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Un-affordable health care – Now we have the numbers

We were promised!
We were taxed!
We were told its affordable!
We waited for it to start!
We were told it was wonderful!

Well – Obama care exchanges have been activated and now we know the truth. Its unaffordable! Its not designed for health care on a daily basis, its not designed for you to visit your doctor regularly, its not lower cost.

I have signed up for the exchange and did some research into the plans available – first I have ot say that picking on the web site and its problems is distracting from the actual issue – any technology that will be accessed by millions is bound to have glitches in the beginning – from a technological standpoint – it will get better over time.

The REAL problem is the costs.
I compared Silver and bronze plans from $308 to $384 per month. What is most shocking BUT expected is the MASSIVE deductibles.
$10 – $12 THOUSAND for drugs and $2000 – $6000 deductibles PLUS a 20% copay on the premium – meaning ANY copay is 20% of your monthly cost. so at $360 per month that’s $72 each time you visit the doctor!

My current insurance is $475 a month with a $15 copay and a $500 deductible

Lets do the math:
Obama care: $308 x 12 = $3696 Per year
Obama care deductible: $4000
Obama care med deductible $6000
Obama care copay $61.60
Total Yearly expense without doctors visits – $3696+$4000+$6000 = $13696

My current insurance: $475 x 12 = $5700.00
Deductible: $500
Copay – $15
Total cost: $6200.00

Am I missing something here? Obama care is NOT designed for your health and regular doctors visits – YOU PAY FOR THAT up to a MAX DEDUCTABLE of $6000!!!!!!!!
So you are paying for insurance you cant use.

Oh yes the government will help you pay for the premium – BUT who is paying the government to pay for your premium? WE ARE!
We are paying ourselves to help ourselves!
Obama care was designed for hospitalization and MAJOE crisis – not health care in general – this is not what was sold to us.
So in the end, we are forced with an EXPENSIVE unaffordable tax not health insurance.

When this folly ends……….

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Why Obama Care Will Not Be Defunded

According to insurance carriers – they anticipate a double digit aka 34% increase In rates next year.
hence WHY would they want this law repealed? They now have 7 million more people forced to buy a their product – and YET they need such an increase.

Simple numbers 7,000,000 x $400 month average that’s $2.8 Billion a month – every month!
Wish they would force people to purchase our products..


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Medicine Is More Than Carrots and Sticks

September 19, 2013, 7:00 am

“Did you take it out yet?” my supervising physician asked me, referring to the urinary catheter I placed in a patient several days before. “You know they’re keeping tabs on that now?”

I did know. We had recently discussed performance metrics during morning rounds, and were taught that prolonged urinary catheterization caused many hospital-acquired infections. Hospitals were now being penalized for that sort of thing.

Dhruv Khullar

Several months before, I had attended a conference where there was a heated discussion about whether to tie reimbursements to how well physicians managed hemoglobin A1c levels – a marker of blood sugar control in diabetic patients. Some argued doctors would pay closer attention to diabetes control. Others thought they would simply select healthier, more compliant patients to make their jobs easier.

Suddenly, a stately gentleman stood up and the room fell silent. I recognized him as one of the most distinguished faculty members at my medical school, a legend that physicians across the state consulted on their most difficult cases.

“What on earth are we teaching these young doctors?” he asked, exasperated.

He stressed that a physician’s responsibilities — to avidly manage diabetes or blood pressure, to promptly remove a urinary catheter, to ensure patient compliance with medications — come not from incentives, but from a sacred duty we assume upon entering the profession. Overemphasizing the former while underemphasizing the latter, he argued, does a disservice to the medical profession and to our patients.

His words struck me because they were so at odds with the language of recent discussions I’d had on quality improvement. I’ve been taught that behavioral economics tells us much about how individuals consciously or subconsciously respond to incentives. If we are able to align incentives to promote safer, higher quality care, then that’s what we’ll get.

But so far, evidence on pay-for-performance incentives has been mixed at best. While incentives can help change simple behaviors and improve productivity of rote tasks, they may actually reduce creativity and dull motivation for the complex tasks and broad thinking required in medicine. Furthermore, incentivizing certain behaviors can sap time and attention away from those not measured. And many aspects of medical care that are evaluated by quality and efficiency metrics — like reducing waits in emergency rooms or shortening hospital stays — are outside an individual doctor’s control.

A recent report by the Robert Wood Johnson Foundation recognizes these limitations, and argues that instead we need to capitalize on the inherent motivation of physicians and support underlying drivers of excellent care like professional purpose, mastery and autonomy. It advocates removing large perverse incentives that can inhibit good decision-making and value-based care – like fee-for-service payment models – but not devising elegant schemes to manufacture desired behaviors.

Today’s physicians are trained in an environment in which discussions of costs and incentives are as much a part of our education as conversations about duty and humanism. It’s an environment in which words like “provider” and “consumer” are used as frequently as “healer” and “patient.” In the midst of this evolution, we must frequently examine the effect of these changes on the medical profession, as well as the kind of education and narrative needed to reinforce physicians’ internal sense of purpose and pride in their work.

A mentor of mine recently took issue with the shifting vocabulary created by discussions of money in medicine. “I don’t drag my butt out of bed at 2 a.m. for a customer,” he said. “But I’d do that any night of the week for my patients.”

He told me the story of the “midnight neurologist” from his first month of residency, more than 30 years ago. He had been in the hospital for almost two straight days and was just settling into a nap shortly after midnight when the neurology fellow paged him to check on a comatose patient he had admitted several days before. Cursing his pager, he opened his bloodshot eyes and trudged down to the patient’s room, exhausted.

When he arrived, he noticed the neurologist slowly lift the patient’s hospital gown just above his left knee, exposing as little of the leg as possible. He tapped gently with the reflex hammer and carefully noted any changes from the day before. He then replaced the gown over the left knee, and repeated the procedure on the right.

My mentor told me he often still thinks of that moment. It was the middle of the night and this neurologist – like him – had been on call for more than 30 hours. They both knew the patient would likely never regain consciousness, and no one was keeping tabs on anything. Yet the neurologist respectfully, tenderly, meticulously completed his familiar routine, as he would on a cherished loved one.

As a student of health policy, I believe that incentives will be a powerful tool for changing physician, hospital and patient behavior – especially given the many perverse incentives that currently exist in our system. But as a student of medicine, I believe this focus on incentives must be coupled with an equally robust discussion of the historic and modern duties of a healer. We must promote a culture among students, residents and policymakers that recognizes that incentives – aligned, misaligned, askance or otherwise – are secondary to a physician’s duty to fervently protect the health of patients.

These two dialogues have largely operated in parallel, but it’s time we integrate them and acknowledge their mutually reinforcing potential for delivering better care. Because alone, no arsenal of carrots and sticks will ever produce the kind of compassion and attention to detail every patient wants and deserves.

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Penalizing People for not giving medical and personal info

[preamble]Obama care at its best – penalizing us for not giving personal information. Socialism in its best form[backtopost]

After weeks of vociferous objections by faculty members, Pennsylvania State University said on Wednesday it was suspending part of a new employee wellness program that some professors had criticized as coercive and financially punitive.

In particular, the university said it was suspending a $100 monthly noncompliance fee that was to be levied on employees who declined to fill out an online questionnaire. The form, administered by WebMD Health Services, a health management company, asked employees for intimate details about their jobs, marital situation and finances. It also asked female employees whether they planned to become pregnant over the next year.

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Costly robotic surgeries no safer than regular procedures

[preamble]Knew this was coming – no way can an expensive robot designed to make the manufacturer money will lower costs. MAYBE better outcomes but as we can see  – nope. Hence, is not this increasing the cost of healthcare? Do we not think I am paying enough? What happened to GOOD surgeons?[backtopost]
September 10, 2013  | By

Increasingly troubling news about robotic surgery continues to emerge. This  time, a study published recently in the journal Obstetrics  and Gynecology finds that robotic cases cost substantially more than  laparoscopic cases of hysterectomy, despite no apparent safety benefits.

After identifying women who underwent robotic or laparoscopic surgery for  benign disease in 2009 and 2010, and using propensity scores based on  in-hospital complications, hospital length of stay, and hospital changes, the  study authors have determined that the perioperative outcomes are similar  between the two modes of surgery, but that robotic surgery costs close to $2,500  more to a hospital, per patient.

“Unfortunately, the greater costs associated with robotic-assisted  hysterectomy were not reflected in improvement in outcomes,” the researchers,  from the University of Texas Southwestern Medical Center at Dallas,  say, according to Bloomberg.

According to research published last week in the Journal for  Healthcare Quality, complications from robotic surgery are widely  underreported. Of the roughly 1 million robotics surgeries performed since 2000,  only 245 complications (including 71 deaths) were reported to the U.S. Food and  Drug Administration, according to the study.

In March, the American Congress of Obstetricians and Gynecologists said that  robotic surgery for hysterectomies should not be a first or even second choice  for women undergoing routine procedures, due, in part, to the learning  curve associated with the robotic system. That same month, health officials in Massachusetts sent a letter outlining safety  concerns about robotic surgery after two damaging incidents involving robots  performing hysterectomies.


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Citing expense, hospitals close maternity wards

[preamble]The inevitable push to health clinics. Malpractice costs are a leading cause as well as hospitals being headed by non business people. Doctors should not in any way shape or form run a hospital other than overseeing doctoring. Business, profitability and sustainability needs to be in the hands of people that understand it.

This again proves that our hospital system is antiquated and we have too many of them.
INteresting how the massive cost of insurance is NOT an issue or tort reform. The leading cause of problems in the medical system especially in NY. Our politicians especially Sheldon silver are making too much money off the lawyers to even touch this – hence we have a “crisis” to deflect from the real issue.

Almost like our president shooting missiles at Syria when in Benghazi we actually lost American lives – did we do anything than? Deny, deflect, diversion – triple D.
If more redundant hospitals close, what will we do with all the money we save? I got it – continue to raise premiums and develop another “crisis”[backtopost]

Private Delivery Room at Katz Women’s hospital

Several Long Island hospitals have delivered their last babies.

Facing precipitous drops in number of Long Island births – and insurance reimbursements – and steep climbs in malpractice-insurance rates, many hospitals are closing their maternity wards. Several ob/gyns are likewise steering away from obstetrics and focusing more on gynecology.

Such consolidations are creating a new medical landscape, with larger regional health-care facilities handling most births – potentially signaling the end of deliveries at the local hospital.

The North Shore-Long Island Jewish Health System plans to close Plainview Hospital’s 15-bed maternity ward, 10 years after it closed the Glen Cove Hospital maternity ward and eight after it closed the maternity unit at Valley Stream’s Franklin Hospital.

In 2004, Catholic Health Services of Long Island cited high costs when it closed the maternity ward at New Island Hospital, now known as St. Joseph’s Hospital.

Observers should not misconstrue this as a lack of commitment to babies or women, according to North Shore-LIJ spokesman Terry Lynam, who said the system has been expanding maternity wards at larger hospitals.

“We’re certainly investing in women’s health,” Lynam said. “But trying to maintain the smaller programs is becoming more difficult.”

Maternity wards are expensive, due primarily to the wide range of around-the-clock staff they require, and “when expenses significantly surpass revenues, folks begin to look at ways to save money,” noted Dr. Arthur Fougner, an ob/gyn in Flushing.

“If you can’t change what’s going on with declining payments,” Fougner said, “you have to figure out how to cut overhead.”

Also challenging those bottom lines: an aging Long Island population creating lower birth rates and obstetrician malpractice rates ranging as high as $200,000 annually – nearly twice the rates paid by gynecologists.

“Running maternity wards is an expensive proposition,” agreed Ed Amsler, a vice president at Medical Liability Mutual Insurance Co., which insures 60 hospitals, 17,000 physicians, 4,200 dentists and thousands of other New York providers and facilities. “One factor in that is professional liability insurance.”

Meanwhile, a new generation of maternity words is putting the pressure on older wards to renovate or shut down. North Shore-LIJ has invested $300 million in its Katz Women’s Hospitals at North Shore University and the Long Island Jewish Medical Center, including new maternity wards featuring private rooms.

“A lot of patients who would normally go to the local place see this and say, ‘I want to go there,’” Fougner said. “There’s patient demand.”

In 2012, Manhasset’s North Shore University Hospital delivered 6,343 babies in its 73-bed unit, while Long Island Jewish delivered 5,879 – collectively, a 13 percent increase over the two facilities’ 2011 totals.

Those increases contrast delivery declines at many smaller hospitals. Between 2011 and 2012, births dipped from 1,429 to 1,167 at Plainview Hospital, which is projecting only 1,000 total births in 2013.

“It really is a volume issue,” Lynam said of North Shore-LIJ’s plans to close the Plainview maternity ward. “It would be a financial issue if we maintained the maternity ward and the volume continued to drop.”

Sometimes, closing the maternity ward at one local hospital can benefit the maternity ward at another. North Shore-LIJ hoped closing the New Island/St. Joseph’s ward would benefit the Plainview ward, for instance, but that didn’t materialize.

And upgrading older maternity wards to keep up with newer models is not always easy and rarely practical, Lynam noted.

“Even if we invested millions of dollars to renovate [the Plainview maternity ward], we still wouldn’t be able to configure the space in a way that would provide families with private rooms,” he said.

Long Island still has plenty of maternity wards: North Shore-LIJ alone operates additional delivery facilities at Huntington and Southside hospitals, Forest Hills Hospital in Queens and Lenox Hill Hospital in Manhattan.

With so many regional options, North Shore-LIJ officials believe the Island’s expectant families are still well-served.

“Is it unreasonable for people to drive 15 or 20 minutes to deliver their babies?” Lynam asked.

The answer, according to Fougner, “depends on how fast your labor’s going.

“And it depends on the time of day,” the ob/gyn added. “If you’re on the Long Island Expressway, it might be a problem.”

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31 Million Americans in a cost saving ACO – so why are we still in a “crisis”?

It’s estimated that some 31 million Americans now receive healthcare through an accountable care organization, according to a recent report from Oliver Wyman, with 8 million to 14 million of them being part of private ACOs launched by national and regional insurers for non-Medicare populations.

If this is the case and ACO’s save money – than why are premiums still going up? Why are we still in a “crisis”? The answer is simple – the quality of care will; be reduced to save costs. Redundant testing etc.. are a small drop in the bucket – however the question still stands – if 31 million Americans are SAVING health care costs even at a $1 each, than that’s $33 million dollars less of a “crisis” we are in. Hence why are not “we – the people” seeing any reduction in taxes or rates?

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Blacks Slow to Opt for HPV Vaccination – racial profiling?

[preamble]In a continuation of racial profiling, if you read this article, it is VERY specific about blacks and their deficiencies. Hence is this not racial profiling? Why is it OK for this type of profiling and not for the police when the statistics state the same deficiencies?

I again postulate that “meaningful use” questions and their usage is discriminatory and racial profiling hence unconstitutional[backtopost]
Published: Aug 28, 2013 | Updated: Aug 29, 2013

By Charles Bankhead, Staff Writer, MedPage Today

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse

Uptake of human papillomavirus (HPV) vaccine has lagged considerably in African Americans as compared with other racial/ethnic groups for reasons that remain unclear, a review of a national database showed.

Young African-American women were about half as likely to report HPV vaccination as compared with whites. Hispanic women also had lower vaccination rates, but the difference did not reach statistical significance.

Adjustment for differences in access to healthcare further attenuated differences between whites and Hispanics, whereas vaccination rates in African-American women remained about 50% below the rate of white women, as reported online in the Journal of Adolescent Health.

“This disparity persisted among both younger (15 to 18) and older (19 to 24) African Americans,” Sonya Borrero, MD, of the University of Pittsburgh, and co-authors said of their findings. “Disparities in HPV vaccination for Hispanics, on the other hand, were fully attenuated after adjusting for sociodemographic and healthcare access variables.”

“Research is needed to further elucidate the reasons for undervaccination among African-American adolescents and young women and identify ways in which providers and healthcare systems may improve HPV vaccine uptake for this vulnerable population,” they added.

Evidence supporting the safety and efficacy of HPV vaccination has so far proven insufficient to persuade a majority of female adolescents and young women to initiate the vaccine series. An estimated 53% of girls 13 to 17 and 21% of women 19 to 26 have reported initiating HPV vaccination, and vaccinations rates have slowed after a period of increasing uptake.

Cervical cancer occurs more often and causes more deaths in Hispanic and African-American women than in white women. The disparity emphasizes the importance of understanding barriers to HPV vaccination in these populations, the authors noted in their introduction.

Previous attempts to quantify vaccine uptake by race/ethnicity have yielded inconsistent results. However, the results have been based primarily on data collected prior to 2008, the authors continued.

To provide more current estimates of vaccine uptake, Borrero and colleagues searched the National Survey of Family Growth for females 15 to 24 who participated in the 2006 to 2010 surveys. Beginning with the 2008 survey, a question about access to a healthcare provider was added, affording an opportunity to examine the impact of access on outcomes of interest.

The study sample comprised 2,168 adolescent females and young women who participated in the surveys from the study period. Whites accounted for 63.6% of the sample, U.S.-born Hispanics for 13.8%, foreign-born Hispanics for 5.3%, and African Americans for 17.2%.

The four racial/ethnic groups differed substantially with respect to sociodemographic characteristics: Hispanics were more likely to be uninsured than whites were. African-American participants were more likely than whites to have public insurance. Hispanics and African Americans were less likely to have a usual source of healthcare.

Overall, 28.4% of participants had received at least one dose of HPV vaccine, including 33.1% of whites, 24.2% of U.S.-born Hispanics, 18.2% of African Americans, and 16.2% of foreign-born Hispanics. All three minority groups had significantly lower vaccination rates as compared with whites: U.S.-born Hispanics, OR 0.35, 95% CI 0.44-0.95; foreign-born Hispanics, OR 0.39, 95% CI 0.23-0.68; and African Americans, OR 0.45, 95% CI 0.33-0.62.

After adjustment for sociodemographic variables, the odds of HPV vaccine initiation for both groups of Hispanics increased and were no longer significantly different from those of whites (U.S.-born, OR 0.76, 95% CI 0.50-1.16; foreign born, OR 0.67, 95% CI 0.37-1.19). In contrast, the odds ratio for African Americans remained significantly different from that of whites (OR 0.47, 95% CI 0.33-0.66).

Further adjustment for access to a usual healthcare provider increased the odds for Hispanics to 0.84-0.85, but did not change the disparity between African Americans and whites (OR 0.49, 0.36-0.68).

Analysis by age groups showed similar results for the younger (15 to 18) and older (19 to 24) survey participants.

The finding that disparities in vaccination rates exist does not come as a surprise, as disparities between whites and other racial/ethnic groups have been demonstrated for nearly all aspects of healthcare, said Leslie Randall, MD, of the University of California Irvine. Given the inconsistency of previous studies of vaccine uptake, the study “sheds light on the fact that these differences probably do, in fact, exist.”

“It is important for practicing physicians to have an awareness of these differences so they can focus extra effort on targeting specific people who might not be taking advantage of the HPV vaccine, which is a safe and effective way of preventing a life-threatening illness,” Randall, who is a spokesperson for the Society of Gynecologic Oncology, told MedPage Today via email.