” In their examinations, healthcare professionals look for physical and psychological weaknesses to exploit in a person. These weaknesses are actively shared with interrogators to help them break a prisoner’s spirit. 

Israeli doctors also conceal injuries they observe during torture. Instead of fulfilling their ethical responsibilities to report abuse, physicians falsify or refrain from documenting the physical and psychological effects of torture on a detainee’s body and mind — depriving victims of using potential evidence against their torturers.

Medical complicity in torture extends further beyond individual physicians to the entirety of the Israeli medical system. Palestinian detainees recount that interrogators are trained in methods of abuse that are designed to inflict maximum harm. This knowledge is not innate; rather, according to Cell 26 medical research is shared with Israeli occupation interrogators to arm them with specific techniques and programs of torture intended to cause extreme suffering to Palestinian detainees while leaving minimal physical evidence.

Since October 7, investigations and testimonies from survivors of torture, advocates, human rights organizations, and even some Israeli whistleblowers have confirmed that the involvement of Israeli physicians in torture is still ongoing. On April 16, an appalling report by the United Nations Relief and Works Agency on the torture of Gazan detainees stated that when attempting to receive medical assistance to treat injuries caused by torture, Palestinian prisoners were instead beaten more by prison doctors. 

[morlock-holmes]

We are now, what, two three years into the Adderall shortage, and I have been informed by my pharmacy that their next order will arrive during a weekday in November.

Yes, that is how specific the information is.

The amount they will get in November will almost certainly not fill all extant prescriptions, so it will be distributed to whoever calls in and asks for the prescription to be filled on that day.

There is no automated method for informing customers whether the pharmacy has received a shipment, you must call and speak to a pharmacy representative.

This is a very small version of what I assume it must have been like to live in the Soviet Union: Every single decision maker insisting that they are actually operating at 110% efficiency and there are no further improvements that could be made, while meanwhile shortages drag on for literal years and everything grinds to a halt in a bureaucratic mire.

Like, the fact that the way to fix this is to literally call the pharmacy every day and talk to a person means that all of the pharmacists are wasting a tremendous amount of time for, and I cannot stress this enough, literally no reason whatsoever except sheer laziness and apathy on the part of Albertsons management.

In other news, you may remember that after calling four different "Health Homes" that my insurance accepts as PCPs, I got an appointment for 9:40 AM on Christmas Eve. Luckily, they have a telehealth program called "Bridges" which allows you to speak to an RN to get basic health care while you are waiting out the effects of the national Physician shortage that all of our politicians are pretending doesn't exist for some reason.

As best as I can tell, my insurance rejected the claim from the bridges team because they want me to use my Health Home. The one I don't have because they don't have any openings. The one that the bridges team is supposed to cover for until you get establishing care.

I wonder if the people who do health insurance claims ever wonder how many suicides they've caused when they go to bed at night.

[lotus-tower]

For those who don't know, there's going to be a demonstration for Long Covid on March 15, which is Long Covid Awareness Day since 2023. You can find the LCDC website here.

Their stated goals:

1. Declare Long Covid a National Emergency. 2.  Implement Emergency Use Authorization for drug repurposing and trials. 3.  Establish annual funding for Long Covid programs and research to find a cure. 4.  Ensure racial and gender health equity in research, access to clinical trials, antiviral drug repurposing, preventative measures, educational campaigns, and social services.  5. Enact Clean Indoor Air Laws to prevent SARS-CoV-2 forward transmission in public spaces and forced-congregant settings. 6. Implement respirator use and clean air protections in healthcare facilities. Additionally, devise strategies to ensure immunocompromised patients or those with Long Covid are given reasonable accommodations and are not penalized. Enforce protected class status for people with Long Covid as disabled. 7.  Fast-track compassionate allowance and sufficient social support for people with Long Covid in addition to increased funding for Home and Community Based Services.  8.  Develop guidelines for physicians on Long Covid and continuing education on breaking research. 9.  Acknowledge that Long Covid affects children and implement specialized care immediately. 10. Public tracking of SARS-CoV-2 in wastewater at Publicly Owned Treatment Works and provide affordable PCR testing nationwide.  11. Establish regular White House press communication regarding progress toward stated goals and real time data for Covid transmission awareness.

There's a gofundme here to raise funds for a stage, sound equipment, respirators, and multimedia equipment in order to stream the event to those who can't physically attend. If you can spare a few bucks I encourage you to donate. Any leftover funds will go to Long Covid research.

If you have Long Covid or know someone who does, LCDC is also looking for stories/personal accounts for their media projects.

[beardedmrbean]

Sen. Elizabeth Warren, D-Mass., "is at long last acknowledging that ObamaCare has increased healthcare prices" and created other unintentional consequences, the Wall Street Journal editorial board wrote Friday.

Warren, who has long supported the Affordable Care Act, the official name for ObamaCare, has recently come to an "epiphany" about "industry consolidation and price increases caused by the healthcare law," per The Journal.

A letter to the Health and Human Services Department inspector general was aimed at determining if "vertically-integrated health care companies are hiking prescription drug costs" and are "evading federal regulations."

In a bipartisan letter, she and Sen. Mike Braun, R-Ind., complained "that the nation’s largest health insurers are dodging ObamaCare’s medical loss ratio (MLR)," according to The Journal. 

As Warren describes in the letter, health insurers have exploited the situation, making for "sky-high prescription drug costs and excessive corporate profits."

"In functioning markets, generic drugs cost 80 to 85 percent less than their name-brand equivalents, giving patients much-needed relief from high drug costs and saving taxpayer dollars," Warren wrote. "But patients – including patients in public health care programs like Medicare and Medicaid – who either use or are compelled to use vertically integrated specialty pharmacies are not seeing this relief."

The senators continued: "By owning every link in the chain, a conglomerate like UnitedHealth Group – which includes an insurer, a PBM, a pharmacy, and physician practices – can send inflated medical payments to its pharmacy. Then, by realizing those payments on the pharmacy side – the side that charges for care – rather than the insurance side, the insurance line of business appears to be in compliance with MLR requirements, while keeping more money for itself." 

The Journal explained that despite Democrats arguing that the MLR would help patients, "the rule has spurred insurers to merge with or acquire pharmacy benefit managers (PBMs), retail and specialty pharmacies, and healthcare providers." 

"This has made healthcare spending less transparent since insurers can shift profits to their affiliates by increasing reimbursements," the board wrote. 

Warren has voted against ObamaCare repeal efforts over the years but also pushed for a "Medicare for All" proposal when she ran for president in 2020.

Warren's office and HHS did not immediately respond to a request for comment from Fox News Digital. 

[lechusza]

This is not make-believe

A wonderful wizard of health? President-elect Trump's selection of Mehmet Oz, or Dr. Oz., to run CMS puts a celebrity physician with no prior experience in government in line to run the nation's biggest health insurance programs. Oz is a household name with a medical degree, a Wharton MBA and Trump's seal of approval. But he has a history of blending mainstream ideas for improving American health with misinformation. #droz #health #trump #politics #news

[houseofpurplestars]

From Tarek Loubani (@ trklou):

"I want to tell you about Hani, an incredible person and doctor. He was killed with his wife, Dr. Samira Al-Ghefari and their five children, Sherin, Thea (Tota), Sara, Samir, and Wafaa.

Hani just turned 41 years old when he was killed and only a few years into his career as an emergency doctor. He boarded in 2019 and became head of Shifa's ER a few weeks before COVID hit. He met the challenge, helping reconfigure the department for the pandemic.

Hani was a talented Emergency Physician, but Emergency was his second career. Hani was first an accomplished neurosurgeon. In 2009, he was part of the first team to remove a brain tumour in Gaza. This remarkable feat allowed patients to be treated under blockade in Gaza.

These weren't just lifesaving surgeries, but also quality of life ones like spinal canal widening. When I met Hani in 2011, I just turned thirty and he was about to. I was beginning my career and he already got bored with his. We served in the ER during the 2012 war together.

He felt he could make a bigger impact in the ER, especially during wars. He joined the board program, and for four years after, he was one of our students. It was obvious he should become the new chief of Shifa's emergency department, a job we had to convince him to take.

In 2021, he led the department through a war. Over the past two months, he served fearlessly, among the last doctors out of Shifa as Israel besieged it. He miraculously escaped arrest as he left, which may be why he was assassinated with his family.

His wife, Dr. Samira Al-Ghefari, was an accomplished doctor in her own right. While raising five children, she got a Master's degree in 2019. She cared deeply about women's health and primary care. I didn't know her well, but I knew enough to be in awe.

His children were killed with him, beautiful and vibrant balls of energy who I only met briefly during visits to Hani's home to talk shop. Samir celebrated his 7th birthday on Nov 14th, hungry and afraid as Israel's bombs fell, not knowing if he would ever see his father again.

In 2020, Hani wrote, "We belong to our nation. In it we'll stay. We were born here; raised here; were students and spent our nights studying here. We worked here. We had a duty, and we honoured it. This nation is carried forward through selfless sacrifice, toil, and perseverance."

Rest in Peace, Hani"

[tscnews]

TSC News TV host Fred Richani interviews Saving AlGeneina Initiative manager Sadeia Hamid about her grassroots organization helping Sudanese refugees and internally displaced peoples within Sudan and Chad, the Sudanese crisis encompassing war, genocide, famine, and occupation, the instability before/during/after former President Omar al-Bashir, as well as how YOU can help donate volunteer for this amazing cause.

 ✅Donation: https://linktr.ee/SavingAlGeneina

✅Donate via PayPal: https://www.paypal.com/paypalme/SadeiaAli

✅Saving AlGeneina IG: https://www.instagram.com/saving.algeneina

✅TikTok: https://www.tiktok.com/@savingalgeneina

✅Twitter/X: https://x.com/sadiea8

00:00 Introducing Sadeia Hamid and Saving AlGeneina Initiative

03:48 Sudan's instability, war since 2023

05:24 Evacuating Sudanese refugees, Chadian border, displacement

06:35 Sudan under illegal occupation, massacres

08:03 Sudanese famine, plagues

10:15 United Nations not helping Sudan, Doctors Without Borders

13:56 Sudan has no real government, shady nonprofit organizations

14:56 Saving AlGeneina's initiatives - medical clinics, food, sports

15:35 Partnering with Sudanese American Physicians Association, famine

17:24 Saving AlGeneina Initiative's sports programs for children, mental health

19:00 Sadeia Hamid on building mobile medical clinic for Sudanese refugees

20:38 Sudanese children's trauma, lack of schools, education

22:36 Challenges with getting aid into Sudan

23:41 Difficulty registering Saving AlGeneina Initiative in Sudan

25:34 Don't turn your back on Sudan, Keep Eyes on Sudan

26:25 Donate and volunteer to Saving AlGeneina Initiative

[justinspoliticalcorner]

Orion Rummler at The 19th:

WILMINGTON — Sarah McBride won Delaware’s at-large U.S. House seat on Tuesday, Decision Desk HQ projects. She campaigned on expanding Delawareans’ access to health care — an effort on which she has focused her career in the state’s 1st Senate district. In January, McBride will be sworn in as the first out transgender member of Congress. 

McBride’s ascension marks yet another milestone for the millennial state legislator. As the country’s first out transgender state senator, the first transgender person to speak at the Democratic National Convention and the first out trans woman to intern at the White House, McBride has repeatedly broken barriers in politics and proven that voters are ready to elect transgender candidates into elected office.   Although McBride didn’t run for Congress to make history, the significance of her campaign for transgender Americans during a time of intense political backlash has propelled a national following behind her. That includes Daisy Hollman and Jimmy Fitzpatrick, two Californians who knocked on hundreds of doors for McBride across Delaware the week before Election Day. 

[...] This election for Delaware’s seat in the House of Representatives had no incumbent for the first time in years, as U.S. Rep. Lisa Blunt Rochester stepped down to run for Delaware’s open Senate seat. McBride was projected to be the winner early on; she had robust fundraising and amassed key endorsements from state political leaders, including Blunt Rochester. Democrats have held Delaware’s at-large House seat for over a decade.  On the campaign trail, McBride called for increased federal investments to support nurses, primary care physicians and independent health care clinics in Delaware. She touted her accomplishments as a state senator, including the passage of a statewide paid family and medical leave insurance program and a recently signed law that is expected to generate more than $100 million in new Medicaid funding for Delaware. 

She faced a Republican opponent who endorsed transphobic policies. John Whalen III, a retired police officer, staked his campaign on cutting federal spending and restricting immigration. He also publicly endorsed Project 2025, the conservative Heritage Foundation’s blueprint for a second Trump administration. The plan equates the act of being transgender — or “transgender ideology” — to pornography. 

Rep.-elect Sarah McBride (D) made herstory by being the first trans person to be elected to Congress by winning the DE-AL seat.

[misfitwashere]

If You Don't Know Medicare Advantage Is a Scam, You're Not Paying Attention

We’re on the edge of the open enrollment period for Medicare, and the Advantage scammers will be carpet-bombing America with advertisements over the next few months. Don't be fooled about what it is—and who is profiting.

Thom Hartmann

Oct 07, 2023

Common Dreams

President George W. Bush and Republicans (and a handful of on-the-take Democrats) in Congress created the Medicare Advantage scam in 2003 as a way of routing hundreds of billions of taxpayer dollars into the pockets of for-profit insurance companies.

Those companies, and their executives, then recycle some of that profit back into politicians’ pockets via the Citizens United legalized bribery loophole created by five corrupt Republicans on the Supreme Court.

Just the overcharges happening right now in that scam are costing Americans over $140 billion a year: more than the entire budget for the Medicare Part B or Part D programs. These ripoffs — that our federal government seems to have no interest in stopping — are draining the Medicare trust fund while ensnaring gullible seniors in private insurance programs where they’re often denied life-saving care.

Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.

As a result, Medicare Advantage programs make the greatest profits for their CEOs and shareholders when they actively refuse to pay for care, something that happens frequently. It’s a safe bet that nearly 100 percent of the people who sign up for Advantage programs don’t know this and don’t have any idea how badly screwed they could be if they get seriously ill.

Not only that, when people do figure out they’ve been duped and try to get back on real Medicare, the same insurance companies often punish them by refusing to write Medigap plans (that fill in the 20% hole in real Medicare). They can’t do that when you first sign up when you turn 65, but if you “leave” real Medicare for privatized Medicare Advantage, it can be damn hard to get back on it.

The doctors’ group Physicians for a National Health Program (PNHP) just published a shocking report on the extent of the Medicare Advantage ripoffs — both to individual customers and to Medicare itself — that every American should know about.

The report, titled Our Payments, Their Profits, opens with this shocking exposé:

“By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these — or other crucial aspects of Medicare and Medicaid — could be funded entirely by eliminating overcharges in the Medicare Advantage program. “Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the fee-for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (generally a commercial insurer) to ‘manage’ patient care.”

With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment they’ve made if they sniff out a fraud.

With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.

Whatever you decide on regarding treatment, many Advantage insurance company will regularly second-guess and do everything they can to intimidate you into paying yourself out-of-pocket. Often, they simply refuse payment and wait for you to file a complaint against them; for people seriously ill the cumbersome “appeals” process is often more than they can handle.

As a result, hospitals and doctor groups across the nation are beginning to refuse to take Medicare Advantage patients. California-based Scripps Health, for example, cares for around 30,000 people on Medicare Advantage and recently notified all of them that Scripps will no longer offer medical services to them unless they pay out-of-pocket or revert back to real Medicare.

They made this decision because over $75 million worth of services and procedures their physicians had recommended to their patients were turned down by Medicare Advantage insurance companies. In many cases, Scripps had already provided the care and is now stuck with the bills that the Advantage companies refuse to pay.

Scripps CEO Chris Van Gorder told MedPage Today:

“We are a patient care organization and not a patient denial organization and, in many ways, the model of managed care has always been about denying or delaying care – at least economically. That is why denials, [prior] authorizations and administrative processes have become a very big issue for physicians and hospitals...”

Similarly, the Mayo Clinic has warned its customers in Florida and Arizona that they won’t accept Medicare Advantage any more, either. Increasing numbers of physician groups and hospitals are simply over being ripped off by Advantage insurance companies.

Not only is the Medicare Advantage scam a screw job for healthcare providers and people who are on the programs and are unfortunate enough to get sick, it’s also preventing Americans from getting expanded benefits from real Medicare.

As the PNHP report notes, for real Medicare to provide comprehensive vision, dental, and hearing benefits to all Medicare recipients would cost the system around $84 billion a year, according to the Congressional Budget Office.

Instead, though, the Medicare system is burdened with at least that amount of money in over-payments to Medicare Advantage providers — over-payments that have no health benefit whatsoever and merely inflate the companies’ profits.

A hundred billion dollars in excess profits can be put to a lot of uses, and the health insurance industry is quite good at it. The former CEO of UnitedHealth, “Dollar” Bill McGuire, for example, made off with over $1.5 billion dollars for his efforts.

And, because five corrupt Republicans on the Supreme Court legalized political bribery with their Citizens United decision, some of these companies allocate millions every year (a mere drop in the bucket) to pay off loyal members of Congress and to dangle high-paying future jobs to high-level employees of CMS who have the power to keep the gravy train going and thwart prosecutions.

As PNHP noted:

“Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American health care, siphoning money from vulnerable patients while delaying and denying necessary and often life-saving treatment. While there is obvious reason to fix these issues in MA and to expand Traditional Medicare for the sake of all beneficiaries, the deep structural problems with our health care system will only be fixed when we achieve improved Medicare for All.”

We’re on the edge of the open enrollment period for Medicare, and the Advantage scammers will be carpet-bombing America with advertisements over the next few months. Representatives Pocan, Khanna, and Schakowsky have introduced the “Save Medicare Act” that would ban Advantage companies from using the word Medicare in their advertising.

They made a video about it that’s well worth sharing with friends and family:

As Schakowsky, Khanna, and Pocan note, “Only Medicare is Medicare.” Don’t be fooled by the Medicare Advantage scam.

And now that you know, pass it on and save somebody else’s health!

[longliveblackness]

Tuskegee Syphilis Experiment

Acting on the presumption that rural southern blacks were generally more promiscuous and syphilitic than whites, and without sufficient funding to establish an effective treatment program for them, doctors working with the Public Health Service (PHS) commenced a multi-year experiment in 1932.

Their actions deprived 400 largely uneducated and poor African Americans in Tuskegee, Alabama of proper and reasonable treatment for syphilis, a disease whose symptoms could easily have been relieved with the application of penicillin which became available in the 1940s.

Patients were not told they had syphilis nor were they provided sufficient medication to cure them. More than 100 men died due to lack of treatment while others suffered insanity, blindness and chronic maladies related to the disease.

The original experiment took on a life of its own as physicians, intrigued by the prospect of gathering scientific data, ignored human rights and ethical considerations and managed to extend it until 1972 when a PHS researcher Peter Buxtun revealed its history to the press. Public exposure embarrassed the scientific community and the government and the experiment was quickly shut down.

Attorney Fred Gray initiated a lawsuit on behalf of the patients. In an out-of-court settlement each surviving patient received medical treatment and $40,000 in compensation.

In the wake of the scandal Congress passed the National Research Act of 1974 which required more stringent oversight of studies employing human subjects.

In 1997, on behalf of the federal government, President Bill Clinton issued a formal apology to the victims of the Tuskegee Syphilis Experiment.

•••

Experimento de Tuskegee (Sífilis)

Actuando bajo la presunción de que los negros en las áreas rurales del sur eran generalmente mas promiscuos y sifilíticos que los blancos, y sin tener los fondos suficientes para establecer un programa de tratamiento efectivo, los doctores que trabajaban para el Servicio de Salud Publica comenzaron un experimento que duró varios años en el año 1932.

Sus acciones privaron a cuatrocientos afroamericanos de un tratamiento adecuado y razonable para el sífilis, una enfermedad cuyos síntomas podrían haberse aliviado fácilmente con la aplicación de penicilina, la cual estuvo disponible en la década de 1940.

A los pacientes no se les dijo que tenían sífilis, tampoco se les brindó suficiente medicamento para curarlos. Mas de cien hombres fallecieron debido a la falta de medicamento, mientras que otros sufrían demencia, ceguera y otras enfermedades crónicas relacionadas con la enfermedad.

El experimento original cobró vida propia cuando los médicos, intrigados por la perspectiva de recopilar datos científicos, ignoraron los derechos humanos y las consideraciones éticas y lograron extenderlo hasta 1972 En este año es cuando un investigador del Servicio de Salud Pública, Peter Buxtun, reveló su historia a la prensa. La exposición pública avergonzó a la comunidad científica y al gobierno y el experimento fue rápidamente cancelado.

El abogado Fred Gray inició una demanda en nombre de los pacientes. En un acuerdo extrajudicial, cada paciente que sobrevivió, recibió tratamiento médico y 40,000 dólares de indemnización.

A raíz del escándalo, el Congreso aprobó la Ley de Investigación Nacional de 1974, que exige una supervisión más estricta de los estudios que utilizan sujetos humanos.

En 1997, en nombre del gobierno federal, el presidente Bill Clinton emitió una disculpa formal a las víctimas del Experimento de Sífilis de Tuskegee.

[reasonsforhope]

"In the oldest and most prestigious young adult science competition in the nation, 17-year-old Ellen Xu used a kind of AI to design the first diagnosis test for a rare disease that struck her sister years ago.

With a personal story driving her on, she managed an 85% rate of positive diagnoses with only a smartphone image, winning her $150,000 grand for a third-place finish.

Kawasaki disease has no existing test method, and relies on a physician’s years of training, ability to do research, and a bit of luck.

Symptoms tend to be fever-like and therefore generalized across many different conditions. Eventually if undiagnosed, children can develop long-term heart complications, such as the kind that Ellen’s sister was thankfully spared from due to quick diagnosis.

Xu decided to see if there were a way to design a diagnostic test using deep learning for her Regeneron Science Talent Search medicine and health project. Organized since 1942, every year 1,900 kids contribute adventures.

She designed what is known as a convolutional neural network, which is a form of deep-learning algorithm that mimics how our eyes work, and programmed it to analyze smartphone images for potential Kawasaki disease.

However, like our own eyes, a convolutional neural network needs a massive amount of data to be able to effectively and quickly process images against references.

For this reason, Xu turned to crowdsourcing images of Kawasaki’s disease and its lookalike conditions from medical databases around the world, hoping to gather enough to give the neural network a high success rate.

Xu has demonstrated an 85% specificity in identifying between Kawasaki and non-Kawasaki symptoms in children with just a smartphone image, a demonstration that saw her test method take third place and a $150,000 reward at the Science Talent Search."

-Good News Network, 3/24/23

[vague-humanoid]

Most recently, he served as the Director of the Division of HIV Prevention in CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention. Dr. Daskalakis has been recognized nationally and internationally as an expert in HIV prevention and has focused much of his career on the treatment and prevention of HIV and other STIs as an activist physician with a focus on LGBTQIA+ communities. He also served as the Deputy Coordinator of the White House's Mpox Response, where he successfully led vaccination and public education efforts that helped to halt the advancement of the virus.

Dr. Daskalakis began his career as an attending physician at Bellevue Hospital in New York City (NYC), New York, where he spearheaded several public health programs focused on community HIV testing and prevention. He has since served in several healthcare and public health capacities in NYC, including the Deputy Commissioner for the Division of Disease Control at the NYC Department of Health and Mental Hygiene. Dr. Daskalakis also directed the public health laboratory and all infectious disease control programs for NYC, including HIV, tuberculosis, sexually transmitted infections, vaccine-preventable diseases, and general communicable diseases. In addition to his leadership in infectious disease control efforts, he served as the NYC Department of Health and Mental Hygiene incident commander during the measles outbreak of 2018-2019, as well as the 2020 COVID-19 public health emergency.

[mariacallous]

Shira Fishbach, a newly graduated physician, was sitting in an orientation session for her first year of medical residency when her phone started blowing up. It was June 24, 2022, and the US Supreme Court had just handed down its decision in Dobbs v. Jackson Women's Health Organization, nullifying the national right to abortion and turning control back to state governments.

Fishbach was in Michigan, where an abortion ban enacted in 1931 instantly came into effect. That law made administering an abortion a felony punishable by four years in prison, with no exceptions for rape or incest. It was a chilling moment: Her residency is in obstetrics and gynecology, and she viewed mastering abortion procedures as essential to her training.

“I suspected during my application cycle that this could happen, and to receive confirmation of it was devastating,” she recalls. “But I had strategically applied where I thought that, even if I didn't receive the full spectrum, I would at least have the support and the resources to get myself to an institution that would train me.”

Her mind whirled through the possibilities. Would her program help its residents go to an access-protecting state? Could she broker an agreement to go somewhere on her own, arranging weeks of extra housing and obtaining a local medical license and insurance? Would she still earn her salary if she left her program—and how would she fund her life if she did not?

In the end, she didn’t need to leave. That November, Michigan voters approved an amendment to the state constitution that made the 1931 law unenforceable, and this April, Governor Gretchen Whitmer repealed the ban. Fishbach didn’t have to abandon the state to learn the full range of ob-gyn care. In fact, her program at the University of Michigan, where she’s now a second-year resident, pivoted to making room for red-state trainees.

But the dizzying reassessment she underwent a year ago provides a glimpse of the challenges that face thousands of new and potential doctors. Almost 45 percent of the 286 accredited ob-gyn programs in the US now operate under revived or new abortion bans, meaning that more than 2,000 residents per year—trainee doctors who have committed to the specialty—may not receive the required training to be licensed. Among students and residents, simmering anger over bans is growing. Long-time faculty fear the result will be a permanent reshaping of American medicine, driving new doctors from red states to escape limitations and legal threats, or to protect their own reproductive options. That would reduce the number of physicians available, not just to provide abortions, but to conduct genetic screenings, care for miscarriages, deliver babies, and handle unpredictable pregnancy risks.

“I worry that we’re going to see an increase in maternal morbidity, differentially, depending on where you live,” says Kate Shaw, a physician and associate chair of ob-gyn education at Stanford Medicine. “And that’s just going to further enhance disparities that already exist.”

Those effects are not yet visible. The pipeline that ushers medical graduates through physician training is about a decade long: four years of school plus three to seven years of residency, sometimes with a two-year, sub-specialty fellowship afterward. Thus actions taken in response to the Dobbs decision—people eschewing red-state schools or choosing to settle in blue states long-term—might take a while to be noticeable.

But in this year, some data has emerged that suggests trends to come. In February, a group of students, residents and faculty surveyed 2,063 licensed and trainee physicians and found that 82 percent want to work or train in states that retain abortion access—and 76 percent would refuse to apply in states that restrict it. (The respondents worked in a mix of specialties; for those whose work would include performing abortions, the proportion intending to work where it remains legal soared above 99 percent.)

Then in April, a study from the Association of American Medical Colleges drawing on the first round of applications to residency programs after Dobbs found that ob-gyn applications in states with abortion restrictions sank by 10 percent compared to the previous year. Applications to all ob-gyn programs dropped by 5 percent. (Nationwide, all applications to residency went down 2 percent from 2021 to 2022.)

Last month, two preliminary pieces of research presented at the annual meeting of the American College of Obstetricians and Gynecologists uncovered more perturbations. In Texas—where the restrictive law SB8 went into effect in September 2021, nine months before Dobbs—a multi-year upward trend in applications to ob-gyn residency slowed after the law passed. And in an unrelated national survey, 77 percent of 494 third- and fourth-year medical students said that abortion restrictions would affect where they applied to residency, while 58 percent said they were unlikely to apply to states with a ban.

That last survey was conducted by Ariana Traub and Kellen “Nell” Mermin-Bunnell, two third-year medical students at Emory University School of Medicine in Atlanta—which lies within a state with a “fetal heartbeat” law that predates Dobbs and that criminalizes providing an abortion after six weeks of pregnancy. The law means that students in clinical rotations are unlikely to witness abortions and would not be allowed to discuss the procedure with patients. It also means that, if either of them were to become pregnant while at med school, they would not have that option themselves.

Before they published the survey, the two friends conducted an analysis of how bans would affect medical school curricula, using data collected in the summer of 2022. They predicted that only 29 percent of the more than 129,000 medical students in the US would not be affected by state bans. The survey gave them a chance to sample med students’ feelings about those developments, with the help of faculty members. They also founded a nonprofit, Georgia Healthcare Professionals for Reproductive Justice. “We're in a unique position, as individuals in the health care field but not necessarily medical professionals yet,” Traub says. “We have some freedom. So we felt like we had to use that power to try to make change.”

Ob-gyn formation is caught between opposing forces. Just over half of US states have passed bans or limitations on abortion that go beyond the Roe v. Wade standard of fetal viability. But the Accreditation Council for Graduate Medical Education, a nonprofit that sets standards for residency and fellowship programs, has always required that obstetric trainees learn to do abortions, unless they opt out for religious or moral reasons. It reaffirmed that requirement after the Dobbs decision. Failure to provide that training could cause a program to lose accreditation, leaving its graduates ineligible to be licensed.

The conflict between what medicine demands and state laws prevent leaves new and would-be doctors in restrictive states struggling with their inability to follow medical evidence and their own best intentions. “I’m starting to take care of patients for the first time in my life,” says Mermin-Bunnell, Traub’s survey partner. “Seeing a human being in front of you, who needs your help, and not being able to help them or even talk to them about what their options might be—it feels morally wrong.”

That frustration is equally evident among trainees in specialties who might treat a pregnant person, prescribe treatments that could imperil a pregnancy, or care for a pregnancy gone wrong. Those include family and adolescent medicine, anesthesiology, radiology, rheumatology, even dermatology and mental health.

“I’m particularly interested in oncology, and I’ve come to realize that you can’t have the full standard of gynecologic oncology care without being able to have access to abortion care,” says Morgan Levy, a fourth-year medical student in Florida who plans to apply to ob-gyn residency. Florida currently bans abortion after 15 weeks; a further ban, down to six weeks, passed in April but has been held up by legal challenges. In three years of med school so far, Levy received one lecture on abortion—in the context of miscarriage—and no clinical exposure to the procedure. “It is a priority for me to make sure that I get trained,” she says.

But landing in a training program that encourages abortion practice is more difficult than it looks. Residency application is an algorithm-driven process in which graduates list their preferred programs, and faculty rank the trainees they want to teach. For years, there have been more applicants than there are spaces—and this year, as in the past, ob-gyn programs filled almost all their slots. What that means, according to faculty members, is that some applicants will end up where they do not want to be.

“Students and trainees do exert their preferences, but they also need to get a training spot,” says Vineet Arora, the dean for medical education at the University of Chicago Pritzker School of Medicine and lead author on the survey published in February. “Would they forgo a training spot because of Dobbs? That's a tall order, especially in a competitive field. But would they be happy about it? And would they want to stay there long term?”

That is not a hypothetical question. According to the medical-colleges association, more than half of residents stay to practice in the states where they trained. But it’s reasonable to ask whether they would feel that loyalty if they were deprived of training or forced to relocate. “If even a portion of the 80 percent of people who prefer to practice and train in states that don't have abortion bans follow through on those preferences, those states that are putting in abortion bans—which often have workforce shortages already—will be in a worse situation,” Arora says.

An ACOG analysis estimated in 2017 that half of US counties, which are home to 10 million women, have no practicing ob-gyn. When the health care tech firm Doximity examined ob-gyn workloads in 2019, seven of the 10 cities it identified as having the highest workloads lie in what are now very restrictive states. Those shortages are likely to worsen if new doctors relocate to states where they feel safe. The legal and consulting firm Manatt Health predicted in a white paper last fall: “The impact on access to all OB/GYN care in certain geographies could be catastrophic.”

Faculty are struggling to solve the mismatch between licensing requirements and state prohibitions by identifying other ways residents can train. They view it as protecting the integrity of medical practice. “Any ob-gyn has to be able to empty the uterus in an emergency, for abortion, for miscarriage, and for pregnancy complications or significant medical problems,” says Jody Steinauer, who is vice-chair of ob-gyn education at UC San Francisco.

Steinauer directs the Kenneth J. Ryan Residency Training Program, a 24-year-old effort to install and reinforce clinical abortion training. Even before Dobbs, that was hard to come by: In 2018, Steinauer and colleagues estimated that only two-thirds of ob-gyn residency programs made it routine, despite accreditation requirements—and that anywhere from 29 to 78 percent of residents couldn’t competently perform different types of abortion when they left training. In 2020, researchers from UCSF and UC Berkeley documented that 57 percent of these programs face limitations set by individual hospitals more extreme than those set by states.

Before Dobbs, the Ryan program brokered individual relocations that let trainees temporarily transfer to other institutions. Now it is working to set up program-to-program agreements instead, because the logistics required to visit for a rotation—the kind of arrangements Fishbach dizzily imagined a year ago—are more complex than most people can manage on their own. And not only on the visiting trainee: Programs already perform delicate calculations of how many trainees they can take given the number of patients coming to their institutions and the number of faculty mentors.

Only a few places have managed to institutionalize “away rotations,” in which they align accreditation milestones, training time, and financing with other institutions. Oregon Health & Science University’s School of Medicine is about to open a formal program that will accept 10 to 12 residents from restrictive states for a month each over a year. Oregon imposes no restrictions on abortion, and both the med school’s existing residents and the university’s philanthropic foundation supported the move.

“I'm very concerned about having a future generation that knows how to provide safe abortion care—because abortion will never go away; becoming illegal only makes it less safe,” says Alyssa Colwill, who oversees the new program and is an assistant professor of obstetrics and gynecology. “There are going to be patients that are going to use unsafe methods because there's no other alternative. And providers are going to be placed in scenarios that are heartbreaking, and are devastating to watch.”

The accreditation council now requires programs that cannot train their own residents in abortion to support them in traveling somewhere else. But even at schools that are trying to accommodate as many learners as possible, trainees can attend for only a month—the maximum that fully enrolled programs in safe states can afford. After that, they must go back home, leaving them less-trained than their counterparts. As faculty look forward, they fear a slow spiral of decay in obstetric knowledge.

This isn’t imaginary: Already, research has shown that physicians practicing in red states are less likely to offer appropriate and legal procedures to treat miscarriages. Receiving abortion training, in other words, also improves medical care for pregnancy loss.

“Ultimately, I do not think there is capacity to train every resident who wants training,” says Charisse Loder, a clinical assistant professor of ob-gyn at the University of Michigan Medical School, who directs the program where Fishbach is training. “So we will have ob-gyn residents who are not trained in this care. And I think that is not only unfortunate, but puts patients in a position of being cared for by residents who don't have comprehensive training.”

Doing only short rotations also returns residents to places where their own reproductive health could be put at risk. Future physicians are likely to be older than in previous generations, having been encouraged to get life experience and sample other careers before entering med school. Research on which Levy and Arora collaborated in 2022 shows that more than 11 percent of new physicians had abortions during their training. Because of the length of training, they also may be more likely to use IVF when they are ready to start families—and some reproductive technologies may be criminalized under current abortion bans.

As a fourth and final-year psychiatry resident, Simone Bernstein had thought about abortion restrictions through the lens of her patients’ mental health, as she talked to them about fertility treatment and pregnancy loss. As cofounder of the online platform Inside the Match, she had listened to residents’ reactions to Dobbs (and collaborated on research with Levy and Arora). She had not expected the decision to affect her personally—but she is in Missouri, a state where there is an almost complete ban on abortion. And this spring, she experienced a miscarriage at 13 weeks of pregnancy.

“I was worried whether or not I could even go to the hospital, if my baby still had a heartbeat, which was a conversation that I had to have with my ob-gyn on the phone,” she says. “It didn’t come to that; I caught the baby in my hands at home, hemorrhaging blood everywhere, and the baby had already passed away. But until that moment, I didn't recognize the effects that [abortion restrictions] could have on me.”

This is the reality now: There exist very few places in the US where abortion is uncomplicated. Faculty and their trainees do not expect that to change, except for the worse. Staying in the field, and making sure the next generation is prepared, requires commitment that they will have to sustain for years.

“Part of the reason why I sought advanced training in abortion and contraception is because I think there will be a national ban,” says Abigail Liberty, an ob-gyn and fellow in her sixth postgraduate year at OHSU. “I think it will happen in our lifetime. And I see my role as getting as much expertise and training as I can now and providing care while I can. And then coming out of retirement, when abortion will be legal again, and training the next generation of physicians.”