Hooray for Obamacare! How’s it doing?

No matter your politics, you must respect a Nobel Prize winning economist when he speaks in economic terms. The following is pulled from yesterday’s New York Times editorial by Paul Krugman.

Hooray for Obamacare!Paul Krugman

“Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies? No — I was pacing the room, too nervous to sit, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.

It didn’t. And that means that the big distractions — the teething problems of the website, the objectively ludicrous but nonetheless menacing attempts at legal sabotage — are behind us, and we can focus on the reality of health reform. The Affordable Care Act is now in its second year of full operation; how’s it doing?

The answer is, better than even many supporters realize. Read More …

Supreme Court upholds Affordable Care Act… Again

BREAKING NEWS

Supreme Court says, "ACA OK"

The U.S. Supreme Court this morning ruled on the landmark King v. Burwell case about the legality of federal insurance subsidies. In their 6-to-3 ruling they saved coverage for more than 6M Americans.

According to FierceHealthPayer, Chief Justice John Roberts said, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

Here at Modern Health Talk, we applaud the Court’s decision.

Fixing the Primary Care Crisis

Available in print form on Amazon.com for $14.95As I keep reminding people, Americans spend twice as much as other countries on health care yet still live sicker and die younger, according to the World Health Organization. At $3 trillion/year, that’s about 18% of the nation’s GDP, and it’s not sustainable, especially as our nation’s baby boomers approach retirement age and start needing more medical care in their later years.

I’ve known Dr. Stephen C Schimpff (electronically) for years and have published several of his articles here on mHealthTalk. I’m happy today to promote his controversial new book, Fixing The Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor. ($3.95 for the e-book and $14.95 for the print edition)

Dr. Schimpff begins his book with an overview of what primary care is and is not, why it’s in crisis, and why the American medical care delivery system is so badly dysfunctional. He then explores the concepts of integrative medicine, trust and the all-important issue of healing. Read More …

Wealth Inequality, Healthcare and the Economy

A Washington Post article last week concluded that People have no idea what inequality actually looks like, and that caused me to respond and to enhance this article, which was published here two years ago. It features some disturbing videos that help us understand the corrupting influence of big money in politics and the direct relationships between:

  • Special interest lobbying and policies resulting in a widening of income & wealth gaps,
  • Between the widening wealth gaps and poverty,
  • Between Poverty and obesity,
  • Between obesity and diabetes and other chronic illness,
  • Between chronic illness and rising healthcare costs, and
  • Between rising healthcare costs and our economic problems.

Read More …

Insurance Cost = Premiums + Deductibles + Copays

Obamacare Enrollment Drive

MIAMI, FL – FEBRUARY 05: Aymara Marchante (L) and Wiktor Garcia sit with Maria Elena Santa Coloma, an insurance advisor with UniVista Insurance company, as they sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on February 5, 2015 in Miami, Florida. Numbers released by the government show that the Miami-Fort Lauderdale-West Palm Beach metropolitan area has signed up 637,514 consumers so far since open enrollment began on Nov. 15, which is more than twice as many as the next large metropolitan area, Atlanta, Georgia. (Photo by Joe Raedle/Getty Images)

OPINION by Wayne Caswell, founder & senior editor, Modern Health Talk

This is an obvious opinion piece that I posted on Huffington Post in response to another opinion piece, It’s Not Just You — Those Health Insurance Deductibles Are Getting Scary.

MY RESPONSE:

The article was well written but misleading because it failed to acknowledge that Total Insurance Cost = Premiums + Deductibles + Copays. Instead, it focused almost exclusively on high deductibles. Read More …

Is American Health Care the Best?

“Is American Health Care the Best?” The answer to that question might depend on whom you ask, but by almost all measures we aren’t even close. That was the message of this article on Vox that says people who believe our health system is the best are “measuring it wrong.” Here’s some measures we should be considering, followed by some supporting graphs and videos and my perspective:

  • Costs: America spends vastly more than any other nation, often more than twice as much
  • Access: Tens of millions of Americans remain uninsured. Even after Obamacare, we’ll be behind.
  • Satisfaction: Patients here are less happy with their system, and nurses & doctors are too.
  • Mistakes: Hospitals are dangerous places, given the number of infections & medical errors there.
  • Outcomes: Americans live sicker & die younger. Longevity is shorter and infant mortality is higher.

Read More …

White House Healthy Aging Policy Brief

White House Conference on AgingHealthy Aging Policy Brief

 By White House Conference on Aging staff, 4/10/2015

Older Americans are calling for a shift in the way we think and talk about aging. Rather than focusing on the limitations of aging, older adults across the nation want to focus instead on the opportunities of aging. Older adults are seeking ways to maximize their physical, mental, and social well-being to remain independent and active as they age.

Healthy aging means living a long, productive, meaningful life and enjoying a high quality of life. Research has shown that older adults who adopt healthy behaviors, use preventive health services, and are involved with their family, friends, and communities, are healthier and more independent.

Remembering that we are essentially the same people we were at our physical and productive peaks, just somewhat adjusted to accommodate the years, allows us to visualize lives of possibility with an overlay of wisdom. (Molly D., Georgia)

Americans are living longer and better than ever before thanks to major medical and public health advances and greater access to health care. Life expectancy at birth in the United States has reached a record high of 78.8 years. A 65 year-old man can expect to live another 17 years and a 65 year-old woman another 20 years. With increased longevity, older Americans have more time to engage in the workforce, in civic and volunteer activities, and in enriching their communities. Read More …

Telehealth Legal Obstacles Delay Home Healthcare

Doctor Robot

DOCTOR ROBOT: Technology like this RP-VITA device at Mercy San Juan Hospital in Carmichael, Calif., lets doctors beam themselves to remote patient bedsides, but government rules need to catch up. (AP / Rich Pedroncelli)

Home telehealth” technology promises to be a critical component of providing quality care to the growing number of Americans who need long-term services and supports to “age in place” at home. Home telehealth and related technology can make it cheaper, easier and more comfortable for seniors to remain at home and avoid nursing facility placement.

But government regulations lag behind telehealth technology, according to this article in the National Law Journal. This is disappointing because “24-hour monitoring would allow Americans who need long-term care to ‘age in place’ at home.”  Read More …

Top 10 Ways Our Healthcare System seems Evil

America is Snake Bit“A Lot Of People In This Industry Are Just Evil”
(Jeff Kushner, founder Of Oscar Health)

That provocative quote from Josh Kushner at the 4th annual Clinton Health Matters Initiative, was aimed at the healthcare industry and reported by Forbes contributor Dan Munro. Josh was one of four panelists in a 90‒minute opening Plenary Session moderated by Former President Bill Clinton.

Clinton opened by lamenting that technology adoption in healthcare can take as long as 17 years and sarcastically said, “By all means let’s wait 17 years and let people die in the meanwhile.” He then asked Josh to begin a discussion of the issue. But what’s behind his claim of excessive greed or evil? I can’t speak for Josh directly, but here are the top 10 ways our healthcare system seems evil.

Excessive greed (evil?) is natural for an industry that:

Read More …

Precision Medicine vs Prevention & Wellness

Health iconsPresident Obama and the National Institutes of Health have announced a Precision Medicine Initiative that complements other programs for Prevention and Wellness. That’s important because too many diseases don’t have a proven means of prevention or effective treatments.

Read More …

The Cost of Aging in America

 

Income levels for aging Americans are increasing,
but not as quickly as “The Cost of Aging in America.”

The infographic below was produced by the Milken Institute School of Public Health at George Washington University. It explores the serious financial burdens faced by aging Americans, their loved ones, and industry — as well as steps our health care system might take to counteract this trend. I gladly feature it today to complement other articles here about health reform, public policy, and the future of healthcare.

Some highlights:

  • The number of seniors 85 and older will triple by 2050, an important statistic because these are people who need the most expensive care.
  • The cost of healthcare in America is already over $3 trillion/year, and that doesn’t even include the roughly $450 billion provided by unpaid family members.
  • Paid caregivers earn just $18-20K per year, and while demand for their services will likely double by 2022, their wages likely won’t increase much.

Read More …

Lack of Fast Internet threatens Telehealth Future

I responded to an online discussion of a call for Congress to Expand Telehealth Services to Improve Patient Access and Outcomes and Decrease Healthcare Costs. Key to delivering telehealth is the availability of high-speed Internet access, and that prompted me to comment on an online conversation of this HIMSS problem description.

The enormous potential of telehealth or telemedicine to positively transform healthcare delivery in America is not being realized due to numerous impediments. These include out-of-date public and private reimbursement structures, inadequate broadband availability, and varying licensure and practice restrictions between some states. … In many areas of the country, there are not enough health professionals to provide in-person visits or appropriate follow up care, especially for mental health and highly specialized services like pediatric critical care. In other areas, distance or unavailability of transportation presents impediments to care.

Read More …

Cars for seniors who can’t drive themselves

Google's Driverless Car

EDITOR: When seniors can no longer drive a car, they lose their independence and become dependent on others for the simplest things — shopping for groceries or Christmas gifts, getting a haircut, going the bank or doctor or the movies, and more. That can be devastating and even force them into institution care, ultimately shortening their lifespan. So it’s why I’m a fan of the autonomous, self-driving car, and Google, the company that’s so far leading the way. And it’s why I’m happy to republish this article by Zachary Shahan at FIX.com about cars for seniors who can’t drive themselves.

Hands-Free Driving: Google’s New Driverless Car

One of the biggest tech stories of the year is definitely the unveiling of Google’s driverless car. The general story is this: Google is manufacturing some completely self-driving cars – no steering wheels, accelerator pedals, or brake pedals. But the details are pretty fascinating, and even more interesting are the broad societal implications. Read More …

The Truth About Ebola – What & WHO to believe?

Ebola virusEDITORIAL: Who are we to believe? The news media that profits from sensationalism? Or federal and public health officials who are desperate to avoid panic? What is the truth about the Ebola virus? Right now it’s not clear who to believe, and we continue to wonder, “What is the Truth about Ebola.” Here are some of my thoughts and related articles, but I invite you to respond.

With the number of Ebola cases doubling, doubling and doubling every week or two, or three; how long might it take to reach millions, or billions? Not only is the number of cases grossly under-reported, but health officials and governments are grossly downplaying the risk and misleading the people. It seems like they’re lying, and that doesn’t help, because it erodes public trust and contributes to growing fears.

Swiss Cheese of Risk

HOLES IN THE SAFETY NET(s)

Even with multiple safeguards, rapid spread of horrific disease (like terrible traffic accidents) can occur. This is the thought behind the “Swiss cheese” model of risk, developed by British scientist James Reason, and described by Vamsi Aribindi, a medical student who wrote Ebola in Texas: A fascinating story of system errors (referenced article below).

Read More …

About Operating Room Safety

 Make Sure You’re in the Safest Possible Operating Room

Operating Room

The Hazards of Hospitals

We all think of the hospital as a place we go to get better, but hospitals in the United States are making people sicker at alarming rates. Between overtired interns, germ-covered doctors,  haphazard record keeping, and equipment failures, you might find yourself in more trouble than you were when you checked in. Here are some alarming statistics, followed by some patient recommendations.

  • 1.7 million infections are contracted in hospitals each year.
  • 1 in 5 patients suffer harm from medical errors, and 99,000 die from them.
  • You’re 30,000 times more likely to die from a hospital visit than a plane crash.
  • And more die from infections each year than from car accidents, breast cancer or aids.

High Anxiety

The simple mention of having a medical procedure brings out anxiety in most people. It’s human nature to become fearful when preparing to undergo a surgical procedure that requires in-patient treatment, sedation and operating rooms, as it is associated with pain and mortality. Read More …

Housing an Aging Population

U.S. Unprepared to Meet the Housing Needs
of Its Aging Population

Harvard Joint Center for Housing Studies & AARP Foundation Release New Report

Washington, D.C. & Cambridge, MA (9/2/2014) – America’s older population is in the midst of unprecedented growth, but the country is not prepared to meet the housing needs of this aging group, concludes a new report released today by the Harvard Joint Center for Housing Studies and AARP Foundation. According to Housing America’s Older Adults—Meeting the Needs of An Aging Population, the number of adults in the U.S. aged 50 and over is expected to grow to 133 million by 2030, an increase of more than 70 percent since 2000 (see interactive map). But housing that is affordable, physically accessible, well-located, and coordinated with supports and services is in too short supply.

Aging Brings Risks

Read More …

Why doctors are so afraid of apples

Old Rotten AppleAs implied in An Apple a Day… the fruit and the smartphone can both keep doctors away, and that has many of them terrified for good reason.

Those at the top of the healthcare mountain especially fear the Healthcare MiniTrends, because they know 429 of the original Fortune 500 companies (1955) are no longer in business today. And they’re looking down at a new class of hungry competitors who are already exploiting these minitrends.

Let’s look at just two of the trends: (1) the new focus on wellness, and (2) new smartphone uses. Read More …

Doctored, about Physician Disillusionment

Doctored - The Disillusionment of an American Physician

Click to buy on Amazon.com

Doctors are just as frustrated with our fee-for-service “sick care” system as patients are. Following on the heels of a related article from a few days ago by Dr. Stephen Schimpff, today’s post introduces an NPR article featuring an in-depth interview with cardiologist Sandeep Jauhar, MD, who wrote the book, Doctored: The Disillusionment of an American Physician. It begins…

“As a young doctor working at a teaching hospital, Sandeep Jauhar was having trouble making ends meet. So, like other academic physicians, he took a job moonlighting at a private practice, the offices of a cardiologist. He noticed that the offices were quick to order expensive tests for their patients — even when they seemed unnecessary. It was ‘made very clear from the beginning’ that seeing patients alone was not financially rewarding for the business.”

Read the rest at NPR, listen to the full interview below,
or watch the Wall Street Journal interview below that. Read More …

101 MiniTrends in Health Care

Watch for Trends Ahead

This image is from MiniTrends, a book by John Vanston that I strongly endorse. I’ve known John for years and did consulting work for his company, Technology Futures. His book inspired my Modern Health Talk vision. (Click image to see book. Go to end to hear about the MiniTrends conference.)

“What the Hell is happening to health care?”

“And is it an Opportunity or a Threat?”

Insights by Wayne Caswell, Founder of Modern Health Talk.

An awful lot has changed in just the last few years and even more will change in the near future, with the aim of reducing (or at least containing) our health care costs. What’s behind these MiniTrends, and what is their implication for providers, payers and consumers? That’s the $1.5 trillion question. Here I talk about many, many MiniTrends–surely you can find 101 of them if you look! 

“It is not the strongest or the most intelligent who will survive but those who can best manage change.” – Charles Darwin

That quote is important, because 429 of the original Fortune 500 companies [1955] are no longer in business today. That’s a scary thought for those sitting at the top of the healthcare mountain, because they know they must adapt to the megatrend of health reform and Obamacare (the Patient Protection and Affordable Care Act) or die. And they are looking down with fear at the hungry competitors who are already exploiting the many related minitrends, because for them these are times of great opportunity.

Read More …