Sharing the burden

Recently UPS was criticized for dropping employee health insurance coverage for spouses who are eligible for health insurance through their employers. But that's only 15,000 people. The majority of their drivers and other employees are covered through Teamster's Union benefits so they will not be affected by the change.

A recent article called Employers Play Obamacare Blame Game discusses reactions to the shared costs complaints and how other companies are reacting to the upcoming changes.

The whole point of mandatory health care is to have a healthier population. This requires change. So of course employers are going to start shifting burdens around as much as they can. Companies which have provided the most benefits I am sure will be some of the first to start making changes.

There is a separate requirement, starting in 2018, where employees who offer richer policies will be required to start shifting more of the costs to employees or start paying a penalty.

People are dying or going bankrupt due to lack of medical care or the high costs associated with it. We need to share the burden and can't assume our employers or the government will hand us everything we need. Its part of taking our place in society and being a contributing human being.

There are those, including me, who face health or other issues, who can't contribute as much as others. But that doesn't make them any less of human beings.
If you do not like the current and upcoming changes for whatever reason, then you can do your part by cooperating with the existing legislation and work to find ways to change it.

What this is all called is change. Get over it. Change is needed to make health insurance more affordable and health care more available. Our current system does not work. Insurance companies, not doctors, are making decisions about the health of people.

Dieting and such

Here's a theory: skip focusing on which diet is best and start focusing on changing eating habits.

This translates to stop focusing on what we eat and getting the balanced diet and change to focus on how we can get people to make healthier food decisions. Are we eating because we are stressed? Do we have bad habits related to the drive through where we make a quick stop on the way home and eat the food in the car?

Researchers look at all sorts of diets - Paleo, Atkins, Weight Watchers - and compare them all. The FDA issues the nutrition pyramid which is now a plate. But does anyone stop and look at the eating habits we have developed and why we have them?

We live in a world full of light this and fat free that and a widening population. Why?

I used to work with a woman who was a fairly healthy eater at work. She did not snack, she didn't go out for donuts. But she was quite large. I never really figured out why.

Then I went on a business trip with her and  she insisted we stop at the grocery store on the way to the hotel so she could get some stuff for her room. I was happy to go and get some seltzer (my secret addiction). She bought a couple boxes of crackers and cookies - for a three day business conference. I think she went out and made another grocery run later on. I think she was an evening snacker - hence her hefty weight.

So why does a normal, bright, well educated person, sit and eat for hours at night by themselves? That is the question to answer.

If you watch the greater loser shows, people talk about their bad eating habits and are taught how to eat healthy -  no soda, no drive through, healthy snacking. They also get exercise and lose weight. But they change their eating habits. Maybe they eat more salads and fewer french fries but often these shows are accompanied by tears and emotional breakthroughs as well.

I know my weight stems from three issues I have.

1. At my job, there are more snacks than any place I have ever worked and the kitchen is right next to my office.
2. I snack after dinner which I shouldn't do. (Why did I eat that granola bar after dinner last night? I didn't have dessert is my justification and I wanted something crunchy. But I didn't need it.)
3. Sometimes I eat when I am not hungry because I am bored, stressed or in pain.

So if I can get rid of those habits, I can lose weight. I have been working on them, my weight is going in the right direction. The funny thing is I am still eating desserts sometimes and normal food. I didn't switch what I eat. I switched when I eat. My goal is to modify my eating habits so I can get to and maintain a healthy weight but still enjoy eating. I will no live on lite versions of crappy prepared food.

Maybe that's what researchers need to figure out so other people can more easily lose weight.

Hospital visitors

When I am hospitalized, I have a list of people who can visit me. They include my husband, my parents, and my siblings. Anyone else has to call and ask. I am serious about this. If people visit unannounced, they will find out how rude I can really be.

My strong feelings about this are due to the fact that once, after a significant surgery, a friend had to stop at the hospital for an early morning appointment, the day after my surgery. So she decided to stop by my room at 830am. I was not ready for guests.

I was talking to someone who was a friend and a nurse who was giving me some information. I did not want to socialize. She didn't understand the concept of good manners and to think that the morning after major surgery might be a bad time to visit someone.

When I am in the hospital:

1. I probably feel like crap.
2. I probably look like crap.
3. I am probably cranky.

Its not that I don't want visitors at all - they do help the time go by - but my goal is to get better enough so I can leave as soon as possible. If I can't get my naps in, I won't be able to get better.  I find the concept of visiting people in the hospital for hours on end to be a bit ridiculous.

I actually feel sorry for the patient's whose families come to visit and stay for hours in big groups. If you are sick enough to be in the hospital, you don't want to host a party, you probably want to take a nap.

There is a hospital in Hawaii which has started the policy of visiting hours 24/7 and let the patients set their visiting times. This was done at patient request citing a study that found that people surrounded by family and friends heal faster and cope with their hospital stay better.

At first I was pretty appalled by this. But then I started to think.

There are lots of people who work odd shifts or have child care issues or travel distances or work nights and I can go on and on that have off hour schedules normally and are used to getting a lot of sleep during the day wherever they are so why should hospital visitation be any different?

Hospitals are where they wake you up for a sleeping pill or to take your blood and vital signs at 2am. So you might as well have a friend hang out with you for it.

Trust

Most people you meet, you generally don't share lots of private information until you have gotten to know them. Your doctor is different. You go see a new doctor for whatever reason and then you start spilling your guts on the state of your gut and other body parts.

If you think about it they are a stranger. I sometimes have to scrape doctors off the floor when I start telling them about my issues and allergies - they all love the fact that I am allergic to benadryl. I have had them start laughing too - with me, not at me.

But it is all about trust. How much do you really trust a stranger?

I think we believe doctors are ethical and honest human beings, with the best interests of the patient in mind. Personally I believe people are honest and ethical for the most part and don't start to lose trust unless I feel betrayed.

I don't mind if my doctors talk about me together in order to figure out how to best treat me. But I would be really upset if my doctors were trying to scam me. You hear the horror stories. I have blogged about a few of them as well. Here's a story with some more but also some good advice:

1. Research your doctor. 
2. Make sure your doctor isn't practicing outside his/her field.
3. Be cautious of doctors who advertise too much.
4. Ask a nurse or other hospital support staff.  
5. Get a second opinion.

Be an educated patient, do your homework and most importantly pay attention to your gut (feelings).

So are you an inpatient or an outpatient?

The hospital and Medicare get to decide. Not your doctor who is actually treating you.

I found this pretty appalling. Medicare patients can be in the hospital for DAYS and be called and an outpatient because they are only being 'observed'. They get the same care as everyone else. But then they get a big fat bill if they were an outpatient.

Their doctor can even admit them and make them an inpatient but then the hospital can change it back to outpatient. Hospitals like this because they get reimbursed more that way.

"Medicare originally intended observation care as a way to give doctors time to evaluate whether a patient should be admitted to the hospital or is stable enough to go home, usually within 24 to 48 hours. But hospitals are increasingly keeping patients in observation status longer: 8 percent of Medicare recipients had observation stays longer than 48 hours in 2011, up from 3 percent in 2006.
Apparently the government can tell by looking at a rule book to figure out how sick you are, not but diagnosing you and reading your chart. Or, God forbid, even talking to you.

That increase may partly be a response to aggressive reviews of hospital billing practices in recent years. Medicare contractors have demanded refunds from hospitals that admit patients the government believes should have been treated as observation patients or outpatients. Medicare pays hospitals less for those patients."

And also hospitals are now rated on their readmission rates. If you aren't admitted the first time, you are not readmitted later on.

"Toby Edelman, senior policy attorney at the Center for Medicare Advocacy in Washington, D.C., said she believes hospitals also could be trying to avoid readmission penalties, which are assessed if too many patients are readmitted within 30 days. Harold Engler, for example, went home after five days, grew sicker, and then returned for another five-day observation stay. If he had been an inpatient, he would have counted as a readmission within 30 days."

Hospitals claim they are working on it because they computer tells them what to do. The computer even knows more than the government:

"Dr. James Hart, who heads a Beth Israel Deaconess committee that makes sure the hospital follows Medicare rules, said he could not comment on Engler’s case. But he said the hospital uses a sophisticated computer program that tries to match patients with the correct Medicare designation based on their illness and the intensity of hospital services required. “We are very focused on getting the level of care accurate,’’ he said."

Medicare knows this is a problem and even has created a brochure on this telling patients the difference. But if you are sick in bed, do you really care about semantics? No.

"Case managers generally inform patients of their status, especially if they require skilled nursing care, he said. But that doesn’t mean patients digest the information, at a time when they have so much to focus on. “Part of the challenge from a patient perspective is there really is an information overload,’’ Hart said."


You just want to feel better and go home where you can be in your own bed eating real food instead of the crappy hospital food they serve.

I knew Medicare had its issues but I didn't think it was out to impoverish seniors. I thought it was supposed to be the other way around. Clearly some changes need to be made here.

Update: 8/30/13 - One of the former heads of Medicare wants the rule on observation to be abolished.

Geographic variances in breast cancer

Recently a  new strain of triple negative breast cancer was found in Ghanian women. This is a strain that is not found elsewhere. The result - a new treatment needs to be developed.

It is a fact that different groups - ethnic and racial - are diagnosed with different diseases or types of diseases at different rates. For example Ashkenazi Jewish women develop breast cancer at a higher rate than other women.

But I have never heard of a new variant of cancer being diagnosed by geographic area.

This opens a whole new direction for cancer research. Women from different parts of the world could be influenced by their local genetic, food, and environmental factors which could skew research results. I don't know how much this is taken into account by the pharmaceutical industry.

I do know that drugs are developed and tested world wide and then start getting approvals from the FDA and its counter parts in other countries. To be eligible for these clinical trials, patients have to meet specific criteria. The rates of clinical trial participation vary from city to city, state to state, and country to country, for a variety of reasons. But this means it is possible that patients who do not meet the criteria could have specific variances in their disease that are not noted.

Am I making sense? Sometimes I wonder.

The point I am trying to make is does current cancer research focus on the big groups that fit into the clinical trial criteria and not take into account the little subgroups that are now being discovered?

The guilt factor

This is a less discussed issue relating to cancer diagnosis and treatment - the guilt factor. Sometimes its not even mentioned, while other times it is just brushed off as something you need to learn to live with.

Guilt is what got you to do what you were supposed to when you were a child. Guilt is what your morals use to keep you in line.

But then we feel cancer guilt which is different. Why didn't I get it and they did? Why did they have a recurrence and I didn't?

The more cancer friends I have gained, I have also lost some. I have the little list of in memorium blogs I used to follow, the group of friends on Facebook that are no longer here and are in memorium, there are the phone numbers in my phone that I know don't work any more. And when they do again, it will be a stranger's voice on the other end.

It seems now every month or two, or even more frequently, someone I know either has just learned about their stage IV diagnosis or I learn about their funeral arrangements.

Each time, there is a double dose of emotions the little tiny - "I'm glad it wasn't me" which is immediately followed by the huge "how could I even think that?" and then followed by cancer survivor guilt.

Sometimes the guilt lurks in the back ground and sometimes it emerges up front. It gives us down days but then we stuff it away and we learn to cope again. But its always there.