Atul Gawande, a doctor who frequently writes for the The New Yorker magazine, said that was got him thinking about medical over-treatment was the study of a million Medicare patients, which suggested that a huge proportion had received care that was simply a waste. "In just a single year, the researchers reported, twenty-five to forty-two percent of Medicare patients received at least one of the twenty-six useless tests and treatment." [1] In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty percent of healthcare spending, or some $750 billion a year, which was more than the entire U.S. budget for K-12 education. [2] The study made the astounding claim that virtually every family in the United States has been subject to over-testing and excessive payment in one form or another.
Dr. Gawande writes that U.S. citizens annually undergo fifteen million nuclear medicine scans, a hundred million CT and MRI scans, and almost ten billion laboratory tests. He cites the CT scans and other forms of imaging that rely on radiation that they are believed to be increasing the population's cancer rates. "Over the past two decades, we've tripled the number of thyroid cancers we detect and remove in the United States, but we haven't reduced the death rate at all."
Treatment of back pain is a particular concern of Dr. Gawande: "Nationwide, we spend more money on spinal fusion, for instance, than on any other operation -- thirteen billion in 2011. One study found that between 1997 and 2005 national health-care expenditures for back-pain patients increased by nearly two-thirds, yet population surveys revealed no improvement in the level of back pain reported by patients."
Dr. Gawande cites our piecework payment system, which rewards doctors for the quantity of care provided, regardless of the results, as a key factor. "The system gives ample reward for over-treatment and no reward for eliminating it."
Dr. Gawande's conclusion is that "Waste is not just consuming a third of health-care spending; it's costing people's lives."
The United States, with between four and five percent of the world's population, houses nearly twenty-five percent of the world's prison population. About 2.3 million U.S. citizens are now incarcerated,. with African-Americans being nearly six times as likely to be incarcerated and Latinos being more than two times as likely to be in prison than whites. Studies have shown that as many as one inmate in five was the victim of sexual assault, by another inmate or by prison staff. [3]
Liberal Democrats have helped .push through harsh prison sentencing: House Speaker Thomas (Tip) O'Neill helped push through the 1986 Anti-Drug Abuse Act, which imposed mandatory sentences, asset forfeiture and the severe sanctions on crack cocaine. The 1994 crime bill, which among other harsh features, imposed the death sentence on a greater variety of crimes, was introduced by a liberal Delaware, Joe Biden, and championed by Bill Clinton.
There are some hopeful signs that the severity of prison sentencing and its aftermath may be lessened. The idea of restoring voting rights to ex-felons has the support of Senator Rand Paul and Patrick J. Nolan, a conservative who is leading the movement among conservatives to lessen or eliminate mandatory sentencing for victim-less crimes, such as possession of small quantities of prohibited drugs. Knowing that without rehabilitative services in prison, just releasing prisoners or diverting them from prison, would just increase crime, Nolan has insisted that money saved through sentencing reforms must be plowed back into providing services in prison or alternatives to prison.
Nolan would like to see abusive prosecutors lose their licenses; also, he would require the police to videotape interrogations from beginning to end, not just a confession that may have been improperly extracted.
ADDENDUMS:
*Pope Francis on Prison Sentencing - While on a visit to Paraquay earlier this year, Pope Francis heard from an inmate told him how he ended up at the severely over-crowded Palmasola prison -- built for 800 but housing 5,000, with more than four in five still awaiting trial -- and of the " 'judicial terrorism' that lets the wealthy bribe their way to freedom, while the poor languish in squalor." [4]
Pope Francis denounced the widespread abuse of pre-trial detention and called life sentences "hidden death penalties."
*Albuquerque Police Lawsuits - The city of Albuquerque, NM has settled officer lawsuits for $28 million since 2010. The shootings of Ken Ellis III and Christopher Torres resulted in respective settlements of $8 million and $6 million. The fatal shooting of the homeless James Boyd has resulted in a settlement of $5 million. The two officers involved in the fatal shooting of Boyd are now on trial.
*Religion Declines - Pew Research polling .published in May 2015 showed that the number of self-reported Christians dropped by almost eight percent in seven years to 71%. The trend held across various population segments. Those not affiliated with a religion increased from 16 to 23% in seven years. Millennials led the increase, going from 25 to 34% since 2007.
#Cleveland police File Lawsuit - In 2012, thirteen Cleveland police officers were disciplined for their role in the shooting of Timothy Russell and Malissa Williams during a pursuit that involved about a third of the Cleveland police on duty. In November 2014, nine of the thirteen filed a federal lawsuit against the city for reverse discrimination, because they were treated more harshly for shooting black people than were black officers who have shot black people -- eight of the officers are white and one is Hispanic. Some of these officers refused to testify in the trial of Michael Brelo, who was acquitted of firing the fatal shots.
Footnotes
[1] Atul Gawende, "Overkill," The New Yorker, May 11, 2015
[2] Ibid.
[3] Bill Keller, "Prison Revolt," The New Yorker, June 29, 2015.
[4] Nicole Winfield and Frank Bajak, "Pope arrives in Paraquay, praises progress," The Albuquerque Journal, July 11, 2015.
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