Thursday, August 20, 2009

Rebuilding Southern Haiti's Economy...

Sugar-cane plantations along with livestocking have strengthened Hispagnola's economy and served as a strategic pylon upon which French's colonialism in the island has settled. In the Mid 1900's, those two economic-driven-forces have created a new middle-class "population" in Southern and Western Haiti (with limited education) when "Centrale Dessalines, IDAI, FACOLEF, Daborne, etc." came into existence. A gradual accumulation of wealth and the improvement of the region's (Southern Haiti) well-being were observed by local citizens, the Haitian government and overseas' commercial partners. However, despite the creation of a local "Union", certain economic and social needs _ such as life insurance, retirement plans, disabilities/ compensations, among others (for those who worked in those factories)_ have never been addressed comprehensively. Additionally, the region' school or education system did not benefit from that short-breathed- explosive- economy.

From 1985 to 1990, the factories/industrie s have collapsed and the region has felt into an economic-state- of-shock, followed by the workforce dispersal, plantations' abandonment, etc. About 10 years later, agricultural lands were tuned into construction lots, farmers became "traders" (machann pèpè, kola, liv, bolèt), machineries turned into industrial wastes, factories (facilities) into drugs and crime's cribs and the "middle-class" into self-employed, unemployed and/or poor retirees.

What were the fundamental causes related to that collapse? What are the measurable social and economic indicators of that collapse? After such a long time, can the region overcome this economic distress? What would it take to rebuild those factories? Would it be a sustainable approach? What are the potential economic stimuli that can be used to reflate the economy?

By: Macceau Médozile

Wednesday, August 19, 2009

A Health Care (Plan) Dilemma :: Part III

Barriers to Enrollment in Medicaid

Medicaid is a jointly state and federal governments funded insurance program for the "poor" created in 1965 through Title 19 of the Social Security Act. Managed by the states, this program reimburses for health care services provided by hospitals and physicians to those who are unable to pay for their own medical expenses. It covers about 40% of the costs of childbirths and 60% of the costs of elderly individual health care. Since 1995, there has been a reduction in the number of elderly Hispanics and Blacks covered by Medicaid (from 40.5 to 23.4 million in 2006). However, as a result of an increase of unemployment and job displacement, in recent years, the number of Medicaid members has been increased tremendously. In 2005, 33.2 million people under 65 years of age were covered by Medicaid nationwide and 36.2 million in 2006; for those who are 65 years of age (and over), 3.2 million were covered in 2005 while 3.3 in 2006 (CDC, 2007). According to the US Department of Health and Human Services, Medicaid spending for outpatient prescription drugs has increased as well by 20% per year on an average from 1997 to 2002, jumping from $11.6 billion to $23.7 billion during that period (USDHHS, 2006). Nevertheless, in urban settings, certain enrollment barriers such as eligibility, language and cultural issues and the public knowledge about Medicaid have kept many uninsured from participating in this program.

Eligibility to Medicaid prevents uninsured from enrolling to this insurance program. Because of the Medicaid funding status, eligibility criteria to the program vary from state-to-state (or even from city-to-city) . In New York State, for example, not all public assistance recipients are eligible to Medicaid. Only those who are under the age of 21, living with deprived families or pregnant women _ ineligible under the LIF category _ with no other children are eligible. Additionally, Medicaid coverage is available to pregnant women or those who require treatment for an emergency medical condition regardless of their legal status. However, for the rest of the population, the minimum salary level required to be eligible for Medicaid varies and/or is uncertain. A family of 4 earning a gross annual salary of about $ 24,000.00 may not be qualified for Medicaid because they would be considered being above the national poverty level. Additionally, the Medicaid form has been reported to be very ambiguous. One must provide Proof of income from sources such as Social Security, Supplemental Security Income (SSI), Veteran's Benefits (VA), retirement, discloses any bank books and current insurance policies enrollment, etc. All those details complicate the process of qualification for uninsured Americans, particularly those living in urban areas. The Kaiser Commission on Medicaid and the Uninsured suggests that being enrolled in Medicaid has more to do with chance than official outreach efforts (KCMU, 2000).

Language and other cultural barriers also influence Medicaid enrollment. In many immigrant communities, English is not very much spoken and understood. Most of the times, parents rely on their children to either translate (for them) or take them to the doctor's office were SCHIP and Medicaid representatives could be easily found. Feinberg et al (2000) suggest that respondents speaking foreign languages are more than twice as likely as others to ignore how to sign up for Medicaid and to even identify barriers related to the application form. Consequently, ethnicity-nationali ty-language concordance mitigates disparities and prevents many from enrolling to Medicaid.

The public knowledge about Medicaid is very limited. Feinberg et al (2002) assert that most commonly, not knowing if a child is eligible for Medicaid and believing that Medicaid is only for people on welfare deter uninsured from enrolling to the program and generating negative perception about Medicaid. There is a lack of outreach that keeps uninsured from learning about Medicaid's eligibility and the types of medical care that are covered. Although in many cities in United States there are a lot of public health activities that are taken place within low income neighborhoods to encourage uninsured parents and their children to enrolling to Medicaid and SCHIP, but many of them are still not getting the message.

Targeted outreach in areas such as employment centers, schools, (churches, public buildings) and other public settings increase children's enrollment in public health insurance programs (Kaiser Family Foundation 2008: 12). Grassroots community has been very successful in helping uninsured understand the eligibility criteria, the kind of health services covered by Medicaid and guiding them through the application process. Dubay et al (2003) suggest that simplifying the application form, lengthening time between renewals, adopting continuous eligibility and eliminating requirements for families to document things that can be verified in different ways are likely to increase Medicaid enrollment. A better understanding of the Medicaid-Medicare system is likely to help Americans (or those who are living in United States) understand why a universal public health plan is important and what is needed to make it work.


The Kaiser Commission on Medicaid and the Uninsured: http://www.kff/. org/about/

kcmu.cfmFeinberg E, Gardner J, Walker DK, Swartz K, Zaslavsky A; Academy for Health Services Research and Health Policy. Meeting. Barriers to Medicaid Enrollment: Lessons from a State Initiative. Abstr Acad Health Serv Res Health Policy Meet. 2000; 17

Dubay Lisa, Guyer Jocelyn, Mann Cindy, Odeh Michael. Medicaid at the Ten-Year Anniversary of SCHIP: Looking Back and Moving Forward. Insurance Design. Project HOPE. The-people-to- people Health Foundation, Inc. 2007

By: Macceau Medozile

A Helath Care (Plan) DIlemma :: Part II

Published on Thursday, April 16, 2009

Over 50 million people in United States do not have health insurance; this isnot a good score for the "most powerful" country in the world. There is aconflict among private insurers, health providers and the general publicvis-à-vis the idea of establishing a federal universal health care system inUnited States. Last month, during a health care forum, President Barack Obamaproposed to offer a Medicare-like insurance plan to anyone, at any age, livingin United States. Such a program would aim to cover the uninsured, givecustomers more choices and create some competition in the private healthindustry. President Obama's proposal will insinuate a reduction of prices fromdoctors and hospitals than private insurers are able to negotiate (Abelson,2009).

Medicare is a self-financing system, in which workers and their employers are"required" to contribute to employees' retirement pensions during employeesworking years and then they will establish moral claims. This has been theinherent weakness of Medicare, for, historically, any benefit increase and/orimprovement has resulted into an increase of Medicare payroll taxes. A federalMedicare-like insurance is likely to follow the same trend, particularly whenover 8% of the country's workforce is unemployed and over 50 million people arestill not covered by any form of private or public health insurance plan.

Although the idea of a national health insurance seems ethically reasonable, butmany doubt that the government will be able to play the duo-niche of reducinghealth cost and insuring the non-insured in parallel without increasing taxes onall employed Americans. In 1965, the enactment of Medicare was politicallyobtainable (Jonathon, 2006) because of its target groups and the successfulsocial security model it was based on. In this state of distressed economy,employment' security becomes more uncertain because of capital displacement,bankruptcy, the cost of wars (Iraq, Afghanistan) , etc.; therefore, trust fundshortfalls are (and will be) inevitable.

The Obama's idea of a health plan for all may be unlikely to insure allAmericans. Without eliminating or restructuring Medicaid and many other healthsub-programs throughout the country, those who are not able to contribute to thetax-pool (over 24 million unemployed and a good portion of the 40 millionMedicaid beneficiaries) might be left out or those who are actually employedwill have to carry the load. But the real issue is the fear of health careproviders and insurers of a government's mainmise over the health care industryand the threat of not providing health care services to those who are (or willbe) covered by the government plan. Historically, there has been a conflictbetween health care advocate/interest groups and supporters of a public plan.The American Medical Association (AMA) has been concerned about physicians'ability to make money when (or if) the government uses its pricing power toregulate the cost of health services__ although recently AMA has been openlysupporting President Obama's health reform proposal. Other health organizationsfear that the government will force them out of business by establishing anunfair competitive system. However, those who support the plan believe thatlowering health service cost will "impose a greater disciple on insurers byforcing them to keep costs in check and make their policies affordable"(Abelson, 2009). Because of persistent trends in the health care system and thedecline of quality-of-life in United STates, the public has favored extendinginsurance coverage since 1993 (Skocpol, 2004).

Nevertheless, the Obama's idea of a health plan for all has not been welcomed bymany organized groups, local citizens, private health care providers and amajority of Republicans; recent/current Town Hall meetings throughout the nationare vivid examples.


•Reed Abelson. The New York Times: A Health Plan for all and the concerns itraises. March 25, 2009. p. C1

•Engel Jonathon. Poor People's medicine: Medicaid and American Charity CareSince 1965. Durham, NC Duke University Press, 2006

•Theda Skocpol , Patricia Seliger Keenan. Policy Challenges in Modern HealthCare: Cross Pressures: The Contemporary Politics of Health Reform. NewBrunswick, N.J. Rutgers University Press, 6th ed. 2004.By: Macceau Medozile

A health Care (Plan) Dilemma :: Part I

Universal Health Care: Why Should Congress Re-open the Discussions?

The idea of universal health care in United States is very conflictual. Almostevery effort aiming to enact regulations in favor of a national health carereform has been unsuccessful. In the early 1900's, President Theodor Rooseveltfailed to unite congress around that idea. After World War II, Harry Truman wasunable to reach a compromising deal with the national's health reform opponents.In 1993, Bill Clinton's administration failed to meet the desiderata of healthadvocate groups along with health care providers and insurers. In themeantime, "health care administration has been transmogrified from the servantof medicine to its master, from a handful of support staff dedicated tofacilitating patient care to a vast army preoccupied with profitability"(Woodhander, 2008). Fuchs et al. (2005) suggest that designing mechanismsthat will alleviate the unfavorable effects on potential health care opponentswhile creating major gains for society as a whole is one of the majorchallenges that health care reformers are facing. Nevertheless, Congress isconsidering taking up the debate once again. Followed are some traditional andcurrent issues that might persuade them to generate discussions over universalhealth coverage for Americans (including Haitian-Amaricans and all legalimmigrants).

The majority of the electorate is in favor of a national or universal healthcare coverage, because too many of them are uninsured, the rising premium,prescription drug costs, among others. As they become salient, these publicconcerns influence the reform possibilities contemplated by politicians and helpset the legislative agenda (Skocpol, 2003). Politically, many of thefirst-time-voters who elected President Barack Obama did so because they adheredto his health care campaign's promises; older voters' constituency was alsovital to his election as it will be for future political actions. Those are thepeople that Senators and House of Representatives will count on to bring themback to Congress at the end of their terms. Many media polls indicate thathealth care is a major domestic concern for Americans, second only to theeconomy. The News Media Network CBS reported that 57% of American would agreeto pay higher taxes for a universal coverage in United States, if such reformwould increase consumers' choices and create some competition in the privatehealth industry. Although Republicans are less likely to favor a nationalcoverage, but 66% of them agreed that the health care system needs to berethought (CNN, 2008).

The distressed stage of the current economy should also convince law makers toconsidering discussions about universal coverage. According to the United StatesDepartment of Labor, in April 2009, the unemployment rate was 8.9% (about 13million people). The professional and business services industry lost 122,000jobs. About 9.4% adult male, 7.1% adult female and 15.0% Blacks wereunemployed. Just a handful of unemployed individuals have a sort of healthinsurance. In 2007, about 43.3 million people (all ages) were not covered byany health insurance (CDC, 2008). Those statistics do not strengthen theMedicare and Medicaid systems, for less wage taxes are being collected by thestate and federal governments and consequently, their beneficiaries might end upgetting less medical care either now or in the near future. Employer-basedhealth insurance has been one of the major pylons of individual and/or familyhealth coverage in the country. The Census Bureau reported that the number ofpeople covered by employer-based has decreased from 60.2% in 2005 to 55.7% in2008 because of lost of businesses and the rise of the unemployment ratethroughout the nation. Small businesses that are unable to cover theiremployees, seek refuge in countries with cheaper labor, less regulation and lesscapital costs. By doing so, more individuals and families have lost their jobsand medical benefits and sought through government agencies and charitableorganizations for medical care, for they are not able to afford anyout-of-pocket medical services. Less medical care will increase the likelihoodof morbidity and mortality within human populations. These facts (among others)should persuade Law-makers _ along with public health professionals and healthcare organizations/providers _ to reopen discussions for universal health carein United States.

Many argue that despite the implementation of panoply of medical care programsthroughout the nation, the quality of care has not been improved. Therefore,the health care system needs to be redesigned.

[More out-of-pocket medical services to the immigrant community will decreasethe number of money transfer and/or the amount of $$$ sent back home to supportfamilies, parents and for charity].

(Literature cited:)

Aaron Henry J. The Costs of Health Care Administration in the United States andCanada — Questionable Answers to a Questionable Question. New England Journalof Medicine 349;8. Aug. 2003

Fuchs Victor R., Emanuel Ezekiel J. Health Care Reform: Why? What? When? HealthAffairs, Vol. 24, No. 6, pp. 1399-1414. Dec. 2005

Skocpol, Theda, and Patricia Seliger Keenan. 2005. "Cross Pressures: The Contemporary Politics of Health Reform." Chapter in Policy Challenges in ModernHealth Care. David Mechanic, Lynn B. Rogut, David C. Colby and James R.Knickman, eds. New Brunswick, NJ: Rutgers University Press.

By: Macceau MedozileMRTG, 2009