A Personal Option for Health Care | Health Care Reimagined | Americans f...

The Covid pandemic did not produce new problems,  it pointed out many that have been in the system for decades, but did not rise to the awareness of the media.

Most of us are too busy with other daily problems of life and have little idea of how the health system is not functional, until they are faced with a serious illness, and get a bill.

Federal Involvement in Health Care Drives Treatment Choices

'Doctors cannot question the federal government. That's how health care works in the United States right now.

Around the United States, in numerous cases, hospitalized COVID-19 patients have asked for Ivermectin but were denied the drug, and then sought a court order forcing the hospital to provide the requested medication. Ivermectin, which has been used safely in humans since 1985, has shown promise in treating the virus, especially when taken early. Although it is an off-label use and not guaranteed to work every time, it is legal for doctors to prescribe Ivermectin for COVID-19, and many patients, some desperate and dying, want to give it a try.

Why are so many hospitals opposed to trying safe, inexpensive Ivermectin? The answer is tied to the complicated financial house of cards covering the entire health care system.

This isn’t a story about Ivermectin; it’s about what COVID-19 exposed in America’s health care system. The federal government, pharmaceutical, and insurance companies hold the reins on what care hospital administrators can offer. They never looked at your chart, but have a say in your treatment, and doctors who stray from administrative protocol can kiss their careers goodbye.

Here is a look at the many forces driving health care decisions outside the doctor-patient relationship.

Sick People Are Profitable

Indiana-based Dr. Dan Stock is a family medicine physician connected to America’s Frontline Doctors, a medical freedom organization promoting treatments such as Ivermectin for COVID-19. He says finances guide much of today’s health care landscape.

“Almost no one pays for direct care anymore,” Stock told The Epoch Times. “You pay for your care as you give your money to the federal government through taxes, or to an insurance company through premiums.”

The insurance company or the government buys the service for you as a third party. That’s a problem, Stock says, because “The federal government never has paid its bills. Every doctor and every hospital lose money on every Medicare and Medicaid patient who comes in the door.” And to make up the loss, he says, the cost of health care is inflated for those with private insurance.

A 2017 fact sheet produced by the American Hospital Association said the annual shortfall borne by hospitals is $57.8 billion, and privately insured patients and others make up the difference.

Nonprofit hospitals are federally required to accept Medicare, Medicaid, retired military insurance, Indian Health Services, and all federal insurance programs.

This cost-shifting caused inflation of medical prices and that sparked increases in private health insurance premiums.

“Employers started screaming about it, people started dropping their private insurance because it just wasn’t worth the money anymore, so that’s why the Affordable Care Act got passed,” Stock said. “The idea was, look, market forces won’t make you join in and buy through the third-party payment scheme to keep Medicare and Medicaid afloat. Hospitals are screaming ‘we’re going to go bankrupt.’ So the Affordable Care Act comes out, which says that everybody in the country has to buy insurance, and if you’re an employer, you have to buy it for your employee. You’re not allowed to say no. If you do, we give you a great big tax.”

That kept Medicare and Medicaid funded, Stock says.

“But there was a problem with the Affordable Care Act. They have this thing called Medical Loss Ratio,” Stock said. “Somebody talked to these idiots in our federal government into saying, hey, if you’re a private insurance company, you have to spend 80–85 percent of the premiums you take in on medical supplies and services. Only 15–20 percent of it can be given to the stockholders or be used to pay administrative fees.”

 Health Care Systems and Codes

How do insurance companies predict the public’s health?

Electronic records, developed around 20 years ago, helped doctors track patient data such as sodium level, blood sugar, and kidney function. About five years later the government realized hospitals and independent doctors were tracking that information but couldn’t share data with each other because of privacy rules associated with the HIPAA Law.

That is why, in 2012, Accountable Care Organizations (ACO) were formed. Doctors and hospitals that join an ACO are now working for one big employer.

Medicare and Medicaid said anybody who is not part of an ACO would have their reimbursement cut by 3 percent. It also offered a 2 percent increase to those who did join an ACO, Stock said.

“You’ve got to know that the margins in medicine are really narrow. Most hospitals have a one or two percent margin,” Stock said.

“The federal government then said, to get that 2 percent and to maintain your reimbursement, there are two other things you have to do,” Stock said.

First, ACOs became obligated to use an electronic medical record system and report data back to the feds and insurance companies.

The data doesn’t drill down to the level of “John Smith has asthma,” but it does tell what percentage of coronary artery disease patients are on a statin drug, or what percent of people with COVID-19 are being treated with respirators.

To enter the information into the computer system, doctors must link a treatment to a diagnosis. They must link a Current Procedural Terminology (CPT code) with an International Classification of Diseases (ICD diagnosis code).

“For instance,” Stock said. “I’m not allowed to just go write somebody a prescription for Losartan. I have to write a prescription for Losartan and link it to a diagnosis, in this case blood pressure, so they can tell what I did.”

If a doctor were to link a treatment like Ivermectin to an off-protocol diagnosis, such as COVID-19, the ACO will be financially punished and the doctor would face consequences, Stock said. To change the diagnosis code to a government acceptable code but use the medicine for something else would be fraud. The prescription must match the diagnosis in the protocol.

Here’s the second thing the government said you had to do to maintain your 2 percent reimbursement: the government and insurance companies came up with a Pay for Performance plan, also known as value-based programs.

“These programs reward health care providers with incentive payments for the quality of care they give to people with Medicare,” the Centers for Medicare and Medicaid Services (CMS) website says. “Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.”

The CMS website lists “quality improvement organizations” that develop and implement these programs, including the National Quality Forum; the Joint Commission of the Accreditation of Health Care Organizations; the National Committee for Quality Assurance; the Agency for Health Care Research and Quality; the American Medical Association. Some of these groups are led by former insurance, pharmaceutical or CMS executives.

Now the government, advised by insurance and drug companies, defines what good medicine is, Stock says. Doctors must make a diagnosis and provide the protocol code of care.

CMS bases reimbursements on how well health care systems meet these guidelines.

Like a social credit score, individual health care providers are being scored by their performance.

Federal Involvement in Health Care Drives Treatment Choices

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How Soon Will COVID Be “Normal”? |

On Thursday, six medical experts close to the White House published three op-eds in the Journal of the American Medical Association, arguing that the time had come for a new approach to the pandemic—one that sets aside the campaign for eradication in favor of living with the disease. covid-19, one op-ed argued, should no longer even be tracked on its own but monitored together with other respiratory viruses, such as the flu—the sort of thing that might be done by epidemiologists rather than by all of us refreshing graphs on the Times’ Web site day and night. The argument was particularly notable because the six experts had all been advisers to President Joe Biden’s covid-19 transition team. “A ‘new normal with COVID’ in January 2022 is not living without COVID-19,” Ezekiel Emanuel, of the University of Pennsylvania, Celine Gounder, of N.Y.U., and Michael Osterholm, of the University of Minnesota, wrote. But they believed that the long era of emergency—the one defined by a wartime feeling and frequent briefings from Anthony Fauci—should draw to a close.

“The Biden Administration’s intentions are usually quite good, but it's messaging is often contradictory,” the epidemiologist William Hanage said.

Even as the Omicron wave spikes, some outside experts believe that the time has come for Anthony Fauci and the White House to declare a new phase in the pandemic.

How Soon Will COVID Be “Normal”?

“A ‘new normal with COVID’ in January 2022 is not living without COVID-19,” Ezekiel Emanuel, of the University of Pennsylvania, Celine Gounder, of N.Y.U., and Michael Osterholm, of the University of Minnesota, wrote. But they believed that the long era of emergency—the one defined by a wartime feeling and frequent briefings from Anthony Fauci—should draw to a close.

That same morning, I spent half an hour interviewing Fauci by Zoom, to try to understand how the Administration saw the current state of the pandemic. Lately, he had been dropping some hints that his view might not be too different from that of the JAMA experts: on ABC last Sunday, he’d said that it might make sense at some point to focus not on covid cases but on hospitalizations, a change that would organize policy around the medical effort to identify and treat the very sick rather than a social campaign to stop the spread of the disease. I asked him what time line he had in mind. “It’s not necessarily something that we’re going to do—or even seriously consider doing—tomorrow,” 

Fauci said. But eventually the Omicron wave would come to an end, 

How Soon Will COVID Be “Normal”? | 

‘Killer’ immune cells still recognize Omicron variant

It is important to remember that most serious complications from a Covid 19 infection are due to immune reactions that result in inflammation in the lung and other vital organs such as the heart, and kidneys.

The body's defense mechanism also includes "killer T cells" a type of white blood cells that capture and destroy foreign organism including bacterira, viruses and other microbial organisms.  This takes place with the assistance of antibodies, and can also take place without antibodies.  The most effective response is to due the synergy of both working together.

In the race against emerging coronavirus variants, researchers are looking beyond antibodies for clues to lasting protection from COVID-19.

How ‘killer’ T cells could boost COVID immunity in face of new variants

Concerns about coronavirus variants that might be partially resistant to antibody defences have spurred renewed interest in other immune responses that protect against viruses. In particular, scientists are hopeful that T cells — a group of immune cells that can target and destroy virus-infected cells — could provide some immunity to COVID-19, even if antibodies become less effective at fighting the disease.

Researchers are now picking apart the available data, looking for signs that T cells could help to maintain lasting immunity.

“We know the antibodies are likely less effective, but maybe the T cells can save us,” says Daina Graybosch, a biotechnology analyst at investment bank SVB Leerink in New York City. “It makes sense biologically. We don’t have the data, but we can hope.”

Coronavirus vaccine development has largely focused on antibodies, and for good reason, says immunologist Alessandro Sette at the La Jolla Institute for Immunology in California. Antibodies — particularly those that bind to crucial viral proteins and block infection — can hold the key to ‘sterilizing immunity’, which not only reduces the severity of an illness, but prevents infection altogether.

That level of protection is considered the gold standard, but typically it requires large numbers of antibodies, says Sette. “That is great if that can be achieved, but it’s not necessarily always the case,” he says.

A T cell targeting coronavirus particles (illustration).

Killer cells

Alongside antibodies, the immune system produces a battalion of T cells that can target viruses. Some of these, known as killer T cells (or CD8+ T cells), seek out and destroy cells that are infected with the virus. Others, called helper T cells (or CD4+ T cells) are important for various immune functions, including stimulating the production of antibodies and killer T cells.

T cells do not prevent infection, because they kick into action only after a virus has infiltrated the body. But they are important for clearing an infection that has already started. In the case of COVID-19, killer T cells could mean the difference between a mild infection and a severe one that requires hospital treatment, says Annika Karlsson, an immunologist at the Karolinska Institute in Stockholm. “If they are able to kill the virus-infected cells before they spread from the upper respiratory tract, it will influence how sick you feel,” she says. They could also reduce transmission by restricting the amount of virus circulating in an infected person, meaning that the person sheds fewer virus particles into the community.

T cells could also be more resistant than antibodies to threats posed by emerging variants. Studies by Sette and his colleagues have shown that people who have been infected with SARS-CoV-2 typically generate T cells that target at least 15–20 different fragments of coronavirus proteins1. But which protein snippets are used as targets can vary widely from person to person, meaning that a population will generate a large variety of T cells that could snare a virus. “That makes it very hard for the virus to mutate to escape cell recognition,” says Sette, “unlike the situation for antibodies.”

So when laboratory tests showed that the 501Y.V2 variant identified in South Africa (also called B.1.351) is partially resistant to antibodies raised against previous coronavirus variants, researchers wondered whether T cells could be less vulnerable to its mutations.

Early results suggest that this might be the case. In a preprint published on 9 February, researchers found that most T-cell responses to coronavirus vaccination or previous infection do not target regions that were mutated in two recently discovered variants, including 501Y.V22. Sette says that his group also has preliminary evidence that the vast majority of T-cell responses are unlikely to be affected by the mutations.

If T cells remain active against the 501Y.V2 variant, they might protect against severe disease, says immunologist John Wherry at the University of Pennsylvania in Philadelphia. But it is hard to know from the data available thus far, he cautions. “We’re trying to infer a lot of scientific and mechanistic information from data that doesn’t really have it to give,” he says. “We’re kind of putting things together and building a bridge across these big gaps.”

Updating vaccines

Researchers have been analysing clinical-trial data for several coronavirus vaccines, to look for clues as to whether their effectiveness fades in the face of the 501Y.V2 variant. So far, at least three vaccines — a protein vaccine made by Novavax of Gaithersburg, Maryland, a single-shot vaccine made by Johnson & Johnson of New Brunswick, New Jersey, and a vaccine made by AstraZeneca of Cambridge, UK, and the University of Oxford, UK — were less effective at protecting against mild COVID-19 in South Africa, where the 501Y.V2 variant dominates, than in countries where that variant is less common.

In the case of AstraZeneca’s vaccine, the results were particularly striking: the vaccine was only 22% effective against mild COVID-19 in a sample of 2,000 people in South Africa. However, that trial was too small and its participants too young for researchers to draw any conclusions about severe disease, says Shane Crotty, an immunologist at the La Jolla Institute for Immunology.

Could mixing COVID vaccines boost immune response?

Some coronavirus vaccine developers are already looking at ways to develop next-generation vaccines that stimulate T cells more effectively. Antibodies detect only proteins outside cells, and many coronavirus vaccines target a protein called spike that decorates the surface of the virus. But the spike protein is “quite variable”, suggesting that it might be prone to mutating, says Karlsson, and raising the risk that emerging variants will be able to evade antibody detection.

T cells, by contrast, can target viral proteins expressed inside infected cells, and some of those proteins are very stable, she says. This raises the possibility of designing vaccines against proteins that mutate less frequently than spike, and incorporating targets from multiple proteins into one vaccine.

Biotechnology firm Gritstone Oncology of Emeryville, California, is designing an experimental vaccine that incorporates the genetic code for fragments of several coronavirus proteins known to elicit T-cell responses, as well as for the full spike protein, to ensure that antibody responses are robust. Clinical trials are due to start in the first quarter of this year.

But Gritstone president Andrew Allen hopes that current vaccines will be effective against new variants, and that his company’s vaccine will never be needed. “We developed this absolutely to prepare for bad scenarios,” he says. “We’re half hoping that everything we did was a waste of time. But it’s good to be ready.”

Nature 590, 374-375 (2021)

doi: https://doi.org/10.1038/d41586-021-00367-7

References

Killer’ immune cells still recognize Omicron variant

9 Schema That Change The Way You See The World, and will effect your Health

About the Author

Dr. Monica Johnson

Dr. Monica Johnson is a clinical psychologist and owner of Kind Mind Psychology, a private practice in NYC that specializes in evidenced based approaches to treating a wide range of mental health issues (e.g. depression, anxiety, trauma, and personality disorders). Additionally, she has a focus on working with marginalized groups of people including BIPOC, LGBTQ+, and alternative lifestyles to manage minority stress. She is also dedicated to contributing to her field professionally through speaking, training, supervision, and writing. She routinely speaks at conferences, provides training and workshops at organizations, supervises mental health trainees, and co-authored a book for professionals on addressing race-based stress in therapy.

Dr. Johnson earned her bachelor's degree from the University of South Carolina, completed her Psy.D. at the Arizona School of Professional Psychology, and completed her postdoctoral training year at Cherokee Health Systems in Knoxville, TN. She currently lives in Manhattan where she indulges in horror movies, sarcasm, and intentional introversion. You can find her on Instagram and online at kindmindpsych.com. 

Schemas are not obvious Social Determinants of Health (SDOH). 

THE QUICK AND DIRTY

There are 18 different schemas that can develop in childhood that may have an adverse effect on how you view the world. You may not even realize you have one of the schemas—in fact, the belief system may feel entirely normal to you. That's why awareness of a schema is the first step towards changing it.For instance, children who develop a schema that they aren’t good enough rarely challenge this belief, even as adults. They can be the CEO of a Fortune 500 company and still go home feeling as though they're inadequate. Schemas, like emotions, are self-serving. They attempt to mold your experiences and encourage you to engage in actions that keep them around.  Today, we're going to discuss early maladaptive schemas. There are so many of them that this will be a 2-part episode, so listen through to the end and make sure you're ready for next week!

Have you ever heard of a schema before? A schema is a stable and enduring negative pattern that develops during childhood or adolescence. It persists and expands throughout our lives.

We view the world through the lens of our schemas. Schemas are closely held beliefs and feelings about yourself, others, and the world. Typically, you accept these beliefs without question and many people are not aware that they have them. They are self-perpetuating and are very resistant to change, but with appropriate treatment, you can change them!

For instance, children who develop a schema that they aren’t good enough rarely challenge this belief, even as adults. They can be the CEO of a Fortune 500 company and still go home feeling as though they're inadequate. Schemas, like emotions, are self-serving. They attempt to mold your experiences and encourage you to engage in actions that keep them around.

Usually, schemas operate in subtle ways, outside of our awareness. However, when a schema is triggered by stimuli in our environment, our thoughts and feelings are dominated by schema-related content. In these moments we may experience maladaptive thinking, extreme and/or intense emotions, and have urges to act in ways that might not be in the interest of our psychological well-being.

(1) An Upgraded Hippocratic Oath Is Needed In The Digital And A.I. Era | LinkedIn

The Hippocratic Oath is the most famous text in Western medicine. It constitutes the ethical basis of the medical profession. For centuries, it has provided an overview of the principles of this noble mission and doctors’ professional behaviour. At the dawn of a new era in medicine, it is high time to rewrite the Oath so that it would reflect the state of technological development, changes in social structures and in general, the requirements of the 21st century.

What is the Hippocratic Oath?

Used by many medical schools at graduation ceremonies, the medical profession adopted the Oath of Hippocrates as its ethical code of conduct centuries ago. That’s not a mere chance. The text articulates perfectly what the noble profession of being a doctor entails and in a compact overview takes a side in every major ethical issue a physician might encounter during their career.

Only a few know that although the oath bears the name of Hippocrates, the well-known Greek physician, there is no evidence that he wrote it. It is claimed that the document was created 100 years after his death; still some 2500 years ago.

The intimacy of a doctor patient encounter has changed since telehealth, electronic medical records have increased social distancing in the past 20 years.  Many people now have access to the medical record, given implied consent to perform their duties.  Can patients still be assured of their privacy and confidentiality of the visit with their physician(s)?  What do physicians think of the HIPPOCRATIC OATH?  As in other modern interpretations of oaths and features of the U.S. Constitution the interpretation varies widely among today's physicians. Some (few) take it's meaning literally.  Others have been influenced by bureaucracy, regulations and common peer behavior to abandon it's meaning as written by our forefathers Upon graduation, many medical students take a modern version of the oath written by Louis Lasagna in 1964.  

MODERN VERSION.  Upon graduation, many medical students take a modern version of the oath written by Louis Lasagna in 196

4. 

CLASSICAL VERSION

The bottom line for patients is do your trust your physician, and will he keep your innermost secrets, sins and indiscretions.  Most will, and will not include any specifics in the electronic medical records. It is up to you to instruct him to not include that which  you do not want passed along.  Most will do so.

Digital Health Space advises. you to not disclose sensitive information on a telehealth visit, nor to an assistant.

Our message to you, get vaccinated against Covid 19 and have a Happy and safe New Year, 2022

1) An Upgraded Hippocratic Oath Is Needed In The Digital And A.I. Era | LinkedIn