Covered California II

Enrollment for Covered California began one month ago, and will end on January 15, 2014. The online internet enrollment worked more smoothly and was easy to access. It functions fairly well and most of the time it proceeds without a hitch.

One problem I encountered was an inability to progress from {adding members}  to where the web page for adding new members. This attempt repeated itself a number of times when 'next' was selected. After several attempts the next page did appear, and the process proceeded without further difficulty.

The people who receive the 'best benefits/premium cost' are clearly in the Medi-Cal category if their income is at or below the poverty level. The web site performed fairly well with numerous pop-ups and drop down menu selection. Because of the relatively large number of selections and fields it was difficult to scan through deductibles, and/or co pays. The site allowed users to select and compare plans by checking the plans one wanted to compare.

The plans all have deductibles and co pays. The lower the premium the higher the copay and and deductible.  In many cases the insurance appears to be 'catastrophic coverage'  Common sense would make one wonder how many people could afford a deductible of $2500 to $10,000.

The financial algorithm was  designed by people who know little about health care or it's real expenses.  It seems the design was to fit health care into the budget process.

Jonathan Gruber, the principal economic adviser and designer is an expert in health economics at the macro level, and is no authority on patient care.  He has no medical experience or clinical credentials and is ignorant of patient-provider health process.  He had received numerous awards in healthcare economics.
Gruber has published more than 140 research articles (the majority of which were for NBER) and has edited six research volumes.^[11] He is a co-editor of the Journal of Public Economics, an associate editor of the Journal of Health Economics, and the author of Public Finance and Public Policy.^[12] In 2011, he wrote Health Care Reform: What It Is, Why It's Necessary, How It Works, a graphic novel delineating the Affordable Care Act, illustrated by Nathan Schreiber.^[2]

An allegation and video content of Gruber testifying in several resulted in an eruption of public outrage and discontent.

In January 2010, after news emerged that Gruber was under a $297,000 contract with the Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some conservative commentators suggested a conflict of interest.^[18][19][20] Paul Krugman in The New York Times^[21] argued that, although Gruber didn't always disclose his HHS connections, the times when he didn't were no big deal. 

In November 2014, a series of videos emerged of Gruber speaking about the ACA at different events, from 2010 to 2013, in ways that proved to be controversial. Many of the videos show him talking about ways in which he felt the ACA was misleadingly crafted and/or marketed in order to get the bill passed, while in some of the videos he specifically refers to American voters as ill-informed or "stupid." In the first, most widely-publicized video taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money." He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage.

Writings:

Gruber's published works include:

• On February 15, 2006, the Center on Budget and Policy Priorities published an article by Gruber entitled "The Cost and Coverage Impact of the President's Health Insurance Budget Proposals"^[13]
• In a December 4, 2008, New York Times op-ed, "Medicine for the Job Market", he claimed that expanding health insurance, even in difficult financial times would stimulate the economy.^[14]
• On February 9, 2011, the Center for American Progress published an article by Gruber titled "Health Care Reform Without the Individual Mandate," analyzing the health insurance coverage impacts of alternative policy options for encouraging purchase of health insurance under the Patient Protection and Affordable Care Act, including the mandate, a late penalty, and auto-enrollment.^[15]

Covered California web site illuminates the copay/deductible inverse relationship and premium subsidy.  The working of Obamacare  obfuscates the ACA bill which was passed by the Democratic party.  Very troubling is  it did not include Republcan legislators in the design process. 

Contrary to Obama's proclamations many patients did not keep their physician,or hospital. Nancy Pelosi's uncannily accurate comment 'we won't know what is in it until we pass it'. Jonathan Gruber's "stupid" must also mean 'congress' was too stupid as well.

Portions of this article are attributable to 

New York Times, Covered California (online enrollment)

Women in Healthcare IT

Mobile Health, Telemedicine and Walgreens

Walgreens app makes virtual doctor visits a reality

The service is immediately available to residents of California and Michigan and will be rolled out in other states in the next few years. Illinois residents should be able to use the app by the end of 2015.  Appointments cost $49, most of which goes to physicians. That fee is also not much more than a copay for an in-person doctor's visit through some insurance plans. “Some insurance companies cover telemedicine”, Leider said.

Walgreens is launching a virtual doctor visit feature on its mobile app, the company announced Monday. The nation's largest drugstore chain is teaming up with MDLive, a provider of virtual health services, to connect Walgreens customers with certified doctors via video chat on a smartphone, tablet or computer. 

"Consumers are demanding to do everything through mobile," Parker said. "Everything else they can do through mobile, and now they can do this too."

MDLive stands to gain 2 million people a day through Walgreens' mobile app and website. CEO Randy Parker said the company has 2,000 doctors available.

Last year Walgreens launched a Pharmacy Chat feature on its app to allow users to instant message with pharmacy staff. The company said it averages 9,000 chats a week.

"I think this will become a normal part of health care in three to five years," Leider said. "We have got some real forces that are going to make this very compelling."

He said a shortage of primary care physicians coupled with more people becoming insured through the Affordable Care Act means the market is growing for people who might find telemedicine useful.

Dr. Leider made the bold statement, “"I think this will become a normal part of health care in three to five years," Leider said. "We have got some real forces that are going to make this very compelling."

In October, Deerfield-based Walgreen announced a similar telehealth initiative partnership with health information website WebMD to encourage customers to increase exercise to earn discounts at Walgreens stores. The company said it now awards points on its Balance Rewards loyalty card for logging activities on the WebMD Healthy Target app.

The service is immediately available to residents of California and Michigan and will be rolled out in other states in the next few years. Illinois residents should be able to use the app by the end of 2015, said Dr. Harry Leider, chief medical officer  for Walgreens.  Appointments cost $49, most of which goes to physicians. That fee is also not much more than a copay for an in-person doctor's visit through some insurance plans. “Some insurance companies cover telemedicine”, Leider said.

"Consumers are demanding to do everything through mobile," Parker said. "Everything else they can do through mobile, and now they can do this too."

Chicago Tribune

ehirst@tribpub.com

CellScope’s iPhone-enabled otoscope, remote consultation service launches for CA parents

Parents in California who have children who get chronic ear infections will soon have a more convenient way to get their kids care.

San Francisco-based CellScope, a Khosla Ventures-backed Rock Health alum, has begun taking preorders for its FDA registered smartphone-enabled otoscope,called Oto Home. The director-to-consumer device is priced at $79 and will ship in four to six weeks. A feature-rich, $299 version of the system, called Oto Pro, is also available for preorder now to physicians located anywhere in the US.

There are caveats in using this device and parents should be trained how to insert the scope. The Otohome will come with an FDA approved label for  users, the same as any FDA approved device or medication.

Buffaloed ?

Thanks to Martin Samuel M.D. I now know why the Canadian Health System works as well as it does.

According to him:

"Some years ago, I was acting as a visiting professor in Canada. I was discussing a patient with a disorder that I thought required a rapid, though not urgent, intervention. I was discussing the optimal timing of the intervention, when a chuckle arose in the audience. I inquired about why people seemed so amused and they told me that considerations of that type did not apply to this particular patient because he was going to be “Buffaloed.”

What could that mean, I inquired?

It means that this patient had private insurance and would go to Buffalo for the procedure rather than wait in the queue in the regular Canadian health care system. The reason the Canadian health care system works as well as it does (and that is not by any means optimal) is because 90% of the population is within driving distance of the United States where the privately insured can be Seattled, Minneapolised, Mayoed, Detroited, Chicagoed, Clevelanded and Buffaloed, thus relieving the pressure by the rich and influential to change a system which works well enough for the other people but not for them, especially when they are worried or in pain."

In the United States, there is no analogous safety valve so the influential simply demand a different level of care and receive it. This includes all the authors of the major books, articles and policies that have been written to repair our allegedly hopelessly expensive and error prone system. The array of suggestions is practically incomprehensible partly because there is a secret hypocrisy. Will the pundit actually use their proposed system themselves?

Whenever anyone writes about the rehabilitation of our health care system, they should be required to publish their own health care history, so the public can see where these experts obtain their own medical care. To protect their privacy, specific diseases need not be declared; just the method by which the pundit handled his or her own medical problems. This would be analogous to requiring that politicians reveal their income tax records or that academic doctors report any real or perceived conflict of interest when publishing a paper. Articles, proposals and laws written by anyone who is unwilling to publish his or her own health care history would simply not be considered or published. If just the leading newspapers and opinion magazines would agree to this system the degree of credibility of proposals for changes in our health care system would be dramatically improved.

Where will you Buffalo ?

My thoughts exactly, and Dr. Samuel expresses it so well

reprinted from The Health Care Blog

Martin Samuels is a practicing neurologist and founder of two Harvard-affiliated neurology departments. He holds a membership in the American Neurological Association, a fellowship in the American Academy of Neurology and a mastership in the American College of Physicians.

Did Jonathan Gruber mean Congress is Stupid

Congress just completed it's hearing on the economic planning prior to  the passage of the Affordable Care Act.  The keynone witness was Jonathan Gruber, PhD, whose credentials include MIT.

This is a continuation of our last post here.


Gruber, who most know was the  financial economic planner for Obamacare.  Any clinician and hospital administrator knew that Obamacare is the 'Kool Aid' for liberals wishing  for change and hope. Since Obamacare became law insurance deductibles tripled.

Darrell Issa, chairman of the committee quizzed Gruber and pointedly, asking him if he  was "stupid'. Gruber, who is obviously smart enough  to be at MIT. Gruber responsed, no he was not, but smart people make stupid comments or decisions.  Jonathan Gruber, PhD is a  theoretical economist, observing and making decisions from orbit, with no clnical expereince based upon reality.

Wikipedia's article on Gruber includes the following,

"An American professor of economics at theMassachusetts Institute of Technology, where he has taught since 1992. He is also the director of the Health Care Program at the National Bureau of Economic Research, where he is a research associate. An associate editor of both the Journal of Public Economics and the Journal of Health Economics, Gruber has been heavily involved in crafting public health policy. He is an academic professor of economics at MIT

He was a key architect of both the 2006 Massachusetts health care reform, sometimes referred to as "Romneycare", and the 2010 Patient Protection and Affordable Care Act, sometimes referred to as the "ACA" and "Obamacare".^[1]He became the focus of a media and political firestorm in late 2014 when videos surfaced in which he made controversial statements about the legislative process, marketing strategies, and public perception surrounding the passage of the ACA.

Most of the Affordable Care Act is based upon Gruber and President Obama's face-to-face meetings. It failed the self-proclaimed promise of openness and transparency promise of President Obama"

Obamacare, Is the American Public Stupid or were they Deceived....Again

According to government sources, Obamacare is a resounding success. Yet industry experts and pundits examining the implementation say otherwise.

More information is forthcoming about ObamaCare. Jonathon Gruber, Professor of Economics at M.I.T a primary author for the Affordable Care Act was interviewed by

the Daily Motion (video)

He was a key architect of both the 2006 Massachusetts health care reform, sometimes referred to as "Romneycare", and the 2010 Patient Protection and Affordable Care Act, sometimes referred to as "Obamacare".^[1]

Sen. Rand Paul (R-Ky.) made a guest appearance on “Hannity” Monday and said that embattled Obamacare architect Jonathan Gruber should be made to give back the money he received for his work on the health care bill.

ObamaCare Architect Thinks You’re Stupid; Pelosi Does Too

Gruber admitted multiple times that Obamacare was written in a non-transparent way intentionally, to exploit the “stupidity” of the American voter.

The Affordable Care Act and Mid-term Elections

Many wonder how the mid-term election will afffect the Affordable Care Act ?

Perhaps not at all, however a recent exit poll of GOP voters indicated an unhappiness factor for most GOP voters.   Almost 60% want the Affordable Care Act repealed.

The current structure of the executive branch, and congress may not make this a practical reality until the Presidential election in 2016.  Obama would veto any motion to repeal the act.  Republicans may thwart a ny further plans Obama has for immigration, unless he complies with GOP plans.

There are no doubt some citizens who benefitted by coverage, if they can meet the extremely high deductibles and copays, and find a physician.  The next two years will shake out those who cannot comply for financial reasons.  The underlying formula is based upon the federal poverty rates, which are unrealistic. Basing any ability to pay any amount on the formula is fantasy 101.

People's incomes show large variations in many cases, month to month, especially for low income workers, average income figures fall far short for eligibility purposes.

The Affordable Care Act and Mid-term Elections

The ACA has had some effect resulting in the Democratic loss of seats in Congress.   Many Democrats feel the pain from voter displeasure with the ACA.   Whether this will make a difference to the ACA is still questionable since President Obama will cast a veto against any proposed changes in the law.  Although some changes have been made to the law, most have been waivers or delays in dates.

In a midterm election with many implications for healthcare, Republicans pulled off their expected takeover of the Senate, which they hope will enable them to rewrite the Affordable Care Act (ACA), even if they can't repeal it outright. Health Train's opinion is the mid-term will not repeal the ACA.

The Republicans can boast that they gained seats due to the backlash against Obama, the ACA.  Some of the backlash due to Obama and his statement, "If you like your doctor and hospital    you will be able to keep your doctor." That was a statement not based upon Obama'sl understanding of the law, when he signed it.

The second act of healthcare.gov enrollment begins again.

Significant changes will have to wait until the next Presidential election.

Ebola, Quarrantine Measures, Politics or Science ? Are the politicians correct?

Politics and Junk Science

The world is not a safe place.  (the truth will set you free?)

The United States has been especially fortunate because of the CDC and it's experience in endemic and epidemic infection. Many third world endemic infection have been controlled, and we have required immunization for diseases prevalent in other countries.

The advent of modern transportation with thousands of people travelling around the world in a matter of hours increases the importance of isolating and containing diseases such as Ebola.  Prevention is less expensive, and treatment on site at the origin of the endemic outbreak is essential.

In areas where endemics occur the population density and the prevalence of the infection increases the liklihood of spread to other locations.

The outbreak of Ebola is a mere test of our CDC's control methods. Far worse could be forthcoming. Politicians are making decisions without accepting recommendations from public health scientists and authorities.  Could they be correct ? The Governors of New York, New Jersey and others have correctly used their authority to protect the public health.

As usual our government reacts slowly.

The major effect has been for  health workers returning from West Africa. Health officials have emphasized repeatedly that direct contact with secretions is required for transmission to non-infected individuals.

This week's NEJM (New England Journal of Medicine) has several articles regarding Ebola, regarding diagnosis, treatment and isolation measures.

Ebola in the United States:  EHRs as a Public Health Tool at the Point of Care    
Ebola and our fragile health system

Despite repeated assurance by the CDC that the transmission of Ebola Virus is not airborne, there are recent articles which report vomitting produces a spray pattern, and protective measures to prevent spread of Ebola Virus.

Ebola Virus Disease and the need for New Personal Protective Equipment.

Ebola, the world's most dangerous virus. (documentary)

Numbers below are time tags and contents of video:

0:00 Introduction to viruses
1:20 Virus anatomy
2:35 Hemorragic fever in Angola (Ebola)
2:56 WHO and GOERM
3:15 WHO and world wide  monitoring
8:25  Infection control and prevention in underdeveloped countries
11:54 CDC
12:00 Biological containment and isolation methods
13:15  Ebola, Marburg virus have no treatments or vaccines. 


25:00 Virology, methodology for research
33:00 Viral Vectors and origins, zoonoses, West Nile Virus
36:00  Threat of bioterrorism
41:00  Limited resources, requiring large volunteer efforts in Africa and elsewere.
45:00  Previous lessons from HIV (25% of Africans had HIV virus leading to AIDS)

Ebola Virus Outbreak 2014 - WARNING

Ebola is named for a river in the Congo where virus first appeared in 1976.

This video is from an active Ebola facility in Western Africa and explains the isolation and containment methods used.

22:23 Health worker evacuation to U.S for treatment.

Experimental Treatment: ZMAPP 

Q: What is this drug?

A: Called ZMapp, it is a cocktail of specially engineered antibodies designed to target and inactivate the Ebola virus.

Q: What do we know about whether it works?

A: Very little. Various antibodies have been tested in small numbers of monkeys, but not people. In one study, 43 percent of treated monkeys survived when the drug was given after the animals showed symptoms.

Mapp Biopharmaceutical now is developing a combination of three antibodies that seemed most promising in those animal studies.

Ebola - What You're Not Being Told  according to reports from Scientific Reports; 

Are you as confused as I am? My education and training in medicine should make me able to discern fact from fiction.

Here are opposing views:

You'll notice if you read virtually any mainstream article on the topic that they make a point of insisting that Ebola is only transferred by physical contact with bodily fluids. This is not true, at all.

A study conducted in 2012 showed that Ebola was able to travel between pigs and monkeys that were in separate cages and were never placed in direct contact.

Though the method of transmission in the study was not officially determined, one of the scientists involved, Dr. Gary Kobinger, from the National Microbiology Laboratory at the Public Health Agency of Canada, told BBC News that he believed that the infection was spread through large droplets that were suspended in the air.
"What we suspect is happening is large droplets; they can stay in the air, but not long; they don't go far," he explained. "But they can be absorbed in the airway, and this is how the infection starts, and this is what we think, because we saw a lot of evidence in the lungs of the non-human primates that the virus got in that way."

Translation: Ebola IS an airborne virus. (as is annotated in the video and below, I am using this term in the layman's sense as TRAVELS THROUGH AIR)

Someone pointed out that in medical terms, if the virus is transferred through tiny droplets in the air this would technically not be called an "airborne virus". Airborne, in medical terms would mean that the virus has the ability to stay alive without a liquid carrier. On one hand this is a question of semantics, and the point is well taken, but keep in mind that the study did not officially determine how the virus traveled through the air, it merely established that it does travel through the air. Doctor Kobinger's hypothesis regarding droplets of liquid is just that, a hypothesis. For the average person however what needs to be understood is very simple: if you are in a room with someone infected with Ebola, you are not safe, even if you never touch them or their bodily fluids, and this is not what you are being told by the mainstream media. Essentially I am using the word "airborne" as a layman term.

The AP's spin on it:
Experts say people infected with Ebola can spread the disease only through their bodily fluids and after they show symptoms.

From CNN:
Ebola spreads through contact with organs and bodily fluids such as blood, saliva, urine and other secretions of infected people.

And from the BBC itself in their article describing the second confirmed case in Nigeria:
The virus spreads by contact with infected blood and bodily fluids - and touching the body of someone who has died of Ebola is particularly dangerous.

To make matters worse, there is something very, very important that the corporate media and public health officials are not telling you regarding this crisis.

You'll notice if you read virtually any mainstream article on the topic that they make a point of insisting that Ebola is only transferred by physical contact with bodily fluids. This is not true, at all.

How Obamacare will effect this year's Medicare Enrollment Period

How to judge Medicare plans

While much of the nation is preoccupied with Obamacare and picking new health insurance at work, older Americans have deadlines of their own coming up — involving Medicare.

We're just a few days away from the two-month period when the nation's 54 million Medicare beneficiaries have a chance to change their Medicare Advantage and prescription drug plans.

Every year, seniors should review their options and compare plans even if they're happy with their current coverage. Experts want people to avoid being surprised after it's too late to change. The deadline is Dec. 7.

The process of shopping can be daunting, and many seniors simply don't heed the advice.

"It's the same advice we give every year, but it's hard to get people off the dime," says Ross Blair, senior vice president of eHealthMedicare.com, which provides tools and information on Medicare insurance issues.

Medicare Advantage plans. Nearly 16 million people — or about 30% of the Medicare population — are enrolled in Medicare Advantage plans. These cover hospitalization, outpatient care and, often, prescription-drug coverage under one plan.

According to the Centers for Medicare and Medicaid Services, the average premium for Medicare Advantage plans will increase less than $3 next year, to $33.90 per month. Residents of Los Angeles County will see average costs of just $13.74 per month. The vast majority of enrollees will face little or no premium increase for next year.

 But out-of-pocket costs, such as deductibles and co-pays, are expected to rise. Looking beyond the monthly premium will be important for shoppers wanting to save money.

Be aware that some Advantage plans will be terminated this year. Be certain yours will continue;

Pay attention to networks, experts stress. Medicare Advantage plans are also reducing the size of their provider networks — in some cases quite dramatically.

If your physician will no longer be participating in your current plan, your insurer is required to send you notice of that fact and help you find another doctor in the network.

Nationwide, the average monthly premium in 2015 will be about $31, the federal government estimates. In California the figures vary, but the average is $58.91.

Although the number of these plans has dropped for 2015, there will still be 1,000 available nationwide. In Los Angeles County, Medicare participants will have 31 plans from which to choose for 2015, down from 34 this year.

As with Medicare Advantage plans, insurers are shifting more costs onto beneficiaries in the form of higher out-of-pocket costs, such as deductibles, co-pays and co-insurance, so you need to look beyond premiums.

Also, many plans have "preferred" status pharmacies, whose costs can be lower than other in-network pharmacies, says Elaine Wong Eakin, executive director of the Medicare advocacy organization California Health Advocates. In fact, 70% of Medicare drug plans had preferred pharmacy networks this year, and the expectation is there will be more in 2015.

Also, pay attention to the ratings. To help consumers determine the value of both Medicare Advantage and prescription drug plans, Medicare created a quality rating system. A plan can receive one to five stars, with five being the best, based on the agency's assessment of medical services and customer satisfaction.

Experts urge consumers to be alert for possible changes since last year's Medicare Advantage and prescription plans.

To review your plan options: Medicare plan finder at http://www.medicare.govor call (800) MEDICARE; eHealthMedicare.com.

For free personalized counseling services: State Health Insurance Assistance Programs, shipnpr.shiptalk.org or call (800) 677-1116; In Los Angeles, California Health Advocates: http://www.cahealthadvocates.org/HICAP

NY Times Article