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

Introduction

• Average out-of-pocket cost for Medicare beneficiaries are expected to keep rising over the next decade when it will reach half of a senior's income. 
• The Kaiser Family Foundation estimated that out-of-pocket costs will increase from 41% of average per capita Social Security income in 2013 to 50% by 2030.
• In its analysis of 2013 numbers, KFF said women paid 44% of their per capita income on out-of-pocket costs, which was more than men, who paid 38% on out-of-pocket costs. That’s expected to increase to 52% and 47% respectively by 2030.

Medicare helps pay for the health care needs of 59 million people ages 65 and over and younger people living with permanent disabilities. Yet, people with Medicare can face significant health-related out-of-pocket costs, including premiums, deductibles, cost sharing for Medicare-covered services, and costs for services Medicare does not cover, such as long-term services and supports and dental services. With half of all Medicare beneficiaries living on annual per capita income of less than $26,200, out-of-pocket health care costs can pose a challenge, particularly for beneficiaries with modest incomes and those with significant medical needs.

As one way of measuring health care affordability for people with Medicare, each year the Medicare Trustees estimate Medicare Part B and Part D premiums and cost sharing as a share of average Social Security benefits. This estimate, however, does not include other health-related costs, such as out-of-pocket spending on hospital and skilled nursing facility stays, supplemental insurance premiums, and costs for services not covered by Medicare. The estimate also does not include income from sources other than Social Security.

In this analysis, we assess the current and projected out-of-pocket health care spending burden among Medicare beneficiaries using a broad definition of health care expenses, and in relation to both per capita Social Security and total income. Our results suggest that rising health care costs pose significant affordability challenges for many people on Medicare today, particularly those with relatively low incomes who derive most of their income from Social Security, and that this burden can be expected to grow in the future. This analysis sets the context for understanding the implications of potential changes to Medicare, Medicaid, or Social Security that could shift more health care costs onto beneficiaries or reduce their future retirement income.

Tables: 

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

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

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

Physicians are people, too.

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

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

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

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

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

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

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

Global Health Observatory (GHO) data

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

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

How our Healh System works (exclusive to Health Train Express) Behind the Scenes

A Supplement That May Block The Toxic Effects of Alcohol

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

I am Dr George Lundberg, and this is At Large at Medscape. September is "be kind to addicts" month (officially National Recovery Month). How can we help?

Of every 100 Americans who drink (140 million), about 12 (16 million) are considered in need of treatment for an alcohol use disorder, and eight will become chemically dependent on alcohol.^[1] Of that eight, one will become addicted very early, even after the first drunken episode. The problem is, we do not yet have a way to predict who that one person will be.

Prevention is always the best answer to addiction. Do not drink. If you do drink, do not ignore the warning signs of becoming a problem drinker.

Let me ask you: How is your blood acetaldehyde today; or, more relevant, how was it late last night? You don't know? Why am I not surprised? Most people don't even think about acetaldehyde.

Ethyl alcohol is metabolized to acetaldehyde by alcohol dehydrogenase in the liver. Acetaldehyde is metabolized to acetate by aldehyde dehydrogenase and then to carbon dioxide and water. Depending on the alcohol dose, some of the acetaldehyde may escape hepatic metabolism and enter the general blood circulation.

Acetaldehyde is a close cousin to my old pathology lab friend formaldehyde. We use it to pickle surgical and autopsy tissues for preservation. Both are known carcinogens. Our body's defense mechanism against excess acetaldehyde is the amino acid l-cysteine and glutathione. These molecules, similarly to thiamine, contain a sulfhydryl group that is chemically active against aldehydes.

Unless you are one of those people (typically East Asian) who are genetically deficient in aldehyde dehydrogenase or are taking disulfiram, you can metabolize roughly one stiff drink per hour. If you drink more than that, depending on body weight, gastric contents, and the efficiency of your metabolic alcohol breakdown, acetaldehyde will build up because aldehyde dehydrogenase capability can be overwhelmed.

If you quit drinking at 11:00 PM, then around about 1:00 AM, your acetaldehyde level may be elevated and you may feel symptoms of acetaldehyde toxicity, including skin flushing, tachycardia, palpitations, anxiety, nausea, thirst, chest pain, and vertigo. Of course, you are trying to "sleep it off," so you may not feel toxic until the next morning when that dreaded hangover appears.

Metabolizing Alcohol

My friends in the nutritional supplement community tell me that you can enhance the metabolism of blood alcohol to acetate, carbon dioxide, and water and minimize the acetaldehyde molecular logjam by taking oral supplements. L-cysteine, vitamin C, and vitamin B₁ are purported to help. At supplement doses, they are cheap and harmless at worst. At best: Goodbye, acetaldehyde toxicity; hello, restful sleep. About 200 mg of L-cysteine per ounce of alcohol consumed is sufficient to block a major portion of the toxic effect of acetaldehyde. But because alcohol is absorbed and metabolized rapidly, it may be necessary to take L-cysteine before and concurrently with consumption to maintain protection. Also, an excess of vitamin C (perhaps 600 mg) can help keep the L-cysteine in its reduced state and "on the job" against acetaldehyde. Experts recommend these doses (with or without extra B₁): one round before drinking, one with each additional drink, and one when finished.

Some say that this regimen works very well. Do not ask me for a list of published randomized, double-blind clinical trials. Not yet, at least. Research funding into "harm reduction" from addicting substances has not enjoyed favored status in research priorities.

Unfortunately, this concoction may have little effect on next-day hangovers, the causes of which are complex and resistant to prevention—except, obviously, by not drinking too much, which is, of course, the best answer to alcohol anyway.

With drug users, be redemptive, not punitive.

That is my opinion. I am Dr George Lundberg, and this is At Large at Medscape.A Supplement That May Block The Toxic Effects of Alcohol

A 2017 New Year’s wish list for healthcare | Suneel Dhand

My New Year’s Wish List

1. Healthcare information technology

2. Patient safety and healthcare quality

3. Patient satisfaction and improving the hospital experience

4. Direction of healthcare consolidation and private doctors

5. Healthcare costs

None of the above categories are exclusive, nor independent of the others.

Dr Suneel Dhand elaborates in the following video

Suneel Dhand is a physician, author and speaker. He is co-founder at DocsDox and founder at DocSpeak Communications. Learn more about him here.






A 2017 New Year’s wish list for healthcare | Suneel Dhand

State air board has urged a 500-foot buffer zone but now emphasizes design rather than distance.

Regulators shift focus on housing by freeways

State air board has urged a 500-foot buffer zone but now emphasizes design rather than distance.
By Tony Barboza and David Zahniser

Twelve years ago, California air quality officials delivered a warning to cities and counties: Avoid putting new homes in high-pollution zones within 500 feet of freeways.
That advice, which relied on years of research linking traffic pollution to asthma, heart attacks and other health problems, was aimed at keeping “children and other vulnerable populations out of harm’s way,” according to the state Air Resources Board’s 2005 handbook .

But earlier this year, the air board shifted its stance. It issued a newadvisory that emphasizes design rather than distance, recommending anti-pollution features such as air filters, sound walls and thick vegetation as “promising strategies” to reduce the health risks from freeways.

With those measures, communities can build “while simultaneously reducing exposure to traffic-related pollution,” the air board said.

In making that change, air regulators acknowledged a stark reality: Despite health risks, cities desperate for more housing at a time of soaring rents keep approving homes near traffic pollution. The Times reported earlier this year that residential development along freeways has surged in the decade since the air board issued its warning.

Business leaders and housing advocates have cheered the pivot by the air board, contending limits on home building near freeways will worsen an affordability crisis. The new advisory has also been embraced by state planning officials, who say urban development near transit is essential to fighting climate change by reducing reliance on cars.

But some worry that amid a push to build homes, the air-quality agency has muddied what had been a clear, if controversial, health warning.

Scott Fruin, professor of preventive medicine at USC, said the air board’s latest document presents best-case scenarios and overstates the extent to which air filters and other anti-pollution measures protect residents. By recommending those steps, he said, state regulators “may give the false impression that it is now OK to put schools and residences close to freeways.”

“The best current strategy to reduce near-freeway exposure is not to put schools and residences there in the first place,” said Fruin, who previously worked at the Air Resources Board. “Even with the best reduction measures available, air pollution in these locations will remain unhealthy.”
Air board officials said they prepared the advisory to give policymakers the latest, scientifically based options to reduce pollution exposure at a time when the state is encouraging home construction near transit lines that are often next to freeways and other high-traffic corridors.

Those projects are challenging in cities like Los Angeles, “where freeways and major thoroughfares abound,” air board spokesman Stanley Young said. “In responding to that reality, we felt it was important to give planners and developers information on how to mitigate the impacts,” he added.
Kurt Karperos, a deputy executive officer for the air board, said the April advisory does not change the agency’s 2005 recommendation to avoid siting homes within 500 feet of freeways. “That’s a very basic health position that the agency has taken and we still stand by.”

In recent years, Karperos said, some have suggested the agency replace its recommendation for a 500-foot buffer, since vehicles have become less polluting over the last decade. “We disagreed.”
Still, one official in Gov. Jerry Brown’s administration reached a different conclusion, saying the 2005 recommendation “was replaced” by this year’s advisory on air filters, sound walls and other anti-pollution strategies.

Ken Alex, who directs the governor’s Office of Planning and Research, pointed to the April advisory as he defended the state’s decision to finance affordable housing next to freeways. The air board’s position is “much more nuanced than ‘don’t build’ ” within 500 feet, said Alex, whose agency is responsible for long-range policies on how California grows and develops.

State air regulators say their 2005 guidelines have not, in fact, been replaced.
Air Resources Board officials said they decided to supplement them in light of new science on freeway pollution and the effectiveness of air filters and other measures. Regulators drafted a report — an appendix to be considered in addition to the 2005 guidelines — and presented it to the air board in January 2016.

At that meeting, air board chair Mary Nichols acknowledged that the push for dense urban development, which can reduce driving and overall emissions, also can “result in increased exposures for people who live or go to school and spend any time outdoors in areas near roadways.”
“Trying to optimize both of these strategies has proven to be somewhat controversial and an interesting challenge,” Nichols said at the meeting.

The final document, published in April, was an advisory. Air quality officials do not have the power to regulate land use. The document said research shows “the public health, climate, financial, and other benefits of compact, infill development along transportation corridors” and found alternatives to distance-based guidelines “that can protect public health while not dictating development patterns.”
Among the suggestions in the report: Lower speed limits to 55 mph or less and install roundabouts to reduce vehicle emissions. Design city streets with parks, bike lanes, wider sidewalks and buildings with “varying shapes and heights” to disperse traffic pollutants.

The Air Resources Board’s influence has grown considerably over the last decade as its core mission — protecting people from pollution — has expanded to include efforts to slash greenhouse gas emissions. That shift has sparked criticism from some environmentalists, who contend that the board has made tackling health threats from local pollution secondary to the global fight against climate change.

The new focus on anti-pollution design puts the air board in closer alignment with the city of Los Angeles, which has adopted stronger filtration requirements but has not imposed limits on how close homes can be built to freeways. That emphasis also drew praise from housing advocates and developers, who viewed the 2005 guidelines skeptically.

Freeway sound barriers

Stuart Waldman, president of the Valley Industry and Commerce Association, said the air board’s latest advisory “just shows that the original policy was unrealistic to begin with.”

Alan Greenlee, executive director of the Southern California Assn. of Non-Profit Housing, said he is happy the state “seems to have moved in the direction of allowing building where previously they weren’t interested.” With filters and other anti-pollution measures, developers “can house people affordably and healthfully in areas where the government says there are air quality issues.”
Some environmentalists view things differently.

Multi-function walls: Solar, sound and pollution barrier

Enivronmental barrier

When the air board’s handbook came out in 2005, “we thought that was a real step forward,” said Bill Magavern, policy director for the Coalition for Clean Air.

Environmental groups have largely favored the state’s push to concentrate new homes near transit, citing the climate benefits. But without limits on home building near freeway pollution, those policies will have unintended health consequences, Magavern said.

“New housing should be well planned so that it’s not putting residents’ health at risk,” Magavern said. “The goal is to have the homes near transit, not near freeways.”

In Southern California, officials with the South Coast Air Quality Management District say they continue to send letters to developers suggesting they increase the distance between new homes and traffic. In the Bay Area, air quality regulators last year published interactive traffic pollution maps and planning guidelines that recommend some of the same design measures as the state.
The Bay Area Air Quality Management District advised communities to put new homes as far from freeway pollution “as is feasible.” The words “as is feasible” were added “at the heavy insistence” of developers and affordable housing advocates, said Jackie Winkel, a principal environmental planner with the agency.

tony.barboza
@latimes.com
Twitter: @tonybarboza
david.zahniser @latimes.com
Twitter: @DavidZahniser