Reportedly receiving Death Threats from supporters of alexandria. From washington came before. Socialism to socialism let me. First. Get more all stories on all back in an hours time right now though its a new episode of the big picture. On this weeks show happy birthday oncle sam 6 months down 6 to go as we pause for the 4th of july weekend the 2019 Halftime Report but 1st as the immigration debate royal. Stations are implementing new ways to help those who make it here in life threatening circumstances and its summer time summer time some some summer time and based on how stressed many of us are at work vacation cant come soon enough im holland cook in washington this is the big picture on our t. America. Unless the economy tanks the 2 biggest issues in the 2020 president ial campaign now unfolding are likely to be health care and immigration and the intersection of both controversies are undocumented immigrants who comprise 3 percent of the usa population and are 27 percent of americas uninsured of them an estimated 6500. 00 people are suffering kidney failure according to the National Institutes of health and anyone whos on dialysis knows that its expensive what kind of care these immigrants get depends on where they live whether they get health care is the political half of the story but as for the medical issues lets ask dr rajiv raj of them a Board Certified internist and just who practices in the houston area and teaches at the Baylor College of medicine dr welcome. Thank you thank you for having me much of the health care that the uninsured undocumented immigrants get is in the emergency room where since 1986 the federal government has required that patients receive care regardless of their immigration status or their ability to pay docked before we zoom in on the kidney issue the wide angle shot even for patients who pay is not the e. R. The least expensive way to get health care. No youre absolutely right the emergency room is definitely inefficient and a lot of it is its very easy you know if you dont have insurance or if you have insurance thats very restrictive and not except in a lot of places all you have to do is pop into the mergence room you may wait a while but you know youre going to be seen the problem with that is that it leads to long lines in the mergence room and so a lot of patients will show up with nonemergent conditions and these take up a lot of valuable resources plus theres poor follow up if youre treated with high Blood Pressure diabetes in the merge and serum you rarely going to get a follow up appointment to help manage those and so you keep showing up in the mergence the room being treated for these chronic conditions so its very inefficient i misspoke a minute ago i said least expensive but youre caught my point at least efficient now about those 6500 who are dialysis dependent fewer than half receive treatment only in life threatening circumstances rather than the ongoing treatment the insured receive and i have read that after just a couple weeks so many toxins have built up that these folks end up in the hospital overnight to be dial ised twice the cost of which is some 300000. 00 per person per year now cost aside what is a life like for someone whos Walking Around in need of regular dialysis that theyre not getting. Yet kidney failure is a terrible disease and so theres about 600000 individuals in this country who are citizens who are getting dialysis and basically for all of us whose kidneys are working 100 percent of the time were filtering the toxins out of the body were making urine but if youre on dialysis the only time that youre actually getting that done is when youre connected to a machine which can be as short is just 12 hours a week so during that time that youre not on the machine these toxins are building up theyre making you feel nauseous sick you have to be on a very restricted diet on average patients on dialysis are taking about 15. 00 to 20. 00. Hills per day just to kind of do the jobs that the kidneys normally do so when you add to it this conundrum of patients who fall through the cracks because of their lack of citizenship theyre getting only on emergency basis so they have to be life threatening critically ill showing up to the mergence room to get a single dialysis treatment and if theyre not theyre just Walking Around like zombies. Yes thats true quality of care status quo depends on where you are in Washington State the medicaid system includes whats called the a. T. M. Alien Emergency Medical Care which pays for dialysis and chemotherapy for undocumented patients and illinois was the 1st state to pay for Organ Transplants for undocumented immigrants doc as i said up front we can talk about the politics of this issue another time but from the standpoint of Health Care Delivery dont programs such as these states are offering straining the entire Health Care System less than the ad hoc life and death status quo elsewhere. Yeah thats true so theres about 38 states that use emergency only dials its only 12 states in the country have used their state resources medicaid primarily to cover dialysis and or Organ Transplantation with illinois being the only state thats passed it so correct as you point out going to the merchants room is much more costly its less efficient and for these individuals its really hampering their way of life and so providing scheduled dialysis or even Organ Transplantation regardless of your political views is a more Cost Effective you more Cost Effective way of treating these patients as a have prepared to chat with you about this ive been reading up about Home Dialysis is this a technology breakthrough. Home dialysis has been around for a long time patients who do dialysis at home primarily do its called peritoneal dialysis which is the dialysis that uses essentially or own body as a filter for fluid comes in the body in fluid leaves is different than he dialysis which is a blood based type of dialysis appeared you know this has been around for a long time its done at home so you do it on your own schedule its cheaper option as such the main resource constraint is that you have to have the space and. House to to do contain all the fluids in the machine and a lot of undocumented patients just dont have that space and so in states that have expanded medicaid and allow patients to do dialysis who are undocumented either at home or in a clinic a lot of times the resource and the space is what constrains them from doing Home Dialysis tech to receive raghav then in houston thank you for joining us on the big picture the wall street journal reports that Employee Health benefits cost starbucks more annually than coffee beans General Motors spends more on them than on steel but beyond that giant budget item every companys Business Practices affect the physical and Mental Health of its employees the centers for Disease Control and prevention is called stress the number one Workplace Health problem head of physical inactivity and obesity it affects both blue and white collar jobs across a wide range of incomes and its a leading contributor to turnover absenteeism and productivity losses why and how to whistle while you work lets ask Mark Rutherford a licensed psycho therapist in private practice in south florida you may have seen his ted talk on you tube mark welcome back to the big picture. Welcome thank you for having a Human Resources professional gave me a new buzzword its not absenteeism its present t. V. Ism meaning youre at work physically youre just not on your game why are employees dragging. Life. Theyre worried about theyre worried about their productivity of work but theyre also worried about their home life and their relationship and their kids and getting everybody to soccer practice and what they are going to have for dinner that night and all of these things kind of are always kind of a whole ruminating thats spinning around in the back wheel of their brain and so when they are thinking about all of these things they might be there are work but theyre not really doing the work mental overload is this why sometimes your mind seems spinning even when youre sleeping. Yes its why oftentimes professionals say turn the screens off at least a half an hour before you go to sleep you know dont answer emails while youre in bed try to find some way to disconnect because in this world of overly connected people were looking at her emails and were looking at instagram and were looking at twitter and were checking you know checking checking checking always fearful of missing something and when were fearful of missing Something Back really of our brain is always going ok when what did i miss when did they miss it how am i going to recoup and try to relax with that going on and it becomes a hard process meanwhile in the workplace corporate consolidation has complicated life in Many Industries in my business Radio Broadcasting the typical downsizing involves the fired workers job landing in a surviving workers lap that person gets more responsibility more work no extra dough ray me from a psychological standpoint even a full employment economy are overworked workers making a mistake just sucking it up rather than testing the waters elsewhere. I think thats a really its a slippery slope because yes from a Mental Health standpoint you want to you know relieve or reduce the amount of stress kind of going on and the correct answer is disconnect you know take some time for yourself said. Or boundaries but the reality of the situation is that the workplace often times like in your business in Radio Broadcasting in the many other industries its kind of squeezing the worker out and so they do have a very legitimate reason to worry about these things so it becomes a kind of internal battle between the the frontal lobe the intellect and the you know a kind of a reactive brain it becomes this kind of tug a tug of war between what we think and what we feel what were halfway through summer and not using use a more lose on Vacation Days is a big mistake isnt it. You know i have patients that come in and say i have 4 months of vacation pay and im just afraid to take it because you know this deadline is due and im working on 6 different projects and i know im supposed to take a break i havent had a vacation in 2 years my kids are complaining its summer theyre out of school my my my spouse would like to take a vacation to see their family but i cant extract myself from being able to do that so they know they know the right thing to do but its fear of loss fear of of you know loss of project productivity fear of loss of their placement in the job strata that keeps them hanging on to the right were all afraid to seem clueless at work thank you again Mark Rutherford for joining us on the big picture. Coming up think the 1st half of the year was a blur grab the armrest or 2019 Halftime Report is next this is the big picture on our t. V. America. Dish you will not obey the voice of the lord youre going to do all the school long months and the state you come onto this day. Then all these curses shall come upon you and overtake you on legs and then the white people the stolen property and death what must pretend to get people if they get rid of whites only problems will go away. The financial need to with and remove what communal as president of the free will. Wide farmers in so theyre free go be a day for every single day. People being tortured to death expression the elderly people in the wooden dont come barfs manias somebody of my funky enough company. Not been you and that nice white horse will find themselves affected by a crash and we are also affected pointedly deflect means in dreams its all sweats and a lot of. What are you going to have for dinner today we dont need anything im asking for a night made bad feelings towards civil war in south africa easy never to. One good profit from one where our search for an n. H. L. Not be in the tone of your hand to get to. You know world of big partisan group logged for years and conspiracy its time to wake up to dig deeper to hit the stories that made stream media refuses to tell more than ever we need to be smarter we need to stop slamming the door on the path and shouting past each other its time for Critical Thinking its time to fight for the middle for the truth the time is now for watching closely watching the hawks. Dont blame youll miss everything you know to date has been a blur what happened and what happens next lets ask on the left which caesar former Florida Democratic party chair and on the right conservative new york radio and t. V. Pundit and our contributor Steve Malzberg welcome hello there how are you lets do the lightning round in the biggest most consequential issue goes 1st war from the recent president ial debates here is u. S. Representative tosi gabbert an army major twice deployed to the war in iraq who says war with iran would be much worse. Lets deal with the situation where we are where this president and his chickenhawk cabinet have led us to the brink of war with iran this is why its so important that every one of us every single american stand up and say no war with iran we need to get back into the Iran Nuclear Agreement and we need to think oh she ate how we can improve it which you said steve if we were as the president says 10 minutes away from attack before he inquired about iranian civilian casualties no less are not even you grin and bear it trump support are concerned about how little it would take to trigger a war there or anywhere we were in close to attack we were close to retaliate atory attack we were attacked our drone was attacked in International Waters after rand put mines on 22. 00 ships i mean this is provocation after provocation and that itching for a war with iran but lets call it what it is if we respond to. Let terry provocation from iran then they get what they deserve and by the way im very disappointed that if trump is going to fight if we get in a war god forbid if hes going to fight that war the way weve been fighting wars by saying well lets figure out do they own dayton damage and they kill 2 of our people if we kill 5 of theirs thats this proportionate dont even bother if youre going to fight a war fight a war to win or dont fight it well steve you talk about provocation and we were in the neighborhood to begin with mitch all our lives we baby boomers have seen the news footage of angry crowds in the streets of countries around the world chanting yankee go home stop me if this question is naive but mitch what if we rebooted the j c p o a nuke deal with which iran was in compliance and we quit and we otherwise just left iran alone. Well you know you bring up an interesting point because we are baby boomers if we were products of the sixtys and the vietnam war where a lot of folks were against the war i even hear a hint of that from steve you know when i grew up i was i always learn in effect being from the sixtys not to trust the generals but based on the fact that trump has no Foreign Policy that really exists with anyone and literally the generals are the only ones left that i do trust specifically how do we respond to this is the question do we do it by cyber techniques do we do with Ground Troops do we do with cloak and dagger or do we go back to the original agreement remember trump likes anything that dismantles anything or president obama had to do with right so if we pulled out of the Iran Nuclear Deal do we go back into it was it perfect no democrats have said that all along but is but there is no such thing as perfection in this world and perhaps wed be better off than we were i will agree maybe shockingly with steve that if we do get into something we have to decide what the calculations are and one final point and that is that when the president said i believe not truthfully that shocking for me as well and not that he said he decided 10 minutes left reminds of the old movies from the sixtys with Peter Sellers and everybody else showing my age most specifically that he decided because what the casualties were all the generals and retired generals 2 stars 3 stories fours came on t. V. Of every a very stripe and said thats absolutely not true thats not how its done they give an assessment they do a balancing act what the possible casualties are for the other side or the be for us what suppose youre is so this didnt happen with 10 minutes left even in a time of possible war the president cant be truthful with the American Public all right also from those recent democratic debates there were some heated exchanges but there sure was consensus on this issue listen. Existential threat is Climate Change we have to confront it before its too late. Climate change the Climate Change. Mitch you are at ground 0 florida is more vulnerable to rising sea levels and anywhere else in the usa and we read that real estate values are already being impacted how much do people there talk about miami turning into venice. Actually all the time very specifically miami beach which is exposed more which is literally minutes from we were sitting right now they get water on dry days when it doesnt rain you