Politics and health


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Higher premiums for younger, healthier people helped fuel opposition to the Affordable Care Act early on. (Credit: Repeal ObamaCare/ Wikimedia Commons)

Democrats are howling about the health care bill passed by the House of Representatives, but it’s likely to resonate with the GOP’s core supporters.

The Affordable Care Act changed the structure of health insurance, mandating that insurers couldn’t charge more for pre-existing conditions, and only three times more for older patients compared to younger ones. That artificially increased premiums for young, healthy people, including those who supported Donald Trump’s candidacy.

You might think, in order to create a better society, that people would be willing to pay for services even though they themselves don’t use them. Childless couples, for example, pay for public education. But somehow, the discussion on health care has become ask not what you can do for your country but ask what you can for me.

Men are complaining about having to purchase policies that include maternity care.

In December, the Kaiser Foundation conducted focus groups among Trump voters to find out what kind of health care plan they wanted. Members of the groups were “unmoved by the principle of risk sharing,” the New York Times reported on Jan. 5.

Although support for the ACA has edged up since the election, a sizeable minority continues to oppose it — a Real Clear Politics polling average puts opposition to the ACA at more than 42 percent, about the same level as President Trump’s approval ratings.

If the new American Health Care Act brings down premiums for younger and healthier Americans, don’t expect a great rush to oust Republicans who voted for it in 2018. They’re just giving their constituents what they want.

In the Kaiser focus groups, participants said they liked the pre-ACA days because they could purchase low-cost plans, “even if it meant that less healthy people had to pay more.”

This is exactly what the new Republican health care system may be about to deliver.

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TRUTH ABOUT DEDUCTIBLES: We keep hearing about how, with deductibles over $5,000 per person under the ACA, the health care plans are expensive and virtually useless. It’s seldom if ever mentioned that benefits kick in well before deductibles are met.

For one thing, plans include a wellness visit, so at least you can get a checkup to find out where you stand.

But let’s say your doctor decides that something needs to be checked out further, and orders an MRI. If you are uninsured, you will pay the full cash rate for that service — which could be up to $3,000. But if you are covered under a policy, even though you are paying for the procedure out-of-pocket, you’re paying much-reduced network negotiated rate.

Instead of the $3,000, you might owe $800. True, you haven’t satisfied your deductible, but you’ve saved $2,200.

The idea that a family of three has to pay a hefty premium of $1,000 a month — and gets no benefit until they fork out $15,000 out-of-pocket — is just dead-wrong.

But hey, if it fits into the anti-ACA argument, let’s keep using it!

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WATER WOES: There’s a lot of talk about how “poor lifestyle choices” contribute to chronic disease.

But there are many environmental risk factors that are clearly beyond our control.

A recent study by the Natural Resources Defense Council (NRDC) said contamination of community drinking water is widespread, and provisions of the Safe Drinking Water Act (SDWA) of 1974 have not been adequately enforced by the federal Environmental Protection Agency.

“Our research shows that in 2015 alone, nearly 77 million people were served by more than 18,000 community water systems that violated at least one SDWA rule, and there were more than 80,000 violations of SDWA rules that year,” the NRDC said in its May 2 report, Threats on Tap: Widespread Violations Highlight Need for Investment in Water Infrastructure and Protections.

“These violations included exceeding health-based standards, failing to properly test water for contaminants, and failing to report contamination to state authorities or the public.”

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Here’s yet another example of the law of unintended consequences — one that could have a harmful impact on the already-struggling U.S. health care system.

About 260 foreign medical students could lose their medical residency assignments as a result of the Trump Administration’s order banning travel to the U.S. from seven countries.

The Association of American Medical Colleges says the order could have a far-reaching effect on medical research and may also ultimately cause problems for patients in the U.S.

The organization released a statement saying that it’s “deeply concerned” about the order, which has been challenged in the U.S. courts and has been suspended — for now.

“International graduates play an important role in U.S. health care, representing roughly 25 percent of the workforce,” the statement said. “Current immigration pathways —including student, exchange-visitor, and employment visas — provide a balanced solution that improves health care access across the country ….”
Atul Grover, executive vice president at the AAMC, told Kaiser Health News: “These are doctors. They could be exceptional practitioners and I don’t know if you want to stop them from coming here and serving their patients.”

The countries are Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen.

One medical student from Sudan described the turn of events as “very devastating. Because you are born in an unfortunate situation, you have to pay the price for that.”

In addition to the 260 applicants for a residency slot — the positions were set to be announced March 17 — others who are already involved in a residency program fear that they won’t be able to complete it.

About a quarter of doctors in the U.S. are foreign-born, according to KHN. AAMC projects that there will be a shortage of 94,700 physicians in the U.S. by 2025.

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CRACKING THE CANCER CODE: Certain kinds of hard-shelled nuts can help fight cancer, new research shows.

Macadamia nuts, hazelnuts, walnuts, almonds and pistachios help initiate “programmed cell death” in cancer cells, researchers found, although it’s unclear whether their anti-cancer power is reduced by roasting.

That will require further study, they said.

The studies were conducted by Friedrich Schiller University Jena in Germany.

Image: pistachios could help in the fight against colon cancer and other types of the disease. (Credit: Wikimedia commons)

Just two weeks from inauguration day, the debate over the Affordable Care Act remains chaotic, with no clear consensus emerging.

Although Republicans seemed in December to be coalescing around a plan to immediately repeal the law — and then delay its implementation for a year or more — some party higher-ups have been contradicting that, insisting that a replacement law accompany the repeal.

House Speaker Paul Ryan, for example, has said a replacement law could be passed this year. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, says it will take “several years” and a consensus with Democrats to come up with a workable alternative.

And now evidence is emerging that Americans don’t want outright repeal of the law. A Kaiser Family Foundation Health Tracking Poll released Friday revealed that 75 percent of the public does not want to see repeal and delay, the option most often discussed by incoming officials.

Forty-seven percent don’t want repeal at all, and another 28 percent say the ACA shouldn’t be repealed until details of the replacement plan are announced.

“Views split not only on partisan lines but also within the Republican Party, where nearly four in 10 think that the government should guarantee health care is available to the elderly and to low-income people, even if it means more federal involvement,” reported Kaiser Health News.

On Thursday, Tennessee Republican U.S. Rep. Marsha Blackburn asked in a poll on Twitter: “Do you support the repeal of Obamacare?” Eighty-four percent said no and only 16 percent said yes. (As any attorney will tell you, never ask a question you don’ t know the answer to.)

A focus group comprised of Trump voters expressed concern that a gap between repeal of the ACA and a replacement would lead to health care chaos. But one member of the group said she didn’t think “a smart businessman like Trump would let that happen.”

Interestingly, The New York Times said members of the group were “unmoved by the principle of risk-sharing,” a cornerstone of the ACA and in fact the insurance business in general. The insurance industry is built around the idea of combining low-risk customers with high-risk customers to create a profitable pool that can bail people out if a problem occurs.

But members of the focus group didn’t like the ACA’s insurance mandate, even though they want coverage for people with pre-existing conditions.

Overall, members of the focus group want health care to be affordable and understandable with adequate access to networks of care providers.

So what would the GOP alternative look like? The bill passed by Congress in 2015 — which was vetoed by President Obama — would remove the mandate, eliminate premium subsidies for low and middle-income Americans, and drop taxes on high income households.

The problem is if you remove the mandate but still require insurers to cover everyone with pre-existing conditions, those people would likely face sky-high premiums.

The two sides in this debate — the public’s demand for affordable premiums and simplified access to health care providers, and Republicans’ preference for market-based solutions — appear to be on a collision course.

An uneasy public can only sit back and wait to see what happens next.

There are media rumblings, in the aftermath of the election, that the Affordable Care Act might remain largely intact, or at least partially intact.

Don’t bet on it.

One popular provision of the ACA, which keeps adult children on their parents’ insurance policies until they are 26, doesn’t cost that much and it’s entirely plausible that this could survive.

But there are other reports that President-Elect Donald Trump may be interested in keeping the requirement that insurers cover pre-existing conditions, and this is where things get sticky.

The idea behind mandatory insurance coverage in the ACA was that risk would be spread out by getting healthy younger people to purchase a plan. If health insurance isn’t mandatory, and insurers can’t turn anyone down, people may not buy insurance until they get sick.

Of course, insurers could offer coverage for those with pre-existing conditions as long as they can charge whatever they feel is necessary to maintain profit margins. Under the ACA, an insurer can only charge based on age on and whether or not an individual is a smoker or non-smoker.

Let’s say the ACA was scrapped, but insurers were required to issue policies regardless of pre-existing conditions. Someone with breast cancer, for example, could be offered coverage at — just to throw out a figure — $5,000 a month.

Effectively, that would put policies out of reach for most people.

So trying to dismantle the ACA piecemeal doesn’t make much sense.

One alternative under consideration would allow consumers to buy policies across state lines. The question is, what does your local provider network look like? Having coverage on paper is pretty useless if you have to travel 100 miles to see a specialist.

At this point, there’s no reason to believe that the Republican health care agenda, which includes repeal of the ACA, won’t be vigorously pursued starting in January. Look for a switch to Medicaid block grants to states so they can run programs as they see fit, with limited federal control.

It’s also quite possible that Medicare could become a voucher program since that has been a goal of House Speaker Paul Ryan, although he prefers to call it “premium support.” Ryan has proposed gradually raising the Medicare age to 67 starting in 2020 and offering seniors tax credits to subsidize the premiums.

If you’re 66 and battling prostate cancer, and are faced with buying a health insurance policy on the open market, good luck.

Of course all of these proposals would face opposition, particularly from Senate Democrats who hold 48 seats. So getting legislation to the White House could take some time.

But not too much time.

As the Democrats learned in 2008, parties that control both Congress and the White House often have just two years to enact their big-ticket items. Beyond that, they risk the wrath of voters in the next congressional election.

The 2018 campaign isn’t that far away, and it may begin sooner than you think.

The answer to who will win the Nov. 8 election may be buried under the avalanche of tweets supporting each candidate, a new paper by the City College of New York contends.

Researchers analyzed 73 million tweets from June 1 to Sept. 1 and concluded that trends match the New York Times polling averages “with remarkable accuracy.”

“More importantly, for the CCNY team, the Twitter opinion trend forecasts the aggregated Times polls by 6 to 15 days, showing that Twitter can be an early warning signal of global opinion trends at the national level,” the college says in an announcement of the research.

clinton_and_trump_cartoon_illustrationHernan Makse, a physics professor at the school, said: “Our analytics, which are available at kcorelab.com, unleash the power of Twitter to predict social opinion trends from elections, brands to political movements. Our results suggest that the multi-billion public opinion polling industry could be replaced by Twitter analytics performed practically for free.”

While Donald Trump supporters are more active overall on a daily basis, Hillary Clinton supporters dominate during major events, such as the conventions, the researchers said.

According to the paper: “While Trump supporters might be gaining the race inside the strongly connected giant component, thus forming a very cohesive group with large influence at the core of the network, Clinton still wins the popular vote when we consider all the Twitter supporters, and not only those in the SCGC.

“Thus, while the Twitter campaign of Clinton seems to be less enthusiastic and dormant compared to the Twitter Trump machinery, candidate Clinton still wins the popular vote in the whole network.”

However, they said, “it remains a question” whether Clinton’s overall support — apparently much less fervent than Trump’s — translates into actual votes on Election Day. But analyses of services like Twitter could eventually replace costlier and more time-consuming polling efforts, the college says.

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OMG. People who lurk on Facebook without posting and get bombarded by friends posting selfies are probably going to end up feeling down in the dumps.

They’re more likely to suffer a drop in self-esteem and life satisfaction, a new study by Penn State University finds.

The people who post the selfies, on the other hand, enjoyed increased self-esteem.

“People usually post selfies when they’re happy or having fun,” said Ruoxu Wang, a Penn State graduate student in mass communications. “This makes it easy for someone else to look at these pictures and think his or her life is not as great as theirs.”

In other words, 21st century life is a cabaret — as long as you have a smartphone with a selfie stick and Internet access.

Image credit: VectorOpenStock via Wikimedia Commons

Twenty million Americans would lose health care coverage under proposals by Republican Donald Trump and his plan would increase the federal deficit by as much as $41 billion, according to a new study released by the Rand Corporation Friday.

The study compared plans offered by Trump and Democrat Hillary Clinton, although a Rand news release on the project said the analysis was challenging because both candidates’ proposals lacked “specific detail, especially on implementation.”

cm-2000Three out of four Clinton health care plans also increase the federal deficit — from $3.5 billion to $90.4 billion — but they increase the number of insured people and decrease out-of-pocket spending among those insured.

A Clinton proposal to offer a “public option” health insurance plan — considered but rejected by Congress in 2010 — would reduce the federal deficit by $700 million, according to the Rand analysis.

The centerpiece of Trump’s plan is to repeal the Affordable Care Act and allow tax deductions for the full cost of health care premiums.

“The combined effect of the Trump proposals is to decrease the number of insured by 20.3 million and increase the federal deficit by $5.8 billion,” said Christine Eibner, Rand senior economist. “The combined effect of the Clinton proposals is to increase the number of insured by 9.1 million and increase the federal deficit by $88.5 billion.”

She added: “One thing that may surprise readers is that repealing the ACA increases the federal deficit, which may seem counterintuitive. The ACA has several mechanisms for raising revenue and reducing federal spending, including changes to Medicare payments; an increase in the Medicare hospital insurance tax for people with high incomes; and various taxes including those on health plans, medical devices, branded prescription drugs, and tanning services.”

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In a global race with other kids, those from the U.S. would probably be huffing and puffing their way to the finish line, a new study says.

A team of researchers from the Children’s Hospital of Eastern Ontario hooked up with the University of North Dakota to study aerobic fitness levels of kids in 50 different countries.
They ran a 20-meter shuffle or “bleep test” — a standard fitness evaluation — on healthy kids age 9-17.

They found that the fittest kids overall came from Tanzania, Iceland, Estonia, Norway and Japan. The U.S. placed 47th out of 50 and Mexico was in last place.

“If all the kids in the world were to line up for a race, the average American child would finish at the foot of the field,” said Grant Tomkinson, senior author of the study and an associate professor at the University of North Dakota.

It could be a coincidence, but I doubt it, that when you look at 2016 estimates of how much each country spends on Internet gaming the U.S. ranks second behind China, even with their 1.5 billion population compared to 324 million in the U.S.

But you can’t blame it all on gaming time, since Japan ranks third in gaming expenditures and still has the fifth fittest kids.

Experts say a lot of it also has a lot to do with time spent watching TV and gobbling down fast food.

In 2014, the federal Centers for Disease Control estimated that more than half of kids ages 12-15 are out of shape.

(Image credit: By Caremate – Own work, CC BY-SA 3.0)

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Eisenhower and Kennedy meet after the election in December 1960. (Credit: Wikimedia Commons)

In this health- and youth-obsessed culture, Americans devour everything they can get their hands on about diet, weight loss and longevity. So I guess it should be no surprise that this preoccupation has finally found its way into presidential elections.

Modern candidates have always owed the electorate a medical report, but this year personal medical issues have become a topic of daily debate and speculation. It threatens to brush aside discussion of more pressing topics like the the student loan crisis, the shaky job market, and the country’s deteriorating infrastructure.

Donald Trump was criticized after his doctor issued a report that said his health was “astonishingly excellent.” Hillary Clinton has increasingly come under the media microscope for a bout with pneumonia and for leaving a 9/11 event after becoming “overheated” on Sunday.

President Barack Obama’s former physician, David Scheiner, has said Americans “need much more medical information from these candidates” due to their ages — Clinton is 68 and Trump is 70.

There’s a new edge to this issue, though, that I think reflects the country’s growing obsession with subjects such as weight reduction, miracle foods (which is it this month — blueberries or quinoa?), exercise and youthful appearance.

If health and fitness had been such a critical issue in past presidential elections, some of our most revered leaders might never have had the chance to make their marks on history.

Dwight Eisenhower was nearing the end of his first term in 1955 when he had a heart attack and ended up hospitalized in an oxygen tent. He announced a few months later he was running for re-election.

A year after he walloped Democrat Adlai Stevenson, Eisenhower suffered a stroke and had trouble completing sentences.

He recovered and went on to complete one of the most successful presidencies of the 20th century, finishing up with a brilliant coup de grace farewell address about the dangers of the military industrial complex.

Lyndon Johnson had a severe heart attack in 1955, and although it was no secret, Johnson’s health was hardly a matter of daily debate when he ran for president in 1960 and 1964.

John F. Kennedy was more secretive about his health problems, which he had been grappling with since childhood. He was hospitalized in college for intestinal diseases, and suffered from ulcers and colitis as well as Addison’s disease.

In a 2002 article, The Atlantic said: “Kennedy’s charismatic appeal rested heavily on the image of youthful energy and good health he projected. This image was a myth. The real story, disconcerting though it would have been to contemplate at the time, is actually more heroic. It is a story of iron-willed fortitude in mastering the difficulties of chronic illness.”

Ronald Reagan had his own health problems, including a battle with pneumonia in 1945. As president, he underwent surgery for colon cancer in 1986.

Many American presidents and high-ranking officials have been treated for skin cancer and other serious illnesses.

The one thing all candidates and elected officials have in common is that they’re human and have to cope with illness, and sometimes chronic disease. Health problems need to be reported but not obsessed over to the exclusion of other issues that have a direct impact on the future of the country.

Reagan was 73 when he ran for re-election in 1984 against Walter Mondale. He skillfully diffused the age issue.

“I will not make age an issue of this campaign,” he said during a debate. “I am not going to exploit, for political purposes, my opponent’s youth and inexperience.”

Even Mondale laughed.