http://www.alternet.org/story/149226/

The severe economic crisis, now in its fourth year, is being used to batter the remnants of the social welfare state. Having decimated aid to the poor over the last 30 years, especially in the United States, the economic and political elite are now intent on strangling middle-class benefits, namely state-provided pensions, health care and education.

The initial neoliberal assault under Ronald Reagan and Margaret Thatcher reorganized the capitalist economy and hammered private-sector unions into submission. This was accomplished by putting labor back into competition with itself by off-shoring industrial production, through deregulation and with frontal assaults on labor rights, organizing and solidarity.

Similarly, the current attack is a two-pronged effort to reorganize state social services, either by eliminating or privatizing them, and decimate public-sector unions whose workers provide those services. While the safety net is being withered by attrition, police and spying agencies are getting more powers and funding, and the wealth of the super-rich and record corporate profits are deemed off-limits to taxation to close any government budget gap.

Simply put, the elderly are superfluous to capitalism. With high rates of joblessness the “new norm,” more and more people are being made disposable. This leads to an efficient if brutal logic: cutting old-age income and health care will make it easier to scrap old, useless workers. In fact, this reality is already coming to pass. One study published in 2008 found that over a 16-year period life expectancy had declined for many poor American women — precisely those who are disproportionately represented among the elderly heavily dependent on Social Security and Medicare.

Slashing social services affects everyone by increasing the pool of workers desperate for any sort of paying job, pushing down wages and benefits. This will all be pushed under the rubric of “personal responsibility,” and it will probably be successful as long as opposition is weak and divided. The main beneficiaries will be the super-wealthy who gain both from tax cuts as the social sector is chopped up and higher corporate profits as wages and benefits are slashed more deeply.

The attack on pensions is mainly occurring in the West and those countries close to its orbit. So while the United States, Greece, Ireland, Japan, France, Turkey, Spain, Poland and Latvia have been cutting or trying to squeeze state-run pensions, others such as Bolivia, China and Venezuela have been increasing funding of old-age pensions in recent years (though within these countries the picture is more complicated because social spending may be declining overall and inflation increasing).

The Right has stridently opposed Social Security since it was enacted in 1935, but the modern attack on pensions originated during the Reagan-Thatcher era. While he proposed making Social Security voluntary during the 1964 Goldwater campaign, when he reached office Reagan temporarily froze cost-of-living adjustments, raised the future retirement age to 67, taxed benefits of higher-income earners, made it more difficult for the disabled to claim benefits and forced the self-employed to pay 100 percent of payroll taxes. Then under Clinton, according to some economists, inflation was understated to suppress cost-of-living adjustments, resulting in benefits that should be 50 percent higher than the current average of $1,072 a month. Thatcher and Tony Blair formed the same one-two punch as Reagan and Clinton, but they went further by partially privatizing much of the state-run pension system.

The second historical component is the current crisis, which is severely widening the economic chasm. According to the New York Times, corporate profits “have grown for seven consecutive quarters, at some of the fastest rates in history,” hitting a record of $1.66 trillion on an annual basis. Taking advantage of Federal Reserve and U.S. Treasury monies, Wall Street has notched record profits over the last two years. And the top one percent actually increased their share of the wealth through the end of 2009.

As for the overall economic picture, industrial production is back to where it was in 2000 and the all-important capacity utilization rate – which measures how much of existing manufacturing plants are actually operating – is below 75 percent, compared to a level above 80 percent before the crash. This is like saying more than one-fourth of factories are idle. The trade deficit is at 3.7 percent of the gross domestic product. Only 874,000 jobs were created during the first 10 months of 2010, well short of the 1.2 million needed to keep up with population growth, and some 260,000 state workers lost their jobs during this period, leaving 7.5 million fewer jobs than when the recession began.

The household picture is even grimmer: family income shrank more than 4 percent in 2008 and 2009; the official poverty rate of 14.3 is the highest since 1994; 13.5 percent of home mortgages are in delinquency or foreclosure; the percentage of people receiving health insurance through their employer has dropped by 13 percent over the last decade and the real unemployment rate — the “U6 rate” which includes those who have given up looking for work — is at 17 percent. Household debt stands at 118 percent of after-tax income.

Most economists say there are really only four sources of potential growth in our economy: consumer spending, business investment, trade and government. As the data above indicates, the first three are on life support, while the Obama White House bungled the stimulus plan, helping the right in discrediting government intervention, which is still the only remaining option. These economic conditions prevail throughout the West, which is the backdrop for the global assault on pension plans. Thus the conclusion is stark: there is no functioning engine to drive economic growth.  

With so much idle productive capacity, the bromide of giving tax breaks to spur business investment is little more than throwing away money. With American families drowning in debt, getting smacked with rising healthcare costs, having lost $15.8 trillion in wealth and fearing joining the armies of unemployed, they are incapable of pulling the economy out of its funk with increased consumption. Increased trade is one possibility, which would require a weaker dollar to make U.S. exports more competitive. But, as Paul Krugman points out, this is opposed by Republicans who believe continued economic decline will enhance their electoral chances in 2012. Despite investment money pouring into the BRIC countries – Brazil, Russia, India and China – agricultural commodities and precious metals, these markets are too narrow and shallow to form a new asset bubble, such as the ones in tech and housing that fueled economic growth for nearly two decades. And in any case, we know how well those bubbles worked out.

When business investment, consumption, trade, debt and speculation all falter, that leaves government as the only sector that can revive a capitalist economy. But, as I first pointed out in December 2008, the Obama administration knew the stimulus was almost certain to fail because the downturn was sapping a staggering $1 trillion a year from the economy at that point, while the plan offered a relatively meager $787 billion. Of that, only $600 billion of stimulus money was spent in the last two years and, according to Paul Krugman, more than 40 percent of that was in tax breaks that tend to offer the least bang for the buck. So in early 2009, faced with an economy leaking 7 percent of the GDP a year, Obama offers a plan that plugs 1 to 2 percent a year.

In the final equation, the Obama stimulus only covered some of the shortfall in state and local budgets. But that money is drying up, and that, to a large degree, is the reason state services and workers are now under attack.

But now we are in for more bloodletting of social services and government workers because the failed stimulus has legitimized the establishment hysteria over the federal debt. Debt matters but the simplest way to reduce it is by a combination of economic growth and inflation. This is what happened to U.S. debt after WW2, which peaked at about 120 percent of GDP, far more than today even with the economic depression and bailouts. Instead, the right is pushing policies that may result in a worst-case scenario. Cutting spending and taxes –which Obama has endorsed – could lead to further economic contraction and deflation. This will make federal debt payments doubly onerous because tax revenues will shrink as the dollar strengthens.

There is another solution to reviving the economy without piling on debt: tax the wealth of the elite. According to economist Rick Wolff, “high-net-worth” Americans have around $12 trillion in investable assets, which excludes the value of their homes. A 13 percent wealth tax would wipe out the entire 2010 federal budget deficit of $1.56 trillion while doing little to crimp the economy because this money is literally lying around.

Yet Obama never seriously considered even the Keynesian policy of debt-driven financing for national re-industrialization because he was the darling of Wall Street – and number one recipient of its dollars – for his unwavering support of the Bush bailout in September 2008 and by taking counsel from Larry Summers and Tim Geithner during the campaign. Once in the White House Obama shunned jobs programs on a massive enough scale to revive the economy because the indirect method of debt-driven financing would shore up benefits, wages and labor bargaining power, thus cutting into corporate profits, while the direct financing method, taxing the rich, would mean they would have to pay for programs that would eventually cut into their profits.

The Obama administration has consistently fought for policies that involve weakening labor — such as its attacks on auto workers and teachers and the cynical gesture of calling for a freeze on the pay of federal workers– driving down wages, letting unemployment rise, and squeezing social services and benefits, all to transfer more wealth upward.

The wealthy have profited three times off the crisis: from the bubble itself, during the bailouts and from government bonds sold to them to pay for the bailouts. Putting pensions on the chopping block would give them a fourth opportunity to profit off the same crisis.

If debt is a problem, then bondholders should take a haircut because they took the risk. Of course, that’s not how capitalism works. So, in the case of Social Security, which has nearly $2.6 trillion in its trust fund and can meet ALL obligations through 2037 even assuming no changes are made, the plan is to raid it to pay off bondholders.

That’s why a crisis is being manufactured. Obama’s deal to reduce payroll tax by two percentage points will pilfer an estimated $120 billion from the trust fund that will supposedly be paid back by revenues from the general treasury. This means the deficit will increase, feeding into the fabricated panic over Social Security and debt.

For any country, cutting pensions is disastrous to long-term economic health. In the United States, Social Security accounts for 40 percent of the income of the population over 65 and nearly 50 percent for women in this group. It would also leave more people in the workforce as older workers delay retirement. Because the elderly tend to spend their benefits right away, on housing, food, transportation and medical services this means less demand and lower economic activity. And combining all this with trying to crush public workers also means more unemployed, less tax revenue and a shrinking economy.

It all adds up to a recipe for a depression. Two conclusions are inescapable: Obama is far more Herbert Hoover than FDR, and change will only come from creative independent movements instead of marching into the tomb of the Democratic Party.

Arun Gupta is a founding editor and the publisher of The Indypendent newspaper. He is writing a book on the politics of food for Haymarket Books.

Countercurrents.org

Ideologically it believes governments must provide for the greatest good for the greatest number of people. It opposes concentrated wealth, demagogy, and despotism, and supports democracy, human and civil rights, and social justice – an ideology the 19th century People’s Party and 20th century Progressive Party endorsed without majorities.

Until recently, faint echoes remained, sadly silenced after Senator Bernie Sanders and sole House populist capitulated.

Former Kucinich for president consultant, David Swanson, said “he gave in to the power of a false narrative, and that he ought to have said so….I think the corporate media has instilled in people the idea that presidents should make laws and the current president is trying to make a law that can reasonably be called ‘healthcare reform’ or at least ‘health insurance reform.’ ” I don’t excuse Kucinich flipping….I just want to find the right explanation for it.”

The web site singlepayeraction.org, (“everybody in. nobody out.”) called the Democrats (like Republicans) “a corporate party, rotting from the core.”

SPA called Kucinich’s “flameout….spectacular” in support of a bill he and progressive Democrats strongly opposed until they flipped, including Congressman Danny Davis, representing this writer’s 7th Illinois District.

Kucinich said “I’ve taken a detour supporting this bill.” For SPA, it’s one “that will condemn millions of Americans to ongoing suffering and death” because insurers make money by denying care, why real reform requires their removal and assuring everyone of universal single-payer coverage. Everyone in. Nobody out. What your senator and House representative get, you get. What congressional Democrats won’t enact.

On March 17, Rep. Dennis Kucinich announced the following:

“I have carried the banner of national health care in two presidential campaigns, in party platform meeting, and as co-author of HR 676, Medicare for All. I have worked to expand the health care debate beyond the current for-profit system, to include a public option and an amendment to free the states to pursue single payer.”

On November 7, 2009, despite enormous pressure, he voted against HR 3962: Affordable Health Care for America Act,” asking “Is this the best we can do” in a prepared text titled, “Why I Voted No,” saying:

“We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care.” Passing “legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry (exacerbates) the very source of the problem….Clearly, the insurance companies are the problem, not the solution.”

On March 17, he reversed himself, saying:

“….after careful discussions with President Obama, Speaker Pelosi, Elizabeth my wife and close friends, I have decided to cast a vote in favor of the legislation.

As this bill passes, I will renew my effort to help those state organizations which are aimed at stirring a single payer movement….I have taken a detour through supporting this bill, but I know the destination I will continue to lead, for as long as it takes, whatever it takes to an America where health care will be firmly established as a civil right.”

He later said that not supporting the bill “would destroy Obama’s presidency,” a nonsensical view given Bill Clinton’s success despite his health care program failure and efforts to impeach him. He survived, served two terms, and left office with a 68% approval rating, matching Franklin Roosevelt at the end of his presidency.

On Democracy Now (March 18), Ralph Nader referred to “the latest chapter of corporate Democrats crushing progressive forces both inside their party and against third parties.” It’s nothing new. It happens every time reform is proposed.

Current legislation doesn’t “provide universal, comprehensive or affordable care to the American people. It shovels hundreds of billions of dollars of taxpayer money (to predators that) created the problem: the Aetnas, CIGNAs” and other insurers. It requires no contractual accountability or other benefits for people denied coverage under a “pay-or-die system that is the disgrace of the Western world.”

For the drug cartel, “it’s a bonanza” heading right to their bottom line, including no government negotiated discounts, lengthy new drug patent protection periods to impede cheaper generic competition, and no reimportation of lower-priced foreign drugs to keep prices high and affordability low.

Further, there’s no public option, and the legislation mostly doesn’t kick in until 2014. It means “180,000 Americans….will die between now and (then) and hundreds of thousands of injuries and illnesses” will go untreated. “There’s (also) no free choice of doctor and hospital under this. There’s all kinds of exploit(ive provisions to let) health insurance (and drug) companies continue their ravenous ways over people who are (the) most vulnerable….when they’re sick or injured.” Who in Washington represents them when the few progressives side with the others.

It’s a sad moment when liberal Democrats caved. “They’ve all caved. They’ve all been put into line by the (House) majority rulers.” It’s a shameless, but predictable climb-down. They want to perpetuate a system that costs double per capita (about $7,600) of other Western states and provides worse coverage. In America, about 800 people die weekly because they can’t afford insurance, enough of it, or insurers deny or delay their claims.

Will new legislation fix this? Not at all because providers, especially insurers, are notorious for gaming the system, and 2,500 pages of legislation contain loopholes, ambiguities, and legal interpretations that experts can easily manipulate to their advantage or create a process so onerous to contest that it amounts to the same thing.

Former CIGNA vice president, Wendell Potter, explained, saying Obamacare lets insurers shift costs to consumers, offer inadequate or unaffordable access, force Americans to pay higher deductibles for less coverage, and even scam subsidized consumers.

“What worries me,” he said, “is that people who are forced to buy coverage and all they can afford to buy is a high deductible. (So) if they get really sick, they have to pay so much out of their own pockets that they’re going to be filing for bankruptcy or (lose) their homes.”

Potter especially dislikes the Senate bill that will force many people to buy insurance only covering about 60% of costs if they’re sick. Many people have no insurance because it’s unaffordable. “They certainly couldn’t afford premiums plus the out-of-pocket expenses in today’s market” that keeps hiking costs higher.

At best, Potter believes Obamacare will move millions of uninsured to underinsured, making them vulnerable to serious illness costs, the main cause of personal bankruptcies. When it happens, no Obamacare provision protects them from losing their homes.

As for prohibiting pre-existing conditions, the Senate bill especially gives insurers “all the flexibility they need” to prevent people from accessing coverage. Health history and age will determine premiums, so the chronically ill and aged will pay far more than the already unaffordable high rates.

The so-called medical-loss ratio is another problem. It determines what percent of premiums cover medical costs. The less restricted, the more profits (in the billions of dollars), and less care for policyholders.

Nader points out that even with more people covered, prices aren’t regulated, “junk insurance policies” will be offered, and there’s nothing to stop insurers “from taking this papier-mache bill and lighting a fire to it and making a mockery of it.” They’re unhindered by controls, and no facility will “create a national consumer health organization” to give people “their own non-profit consumer lobby (in) Washington. This is really a disaster.”

Obamacare forces coverage on consumers, assesses penalties for noncompliance, empowers the IRS to collect them, protects corporate profits, rations care, and dumps millions of Americans (insured and millions left uninsured) in the scrap heap to fend for themselves. It’s not a step forward. It’s a full-scale retreat.

Obama is like Bush. He froze out dissenters, single-payer advocates, and surrounded himself with corporate hacks and warmongers. It’s the same old, same old, the people getting scammed and harmed because no one in Washington represents them. Unless they act on their own, they’ll get no help from politicians delivering the best reform money can buy, with no restrictions on spending amounts for it.

In June 2009 on a visit to Gaza, Jimmy Carter said “the citizens of Palestine are treated more like animals than like human beings.” So will millions of Americans under Obamacare, a sellout scheme to provide less than they now have and charge more for it.

Kucinich said his constituents urged him to do something, rather than nothing even if it meant passing a bad bill. Unfortunately, most people don’t know the tawdry fine print, that insurance giant Wellpoint wrote the Baucus bill, that corporations write virtually all legislation, that Obamacare gives America’s healthcare system to predatory insurers and Big PhRMA, something Kucinich, Bernie Sanders, other progressive Democrats understand, but capitulated anyway. Why so?

Despite his stated reasons, only Kucinich knows for sure, but here’s a guess. Washington is notorious for pressuring, intimidating, and/or bribing members of Congress for support. Kucinich may have been told, either vote yes or face a well-funded fall primary challenge that could succeed given the power of deep pockets and deceptive ads. It’s a prospect no member of Congress relishes. They could also take away his Government Reform Subcommittee on National Security, Emerging Threats and International Relations.

Whatever the reason, he may have tipped the balance with House, then Senate votes, imminent, perhaps as early as Sunday, March 21. Going first, it’s believed the House will use a controversial “self-executing rule” for a package of Senate bill fixes to “deem and pass” the entire bill that would otherwise fail. The Senate will then consider the revised bill through “reconciliation,” requiring a simple majority to pass. Self-executing has been used many times before, but never for a bill impacting health care for everyone, amounting to one-sixth of the economy.

It also bypasses the 1985 Byrd Rule that restricts reconciliation to budget revisions according to provisions under Section 313(b)(1) of the 1974 Congressional Budget Act.

What’s at stake? Plenty!

House and Senate bills will ration care, enrich providers, and make a dysfunctional system worse. Hundreds of billions of Medicare cuts will harm seniors. Most others will pay more, get less, and millions will remain uninsured. According to an earlier AMA estimate, those covered “will face higher premiums, deductibles, copayments and coinsurance, effectively reducing the scope of their coverage,” what Wendell Potter explained above.

Business Week magazine acknowledged it last August saying, “No matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall (or now), the insurance industry (and drug cartel) will emerge more profitable.” Quoting an unnamed Senate Finance Committee staffer, “The bottom line is that health reform (will) lead to increased revenues and profits,” and for doubters, check current insurance and drug company stock prices for confirmation.

Relevant International Law

Adequate health care is a human right, not a commodity for those who can afford it.

Article 25 of the 1948 Universal Declaration of Human Rights (UDHR) states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care….”

Article 12 of the 1966 International Covenant on Economic, Social & Cultural Rights (ICESCR) states:

“The State Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (including universally ensuring) medical service and medical attention in the event of sickness…. government(s) must ensure all citizens have (affordable) access to basic health services.”

Under international law, UDHR and ICESCR form the backbone of the right to health for everyone. The UN Committee on Economic, Social, and Cultural Rights (CESCR) developed guidelines to implement it, including a “minimum floor” below which no country may fall, that for health ensures it, in terms of availability, accessibility, acceptability, quality, and universality without discrimination.

America’s Low Healthcare Delivery Ranking among Industrialized Nations

Of all industrialized countries, America is the only one that doesn’t recognize the right to health and a way to provide it. In fact, in Maher v. Roe (1977), the Supreme Court declared it unnecessary for Congress to require minimum health care standards. The closest to it are Medicare and Medicaid.

Removing middleman insurers would save over $400 billion annually, enough to cover all the uninsured and provide quality care at lower overall cost. Letting corporate predators game the system ensures the opposite, a problem Obamacare exacerbates.

In 1943, Franklin Roosevelt proposed a Second Bill of Rights, declaring “freedom from want” an essential liberty necessary for security, including “the right to adequate medical care and the opportunity to achieve good health.” Predatory insurers deny it. Focusing on outcomes consistent with internationally-recognized standards is vital, not the right of business to commodify a human right, charge what they want, and deny access for those who can’t afford it.

Obamacare will worsen the current system. It’s about profits, not people, especially the nation’s poor, most vulnerable, and disadvantaged on society’s fringes, most hurt by all congressional measures, including one this vital.

What the 1913 Federal Reserve Act did for bankers, Obamacare may do for the insurance and drug cartels.

Stephen Lendman lives in Chicago and can be reached at lendmanstephen@sbcglobal.net. Also visit his blog site at sjlendman.blogspot.com and listen to cutting-edge discussions with distinguished guests on the Progressive Radio News Hour on the Progressive Radio Network Thursdays at 10AM US Central time and Saturdays and Sundays at noon. All programs are archived for easy listening.

http://prognewshour.progressiveradionetwork.org/

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Despite abortion being severely legally restricted – and potentially unsafe – in Peru, the incidence of abortion is as high as or higher than the incidence in many countries where it is legal and safe, found researchers from Peru, the United Kingdom and the United States in an article published in CMAJ http://www.cmaj.ca/press/pg298.pdf.

Clandestine induced abortion is a significant public health issue in many countries where access to abortion is severely legally restricted. Abortions are often available only in cases of rape or incest or when a pregnancy threatens the health or life of the woman, causing many women to pursue clandestine abortions, which are often unsafe. Forty percent of women live in countries where abortions are legally restricted.

As comprehensive official statistics are lacking, this study provides valuable public health data.

The researchers conducted a population-based survey of almost 8000 women aged 18-29 years in 20 Peruvian cities. They found that 11.6% of women reported having abortions and 7.5% of sexually experienced 18-year-olds – the youngest age surveyed – reported having had abortions.

“We hope that this study will contribute to increased awareness of the scale of the problem and political willingness to address it, for which there is public support in Latin America,” write Dr. Bernabé Ortiz from the Universidad Peruana Cayetano Heredia in Lima, Peru and coauthors.

They state that provision of contraception and education needs to be greatly improved and will lead to reduced abortion rates as half of the sexually-active women in the study did not use birth control.

In a related commentary http://www.cmaj.ca/press/pg272.pdf, Professor Rebecca Cook of the University of Toronto’s Faculty of Law writes that laws limiting access to abortion do not reduce the number of abortions but reduce safety.

“When governments ignore evidence, such as that presented in the study by Bernabé Ortiz and colleagues, and refuse to collect official statistics on abortion or ensure transparent access to legal abortion services, they are increasingly held accountable by national, regional and international human rights courts and tribunals for the arbitrary exercise of their power,” states Professor Cook. “They are also increasingly held accountable for causing preventable deaths and disabilities of women.”

A summary of abortion policies around the world, compiled by the UN Department of Economic and Social Affairs Population Division, can be obtained from http://www.un.org/esa/population/publications/2007_Abortion_Policies_Chart/2007_WallChart.pdf

Versión Española http://www.cmaj.ca/press/abort_spanish_abstract.pdf

Reprinted from Canadian Medical Association Journal.

Berkeley — Two new studies led by researchers at the University of California, Berkeley, suggest that taking maternity leave before and after the birth of a baby is a good investment in terms of health benefits for both mothers and newborns.

One study found that women who started their leave in the last month of pregnancy were less likely to have cesarean deliveries, while another found that new mothers were more likely to establish breastfeeding the longer they delayed their return to work.

Both papers were part of the Juggling Work and Life During Pregnancy study, funded by the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration and led by Sylvia Guendelman, professor of maternal and child health at UC Berkeley’s School of Public Health. The research takes a rare look into whether taking maternity leave can affect health outcomes in the United States.

“In the public health field, we’d like to decrease the rate of C-sections (cesarean deliveries) and increase the rate of breastfeeding,” said Guendelman. “C-sections are really a costly procedure, leading to extended hospital stays and increased risks of complications from surgery, as well as longer recovery times for the mother. For babies, it is known that breastfeeding protects them from infection and may decrease the risk of SIDS (Sudden Infant Death Syndrome), allergies and obesity. What we’re trying to say here is that taking maternity leave may make good health sense, as well as good economic sense.”

The study on the use of antenatal leave – time off before delivery with the expectation of returning to the employer after giving birth – and the rate of C-sections is the first examination of birth outcomes in U.S. working women, the researchers said. It will appear in the January/February print edition of the journal Women’s Health Issues.

The researchers analyzed data from 447 women who worked full-time in the Southern California counties of Imperial, Orange and San Diego, comparing those who took leave after the 35th week of pregnancy with those who worked throughout the pregnancy to delivery. Only women who gave birth to single babies with no congenital abnormalities were included in the analysis. They adjusted for sociodemographic factors such as income, age and type of occupation, as well as for various health measures such as high blood pressure, body mass index, amount of self-reported stress and average number of hours of sleep at night.

Using a combination of post-delivery telephone interviews and prenatal and birth records, the researchers found that women who took leave before they gave birth were almost four times less likely to have a primary C-section as women who worked through to delivery.

The study authors pointed out that the United States falls behind most industrialized countries in its support for job-protected paid maternity leave. The federal Family and Medical Leave Act provides for only unpaid leave of up to 12 weeks surrounding the birth or adoption of a child.

The bulk of studies on leave-taking and health outcomes from other countries suggest that taking leave prior to birth can be beneficial. The authors point to a macroanalysis of 17 countries in Europe that linked failure to take such leave with low birthweight and infant mortality. Rates of pre-term delivery were lower among female factory workers in France if the women took antenatal leave, and a study conducted in several industrialized countries found that paid leave, but not unpaid leave, significantly decreased low birthweight rates.

According to the U.S. Census, among working women who had their first birth between 2001 and 2003, only 28 percent took leave from their jobs before giving birth while an additional 22 percent quit their jobs. Twenty-six percent of women took no leave before birth.

“We don’t have a culture in the United States of taking rest before the birth of a child because there is an assumption that the real work comes after the baby is born,” said Guendelman. “People forget that mothers need restoration before delivery. In other cultures, including Latino and Asian societies, women are really expected to rest in preparation for this major life event.”

The authors added that financial need may also deter women from taking leave in the last month of pregnancy. Only five states – California, Hawaii, New Jersey, New York, Rhode Island – and the territory of Puerto Rico offer some form of paid pregnancy leave, and none offer full replacement of the woman’s salary.

The study on maternity leave and breastfeeding is in the January issue of the journal Pediatrics. Using data from 770 full-time working mothers in Southern California, researchers assessed whether maternity leave predicted breastfeeding establishment, defined in this study as breastfeeding for at least 30 days after delivery. Phone interviews were conducted 4.5 months, on average, after delivery.

In this study, women who had returned to work by the time of the interview took on average 10.3 weeks of maternity leave. Overall, 82 percent of mothers established breastfeeding within the first month after their babies were born. Among women who established breastfeeding, 65 percent were still breastfeeding at the time of the interview.

Researchers found that women who took less than six weeks of maternity leave had a four-fold greater risk of failure to establish breastfeeding compared with women who were still on maternity leave at the time of the interview. Women who took six to 12 weeks of maternity leave had a two-fold greater risk of failing to establish breastfeeding.

Having a managerial position or a job with autonomy and a flexible work schedule was linked with longer breastfeeding duration in the study. After 30 days, managers had a 40 percent lower chance of stopping breastfeeding, while those with an inflexible work schedule had a 50 percent higher chance of stopping.

Overall, the study found that returning to work within 12 weeks of delivery had a greater impact on breastfeeding establishment for women in non-managerial positions, with inflexible jobs or who reported high psychosocial distress, including serious arguments with a spouse or partner and unusual money problems.

“The findings suggest that if a woman postpones her return to work, she’ll increase her chances of breastfeeding success, especially if she’s got a job where she’s on the clock and has less discretion with her time,” said Guendelman. “Also, women who are in jobs where they have more authority may feel more empowered with how they use their time.”

The American Academy of Pediatrics (AAP) recommends that babies be breastfed for at least the first year of life, and exclusively so for the first four to six months.

According to the AAP, increased breastfeeding has the potential for decreasing annual health costs in the U.S. by $3.6 billion and decreasing parental employee absenteeism, the environmental burden for disposal of formula cans and bottles, and energy demands for production and transport of formula.

The study authors noted that just having maternity leave benefits offered by an employer was not helpful in breastfeeding establishment unless the leave was actually used, indicating the importance of encouraging the use of maternity leave and making it economically feasible to take it.

“These new studies suggest that making it feasible for more working mothers to take maternity leave both before and after birth is a smart investment,” said Guendelman.

###

Other co-authors of the paper in Women’s Health Issues are Michelle Pearl and Steve Graham, senior research scientists at the Sequoia Foundation, a California-based non-profit organization focused on public health research; Alan Hubbard, UC Berkeley assistant professor of biostatistics; Dr. Nap Hosang, lecturer at UC Berkeley’s Maternal and Child Health program and a practicing obstetrician; and Martin Kharrazi, research scientist supervisor in the California Department of Public Health Genetic Disease Screening Program.

In addition to Guendelman, Pearl, Graham and Kharrazi, the Pediatrics paper was co-authored by Jessica Lang Kosa, research associate, and Julia Goodman, former graduate student, both at UC Berkeley’s School of Public Health.

The study published in Women’s Health Issues received additional funding from the Center for Health Research at UC Berkeley. The paper in Pediatrics also received support from the UC Labor and Employment Research Fund and the UC Berkeley Institute for Research on Labor and Employment.

Reprinted from University of California – Berkeley.

Reforming the system will require strong medicine, tough choices

To heal our ailing health care system, we need to stop thinking like Americans. That’s the message of two articles by UCLA’s Dr. Marc Nuwer, a leading expert on national health care reform, published this week in Neurology, the journal of the American Academy of Neurology.

“Americans prize individual choice and resist limiting care,” says Nuwer, a professor of clinical neurology at the David Geffen School of Medicine at UCLA. “We believe that if doctors can treat very ill patients aggressively and keep every moment of people in the last stages of life under medical care, then they should. We choose to hold these values. Consequently, we choose to have a more expensive system than Europe or Canada.”

Consider these statistics:

• The United States boasts the world’s most expensive health care system, yet only one-sixth of Americans are insured. Medical expenditures exceed $2 trillion annually, making health care the economy’s largest sector, four times bigger than national defense.

• By 2015, the U.S. government is projected to spend $4 trillion on health care, or 20 percent of the nation’s gross domestic product.

• An aging population will boost spending. Half of Medicare costs support very sick people in their last stages of life, and experts estimate that Medicare funds will be exhausted by 2018.

• 31 percent of U.S. health care funds go toward administration. “We push a lot of paper,” Nuwer says. “We spend twice as much as Canada, which has a more streamlined health care system that demands doctors complete less paperwork.”

• 10 percent of U.S. expenses are spent on “defensive medicine” – pricey tests ordered by doctors afraid of missing anything, however unlikely. “Doctors don’t want to be accused in court of a delayed diagnosis, so they bend over backwards to find something – even if it’s a rare possibility – in order to cover themselves,” Nuwer says.

Reforming the U.S. health care system with the goal of providing universal, affordable, high-quality care will require rethinking our overall values and paying greater attention to care-related expenditures, according to Nuwer.

Part of the current problem, he says, is that doctors are oblivious to the price tags of options they’re prescribing for patients. He recommends educating physicians about the costs of care, including imaging, blood tests and specific drugs.

“Does a fancy electric wheelchair cost $500 or $50,000?” Nuwer asks. “Most doctors have no clue. We need to give physicians feedback about the dollar signs behind their orders.”

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Nuwer’s co-authors on both articles include Dr. G.L. Barkley (Henry Ford Hospital, Detroit); Dr. G.J. Esper (Emory University School of Medicine, Atlanta); Dr. P.D. Donofrio (Vanderbilt University School of Medicine, Nashville); Dr. J.P. Szaflarski (University of Cincinnati Academic Health Center); and Dr. T.R. Swift (Medical College of Georgia, Augusta).

UCLA is California’s largest university, with an enrollment of nearly 38,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university’s 11 professional schools feature renowned faculty and offer more than 323 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Four alumni and five faculty have been awarded the Nobel Prize. For more news, visit the UCLA Newsroom.

Reprinted from the UCLA Newsroom.

When you are sick or injured, you want to know what’s wrong and what can be done. You want a diagnosis. A correct diagnosis reveals what is wrong, what is the preferred treatment and what is the likely outcome. For example, a diagnosis of pneumonia indicates a serious lung infection that can usually be cured with antibiotics.

While medical diagnoses are based on science, psychiatric “diagnoses” are not at all scientific. They do not reveal what is wrong, what is the preferred treatment, and what is the likely outcome. Nor are they reliable. Different psychiatrists who examine the same patient typically offer different “diagnoses.” Moreover, psychiatric “diagnoses” move in and out of favor, depending on a variety of social factors.

Psychiatric “diagnosis” is actually a labeling process, where the patient’s symptoms are matched with a grouping of symptoms listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Psychiatric Disorders (DSM). As we shall see, this psychiatric “bible” was developed and is maintained by financial and political interests.¹

Sigmund Freud

Who decides what is normal or healthy and what is deviant or sick?

Before the 20^th century, life stresses were generally seen as spiritual problems or physical illnesses, and people turned to religious advisors and physicians for help. Medical doctors treated “hysteria” and “nerves” as physical problems. Psychiatry was restricted to the treatment of severely disturbed people in asylums.² The first classification of psychiatric disorders in the United States appeared in 1918 and contained 22 categories. All but one referred to various forms of insanity.

In 1901, Sigmund Freud revolutionized psychiatry by breaking down the barrier between mental illness and normal behavior. In The Psychopathology of Everyday Life,³ Freud argued that commonplace behaviors – slips of the tongue, what people find humorous, what they forget and the mistakes they make – indicate repressed sexual feelings that lurk beneath the surface of normal behavior.

By linking everyday behavior with mental illness, Freud and his followers released psychiatry from the asylum. Between 1917 and 1970, as psychiatrists cultivated clients with a broad range of problems, the number of psychiatrists practicing outside institutions swelled from eight percent to 66 percent.⁴

The social movements of the 1960′s opposed psychiatry’s focus on inner conflict and emphasized the social sources of sickness instead. Dr. Alvin Poussaint recalls the 1969 convention of the American Psychiatric Association (APA).

“After multiple racist killings during the civil rights movement, a group of black psychiatrists sought to have murderous bigotry based on race classified as a mental disorder. The APA’s officials rejected that recommendation, arguing that since so many Americans are racist, racism in this country is normative.”⁵

Growing the industry

In 1980, the APA overhauled the DSM. The Task Force established to create the new manual declared that any disorder could be included,

“If there is general agreement among clinicians, who would be expected to encounter the condition, that there are significant number of patients who have it and that its identification is important in the clinical work it is included in the classification.”⁶

In other words, the new DSM was not based on science, but on the need to maintain existing patients and include new ones who might seek help for any number of problems. A profitable and self-perpetuating industry was born. The more people could be encouraged to seek treatment, the more conditions could be entered into the DSM, and the more people could be encouraged to seek treatment for these new conditions.

By 1994, the DSM listed 400 distinct mental disorders covering a wide variety of behaviors in adults and children. Significantly, racism, homophobia (fear of homosexuality) and misogyny (hatred of women) have never been listed as mental disorders. In 1999, the chairperson of the APA’s Council on Psychiatry and the Law confirmed that racism “is not something that is designated as an illness that can be treated by mental health professionals.”⁷ Homosexuality was listed as a mental disorder until activists campaigned to have it removed.⁸

The women’s liberation movement condemned labeling symptoms of oppression as mental illnesses. In They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, Paula Caplan explains,

“In a culture that scorns and demeans lesbians and gay men, it is hard to be completely comfortable with one’s homosexuality, and so the DSM-III authors were treating as a mental disorder what was often simply a perfectly comprehensible reaction to being mocked and oppressed.”⁹

Caplan describes efforts to prevent “Masochistic Personality Disorder” from being included in the DSM. This disorder assumes that women stay with abusive spouses because like to suffer, not because they lack the resources to leave. Despite protest, “Masochistic Personality Disorder” was added to the 1987 edition of the DSM, although it was later dropped.

The inclusion of “Pre-Menstrual Dysphoric Disorder” (PMDD) in the DSM also raised a protest. According to Caplan,

“The problem with PMDD is not the women who report premenstrual mood problems but the diagnosis of PMDD itself. Excellent research shows that these women are significantly more likely than other women to be in upsetting life situations, such as being battered or being mistreated at work. To label them mentally disordered – to send the message that their problems are individual, psychological ones – hides the real, external sources of their trouble.”¹⁰

As soon as PMDD was listed in the DSM, Eli Lilly repackaged its best-selling drug, Prozac, in a pink-pill format, renamed it Serafem, and promoted it as a treatment for PMDD. By creating Serafem, Lilly was able to extend its patent on the Prozac formula for another seven years.

A marketing gold mine

The DSM is a marketing gold mine for the drug industry. The FDA will approve a drug to treat a mental disorder only if that disorder is listed in the DSM. Therefore, each new listing is worth millions in potential drug sales. Most of the experts who construct the DSM have financial ties to pharmaceutical companies, and every new edition of the DSM contains more conditions than the previous one.

Once the DSM lists a new mental disorder, drugs for that disorder are heavily marketed for everyone who might fit the symptom checklist. (Doctors are also encouraged to prescribe these drugs for “off-label use,” which means to anyone they think might benefit.) Not surprisingly, the   numbers of people “diagnosed” with a mental condition rise rapidly after a drug is approved to treat that condition.

In 2005, a major study announced that “About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life…¹¹ How is this possible? Has it become normal to be mentally ill, or has the definition of mental illness expanded beyond reason? Both could be true.

Capitalism damages people in many ways. It’s also true that the more people can be labeled as sick, the more profits can be made from selling them treatments. In Creating Mental Illness, Alan Horowitz warns,

“…a large proportion of behaviors that are currently regarded as mental illnesses are normal consequences of stressful social arrangements or forms of social deviance. Contrary to its general definition of mental disorder, the DSM and much research that follows from it considers all symptoms, whether internal or not, expected or not, deviant or not, as signs of disorder.”¹²

Most people know the difference between normal behavior (such as grief over the death of a loved one) and abnormal behavior that could indicate an internal disorder (such as prolonged grief for no apparent reason). However, the DSM does not consider what happens in people’s lives. With one exception (Post-Traumatic Stress Disorder), the DSM lists and categorizes symptoms outside of any social context. As a result, DSM-based surveys artificially increase the numbers of people suffering from mental disorders and, therefore, the market for drug treatments.

DSM-inflated rates of mental illness are typically accompanied by the warning that not enough people are getting treatment,¹³ which serves to further expand the market for drugs. The question of whether all these people are actually sick is never raised, nor is the question of whether their symptoms might be linked to physical illnesses. 

Many physical diseases generate psychological symptoms. Researchers estimate that from 41 to 83 percent of people being treated for psychiatric disorders are actually suffering from misdiagnosed physical diseases like hyo- or hyper-thyroidism, heart disease, immune-system diseases, nervous system diseases (including multiple sclerosis) and cancer.¹⁴ Undiagnosed and untreated, these physical diseases can progress to cripple or kill. Furthermore, psychiatric drugs can worsen physical diseases, sometimes fatally. None of these “costs” are borne by the pharmaceutical industry – the most profitable industry in America.

Social control

Psychiatry has a long history of medicating the oppressed, including children, for social control.¹⁵

Schools force youngsters to sit still in closed rooms for long periods of time and force-feed them information that has no connection to their lives. Those who rebel are diagnosed with mental disorders (Attention-Deficit Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder, etc.) and forced to take mind-altering drugs. To preserve a crazy-making system, the healthy child must be made “crazy.”

Using DSM criteria, at least six million American children have been diagnosed with serious mental disorders, triple the number in the early 1990′s. The rate of boys aged 7 to 12 diagnosed with Bipolar Disorder more than doubled between 1995 and 2000 and continues to rise.

A 2007 survey of 8- to 15-year-olds discovered that nine percent met the DSM criteria for attention deficit/hyperactivity disorder (ADHD). The survey found that fewer than half of these children had been diagnosed or treated, “suggesting that some children with clinically significant inattention and hyperactivity may not be receiving optimal attention.” Noting that poor children were least likely to receive medication, the authors of the study recommend “further investigation and possible intervention.”¹⁶

Instead of addressing the oppressive social conditions that agitate children, psychiatry imposes conformity through medication. To force compliance with this oppressive system, access to insurance benefits, medical care and social services depends on “having a diagnosis.”

Most of the symptoms listed in the DSM describe human responses to deprivation and oppression (anxiety, agitation, aggression, depression) and the many ways that people try to manage unbearable pain (obsessions, compulsions, rage, addictions). Depression is strongly linked with poverty,¹⁷ and alleviating poverty can lift depression.¹⁸

The suffering of war veterans is labeled as a mental disorder (PTSD) instead of the inevitable consequence of war. These soldiers are sick because they have been violated. Their symptoms express their anguish and outrage at the barbarism they witnessed and perpetrated on others.  What’s sick is sending good people into the hell of war.  

Schizophrenia is designated as a mental illness that is assumed to be genetic. However, studies from several countries show that living in a city gives a person a higher probability of developing schizophrenia than having a family member with the disease. Moving from rural to urban centers increases the risk of developing schizophrenia, while moving in the other direction reduces the risk.¹⁹ City living is associated with increased stress and trauma, exposure to lead,²⁰ infection,²¹ malnutrition,²² and racial discrimination²³- all of which are linked with higher rates of schizophrenia.

Under capitalism, addressing the social causes of illness is politically risky and unprofitable. So psychiatry extracts the individual from society, splits the brain from the body, severs the mind from the brain and drugs the brain.²⁴

A sick society

Capitalism is a system that requires the majority to have no control over their lives and to believe that this condition is normal. Therefore, all reactions to inequality and deprivation must be viewed as signs of personal inadequacy, biological defect, mental illness – anything other than reasonable responses to unreasonable conditions.

During slavery days, experts argued that Black people were psychologically suited for a life of slavery, so there must be something wrong with those who rebelled.² In 1851, the diagnosis of “drapetomania”(runaway fever) was developed to explain why slaves try to escape.²⁶ Not much has changed. Today, exploitation and oppression are considered normal, and those who rebel in any way are considered to be sick or deviant and in need of medication or incarceration.

What’s the diagnosis for a sick society? We know what’s wrong. Most people are kept in sick social conditions so that a few can maintain their wealth and power. What is the treatment?  Putting human needs first would eliminate most human misery. Who will deliver the medicine? The majority must organize to take collective control of society.

I don’t expect this diagnosis to appear in the DSM anytime soon.

1  Kirk, S.S. & Kutchins, H. (1992). The selling of DSM: The rhetoric of science in psychiatry. New York: Aldine De Gruyter.

2. Horowitz, A.V. (2002). Creating mental illness. Chicago: University of Chicago Press.

3. Freud, S. (1901/1991). The psychopathology of everyday life. New York: Penguin

4. Shorter, E. (1997). A history of psychiatry: From the era of the asylum to the age of Prozac. New York: John Wiley & Sons.

5. Poussaint, A.F. & Alexander, A. (2000). Lay my burden down: Suicide and the mental health crisis among African-Americans. Boston: Beacon Press, p.125.

6. Spitzer, R.L., Sheeney, M. & Endicott, J. (1977).  DSM III: Guiding principles. In Psychiatric diagnosis, (Eds). Rakoff, V., Stancer, H. & Kedward, H. New York: Brunner Mazel.

7. Egan, T. (1999). Racist shootings test limits of health system and laws. New York Times, August 14, p.1.

8. “DSM and homosexuality: A cautionary tale.” in Kirk, S.A. & Kutchins, H. (1992). The selling of DSM: The rhetoric of science in psychiatry. New York: Aldine De Gruyter  p 81-90

9. Caplan, P. (1995). They say you’re crazy: How the world’s most powerful psychiatrists decide who’s normal. New York: Addison-Wesley, pp.180-181.

10. Caplan, P.J. (2002). Expert decries diagnosis for pathologizing women. Journal of Addiction and Mental Health. September/October 2001, p.16.

11 Kessler, R.C. et. al. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. Vol.62, No.6, pp.593-602.

12. Horowitz, A.V. (2002). Creating Mental Illness. Chicago: University of Chicago Press. p.37.

13. Talen, J. (2005). Survey says nearly half of all Americans will be affected by a mental illness, some before adulthood. Newsday, June 7. www.newsday.com/news/health/ny-hsment0607,0,6745489.story 

14. Klonoff, E.A. & Landrine, H., 1997, Preventing misdiagnosis of women: A guide to physical disorders that have psychiatric symptoms. Thousand Oaks, CA: Sage 

15. Breggin, P.R. & Breggin, G. R. (1994). The war against children: How the drugs, programs, and theories of the psychiatric establishment are threatening America’s children with a medical ‘cure’ for violence. New York: St. Martin’s Press.

16. Froehlich T.E., et. al. (2007). Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med. Vol.161, pp.857-864. 

17. Duenwald, M. (2003). More Americans Seeking Help for Depression. New York Times, June 18. http://www.nytimes.com/2003/06/18/health/18DEPR.html

18. Costello, E.J., Compton, S.N., Keeler, G. & Angold, A.(2003). Relationships between poverty and psychopathology: a natural experiment. JAMA. Oct 15, Vol.290, No.15, pp.2023-9.

19.. Pedersen, C.B. & Mortensen, P.B. (2001). Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiatry. Vol. 58, No. 11, pp.1039-46.

20. Calamai, P. (2004). Lead exposure in womb linked to schizophrenia. Risk also found if mother had flu: 1960′s U.S. data help unravel mystery. The Toronto Star, Feb. 15.

21. Opler, M.G.A. et al. (2004). Prenatal lead exposure, -aminolevulinic acid, and schizophrenia. Environmental Health Perspectives, Vol.112, pp.548-552.

22. St Clair, D., Xu, M., Wang, P. Yu, Y., Fang, Y., Zhang, F. Zheng, X., Gu, N., Feng,G., Sham, P. & He, L. (2005). Rates of adult schizophrenia following prenatal exposure to the Chinese Famine of 1959-1961. JAMA. Vol.294, No. 5, pp.557-562.

23. Joan Arehart-Treichel, J. (2003). Is schizophrenia a downside of urban life?  Psychiatric News (American Psychiatric Association) May 16, Vol.38,  No.10, p.37.

24. Ross, C.A., & Pam, A., (1995).  Pseudoscience in biological psychiatry: Blaming the body.  New York: Wiley.

25. Poussaint, A.F. & Alexander, A. (2000). Lay my burden down: Suicide and the mental health crisis among African Americans. Boston: Beacon Press.

26. Cartwright, S. (1851). Report on the diseases and physical peculiarities of the Negro race. New Orleans Medical and Surgical Journal. May, p. 707.

Susan Rosenthal is a practicing physician and the author of POWER and Powerlessness (2006) and Class, Health and Health Care (2008). She is a founding member of International Health Workers for People Over Profit. She can be reached through her web site: http://www.powerandpowerlessness.com/ or by email: powerandpowerlessness@rogers.com

This article was origanily published on Dissident Voice.

Nationwide, uninsured children in families earning between $38,000 and $77,000 a year are just as likely to go without any health care as uninsured children in poorer families. More than 40 percent of children in those income brackets who are uninsured all year see no physicians and have no prescriptions all year, according to new research from the University of Rochester Medical Center.

“There’s an assumption that children in families with higher income levels don’t need insurance, that they are uninsured but are somehow still receiving health care anyway,” said Laura Shone, Dr.P.H., M.S.W., an assistant professor of pediatrics at the University of Rochester Medical Center and author of the study being presented today at the Pediatric Academic Societies meeting in Honolulu, Hawaii. “This study shows that in reality, a large percentage of these children don’t receive any care at all – which pediatricians say is unacceptable, and parents know is unrealistic. Even healthy, older children need to see their physicians at least once over the course of a year.”

Overall, almost 3 million uninsured children had no medical care and no prescription use for a full year, according to an analysis of nationally representative data from the 2004 Medical Expenditure Panel Survey. Of those, about 1.6 million children may qualify for public coverage but are not enrolled, and about 1 million more could be covered through expansions that were proposed yet vetoed at the national level in late 2007. The percentage of uninsured children who forego all health care for a full year is:

• 55 percent at 0 to 100 percent of the federal poverty level ($0 to $19,157 for a family of four)
• 51 percent at 101 to 200 percent of the federal poverty level ($19,158 to $38,314)
• 42 percent at 201 to 300 percent of the federal poverty level ($38,315 to $57,471)
• 44 percent at 301 to 400 percent of the federal poverty level ($57,472 to $76,628)
• 30 percent for those over 400 percent of the federal poverty level ($78,629 and above)

Since 1997, the national State Children’s Health Insurance Program has provided health insurance to low-income children who are not eligible for Medicaid and do not have private coverage. Under the federal law, states received grants of federal dollars to help with costs of insurance expansions, and they had several options for how to expand coverage for children using those dollars.

A pediatric research team at the University of Rochester Medical Center has been studying Child Health Plus (New York’s state-specific plan beginning in 1991, which in 1997, received federal approval to become the state’s SCHIP plan) since its inception. Earlier research by this team has shown that the program greatly increases children’s access to primary care, preventive care, as well as other needed health care. SCHIP markedly reduces children’s unmet health care needs and reduces pre-existing racial disparities in access, unmet need and continuity of care. Parents of children with asthma and special health care needs were more satisfied and better able to afford care and medications for their child’s condition once enrolled.

When the program came up for federal renewal last year, there were several sources of disagreement over whether to expand the program. In addition to debating the potential funding source for the expansion, the executive and legislative branches held different expectations as to how often families would leave private insurance for the public program, particularly at the higher income levels (200 to 400 percent of the federal poverty level).

Congress has extended SCHIP at flat funding, with no expansion. Questions remain about whether current funding will continue to cover those already enrolled. Since expansion was vetoed at the national level, New York’s Governor David Paterson has signed state-level proposals to expand Child Health Plus in New York using only state monies. Several other states are considering similar state-level expansions.

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Reprinted from the University of Rochester Medical Center.

CINCINNATI — Two new studies conducted by researchers at Cincinnati Children’s Hospital Medical Center point to the negative impact of parental job loss on children’s healthcare and the importance of having continuous health insurance coverage to meet children’s healthcare needs and reduce healthcare disparities.

The studies will be presented Saturday May 3 at the annual meeting of the Pediatric Academic Societies in Honolulu.

“These studies describe a situation that should be of grave concern to parents, health care providers and policymakers,” says Gerry Fairbrother, Ph.D., a researcher in the division of health policy and clinical effectiveness at Cincinnati Children’s who was an author of both studies. “The impact of not having insurance coverage in place year-round hurts children in many ways, including not being able to get the prescribed medications they need, and not having a regular source of health care – and that puts their health at risk.”

The first study shows that children whose parents lose or change jobs were twice as likely to lose their health care coverage as children whose parents did not lose or change jobs. In addition, children with private insurance were more than three times as likely to lose coverage.

“This is a particularly disturbing finding, coming at a time when job loss is becoming more common due to the economy,” says Dr. Fairbrother, Ph.D., the study’s lead author. “As unemployment rises, more and more children are likely to experience a break in coverage that affects their health care. Our study showed that most of these children are eligible for public coverage but are not getting the coverage to which they are entitled. Much more needs to be done to reach out to children with private coverage when their parents experience job loss or change.”

Dr. Fairbrother’s study examined data collected over two years from the Medical Expenditure Panel Survey, a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. She examined the effect of parental job loss in an early round of data collection with children’s insurance coverage in a later round. Children who lost insurance when their parents lost or changed jobs were more likely to be poor, black, from Spanish-speaking homes and reside in the southern United States, according to Dr. Fairbrother.

The second study examined children who did not have continuous coverage — insurance in place consistently year-round — and found that they had unmet health care needs similar to the chronically uninsured. These children were three times as likely to have unfilled prescriptions and 14 times as likely not to have a usual source of health care as insured children.

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This study used data on 15,447 children up to the age of 17 from the Ohio Family Health Survey, which was conducted from Oct. 2003 to July 2004. The lead author of the study was Joseph Schuchter, an epidemiologist at Cincinnati Children’s. Dr. Fairbrother was senior author.

The PAS meeting, sponsored by the American Academy of Pediatrics, the American Pediatric Society, the Society for Pediatric Research and the Ambulatory Pediatric Association, is the largest international meeting to focus on research in child health.

Cincinnati Children’s Hospital Medical Center, one of the leading pediatric research institutions in the nation, is dedicated to changing the outcome for children throughout the world. Cincinnati Children’s ranks second among all pediatric institutions in the United States in grants from the National Institutes of Health. It has an established tradition of research excellence, with discoveries including the Sabin oral polio vaccine, the surfactant preparation that saves the lives of thousands of premature infants each year, and a rotavirus vaccine that saves the lives of hundreds of thousands of infants around the world each year. Current strategic directions include the translation of basic laboratory research into the development of novel therapeutics for the treatment of disease, and furthering the development of personalized and predictive medicine. Additional information can be found at www.cincinnatichildrens.org.