ACA Enrollment Issue? If All Else Fails Try Social Media

From Fierce Health Payers

Many consumers can't get through to insurers due to long customer service wait times, so they're turning to social media--Twitter in particular--to express their complaints and criticisms. And insurers are listening, often responding directly to consumers with ways to immediately rectify the problems.

The Affordable Care Act has severely effected customer service for all companies participating in the affordable care act.  Frustration has mounted even for those not involved with health benefit exchanges or subsidized care. Anthem Blue Cross in California is experiencing the brunt of many tweets after it canceled individual plans and switched hundreds of its members into new plans and withdrew premiums from their bank accounts without their knowledge. In several situations, Anthem spokesperson Darrel Ng tweeted individually to people who complained about the withdrawals, asking for their contact information so he could resolve the problem, ProPublica reported.

Did you know that Anthem has been using social media for customer service and complaints for some time?

Ng told ProPublica that consumers now are interacting with companies, including Anthem, beyond the traditional phone call. "In response to this new demand, we created our customer service Twitter account @AskAnthem several years ago to assist members," he said. "As consumers themselves started proactively contacting our other Twitter accounts, we started directing these inquiries to customer service for assistance."

Aetna spokesperson Matt Wiggin said the insurer recognizes people are using other methods to communicate. "There have been some instances where call volumes have been heavy and if people have not been able to get through or been able to get the information we need, they've either reached out to us through social media or other means available," he told ProPublica.

California HealthCare Foundation has been tracking Twitter comments related to the reform law and its recentreport found less conversation about the law between December 2013 and Jan. 15, 2014, compared to several months ago when HealthCare.gov launched with glitches and enrollment errors.

Recognizing consumers take more frequently to Twitter, insurers Aetna and Cigna have been maintaining a strong social media presence to manage their brand while taking quick action to remedy any complaints aired publicly,FierceHealthPayer previously reported.

"Social media gives us a tremendous opportunity to learn what the community needs," Carissa O'Brien, Aetna's social media director, told KHN. And by using Twitter, Aetna can educate and inform their followers about health and wellness.

She and her team of six employees aim to respond within an hour of the roughly 250 Tweets each month dealing with claims and other services. But O'Brien recognizes that it's just the beginning. "If we're looking to focus a 100-plus-year-old company on social media, that's massive cultural change," she said.

Using Twitter also keeps the insurers accountable. "Social media acts as a public documentation of how you resolve the situation," Ini Augustine, a social media strategist and head of SocialWise Media Group, told KHN. "It's more than a marketing tool."

Insurers like Aetna, Anthem Blue Cross Blue Shield and Cigna have designated Twitter feeds, @aetnahelp   @askanthem and @cignaquestions, respectively, that focus solely on marketing and sharing health-related news.

            

Read more: Insurers increase their Twitter presence to manage image - FierceHealthPayer http://www.fiercehealthpayer.com/story/insurers-increase-their-twitter-presence-manage-image/2013-08-09#ixzz2sP3Ud2Nd
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The Affordable Care Act and Medicaid------False Promises

The Los Angeles Times and the Calfornia Medical Association have printed a report on Covered California.

Copyright © 2014, Los Angeles Times

Medi-Cal seen as relief for some, confusing burden for others

The majority of patients who have enrolled in the Affordable Care Act were assigned to Medi-caid. Most feel some ecstasy and relieve that they have health insurance. On Jan. 21, Covered California reported that 584,000 had been "determined likely eligible" for Medi-Cal after visiting CoveredCa.com and an additional  630,000 transitioned into Medi-Cal from separate low-income health programs run by counties. Patients signing on for Medi-Cal join a health plan and receive their care from networks of participating doctors, clinics, hospitals and pharmacies, much like other managed care patients who have private insurance.

There are however many gaps and questions about just what that means.  We reported these deficits several months ago.  I became aware of these when a member of my family who had been disabled for ten years and  had several pre-existing conditions.  They did not qualify for SSDI because she had not worked enough in the past 10 years to qualify...largely because she was not able due to her permanent disability.

The Los Angeles Times reports several scenarios that will disappoint those assigned to Medi-caid. Supporters of national healthcare reform tout the expansion of Medicaid — called Medi-Cal in California — as one of the great successes of the Affordable Care Act.

For many needy people, learning they're eligible for the usually free program has been a tremendous relief — assurance that, after decades of forgoing care or worrying about medical expenses, they'll now be able to afford medications, see a doctor or seek emergency care without worrying about ending up broke.

But the news isn't wholly welcome for others, who find the complexities of signing up with Medi-Cal bewildering and onerous. And some, like Golden, who don't consider themselves low-income and don't know how Medi-Cal works, also fret over being placed on state healthcare rolls — "on the dole" — and would rather just pay for insurance. 

Medi-caid and Medi- Cal (California's Medicaid program) has a significant 'stigma' for patients and for hospitals. Some hospitals have contracted with medicaid, and providers must apply and be eligible as a provider.  Many providers do not accept Medi-caid.  Patients without a share of cost (another story) are elibible and encouraged to join a managed care Medi-Cal program. (a prefarable alternative to fee for service.) 

Low-priced insurance policies aren't available for Medi-Cal-eligible Californians, who are welcome to buy insurance through the exchange only if they give up any subsidy.

Another hidden glitch is for families with children, and despite the Affordable Care Act's promise of guarranteeing  coverage to children until age 26 under the parent's policy California dances to its own set of rules.  Martin Gross, a self-employed lawyer and Obamacare proponent in Mar Vista, bought Kaiser Permanente policies for himself and his wife through Covered California.

But when his 16-year-old son qualified for Medi-Cal, it gave him pause.

"I said, 'Wait a minute — I'm not that poor. Why is my son on Medi-Cal?' " he recalled. "I wasn't crazy about it. It was a hit to my ego."

Gross said he would have liked to have had the option of paying what he used to for his son's coverage.

"I just didn't want to pay double," he said, referring to what would have been the unsubsidized Covered California cost.

Edward Chavez, co-chairman of the health enrollment team at One L.A., a community group that works through religious congregations, said that he and other advocates had encountered similar resistance to Medi-Cal among the mainly Latino and working-class clients he has in the northeast San Fernando Valley.

Little-known Medicaid provision allows states to seek repayment from enrollees

A little-known wrinkle in the decades-old Medicaid law may be prompting some Americans ages 55 to 64 to shy away from the health plan of last resort -- called Medi-Cal in California -- after learning there's a catch: Once they die, their estates may have to reimburse the government for the cost of their medical care.  There are significant waivers and exemptions to this law.

MEDICAID ESTATE RECOVERY PROGRAM 
From fiscal year 1993-94 to 2013-14, California's Medi-Cal Estate Recovery Program recouped $978.5 million. Of that, 50 percent was returned to the federal government. Over the same period, California's Medi-Cal budget was $621 billion. 
California is typically ranked at the top of the list of states in Medicaid estate recovery.
The average estate claim amount in California is $95,000. The average recovery amount is $15,000. This amounts to a paltry amount of less than .000000005 % of the Medi-Cal budget.

Source: California Department of Health Care Services

Copyright © 2014, Los Angeles Times

Health System: Beginning and Ends with Politics

I have never considered myself a politically influential  person. I always considered my self to be conservative independent and never registered for any particular party.  I had some hope for the Tea Party movement which has erroneously called the Tea "Party"  The Tea Party Movment began as an idea and attracted those of all political persuasion. It's based upon fundamental beliefs about America and the documents and laws from which it sprang.

Largely because it was supported by Sarah Palin, who at the time was a Vice-Presidential candidate with John McCain and the Republican Party. Palin  was labelled a "right wing" politician.  However the TPs ideas also fit well with many democrats.

Gradually I have been swept along and have become politically active largely because of my role as a physician and sometimes leader in some circles.  My circles are small and I probably have few followers.

For over 30 years as a physician  I dealt with older patients, and children as in my specialty of ophthalmology.  In the last fifteen years the economics and science of medicine changed immensely. As science and technology improved it economically impasted the financing of healthcare with changes in administering payments and requiting prior authorizations to perform many procedures, both diagnostic and therapeutic.  In order to facilitate these new mechanism bureaucracy fluorished along with the attendant cost.  As regulatory functions increased cost skyrocketed, and efficiency declined. The added addition of health information technology which promised to reduce cost actually increased cost and reduced efficiency for many reasons.  The return on investment is moot.

Much as the title of this post as Charles Krauthammer succintly summarizes America's choices and directions, 'It all begins and ends with politics'.

So too has the decision and formulation of the Affordable Care Act. Perhaps this is why it is so chaotic and poorly implemented.  Political choices come down to the court of last resort. (Let's vote on it)  The best decisions are rarely chosen by a vote. If a law is passed subject possibly to constitutional doubt the question is sent to the Supreme Court where frequently the decision rests on an obscure readily available consitutional guarranttee of certain rights.

Conflict and opposition are the soil of politics.

The Affordable Care Act is now the law of the land.  However like most laws it will be amended as circumstance warrants.

Health Train Express has been swept along in the past year, from healtth information technology and reform to political inflluence.

Health 2.0 India

The term Health 2.0 is an outgrowth of Web 2.0 as second generation internet technology and web sites developed in the last decaded of the 21st Century. It now is synonymou with the annual gathering of HIT professionals, including EMR,  HIE,  Mobile apps, Web Portals, and WiFi enabled embedded sensors

Health 2.0 has developed a global presence, beginning in the United States and expanding first to Europe, and Asia. Begiinning as a relatively small meeting it has grown exponentially.  The geographic diversity allows 'techies' in a wide variety of locations and cultures to meet and translate ideas as well as market to potential users. It serves well as a '"thought tank" for mobile health, consumer directed Many software development occurs at these meetings.

Health 2.0 India is the most recent iteration of the exposition.  It begins on February 7, 2014 in Bangalore, India.

2014 Topics will include :

• Designing an improved patient experience for a Billion people

• Trending – Startups, Funding and Accelerating Health 2.0

• Health 2.0 in the village

• Quantified self, wearable sensors and trackers

• Mobile health in real life

• Rise of big data and better decisions

• Pharma and better outcomes

• C-Level executives unplugged

• Unmentionables amplified – Sex, Sport & Rock n’ Roll

India has unique demographics and geographic criteria. It is heavily rural, with scattered villages, weak infrastructure and other limitations for networks. Rural communities often have no electricity. Telemedicine and televideo is highly desireable to spread the healthcare workforce.

One advantage is as infrastructure is built, cell phone, cable internet will be built with modern technology including fiberoptic backbone.

Boris' Grandson

My good Friend Boris Gorelik from Brooklyn, NY had a grandson born at 24 weeks. His medical expenses will be very high, and I wanted my readers to help in any way they can by following the instructions above.

Thanks so much

GML

Covered California Rates Plans It Sells

Sorcea:

 San Diego UT
 CMS

For many people enrolling in Covered California this may be their first time in many years to enroll in any health  insurance plan.  For some it may be the first time they have qualified to be insured.

The array of plans is overwhelming at best and the enrollment program (contrary to  President Obama's statemtn) is not user friendly (such as buying on Amazon.com).  In fact the process has been made more difficult by this attempt to make health care fit into a business model for shopping.

Health Insurance has been like no other, and labelling a web site to encourage enrollment as the "Market Place" demeans the process further.  It equates health along with such things as a meat packing plant, and a piece of steak.

Although statistics can be misleading and subject to interpretation , this attempt to rank plans is a starting point for 'newbies'.

Nevertheless in order to assuage critics of Obamacare by pretending to offer quality comparison Covered California has listed their 'ratings'.

Several articles have appeared, one in the San Diego Union Tribune,  which stated that the two plans in San Diego which  rated the highest were Kaiser Permanente, and  Sharp Health Plan. Sharp and Kaiser each got four stars, one better than Anthem Blue Cross and Blue Shield of California.  This applies specifically to the San Diego region.  This is a truly unique area in terms of Kaiser and Sharp Health Plan for which there is no equivalent plan in other regions of California.

There are several organizations that rate health insurers based upon selected criteria.

NerdWallet Health offers The Best Hospitals tool which includes the most recent hospital data available through Medicare. The data features the 100 most frequently performed inpatient procedures from over 3,200 hospitals across 50 states. This website offers a straight forward chart which ranks hospitals/plans

NerdWallet devised the Easy Index, which ranks each company as Easy!, Decent, or Painful, based on our experience calling each company and health plan data from the National Committee for Quality Assurance (NCQA’s Private Health Insurance Plan Rankings 2012-2013 and NCQA’s Medicaid Health Insurance Plan Rankings 2012-2013).  NerdWallet Health's ranking differ significantly from what Covered California rated.

The other organizations that rank healthplans and/or hospitals are:

     NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA         accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care.

Hospital Consumer Assessment of  Health Care Providers and Systems (HCAHPS) is a national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay. These rankings appears at Data.Medicare.Gov

NerdWallet Health offers their criteria for ranking.
  
 This is a beginning for some. For many assessing co-pays, deductibles, and benefits will be more of a challenge, especially those on subsidized plans who were previously covered by Medi-caid.  It is unclear to me whether Medi-caid will upgrade their coverage, provider lists, or hospital eligibility.

Repeal the President’s Health Care Law

I wrote in several posts why Obama Care will be de-constructed by the American Culture for many reasons.  Eventually it will be re-constructed in a manner consistent with the American Cultual beliefs,  which will avoid intruding on basic Constitutionally guaranteed freedoms. (regardless of what the Supreme Court has ruled.

All early signs point to erosion of ObamaCare

    All Signs Lead to the Destruction of ObamaCare
    Vital Signs Diminishing for Obamacare Is Life Support Imminent?
    The Fears About IPABs in the Affordable Care Act
    Death Spiral ? Is this the Black Hole for the Affordable Care Act?
    Will the Affordable Care Act Overwhelm the Health System?

    ACO Expectations May be Unrealistic
   

Senator Orin Hatch has initiated a Legislative proposal has connected changes leading to a uniform health insurance system:


Title 1: Repeal the President’s Health Care Law
        Section 101: Repeal Obamacare
Title 2: Replace Obamacare With Sustainable, Patient-Centered Reforms
        Section 202: Create a New Protection To Help Americans With Pre-Existing Conditions
Section 203: Empowering Small Business and Individuals with Purchasing Power
Section 204: Empowering States With More Tools to Help Provide Coverage While Reducing Costs
Section 204: Expand and Strengthen Consumer Directed Health Care
Title 3: Modernize Medicaid to Provide Better Coverage and Care to Patients
        Section 301: Transition to Capped Allotment to Provide States with Predictable Funding and Flexibility
        Section 302: Reauthorize Health Opportunity Accounts To Empower Medicaid Patients
Title 4: Reducing Defensive Medicine Practices And Getting Rid of Junk Lawsuits
        Section 401: Medical Malpractice
Title 5: Increasing Price Transparency to Empower Consumers and Patients
        Section 501: Requiring Basic Health Care Transparency to Inform And Empower Patients
Title 6: Reducing A Distortion in the Tax Code That Increases Health Costs
        Section 601: Capping the Exclusion of An Employee’s Employer-Provided Health Coverage

There is no reason why employer group coverage cannot be continued with the caveat that it must conform to not banning pre-existing issues, and eliminating any cap on benefits.
Tax code issues regarding health benefits should not have a limit, nor require a threshold of income under which deductions can be claimed.
The IRS should be prevented from administering penalties, nor punish using a penalty and/or fine mechanism.

Taken together the aforementioned ideas will lead to an end result. Each section must be evaluated against a background of common sense without regard to self-interest in any part of the health system.

If we want a re-birth of our system we cannot drag along the dysfunctions present in our present system.
I would add the aspect of improving the health of our citizens.  This may not be properly measured by outcome studies based on reducing costs. The metrics need to be re-evaluated for that component of reform.

The underlying and most important goal is to improve access and quality of care. While Obamacare addresses costs, it does little if nothing to improve access. This challenge requires more funding for primary care physicians education and reassess certain specialties now included in primary care listings. Many internist are not primary care oriented, although considered PCP, nor are obstetricians/gynecologists.

ObamaCare is the Central Battle over the future Direction of our Country.

Richard Reece MD who blogs at Medinnovation has some profound quotes from Thornton Wilder. From it derives the title of this article. Thorton Wilder,  a quintessential American writer, the author of The Bridge of Saint Luis Rey, Our Town, The Skin of Our Teeth,  and the inspiration of Hello Dolly !.  

Some of you will disagree with our view of the Affordable Care Act.

Wilder was a true patriot – a believer that America had created the most dynamic,  creative,  individualistic, and freedom-loving nation on earth.   

ObamaCare is the central battle over the future direction of our country. It cannot stand. It is a looming disaster for patients- especially seniors- for our economy and for the future of health care in America. It will lead to rationing and government control over health are decisions. The quality of care will decline. Medical progress will slow. And the resulting third-rate health care system will likey bankrupt our country.  The federal government is already racing toward a budgetary train wreck, and ObamaCare will only speed us down the tracks.”

Fortunately ObamaCare as it now is written will self-destruct and in the next five years the American Culture will de-construct it.

      Paul Rosenberg in FreemansPerspective.com  in a blog post entitled “Why ObamaCare Will Not Conquer American Culture,” November 1, 2013, in which he says,”Americans expect to choose whenever they want.. Americans expect choices; it is built for individual changes, not collective changes.  This is the DNA of the culture, and no matter what political controlling th liberal ruleship, the culture will simply not fall.

Grace-Marie Turner, James Capretta, Thomas Miller, and Robert Moffitt,  Why ObamaCare is Wrong for America: How the New Health Care Law Drives up Costs, Puts Government in Charge of Your Decisions, and Threatens Your Constitutional Rights (Broadside, a Harper Collins Imprint, 2011) who say, “The passage of ObamaCare was deeply polarizing. Never before had Congress passed - and the president signed into law – such sweeping legislation that was so strongly opposed by so many Americans."  

author:

Physicians in particular with our ethic of privacy and one on one relationships with our patients will not be misled by this plan which does not justify the means toward an end. We all are adamant about an equitable health care for all.  But this is not the way.

Take heart my colleagues.....the deconstruction will take place by the very people who put it together.....or they will be gone......voted out of office.

Vital Signs Diminishing for Obamacare Is Life Support Imminent?

Moody's: Uncertain healthcare landscape leads to negative outlook 

for US health insurers

Global Credit Research - 23 Jan 2014

Insurance companies, long held in high ESTEEM in the finance world, because of their wide base of investment and astute leadership are beginning to feel the effects of ObamaCare even before they begin paying reimbursements to providers, hospitals, and enrolled providers.

Moody's Corporation is an essential component of the global capital markets, providing credit ratings, research, tools and analysis that contribute to transparent and integrated financial markets.

Moody's changed the outlook for US health insurers to negative from stable, as implementation of the Affordable Care Act (ACA)continues to create uncertainty for the industry, says Moody's Investors Service in its new industry outlook "US Healthcare Insurers: Outlook Changed to Negative from Stable."

The ACA—signed into law in March 2010—seeks to increase affordability of health insurance and expand both public and private insurance coverage through a number of mechanisms including exchanges, mandates and subsidies.Uncertainty over the demographics of those enrolling in individual products through the exchanges is a key factor in Moody's outlook change, says the rating agency. Enrollment statistics show that only 24% of enrollees so far are aged 18-34, a critical group in ensuring that lower claim costs subsidize the higher claim costs of less healthy, older individuals. This is well short of the original 40% target based on the proportion of eligible people in this cohort, says Moody's.

Looking forward, Moody's expects reduced net earnings margins of approximately 2% in 2014, compared to an average of 3% the previous year and smaller overall membership growth of approximately 1%, down from 3% in 2013, with company strategies continuing to focus on revenue and income diversification.

Still, these changing dynamics will have an uneven effect on insurers, as the impact of these factors will vary by market segment and geography. Moody's view continues to be that the larger and more diversified insurers will be better positioned, both financially and strategically, to meet the challenges facing the sector.

Earlier this week, the conservative American Action Forum released a report which found"that after accounting for subsidies and cost-sharing, 6 out of 7 uninsured, young adult households will find it financially advantageous to forego health coverage, and instead pay the mandate penalty and cover their own health care costs.

*A reader points out that there's a difference between a negative outlook and a formal downgrade, which is what I originally implied. A credit downgrade is likely, but has not yet occurred.

Nevrtheless the Perverse Incentives of the Obama Care Act (Affordable  Care Act) come into play to increase the shortfall of funding health insurance for all, with no limitations..

The American Action Forum prints a readable and understandable explanation of how ObamCare is supposed to work.

This short infographic illustrates the reverse logic for young people

Technology Advances In The Clinic and Cost Savings

Eric Topol is on a mission to get health care out of the mess it’s in.

Topol is known for his sounding the  alarm about Vioxx a drug which was very popular but carried with it significant risk.

He’d had a busy morning seeing patients and, by about noon, was claiming to have already saved the medical system thousands of dollars using his iPhone and a pocket-sized ultrasound machine. Then he pointed to the stethoscope in his pocket and said he hasn’t used it in three years. “I should just throw it out,” he said. “This is basically a worthless icon of medicine.”.

This profound statment spoken by a cardiologist articulates what most physician's may already have concluded.  Topol is perhaps the most prominent advocate in the U.S. of how digital technology can lead to less expensive health care, and he invited me to see the savings in action. As we lope toward the exam room, Topol, slightly hunched and repeatedly turning to deal with questions flying at him from his staff, seems a little rattled by the commotion and barrage of demands, but a calm sets in the moment he enters the exam room. He folds his arms across his chest as a young colleague updates him on the patient’s history. Topol introduces himself to the 85-year-old man, who has been tiring easily as of late, and then the doctor immediately pulls out his iPhone.

Topol, who since 2007 has aggressively promoted digitizing medicine, does not check his e-mail, Google a fact, or call a pharmacy. Rather he slips what looks like a protective case onto the phone. The outside of the case has two oval, metal pads that are electrodes, and Topol asks his patient to place his thumbs on them.

“He’s bradyacardic without any good reason to be bradyacardic,” Topol says to his colleague, Hashim Khan, watching as a graph of blips rollercoasters across his phone’s screen. He looks at me. “We save $100 for every one of these we do.”  

The add-on to the iPhone is a $199 version of a hospital-grade electrocardiogram machine that sells for much more. By getting the reading of the heart rhythm himself, Topol says, he’s saved the patient from going to a special station with a trained technician who will spend 15 minutes hooking up wires.

The old ways of ultrasound:

Moments later, Khan pulls out a Vscan, an ultrasound device made by GE Healthcare that resembles a large flip phone. With Topol looking on, Khan squirts gel on the man’s chest and then scans his heart’s chambers with a wand attached to the device. “His function looks actually not so bad,” says Topol, adding that most doctors charge $600 to perform an ultrasound using a $350,000 machine. But Topol bills nothing when it’s done as part of a routine physical exam like this. “There are 125 million ultrasound studies done in the United States each year,” says Topol, shaking his head. He says “probably 80 percent” of those could be done with the Vscan at no extra charge.

Topol promotes the use of wireless technology for diagnostics. The savings will be enormous, not just in the capital required for instruments, but the efficiency and utilization of small handheld devices in the clinic, devices that can be carried in the doctor's pocket (or bag). Included in his 'deck of cards' are things like  another of Topol’s projects, a collaboration with Caltech, aims to put a wireless sensor into an artery. The sensor would be about a third of the size of a grain of sand, and will stay put and potentially detect an imminent heart attack. If it works better, it could prevent heart attacks—an outcome that Topol says doesn’t require a cost-effectiveness study, ZioPatch, a Band-Aid sized heart monitor that people wear for up to two weeks, can more readily detect heart arrhythmias than the clunky Holter monitor used for 50 years. Consider sleep labs. Topol says smartphone add-ons that measure oxygen use and pulses can diagnose sleep apnea without requiring someone to spend a night in a sleep lab, which costs thousands of dollars. “Talk about putting them out of business,” says Topol. “We can do a screening test which is basically free through a smart phone.”

Another of Topol’s projects, a collaboration with Caltech, aims to put a wireless sensor into an artery. The sensor would be about a third of the size of a grain of sand, and will stay put and potentially detect an imminent heart attack.

It is a 'brave new world" and these devices are only the beginning. Continuing miniaturization of processors, and new developments in materials,nanotechnology, chemistry and physics will drive innovation.  

These events will radicalize medical education.

The Fear about IPABs in the Affordable Care Act

The fear of 'death panels' may be overaggerated but do pose an ominous warning to us all. The concept of an IPAB (Independent Patient Advisory Board) looms in an uncertain way during these perilous times of intertwining and complex changes to a complex health system.

The very recent experience of a child who was declared 'brain dead' exemplifies the problem of determining 'what is death' ?

The LA Times Headlines on Januray 21, 2014  read:

McMath attorney: Jahi's family aren't fools; they deserve better than ignorant attacks

Brian Franklin, left, attorney for Children's Hospital Oakland, and Christopher Dolan, attorney for Nailah Winkfield, mother of Jahi McMath, speaks during a court hearing to discuss the treatment of Winkfield's daughter in Oakland. Among those in the courtroom were Martin Winkfield and wife Nailah Winkfield, behind the attorneys.

"I am the attorney who answered a call for help from Jahi McMath's family in December. I have represented them for free — starting 10 hours before the first order to turn off Jahi's ventilator at Children's Hospital Oakland — as they have fought for their right to make medical decisions for a beloved child."

Despite the incendiary, hateful public rhetoric that has surrounded this case, I believe that self-interest alone should lead most Americans to thank Nailah Winkfield, Jahi's anguished mother, for her courage..............

I applaud Mr McMath who so eloquently discusses the conundrum of family vs a medical system stressed financially and the importance of medical providers and hospitals to act as fiduciaries of their patients.

Death Spiral ? Is this the 'Black Hole for the Affordable Care Act

A better title for this may be "Failure to Launch"

Our congress has launched a multi-stage rocket. Whether it will obtain a free standing orbit is open to question.
Stage I success is very much in doubt. The velocity may be inadequate to launch stage II and even if Stage II lights off the orbital insertion velocity will be insufficient to obtain an orbit.

The lack of success in the enrollment process due to the failures of healthcare.gov and other related items in enrollment of young people may be a fatal even in financing the entire initiative for the Affordable Care Act.

This enrollment was meant to offset the expanded coverage for older patients, and increased enrollment of previously uninsured due to income limitations, and patients with pre-existing conditions.

Those in the know are already talking about a 'bailout' for insurers amounting to billions of dollars.  Again, 'it's too big to fail".

Nancy Pelosi was correct, "We won't know what is in it until it is passed"  This is a hell of a way to run 1/6th of our economy.

Prominenrt voices are being raised in the credible media about these real risks. Even dome Democrats have lowered their flag, although there remain some demagoguery and social engineers who are attempting to hi-jack our freedoms and bankrupt our already insolvent government.

Let's face it, our government lies, not only about health care, and politics, but national security issues.

Keep and open mind, but verify what we are being told by our government.

When Sharing may not be Caring

It's basic, my dear Watson....as Sherlock Holmes would inform his sidekick whose name was  Wastson (not the cyber-edition from IBM.

As written by Tina Reed Johnson

When Sharing is *Not* Caring on Social Media!

You might think that photographers appreciate it when you share their images online.  Believe it or not, this isn’t always the case!  There are oftentimes conditions on image use, and you can get into trouble if you are not paying attention.  If you are using someone else’s image to spice up your post, you might want to think about it first.

But it’s so quick and easy to share social media images, and if it’s online it’s okay to use it right?  And especially if the photographer name is already on a photo then there shouldn’t be a problem.  Hold on there a minute!  

And it's safe to use your own images?  Right ?

It’s important to follow image use guidelines to avoid violating a copyright, and causing problems for yourself and your business. It can be expensive to pay for your mistakes. You may have to hire an attorney, repair damage to your online reputation, in addition to compensating an artist or photographer for image (mis)use.

The Basics on sharing images, art and more on Social Media

Just as in health care privacy and sharing are intertwined. HIPAA establishes strong guidelines (boundaries) and so to do copyright law.......