5 Doctors You Should Be Following on Twitter

5 Doctors You Should Be Following 

on TwitterRead , and Health Train Express @glevin1 or @digitalhealthspace

The article describes five pioneers in blogging and online information.

OK Google Voice : "What is Lupus?"

Most physicians are quite familiar with Google's search function, and if they use Apple's Siri they know how to use voice commands and queries. This function is now available on any recent update of Android and/or Chromebooks. The following infographic covers the most common 'OK Google" commands. The possibilities become endless.

OK Google publish this blog !

Obamacare and Reimbursement Rates to Providers

In an undated press release from Sharp Health in San Diego an optimistic opinion was given for Obamacare. Several caveats however remain.

"Covered California™ today announced 13 diverse health insurance plans that will offer in 2014, affordable, quality health care coverage to millions of Californians. The plans reflect a mix of large non- profit and commercial plan leaders, along with well-known Medi-Cal and regional plans.

The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions. This is impressive since the 2014 products include doctor visits, prescriptions, hospital stays and more essential benefits; protecting consumers from the "gimmicks and gotchas" of many insurance policies. “This is a home run for consumers in every region of California,” said Peter V. Lee, Executive Director of Covered California. “Our active negotiating will not only benefit potential enrollees to Covered California, but will benefit all Californians by making health care affordable.” (No doubt that some of the rhetoric is self-serving for Covered California.)

Once plan rates are approved by state regulators, Covered California looks forward to signing final contracts and beginning the work of enrolling millions of Californians in the following health plans:

• Alameda Alliance for Health
• Anthem Blue Cross of California
• Blue Shield of California
• Chinese Community Health Plan
• Contra Costa Health Services
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage

 "Covered California plans include the largest current health insurers in the individual market, as well as new entrants, regional plans and local Medi-Cal plans that want to be part of making history," Lee said. On average, there will be five plans from which to choose. Even in rural areas where choice has been historically sparse, there will be two or three health plans. Throughout the state consumers will have a choice of Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Exclusive Provider Organizations (EPOs). To get prices at such competitive points, winning health plans built their bids around the expectation of high enrollment, not high profit. Plans reduced profit margins down to two and three percent; embraced Affordable Care Act programs such as Accountable Care Organizations and Patient-Centered Medical Homes, that seek to improve care while lowering costs; found common ground with doctors, medical groups and hospitals on lower reimbursement rates to make care affordable.

(Note that many items such as Accountable Care Organizations, and Patient-Centered Medical Homes are still in development, untested, and not yet operational. which all sounds like a replay of the failed rollout of Healthcare.gov. ) 

Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected. The current list of insurers is for individual policies only.

Covered California will announce its options for small businesses to buy health insurance in June. Providers who will be approved for Covered California will be required to agree to new contracts and new reimbursement rates. The real final participants will be told when the signed contracts are ratified. Until then, all predictions are just that. I have heard from sources that the rates, even for conventional coverage under Covered California will be unique and include a sizable decrease to providers. No mention has been made about Medi-caid rates increasing....and frequently that is not known until the first payments are received by providers."

On the provider side....looking in on Covered California and whether to participate, most providers remain very cautious, and some have a wait and see attitude delaying a decision for at least one year. In the current environment of lean reimbursements, and profit margins, there are few providers willing to risk their 'livlihoods' and solvency on unproven programs, rift with political promises and goals.

Previous experience with government programs have created a lack of faith and/or trust in government programs with private insurers only slightly behind.

Few providers can expand their patient base without increasing overhead or numbers of providers. Most providers are already near capacity to see patients, and will not feel the need to see this new group of patients.

The exact method of reimbursement, if it changes from fee for service to another model is unknown, and mechanisms are still not  yet in place for that to occur, either.

Iin summary it seems foolish  for any segment of health to promise success when each has it's own issues and challenges that are intertwined while heading to an 'unknown destination'.

Does Obama really want the Affordable Care Act to Suceed?

President Obama really does not want the Affordable Care Act to suceed. Obama's ideology does not match the system of the Affordable Care Act. The ACA is a mix of governmental regulation, socialistic ideology and capitalistic free market competition. Obama's mantra is 'hope and change'....a change in direction for the United States. This includes redistribution of wealth. The Affordable Care Act is a guise for this goal. It is blatant, and thinly disguised. Those who believe the ACA will provide health care to the uninsured are misguided. The preventive measures guarranteed by Obamacare could have been delivered without revising health insurance. Expanding Medi-caid (a failed system in many states) is a poor option for the poor and uninsured. A better choice would have been to design a new agency to administer subsidized Obamacare. The entrenched administrators of Medi-caid will not have fresh ideas having been bogged down for decades in public social services which also is in charge of cash aid,, and the SNP Food stamp programs. Let's put some of the 'poor' to work administering their own ACA benefit.It is going to take tens of thousands of people to administer the program. The secondary benefit will be fewer unemployed, and perhaps they will be able to pay an insurance premium. They already know what is at stake, having been 'victims' of the present system for decades. Are these people going to have to stand in line with a pile of paperwork to enroll in Medi-caid....or is the HBX going to bypass this process? We have not heard any answers to these questions.

Ultimately the impending confusion and chaos will make the public demand universal payer or some type of total governmental health system. The current system is unsustainable regardless, and the ACA is no better. In terms of the initial success or failure of Healthcare.gov the ultimate result will be who has an insurance card on January 1, 2014. Obama and his administration's announcements how successful the HBX now is, and how many people have enrolled, there remains a large gap between enrolling on an unproven and a demonstrated unproven IT system.

Covered California

I spent the last week attempting to enroll in the Covered California HBX. I had the following frustrations.

1. Although I had successfully registered a user name and password on my next attempt the website refused to accept my userid/password. The password retriever did not recognize the user name.
2. The chat online function does not work.
3. Wait times are very long, and at times the link time-outs

Most people do not have the time to sit all day to access a web site that is critical in their life.

I made an appointment to see a 'certified insurance agent'. and/or Enrollment Counselors

There are many' private insurance agents, and also several non profit enrollment counselors in my area.
The choices appear to be highly prejudicial against 'white Americans' with many Hispanic, Native American, and African American organizations dominating the selections. Some choices were in the Federally Qualified Community Health Centers.

President Obama's efforts minimize the role and availability of already existing agents to enroll patients in all health plans. His emphasis has been on producing jobs for unemployed by training inexperienced 'non-profit beneficiaries' in the process.

My observations are that although the Affordable Care Act is designed for poorer Americans there are also many middle class Americans (white, yellow, and black) that would benefit from enrollment help.

There is a wide divergence of opinion on how much improvement has taken place in the past month regarding the national HealthCare.gov website. Democrats appear to be in denial clinging to 'wait and see'. Even when confronted about the failings of the system they are unable to address answers to specific issues. Republicans have become more critical,and outright hostile, frustrated by the lack of Democratic response to criticism, even when based on fact and evidence.

The states who have formed their own HBX in lieu of the national HBX appear to be better off...however, early numbers are deceiving and subject to variance. Early numbers of enrollees may not reflect how successful the Affordable Care Act will be. These numbers will depend upon the numbers who actually pay the premiums. The majority of users have been enrolled in the expanded Medi-caid program, and that is another disaster waiting to happen.

Obamacare does not and will not forge a uniform health system in the United States. Rather it will create several different tiers with a large percentage falling into lesser quality programs, less hospital and provider access. It will serve to stress further the already dysfunctional overburdened medicaid programs.

THE FUTURE OF MEDICINE

The Future of Medicine may not be determined by technology.

There have been wonderful and amazing advances in medical science, most of it good. However there is an ominous warning. Despite the revolution in antibiotics and pharmacologic ‘tweaking’ of basic antibiotic structures, bacteria, viruses have an almost infinite ability to adapt according to Darwin’s hypothesis “Survival of the Fittest” Bacteria are endlessly dividing creating millions of opportunities to select the survivor gene when surrounded by antibiotics. Is this the future? Will nature outsmart us? Imagining the Post-Antibiotics Future After 85 years, antibiotics are growing impotent. So what will medicine, agriculture and everyday life look like if we lose these drugs entirely? A few years ago, I started looking online to fill in chapters of my family history that no one had ever spoken of. I registered on Ancestry.com, plugged in the little I knew, and soon was found by a cousin whom I had not known existed, the granddaughter of my grandfather’s older sister. We started exchanging documents: a copy of a birth certificate, a photo from an old wedding album. After a few months, she sent me something disturbing. It was a black-and-white scan of an article clipped from the long-goneArgus of Rockaway Beach, New York. In the scan, the type was faded and there were ragged gaps where the soft newsprint had worn through. The clipping must have been folded and carried around a long time before it was pasted back together and put away. The article was about my great-uncle Joe, the youngest brother of my cousin’s grandmother and my grandfather. In a family that never talked much about the past, he had been discussed even less than the rest. I knew he had been a fireman in New York City and died young, and that his death scarred his family with a grief they never recovered from. I knew that my father, a small child when his uncle died, was thought to resemble him. I also knew that when my father made his Catholic confirmation a few years afterward, he chose as his spiritual guardian the saint that his uncle had been named for: St. Joseph, the patron of a good death. I had always heard Joe had been injured at work: not burned, but bruised and cut when a heavy brass hose nozzle fell on him. The article revealed what happened next. Through one of the scrapes, an infection set in. After a few days, he developed an ache in one shoulder; two days later, a fever. His wife and the neighborhood doctor struggled for two weeks to take care of him, then flagged down a taxi and drove him fifteen miles to the hospital in my grandparents’ town. He was there one more week, shaking with chills and muttering through hallucinations, and then sinking into a coma as his organs failed. Desperate to save his life, the men from his firehouse lined up to give blood. Nothing worked. He was thirty when he died, in March 1938. The date is important. Five years after my great-uncle’s death, penicillin changed medicine forever. Infections that had been death sentences—from battlefield wounds, industrial accidents, childbirth—suddenly could be cured in a few days. So when I first read the story of his death, it lit up for me what life must have been like before antibiotics started saving us. Lately, though, I read it differently. In Joe’s story, I see what life might become if we did not have antibiotics any more. Predictions that we might sacrifice the antibiotic miracle have been around almost as long as the drugs themselves. Penicillin was first discovered in 1928 and battlefield casualties got the first non-experimental doses in 1943, quickly saving soldiers who had been close to death. But just two years later, the drug’s discoverer Sir Alexander Fleming warned that its benefit might not last. Accepting the 1945 Nobel Prize in Medicine, he said: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them… There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” As a biologist, Fleming knew that evolution was inevitable: sooner or later, bacteria would develop defenses against the compounds the nascent pharmaceutical industry was aiming at them. But what worried him was the possibility that misuse would speed the process up. Every inappropriate prescription and insufficient dose given in medicine would kill weak bacteria but let the strong survive. (As would the micro-dose “growth promoters” given in agriculture, which were invented a few years after Fleming spoke.) Bacteria can produce another generation in as little as twenty minutes; with tens of thousands of generations a year working out survival strategies, the organisms would soon overwhelm the potent new drugs. Fleming’s prediction was correct. Penicillin-resistant staph emerged in 1940, while the drug was still being given to only a few patients. Tetracycline was introduced in 1950, and tetracycline-resistant Shigellaemerged in 1959; erythromycin came on the market in 1953, and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly. Methicillin arrived in 1960 and methicillin resistance in 1962; levofloxacin in 1996 and the first resistant cases the same year; linezolid in 2000 and resistance to it in 2001; daptomycin in 2003 and the first signs of resistance in 2004. With antibiotics losing usefulness so quickly — and thus not making back the estimated $1 billion per drug it costs to create them — the pharmaceutical industry lost enthusiasm for making more. In 2004, there were only five new antibiotics in development, compared to more than 500 chronic-disease drugs for which resistance is not an issue — and which, unlike antibiotics, are taken for years, not days. Since then, resistant bugs have grown more numerous and by sharing DNA with each other, have become even tougher to treat with the few drugs that remain. In 2009, and again this year, researchers in Europe and the United States sounded the alarm over an ominous form of resistance known as CRE, for which only one antibiotic still works. Health authorities have struggled to convince the public that this is a crisis. In September, Dr. Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention, issued a blunt warning: “If we’re not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there.” The chief medical officer of the United Kingdom, Dame Sally Davies — who calls antibiotic resistance as serious a threat as terrorism — recentlypublished a book in which she imagines what might come next. She sketches a world where infection is so dangerous that anyone with even minor symptoms would be locked in confinement until they recover or die. It is a dark vision, meant to disturb. But it may act tually underplay what the loss of antibiotics would mean.Urticaria rash on the back of an 80-year-old man due to an allergic reaction to the antibiotic penicillin. In 2009, three New York physicians cared for a sixty-seven-year-old man who had major surgery and then picked up a hospital infection that was “pan-resistant” — that is, responsive to no antibiotics at all. He died fourteen days later. When his doctors related his case in a medical journal months afterward, they still sounded stunned. “It is a rarity for a physician in the developed world to have a patient die of an overwhelming infection for which there are no therapeutic options,” they said, calling the man’s death “the first instance in our clinical experience in which we had no effective treatment to offer.” They are not the only doctors to endure that lack of options. Dr. Brad Spellberg of UCLA’s David Geffen School of Medicine became so enraged by the ineffectiveness of antibiotics that he wrote a book about it. “Sitting with a family, trying to explain that you have nothing left to treat their dying relative — that leaves an indelible mark on you,” he says. “This is not cancer; it’s infectious disease, treatable for decades.” As grim as they are, in-hospital deaths from resistant infections are easy to rationalize: perhaps these people were just old, already ill, different somehow from the rest of us. But deaths like this are changing medicine. To protect their own facilities, hospitals already flag incoming patients who might carry untreatable bacteria. Most of those patients come from nursing homes and “long-term acute care” (an intensive-care alternative where someone who needs a ventilator for weeks or months might stay). So many patients in those institutions carry highly resistant bacteria that hospital workers isolate them when they arrive, and fret about the danger they pose to others. As infections become yet more dangerous, the healthcare industry will be even less willing to take such risks. Those calculations of risk extend far beyond admitting possibly contaminated patients from a nursing home. Without the protection offered by antibiotics, entire categories of medical practice would be rethought. Many treatments require suppressing the immune system, to help destroy cancer or to keep a transplanted organ viable. That suppression makes people unusually vulnerable to infection. Antibiotics reduce the threat; without them, chemotherapy or radiation treatment would be as dangerous as the cancers they seek to cure. Dr. Michael Bell, who leads an infection-prevention division at the CDC, told me: “We deal with that risk now by loading people up with broad-spectrum antibiotics, sometimes for weeks at a stretch. But if you can’t do that, the decision to treat somebody takes on a different ethical tone. Similarly with transplantation. And severe burns are hugely susceptible to infection. Burn units would have a very, very difficult task keeping people alive.” Doctors routinely perform procedures that carry an extraordinary infection risk unless antibiotics are used. Chief among them: any treatment that requires the construction of portals into the bloodstream and gives bacteria a direct route to the heart or brain. That rules out intensive-care medicine, with its ventilators, catheters, and ports—but also something as prosaic as kidney dialysis, which mechanically filters the blood. Next to go: surgery, especially on sites that harbor large populations of bacteria such as the intestines and the urinary tract. Those bacteria are benign in their regular homes in the body, but introduce them into the blood, as surgery can, and infections are practically guaranteed. And then implantable devices, because bacteria can form sticky films of infection on the devices’ surfaces that can be broken down only by antibiotics Dr. Donald Fry, a member of the American College of Surgeons who finished medical school in 1972, says: “In my professional life, it has been breathtaking to watch what can be done with synthetic prosthetic materials: joints, vessels, heart valves. But in these operations, infection is a catastrophe.” British health economists with similar concerns recently calculated the costs of antibiotic resistance. To examine how it would affect surgery, they picked hip replacements, a common procedure in once-athletic Baby Boomers. They estimated that without antibiotics, one out of every six recipients of new hip joints would die. Antibiotics are administered prophylactically before operations as major as open-heart surgery and as routine as Caesarean sections and prostate biopsies. Without the drugs, the risks posed by those operations, and the likelihood that physicians would perform them, will change. “In our current malpractice environment, is a doctor going to want to do a bone marrow transplant, knowing there’s a very high rate of infection that you won’t be able to treat?” asks Dr. Louis Rice, chair of the department of medicine at Brown University’s medical school. “Plus, right now healthcare is a reasonably free-market, fee-for-service system; people are interested in doing procedures because they make money. But five or ten years from now, we’ll probably be in an environment where we get a flat sum of money to take care of patients. And we may decide that some of these procedures aren’t worth the risk.” Medical procedures may involve a high risk of infections, but our everyday lives are pretty risky too. One of the first people to receive penicillin experimentally was a British policeman, Albert Alexander. He was so riddled with infection that his scalp oozed pus and one eye had to be removed. The source of his illness: scratching his face on a rosebush. (There was so little penicillin available that, though Alexander rallied at first, the drug ran out, and he died.) Before antibiotics, five women died out of every 1,000 who gave birth. One out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite. Three out of ten people who contracted pneumonia died from it. Ear infections caused deafness; sore throats were followed by heart failure. In a post-antibiotic era, would you mess around with power tools? Let your kid climb a tree? Have another child? “Right now, if you want to be a sharp-looking hipster and get a tattoo, you’re not putting your life on the line,” says the CDC’s Bell. “Botox injections, liposuction, those become possibly life-threatening. Even driving to work: We rely on antibiotics to make a major accident something we can get through, as opposed to a death sentence.” Bell’s prediction is a hypothesis for now—but infections that resist even powerful antibiotics have already entered everyday life. Dozens of college and pro athletes, most recently Lawrence Tynes of the Tampa Bay Buccaneers, have lost playing time or entire seasons to infections with drug-resistant staph, MRSA. Girls who sought permanent-makeup tattoos have lost their eyebrows after getting infections. Last year, three members of a Maryland family — an elderly woman and two adult children — died of resistant pneumonia that took hold after simple cases of flu. At UCLA, Spellberg treated a woman with what appeared to be an everyday urinary-tract infection — except that it was not quelled by the first round of antibiotics, or the second. By the time he saw her, she was in septic shock, and the infection had destroyed the bones in her spine. A last-ditch course of the only remaining antibiotic saved her life, but she lost the use of her legs. “This is what we’re in danger of,” he says. “People who are living normal lives who develop almost untreatable infections.” In 2009, Tom Dukes — a fifty-four-year-old inline skater and body-builder — developed diverticulosis , a common problem in which pouches develop in the wall of the intestine. He was coping with it, watching his diet and monitoring himself for symptoms, when searing cramps doubled him over and sent him to urgent care. One of the thin-walled pouches had torn open and dumped gut bacteria into his abdomen — but for reasons no one could explain, what should have been normal E. coli were instead highly drug-resistant. Doctors excised eight inches of his colon in emergency surgery. Over several months, Dukes recovered with the aid of last-resort antibiotics, delivered intravenously. For years afterward, he was exhausted and in pain. “I was living my life, a really healthy life,” he says. “It never dawned on me that this could happen.” Dukes believes, though he has no evidence, that the bacteria in his gut became drug-resistant because he ate meat from animals raised with routine antibiotic use. That would not be difficult: most meat in the United States is grown that way. To varying degrees depending on their size and age, cattle, pigs, and chickens — and, in other countries, fish and shrimp — receive regular doses to speed their growth, increase their weight, and protect them from disease. Out of all the antibiotics sold in the United States each year, 80 percent by weight are used in agriculture, primarily to fatten animals and protect them from the conditions in which they are raised. A growing body of scientific research links antibiotic use in animals to the emergence of antibiotic-resistant bacteria: in the animals’ own guts, in the manure that farmers use on crops or store on their land, and in human illnesses as well. Resistant bacteria move from animals to humans in groundwater and dust, on flies, and via the meat those animals get turned into. An annual survey of retail meat conducted by the Food and Drug Administration—part of a larger project involving the CDC and the U.S. Department of Agriculture that examines animals, meat, and human illness—finds resistant organisms every year. In its 2011 report, published last February, the FDA found (among many other results) that 65 percent of chicken breasts and 44 percent of ground beef carried bacteria resistant to tetracycline, and 11 percent of pork chops carried bacteria resistant to five classes of drugs. Meat transports those bacteria into your kitchen, if you do not handle it very carefully, and into your body if it is not thoroughly cooked—and resistant infections result. Researchers and activists have tried for decades to get the FDA to rein in farm overuse of antibiotics, mostly without success. The agency attempted in the 1970s to control agricultural use by revoking authorization for penicillin and tetracycline to be used as “growth promoters,” but that effort never moved forward. Agriculture and the veterinary pharmaceutical industry pushed back, alleging that agricultural antibiotics have no demonstrable effect on human health. Few, though, have asked what multi-drug–resistant bacteria might mean for farm animals. Yet a post-antibiotic era imperils agriculture as much as it does medicine. In addition to growth promoters, livestock raising uses antibiotics to treat individual animals, as well as in routine dosing called “prevention and control” that protects whole herds. If antibiotics became useless, then animals would suffer: individual illnesses could not be treated, and if the crowded conditions in which most meat animals are raised were not changed, more diseases would spread. But if the loss of antibiotics change how livestock are raised, then farmers might be the ones to suffer. Other methods for protecting animals from disease—enlarging barns, cutting down on crowding, and delaying weaning so that immune systems have more time to develop—would be expensive to implement, and agriculture’s profit margins are already thin. In 2002, economists for the National Pork Producers Council estimated that removing antibiotics from hog raising would force farmers to spend $4.50 more per pig, a cost that would be passed on to consumers. H. Morgan Scott, a veterinary epidemiologist at Kansas State University, unpacked for me how antibiotics are used to control a major cattle illness, bovine respiratory disease. “If a rancher decides to wean their calves right off the cow in the fall and ship them, that’s a risky process for the calf, and one of the things that permits that to continue is antibiotics,” he said, adding: “If those antibiotics weren’t available, either people would pay a much lower price for those same calves, or the rancher might retain them through the winter” while paying extra to feed them. That is, without antibiotics, those farmers would face either lower revenues or higher costs. Livestock raising isn’t the only aspect of food production that relies on antibiotics, or that would be threatened if the drugs no longer worked. The drugs are routinely used in fish and shrimp farming, particularly in Asia, to protect against bacteria that spread in the pools where seafood is raised—and as a result, the aquaculture industry is struggling with antibiotic-resistant fish diseases and searching for alternatives. In the United States, antibiotics are used to control fruit diseases, but those protections are breaking down too. Last year, streptomycin-resistant fire blight, which in 2000 nearly destroyed Michigan’s apple and pear industry, appeared for the first time in orchards in upstate New York, which is (after Michigan) one of the most important apple-growing states. “Our growers have never seen this, and they aren’t prepared for it,” says Herb Aldwinckle, a professor of plant pathology at Cornell University. “Our understanding is that there is one useful antibiotic left.” Is a post-antibiotic era inevitable? Possibly not — but not without change. In countries such as as Denmark, Norway, and the Netherlands, government regulation of medical and agricultural antibiotic use has helped curb bacteria’s rapid evolution toward untreatability. But the U.S. has never been willing to institute such controls, and the free-market alternative of asking physicians and consumers to use antibiotics conservatively has been tried for decades without much success. As has the long effort to reduce farm antibiotic use; the FDA will soon issue new rules for agriculture, but they will be contained in a voluntary “guidance to industry,” not a regulation with the force of law. What might hold off the apocalypse, for a while, is more antibiotics—but first pharmaceutical companies will have to be lured back into a marketplace they already deemed unrewarding. The need for new compounds could force the federal government to create drug-development incentives: patent extensions, for instance, or changes in the requirements for clinical trials. But whenever drug research revives, achieving a new compound takes at least 10 years from concept to drugstore shelf. There will be no new drug to solve the problem soon—and given the relentlessness of bacterial evolution, none that can solve the problem forever. In the meantime, the medical industry is reviving the old-fashioned solution of rigorous hospital cleaning, and also trying new ideas: building automatic scrutiny of prescriptions into computerized medical records, and developing rapid tests to ensure the drugs aren’t prescribed when they are not needed. The threat of the end of antibiotics might even impel a reconsideration of phages, the individually brewed cocktails of viruses that were a mainstay of Soviet Union medical care during the Cold War. So far, the FDA has allowed them into the U.S. market only as food-safety preparations, not as treatments for infections. But for any of that to happen, the prospect of a post-antibiotic era has to be taken seriously, and those staring down the trend say that still seems unlikely. “Nobody relates to themselves lying in an ICU bed on a ventilator,” says Rice of Brown University. “And after it happens, they generally want to forget it.” When I think of preventing this possible future, I re-read my great-uncle’s obit, weighing its old-fashioned language freighted with a small town’s grief. The world is made up of “average” people, and that is probably why editorials are not written about any one of them. Yet among these average people, who are not “great” in political, social, religious, economic or other specialized fields, there are sometimes those who stand out above the rest: stand out for qualities that are intangible, that we can’t put our finger on. Such a man was Joe McKenna, who died in the prime of life Friday. Joe was not one of the “greats.” Yet few men, probably, have been mourned by more of their neighbors — mourned sincerely, and sorrowfully — than this red-haired young man. I run my cursor over the image of the tattered newsprint, the frayed creases betraying the years that someone carried the clipping with them. I picture my cousin’s grandmother flattening the fragile scrap as gently as if she were stroking her brother’s hot forehead, and reading the praise she must have known by heart, and folding it closed again. I remember the few stories I heard from my father, of how Joe’s death shattered his family, embittering my grandfather and turning their mother angry and cold. I imagine what he might have thought — thirty years old, newly married, adored by his siblings, thrilled for the excitement of his job — if he had known that a few years later, his life could have been saved in hours. I think he would have marveled at antibiotics, and longed for them, and found our disrespect of them an enormous waste. As I do. This article was written by Maryn McKenna and produced in collaboration with the Food & Environment Reporting Network, an independent, non-profit news organization producing investigative reporting on food, agriculture and environmental health. 6 1 1 1 1 2 1 2 2 FURTHER READING What's Causing the Rise in Antibiotic-Resistant Bacteria in Our Food Supply?  —  Last fall I flew halfway across the country to go grocery shopping with Everly Macario. We set out from her second-story apartment in Hyd... on thefern.org → How Your Chicken Dinner is Creating a Drug Resistant Superbug  —  Up to 8 million women suffer from urinary tract infections, many of which are drug-resistant. What’s less known is that researchers have linked those infections to drug-resistant bacteria in chickens. Suggest a link Recommend PUBLISHED BY FERNnews Non-profit investigative journalism on the subjects of food, agriculture and environmental health in partnership with local and national media outlets. Published November 20, 2013 Follow PUBLISHED IN Editor's Picks Posts we’ve noticed that we think more people should notice. Edited by Medium staff. Read next We don’t Live in an Emergency Room and Other Maxims. A lightweight collection of practical and witty maxims Arun Keepanasseril 3 min read

A Doctor's Perspective of Obamacare

Doctors are currently witnessing the profession of medicine moving from the ethic of the individual to the ethic of the collective. The passage of the Affordable Care Act has solidified this treatment ethic and, as a consequence, often creates conflicts between the treating physician and their individual patients. Nowhere is this shift to the ethic of the collective clearer than our expanding attempt to determine treatment "appropriateness" using a look-up chart of euphemistically-scored clinical scenarios owned and trademarked as "Appropriateness Criteria®" or "AUC®" by our own medical professional organizations. For those unfamiliar, these "criteria" label the care rendered in hypothetical clinical situations as "appropriate", "uncertain" or "inappropriate." (ed's note: oops, this year's update labels these "appropriate," "may be appropriate," or "rarely appropriate"). While touted as "evidence-based," these criteria simply are not - they are a consensus opinion of a collection of physicians for clinical scenarios unrelated to any real patient. These are the words of 'Wesley Fisher M.D. who blogs at 'Dr. Wes'. It seems a day never ends that physicians aren't being instructed on what else we must do to massage a chart for the good of the collective without a moment's consideration of what their "criteria" might mean for our patient's best care. This is our new ethic, our new reality. Wesley Fisher says it so succintly, Speak out against this practice and the doctor is instantly labeled "non-evidence-based," "greedy," "self-serving," and "unconcerned" about the "patient collective." So doctors actively put their heads down and care for their patients as best they can. Daily, doctors experience the angst of this movement. We don't want to admit what has happened. Time and again we find ourselves constrained by these "guideline"- or "appropriateness use"-directed care that has been authorized by our own "physician collective" as "appropriate" when, by its very nature, is outdated by the time the guidelines are published, static and fail to incorporate newly-vetted therapies, and conflict with our patient's actual medical needs. Our field of medicine has become so complicit with this movement that we've even allowed our political and justice systems to threaten or impugn those who step outside these or other outdated care guidelines. When doctors abandon our most basic ethic of caring for the individual for that of the collective, we are served our just desserts. Perhaps writing something like this will open our eyes. Or perhaps, as we've been so quick to do, we'll choose to keep them closed and not admit that this has happened. Remember this when others say no to the care your patient needs.

ObamaCare--The End of Affordable Care

The Affordable Care Act signals the end of affordable and quality health care in America. It also signals the redistribution of money flow. Unfortunately the cash flow will not go to the poor with low incomes. It will be directed to the most wealthy in America….insurance companies, pharma, and government agencies. President Obama promised ‘Hope and Change’. Change is what we are beginning to get. Hope? That may be a long way off, or never. A sense of doom has settled in on most intelligent people. Those without, and who have little have been given an empty promise of more for less. Those who wish to change or revert the system are faced with the inertia of a moving object. However it is easier to redirect a moving object than to move a sationery object. 1200 pages of the Affordable Care Act outline with autocratic mandates what shall be done by governmental administrators. While most ‘experts’ are bogged down in the details, wandering in the trees, the forest is dying. The naturally occurring economic rules are being bypassed, by socialistic cronyism. We normally think about capitalistic cronyism, however socialistic cronyism is far more dangerous because it is embedded in the ‘power’ structure. True cronyism is family or business based. The affordability of health insurance has been based upon actuarial tables, many of which are false and unproven. There is no assurance that you will be able to keep or afford your current or new insurance plan. This is not socialized medicine, or universal payer system. This will affect every American family, as a greater percentage of their income is diverted from food, housing, disposable income and purchasing power. The Affordable Care Act (most likely funded by the National Debt) will create a cascade of lost employment, fewer small businesses, and great stress upon the giants of industry. The outcome will be fewer hospitals, doctors, and poorer public health despite all the promises of HHS and their propaganda about public health, nutritious food, and healthy life styles. Increased stress caused by the Affordable Care Act will have a deletorius effect on those who ‘run out’ of money to feed their family, and who will no longer be able to afford healthy food, switching to high fat, low protein diets. Disposable income will diminish creating a reduction in consumer demand, carrying over to a decrease in production of goods. Creating and operating an IT system to run the Health Benefit Exchange is the most simple aspect of the Affordable Care Act. The stalled opening of Healthcare.gov and further uncertainty about it’s security and operational reliability are flaws that should and will raise concern in the populous. The actual implementation of payment for and delivery of care will not be so simple. The prospect of HHS and the government being able to deliver on it’s promise is like having a check book with no money in the account(s).

What They Said Before the Train Wreck: The Top 10 Worst Quotes Pushing ObamaCare

 

A train looking for a track.  MRC   A Media Reality Check. 

If we truly want health reform, we need to rethink the process.

I did not have my computer this past weekend, however I reverted to an older edition of my ‘software’….#2 yellow pencil and a yellow legal pad.

Thoughts flashed through my cranial space.

“ObamaCare”………..whose care is it, anyway? Obama is not delivering the care, so why should his name be on it.?  The plan was orchestrated by Ezekiel Emanuel,  a well known authority and academic expert on health policy matters. also  elder sibling of Rahm Emanuel, known for his family traits of high achievers, and lack of humility or ability to be diplomatic. Rahm and Zeke used to go at it, something like this,

Emanuel and his brother Rahm frequently argue about healthcare policy. Emanuel mimics his brother's end of the conversation: "You want to change the whole healthcare system, and I can’t even get SCHIP [State Children’s Health Insurance Program] passed with dedicated funding? What kind of idiot are you?"^[8]

Dr Emanuel spent thousands of hours and several years developing the plan. He was head of the NIH at one time as well.  He was pretty high up in medical organizations and must be an expert on health care, yes?  NO ?  He has an outstanding bibliography having written papers on euthanasia, rationing, death panels, end of life and other optimistic and positive views on life.

I don’t believe he has seen a patient in many years, nor ever operated a medical practice business.  The law rightly should be named after the author, let’s call it “Ezekiel Care”, or  “Emanuel Care”.   That sounds holy and authoritative.  After all the law is over 1200 pages long, only slightly shorter than my bible at 1400 pages.

Obamacare is written much like the bible….a multitude of The  Secretary of HHS shall………it does sound a bit biblical, indeed.  Many ‘thou shalt’s under penalty of ……. Obamacare reads a bit like hail and brimstone.    And it will truly end with an apocalypse. I am still figuring out who the 7 horsemen will be in this apocalypse.

However, as usual I digress…

Health Reform is too important to be in the political arena, nor reformed by the ingrained establishments of Congress, the Department of Health and Human Services (HHS) or the Center for Medicare Services (CMS).

Americans are now highly suspicious about both parties and see much self interest in Congress, progress bogged down by process and parliamentary.  There is little if any creative thought going on in those mighty buildings.

In order for Americans to have faith and trust in a health system, the system cannot be devised or run by those in Washington, D.C.  Perhaps even a referendum must be organized to win approval of a totally new organization.

Health is a ‘like no other’ service.  It involves life or death matters (not only) with almost a religious sense of ethics, priorities and privacy matters.

Reform must be proposed by neutral agnostic non political principals. Who will be these leaders?  That in itself will determine the ultimate outcome, success or failure of what is proposed. It will take Jeffersonian creativity to accomplishment and a strong believer in the Constitution.  It has a great deal to do with freedom and individual rights. 

All of our leaders and Supreme Court Justices are sworn to uphold the  U.S. Constitution, however often fail to deliver on their oaths.

The task is awesome to develop a consensus among patients, providers, insurers, hospitals and regulators.

Empty Mandates are worthless, the proposal must have genuine timely deliverables to succeed. It should not be a  ‘ Ponzi scheme’ dependent upon the early success of capitalization to work. 

We need to begin again….Repeal Obama Care.

 

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ObamaCare Going Over the Cliff

I know most of us who had this figured out are not going to say, "I told you so." The rope is already unravelled. There is not going to be a quick fix, except to have the Dems do a mea culpe. Time to sit down and re-do health reform, this time with non politicians and a real CEO, not a head of CMS nor HHS running the show. Most of us are running out of patience, having run out of money a long time ago. I ccurrentlly have very limited access to the internet so that is it for today Happy Veteran's Day to all.

Obamacare Will Be Repealed Well In Advance Of The 2014 Elections

That is less than six months from now.  Forbes magazine this week has an op-ed by Steve Hayward.
“Prediction: even if HealthCare.gov is fixed by the end of the month (unlikely), Obamacare is going to be repealed well in advance of next year’s election.  And if the website continues to fail, the push for repeal—from endangered Democrats—will occur very rapidly.  The website is a sideshow: the real action is the number of people and businesses who are losing their health plans or having to pay a lot more.  Fixing the website will only delay the inevitable.
This video is from 1993 when Hillary-care was being discussed. Many of the same concerns as we see today, however much further down the road.

CBS Audio Transcript  mp3
Monday's CBS This Morning revealed how "a trusted Obama health care adviser warned the White House it was losing control of ObamaCare". Major Garrett underlined that "the warnings were dire and specific, and ultimately ignored" by the Obama administration. Instead, they "relied on appointed bureaucrats and senior White House health care advisers" to implement the health care law. Garrett also pointed out how "the White House became secretive about the law's complexity and regulatory reach" because they were apparently "fearful of constant attacks from congressional Republicans" over the controversial issue.Garrett also pointed out how "the White House became secretive about the law's complexity and regulatory reach" because they were apparently "fearful of constant attacks from congressional Republicans" over the controversial issue.
Despite this bold statement there are many clinging to a sinking ship.

As Obamacare rolls out fitfully there  will be many confounding variables….stay tuned.

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Sherpa Health vs. Obamacare and Healthcare.gov

 

One thing for certain (if there is any) is that “Obamacare” elicits a guttural reaction for many people.  If you are in favor of it then you might be a left wing liberal, a socialist, or maybe even a ‘Pinko”.  If you are against it then you are a right wing conservative, possibly a racist, or worse.

A lofty goal, to insure all our citizens should be removed from the  political stage.

Not only was Nancy Pelosi correct in her statement “We won’t know what is in it until we pass it”.  Even after it’s passage into law most people will not find out what is in it until they look over the policies on the Healthcare.gov website (if you can use it).   The ultimate test is how badly you want it….using the web site is a mixed experience. On some days it works, partially, on other days it is like the old Microsoft “blue screen of death”…

The latest exciting news is that a ‘band of brothers’ has a website named “Sherpa Health” It took three 20 something's and three weeks to created the site.

To quote from the web site, “"The Health Sherpa is a free guide that makes it easier to find and sign up for health insurance under the Affordable Care Act. We only use carefully vetted, publicly available data," the site reads. "The Health Sherpa is not affiliated with any lobby, trade group or government agency and has no political agenda."

I tried Covered California, then the National Healthcare.gov to start.  It took several days, however I think I am registered, however there was no way to immediately confirm my registration.  There was a rather vague message about how I wanted to be notified, email, telephone, regular mail (or morse code….just kidding)

Three Guys Built a Better Healthcare.gov    and while it does not have some of the complexity and linkages to ‘back end’ processes of HHS, IRS and eligibility authorizations it serves as a very friendly usable site for the ‘unintelligent’ (including me)

"It isn't a fair apples-to-apples comparison," Kalogeropoulos said. "Unlike Healthcare.gov, our site doesn't connect to the IRS, DHS, and various state exchanges and authorities. Furthermore, we're using the government's data, so our site is only possible because of the hard work that the Healthcare.gov team has done."

But it does cast light on the difference between what can be done by a small group of experts, steeped in Silicon Valley's anything-is-possible mentality, and a massive government project in which politics and bureaucracy seem to have helped create an unwieldy mess.

HHS and CMS spent hundreds of millions of dollars to erect Healthcare.gov.  For a few dollars less (reportedly for a few hundred dollars).  Sherpa Health does give credit to HHS for the background data bank which is used by Sherpa Health.

Even at this early date there have been surprises, insurance cancellations, healthcare.gov failures, and there will be more regarding penalties, individual mandates, employer mandates, and conflicts such as HIPAA regulations. The early success or failure may be a telltale sign for the financial future of the Affordable Care Act.

Good luck to us all.

Full Committee Hearing - The Online Federal Health Insurance Marketplace: Enrollment Challenges and the Path Forward

 

This morning I awoke to my alarm set to the time of the Senate’s committee hearing on the Affordable Care Act and the botching of it’s “Go live”  date.  Usually “Go Live” dates are immense are of importance and a clear sign of significant change in an industry.

It is still uncertain if the ‘baby’ was born. 

         

President Obama continues to alter his signature promise in selling the Affordable Care Act back in 2009 and 2010.

"If you like your plan, you can keep your plan," he said back then.

But that simple pledge has had to change as the Affordable Care Act has been implemented and a small percentage of Americans, albeit millions of people, have received cancellation notices from their insurance companies. And for the second time in two weeks, he's tweaked the line.

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Debunking 4 Obamacare myths: Both sides get it wrong

On FactCheck.org a website published by Annenberg Public Policy Center, the myths are further analyzed.  The number of experts is legion. Our senators asked many questions but failed to see the what the light of discontent is about and the depth of concerns.

The committee discusses that the Health Benefit Exchange is not the Affordable Care Act. I don’t think anyone thinks it is,, However no one indicated that discontent rises not in the HBX, but in the uncertainty of what the remainder of the ACA will cause to happen or not happen.  The front page open to the public (if and when it works) is not reassuring to the public.

The discontent of consumers is  trust and faith have been lost in regard to the entire program.  Technology cannot replace a trust in the basic tenets of the act. There are many flaws, each a small one, however failure is usually results from multiple errors.

There are proponents of Obamacare who are endlessly optimistic, and offer enduring patience as one of the solutions.

There has been a growing discontent among those not of the mind that given more time the Affordable Care Act will work. If that is the case, there is sufficient time to place matters on hold and delay certain mandates while the law is modified to give authority to redirect the law as needed.

To push on in the face of serious doubt and to ignore the possible demise of the entire act would not  be more than foolhardy. 

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