Month: June 2017

Firearm Fatalities – What Are the Issues?

By Mark A. Kelley, MD |6/22/17

The recent shooting at a Congressional baseball practice is another example of firearm violence. When such crimes grab headlines, it is helpful to review the national statistics concerning guns and safety.

According the Centers for Disease Control, 33,000 Americans die from gun injuries annually. About 65% of these deaths are from suicides. Easy access to firearms, especially in the home, is associated with higher rates of suicide.

Because self-inflicted gun injuries are highly lethal, most suicide attempts by this method are successful. However, patients with unsuccessful suicide attempts rarely succumb to suicide later. Therefore, keeping these patients away from guns is life-saving.

The second major cause of firearm death is homicides (33%). Nearly all of these deaths are in the home or among people who know one another. Random shooting fatalities are rare.

The final cause of firearm deaths is accidental shootings, usually in the home, and often involving children. These deaths account for 2% of firearm fatalities.

Mass shootings, such as at the Sandy Hook Elementary School in 2012, are heart-breaking tragedies. From 2007-2016, the national fatalities per year from mass shootings ranged from eight to 67 victims. Over that decade, the nation averaged 38 deaths per year, or 0.3% of the total gun-related homicides.

Firearm mortality statistics can be summarized as follows:

• The majority of Americans who die from gunshot wounds are the victims of suicide.

• Most other fatalities are due to domestic violence or among people who know one another.

• Mass shootings, while dramatic, are a very small part of this problem.

In all these scenarios, easy access to firearms increases the likelihood of a fatal outcome.

Mass shootings are a relatively new phenomenon in our country. Many hypotheses have been raised to explain this change. Among them are the expansion of social and news media, the availability of automatic weapons, and weak gun control laws.

These who commit these crimes share some common characteristics. In many cases, they do not know their victims. Most of the perpetrators act alone, have no plans for escape, and die violently, often by their own hand. Many obtain firearms legally.

Why motivates such people? Psychologists have suggested that this violence stems from rage at society because of some grievance. The result of this anger is mass casualties and usually the shooter’s own death by gunfire, often self-inflicted.

This raises several issues. Are mass shootings a form of public suicide? If so, will they occur more often? While no one has the answers, one fact is clear. The behavior behind these shootings is highly abnormal and suggests serious mental health problems as the root cause of the violence.

Our society has two problems that are closely linked—lethal weapons and mental health. Those with mental health issues and violent intent are more likely to harm themselves or others if they have access to guns. However, gun control is only a partial solution.

The major challenge is early recognition and treatment of mental illness. We need to help mentally ill patients well before their depression or rage reaches the breaking point.

Our elected officials are now considering cuts to healthcare benefits, particularly in mental health. Such cuts would be a major public policy mistake. In this era of gun violence, public safety requires that we make mental health one of our top priorities.

What Can We Expect From the Proposed American Health Care Act?

By Mark A. Kelley, MD |6/1/17

Our last blog focused on the political movement to replace Obamacare. Since then, the U.S. Senate has been busy revising a new healthcare bill passed by the House of Representatives called The American Health Care Act (AHCA). Some of the specifics of the bill have been clarified.

The Facts to Date

If the AHCA replaces Obamacare, the Congressional Budget Office (CBO) predicts the following outcomes:

• 14 million Americans would lose their coverage within the next two years. Most of them have little or no income and have serious healthcare challenges.

By 2026, over 51 million Americans would be uninsured compared to 28 million if Obamacare remained in place.

By 2020, insurance companies would be able to exclude those with pre-existing conditions. As a result, millions of sick Americans could lose their current health insurance.

The AHCA also cuts taxes for the rich, and reduces federal revenue by $700 billion over ten years. The impression is that health care is being sacrificed to help the top 1% of wage earners in the nation.

The Key Issues – Insurance Availability and Cost

Most Americans are focused on two health insurance issues: availability and affordability. There are reasons to worry on both counts.

Insurance Availability: The AHCA cuts Medicaid and threatens other forms of insurance coverage. Obamacare defined the benefits for all health insurance, including no penalty for pre-existing conditions. The AHCA offers “waivers” for insurance companies to “customize” these features to reduce cost. These waivers could include denying coverage for pre-existing conditions or any future expensive illness. In a worst-case scenario, pre-existing conditions might include common problems like hypertension, asthma, and obesity that affect many Americans.

Insurance Affordability: The AHCA may lower premiums by limiting benefits or covering only low risk patients. However, this would deny health insurance from those who need it most.

Even more worrisome is a long-standing problem of national healthcare costs. The reality is that cost inflation continues to drive higher premiums and threatens the national economy. There has been little attention paid to that major challenge.

Can we afford to cover more people when health care cost inflation continues to rise? The answer is “No”…unless we change the current status quo.

Health Care Cost Inflation – A National Problem

The cost problem can only be solved through a national system that has a budget, reliable revenue, and the tools to control costs.. The best example is Medicare, which covers the elderly. With the advantages of national price and policy controls, Medicare has begun to curb the rate of medical cost inflation.

Why is this example important? Medicare is a federal insurance plan that sets prices, controls costs, and covers its beneficiaries through taxes. Private health insurance is different. It is an industry that operates as a free market, like any other type of insurance. No country has successfully used the free market to provide health care for its citizens. The reason is that many people cannot afford to buy private health insurance. Only a government program can help them.

Obamacare was a major step forward. The law standardized benefits and offered subsidies to help cover the cost of private insurance. The result was that over 14 million Americans were newly insured.

But that plan will fail without a system that has enough predictable revenue to cover everyone and has the power to control costs. That is a task that only the federal government can manage.

We have already started down that pathway. The federal government manages, directly or indirectly, more that half of all U.S. health care expenditures: Medicare, Medicaid, the Veterans Administration, and the Armed Forces. In effect, we have a large national health portfolio supported by taxes.

Voters are becoming weary of the politics of health care. Soon they will wonder why they cannot enjoy the same benefits as their parents on Medicare. If that bandwagon gains momentum, politicians will scramble aboard.

The process may take time but as Winston Churchill quipped, “You can count on Americans to do the right thing…after they have tried everything else.”

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