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THIS ARTICLE STATES THAT NOWHER IS THE INABILITY OF THE SOVIET STATE TO UPHOLD ITS PART OF THE SOCIAL CONTRACT WITH ITS SITIZENS DEMONSTRATED MORE GRAPHICALLY AS IN HEALTH CARE. THE DUAL ILLNESS THAT PARALYZES THE SOVIET ECONOMY AND SOCIETY MATERIAL PVERTY AND EXHAUSTION ON ONE HAND AND THE TOTAL BREAKDOWN OF LABOR MORE ON THE OTHER-IS LEAVING DEEP SCARS ON SOVIET MEDICINE.

The United States has seen major advances in medical care during the past decades, but access to care at an affordable cost is not universal. Many Americans lack health care insurance of any kind, and many others with insurance are nonetheless exposed to financial risk because of high premiums, deductibles, co-pays, limits on insurance payments, and uncovered services. One might expect that the U.S. poverty measure would capture these financial effects and trends in them over time. Yet the current official poverty measure developed in the early 1960s does not take into account significant increases and variations in medical care costs, insurance coverage, out-of-pocket spending, and the financial burden imposed on families and individuals. Although medical costs consume a growing share of family and national income and studies regularly document high rates of medical financial stress and debt, the current poverty measure does not capture the consequences for families' economic security or their income available for other basic needs. In 1995, a panel of the National Research Council (NRC) recommended a new poverty measure, which compares families' disposable income to poverty thresholds based on current spending for food, clothing, shelter, utilities, and a little more. The panel's recommendations stimulated extensive collaborative research involving several government agencies on experimental poverty measures that led to a new research Supplemental Poverty Measure (SPM), which the U.S. Census Bureau first published in November 2011 and will update annually. Analyses of the effects of including and excluding certain factors from the new SPM showed that, were it not for the cost that families incurred for premiums and other medical expenses not covered by health insurance, 10 million fewer people would have been poor according to the SPM. The implementation of the patient Protection and Affordable Care Act (ACA) provides a strong impetus to think rigorously about ways to measure medical care economic burden and risk, which is the basis for Medical Care Economic Risk. As new policies - whether part of the ACA or other policies - are implemented that seek to expand and improve health insurance coverage and to protect against the high costs of medical care relative to income, such measures will be important to assess the effects of policy changes in both the short and long term on the extent of financial burden and risk for the population, which are explained ...

The potential for urban violence is increasing as the world population continues to migrate towards cities. Recent examples of urban warfare with insurgent groups has occurred in Damascus, Mosul, Raqqa, Marawi, Ramadi, and Fallujah, although non-State actor conflict covers a wide range of violence from ordinary crime, to terrorism and transnational crime, to near conventional conflict. Further, transnational terrorist groups have sought to extend the conflict into countries seen as the "far enemy." A key issue is determining if an armed conflict is in existence so that the protective focus of international humanitarian law regarding the provision of medical care and humanitarian relief will be applied. However, even where an armed conflict does exist, consideration must also be given to human rights law. This occurs for a number of reasons, including its continuing application during armed conflict, rulings by human rights courts that view that body of law as exclusively governing internal "counterterrorism operations," a decision by States to deny the existence of an armed conflict, or a policy decision that law enforcement operations will be exclusively applied to counter a terrorist or insurgent threat. The result has been an increasing recognition of the applicability and relevance of both bodies of law. While humanitarian law provides a more comprehensive and specific body of rules for the provision of medical care, human rights law has a role to play, particularly since it better addresses the broader dimensions of health care. With many States preferring a human rights-based law enforcement approach even during armed conflict there likely will be a trend towards incorporating humanitarian based obligations into human rights law-based medical care considerations. In any event, challenges remain regarding the treatment of civilians who are increasingly the victims of urban violence. These include providing adequate medical care to civilians at the tactical level; the targeting of medical hospitals, clinics, and medical personnel; and the impact of explosive weapons in an urban environment. Whether medical care is provided under international humanitarian law or human rights law, the focus must remain on ensuring both military personnel and civilians are equally protected under the law.