Hospitals Find Asthma Hot Spots More Profitable To Neglect Than Fix

Lambert here: A neoliberal epidemic (in this case, of asthma “hot spots” in poor neighborhoods) conforming neatly to the two simple rules of neoliberalism.

Jay Hancock, Kaiser Health News and Rachel Bluth, Kaiser Health News and Daniel Trielli, Capital News Service. Originally published at Kaiser Health News.

BALTIMORE — Keyonta Parnell has had asthma most of his young life, but it wasn’t until his family moved to the 140-year-old house here on Lemmon Street two years ago that he became one of the health care system’s frequent customers.

“I call 911 so much since I’ve been living here, they know my name,” said the 9-year-old’s mother, Darlene Summerville, who calls the emergency medical system her “best friend.”

Summerville and her family live in the worst asthma hot spot in Baltimore: ZIP code 21223, where decrepit houses, rodents and bugs trigger the disease and where few community doctors work to prevent asthma emergencies. One mom there wields a BB gun to keep rats from her asthmatic child.

Residents of this area visit hospitals for asthma flare-ups at more than four times the rate of people from the city’s wealthier neighborhoods, according to data analyzed by Kaiser Health News and the University of Maryland’s Capital News Service.

Baltimore paramedic crews make more asthma-related visits per capita in 21223 than anywhere else in the city, according to fire department records. It is the second-most-common ZIP code among patients hospitalized for asthma, which, when addressed properly, should never require emergency visits or hospitalization.

The supreme irony of the localized epidemic is that Keyonta’s neighborhood in southwest Baltimore is in the shadow of prestigious medical centers — Johns Hopkins, whose researchers are international experts on asthma prevention, and the University of Maryland Medical Center.

Both receive massive tax breaks in return for providing “community benefit,” a poorly defined federal requirement that they serve their neighborhoods. Under Maryland’s ambitious effort to control medical costs, both are supposed to try to improve residents’ health outside the hospital and prevent admissions.

But like hospitals across the country, the institutions have done little to address the root causes of asthma. The perverse incentives of the health care payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.

Hopkins, UMMC and other hospitals collected $84 million over the three years ending in 2015 to treat acutely ill Baltimore asthma patients as inpatients or in emergency rooms, according to the news organizations’ analysis of statewide hospital data. Hopkins and a sister hospital received $31 million of that.

Executives at Hopkins and UMMC acknowledge that they should do more about asthma in the community but note that there are many competing problems: diabetes, drug overdoses, infant mortality and mental illness among the homeless.

Science has shown it’s relatively easy and inexpensive to reduce asthma attacks: Remove rodents, carpets, bugs, cigarette smoke and other triggers. Deploy community doctors to prescribe preventive medicine and health workers to teach patients to use it.

Ben Carson, secretary of the Department of Housing and Urban Development, who saw hundreds of asthmatic children from low-income Baltimore during his decades as a Hopkins neurosurgeon, said that the research on asthma triggers is unequivocal. “It’s the environment — the moist environments that encourage the mold, the ticks, the fleas, the mice, the roaches,” he said in an interview.

As the leader of HUD, he says he favors reducing asthma risks in public housing as a way of cutting expensive hospital visits. The agency is discussing ways to finance pest removal, moisture control and other remediation in places asthma patients live, a spokeswoman said.

“The cost of not taking care of people is probably greater than the cost of taking care of them” by removing triggers, Carson said, adding, “It depends on whether you take the short-term view or the long-term view.”

The Long View

Asthma is the most common childhood medical condition, with rates 50 percent higher in families below the poverty line, who often live in run-down homes, than among kids in wealthier households. The disease causes nearly half a million hospital admissions in the United States a year, about 2 million visits to the emergency room and thousands of deaths annually.

That drives the total annual cost of asthma care, including medicine and office visits, well over $50 billion.

Keyonta lives in a two-bedroom row house on the 1900 block of Lemmon Street, which some residents call the “Forgetabout Neighborhood,” about a mile from UMMC and 3 miles from Hopkins.

Reporters spent months interviewing patients and parents and visiting homes in 21223, a multiracial community where the average household income of $38,911 is lower than in all but two other ZIP codes in Maryland.

To uncover the impact of asthma, the news organizations analyzed every Maryland inpatient and emergency room case over more than three years through a special agreement with the state commission that sets hospital rates and collects such data. The records did not include identifying personal information.

For each emergency room visit to treat Baltimore residents for asthma, according to the data, hospitals were paid $871, on average. For each inpatient case, the average revenue was $8,698. In one recent three-year period, hospitals collected $6.1 million for treating just 50 inpatients, the ones most frequently ill with asthma, each of whom visited the hospital at least 10 times.

Hopkins’ own research shows that shifting dollars from hospitals to Lemmon Street and other asthma hot spots could more than pay for itself. Half the cost of one admission — a few thousand dollars — could buy air purifiers, pest control, visits by community health workers and other measures proven to slash asthma attacks and hospital visits by frequent users.

“We love” these ideas, and “we think it’s the right thing to do,” said Patricia Brown, a senior vice president at Hopkins in charge of managed care and population health. “We know who these people are. . . . This is doable, and somebody should do it.”

But converting ideas to action hasn’t happened at Hopkins or much of anywhere else.

One of the few hospitals making a substantial effort, Children’s National Health System in Washington, D.C., has found that its good work comes at a price to its bottom line.

Children’s sends asthma patients treated in the emergency room to follow-up care at a clinic that teaches them and their families how to take medication properly and remove home triggers. The program, begun in the early 2000s, cut emergency room use and other unscheduled visits by those patients by 40 percent, a study showed.

While recognizing that it decreases potential revenue, hospital managers fully support the program, said Dr. Stephen Teach, the pediatrics chief who runs it.

“‘Asthma visits and admissions are down again, and it’s all your fault!’” Children’s chief executive likes to tease him, Teach said. “And half his brain is actually serious, but the other half of his brain is celebrating the fact that the health of the children of the District of Columbia is better.”

The Close-Up View

Half of the 32 row houses on Summerville’s block of Lemmon Street are boarded up, occupied only by the occasional heroin user. At least 10 people on the block had asthma late last year, according to interviews with residents then.

“We have mold in our house” and a leaky roof, said Tracy Oates, 42, who lived across the street from Summerville. “That is really big trouble as far as triggering asthma.”

Two of her children have the disease. “I don’t even want to stay here,” she said. “I’m looking for a place.”

Shadawnna Fews, 30, lived with her asthmatic toddler on Stricker Street, a few blocks east. She kept a BB gun to pick off rats that doctors said can set off her son’s wheezing.

Delores Jackson, 56, who lived on Wilkens Avenue, a few blocks south of Lemmon Street, said she had been to the hospital for asthma three times in the previous month.

All three of Summerville’s kids have asthma. Before moving to Lemmon Street two years ago, she remembers, Keyonta’s asthma attacks rarely required medical attention.

But their new house contained a clinical catalog of asthma triggers.

The moldy basement has a dirt floor. Piles of garbage in nearby vacant lots draw vermin: mice, which are among the worst asthma triggers, along with rats. Summerville, 37, kept a census of invading insects: gnats, flies, spiders, ants, grasshoppers, “little teeny black bugs,” she laughed.

Often she smokes inside the house.

The state hospital data show that about 25 Marylanders die annually from acute asthma, their airways so constricted and blocked by mucus that they suffocate.

Keyonta missed dozens of school days last year because of his illness, staying home so often that Summerville had to quit her cooking job to care for him. Without that income, the family nearly got evicted last fall and again in January. The rent is $750.

About a third of Baltimore high school students report they have had asthma, causing frequent absences and missed learning, said Dr. Leana Wen, Baltimore’s health commissioner.

With numbers like that, West Baltimore’s primary care clinics, which treat a wide range of illnesses, are insufficient, as is the city health department’s asthma program, whose three employees visit homes of asthmatic children to demonstrate how to take medication and reduce triggers.

The program, which an analysis by Wen’s office showed cut asthma symptoms by 89 percent, “is chronically underfunded,” she said. “We’re serving 200 children [a year], and there are thousands that we could expand the program to.”

‘The Hospital Instead Of The Classroom’

The federal government paid for $1.3 billion in asthma-related research over the past decade, of which $205 million went to Hopkins, records show. The money supports basic science as well as many studies showing that modest investments in community care and home remediation can improve lives and save money.

“Getting health care providers to pay for home-based interventions is going to be necessary if we want to make a dent in the asthma problem,” said Patrick Breysse, a former Hopkins official, who as director of the National Center for Environmental Health at the Centers for Disease Control and Prevention is one of the country’s top public health officials.

Other factors can trigger asthma: outdoor air pollution and pollen, in particular. But eliminating home-based triggers could reduce asthma flare-ups by 44 percent, one study showed.

Perhaps no better place exists to try community asthma prevention than Maryland. By guaranteeing hospitals’ revenue each year, the state’s unique rate-setting system encourages them to cut admissions with preventive care, policy authorities say.

But Hopkins, UMMC and their corporate parents, whose four main Baltimore hospitals together collect some $5 billion in revenue a year, have so far limited their community asthma prevention to small, often temporary efforts, often financed by somebody else’s money.

UMMC’s Breathmobile program, which visits Baltimore schools dispensing asthma treatment and education, depends on outside grants and could easily be expanded with the proper resources, said its medical director, Dr. Mary Bollinger. “The need is there, absolutely,” she said.

Hopkins runs “Camp Superkids,” a weeklong, sleep-away summer session for children with asthma that costs participants $400, although it awards scholarships to low-income families. It’s also conducting yet another study — testing referral to follow-up care for emergency room asthma patients, which Children’s National long ago showed was effective.

But no hospital has invested substantially in home remediation to eliminate triggers, a proven strategy supported by the HUD secretary and promoted by Green and Healthy Homes Initiative, a Baltimore nonprofit that works to reduce asthma and lead poisoning.

“We either go forward to do what has been empirically shown to work, or we continue to bury our heads in the sand and kids will continue to go to the hospital instead of the classroom,” said Ruth Ann Norton, the nonprofit’s chief executive.

Hopkins and UMMC say they do plenty to earn their community benefit tax breaks.

“It’s always a challenge to say, ‘Where do we start first?’” said Dana Farrakhan, a senior vice president at UMMC whose duties include community health improvement.

Among other initiatives, UMMC takes credit for working with city officials to sharply reduce infant mortality by working with expectant mothers. The organization’s planned outpatient center will include health workers to help people reduce home asthma triggers, Farrakhan said.

“What we do is perhaps not sufficiently focused,” Brown of Hopkins said. At the same time, “we have to have revenue,” she said. “We’re a business.”

After months of waiting, Summerville considered herself lucky to get an appointment with the city health department’s asthma program.

One of its health workers came to the house late last year. She supplied mousetraps and mattress and pillow covers to control mites and other triggers. She helped force Summerville’s landlord to fix holes in the ceiling and floor.

She urged Summerville to stop smoking inside and gave medication lessons, which uncovered that Summerville had mixed up a preventive inhaler with the medicine used for Keyonta’s flaring symptoms.

“The asthma lady taught me what I needed to know to keep them healthy,” Summerville said of her family.

That was late in 2016. Since then, Summerville said last month, she hasn’t called an ambulance.


Kaiser Health News and the University of Maryland’s Capital News Service obtained data held by the Maryland Health Services Cost Review Commission on every hospital inpatient and emergency room case in the state from mid-2012 to mid-2016 — some 10 million cases. The anonymized data did not include identifying personal information.

The news organizations measured asthma costs by calculating total charges for cases in which asthma was the principal diagnosis. Maryland’s hospital rate-setting system ensures that such listed charges are very close to equaling the payments collected.

To determine asthma prevalence, reporters calculated the per capita rate of hospital visits with asthma as a principal diagnosis — a method frequently used by health departments and researchers. This may exaggerate asthma prevalence in low-income ZIP codes such as 21223, because of those communities’ tendency to use hospital services at greater rates.

However, the data also point to high asthma rates in 21223 and other low-income Baltimore communities — for example, asthma prevalence within the population of all hospital patients in a ZIP code.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. The Rev Kev

    This is crazy. The medical authorities are leaving an asthma hotspot in place to incubate? Excuse me for dropping a nasty one but what happens if there is a mutation in this hotspot? Asthma is not a contagious disease but is it possible for it to incubate with a strain of influenza to make a strain of asthma that would be?
    And whatever happened to the Hippocratic Oath’s “and I will do no harm or injustice to them”? That $1.3 billion in asthma-related research over the past decade from the Federal government would have been more effectively spent treating it in places like this. But I suppose that that would be giving money to the under-deserving poor and we know that you can’t do that.

    1. JTMcPhee

      RK, I believe you come from a place where, if Masterpiece Theatre and BBC series shows are to be believed, “medical authorities” sort of exist and grow out of a social-goodness background and tradition, as in the NHS Act and its progeny. “Medical authorities” here in the US have pretty much all been subverted and converted into “billing and bottom-line machinery,” where there are “medical authorities” at all, out among us “underserved” (read by many in the US neoliberal mindset as “undeserved”).

      I’ve mentioned what’s been happening at the local Level 2 trauma hospital where I live. After a series of M&A “deals,” it is (sort of) owned by a company called “Community Health Systems LLC,” in a transaction largely funded by debt obligations that apparently cannot be “serviced” fully, even after the usual imposition of “cost control measures” like staffing cuts and freezes, aggressive billing practices, and “moar management.” The now standard “capitalist” model of “more and more work, from fewer and fewer people, for less and less pay, with less and less attention to needs, with more and more enforced metrics and micromanagement, and bigger and bigger paydays for C-suite-ers.”

      The doctors in whose clinic I used to work include one high in the medical administration. Imagine his surprise to show up to work a month ago, to start his rounds, only to discover that CHS bean counters had replaced the entire facility’s electronic health record system. That system was acculturated to, and tweaked, and specialized by the hospital working mopes, over a ten year process, based on an adaptable platform. It was replaced with a New! Improved! generic (and slightly less expensive, immediate bottom line considered) EHR system. Which was Surprise ! rolled out without, apparently, a whole lot of testing to check integration issues. Since suddenly the patient records, the radiology reads and imaging, the lab tests, the medication orders and charting, were “not available.” And since then, with a lot of extra effort by already overworked staff, some kludges, largely paper-chart-based, have apparently been laid over the generic system, which unlike its predecessor (itself a not-so-well-engineered item) cannot be readily customized to the actual needs of the staff and patient population. It’s a “popular product” as a generic, which has been force-fitted into a lot of the CHS hospitals and clinics. No information as yet on how that switch has affected “patient outcomes,” from stuff like nurses suddenly not having access to the orders they cannot act without, in administering medications and treatments to patients, and doctors not having labs and radiology and other inputs needed to guide medical judgment and patient care.

      Here’s a bit of randomness I happened across in looking through CHS’s web site: a neat disclaimer and release of liability that pops up when you go to see CHS’s “locations ,” 127 hospitals in 20 states — to advance through to the facilities information, you have to agree to this:

      You are leaving the Community Health Systems, Inc. and CHSPSC, LLC sponsored portion of this website. Community Health Systems, Inc. does not employ any employees, own (or lease) or operate any hospitals, or recruit or employ any physicians. CHSPSC, LLC does employ personnel in its headquarters locations in Brentwood and Franklin, Tennessee. CHSPSC, LLC does not employ any clinical, management or administrative staff at any affiliate hospitals, nor does it own (or lease) or operate any hospitals or recruit or employ any physicians. The job postings, hospital descriptions, and physician opportunities described in the following windows are local in nature and all information has been provided solely by the sponsoring facility/entity. By accessing this additional information, users agree to look solely to the individual sponsor and to hold Community Health Systems, Inc. and CHSPSC, LLC harmless for any act or omission that may arise from the user’s reliance on this information.
      I acknowledge these terms and want to proceed »

      The Age of Impunity. We are well and truly into it.

      I happen to need some surgery shortly. I’ve had to find a surgeon who practices at another hospital to get it done — no way I am going to subject myself to the tender mercies of MBA-“managed” treatment where the medical errors machine has just gotten a huge shot of steroids… (Though the facilities “owned by or associated with” the other major Medical Monstrosity here, BayCare, have their own unique lists of Major Problems.) I’ve composed myself to accept the manifest victory of the Two Rules of Neoliberalism. Because as Keynes observed, in that often-quoted extract from a much deeper observation (as discussed here,, “in the long run, we are all dead.” Except for maybe Peter Thiel and the Gates Family and the Kochs and Bezos and Soros and other public benefactors…

    2. Jamie

      I applaud your outrage, but no, it is not possible for it to mutate, because it is not a “disease” in that sense. It is an allergic reaction, and there is no microbe (no bacteria or virus) present to mutate.

      But I don’t think this is a simple misunderstanding on your part. I think it is one of the consequences of a culture in which “the medical model” is overused and abused. We have been indoctrinated to think of every discomfort as “disease” needing medical treatment. Often, as in the cases of “mental health” and addiction, this has been done at least in part in an attempt to bring positive attention to the plight of suffering people. But in the long run, giving in to this miscategorization of things simply leads to a different kind of suffering.

    3. Jim Thomson

      Rev Kev:

      To expand on a technical point:
      Asthma is not contagious, as you note. It is not caused by a virus, nor a bacteria, nor any infectious agent. It is an auto-immune or exaggerated response by the person to an, often external, condition.
      There is no way for an asthmatic to affect the mutations that occur in influenza. There is no “it” to incubate with the influenza virus.

      Otherwise, I agree, it is all crazy.

      1. Wade Riddick

        Not to nitpick, but viral evolution is driven by opportunity. The sicker a population and more vulnerable they are to infection, the more likely they will incubate more of a virus which, in turn, drives the evolution of that pathogen. Any amount of time spent in a human host can offer a chance to evolve to a more virulent state via random mutation – at least in the short term. If asthmatics are more often hosts to influenza, then they are a reservoir of mutation capacity.

        Having said that, asthma cases are associated with infection by the respiratory syncytial virus that alters the adrenal system. So, yes, there is a communicable component to asthma risk.

        And asthma is driven by communicable social practices. Asthma is caused not only by the presence of certain factors but also by the absence of others. Ironically, both factors often fall into the category of “filth.” Friendly bacteria in dirt program the immune system to be more quiescent. Asthma risk rises when you’re not exposed to these probiotic species.

        As usual, you’re only seeing half the picture in the war of enclosure. It isn’t simply about the presence of something bad in the environment. It’s about the absence of public goods – in this case, friendly bacteria and their nourishment (e.g., dietary fiber). What we need to sustain ourselves is being confiscated by the ambient “business” environment.

        Humans have certain requirements for healthy living. Think Vitamin A, for instance. Without it, you get sick. What’s happening is that people who make money on expensive drugs to treat vitamin A deficiency are taking vitamin A out of our food.

        If you take antibiotics, get dewormed, don’t get to breathe in the right fresh air and dirt and eat processed food without enough sunlight or exercise, you get a greater asthma risk. And colon cancer. And heart disease. And autism/ovarian cysts/atherosclerosis/Alzheimer’s/multiple sclerosis/allergy/obesity/diabetes/etc.

        Our war on the ecology of the Earth isn’t some abstract battle over global warming. It’s happening in the gut and lungs of each and every person on the planet. The damage is very real and immediate and it involves everyone from food companies to cell phone providers who bathe your eyes in light after sundown, altering your circadian rhythms.

        1. Jim Thomson

          Yes,all you say is true.
          But to the original point, there is no “strain” of asthma that can incubate with a strain of influenza and hybridize to create a more “infectious” strain of asthma.

          As DJT said, Its complicated. ( no dummy he)

        2. JBird

          Humans have certain requirements for healthy living. Think Vitamin A, for instance. Without it, you get sick. What’s happening is that people who make money on expensive drugs to treat vitamin A deficiency are taking vitamin A out of our food.

          What? I got me my XXXL Tinfoil Hat, and my SuperDuperSecret Decoder Ring, plus my class, and personal, studies have shown oh so, so many ways of murder for profit; taking out vitamin A for the money seems a bit much, not because they wouldn’t do it mind, it’s just doesn’t seem practicable.

          Any good links, or books, for me? (As if I needed anymore reason for paranoia!)

          1. Wade Riddick

            I was speaking figuratively in regards to “Vitamin A.” But food processing does cause disease. Companies have been stripping fiber out of foods for generations now because the sugar rush activates the same addiction circuit in the brain that heroin and meth do. This generates repeat business and gooses profits. The result is a rash of avoidable inflammatory diseases – which for-profit companies make money on at the other end too. Then you have two ends of the market with incentives to keep the pseudo-food toxic.


            Fiber is essential to GLP-1 secretion in the gut and GLP-1 signaling regulates how we experience pleasure.


  2. JohnM

    Here is a recent article about the apparent huge impact of air pollution control efforts on asthma hospitalization in these same neighborhoods. 57% reductions in some of the worst areas! I was involved in the environmental permitting for these upgrades and was told it was a billion dollar project. Improvements don’t come cheap.

    1. JTMcPhee

      “Improvements don’t come cheap.” Neither do MBAs. Funerals do, however, and they are all only one-time expenses, usually borne by the afflicted…

      It’s all about distribution and allocation.

  3. freedeomny

    Would be interesting to note if asthma costs have gone up since 2011-2012 when Primatene was pulled of the shelves because of federal concern about CFC’s which are known to damage the ozone layer. I always thought this was bs as lower income people really depended on Primatene…and we all know just how really concerned the government (and big business) is about the environment…..

  4. Steve

    I do not understand why hospitals are seen to be responsible in anyway for doing this. This is the job of the County and City health departments. Many hospitals are running in the red and being closed. Hopkins, Mayo, and Cleveland should never be used as an example of hospitals. As far as education goes it often doesn’t work well. I knew people in very well to do neighborhoods that ended up with their children on inhalers due to mold and mildew problems in their homes. The cause of the problem were poorly vented spa baths or over humidifying their homes. The parents refused to stop using the baths no matter how many times they were told. Keeping products that out gas toxic chemicals into homes and businesses would go a long way along with better HVAC systems but that is never going to happen.

    1. Jer Bear

      agree completely. This is not a medical issue, it is an issue of cleanliness, plain and simple. The people who need to be held accountable are landlords and homeowners. The task of this falls to community education services, which are available in every city.

      All a hospital could do is come in and say, yep, you have rats and mold everywhere. clean it up and the problem is solved. I suppose some could say this is a problem that the medical complex could “fix”, but I do not see it.

  5. TomDority

    You would think that landlords would be tortuously liable and treble so for knowingly exposing their customers (tenants) to unsafe conditions caused by their bringing substandard and unfit product to market – I mean, how do you avoid liability for a leaking roof that is part of the building envelope and not the living space that is being rented.

    1. JTMcPhee

      I’d suggest spending some time in your local “housing court” or its equivalent, and investigate the resources of legal aid and tenants rights groups in your area. That most people have “legal rights” is a comfortable shibboleth to us educated people, but “without an enforceable and effective remedy, there is no right.” An aphorism that a couple of my law school professors grudgingly acknowledged, including my torts and contracts and constitutional law professors, in having to agree that the models of legal process bear little relation to what happens “in practice.” See fraudulent mortgage foreclosures, and all that lies behind that, and places like Jefferson, MO and Baltimore. The hospitals get lots of federal money in the understanding that they will provide “public benefit.” Local health departments, where they exist, are starved by austerity.

  6. Lynne

    On a somewhat related tangent: note that removing carpet is one of the recommendations for mitigating environments for asthmatics. My parents (one of whom has severe asthma) were looking at housing in a retirement community and everything except a strip in the shower room was carpeted. They wanted to pay to have the carpets removed and replaced with quality hard flooring and were told that was not allowed because “non-carpeted floors are unsafe.” ??!

    1. JBird

      They wanted to pay to have the carpets removed and replaced with quality hard flooring and were told that was not allowed because “non-carpeted floors are unsafe.” ??!

      Speaking as one whose parent is unsteady because of previous injuries, and general health, not falling is a very large concern, believe me. Having had more than one relative break something just walking, the worry over having hard slippery flooring as opposed to less hard, not slippery carpet, is not surprising at all. Of course, their ability to breath was/is just fine.

  7. Mickey Hickey

    When I was growing up in impoverished Ireland we had Public Health nurses who worked with schools, doctors and families to identity children at risk. Once identified the family was provided with whatever was needed to rectify the problems. This could be anything from advice to a new house. The quality of public housing in Ireland is equeal to what is found in Germany. Mothers of young children are entitled to good quality housing, nutrition and health care, that is the law but more important is that it is overwhelmingly supported by the population at large. Even mothers saddled with drunken husbands are entitled. I remember being in a bar in Ireland when I was a teenager after a few years in London England on budget night. The usual assault on luxuries, tobacco and alcohol was announced. The amazing thing was the bar clientele mostly middle aged and up grizzled men, smokers and drinkers were supportive of the sin taxes and told me this was good for mothers and children. This did not reflect public opinion in England at the time and surprised me. Clearly Ireland is not the only European country that is supportive of mothers and children. In America and some other countries infected with the less government is better government disease (which seems to be infectious) the barbarism of survival of the fittest and to hell with the hindmost seems to be the dominant ideology.

  8. Kris Alman

    Both receive massive tax breaks in return for providing “community benefit,” a poorly defined federal requirement that they serve their neighborhoods. Under Maryland’s ambitious effort to control medical costs, both are supposed to try to improve residents’ health outside the hospital and prevent admissions.

    “Nonprofit” hospitals have great accountants who can make them appear benevolent.

    Oregon has only two for-profit hospitals in the entire state. Oregon’s 2017 legislature focused attention as to whether non-profit hospitals are deserving of their huge tax breaks for providing “community benefits”–though got nowhere.

    Oregon’s Medicaid expansion (at risk with a funding mechanism that is going to the ballot on Jan. 23rd) puts our state in a top tier of uninsured residents.

    A graph on page 3 of this report shows how little money goes to community health improvement. The vast bulk went toward “unreimbursed” Medicare and Medicaid.

    1. Kris Alman

      Also, this article goes deep into the weeds of what nonprofit hospitals can do to provide community benefits. They point out that more than half of all U.S. hospitals operated as nonprofit corporations, and their numbers surpassed 2900 that year.

      Community Benefit and the ACA
      A Brief History and Update

      I guarantee, “nonprofit” hospitals will continue to call reimbursement of Medicare and Medicaid “charity”–unless they are called out on it!

  9. NV

    Regarding the mention (see article) of the build of mucus in the airways, Mucosolvan is excellent for preventing and treating this. (And no, I am not confusing this with Mucinex, which works differently.) Mucosolvan, also known as Ambroxol, comes in different forms, has been around for thirty years, and is NOT
    available in the US or Canada. It is cheap: Six Euros for a packet of twenty, once a day, 75mg capsules. It is from Boehringer Ingelheim. It works by making the cilia throughout the respiratory system better sweepers. It is labeled use for bronchopulmonary conditions. It is also used in cough syrups and in a lozenge form it treats the pain of sore throats.

    I randomly asked pharmacists in New York about it, and none had heard of it. One looked it up and reported that in powder form it was put in nebulizers to treat kids with cystic fibrosis.

    Guess no one would (ka-ching!) benefit from marketing it here. As for accessing an online pharmacy, say, in Mexico, a US IP address is blocked.

  10. adrena

    Another effective method for asthma prevention and control is the use of specific essential oils. In fact, it’s effective for any respiratory problem

    RC is an essential oil blend consisting of:

    Three varieties of Eucalyptus oil (E. Globulus, E radiata, E citriodora)

    Methods of application:

    Directly inhale
    Apply topically (using a carrier oil)

    Most important is to use only pure organic oils. I’ve tried several and found a company called Young Living to be the absolute best. (I don’t receive a commission. I’m just a customer)

    Since I’ve had RC essential oil I’ve kissed my respiratory problems goodbye ( mild asthma, occasional sob).

    RC is also extremely effective against coughs, congestion, sore throat etc.

    For topical application, add three drops RC to 1/8 tsp organic coconut butter and massage into chest, neck and around the nostrils.

    and …..

    Inhale directly from the bottle (then it lasts longer) using alternate nostril breathing.

    The price of 5 ml of RC essential oil blend is $17.11 CAD

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