Life Flies By . . .

May 9, 2013

ImageQuack Quack Quack . . .

May 13, 2013… I flew by and posted a piece on the above date about ObamaCare and the Health Exchanges and no one seems to be home around this empty nest to wish to comment… Although, Thanks for the “Likes” from @lobotero and @cmaukonan Oh well.

In closing: Be Well!


The Choking Hypocracy of Tea Party Republicans in Michigan

Several months ago on the Michigan statehouse floor, two state representatives were censured for uttering the word “vagina”.
The word offended the delicate ears of a few other representatives so the two women, Brown and Byrum , were stripped of their right to speak on behalf of their constituents for a day.
Yesterday, a bill was introduced by Michigan Republicans that insists upon the insertion of a medical device into the vagina prior to an abortion.
On a personal note, I’ve had recent experience with a transvaginal ultrasound. Physically, it was mildly uncomfortable. Emotionally, it was as embarrassing as hell. Was it medically necessary? Yes. Very much so as a way to determine if some of my lady parts were cancerous.
But, there is no reason for this extra intrusion into a woman’s body before an abortion is performed. An abortion that the woman has requested.
I mean, the woman already knows there’s a fetus up in there. A transvaginal ultrasound is not needed to medically prove what has already been established. I can’t fathom any other reason why this type of test should be done on a pregnant woman other than to establish pregnancy which can be more easily done by peeing on a stick.
As far as I can tell, this is an attempt by Tea Party Republicans to coerce a woman to forgo an abortion through embarrassment and frustration, to cause her further financial hardship because any ultrasound procedure is not cheap, all for the sake of an ideology that only a sliver of the population embrace.
But, a transvaginal ultrasound as a prerequisite for an abortion? It’s just simply ridiculous. Unnecessary. I see it as nothing more than a power trip by a bunch of old white guys that get their rocks off by humiliating women.
That might be a little harsh, but, it’s exactly how I see it.
It’s amazing. One minute a Tea Party Republican cannot bear to hear the word “vagina” and the next they want to ram a probe up there and take a picture.

UPDATE: This bill has been shot down by the Michigan House Speaker….but, I’ll be waiting to hear what will replace it. House Speaker Jase Bolger still has not been cleared by a grand jury investigating election fraud. Who can trust what is said by someone who can cheat so easily?

Tales from the Psychiatric Nurses Station – Child/Adolescent Part 1

It has been a while since I’ve written on here so I thought I would come on and say hello.  Alot has happened on the unit that I have worked for about a year.  Among the lack of sleep from my thoughts racing due to the kids on my mind from all of their traumas to being in school again to work on my Bachelors degree.  I’d like to give you two the brief case studies  on my most memorable patients and how they’ve impacted me.

Over the past year I have learned a lot about child and adolescent psychiatric care.  Never before in my life did I think a small child would have to endure the pain, horror, and terrifying abuse that some of these children have had to face. Seeing the look on the faces of these children who have been sexually abused by relatives, family friends, or rarely strangers; rips at your very soul.  I find sleep escapes as the child’s face enters my mind’s eye, an image of them cowering in the corner fills my thoughts. I’m paralyzed with reality and I am not a confused child who is inexperienced in the trials of life and all that is evil.  I am not the abused.  The same child has been to 4 or 5 different foster homes in the span of 4 weeks.  She has no one to love her and she asks me “can you be my mommy?”

Continue reading “Tales from the Psychiatric Nurses Station – Child/Adolescent Part 1”

The Angriest Liberal

Today Jeffrey Goldberg exposes the Komen Memos, prepared early in January to obfuscate the firestorm they knew would occur when they made moves to target Planned Parenthood in a larger war that the ultra right is waging to curb no vanquish complete access to health care for women. We aren’t just discussing abortion now, we are also discussing contraception and ultimately whether or not women can make choices for their own bodies without interference.

Today we all know Komen reversed their decision because of a sustained backlash against the group for politicizing the health of women.

December 16, 2011: According to this memo sent out to Affiliates for SGK that grant eligibility criteria had been rewritten, bullet point 2 states this:

Further, should Komen become aware that an applicant or its affiliates are under formal investigation for financial or administrative improprieties by local, state or federal authorities, the…

View original post 828 more words

My New Favorite Comment

Slowly, but surely, the Affordable Care Act is having a positive impact on everyday life in the ole USA.

In the Washington Monthly, Steve Benen writes in the Political Animal blog how the ACA is working — actually working — right now. Not in 2014. Right now. It’s a short blog with links to stories (mostly written by him) that illustrate his points.

Now, after all the negative feedback about the ACA, all the bellyaching and boohooing about “Obamacare” and how it sucks, blows, ain’t enough, is way too much, repeal it and yadda-yadda, we are beginning to get reports that it’s working out better than what was wildly imagined.

Which brings me to my new favorite comment.

From commenter #3:

Hedda Peraz on December 19, 2011 1:21 PM:

This Affordable Care Act sounds like just the ticket to replace the failed ObamaCare!


Gotta love it!


Helping the Working Poor — A Practical Defense of PPACA

The Health Care Bill, more often than not, raises the ire of both conservatives and progressives. They’ve teamed up to spread as much misinformation about the bill as possible. Why? I am not sure, because this bill goes a long way to get more people access to health care.

I think it all began with a guy named Howard Dean and some comments he made In December of 2009.  Dean was very angry that the public option was eliminated from the Senate bill. The target of Dean’s rant was Joe Lieberman, ( I)CT, he was pretty pissed at Lieberman and he seemed to feel no bill would be better than this bill now. He was angry at the process. And his anger is not unfounded. This Senate has become a branch of our government that is immovable, ideologically entrenched, almost completely unable to pass any worthwhile legislation. Dr. Dean was pretty pissed about that, as we all should be. However, instead of directing his anger at the improbable 60 vote requirement to pass any legislation of substance, he decided it would be time to just let Republicans win by killing the bill. That didn’t happen of course, but that was an extreme reaction, one Republicans were relying upon, this is where they were able to begin to sow the seeds of discontent among voters, they have filled the air with misinformation, with the help of people who are otherwise quite progressive. All that discontent, and the Executive Branches unbelievable inability to fight back against the propaganda has left people with a sour taste in their mouths when it comes to their thoughts about PPACA.

A number of people jumped on Dr. Dean’s bandwagon, Keith Olbermann went on the air to loudly proclaim why the Senate Bill should not be passed. Two days after Dean’s rant against the bill, a number of left leaning organizations and people banded together to help kill the bill:

Dave Linderhoff of The Public Record
Jane Hamsher of FireDogLake
Markos Moulitsas; Daily Kos Founder
Darcy Bruner; a past candidate for Congress

Lying about ACA has become something of a cottage industry. But don’t believe the hype, the reforms already implemented have brought down insurance costs, added more people to insurance rolls, new benefits for senior citizens, implemented necessary regulations regarding pre-existing conditions and an 80% requirement that premiums be spend on the consumers health care costs, with 20 mandated for administrative costs.

People who will benefit most from the bill:

  1. Those without any insurance.
  2. Those who have paid for expensive individual policies on their own.
  3. Employees of small businesses that have trouble affording the cost of joining a group plan.
  4. Low income Medicare participants who are left paying for whatever is not covered by Medicare for their medical bills and prescriptions.

Who is without access to health insurance? Some of those people are the working poor. It has been a long struggle to get federal legislation dealing with this problem, the estimates are there are some 45 million people without access to basic heath care.  In the past, some states attempted to solve this problem on their own by setting up their own state run “group” for people who didn’t qualify for Medicaid. When the boom of the 1990’s ran its course, those programs began to be cut severely because of the expense of running the programs and because states don’t have as much revenue since the economic downturn and they are having to make tough choices.  Many states of course never attempted such things. Washington State has such a program, but its funding has been cut in the past few years so although people may qualify by their income, there are no slots open to take them as customers, in fact the plan has had to disenroll people because of a lack of funding, in total 17,000 members were disenrolled.

However the results of PPACA have been positive.

  • More young adults have coverage
  • Requires beginning this year, insurers must spend 80% – 85% of premiums in actually delivering care
  • Premiums decreasing even for state employees.
  • Our health insurance plans now have to justify their premium rate increases to the State and pass an approval process before they can raise prices.
  • Because of the ACA, young adults can now stay on their parents’ insurance until the age of 26.
  • New York has something called “community rating,” which means that health insurers can’t charge you higher rates simply because of your age, gender, or health history.
  • Because of the ACA, we no longer have to pay co-pays for many preventative care services.
  • Because of the ACA, people with pre-existing conditions now have choices for coverage, one example the NY Bridge Plan.
  • Because of the ACA, seniors who hit the Medicare “donut hole” are now getting help with their prescription drug costs.
  • States like New York have a law in place called “guaranteed issue,” which means that insurers have to offer health insurance to everyone, even if they have a pre-existing condition (even though they have waiting periods for coverage related to that condition.  But thanks to the ACA – those waiting periods will soon be a thing of the past!). 
  • More changes to Pre-existing condition plans by states, here is a preview, premiums have decreased.
  • Premium and Cost sharing subsidies to individuals: the mechanism provides refundable and advanceable premium credits to eligible individuals and families who fall between 133% and 400% of FPL (Federal Poverty Level) to purchase insurance through state created health exchanges.
  • Provide Costsharing subsidies to eligible individuals and families. Cost-sharing credits reduce the cost sharing amounts and annual cost-sharing limits and have the effect of increasing the actuarial value of basic benefit plan to the following percentages of the full value of the plan:
    • 100 – 150% FPL  94%
    • 150 – 200% FPL  87%
    • 200 – 250% FPL  73%
    • 250 – 400% FPL  70%

Health Exchanges: a few examples

  • Vermont : passed legislation to build a single payer plan for the state of Vermont and in October  of this year, (2011) that plan got one step closer to implementation.

These new federal policies are working. I think this is good. There seems to be a small, but loud coalition of people on both sides of the ideological aisle who would have you believe PPACA is a complete failure, but the evidence says otherwise. Let’s stop letting them get away with their propaganda war against delivering health care to those who would not otherwise have access. Let’s fight back with the facts at hand, because the facts indicate the legislation is working.

Crossposted at TheAngriestLiberal

ObamaCARE … Embrace it … folks…

The following comes from the Kaiser Health News Blogs

This is what the people in Colorado are doing to help others understand what ObamaCARE can do for all of us.


Short Takes On News & Events

Groups Thank ‘Obamacare,’ And Not Sarcastically

By Andrew Villegas

October 25th, 2011, 11:28 AM

“Thanks Obamacare.”

Usually Americans hear that phrase only in the most sarcastic contexts. Opponents of the health reform law have hung the “Obamacare” moniker on it to belittle the measure as nothing more than an attempt to fix America’s health care problems – varied as they are – with a one-size-fits-all approach they say expands the reach of government to never-before-seen levels.

We hear it used almost daily by Republican candidates for president, who have picked up the theme and taken it one step farther — to ”Romneycare,” which has become a the negative label for GOP presidential hopeful Mitt Romney’s health reform in Massachusetts. Former GOP presidential candidate Tim Pawlenty even coined the phrase “Obamneycare” to link the state law Romney signed while governor to the federal law advanced by President Barak Obama.

This is not the first time “-care” has been used to describe a health reform effort. Back in the 1990s, “Hillarycare,” named for the former first lady and now secretary of state, was used to describe the Clinton administration’s attempt at overhauling the health care system. In the 2008 presidential primary elections, the GOP candidates in turn linked “Hillarycare” to Romney to try to unseat him as the odds-on favorite candidate.

But now, two nonprofit advocacy groups, ProgressNow Colorado Education and the Colorado Consumer Health Initiative, are trying to take back “Obamacare,” painting it as a positive brand in a new campaign (complete with its own Twitter feed and hash tag, #thanksobamacare) launched Monday. The campaign highlights 10 reasons people should  be thankful for the health law. Among them: allowing people younger than 26 to stay on their parents’ health insurance plans and stopping insurers from denying coverage to children with pre-existing conditions (the law does the same for adults beginning in 2014).

The effort also comes with a video, below, which places a special emphasis on the “-care” part of “Obamacare.”


~OGD~ Report: Medicare Advantage 2011 Data Spotlight: Medicare Advantage Enrollment Market Update

Tighten the screws on the lying right…


(Cross-posted from TPM Café Castaway . . .)


Recall the Republican meme during the 2010 elections that the Obama Medicare plan was going to cut seniors’ Medicare benefits and the premiums would increase?

Well… As we all know – if one were to actually have a grip on the facts – the Republicans and there bastard offspring in the Tea Party were full of crap.

In 2010 there were 11.7 million seniors in Medicare Advantage plans, the private insurance alternative to Medicare. The CBO predicted Medicare Advantage enrollment would be 10.2 million in 2012. Health and Human Services now project that figure will be 13.1 million. And, in the words of HHS Secretary Kathleen Sebelius, “On average, Medicare Advantage premiums will go down next year and seniors will enjoy more free benefits and cheaper prescription drugs.”

By Phil Galewitz,  WaPo Published: September 15

The nearly 12 million senior citizens enrolled in private Medicare health plans will see their monthly premiums drop by an average of 4 percent while benefits remain stable next year, the Obama administration officials announced Thursday. In addition, they said, premiums fell by an average of 7 percent this year, much higher than the 1 percent the government projected a year ago.The plans, called Medicare Advantage, are offered by health insurance companies as an alternative to traditional, government fee-for-service Medicare.

Enrollment in the plans, which now cover about a quarter of all Medicare beneficiaries, is expected to grow by 10 percent in 2012, said Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services. Blum said health plans are also lowering co-payments and deductibles.

He attributed the premium drop to the agency’s strong negotiations with plans, as well as to the companies’ continuing desire to serve the market. (continues…)

And the following is the data compiled by the Kaiser Family Foundation

Medicare Advantage 2011 Data Spotlight: Medicare Advantage Enrollment Market Update

This data spotlight examines enrollment trends in Medicare Advantage plans in 2011 and finds that despite concerns about the effects of the 2010 health reform payment reductions on private Medicare Advantage plans, enrollment continued to rise this year.  Additionally, Medicare Advantage enrollees are paying lower premiums, on average, than they did in 2010. Preferred Provider Organizations gained more enrollees than any other plan type, while enrollment in Private Fee-for-Service plans continued to decline.The analysis was conducted by a team researchers at Mathematica Policy Research, Inc. and the Kaiser Family Foundation.

Data Spotlight (.pdf)

Information provided by the Program on Medicare Policy
Publication Number: 8227
Publish Date: 2011-09-09

That is all…



(Cross-posted from TPM Café Castaway . . .)



Global Population Aging, But Absent Income For Healthcare

Peak child and the graying population of the developing world.

Some researchers suggest we have already passed what is known as ‘peak child’. That supposedly happened in 2005. Incomes aren’t going up relevant to the aging population but are necessary to support age related illnesses.

This is an extremely interesting piece identifying the global aging trend and ties it to the global economy and makes some assumptions and conclusions about the sustainability of populations.

This isn’t unfamiliar to us becasue we have already experienced (for whatever reason) issues with our healthcare system which have a broad impact upon our overall population. How this interaction happens isn’t much agreed upon except to say our healthcare resource is under stress.

Definitely worth a read.

What are the biggest challenges of global health? Typically, we think in terms of things like vaccines and basic sanitation, which are issues in the poorest nations. But a panel on the topic, hosted by the Lindau Nobel Laureates Meeting, painted a very different picture. The majority of the world’s nations now look very much like the industrialized world, with small family sizes and life expectancies of around 70 years and up. Many of them, however, have gotten there without the sort of economic growth that preceded a graying population in the industrialized world. As a result, one of the big challenges in global health is now caring for an older population on a low budget.

The trends were driven home by the Karolinska Institute’s Hans Rosling, who relied on graphs that can be created using a site called . These track various demographic features of most of the world’s nations, such as life expectancy, GDP per capita, etc. The plots can be rolled forward and backward in time, and individual countries can be traced as changes occur. Rosling used a series of these graphs to demonstrate a number of points about the trends that have taken place over the past century.

Rosling started with a plot of family size vs. life expectancy; in the 1960s, the industrial world occupied the upper-left corner of the graphs below, with small families and longer life expectancies. Track forward to today, and all but a few African countries (many of which are suffering from HIV epidemics) have made their way to the upper left of the graph. Now, as he pointed out, Bangladesh is where Germany was in the 1960s. For adults, the greatest risk of death is in traffic accidents; for children, it’s drowning. “The world has gotten better,” Rosling declared. “It’s bullshit to say otherwise.”

A century ago, only the most industrialized nations were beginning to see increased life expectancy.

Outside of Africa, almost all countries now see smaller families and much longer life expectancies.

The net result is that we reached what he termed “peak child” in about 2005. The world used to be dominated by the population in the lowest age brackets. That’s now starting to shift—with the biggest chunk of the population now being in adolescence. The world isn’t getting gray just yet, but, as Rosling put it, “we now just have adult population growth.”

But that’s going to pose some significant challenges, since Bangladesh hasn’t tracked Germany exactly. If you plot life expectancy against GDP/capita, you’ll see that Bangladesh’s growing life expectancy hasn’t been paralleled by economic growth. Similar things are happening all over the globe; Vietnam now has a life expectancy that US had during Vietnam war, but its purchasing power is where the US was during its Civil War. “We’ve never had a point in our history where countries have modern life expectancy illnesses without the income to support treatments,” Rosling concluded.

This isn’t to say that diseases related to abject poverty weren’t a problem; there are certainly areas of the globe with failed governments or persistent poverty that don’t have the basic nutrition and sanitation to see these sorts of extended life expectancies. But, in general, those have become the exceptions.

Making medicine cheaper

With that as an introduction, the entire panel looked at how this might influence global health over the next few decades. Unni Karunakara of Médecins Sans Frontières, summarized Rosling’s talk as follows: there’s a difference between spending on health and spending on essential healthcare. More and more of the world is starting to do the former, but it’s making for a bumpy transition. India, he said, still spends 15 times its health care expenditures on its military. If it decided to flip those around, the system couldn’t handle the large influx of funds; there simply aren’t enough nurses to handle that much additional care.

The low funding in much of the developing world actually helps in some ways. Karunakara argued that corruption hasn’t become a problem when it comes to the delivery of medicine since there’s not enough money to attract it. That’s not to say that these places are spending so little that they’re not getting anything out of their healthcare spending. Karunakara said India gets more bang per buck than the US, but there’s simply not as many bucks there.

Of course, this highlights the fact that the US spends a lot on its healthcare without a clear benefit compared to a number of other countries that spend less. One of the panelists, James Vaupel of the Max Planck Institute for Demographic Research, didn’t think this was a big deal. “The US already has more than one car per driver,” Vaupel noted. “What are you going to do with that money anyway? You spend it on health care by choice.”

In the end, the panel argued that both types of economies could benefit from some of the trends that are being driven by the graying population of the developing world, mostly in terms of a new focus on research. Rosling gave one example, saying that an implant used during cataract surgery (which is primarily performed on older populations) used to cost hundreds of Euros; researchers in India figured out how to make it for €0.80. He expects to see more developments like that, as he noted that middle-income countries have started pooling their resources (India, for example, is funding work at his home institution, the Karolinska).

There are limits to this sort of progress, however. The complex regiments of small-molecule drugs that often treat chronic diseases in the developed world don’t always translate well to places without amenities like reliable refrigeration. Both Rosling and Karunakara feel that innovation in small molecule drugs is often the best way forward, but believe that the patent system has become an impediment here.

R&D in this area is hugely expensive, Rosling said, and a patent is often enough to keep anyone from working on improvements or related chemicals for nearly 20 years. Karunakara suggested that patent pools, in which a company licenses its work to all participants for a smaller profit up-front, could help alleviate this bottleneck. Rosling countered that we needed new, clever incentives for pharmaceutical companies that didn’t involve patents (although he didn’t specify what they might look like).

Overall, the panel suggested there were two inherent tensions to the demographic trends. One is that economic growth is providing greater access to healthcare even as it increases the incidence of the chronic diseases of wealthy nations. Overall, as Vaupel noted, this is improving the quality of life, and allowing people to remain productive longer, which could help us overcome the challenges of caring for an increasingly aging population. Unfortunately, nobody wants to work longer than they already do, so these challenges remain largely unmet.

A German minister, Georg Schütte, was on hand, and he said that some of the issues can be handled with simple policy changes. In response to demographic changes, the German government is closing schools in the former East, and focusing on programs that made life better for those in their 60s and 70s.

But most governments don’t have Germany’s resources to use to address their problems, and health care will be evolving under pressure from potentially catastrophic events. Vaupel, who was generally an optimist, noted that significant climate change and global epidemics were possible, and could trigger wars or economic collapse in their wake. But the optimist in him returned when he noted, “The 20th century was not a good time for Germany,” as it went through two wars and an economic collapse. Somehow, throughout that time, its life expectancy went from about 40 to over 80.

The message seemed to be that, even if we make a mess of things, we may still manage to make the world a better place.

Photo by Fang Guo