Information provided by Health Train Express and Digital Health Space is informational only. We do not endorse specific solutions. Inclusions are provided as reference only. Readers should consult with their own consultants for further details.

Tuesday, October 29, 2013

Point and Counterpoint


There are those on both sides of the argument as to whether the Affordable Care Act will flourish or die on the vine. 

Unfortunately the ACA has been linked with ‘Obama” and is more commonly called Obama care.

Recently in a street level survey Watters of the FOXNEWS channel reported that many people thought Obama care and the Affordable Care Act were two different laws.  When asked which was better, some responded Obama care since it had President Obama’s name on it.

Point:  Obama’s name gives the law high visibility, if it succeeds he will be remembered for his signature accomplishment…..good or bad.

Counterpoint:  President Obama’s name attached to any bill or law invited political exploitation and the merits of the plan are soon forgotten.

Viewpoint: Obama care Will Survive Its Botched Rollout

Point:  The debacle, and the cover-up and blame game that followed it, have reinvigorated Obama care's critics, who argue anew that the law represents expensive government overreach. So it's worth stepping back from the website mess to remember the deeper problems that made this law necessary in the first place -- and, by extension, why the issues with, which seem so important today, pale in comparison.

Counterpoint: The Health Benefit Exchanges are not the Affordable Care Act, however it was promoted as a key catalyst for enrolling previously uninsured among the uninsurable, young adults, and people just above the poverty level with large subsidies for premium payments. 

Point: The Websites are a disaster, and much hype was broadcast about it’s opening, ready or not, even when those responsible knew it was not ready for prime-time.

Counter-point:   Statements made in the recent past by HHS and President Obama included:

HBX would be ready

If you like your doctor or insurance plan You will not lose their doctor, hospital, and no one would lose their insurance plan.  (read the fine print)….

If these major statement were incorrect, a lie or a deception who would or should trust anything coming from the executive branch, or HHS.? (Fool me once, fool me twice, fool me three times…well you already know the answer)

Point:  If the HBX is considered fairly simple to build and it is a disaster, how will HHS manage to roll out the rest of the ACA which is far more complicated and involves hundreds of insurers, thousands of doctors and hospitals? This part of the ACA requires successful completion of each phase for the law to function without serious damage to health care financing but also to the economy in which health care spending is 17% of GDP or 1/6th of the economy.

Counterpoint: No problems….according to proponents the law will work because it is a good thing to counteract all the bad things about our health system.

The first problem with the status quo can't be repeated often enough: The U.S. spent 17.7% of its gross domestic product on health care in 2011, 50% more than the next highest among countries in the Organization for Economic Co-Operation and Development. The average for developed countries is less than 10%. Yet unlike every other developed country, a big chunk of Americans didn't have insurance -- almost one in six Americans last year.

Of course, for those with access to care, the U.S. is a good place to be sick. Americans received 103 MRI exams per 1,000 people in 2011, more than any other rich country, including Belgium (77), Spain (66) and Canada (50). The discrepancy was even higher for CT scans. And deaths from cancer are lower in any given year than for many rich countries -- 194 for every 100,000 people in 2010, which was better than the U.K., Italy, Germany, the Netherlands and Denmark.

Americans on average get less care and die younger, despite spending more as a country. As Eduardo Porter noted in The New York Times last week, the U.S. has an alarmingly high infant mortality rate -- higher than any OECD nation, with the exception of Mexico and Turkey. And not just a little bit higher. In 2011, 6.1 infants died for every 1,000 live births. The corresponding figures were 2.3 in Japan; in Sweden, 2.1; and in Iceland, 0.9.
The U.S. is also lagging at the opposite end of life. An American born in 2011 can expect to live 78.7 years -- less than somebody born in almost any European country, and 26th out of 36 in the OECD.


You could also measure the inadequacy of American health care through the amount of health-care resources that are available to the population as a whole. The U.S. has fewer hospital beds per person than most developed nations; a fraction as many psychiatric care beds; and trails every European nation in medical graduates, at 6.6 per 100,000 people. (Germany and the UK have almost twice as many.)


The reason for this is the two decade old campaign to save money by forcing smaller and less efficient hospitals to merge, or close. Rising overhead coupled with another reimbursement paradigm change ‘the DRG or diagnostic related group. The DRG mandates a set fee by disease category, not what occurs during the hospitalization, nor the actual cost of the events. (Another one size fits all government mandate)

Waiting for a hospital bed in Beijing.  Are we headed for this?

The entire article from Health Benefit Exchange can be read here;

Attribution:  Health Benefit Exchange Publication


Affordable Care Act and Health Benefit Exchanges

Health Train Express is searching for a ‘volunteer’ to help with research and writing for the blog.  We are struggling to keep up with the surge in interest in health reform.The ideal candidate would be a graduate student in MPH program or in a health related MBA program.  Full attribution will be given to writers, and your contribution would be subject to the ‘Creative Commons” copyright regulations. You may use this material as a reference.

The blog is focusing on the credibility of the ACA. Your activity is very important at this time to  ‘expose’  Obamacare. 

The lastest information regarding premiums, exclusions, and special conditions are brought to  you courtesy of Matthew Taber .  Keep in mind that these figures are from the Federal HBX, subject to change, delayed deadlines, and inaccurate statements.

Scroll down to the bottom of the page for a viable legal alternative to the Affordable Care Act.

 Click here

“October 28, 2014

Keep in mind all of the data concerning premiums and subsidies (subsidies on federally run state exchanges are illegal per ACA) are completely screwed up but below should give you at least an idea of what they could be.
*Note on smokers.  Insurers charge a tobacco surcharge of up to 50% of total premium. Tax subsidy can not be applied to the tobacco surcharge *
Healthy single non-smoker  30 year old living in Cypress TX making $26,000 a year
Silver plan  -  $2,614 per year
Subsidy      -  $737 per year (covers 28% of overall premium)
Amount you pay  -  $1,877 per year (7.22% of household income, 72% of overall premium)
Healthy single non-smoker 30 year old living in Nashville TN making $26,000 a year
Silver plan  -  $2,006 per year
Subsidy      -  $129 per year (covers 6% of overall premium)
Amount you pay  -  $1,877 per year (7.22% of household income, 94% of overall premium)
Healthy single non-smoker  30 year old living in Riverside CA making $26,000 a year
Silver plan  -  $2,790 per year
Subsidy      -  $913 per year (covers 28% of overall premium)
Amount you pay  -  $1,877 per year (7.22% of household income, 67% of overall premium)
Healthy single smoker 30 year old living in Pinehurst NC making $26,000 a year
Silver plan  -  $3,139 per year
Subsidy      -  $1,262 per year (covers 40% of overall premium)
Amount you pay  -  $1,877 per year (7.22% of household income, 60% of overall premium)
Healthy single smoker 30 year old living in Gulf Shores AL making $26,000 a year
Silver plan  -  $2,650 per year
Subsidy      -  $773 per year (covers 29% of overall premium)
Amount you pay  -  $1,877 per year (7.22% of household income, 71% of overall premium)
Healthy family with two children living in Cypress TX  making $40,000 a year
Silver plan  -  $8,866 per year
Subsidy      -  $6,901 per year (covers 78% of overall premium)
Amount you pay  -  $1,965 per year (4.91% of household income, 22% of overall premium)
Health family with two children living in Nashville TN  making $40,000 a year
Silver plan  -  $6,805 per year
Subsidy      -  $4,840 per year (covers 78% of overall premium)
Amount you pay  -  $1,965 per year (4.91% of household income, 29% of overall premium)
Healthy family with two children living in Riverside CA  making $40,000 a year
Silver plan  -  $9,465 per year
Subsidy      -  $7,500 per year (covers 79% of overall premium)
Amount you pay  -  $1,965 per year (4.91% of household income, 21% of overall premium)
Healthy family with two children living in Pinehurst NC  making $40,000 a year
Silver plan  -  $10,649 per year
Subsidy      -  $8,684 per year (covers 82% of overall premium)
Amount you pay  -  $1,965 per year (4.91% of household income, 18% of overall premium)
Healthy family with two children living in Gulf Shores AL  making $40,000 a year
Silver plan  -  $8,989 per year
Subsidy      -  $7,024 per year (covers 78% of overall premium)
Amount you pay  -  $1,965 per year (4.91% of household income, 22% of overall premium) “

You can avoid all of the above stipulations by using a ‘Direct Payment” program, such as MedicalAccessUSA and by purchasing a ‘catastrophic health insurance plan”  If you are curious and want more details, click on the ‘Contact Us’ black tab on the upper right hand corner of the landing page.  No obligation, this is an informational demo site only.

Author disclosure:  No guarrantees of coverage or benefits should be accrued to this message.  Informational purpose only.


Sunday, October 27, 2013

CORDS : Coordination of Rare Diseases at Sanford


Not to be confused with ‘Stanford University School of Medicine, CORDS offers a centralized web site for patients with Rare Diseases, and Researchers in the field of rare diseases.

  Register Here

Mission statement, as stated on web site.

At Sanford Research, we are committed to finding cures and advancing therapies for rare diseases. There are approximately 7,000 rare diseases affecting 25 million Americans and 350 million people worldwide. Many new developments in the diagnosis and treatment of human disease rely on research that involves the collection and analysis of data, but research into rare diseases is challenging due to a lack of information, the low numbers and geographic spread of individuals affected by rare disease, and data collected and stored in separate databases. To help address these challenges and advance research into rare diseases, we established the Coordination of Rare Diseases at Sanford (CoRDS).

Click here to view CoRDS Metrics & a list of diseases represented in CoRDS.

These diseases, although serious with morbidity and mortality are rare and often do not qualify for research grants because there are so few patients with each of these diseases.

The aims of the Affordable Care Act may optimize treatment for these rare diseases.  As the Affordable Care Act rolls out we will see how well it addresses this challenge.  Will it affect the number of children and adults who are not eligible for  health insurance.?

Activities such as this from a small rural hospital system in South Dakota do much to illuminate the  research, progress and patient advocacy for rare diseases. It was originally founded to fund raise for Breast Cancer by  Mr. Denny Sanford.

T. Denny Sanford

In 2007, Mr. Sanford made history with his gift of $400 million to Sanford Health—the largest donation ever to a health care organization.


Saturday, October 26, 2013

Twitter and the Affordable Care Act


Statistical analysis of social media interest in health reform. (The Affordable Care Act)


What was it that caused twitter activity to spike on the 24th ? Tweet me the answer @glevin1l or reply here in comments.

#tags by #symplur.


Friday, October 25, 2013

Educating in Health Care with Social Media


What you can learn using social media..

Edutopia, and Mimi Ito  bring a fresh perspective about social media, and it’s entertainment value for education.  It applies to adults as well as children.

The requirements  for Continuing Medical Education  for medical license renewal converts a previously enjoyable learning experience into an exercise in frustration signing up for useless CME courses in order to meet a mandate for CME.

Learning should be fun, creative and stimulating. Social Media has the capability to accomplish all of that.  The most creative people are those activating “their inner child”

Mimi Ito elaborates in this video. Much of this applies to adult education and professionals as well.

On the flip side of this, Social Media Courses for physicians, termed residencies to align the format with CME courses and CME credits have grown and presented by several large established educational institutions.  Who could have predicted that physicians would line  up to apply for a  social media residency ?  Lee Aase as head of Mayo Clinic’s Social Media Department.

Lee Aase has been known for his traditional social media, and now his lead role in health care social media as demonstrated by his writings, and lectures.

"Mayo Surgeons Use Twitter as Teaching Tool", ABC5 Eyewitness News (St.Paul-Minneapolis), 16 April 2009

"Why Doctors Are Tweeting During Surgery", ABC Good Morning America (New York), 16 April 2009

"Mayo Turns to Social Media to Reach Out to Potential Patients", St. Paul-Minneapolis Star Tribune (St. Paul-Minneapolis), 19 April 2009

"How to Use Social Media: An Interview with Lee Aase of Mayo Clinic", American Express Open Forum, 23 June 2009

"Social Media Smarts: Interview with Lee Aase", Online Marketing Blog, 3 August 2009

"Mayo Clinic's Lee Aase: Simple Marketing in Action", Simple Marketing Blog, 13 August 2009

"Social Media Case Study from Lee Aase of Mayo Clinic", Gaspedal's Business Blogging Blog, 14 October 2009

"Lee Aase, Mayo Clinic: The future of health brands and social media",,


Social Media Use in the United States: Implications for Health Communication:  as published in the Journal of Medical Internet Research

Social Media has large implications for patient education, physician education, physician-patient education and peer-to-peer knowledge transfer.


Wednesday, October 23, 2013

The Affordable Fiasco


For the past two weeks I had unsuccessfully attempted to access the Covered California online enrollment website.

I had been met with a variety of problems, none of which I had not experienced on other websites, private or governmental.  Some of the messages….

“error 404”

“page unavailable”,

“blank screen with whirling circle”,

“website is busy”,

“please wait”,

“blank screen….”

“try again later”,

“refresh to submit information again, do not click on back arrow”.  I have also had some success although on different occasions I hit a stone wall at different places on Covered California, and each time the ‘glitch’ occurred at a different stage of ‘’enrollment’. 

Along the way I came across an article by Paul Ehrlich about the 13 greatest error messages from computers.

The upside was that none of the messages were DOS errors, i.e.  Abort, Retry, Fail which is usually just before the “Windows Blue Screen of Death”

  Anyone who has seen this screen knows the next event is the computer shutting down and if you are lucky it will re-boot on it’s own. 

“To err is human, but to really foul things up you need a computer.” So goes an old quip attributed to Paul Ehrlich.  So one sees that this is not an Affordable Care Act failure, at all.

Never once did I receive positive reinforcement nor a ‘successfully enrolled’.  On one occasion I did see a screen with the different plans, and calculators which revealed subsidized plans and premium rates based upon your level of near poverty or destitution….It is hard to believe how many of us are on the thin line and impoverished, living from paycheck to paycheck.

I discovered a secret path and backdoor by searching on Google.  It took me to another non-official looking site that allowed me to look up plans and premiums.

Finally after two weeks of unenthusiastic attempts to register I submitted to the old fashioned  “P.O.T.S.”  It worked ! I was able to reach a person in one minute without going through a telephone triage system. The entire process took about five minutes. I will receive a mail (snail) within ten days informing me of eligibility and plans I from which I will chose.

This ‘foolproof’ system cost a lot less than $ 650 million dollars, and has been around for at least one hundred years.

(My telephone---the worst that happens is, there is no dial tone.)

For the young crowd (those who are mandated to obtain health insurance, to pay for the rest of us old codgers  P.O.T.S. is the abbreviation for  “Plain Old Telephone Service”  This was in the age before transistors and silicon valley.

My answer to Californians is to dial  800-300-1506 . Overly simple for most and it worked the first time.  (Don’t tell anyone else, until you have enrolled)

In all  fairness here is what the  HHS blog had to say,

We’re listening — and improving every day

October 21, 2013

We know using HealthCare.go has been frustrating for many Americans. The initial consumer experience of HealthCare.go has not lived up to the expectations of the American people. We are committed to doing better.

We’ve been gathering feedback since the day we launched – from our customer service representatives, social media channels, and through hundreds of thousands of online surveys and comments. And we’re listening.

We’ve been making changes to respond directly to your feedback and will continue to do so. A few of our most important changes so far:

  • You can now preview plans and prices available in your area without filling out the online application.
  • You can find out, with an improved calculator, whether your income and household size may qualify you for lower costs on your monthly premiums and out-of-pocket costs.
  • You can apply for coverage 4 ways: By phone, online, by mail with a paper application, or with the help of an in-person assister.
  • We’ve been adding educational online content where you tell us you need more information: About estimating your income, accounting for people in your household, eligibility rules, and more.

And please keep the feedback coming – on this blog post below, on any of our social media pages, or by using the little “Was this page helpful?” survey that appears near the bottom of most pages on the site.

We won’t rest until every American who needs affordable, high-quality coverage can get it - using whatever method works best for them.


Physicians Digital Marketing Guide for 2014


Most physicians shy away from marketing. Our ethics discourage self-aggrandizement and most marketing falls into that category.

However there are alternative positive reasons for promoting your medical practice.

Charitable and Philanthropic Goals


Public Health Informational Content


Mission positive statements


Clarity and Distinction from other Medical enterprises

Informational, educational and training opportunities


Location Information using Mapping technology, Directions to facility

With these ideas in mind, today’s lesson will be on Digital Marketing for 2014.  The information is time-limited due to the nature of electronic media.

White papers on digital marketing, social media, organic marketing, are readily available online,in digital form and for downloading as printed documents.

Conventional 20th Century marketing in industry publications, journals, meetings,and even emails are passé. 


Emails are considered spam and frequently deleted without being opened. Email is also considered a viral threat is attachments and/or links are opened.  Readers will frequently not click on a link in the body of the email.

Online marketing can be a challenge to analyze what, when and where potential clients (patients) read online content.

Recent experience and reports from media experts also reveal the fluid and ever-changing tools and structure of social media platforms.

Social media is dynamic and must be interactive, with Q&A capabilities. Social media platforms allow for business pages (Facebook, Google +)

Not only is what you say important, but how you say it, where it is placed in your content, and who reads your material.

Modern search algorithms have morphed into natural language processing and semantic interoperability.  If your content is designed properly it will favor  a ‘viral message’



Tuesday, October 22, 2013

How Long Does Obama Have To Fix


By Julie Appleby

KHN Staff Writer

OCT 21, 2013

“They've got a few weeks.

But if federal officials can’t get the new online insurance marketplace running smoothly by mid-November, the problems plaguing the three-week-old website could become a far bigger threat to the success of the health law, hampering enrollment and fueling opponents’ calls to delay implementation, say analysts.”

That is only 3 weeks from today   October 22, 2013.  According to sources, there are over 3 million lines of ‘code’ to review and correct as necessary.

If the administration solves the problems before the end of October, “this would just be a blip on the radar,” said Dan Mendelson of consulting firm Avalere Health in Washington.

If problems cannot be resolved that quickly, Mendelson said “there are other options for getting people enrolled,” noting that Medicare beneficiaries signed up for coverage for decades without using computers.



The president also mentioned those options Monday, saying consumers could sign up by telephone, in person with trained assisters or by downloading an application and mailing it in. (28 pages)

But those options are not ideal, mainly because millions of applications would have to be manually checked across several federal agencies.

“That would take significantly longer than if it was automated,”

Some analysts suggest that if problems persist into late November or December, that the Obama administration will need to consider extending the open enrollment period.

Such a decision, however, would have political and financial ramifications.

These events have created a political and administrative bonfire. It impacts financial planning by insurance companies, and to say the least…..the object for affordable care, the patients themselves. Unfortunately patients are left for last, covered in dust, smoke and mirrors.

Because the health law is primarily aimed at low to moderate income people – and their household cash flow is often drained by holiday gift spending and replenished by February tax refunds -- getting the exchange working by November isn’t critical, said Brian Haile, senior vice president of healthcare policy at Jackson Hewitt tax service.

“If you’re trying to sell something you need to do it at a period during which you don’t have competing consumption,” said Haile. “After Nov. 1 … foremost on their minds is not, ‘Am I going to buy insurance?’ but ‘What am I going to put under the tree?’ ”

Jay Hancock, Anna Gorman and Philip Galewitz contributed.

Monday, October 21, 2013

Health Beneficiary Exchange: How is Social Media Involved?


#navigator #hbx

The recent roll out of the Health Benefit Exchange has not gone exactly as planned.

The latest on the Health Benefit Exchange snafu : HHS maintains a ‘blog” as part of their “Digital Strategy” web pages.

In a post published Sunday on the HHS "Digital Strategy" blog, the Obama administration said it has formed a team of IT experts from the public and private sectors to help resolve the technical glitches that have plagued the Affordable Care Act's federally run health insurance exchange website

Although the Navigator program envisioned by HHS to educate and assist patients in navigating health benefit exchanges, there are several problems. The Navigator program is not fully implemented and difficult to find and/or contact.

Much of the affordable care act is targetted at young people, those who are on social media platforms including Google +, Facebook, and Twitter as well as many others, Pinterest, Myspace, and a host of other sites.

twitter page Digital Health Space

It makes sense that social media can be used with better comunication than all other media. Mobile provides ubiquitous messaging with apps for all of the above social media sites.

Illinois is one of the first to harness social media to broadcast their ‘message’.

llinois Social Media Experts Seek To Help Frustrated Exchange Users

Chicago marketing agency FleishmanHillard has deployed a small team of social media experts to monitor and respond to online comments about glitches associated with the federally run health insurance exchange under the Affordable Care Act, the AP/Washington Post reports (AP/Washington Post, 10/18)

Since the Oct. 1 start of the open enrollment period, many consumers have experienced technical glitches on  that have hindered their attempts to enroll in coverage (iHealthBeat, 10/15).

Since the website opened for enrollment Oct. 1, consumers and health insurers have continued to report application delays and errors with that extend beyond the high visitor traffic and software issues that HHS officials initially identified as the causes of the problems

In Illinois, the federally run Get Covered Illinois website teaches state residents about their insurance options before sending them to

According to FleishmanHillard, the agency has put on hold all paid advertisements.

Instead, social media experts now are engaging with discouraged consumers and posting new information and advice on Twitter, as well as other social media websites.

The team also is using Facebook to post updates about

hhs fb page

Meg Poulelis -- a social media expert working for the outreach campaign -- said, "We're making sure we're listening [to consumers] and we're supportive and we're there for them when they're having difficulties."

Dave Kerpen -- social medial strategist with New York-based Likeable Media -- said, "Given people's frustrations with the federal website, Get Covered Illinois has to be able to respond promptly with great care to their customers."

Several other avenues will be email, and networking with influential bloggers.

However, a word of caution….some social media users have ulterior motives and may offer highly biased views if they oppose the Affordable Care Act, or are out to market self-interest views.


Dr. Manny: America, stop turning to social media for information on Obama Care

Dr. Alvarez notes that many politically inclined ObamaCare enrollment continues, the folks in charge of informing Americans about health care are politically biased individuals who don’t necessarily care about or understand health care issues, but rather simply want to promote a progressive agenda of a socialized America.

For all the questions you can’t find answers to about Health Benefit Exchanges #hbx or #navigator may help to begin.

The Obama Code


Few people don’t know about the run up and hype about the national launch as a pre-mature birth.  HealthCare.Gov is now being rushed to the NICU (neo-natal intensive care unit).

Obamologists are running some quick diagnostics on the new baby, to determine if it’s a hardware or software problem. 

Early indicators are that despite President Obama’s announcements,this will not be a quick recovery from a birth with an Apgar score of less than 4.  At that level any prognosis is guarded.

It’s all  in the code…..or is it the hardware, servers, and networks? Experts are being rushed in to replace and/or augment government contractors from the space, and military industry.  Outside experts not familiar with, or having no desire to file for a government contract and it’s byzantine contracting process have been sought to fix another government fiasco. Will this be through a bidding process or just another government contract over-run with which we are all too familiar?  After all isn’t software for health the same as for rockets, space-craft and running the IRS?

The Health and Human Services Department, which administers the site, said Sunday it has recruited "some of the best and brightest" technology experts from inside and outside the government to resolve the defects.

Internet users have been unable to create accounts, received confusing error messages and had to endure pages loading slowly or failing to respond in a timely way.  President Obama considers those problems "unacceptable. Thank you Mr President, so do the rest of us.

When and if Mr.Obama’s aides read the ACA he is in for some even bigger surprises. After enrollees enter the door and enroll in whatever plan they chose, there will be even bigger surprises. Some will enter the system, chose a provider (maybe an MD, or a PA or NP).  Some will find surprisingly high premiums and a sticker shock of 10,000 dollar deductibles as a trade-off for lower premiums.

For Example:



Sunday, October 20, 2013

Betrayals, Lies, and Deception


As I was sitting down this Sunday morning to think about my next blog posting, my twitter feeds, facebook and Google + lighted up my smartphones, tablets and desktop PC.

A life-long friend, David Fox sent me an email about Dan Bongino who is a candidate for the Congressional seat (2nd district), Maryland about Obamacare which he sent to his former employer.

Mr. President,

In one of your famous Obamacare speeches you stated, "If you like your plan, you can keep your plan."
Well, as evidenced by the letter below, which my wife and I just received, you lied. We did "like" our plan.  But we were informed in this letter that our plan will no longer exist and we will be forced to purchase a new plan, from a website which doesn't work, for a higher monthly premium, for services we don't want.
Now, I know I am not one of your connected cronies and insiders, who were all given waivers from this disastrous piece of legislation. I was just one of your Secret Service agents who put my life on the line for you every day. I was still praying that given our middle-class existence, operating a small-business in Maryland, that your "fundamental transformation" of America would have stayed out of our home. Apparently that is not the case as my public battle against your disastrous presidency has just become very personal.
Dan Bongino

Letter from Blue Shield