Uninsured Kids..Blame Abounds

Here are my comments
Children’s Health Care

Children have access to healthcare buy going to emergency rooms.  Many states are improving childrens access to health insurance by plans like Texas' CHIPS.  I think the Children's health plan will pass congress soon.  This will cover poor children but not the working well family's children.  I is much cheaper to buy insurance for children and/ or  pay cash for doctor's visits, when compared to adults.

 

I agree with your article.  Another issue is that to improve the health of uninsured children, you must educate the parents.  Educate them about jobs, nutrition, priority setting, basic hygiene. 

Giving health insurance to 100% of all children will not solve all the health problems of children.

9/8/07

A 10 year plan to fix Healthcare

Here are my comments on this article.   10 year reform plan

I agree your plan would reduce prices.  Look how medicare part D plan have increased the cost of medicare recipient's medications.  I'm guessing medication prices have gone up 25% since medicare began paying for prescriptions.

 

As part of your plan I would like an ad campaign regarding the importance of good health behaviors.  Many , many people have little regard for disease if they are feeling good.  Perhaps they don't trust doctors and the healthcare system enough to pay money for a painless illness like diabetes and high blood pressure.  These diseases are painless until you get your first complication, but then it is too late to cure.

 

Your plan requires personal responsiblity.  Some people want the government to solve their problems like obesity.

crherrerahot@hotmail.com

No "Health Care"?
By Thomas Sowell
Tuesday, September 4, 2007

Send an email to Thomas Sowell

 

 

Yes,  government healthcare has unintended consequences.    Look how medicare part D plan have increased the cost of medicare recipient's medications.  It is my empression from talking to my patients that medication prices have gone up 25% since medicare began paying for prescriptions.

 

I would like the government to perform  an ad campaign regarding the importance of good health behaviors.  Education is cheaper and more productive than paying for healthcare.  Many , many people have little regard for disease if they are feeling good.  Perhaps they don't trust doctors and the healthcare system enough to pay money for a painless illness like diabetes and high blood pressure.  These diseases are painless until you get your first complication, but then it is too late to cure.

 

No health insurance  requires personal responsiblity.  Some people want the government to solve their problems like obesity.

crherrerahot@hotmail.com

Here is an article about medicare
http://jevica2003.townhall.com/g/7317fb88-a606-47f8-8b91-1dd14bb4f493&comments=true#comments

Here are my comments:
Good ideas.  I favor letting medicare participants choose amoung private health plans.  Some politicians want to make health decisions for us.  Healthcare reform needs a  variety plans to attend to the widely varying needs of the public.

Edwardscare!

Edwards and Prevention

Finally prevention gets some press. It is the unglamourous but necessary way to good health. It is the key to improving the health of the United States. But it is a very hard thing to sell. Patients like technology when they see the doctor, not a lecture on how to eat right and exercise. Things like mammograms, prostate cancer blood test, and colonscopy are only the tip of the iceberg when teaching the public about prevention. Prevention needs to be embraced by the patient. Mandates won't work but at least they spread the word on the imporatnce of prevention. As Newt Gingrich said "good health is a combination of nutrition, activity and attitude." Crherrerahot@hotmail.com

California’s Healthcare reform

Just as other states (Hawaii, Oregon, and Massachusetts)  attempts at healthcare reform, California’s proposals have focused on universal coverage as the major step to improve health.  The idea is, better access means better health.  This has been shown to be true in multiple health surveys (Kaiser foundation ).  Governor Schwarzenegger’s plan has employers paying most of the costs but taxes doctors and hospitals to pay for the plan.  According to Calhealthreform.org here is a summary of the two major plans that may be passed:

“Governor Schwarzenegger's Plan
Creates an individual mandate, employers must "pay or play," expands eligibility for public programs, and subsidizes coverage for low-income Californians. (Not a bill.)”

“AB 8 (Núñez) Bill
Employers must "pay or play," and workers whose firms pay a fee instead of covering health expenses must enroll in a new purchasing program. Expands eligibility for public programs and reforms the private insurance market. (In Senate Appropriations Committee, 7/17/07.)”

This year’s California’s health reform package is similar to a plan rejected by the public in 2004.  The difference is that the 2007 plan allows employers more options for employers to pay for their employees’ health costs.   Also more uninsured persons (4.1) are covered in the 2007 plan and this includes 75 % of uninsured Californians.    This plan is very similar to Massachusetts ‘s plan that passed in 2006.  However California has many more ininsured persons and many more low wage workers than Massachusetts . 

Carlos Herrera MD, MPH

References

http://www.townhall.com/news/health/2007/08/29/schwarzenegger_tries_to_save_health_plan
http://www.kff.org/uninsured/

http://www.calhealthreform.org/

My patients frequently refer to health information they received on the internet when they   discuss their illnesses with me.  In general, this is good thing.  However, many are confused with conflicting information and need help with finding non-biased web sites.  The article below discusses the confidence people have of internet information.  According to my biased memory, the numbers don't seem to represent the majority of patients in my practice.   Of course my patients are sicker, older, and more are spanish speaking when compared to the opinion pole of Prostpectiv,.   Illnesses drastically  interfere with internet access and understanding.  However, illness can be a powerful motivating force to encourage internet use. I do believe improving internet access to sick persons, especially the elderly, will improve health and quality of life.

http://www.prospectiv.com/press121.jsp
PRESS RELEASES
Return to Press Releases
75 Percent of Consumers Say Internet is Their First-Choice Resource for Drug Treatment Information, according to Prospectiv Survey

Majority surveyed conduct research on health and
ailment-focused web sites versus pharmaceutical company sites

July 24, 2007
WOBURN, MA - July 24, 2007 -A recent study by Prospectiv shows that for the majority of consumers, the cure for what ails them can be found online.

Prospectiv says:
"The survey also found that consumers who conduct online ailment and drug research largely favor general health web sites (54 percent) and specific ailment-focused sites (37 percent) over pharmaceutical company sites (4 percent). Respondents also shared their frequency of conducting online health-related research. While the majority (40 percent) said that they had conducted online research only two times or less during the past six months, 33 percent reported research frequency of at least once-a-month, followed by every other month (27 percent).   "

Of the many articles about the movie Sicko, by Micheal Moore,  below is the best one I have read.  It talks about the disadvantages and advantages of the US healthcare system.  It makes good points about the cancer rates between US and other Eurpean countires.  Also he discusses the infant mortality rate and few opinion polls on healthcare beliefs.
by Carlos Herrera MD, MPH


http://abducens.townhall.com/
author: Dr. Ed
Location: Newport Beach, CA


here are a few excerpts:

Sicko does not mention that IMR is measured differently here than in many other countries. The U.S. includes many infant births in our IMR calculation that other countries do not, thereby appearing to have a much higher rate of infant mortality. Some European countries have certain age (minimum 26 weeks) and size limits (12 inches or 1000 grams) under which the baby is excluded from IMR statistics.  IMR data from third world countries like Cuba are likely underreported as most births occur outside of the hospital.

 

Mr. Moore notes that Americans pay more for health care but have a shorter life expectancy than in some socialized systems.  But are measures of IMR and life expectancy really an accurate reflection of a country’s medical system?  Don’t they really have a lot more to do with sociology than medical care?  Americans happen to have more car accidents, murder each other more often, and many of them look like, well, Mr. Moore.  The latter risk diabetes, hypertension, and heart disease. 

 

Americans’ perception of the health care system

How do Americans themselves feel about their health care?  If you ask them how they feel about the quality and cost of health care, thinking about the country as a whole, 54% are dissatisfied with the quality and 80% are dissatisfied with the cost according to a 2006 ABC News / Kaiser Family Foundation survey. 

 

But if you ask how satisfied Americans are with the care they receive themselves and their own health care costs, 89% are satisfied with the quality and 57% are satisfied with the cost. 

The article below talks about the many risks of obesity.  This article mentions the importance of good healtlh behavior in determining longevity.  I want to stress the importance of personal health habits in determining good health.  People live longer today because they reduce stress, eat right and do a lot of small things like wear seat belts.  I don't think things like cat scans, bariatric surgery and other technologies improve health as much as good  behovioral activities do. 
by Carlos Herrera M.D., M.P.H.



Mr Fumento says:
There are fatophiles who have found their life’s calling in catering to delusional overweight people, which can be a lucrative market insofar as two-thirds of adult Americans are overweight or obese. Most fat people realize they have a problem, but many would rather believe their condition to be benign rather than taking the difficult (but hardly impossible) route of doing something about it.

I agree in general with the article below.  Patients are not motivated to save costs in the presesnt healthcare system.  Also patients need to be educated on to what is most cost effective to improve their health.  In my practice most patiens favor technology.  But I favor wellness, diet, good attitude, exercise and stress reduction.  Web sites and other ecucational materials would help patients make wise cost effective choices in healthcare without excessive govenement regulation.  Below is the link.
Doc



Ron Paul says:
"The excessive reliance on third-party payers removes all incentive from individual patients to concern themselves with health care costs. Laws and policies promoting Health Maintenance Organizations (HMOs) resulted from a desperate attempt to control spiraling costs. However, instead of promoting an efficient health care system, HMOs further took control over health care away from the individual patient and physician. "

More interesting links:

French health system broke; must copy US

Monday, August 27, 2007 9:31

WHO says US Health Care system ranks 37th in the world

Friday, August 24, 2007 5:39 PM

Doc comments:  The US system is strong in some points but week in others.  We can learn from socialized medicine in other countries.  A major issue that few have mentioned is that low socioeconomic status contributes to poor health.  We need to raise the socioeconomic status of the poor if we want to improve their health and increase the US ranking in the world.  There was good news regarding this from the 2007 Census yesterday.


http://www.census.gov/Press-Release/www/releases/index.html

August 28, 2007

Household Income Rises, Poverty Rate Declines, Number of Uninsured Up

Spanish Version -- Household Income Rises, Poverty Rate Declines, Number of Uninsured Up

Here is related link:  How undocumented persons effect the percent of uninsured persons in the United States:

Tuesday, August 28, 2007

Illegals Skew Healthcare Stats

Posted by: Matt Lewis at 4:33 PM

 

 

Uninsured persons in the United States

 

Forty-five  million persons lacked health insurance in 2004 (Kaiser Commission).  Since those 65 and older automatically have Medicare and persons at the poverty level of income or less have Medicaid, those who are uninsured include those who are earning just above the poverty level, and those working in a job that does not offer insurance.  According to the Kaiser Commission on Medicaid and the Uninsured,  lack of insurance leads to delay in receiving medical care and is associated with a 10 to 15 % higher mortality.  Some people want insurance but can’t obtain it due to pre-existing conditions.  Some people are offered insurance through their job but refuse it because they don’t want to pay the employee contribution of the health insurance premium.

 

Here is an example of an uninsured man from my practice. Minor details have been changed for confidentiality reasons.   A 50 year old man comes to see me because of weight gain and frequent urination.    I diagnosed him with diabetes.  He was self employed, made a good salary, but did not have health  insurance.  He was able to pay the office charges for the doctor’s fee ($55) and complete blood test($140) and for his medications($30).  The blood tests showed a  very high cholesterol.  One week later, because of continued high glucose, he was started on a second diabetes medication ($80 per month) and cholesterol medications ($70 per month).  Even though these are expensive he was willing to pay for them.  Another week later, he told me about chest pain.  I recommended that he see a cardiologist ($200)and have a stress test ($750).  He said he could not afford these so I started a medication for heart disease just in case he has blocked arteries.  Even though I recommended that he see me monthly to lower his glucose according to national standards, the patient returned to see me four months later.  His glucose remained poorly controlled.

Here is my comment on this example.  Would this man have better control of his diabetes and a less chance of a heart attack if he had insurance?  Probably yes.  Initially he was very motivated to see me but after time he lost enthusiasm to come to my office.  But this applies to patients WITH insurance also.  In my practice there are plenty of insured patients who have poorly controlled diabetes and refuse to see the cardiologist.  Money is not the only reason for poorly controlled disease.  Stress, personal priorities, and lack of trust in medical professionals are other reasons persons don’t receive the highest quality of care recommended by national guidelines.

Reference: Kaiser Commission on Medicaid and the Uninsured

1.     The Uninsured: A Primer, Key Facts About Americans Without Health ... (PDF)  

accessing health services, and why the number of uninsured Americans continues to grow. ... a quarter of Native Americans are uninsured compared to 13% of ...

www.kff.org/uninsured/upload/7451.pdf

Carlos Herrera, M.D., M.P.H.   08 26 2007