Tuesday, January 30, 2018

Medicare Beneficiaries’ Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future | The Henry J. Kaiser Family Foundation


  • Average out-of-pocket cost for Medicare beneficiaries are expected to keep rising over the next decade when it will reach half of a senior's income. 
  • The Kaiser Family Foundation estimated that out-of-pocket costs will increase from 41% of average per capita Social Security income in 2013 to 50% by 2030.
  • In its analysis of 2013 numbers, KFF said women paid 44% of their per capita income on out-of-pocket costs, which was more than men, who paid 38% on out-of-pocket costs. That’s expected to increase to 52% and 47% respectively by 2030.
Medicare helps pay for the health care needs of 59 million people ages 65 and over and younger people living with permanent disabilities. Yet, people with Medicare can face significant health-related out-of-pocket costs, including premiums, deductibles, cost sharing for Medicare-covered services, and costs for services Medicare does not cover, such as long-term services and supports and dental services. With half of all Medicare beneficiaries living on annual per capita income of less than $26,200, out-of-pocket health care costs can pose a challenge, particularly for beneficiaries with modest incomes and those with significant medical needs.

As one way of measuring health care affordability for people with Medicare, each year the Medicare Trustees estimate Medicare Part B and Part D premiums and cost sharing as a share of average Social Security benefits. This estimate, however, does not include other health-related costs, such as out-of-pocket spending on hospital and skilled nursing facility stays, supplemental insurance premiums, and costs for services not covered by Medicare. The estimate also does not include income from sources other than Social Security.
In this analysis, we assess the current and projected out-of-pocket health care spending burden among Medicare beneficiaries using a broad definition of health care expenses, and in relation to both per capita Social Security and total income. Our results suggest that rising health care costs pose significant affordability challenges for many people on Medicare today, particularly those with relatively low incomes who derive most of their income from Social Security, and that this burden can be expected to grow in the future. This analysis sets the context for understanding the implications of potential changes to Medicare, Medicaid, or Social Security that could shift more health care costs onto beneficiaries or reduce their future retirement income.

Medicare Beneficiaries’ Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future

Medicare Beneficiaries’ Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future | The Henry J. Kaiser Family Foundation

Monday, January 29, 2018

The Wisdom of Doug Farrago, M.D. The Kobyashu Maru of Health Care

Physicians are people, too.

Dr. Farago is a family doctor, articulate and funny !  He takes a subject which is causing major problems in health care administration.  Patients must know what has happened to physicians in the past twenty years.

He has adopted direct patient care to avoid the unsolvable Kobyashi Maru. He elaborates on the shell game of hospital administrators, creating chaos, confusion and distraction.  Learn how he escaped from the jewel of the north and the pearl of the east.  Incidentally he worked at a Federally Qualified Medical Center.

For my fellow colleagues, you are welcome to watch this video as well, and weep.  I know there is not one of you who does not agree with Doug Farago M.D.

It ia not a good time for the United States, nor is it for medicine. However we will change it. After all we cure and conquer diseases now that were unmanageable in the past. No one can identify one particular even that changed everything.   Those of us who are as old as I am remember certain events precipitated by laws which destroyed the freedom of patients while promising less expensive and more availability of health care.  None of that proved to be true.  Yet physicians protested, but did not revolt.  The shell game was in progress.

Saturday, January 13, 2018

Are tens of thousands of California kids about to lose their health care? – Orange County Register

Pathetic, shameful and a disgrace !  One of the key measures of a society is how children are treated and more important protected. A key measure is infant mortality rates, vaccination rates and other metrics.  It is well known that the United States is not in the top ranking of chldren's survival rates.

There are numerous governmental agencies that compile this information, to include:

Global Health Observatory (GHO) data

The federal government funds the Children's Health Insurance Program, which is set to expire in September 2019 unless you act now.

Are tens of thousands of California kids about to lose their health care? – Orange County Register

Sunday, January 7, 2018

A Supplement That May Block The Toxic Effects of Alcohol

If true and verified and credible it adds much to the alcoholism preferred pattern of practice 

I am Dr George Lundberg, and this is At Large at Medscape. September is "be kind to addicts" month (officially National Recovery Month). How can we help?
Of every 100 Americans who drink (140 million), about 12 (16 million) are considered in need of treatment for an alcohol use disorder, and eight will become chemically dependent on alcohol.[1] Of that eight, one will become addicted very early, even after the first drunken episode. The problem is, we do not yet have a way to predict who that one person will be.
Prevention is always the best answer to addiction. Do not drink. If you do drink, do not ignore the warning signs of becoming a problem drinker.
Let me ask you: How is your blood acetaldehyde today; or, more relevant, how was it late last night? You don't know? Why am I not surprised? Most people don't even think about acetaldehyde.
Ethyl alcohol is metabolized to acetaldehyde by alcohol dehydrogenase in the liver. Acetaldehyde is metabolized to acetate by aldehyde dehydrogenase and then to carbon dioxide and water. Depending on the alcohol dose, some of the acetaldehyde may escape hepatic metabolism and enter the general blood circulation.
Acetaldehyde is a close cousin to my old pathology lab friend formaldehyde. We use it to pickle surgical and autopsy tissues for preservation. Both are known carcinogens. Our body's defense mechanism against excess acetaldehyde is the amino acid l-cysteine and glutathione. These molecules, similarly to thiamine, contain a sulfhydryl group that is chemically active against aldehydes.
Unless you are one of those people (typically East Asian) who are genetically deficient in aldehyde dehydrogenase or are taking disulfiram, you can metabolize roughly one stiff drink per hour. If you drink more than that, depending on body weight, gastric contents, and the efficiency of your metabolic alcohol breakdown, acetaldehyde will build up because aldehyde dehydrogenase capability can be overwhelmed.
If you quit drinking at 11:00 PM, then around about 1:00 AM, your acetaldehyde level may be elevated and you may feel symptoms of acetaldehyde toxicity, including skin flushing, tachycardia, palpitations, anxiety, nausea, thirst, chest pain, and vertigo. Of course, you are trying to "sleep it off," so you may not feel toxic until the next morning when that dreaded hangover appears.

Metabolizing Alcohol

My friends in the nutritional supplement community tell me that you can enhance the metabolism of blood alcohol to acetate, carbon dioxide, and water and minimize the acetaldehyde molecular logjam by taking oral supplements. L-cysteine, vitamin C, and vitamin B1 are purported to help. At supplement doses, they are cheap and harmless at worst. At best: Goodbye, acetaldehyde toxicity; hello, restful sleep. About 200 mg of L-cysteine per ounce of alcohol consumed is sufficient to block a major portion of the toxic effect of acetaldehyde. But because alcohol is absorbed and metabolized rapidly, it may be necessary to take L-cysteine before and concurrently with consumption to maintain protection. Also, an excess of vitamin C (perhaps 600 mg) can help keep the L-cysteine in its reduced state and "on the job" against acetaldehyde. Experts recommend these doses (with or without extra B1): one round before drinking, one with each additional drink, and one when finished.
Some say that this regimen works very well. Do not ask me for a list of published randomized, double-blind clinical trials. Not yet, at least. Research funding into "harm reduction" from addicting substances has not enjoyed favored status in research priorities.
Unfortunately, this concoction may have little effect on next-day hangovers, the causes of which are complex and resistant to prevention—except, obviously, by not drinking too much, which is, of course, the best answer to alcohol anyway.
With drug users, be redemptive, not punitive.
That is my opinion. I am Dr George Lundberg, and this is At Large at Medscape.A Supplement That May Block The Toxic Effects of Alcohol