All New for a New Year

 

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Lessons From God at Christmas

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Excessive pharmaceutical pricing needs curbing

The pharmaceutical industry is out of control. That is the conclusion of a recent article in the New York Review of Books (NYRB). A case in point is Moderna, the maker of a COVID-19 vaccine. The federal government paid the company $2.48B to develop a vaccine and bought millions of doses at $26 each. With the end of government funding in sight, the company announced that it would produce an updated vaccine at $130 per dose. The public was outraged.

NYRB delivers an “indictment of American drug companies and the federal government for all too often privileging profit over health, and of the research universities, medical professionals and philanthropists who have been deeply complicit with them.”

Things started to go bad after World War II, as “the pharmaceutical industry, aided by the federal government and philanthropic foundations … produced an enormous arsenal of drugs against a variety of fearful diseases and disorders,” but it “also single-mindedly profit maximization by engaging in price gouging, blocking the availability of cheaper generics, and exploiting the patent and regulatory systems to harass and suppress competition.”

Part of the problem has been the use of patents, which “enabled huge price markups, generating corporate profit margins” … “double and often triple those found in other manufacturing sectors.” The original intent of granting patents was to make sure companies would make the drugs “available to the public on ‘reasonable terms.’” Significant reforms of the patent practices have been proposed and struck down.

The industry managed to extend the life of patents beyond the limit of 17 years, raising it to 20 years. And patents would be longer still with the introduction of slightly modified versions of the medicine in question, a “process called evergreening.” Without providing evidence, pharmaceuticals argued that higher prices were necessary to meet “the costs of development, including research, clinical trials and failures.”

A notorious case was the drug ATZ, the first treatment for AIDS. It came to market in 1987 at a cost of $10,000 for a year’s supply. Public pressure forced the maker, Burroughs Wellcome, to lower the price to $8,000 per year. It did not make a dent in the company’s profit, with sales of more than $1B by 1991.

Overall, the industry fought hard against the introduction of much cheaper generic medicine, declaring them to be “counterfeits.” In 1970, the pharmaceutical industry successfully lobbied for the introduction of laws in all 50 states prohibiting pharmacists from dispensing the more affordable medicine. (In the mid-70s, a coalition of the AARP, organized labor, and consumer groups overturned these laws in 40 states.) Pharmaceutical companies also successfully resist a call from poor nations to allow for the production of life-saving generic COVID-19 vaccines.

 The excessive cost of medicine is a stark reality confronting SOMOS Community Care, a network of over 2,500 independent doctors who serve some 1 million of New York City’s most vulnerable Medicaid patients. Drug prices in the US are four times as high as prices in other high-income societies. Many low-income patients—struggling to pay for the drugs they need even on Medicaid—cut pills or forego doses altogether, putting their health at risk. At times, there is also drug scarcity, leaving doctors and their patients at a disadvantage. And insurance companies will not cover certain medicines.

The monopoly enjoyed by the pharmaceutical industry—prone to corruption—is a glaring injustice hurting people with low incomes, denying them vital medication. It is a practice opposed to the higher calling of companies to serve the well-being of society. The industry must reform itself and consider its research and development slate, as there is a flipside to the high cost of medicine—the saturation of the market that instills a need in the public to consume ever more drugs.

There is a glimmer of hope as the US government has set in motion a negotiation with the pharmaceutical industry to lower the prices of 10 drugs taken by Medicare enrollees and covered under Medicare Part D. In 2022, Medicare members paid a total of $3.4B for these drugs that are used to treat diabetes, heart failure, blood clots, and autoimmune disorders, conditions that disproportionately impact women, communities of color, and people in rural areas. Some 9 million people take these drugs, which has generated $493B in global revenue for the drug companies.

Now, finally, the federal government is putting some pressure on the industry to curb its prices, just as is standard practice in other industrialized nations. The move is part of the Inflation Reduction Act of 2022, signed into law by President Biden. Not surprisingly, a coalition of drug companies and industry lobbying groups have filed lawsuits aimed at forcing the US government to halt its bid to move ahead with the negotiations—even though 9 companies have agreed to sit down with federal negotiators. It appears, however, that the lawsuits will have little traction. The negotiations may mark the beginning of real change.

 

Mario J. Paredes is CEO of SOMOS Community Care, a network of over 2,500 independent providers responsible for reaching and delivering care to over one million Medicaid lives across New York City.

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City MD vs. SOMOS Community Care — A Study in Contrasts

A two full-page advertorial in The New York Times published on November 17, 2023 sang the praises of City MD and the host of differently named urgent care centers as a solution for people confronted with the "glacial pace of getting medical care in New York City and across the country: "It can take weeks to see a primary care doctor, and an emergency room visit can set you back many hours." 

There is no disputing the time it takes to get treatment in an ER. Still, the SOMOS Community Care network of over 2,500 mostly primary providers is highly accessible, caring for some one million of New York City's most vulnerable Medicaid patients. City MD—not particularly present in the city's most needed neighborhoods—is an option for those with Medicare or private insurance but not for those with traditional Medicaid coverage. This reality makes SOMOS, in fact, the "City MD" for the underprivileged. 

SOMOS offers an answer to City MD's claim that "with primary care doctors overburdened, navigating the current health care system can feel overwhelming for patients." SOMOS practices are located in the very communities that are being served, notably neighborhoods that are home to Asian Americans, Hispanics, and African Americans. These community-based practices readily welcome new patients, including those requiring urgent care. 

The advertorial cites an example: "a kid who split his chin open at the gym. He was out of the clinic in 25 minutes. He would have waited five hours in the ER, and his primary care doctor isn't trained for that." City MD acknowledges that "primary care is super important—preventative care is huge." That, indeed, is the focus of SOMOS doctors. They are highly qualified to deal with stitches or other emergencies. If needed, those SOMOS doctors would refer a patient requiring urgent specialized care to a colleague in the community.

There is no disputing the need for primary care doctors. City MD argues that the model of care they provide has changed: "At one point in time, if you had a problem, you would call your primary care doctor. They would interrupt their dinner to take your call and give you advice. That model has become less prevalent." 

This claim touches precisely on SOMOS's unique contribution to the New York State healthcare universe: the restoration of the family doctor of old as a trusted figure and community leader who has a bond with patients and is intimately familiar with patients' medical situations and overall circumstances—someone, indeed, who will take a call at dinnertime.

SOMOS care revolves around the patient-doctor relationship, carefully nurtured and fed with doctors' critical knowledge of their patients' lives. The provider gets vital information about his patient thanks to the work of Community Health Workers, who are doctors' eyes and ears in the community. They visit patients' homes to remind them of medical appointments, assess conditions in the home and the neighborhood, and gather pertinent information about the family as a whole.

Patient intelligence gathered in this fashion includes the so-called social determinants of health: social factors—poverty, subpar housing, and lack of access to healthy foods and other conditions—that can impact both mental and physical health. SOMOS doctors also engage Community-based Organizations to help address patients' social needs. The awareness of a patient's social and environmental circumstances is impossible for City MD doctors, who only get a snapshot of the overall condition of the people they see.

The City MD advertorial cites a finding by the American Medical Association that there is a growing shortage of doctors in the US, which is particularly true when it comes to PCPs. The AMA reports that the causes of the lack of doctors include burnout and "shrinking Medicare reimbursements." The same is true for Medicaid reimbursements, but SOMOS doctors have an edge as they have signed on to the Value-Based Payment model, which stipulates that providers' compensation is tied to the longer-term well-being of their patients. SOMOS doctors are paid extra for going the extra mile. Thus, their earnings are significantly boosted.

Finally, the advertorial states that, besides the shortage of PCPs, doctors "are spending their time doing administrative duties, rather than treating patients." On this score, too, SOMOS has developed a solution:  training doctors' staff to take on the bulk of administrative responsibilities, such as the careful maintenance of Electronic Health Records—thus freeing doctors to focus on their patients.

Of course, City MD meets a need and offers convenient access to medical care. However, there is no substitute for the intimate, comprehensive, and preventative health care at the heart of SOMOS.

Mario J. Paredes is CEO of SOMOS Community Care, a network of over 2,500 independent providers responsible for reaching and delivering care to over one million Medicaid lives across New York City.

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What Reasons Do We Have for GIVING THANKS?

 

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SETTING OFF AGAIN ON NEW CONQUESTS

Every year, on October 12, we celebrate the Day of the Race and commemorate the first time Spanish navigators, led by Christopher Columbus, arrived on the American continent. Generally, and popularly, this date is also known as the discovery of America.

Beyond the different points of view and the many discussions that this historical event generates today, from those who see this “discovery” as very positive for the American continent and those who emphasize all the negative effects that this “meeting” wrought for the inhabitants and original cultures of these lands, I share today some reflections on the profile, lifestyle, primary convictions and desires that drive people today, especially young people: the present, hope, and future of our race, societies and all humanity.

We live in the historical conjuncture that anthropologists, historians, philosophers, and sociologists call the “transition from modernity to postmodernity.” Like every stage of human history, this one we live in has its lights and shadows.

There is consensus that the 1960s marked a rupture and novelty compared to past decades and those in which we now live. We have persevered through two world wars and many other international and local wars, failures of democracy and the capitalist economic system, the failure of science and technology to solve the great problems of human beings and all humanity, the growing situation of injustice, inequality, violence, migration and death of large masses of people in all corners of the planet, etc. These have shattered the unshakable faith of our modern ancestors in the unlimited progress of humanity through science and technology, which – at the time – once produced the Industrial Revolution.

For the generation of the 60s and their famous youth and student protests, their hope for a better world fell apart, and the idea of progress that their grandparents believed in became a story of history without a future or meaning, lacking direction.

In its totality, this formed societies that no longer produced but consumed, where everything can be negotiable, where “having” trumps being. This formed men and communities that, faced with the prospect of no future, live with no interest in work and effort, in advancing and overcoming. Instead, they seek the easy and fast, the disposable and perishable, the “deconstruction,” the “light” and disengaged.

The rejection of everything institutional and hierarchical in all areas of life in society (political, religious, etc.), since these institutions once controlled and sustained the ideal of progress, now failed, produces a retreat to the sanctuary of the individual, the personal and private, to the detriment of the interest in everything collective and in the search for the common good. We follow characters, individualities, sects, therapies, or small groups, where individuals can feel like people and not amorphous masses.

We thus arrive at anarchy, a world without dogmas and lacking unique, absolute, or universal truths. We inhabit a world of subjectivism and “moral” relativism, according to which everyone elaborates “à la carte” their own truths and life projects. It is a world without certainties, a world of fragmented beings seeking what serves them, a world where “having” and pleasure form the foundation of happiness. We live in times of rapid change, uncertainty, crisis, nonsense, stories, and precarious knowledge, in which aesthetics prevail over ethics, feeling over reason, in a world of entertainment.

We inhabit pansexualist and hedonistic societies, living without the perspective of transcendence. We seek enjoyment in the here and now. We seek to achieve maximum luxury, comfort, and waste with the least possible sacrifice, commitment, and effort. The end justifies the means in this mad and frantic race for pleasure and happiness.

This all leads to sexuality, also light, in which the pleasure of physical contact prevails without fidelity. This human dimension is reduced to genitality because the authentic is forbidden.

In the realm of religion, the human beings of our times, our young people, inherited F. Nietzsche’s premise that “God is dead” because if we have science and technology, we can do without God. “The superman” emerges. All of this causes secularism and the decline of everything religious.

Postmodern man believes, but does so within a “religious market” and “à la carte.” A thousand ideas, sects, therapies, and pseudo-religious movements proliferate due to the need to find meaning in existence and a solution to the serious problems of humanity that have not yet been resolved. But this “return” or need for the religious and transcendent is also “light,” without strong convictions and always utilitarian, amidst an overload of media and information in which nothing is worth and every subject is worth the same.

Young people today, in line with everything I have said here, believe but not in the way of institutions. They believe, but without affiliations, labels, or memberships of religious institutions. They believe but without institutional religious practices. They believe without belonging to any religious institution, rejecting imposed and traditional religious practices. They believe, but they do so heterogeneously and eclectically.

They are interested in ideas and movements of spirituality but reject all membership in official religions. They live and seek some kind of spiritual experience that does not have the regulation of religious institutions.

This brief review of the main features of the person, society, and culture of our time, even in the face of modernity, portrays ways of being and acting of today’s person amidst a human and social crisis, and at the same time, invites us to opportunities to make changes.

The emphases of today’s culture and man are usable and salvageable. We must applaud, for example, the achievements in respect for the rights of individuals and minority groups in the world, but without forgetting the need always to seek and find ways that ensure the good of the great majority, the common good.

Young people are the treasure of our race and the present and future of our hope. They are the ones who must build, with the best of the heritage of their parents and grandparents, a society that respects “the dignity, the liberty, and the rights of individuals” without being tempted to “yield to the seductions of egoistic or hedonistic philosophies or to those of despair and annihilation” affirming “faith in life and what gives meaning to it, that is to say, the certitude of the existence of a just and good God.”

Enlarging “hearts to the dimensions of the world, to heed the appeal of your brothers, to place your youthful energies at their service. Fight against all egoism. Refuse to give free course to the instincts of violence and hatred which beget wars and all their train of miseries.”

The world urgently needs young people who are “generous, pure, respectful, and sincere,” who “build in enthusiasm a better world than [their] elders had with “the ability to rejoice with what is beginning, to give oneself unreservedly, to renew oneself and to set out again for new conquests.” (Phrases in quotation marks are excerpts of the MESSAGE OF THE II VATICAN COUNCIL TO YOUTH).

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Mario J. Paredes is CEO of SOMOS Community Care, a network of 2,500 independent physicians—most of them primary care providers—serving close to a million of New York City's most vulnerable Medicaid patients.

A Synod to Walk Together

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Hispanic Heritage Month: Everyone's Responsibility

 

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The underbelly of health care in America—and an answer

The New York Times’s recent coverage of the state of health care in the United States paints a very discouraging picture. Despite all the money going to health care in the country—which outspends other developed nations in spending on health care per capita—the US has a sorry record. In fact, Americans rank among the least healthy compared to other rich countries; they are also in a cohort that is most likely to die early. 

For example, life expectancy in Mississippi, which stands at 71.9, has fallen below the life expectancy in Bangladesh (72.4). An infant in the US is close to 70 percent more likely to die in the US compared to other wealthy nations. And for the first time in what might be a century, the likelihood that an American child will live to age 20 has diminished. Newborns in India, Rwanda, and Venezuela have a longer life expectancy than Native American newborns in the US. The life expectancy of a Native American adult male, at 61.5, is below that of the life expectancy in Haiti.

The so-called “healthy life expectancy—the years someone lives without suffering severe medical problems, like amputations, dialysis, or blindness—is 66.1 in the US, which is lower than that figure in Turkey, Sri Lanka, Peru, and Thailand, as well as other countries, all significantly poorer than the US.

The most gruesome statistic shows the US to be the “global leader in avoidable amputations,” resulting from grave shortcomings in the care and management of diabetes. These preventable amputations writes The Times, “are the most heart-rending symbol of America’s failure in health care. Patients fail to obtain blood sugar management, which leads to diminished circulation and diabetic wounds on the foot that can lead to amputation, first of the toes and next of the legs, both below and above the knee.

A patient whose leg is amputated above the knee generally dies within five years. Some 150,000 amputations are performed each year, of a toe, foot, or leg. The neglect of diabetes and other preventable conditions is really hurting Americans of all ages. The hardest hit are men with little education and low incomes, especially people of color. The poorest men in the US have life expectancies comparable to those of men in Sudan and Pakistan.

By contrast, the wealthiest men in the US live longer than the average male in any country, a Harvard study has found.

Being poor and having little education, makes Americans very likely to suffer from multiple conditions, in addition to diabetes, including hypertension, arthritis, and heart disease. The Times pins an important part of the blame on soda and -fast food companies, marketing their sugary and rich-in-fat products primarily to the underserved, people who struggle to get by, often lacking health insurance and relying on cheap fried food and sugary drinks. As it stands, 28 million Americans lack health insurance.  

Researchers have found that an estimated 183,000 Americans die each year because of poverty—far more than the number of homicides. Part of the solution must focus on overcoming “intergenerational poverty and despair,” which cries out for improvement in education, job training, pay, and opportunities for self-betterment. What would also hold promise is promoting diversity among health workers. It has been shown that Black patients do better with Black doctors.

Ethnic affinity is one of the keys to the success of SOMOS, a network of 2,500 doctors—most of them primary care physicians—in New York City. They provide some one million of the poorest and most vulnerable Medicaid recipients in the inner-city with quality care. Most patients are African American, Asian American, and Hispanic. Many of their doctors share an ethnic and cultural background with their patients, in whose communities they live and work. That shared identity contributes to the bond between patient and doctor.

That bond is also strengthened by the fact that SOMOS doctors have comprehensive knowledge of their patients’ needs. Community Health Workers are the doctors’ eyes and ears, as they are kept informed about patients’ family situations. These include awareness of social conditions, the so-called Social Determinants of health, such as housing conditions, poverty, or educational issues. Such social conditions can play a critical role in patients’ physical and mental health.

Patients also greatly value the fact that the doctor has a real sense of their circumstances, which is the foundation of a relationship of trust. This is how SOMOS delivers superior care to a population that has traditionally suffered from poor or mediocre care.

SOMOS doctors adhere to high standards in their practice. They have embraced a formula called Value-Based Care (VBC), which stipulates that doctors are compensated in accordance with the health of their patients. The better the patients’ health in the longer term, the greater the financial incentive for the doctor.

SOMOS's success was dramatically demonstrated by SOMOS’s ability to reduce by 25 percent both preventable visits to the ER and unnecessary hospitalizations. In the process, SOMOS saved

New York State taxpayers $330M. VBC clearly demonstrates that care for the underserved can be both excellent and cost-effective—an antidote to poverty being an obstacle to quality health care.

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There is a solution for Medicaid fraud—innovation

In 2020, Medicaid fraud was estimated to be close to $86.5M. It is a staggering figure burdening taxpayer. And clearly, more needs to be done to remedy a situation where fraud is so pervasively present in a program that cares for the most vulnerable patients.

The FBI lists several main types of fraud: double billing, submitting multiple claims for the same service; phantom billing, billing for a service visit or supplies that the patient never received; unbundling, submitting multiple bills for the same service, or charging more for a service that is usually part of a package; upcoding, billing for a more expensive service than the patient actually received; and over-billing, charging the government for medically unnecessary drugs, procedures, or drugs.

Medicaid patients are particularly vulnerable to physicians' fraudulent practices, as they have no easy access to their medical records. For example, a doctor might falsify or exaggerate a diagnosis to facilitate over-billing. The patient may be subject to unnecessary or unsafe medical procedures. 

They are also vulnerable to individuals asking for their insurance identification number and other personal information to bill for non-rendered services. Or their identity may be stolen, and they would find themselves enrolled in a fake benefit plan. 

To battle rampant Medicaid fraud, a new healthcare delivery model holds great promise: Value-Based Care (VBC). The VBC formula stipulates that doctors get compensated according to the longer-term well-being of their patients. The healthier the patients, the greater the compensation for the doctor. In sum, doctors are encouraged and put in a position to do their very best for the people under their care.

The model, as instituted by the New York Department of Health in 2014, was called Delivery System Incentive Payment Program (DSIRP). It provided for an iron-clad protocol that would make fraudulent practices pretty much impossible. Its success is exemplified by the achievements of SOMOS, a network of 2,500 inner-city physicians caring for some 1 million of New York City's most vulnerable Medicaid patients, mostly Hispanics, African Americans, and Asian Americans. 

To make the VBC model work, doctors must carefully maintain patients' Electronic Health Records (EHR), which would periodically be sent to the Department of Health for assessment. That is when it is determined if the patient population is showing signs of enduring health, which in turn governs the doctor's compensation level. Maintaining the EHRs is a job for both doctors and their staff. Fraudulent records would be readily flagged.

Record-keeping also plays a role in Patient-Centered Medical Homes (PCMH). SOMOS staff works with medical practices to turn them into a one-stop portal where a patient's entire care history is recorded, allowing the doctor to keep track of which services a patient receives, be they medical, behavioral, or social. The social refers to doctors keeping track of patients' social issues that may impact their health, such as substandard housing, unemployment, and poverty. Again, a careful electronic portrait of the patient is maintained, with both doctor and staff doing the record-keeping. Fraudulent entries would quickly be spotted.

Now, doctors prone to committing fraud would be ill at ease being part of VBC, even though such physicians would see their income increase, a factor that prompts their criminal behavior. Ideally, VBC would make honest men and women of them. However, it is hard to picture a less-than-ethical doctor in the SOMOS VBC system, which revolves around a close patient-doctor relationship. That bond is created as physicians earn the patients' trust by getting to really know them, their families, and their circumstances. For much of that intimate detail, SOMOS doctors rely on Community Health Workers as their eyes and ears in the community. Given the stature of SOMOS doctors, it is difficult to imagine fraud-prone physicians, with far less than adequate concern for the well-being of their patients, earning such a position of trust.

Above and beyond traditional Medicaid's vulnerability to fraud and waste, there is a relatively poor record of delivering health care to the most vulnerable. Needy patients, people of color among them, often have a difficult time gaining access to the care they need, given the labyrinthine network of doctors to whom, on paper, they have access. A famous Oregon study (conducted in 2009/2010) found that people with Medicaid coverage showed no significant positive effect on major medical conditions—including hypertension, diabetes, and high cholesterol—compared to those without coverage.

SOMOS saved US taxpayers $330M by reducing by 25 percent both unnecessary visits to the emergency room and unnecessary and costly hospitalization. That is the fruit of Value-Based Care. It is high time for traditional Medicaid to be dismantled and for VBC to be rolled out system-wide. Doctors, patients, and taxpayers stand to benefit greatly.

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SOMOS: May we be like the sandalwood tree…

Since its very beginnings, SOMOS Community Care was founded and has developed as an organization with the mission to create and cultivate a collaborative network of primary care physicians and their clinics. Our goal is to implement an innovative and revitalized model of healthcare that prioritizes the needs of our community’s most vulnerable and underprivileged individuals, focusing especially on migrants in New York City.

The highest moral principles inspire us in our pursuit of the common good and we dedicate ourselves to the health and well-being of those we serve. Strong ethical values guide our healthcare organization in the interpersonal relationships we form within the company as well as in how we manage all economic and administrative aspects of our operations.

Our doctors focus on primary and family healthcare with a preventive approach and aim to relieve the strain faced by hospitals. We do this by championing a model where hospital institutions attend to patients with the most urgent and prioritized needs.

Through the years, we can trace the success of our healthcare services, as I have said, to the integration of hundreds of physicians and their clinics, as well as the government funding we have secured through the DSRIP program for state healthcare system reforms. We have been awarded this funding based on our exceptional results and competencies, which allows us to continue developing our mission and vision already detailed above. These results include reductions in the statistics that track stress on hospital emergency systems and reductions in rates of unnecessary hospitalizations.

Our healthcare model emphasizes prevention over treatment, and, as much as possible, healthcare is delivered in the patient’s respective culture, customs, and language by physicians who are immigrants themselves. This model not only enhances the MEDICAID system, but it also reveals, let’s not forget, the difficulties that our organization’s work may face with the traditional hospital system, because, due to a lack of prior, personalized, and preventive care, large numbers of patients who do not need emergency services, or even hospital services at all, attend these facilities.

As the CEO of SOMOS, I can attest to the ethical standards, transparency, and honesty with which we manage our financial resources, the code of ethics that exists at the very heart of our organization, and the desire and spirit that drives us to continually improve our service to the health and well-being of all, particularly the most at-risk members of our city.

 We strive to ensure that all professional services contracted for the development or promotion of SOMOS are executed and compensated accordingly. Likewise, we also strive to guarantee that the healthcare services our network of affiliated physicians provides bear the hallmark of scientific excellence, efficiency, timeliness, and solidarity that the invaluable nature of healthcare demands.

At SOMOS, we are committed to promoting the highest and noblest values of the human spirit both within and outside our organization. We have fostered collaborative, non-denominational partnerships with various religious institutions, including Catholic, Muslim, Jewish, and Protestant denominations.

Our shared pursuit of the common good and the provision of healthcare, as integral values that support individuals, families, and society, has brought us together with these religious organizations. We have supported each other, especially during the pandemic, by utilizing their places of worship to facilitate health campaigns within their communities.

This collaborative work with religious communities has allowed us to personally connect with and draw inspiration from spiritual leaders such as Pope Francis, who continues to inspire us and all of humanity.

The prestige that SOMOS has earned with the passage of time can be traced to the vital healthcare services we have provided to our city, particularly during the COVID-19 pandemic. Also, our humanistic vision and solidarity with those who suffer the most have driven us to extend our services, focused attention, and targeted assistance to communities experiencing catastrophes and emergencies in Haiti, Cuba, the Dominican Republic, Puerto Rico, and beyond.

We aspire to continue to be an increasingly recognized and sought-after healthcare organization. We aim to expand and enhance our services over time, and to achieve this, we hope to continue relying on local, state, and national government support that aligns with our accomplishments, competencies, and workforce contributions.

Neither individuals nor institutions are immune to the challenges of competition, power dynamics, economic fluctuations, and political turbulence that are intrinsic to every society. At SOMOS, we see ourselves as a vital and dynamic component of the social fabric, embracing the risks associated with being an active and productive entity within society. We appeal to the trust of all in our vision and commitment to healthcare as we continue to grow and thrive.

Acknowledging the difficulties that all of us may encounter, individuals and organizations alike, be they due to internal or external causes, we, at SOMOS, strive to be, in the words of Nobel Laureate Rabindranath Tagore, like the sandalwood tree that perfumes the very axe of the woodcutter that lays it low.

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A BETTER KIND OF POLITICS

I appreciate this invitation to participate in this Seminar of Catholic Leaders.

I have been asked to share with you some reflections on THE CULTURE OF ENCOUNTER AND CIVIC FRIENDSHIP from the Magisterium of Pope Francis, and what these categories and doctrines pose – as challenges – for the life and political participation of Hispanic Catholics of this Nation.

In his Petrine Magisterium, and especially in the Encyclical Fratelli Tutti of October 3, 2020, Pope Francis invites us to build a better world through the fraternal coexistence to which Jesus of Nazareth invites us all in his Gospel. He exhorts us to make possible better relationships and communities through civic, citizen, or social friendship; friendships that make possible the “culture of encounter.” The “civic friendship” and the “culture of encounter” are two categories that are not the doctrinal or ideological property of Christianity or anyone else. Rather, they are the heritage of all humanity.

The “culture of encounter” assumes, in individuals, “civic virtue,” which traces its roots to the philosophy and teaching of great Greek philosophers such as Plato and Aristotle (especially in his Nicomachean Ethics). It assumes civic virtue and all that it implies in terms of civic and social life, which entails a form of citizen ethics, a normativity that regulates our indispensable and necessary social coexistence. It assumes a civic virtue that, if practiced among citizens, can strengthen civic or social friendship and, with it, enable a “culture of encounter” as an ideal for human coexistence. We can achieve an understanding that civic virtue is a motivation to act as the good that society requires of us, where self-interest does not take precedence over that which is good. Thus, selfish motivation cannot be virtuous in any case https://www.scielo.org.mx/scielo).

Civic, citizen, or social friendship does not consist of the good manners of civility that we must observe in personal and social relations. Rather, it deals with the relationships that should occur among citizens in the pursuit of the common good. This means that, regardless of our particular interests or our political, religious, etc., differences, there are – in social life – issues (education, health, etc.) where we must all put our best effort in the pursuit of the general social good.

Therefore, civic friendship, while demanding respect for individual human rights, is located at a level of higher interests and rights, which concerns the pursuit of the well-being of all. Civic friendship thus becomes the condition we need for Aristotelian “peaceful and social concord,” because friends watch over the good of all friends.

Pope Francis, “acknowledging the dignity of each human person,” earnestly hopes that “we can contribute to the rebirth of a universal aspiration to fraternity… as a single human family, as fellow travelers sharing the same flesh, as children of the same earth which is our common home…” (FT 8). He hopes that we can contribute to a universal fraternity that is “without borders,” which must be built – and precisely for this reason – amidst “shattered dreams,” “insufficiently universal human rights,” or “conflict and fear,” “globalization and progress without a shared roadmap,” amidst “dark clouds over a closed world,” pandemics and other scourges of history, etc.

Universal fraternity – according to Pope Francis – opens us to the hope to “engender an open world,” having love as its only value, in societies where everyone is integrated, with a solidary and universal love, which promotes people and “rights without borders,” as long as men and women discover the concept of giving freely in everyday life, with “a heart open to the whole world,” to all humanity.

With these assumptions, Pope Francis builds his doctrine of “a better kind of politics,” affirming that “the development of a global community of fraternity based on the practice of social friendship on the part of peoples and nations calls for a better kind of politics, one truly at the service of the common good. Sadly, politics today often takes forms that hinder progress towards a different world.” (FT 154)

We must build this kind of politics upon the foundation of “political love,” and it must be effective, one that integrates and joins us together, through kindness and the pleasure of recognizing the “other.” It is through social dialogue, truth and consensus that we will make possible – in social friendship – the emergence of a new culture: the culture of encounter.

We understand “culture” through Francis’ definition: “something deeply embedded within a people, its most cherished convictions, and its way of life. A people’s “culture” is more than an abstract idea. It has to do with their desires, their interests and ultimately the way they live their lives.” (FT 216)

So, “to speak of a “culture of encounter” means that we, as a people, should be passionate about meeting others, seeking points of contact, building bridges, and planning a project that includes everyone. This becomes an aspiration and a style of life. The subject of this culture is the people, not simply one part of society that would pacify the rest with the help of professional and media resources.” (FT 216)

“A better kind of politics,” “social friendship” and a “culture of encounter,” in the vision of Pope Francis, have as their ultimate purpose the construction of peace or the reign of God (in biblical theology) through forgiveness, as an expression of universal and evangelical love; a task that all religions in the world have to serve. (FT Ch. 8) Because “in many parts of the world, there is a need for paths of peace to heal open wounds. There is also a need for peacemakers, men and women prepared to work boldly and creatively to initiate processes of healing and renewed encounter.” (FT 225)

This dream, this longing of Pope Francis contains many implications for our daily life as citizens and, therefore, for our life and political participation, in the broadest Greek sense of the meaning of the term “politics,” as a search for the common good of the “polis,” of the city and of all citizens in it.

Thus, civic life as an exercise of politics or the exercise of politics as a partisan professional choice and electoral and governmental tasks is not, first of all, a matter of laws but of ethical coexistence, that is, of coexistence that seeks – through the gift of friendship among men – the good of all.

Politics is not an exercise in publicity, untruthful speeches, or the search for privileges and particular interests. Politics is, above all, a daily exercise of shared values and common interests in the search for the common good, especially those most in need of the polis, of society.

Every day, the news tells us that joint efforts benefit us all, but that the exercise of individualistic, selfish politics, full of ambitions for power and profit, leads also to social ruin.

The exercise of daily politics, with our deeds, words, and citizen attitudes, or the professional exercise in socio-political leadership makes us sink or swim together, because we are deeply interconnected and share responsibility both in good and in evil.

Today, unfortunately, especially in the professional and partisan exercise of politics, the concept of friendship is associated with that of complicity in corruption in the management and administration of public affairs.

But selfishness and individualism in the public sphere and political corruption due to the absence of “social friendship” and fraternal and universal sense in civic life, are undermining democratic institutions and generating “social discord,” which translates into tragic forms of violence, injustice, inequality, and death.

Ladies and Gentlemen, you are leaders in different areas of life in society. You are leaders of the Hispanic community present in this Nation.  

You are called to organize, guide, and lead people in your Hispanic professional and community environments in building social friendship for the culture of encounter, a “better kind of politics,” and social peace.

You are charged with forming, educating, and leading our Hispanic communities for the daily exercise of citizenship for the benefit of all and for the best causes.

You have the capacity and responsibility to “give freely what you have received freely,” to build the world of which Francis dreams and of which we all dream: a world in universal fraternity and with an abundance of life for all.

A world in which we all respect our rights and fulfill our duties.

A world in which we go from being anonymous individuals aggregated socially or partners and competitors to recognizing ourselves as brothers and sisters with a common destiny, in a common home.

A world in which, as disciples of Christ, and through the commandment of love, we all live together as brothers, children of the same Father.

We all share a responsibility in creating, for present and future generations of Hispanics in the United States, better and greater citizen and political participation and, with it, better lives and a better Nation.***

Thank you very much!

***The words and phrases in quotation marks are from FRANCIS, in his Encyclical Fratelli Tutti.

Mario J. Paredes is a member of the Board of Directors of the Latin American Academy of Catholic Leaders.

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Value-Based Care holds promise to transform healthcare— especially for the underserved

By 2030, the Centers for Medicare and Medicaid Services plans to see all Medicare beneficiaries and most Medicaid beneficiaries enrolled in Value-Based Payment (VBP) or Value-Based Care (VBC) programs. Simply put, VBC links the compensation of healthcare providers to patients’ health outcomes in the longer run. The formula holds doctors more accountable for improving the well-being of the people under their care and provides them with sufficient freedom and incentive to deliver the right care at the right time.

VBC is a remedy for the pitfalls of the traditional fee-for-service system. Fee-for-service means doctors and hospitals are compensated for each service they deliver; they are rewarded for volume—they are paid more if they deliver more services, even if these do not achieve the desired result. VBC changes that dynamic by incentivizing the provision of quality care for the good of the patient—bringing costs down in the process.

VBC also offers a solution for the troubled state of healthcare in the US. The country spends a greater percentage of its GDP on healthcare than other countries. Yet, the US sees the highest incidence of preventable deaths and has the highest infant mortality rate. What’s more, longstanding inequality of access to healthcare leaves people of color and the underserved more vulnerable to illness and disease than the rest of the population. VBC promises to revolutionize healthcare for the most vulnerable.

VBC produced significant savings for taxpayers, as better health keeps people out of ERs and costly hospital beds, and all along, doctors are rewarded for doing a better job. The latter depends to a large degree on the coordination of a patient’s care; that means a primary care physician keeps close track of all the services a patient is getting or needs. This includes medical care as well as behavioral health services. Significantly, doctors are also encouraged and rewarded for being aware of patients’ social needs. Such needs would never be attended to in the fee-for-service model.

Quality of care in the VBC is driven by key dimensions, including efficiency, meaning doctors only use resources that are needed; equity in care stipulates that quality of care does not vary based on race, gender, or income; care is centered on the patient and respects values, preferences, and particular needs; and timeliness means care is given without lengthy delays.

VBC models feature different approaches to doctors’ risks. There is an upside-only risk, with doctors getting more revenue if meet or exceed standards when it comes to quality, cost, or equity. A two-sided risk means doctors also stand to lose revenue if they fail to achieve specific measurements of success. This formula is believed to discourage risk-averse doctors from joining VBC programs.

There are also non-financial rewards for doctors who join VBC programs. The freedom to deliver the right aid at the right time can give providers a sense of purpose and mission. Participation in VBC also enhances a doctor’s reputation.

There is growing interest in VBC models on the part of the commercial healthcare sector. It seems clear the significant growth of the model will require that VBC models become more accessible and offer greater incentives, especially for those providers serving disadvantaged populations. Overall, more research is needed to determine the impact of VBC models on patients, doctors, and the healthcare system at large.

There is a success story in New York City, where SOMOS, a network of 2,500 doctors—most of them primary care providers—is serving some one million of the city’s most needy Medicaid patients. Caring for Hispanics, African Americans, and Asian Americans, the organization has been developing a VBC program since 2014, when it joined New York State’s Delivery System Reform Incentive Payment (DSRIP) program—one of the country’s first such programs.

SOMOS puts its doctors in the optimal position to deliver superior care to their patients. Thanks to the work of Community Health Workers—who visit patients’ homes to remind patients to keep medical appointments—doctors learn of the social circumstances of the patients’ households. These are the Social Determinants of Health. For example, mold in subpar housing may impact physical as well as mental health, while poverty can mean that there are no means to buy fresh and healthy foods.

SOMOS transforms doctors’ practices into Patient-Centered Medical Homes, a gateway to all the care needed for patients, with staff keeping close track of, for example, care given by specialists and its contribution to the patient’s overall health. SOMOS doctors bring another dimension to the job: in many cases, they share a cultural and ethnic background with their patients in whose communities they live and work. Their intimate knowledge of their patients’ health needs and their personal circumstances make doctors into trusted figures and leaders of their communities. This dimension is key to SOMOS’s VBC success. That success translated into savings of $330M through a reduction of 25 percent in the number of ER visits and the number of unnecessary hospitalizations.

There is no doubt that the transformation of US healthcare—especially for the neediest Americans—will require the adoption and embrace of VBC programs. Both doctors and patients are the better for it.

A Medicaid Purge is Under Way

With the pandemic crisis passed, the government has ended special provisions that allowed millions to be covered by Medicaid. Until recently, 93 million people—one in four Americans—were on Medicaid or on the Children’s Health Insurance Program (CHIP). Since pandemic protections ended on April 1, more than 600,000 people have lost their Medicaid coverage. The vast majority lost their coverage because they failed to complete and submit paperwork, as required by state policy.

For example, in Indiana, 53,000 people lost coverage during the first month after the end of pandemic provisions. Almost 90 percent were taken off Medicaid for things like failing to return renewal forms. Many forms were mailed to out-of-date addresses. Activists have urged state officials to give people more than two weeks’ notice before losing coverage. In Florida, 250,000 people lost coverage, 82 percent of them for failing to complete paperwork.

It is clearly unfair to penalize people for failing to fill out and mail in forms. The poor, and especially vulnerable people of color among them, are not adept in dealing with often complicated forms. For those whose first language isn’t English, the process is still more difficult—most forms offer only limited foreign language options. What’s more, many people on Medicaid simply did not know they had to fill out lengthy forms to renew coverage, because during the three years of pandemic provisions renewals weren’t required.

Data from14 states that began cancellations May 1 show that 36 percent lost Medicaid upon review of their eligibility. Most people will get coverage through their jobs, or they will quality for coverage through the affordable care act. Nonetheless, millions of others, including children, will become uninsured, losing access to preventive care and basic prescriptions. The uninsured rate will rise from a historical low of  8.3 percent today to 9.3 percent next year.

Going without access to medical care for many will result in untreated chronic illnesses—diabetes, cardiovascular conditions, hypertension—spiraling out of control. These patients will eventually end up in emergency rooms and costly hospital beds, at the expense of state taxpayers. This is ironic given that states looking to purge Medicaid rolls do so to save money.

There is an alternative. The experience of a unique network of inner-city physicians in New York City—most of them primary care providers—demonstrates that affordable, superior care for Medicaid recipients can produce significant savings. The 2,500 doctors are part of SOMOS Community Care and provide care for some 1 million of New York City’s most vulnerable and needy Medicaid recipients, mostly African Americans, Asian Americans, and Hispanic Americans. 

SOMOS doctors operate under the Value-Based Payment (VBP) system. VBP stipulates that providers are paid according to longer-term health outcomes of their patients. The healthier the patients, the greater the compensation for the doctor. SOMOS has put in place a model of healthcare that enables and encourages physicians to do their best. The key to success is doctors really knowing their patients and responding to their needs—medical, behavioral, and social. This comprehensive understanding of patients cultivates a strong doctor-patient relationship, with the doctor assuming the role of a trusted figure—not unlike the traditional role of the family doctor who was recognized and respected as a community leader.

Community Health Workers play a critical part as the eyes and ears of SOMOS doctors. They visit patients’ homes, reminding patients of doctors’ appointments and assessing their living conditions. The home may have mold issues, or money is scarce due to unemployment, and there is no access to education. These factors are known as Social Determinants of Health, which have a significant impact on medical and behavioral health.

Overall care of patients is carefully coordinated and kept track off. SOMOS transforms doctors’ practices into Patient-Centered Medical Homes, serving as a portal for patients to access the care that they need. The primary doctor can monitor patients’ progress, for example if they must go for treatment to specialists.  The patient is never left to wander alone through a labyrinth of difficult to access care, as is the case with traditional Medicaid. Finally, many SOMOS doctors share the background and culture of their patients, another element that builds trust.

Functioning as a part of an innovative health care initiative launched by the New York State Department of Health called the Delivery System Reform Incentive Payment (DSRIP), SOMOS proved superior care produces significant savings. SOMOS succeeded in reducing by 25 percent both unnecessary visits to the emergency room and costly hospitalizations. This accomplishment saved New York State taxpayers $330M.    

Reforming Medicaid—especially by introducing the Value-Based Payment system—would obviate the purging of Medicaid rolls, and instead make for healthier patients and significant saving.

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Immigration Reform Now!

We all recognize the images in recent news. Buses transport people to discard and abandon them in some “sanctuary” city or anywhere else, relegated to the whims of leaders, in Florida or Texas for example, as if they are dealing with cattle, viciously, mockingly and with contempt for the most rudimentary human rights and to satisfy partisan whims – as if they were playing some disgusting, macabre game. The news and the images leave us somewhere between perplexed and indignant and show us the serious, shameful deterioration and moral and social degradation that the political management of the immigrant situation has in this nation.

This is a nation that presents itself to the world as a model of democracy and respect for human rights, without considering the enormous suffering that takes place in a thousand different ways on long journeys and that awaits all who want to achieve “the American dream.”

In our world and times, human immigration is culminating into an unsuspected drama and the human tragedies (separation of families, diseases, violence, displacement, hunger, death, etc.) this causes fall beyond the control of governments and nations. This results in a Dantesque and catastrophic situation, with thousands of human lives in subhuman conditions, and speaks very poorly of our human spirit while we boast of our times of globalization and scientific and technological advances.

Material progress is of little use if we do not advance or, worse, we regress in humanization, solidarity, and justice. All this speaks ill of our degree of civilization and the search for the common good—and not for individual and corrupt interests—that must guide us. This also speaks ill of our leaders here and in the countries from which these migrants come.

Since the most recent IMMIGRATION REFORM, we have been hearing for decades in this nation about the urgency of this issue. Unfortunately, today’s politicians manipulate, politicize, and exploit the issue of Immigration Reform, not for the desire to do justice and seek humanity, but with the electoral interest of one side or the other.

Each political party blames the other in this petty and perverse electoral game; they change the subject; they block it indefinitely. They leave important issues unresolved, causing suffering and uncertainty for the millions of people who—already within our borders and residing here for many years—seek to legalize and normalize their status as citizens in this nation, with all the duties and rights that this entails, so they can stop living in fear, ostracism, in the shadows and at the mercy of so many of those who abuse human and civil rights. These abusers find in undocumented immigrants the opportunity to pay cheaply for labor, exploit labor and persecute those who do not submit to their violence and injustices.

But there are interests that must rank above partisan, demagogic and electoral interests that we must reclaim and prioritize to resolve stalled and urgent immigration reform. These issues include the recognition of human and civil rights, the recognition of the valuable cultural contributions and work that immigrants have contributed in the construction of the development and progress of this great nation, the right to a dignified life and homeland and the need for the stability of this nation to be based on respect for the human being and values such as equity, justice, social peace and respect for life.

 Through humanitarian actions and other contributions, social organizations and churches, among others, seek to relieve this pain and reduce the human drama of migrants inside and, awaiting entry, outside our borders. At SOMOS Community Care, a medical organization where I serve as CEO, for example, we offer medical care needed by newly arrived migrants to our city of New York.

But these are all “first-aid bandages” that do not solve the root of the problem and that—perhaps—achieve the opposite, unwanted effect: that of prolonging the nightmare suffered by millions of our brothers and sisters.

The solution to this serious, complex human problem lies with legislators. Enough of postponing a strong, definitive legal solution for undocumented migrants in our nation! Those who have taken up the task of legislating for the common good must find their political will and determination!

We must remember that this resolution also involves joint work with the governments of the countries from where these migrant majorities originate. These governments—almost always—shoulder blame for this multitudinous exodus, through administrative corruption that impoverishes and creates all kinds of social inequalities, injustices and violence that force so many to leave everything they have and have earned to seek better living conditions.

In the United States, within our communities, our political, social and religious leaders must solve this enormous human, social and international problem, and it occurs to me, right now, that this includes, especially, Hispanic community leaders. IMMIGRATION REFORM as a political and legal action requires commitment, organization, the unification of all forces and demonstrations as an instrument of social pressure before our lawmakers.

Our present-day migratory phenomenon differs from that of decades ago. Humanity and its history are dynamic and ever-changing. Therefore, the IMMIGRATION REFORM that we need right now must consider today’s new realities and cultural and social changes.

When a human being suffers, humanity suffers. So, no one is without blame or disconnected from the phenomenon of migration and its sufferings. We all bear responsibility, and we can and must do our best, invest our best efforts, to find a definitive legal solution that will restore the right to a dignified life and hope for a better tomorrow to millions of men and women who need and deserve it.

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Quality Care for the Underserved: The Story of SOMOS

At the heart of the success of a unique network of 2,500 independent physicians serving one million of New York City's most vulnerable Medicaid patients lies the conviction that medicine is more than a diagnosis, treatment, or cure. Instead, the medical profession is called to integrate a humanistic element that faith, life experience, or drive shapes in every doctor, and that is decisive in how physicians ply this ancient trade of seeking to prevent illness and heal the sick.

Before creating the physician's network, SOMOS Community Care, SOMOS Chairman and Founder Dr. Ramon Tallaj, an immigrant from the Dominican Republic, learned that independent doctors were isolated. They occasionally crossed paths, but in their private practices, they were exposed to a system that increasingly devoured them in every sphere: pressure from insurance companies, competition with hospitals, and the demands of government bureaucracy.

Dr. Tallaj set out to unite doctors, inviting them to join the Corinthian Medical Group, a precursor of SOMOS. Working together, they were able to benefit from respective individual experiences and unite as a collective in negotiating with insurers and providers. Joining CMG proved to be a significant step toward the progress and stability of doctors' practices.

In August 2014, SOMOS began participating in the application for the DSRIP or Delivery System Reform Incentive Payment (DSRIP) program, an initiative launched by former New York Governor Andrew Cuomo to significantly reduce Medicaid expenses and reform the reigning healthcare model as much as possible.

DSRIP embraced a noble purpose, seeking to improve medical care for those most in need. But from its inception, the hospitals tried to set the tone and prevent a network of independent doctors such as SOMOS – not affiliated with a hospital system and with many of its doctors living in the same neighborhoods as their patients – from being included among the 25 medical service provider systems that would be approved to join the initiative. Hospital systems were very interested in removing SOMOS from New York City's medical landscape. Vested interests put up major roadblocks for SOMOS. But in the end, SOMOS became a Performing Provider System under DSRIP serving African Americans, Chinese Americans, and Hispanics, including many immigrants.

Still, SOMOS was not deemed reliable. Hence, a hospital was imposed upon the organization as a trustee, charged with monitoring SOMOS spending and approving organizational decisions. Happily for SOMOS, Montefiore Hospital was eventually engaged as a SOMOS trustee, leading to the creation of a robust and collaborative partnership.

For decades, the US healthcare system has focused on maintaining the status quo. Even when there were Hispanic leaders at the helm of hospital systems, health care was always dependent solely on hospitals. The United States has the best disease service in the world, but not the best health service that puts a premium on prevention. The underserved, elderly, immigrants, etc., have had to go to hospital emergency rooms even for a headache. And then, the astronomical bills come. All this has been known for years, but no one wanted to do anything. It was better to stay on the side of the big powerful groups than to risk a political career to benefit the neediest.

It should be noted that, under DSRIP, SOMOS was paid only for services rendered. The SOMOS Board closely managed its spending. Nothing is approved with the mere stroke of a pen, without prior consultations, discussion, and, above all, verification.

SOMOS booked notable success: by keeping patients out of the ER and hospital beds, it saved the federal government $48M a year for five straight years; New York State taxpayers saved more than $300M due to a 25 percent reduction in visits to the ER and hospitalizations; pilot programs enhanced the quality of the services rendered to patients; and SOMOS earned Innovator status in New York State, in recognition of its pioneering work featuring the Value-Based Payment formula, enhancing physicians' fees in accord with patients' longer-term health outcomes.

Key to SOMOS' success has been the cultivation of strong doctor-patient relationships. A major factor in this regard is the fact that many SOMOS doctors live and work in the same neighborhoods as their patients, with whom, in many cases, they share the same language and cultural background. Plus, aided by Community Health Workers, doctors get a sense of the social, family, and emotional circumstances of their patients' lives—the so-called Social Determinants of Health. For example, poverty may prevent families from consuming nutritious meals, which may cause obesity, or diabetes, along with attendant stress.

Unlike hospitals and the countless Urgent Care facilities, SOMOS doesn't wait for patients to show up at their doctor's door. Since the beginning of DSRIP, SOMOS has been developing extensive health education campaigns and distributing healthy eating models and plans. Working with invited personalities from the Latino world, it developed an app with exercise plans and nutritional suggestions. Health education is provided in medical offices, at community gatherings, in churches, and on the street.

SOMOS seeks out, talks to, teaches, and educates people so that they do not come to their doctor with perfectly preventable diseases. SOMOS sees the patient holistically, within a 360-degree viewing radius, considering many factors that other healthcare approaches do not consider. The highest moral principles inspire SOMOS staff and doctors in their pursuit of the common good. They are dedicated to the health and well-being of the people served by SOMOS.

The SOMOS difference between hospitals and the traditional health system lies in the formula of prevention before treatment. Our doctors are in the neighborhoods, immersed in the same life dynamic as many of their patients, whom they also know and have cared for generations. This intimate familiarity with patients' lives is key to preventive care. It is ironic that what was once traditional, the family or neighborhood doctor, is now revolutionary. This has its explanation in the stalemate that large hospital systems have created as the defining power of health care for years. Hospital systems, in general, evolved from healthcare facilities to interest groups and lobbyists that influence and determine health policies at the state and federal levels. This makes them key factors in a disease-based health system, but not a healthcare system that has the patient at the center of its vision and mission.

For these large systems established on the idea that the sicker people are, the better the economic results, it is a nuisance that a group of 2,000 independent doctors has acquired power and reputation with their work within the community. They are also concerned that they are losing money on emergency room visits because SOMOS doctors are treating hundreds of thousands of people, trying to keep them from getting chronically ill, or having to go to emergency rooms because they have no one to treat them. In the SOMOS vision, hospitals attend to only patients with the most urgent and prioritized needs.

The end of the first DSRIP mandate coincided with the onset of the COVID-19 pandemic. On this front, too, SOMOS took a course decidedly different than that of the healthcare establishment, which focused on hospitalization and the purchase of costly ventilators and other medical equipment. SOMOS focused on educating the community as to the importance of isolating people struck by the virus and protecting family members living together in close quarters. Here, too, the focus was on prevention rather than treatment of the disease. SOMOS fought hard every day so that our message of isolation and protection reached all communities. The strategy flew in the face of large institutions seeking to maintain the status quo of a disease system.

Our doctors took to the streets. SOMOS bought and set up tents in different neighborhoods to administer COVID-19 tests which SOMOS often bought with its own funds. SOMOS took to the radio stations, television stations, and the press with messages that people had to social-distance, and that they had to isolate the sick, especially from the elderly. Messages were delivered in English, Spanish, and Chinese. SOMOS educational campaigns were comprehensive and efficient. Eventually, SOMOS convinced authorities of the need for people to isolate themselves and of the importance of educational and outreach campaigns among those most in need.

When, after lengthy delays, SOMOS was mandated to distribute the COVID-19 vaccine, it did so at distribution points in the community, going to the people and facilitating access to the vaccine for the neediest. From the start of the pandemic, SOMOS also delivered food to the neighborhoods, working in tandem with major charitable organizations. SOMOS is yet to be reimbursed by the State for all its work and contributions in fighting the pandemic.

Dr. Tallaj, concluding a recent report on the history of SOMOS, put it thus: "My mission, and as such the mission of the network of doctors I lead, is to educate our community, our children, and our youth today; and treat them preventively, if possible, to prevent avoidable chronic diseases from conditioning their lives in the future."

"This has an economic benefit for the government as a beneficiary of health programs and for insurance companies. But the greatest benefit is for the person, the human being, who will be able to live and function well in our society. If we manage to see the role of the doctor like this, if we can convince politicians of the fundamental importance of the primary physician (general practitioner or family doctor) and of the need to allocate funds to those doctors so that the neighborhoods, regardless of the social class that resides in them, become conglomerates of healthy people, it will have been worth facing so many challenges... and to have kept fighting."

 

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The faith, or lack of it, of US Hispanics

Though it remains the faith to which most US Hispanics belong, it also is the faith that is losing more Latinos than any other religious group, with an increasing number of Hispanics identifying as religiously unaffiliated. These were some key findings of a Pew Research Center report released April 13. 

In 2010, 67 percent of Hispanics said they were Catholics. That figure has dropped significantly to 43 percent in 2022. That figure stood at 49 percent in 2018. Almost one-in-four US Hispanics are former Catholics. Of the 65 percent of Hispanics who said they were raised Catholic, 23 percent report that they no longer identify as Catholics. Some have joined another faith, becoming mostly Protestants, while many no longer belong to a Church. 

Protestants are the second largest faith group to which Hispanics belong, accounting for 21 percent of US Hispanics. Among Hispanics, 39 percent say religion is “very important.” Of Hispanic evangelicals, 73 percent say religion is very important, with 46 percent of Catholic Hispanics saying so. Among US Hispanic Catholics, 22 percent attend Church weekly or more often. Just 1 percent of religiously unaffiliated do so.

The share of Hispanics who identify as atheist, agnostic, or “nothing in particular” stands at 30 percent. That compares to 10 percent belonging to this category in 2010 and 18 percent in 2013. It should be noted that 29 percent of Hispanics who say they do not belong to any faith continue to pray at least weekly. Almost a quarter of all US Hispanics are former Catholics.

The abandonment of Catholicism is most pronounced among young people ages 18-29. Of this group, 49 percent identify as religiously unaffiliated. The 50-64 and 65-plus age groups are least likely to identify as unaffiliated, with respectively 20 percent and 18 percent claiming religiously unaffiliated status. Those are still significant numbers. 

Among foreign-born immigrant Hispanics, 52 percent belong to the Catholic Church, with 21 percent identifying as religiously unaffiliated. By contrast, 36 percent of US-born Hispanics say they are Catholic, while 39 percent say they are religiously unaffiliated. Language also plays a role, with 56 percent of Spanish-dominant individuals identifying as Catholic, compared with 32 percent of English-dominant saying they are Catholic. That figure stands at 42 percent of bilingual respondents.

The decline in the number of Hispanics embracing the Catholic faith—especially but not exclusively among young people—should give Hispanic Church leaders pause. It calls for innovative evangelization efforts that consider what is most important in people’s lives, which for many revolves around material success. Hispanics going to Mass and living a Catholic life can no longer be taken for granted.

It seems clear that the American way of life, predicated on entertainment and the acquisition of money and material goods, numbs Hispanics with respect to their Catholic roots and values. It leaves them empty in critical ways. People are working two or three jobs to keep up, which pushes reflection and spirituality to the sidelines. There is a sharp decline in the appreciation of the faith that has shaped and sustained the cultures of Latin America. For hundreds of years, the Church has played a vital role in US Hispanics’ countries or cultures of origin, while Catholicism is also the foundation of the formation of the human person.

For Church leaders, the task ahead is presenting Catholicism in a more dynamic form that drives home the historical and contemporary importance of the faith. Somehow, the Church must engage and convincingly challenge the dominant culture to present a viable alternative in a culture driven by materialism and the ambition to succeed. The Church can borrow a page from the evangelical playbook and its commitment to going out to the people rather than waiting for the people to come to the Church.

There also is a political and ideological battle that must be waged. Former Catholics, the Pew survey notes, cite the Church’s lack of LGBTQ inclusivity, the clergy sex abuse scandal, and the ban on women priests as key factors that prompted them to leave the Church. On this front, too, the Church must demonstrate sensitivity and sophistication to make a compelling case for its teachings.

Failing a concerted, creative effort on the part of the Church, the loss of Hispanic Catholics will continue apace, further undermining a faith that goes to the heart of the Hispanic community.

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