Category Archives: George W. Bush

Children from Central America Surge Across Our Border: Congress Must Now Decide Whether to Change the Immigration Law that George W. Bush Signed in 2008

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If you think fertilized eggs are people but refugee kids aren’t, you’re going to have to stop pretending your concerns are religious– Syd’s SoapBox

News reports have been filled with conflicting theories explaining why tens of thousands of unaccompanied children from Honduras, El Salvador and Guatemala, have been streaming into the U.S.  Some observers say that their parents are sending them here, so that they can take advantage of the social services and free education available in the U.S. Others argue that they are not coming here willingly, but that they have been forced to flee gang violence in their home countries that ranges from murder to rape. Still others charge that President Obama’s lax immigration policy has drawn these migrants to the U.S.

Unfortunately many of the reports circulating in the media and the blogosphere are not backed up by evidence.  Even worse, the American Immigration Council  (AIC) says, “some are intentionally aimed at derailing the eventual overhaul of our broken immigration system.” 

I have been fact-checking those reports for more than two weeks.  Below, a summary of you need to know as we debate this tangled story.

The AIC recently released a report, based on documented interviews with more than 350 children from El Salvador which states that  “crime, gang threats, or violence appear to be the strongest determinants for childrens’ decisions to emigrate.

Typically, the gangs try to recruit children. If they refuse, they and/or family members are shot. 

The United Nations High Commissioner for Refugees (UNHCR) offers charts showing how that in 2012, the murder rate in Honduras in was a whopping 30 percent higher than UN estimates of the civilian casualty rate at the height of the Iraq war. The charts  also reveal that, statistically speaking, Honduras, Guatemala and El Salvador are twice as dangerous for civilians as Iraq was.

Writing on Vox, Amanda Taub explains why minors are in special danger: “Children are uniquely vulnerable to gang violence. The street gangs known as “maras” — M-18 and Mara Salvatrucha, or MS-13 — target kids for forced recruitment, usually in their early teenage years, but sometimes as young as kindergarten. They also forcibly recruit girls as “girlfriends,” a euphemistic term for a non-consensual relationship that involves rape by one or more gang members.”  

This is what 15-year-old Maritza told the UNCHR when it interviewed hundreds of the fleeing children: “One member of the gang  “liked” me. Another gang member told my uncle that he should get me out of there because the guy who liked me was going to do me harm. In El Salvador they take young girls, rape them and throw them in plastic bags.”

Maritza’s uncle knew that neither he nor the police could protect her. “My uncle told me it wasn’t safe for me to stay there. They told him that on April 3, and I left on April 7.”
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George W. Bush’s Recent Stent Surgery—Two Perspectives

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Last week, when former President George W. Bush underwent stent surgery, the procedure was declared a great success.  What is surprising is that not everyone in the mainstream media applauded.  

From Bloomberg News “Former President George W. Bush’s decision to allow doctors to use a stent to clear a blocked heart artery, performed absent symptoms, is reviving a national debate on the best way to treat early cardiac concerns.

“The discussions have been ongoing since 2007, when the trial known as Courage first found that less costly drug therapy averted heart attacks, hospitalizations and deaths just as well as stents in patients with chest pain. The results were confirmed two years later in a second large trial.

“The debate has centered on both the cost of stenting, which can run as high as $50,000 at some hospitals, and its side effects, which can include excess bleeding, blood clots and, rarely, death. Opponents say the overuse of procedures like stenting for unproven benefit has helped keep U.S. medical care on pace to surpass $3.1 trillion next year, according to the U.S. Centers for Medicare and Medicaid Services.

“’This is really American medicine at its worst,’” said Steven Nissen, head of cardiology at the Cleveland Clinic in Ohio  . . .  ‘It’s one of the reasons we spend so much on health care and we don’t get a lot for it. In this circumstance, the stent doesn’t prolong life, it doesn’t prevent heart attacks and it’s hard to make a patient who has no symptoms feel better’” . . .

“’Stents are lifesaving when patients are in the midst of a heart attack’ added Chet Rihal, an interventional cardiologist at the Mayo Clinic in Rochester, Minnesota . . . ‘They allow immediate and sustained blood flow that help a patient recover. For those who aren’t suffering a heart attack, the benefits are less clear   . . . While stents may be used in patients with clear chest pain, there’s no evidence that they prevent future heart attacks.’  A review of eight studies published last year in JAMA Internal Medicine also found no differences.

“Two large-scale clinical trials completed within the last seven years have shown that drug therapy works just as well as stents in preventing cardiac complications. (The three major U.S. heart associations changed their guidelines in 2011 in an effort to reduce excess treatment.  )

[This is important. The major U.S. heart associations have absolutely no vested interest in recommending fewer procedures. When they say “Do Less,” everyone should listen–mm. ]

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A New IOM Report Reveals Why Medicare Costs So Much (Hint–It’s Not Just the Prices)

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George W.  Bush is 67. Chances are Medicare paid for the stent operation that I describe in the post above.  For years, medical researchers have been telling us that this procedure will provide no lasting benefit for a patient who fits Bush’s medical profile.   Nevertheless, in some hospitals, and in some parts of the country, stenting has become as commonplace as tonsillectomies were in the 1950s.

Location matters. Last month, a new report from the Institute of Medicine confirmed what Dartmouth’s researchers have been telling us for more than three decades: health care spending varies  across regions. More recently, as Dartmouth’s investigators have drilled down into othe data,, they have shown that even within a region, Medicare spends far more per beneficiary in some hospitals than in others.

In a recent Bloomberg column, former CBO director Peter Orszag notes that “Because this variation doesn’t appear to be reliably correlated with differences in quality, the value [that we are getting for our health care dollars] seems to be much higher in some settings than in others.” He asks the logical question: “What is causing this and what might we do about it?”

Some health care analysts claim that as a nation, we spend far more on health care than any other developed country because we over-pay for everything—from statins to surgery. (A landmark article that appeared in Health Affairs in 2003 put it this way “It’s the Prices Stupid!” )

Others put more emphasis on overtreatment. Up to one-third of Medicare dollars are squandered, physicians like Dartmouth’s  Dr.  Elliott Fisher, Boston surgeon Atul Gawade and former Medicare director Dr. Don Berwick argue.  As Fisher puts it, “hospital stays in the U.S. may not be as long as in some other countries, but more happens to you while you’re there.” (Note: the authors of “It’s the Price’s Stupid” also point out that care in the U.S. is “more intensive.”)

I agree that both theories are true: We have managed to devise a health care system where we both over-pay AND are over-treated. The  Institute of Medicine report that came out at the end of July supports this thesis.

              The Difference between Medicare and Commercial Insurers

The IOM report reveals that both Medicare and commercial insurers are spending about 40 percent more per patient in some areas and in some hospitals than in others. “This has persisted over decades;” Orszag observes.  “Regions that spent the most in 1992 tended to remain big spenders in 2010.”

But, he adds, “There is one important difference between Medicare and commercial insurance, the Institute found, and that is in the causes of spending variation. With commercial insurance, spending is higher in some areas because of markups — that is, the difference between the charge for a service and the cost of providing that service.

“Seventy percent of the variation in commercial spending was attributed to differences in markups, which in turn probably reflect local differences in market power among hospitals and other providers relative to insurance companies and beneficiaries.”

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