The EB-5 Immigration Program (and you thought H1-Bs were a problem)

The EB-5 program allows  rich investors from China and India to bypass waiting lists to get visas and green cards for permanent immigration to the US.  The program was created during the first Bush administration as a way to stimulate foreign investment in the US.

Frankly, the requirements aren’t much. The minimum is the creation of 10 new full time jobs — and those jobs can be created by companies with which you do business, not the company in which the investor puts money. If investing in a “troubled company,” the requirement is maintaining the existing headcount.

If I read the regulations correctly, buying a pizza joint or car wash could entitle someone to permanent residency in the US. Or investing on one of Donald Trump’s family properties.

This came into focus today because of a Washington Post story about members of the Kushner family hawking real estate investments to wealthy Chinese as a device for gaining US residency.  (Remember, these are Trump’s inlaws.) The sales pitch is invest now before the regulations change.

Selling citizenship to the highest bidder. Is that what making American great again really means?

 

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Sources:

1. US Customs and Immigration Service, “EB-5 Immigrant Investor Program.” https://www.uscis.gov/eb-5
2. Emily Rauhala and William Wan, “In a Beijing ballroom, Kushner family pushes $500,000 ‘investor visa’ to wealthy Chinese,” The Washington Post, 6 May 2017. https://www.washingtonpost.com/world/in-a-beijing-ballroom-kushner-family-flogs-500000-investor-visa-to-wealthy-chinese/2017/05/06/cf711e53-eb49-4f9a-8dea-3cd836fcf287_story.html?utm_term=.81a547273401

No room for historical revisionism

I’ve been a history buff for years. Growing up in Kentucky, I dealt with people intent on glossing over the evils of slavery. I was born less than 90 years after the Civil War ended, and there are people still intent on re-fighting that war today.

This bit from History.com leaves little room for gloss. Written about a skirmish in Arkansas in 1864,

The Rebels’ treatment of black troops was harsh. No black troops were captured, and those left wounded on the battlefield were brutally killed, scalped, and stripped. The Washington Telegraph, the major Confederate newspaper in Arkansas, justified the atrocity by declaring “We cannot treat Negroes taken in arms as prisoners of war without a destruction of social system for which we contend.”
http://www.history.com/this-day-in-history/confederates-inflict-pain-at-battle-of-poison-spring

The men ultimately responsible for this atrocity were Confederate General John Marmaduke, later governor of Missouri, and Confederate General Samuel Maxey, who later represented Texas in the US Senate.

I rather suspect that in the current era, both would have been imprisoned or shot for war crimes. However, in Missouri and Texas, they get elected.

I was in Charleston a few years ago when a tour guide tried to claim that the Civil War wasn’t about slavery. That’s a difficult case to make if you look at the newspaper and diary accounts from that time. We’re better off being honest with ourselves about our past and our future.

 

Inequality in Healthcare

There is inequality in the provision of healthcare in the US.  We know that since we know that life expectancy is associated with wealth.  However, an outright admission of prejudice is rare.

 

Enter the Mayo Clinic.  According to Becker’s:

The Minnesota Department of Human Services has launched a review of Rochester, Minn.-based Mayo Clinic for possible violations of civil and human rights laws. The review comes after news surfaced of an internal video memo from Mayo Clinic CEO John Noseworthy, MD, in which he told staff to prioritize care for patients with commercial insurance over those who are publicly insured, according to MPR News.

“We’re asking … if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so … we can be financially strong at the end of the year to continue to advance, advance our mission,” Dr. Noseworthy said in the videotaped speech, which was recorded in late 2016, according to the Minneapolis Star Tribune.(1)

How many other hospitals (and clinics and doctors) do the same thing?

This is also a clear message that newspapers and public radio still matter.  ABC News is to be commended as the only national news service to run with this story.

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1. Tamara Rosen, “Minn. state department questions whether Mayo Clinic policy violates civil, human rights laws,” Becker’s Hospital Review, 17 March 2017. http://www.beckershospitalreview.com/legal-regulatory-issues/minn-state-department-questions-whether-mayo-clinic-policy-violates-civil-human-rights-laws.html
2. Jeremy Olson, “Mayo to give preference to privately insured patients over Medicaid patients,” Star Tribune, 15 March 2015. http://www.startribune.com/mayo-to-pick-privately-insured-patients-amid-medicaid-pressures/416185134/
3. Elizabeth Whitman, “Cherry-picking patients? Mayo Clinic aims to ‘prioritize’ privately insured,” Modern Healthcare, 15 March 2017. http://www.modernhealthcare.com/article/20170315/NEWS/170319942

A Timely Quote

In a speech honoring Lincoln in 1905, President Theodore Roosevelt said the following:

“We of to-day, in dealing with all our fellow-citizens, white or colored, North or South should strive to show just the qualities that Lincoln showed – his steadfastness in striving after the right and his infinite patience and forbearance with those who saw that right less clearly than he did; his earnest endeavor to do what was best, and yet his readiness to accept the best that was practicable when the ideal best was unattainable; his unceasing effort to cure what was evil, coupled with his refusal to make a bad situation worse by any ill-judged or ill-timed effort to make it better.”

More Problems with Healthcare for US Vets

Here we go again.

The survivors from the 4,000 soldiers who were assigned to clean up radiation from nuclear tests are now being denied government assistance for illness that are likely to have resulted from exposure.

At the time, the US government provided protective gear for a photo op on arrival on the site, but did not allow the troops to keep the gear or use it while doing the cleanup.

The troops and their doctors believe that the abnormally high incidence of birth defects and tumors among the troops resulted from exposure.  The government claims that exposure levels were never unsafe.  (If so, why the photo op with the protective gear?)

We seem to have changed doctrines, from “guilty until proven innocent” to “let’s assume every individual is trying to rip off the system.”  The government is denying claims apparently with insufficient proof that the claims are in fact false.

Of course, if the government is successful in denying these claims, the costs will show up in the health insurance premiums consumers pay. 

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Sources:

• Dave Phillips, “Troops Who Cleaned Up Radioactive Islands Can’t Get Medical Care,” The New York Times, 28 January 2017.  https://www.nytimes.com/2017/01/28/us/troops-radioactive-islands-medical-care.html?emc=edit_th_20170129&nl=todaysheadlines&nlid=57250219&_r=0

A Solemn Thought at Christmas

Aristotle is usually correct.  Anything taken to excess turns bad.  Think of the examples:  too much sugar, too much poverty, too much power, too much self-righteousness.

“There is nothing superstitious in using the name of the Deity. I believe myself in those eternal principles on which human weakness reposes before it starts on the path of virtue.  These are not idle words in my mouth any more than they have been idle words in the mouths of many great men, nonetheless moral for their belief in the existence of God.”

Who would make such a statement?  None other than Robespierre, The Incorruptible, author of the Reign of Terror during the French Revolution, responsible for the deaths on tens of thousands on the guillotine.  He was the 1700s version of ISIS, using a device far more efficient than modern terrorists now use to behead victims.

Why think of him today?

An important lesson from history and from the 14th Dalai Lama is that happiness comes from within and not from material goods or conquest.  Conversely, while extremism in the pursuit of anything can produce short term gain, the gain tends to be short term, and the misery it causes is overwhelming.

So, why think of him today?

Simply, Christmas isn’t supposed to be about material gifts or about the superiority of one religion over another.  Jesus was called The Prince of Peace for a reason, and while his message may have been twisted over the last 2000 years, the promise of peace remains profoundly appealing.  Its what people need.  It’s some thing each of us can act to bring into being.

Please remember the mantra:  “change begins with me.”

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Sources:

• Scurr, Ruth, Fatal Purity, Henry Holt and Co., New York, 2006, p. 192.
• Dalai Lama and Archbishop Desmond Tutu, The Book of Joy,Penguin Publishing Group, 2016

Discrimination in Healthcare

45% of patients with advanced rectal cancer don’t receive the recommended treatment for this disease.

Rectal cancer is a problem.  Forecasts call for 39,000 new cases of this type of cancer in the US by the end of this year.  Rectal cancer is the largest subcategory of colorectal cancer, and is the second leading cause of cancer death in the US (roughly 15,000 deaths per year).

Colorectal cancer is most common among African-Americans.

Minorities (African-American, Latino and Native American) are less likely to receive regular screening for rectal cancer, which means that when the cancer is identified, it is usually at an advanced state.

The gold standard for treatment is neoadjuvant chemoradiation therapy (NACRT) before surgery.  This approach uses three complementary approaches to treating rectal cancer, and produces better results than chemotherapy or surgery alone.

However, almost half of Americans with advanced rectal cancer don’t receive the recommended treatment for it.  Why?

A statistical analysis of advanced rectal cancer cases treated between 2004 and 2009 identified the following factors as related to whether patients received the optimal treatment or not:

• Age
• Presence of comorbidities (e.g., other disease conditions)
• Primary tumor size
• Lymph node involvement
• Non-Hispanic white ethnicity
• Lack of private insurance
• Being treated at a non-high case volume facility

In plain English, if you are white or have private insurance, you’re more likely to get the NACRT treatment.  If you’re minority, have other serious illnesses, don’t have health insurance, or are being treated by doctors who don’t handle a large volume of these cases, you’re much less likely to have NACRT offered to you.

Most of these characteristics are related to ethnicity, wealth and where you live.  Minorities, the poor and those living in rural areas are less likely to get the best care.

Why does NACRT matter?

The five year survival rate for persons with advanced rectal cancer (Stages II and III) treated with NACRT is 72%.  For those treated with surgery alone, it’s 45%.  For those treated with chemo alone, it’s 49%.  So the course of treatment can make a huge different for the patient.

Recommendations:

• Regular screening is a must.  You may want to go beyond normal guidelines, because rectal cancer is becoming more common among younger adults.
• Second opinions are a must.  The first doctor you see may not know the best course of treatment.

Finally, one oncologist I know swears by a smoothie that is a mix of kale or spinach (2 cups), one green apple and a one-inch-thick ring of pineapple.  One of these a day may keep cancer away — for than one can help the consumer lose weight.

Finally, as a society, we need to decide:  does the right to “Life, Liberty and the Pursuit of Happiness” enshrined in the Declaration of Independence include a right to healthcare?  Can you in fact use any of your other rights without some reasonable level of health?

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Sources:

1. Cho, Stephen, “Substantial Increase in Use of Neoadjuvant Chemoradiotherapy for Rectal Cancer”, Oncology Nurse Advisor,  14 April 2016.  http://www.oncologynurseadvisor.com/daily-oncology-news/rectal-cancer-neoadjuvant-chemoradiotherapy-nacrt-substantial-increase/article/489751/
2. National Cancer Institute, “SEER Stat Fact Sheets: Colon and Rectum Cancer”.  https://seer.cancer.gov/statfacts/html/colorect.html
3. http://fightcolorectalcancer.org/prevent-it/facts-about-colorectal-cancer/
4. 2016 Gastrointestinal Cancers Symposium, “Changes in treatment patterns for patients with locally advanced rectal cancer in the United States over the past decade: An analysis from the National Cancer Data Base (NCDB),” 23 January 2016.  https://www.mdlinx.com/oncology/conference-abstract.cfm/56212/?conf_id=231384&searchstring=&coverage_day=0&nonus=0&page=4