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Social Justice, Military, and Affordable Care Act: Part 2

IMGP3125September 20, 2013

Other early federal debates led to the provision of health care to the armed forces, naming the public good and satisfaction of economic aims to support the government’s role. It was argued that a healthy army and navy were necessary for national defense. The patchwork of care for the U.S. military covers decisions relating to those who serve, have served, and their families [see http://usmilitary.about.com/cs/healthcare/a/medicalcare_4.htm for a summary]. Lost in the conversation about the uninsured and the Affordable Care Act is the data about our nation’s veterans. They comprise a very large group of the uninsured. Here is the estimate from the Robert Wood Johnson Foundation: http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/uninsured-veterans-and-family-members.html — 1.3 million veterans plus their families [about another 1 million] have no access to health care.

How does the Affordable Care Act affect military families? An analysis that includes comparisons between Tricare and ACA requirements appears at: http://www.militarytimes.com/article/20130926/BENEFITS06/309260025/Affordable-Care-Act-No-impact-Tricare-some-coverage-isn-t-equal. It appears that the ACA will require more coverage than Tricare offers in various instances.

As for veterans and their families, if their income levels fall within Medicaid guidelines, they may receive care through an ACA Medicaid-expansion option. That depends upon their State’s buy-in, however, so it remains unclear whether this group of hundreds of thousands will find a path to care or not.   

Social Justice and the U.S. Affordable Care Act: Part 1

IMGP3158September 15, 2013

As President Obama took on the health care issue, his overall aim appeared to be to address access to health care for those who do not have it. This includes some of our most vulnerable citizens, ranging from children living in poverty to the elderly who lack the resources for care. This President, as others before him, sought to promote the dignity of citizens through the provision of health care and to exercise social justice in ways that represent ideals expressed in the Declaration of Independence—promoting “life, liberty, and the pursuit of happiness.”

The U.S. Constitution, which was adopted in 1787 as the supreme law of the newly formed national government for the thirteen states, does not endow Americans with a protected right to health care. This was a conclusion reached by the U.S. Supreme Court but one that finds itself at odds with other republics where a level of health and health care are explicitly guaranteed [see Poland, for example—p. 3 of http://www.ehma.org/files/Benefit_Report_Poland.pdf].

The reasons for an absence of reference to health and health care in the U.S. Constitution likely reflect both the desire to avoid government intervention—related to the very foundation leading to the formation of this nation–and the practical reality that medicine was in its infancy at that time. Thus, there was not much anyone, let alone government, could do to promote the health of individuals. Family comprised the primary unit of both social and economic life, and family assumed the role of caring for sick and injured members.

Very early on, these realities conflicted with the fact that merchant seamen, who acted on behalf of the welfare of all U.S. citizens, became ill and/or disabled in the performance of their duties. Thus, it was only “just” to pay for their health care. In accord with this premise, Congress passed an act to provide for merchant seamen’s medical care in 1798. Congress used the authority of Article I, Section 8 of the U.S. Constitution to support this policy. It empowers the federal government to regulate commerce with foreign nations and to tax for the general welfare as a means to that end. The health and well-being of individual seamen was not the argument used to support a role for government in providing health care. The need for a government role in health and health care resided in a focus on promoting commerce. Government efforts to provide health care, however, were squarely on the table, beginning a path toward where we are today.


Patient-Centered Outcomes Research Institute News on My Birthday

IMGP3168September 10, 2013

Nothing I enjoy more than a walk along a creek or stream and gathering fall foliage. In this case, it is cattails. A great way to spend a birthday.

At the same time, an announcement came into my email about the approval of 114 million dollars to support patient-centered outcomes research. The Affordable Care Act introduced this new research institute as part of its overall mission. Each of us will contribute one dollar to the initiative as part of the plan to fund its activities. I am not yet sure why a new institute was needed in addition to the National Institutes of Health which often includes patient centered outcomes research. I haven’t heard any real public discussion about this new initiative to fund research. You can check it out here: http://www.pcori.org/about-us/how-were-funded/

I will continue to ponder the meaning of another institute as part of the Affordable Care Act and share any insights I gain. Please do the same.

What we all should know about the Food Safety Modernization Act

john and rox in riffle jcwp facebookSeptember 6, 2013

The news often tells us something about the quality of our food. It may be a story about salmonella and chicken. Or it may be about a recall based on something being in a food that should not be there–perhaps due to defective equipment in a processing plant or two foods getting mixed together or peanuts being present when they should not have been. These stories help us select healthy food and should make us realize how much is done to keep our food safe. One of the more recent policies relating to our food safety is explained at http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm247559.htm and makes clear that illness from food remains a big problem. With one in six of us becoming ill from foodborne illness, more than 120,000 hospitalizations, and about 3,000 deaths each year–we should all be aware of what we can do to stay safe and what the modernization act does to make it more likely.


Happy birthday to my little sister–her story has inspired so many

August 28, 2013

IMG_1202[1](1)One of the fun things about writing a book like ‘Talking about health’ is that readers tell me that they are inspired by the family stories included in the book. My youngest sister includes her story about a long road to conceiving her daughter–both pictured here with popsicle stick in hand.

I have read many of the stories in my book to my undergraduates and they, like some readers who have told me what they like about the book, love my sister’s story.  Perhaps  many can relate because they know someone who has gone through something similar [see http://www.cdc.gov/nchs/fastats/fertile.htm for CDC statistics about just how many].

Today is my sister’s birthday. I wish we lived closer so that we could have shared a cup of peach green tea. ‘Happy Birthday, Sis!’

“Your potassium level is low”–what fruits can do about this message from my doctor

August 23, 2013

IMGP0012Well, the annual check-up was mostly good news. My numbers were mostly good. 64 resting pulse. 120 over 78 for blood pressure. But then my doctor said, “Don’t you like fruit?” Huh?

“Your potassium is low. Don’t you like fruit?” I eat an apple almost every day, I say. He nods and says, “Eat more fruit.” OK. What kind? How much?

First, potassium–why is it important? I guess I could’ve asked but it seemed as if I was expected to know. And I knew I could find out online. Which I did.  Let’s just say that potassium is very important. It is crucial for heart function and for muscle contraction.

There are lots of food sources of potassium but I did find a ‘top 10’ list of fruits at  http://www.healthaliciousness.com/articles/high-potassium-fruits.php. Dried apricots are number 1 and bananas are on the list but much closer to the bottom. Prunes,  raisins, dates, and figs are on the list as well. I guess I will try a little harder to get some more of these in my daily routine.

What is an ‘improvement standard?’

August 21, 2013


A familiar image. What do you see when you first glance at it? An older woman? A younger woman? Can you see both?

Much of the language being used to define standards for care reminds me of this image. There has been a lot of discussion about an ‘improvement standard’ in the health care arena. The notion is that providers may not cover care if a patient is not expected to have long-term improvement in  their medical condition. Some law suits have tackled this issue, especially in relation to paying Medicare.

In one such case, skilled nursing care for a patient was argued to have been denied because the patient was not expected to improve in the long term. In the case of Jimmo vs. Sebelius, the improvement standard was considered and never directly addressed. The decision instead was that skilled care would not be covered when less skilled care would suffice. The Center for Medicare Services declared that they would do an educational campaign to address the issue of the improvement standard. Read more here: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf

What vegetables have protein?

August 18, 2013

ParrottCh7Fig2There is a tendency to think of protein as ‘meat’ and vegetarians as having a hard time getting enough protein in their diets. Actually, most vegetables have some protein. Even corn has some protein. The challenge in getting protein from vegetables is to know how much protein we need and how much protein a given vegetable has in it.

Taking corn, for example, you can get between 3 and 5 grams of protein, depending on whether the corn is fresh or cooked, in one cup of corn [see http://healthyeating.sfgate.com/much-protein-corn-7969.html]. That is about 3-9% of what we need in terms of protein in a day for a diet based on 1,800 calories.

There are different types of protein as well. So it is not just a matter of deciding to have 10 cups of corn to add up to your daily protein needs.

Lyme’s disease is not just part of living in the woods

August 16, 2013

trilliumI was flipping through channels and saw Martha Stewart on David Letterman the other night. Dave was revealing that he had a ‘bull’s eye rash’–the stand-out characteristic of Lyme’s disease associated with exposure to ticks. Martha Stewart was completely dismissive, telling him she’d had it numerous times and it’s no big deal, just part of living in the woods. Basically, she told him she didn’t want to see his rash and to take some antibiotics and get over himself.

It is fortunate that Martha Stewart has not had any severe long-term and chronic conditions associated with having had Lyme’s disease. But many others are not as fortunate. For one, they do not display the ‘bull’s eye rash’ and the test for the condition is not very effective, so many people will not be correctly diagnosed. Many others may assume that it is no big deal after hearing Martha Stewart proclaim as much and fail to get care. She does say that antibiotics are needed, meaning that she does get care when she has the condition. So let’s not lose sight of that message. If you think you have been exposed, and if you have a bull’s eye rash most especially, see your doctor immediately and get on those antibiotics. Hopefully, you will have the same outcome as Martha and be fine after doing so.

In the meantime, become better informed than Martha appeared to be. Skim some of the highlights at this site: http://www.lymemd.org/?gclid=CN2wm6uMiLkCFcRlOgodFigAfQ

10 Potentially Devastating Public Health Threats
Source: Best Public Health Schools

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