Category Archives: Thanksgiving

And A Few More Suggestions to Fix the Affordable Care Act- Keep improving healthcare quality

 

 

clueless145[458]Republican response to Trump’s declaration of war on the Affordable Care Act-McConnell to Trump: We’re not repealing and replacing ObamaCare
This last week Alexander Bolton reported that Senate Majority Leader Mitch McConnell (R-Ky.) told President Trump in a conversation Monday that the Senate will not be moving comprehensive health care legislation before the 2020 election, despite the president asking Senate Republicans to do that in a meeting last week.
McConnell said he made clear to the president that Senate Republicans will work on bills to keep down the cost of health care, but that they will not work on a comprehensive package to replace the Affordable Care Act, which the Trump administration is trying to strike down in court.
“We had a good conversation yesterday afternoon and I pointed out to him the Senate Republicans’ view on dealing with comprehensive health care reform with a Democratic House of Representatives,” McConnell told reporters Tuesday, describing his conversation with Trump.
“I was fine with Sen. Alexander and Sen. Grassley working on prescription drug pricing and other issues that are not a comprehensive effort to revisit the issue that we had the opportunity to address in the last Congress and were unable to do so,” he said, referring to Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and Finance Committee Chairman Chuck Grassley (R-Iowa) and the failed GOP effort in 2017 to repeal and replace ObamaCare.
“I made clear to him that we were not going to be doing that in the Senate,” McConnell said he told the president. “He did say, as he later tweeted, that he accepted that and he would be developing a plan that he would take to the American people during the 2020 campaign.”
After getting the message from McConnell, Trump tweeted Monday night that he no longer expected Congress to pass legislation to replace ObamaCare and still protect people with pre-existing medical conditions, the herculean task he laid before Senate Republicans at a lunch meeting last week.
“The Republicans are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare,” Trump wrote Monday night in a series of tweets after speaking to McConnell. “In other words, it will be far less expensive & much more usable than ObamaCare Vote will be taken right after the Election when Republicans hold the Senate & win back the House.”
Trump blindsided GOP senators when he told them at last week’s lunch meeting that he wanted Republicans to craft legislation to replace the 2010 Affordable Care Act.
The only heads-up they got was a tweet from Trump shortly before the meeting, saying, “The Republican Party will become ‘The Party of Healthcare!’”
The declaration drew swift pushback from Republicans like Sen. Susan Collins (Maine), who said the administration’s efforts to invalidate the entire law were “a mistake.”
Other Republicans, including Sen. Mitt Romney (Utah), said they wanted to first see a health care plan from the White House.
Senate Republican Whip John Thune (S.D.) on Tuesday said the chances of getting comprehensive legislation passed while Democrats control the House are very slim.
“It’s going to be a really heavy lift to get anything through Congress this year given the political dynamics that we’re dealing with in the House and the Senate,” he said. “The best-laid plans and best of intentions with regard to an overhaul of the health care system in this country run into the wall of reality that it’s going to be very hard to get a Democrat House and a Republican Senate to agree on something.”
Back to our/my suggestions to improve the Affordable Care Act.
Healthcare organizations like the Cleveland Clinic have made front-end investments to change their approaches to care delivery.
Another writer on healthcare reported that the GOP’s proposals to replace the Affordable Care Act have so far focused on health insurance coverage, cutting federal aid for Medicaid and targeting subsidies for those who purchase private insurance through the health insurance marketplace.
But there’s a lot more to the ACA than health insurance. Republican lawmakers would do well to take a closer look at other parts of the healthcare reform law, which focus on how the United States can deliver high-quality care even while controlling costs.
The ACA helped spur the transition away from fee-for-service reimbursement models that rewarded providers for treating large numbers of patients to value-based care payments, which reward providers who deliver evidence-based care with a focus on wellness and prevention.
And any revisions to the law should continue to support these endeavors—such as programs to reduce hospital readmissions and hospital-acquired conditions—that aim to improve patient outcomes while lowering overall healthcare costs.
It’s true that some physicians are reluctant to embrace value-based contracts, which they argue increase their patient loads and hold them responsible for overall wellness, which is often beyond their typical scope of practice or beyond their control if patients aren’t compliant. Smaller hospitals and health systems may have trouble implementing quality-improvement changes, too.
But it’s too soon to give up on a model of care that strives to meet the Triple Aim and improve individual care, boost the health of patient populations and reduce overall costs.
The country must do something to address the quality of its healthcare. Although the United States spends more on healthcare than other wealthy nations do, we rank last in quality, equity, access, efficiency and care delivery. And we’ve come in dead last in quality for the past 13 years.
But it’s not for lack of trying.
The Centers for Medicare & Medicaid Services is still experimenting with advanced payment models that reward providers for quality of care. Although the results have been a mixed bag, there are signs of progress.
Yes, several of the Pioneer accountable care organizations exited the model early on after suffering financial losses and struggling to meet the demands of the program. But other participants of the Pioneer model and the Shared Savings Program reported clinical successes as well as significant savings.
In response, CMS has adapted the models, offering providers options for lower and higher risk tracks.
Whereas some healthcare organizations took a wait-and-see approach to value-based care until one successful model emerged, many leaders say it takes time to see results and that what works in one region or for one organization won’t necessarily work somewhere else.
But the organizations that have made front-end investments to change their approaches to care delivery and have stuck with it are beginning to see their efforts pay off.
Donald Berwick, M.D. noted that Ohio’s Cleveland Clinic, for instance, has standardized care pathways to reduce variations in care, lower costs and increase quality. Its stroke care pathway has led to a 43% decrease in stroke mortality and a 25% decline in the cost of care.
And California-based Dignity Health has developed community partnerships to discharge homeless patients to a recuperation shelter and address the social determinants of health via a referral program to connect patients in need with outside agencies.
“All three [aims] are achievable, all three show progress and all three are vulnerable,” Donald M. Berwick, M.D., president emeritus and senior fellow at the Institute for Healthcare Improvement, said recently.
“It seems to me incumbent upon those who claim to lead healthcare and healthcare systems to defend that progress against threats.”
Improve payment models and cut costs
We must all remember there is no silver bullet that will cut costs and improve care. But allowing the Center for Medicare & Medicaid Innovation to keep working on it is key.
Reporter Paige Minemyer went on to state that if they really want to repair the Affordable Care Act, lawmakers must focus on the transition to value-based care, which has accelerated under healthcare reform.
The first step? Support the Center for Medicare & Medicaid Innovation (CMMI) as it tests new payment models that will cut costs. There is no silver bullet that will cut costs and improve care. But allowing CMMI to keep working on it is key.
Payment model innovation
Providers that have seen the benefits of CMMI’s initiatives, including bundled payments, say they’re sticking with it regardless of what the White House or Congress decide. Helen Macfie, chief transformation officer for Los Angeles-based Memorial Care Health System, is taking that route: She says her organization is “bullish” on continuing the model voluntarily.
Bundled payments get specialists together with providers “to do something really cool,” she says.
Providers have seen mixed success in accountable care organizations (ACOs), the most complex advanced payment model (APM) there is. But their longevity requires commitment to reduced regulations.
On that point, the Donald Trump White House and the healthcare industry agree: Less is sometimes more. A reduced regulatory burden can also make it easier for providers to balance multiple APMs at once, which can improve the effectiveness of each.
Providers that have found success with ACOs may not see the benefits immediately, studies suggest, but the savings instead compound over time. ACO programs may require significant startup costs upfront.
However, the evidence is growing that these advanced value-based care models do pay off in both cost reduction and quality improvement, even if there’s still much for researchers to learn about what really makes an ACO model succeed.
Cost-cutting measures
Also lost in the debate over insurance reform is the growing cost of healthcare in the U.S., which far outpaces that of other developed nations despite lagging behind in quality. An element of this that is totally untouched in Republican-led reform is drug pricing, which providers argue is one of the major drivers of increased costs.

And now a suggestion from President Donald Trump!
As part of the party’s updated platform for 2018, Democrats unveiled plans to allow Medicare to negotiate drug prices. The suggestion has been championed both by former President Barack Obama and by President Donald Trump, whose vacillating views on health policy have been known to buck the party line.
But not everyone is convinced that this is the best solution. Experts at the Kaiser Family Foundation noted that negotiating drug prices could have a limited impact on savings, and even the Congressional Budget Office has been skeptical.
And if you ask pharmaceutical companies, they’re not the problem when it comes to rising healthcare costs, anyway; hospitals are.
Harness the power of Medicaid
Leslie Small noted that for Medicare & Medicaid Services Administrator Seema Verma is a big advocate for expanding the use of state innovation waivers to reimagine Medicaid. (Office of the Vice President)
By now, a laundry list of studies chronicles all the benefits of expanding Medicaid eligibility under the Affordable Care Act. Thanks to a previous Supreme Court decision, the remaining 19 states aren’t obligated to follow suit, but now that legislative attempts to repeal the ACA have failed, they would be foolish not to.
Not only have Medicaid expansion states experienced bigger drops in their uninsured rates relative to nonexpansion states, but hospitals in these states have also seen lower uncompensated care costs. In addition, low-income people in Medicaid expansion states were more likely than those in nonexpansion states to have a usual source of care and to self-report better health, among other metrics.
Crucially, the Trump administration has even given GOP governors who might be worried about the political fallout a convenient reprieve, as it’s signaled openness to approving waivers that design Medicaid expansion programs with a conservative twist.
Previous HHS Secretary Tom Price suggestion had a suggestion.
“Today, we commit to ushering in a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population,” Centers for Medicare & Medicaid Services Administrator Seema Verma and Department of Health and Human Services Secretary Tom Price said in a joint statement in March.
In fact, Vice President Mike Pence and Verma both designed such a program in Indiana, which requires beneficiaries to pay a small amount toward their monthly premiums.
Other states, meanwhile, have applied for a more controversial Medicaid tweak—enacting work requirements for beneficiaries—and it remains to be seen whether those experiments will be approved and if so, face backlash.
But under the 1332 and 1115 waivers in the ACA, states have plenty of latitude to dream up other ways to better serve Medicaid recipients, such as integrating mental and physical health services for this often-challenging population.

So, I have laid out a number of real options to improve the health acre bill that was passed already and by all data imputed it seems to be working with reservations. My biggest reservation is that over time the Affordable Care Act/ Obamacare needs definite tweaking and needs revenue of some sort to make the healthcare system affordable and sustainable without putting the burden on our young healthy hard-working Americans.
I’ve heard the suggestion that all big government has to do is print more money. Ha, Ha, this sounds like the suggestions of the new socialists like Ocasio-Cortez and all her buddies. Maybe we can keep borrowing money as we have in the past from Social Security Funds, Medicare or shifting funding for other projects like the Pentagon. I am kidding, but there are people in high places who would suggest these options not knowing much about what comes out of there ignorant mouths or social media posts.
We as a Country have to get smart, ignore the idiots yelling and screaming about their poorly thought out suggestions to get re-elected or just elected as potential presidential hopefuls, gather the intelligent forces in healthcare to come up with solutions and get Congress to come to their senses to achieve a bipartisan solution for the good of all Americans. It seems as though both political parties are truly clueless, especially the Nancy Pelosi and her Democrats who have taken over power in Congress, and yes both the House and the Senate!
Next on the agenda is looking more into Medicare For All, Single Payer Healthcare Systems and Socialized Healthcare. And even more on the status of the Affordable Care Act/Obamacare. Joy, Joy!!

Thousand Oaks and Our Peculiarly American Affliction. And will the Dems get Gun Control?

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Be shocked by the massacre at a bar. It’s not normal.

Tim Dominguez sits under the freeway after escaping the Borderline Bar and Grill in Thousand Oaks, Calif., where a gunman killed 12 other people Wednesday night.

According to statistics from the Gun Violence Archive, there have been 307 mass shootings in the 312 days of 2018. They are a commonplace occurrence. This is a horrifying thing to say, but it is the truth. We need to say this truth over and over. We need to face this horror without looking away. We live in a country where there are relatively few restrictions on gun ownership and where our cultural tolerance for mass murder appears to be infinite.

Less than a month ago an author visited California State University Channel Islands, not far from where the shooting on Wednesday night took place. A deeply engaged audience greeted her. They had a thoughtful discussion about sexual violence, justice, trauma, and healing. Some of those students might have been at the Borderline Bar and Grill in Thousand Oaks, Calif., Wednesday night, doing what college students are supposed to be doing — dancing and hanging out with friends, having fun. As she read the news Thursday morning, her chest tightened. She read quotes from students from that campus describing the sparks and the smoke they saw. She felt resignation creeping in.

Over the past two years, there has been increased security at his events, armed guards. Sometimes they are there because he had received a threat. Sometimes they are there because she is a black woman with opinions and the threat is already implied. Every time she goes on stage, she looks out into the audience and wonders if there is a man with a gun in the sea of faces. She is not scared of him. She is resigned to the inevitability of him pointing that gun at me, at the crowd, and pulling the trigger. She doesn’t want to be this resigned. She doesn’t want you to be, either.

In an interview, the father of one of the young women who escaped the carnage at the Borderline Bar said his daughter did what he has taught her to do in the event of a mass shooting. It took me a moment to realize what he was saying. We are raising generations of children who are prepared for this kind of crime.

It is a peculiarly American affliction that this epidemic of gun violence doesn’t move us to take any real steps toward curbing gun violence and access to guns.

It is painfully obvious that there is no shooting appalling enough to make American politicians stand up to the National Rifle Association and gun makers. A congressman was shot and critically wounded. Children at Sandy Hook Elementary were murdered. Revelers at the Pulse nightclub were murdered. Concertgoers in Las Vegas were murdered.

Our leaders think and pray their way through the horror. The politicians who rely on N.R.A. donations feign concern and continue taking that money. American voters keep these people in office, perhaps, because it isn’t their loved ones being murdered. Yet. And even if it were, I don’t know that their votes would change. Instead, people treat the Constitution like a fast-food value menu, choosing which amendments are sacrosanct (the First and Second) and which are disposable (any of those giving civil rights to anyone but white men).

The script following these shootings is too familiar — flags at half-staff, hollow words of sympathy — but what chills me is the relatively calm eloquence of the survivors speaking to reporters. How they don’t seem particularly surprised to have survived a mass shooting. That they are able, in the immediate aftermath of trauma, to articulate their experiences. They can do this because they have seen it done.

How do we change this script? How do we convince enough people that we are well past the time for radical action?

We must elect politicians who will ban assault weapons and at the very least enact legislation requiring federal, rigorous background checks for gun owners. But really, that’s not radical. It’s the bare minimum, and by the grace of that kind of legislation in California, the shooter was able to use only a handgun. This massacre where 13 people died could have been much worse.

In late September, I went to a gun range with my brother, who is a gun enthusiast. We spent about an hour shooting guns as he explained the merits of the various weapons. We wore safety goggles, and though it wasn’t my first time shooting a gun, he went over the safety protocols. Before we could even enter the range we watched a safety video. From the moment we entered the facility until the time we left, we were reminded of the danger of these weapons. Each gun was heavy in my hand, hot. Before long, the space around us was thick with the stench of oil and gunpowder. We were shooting at targets, metal, and paper. There was a certain satisfaction when I shot well. I understood the appeal of holding that kind of power in the palm of my hand. I also understood the responsibility of holding a gun. I was awed by it. I was not so enamored that I want to own a gun myself. Yet.

Today I held a 4-month-old baby. He is cute and strong and wide-eyed. He still smells sweet and new. I held him and for a few minutes, I forgot about everything terrible. I forgot about the man with a gun and the 12 other people he killed and the people he injured. I forgot about the man with a gun who walked into a yoga studio and started shooting. I forgot about the man with a gun who walked into a grocery store and started shooting. I forgot about the man with a gun who walked into a synagogue and started shooting. And then I looked at this baby’s tiny face and his wide, gummy smile. I remembered everything terrible. I understood the responsibility of holding a child. I was awed by it. I realized that as horrifying and commonplace and inevitable as mass shootings are, we cannot do nothing. Stare into the horror. Feel it. Feel it so much that you are moved to act.

Deaths From Gun Violence: How The U.S. Compares With The Rest Of The World

Nurith Aizenman reported these statistics about a year ago but I thought that the story and the comparisons were relevant regarding gun violence rates. The timing of that report couldn’t be more apt — or grimmer even today. The statistics were released just as Americans were waking up to the news that a gunman had opened fire the night before at the Borderline Bar and Grill in Thousand Oaks, Calif. He killed 12 people and was found dead at the scene.

The attack came just 11 days after the fatal shooting that claimed 11 lives at Pittsburgh’s Tree of Life synagogue. Eight months before that, a gunman shot 17 people dead at Marjory Stoneman Douglas High School in Parkland, Fla. And just over a year ago a gunman massacred 58 people at a music festival in Las Vegas.

As in previous years, the University of Washington’s latest data indicates that this level of gun violence in a well-off country is a particularly American phenomenon.

When you consider countries with the top indicators of socioeconomic success — income per person and average education level, for instance — the United States is bested by just 18 nations, including Denmark, the Netherlands, Canada, and Japan.

Those countries all also enjoy low rates of gun violence. But the U.S. has the 28th-highest rate in the world: 4.43 deaths due to gun violence per 100,000 people in 2017. That was nine times as high as the rate in Canada, which had 0.47 deaths per 100,000 people — and 29 times as high as in Denmark, which had 0.15 deaths per 100,000.

The numbers come from a massive database maintained by the University’s Institute for Health Metrics and Evaluation, which tracks lives lost in every country, every year, by every possible cause of death. The 2017 figures paint a fairly rosy picture for much of the world, with deaths due to gun violence rare even in many countries that are extremely poor — such as Bangladesh, which saw 0.07 deaths per 100,000 people.

Prosperous Asian countries such as Singapore and Japan boast the absolute lowest rates, though the United Kingdom and Germany are in almost as good shape.

“It is a little surprising that a country like ours should have this level of gun violence,” Ali Mokdad, a professor of global health and epidemiology at the IHME, told NPR in an interview last year. “If you compare us to other well-off countries, we really stand out.”

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To be sure, there are quite a few countries where gun violence is a substantially larger problem than in the United States — particularly in Central America and the Caribbean. Mokdad said a major driver is the large presence of gangs and drug trafficking. “The gangs and drug traffickers fight among themselves to get more territory, and they fight the police,” said Mokdad. And citizens who are not involved are often caught in the crossfire. Another country with widespread gun violence is Venezuela, which has been grappling with political unrest and an economic meltdown.

Screen Shot 2018-11-11 at 12.30.59 PMMokdad said drug trafficking may also be a driving factor in two Asian countries that have unusually high rates of violent gun deaths for their region, the Philippines and Thailand.

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With the casualties due to armed conflicts factored out, even in conflict-ridden regions such as the Middle East, the U.S. rate is worse.

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The U.S. gun violence death rate is also higher than in nearly all countries in sub-Saharan Africa, including many that are among the world’s poorest.

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One more way to consider these data: The institute also estimates what it would expect a country’s rate of gun violence deaths to be based solely on its socioeconomic status. By that measure, the U.S. should be seeing only 0.46 deaths per 100,000 people. Instead, its actual rate of 4.43 deaths per 100,000 is almost 10 times as high.

Dems vow swift action on gun reform next year

Mike Lillis and Scott Wong wrote that the nation’s latest mass shooting has rekindled the fire under Democrats to use their newly won majority to strengthen federal gun laws in the next Congress.

The issue was off the table for eight years of Republican rule, as GOP leaders have sided with the powerful gun lobby against any new gun restrictions.

But House Minority Leader Nancy Pelosi(D-Calif.), who’s seeking to regain the Speaker’s gavel, vowed to move quickly on gun reform next year, citing Wednesday night’s shooting massacre at a California country music bar as the latest reason Congress should step in with new restrictions on the sale and ownership of firearms.

Universal background checks, Pelosi suggested, would be the likely first step.

“It doesn’t cover everything, but it will save many lives,” Pelosi said Thursday night on CNN’s “Cuomo Prime Time” program.

“This will be a priority for us going into the next Congress.”

Rep. Jerrold Nadler (D-N.Y.), likely the incoming chairman of the House Judiciary Committee, said this week that he’ll “immediately get to work” on that legislation next year.

That position marks a shift from almost a decade ago when Democrats last controlled the House and party leaders declined to consider tougher gun laws despite entreaties from some rank-and-file members.

Rep. Mike Quigley (D-Ill.), a gun reformer from Chicago and member of the Judiciary Committee, had requested hearings on background checks in 2010, only to be refused.

The reasons were largely political: House Democrats, at the time, had a more conservative-leaning caucus, boasting more than 50 Blue Dogs in battleground districts the party was fighting to preserve.

After a 10-year ban on assault weapons signed by former President Clinton was widely viewed as a “third rail” that helped secure George W. Bush’s White House victory in 2000, Democrats didn’t want to repeat history.

Since then, the country has seen a long string of prominent mass shootings, including violence targeting a congresswoman in Tucson, Ariz., elementary school students in Newtown, Conn., nightclubbers in Orlando, churchgoers in Charleston, S.C., country music fans in Las Vegas, high schoolers in Parkland, Fla. and Jews praying at a synagogue in Pittsburgh last month.

The most recent tragedy occurred Wednesday night at a bar in Thousand Oaks, Calif., where authorities say a Marine combat veteran killed 12 people before fatally shooting himself.

One of the victims, 27-year-old Telemachus Orfanos, survived last year’s Las Vegas massacre but was killed in the Thousand Oaks shooting.

“I don’t want prayers. I don’t want thoughts. I want gun control, and I hope to God nobody else sends me any more prayers,” Orfanos’s mother, Susan Orfanos, said in an emotional interview with KABC that has been viewed millions of times on social media. “I want gun control. No more guns.”

The rash of devastating episodes shifted public sentiment in strong favor of gun reform, and polls show overwhelming support for measures like expanded background checks among voters of all political stripes.

Three Parts Brands Have Come Together

The Ford Motor Company reported that among the host of Democrats elected to the House on Tuesday in conservative districts, many embraced new restrictions on gun purchases without facing the previously feared backlash at the polls.

“The public has evolved on their belief about this, given the magnitude and disparity of gun violence and mass shootings,” Quigley said Friday by phone.

The Democrats’ plans for gun-reform legislation remain unclear.

Rep. Mike Thompson (D-Calif.), the head of the party’s task force to prevent gun violence, has taken the lead on the background check bill, and will likely do so again next year. There are also dozens of related proposals other lawmakers will surely promote, including bills to ban bump stocks, eliminate assault weapons, spike taxes on guns and ammunition and prohibit high-capacity magazines like the one allegedly used by the shooter in Thousand Oaks.

Quigley is all for pushing bold reforms, including a ban on assault weapons, but is promoting the idea of securing early victories on more popular measures.

“Let’s start where we have some commonality,” he said. “The vast majority of Americans, the majority of gun owners, the majority of NRA [National Rifle Association] members support universal background checks.

“That’s a good place to start.”

That the House will pass some kind of background-checks legislation is clear. But any new gun restrictions face tall odds in the GOP-controlled Senate, where Republicans are near unanimous in their opposition to such reforms.

In 2013, in the wake of the Sandy Hook Elementary School shooting in Newtown, Sens. Pat Toomey (R-Pa.) and Joe Manchin (D-W.Va.) authored legislation to expand background checks for firearms purchased online and at gun shows. It fell six votes short of overcoming a GOP-led filibuster, with only four Republicans — Toomey, and Sens. Susan Collins (Maine), John McCain (Ariz.) and Mark Kirk(Ill.) — supporting the measure.

Kirk lost his reelection bid in 2016 and McCain died this year, leaving just two Senate Republicans who back strengthening background checks. Manchin just won re-election this week and Toomey isn’t up for reelection until 2022.

“Senator Toomey is continuing to work with his colleagues in the Senate to find a path forward to 60 votes for his background check legislation,” said Toomey spokesman Sam Fischer.

Complicating the math for gun reform supporters, Tuesday’s midterms added to the GOP Senate majority, and the incoming Republicans are all gun-rights promoters supported heavily by the firearms lobby.

Asked about the appropriate response to the Thousand Oaks shooting, Sen.-elect Marsha Blackburn(R-Tenn.) was terse.

“What we do is say, how do we make certain that we protect the Second Amendment and protect our citizens?” Blackburn told Fox News on Thursday.

President Trump could be a wild card in the coming gun debate. The president has a long and conflicting history on the topic, from the promotion of an assault-weapons ban years ago to a more recent embrace of the Second Amendment protectionism advocated by the NRA.

Gun-reform advocates, long accustomed to congressional inaction on the issue, say they’ve been encouraged by what they’ve heard from Pelosi and other Democratic leaders so far.

“While so many other factors have not been settled, we believe that House Democrats will move universal background checks in early 2019,” said Robin Lloyd, government affairs director for the Courage to Fight Gun Violence, the gun-reform group led by former Rep. Gabrielle Giffords (D-Ariz.), the congresswoman shot in the head in Tucson in 2011.

Medical professionals to NRA: Guns are our lane. Help us reduce deaths or move over.

 Megan L. Ranney, Heather Sher, and Dara Kass, Opinion contributors, reported that after the American College of Physicians released a paper last week about reducing firearm injuries and deaths in America, the NRA tweeted the statement: “Someone should tell self-important anti-gun doctors to stay in their lane.”

A couple of days later, the Centers for Disease Control published new data indicating that the death toll from gun violence in our nation continues to rise. As the NRA demanded that we doctors stay in our lane, we awoke to learn of the 307th mass shooting in 2018 with another 12 innocent lives lost to an entirely preventable cause of death — gun violence.

Every medical professional practicing in the United States has seen enough gun violence firsthand to deeply understand the toll that this public health epidemic is taking on our children, families, and entire communities.

It is long past time for us to acknowledge the epidemic is real, devastating, and has root causes that can be addressed to assuage the damage. We must all come together to find meaningful solutions to this very American problem.

We bear witness to every gun-related trauma

The physicians, nurses, therapists, medical professionals, and other concerned community members signing this letter are absolutely “in our lane” when we propose solutions to prevent death and disability from gun violence.

As the professionals who manage this epidemic, we bear witness to every trauma and attempt to resuscitate, successful or not.

►We cut open chests and hold hearts in our hands in the hopes of bringing them back to life.

►We do our best to repair the damage from bullets to pulverized organs and splintered bones.

►We care for the survivors of firearm injury for decades after they’ve been paralyzed, lost a limb, or been disabled.

►We deliver mental health care to the siblings and parents of the children who have been shot as well as to the survivors of gun violence.

►We treat the anxiety of teachers and students who are already traumatized by the news of mass shootings who are then are asked to participate in active shooter drills in their own schools.

►We prepare for mass casualty shootings with drills ourselves and practice sorting victims by how life-threatening their injuries are while fervently hoping that a mass shooting never touches our own communities.

►We are asked by families, schools, employers and law enforcement to conduct mental health evaluations and threat assessments of individuals who demonstrate dangerous behaviors with legally-owned firearms — yet we have no protocols to decrease firearm risk when they present to us.

►We support our own medical colleagues as they themselves must recover from the psychological trauma of being first responders to mass shootings.

►We design trauma protocols to reduce the loss of life from even the most horrific gunshot wounds.

►We train civilians to carry and use tourniquets to #StopTheBleed, something that should be necessary on battlefields but not in American grade school classrooms.

►We try our best to conduct research to stop the epidemic of gun violence.

►We hold the hands of gunshot victims taking their final breaths.

►We cry, ourselves, as we tell parents that their child has been shot and that we did our best.

►We escort parents into our treatment rooms to take one last look at their dead child before they have been able to process the news.

►We see firsthand how a single moment ends a life and forever changes the lives of survivors, families, and entire communities.

NRA should help us reduce gun death toll

Our research efforts have been curtailed by NRA lobbying efforts in Congress. We ask that the NRA join forces with us to find solutions.

We invite the NRA to collaborate with us to find workable, effective strategies to diminish the death toll from suicide, homicide, domestic violence and unintentional shootings for the thousands of Americans who will one day find themselves on the wrong side of a barrel of a gun.

We are not anti-gun. We are anti-bullet hole. Let’s work together.

Join us, or move over! This is our lane. We as a society must do something about gun violence NOW!

Also, I live in a region where about 70% of the population owns guns. But the homicide and suicide rate is very, very low. Why? I’m not sure at this time but I along with the majority of our country are tired and scared of the gun-related violence.

The holiday of Thanksgiving reminds us that we ought to be thankful for the blessings and the people in our lives. But what do we do when it seems that everything is going haywire? Maybe somebody recently wronged you. An unexpected expense has thrown off your budget. That new role at your job isn’t as shiny as you thought it would be. Or maybe you’ve been trying to do the right things, live the right way, but situations STILL aren’t working out in your favor.

How do you cope? How do you resist the urge to give up? How do you continue to do good even when you’re not seeing any immediate benefits from “living the right way? And HOW IN THE WORLD can you be thankful for all of this? Sometimes we have to be thankful for what we have and enjoy the day and family and friends.