State Expansion of Short-Term Plans Will Not Contain the Cost of ObamaCare

Short-term health insurance is medical insurance that provides coverage for less than 365 days. After the passage of the Affordable Care Act (ACA), the Obama Administration had limited this type of coverage to less than ninety days. On August 1, 2018 the Trump Administration released a ruling which allowed the public to purchase short-term health insurance up to one year, reversing the Obama Administration ruling. The new policy also allows the short-term insurance to be renewed twice, essentially allowing coverage to extend up to three years.
The Obama Administration’s decision in 2016 to limit coverage to ninety days was a result of the mandates of the ACA. Under the ACA people without health insurance that provided adequate coverage for more than three months were required to pay a penalty of 2.5% of their income. The intent of this requirement was to encourage young, healthy people to purchase health insurance. Since these individuals generally have low health care costs, their medical premiums would offset the costs of providing care to older people and to those people with preexisting conditions. The option for healthy people to obtain inexpensive, short-term coverage would undermine the ACA.
Short-term health insurance does not need to comply the ACA requirements including the ACA’s essential health mandates. For example, it does not need to cover psychiatric problems, substance abuse, or maternity care. Applicants for short-term insurance can also be excluded if they have preexisting problems. Large deductibles, high copays, and low caps are the rule. Policy holders who become sick while under these policies will have large out of pocket costs and will probably not have their policy renewed. However, the premiums are far lower than the more comprehensive ACA compliant policies. Short-term policies provide an option for healthy people who are looking for interim coverage between jobs or for people awaiting Medicare.
The Trump Administration, by extending short-term coverage for up to three years goes along with its plan to rescind the penalty placed on uninsured people and by allowing association health plans to small businesses that are not ACA compliant. These measures are part of a continuing plan to dismantle Obamacare.
The ACA did succeed in extending coverage for many Americans but it did so by easing requirements for Medicaid eligibility. The majority of people who are now insured are on state programs. The ACA has been unsuccessful in halting the sky-rocketing increases in private insurance, especially those obtained on the ACA state exchanges. Although increases in premiums for insurance obtained on the exchanges vary from state to state, they are generally rising by double digit per cents each year.
Extending the length of time for short-term insurance provides an option of marginal real benefit to some healthy people. It does little to control rising health care costs. Unfortunately, neither did the ACA. Unaffordable care is essentially unavailable. Until the fundamental reasons for our overpriced health care system are addressed, states should tread carefully in expanding short-term plans.

Are You Getting Too Much Medical Care?

Some tests and procedures lead to worse—rather than better—health

With all the high-tech—and expensive—medical care available in the US, you may assume that Americans are among the healthiest people in the world. But that’s not true.

Troubling fact: The US spends more than any other country (about 17% of its gross domestic product) on health care but ranks 12th (among 13 industrialized nations) in measures of overall health, such as life expectancy.

For an insider’s perspective on what’s wrong with our medical system—and advice on how we can protect ourselves—Bottom Line/Health spoke with Dennis Gottfried, MD, who has extensively researched this subject and worked as a general practice physician for more than 25 years. Click here to read full article on Bottom Line/ Health

Critique of AHA/ACC BP Guidelines

The Flawed ANA/ACC Blood Pressure Guidelines:Making More People Sick
by Dennis Gottfried MD on the Huffington Post.

12/19/2017 09:56 am ET

It is well accepted that high blood pressure increases the risk for strokes, heart disease, and kidney failure and that lowering that pressure decreases the risk. Sometimes the treatment for high blood pressure consists solely of life style changes such as regular exercise, diet, and weight control but, more often, medications are also required. These blood pressure medications, although generally not very expensive, still come with a price tag and more importantly, introduce potentially serious Click here to read more

 

 

FOMO ( Fear of Missing Out)

 
Americans are spending increasingly more time online on social networks and among those networks, Facebook is the most popular. This is especially true in the millennial age group, those born between 1980 and the early 2000s. Although one might expect that spending time on social networking would enhance human connection and communication, research actually suggests quite the opposite. Primarily as a result of the widespread use of social networking, the acronym, FOMO, has been added to the Oxford dictionary. FOMO, or fear of missing out, typically arises from posts seen on social media networks. It is defined as anxiety that an interesting or exciting event might currently be happening elsewhere and that the person with FOMO might be missing out on that possibly exciting occurrence. To avoid these feelings, people with FOMO are constantly connecting to social media and checking posts from their various acquaintances. As they view the activities described in other posts, these people feel unworthy, and unfulfilled. They have the fear that other people are having a better time than they are and that they are missing out.
These dissatisfied people with FOMO can also have physical complaints including headache, chest pain, and impaired thinking. The more that they feel like they are left out, the greater the impulse to check social media and it becomes a vicious, time consuming cycle. The higher the FOMO score as measured by a questionnaire (https://psychcentral.com/quizzes/fomo-quiz.htm), the lower are the individual’s feeling of autonomy, connectivity, and competence. The greater the use of smartphones and social media, the lower the length and quality of sleep. When separated from their phones in experimental studies, the participants exhibited classical symptoms of addiction withdrawal including rapid heart rate, elevated blood pressure, and anxiety.
With increasing public awareness of these challenges, online apps have been developed to control social media time. Mindfulness training and cognitive behavior therapy, psychological tools, have been successfully employed to limit social media exposure. The attempt is to limit social media contact to one or two specific time windows each day. With this becoming a more common problem, approaches to its control will undoubtedly be aimed at preventing it in the first place through psychological, electronic, or pharmacological means.

Chronic Cough

According to the Center for Disease Control and Prevention, a cough is the most common presenting symptom for a patient to a primary care doctor’s office. Coughs, though, can have a variety of etiologies. The most usual cause of a cough is a viral illness such as the common cold.These coughs typically are associated with runny noses or sore throats and last only a few days although they can linger up to two or three weeks.

A more bothersome cough is the chronic cough which, in adults, is defined as a cough that lasts longer than eight weeks. Although a chronic cough is only rarely serious or life-threatening, it can cause fatigue, loss of sleep, muscle pain, and even depression. A chronic cough has many possible origins, but most are uncommon and only a few conditions cause the vast majority of cases.

Associated symptoms are important in evaluating each person to determine the cause. Is there a history of cigarette smoking, weight loss, excessive shortness of breath, environmental exposures, fevers, or asthma? Occasionally, a chest x-ray might be helpful in finding the etiology.

Overall, the most common cause of a chronic cough is the “upper airway cough syndrome”, more commonly known as post nasal drip. Usually, patients with this problem will complain of nasal congestion or of drainage in the back of their throats. Its treatment may include anti-histamines, decongestants, saline nose rinses, steroid nose spray, and occasionally antibiotics. Improvement with treatment usually occurs within a few days.

About one quarter of chronic coughs are produced by asthma even when wheezes are absent. Treating asthma with inhalers or oral steroids relieves the cough. A condition called non-asthmatic eosinophilic bronchitis is an allergic condition in the airways which is also a frequent cause for a chronic cough. Like asthma, this type of cough improves with inhaled or oral steroids. GERD, or acid reflux, causes heartburn, hoarseness, sour taste, and occasionally, a chronic cough. Weight loss, raising the head of the bed, and medications to decrease gastric acid production can relieve the cough associated with GERD. Other, less common causes of chronic cough, include medications like Lisinopril or Enalapril, chronic lung disease, environmental triggers, and aspiration. The causes for a chronic cough are varied and are only uncommonly related to an infection. Through a careful evaluation, effective treatment can almost always be recommended.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is a very common disorder affecting about 10% of the population with an increasing incidence in those above 60. It is particularly common in the obese and in those with large necks. It is characterized by a temporary stoppage in breathing or decrease in breathing that occurs multiple times during the night caused by obstruction in the airway. The fragmented, non-restful sleep that results can cause daytime problems such as headaches, abnormal fatigue, and depression. OSA is also associated with an increase incidence of hypertension and atrial fibrillation. People with OSA are at particular risk for unintentional injuries, especially motor vehicle accidents, because of their daytime sleepiness. The diagnostic test for OSA is polysomnography, a test which measures breathing during sleep. This is an overnight test that is best done in a sleep laboratory but can also be done at home. Apnea, a complete absence of airflow, and hypopnea, in which effective breathing is decreased enough to drop the blood oxygen saturation, are measured. All apneic and hypopneic episodes lasting at least 10 seconds are added up and divided by the total sleep time. If there are 15 episodes of apnea or hypopnea per hour, or if there are at least 5 episodes in the presence of symptoms, the diagnosis is made.
Once the diagnosis is confirmed, the treatment of choice is continuous positive airway pressure (CPAP) in which air pressure is administered through a mask worn during sleep. The pressure maintains open airways and the optimal pressure must be individually determined. This allows a more restful sleep, improves daytime fatigue, and seems to be helpful in the blood pressure control and some cardiac symptoms that accompany OSA. Unfortunately, almost half of people prescribed CPAP do not tolerate its use by 6 months. New styles of masks often allow more comfortable fits. Surgery to the mouth and throat for OSA is of doubtful value although bariatric surgery for weight loss is very effective in correcting OSA.

Medical Marijuana

 

Medical marijuana, or cannabis, has been legalized in 28 states, including Connecticut, and recreational marijuana is available in 7 states and the District of Columbia. Recreational and medicinal cannabis use has increased 45% in the general population since 2007. In states that allow medical marijuana, the most widely recognized qualifying diagnoses include cancer, HIV, multiple sclerosis, glaucoma, seizure and pain. With its wide spread availability, what is actually known about its biological effects?Unfortunately, evidence regarding its health and therapeutic benefits are surprisingly scant. This year, the National Academies of Science, Engineering, and Medicine released its third comprehensive review of the literature concerning the health effects of cannabis. The committee found that among adults with chronic pain, those treated with cannabinoids (active chemicals derived from marijuana) had a modest improvement in pain compared to placebo. Similarly, in MS, there was a modest improvement in spasticity compared to placebo. In neither case were the cannabinoids compared to other established effective treatments, like Ibuprofen or Tylenol for pain. The control group in these studies only received placebos. Oral cannabinoids also have a modest benefit in chemotherapy induced nausea and vomiting. Overall the committee found a lack of evidence to support marijuana’s use for most of its stated approved indications.

The use of cannabis also presented worrisome side effects. The committee found an association with cannabis use and respiratory complaints including chronic obstructive lung disease and acute bronchitis. Recent evidence also linked marijuana to coronary artery disease. Cannabis use has also been associated with low birth weight in infants, poor achievement in school and/or work, difficulties in social situations, and motor vehicle accidents.  Problems with its use are generally linked to marijuana’s euphoric effect and to its being inhaled. The committee recommended high quality studies using non euphoric, orally administered preparations to define more clearly possible therapeutic indications.