The Social Security amendments of 1960: completing the foundation for Medicare and Medicaid.

The expansion of social security coverage enabled northern, industrial states to transfer a larger share of their Old Age Assistance (OAA) clients to the Social Security (OASDI) rolls at an earlier date than was possible in southern, agricultural states. Due to the differential rate of transferring clients, northern states could achieve a larger financial return from the establishment of Medicare while an increase in federal medical reimbursement for public assistance clients was more beneficial to southern jurisdictions. Although public opinion overwhelmingly supported the former option, partisan presidential politics and a split in the Democratic ranks enabled southern Democrats to thwart the will of the people by enacting legislation that significantly expanded federal contributions for the health care of indigent, elderly citizens. The evidence, therefore, indicates that regional differences in the share of elderly citizens receiving OASDI and OAA benefits contributed to the suppression of Medicare amendments. It is also evident that, in the absence of a presidential veto threat, southern opposition to Social Security health insurance would have been muted and Congress may gave enacted Medicare legislation in 1960 instead of 1965.

Extended laboratory panel testing in the Emergency Department for risk-stratification of patients with COVID-19: a single centre retrospective service evaluation

BackgroundThe role of specific blood tests to predict poor prognosis in patients admitted with infection from SARS-CoV2 virus remains uncertain. During the first wave of the global pandemic, an extended laboratory testing panel was integrated into the local pathway to guide triage and healthcare resource utilisation for emergency admissions. We conducted a retrospective service evaluation to determine the utility of extended tests (D-dimer, ferritin, high-sensitivity troponin I, lactate dehydrogenase, procalcitonin) compared to the core panel (full blood count, urea & electrolytes, liver function tests, C-reactive protein). MethodsClinical outcomes for adult patients with laboratory-confirmed COVID-19 admitted between 17th March to 30st June 2020 were extracted, alongside costs estimates for individual tests. Prognostic performance was assessed using multivariable logistic regression analysis with 28-day mortality used as the primary endpoint, and a composite of 28-day intensive care escalation or mortality for secondary analysis. ResultsFrom 13,500 emergency attendances we identified 391 unique adults admitted with COVID-19. Of these, 113 died (29%) and 151 (39%) reached the composite endpoint. "Core" test variables adjusted for age, gender and index of deprivation had a prognostic AUC of 0.79 (95% Confidence Interval, CI: 0.67 to 0.91) for mortality and 0.70 (95% CI: 0.56 to 0.84) for the composite endpoint. Addition of "extended" test components did not improve upon this. ConclusionOur findings suggest use of the extended laboratory testing panel to risk stratify community-acquired COVID-19-positive patients on admission adds limited prognostic value. We suggest laboratory requesting should be targeted to patients with specific clinical indications.