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Wednesday, November 19, 2014

Obamacare, Is the American Public Stupid or were they Deceived....Again

According to government sources, Obamacare is a resounding success. Yet industry experts and pundits examining the implementation say otherwise.

More information is forthcoming about ObamaCare. Jonathon Gruber, Professor of Economics at M.I.T a primary author for the Affordable Care Act was interviewed by

He was a key architect of both the 2006 Massachusetts health care reform, sometimes referred to as "Romneycare", and the 2010 Patient Protection and Affordable Care Act, sometimes referred to as "Obamacare".[1]

Sen. Rand Paul (R-Ky.) made a guest appearance on “Hannity” Monday and said that embattled Obamacare architect Jonathan Gruber should be made to give back the money he received for his work on the health care bill.

ObamaCare Architect Thinks You’re Stupid; Pelosi Does Too

Gruber admitted multiple times that Obamacare was written in a non-transparent way intentionally, to exploit the “stupidity” of the American voter.

Sunday, November 9, 2014

The Affordable Care Act and Mid-term Elections

Many wonder how the mid-term election will afffect the Affordable Care Act ?

Perhaps not at all, however a recent exit poll of GOP voters indicated an unhappiness factor for most GOP voters.   Almost 60% want the Affordable Care Act repealed.

The current structure of the executive branch, and congress may not make this a practical reality until the Presidential election in 2016.  Obama would veto any motion to repeal the act.  Republicans may thwart a ny further plans Obama has for immigration, unless he complies with GOP plans.

There are no doubt some citizens who benefitted by coverage, if they can meet the extremely high deductibles and copays, and find a physician.  The next two years will shake out those who cannot comply for financial reasons.  The underlying formula is based upon the federal poverty rates, which are unrealistic. Basing any ability to pay any amount on the formula is fantasy 101.

People's incomes show large variations in many cases, month to month, especially for low income workers, average income figures fall far short for eligibility purposes.

Wednesday, November 5, 2014

The Affordable Care Act and Mid-term Elections

The ACA has had some effect resulting in the Democratic loss of seats in Congress.   Many Democrats feel the pain from voter displeasure with the ACA.   Whether this will make a difference to the ACA is still questionable since President Obama will cast a veto against any proposed changes in the law.  Although some changes have been made to the law, most have been waivers or delays in dates.

In a midterm election with many implications for healthcare, Republicans pulled off their expected takeover of the Senate, which they hope will enable them to rewrite the Affordable Care Act (ACA), even if they can't repeal it outright. Health Train's opinion is the mid-term will not repeal the ACA.

The Republicans can boast that they gained seats due to the backlash against Obama, the ACA.  Some of the backlash due to Obama and his statement, "If you like your doctor and hospital    you will be able to keep your doctor." That was a statement not based upon Obama'sl understanding of the law, when he signed it.

The second act of enrollment begins again.

Significant changes will have to wait until the next Presidential election.

Wednesday, October 29, 2014

Ebola, Quarrantine Measures, Politics or Science ? Are the politicians correct?

Politics and Junk Science

The world is not a safe place.  (the truth will set you free?)

The United States has been especially fortunate because of the CDC and it's experience in endemic and epidemic infection. Many third world endemic infection have been controlled, and we have required immunization for diseases prevalent in other countries.

The advent of modern transportation with thousands of people travelling around the world in a matter of hours increases the importance of isolating and containing diseases such as Ebola.  Prevention is less expensive, and treatment on site at the origin of the endemic outbreak is essential.

In areas where endemics occur the population density and the prevalence of the infection increases the liklihood of spread to other locations.

The outbreak of Ebola is a mere test of our CDC's control methods. Far worse could be forthcoming. Politicians are making decisions without accepting recommendations from public health scientists and authorities.  Could they be correct ? The Governors of New York, New Jersey and others have correctly used their authority to protect the public health.

As usual our government reacts slowly.

The major effect has been for  health workers returning from West Africa. Health officials have emphasized repeatedly that direct contact with secretions is required for transmission to non-infected individuals.

This week's NEJM (New England Journal of Medicine) has several articles regarding Ebola, regarding diagnosis, treatment and isolation measures.

Ebola in the United States:  EHRs as a Public Health Tool at the Point of Care    
Ebola and our fragile health system

Despite repeated assurance by the CDC that the transmission of Ebola Virus is not airborne, there are recent articles which report vomitting produces a spray pattern, and protective measures to prevent spread of Ebola Virus.

Ebola Virus Disease and the need for New Personal Protective Equipment.

Ebola, the world's most dangerous virus. (documentary)

Numbers below are time tags and contents of video:

0:00 Introduction to viruses
1:20 Virus anatomy
2:35 Hemorragic fever in Angola (Ebola)
2:56 WHO and GOERM
3:15 WHO and world wide  monitoring
8:25  Infection control and prevention in underdeveloped countries
11:54 CDC
12:00 Biological containment and isolation methods
13:15  Ebola, Marburg virus have no treatments or vaccines. 

25:00 Virology, methodology for research
33:00 Viral Vectors and origins, zoonoses, West Nile Virus
36:00  Threat of bioterrorism
41:00  Limited resources, requiring large volunteer efforts in Africa and elsewere.
45:00  Previous lessons from HIV (25% of Africans had HIV virus leading to AIDS)

Ebola Virus Outbreak 2014 - WARNING

Ebola is named for a river in the Congo where virus first appeared in 1976.

This video is from an active Ebola facility in Western Africa and explains the isolation and containment methods used.

22:23 Health worker evacuation to U.S for treatment.

Experimental Treatment: ZMAPP 

Q: What is this drug?

A: Called ZMapp, it is a cocktail of specially engineered antibodies designed to target and inactivate the Ebola virus.

Q: What do we know about whether it works?

A: Very little. Various antibodies have been tested in small numbers of monkeys, but not people. In one study, 43 percent of treated monkeys survived when the drug was given after the animals showed symptoms.

Mapp Biopharmaceutical now is developing a combination of three antibodies that seemed most promising in those animal studies.

Ebola - What You're Not Being Told  according to reports from Scientific Reports; 

Are you as confused as I am? My education and training in medicine should make me able to discern fact from fiction.

Here are opposing views:

You'll notice if you read virtually any mainstream article on the topic that they make a point of insisting that Ebola is only transferred by physical contact with bodily fluids. This is not true, at all.
study conducted in 2012 showed that Ebola was able to travel between pigs and monkeys that were in separate cages and were never placed in direct contact.
Though the method of transmission in the study was not officially determined, one of the scientists involved, Dr. Gary Kobinger, from the National Microbiology Laboratory at the Public Health Agency of Canada, told BBC News that he believed that the infection was spread through large droplets that were suspended in the air.
"What we suspect is happening is large droplets; they can stay in the air, but not long; they don't go far," he explained. "But they can be absorbed in the airway, and this is how the infection starts, and this is what we think, because we saw a lot of evidence in the lungs of the non-human primates that the virus got in that way."

Translation: Ebola IS an airborne virus. (as is annotated in the video and below, I am using this term in the layman's sense as TRAVELS THROUGH AIR)
Someone pointed out that in medical terms, if the virus is transferred through tiny droplets in the air this would technically not be called an "airborne virus". Airborne, in medical terms would mean that the virus has the ability to stay alive without a liquid carrier. On one hand this is a question of semantics, and the point is well taken, but keep in mind that the study did not officially determine how the virus traveled through the air, it merely established that it does travel through the air. Doctor Kobinger's hypothesis regarding droplets of liquid is just that, a hypothesis. For the average person however what needs to be understood is very simple: if you are in a room with someone infected with Ebola, you are not safe, even if you never touch them or their bodily fluids, and this is not what you are being told by the mainstream media. Essentially I am using the word "airborne" as a layman term.
The AP's spin on it:
Experts say people infected with Ebola can spread the disease only through their bodily fluids and after they show symptoms.
From CNN:
Ebola spreads through contact with organs and bodily fluids such as blood, saliva, urine and other secretions of infected people.
And from the BBC itself in their article describing the second confirmed case in Nigeria:
The virus spreads by contact with infected blood and bodily fluids - and touching the body of someone who has died of Ebola is particularly dangerous.
To make matters worse, there is something very, very important that the corporate media and public health officials are not telling you regarding this crisis.
You'll notice if you read virtually any mainstream article on the topic that they make a point of insisting that Ebola is only transferred by physical contact with bodily fluids. This is not true, at all.

Sunday, October 12, 2014

How Obamacare will effect this year's Medicare Enrollment Period

How to judge Medicare plans

While much of the nation is preoccupied with Obamacare and picking new health insurance at work, older Americans have deadlines of their own coming up — involving Medicare.
We're just a few days away from the two-month period when the nation's 54 million Medicare beneficiaries have a chance to change their Medicare Advantage and prescription drug plans.
Every year, seniors should review their options and compare plans even if they're happy with their current coverage. Experts want people to avoid being surprised after it's too late to change. The deadline is Dec. 7.
"It's the same advice we give every year, but it's hard to get people off the dime," says Ross Blair, senior vice president of, which provides tools and information on Medicare insurance issues.

Medicare Advantage plans. Nearly 16 million people — or about 30% of the Medicare population — are enrolled in Medicare Advantage plans. These cover hospitalization, outpatient care and, often, prescription-drug coverage under one plan.
According to the Centers for Medicare and Medicaid Services, the average premium for Medicare Advantage plans will increase less than $3 next year, to $33.90 per month. Residents of Los Angeles County will see average costs of just $13.74 per month. The vast majority of enrollees will face little or no premium increase for next year.
 But out-of-pocket costs, such as deductibles and co-pays, are expected to rise. Looking beyond the monthly premium will be important for shoppers wanting to save money.
Be aware that some Advantage plans will be terminated this year. Be certain yours will continue;
Pay attention to networks, experts stress. Medicare Advantage plans are also reducing the size of their provider networks — in some cases quite dramatically.
If your physician will no longer be participating in your current plan, your insurer is required to send you notice of that fact and help you find another doctor in the network.
Nationwide, the average monthly premium in 2015 will be about $31, the federal government estimates. In California the figures vary, but the average is $58.91.
Although the number of these plans has dropped for 2015, there will still be 1,000 available nationwide. In Los Angeles County, Medicare participants will have 31 plans from which to choose for 2015, down from 34 this year.
Also, pay attention to the ratings. To help consumers determine the value of both Medicare Advantage and prescription drug plans, Medicare created a quality rating system. A plan can receive one to five stars, with five being the best, based on the agency's assessment of medical services and customer satisfaction.
Experts urge consumers to be alert for possible changes since last year's Medicare Advantage and prescription plans.
To review your plan options: Medicare plan finder at http://www.medicare.govor call (800) MEDICARE;
For free personalized counseling services: State Health Insurance Assistance Programs, or call (800) 677-1116; In Los Angeles, California Health Advocates:

Friday, September 26, 2014

Venture capital in healthcare is flowing, but how long will it last?

Despite the lingering slow recovery of the economy one sector that is booming is in health care financing and funding of health information technology, ranging from electronic data storage, evolutionary development of current technology which includes, EHR HIX, telehealth, health information exchanges, and mobile health apps. 

Much of the financing of these are not through conventional funding, but depends upon venture capital and startups from young entrepeneurs just entering the work-force.  Some are triggered by well funded, successful companies such as Google, Microsoft, and Apple.  Apple and Google have recently entered the health space in a more visible manner. Both Apple and Google have already developed many moble health apps,  now both companies are launching a more visible presence as Google Health, and Apple's Healthkit.With so much venture capital being foisted onto the digital health space, it’s beginning to beg the question: how long will this last, can it sustain itself, and what’s an entrepreneur to do? And, what are the implications for emerging companies versus traditional healthcare companies and systems?
Those were just a few of the burning questions discussed at Health 2.0‘s Pre, Post, M&A IPO panel held in Santa Clara.
"In the current landscape, larger-than-average sums of seed and early series funding is available to startups across a wide spectrum within the healthcare space. While that may seem like an obvious benefit, entrepreneurs need to be mindful of what’s reasonable and what’s actually needed, so as not to over-promise with a big initial raise and under deliver with a sub-par series b or c.
“You need to be careful to not overreach on your first round,” said Johh de Souza of MedHelp. “It can be very hard then on the second round. It matters on who the investor is, too.”
Frank Williams, of Evolent, agreed: “ You can overreach and then under deliver, and that creates a lot of issues.”
Sage advice, to be sure, but the entrepreneur should also capitalize on the current market conditions, and shouldn’t necessarily be faulted for the seeming glut of capital being heaped upon healthcare startups, Glen Tullman of 7wire Ventures cordially countered.
“I don’t think you can blame, nor should the entrepreneur be conservative, in terms of how big the raise is,” he said. “It doesn’t matter what you raised at a valuation – either you’re performing or you’re not.”
The venture capital funds are increasingly shifting away from life sciences and biotech and toward the digital health realm, with investors realizing that much less capital is needed to get off the ground for the latter while a return is still enticing, said Milena Adamain of Azimuth Partners.
To that end, on the M&A side, much of it’s a seller’s market, certainly as it relates to digital health, Williams said.
“It’s really hard to buy thinks now,” he said. “Everything is really expensive because of the competition.”
But the overall M&A landscape of healthcare in general will continue to be much more varied, with a good deal of late-comers merging as a means of survival. Yet at the same time, the different types of buyers, including nontraditional players like big consumer companies, bodes well for activity.
“As far as M&A, it looks incredibly attractive because of a broad base of buyers that you’ve never had,” Adamain said.
On the IPO side, everyone still looks to Castlight as what might be, but it’s still too soon to say whether long-term stability can be achieved, the panel said. Although at the moment, being a billion dollar company certainly appears to be working in Castlight’s favor.
“I would say the jury is still out,” Williams said. “Right now it’s a massive success. The question is do they continue to grow.”
So what does that mean for companies pondering the IPO? It’s hard to say exactly, but Tullman, of 7wire Ventures, said one gauge is to see how feasible it is for investors to sell within a year and what sort of return they can get.
All told, while it’s speculative to insist a bubble will burst around the available capital for digital health, and tech in general, the healthcare space is likely big enough to sustain a significant share of investor interest."

“Everyone is looking at something that is a fifth of the economy and so there’s a lot of strategic thinking to get a piece of that,” Williams said.
attributions:  Medcity News, Dan Verel, Marc O'Connor

The Affordable Care Act and the Internal Revenue Service

Part I

In October 2013 enrolllment  for the Affordable Care Act became available.  It's introduction and enrollment were plagued with unanticipated challenges.

It is one year post-enrollment apocalypse. Some are happy, some are not happy, all are confused. Despite problems, and delays almost 7 million people have enrolled.  How many are still enrolled and how many have actually seen a doctor are still unanswered questions.

In addition to the delays the Los Angeles Times reports that 30,000 ACA enrollees from Octobr 2013 were never enrolled or had eligibility issues undetetced at the time of enrollment.

California's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall.
Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage.
Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said.
C alifornia's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall.
Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage.
Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said.

At a time when many taxpayers have lost faith in the IRS' ethics do we let the IRS be involved in our health care?
An unlikely partnership, will it work, and do we have a choice?