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What To Do When You're Stopped By Police - The ACLU & Elon James White

What To Do When You're Stopped By Police - The ACLU & Elon James White

Know Anyone Who Thinks Racial Profiling Is Exaggerated? Watch This, And Tell Me When Your Jaw Drops.

This video clearly demonstrates how racist America is as a country and how far we have to go to become a country that is civilized and actually values equal justice. We must not rest until this goal is achieved. I do not want my great grandchildren to live in a country like we have today. I wish for them to live in a country where differences of race and culture are not ignored but valued as a part of what makes America great.

Wednesday, September 22, 2021

Herd Immunity: Covid Deaths Devouring the South Are No Accident | The Nation

Herd Immunity: Covid Deaths Devouring the South Are No Accident

"For Scott Atlas, as for Republican governors like Ron DeSantis, Greg Abbott, Tate Reeves, and Kay Ivey, the human cost of our shredded public health system is a feature, not a bug.

At the end of August, I wrote about the deficiencies in President Joe Biden’s initial response to the Covid-19 pandemic. At the beginning of September, the president announced a series of new initiatives that will tackle many, though not all, of these shortcomings. I am not positing a cause and effect here: I don’t think the president’s inner circle is reading my columns in The Nation to decide what to do. However, what is driving the Biden administration’s moves is reasonable scientific advice, and my comments here were largely framed within the existing scientific consensus of what we should be doing now. We can argue the specifics—and certainly still criticize—but by and large, “science is back” in 2021 (depending where you look, but more on that later). 

It’s hard to remember—perhaps because I am trying so hard to forget—the sheer lunacy of Trump’s science last year: second-rate economist Peter Navarro’s campaign to put hydroxychloroquine in the drinking water (with help from my own institution’s Harvey Risch); the president’s ravings about bleach and ultraviolet light; and then there was Scott Atlas, the Rasputin of 2020. Though an actual physician, his training was in neuroradiology, not infectious diseases; until 2012, Atlas was a professor in his field of expertise at Stanford. After 2012, his relationship with the university shifted, and he became a fellow at the Hoover Institution, the conservative think tank loosely affiliated with the university, where he was a vocal opponent of the Affordable Care Act and pushed for Medicaid to become a bridge to private insurance.

But Scott Atlas’s claim to, well, infamy, was his embrace of the concept of herd immunity: the idea that Covid-19 was of negligible clinical significance for anyone but the elderly, and that—apart from sequestering the elderly from the rest of the population—public health restrictions were unnecessary. Rather than heed public health advice, Atlas claimed as many people needed to get infected as possible as quickly as possible to develop herd immunity and put the pandemic behind us. This was met with vociferous pushback from the medical and public health community, since “letting ’er rip”—letting the virus spread uncontrolled and thus allowing millions to get infected—also risked millions of deaths. Besides, actually sequestering the elderly and those with underlying conditions was nearly impossible given the sheer number of individuals in these categories. Atlas resigned his White House post on December 1, 2020.

I started to think about Atlas again over the past few weeks. As the Covid-19 epidemic has torn through the American South, I’ve been trying to make sense of it all. It’s easy to criticize Southern governors as ignorant, uninformed actors in the sheer catastrophe unfolding in the ICUs in the region. But then I remembered a passage in a book I read a while ago, by economists Daron Acemoglu and James Robinson, called Why Nations Fail. In it they examine how poverty happens across the world throughout history, arguing that 

poor countries are poor because those who have power make choices that create poverty. They get it wrong not by mistake or ignorance but on purpose. To understand this, you have to go beyond economics and expert advice on the best thing to do and, instead, study how decisions actually get made, who gets to make them, and why those people decide to do what they do.

What is happening in the American South is no accident. It is not born of ignorance or folly. It is a choice. Consider this comment in a New York Times article by Florida Governor Ron DeSantis: “Clearly the vaccines are keeping most of these people out of the hospital, but we’re not building the herd immunity that people hoped,” he said (emphasis mine). Herd immunity. We’re back to Scott Atlas, who would be a footnote in epidemic history—except for the thousands of deaths for which he is responsible. DeSantis was an early adherent of the notion of herd immunity espoused by Atlas and a group of scientists funded by the libertarian American Institute for Economic Research. Governor DeSantis and his colleagues in the South genuinely think they are doing the right thing. Their persistent, horrific quest for herd immunity confirms preexisting biases about the role of the state in our lives—the less the better. In the People’s Temple of the Sunshine State, this faith has led the people’s leader to hand out the Kool-Aid to his own citizens, leading them to their own deaths.

Remember, before Covid-19 the South was already the least healthy region in the country: People there lived shorter lives, with much higher rates of chronic conditions. The South was the epicenter of the American AIDS epidemic—and rife with other infectious diseases. Yet, except for Louisiana and Arkansas, most of the states in the Deep South refuse to expand Medicaid—depriving many of their citizen of access to medical care that can make their lives better. While that, too, may be rooted in a libertarian, small-government impulse, writers like Jeneen Interlandi of The New York Times have made a compelling case that decisions to restrict access to health care in the United States have everything to do with race. This is where American libertarianism meets white supremacy. 

Conservatives have worked hard for decades to bring us to this very moment, always implying that the safety net they were shredding—the basic fundamentals of public health they’ve been chipping away at over the past year—were benefiting someone else. Someone darker. Someone less deserving. Before Atlas was pro-Covid, he was looking to roll -back the ACA and dismantle Medicaid.

Lest there be any doubt, let’s take a detour to another aspect of American health care and public health: abortion and reproductive health. The new ban on abortion in Texas was crafted carefully to make it difficult to challenge. This was a considered, deliberate approach, which will deprive thousands of women of the care they need, but first and foremost women of color in the state. As Thomas Edsall wrote in the Times recently, abortion has never really been just about abortion but always tightly linked with racist ideologies. Edsall offered this quote from Richard Ballmer at Dartmouth: “Opposition to abortion became a convenient diversion—a godsend, really—to distract from what actually motivated their political activism: the defense of racial segregation in evangelical institutions.”

This is our post-pandemic future—and it is bleak. When the next virus arrives here, we will be even weaker than we were before 2020. The trajectory of the pandemic in the United States has many drivers and we cannot lay all the regional variations at the feet of our politics. However, the toxic stew of Trumpism, white supremacy, and small-government-at-all-costs mania—the embrace of pseudoscience—has made things much worse.

Watching developments over the past few weeks and months has, frankly, frightened me. Now Republican governors are going after vaccine mandates—though all their states have long had them for preventable childhood illnesses and for sectors of the workforce who interact with the sick and dying (e.g., health care workers). When Amy Coney Barrett assured us that the Supreme Court isn’t just a bunch of partisan hacks, what we heard was the Lady Macbeth of the judiciary trying to rub out the stain of the past few years’ judgments, even as she feels compelled to acknowledge it, in public, as real. With such partisanship now in place, might we see the striking down of long-held precedents on vaccine mandates and other public health measures? We’re already seeing state after state enact new laws to constrain public health authority. 

There has been a thread of the national conversation that blames public health for being its own worst enemy. The charge is that our failure to communicate clearly over the course of the pandemic has undermined public trust—and that much of what is happening now in terms of the attacks on public health is self-inflicted. Admittedly, there were significant failures in public health communications over the course of the pandemic, and there is huge room for improvement in this regard. However, separating the signal from the noise is harder in the context of state-sponsored misinformation and the deliberate manipulation of public sentiment for political gain.

But let’s head south again. The recent attacks on public health, the willingness on the part of Ron DeSantis, Greg Abbott, Tate Reeves, Kay Ivey to defy standard public health practice—even as they see their constituents suffer—has its roots in a deep ideological commitment. This isn’t about the CDC’s shifting mask guidance, or about the belated acknowledgement of airborne transmission of the virus. This isn’t what matters to these leaders. And it’s simply willful ignorance to suggest that “bad communication” is at the root of what is happening now. As Naomi Klein notes, every catastrophe is an opportunity.

The pandemic has enabled these leaders to pursue policies they have wanted to push way before SARS-COV-2 had entered the scene. As the poet Anne Sexton said of self-destruction in another context: “Suicides have a special language. Like carpenters they want to know which tools. They never ask why build.” The GOP is looking for ways to undermine access to health care, public health regulations and programs—the whole already-frayed safety net. Right now, we need a massive investment to revive public health in America. We were in dire shape before the pandemic; now we have one party that is hell-bent on destruction and the other party, for all its welcome departure from the Trump administration’s insanity, thinks it can McKinsey its way out of a crisis, ignoring the fundamental weaknesses in our public health system.

Scott Atlas may be gone, but what he helped bring to pass must give him some measure of satisfaction. And as for the deaths of those who might still be alive if they had gotten vaccinated instead of being told they were defending freedom? In my mind’s eye, I see him shrugging it all off, telling us blithely that you can’t make an omelet without breaking some eggs. For Dr. Atlas and the politicians who share his views, the chilling fact may be that all of this has been worth it."

Herd Immunity: Covid Deaths Devouring the South Are No Accident | The Nation

High Covid Hospitalizations Have Delayed Elective Surgeries - The New York Times

‘I Just Cry All the Time’: Non-Covid Patients Despair Over Delayed Care

"In areas inundated with coronavirus patients, hospitals have postponed treatments and surgeries for people with other serious conditions.

Paul McAlvain, 41, at OHSU Hospital in Portland, Ore., this month. A spike in Covid-19 cases led the hospital to postpone an operation to repair his leaky heart valve. 
Alisha Jucevic for The New York Times

In chronic pain, Mary O’Donnell can’t get around much. At most, she manages to walk for a short time in her kitchen or garden before she has to sit down. “It’s just frustrating at this point,” said Ms. O’Donnell, 80, who lives in Aloha, Ore. “I’m really depressed.”

She had been preparing for back surgery scheduled for Aug. 31, hoping the five-hour procedure would allow her to be more active. But a day before the operation, at OHSU Health Hillsboro Medical Center, she learned it had been canceled.

“Nope, you can’t come, our hospital is filling up,” she said she was told.

Faced with a surge of Covid-19 hospitalizations in Oregon, the hospital has not yet rescheduled her surgery. “I don’t know what is going to happen,” Ms. O’Donnell said, worrying that her ability to walk might be permanently impaired if she is forced to wait too long.

Alisha Jucevic for The New York Times

Echoes of the pandemic’s early months are resounding through the halls of hospitals, with an average of more than 90,000 patients in the United States being treated daily for Covid. Once again, many hospitals have been slammed in the last two months, this time by the Delta variant, and have been reporting that intensive care units are overflowing, that patients have to be turned away and even that some patients have died while awaiting a spot in an acute or I.C.U. ward.

In this latest wave, hospital administrators and doctors were desperate to avoid the earlier pandemic phases of blanket shutdowns of surgeries and other procedures that are not true emergencies. But in the hardest-hit areas, especially in regions of the country with low vaccination rates, they are now making difficult choices about which patients can still be treated. And patients are waiting several weeks, if not longer, to undergo non-Covid surgeries.

“We are facing a dire situation,” said Dr. Marc Harrison. the chief executive of Intermountain Healthcare, the large Utah-based hospital group, which announced a pause of nearly all non-urgent surgeries on Sept. 10.

“We do not have the capacity at this point in time to take care of people with very urgent conditions yet are not immediately life threatening,” he said at a news conference.

In some of the hardest-hit areas, like Alaska and Idaho, doctors are taking even more extreme steps and rationing care.

When they can, some hospitals and doctors are trying to seek a balance between curtailing or shuttering elective procedures and screenings — often lucrative sources of revenue — and maintaining those services to ensure that delays in care don’t endanger patients.

The industry was largely insulated last year from the revenues they lost during the pandemic after Congress authorized $178 billion in relief funding for providers. Some large hospital groups were even more profitable in 2020 than before the virus took its financial toll, with some going on spending sprees and buying up doctors’ practices and expanding. Many had started seeing operations return to normal levels.

A few large hospital chains did not meet the criteria for aid they had received, and returned some of it. It’s unclear how much more hospitals can expect, even if they shutter some of their operations during this latest wave. The Biden administration said earlier this month that it planned to release $26 billion in remaining Covid relief funds.

Officials have also had to weigh the risk of admitting patients who could infect others.

But doctors have also been monitoring some of the long-term effects of long waiting times for non-Covid patients during the pandemic, wary of the specter of unchecked cancers or ignored ulcerative conditions if screenings are postponed.

And the waiting is still extremely stressful, troubling both doctors and patients with pressing illnesses who do not view their conditions as non-urgent.

Audra Melton for The New York Times

In Columbus, Ga., Robin Strong’s doctor told her a few weeks ago that the rising Covid caseloads there would delay a procedure to repair a vocal cord that was paralyzed in a previous surgery.

Because of her condition, she chokes easily and has a hard time breathing. “I just cry all the time because of my situation,” she said.

Compounding the physical discomfort is her frustration that so many people in her state won’t get vaccinated against Covid, and they are getting sick and taking up hospital beds.

Only 66 percent of adults in Georgia have received at least one vaccine dose, compared with 77 percent of all adults in the United States who have received at least one dose of the vaccine, according to the latest data from federal and state health officials.

“They are punishing people like me,” Ms. Strong said.

In some areas, doctors are explicitly rationing care. On Thursday, Idaho state officials expanded “crisis standards of care” across the state, a standard that had been limited to the northern part of the state earlier in the month. “We don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for Covid-19 or a heart attack or because of a car accident,” Dave Jeppesen, the director of the Idaho Department of Health and Welfare, said in a statement.

With precious few available intensive-care beds, Idaho hospitals had largely stopped providing hernia surgeries or hip replacements before the new order. Now they are postponing cancer and heart surgeries, too, said Brian Whitlock, the chief executive of the Idaho Hospital Association. The hospitals there “have been doing their level best,” he said.

In Alaska, the state’s largest hospital, Providence Alaska Medical Center in Anchorage, has also begun rationing care as patients wait for hours to get to the emergency room and doctors scramble to find beds. “While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” said the hospital’s medical staff in a letter to the community in mid-September.

When the pandemic first slammed hospitals last year, many institutions found no alternative to postponing nonessential procedures. “We weren’t sure what we were really going to face,” said Dr. Matthias Merkel, senior associate chief medical officer for capacity management and patient flow at Oregon Health & Science University, the state’s academic medical center in Portland. “We pre-emptively stopped elective surgeries and emptied out the hospitals.”

In this latest round, hospitals and doctors have been more willing to continue doing procedures like colonoscopies for some patients if they can. “We want to continue to do as much as we can in all areas,” Dr. Merkel said.

His hospital, he added, hadn’t “yet recovered from the backlog we created” from delaying treatments earlier in the pandemic.

Even so, some patients with serious conditions are living in a precarious limbo. Paul McAlvain, 41, had waited months to get a surgery opening at OHSU to repair a leaking heart valve.

“They kept saying how bad I was and how they needed to get me in right away,” said Mr. McAlvain, a helicopter pilot for Life Flight Network, which ferries critically ill patients to medical centers. He had developed an irregular heart beat from his condition, and was finally scheduled for surgery Sept. 1.

But the spike in cases this summer further postponed his operation. “I had made work arrangements, life arrangements, got mentally ready,” Mr. McAlvain said. The surgery took place on Sept. 8.

Dr. Merkel acknowledged the toll that uncertainty can take on patients. “It might medically make no difference, but emotionally it could have a huge impact,” he said.

Alisha Jucevic for The New York Times

Some hospital officials say they have been assessing the effects of delayed care caused by the shutting down of elective procedures earlier in the pandemic. “It was very clear that many of these folks had decompensated or were more acutely ill than they would have otherwise been,” said Dr. Bryan Alsip, the chief medical officer at University Health in San Antonio, Texas.

Understand Vaccine and Mask Mandates in the U.S.

Though his hospital is confronting yet another wave of Covid cases, Dr. Alsip said, it is still scheduling surgeries that do not require an overnight hospital stay.

In North Carolina, the pent-up demand for care has added a new layer of strain now that Delta has pushed some hospitals to their limits.

“From an overall community perspective, this time, compared to March and April, our E.D. volumes are at all-time highs,” referring to the hospital emergency department, said Dr. John Mann, a surgeon who oversees surgical and specialty care services for Novant Health, a large hospital group based in North Carolina. “It’s every illness imaginable. They’re all coming in for care.”

This year, unlike last, Novant is not making any universal decisions about how to handle cases that have been deemed non-urgent. While rising Covid cases forced it to stop elective procedures at its Rowan Medical Center for weeks, orthopedic and colorectal surgeries are continuing at Novant Health Clemmons Medical Center, a much smaller hospital. “We’re doing it facility by facility,” Dr. Mann said.

While hospitals have generally been better able to predict what resources they will need as the pandemic ebbs and flows, making them less likely to halt elective procedures, more have started to do so recently, said David Jarrard, a hospital consultant.

Hospitals are also still struggling with a severe shortage of nurses, but are less worried about running out of critical equipment like N95 masks.

“We all learned a tremendous amount over the last year and a half,” said Dr. David Hoyt, the executive director for the American College of Surgeons, which released guidelines to help surgeons adjust their caseloads rather than cancel non-urgent procedures.

Government officials have also been much less likely to call for an absolute stop, which occurred frequently in the early months of the pandemic. Amber McGraw Walsh, a lawyer with McGuireWoods who has closely monitored Covid restrictions, said state, local and even federal agencies do not have the appetite this time around to prohibit elective surgeries.

Now, hospitals are much more likely to work with public health officials and their competitors to better manage the higher demands for care, making decisions as a group rather than individually. “You do see a lot of local hospital associations coming together, making their own rules of the road,” she said.

Alisha Jucevic for The New York Times

Still, the last few weeks have tested nurses and hospital staffs like no other period of the pandemic.

As an anesthesiologist and intensivist working in critical care, Dr. Merkel described the last two weeks as the most difficult of his career.

Despite widespread vaccine availability, Dr. Merkel and his colleagues are now caring for younger patients, those under 50, who are dying of complications from Covid, including organ failure and acute respiratory distress syndrome. Many were transferred from other hospitals because they were so ill.

“It is hard to see a patient’s life ending from something where we could have had a preventive intervention,” Dr. Merkel said."

High Covid Hospitalizations Have Delayed Elective Surgeries - The New York Times

Tuesday, September 21, 2021

Haitian immigrants gathered at southern border advocated for by Rep. Ilhan Omar


Homeland security officials will investigate after images show agents on horseback grabbing migrants, Mayorkas says - The Washington Post

Homeland security officials will investigate after images show agents on horseback grabbing migrants, Mayorkas says

A U.S. Border Patrol agent on horseback tries to stop a Haitian migrant in Del Rio, Tex., on Sept. 19.
A U.S. Border Patrol agent on horseback tries to stop a Haitian migrant in Del Rio, Tex., on Sept. 19. (Paul Ratje/AFP/Getty Images)

"Homeland Security Secretary Alejandro Mayorkas traveled Monday to the makeshift camp in Del Rio, Tex., where nearly 15,000 border-crossers have arrived, and he was quickly pulled into an escalating controversy over the treatment of the mostly Haitian migrants by U.S. agents.

News cameras and photographers recorded scenes Sunday along the Rio Grande where horse-mounted Border Patrol agents attempted to grab migrants and used their animals to push them back toward Mexico. One agent is heard on video shouting an obscenity as a child jumps out of the horse’s path.

Mayorkas told reporters in Del Rio that DHS would look into the incident. By Monday evening, as criticism mounted, the department released a statement announcing more formal inquiries, which it said Mayorkas had directed after watching the videos.

“The Department of Homeland Security does not tolerate the abuse of migrants in our custody and we take these allegations very seriously,” the DHS statement read. “The footage is extremely troubling and the facts learned from the full investigation, which will be conducted swiftly, will define the appropriate disciplinary actions to be taken.”

The statement said Mayorkas has directed DHS’s internal oversight office to send personnel to the camp and oversee agents’ conduct “full-time.”

“We are committed to processing migrants in a safe, orderly, and humane way,” it said. “We can and must do this in a way that ensures the safety and dignity of migrants.”

Several Democratic lawmakers condemned the agents’ actions shown in the footage. Rep. Bennie G. Thompson (D-Miss.), chairman of the House Homeland Security Committee, denounced the agents’ behavior in a statement Monday.

“Video and photos coming out of Del Rio showing U.S. Border Patrol’s mistreatment of Haitian migrants along the border are horrific and disturbing,” Thompson said.

Rep. Alexandria Ocasio-Cortez (D-N.Y.) described the scenes as “a stain on our country.”

“It doesn’t matter if a Democrat or Republican is President, our immigration system is designed for cruelty towards and dehumanization of immigrants,” she wrote on Twitter. “Immigration should not be a crime.”

Border Patrol chief Raul Ortiz, who addressed reporters in Del Rio alongside Mayorkas, said he made the decision to deploy the horse patrol agents to “find out if we had any individuals in distress, and be able to provide information and intelligence as to what the smuggling organizations were doing in and around the river.”

The Border Patrol typically uses horse-mounted officers to access difficult or roadless terrain, and at times as a crowd-control tool, not unlike other law enforcement organizations.

Contrary to some reports, the agents in the images were not carrying whips but were seen swinging their horses’ reins. They did not appear to strike anyone. Ortiz said that he was confident the agents were “trying to control” their animals but that officials would “look into the matter to make sure that we do not have any activity that could be construed” as misconduct.

In one video by Al Jazeera English that circulated widely on social media, an agent yells “This is why your country’s s---, because you use your women for this!” at a group emerging from the river. His horse charges, attempting to cut off a family’s path to the camp, as a young girl in a green dress jumps out of the way.

Tensions at the camp have been building after thousands of migrants were crossing the river daily last week, overwhelming U.S. capacity. Authorities have closed off the main crossing point used by migrants to enter the United States and return to Mexico for supplies, but migrants in the camp say that has worsened food shortages.

One agent stationed under the highway bridge said conditions improved significantly Monday as Mayorkas arrived, along with hundreds of additional agents and other personnel to increase staffing and security. Mayorkas said thousands would be relocated away from Del Rio to other Border Patrol sectors with more capacity to process them.

The Biden administration also continued sending Haitians back to their home country Monday, with two flights from Texas to Port-au-Prince. Mayorkas told reporters the Biden administration would continue sending up to three flights of returnees per day back to Haiti, a country struggling with rampant gang violence, the assassination of its president in July and a 7.2-magnitude earthquake last month.

Many of the nearly 15,000 who have crossed the Rio Grande to reach the camp are Haitians who were living in Chile and other South American nations, telling reporters they decided to make the journey north this year after hearing the Biden administration would allow them to enter.

Mayorkas said they were misled.

“We are very concerned that Haitians who are taking this irregular migration path are receiving false information that the border is open or that temporary protected status is available,” he said, referring to protections the Biden administration extended to Haitians who were present in the United States before July 29.

“This administration is committed to developing safe, orderly and humane pathways for migration,” he said. “But this is not the way to do it.”

The United States sent two flights carrying returnees back to Haiti on Monday, including 128 parents and children who arrived as part of a family group, according to U.S. officials.

Most of the passengers are not being sent back through the formal deportation process. They are being “expelled” from the United States under an emergency provision of the U.S. public health code known as Title 42.

A federal judge ordered the Biden administration last week to stop using Title 42 to return family groups, but he stayed the order until the end of September. The Biden administration has appealed the ruling.

Of the roughly 11,000 migrants who remained in the Del Rio camp, about 8,000 were part of family groups, according to one U.S. agent stationed at the site.

Mayorkas said the administration had sent 600 additional U.S. agents and other personnel to Del Rio to increase staffing and security, allowing authorities to increase the number of migrants they are transferring to other Border Patrol sectors for processing.

Caravans of buses were visible Monday lining up at the camp, according to two people at the site who were not authorized to speak to reporters.

As the White House came under intense criticism from members of the president’s party over the treatment of the migrants, the Biden administration announced it would raise the refugee admissions cap for the next fiscal year to 125,000.

The announcement comes as the United States plans to resettle tens of thousands of evacuees from Afghanistan, most of whom have arrived with a tenuous legal status as “humanitarian parolees.” The administration is also expanding resettlement programs for Central Americans and Myanmar dissidents.

The 125,000 number has long been the aspirational figure that the Biden administration set for fiscal 2022, which begins Oct. 1.

The White House angered refugee advocates and immigration activists earlier this year when Biden hesitated to boost refugee admissions, which remain on pace for their lowest levels on record.

Biden in May raised this year’s cap to 62,500 from the record low of 15,000 set by the Trump administration, but the latest figures show only 7,637 refugees have arrived over the past 11 months. Biden officials have blamed the pandemic for crippling consular services and refugee processing abroad."

Seung Min Kim in Washington and Anthony Faiola in Miami contributed to this report.

Homeland security officials will investigate after images show agents on horseback grabbing migrants, Mayorkas says - The Washington Post

Covid-19 live updates U.S. reported deaths surpass toll of 1918 flu pandemic

A self inflicted wound my willfully ignorant people who are putting the rest of us in danger.

People walk through the flags of the 'In America: Remember' public art installation, which commemorates all the Americans who have died due to covid-19, near the Washington Monument on Sept. 19, 2021 in Washington, DC. (Al Drago/Getty Images)

More people have died during of covid-19 in the United States than those estimated to have died of influenza during the 1918 pandemic. As of Monday, more than 675,000 U.S. deaths associated with the coronavirus have been reported since Feb. 29, 2020, per a Washington Post tracker.

According to the U.S. Centers for Disease Control and Prevention, that’s roughly how many died of influenza in the United States between 1918 and 1919 — along with more than 49 million people globally in the “deadliest pandemic of the 20th century.” (Coronavirus has killed nearly 4.7 million globally.)

That’s a grim milestone, but as The Post’s Aaron Blake explains, it needs to be put into context. The U.S. population is more than three times larger than it was roughly a century ago: While in 1918, 675,000 deaths represented about 1 in 150 Americans, it’s currently 1 in 500. The coronavirus has also killed fewer of the people it infects than the 1918 H1N1 flu virus, although it’s not clear whether “that reflects the relative deadliness of the virus, the advances in health care and mitigation over the past 100 years, or some combination of both,” Blake writes.“

Their Baby Died in the Hospital. Then Came the $257,000 Bill. A New York family had good health insurance. But the bills for their daughter’s care started showing up and kept coming.

Their Baby Died in the Hospital. Then Came the $257,000 Bill.

A New York family had good health insurance. But the bills for their daughter’s care started showing up and kept coming.

Brittany Giroux Lane and her husband, Clayton, are still caught in a billing dispute between hospital and insurer after the death of their daughter in 2019.
Kholood Eid for The New York Times

Brittany Giroux Lane and her husband, Clayton, are still caught in a billing dispute between hospital and insurer after the death of their daughter in 2019.Kholood Eid for The New York Times

Brittany Giroux Lane gave birth to her daughter, Alexandra, a few days before Christmas in 2018. The baby had dark eyes and longish legs. She had also arrived about 13 weeks early, and weighed just two pounds.

Alexandra initially thrived in the neonatal intensive care unit at Mount Sinai West.  Ms. Lane, 35, recalls the nurses describing her daughter as a “rock star” because she grew so quickly. But her condition rapidly worsened after an infection, and Alexandra died early on the morning of Jan. 15 at 25 days old.

A flurry of small medical bills from neonatologists and pediatricians quickly followed. Ms. Lane struggled to get her breast pump covered by insurance because, in the midst of a preterm birth, she hadn’t gone through the health plan's prior approval process.

Last summer, Ms. Lane started receiving debt collection notices. The letters, sent by the health plan Cigna, said she owed the insurer over $257,000 for the bills it accidentally covered for Alexandra’s care after Ms. Lane switched health insurers.

Ms. Lane was flummoxed: It was Cigna that had received the initial bill for care and had paid Mount Sinai West. Now, Cigna was seeking the money it had overpaid the hospital by turning to the patient.

“For them, it’s just business, but for us it means constantly going through the trauma of reliving our daughter’s death,” said Clayton Lane, Alexandra’s father and Ms. Lane’s husband. “It means facing threats of financial ruin. It’s so unjust and infuriating.”

The Lanes with their daughter, Alexandra. “The letters mean I’m constantly reliving the day,” Brittany Giroux Lane said. 

Medical billing experts who reviewed the case described it as a dispute between a large hospital and a large insurer, with the patient stuck in the middle. The experts say such cases are not frequent but speak to the wider lack of predictability in American medical billing, with patients often having little idea what their care will cost until a bill turns up in the mail months later.

Congress passed a ban on surprise medical bills last year, which will go into effect in 2022. It outlaws a certain type of surprise bill: those that patients receive from an out-of-network provider unexpectedly involved in their care. There are plenty of other types of bills that surprise patients, such as those received by the Lanes, that are likely to persist.

The Lanes describe the process of fighting their surprise bill as frustrating and Kafkaesque. They have spent hours on the phone, sent dozens of emails, and filed complaints with regulatory agencies in two states.

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“The letters mean I’m constantly reliving the day, and that is such a hard space to be in,” Ms. Lane said. “I feel so frustrated that the hospital is making decisions about their own bottom line that influence our potential future, and the memory of our child.”

“This patient had no control over what was paid, and she has no control over whether it gets returned,” said Susan Null, a medical billing expert with the firm Systemedic Inc. “Sometimes things like this might be done to motivate the patient to contact the hospital, to get them to release the funds.”

Americans are familiar with medical debt: About 18 percent of them have an outstanding bill from a hospital, doctor or other type of provider in the health system. But most do not expect to get collection notices for bills that were already paid by their health plan.

Courtney Jones, a senior case manager with the Patient Advocate Foundation, described working on cases in which patients have received similar collection notices for bills that the insurer, not the patient, was responsible for covering. It usually happens with large medical bills, as with the Lanes, in which the insurer and hospital both have more at stake.

“They use it as a tactic to put some pressure on the medical facility to refund the money,” Ms. Jones said.

In a response to questions from The New York Times, Cigna said it “regrets” the letters and, in light of the Lanes’ experience, was now reviewing how it communicates with patients in such cases.

After the Lanes filed a complaint to a state regulator, Cigna sent them a letter stating they would no longer receive similar letters. “We empathize with the pain and confusion this experience has caused for Mr. and Ms. Lane,” it said in a statement. “We are working with our vendor to ensure this doesn’t happen again to the Lanes or any other customer.”

Ms. Lane received the first collection notice about 18 months after her daughter’s death. Her family had switched health plans in the middle of Alexandra’s hospital stay because of a change in employment.

The day Ms. Lane went into labor with Alexandra was supposed to be her last day at the first job, before starting a new position a few weeks later.

“I was terrified of getting hit with a massive bill, so even while I was in labor I was updating my insurance with Mount Sinai,” Ms. Lane recalled.

The hospital appeared to have both insurance plans on file — Cigna for 2018 coverage, and UnitedHealthcare for 2019. But Cigna accidentally covered the entire bill, overpaying $257,000 for the baby’s care in January that should have been paid by UnitedHealthcare.

A Mount Sinai representative told the Lanes that UnitedHealthcare did in fact pay the bill — meaning the bill was paid twice — but that did not resolve what appears to be a wider issue that Mount Sinai has with Cigna.

When Ms. Lane received the first collection notice, she contacted the hospital. A patient services representative apologized and, over email, wrote that “Cigna is going to receive back” the overpayment. The third-party contractor that sent the letter, on Cigna’s behalf, also told her the matter would be settled within days.

“I was supposed to get a confirmation; I didn’t, but I was exhausted and I didn’t follow up,” she said.

Kholood Eid for The New York Times
Kholood Eid for The New York Times

She realized the refund never happened when another collection notice arrived this summer, in early July. When she reached out to the hospital again, a top executive said she did not know when the refund would be released.

“I can’t give you a response about the refund due to Cigna as it is being discussed as part of a larger settlement agreement that is ongoing,” Gail Spiro, Mount Sinai’s assistant vice president for patient financial services, wrote in an Aug. 10 email. “I apologize again for how long it’s taken to get you what you need.”

In a statement, Mount Sinai West said: “It is normal business practice to reconcile accounts with insurers in this manner. It is not typical for an insurer to pursue a patient in this way.”

The Lanes have also had several phone calls with Cigna and ultimately filed a complaint with the insurance department in California, where their Cigna health plan was registered.

“Getting another letter was completely disruptive to our lives and our healing,” Mr. Lane said. “It meant a lot of tears.”

In a response to that complaint, Cigna sent the Lanes a letter stating the notices were sent in error by a third party vendor called HMS, which the insurer uses to monitor overpayments to hospitals. The letters were meant only to “inform” the family about the continuing dispute with Mount Sinai, the Cigna letter said.

The notices that the Lanes received both informed them of the debt and asked them to “pay in full” within 30 days, using a slip at the bottom of the letter meant to be sent back with payment.

HMS declined to comment for this article, citing its patient privacy practices. The Lanes have requested that Mount Sinai and Cigna provide statements on letterhead that the family does not owe this debt. No such letter has yet been provided, although Mount Sinai says it will issue one in coming weeks.

The Lanes said it was difficult to reconcile the kind and loving care their daughter received in the neonatal intensive care unit with the billing experience that followed.

“She died surrounded by people who cared for her so lovingly and wonderfully,” she said. “We continue to support the NICU directly, so we can help families that are there.”

Since Alexandra’s death, the Lanes have donated supplies to the Mount Sinai West neonatal unit, including infant rockers; books about caring for premature babies; and a camera with a photo printer (taking baby pictures can be hard, they learned; phones are often not allowed because of hygiene concerns). The family is also now welcoming a new addition: They are adopting a baby boy.

“He’s six weeks now, and we’re definitely falling in love,” Ms. Lane said. “There are a lot of firsts, though, that should be seconds — the first time he smiled was a first for him, but should have been a second for us. There is a lot of joy, but also a lot of secondary loss, and a lot of thinking of Alexandra.”