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Above: Lake Geneva, Switzerland. At Montreux.

Fodderize v.t. 1. To break down individual components; to make fungible; to disregard difference; to render one easily substituted for another 2. To impose sub-quality goods or services upon, with little recourse 3. To cap role choices, hinder access to resources regardless of merit, and so avoid competition 4. To manage perception by propaganda-spin techniques, while concealing dispositive facts 5. To manipulate, lure, exploit, deceive

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Thursday, October 16, 2014

The State that Perry built. No Medicaid expansion. Hospital admissions only for profit. Failure to expand Medicaid predictably fosters contagion.


Texas. The State where Mr. Duncan died. 
Weigh heavily Texas' refusal to expand Medicaid.

Texas is liable for its negligent refusal to admit. With no guarantee of payment, the profit-bound hospital's decision to refuse him admission is predictable, but culpable.  Public health considerations require expansion of medicaid.


1.  Texas.  This is the state where Thomas Eric Duncan lived. He is mourned. See http://www.dallasnews.com/opinion/latest-columns/20141014-josephus-weeks-ebola-didnt-have-to-kill-my-uncle.ece

2.  This is the state that Perry built, where Mr. Duncan lived,
  •  The State that refused Medicaid expansion as not profitable for its budget, see http://keranews.org/post/where-do-greg-abbott-and-wendy-davis-stand-medicaid-texas; 
    • This Texas Health Resources site says that its hospitals cover charity care, see http://www.texashealth.org/CharityCare/ ; 
      • and a poor person need only download (who has the computer? the literacy?) the Charity Care Application (that title is a humiliation) and a committee will decide how much if any of the bill will be forgiven. And:
      • You need a Guarantor, see http://www.texashealth.org/workfiles/THR%20System/Business_Office/Charity_Application_English_12-12-2012.pdf
      • What kind of ersatz human need care is that?  
  •  The State that promotes healthcare as merely business, profit-driven, as a state policy, including apparently no problem with refusing admission to those who cannot pay to play.
    • No health insurance? Stay here for 4 hours then you are on your own, regardless of presenting symptoms, and ignoring broadly disseminated public epidemic information about infections to which travelers and now this patient may have been exposed.  See http://www.covertexasnow.org/content/uninsured-big-problem-texas/.
      • An Emergency Room stay (what exams were given?), some four hours, says the hospital, is no measure of common sense with the presenting facts here, and no excuse for negligence, even gross negligence, see http://www.nbcdfw.com/news/health/Hospital-Releases-Statement-About-Ebola-Victims-Care-278707821.html
  • The State that sought secession and did not succeed, seeking to be on its own to conduct governing as a business in all regards for profit rather than for the common good.  See http://www.usnews.com/news/blogs/washington-whispers/2012/11/13/white-house-flooded-with-secession-petitions-after-obama-re-election/; 
    • The same State that now blames the CDC for consequences of the hospital's own policy and errors -- predictable once the unlikely event of the first case indeed occurred -- in infection spreading, see http://www.reuters.com/article/2014/10/13/us-health-ebola-usa-nurse-idUSKCN0I206820141013/
  • Thank you, Governor Perry.  For nothing?  For passing bucks?  We see you may yet consider doing what is right. See http://www.forbes.com/sites/brucejapsen/2014/08/17/why-rick-perry-could-warm-to-obamacares-medicaid-expansion/
3.  And this is the state where Mr. Duncan died.

See http://www.theguardian.com/world/2014/oct/08/thomas-eric-duncan-liberia-ebola-war-texas-family-obituary

4.  Texas.

This is the State where Mr. Duncan lived, and died, and the nature of the State made a great difference. Vetting needed:  Would Mr. Duncan have had a greater chance of timely admission if the hospital had been assured of reasonable payment through Medicaid?
  • Who has stats on states without Medicaid expansion, and needed hospital admissions; and those with Medicaid expansion.  Is there a correlation to serious illness? 
  •  Do hospitals operated for profit (charity care looks like a sham, see above) tend to release uninsured persons without admission, or early -- to fend for selves back in the community, regardless.  Go. Find out.
  •  Are the remaining 25 or so states without Medicaid expansion putting the rest of us more at risk, because they tend to early release without admission. Will a hospital in a non-expansion state be equally ill prepared by policy and economics to avoid care unless it profits.  See FN 1

5.  Is it time to move Texas?

a.   Move where?
  • It has already failed at independence, secession.  Even if it had succeeded, it would be back on our collective doorsteps for help now, now that we know how its desire for unregulated exploitive government for its elites is shown faulty even for the elites. 
  • Re-absorption into Mexico? Explore. Would Mexico accept it as another Mexican state? Bonanza!  If so, Originalists should cheer. 
  • Go on. Git.

The Texas elites would turn reabsorption into Mexicot down, however, with no seniority offered, and as just another state in Mexico, no supremacy, and worse, its loss of scapegoats.
 b.  Move how?

Try change of mindset, now that we have an election pending.

Change of mindset keeps criticism of outsider meddling at bay; and requires only insiders.  Who can complain?  Texas failure, not CDC.  CDC can improve mightily, but in this case, with the release of Mr. Duncan, that buck has stopped.  Ask fast, before elections:
    • Who in Texas supported, supports expansion of medicaid, as that expansion done timely might well have paved the way for Thomas Eric Duncan's survival, instead of his callously driven demise.  

Some elections do funnel down to an unexpected breaking single issue.  What if Rick Scott loses in Florida because of #fangate?

6.  The refusal of Texas and other states to expand medicaid could well be that change issue now.

Clearly, however, the Medicaid expansion refusers may continue to prevail in pending elections, but at a new cost. The refusal is now tied to a tangible consequence:  epidemic because of the refusal to treat an uninsured person.  Payback time.

  • So, ye Texans, vote only for officials who will expand medicaid and fast can change the refusers' tune.
It is common knowledge that, in Texas, the failure of the legislature-governor to enact medicaid expansion leaves many uninsured, see statistics at http://www.texmed.org/Template.aspx?id=5519/  This lack of coverage always had predictable consequences in terms of releasing infected people, with the main issue being when, not whether.

The issue is of national import.  Lack of coverage affects the workforce as well as epidemiologoy.  This lack of coverage has been the focus of some in-state criticism, but not enough.  See http://www.covertexasnow.org/content/uninsured-big-problem-texas/.

7.  Who could move Texas? So who in Texas can turn the mindless tide of running government for profit?
  • Try Leticia Van de Putte. Leticia Van de Putte.  Le-ti-cia Van de Putte.  
  •  Hers is not exactly a household name.  She is a democrat in Texas, a Senator from the 26th District, running for lieutenant governor and supported by the Dallas news, see http://www.dallasnews.com/opinion/editorials/20141015-editorial-we-recommend-leticia-van-de-putte-for-lieutenant-governor.ece/  She supported and supports expanded healthcare coverage, see http://blogs.sacurrent.com/thedaily/leticia-van-de-putte-calls-for-expanded-health-coverage/  
  • And, of course, Wendy Davis, who promotes Medicaid expansion, see http://www.dallasnews.com/news/politics/headlines/20131203-greg-abbott-wendy-davis-split-over-approach-to-federal-government.ece
8.  From this moment on:  The nation should tolerate no scapegoating the CDC or federal government on ebola.  It was right in assessing that infection in this country was highly unlikely.  It was.  States and governors are to be proactive, however, not sitting back with their juleps and waiting for someone else to represent their people.  A state that just leaves its people to go find and pay for its own insurance, see http://www.texashealthoptions.com/cp/findingcoverage.html/, is in need of an election upset.

9.  Let's get torty.   Assumption of the risk.  States refusing Medicaid expansion assume the risk that the policy of releasing infectious people back into the population -- negligent screening -- is culpable when bad results ensue.  Negligence, and especially gross negligence -- the hospital knew this person had just been in Liberia -- is enough to trigger that one.  Sue the State, and if Texas won't allow suits against it, figure something else out.

  • What on earth justified that hospital releasing Mr. Duncan, except that it was not going to be paid and the policy is to trash the poor.  Coaching on protocols is needed, but that does not pass the buck from Health Presbyterian Hospital Dallas in its initial contact and release. See http://www.theguardian.com/world/2014/oct/01/ebola-us-doctors-texas-liberia

10.  Vetting.

10.1.  Fact check on whether Mr. Duncan had health insurance.  Our source may not be correct. Then ask, was his income enough for him to qualify for healthcare insurance, or was he poor poor.  That may help our assessment of the responsibility of residents.  His nephew claims he had no insurance, see http://www.dallasnews.com/opinion/latest-columns/20141014-josephus-weeks-ebola-didnt-have-to-kill-my-uncle.ece/  On the other hand, the cost to public health is so great when people are untreated, that the State should not allow uninsured people to go untreated regardless of their own negligence in not getting insurance.  Figure out a way. 

10.2   Fact check on the role of health insurance in admissions questioning: If money is put ahead of symptoms, the hospital is culpable. Ask whether Medicaid patients are admitted and the uninsured are not,  and what forms and questions the hospital poses to patients before deciding what kind of treatment to give.

What are the real alternatives?  Merely being at a hospital for 4 hours does not mean much was done in that time. Reconstruct those 4 hours.  This is a hospital touted for its acute care, see http://www.texashealth.org/dallas

  • Texas Health Presbyterian Hospital Dallas.  Texas, vet the record.  Vet the forms filled out.  How clear was it that he did not have health insurance.
  • We know how important the money up front is.  Pre-register, and the second in the list at the website is paying the bill.

10.3  Past practice.  What is the hospital's policy when someone has no health insurance.  What percentage of patients pass the big charity test.  Did the emergency room follow its own protocol in not admitting Mr. Duncan.  What discretion do the personnel have.

10.4 .  Even without the CDC, does Texas simply bar the door as a matter of policy; and in this case, to the risk of all of us.

.............................................................................................................................

FN 1  Expanding healthcare in Texas comes too late for Thomas Eric Duncan, who apparently had no health insurance and so was turned away from treatment by the Texas Health Presbyterian Hospital in Dallas.  Vet those statements, inferences, see Mr. Duncan's letter to the editor at  http://www.dallasnews.com/opinion/latest-columns/20141014-josephus-weeks-ebola-didnt-have-to-kill-my-uncle.ece/   If he had no health insurance, vet Texas further:  what were his options for care?
  •  Texas says all is fine for "qualified" people, see http://www.tmhp.com/Pages/ClientEnglish/client_health_care.aspx/  
  • For those who do not "qualify," there is a website for finding health insurance, see http://www.texashealthoptions.com/index.html/  
  • Overall, Texans are on their own: advised to get health insurance before an emergency happens, and the federal government will penalize you with a fine if you do not have it, see http://www.texashealthoptions.com/cp/whyinsurance.html/