Available Care Act – Beyond “Coverage”

Much talk about insuring people for healthcare needs.  The giant bedpan in the room is availability.  What good is having Medicare, Medicaid, exchange plans, if you cannot find a doctor for hundreds of miles who will accept your provider’s coverage?  Just look.

The pundits talk about providing millions of people “access” to healthcare; however, they cannot explain why many of the “covered” still do what they did when they had no insurance, go the emergency room of the public hospital known to be the one that cannot turn them down.

Health insurers specify what they will cover and what the insured must pay, in terms of dollars and percentages.  What they do not spell out, is the amounts they are willing to pay the doctors and hospitals for various treatments.  The doctors and hospitals that are willing to accept the insurer’s terms are added to a “network.”  If the insured uses these doctors and hospitals, “in network,” the patient pays less; “out-of-network” providers, the insured pays much more.

Medicare, and the related private insurance plans are shunned by many healthcare providers because of the intense complexity of coding rules, poorer reimbursement rates, and 6-month slow-pay of claims.  I cannot blame them for wanting the easiest, most profitable patients, but look at what that does to retirees:  it shoves them into the offices of the newest, least experienced doctors, who do not have privileges at the best hospitals.

Another specious barrier doctors erect is “not accepting new patients.”  If that is true, why do they prominently promote their doctors, facilities, and services?  Why do they list the insurance plans they accept, on fancy websites?  What do they do when patients get well, move, change, outgrow their need, or die?  Who takes their places?  Are there waiting lists?  This policy seems wildly inconsistent, and dubious to me.

Today’s labyrinth of laws, maze of insurance coverages, intricacies of medical practice, incorporation of hospitals, vast array of medical devices, tests, and procedures, and incomprehensible myriads of drugs and medicines, are the starting point of future choices.  The concept of choosing your doctors, clinics, and hospitals still appeals to me.  If all health insurance policies must meet some minimum standards of coverage, why should health providers exclude any of them?

We have a historic opportunity to put features into the fabric of healthcare; the federal government has more incentives and flexibility to “get it right” as they formulate new laws.  Why not pass a new law called “The Available Care Act?”  If you accept anything except cash for medical services or goods, you accept the coverage of any patient who walks in your door.

 

Apnea – The Loud Annoying Killer

Could you be suffering from sleep apnea?

I have sleep apnea, and have been treating it for 2.5 years.  Snoring is a symptom, although not all snoring is caused by apnea.  I am not talking about your run-of-the-mill snoring; I mean SNORING!!  I thought snoring was universal.  Snoring runs in my family – my brothers and I can easily drown out the sound of a chain saw.

Sometimes I can be a little stubborn and skeptical.  (After all, I did not hear any snoring, and it did not keep me awake.)  OK, so I snore a bit.  Doesn’t everyone?  I found out how much my snoring kept my wife awake, because she told me about it.

Sleep is very important to my wife.  Unless she gets 9+ hours every night, I wake up with a zombie.  I bring her a cup of coffee, in bed; she drinks it over 5 – 10 minutes; her eyes open to slit-level; I put the second cup of coffee next to her sink in the bathroom, and run to the kitchen; she smells it and gets slowly out of bed, and does that slow, side-to-side, living-dead sleep-walk into the bathroom.  Twenty minutes later, she is the living, breathing, woman I love.  But, that is when she gets enough sleep.

She tried earplugs, but the vibrations shook her awake, or gave her tremor-nightmares. (She lived in California years ago, and has not gotten over fear of earthquakes.)  I tried sleeping on my side, elevated pillows, breathe-right nose strips, sinus washing, those things you put in your mouth at night to keep your jaw positioned, only minor improvement.  Things came to crisis mode when I started waking up to an empty place in the bed.  I found her sleeping in another room.

Then I heard the word “Apnea;” sounded like a Balkan dialect.  How did this apply to me?  So, I went to the sleep doctor. At first, I did not believe it, even after I had my first overnight sleep study at an apnea clinic.

It took a second sleep study before I accepted the fact:  I do have severe “complex” sleep apnea.  The problem is not so much the snoring, but the silences, when no air is going in or out.  Without treatment, the study showed that, when I was asleep, I stopped breathing 67 times an hour, for 10 – 20 seconds; over eight hours, that would be 536 times per night, 5,360 to 10,720 seconds; 90 – 180 minutes; this is like holding my breath for one and a half, to three hours a night; my blood oxygen dropped to 89 – 94% several times each night (normal is 100%). Frequent interruptions to the sleep cycle can keep you from getting enough REM “deep” sleep, needed for quality rest and restoration of the brain.  That is not good for the brain, or anything else.

Things that could happen with untreated apnea:

  • High blood pressure
  • Forgetfulness
  • Depression
  • Daytime fatigue
  • Weight gain & difficulty losing weight
  • Lack of ardor
  • Trouble concentrating
  • Accidents
  • Nodding off during the daytime
  • Heart attacks
  • Strokes
  • Type 2 diabetes
  • Liver problems
  • Lower response to medications
  • Sleep deprivation
  • Spouse sleep deprivation
  • Divorce

Still skeptical, I ask, “aren’t these people just selling stuff?” Well, yes, no, yes, and yes, depending on who you mean by “these people.”  Yes, sleep clinics “sell” sleep studies, and they prescribe equipment to keep me from holding my breath 66 times an hour, in my sleep; no, the clinics do not sell the gear.  Yes, “durable medical equipment” companies sell the equipment.  And, yes, medical insurance and Medicare cover their share of the costs.

The doctor prescribed a heavy-duty, nighttime breathing machine called a “bi–pap.”  People with less severe cases use a similar machine called a “c-pap.”

I wish I could tell you that using the machine is a pleasure.  This would be a real treat, if you would find pleasure going to bed, wearing a plastic mask over your nose (and maybe your mouth too), with elastic straps to hold it in place, attached to a plastic air hose, attached to an electronic device that looks something like a portable radio, but without the music, that makes you feel like a scuba diver, or a jet pilot, and makes you sound like Darth Vader, or the announcer at a bus station.  Oh, you will need another elastic strap under your chin and over your crown, if you have trouble keeping your mouth shut, and only breathing through your nose. All this, just to keep breathing a few years longer.

It took me a while (60 nights) to get used to wearing it, AND sleeping; (you also need to remember you are hooked up when you get up in the middle of the night; it makes a bit of a mess when you sweep your bedside table clean with the air hose, in the dark, half asleep, waking your spouse, everyone in the house, and your next-door neighbors’ dogs.)  But, I am resolute; I use it religiously; now it only annoys me.  (Note: Any chances of spontaneous romance at night are, let’s say, ZERO.  Planning is the key.  It is sort of fun dating my wife again.  “Would Saturday about 8ish work for you, Sweetheart?”)

This is an amazing, computerized machine.  It monitors every inhale and exhale, to adjust to your normal breathing patterns and air pressure. It generates a constant flow of air at about the same speed and pressure you create when you inhale.  (If you close your throat, and open your mouth just a little, you can make the sound of the wind blowing; by pursing your lips a little tighter, you can make your lips sputter and vibrate.)

If you stop breathing, it blows air into your nose to fill your lungs, and gets you going again. The machine keeps track of sleep stoppages, and sends the results to the doctor.  After six months, the records showed only 1 or 2 brief stoppages an hour; not enough to cause any more brain damage.

I would encourage you to consider the possibility that you, too, might have sleep apnea.  If so, the treatment can change, even save your life.

Here are links to good sites about apnea.  You might want to check them out.

http://www.mayoclinic.org/diseases-conditions/sleep-apnea/basics/symptoms/con-20020286

https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea

https://www.helpguide.org/articles/sleep/sleep-apnea.htm

http://www.webmd.com/sleep-disorders/guide/central-sleep-apnea#1

 

Obamacare 6.7 Million Employees Lose Health Insurance

Yes, as I wrote in my August 31, 2016 article “Middle-Class Families Robbed by Obamacare – Before and After Taxes,” Obamacare has seen employers drop health insurance benefits for employees (6.6 million in 2014).

The administration boasts an increase of 9.5 million using the new exchanges in 2014.  Heritage.org provided this diagram of changes in health insurance coverage for 2014.  It shows that of 9 of the 9.25 million people newly covered were enrolled in expanded Medicaid.

It also shows the decrease in 6.7 million employer provided health insurance and 4.8 million increase in individual insurance.  Apparently 2.1 million self-insured (private pay, no insurance).

Employers stopped health insurance for 6.7 million employees after Obamacare came into effect.  The premiums paid by the employer for those insurance benefits were not taxed to the employees.

Often, those employers did not increase the paychecks of employees, they just pocketed the money.   The employees got a pay cut equal to the premiums.  The employees bought new coverage through the exchanges with after-tax dollars, probably for higher premiums than the employer paid.  But, even if the employee could buy equivalent coverage for the same premium, the employees lose.

Example:

Mary Smith earns $4,000 per month (taxable) and health benefits of $1,000 per month (not taxable).

Employer health insurance $1,000.  Equivalent individual coverage $1,400.

In the first example, Mary has $1,400 less per month, $16,800 per year.  The employer gains $1,000 per month, $12,000 per you.

In the second example, Mary has $615 less per month, $7,380 per year.  The employer loses $65 per month, $780 per year.

Employer Drops Health Insurance and Does Not Increase Salary to Offset

Obamacare

Employee Compensation

Before After Change
Salary 4,000 4,000 0
Income tax withholding 15%    600    600 0
Social Security & Medicare 6.75% 260 260 0
Paycheck                                              3,140 3,140 0
     
Health Insurance -1,400 -1,400
Total After-tax, after insurance       3,140 1,740 -1,400
Employer Costs
Salary 4,000 4,000 0
Social Security & Medicare 6.75% 260 260 0
Health Insurance 1,000 0 +1,000
Total Costs                                          5,260 4,260 +1,000

 

 

Employer Drops Health Insurance and Does Increase Salary to Offset

 

Obamacare
Employee Compensation Before After Change
Salary 4,000 5,000 +1,000
Income tax withholding 15%    600 750 -150
Social Security & Medicare 6.75% 260 325 -65
Paycheck                                              3,140 3,925 +785
     
Health Insurance -1,400 -1,400
Total After-tax, after insurance       3,140 2,525 -615
Employer Costs
Salary 4,000 5,000 +1,000
Social Security & Medicare 6.75% 260 325 -65
Health Insurance 1,000 0 -1,000
Total Costs                                          5,260 5,325 -65

 

 

 

 

Whining the Election – Trumpled Aspirations

Over the 52 years and 13 presidential elections I have been eligible to vote, I have never seen such sore losers, and humble winners.

I am disappointed with the disparate responses to the results of the 2016 presidential election.  Smug expectations from pollsters and pundits seem to have set a trap for Hillary’s disciples, and set a stage for impetuous, righteous indignation.  Rejection, disputation, refutation, spoilsport language, protests, and denial among disgruntled Clinton supporters is “over-the-top,” and “unpresidented.”  “He is not my president,” spake Gloria Steinem, Wednesday morning.  (Ironically, in the past, she also said, “The truth will set you free, but first it will piss you off.”) 

Why have Mrs. Clinton’s avid proponents gone off the rails into the deep waters of denial and despair?

I believe the presumption that Hillary Clinton had a commanding lead over Donald Trump was their downfall.  Belief in optimistic statistics led to haughty attitudes and supercilious sneers on the faces of Hillary’s fans.  The extreme vanity of the oracles’ predictions led to nasty, braggadocios, arrogance.  When pride met gravity, the indignity of the pratfall magnified the embarrassment of hubris. The expectations of overwhelming victory were shredded, by the unexpected appearance at the polls of hordes of angry, underserved workers.  The ambush of the uncounted, disenfranchised citizens prevailed.

The carefully crafted deception of optimistic unemployment statistics did not fool the people who took discounted wages and lesser jobs over the last eight years.  These voters had no voice among Democrats who applauded the “champion of hope” for his rescue of the economy, and restoration of the American Dream.  They were not deceived by or grateful for their thinly disguised demotions and the smiling, dismissive, carefully worded denigrations spun by an accommodating media on behalf of the Obama administration.

The scales did not fall from their eyes, because no scales formed as they lost their jobs, houses, cars, and pride.  The Affordable Care Act did not replace the healthcare insurance they lost when their employer dropped their health coverage; when they lost their jobs, their hopes were dashed by the failure of the “marketplace” to make personal health insurance and their out-of-pocket costs affordable.  Instead, they found themselves ravaged by astronomical premiums, deductibles, copays, and incredible prescription prices.  Hospitals and pharmacies raised their nominal, private pay prices to offset the discounts demanded by insurance providers.  The uninsured were left with impossible choices.

Promise after promise lay fallow by the roadside.  Example after example of the USA borrowing trillions of dollars to pay for the rest of the world’s problems and defense festered, while Americans suffered from the Great Recession.  Pact after pact, treaty after treaty left us at disadvantage.  Military efforts left us looking weak, as we shrank from conflicts under cover of spin.  Former allies spat disparaging invectives on our leaders.

Did Hillary’s followers believe she could pull us out of the ditch of weakness and doubt created these past eight years?  Did her apostles think her baggage and prevarications would evaporate by inauguration?  No wonder they were blindsided when Trump won.

Hillary’s “Health Issues” Might Have Been Better Managed

At the time of Hillary Clinton’s departure from the 9/11 ceremony, the temperature in Manhattan was 79 degrees with 54% humidity, & wind 6-8mph.  The Government Heat Index for those conditions is 80 degrees.  90 minutes would not cause dehydration, though it might aggravate existing dehydration.

Mrs. Clinton’s complaints of overheating, and the subsequent difficulties with walking could be from a combination of medicines and dehydration.

Mr. Clinton takes medicine such as Synthroid for hypothyroidism, takes Coumadin as a blood thinner, is under great emotional stress, and has pneumonia.  She may also be dehydrated.

According to Barbara S Lougheed, author of Tired Thyroid book and website, “When someone is VERY hypothyroid, noradrenaline will kick in to compensate for the lack of thyroid hormone, which makes the person feel hot and sweaty with an elevated heart rate.“ Medicine to treat hypothyroidism such as Synthroid may have similar symptoms.

Sources of feeling overheated are discussed at http://www.healthline.com/health/menopause/hot-flash-causes#Overview1

They include:

  • Side effects of Coumadin, which Hillary takes to combat deep vein thrombosis
  • Side effects of Synthroid or similar drugs, which Hillary takes for hypothyroidism
  • Alcohol, which can also aggravate dehydration
  • Emotional Stress
  • Infections, such as flu or pneumonia

Dehydration symptoms include:

So the question is, why is Hillary suffering from these symptoms and side effects while under constant care of her physician?  The testing and regulation of Hillary’s drugs and dosages, as well as the monitoring of her hydration is her doctor’s responsibility.  The treatment of infections, including pneumonia is also her responsibility.  Vaccinations are available for the most common causes of pneumonia, including the flu; has Mrs. Clinton had those vaccinations?  There are news reports of several campaign staffers going to the emergency room for illnesses like pneumonia or flu last week.  http://www.people.com/article/hillary-clinton-staff-sick-pneumonia

I guess what I am getting at is, could these problems have been avoided by proper medical attention?  The management of the disclosures is a separate matter.

Who Examines Presidents? – Whoever They Choose

 

Americans deserve and need to know the health of our President, and our Vice-President; but we do not.

That is right:  There is no impartial national medical team for our country’s top executives, or those who seek those positions.  Each president and vice-president picks their own doctors, and decides what medical information they disclose.  In fact, several presidents have withheld and even falsified their health conditions to the public.  Kind of scary to not know the health of the most powerful politician in the world.  And, a heartbeat away, it also makes knowing the health of the Vice-President more than a casual concern.

The 25th amendment to the U.S. Constitution provides emergency options, should the president be incapacitated.  It lays out protocols for the vice president to take over, temporarily, when the president is stricken.  Why rely on such extraordinary measures when we can anticipate, and avoid problems by knowing the health of our president?  We have the technology.

In a 1993 edition of The Journal of the American Medical Association, former President Jimmy Carter advocated “the creation of a ‘nonpartisan group’ of physicians to help decide when a president’s illness affects his judgment.”   Apparently, doctors of previous presidents said presidential disability was a terrible problem.

Examples of hidden conditions:

Ronald Reagan

Reagan fought hard to dispel any rumors about his ill health, even after surviving an assassination attempt and colon cancer.  Some historians speculate the 40th president suffered from dementia  while he was in office.  He was publicly diagnosed with Alzheimer’s Disease before his death in 2004.

John F. Kennedy

John F. Kennedy presented the image of youthful vigor, but was in chronic pain due to back troubles from a World War II injury and constantly fatigued from Addison’s Disease (a chronic insufficiency of the adrenal glands).

Franklin D. Roosevelt

FDR hid the severity of his polio until after his death in 1945. Roosevelt was barely able to stand as he governed through World War II.

Woodrow Wilson

Wilson concealed the fact that he had three minor strokes leading up to his run for the presidency.  During his second term, Wilson suffered a massive stroke that left him paralyzed and blinded on the left side of his body.  He couldn’t have a cabinet meeting for nine months.

His vice president, Thomas Marshall, refused to take over; Wilson could only manage his presidential duties with the help of his wife, Edith, who decided which issues deserved the president’s attention.

In this case voters were denied knowledge of conditions that seriously limited Wilson’s ability to govern.

William Henry Harrison

The 9th president of the United States died in his first month in office of “bilious pleurisy” which appeared as “inflamed lungs,” an “engorged liver,” and a “delirious mental state.”

We want to know that our top leaders are healthy enough to perform their vital roles.  As we approach the 2016 election, Americans are concerned that we have no reliable way to learn about the physical and mental health of the presidential candidates, and their running mates.  Right now, with no other mechanism in place, only the candidates can relieve our concerns.

Middle-Class Families Robbed by Obamacare – Before and After Taxes

The New York Times just published an article claiming that middle-class families are better off financially.  They blithely overlooked the greatest tax increase in recent memory and the greatest increase in medical cost Americans have ever seen.  We have been robbed blind.

Many employers dropped or reduced their health insurance benefits and left their employees to shop Obamacare market places.  Not only are the premiums higher and the benefits lower, but now they must pay with after-tax dollars.  Insurance premiums paid by employers is exempt from payroll and income taxes.  Any of the premiums employee pays must come from earnings that have been taxed at about 8% for Social Security, Medicare taxes; the employer pays the same amount in matching payroll taxes.

But that’s not all; the employee also pays income taxes on the earnings – at least 15%.  So 8% + 15% is 23% fewer dollars in the employees’ pockets just to get the money to pay for healthcare insurance.  Since Obamacare started, health insurance for middle-class families has roughly doubled.  They get no government subsidies; they have fewer choices of doctors and hospitals; the deductibles and copays empty the bank accounts.  People who have worked hard, have been nicked by the recession.  They may be working for a fraction of their former incomes.  Families are now strapped for cash, and struggle to find medical providers that will accept their healthcare insurance.

Ask yourself, is the New York Times right?  Have we increased our incomes enough to rise above the tax grab and the insurance double-cross?  Our economic anemia verges on leukemia; Obamacare is the pathogen, not the cure.