Healthcare in the US: Restating the Problem

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The following is from a longer piece by Dr. Jeffrey Lieberman (MD) of Columbia University.  The entire address is on Medscape (see footnote), but I thought these paragraphs explain the current healthcare mess with brevity and precision.  The passage is unedited.

What should be done? I am not a politician, I am not a legislator, I am not an economist. I am a physician, but it seems to me that this is not rocket science. This really is something for which common sense could articulate the questions and develop a way to answer.

The first question is, is healthcare a right or is it a commodity? If it is a commodity, then you get what you pay for. If it is a right, then everybody deserves it. If it is a right, then it is the government’s responsibility to ensure that everyone deserves it. If that is the case, as was suggested with the passage of the Medicare and then Medicaid legislation, then how much is the government prepared to spend? How do we in a society want to spend? Is it 5% of our GDP? Is it 25% of our GDP? That determines how much money we can spend on delivering healthcare to the entire population.

This then needs to be translated into an infrastructure, work force, and financing system that will enable this care to be provided at whatever level we as a society, represented by our government, have determined should be done. What are the benefits and what are the limitations? Are we going to give everything possible to everyone through end-of-life care or are we going to have to ration it?

This is not an unprecedented situation; other countries have dealt with this already. There are single-payer systems, there are single-provider systems, there are hybrid systems. There are nonexistent healthcare systems. We really have a default system in which nobody has taken the responsibility to try to develop something in an enlightened fashion, and the result is what we have, which is not working.

Another issue that must be considered in any serious approach to try to deal with healthcare has to do with how we view biomedical research and the advances that it provides. The real solution to disease care cost is through research which provides, ostensibly, a better understanding and better treatments—and, ultimately, cures for illness. We have seen this over history how scientific breakthroughs lead to medical innovations that lead to reduction of disease and mortality, reduction in cost, greater productivity, longer lives.

Right now, we barely fund biomedical research.

My comment:  The Affordable Care Act and Trumps AHCA were both band-aids rather than solutions to fundamental problems.  Both sought to make the current mess more livable rather than actually fix anything.  Now, Trump’s budget proposes cutting funds for medical research to use for the border wall, which pushes any possible solution further into the future. While one might question whether spending on medical research is correctly prioritized, moving money from there to concrete in a desert solves nothing.


Sources:

  1. Jeffrey A. Lieberman, MD, “‘I’m Mad as Hell!’: Healthcare in America Today,” Medscape, 28 March 2017. http://www.medscape.com/viewarticle/877282?nlid=113688_1521&src=WNL_mdplsfeat_170328_mscpedit_wir&uac=153634BV&spon=17&impID=1317735&faf=1#vp_3

Spending time with Poe

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Poe has always been a favorite of mine. Please enjoy what Lyn has to say about him.

lyncrain

“Those who dream by day are cognizant of many things which escape those who dream only by night.”

A Dream is one of the countless poems Poe has written, a poem that contains imagery, symbolism, and a profound theme that explains how a dream can cause hope as well as sorrow. My attraction to Poe has always been because of the dark topics he focused his work on. Last year I shared my very favorite Annabel Lee and also the Raven. Anyone that reads poetry is familiar with the Raven, it’s a classic. But if asked are they familiar with some of his other great poems probably not. I hope you enjoy reading some of his less known works as much as I do.

A Dream Within a Dream  by Edgar Allen Poe
Take this kiss upon the brow!
And, in parting from you now,
Thus much let me avow —

View original post 668 more words

ABCMomma — Poem from LynCrain.com

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ABC Momma Is
A cool momma always
becomes a child’s best
consistent companion
during difficult times
encouraging and supportive 

A cool momma

finds ways to make
good and fun things
happen when needed most
invests herself without
juggling too much

A cool momma has

kisses and hugs in abundance
love shines like honey on a comb
multiplying over time and
nurtured just right
only to improve with time

A cool momma

propels us on a course
quintessentially perfect
regaling us with directions to
sail through life’s obstacles
taking strides confident
united universally on a mission

A cool momma is

vital to a child’s success
without ever loosing sight
xenia rocks way
yelling joyfully
zealous always

A cool momma knows
she is blessed to have a child.©

ABC Acrostic
Dedicated to my children, I love you!

 

via ABC Momma — lyncrain

Salt, Food, Sleep, Health and Taxes

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largeThere have been a number of articles relating salt and urination. The more salt you ingest, the more urine you produce.  Simple.

Now a Japanese study relates salt consumption to waking in the middle of the night to use the toilet. More salt means more trips to the bathroom at night.(1)

Salt affects blood pressure, and that in turn contributes to heart disease and stroke..  According to the American Heart Association, on average, Americans eat more than 3,400 milligrams of sodium each day.(3)

  • The recommended consumption amount is 1,500 mgs. per day for most adults, so this is more than double the recommended amount. Either too much or too little can be a problem. 
  • The maximum “safe” consumption is 2,400 mgs. per day.  The average American is way over the limit.
  • Most salt comes from processed foods such deli meats and canned soups. It’s important to read the labels and know what you are eating.

The British National Health Service estimates that salt reduction would result in 14,000 fewer deaths per year, at a savings of more than £3 billion.  The savings to Americans would be proportionally greater.

  • Converted to US dollars, the British cost savings is greater than the annual deficit reduction the recently deceased healthcare reform bill was supposed to produce.

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NOTE: There are contrarians who argue that concerns with salt consumption are a “myth.” I read one by Kris Gunnars, who claims to use an “evidence-based” approach. However, there is a complete lack of data in his argument; it reads like wishful thinking. My strong preference is for experimental designs using test and control groups rather than theory.

If you want to ignore facts, that’s your choice. However, you should know what you are doing and accept responsibility for the consequences of your actions. Making up “alternative facts” to justify your choice isn’t acceptable.

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What you need to consider:

  • What you eat can affect your quality of life, your health care and health insurance costs, and even your taxes.
  • However, this is one of those issues that requires large numbers of people to change behavior to make a difference. You need to mobilize your family and friends.

 


Sources:

  1. Sarah Knapton, “Cutting salt intake could stop excessive toilet trips in the wee small hours,” The Telegraph, 26 March 2017. http://www.telegraph.co.uk/science/2017/03/26/cutting-salt-intake-could-stop-excessive-toilet-trips-wee-small/
  2. American Heart Association, “What should my daily sodium intake be?” https://sodiumbreakup.heart.org/how_much_sodium_should_i_eat?utm_source=SRI&utm_medium=HeartOrg&utm_term=Website&utm_content=SodiumAndSalt&utm_campaign=SodiumBreakup
  3. American Heart Association, “Sodium and Salt.” http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/HealthyDietGoals/Sodium-Salt-or-Sodium-Chloride_UCM_303290_Article.jsp?gclid=CIbzu9fO9NICFYOKswodxbgPdw#.WNf0OKKVtPZ
  4. Kris Gunnars, “The Salt Myth – How Much Sodium Should You Eat Per Day?” https://authoritynutrition.com/how-much-sodium-per-day/
  5. Centers for Disease Control and Prevention, “Most Americans Should Consume Less Sodium.”  https://www.cdc.gov/salt/

Healthcare Reform: We’re probably not done yet

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There’s no question that Washington is in disarray today.

On the heels of President Trump’s ultimatum to Republicans late Thursday to either pass the American Health Care Act on Friday or be stuck with ObamaCare, Collins [R, NY] said tensions are at an all-time high. “I’ve never seen this before,” Collins said. “People are just refusing to talk to each other. They’re storming past each other.”(1)

The ultra conservative Freedom Caucus was demanding a straight repeal of the Affordable Care Act with no replacement. To that, Collins responded, “Oh, that would get about 50 votes.” 217 would be needed for passage. Not happening.

With the AHCA bill, the last minute attempts to gain support among ultra conservatives chased away more moderate GOP congressmen. Functionally, the bill died at 11AM Friday morning, when GOP Representative Rodney Frelinghuysen (NJ, a moderate and chair of the powerful House Ways and Means Committee) announced his opposition to it. That’s when Paul Ryan requested a meeting with Trump, and the decision to withdraw the bill followed.

That leaves obvious choices for the Administration:

  • Figure out how to unify conservative and moderate Republicans (hasn’t happened and there’s no clear way forward), or
  • Start working with Democrats, which will further anger the GOP right wing, or
  • Simply play golf for the next four years.

The Freedom Caucus wants to revisit repeal of the ACA. Trump has said he will leave ACA alone and move to other issues, notably tax reform.

GOP Senator Lindsey Graham said this today:

A day after President Donald Trump labeled the Democrats the ultimate losers in the failed Republican plan to repeal and replace the Affordable Care Act, Sen. Lindsey Graham urged bipartisanship on the issue moving forward.

“I don’t think that one party’s going to be able to fix this by themselves,” the South Carolina Republican said Saturday at a town hall event. “I think the President should reach out to Democrats, I should reach out to Democrats, and we should say, ‘Let’s take a shot at doing this together because it ain’t working doing it by ourselves.'”
After Republicans were forced to pull their bill to replace Obamacare from the floor of the GOP-controlled House on Friday, Trump blamed Democrats and vowed to let Obamacare “explode.”(2)
Unless Trump wants to learn from this experience, golf might be his best option.
What you need to consider:
  • We’re probably not done with changes in healthcare. Something may happen later this year. However, any bill that ignores the needs of consumers is unlikely to pass. Most Congressmen want to keep their jobs and the House is up for re-election next year.
  • You need to conserve cash because healthcare costs are likely to rise, although perhaps not as much as forecast if the AHCA had passed.  Whatever you have in savings probably isn’t enough.
  • Despite the dire warnings from the GOP, it’s unlikely that the ACA (aka Obamacare) will “explode.” Insurance companies like to make money, and they only do so when they write profitable insurance policies. The sky isn’t falling.
  • People who put ideology ahead of common sense and practical solutions should be in theology, not politics. They perform no useful service in Congress.

Sources:

  1. “Republican congressman says the GOP ‘hasn’t figured out yet how to be the governing party’,” The Week, 24 March 2017. http://theweek.com/speedreads/688200/republican-congressman-says-gop-hasnt-figured-how-governing-party
  2. Eugene Scott, “Lindsey Graham on health care: Republicans and Democrats need to work together,” CNN, 25 March 2017. http://www.cnn.com/2017/03/25/politics/lindsey-graham-donald-trump-healthcare/

Treating Blocked Arteries and Heart Failure

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This statement appears in an article about new mouse experiments to alleviate stress on the heart.  Now, I have talked to cardiologist, and even had one recommend an invasive procedure to detect a blockage, but had never heard this.  Have you?

According to the Centers for Disease Control and Prevention, approximately 735,000 Americans experience a heart attack each year. Opening a blocked coronary artery to restore blood flow to the heart prevents sudden cardiac death. However, doing so also triggers cardiac damage through oxidative stress and inflammation, which eventually can lead to heart failure.(1)

What you need to know:

  • Don’t passively accept a recommendation for a procedure. Get a second opinion from a doctor from a different medical practice.  Ask about risks and post-procedure quality of life. 
  • If you physician isn’t happy about your questions, find another physician.
  • Where the heart is concerned, you need to be energetic and efficient. Don’t squander time. 

Sources:

  1. University of Missouri-Columbia. “Limiting protein reduces post-heart attack injury in mice: Researchers use ultrasound to deliver new gene therapy to mouse model.” ScienceDaily. ScienceDaily, 23 March 2017. <www.sciencedaily.com/releases/2017/03/170323125531.htm>.
  2. John M. Erikson, Anthony J. Valente, Srinivas Mummidi, Hemanth Kumar Kandikattu, Vincent G. DeMarco, Shawn B. Bender, William P. Fay, Ulrich Siebenlist, Bysani Chandrasekar. Targeting TRAF3IP2 by Genetic and Interventional Approaches Inhibits Ischemia/Reperfusion-induced Myocardial Injury and Adverse Remodeling. Journal of Biological Chemistry, 2017; 292 (6): 2345 DOI: 10.1074/jbc.M116.764522

 

AHCA Outcome: questions?

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As described in my previous post, the AHCA was a bad bill that would have hurt most Americans.  The damage became worse in the late night negotiations, will traded away deficit reduction for more tax breaks for the rich and less care for everyone else.  That trade was to woo members of the ultra-conservative “Freedom Caucus” to vote for the bill, and it failed.  However, it forced GOP moderates to abandon the bill.  The final vote would have been ugly, so Trump opted to pull the bill.

What I don’t understand is why Trump supported this piece of legislation at all.  It didn’t match with his public statements about what he wanted to do.  He could have had his staff assemble the bill he said he wanted instead of wasting his efforts on this mess.

Frankly, I’m not sure Trump ever read this bill.  His tweets never were in sync with the content of this legislation.

Very strange.