Gov. Barbour's civil rights fairy tale
Eugene Robinson Washington Post
Mississippi Gov. Haley Barbour, who may seek the Republican nomination for president, is trying to sell the biggest load of revisionist nonsense about race, politics and the South that I've ever heard. Ever.
He has the gall to try to portray Southern Republicans as having been enlightened supporters of the civil rights movement all along. I can't decide whether this exercise in rewriting history should be described as cynical or sinister. Whichever it is, the record has to be set straight.
In a recent interview with Human Events, a conservative magazine and Web site, Barbour gave his version of how the South, once a Democratic stronghold, became a Republican bastion. The 62-year-old Barbour claimed that it was "my generation" that led the switch: "my generation, who went to integrated schools. I went to integrated college -- never thought twice about it." The "old Democrats" fought integration tooth and nail, Barbour said, but "by my time, people realized that was the past, it was indefensible, it wasn't gonna be that way anymore. And so the people who really changed the South from Democrat to Republican was a different generation from those who fought integration."
Not a word of this is true.
Barbour did not attend "integrated schools," if he's referring to his primary and secondary education. Mississippi ignored the 1954 Brown v. Board of Education decision that was meant to end separate-but-unequal school systems. Eventually, officials implemented a "freedom of choice" desegregation plan -- but black parents who tried to send their children to white schools were threatened and intimidated, including by cross-burnings. Finally, in 1969, the Supreme Court ordered Mississippi to integrate its schools immediately. The long-stalled change took place in 1970.
That was long after Barbour had graduated from high school in Yazoo City and gone on to attend the University of Mississippi -- the "integrated college" he mentioned in the interview. The federal government had forced Ole Miss to admit its first black student, James Meredith, in 1962; he had to be escorted onto the campus by U.S. marshals as white students rioted in protest.
The following year, a second black student was admitted. In the mid-1960s, when Barbour was attending Ole Miss, it's no wonder that he "never thought twice" about integration. There were only a handful of black students, and by all accounts -- except Barbour's -- they were isolated and ostracized by their white peers.
The governor's assertion that segregation was a relic of the past "by my time" is ludicrous. He was 16, certainly old enough to pay attention, during the Freedom Summer of 1964, when civil rights activists James Chaney, Andrew Goodman and Michael Schwerner were murdered by the Ku Klux Klan near Philadelphia, Miss. He was a young adult, on his way to becoming a lawyer, when the public schools were forced to integrate. I'll bet Barbour could remember those days if he tried a little harder.
Equally wrong -- and perhaps deliberately disingenuous -- is his made-up narrative of how the South turned Republican. Barbour's fairy tale doesn't remotely resemble what really happened.
As he signed the 1964 Civil Rights Act into law, Lyndon Johnson is supposed to have said that the Democratic Party had "lost the South for a generation." Among those who voted against the landmark legislation was Sen. Barry Goldwater, who became Johnson's opponent in the presidential race that fall.
Johnson scored a landslide victory. Goldwater took his home state of Arizona and just five others: Louisiana, Mississippi, Alabama, Georgia and South Carolina. It was the first time those Deep South states had voted for a Republican presidential candidate since Reconstruction -- and marked the moment when, for many Southern voters, the GOP became the party of white racial grievance. It wasn't "a different generation from those who fought integration" that made the switch. Integration was the whole reason for the switch.
Now, Haley Barbour is not stupid. Why is he telling this ridiculous story?
Maybe this is the way he wishes things had been. You'll recall that earlier this year, when asked about a Confederate history month proclamation in Virginia that didn't mention the detail known as slavery, Barbour said the whole thing "doesn't amount to diddly." Most charitably, all this might be called denial.
It's much more likely, however, that Barbour has a political purpose. The Republican Party is trying to shake its image as hostile to African Americans and other minorities. It would be consistent with this attempted makeover to pretend that the party never sought, and won, the votes of die-hard segregationists.
One problem, though: It did.
Tuesday, September 07, 2010
Army base gunman threatened to kill Obama
EDITOR NOTE: Is this the dividend of all the hate broadcasters?
SAVANNAH, Ga. -- A former soldier accused of demanding mental treatment as he took hostages at gunpoint at a Georgia Army hospital later told investigators he planned to kill President Barack Obama and former President Bill Clinton, federal prosecutors said in court documents filed Tuesday.
Federal charges filed in U.S. District Court in Savannah identified the accused gunman as 29-year-old Robert Anthony Quinones. The Army says he took three hospital workers hostage early Monday in a two-hour standoff at Winn Army Community Hospital at Fort Stewart, 40 miles southwest of Savannah. Army officials say the gunman surrendered. No one was injured.
Federal prosecutors charged Quinones with kidnapping and assault with deadly weapons in connection with the hospital hostage standoff. He was also charged with making threats to kill Obama and Clinton.
An initial court appearance for Quinones was scheduled for Wednesday afternoon.
Quinones' mother, Janet Gladwell, said she had no idea her son had slipped out of their home in the early hours and gone to the hospital. She said he was medically discharged from the Army months ago because he suffers from post-traumatic stress disorder.
"The reason he was at the hospital the other night was to seek some treatment," Gladwell told The Associated Press. "He's been diagnosed as being ill and this was a desperate cry for help."
Quinones' mother said her son was diagnosed after serving a 15-month tour in Iraq in 2006 and 2007 with an Army Stryker brigade based at Fort Lewis, Wash. She said he moved to Hinesville, next to Fort Stewart, to live with her after his discharge.
Gladwell declined to discuss her son's history in detail. She said he did not yet have a lawyer.
But Gladwell sounded stunned to hear prosecutors had charged her son with threatening to kill Obama and Clinton.
"I know nothing about that," she said. "That's totally off the wall for him."
Court documents say Quinones told FBI, Secret Service and Army investigators after his arrest that as part of his assassination plots he had studied Secret Service protocols, sniper techniques and ways to disguise himself and conceal weapons.
Investigators said a search of the suspect's home turned up at least 15 guns, including high-powered rifles with scopes, as well as books and DVDs on Secret Service protocols, Israeli sniper techniques, Osama Bin Laden and Oklahoma City bomber Timothy McVeigh.
An affidavit by FBI and Secret Service agents who interviewed Quinones, filed in court, says the suspect was asked if he would kill Obama and Clinton given a chance.
"Yes. On a scale of 1 to 10 about being serious, I am a 10," Quinones responded, according to the affidavit.
The court documents say Quinones was discharged from the Army in February and worked a civilian job at Fort Stewart.
A neighbor, Jerry Franklin, said Quinones worked at one of the post-exchange stores on Fort Stewart. Franklin said he'd last seen Quinones at a neighborhood cookout last weekend.
"Generally, he was really nice - you talk to him and he's happy," Franklin said. "If you needed help, he'd help you."
Brig. Gen. Jeffrey Phillips, a senior Fort Stewart commander, said the former soldier told hostages he needed help for mental problems "connected, I'm quite certain, to his past service."
The suspect walked into the hospital's emergency room at about 4 a.m. carrying two handguns, a semiautomatic rifle and a semiautomatic version of a submachine gun, Phillips said. He took a medic hostage and headed to the building's behavioral treatment wing on the third floor.
An Army psychiatric nurse spotted the gunman and approached him to talk, Phillips said. That nurse was then taken hostage along with a behavioral health technician who refused to allow the gunman through a locked door to the patient area.
Phillips said the nurse, an Army major, was able to start calming the gunman down before Army investigators trained in hostage negotiations arrived and persuaded him to drop his weapons and surrender.
Fort Stewart, the largest Army post east of the Mississippi River, is home to the 3rd Infantry Division. Most of the division's 19,000 soldiers are deployed to Iraq. It's the 3rd Infantry's fourth tour in Iraq since the war began in 2003.
Phillips said he'd seen nothing to indicate the former soldier had previously sought treatment at the Fort Stewart hospital. RUSS BYNUM Associated Press
SAVANNAH, Ga. -- A former soldier accused of demanding mental treatment as he took hostages at gunpoint at a Georgia Army hospital later told investigators he planned to kill President Barack Obama and former President Bill Clinton, federal prosecutors said in court documents filed Tuesday.
Federal charges filed in U.S. District Court in Savannah identified the accused gunman as 29-year-old Robert Anthony Quinones. The Army says he took three hospital workers hostage early Monday in a two-hour standoff at Winn Army Community Hospital at Fort Stewart, 40 miles southwest of Savannah. Army officials say the gunman surrendered. No one was injured.
Federal prosecutors charged Quinones with kidnapping and assault with deadly weapons in connection with the hospital hostage standoff. He was also charged with making threats to kill Obama and Clinton.
An initial court appearance for Quinones was scheduled for Wednesday afternoon.
Quinones' mother, Janet Gladwell, said she had no idea her son had slipped out of their home in the early hours and gone to the hospital. She said he was medically discharged from the Army months ago because he suffers from post-traumatic stress disorder.
"The reason he was at the hospital the other night was to seek some treatment," Gladwell told The Associated Press. "He's been diagnosed as being ill and this was a desperate cry for help."
Quinones' mother said her son was diagnosed after serving a 15-month tour in Iraq in 2006 and 2007 with an Army Stryker brigade based at Fort Lewis, Wash. She said he moved to Hinesville, next to Fort Stewart, to live with her after his discharge.
Gladwell declined to discuss her son's history in detail. She said he did not yet have a lawyer.
But Gladwell sounded stunned to hear prosecutors had charged her son with threatening to kill Obama and Clinton.
"I know nothing about that," she said. "That's totally off the wall for him."
Court documents say Quinones told FBI, Secret Service and Army investigators after his arrest that as part of his assassination plots he had studied Secret Service protocols, sniper techniques and ways to disguise himself and conceal weapons.
Investigators said a search of the suspect's home turned up at least 15 guns, including high-powered rifles with scopes, as well as books and DVDs on Secret Service protocols, Israeli sniper techniques, Osama Bin Laden and Oklahoma City bomber Timothy McVeigh.
An affidavit by FBI and Secret Service agents who interviewed Quinones, filed in court, says the suspect was asked if he would kill Obama and Clinton given a chance.
"Yes. On a scale of 1 to 10 about being serious, I am a 10," Quinones responded, according to the affidavit.
The court documents say Quinones was discharged from the Army in February and worked a civilian job at Fort Stewart.
A neighbor, Jerry Franklin, said Quinones worked at one of the post-exchange stores on Fort Stewart. Franklin said he'd last seen Quinones at a neighborhood cookout last weekend.
"Generally, he was really nice - you talk to him and he's happy," Franklin said. "If you needed help, he'd help you."
Brig. Gen. Jeffrey Phillips, a senior Fort Stewart commander, said the former soldier told hostages he needed help for mental problems "connected, I'm quite certain, to his past service."
The suspect walked into the hospital's emergency room at about 4 a.m. carrying two handguns, a semiautomatic rifle and a semiautomatic version of a submachine gun, Phillips said. He took a medic hostage and headed to the building's behavioral treatment wing on the third floor.
An Army psychiatric nurse spotted the gunman and approached him to talk, Phillips said. That nurse was then taken hostage along with a behavioral health technician who refused to allow the gunman through a locked door to the patient area.
Phillips said the nurse, an Army major, was able to start calming the gunman down before Army investigators trained in hostage negotiations arrived and persuaded him to drop his weapons and surrender.
Fort Stewart, the largest Army post east of the Mississippi River, is home to the 3rd Infantry Division. Most of the division's 19,000 soldiers are deployed to Iraq. It's the 3rd Infantry's fourth tour in Iraq since the war began in 2003.
Phillips said he'd seen nothing to indicate the former soldier had previously sought treatment at the Fort Stewart hospital. RUSS BYNUM Associated Press
Police actions in U.S. rarely ruled criminal?
CORONER'S INQUEST: Police actions in U.S. rarely ruled criminal
Experts: Laws protect police in officer-involved shootings
Moments after a coroner's inquest jury ruled her fiance's death at the hands of a police officer justified, Sequioa Pearce cradled her infant daughter as she waited for an elevator to whisk her out of the Regional Justice Center.
Was she surprised by the verdict?
She paused. "I hoped for a different outcome."
A Clark County inquest jury hasn't ruled a fatal officer-involved shooting "criminal" in 34 years, a fact that many in the community have used as an indictment against the much-maligned process.
But the truth is that juries in courtrooms across the country are extraordinarily reluctant to find officers' actions in shootings criminal, experts say.
And if the inquest process were changed to become more adversarial, as activists push for, that wouldn't necessarily mean more criminal verdicts.
"It may be that the dearth of findings of criminality is appropriate," said Gary Peck, a longtime critic of the inquest process and police practices.
During last month's inquest into the death of 21-year-old Trevon Cole, the physical evidence and testimony of nearly everyone else at the scene was at odds with what officer Bryan Yant said. His testimony sometimes even contradicted what he told police shortly after he shot Cole.
Yet the jury forewoman later told the Review-Journal that she and others on the seven-member jury found Yant's testimony the most credible, and they deemed his actions justified.
With two inquests scheduled this month, including an unusual three-day session on the July 10 shooting of Erik Scott at a Summerlin Costco store set to begin Sept. 22, Nevada's coroner's inquest system and the use of deadly force by police will again be in the spotlight.
Ever since police officers on the East Coast started carrying guns in the mid-19th century, the public has been outraged by police shootings, said David Klinger, a professor at the University of Missouri, St. Louis.
But rarely are officers charged with a crime when they shoot, and even less often do juries find them guilty. One of the most famous officer-involved shootings ended up just that way, in 1881, when Wyatt Earp and "Doc" Holliday were charged but not convicted in the killings at the OK Corral.
Legislatures and courts tend to create laws that protect officers, experts say. But society as a whole has difficulty calling officers criminals.
"In the mind of the public, there is a strong sentiment that officers don't get up in the morning to commit crimes," said Cal Potter, a Las Vegas attorney who has sued police numerous times.
The U.S. Supreme Court, in its 1989 ruling in Graham v. Connor, determined that officers are allowed to make "reasonable" mistakes when using force.
The language in the decision "gave a tremendous amount of latitude to officers, given the fact they have to make split-second decisions," said Thomas Aveni, executive director of The Police Policy Studies Council, a New Hampshire-based training and consulting company.
But because of the court's "reasonableness" standard, "it's very difficult to charge an officer ... and they're even more difficult to convict because they're very easy to defend," Aveni said.
Even apparently open-and-shut cases against officers are difficult for prosecutors.
In January 2006, a San Bernardino County, Calif., sheriff's deputy shot an off-duty Air Force military policeman who was complying with the deputy's orders. The military policeman was lying on the ground when the deputy, Ivory J. Webb Jr., yelled repeatedly for him to "get up." When the military policeman complied, Webb shot him three times.
The shooting, caught on videotape by a bystander, sparked outrage in Southern California and brought felony charges against the deputy. Yet a jury later found Webb not guilty of attempted voluntary manslaughter.
An exasperated deputy district attorney later told the Riverside newspaper, "The only thing we can take away from this is the question: Is it impossible to convict a police officer?"
But should it be easier to convict officers for shootings? Experts say no.
"I too worry a little about the long-term effects about making it easier to prosecute cops," said Laurie Levenson, a professor at Loyola Law School Los Angeles. "A lot of them will just go find another job."
Nevada's coroner's inquest, officially deemed a "fact-finding" process, cannot end with any criminal charges against anyone. The inquest jury can reach three conclusions regarding an officer-involved death: justified, excusable or criminal. The attorney general's office, through an agreement with the Clark County District Attorney's Office, can choose whether to press charges without regard for the inquest jury's verdict.
Advocates such as Peck say the process should at least be opened up to allow a representative of the deceased's family to cross-examine the officer, but law enforcement representatives say that would prompt officers to refuse to testify.
But criticizing the process for the lack of "criminal" verdicts is attacking it for the wrong reasons, say Peck and Allen Lichtenstein, general counsel for the American Civil Liberties Union of Nevada. They say they want a fair process, regardless of the verdict.
Lichtenstein said the "criminal" option should be removed from the process.
"I'm not sure the coroner's inquest process is really the place to decide where a cop says, 'I'm going to go out and kill somebody,' " he said.
Instead, the jury should have just two options -- justified and unjustified, he said.
There are no plans to overhaul the process, but Lichtenstein said he believes it inevitably will be changed.
"I think that within the community and even within government, there's a growing realization that ... the current system that we have isn't really working for the public or even the police, for that matter," he said.
LAS VEGAS REVIEW JOURNAL by LAWRENCE MOWER
EDITOR NOTE: We invite your comments and personal stories. Please POST here:
Experts: Laws protect police in officer-involved shootings
Moments after a coroner's inquest jury ruled her fiance's death at the hands of a police officer justified, Sequioa Pearce cradled her infant daughter as she waited for an elevator to whisk her out of the Regional Justice Center.
Was she surprised by the verdict?
She paused. "I hoped for a different outcome."
A Clark County inquest jury hasn't ruled a fatal officer-involved shooting "criminal" in 34 years, a fact that many in the community have used as an indictment against the much-maligned process.
But the truth is that juries in courtrooms across the country are extraordinarily reluctant to find officers' actions in shootings criminal, experts say.
And if the inquest process were changed to become more adversarial, as activists push for, that wouldn't necessarily mean more criminal verdicts.
"It may be that the dearth of findings of criminality is appropriate," said Gary Peck, a longtime critic of the inquest process and police practices.
During last month's inquest into the death of 21-year-old Trevon Cole, the physical evidence and testimony of nearly everyone else at the scene was at odds with what officer Bryan Yant said. His testimony sometimes even contradicted what he told police shortly after he shot Cole.
Yet the jury forewoman later told the Review-Journal that she and others on the seven-member jury found Yant's testimony the most credible, and they deemed his actions justified.
With two inquests scheduled this month, including an unusual three-day session on the July 10 shooting of Erik Scott at a Summerlin Costco store set to begin Sept. 22, Nevada's coroner's inquest system and the use of deadly force by police will again be in the spotlight.
Ever since police officers on the East Coast started carrying guns in the mid-19th century, the public has been outraged by police shootings, said David Klinger, a professor at the University of Missouri, St. Louis.
But rarely are officers charged with a crime when they shoot, and even less often do juries find them guilty. One of the most famous officer-involved shootings ended up just that way, in 1881, when Wyatt Earp and "Doc" Holliday were charged but not convicted in the killings at the OK Corral.
Legislatures and courts tend to create laws that protect officers, experts say. But society as a whole has difficulty calling officers criminals.
"In the mind of the public, there is a strong sentiment that officers don't get up in the morning to commit crimes," said Cal Potter, a Las Vegas attorney who has sued police numerous times.
The U.S. Supreme Court, in its 1989 ruling in Graham v. Connor, determined that officers are allowed to make "reasonable" mistakes when using force.
The language in the decision "gave a tremendous amount of latitude to officers, given the fact they have to make split-second decisions," said Thomas Aveni, executive director of The Police Policy Studies Council, a New Hampshire-based training and consulting company.
But because of the court's "reasonableness" standard, "it's very difficult to charge an officer ... and they're even more difficult to convict because they're very easy to defend," Aveni said.
Even apparently open-and-shut cases against officers are difficult for prosecutors.
In January 2006, a San Bernardino County, Calif., sheriff's deputy shot an off-duty Air Force military policeman who was complying with the deputy's orders. The military policeman was lying on the ground when the deputy, Ivory J. Webb Jr., yelled repeatedly for him to "get up." When the military policeman complied, Webb shot him three times.
The shooting, caught on videotape by a bystander, sparked outrage in Southern California and brought felony charges against the deputy. Yet a jury later found Webb not guilty of attempted voluntary manslaughter.
An exasperated deputy district attorney later told the Riverside newspaper, "The only thing we can take away from this is the question: Is it impossible to convict a police officer?"
But should it be easier to convict officers for shootings? Experts say no.
"I too worry a little about the long-term effects about making it easier to prosecute cops," said Laurie Levenson, a professor at Loyola Law School Los Angeles. "A lot of them will just go find another job."
Nevada's coroner's inquest, officially deemed a "fact-finding" process, cannot end with any criminal charges against anyone. The inquest jury can reach three conclusions regarding an officer-involved death: justified, excusable or criminal. The attorney general's office, through an agreement with the Clark County District Attorney's Office, can choose whether to press charges without regard for the inquest jury's verdict.
Advocates such as Peck say the process should at least be opened up to allow a representative of the deceased's family to cross-examine the officer, but law enforcement representatives say that would prompt officers to refuse to testify.
But criticizing the process for the lack of "criminal" verdicts is attacking it for the wrong reasons, say Peck and Allen Lichtenstein, general counsel for the American Civil Liberties Union of Nevada. They say they want a fair process, regardless of the verdict.
Lichtenstein said the "criminal" option should be removed from the process.
"I'm not sure the coroner's inquest process is really the place to decide where a cop says, 'I'm going to go out and kill somebody,' " he said.
Instead, the jury should have just two options -- justified and unjustified, he said.
There are no plans to overhaul the process, but Lichtenstein said he believes it inevitably will be changed.
"I think that within the community and even within government, there's a growing realization that ... the current system that we have isn't really working for the public or even the police, for that matter," he said.
LAS VEGAS REVIEW JOURNAL by LAWRENCE MOWER
EDITOR NOTE: We invite your comments and personal stories. Please POST here:
Health Care Wastefulness Is Detailed
EDITOR NOTE: America quit screwing around and get a single payer system for all like
extention of MEDICARE for all and get care at a much cheaper price for ALL not a luckey few at a high cost which no sane person can be happy with!! HKirch
**************************
Now here is the Kevin Sack story on the current study.
In a snapshot of systemic waste, researchers have calculated that more than half of the 354 million doctor visits made each year for acute medical care, like for fevers, stomachaches and coughs, are not with a patient’s primary physician, and that more than a quarter take place in hospital emergency rooms.
The authors of the study, which was published Tuesday in the journal Health Affairs, said it highlighted a significant question about the new federal health care law: can access to primary care be maintained, much less improved, when an already inadequate and inefficient system takes on an expected 32 million newly insured customers?
The study is the first to quantify the problem, according to Dr. Stephen R. Pitts, the lead author and an associate professor of emergency medicine at Emory University. Examining records of acute care visits from 2001 to 2004, the researchers concluded that 28 percent took place in emergency rooms, including almost all of the visits made on weekends and after office hours.
More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy. Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.
“More and more patients regard the emergency room as an acceptable or even proper place to go when they get sick,” Dr. Pitts said, “and the reality is that the E.R. is frequently the only option. Too often, patients can’t get the care they need, when they need it, from their family doctor.”
The new federal law is expected to bolster primary care by increasing reimbursement for practitioners, luring students into the field with incentives, expanding community health centers and encouraging new models known as accountable care organizations and patient-centered medical homes.
The authors warn that it might not be enough. “If history is any guide, things might not go as planned,” they wrote. “If primary care lags behind rising demand, patients will seek care elsewhere.”
A separate study in the same issue of Health Affairs illuminates another source of waste in the health care system — medical liability and defensive medicine.
The paper by three Harvard professors and a colleague at the University of Melbourne in Australia estimates that the medical-liability system added $55.6 billion to the cost of American medicine in 2008, equal to 2.4 percent of total health spending.
More than 8 of every 10 of those dollars — $45.6 billion — was attributed to defensive medicine by physicians who order unnecessary tests and procedures to protect themselves from malpractice claims.
While the dollar amount is “not trivial,” the authors noted that the fraction of total health spending “is less than some imaginative estimates put forward in the health reform debate.”
The authors, led by Michelle M. Mello of Harvard’s School of Public Health, estimated the cost of various components of the medical liability system, including payments to malpractice plaintiffs, defensive medicine, administrative costs like legal fees and lost time by clinicians. Rigorous estimates have been scarce in the past, they wrote, while adding that their own calculations “should be interpreted cautiously.”
The new health law did not make substantial changes to the medical liability system, despite Republican calls for restrictions on malpractice claims.
“Reforms that offer the prospect of reducing these costs have modest potential to exert downward pressure on overall health spending,” the study concluded. “Reforms to the health care delivery system, such as alterations to the fee-for-service reimbursement system and the incentives it provides for overuse, probably provide greater opportunities for savings.”
extention of MEDICARE for all and get care at a much cheaper price for ALL not a luckey few at a high cost which no sane person can be happy with!! HKirch
**************************
Now here is the Kevin Sack story on the current study.
In a snapshot of systemic waste, researchers have calculated that more than half of the 354 million doctor visits made each year for acute medical care, like for fevers, stomachaches and coughs, are not with a patient’s primary physician, and that more than a quarter take place in hospital emergency rooms.
The authors of the study, which was published Tuesday in the journal Health Affairs, said it highlighted a significant question about the new federal health care law: can access to primary care be maintained, much less improved, when an already inadequate and inefficient system takes on an expected 32 million newly insured customers?
The study is the first to quantify the problem, according to Dr. Stephen R. Pitts, the lead author and an associate professor of emergency medicine at Emory University. Examining records of acute care visits from 2001 to 2004, the researchers concluded that 28 percent took place in emergency rooms, including almost all of the visits made on weekends and after office hours.
More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy. Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.
“More and more patients regard the emergency room as an acceptable or even proper place to go when they get sick,” Dr. Pitts said, “and the reality is that the E.R. is frequently the only option. Too often, patients can’t get the care they need, when they need it, from their family doctor.”
The new federal law is expected to bolster primary care by increasing reimbursement for practitioners, luring students into the field with incentives, expanding community health centers and encouraging new models known as accountable care organizations and patient-centered medical homes.
The authors warn that it might not be enough. “If history is any guide, things might not go as planned,” they wrote. “If primary care lags behind rising demand, patients will seek care elsewhere.”
A separate study in the same issue of Health Affairs illuminates another source of waste in the health care system — medical liability and defensive medicine.
The paper by three Harvard professors and a colleague at the University of Melbourne in Australia estimates that the medical-liability system added $55.6 billion to the cost of American medicine in 2008, equal to 2.4 percent of total health spending.
More than 8 of every 10 of those dollars — $45.6 billion — was attributed to defensive medicine by physicians who order unnecessary tests and procedures to protect themselves from malpractice claims.
While the dollar amount is “not trivial,” the authors noted that the fraction of total health spending “is less than some imaginative estimates put forward in the health reform debate.”
The authors, led by Michelle M. Mello of Harvard’s School of Public Health, estimated the cost of various components of the medical liability system, including payments to malpractice plaintiffs, defensive medicine, administrative costs like legal fees and lost time by clinicians. Rigorous estimates have been scarce in the past, they wrote, while adding that their own calculations “should be interpreted cautiously.”
The new health law did not make substantial changes to the medical liability system, despite Republican calls for restrictions on malpractice claims.
“Reforms that offer the prospect of reducing these costs have modest potential to exert downward pressure on overall health spending,” the study concluded. “Reforms to the health care delivery system, such as alterations to the fee-for-service reimbursement system and the incentives it provides for overuse, probably provide greater opportunities for savings.”
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