Public health prevention vs. biomedical early detection

From The Mail in the Sept. 1&8, 2025 New Yorker Magazine:

Medical Trials

Siddhartha Mukherjee, in his piece on early-stage cancer detection, presents a convincing argument concerning the perils of screening ("Early Warnings," June 23rd). He also suggests that the bio-medical model, which finds disease, is being privileged over the public-health model, which seeks to prevent illness and can do so effectively given enough resources. Clean air and water, quality food, adequate housing, safe workplaces, education, and vaccination contribute far more to the health of a population than catching disease early. But biomedicine is where the money is, and screening brings in a significant share. Mammography alone is an eleven-billion-dollar industry.

Burden Lundgren, M.P.H., Ph.D., R.N.
Norfolk, Va.

It is much cheaper preventing disease than treating it once it starts and is detected. However, prevention, by its very nature, does not lead to the manifestation of a problem, and if there is no problem, why spend resources to prevent it from occurring in the future? "We'll cross that bridge if and when we come to it is an easier political sell than spending resources up front to prevent a problem that may not occur.

An ounce of prevention is worth a pound of cure.

A stitch in time saves nine.

"Be prepared!" (Old Boy Scout motto.)

Proper Planning Prevents Piss-Poor Performance

The Republican America - Cuts at the VA

 NOTES/COMMENTS about this article:

1). According to the VA’s workforce dashboards, since the Trump administration took office in January the VA has recorded a net loss of thousands of health care positions, the only net loss in the last five years. 

2). The losses include, among others:

        *** 688 physicians, 

        *** 1,882 registered nurses, 

        *** 365 licensed practical nurses, 

        *** 316 nurse assistants,

        *** 511 social workers, 

        *** 201 psychologists 

        *** 766 medical support assistants. 

3). In June 2025 alone, VA health system staffing fell by 2,096. 

4). Department-wide job announcements have plummeted by 30 percent and applications by 44 percent since last year, while new employee onboarding has sunk by 52 percent. 

5). These figures paint a stark picture of an agency diminishing its capacity to provide direct health care, while pretending that its  services remain unchanged.

6). The 2024 “Red Team” assessment by independent experts issued a dire warning: The swelling volume of private-sector referrals has created an “existential crisis” for VA health care. 

7). Excessive utilization of private providers threatens to close VA units and facilities nationwide, destabilizing the direct care system and undermining its long-term sustainability.

Peace,

            Doug Stephenson, LCSW, BCD

            Gainesville, Florida

For more click here.

Corporate Influence in Healthcare: A Decline in Quality and Ethics

Corporate influence in healthcare has led to a decline in the quality of care and a shift in focus from patient well-being to profit generation.

Private equity firms, in particular, have been criticized for their extractive practices.

One example is the case of Steward Health Care, where a private equity firm, Cerberus Capital Management, bought six Catholic hospitals, only to later sell the land and force the hospitals to pay rent.

This financial strain led to understaffing, outdated equipment, and a decline in basic services, ultimately resulting in poorer patient outcomes and even increased mortality rates.

Despite these issues, the firm still profited significantly from their investment.

This focus on profit over patients is not limited to private equity firms.

Health insurers, for example, have been accused of "gamifying" the system to maximize profits.

UnitedHealth, the largest private insurer in the US, has been found to incentivize doctors to diagnose more conditions in patients, even offering bonuses for those who complete the most appointments with seniors enrolled in Medicare Advantage.

This practice leads to overpayments from the government to insurers, diverting taxpayer money away from those who need it.

Even nonprofit health care organizations have been found to engage in practices that prioritize revenue over patient care.

There are examples of nonprofits, like Providence and Allina Health, using debt collectors against low-income patients who were entitled to free care and denying care to patients with unpaid bills.

This shift in focus from patient care to profit has eroded the traditional ethical foundations of medicine.

The professional ethic of placing patients' interests above commercial ones is being replaced by a view of medicine as just another business.

This change is reflected in the language used to describe healthcare, with patients becoming "consumers," doctors "providers," and health care a "commodity."

However, the sources also highlight some positive developments, suggesting that the tide may be turning.

Lawmakers are expressing concern about the practices of Medicare Advantage insurers and are seeking ways to curb excessive patient diagnoses.

There are also legislative efforts to increase scrutiny of private equity in healthcare and to penalize firms engaging in harmful practices.

Additionally, doctors across the country are unionizing at unprecedented rates to advocate for better patient care and resist corporate dominance in healthcare.

For more click here.

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The financialization of American health care

Summary The provided text examines the detrimental effects of corporate influence on healthcare in the United States. It details how private equity firms, like Cerberus Capital Management with Steward Health Care, prioritize profit over patient care, leading to declines in quality and accessibility. The article further illustrates how large insurance companies, such as UnitedHealth, incentivize excessive diagnoses and treatments to maximize Medicare reimbursements. This corporate model is contrasted with the traditional medical ethos of prioritizing patient well-being, revealing a system where financial motivations undermine the core values of healthcare. Ultimately, the piece argues that this "Gilded Age of medicine" necessitates systemic reform to protect patients and preserve the integrity of the medical profession.

For The New Yorker Article click here.

Subscribe to Markham's Slow News in the upper right corner. 

Send this article to friends and family to let them know the high quality of life afforded to citizens of New York State using the email icon at the bottom of the post. 

Post this article to your social media to help spread the good news that New York cares about mothers, babies, families, and their community.

OB-GYNs leaving Texas

What happens in states where OG\B-GYN can no longer provide women with reproductive health care without engaging in criminal activity? They leave the state to practice elsewhere.

Increasingly red states have inferior health care with poorer health care outcomes for women.

For more click here.

This is another example of how poor social policies contribute to lower quality of life for people who live under the jurisdiction of those policies.

New York State as #3 for health care in the U.S.

 

The ranking of New York State as #3 for health care in the U.S. News & World Report's "Best States" rankings for 2021 reflects a combination of factors related to access to care, quality of care, and public health.

1. Access to care: This indicator looks at factors like the percentage of adults with health insurance, the availability of primary care providers and mental health professionals, and the affordability of health care. New York State ranked #4 for access to care, indicating that many residents have health insurance and can access necessary medical services.

2. Quality of care: This indicator considers factors like the quality of hospitals, nursing homes, and home health care providers, as well as the effectiveness of public health interventions like vaccination rates and cancer screenings. New York State ranked #5 for quality of care, suggesting that residents receive high-quality medical treatment and preventive care.

3. Public health: This indicator looks at factors like the prevalence of smoking, obesity, and other health risk factors, as well as the overall health of the population and the effectiveness of public health policies and programs. New York State ranked #11 for public health, indicating that there is still room for improvement in this area.

The high ranking for health care in New York State suggests that residents generally have access to high-quality medical care and preventive services.

Good social policies produce good outcomes. Good social policies are legislated by competent, capable, knowledgeable, ethical legislators. It makes a difference who you vote for. Choose wisely when you vote for politicians to represent you.

Health care companies and trade organizations spent $308 million on lobbying the federal government representatives in 2019

According to The Week magazine issue on February 2, 2020, on page 36 referring to a report on Axios.com, sixty health-care companies and trade organizations spent collectively $308 million on federal lobying in 2019 up 9% from 2018. The $308 million includes $120 million from the pharmaceuticals trade group PhRMA to pay 450 lobbyists.

How soap and hand washing kills coronavirus.

What is the Coronavirus incubation period?

From Big Think. Click here for more.

Coronavirus incubation About 97.5 percent of people who develop symptoms will do so within 11.5 days, according to the new study.

An important bit of data for anyone following the coronavirus outbreak, aka everyone: It takes an average of 5.1 days for a person infected with the new coronavirus to show symptoms, according to recent research from Johns Hopkins University. Published in the journal Annals of Internal Medicine, the study estimates that the median incubation period of the SARS-CoV-2 (the virus that causes COVID-19) is 5.1 days, and that 97.5 percent of people who develop symptoms will do so within 11.5 days. However, approximately 2.5 percent of people with the virus seem to develop symptoms after 11.5 days. That means a 14-day quarantine might not be 100 percent effective. In other words, for every 10,000 people quarantined, about 101 would develop symptoms after being released, according to the researchers. "Whether this rate is acceptable depends on the expected risk for infection in the population being monitored and considered judgment about the cost of missing cases," the researchers wrote. "Combining these judgments with the estimates presented here can help public health officials to set rational and evidence-based COVID-19 control policies."

Markhams Slow News Index - heatlh insurance statistics

MarkhamsSlowNews index

• Percentage American family's health care premiums have gone up over past decade = 54%
• Number of American families who file for bankruptcy every year because of medical bills = 530,000
• Percentage of Americans who support Medicare for all = 70%
• Amount of money Medicare for all would save in health care spending over first decade = $5.1 Trillion
• Amount of money health insurance companies spent lobbying congress last year = $117 million

Source, The New Republic, March, 2020, p.8

What's the deal with Medicare For All?

Misinformation about universal health care