Posted in Health, news, Politics

Ending Surprise Medical Bills…Not So Easy

The Trump Administration has vowed to put an end to “surprise medical bills.”  But this may be easier said than done.

Reports of “sticker shock” have exponentially grown over the years and consumers want transparency of what their health care visit is going to cost.  However, the average physician, nurse practitioner, physician assistant, hospital, medical center, etc. don’t know themselves until the insurance company sends an EOB “Explanation of Benefits” delineating what is discounted, what is covered, and what is the patient responsibility.

So to start, President Trump is asking Congress to address those charges incurred by “out of network” facilities to which patients go to in an emergency setting.  Wanting to hold “insurance companies and hospitals accountable,” President Trump wants to put an end to patients getting charged for “services they did not know anything about, and sometimes services they did not have any information on.”

Can he do it?  Politicians on both sides of the aisle want to help curb health care costs, but both sides want to get the credit.  There’s race to see who could do more for healthcare before the 2020 election.

Why can’t health costs be predictable/fixed?

There’s a few reasons why cost transparency in an emergency medical setting is challenging.

Firstly, insurance companies aren’t transparent to hospitals. They only inform the medical facility of the out of pocket costs once they take weeks to review the claim.  This can be streamlined and cut down in time with software, but same day pricing by an insurance company is impeded by the need to see if the patient paid (or will pay) their premiums that month, or if they are still employed and have the same active insurance.

Secondly, patients don’t always know what their diagnosis is when they walk up to the front counter. Some may think they have a “cold,” but actually end up having a bout of pneumonia. Some may think they have a “stomach bug,” but after CT confirmation, learn they have appendicitis. Hence until the medical provider performs the evaluation and testing, a diagnosis and then “cost to treat”, cannot be given.

Finally, patients may not prefer the “cost factor” added into their facilities’ decision making.  If they pay a certain amount for a visit and end up needing more pain control, a repeat breathing treatment, or some extra bandages, they may not want to have to take out their wallet, sort of speak, each time they need more services.

As a physician who, for years, pleaded with insurance companies to give us an idea of what they would want a patient to pay, I’m for any campaign to increase price transparency and offer patient’s more choice.  However, since medicine and health can be unpredictable, coming up with predictable “costs” may prove difficult.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

 

 

 

 

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Posted in Health, news, Politics

Medicare For All: Realistic or a Fantasy?

Image above from Getty Images

Senator Bernie Sanders during the 2016 Presidential Election called for a single payer system to cure our healthcare woes. Now Democratic contenders for the 2020 election are calling for the same.  Some voters are salivating at the thought, tired of high insurance premiums and deductibles. Others are cringing at the idea of the government running our healthcare system. Yet most are confused and want more details. So let’s break it down.

What is Medicare?

Medicare is the health insurance offered by the federal government for those over 65 and with disabilities.  According to medicare.gov they breakdown medicare as the following:

Medicare is the federal health insurance program for:

  • People who are 65 or older

  • Certain younger people with disabilities

  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)  

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part D (prescription drug coverage) 

Part D adds prescription drug coverage to:

  • Original Medicare
  • Some Medicare Cost Plans
  • Some Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans

Medicare Advantage (also known as Part C) is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

 

What is Medicare For All?

Originally suggested by Senator Bernie Sanders, Medicare for All would essentially allow all Americans to qualify for Medicare.  According to Unitedmedicareadvisors.com:

Medicare for All promises to cover numerous healthcare products and services, including the following:

  • Inpatient and outpatient health care services

  • Preventative, emergency, and nonemergency health care services and treatments

  • Primary and specialty health care, including palliative and long-term care

  • Care for vision, hearing, and oral health problems

  • Mental health and addiction services

  • Prescription medication

  • Medical equipment and supplies

  • Diagnostic tests

The concept sounds nice but Medicare doesn’t currently cover many of the above such as hearing aids, dental exams, and long-term care.

 

How would Medicare For All be subsidized?

Unitedmedicareadvisors.com reports the following:

Medicare for All, estimated to cost around $1.38 trillion a year, would operate with funding from the following sources:
  • $630 billion from a 6.2 percent income-based premium paid by employers
  • $210 billion from a 2.2 percent income-based premium paid by households making more than $28,800
  • $110 billion from progressive income tax rates for Americans with yearly earnings over $250,000
  • $92 billion from taxing capital gains and dividends in line with employment income
  • $15 billion from limiting tax deduction for Americans with yearly earnings over $250,000
  • $21 billion from a new Responsible Estate Tax applied to the homes of Americans inheriting more than $3.5 million
  • $310 billion from savings as health-related tax expenses become obsolete

Unfortuantley tax hikes on employers could lead to price hikes and less employment.

So the concerns I have are Medicare doesn’t currently cover what Medicare for All is touting and the expense may be underprojected.

7615-04-figure-31

The image above from Kaiser Family Foundation predicts beneficiaries will outnumber workers.

Moreover many healthcare providers do NOT take Medicare so access can be an issue.

However, until premiums and dedutibles go down, and more Americans become insured, plans such as this will gain attention and popularity.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

Posted in Health, news, Politics

Ruth Bader Ginsburg Undergoes Surgery for Cancer

Supreme Court Justice Ruth Bader Ginsburg has had surgery to remove two cancerous nodules in her lungs.

These were found a few weeks ago when she was undergoing treatment for a fall in which she sustained broken ribs on her left side.

The pulmonary lobectomy surgery occurred Friday morning at Memorial Sloan Kettering Cancer Center in New York City.

We’re told margins were clear and the cancer does not appear to have spread to other parts of the body.

The 85-year-old Justice has previously battled colon and pancreatic cancer.

Broken ribs can occur from trauma such as a fall, or as a result of pathological fractures such as those from cancer.

This is a developing story.

Posted in Health, news, Politics

President George H. W. Bush Passes at Age 94

BREAKING NEWS

The 41st President of the United States, George H. W. Bush,  has passed away at the age of 94.  Family spokesman Jim McGrath stated he passed at 10:10 CT Friday in his home in Houston, TX.

The statement from his office reads:

“Jeb, Neil, Marvin, Doro and I are saddened to announce that after 94 remarkable years, our dear Dad has died,” his son, former President George W. Bush, said in a statement released by family spokesman Jim McGrath. “George H.W. Bush was a man of the highest character and the best dad a son or daughter could ask for. The entire Bush family is deeply grateful for 41’s life and love, for the compassion of those who have cared and prayed for Dad, and for the condolences of our friends and fellow citizens.”

bush image.jpg

Over the last few years the WWII veteran had battled multiple health issues including Parkinson’s, pneumonia and a neck fracture sustained after a fall.  It’s been reported that he was recently hospitalized with low blood pressure, I suspect from sepsis, a blood infection.

This is a developing story.

Posted in Health, news, Politics

Justice Ginsburg Suffers Multiple Rib Fractures

85-year-old Supreme Court Justice Ruth Bader Ginsburg suffered multiple rib fractures during a fall in her office on Wednesday.

She originally went home but then felt ill and checked herself in to George Washington University Hospital early Thursday morning.

It was found she broke three ribs on the left side and has been admitted for observation.

Those who suffer rib fractures find it very painful to breathe and may fail to take deep breaths. This puts one at risk for pneumonia as pathogens can fall into the lungs and not be expelled out.  Medical providers are more liberal with pain management as we want to maintain a patient’s ability to breath fully.

BrokenRidCTParaSag

Image from Wikipedia

This is a developing story.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in Health, news, Politics

Election Depression: How to Avoid it

For over a year we’ve been bombarded daily with candidate interviews, political commentary, primaries, speeches, polls, mudslinging, ads, and frankly, we’re sick of it.  The amount of negativity spewing from both sides is exhausting and out-right depressing!

But as we receive the election results, some of us will be rejuvenated with hope while others will fall into the abyss of an election loss.  Election depression is real, very real.

What is election depression?

It’s despondency (a drop in mood stemming from a loss of hope) after an election.   We’ve discussed election anxiety recently as many people are fearing the result, but we haven’t prepared the country for what happens when the vote doesn’t swing their way.  Feelings of sadness, guilt, remorse,  agitation, irritability, are just a few of the signs.

Why “depression”? What causes election depression?

Multiple factors can cause this..

  1.  The loss.  Humans don’t like to lose. We’re competitive in nature and want to win, or be on the winning side.    The losers get nothing after their loss but a future they did not choose. Which brings us to….
  2. Lack of control.  Humans like to make their own destiny.  If they work hard, do the right thing, they can mold their future.  The loss of an election that they hoped would change their future, is perceived as a loss of the future they were supposed to have.
  3. Embarrassment.  Those of us who were vocal about who we were supporting and incurred bullying from opponents, now have to face these same individuals with the public humiliation of a loss.
  4. Much pain, no gain.  The year long physical and psychological build up and work that went into the election brings very little gain during an election loss.  Feeling like one wasted his time, energy, and money may affect his psyche.
  5. The end is abrupt.  Election results, as compared to the year long process, comes at us like a ton of bricks.  Many people may not be psychologically prepared to take bad news in such a swift blow.
  6. Regret.  We defriended social media contacts and ended year-long relationships with friends and family over this election.  Maybe even quit our job.  This could seem impossible to repair.

 

voting-booth

 

  How do we prevent election depression?

On one hand its good to passionate about an issue or candidate. Passion drives us to make change, build, progress, restore, and all the good verbs that our great country needs.

However, while we’re being passionate, we need to be prepared.  

When you’ve been through as many elections as I have, you learn that you don’t win them all.  You also learn that one candidate will always win and one candidate will always lose.  Not thinking about the latter won’t wish it away.  The reality of your last choice candidate being your legislator needs to be faced.  So its better to mentally prepare for it early.

Here’s some things you can do:

  1. Pseudo-reality role-playing

One technique I’ve done with patients is pretend for 24 hours “So and So” won the          Presidency/Senate/House.  After the group laughs and makes vomit gestures, I remind them that they need to, over the course of 24 hours, live their day with that pseudo-reality in play.  The results?  Many say “it wasn’t so bad”….”we’re still living”….”we may handle our finances a different way,” etc.

2.  Don’t drink the night of the election.  

Getting wasted will just make you feel awful the next day, and election depression is worse the 24 hours after an election.

3.  Plan family and friend gatherings of like-minded individuals the week of the results

Avoiding those who will gloat may help soften the blow and being around your support team will help you realize there is emotional strength in numbers

4.  Take a break from the news

Watch programs that will cheer you up or begin diving into new projects for the coming months.

5.  Make up with friends you lost

The guilt will consume you when you realize you threw away a good friendship over a “stupid election”.  Shake hands and hug it out.

6.  Plan a vacation

The Holidays are coming, so enjoy yourself. You deserve it will all the hard you work you’ve done.

Losing isn’t easy, but its something that we eventually become good at.  If my candidate loses, I will start an Election Loser Club. I’ll probably invite Mickey Mouse to be our first guest speaker, since he always seems to be on the ballot each election anyway and never wins.  He still though manages to keep a smile on his face.  So should we.

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

 

Posted in Health, news, Politics

Anthony Weiner to be Released From Prison This Spring

According to the Federal Bureau of Prisons, the former New York Congressman will be set for early release in May of 2019, up from August 2019 due to good behavior.

In 2017, Anthony Weiner was convicted of transferring obscene material to a minor when he sexted a 15-year-old girl.

He was sentenced to 21 months in federal prison, beginning his sentence in November 2017 and is currently at FMC Devens in Massachusetts.

He had unsuccessfully run for Mayor of NYC in 2013 when photos emerged of him in his underwear.

Weiner, 54, had admitted publicly he was “a very sick man for a very long time.”

This is a developing story.