Sunday, November 24, 2013

Healthcare Triage #5: Turkey Doesn't Make You Sleepy...

You've heard the notion that eating a lot of turkey makes a person sleepy because of the Tryptophan it contains, right?

Well, its wrong...

Here's Doctor Aaron Carroll explaining the whole thing...

Go eat turkey! Happy Thanksgiving!

Wednesday, November 20, 2013

Why Do Presidents Even Bother To Reform Health Care?

Terrific read from David Blumenthal at The Commonwealth Fund on the incredible difficulty that several presidents have encountered in trying to reform our failed healthcare system. From Truman to Johnson, from Carter to Obama, one has to ask themselves, why bother?

It's called:

Reflecting on Health Reform—The Presidential Health Care Curse: Why Do They Bother?

Last week the Commonwealth Fund released its 13th cross-national survey documenting health care experience in the developed world. Based on responses from more than 20,000 individuals in 11 countries, the survey shows unequivocally that the United States has the worst health insurance among industrialized nations. Whether you’re talking administrative hassles, out-of-pocket expenses, costs of administration, complexity of policies, or adequacy of coverage, the U.S. consumer gets a bad deal. 
The system is not only bad, but getting worse. Every year, more people lose insurance as they or their (usually small) employers get priced out of the health insurance market by rising premiums. The Commonwealth Fund biennial health insurance survey shows that 55 million Americans are now uninsured and, equally telling, another 30 million are underinsured, meaning that they spend more than 10 percent of their income on medical expenses despite having health care coverage (5 percent if their income is under 200 percent of poverty). The U.S. has more uninsured and underinsured citizens than the entire population of Germany, where, by the way, private insurance organizations compete, no one is uninsured or underinsured, and the economy is thriving. 
Good stuff...go read!!!

How Doctors Die: Showing Others The Way...

Powerful article in today's New York Times from NPR's Dan Gorenstein on how some Physicians are preparing themselves for death. They have many the same fears the rest of us do, but there is one significant difference in how they approach their end of times than how many of us do.

An excerpt:

There is no statistical proof that doctors enjoy a better quality of life before death than the rest of us. But research indicates they are better planners. An often-cited study, published in 2003, of physicians who had been medical students at Johns Hopkins University found that they were more likely than the general public to have created advance directives, or living wills, which lay out specific plans for care if a patient is unable to make decisions. Of the 765 doctors studied, 64 percent had advanced directives, compared with about 47 percent for American adults over 40.

Read the full article here:

JFK's "President And The Press" Speech...How Would It Play Now?

This Friday marks the 50th anniversary of the assassination of our 35th President, John F. Kennedy. There is plenty of coverage across many media platforms of late to mark the occasion. I'll leave it to my readers to seek out their preferred source for this content.

This morning, I gave attention to a speech President Kennedy gave on April 27th, 1961 at the Waldorf Astoria in New York City to a meeting of the American Newspaper Publishers Association. The gist of the speech focuses on what President Kennedy felt the role of the press was in terms of covering his Administration. He had taken the oath of office on January 20th, 1961, so had served a fairly short time. To my knowledge, these remarks were his first extended comments directed toward the press.

Its an interesting speech Kennedy titled "President And The Press." Throughout the speech, care is taken to praise as highly important, valuable and necessary, the role of the press in our Country.

"Without debate, without criticism, no Administration and no country can succeed—and no republic can survive. That is why the Athenian law-maker Solon decreed it a crime for any citizen to shrink from controversy. And that is why our press was protected by the First Amendment—the only business in America specifically protected by the Constitution—not primarily to amuse and entertain, not to emphasize the trivial and the sentimental, not to simply "give the public what it wants"—but to inform, to arouse, to reflect, to state our dangers and our opportunities, to indicate our crises and our choices, to lead, mold, educate and sometimes even anger public opinion.

Kennedy continues:

"No President should fear public scrutiny of his program. For from that scrutiny comes understanding; and from that understanding comes support or opposition. And both are necessary. I am not asking your newspapers to support the Administration, but I am asking your help in the tremendous task of informing and alerting the American people. For I have complete confidence in the response and dedication of our citizens whenever they are fully informed."

It is quite obviously a dramatically different time that the press operates in today. Exponential growth of its industry as a result of the internet, which has resulted in an explosion of "information" websites, blogs and bloggers, as well as the expansion of our television viewing options brings us to a place never before visited by the American people. Intuitively, most agree that more and better access to information is both important and desirable. Are there limits? Can the press be compared to an automobile? Speed is good but isn't there a degree where too much acceleration poses more of a threat than a benefit? Of course. Society has decided that for the vast majority of our roads and highways there will be a limit to be observed and penalties applied if a motorist elects not to.

Similarly, today's "news" media doesn't deliver "just news" (pun intended.) An intoxicating blur between information and entertainment aka "infotainment" I say has done far more harm than good. Too many viewers see no distinction between the two forms and are worse off for it. To confuse Glen Beck with Chris Wallace, to confuse Ed Schultz with Andrea Mitchell, to confuse Sean Hannity with Ed Henry, etc. has its price. While television, radio, the web are mostly revenue seeking and revenue driven enterprises, the audiences tuning in/clicking on their favorites too often seem not to be aware of the difference or perhaps not to care. Either way, its a sad state we find ourselves in. 

Kennedy asks his audience the basic question of is additional restraint to be expected from our media when it comes to matters of national security? He does not answer his question, rather leaving it to his listeners to consider it and do as their conscience guides them. A conscience that Kennedy seems to have a confidence in producing the right decision. (Boldface mine.)

"That question is for you alone to answer. No public official should answer it for you. No governmental plan should impose its restraints against your will. But I would be failing in my duty to the Nation, in considering all of the responsibilities that we now bear and all of the means at hand to meet those responsibilities, if I did not commend this problem to your attention, and urge its thoughtful consideration.

On many earlier occasions, I have said—and your newspapers have constantly said—that these are times that appeal to every citizen's sense of sacrifice and self-discipline. They call out to every citizen to weigh his rights and comforts against his obligations to the common good. I cannot now believe that those citizens who serve in the newspaper business consider themselves exempt from that appeal.

I have no intention of establishing a new Office of War Information to govern the flow of news. I am not suggesting any new forms of censorship or new types of security classifications. I have no easy answer to the dilemma that I have posed, and would not seek to impose it if I had one. But I am asking the members of the newspaper profession and the industry in this country to reexamine their own responsibilities, to consider the degree and the nature of the present danger, and to heed the duty of self-restraint which that danger imposes upon us all."

I wonder aloud today, how such a speech would be received today? I suspect not very well. A percentage of media outlets would find it to be quite acceptable, while others would find it offensive and set out with its consumers a mission of objecting to a President of the United States attempting to, albeit with clever words, censor the Fourth Estate. 

I am reminded of a famous quote by one of our earliest journalistic heroes, Edward R. Murrow. Allowing myself some light editing, I suggest his words address my primary concern rather well: (Boldface mine.)

We will should not walk in fear, one of another. We will should not be driven by fear into an age of unreason, if we dig deep in our history and our doctrine, and remember that we are not descended from fearful men — not from men who feared to write, to speak, to associate and to defend causes that were, for the moment, unpopular. This is no time for men who oppose Senator McCarthy's methods to keep silent, or for those who approve. We can deny our heritage and our history, but we cannot escape responsibility for the result. There is no way for a citizen of a republic to abdicate his responsibilities. As a nation we have come into our full inheritance at a tender age. We proclaim ourselves, as indeed we are, the defenders of freedom, wherever it continues to exist in the world, but we cannot defend freedom abroad by deserting it at home. The actions of the junior Senator from Wisconsin the media have caused alarm and dismay amongst our allies abroad, and given considerable comfort to our enemies. And whose fault is that? Not really his. He didn't create this situation of fear; he merely exploited it—and rather successfully. Cassius was right. "The fault, dear Brutus, is not in our stars, but in ourselves." 

(H/T to Tim Farley/POTUS Sirius/XM Channel 124)


Thursday, November 14, 2013

President Obama Screws This Up...Let me count the ways....

Sarah Kliff of the Washington Post the details on the proposed "fix" from President Obama to address those policy holders who have recently lost their coverage.

Its a mess.

The whole thing is a god-damned mess.

A few thoughts:

1) No excuse for this. Many pro-ACA people were looking forward to a reasonably competent rollout on October 1st. The expectation wasn't perfection, but something usable that most people could access and find a reasonable experience awaiting them. Didn't happen. Now, a lot of people who were apprehensive about this idea in the first place are even less inclined to give it a chance. True, many don't really get a choice, but my God, does it look silly and amateurish. The White House knew this time was coming and fucked it up anyway. All that crap we listen to on a daily basis about how Government doesn't anything very well just got a whole lot stinkier.

2) Another thing this White House screwed up royally was in permitting Mr. Obama to repeat over and over again that "if you like your health insurance, you can keep your health insurance." I don't buy that no one thought about the small percent of consumers for whom this would not hold true. I think the White House realized it would perform poorly politically and just decided to procrastinate on dealing with it. Wrong move.Perhaps the White House did try to warn the POTUS and he ignored them. Who knows? Regardless, almost nothing of this sort improves by being ignored. Again, you look foolish at best and a liar at worst on this one.

3) Lest I give the loyal opposition a pass, I also don't believe that no one from the Republican party who realized this issue for the 5% individual market really gives a crap about them staying insured. No voices proposed any solutions, they were too busy voting on full repeal votes in the House or shaving bits and pieces of the law wherever they could. They were perfectly happy to let this crash and then raise holy hell, rather than exert pressure on the Administration months ago to avoid this. The blind squirrels found themselves a nut, finally after months of looking for them.

4) The media is also doing itself no favors with Obamacare. I know that the happy stories don't play nearly as well as the disaster stories do, but give me a break, would you? Many of the disaster stories have already been debunked, but again, perception is reality. More damage done.

5) Surely I'm not alone today in telling President Obama, the White House, both parties, etc. you are ALL at times simply pathetic. This sort of performance doesn't fly in the private sector and as the guardians of our Country, we deserve better than this. We really do. How much of this is political game playing and how much is incompetence, I can't say other that that I suspect there's plenty of both to go around.

I still support the ACA. More than a million Americans are on their way securing new health insurance as a result of the ACA and that is a good thing. It will improve, certainly. Some day, these frustrations will be behind us. But until then...

Please get your heads out of your asses, would you?


Wednesday, November 13, 2013

Do Republicans Really Want People to Keep Their Old Insurance?

We all know the rollout of President Obama's signature legislative achievement has been a disappointing combination of both pathetic and laughable. Aside from the website debacle, we have the mess of "if you like your insurance, you can keep your insurance." A few additional words added to that quote from Mr. Obama would've made life a lot easier for the President's team.

Republicans and conservative media are really hammering the POTUS on the "promise" he made several times. We see a regular dose of people with cancellation letters telling their stories on Fox News. Gloom and doom are here, friends...

The White House has its work cut out for them. The need to figure out a way that they can permit this 5% of insured, the individual market as its known, to keep the coverage they most recently had? Its almost a certainty that additional subsidies would be needed to help pay for the continued coverages.

We'll find out pretty soon just how bad the GOP really wants these folks to keep their own insurance. If President Obama proposes an additional level of subsidies and the Republicans say no to the required money to fund it, the tables will turn quickly, won't they?

If the GOP says, no, we can't spend any more money on the ACA, that will take the White House of the hook.

Which is what I predict will happen over the next six weeks.

Tuesday, November 12, 2013

Why Obamacare’s Troubled Rollout Might Force the Cooperation Health Reform Needs

Excellent piece by The Incidental Economist's Harold Pollack.

Why Obamacare’s Troubled Rollout Might Force the Cooperation Health Reform Needs

An excerpt:

The administration and its supporters made some serious errors. Yet they didn’t commit the only or the most epic failures here. News media are also making sowing public confusion. Major outlets repeatedly misreported stories of coverage cancellations within the individual and small-group marketplace. A series of stories described the predicament of specific people whose insurance was apparently cancelled, and who now apparently face massive premium increases because of health care reform. Anecdata always has the potential to mislead. Consumers with individual or small-group policies that have been cancelled are a tiny proportion of the insured, and are also a small proportion of those most affected by health reform. Many of the cancelled plans were incredibly limited, and would not have protected people from financial ruin in the event of serious injury or illness. Many people whose coverage was cancelled are eligible for subsidies on the new health insurance exchanges or are now eligible for Medicaid. Some are young adults who can enroll on a parent’s group plan.
A striking proportion of supposed ACA horror stories fall apart entirely when subjected to scrutiny. A particularly egregious example: On October 11, Sean Hannity featured featured six ostensible victims of Obamacare. Each of the six stories proved fell apart upon straightforward fact-checking conducted by Salon’s Eric Stern. To my knowledge, Hannity has run no correction.

Monday, November 11, 2013

A Graphic Depiction of What Our Soldiers Are Being Subjected To In These Senseless Wars.

There is a new book out that is especially topical today. Ann Jones' new book, "They Were Soldiers: How the Wounded Return from America's Wars—The Untold Story" ($12.95, Haymarket Books)

A summary from the publisher:

Ann Jones shines a much-needed light on the dead, wounded, mutilated, brain-damaged, drug-addicted, suicidal, homicidal casualties of our distant wars, taking us on a stunning journey from the devastating moment an American soldier is first wounded in rural Afghanistan to the return home. Beautifully written by an empathetic and critical reporter who knows the price of war.

Read a short, but powerful excerpt about a surgeon's first surgery on a soldier who had stepped on an IED in Afghanistan:

His first surgical patient, three days after he arrived at Bagram, was a young soldier who had stepped on an IED, triggering an upward blast that destroyed his legs and left his pelvic cavity “hollowed out.” His urinary system was in shreds. His testicles were destroyed. His penis was attached to his body by only “a little thread of skin.” That first surgery, the doctor said, was “emotional” for everyone on the surgical team. “The others hadn’t seen anything like these injuries for a while,” he said, “and I had never seen anything like it. To have to amputate that boy’s penis and watch it go into the surgical waste container—it was emotional.”
In two months at Bagram, the urological surgeon had done 20 similar surgeries, though that was the worst. Injuries confined mainly to the testicles are “easier,” he says, but for the soldiers they are brutally serious. Most soldiers who survive blasts that require high-level amputations of their legs also suffer severe injury to the scrotum and ruptured testicles. Surgeons can debride and clean the scrotum, and in many cases salvage at least part of one testicle and put it back. Keeping even part of his genitals is a psychological break for the soldier, but since the testicles produce testosterone, he still faces the inevitable ill effects of a deficient supply—a long and imperfectly understood list headed by osteoporosis, metabolic syndrome, cardiovascular problems including coronary artery disease and atherosclerosis, erectile dysfunction with its attendant psychological difficulties, low sperm count impairing fertility, obesity, depression, and a lifetime seesaw of hormonal treatment.
The full excerpt as published in the Alternet article, provides a fascinating and detailed look into what the experience is actually like. If you read my earlier post from this morning, THESE men and women reach the threshold for hero in my book.


All Vets Are Not Created Equal...

Veterans's Day, 2013...

I never served.

I didn't want to serve when I was of age.

Now in my 50's looking back, I think the experience would have been far better than I thought it would at the time.

Every year, we honor those fellow citizens who have served in our country's military. The accolades and praise are highly deserved for many. To volunteer to do a job where you are directly involved in high risk, high danger tasks isn't for everyone. When the job description includes avoid the bad guys trying to kill you in places most of us can't find on a map, it becomes a thing like no other.

To all the front line soldiers, infantry, engineers, etc. who are in harm's way on a constant basis, huge thanks to you guys. I don't quite subscribe to the overused phrase "they're fighting for our freedom" but that's more of a political issue. These guys/gals follow orders, do really hard/dangerous stuff and too often pay a high price for doing so. PTSD is at epidemic levels, far too many vets are seeing shamefully hard times upon discharge, too many families are paying the price for their loved ones serving the country. The issue of military suicides is beyond shameful and our leaders need to spare no expense at making these folks whole again. Period.

I can't however, in good conscience, group the folks I've just described with everyone in the military. Those folks who work in safe environments, often stateside in support positions, don't warrant the same recognition that the front liners and risk takers deserve. I've never been able to portion out the same respect for a sax player in the Air Force band as I do a sniper taking point in Iraq. Big, big difference to me.

I support everyone who works for our military and appreciate what they do. I reserve special and higher respect for those who went to work on a daily basis with a real fear that they may not live to see the next one. Again, putting all politics aside, these guys/gals are pretty admirable folks.

To say everyone in the military is a hero on days like today, I think does a real dis-service to the real heroes in uniform. To make this distinction shouldn't make one less a Patriot, either. Just a realist.

Happy Veterans Day!

Saturday, November 9, 2013

Obamacare By The Numbers. ..

Sarah Kliff of the Washington Post uses some easy to read graphs to illustrate the President's new health care program. A fresh look I haven't seen done as well any where else.

Friday, November 8, 2013

Ezra Klein on President Obama's "apology" and why the Private Insurance Market is a Mess...

Ezra Klein had a top rate piece this morning on the "apology" President Obama gave to the American people via a sit-down interview with NBC's Chuck Todd last night. Klein believes the President owed an apology for his now infamous "if you like your coverage, you can keep it" quote that we're all sick of. Klein also makes a sound case as to why Obama was exactly right to reform the individual insurance market.

An excerpt:

"The individual market -- which serves five percent of the population, and which is where the disruptions are happening -- is a horror show. It's a market where healthy people benefit from systematic discrimination against the sick, where young people benefit from systematic discrimination against the old, where men benefit from systematic discrimination against women, and where insurers benefit from systematic discrimination against the uninformed."

The article is very much worth your time...

Go read....


Monday, November 4, 2013

What is Health Insurance, and Why Do You Need It?: Health Care Triage #2

The latest from Dr. Carroll and Health Care Triage: In this episode, Carroll gives an overview of what health insurance is, a short history of what's been tried in the United States and what we're looking at going forward under the Affordable Care Act.

If you enjoyed this, please subscribe to his You Tube channel so you can follow along as they release new videos every Sunday afternoon.