RUTHFULLY YOURS

https://issuesinsights.com/2024/09/25/women-children-disabled-pay-the-price-for-obamacares-medicaid-expansion/

Obamacare greatly expanded Medicaid eligibility. As a result, about 20 million able-bodied, working-age adults who were previously ineligible are now enrolled in the program. 

But as a new report from the Paragon Health Institute makes clear, their gains have come at the expense of the pregnant women, children, and people with disabilities that Medicaid was established for. 

The harm to these legacy beneficiaries, and to taxpayers, will only mount unless Congress fixes the perverse incentives that Obamacare created for the nation’s flagship health program for the poor.

Obamacare directed states to expand Medicaid eligibility to able-bodied adults earning up to 138% of the federal poverty line. Forty states and the District of Columbia have complied.

Previously, eligibility had been restricted to vulnerable people — like nursing home residents with virtually no assets, or minor children, or pregnant women who lacked other health coverage. 

Obamacare incentivized states to enroll able-bodied adults by having the federal government cover most of the cost. 

For the legacy Medicaid population, the feds normally pick up between half and three-quarters of enrollees’ health care costs; states foot the rest of the bill. For the expansion population, Washington initially picked up 100% of the cost. Now the federal government covers 90%. 

https://www.city-journal.org/article/hhs-has-misled-on-gender-medicine

In 2015, the Centers for Medicare & Medicaid Services (CMS) accepted a formal request to initiate a national coverage analysis for “gender-reassignment surgery.” When making these coverage determinations, CMS is legally obligated to evaluate relevant clinical evidence and answer the question: Is the evidence sufficient to conclude that the application of the item or service under study will improve health outcomes for Medicare patients? In June 2016, CMS released its 109-page analysis, which it made open for public comment. The agency published its final decision memo two months later. The differences between the two documents were revealing—and disturbing.

At first sight, the summaries of both memos seemed similar. Each mentioned that the CMS was not issuing a national coverage determination on “gender-reassignment surgery” for Medicare beneficiaries with gender dysphoria. Such determinations, the CMS said, would continue to be made by local contractors on a case-by-case basis. On closer examination, however, the final document included substantial changes. These were not corrections. They amounted to a systematic effort to scrub any reference to the evidence of the harms associated with these surgeries.

The agency’s shifting analysis of gender surgery is glaring enough. But it is just one of several examples, between 2016 and the present day, of how key figures and agencies within the U.S. Department of Health and Human Services have misled the American public about the evidence for “gender-affirming care.”

Start with the tale of two memos. To conduct a proper analysis of the clinical evidence, CMS identified a large number of publications related to “gender-reassignment surgery.” As CMS explained:

Studies with robust study designs and larger, defined patient populations assessed with objective endpoints or validated test instruments were given greater weight than small, pilot studies. Reduced consideration was given to studies that were underpowered for the assessment of differences or changes known to be clinically important. Studies with fewer than 30 patients were reviewed and delineated, but excluded from the major analytic framework. Oral presentations, unpublished white papers, and case reports were excluded. Publications in languages other than English were excluded.

Thirty-three publications, ranging from 1979 to 2015, were eventually identified and included.

https://www.nationalreview.com/2024/08/the-voter-registration-guide-will-see-you-now/

A worrisome new consensus in the medical community holds that doctors should be as concerned with politics as they are with medicine.

‘We again discussed . . . the importance of voting and the safety, security, and effectiveness of voting by mail.”

These probably aren’t the words you’d expect to see in a medical record. Yet that’s what a medical professional at a prominent northeastern hospital wrote earlier this year after seeing a patient. The record, a de-identified version of which was provided to my organization, shows a new and profoundly concerning trend in medicine: Leftists are making the doctor’s office a major cog in their voter-registration and turnout machine.

The movement has been building since at least 2020, growing out of the woke fixation with so-called “social determinants of health.” This concept holds that medical professionals should be as concerned with welfare, housing, and climate policy as they are with diagnosing illnesses and prescribing medications.

As the argument goes, such policies affect patient health, so health care has a duty to shape them. In 2022, the American Medical Association — which is thoroughly captured by woke ideologues — passed a resolution asserting that “voting is a social determinant of health.”

Statements from such influential sources signal to medical employers and educators that doctors should make voter registration a central part of their work. Medical journals are applying further pressure by publishing a slew of opinion articles and tendentious studies arguing that voter registration in medical settings will improve health equity.

Having practiced and worked in academic medicine for 50-plus years, I know that when the New England Journal of Medicine says jump, the medical establishment collectively leaps.

https://www.city-journal.org/article/covid-public-authorities-pushing-health-practices-contrary-to-medical-and-scientific-knowledge

Times have changed. Two years ago, tennis great Novak Djokovic could not play in the U.S. Open tournament. It was not because he had Covid-19 and posed a danger to fellow athletes and fans. Djokovic could not come into the country because of President Biden’s proclamation banning the entry of unvaccinated noncitizen air travelers into America.

Now, U.S. sporting officials let American sprinter Noah Lyles compete at the Olympics with an active case of Covid-19, putting his fellow athletes at risk of contracting the disease and impairing their performance.

Lyles tested positive on Tuesday. But he was allowed to run the 200-meter semi-final on Wednesday and the final Thursday, despite having a fever. It was hard not to notice Lyles talking with and hugging other athletes, exposing them at a time when he was surely contagious. Yet, Lyles said that he never considered withdrawing from the event. Nor did he notify anyone of his condition outside of the USA Track & Field medical staff that allowed him to compete.

Lyles was not alone. The World Health Organization reported that at least 40 Olympic athletes have tested positive for the virus. Yet the International Olympic Committee has removed all requirements for health measures or notifications. And the Paris Olympics officials have likewise taken a hands-off approach, letting athletes and teams determine for themselves how to respond to infection.

Amid this change, however, one finds a Covid constant: public authorities have consistently promulgated health requirements that have been, and remain, contrary to medical and scientific knowledge. Imposing a vaccination requirement on noncitizen air travelers, but not citizens and other types of travelers, made zero sense. Moreover, it has long been clear that the vaccine’s primary utility is to protect the person vaccinated from severe disease—the guard against infection is limited and short-lived; thus, vaccine mandates could not be justified as protecting the public.

Public authorities also seemed intent on denying the existence of natural immunity resulting from earlier infections. In Djokovic’s case, he had already had Covid twice. It was common medical knowledge that natural immunity is generally as good as or better than vaccine immunity, though, in the case of Covid, the public health authorities tried to ignore this for years. By April 2022, even Anthony Fauci acknowledged that natural immunity was just as protective as vaccinations for Covid.

https://www.city-journal.org/article/a-consensus-no-longer

The main justification for “gender-affirming care” for minors in the United States has been that “all major U.S. medical associations” support it. Critics of this supposed consensus have argued that it is not grounded in high-quality research or decades of honest and robust deliberation among clinicians with different viewpoints and experiences. Instead, it is the result of a small number of ideologically driven doctor-association members in LGBT-focused committees, who exploit their colleagues’ trust. Physicians presenting different viewpoints are silenced or kept away from decision-making circles, ensuring the appearance of unanimity.

As the U.K.’s Cass Review pointed out, the World Professional Association for Transgender Health (WPATH) and the U.S. Endocrine Society were especially important in forging this consensus, and they did so by citing each other’s statements, rather than conducting a scientific appraisal of the evidence. The “circularity” of this approach, says Cass in her report to England’s National Health Service, “may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”

Perhaps because it has never really depended on evidence, this doctor-group consensus has shown remarkable resilience in the face of major system shocks, including several whistleblowers, revelations from court documents that WPATH manipulated scientific evidence reviews, the Cass Review, a bipartisan commitment in the U.K. to roll back pediatric medical transition, and a growing international call for a developmentally informed approach that prioritizes psychotherapy over hormones and surgeries.

https://www.statnews.com/2024/07/09/human-genome-project-untold-story-how-single-volunteer-became-genetics-foundation/?utm_source=pocket-newtab-en-us

STAT is co-publishing this investigation by Undark.

They numbered 20 in all — 10 men and 10 women who came to a sprawling medical campus in downtown Buffalo, N.Y., to volunteer for what a news report had billed as “the world’s biggest science project.”

It was the spring of 1997, and the Human Genome Project, an ambitious attempt to read and map a human genetic code in its entirety, was building momentum. The project’s scientists had refined techniques to read out the chemical sequences — the series of As, Cs, Ts, and Gs — that encode the building blocks of life. Now, the researchers just needed suitable human DNA to work with. More exactly, they needed DNA from ordinary people willing to have their genetic information published for the world to see. The volunteers who showed up at Buffalo’s Roswell Park Cancer Institute had come to answer the call.

To take part in the study was to assume risks that were hard to calculate or predict. If the volunteers were publicly outed, project scientists told them, they might be contacted by the media or by critics of genetic research — of whom there were many. If the published sequences revealed a worrisome genetic condition that could be tied back to the volunteers, they might face discrimination from potential employers or insurers. And it was impossible to know how future scientists might use or abuse genetic information. No one’s genome had ever been sequenced before.

But the volunteers were also informed that measures had been put in place to protect them: They would remain anonymous, and to minimize the chances that any one of them could be identified based on their unique genetic sequence, the published genome would be a patchwork, derived not from one person but stitched together from the DNA of a large number of volunteers. “If we use the blood you donate” to prepare DNA samples, the consent form read, “we expect that no more than 10% of the eventual DNA sequence will have been obtained from your DNA.”

Soon, however, those assurances began to wither. When a much-celebrated working draft of the human genome was published in 2001, the vast majority of it — nearly 75 percent — came from just one Roswell Park volunteer, an anonymous male donor known as RP11.

https://www.city-journal.org/article/the-white-houses-transgender-tangle

New evidence suggests that the White House is taking its marching orders on so-called gender-affirming care for kids from transgender interest groups. A messaging blunder last week revealed that the Biden administration likely knows that gender hormones and surgeries for kids are unpopular but fears that saying so will alienate the powerful organizations that support these controversial procedures.

In late June, documents released in Boe v. Marshall—a case challenging Alabama’s ban on sex-trait modification procedures for minors—revealed that the assistant secretary for health at the U.S. Department of Health and Human Services, Rachel Levine, pressured the World Professional Association of Transgender Health (WPATH) to eliminate age minimums from its latest “standards of care,” due to fear that specifying adolescent ages for surgeries would invite political backlash and result in legal restrictions on teen gender surgeries.

Even worse for a group that claims the mantle of medical science, internal emails reveal that WPATH suppressed the publication of evidence reviews that it had commissioned from researchers at Johns Hopkins University. As The Economist reported, WPATH also required the researchers to secure the organization’s approval before publishing their findings. And, according to a court document, WPATH forced the authors to add a disclaimer that they were “solely responsible for the content” of their published work.

Within days of the Alabama documents being unsealed, the White House told Fox News and the New York Times that it opposes gender surgeries for kids. It did so despite the administration’s longstanding, well-documented support for these very procedures. On July 2, 19th News, a progressive news site, published another statement that it had received from the White House. This one reiterated the Biden administration’s opposition to surgeries but added that the White House “continue[s] to support gender-affirming care for minors like mental health care and respect[s] the role of parents, families, and doctors in these decisions” (emphasis added). Notably absent was explicit support for puberty blockers and cross-sex hormones; the statement seemed to equate “gender-affirming care” with “mental health care.”

https://www.nationalreview.com/corner/a-supreme-court-showdown-looms-on-transgender-surgeries-and-puberty-blockers/?utm_source=recirc-

The Supreme Court took seven cases this morning to hear next year, including a long-running lawsuit by Holocaust survivors against Hungary for expropriation of property. The big one is United States v. Skrmetti, a Biden administration challenge on equal-protection grounds to Tennessee and Kentucky laws that restrict the use of potentially irreversible gender-transition treatments such as transgender surgeries and puberty blockers on minors.

I explained, back when the lawsuit was filed in May 2023 as part of Merrick Garland’s campaign to stamp out self-government in the states on any issue where states dissent from cultural progressivism, why it was nuts:

The legislature reached its own conclusions about whether the treatments at issue were medically supported or abusive to children. . . . Are these really interests no legislature is permitted to consider? The complaint cites the American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (“DSM-V-TR”) as “an authoritative source for psychiatric conditions,” ignoring how often the DSM has been revised — and politicized — over the years. Of course, unlike the Tennessee legislature, the authors of the DSM are neither representative of, nor accountable to, a democratic populace. Moreover, on transgender issues, there is a significant divide between the American medical establishment and the European medical establishment. I’m as rah-rah USA as the next guy, but when that happens, it’s at least reasonable to allow the democratic process to consider the possibility that the Americans are wrong. Once upon a time, the American medical profession refused to accept the European consensus that doctors should wash their hands.

We may get a sense of how this Court resolves this question soon in this term’s big abortion case, Moyle v. United States, in which the Biden administration and the liberal justices argue that a federal statute puts an unelected national “medical consensus” above the elected legislatures in determining the standards for emergency-room care. Then again, Moyle is a statutory case rather than a constitutional one, and it might well be resolved on other grounds.