20 Questions for President Trump | Public Health Post

The last six and a half years have been uncharted territory in our nation’s century-long 

debate over health reform. For the first time the fight was about how to implement an attempt at near-universal coverage 

rather over what this plan should look like and what could win enough support in Congress. The Affordable 

Care Act (ACA) has survived major political, legislative, and legal tests, including dozens of 

repeal votes, two Supreme Court decisions, the 2012 

presidential election, and state-level resistance.

I was outside the Supreme Court on June 25, 2015 when the King v. Burwell decision was released. I was there the moment activists switched their signs from saying “Don’t you dare take my care” to “The ACA is here to stay.” I wrote that we could finally say with some certainty that they were right, the law is here to stay. They were wrong. I was wrong.

Donald Trump’s victory throws the future of health reform into complete chaos. He will take office in January 2017 with Republican majorities in the House and Senate. President Trump, Speaker Ryan, and Senate Majority Leader McConnell have all made repeated promises to get rid of Obamacare. They will face enormous pressure to follow through with their threats of repeal. Approximately 21 million people are projected to lose insurance if they follow through with their initial proposals.

The first step to figuring out where to go from here is understanding what decisions are on the horizon. Here are my first 20 questions about health reform under the Trump administration , in no particular order:

1. Will Republicans follow through with repealing the ACA? It is one thing to make threats when there is no chance they will come to pass. Where will health reform fit in the constellation of issues Donald Trump promised to focus on such as immigration and the economy?

2. If they decide to move forward with repeal in the first year—as I fully expect them to do—what will this look like? The details matter greatly. Will this be a mostly symbolic gesture to appease the conservative base without upsetting interest groups and taking away people’s insurance, or will this be a more comprehensive overhaul of the ACA?

3. Will legislation to repeal the ACA include specifics about what to replace it with or will these be two separate conversations?  The history of health reform clearly shows that it is very hard to gain consensus on the details even if there is agreement on the broad goals. It will be much harder to pass repeal legislation if Republicans have to agree on what comes next.

4. I expect they will target the individual mandate. What will they do to combat the likely adverse selection problems that will lead to weakened risk pools and increased premiums increases?

5. Will they try to keep popular parts of the law such as allowing children to stay on their parents’ plans until age 26 or banning insurance companies from excluding people because of pre-existing conditions?

6. Will Republicans re-claim ownership of policy ideas they supported before they became part of Obamacare, such as using tax-credits to subsidize the purchase of private insurance through state-based health insurance exchanges?

7. Would they repeal the ACA’s coverage expansions across the board or use a federalism approach similar to the ACA which gives states flexibility to opt-in to keeping things like the Medicaid expansion and insurance exchanges?

8. What does a repeal timeline look like? How long will insurance companies, states, and consumers have to adapt before the coverage expansions are phased out?

9. What effect will all this uncertainty have on the current enrollment period for the exchanges?

10. What will state leaders do? In particular, what will leaders do in the states that have expanded Medicaid but voted for Trump, including Arizona, Michigan, and Pennsylvania? Will they fight to keep the federal money coming into their state or will they support ending the expansion?

11. Will we finally see a voter feedback effect in which the 20 million people who stand to lose insurance mobilize and fight against the ACA’s repeal? We have not seen this in Kentucky where Governor Bevin has undone the state’s exchange and is trying to remove or scale back the state’s Medicaid expansion.

12. What happens to all the current and future negotiations over Medicaid 1115 waivers? Will the Trump administration halt conversations? Will they be more permissive and allow things like work requirements which the Obama administration has rejected?

13. Will any state try a 1332 waiver? If so, how will the Trump administration respond?

14. Assuming block grants are part of the ACA replacement plan, what does this actually look like? What will this mean for states and beneficiaries?

15. This a crucial stage in the dramatic movement away from fee for service to alternative payment models. Will the Trump administration continue in this direction or shift course entirely?

16. What is the future of Accountable Care Organizations?

17. What happens when the Children’s Health Insurance Program (CHIP) expires on September 1, 2017? Will the bipartisan coalition that has supported CHIP further erode? Check out these articles in NEJM and Health Affairs that Jon Oberlander and I wrote about CHIP politics as it stood earlier this year.

18. Will Donald Trump follow through with his early campaign promises to allow Medicare to negotiate pharmaceutical prices?

19. Will public health emerge as a health reform issue that can transcend the partisan divide? In other words, will leaders be able to move beyond the fights over insurance coverage to focus on non-partisan population health issues such as maternal and infant mortality?

20. What does the future look like for federal funding for research on health services, medical care, and social sciences through AHRQ, NIH, and NSF?

20 Questions for President Trump | Public Health Post

FDA launches app contest for opioid overdoses | Articles | HIPAA

An “unprecedented opioid epidemic” has prompted health leaders to launch a first-of-its-kind public outreach that could save lives.

The U.S. Food and Drug Administration has launched the 2016 Naloxone App Competition. The goal? To give opioid users a way to get access to naloxone via their phone.

This week, the FDA released details of the contest. ABCNews.com was among the numerous news outlets that teased the challenge:

The FDA, along with the National Institute on Drug Abuse (NIDA) and the Substance Abuseand Mental Health Services Administration (SAMHSA) announced the 2016 Naloxone App Competition on Monday to bring together computer programmers, public health researchers and other experts to help combat the opioid crisis. The goal is to create an easy-to-use app that will identify the closest provider of naloxone, whether it's a hospital, clinic or police station.

FDA launches app contest for opioid overdoses | Articles | HIPAA

Trump Can Kill Obamacare With Or Without Help From Congress -

T.G.I.O.  (Thank God it's Over)

President-elect Donald Trump has promised over and over in recent months that he will repeal and replace the Affordable Care Act, also called Obamacare, when he reaches the White House.

"Obamacare is a disaster. You know it. We all know it," Trump said at a debate last month. "We have to repeal it and replace it with something absolutely much less expensive."

Now that Trump will move into the Oval Office in January, the question is whether he'll be able to completely repeal the six-year-old law that has had an impact on every aspect of the U.S. health care system.

"It's a challenge for a Trump presidency," says Jack Hoadley, a research professor at Georgetown University's Health Policy Institute. "To get a true repeal and replace through, he needs 60 votes in the Senate." That's the minimum number of votes needed to overcome a filibuster in the Senate.

"Repeal of the law is absolutely going to come up, and the only potential defense against that would be a Democratic filibuster — if Republicans even allow a filibuster," says Austin Frakt, a health economist who runs the blog The Incidental Economist.

But even if Trump can't repeal the Affordable Care Act in its entirety, there's a lot he can do through rule-making and smaller legislative changes to weaken the law and mold it more to his liking.

Trump upset will force healthcare leaders to rethink the future

Modern Healthcare - Nov. 9, 2016
Republican Donald Trump's shocking victory Tuesday will force a major shift in the healthcare industry's thinking about its future. Combined with the GOP's retention of control of the Senate and the House, a Trump presidency enables conservatives to repeal or roll back the Affordable Care Act and implement at least some of the proposals outlined in the GOP party platform and the recent House Republican leadership white paper on healthcare. 

Trump Can Kill Obamacare With Or Without Help From Congress
Capital Public Radio - Nov. 9, 2016
President-elect Donald Trump has promised over and over in recent months that he will repeal and replace the Affordable Care Act, also called Obamacare, when he reaches the White House. Now that Trump will move into the Oval Office in January, the question is whether he'll be able to completely repeal the six-year-old law that has had an impact on every aspect of the U.S. health care system.


Trump Can Kill Obamacare With Or Without Help From Congress - capradio.org

What Does Hearing Loss Sound Like? | Tonal, by Goodhertz

Perhaps we all should wear ear plugs at rock concerts. Try this little do it yourself aging test. What are you missing. ?

What Does Hearing Loss Sound Like? | Tonal, by Goodhertz







The link above is an interactive display of what happens to your hearing as you age normally. It is quite significant, probably due to ossification of the middle ear ossicles, tiny bones that transmit sound vibrations from the external ear to the inner ear.  In addition to that hearing loss also increases from excessive amplitude which creates an auditory nerve dysfunction.  Most of these losses occur gradually and are irreversible.

Naval Gunfire and Artillery as well as munitions cause acute hearing loss as well.  The recent spate of hostilities in the middle east undoubtedly will lead to an epidemic of hearing losses in military personnel.

It is a good idea to have your hearing tested. If you have a hearing problem it is unlikely you would notice it yourself. You cannot recogniize what is not there. Seems like a  catch 22.  Be safe, ask for a hearing test. You will then be able to plan how much sound protection you need.

 Ask your family physiciian how to get an audiology examination.  A tuning fork and whisper test are NOT ADEQUATE for purposes of detection or prognosis.   As important as having an examination to determine if you need a hearing aid is the goal of ear protection.

The Importance of Sex Differences in Disease and Health

Precision medicine is driving innovation and research  into the differences between boys and girls other than the obvious external appearances and internal organs.

Population health studies already reveal differences in the proclivity of diseases to effect the genders, and also their responses to drugs. This was apparent in heart disease,  and responses to medications.

Even though the observation that men and women are different is arguably as old as human life, women have been included in clinical trials for only a few decades. Women have a unique physiology and their experience of illness, and responses to therapeutic interventions are often significantly different from those of men. Recent regulations from the National Institutes of Health requiring grant applicants to consider sex as a variable in biomedical research are a welcome development.¹ However, despite increasing evidence that an individual’s sex is one the most important modulators of disease risk and response to treatment, consideration of the patient’s sex in clinical decision making (including the choice of diagnostic tests, medications, and other treatments) is often lacking. This is surprising given the increasing interest in precision medicine, which should begin with attention to sex differences in medicine.

Sexual Dimorphism in Response to Drugs

Many medications are metabolized differently in women than men due to variances in body size and distribution volumes, sex hormone levels, activity of enzymes, and effects of routes of excretion on sex-specific responses to drugs.²

What is the impact of the differences between having two X chromosomes, or one X and one Y chromosome.  The new tools of genomics, computer power and the drive toward less expensive and more effective diagnostic and therapeutic modalities are creating a synergy that may prove to yield some surprising secrets.  The secrets are only now becoming exposed.

Sex Differences in Cardiovascular Disease

Arrhythmias, particularly atrial fibrillation, have different consequences for women, who have higher mortality, more symptoms, and higher rates of recurrence following ablation procedures.² Women have a higher risk of atrial fibrillation–associated stroke than men (25% vs 10%) and experience significantly higher mortality after stroke (25% vs 19% at 6 months).^2,7Women's unique electrophysiology (which produces a longer cQT interval than that of men) increases the risk of drug-related torsades de pointes (TdP)^8,9; risk of TdP associated with sotalol is higher among women than men (4.1% vs 1.0%). The observed vs expected prevalence ratio for TdP associated with amiodarone, dofetilide, and azimilide is at least twice as high among women as it is in men.⁹

Coronary Artery Disease

Hypertension, dyslipidemia, smoking, diabetes, and obesity account for 80% of risk of acute MI in both sexes, but presence of diabetes is associated with a 6-fold increase in women's risk of coronary artery disease (CAD), from 107 per 100 000 person-years to 651 per 100 000 person-years vs a 3-fold risk among men with diabetes (Box).^2,10 Moreover, women with diabetes and CAD have a 3-fold increased risk of heart failure; men with diabetes have minimal increase in risk.² 

Timely diagnosis of MI is often delayed in women because of their different symptom complex (shortness of breath, unusual fatigue, sleep disturbances, indigestion, and anxiety; almost one-half may not report chest discomfort). 

Read the entire story here:

The Importance of Sex Differences in Disease and Health | Cardiology | JAMA | The JAMA Network

IT'S ALL ABOUT NETWORKING

The topic is germane to the changes in our world today, not just in health care.

The Seventh Sense, written by Joshua Cooper Ramo offers an explanation and an open ended question about Endless terror. Refugee waves. An unfix-able global economy. Surprising election results. New billion-dollar fortunes. Miracle medical advances. What if they were all connected? What if you could understand why? 

Beyond the aspects of how and why lies the simple fact that change is inevitable,no matter what time period we examine. Looking backward from the present globalization, health care revolution, digital/internet revolution, the industrial revolution, 

The next generation of revolutionary leaders is a continuing  stream of bright, creative, and out of the box peoples. Linked in describes the 2016 LinkedIn Next Wave. Not surprisingly there are some from the health care sphere , notably three physicians.

Linkedin identified ten people in health care as thought leaders and exceptional networkers.

Dr. Loren Robinson

Dr. David Mou

Co-founder and medical director, Valera Health

Elizabeth Asa  CEO, 3Derm Systems

Zoe Barr  Founder and CEO, ZappRx

The list mentions ten innovators

In a recent book, The Seventh Sense, called this instinct to connect a whole new skill—really a sensibility that marks success now. I mean an ability to look at the world, see connection, and use it. It’s a skill that can be learned. And it is what will mark the winners and losers of our age when we look back several decades from now. What the data tells us about the Next Wave leaders is something I think we all know by instinct now anyhow: Success and connection are really the same thing now.

Much of the criteria for a mention in the New Wave is related to the power of their network. Of course this selection is highly biased by their presence on social media. This new metric is foreign to most established businesses, However it has gained traction among young professionals and must not be ignored.

In reality networking has become essential, health maintenance organizations, group medical practice, large health systems, accountable care organizations. The  impetus to network is also  being driven by visions from CMS and the Department of Health and Human Services.

Many of these new networks are unproven and promoted on the basis of cost containment, quality  assurance, and regulatory processes.

Some of these networks will not suceed.  Early evidence indicates an inability to be self-sustaining without government  support, and questionable metrics for measuring success.

How Your Doctor's Politics Affects Your Health Care -- And What You Can Do About It

It seems timely to discuss what politics has done to your health.  It has certainly affected your first amendment rights. It flies in the face of the bill of rights, and the declaration of independence.  No doubt few of our leaders have read either of those cherished documents.  If you have not reviewed the I highly recommend it. To my knowledge no one as cancelled the pledges, nor suspended those rights, which we all cherish.

Paul Hseih M.D., a praciticng internal medicine physician speaks:

Does your doctor’s politics affect his or her medical advice?

Although I would like to think not, a recent study by Yale researchers Eitan Hersh and Matthew Goldenberg has shown the opposite. They’ve published some eye-opening results in a recent research paper, “Democratic and Republican physicians provide different care on politicized health issues”:

We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage).

Their results were interesting. For most issues, the physician’s political leanings did not affect their treatment. But for three specific issues, the doctor’s political leanings did — abortion, marijuana, and guns.

With respect to the first two issues:

Faced with a woman who wasn’t currently pregnant but had undergone two abortions earlier in life, Republican doctors were twice as likely as their Democratic counterparts to say they’d discourage any future abortions and 35 percent more likely to discuss so-called mental health aspects of abortion…

Faced with a man who uses recreational marijuana three times a week, Republican doctors were 64 percent more likely to say they’d discuss marijuana’s legal risks and 47 percent more likely to urge them to cut back than Democratic doctors.

Paul Hsieh ,  

 CONTRIBUTOR

I cover health care and economics from a free-market perspective.  

Opinions expressed by Forbes Contributors are their own.

Does your doctor’s politics affect his or her medical advice?

Although I would like to think not, a recent study by Yale researchers Eitan Hersh and Matthew Goldenberg has shown the opposite. They’ve published some eye-opening results in a recent research paper, “Democratic and Republican physicians provide different care on politicized health issues”:

We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage).

Their results were interesting. For most issues, the physician’s political leanings did not affect their treatment. But for three specific issues, the doctor’s political leanings did — abortion, marijuana, and guns.

With respect to the first two issues,  Faced with a woman who wasn’t currently pregnant but had undergone two abortions earlier in life, Republican doctors were twice as likely as their Democratic counterparts to say they’d discourage any future abortions and 35 percent more likely to discuss so-called mental health aspects of abortion  Faced with a man who uses recreational marijuana three times a week, Republican doctors were 64 percent more likely to say they’d discuss marijuana’s legal risks and 47 percent more likely to urge them to cut back than Democratic doctors.

As a physician and a gun owner, I was especially interested in how political affiliation affected doctors’ treatment of patients who owned guns:  When it came to firearms stored in patients’ homes, Democratic physicians expressed far more concern than Republicans. However, Republicans doctors were more likely to actually talk with patients about storing guns safely in the home, despite being far less concerned about the issue overall…

In contrast to abortion, marijuana use, and gun ownership, doctors’ political affiliation did notaffect their treatment of other issues such as depression, alcohol abuse, or riding a motorcycle without a helmet.

How Your Doctor's Politics Affects Your Health Care -- And What You Can Do About It