What's On Your Mind Today???

De-Bunking the Myth - Congressional Open Seats in 2010

2010-03-14T12:31:00.000-07:00

Hi again -

Another myth is in need of de-bunking this year. More scare tactics by the conservative side need to be clarified. I've heard a lot of hoopla about how many seats in the House and Senate are going to be open this year. They've made it sound like the Democrats have a lot of people retiring and the Republicans have none.
The truth is that it's about even - actually the Republicans have a few more.

Right now, the Senate has 59 Democratic Seats and 41 Republican Seats.

Here's the breakdown. Let's look at Senate Seats first.

Democrats retiring in 2010 are:

Chris Dodd from Connecticut
Ted Kaufman from Delaware
Roland Burris of Illinois
Evan Bayh of Indiana
Byron Dorgan of North Dakota

Republicans retiring in 2010 are:

George Le Mieux from Florida
Sam Brownback from Kansas
Jim Bunning of Kentucky
Kit Bond of Missouri
Judd Gregg of New Hampshire
George Voinovich of Ohio

Then there are the seats up for elections this year. This makes it even as there are 13 Democratic seats and 12 Republican seats up for re-election.

Democratic Seats up for re-election in 2010 are:

Blanche Lincoln from Arkansas
Barbara Boxer from California
Michael Bennet from Colorado
Daniel Inouye from Hawaii
Barbara Mikulski from Maryland
Harry Reid from Nevada
Kirsten Gillibrand from New York
Chuck Schumer from New York
Ron Wyden from Oregon
Arlen Specter from Pennsylvania
Patrick Leahy from Vermont
Patty Murray from Washington
Russ Feingold from Wisconsin

Republican Seats up for re-election in 2010 are:

Richard Shelby from Alabama
Lisa Murkowski from Alaska
John McCain from Arizona
Johnny Isakson from Georgia
Mike Crapo from Idaho
Chuck Grassley from Iowa
David Vitter from Louisiana
Richard Burr from North Carolina
Tom Coburn from Oklahoma
Jim DeMint from South Carolina
John Thune from South Dakota
Bob Bennett from Utah

In the House currently, there are 242 Democratic Seats and 193 Republican Seats.

There are far more retirements happening in the House - 15 Democrats and 19 Republicans. 434 of the 435 Seats in the House are up for re-election in 2010.

Democrats retiring in 2010 total 15.

Artur Davis from Alabama
Marion Berry from Arkansas
Vic Snyder from Arkansas
Diane Watson from California
Kendrick Meek from Florida
Brad Ellsworth from Indiana
Dennis Moore from Kansas
Charlie Melancon from Louisiana
Bill Delahunt from Massachusetts
Paul Hodes from New Hampshire
Joe Sestak from Pennsylvania
Patrick Kennedy from Rhode Island
Bart Gordon from Tennessee
John Tanner from Tennessee
Brian Baird from Washington

Republicans retiring in 2010 total 19.

John Boozman from Arkansas
John Shadegg from Arizona
George Radanovich from California
Michael Castle from Delaware
Adam Putnam from Florida
Lincoln Diaz - Balart from Florida
Mario Diaz - Balart from Florida
John Linder from Georgia
Steve Buyer from Indiana
Mark Kirk from Illinois
Jerry Moran from Kansas
Todd Tiahrt from Kansas
Peter Hoekstra from Michigan
Vern Ehlers from Michigan
Roy Blunt from Missouri
Mary Fallin from Oklahoma
Henry Brown Jr. from South Carolina
J Gresham Barrett from South Carolina
Zach Wamp from Tennessee

Now, the next question what's going to happen in November. I guess it's going to depend on who decides to go to the polls and vote and who stays home. It also depends on how inpatient we are as a whole. Do we decide to vote anti-government and anti-incumbent because we're all just so unhappy with the economy and jobs and the inaction of Congress?

I'd like to think we could all pick ourselves up by our boot straps so to speak. Let's not forget what the previous 8 years were all about. Let's not have amnesia about how bad it was. I don't know about the rest of you - but I still have hope, I still want things to change. I still think "Yes We Can." No one ever said it was going to be easy, no one ever said it would happen in a year or two - Remember! No one ever said we wouldn't have to give up anything.

I still want all those things - Health Care Reform, Climate Change Legislation, more stringent Financial Reform, Green Energy, Energy Independence and Government Transparency. Transparency sure isn't pretty - but what it does provide is insight. It allows us to see whose dirty and unethical. And it allows them to continue to try to lie, to turn tail and "retire" or quit or it allows us to vote those people out at the next election time.

So I say, let's keep moving forward, looking to the future. Let's keep fighting for change. See ya at the polls - I hope !

Rationing of Care - Now or the Future

2010-03-13T15:30:00.001-08:00

Hi everyone -

Just a short note to open up another facet of the Health Care Reform debate.

Are we headed for Health Care Rationing or is it already here???

As the week proceeded, I listened to more news talk shows and some of the debates happening on The Hill.
I caught some of the "interrogation" of the Health Insurance Industry in the Capitol. I found their conviction in their insurance rate hikes quite pitiful. The CEO of Wellpoint disclosed her salary - $1.1 Billion in salary, plus $80,000.00 in bonuses plus $8.5 Billion in Stock Options. She had the nerve to say the company's profit margin was ONLY 4% - well and that totaled $2.9 Billion. She said they needed to raise their premiums 39% to just break even next year - well how about taking some of those overhead costs down a bit - like the CEO's salaries or per diem rates?

So my question at the end of the week was "Aren't we already having our health care rationed?" It sure seems this way to me.

Let's talk about it a little bit.

I've heard the horror stories of the other "socialized" medicine nations - people who die while waiting on surgeries or treatments; procedures being denied, etc....

Well I think we're already doing that in our Nation - the difference is we're not calling it rationing of care. It's being hushed up - not talked about. It's known by another name. It's called "denied service" or "not medically necessary" or worse yet, give me lots of money and we'll do whatever you want.

Once again, lucky for me and my family, right now, I don't have to worry about these scenarios because I've got a great job with great medical benefits. If I want a surgery - whether it's emergent or not, all I have to do is make an appointment and have my doctors say it's OK to do because of my condition. No questions asked, not much paid out of pocket. My doctor and clinic appointment co-payments are next to nothing - $5.00 a visit. My prescriptions, the same $5.00 a piece. And I don't have to pay anything for lab work or x-rays or most procedures. I consider myself one of the lucky few. Maybe you all know someone with this kind of plan - and maybe you're lucky enough to have the same. But I don't think there are a lot of us out there today. And because of my insurance coverage, I don't dare decide that I don't like working where I do - I sure can not afford to go somewhere else.

A few years ago, 60% of families could afford their insurance premiums. Few would consider not having health insurance. Today's figures are more like 30% can afford their insurance premiums and many more are on the brink of trying to decide whether to keep their coverage or not.

Now let's take a look at just one case and tell me it isn't some sort of rationing of care. Say you've suffered from arthritis for a few years, all those years of high impact aerobics or football games in the park from our youthful years. In the morning, as each year passes, it gets harder and harder to get out of bed and more and more anti-inflammatories to get rid of the pain. Now, let's say you're only 30 years old or you're a little bit over weight.

Finally you decide to make an appointment with your doctor to see if you need some sort of joint replacement. After your initial consultation, x-rays are ordered and it's decided that you could use one but it's not an emergency. It's an elective surgery per your insurance company's guidelines. First you're only 30 and you're a little over weight. The insurance company decides they just aren't going to approve the procedure as your x-rays don't lie - your joints just aren't that bad YET. But, don't tell your pain that.

Supposedly, hip surgeries cost between $35,000.00 and $50,000.00 in the U.S. depending where you get them done.

Because you've been denied coverage for this procedure, if you want to have it done, you'll have to pay the entire amount out of your pocket. Now who can afford that? Not anyone I know. So you just won't be able to get it done now, sorry, maybe in 20 years when you're older and your x-rays confirm the pain that you've been having for years. Then your surgery will be paid for.

Isn't this rationing of care? You can't have it done unless you can afford to pay out of pocket for it - or go to another country where it's cheaper. Oh, and in Canada, it would be done - although you may have to wait a year.

Now, let's say, you already pay $1,115.00 a month for your insurance premiums - that's the average cost of an health plan for two - so let's divide it in half. So you already pay $6,690.00 a year for your coverage - which isn't even going to count because they aren't going to cover your surgery.

Let's change the scenario a little bit. Your insurance company now says they'll approve your surgery. But ......you still have co-payments and deductibles to pay. It's still an elective surgery, not emergent. So you're already paying almost $7000.00 a year in premiums. You have had your pre-op appointments and now are getting ready to set your surgery date. The hospital now tells you, you haven't met any of your deductibles for the year and you'll have a co-payment as well.

Your plan has a $3,000.00 per person deductible and a 30% co-payment. These are the types of plans you can get for $1,115.00 per month. Wow! What a plan. That's what we call affordable insurance in this Country. So let's do a little bit of math.

The hospital won't do your surgery unless you can pay the up front fees - because it's not emergent. It can wait. So you have to come up with:

Let's say your surgery is going to cost $42,000.00. That's in the middle of the guesstimate for this type of surgery.

You owe $3,000.00 up front for your deductible. You'll owe $12,600.00 for your co-payment. Again do you know anyone who can just come up with $15,600.00 out of pocket for your surgery. I sure don't.

And that's not even the whole story. You're also going to be off work for at least, at the very least 8 weeks or longer. You'll miss work. If you have vacation or sick time, you're lucky. But if not, you're out of your income as well. If you're lucky, you have short term disability coverage. Let's say you make $30,000.00 a year which is the current median income for individuals per the census figures. That's $5,000.00 you'll lose over 2 months time if you don't have paid vacation or sick time. Now, if you have short-term disability, you can recoup some of that - usually 2/3s. So you'll only lose $1,670.00 out of pocket. But wait, don't forget you'll have to pay income tax on that at the end of the year so you'll have to take $830.00 back out.

So let's do a quick tally.

So even if you have insurance and you have this type of common plan, you'll owe out of pocket....

$15,600.00 in deductibles and co-payments.
$5,000.00 in lost wages if you don't have vacation or sick time.

That's a total of $20,600.00 out of pocket when you have insurance that you're paying $7,000.00 a year for.

If you have short term disability, you'll pay......

$15,600.00 in deductibles and co-payments.
$2,500.00 in lost wages and taxes.

That's a total of $18,100.00 out of pocket when you have insurance that you're paying $7,000.00 a year for.

Now figure on top of that all of the credit card debt that you will be using too if you decide to just bite the bullet and start paying for some of this as you are really having a lot of pain. Think of the new interest rates of 20% if you're carrying balances.

And what if there are complications???

Now take the choice away - what if you have to have emergent surgery and you have these kind of deductibles and co-payments. What if you make $20,000.00 a year instead and you don't have a good job. What if you live paycheck to paycheck? I sure can see how one illness can bankrupt a family. Cant' you?

And if you're going to tell me that the hospitals will work with you on a payment plan - yes they will IF it's an emergency surgery. But they WILL NOT if it's an elective surgery. They demand their money up front or they won't even consider doing the surgery.

Now you tell me this isn't BS. Why do we even have insurance? I find this quite appalling and a bit of a mystery? What kind of Nation are we anyway? What happened to "We the People"? I guess we know the bottom line, the profitability of the insurance companies and even the hospitals and providers are much more important then the health and well being of our citizens.

It's all quite clear to me. There already is rationing. And people are suffering and dying already while waiting to get the care they need and deserve.

Bottom Line - it's here already. And even if you haven't experienced it, it doesn't mean it's not happening to some one else that you already know or may know in the future. We can only hope it never touches us and our loved ones.

The Truth as It Is - Not as It's Being Told - Reconciliation

2010-03-07T14:30:00.000-08:00

Hi everyone -

Well today, I'm going to try to de-bunk some of these "myths" out there floating around. I'm going to talk a little bit about the Reconciliation process. If anyone wants to fact check, go ahead. I got all my information off the official House and Senate Sites - attached to the actual Bills that passed as well as the CBO site.

So let's take a look at what Reconciliation is really about, what it was originally supposedly intended to do and a couple of little tiny loopholes that sure been taken advantage of over the last 20 years.

Reconciliation was originally initiated in 1974 to allow consideration of contentious budget bills without the threat of filibusters. It's intent was to limit debate and favor the majority party. It changes existing law to bring spending, revenues or debt limit into conformity with budget resolution.

The one loophole was that it only specifies that the measures would include budgetary "changes". It did not specify whether or not these changes would be an increase or decrease in the deficit. This loophole has never been changed and I find that quite interesting as the Byrd Amendment has been amended on multiple occasions. So although I'm sure Mr. Byrd's intent was to only include items that reduce the debt (wink, wink), that's not the way it was written and it's not the way it's been used.

The second loophole is that if the Reconciliation Bill causes a budget deficit, it has to expire or get renewed in 10 years. Again, if it's intent was only to reduce the deficit, why is this little part written in as well. This is the loophole that President Bush used for the tax cuts for the rich. That's why this is such a talking point now as it's been 10 years and President Obama is not willing to renew the tax cuts for the wealthiest 1% of the population.

And don't forget, there's a Parliamentarian whose supposed to determine what can and can not be decided by Reconciliation. This year, that would be Alan Frumin. But surprise, the Presiding Officer doesn't have to follow his recommendation. And guess who that is - Vice President Joe Biden.

So here are some statistics on reconciliation.

It was enacted in 1974.
It was first used in 1981.
17 of 23 times it was used during a Republican Presidency.
9 times, the Republicans had control of both the House and the Senate.
6 times, the Democrats had control of both the House and the Senate.
1 time, the Democrats had control of the Senate and the Republicans had control of the House.
7 times, the Republicans had control of the Senate and the Democrats had control of the House.

1 time, it was used completely for a non-budgetary issue. The College Cost and Access Act of 2007 passed
with a Republican President and a Democratic Congress.

Health Care issues were addressed in a few of these Bills. The Consolidated Omnibus Budget Reconciliation Act of 1985 was mostly Health Care Reform. Medicare and Medicaid - yes, "entitlement" programs were
addressed in many of these Bills. Here are a few of them:

1982 Tax Equity and Fiscal Responsibility Act
1985 COBRA
1987 OBRA
1989 OBRA
1990 OBRA
1993 OBRA
1995 Balanced Budge Act - This was Vetoed by President Clinton.
1996 Personal Responsibility and Work Opportunity Reconciliation Act/Welfare Reform
1997 Balanced Budget Act which Includes the Medicare Advantage Programs/Insurance Company
Give-Aways
1999 Taxpayer Refund and Relief Act - This was Vetoed by President Clinton as it increased the deficit.
2000 Marriage Tax Relief Reconciliation Act - Again, Vetoed by President Clinton as it increased the deficit.
2005 Deficit Reduction Act

Now, the next talking point I want to talk about is the "huge majority passage" and "bi-partisan" passage of these Reconciliation Bills. The Republicans contend that all of their Reconciliation Bills passed with "huge majorities" and "bi-partisan" votes. OK, now, that's a red flag for me. Let's just go there.

I've checked the votes on these Bills on the Congressional Sites.

7 of these 23 Bills passed with less than 60 votes. OK I know that 7 out of 23 is not "all" or 100%. I also know my math - I'm thinking that would be 70% of these Bills were passed with a majority vote. Let's look at some of the numbers. These are the ones I could find easily.

1996 - H.R. 3734 which is the Welfare and Medicaid Act. This was during President Clinton's Presidency
with a Republican Congress. This Bill passed with a 78-21 vote.
53 Yeas were Republicans, 25 Yeas were Democrats. All 21 Nays were Democrats.

1997 - H.R. 2015 which is the S-CHIP Program - which by the way, is a complete "entitlement" program.
This Bill has a significant Health Care platform.
Again, still a Democratic President with a Republican Congress. This Bill passed 85-15.
43 Yeas were Republicans, 42 were Democrats. 12 Nays were Republicans, 3 were Democrats.

2001 - H.R. 1836 which was President Bush's first Tax Cut for the Wealthy. So it was a Republican President
with a Republican House and a 50-50 Split Senate. This Bill passed 58 - 33.
46 Yeas were Republicans, 12 were Democrats. 2 Nays were Republicans, 31 were Democrats.

FYI - The non-partisan Congressional Budget Office predicted that this Bill Decreased the Surplus
by 1.35 Trillion Dollars.

2003 - H.R. 2 which was President Bush's second Tax Cut for the Wealthy. So it was a Republican President
with a Republican Congress again. This Bill passed 50 - 50 with Vice President Cheney breaking the tie.
48 Yeas were Republicans, 2 were Democrats. 3 Nays were Republicans, 47 were Democrats.

FYI - The CBO predicted that this Bill Increased the Deficit by 350 Billion Dollars.

2006 - H.R. 4297 which was President Bush's third Tax Cut for the Wealthy. Again, a Republican President
with a Republican Congress. This Bill passed 54 - 44.
51 Yeas were Republicans, 3 were Democrats. 3 Nays were Republicans, 41 were Democrats.

FYI - The CBO predicted that this Bill Increased the Deficit by 70 Billion Dollars.

I also found evidence that some other Bills passed with Reconciliation with close votes but I couldn't find the Bill numbers so I couldn't verify the final votes.

I found articles that said 7 Bills passed with less than 60 votes. Again, far from the 100% that the Republicans have claimed to have had a huge majority win on.

2 of the others listed were the 1995 Balanced Budget Act with a win of 52 -47 (later vetoed) and the 2005 Deficit Reduction Act with a 50 - 50 tie with Vice President Cheney breaking the tie again - and only after they fired the Parliamentarian.

Now to me, there are some really important facts that we need to look at. These facts are not debatable - they're not open to interpretation. They are just the facts. I just don't see how any or either side or any person can put a spin on them. The facts are the facts. They are part of public record.

My first question would be:

Why would the Republicans have to have a Bill pass through Reconciliation if they had a majority vote?
Now the only reason to use Reconciliation is because of a filibuster or not having the majority vote. This means that the minority (mostly the Democrats) would have been filibustering these Bills. Therefore, I predict that they did not have a majority vote to begin with. Make sense?

Now then what comes next is a lot of back room dealing or horse trading, pork, pork, pork. So at some point, the majority (mainly the Republicans) must have been really wheeling and dealing to get these Bills through. So in the end, they brought along a few other "friends" to vote on the final Bill - either with back room deals or the amendments that were attached to these Bills. Then when the final Bills came to the floor, they ended up with a majority vote.

The other possibility could be that if the members opposed to the Bill then realized the Bill would pass with a 50% vote, some of them decided to vote for the Bill as they felt it would look good to their constituents. This in itself is reason enough that there shouldn't be anonymous votes allowed on the floor.

So there it is - the first of the de-bunking myths entries in my blog.

Off for some red carpet viewing - something almost as controversial. lol. Take Care.

Keith Olbermann Video

2010-02-24T20:39:00.000-08:00

Special Commentary by Keith Olbermann - His Dad and the Health Care System

2010-02-24T20:21:00.000-08:00

Hi everyone -

Tonight I was on the computer and half-heartedly listening to another one of Keith Olbermann's special comments. Again, most of the time, I think he's a little over the top. And yes, I could almost compare him on a bad day to Glenn Beck on on a good day - except well, I just don't care for all the blithering that Beck does.

Tonight, like one other night that he did a special comment on his father's illness and the state of our country's health care crisis, I found myself getting choked up. I looked over at my fiance, and he was all teary-eyed as well.

Now, before all you conservatists jump on the bandwagon, take it for what it was about. He's emotional - he's probably losing his dad - it's raw emotion. But, it's far from being wrong. It's very important to have these conversations with your family members so you know what they'd want in a time like this. His dad's been fighting for his life for months and Keith has been by his side. On the emotional family front, I'm sure it's been hard.

But I must say, I do love a story told by a family going through the broken health care system. Kind of ironic that he says he's spent more out of pocket money for his dad's care than the insurance has paid for. Kind of sad isn't it - that he can afford it - unlike most Americans.

Listen and watch here if you like and take it to heart while the Health Care Summit is going on tomorrow and we listen to all the B.S. that we're bound to hear. I do love transparency - let's see who shows their asses more.

Have a great night.

Anyone for Dodge Ball in the Capital Rotunda??

2010-01-30T19:05:00.000-08:00

Hi everyone -

I just had to write this all down before I forget it all or lose the whimsical side of it !

So after thinking about the whole stalemate in the House and Senate with pretty much any and all issues, I had this silly kind of idea.

Do you guys all remember Dodge Ball from school??? Gosh, I miss dodge ball. It was a blast - albeit a bit dangerous at times. You could really lose an eye or worse if you were a guy.

I had this vision. If the boys on the hill are going to act like children, maybe they'd like to be treated more like children. Let's line them up - Republicans on one side, Democrats on the other side. Now sorry, Republicans, you're going to be a little short on people to start - but there are consequences to losing Congressional seats. And besides, you don't quite play fair anyway, so you'll make up for it in spirit and scrapiness.

So let's take a certain Bill or two - like the Health Care Reform Bills. Since, supposedly, they all agree on 80% of these Bills - why not pass just the 80% for now. If they agree on it, put it in writing, pass it through, no questions asked - because they all agree, right? What's so hard about that?

Then the compromising and negotiating can begin. We'll make it like dodge ball where we pick teams and take turns throwing the ball.

First each side would divide out the other points they want in the Bill, two at a time. Start with the easiest ones to negotiate and work their way up to the tough ones. Now, they'd have to go back to some point where the Democrats already started to really compromise. The Democrats really want to include all Americans for coverage, the Pre-Existing Clause, etc. on their side. The Republicans really want better language to exclude Illegal Aliens and Abortions from being covered; they want to sell across State Lines, etc.. So now each side just picks one talking point, everyone gets to discuss it and take it to a vote - compromise. Get enough votes on both sides to pass both their requests - now pass that as an amendment. Sounds pretty darn easy doesn't it???

Then of course, they could work up to the top big two - Tort Reform for the Public Option. Now that would be a real battle. But if either side really wanted their choice to go through, they'd be more apt to try harder to get it.

And overall then, what would be the worse that would happen. If they couldn't agree on anything else, then the 80% would have already been passed.

I feel that this would really take all the horse trading and back room deals off the table. Maybe they could remember that they are working for all Americans, not just their districts and own personal gains.

And I'd sure like to see this posturing on C Span. Maybe we'd see some real testosterone at play - men do like competition and what better way then to indulge their sports-mindedness.

And one more thought - if you act like a 5 year old, you should be expected to be treated like a 5 year old. If you can't play nice together, you shouldn't be allowed to play together. If you have a child and he/she misbehaves, don't you take privileges and/or money/personal property away from that child? I liken this concept to the insurance companies, pharmaceutical companies and banks - if you screw up and rob vulnerable people out of billions of dollars - you should lose your privilege to continue to do the same until you learn to play nicer. I personally think you deserve a much sterner punishment than just a chastising from the President.

To make this end on even a funnier note, while I was explaining my latest concept to my fiance, Kevin, he just kept telling me he couldn't think any more about my actual concept as it related to legislation - because as a man, he couldn't get the image of all the members of the House and Senate lined up smacking each other in the heads with the Dodge Ball - and he wanted to see it in the Capital Rotunda.

So to each of you - what do you think? Could they pass reform this way? Or do you now just have a bunch of men and women in your mind, in suits and dresses, lined up, winging the balls at each other. I must say, that would be just hilarious and I have a few I'd like to just nail and nail good.

Oh the Big Liars - Which Ones This Week? Big Health Insurance Companies !

2010-01-21T16:45:00.001-08:00

Hi Everyone -

I ran across this interesting article yesterday. And once again, I must say Liar, Liar, Pants on Fire. I guess in the back of my mind, I thought the insurance companies couldn't possibly be for health care reform. After all, they stand to lose billions of dollars off of this legislation.

I'm glad some reporters are doing their work. Aetna, Cigna, Humana, Kaiser, United Health and Wellpoint were all called out about their roll in paying for anti-reform ads - to the tune of $10 - $20 million dollars. Apparently money was solicited by AHIP and funneled through the Chamber of Commerce. It was too risky, I guess, to just run the ads themselves like they did back under the Clinton administration.

I was initially really disappointed in Kaiser, since I work for them, and they had been so positive in all of our employee emails about reform. The article states that their monies went for positive health care reform ads. If you read down through the response threads, you'll actually see a thread from John Nelson from Kaiser Foundation. I'm wondering what positive ads were run by AHIP and if Kaiser should ask for a refund of their money.

Wow, and we wonder why the insurance companies are charging us such absorbent fees for our premiums and ailments. Who says special interest groups don't throw big bucks at potential legislation and campaigns. I would think they could take these millions of dollars and use them for something positive - like lowering premiums or covering our bills. Novel idea, huh?

So anyway, here's a link to read the article in full. Click here.

Have a great night everyone.

House Bill 3962 Cliff Notes

2010-01-20T20:28:00.000-08:00

Hi everyone -

I'm trying to find an easier way to share my cliff notes from the Health Care Reform Bill with everyone. Now I'm not finished yet - but here's a start. I'll post updated ones as I get further.
But at the very least, you can see all the good stuff (my personal thought) - as well as bad stuff (depending on your view).

Please let me know your thoughts.

Let's see if it works. Click here. When you get to the google doc page, just hit download and open with Microsoft Word. The document should just open.

Take care. Stay in and stay warm and dry! It's pouring here STILL.

1 Year Later - What has He Accomplished - Or Not

2010-01-13T14:12:00.000-08:00

Hi -

Wow, long time, no write. I guess the holidays kind of kicked my proverbial free time for writing.

Here I go easing back into with a noncontroversial subject.

So let's talk a little bit about the past year. This blog is in preparation for all the nay-saying that will be going on next week about President Obama's one-year anniversary in office.

I guess it's pretty debatable. Are we in a better place than we were last year at this time? I guess it depends on who you are, where you live, what circumstances are occurring in your life. It's been a hard year for a lot of people. And a lot of people have no idea how hard it's really been for a lot of people in our Country. I have to say, if more people had a clue - and a bit of a soul, they'd be a lot more humble and thankful.

Have we gotten the change we thought was going to happen - in the magnitude we expected? I'm pretty sure the answer to that is a resounding No ! . I still believe in "Yes, We Can", but the question is how fast can we? and who is going to be and stay in the way? I do believe we are on our way - at least I hope. And without hope - and a lot of faith, there is nothing.

We've seen a lot of greed, hatred and prejudice over the last year. I guess maybe Washington DC has always been a politically corrupt ugly place - but I don't think a lot of us knew the extent of it - and probably still don't. With the Internet and the media of today, it's a lot more evident. It's not pretty - and I think, personally a lot of people should be losing sleep at night and be ashamed of themselves.

This is supposed to be a democracy - I think we're all supposed to be humanitarians - maybe not. I'm going to research that a little bit later and come back to that issue - what kind of a society are we really living in? I don't believe our Country qualifies as a true democracy, looking out for each other.

So let's do a little recap of President Obama's accomplishments. What did he campaign on - what if anything did he promise? Has he flipped on his priorities? Or is he just taking it slow and easy - getting what he can when he can? Pacing himself and concentrating on his priorities?

I've done a lot of googling, visited a multitude of web sites - some partisan, some bi-partisan and some claiming to be non-partisan. Here's what I found.

During his campaign, the following items were President Obama's top priorities:

#1 - Withdrawal from Iraq
#2 - Health Care Reform/Universal Coverage for All Americans
#3 - Climate Change

Increased Energy Independence
Decreased Lobbyist/Special Interest Group Influence
Re-Focus Anti-Terrorism Strategies on Afghanistan, Pakistan and Other Problem Spots
Eliminate Weapons of Mass Destruction World-wide
Immigration Reform, including Electronic Tracking Systems to Identify Illegal Aliens
Education Reform

Supports Affirmative Action
Supports Roe v Wade and Women's' Reproductive Rights
Supports Civil Unions
Supports Gun Control, While also Supporting Right to Bear Arms, Tightening Loopholes
Supports Stem Cell Research

Now those items were the talking points on his campaign trail, mostly during interviews.

The next items are actually things that he's either signed into legislation or accomplished so far. Again, these items were found on multiple web sites. I have no reason to question any of these items.

Hate Crime Bill making it a federal offense to harm someone because of their sexual orientation
S-CHIP Bill extending health insurance to low-income children
Lilly Ledbetter Fair Pay Act forbidding wage disparities due to gender
$787 Billion America Recovery and Reinvestment Act - otherwise known as the Stimulus Plan.
This includes the Cash for Clunkers Program, Making Home Affordable Plan,
Bank Bailout, Auto Industry Bailout, Tax Cuts for Low and Middle Income Americans
Set new Federal Fuel Efficiency Standards - Part of Cap and Trade
Increased Tax Rebates for Purchase of Hybrid Cars
Extending the First Time Homeowners Tax Credits
Credit Card Act Blocking some of the Unfair Consumer Protections Laws, Limiting Fees
Increased Student Loans, Enabled Students to Refinance if Needed
Increased Disaster Management and Prevention Funding, Infrastructure Changes
Froze Salaries for Top White House Staff and Aides
Set Lobbying Constraints on Gifting and Employment Practices
Ended Tax Benefits for Companies who Outsourced Employment of US Jobs
Ended the Practice of Forbidding Medicare Drug Price Negotiations - Saving Seniors Money
Allowed Visitation to Cuba by US Family Members
Closed Off-Shore Tax Loopholes
Remodeled Global Role for Better Foreign Policy
Set a Deadline to Pull out of Iraq
Set a Deadline to Close GITMO
Increased Troops in Afghanistan
Banned Torture and Inhumane Treatment of Prisoners
Ordered "Secret" Prisons Closed throughout World
AMD Stabilization and Support Bill Passage to Change Military Practices
Phased Out F22s
Purchased Better Body Armor
Money for Better Housing
Money for Better Wages
Hiring of Spouses into Federal Jobs
Ended Media Blackout for Fallen Soldiers
Expenses of Families Paid to go to Dover AFB to Meet Fallen Soldiers Bodies
Ended Stop-Loss Date that was Keeping Soldiers Abroad Past their Enlistment Date
Increased Patrols off Coast of Somalia
More Money for Veteran Services and Medical Care at Walter Reed Hospital
National Service Legislation to Increase Money for the Ameri-Corps and Youth Groups

And a little bit of gossip - supposedly he paid for the redecoration of the White House out of his own pocket. I wondered who paid for that.

If you ask me, not too shabby. Have I gotten everything that I would want or everything that he said he was going to do, no, not yet - but I think it's a good start.

Now let's go back and go over what he hasn't gotten done - according to his campaign platform.

We're not out of Iraq - although there is a deadline.
Health Care Reform hasn't passed - although it's gotten further than it has in the last 60 years.
Climate Change, Cap and Trade, Education Reform and Immigration Reform haven't
even taken off yet.
GITMO isn't closed yet - I think he's taking his time on this one, making sure he handles it
the best way he can.
He hasn't Repealed "Don't Ask, Don't Tell" - which seems like it should just be so easy.

Pres. Obama sure has a lot on his plate - a lot of unfinished business to tend to. All the above items still need a lot of attention, plus our economic forecast is still in bad shape. Plus:

All of the Stimulus Package isn't Rolled Out Yet
Unemployment Rates are Still High although trending Down

I'd like to try to attach a copy of my notes about Obama's Vision for Health Care Reform. I made notes and continue to make notes as I read more of the Bills. My goal is to read the entire House and Senate Bills and then the combined Bill. I'm taking notes on the parts of the Bills so when the final one is out, I can put out what stayed in and what got left out. I'll share those notes with everyone along the way.

Let's see if it works. Click here. Let me know if you can't see it and I can email it to you. It's kind of interesting what people actually think his vision for Health Care Reform is. And no the public option isn't in there - although I know he did voice this as something he wanted and needed at times, but he didn't include this in his vision that was published on his web site or online.

So now, I'll move onto some of the verbiage of some of the political tabloids and pundits. Sorry, for me, I'm going to concentrate on the positive - not the negative - and I'm going to look toward the future, not the past.

According to the Congressional Quarterly, Pres. Obama has done better than any of the Presidents in getting Congressional Votes on the issues he took a position on. Now, they've only been keeping track for 50 years or so - but Pres. LB Johnson held the record before at 93%. According to this study, Pres. Obama has a 96.7% record so far. If you google it, you can see the graph. They attribute this high percentage to two concepts - his past background in the Senate, knowing how DC works and being a little bit smart in picking his battles and taking his time.

Next I pulled up a few articles on the state of the economy. CNBC and the BBC commented on the Profit of the twelve Federal Banks. Imagine this, they actually made a huge profit this year, greater than any time since the Federal Reserves inception in 1914. Their profit was $52.1 Billion dollars and they paid the US Treasury $46.1 Billion in 2009. Technically this also means that we, as citizens, made a profit off of the Bank Bailouts. Now if only, we could get the banks and the credit card companies to finally lend some money to us again, we'd all be good.

According to Slate, the Stimulus plan and the Bail Outs seem to have diverted a depression.

The most interesting study I found though was published in the Washington monthly, showing the unemployment rates from Jan 2008 until Nov 2009. If you get a chance, you should google it. It clearly shows how OK it was in Jan 2008 and how horrible unemployment was in Dec 2008 and Jan of 2009. It also shows that as of Nov 2009, the rate is actually better than it was in Jan 2008. Now again, I've heard these rates are very open to interpretation and there is a lot of information that isn't available for statistics - but of what is trackable, they tracked it here. Now granted, I am in no way saying it's still not horrible. There are so many people out there out of work, so many that desperately want to work and can't find jobs, so many that have given up. I'm just saying, it looks like it's going the other way - it may take some time, but again, I'm being hopeful for everyone out there that is struggling and being thankful for the job that I have, so thankful.

So in summary what I'd like to say is, there are a lot of nay-sayers out there, a lot of pessimists, a lot of people who want instant gratification and an answer to all of our problems. One thing I do remember from Pres. Obama's many speeches is that he said, over and over again and very clearly, our Country is in a great economic mess, he was going to work hard on fixing it, but it was going to take time (I recall he said he didn't even know if it would be better in 4 years, that some of the progress would take longer than that.) and we were all going to have to sacrifice in one way or another. I don't know about all of you out there reading this article, but it's been a year. I think we're moving in the right direction. And although it's been harder for me, financially this year, I am very thankful that I still have my health, my health care, my job, my house, my loved ones, friends and family included.

What I'd like to wish for the New Year is a lot more of the good stuff, and a lot less of the bad stuff. Again, I sure would like to see a lot more of Country Unity taking place. I'm all for everyone having their own opinions and passions, but I wish we could work on merging those ideas peacefully or just agree to disagree and let democracy rule. Take care.

Critique of Past Week's Medical Shows

2009-11-26T15:07:00.000-08:00

Hi again -

This one is for a little bit of fun again. I do love watching my medical shows. This week they fared much better.

I watched two different shows - Mercy and Three Rivers. I do love both of them.

I only found one mistake between the two of them this past week.

On Mercy, they were very busy saving a young Asian man who had an injury and became septic. When his heart stopped, the team was doing everything they could to save him - which they eventually did. They were doing CPR, ordering and giving all the correct medications - and then .............. placed a pacemaker - which was a last ditch effort to save him. Well, they placed the pacemaker, captured the rhythm and voiced all of these actions out loud. Too bad when they showed the monitor, it didn't show a paced rhythm like they said. Oh well - good job anyway.

On the other side, no errors this week at all on Three Rivers that I saw. But I do need and want to say one thing. Can any one say EMMY for Mandy Patinkin? Wow - he was amazing - although I guess he usually is. He played an ALS guy who was in an automobile accident. Post recovery, he found out he was going to have to be bed bound on a ventilator. He decided to make himself a DNR and remove himself from life support so he could donate his organs to other people and die a respectable death. He had it all down - even the voice and the movements. I must say I cried multiple times due to interactions with his daughter, the staff and the other patients vying for his organs. This show had a lot of ethical issues that were addressed and they handled them all well as far as I could tell.

Anyway - off this thing for today. I hope everyone is having or will have a Safe, Great and Happy Thanksgiving. I hope everyone is either spending their week with family or friends - or in our case, treating the ill and spending the day with co-workers. Keep the less fortunate in your thoughts.

New Study shows Uninsured Trauma Patients 80% More Likely to Die than Insured

2009-11-26T14:34:00.001-08:00

Hi there everyone -

As I walked into work the other day, I was surprised to find an article posted on the board with the above headline. Wow - Uninsured Trauma Patients 80% more likely to die than the Insured.

The study was conducted by Harvard University and Brigham and Women's Hospital in Boston and the information was extrapolated from the National Trauma Data Bank. They looked at 2.7 million patients from 900 different trauma centers across the US.

This surprised many trauma hospitals, physicians and staff because of the EMTALA laws. These laws are supposed to protect patients without insurance. Anyone presenting to an emergency room is supposed to be treated equally without regard to insurance coverage.

The study seems to conclude otherwise. Patients with private insurance, HMOs and Medicaid all seems to fair equally. Medicare patients died 56% more often and the Uninsured patients died 80% more often.

The researchers thought that the Medicare population was adversely affected by their chronic medical conditions and age. So, they next decided to remove the age and chronic condition criteria - they concentrated on 200,000 + patients from 18 - 30 years of age. Surprisingly the numbers got worse, those uninsured individuals died 89% more often than their insured counterparts.

So why is this happening???? I work in an ER and I still think that we treat anyone that walks through our doors - I don't believe that we withhold care from the uninsured. Anyone else experiencing anything different?

Some studies do show that the uninsured do wait longer to go to the hospital for treatment, maybe too late. Others don't seek care for their chronic conditions so this could make recovery from a trauma more complicated. Studies do show that uninsured individuals do get less testing done and are transferred to rehab. facilities less frequently.

I believe it could also have to do with the type of traumatic injuries these patients are suffering. The age range seems to indicate that maybe the high risk behaviors they participate in and the injuries they suffer from them attribute to these numbers. But then again, why are the insured in this age group surviving more?

I also believe it may have something to do with the course of the treatment of the uninsured. I believe that the uninsured do get the same treatment in the ER or trauma center- but I do believe at some point after stabilization, these patients may get transferred to some other hospital or rehab centers. Post -stabilization care, treatments, tests and maybe even staffing or after discharge followup and compliance may also be hidden factors in these outcomes.

So I hate to sound like a broken record - but how much money do we sink into these bad outcomes? Would it change if we insured everyone? Would it cost less to save them? Maybe they would get out of the hospital sooner if we were already treating their chronic conditions.
Are we proving that we give sub maximal care to the uninsured?

What do you think?

This Week in Medical Show Critique - I Play a Doctor on TV - BUT Do I ever Wear a Mask????

2009-11-16T15:28:00.001-08:00

Hi everyone -

I thought I'd once again do a little critique on the medical mistakes we see on TV. Maybe you've seen some as well - if so feel free to post them here.

It's kind of funny to think we live this every day and some of the shows do a really good job, others not so much. But I still love to watch them - for me, it's more about escapism - I love it when they make me laugh and cry. I still do have the urge to scream though when they're doing a great job and then mess up - medically speaking.

So the theme of the last week or so shows seem to be their ability to screw up the use of masks - any kind of masks.

First I was watching Three Rivers - which I love. The medical consultants were doing such a great job with all medical aspects of the show. I was very impressed with their portrayal of the "John Ritter syndrome" case. The patient was having chest pain and had ST elevation on his EKG. The star of the show wanted to wait for the CXR results - but oh no, the other doctor just wanted to give TNK and head to the cath. lab. Oops - guess what - dissecting aneurysm and now the thought of this patient dying on the table.

After a lot of show casing - first they tried a balloon expandable stent graft - which I must say was pretty amazing to watch. I've never seen one in person - but they used fluoroscopy and it showed it in real time which was way cool. Of course, it didn't really work.

A few hours later when the patient was ready to crash, they cut him open and repaired it surgically - of course after giving him lots of FFP to reverse the thrombolytics they had pumped him full of earlier. And success, the patient lived. All in all, pretty impressive.

So it was with great dismay that they could pull something off this complicated, and they can't put a nonrebreather mask on correctly - it was flat as a pancake. The whole scene was killing me - I was saying, "could you please blow that darn bag up just a little so the patient doesn't suffocate?"

Then the next show was Mercy. Again, loving this show. Love all the drama - all the dysfunctional family dynamics and all the whackiness of some of the characters.
I also think they do pretty good with the nursing aspects - they're not too over the top. They do just basic medical things so far, a lot of bedside stuff and stay away from portraying complicated medical practices.

So this show was about a chemo patient who was going to get a bone marrow transplant. They were sooo good in portraying the cleanness of the room - the patient's kids had given her a teddy bear and it was in plastic. The staff all had on gowns and hats and shoe covers and MASKS - but they were around their necks. Now, why oh why go to so much trouble to show the white room but make it not so white. lol. Now, I know they're actors and we want and need to see their faces - but ...... oh well.

And one more thought on last week's Mercy. I don't think we needed to give the family another blow to deal with - they're already dysfunctional enough - they didn't have to give the dad Alzheimers too.

And by the way - can you say hot fireman-nurse sex in the storage closet? Oh yes they did.
Of course, they hit the nail on the head about the whole firemen thing. They made him a hot dog - and what I mean by that - he's hot - but he's a dog - he's married and the nurse he's having sex with in the closet doesn't know. And all her nurse friends told her not to fall for him - "he's just to play with, not to get hooked on." lol

Anyway, off this thing for now. Just having some fun. Got a diamond today !

The Military and the Ball and Chain that Holds Their Members

2009-11-09T10:18:00.000-08:00

Hi everyone -

Just a little note today - curious about what every one's thoughts are on the military contract with it's members.

In light of the tragedy at Fort Hood this week, I'm questioning the responsibility that a member of the Armed Forces has with the establishment. I'm wondering if things could have been different if they had just left this person out of the military. What do you think? Is there a way they could have discharged him? Is there another way he could have repaid his financial obligation?

Being an ex-military wife, I'm fully aware of the adage "If the military wanted you to have a wife, they would have issued you one." They've always been known for their bold and brass techniques to keep you in their fold, to beat you down so you can't really think for yourself, to stay loyal to the beast, to be strong in hard times.

Now, be clear, I'm not saying the Military isn't a wonderful place for a special kind of person. I totally respect and honor every member of the service that is there due to their personal beliefs and desires, those that are loyal - those who fight for our freedoms and country - those who love this tight knit community. But I do think, it's not for everyone. And I do feel that a great many people of my generation joined the military for the wrong reasons.

At the very least, in the 70s and 80s, it was a time of peace. It still remains a time of opportunity to escape the high unemployment rates of our small home towns, the towns where blue collar jobs are disappearing. It is still a time of educational opportunities where most young people will never be able to afford to continue their education, learn a skill, climb the ladder, move away from their small towns. And maybe it is even a time of opportunity to escape the violence of our towns and cities - either in our own families or a life of crime and violence that we have chosen. It used to be the only choice young people had - when the local law enforcement said you had to join the military or go to jail.

Obviously this person who shot many co-workers was in a lot of turmoil and for years. He apparently tried many times to get out of the military. He even offered to pay back the money he felt he used to get his education. I'm guessing, and I do mean just that, as I didn't know him, that there were moral and religious beliefs that were involved. And I truly believe there were a lot of emotional problems - both personally and also because of the travesties that he heard day in and day out from the soldiers returning from battle. If I recall correctly, some of the most affected people from times of war are the mental health professionals and the chaplains. Both have to hear people struggling everyday because of what they'd been through and their problems with reintegrating into society. And I do believe no one took him seriously. He had been investigated and nothing happened. Maybe he was calling out for help?

So what do we do now? Times are different. We're at war. Some people don't believe in war.

Why do we not question some people's internal conflicts when their own religious beliefs or cultural background are in play? In World War II, some of the Japanese men who were in internment camps fought for our Country - but our Country was sensitive to them - either because they didn't trust them or they didn't want them to have to kill their own people. They didn't ask them to fight against their own - they fought in other countries instead and proved their loyalty without this internal conflict.

Do we change the way we handle these situations in the future? Does the military determine how much money they spend on a members education so that if this same situation happens in the future, these members can be discharged? Can they repay the military in a dollar amount instead of a "years due" manner?

Why does the Military actually want to keep someone who isn't there 100% mentally and physically? Why would they want to keep someone who is bad for other soldiers' morale? Why would they want to keep someone who then chooses to open fire on innocent victims.

Will anything change? Well, I think I know the answer - they'll apologize to the families of the innocent victims for missing the tell tale signs. But unfortunately nothing will really change. Members won't be discharged. This man's mental health will be blamed. The government will need to step up their commitment in addressing the mental health toll it's taking on it's members.

What a shame - so many lives lost on our own ground. What is the price of war - a war that may or may not even be ours to fight???

At some point, I'd like to visit a subject close to this one - requiring young people to actually volunteer for a Country's welfare - something like a mandatory draft - but not all on a military scale. I think it would help with the unemployment rate. It would help these young people find their way when they aren't sure what they want to do. It could help them see the world, get an education, learn a skill and give back. What do you think?

See you soon.

Inching Towards Health Care Reform

2009-11-08T17:01:00.000-08:00

Hi it's me again.

I'm writing just a little update on the Health Care Reform Topic. Good news - ever so slow, but inching towards a bill being passed.

Last night, the House passed their Health Care Reform Bill by a narrow margin. They got 220 votes, needed 218. Yikes!

Anyway, it's good news because it means now the Senate can call for their vote as well. The House Bill was pretty wide and all encompassing, so expect the Senate Bill to be more conservative so that in negotiations, they can meet somewhere in the middle. Politics, politics, my pretties!

I'd like to urge everyone to actually read this bill. It's huge, a lot of verbage. But if you really want to know what's actually there, please feel free. And it's a lot better than listening to all the negative talking points and little snippets out of context that everyone has. Yes there are some regulations, OK a lot of them - but they are there to protect the citizens. There is also a lot of reform and change in this bill.

Stayed tuned here for updates and talking points. I'm going to try to read a little each day so that I can keep everyone informed on what's actually in the final bill.

I think it's important to remember that this is all a slow process. I know a majority of Americans voted for President Obama wanting change. If you remember, he always said it in his speeches - he said that things may not be different for years, some things wouldn't get accomplished even in his first 4 years. Change is slow, a lot slower than we'd all like. We're a generation of instant gratification. And it's hard to ask people who aren't working or who are drowning in debt, to be patient. But we all need to do just that.

Once we get past this big hurdle and I sure hope we do - at least in some effective form, we can all move on to other important issues that will get our economy back on track.

So if you want to check out the bill, click here. It's not a great copy. You have to click back and forth on all the sections. I'm guessing in a few days, there will be a complete copy online. Or you can go to this link - this is a copy of the 1990 page bill without the amendments.

Anyway, take care and keep checking back.

Interesting Article on Health Care Stats

2009-11-05T18:13:00.000-08:00

Click here to read this article.

When It's Your Time, It Must be Your Time

2009-10-28T14:29:00.000-07:00

Hi everyone -

I have just enough time, to write a short little bit about something that happened at work this week. I haven't really been able to get it out of mind for a couple of days.

I was having this wonderful day the other day - I was totally in love with my job and all my patients for the day - which isn't always the case. No one could seem to get on my nerves.

I had this cute little 5 year old girl who was such a joy. She never made a peep when I poked her for her IV. And she even told me, it didn't hurt at all. I could not believe it. How can some people just scream and cry and carry on - and this little girl, who really wasn't sick, not make a peep. Amazing.

I also had this nice guy whose wife worked somewhere in the hospital. He was just a crackup with a sick sexual sense of humor.

Then, there was this really nice lady with this amazingly nice family. We joked around all day long and talked about a lot of personal things - mostly gardening and some hot peppers that I had been growing and sharing with my co-workers. Thanks to Duane, we were having a good laugh - especially with his translation from Spanish to English for habanero.

Anyway, I knew this lady had a new diagnosis and probably a weakened heart. But at 80+, she'd been doing pilates, yoga and some aerobic exercises less than 2 weeks later. She was feeling a little short of breath and weak - but her troponins were negative. We thought she'd just spend the night, get an echo of her heart and go home with some new medications and a few more good years. I left that day without saying good bye to her or her family.

A couple hours later, she coded - not once, not twice - but probably 8 - 10 times before finally moving on to some place else - hopefully very peaceful and joyful.

I guess that just really does prove when it's your time, it's your time. When you're in the hospital and on the monitor and you go into VFib - get shocked and shocked and shocked - keep coming back - and you still don't make it. Sometimes, it's just so bizarre to me.

I'm guessing I wished at this point, I had gone back in the room before I left, to say what I usually do - I'm leaving. I hope you get better and get to go home quickly. It's been fun spending the day with you. I hope I run into you at Walmart or McDonalds sometime.

The Public Option Broken Down

2009-10-13T17:59:00.000-07:00

Hi all -

Good news today - well at least fair news on the health care reform front - the Senate Finance Committee got a bill through their committee. Although it's a really watered down bill, at least it's a start - and it's progress. Now on to meshing them all together. I need to get back to reading now that they've actually gotten somewhere.

And with the report out yesterday from Pricewaterhouse Coopers, there's no time like the present to talk about the Public Option.

First, let me review their report with you. I have to say, I think it's a bit funny and sad at the same time. It seems like the insurance companies, which may have been feigning their support all along, holding out for the last minute to drop a bomb or two, got caught up in the circus over the last couple of days.

It seems that the insurance companies had an "independent" review board conduct some kind of a study after reviewing just part of the Senate Finance Committee bill - the part they paid them to review. Surprise, surprise. They predict that insurance rates will increase by 111% over the next 10 years. Let's put that in more tangible figures - By 2019:

Single people will see their premiums increase $1,500.00 per year. Families will pay $4,000.00 more per year.

A further breakdown shows that single people now pay approximately $4,600.00 yearly. With the current system, these rates will increase to $8,200.00 yearly. Under the Baucus plan, these rates will increase to $9,700.00 yearly.

Families pay approximately $12,300.00 yearly. With the current system, projected rates would increase to $21,900.00 yearly. Under the Baucus plan, these rates would be $25,900.00 yearly.

Now keep in mind, under the current system we have, they are still projecting a 79% inflation rate.

Now, that's just ridiculous - especially since wage growth only averages 3 - 4 % annually.

And even more ridiculous - the insurance industry just shot themselves in the foot by releasing that report. Maybe they thought they could scare the people or the congress by talking about how high premiums would continue to rise. I guess no one stopped to think, well, if they can't control their own growth in their own premiums - maybe, just maybe we should have a public option.

Let's talk about what a Public Option is and how it could benefit or hinder health care reform.
Let's hit the basics first - what is a Public Option when we're talking about health care?
Basically, all it is is another company, the government, competing for business in the health insurance industry.

Right now there are a lot of different insurance companies -Aetna, Blue Cross/Blue Shield, Cigna, Kaiser, etc.... Technically speaking, because there are so many different insurance companies, they should be able to keep each other in check - to help keep prices competitive and affordable. Unfortunately, in most of the country, more than 70% of the market is controlled by one insurance company. This is bad for the market, as there is no competition from other companies to help keep premiums affordable. Plus, there is no way that providers, doctors or hospitals, can negotiate for better prices for services. And as the companies get bigger, they just keep buying each other out. In the last 10 years, there have been more than 400 health care related mergers.

With the Public Option, congress is hoping it would keep the insurance companies under control. Because the government has fewer overhead expenses, they can run their "business" a little cheaper. They can also negotiate cheaper fees for services provided, and this would force the insurance companies to be more competitive with their prices, to offer superior plans and to give excellent service.

Let's review some of systems that have a government agency in force already, ones that compete with the private sector.

First up - the obvious choice to discuss is the US Postal Service. Now granted, private companies like UPS, DHL and FedEx came about partly because of this agency's inefficiency and poor service. But let's be honest, someone would have eventually figured out they could make money off of something that most of us need daily in our lives - sending stuff from one place to another.

So let's take a look at these companies. They all seem to compete on a fairly even level. They all ship packages for about the same prices. They each have their own little niche they fill.

DHL, who tried to compete in the US, finally turned their domestic shipping over to UPS, I think. Guess why - they weren't making any money here. They still are excellent and competitive with international shipping services.

FedEx is relatively more expensive but they're known for their excellent service and speedy deliveries. They also provide some of their shipping materials for free. They have the best online package tracking system of them all.

UPS's fortes are their speed of service and their 100.00 worth of insurance for free. They also have cheaper shipping rates for larger packages.

The US Postal Service is still the cheapest form of shipping for many things. None of the other companies can ship - or do they try to ship - a letter for $.44. Guess why - they can't compete. Plus in comparison, a small priority mail package can be shipped by them for $4.95. The other three carriers can't compete with that. Their cheapest packages ship for over $10.00. The USPS also offers some of their shipping materials for free. They do have a 70 lb limit on packages though and their online tracking system isn't very efficient.

Funny, I think the private companies have made the Public Option pick up it's game. I have to say it's been a long time since the USPS has lost something I've sent. I think they've learned to become more efficient and concentrate more on their customer service.

So when making your choices on who you give your business to, it's on a very personal level - what kind of package are you sending, what kind of expectations do you have, what will the cost be. These are all things you consider and I don't think you really say, "Well, I'm not going to pick the Public Option because they don't compete fairly with the private sector." Maybe I'm wrong, do you?

Now, let's move on to our Education System. There are plenty of public and private schools - in primary, secondary and collegiate level education. Public schools are subsidized by our tax dollars; private schools are owned and run by private companies for a profit and charter schools are somewhere in between. Charter schools are subsidized by our tax dollars, but run by private companies for a profit. 75% of schools are public, 25% private.

Interesting enough, private schools have been good for the Public Option. They've made the public schools pick up their game. And public schools are good for private schools as well. Private schools now have to offer something special - something worth paying more for.

In comparison - public/state school tuition is generally less than $10,000.00 a year; private school tuition is anywhere from $30,000.00 - $120,000.00 a year. On the other hand, there are more grants and scholarships available for private schools.

There are a lot of regulations for public schools, where as next to none for private schools. The private schools pretty much make up their own rules. Some private schools don't even require their teachers to have college degrees or state licensure. Public schools have to follow all the anti-discrimination laws as well - private schools, not so much. And believe it or not, recent studies show that public school scores are as high and even higher in some areas.

Now, again, when making a decision about where you or your family goes to school, a lot of personal choice comes to mind. I think it's nice to be able to choose. I think we choose what works best for our family, our children - I'm guessing we decide with a lot of factors in mind - what the school has to offer, curriculum, location, costs, etc. I'm sure there's also some perceived thought that if we're paying more, we must be getting more for our dollar. I'm not sure that's always the case. Again, I'm not sure we think, well, we aren't going to even look at that school as it's a Public School.

Let's move on to another Public Option in the insurance industry. This one should make you chuckle a little bit - especially if you read my earlier blog about how the government programs take the biggest hit on the sickest and poorest people - while the insurance companies make billions off of us.

Have you ever heard of the National Flood Insurance Program? I know, in the past, I almost bought a house that was in a flood zone - not knowing of course, how much it would cost me to insure the place and it's contents.

Well after some of the horrible hurricanes over the past few years, most insurance companies started to drop their clients and they refused to pay a great deal of flood claims, through loopholes in their policies. After Hurricanes Rita and Katrina they denied numerous claims saying that the water destroyed the properties before the wind could. The private insurers decided there wasn't any money to be made. Well, guess who stepped in - the government. The private insurance companies still run these programs, but it's 100% backed by the government with our tax dollars of course. And this insurance is MANDATORY.

Funny, some of the senators that have been so nasty about the Public Option in Health Care - like Grassley, Enzi, Snowe and some other 44 Republicans - voted for this flood insurance program. And even funnier, the more conservative states have used the most money from the program - North Carolina, Mississippi, Wisconsin, Florida, Illinois, Missouri, Indiana, Iowa, Louisiana - and ........ wait for it ....... Texas. Texas has benefited the most. They've taken 1.5 billion dollars in claims. 682,000 people have turned in claims under this program.

So, I say what's the harm in having a Public Option? Come on people, weigh in.

I know, some people are going to say that the government competes unfairly in business against the private sector - they may put the private companies out of business. On the other hand, a lot of us choose to spend a little bit more money going to the UPS or Fed Ex store to ship our packages because we want to, because it's an option, because we can. I say bring it on, I'll choose it if I think it's just what I'm looking for, what's right for me and my family, for a price I can afford - because I can if I want - it's my choice.

I also say the insurance companies should say the same, bring it on. If they think they have a great product, give excellent service, are as efficient as they can be and their clientele are satisfied, then it should be a non-issue for them as well. My question to them, do they actually have a product or service to offer me that is worth paying more for????

And in closing, I must say, that the Public Option in itself will not solve the inflationary problems we have with the health care system. Competition can only help control costs so much. I'm guessing that's why Pres. Obama said it was only a small part of the whole picture.

From 1970 - 2000, Health Care spending increased by 11% in the private sector and 9.5% in the Medicare system. From 2000 - 2004, it increased by 9.5% in the private sector and 6.7% in the Medicare system. So although, you can say the government program is inefficient, just by price comparisons alone, you can see that the government program still does a little better than the private insurance industry. But sadly, the increases on either side are just too much.

What we really need more than anything is health care reform. A strong Public Option and Health Care Reform has to happen and has to happen now. We need to control costs, reduce waste and fraud. We need to restructure the payment system to pay for performance programs - quality of care, not quantity. We need to have a national information technology system - all computers, all providers talking to each other, sharing their tests and results - prevent duplication of services. We need transparency in the health care delivery system - we need to know who is charging how much for what and what their outcomes in care are. We need to form a committee that studies and implements best clinical practices for all patients. And last but not least, we have to find ways to increase access to all Americans. I can not say it enough ACCESS, ACCESS, ACCESS. We need more community health centers, more primary doctors and staff. We need to start now.

Let's do some brainstorming together to see where we can cut costs - what we can do to turn this machine around. Tell me your ideas.

More later. Off this thing for now.

My Latest You Tube Video - Country in Crisis

2009-10-12T08:11:00.000-07:00

Hi there -

Well here's my 3rd you tube video. Let me just say this one was not easy. It took me like 20 hours to finally get it all together and then get the editing software to actually do it's thing. I would not be defeated though and finally beat it.

This is not for the faint at heart. The message is clear - we better get it together as a country - all the fighting has never really worked out well for us. Time to play nice and take care of things that need to be taken care of.

Let's muscle through the rest of the health care reform stuff so we can move on to the wars and the energy situation. Once we start talking about green energy, more jobs can be created and we can start to be on the road to some sort of financial recovery.

Have a great day everyone. More on health care and the public option next.

Weekly Medical Show Critique

2009-10-10T11:21:00.000-07:00

Hi everyone -

Well, today I thought I'd start out on a lighter note - it came to me last night while watching tv that it might be fun to write about some of the medical writing errors of today's tv shows.

Last night I watched the pilot of Three Rivers - which I have to say, I kind of enjoyed. I think it was a bit of a new idea for a medical show - set in a transplant hospital - with the hot Alex O'Loughlin from the undead Moonlight. I have to admit that I only watched it because I wanted to see O'Loughlin again. I was pleasantly surprised at the direction of the show, I enjoyed a lot of the subtle things about the medical field - sense of humor, use of our need for food all the time. lol. Then I caught the writers with their pants down a couple of times - at least 3. 2 may be forgivable - but one I just can't let go.

Mistake #1 was at the bedside of a dying patient - the doctor taking care of the patient brought up the whole donor aspect with the distraught wife. This just doesn't happen anymore. The medical professionals taking care of the patient are not supposed to be involved in the harvesting conversation. Here in CA, we're to call Legacy One and their representative is to come out and discuss this with the family to assure that there aren't any conflicts of interest. But, on my scale, forgivable sin - because this opened up the conversation later in the show to actually talk about the process and the conflicts involved.

Mistake #2 near the end of the show - showing the circle of life. It was a wonderful scene - the saved new mother with a new heart getting to see her brand new newborn on video. The electronic records and information technology aspects of the show are amazing. They have computer screens everywhere on the walls and windows. Anyway, just not realistic to think someone who just woke up from her heart transplant would already be extubated with a little nasal cannula on - and that her beautiful 28 weeker would be held by her husband in the nursery looking like a 6 month old. Again, forgivable for tv delivery. Cute moment for closing.

Mistake #3 - never ever forgivable. They were so on cue during the code in the beginning of the show. I was impressed. Then, when the pregnant girl codes again later, they defibrillate asystole. Oh noooooooooo. During CPR, there's only two heart rhythms that you can defibrillate safely and they are ventricular fibrillation/vfib and pulseless ventricular tachycardia/vtach. Not forgivable - who on earth was the medical adviser on this scene?

Anyway, overall an enjoyable fresh new show with a good pretty cast. We'll see how long it lasts.
Anyone else out there catch this show and see anymore medical mistakes? Let me know.

And then on a personal note, it was kind of funny watching the show because they were talking about cardiomyopathy and 10% ejection fractions and it just so happens that my favorite KP patient was in the ER yesterday. I always enjoy this man, he's just a joy for someone who is so chronically ill. He's been my patient many times over the last 9 years and even when he's not my patient, I actively seek him out to say Hi and see how he's doing.

I'd like to give a kudos to KP here and applaud a look into the future of health care reform. This is a man that normally would have died years ago. His heart is just a weak, weak muscle. He's got multiple chronic conditions - COPD, Diabetes, CHF, Cardiomyopathy just to name a few. He made himself a DNR years ago with a lot of discussion with his family and medical professionals. Yesterday he told me that he may be taken off Hospice/Palliative care now as he's doing so well. The Chronic Condition Department has been working with him and his family now very diligently, trying to keep him healthy and out of the hospital - which is one of the big goals of health care reform - cutting down on costs be preventing readmissions for the same diagnoses.
Apparently it works. So wow, if we're going to start paying for preventative services and better outcomes - to me, it looks like it just might work on several levels - the patients do better and we can cut costs and save money. Kudos.

Take care. More later on the public option.

A Special Commentary - A Must See Video

2009-10-07T20:01:00.000-07:00

Hi everyone -

Since the health care debate started, I've heard and seen a lot of stuff that's irritated me, angered me, inspired me - made me laugh, made me cry and made me cuss. Today, while I was at my desk getting caught up on some emails and paperwork, I had MSNBC on in the background. I do like to watch a few of their shows on occasion - but was ultimately surprised at what I heard today.

I always thought of Keith Olbermann as a little over the top - he does report the news - but was a little over the top in the delivery. I've listened to him many times over the last several months - and I was sure that he was the greenest of the commentators on health care issues. He never really seemed to grasp the policies or bills. He was quick with the rhetoric - but didn't seem to hone in on the details like some of the others did.

Well tonight was a lot different. If you have time, watch the video to listen to his own personal family story about health care and his personal views on the need for health care reform.

These are the stories we all need to hear while all this fighting and lying is going on - personal stories of real life health care in crisis and people being genuinely emotional and impassioned.

Hang in there - sometimes he's ranting and raving, sometimes he's angry - but he's truly moved by the illnesses that have occurred recently to his own mom and dad. He's near tears many times - and Kevin and I were in tears several times just listening.

I especially appreciated his challenge at the end. He asks free clinics to set up a day in each of the cities of Senate Finance Committee members that are against some of the reform. It's a challenge I'd certainly like to see.

Enjoy:

Visit msnbc.com for Breaking News, World News, and News about the Economy

I promise - this weekend back to blogging on my own.

Take care.

Health Care Reform You Tube Video #2

2009-10-02T19:52:00.000-07:00

Hi everyone -

Here's my second You Tube Video. This one is for some TV ad competition. It could only be 30 seconds. That was by far much harder than I imagined - Getting a message out in 30 seconds or less.

Click here.

I'll be back blogging in no time flat - next up - the public option .......

The New Public Option - Traveling Abroad for Health Care

2009-09-29T19:54:00.000-07:00

Hi everyone -

Today as the Senate Finance Committee plays some more head games with American lives, I decided to do some research on a different aspect of universal health care - what I think I'll call The New Public Option.

I've been hearing very little scuttlebutt on what I'd consider a pretty good option in health care - medical tourism - traveling abroad for affordable, comprehensive health care packages. I find it particularly funny that I don't hear a whole lot of media or government officials discussing this particular option we now have as Americans. There are a lot of companies out there offering travel abroad for the needed affordable care that our own country is not offering our citizens. Of course, I've heard numerous party representatives talking about how Canadians or Britains come to the US for their care because they just despise their socialized medicine. But I find it quite interesting that a lot of Americans are going abroad as well as our own system is failing just way too many of our citizens.

At first glance, I think it would be pretty scary to go to some other nation, where I've always heard they give second rate care, you get what you pay for, no regulation or FDA approval, etc... But when I did a little research and also looked at numerous forums, I'm finding something quite to the contrary. People are getting affordable, top rated comprehensive care for their needed and elective procedures and care. And they're being treated like kings and queens during the process. I think the US has a lot to learn about medical care meets outstanding customer service.

Many of the larger hospitals in major metropolitan areas like India, Thailand, South Africa, Costa Rica, Argentina and Dubai offer medical tourism packages which include your surgery and a short recovery vacation. Some of these hospitals even have big names attached to them - like John Hopkins International Hospital in Singapore. Many have several accreditations including US endorsed. Many other citizens go across the borders to Canada and Mexico to save money on medications and treatment. It's estimated that anywhere from 150,000 - 1 million people cross the borders annually for their medical care. Some employers are now offering medical tourism packages to their employees as a way of saving big dollars for their employees needs.

I was surprised to read about the advanced technology and treatments for complicated diseases as well as world-wide known doctors these places have snagged. And surprisingly, I found most studies show that some foreign nations have about the same and even better patient outcomes as far as cure and remission rates for chronic illnesses like cancer and seizures. Also, the foreign country infection rates are far below some of the US facility rates.

Costs alone are a huge motivator in people going abroad for their care. With our 40 million plus uninsured and under-insured population, employers and people a like would be crazy not to take advantage of some of these packages. For instance, a hip replacement in the US costs approximately $65,000.00, only $8,000.00 abroad; a face lift costs approximately $20,000.00 in the US, only $1250.00 abroad and a heart valve replacement costs approximately $200,000.00 in the US and only $10,000.00 abroad. Keep in mind that these abroad costs cover everything - round trip airfare for two, all pre-op and post-op costs, a short stay-cation with a personal nurse and room service in a 5 star hotel setting. It's kind of like surgery meets spa day.

Click here to read a little bit about this publication - "Patients beyond Borders". Just look at the slide show that shows these amazingly aesthetic facilities.

Now I'd be irresponsible to think that all abroad care is up to "our" standards or safe, but I think it might just be something to look into, research, visit, compare, etc.. Fair Market anyone???? I think if the insurance companies and some of the US citizens are afraid of government run programs or getting control of costs through major reform, what will they think of outsourcing our health care as well??? Talk about something that could put all the insurance companies out of business. New Public Option anyone???

Let me know what you think ! Would you go abroad for an elective surgery, prescription refill, dental work. I think it would be pretty scary - but then on the other hand, if I weren't insured or weren't insured enough, I'd think I'd consider it. No waiting list, great doctors, great facilities, a spa week - you bet ch'a.

Take care until next time.

Should we really send more troops to Afghanistan???

2009-09-26T17:47:00.000-07:00

Hello everyone -

I'm going a little off track today because of something that piqued my interest
today. I was watching the Bill Moyers Journal today on PBS and saw this interview with Rory Stewart. I took a look at his credentials - he was in the British military and worked for the foreign ministry as a diplomat - but I think I'd call him more of a scholar and humanitarian. His demeanor, which was very calm and gentle impressed me. And his knowledge about the Afghans and their culture as well as his 6000 mile trek across their country and his humanitarian efforts there interested me. I think our government needs to entertain some of his ideas - just maybe a little bit. I think possibly we need more people like this consulting with our government and military leaders when we fight on foreign lands.

Now, granted I pretty much know nothing about war or policy on war. I've always buried my head in the sand about it. I even, as an ex-military wife, just despised the fact that my husband, my family or my friends would ever have to deal with the misery of someone I know and love being some place far away and in danger. Or worse yet, they would be captured, tortured and killed or come home in a body bag.

I am very concerned about our soldiers safety - but also don't know whether we doing more harm than good to the innocent citizens of this foreign country as well. Don't misunderstand me, I want to be able to protect our country, I want to get rid of Al-Qaida as much as the next person - but what I'm questioning now is - are we doing it the right way? Do we continue to go in full force, all in the name of national security and state building? - at the risk of not accomplishing a whole lot of national security and doing more state destroying because we aren't successful on our reasonably short time table. After hearing this interview - I'm concerned that we'll go in with a lot more troops, lose a lot of men/women and not stay in long enough to accomplish the task at hand. Then we'll leave suddenly when the US citizens get tired of it - and leave the country in more shambles.

Take a watch and listen to what the man says. Tell me what you think. Do we need to refocus our goals on what's more realistic and attainable - with some more practical short and long term goals - protecting our national interests, conquering Al-Qaida and starting some humanitarian efforts - with more intel, more special forces - less ground troops.

Copy and paste this link to your browser.

http://www.pbs.org/moyers/journal/09252009/watch.html

I want to say again that I don't know a whole about this subject and am still learning. I don't want to offend anyone or belittle at all what we've done so far and what it's cost anyone.

Life in the ER - Another Day, An Uninsured

2009-09-24T15:49:00.000-07:00

Hi -

I'm just sitting here, taking a break from my day - to think another time about how the health care crisis affects us every day.

I decided that once in awhile, I'll just write a short blip about events that come to mind.

So, today - although I know I've told this story to some people, it's worth repeating.

Not so long ago, I had a patient in the ER that I won't be forgetting any time soon. I was just infuriated at the cost this gentleman has to pay for not being insured.

I don't know a lot about him - except that he was a hard working middle class American. He hadn't had insurance for at least 10 years; he just couldn't afford it. He worked hard to support his family and just hoped that he wouldn't get sick.

Well, in July, 4 weeks from when his Medicare would kick in - he would soon be 65, he dropped a board on his foot at home. It left a little wound on the top of his foot. He cleaned it up and kept an eye on it. About 3 weeks later and only a week before his Medicare would kick in - he woke up having pain. He noticed that his foot was now red and painful and looking kind of bad. Of course, he proceeded to the ER where he knew he would get treatment - like so many other uninsured individuals.

Gangrene had already set it. He was probably diabetic for awhile and didn't even realize it.

Now this was and is very sad - not just for this man and his family, but for all of us.

The man will lose his leg, not be able to work or support his family and have a lot of medical
bills and emotional trauma to come for years - all because he was just trying to hang on for 1 more month. As a nation, we will also lose - this man and probably his family will be our dependents. We'll have to pick up the tab for his uncompensated care. This will also probably take him out of the work force, requiring us to help support his family through other public programs.

I don't know about all you - but I just do not understand why this happens in America and in the 21st century.

My thoughts are with him and his family and the other Americans who suffer needlessly due to the way our health care system is today.

The Old, The Sick, The Disabled - and Insurance Companies

2009-09-22T18:08:00.001-07:00

Hi there everyone -

I have time for a quick note - one that I've been thinking about for a couple of days - one I'd like to get your opinions on.

So - what do you think the purpose of insurance companies are? And do you think they should be making money off of sickness and disease???

I was thinking about it. I think that the government has been providing them with a windfall.
If the government runs Medicare, then all people over 65 are covered under Medicare. If the indigent and disabled people of the country are covered under Medicaid, then the government pays for their health care as well. If you're in the military, your health insurance is covered by the VA or Tri-care - so if you were disabled while in the military, the government pays for your medical care.

Now on the flip side, if you have insurance with a private insurance company, and you're not sick or don't really use your insurance much - they keep you as a client. But if you get sick, they drop your coverage. If you meet your lifetime maximums, they don't pay any of your bills. They don't pay your medical bills until you reach your yearly deductibles, cost-sharing and co-pays. And if you have a pre-existing medical condition, you can't get insurance.

How much sense does this make to everyone???? We, or our employers buy insurance just in case we get sick, right???? Then what are the private insurance companies insuring if they aren't insuring us against sickness and disease?

And why are we all afraid of the government providing or running an insurance exchange or public option???? It sure seems like the government is the only one that is actually insuring the sick. I think I've concluded that Medicare, Medicaid, VA, Tri-care - all these government run programs have been a gift to the insurance companies. So while they are off making billions of dollars off of us - until we're sick - then we're all actually footing the bills of the sick. Because it's our tax dollars that are paying for the government run medical programs.

So what's up with all that? In closing, we're paying for insurance we don't need or use through the private insurance companies - plus we're actually paying for everyone else - including ourselves again - when we get sick. So we (the employers and the employees) are actually paying health care premiums, plus the cost of the government run programs (through taxes) - as well as the uncompensated care of the uninsured.

Sure doesn't seem right to me - how about to you??

My First YouTube Video - Health Care Reform Circus

2009-09-21T17:06:00.000-07:00

Hey all -

I finally finished my first Health Care Reform You Tube Video. It's the funny, making fun of people one. There will be a couple more. Hopefully they get easier. Enjoy !

Click here.
http://www.youtube.com/watch?v=PDqX5EXG7pc

I'll be back blogging in a couple of days.

4 Minute Pres. Obama Healthcare Plan Video

2009-09-21T09:42:00.000-07:00

Emergency Room Visits for Non-Urgent Medical Needs

2009-09-12T09:32:00.000-07:00

Good Morning to Everyone !

Let's tackle another hot topic of health care - non-urgent use - abuse of ERs. I would like every one's opinion on why people use ERs for their primary care or non-urgent needs. I did a little research and have found that the media, the government, the patient population and medical personnel really have differing thoughts on this - which I find very interesting. As a health care professional, I do like to try to be convinced of the other sides' viewpoints.

So let's take a spin around the googling world. I read several forums and news articles on this subject and there are varying views on the reason people come into ERs and how these costs affect our already broken health care system.

The governmental agencies seem to realize that a big factor in ER use is the broken health care system. They think with broad reform and insuring the entire population, these numbers will decrease significantly. They feel that many more ERs would be able to stay open and the lines would diminish if everyone was insured. The President, the Democrats and Republicans alike all think that if we insured everyone, increased our funding in the public programs and rebuilt our infrastructure to include strong community-based and home-based medical services, we would all be much better off.

The media has an entirely different view of the subject. They claim that most people come to the ER with non-urgent needs for two reasons - that they either are uninsured or have Medicaid and don't have access to providers they can see - as doctors are refusing care in the clinic settings for nonpayment. So they trickle into the ER where they know legally they have to be seen due to EMTALA laws. Interesting concept and one I hadn't really considered. And secondly they feel that most patients do not know what is emergent or urgent or routine. They feel that in the moment any amount of pain or suffering that people are feeling is real and they can't differentiate between something that is life-threatening or not. Again, interesting.

Next on to people in general - what I found online is almost next to nil. People don't really weigh in too much online about health care issues. There are a lot of right wing and left wing spouting off about the health care system in general - but I didn't find a whole lot of people just asking general health care questions. I did find a few real life stories of the pay offs of going to the ER - and then some nightmare stories of private sector clinic care. Again, interesting enough, it seems we do too good of a job in the ER of giving patients just what they want and what they need. There were many stories of patients not being able to get into their doctor's office for routine or non-urgent needs - having to wait weeks to months to see their doctors. Plus there were many sightings of patients wanting a fast track to getting the xrays, CTs, MRIs and specialist referrals they have been having trouble getting from their own doctors. Plus, where else can you go to get IVs, medications, tests, etc.. - one stop shopping for your needs - in a relatively short period of time.

On the other hand, there were also several stories about how the general population feels they get the best care from the best trained personnel in the system. They talked of nightmare stories of their loved-ones dying from delayed treatment and missed diagnosis in the primary care setting. And they also expressed that they weren't sure when they should or should not use the ER. There seems to be a little confusion about what is emergent and what is not. Most people seem to know if you're having chest pain or shortness of breath, they should go - or if they have an ear ache or a sore throat, they shouldn't go. But with the Internet and the symptom checking on web sites, they are confused about is emergency in the abdominal pain, nausea and vomiting, back pain, headache, broken bone and laceration categories. And truthfully, there leaves a lot to desire with telephone triaging - if you can't see the patient, you don't know where to send them - so you send them all to the ER. Great ! I know, you're all worried about being sued for liability for missing something - but come on.

Now, let me just say, there are a lot of online forums from health care professionals. Some are constructive - some are just plain mean. Some people have definitely identified a lot of factors in the use/abuse of the ERs. And some people just get soooo frustrated about the piddly little things that come in.

Let me just give you some real-life examples from my friends and co-workers - you tell me what you think. Are they emergencies - could they be - or come on, should you just stay home for a day or two - go to urgent care - or wait for an appointment with your doctor? Let me know what you all think !

Examples:

2am STD check
Sore Throat for 3 Days
Knee Pain for 10 Years
Bug Bites
I need a Note to go back to work because I called in sick last Friday.
I had a Fever ....yesterday.
My Child was at a Party yesterday and was exposed to Chicken Pox. Is there a Shot for that?
Cold Sore
Dandruff
Pregnancy Test
Prescription Refill
Rash for 14 Years
The Cops or the Airport Security took my Prescription for Pain Medicines, Can I have Another?
I drink too much but I don't want to be here - but called the Paramedics anyway?
A Zit?
Someone concerned about getting AIDS from a Bite.

The ultimate and funniest and saddest one of the bunch - a Dialysis Patient was sent to the ER because of a necrotic belly button - OK, did any one look? It was a blueberry that missed his mouth in the morning. Come on !

OK - now, I know people aren't just feeble-minded - at least not everyone - but in all these cases, we all know - us and patients alike - these are not emergencies and do not belong in the ER. I'm not sure that even one of them, in the worst-case scenario would be urgent or emergent. OK - maybe one - the sore throat could be something cooking - I'll give them one - maybe - unless of course, it was just a sore throat with no other symptoms.

I want to tell you what I think about all this. I'll give the government, the media, the people and the health care professionals all kudos. Everyone has touched on at least one aspect of the system that is just all or partly wrong in the US.

But I think we're missing one important aspect - and I'm not sure how to fix it - well I have a few ideas that I'll touch on a little later. This is the generation of instant gratification - and not wanting to be inconvenienced by anything. It's all about me, me, me. And I can attest to this as I know, I have a little bit of that in me as well.

So let's be a little constructive and talk about how we can fix some of these issues.

#1 - Health Care Reform, Health Care Reform, Health Care Reform - can I say it any more??
We so need to refocus our infrastructure. We need to insure everyone in this Country - well everyone here legally. There is a certain sub-population that is always going to end up in the ER and not have coverage. With EMTALA laws, we have to see anyone who shows up in the ER. Sorry, that includes illegal aliens. There's no way to get around that - they are always going to cost all of us some money. But if we insure everyone else, then we cut down on all the uncompensated care we give to the poor and the homeless, uninsured and under-insured population. It just has to be done.

#2 - Let's rebuild - increase funding for our community health systems. We need more community health centers, more urgent cares, more primary doctors who see all people. We just really need more Primary Care Doctors - they need to be compensated more. People need more access to their doctors. There are not enough doctors to go around. We need to refocus our funding on the home-health field as well. People would love to stay in their homes if only they could afford to be taken care of there - or in residential homes.

#3 - Education, Education, Education. Patients need to be educated on where to get their care, how to get their care, the costs of their care, alternatives to care, what's emergent and what's not. Transparency is all too important. Maybe a big sign in front of the hospital with all this information would be good. Maybe simpler plan books or brochures with easily understandable language would be nice. Written instructions at discharge from the doctor's office, the ER, the inpatient setting could be mandatory. Maybe some big organization could take on this task - the American Heart Assoc., Blue Cross/Blue Shield, Kaiser Permanente, maybe the government could launch a big advertising campaign about this???

#4 - There needs to be some sort of sliding scale co-payment system in the ER- in my opinion.
If someone comes to the ER with a true urgent or emergent condition, the co-pay should be less. People should be charged more for non-urgent, routine ER visits to discourage them from coming in on just a whim. I don't know exactly how to restructure this, but I believe if people have to pay $200.00 + for an ER visit (if that's what the estimated cost would be to see an ER doctor), I believe that it would only take once to figure out that you shouldn't do it. I think that the pocket book hit would squash some of the instant gratification drive.

#5 -And lastly from me, I think that every hospital should have some sort of in-person triaging system. The ERs should have a triaging doctor in front - and the hospitals should have a system of deflecting patients to the clinics, PMDs, urgent cares and clinics. If everyone is insured, this should not be a problem. If your clinics don't have any openings, then the patients get sent down the street to a place where there is an opening. I like the idea of a concierge service. I feel it would help everyone involved. The ERs would be used for emergencies - the uncompensated care would go down and the people would get the care they want, deserve and need in a fairly short period of time.

And to Stan - I love your philosophy on our ER specialty - I'll call it your mantra -

"Common Sense is Not that Common"
"Job Security - There will always be plenty of "Emergencies""

So come on everyone - brain storm - what do you think? Do you have any other solutions to the health care crisis that is happening in our ERs???

Comments, Fixes, Bitches !

See Ya back here Later !

Miscellaneous Info., Statistics, Etc. - Food for Thought - a Pawn

2009-09-10T20:45:00.000-07:00

Hi everyone -

Well another day, more policy reading. I tackled Max Baucus's Call to Action that he wrote back in November 2008. I'm going to talk a little about it today here - but I'm going to reserve my kudos for now. After reading some news posts today - I believe his health care proposal to the President is different from the Call to Action he wrote last year. So, I actually want to read the new plan before committing to it.

He did have some interesting statistics:

46 Million UnInsured Americans - 15% of Population
25 Million UnderInsured Americans
158 Million Americans are Covered by Employer-Offered Plans
U.S. spends 16% of GNP on Health Care - Over Twice as Much Averaged as Any Other
Industrialized Nation
U.S. is 19th in World in Unneccesary Deaths
U.S. is 29th out 37 Nations in Infant Mortality
Adults get Recommended Care only 55% of Time
Children get Reccommended Care only 47% of Time
People get Preventative Care only 41% of Time

At first look, I was pretty impressed. It's obvious he's coming at it from a Finance perspective.
The Call to Action had a lot of the same stuff in it that the House Bill 3200 has in it.

Here are just a few of the similar points:

You can Keep your Doctor if you Like Him/Her
No Pre-Existing Conditions Allowed
Electronic Records Integration
Preventative Services for Free
Subsidies to Individuals and Small Businesses who Need Assistance with Premiums
Expansion of the Medicaid Program and Indian Health Plan
No Waiting Period for Disabled or other Legal Immigrants (children and pregnant women)
Reform for Medicare/Medicaid to Control Fraud and Abuse and Quality vs Quantity HealthCare
Heath Care Exchange with a Public Plan

So a lot of similarities - but:

I did find a few interesting additions - although maybe they are in the House Bill as well - I haven't gotten all the way through the 1000+ pages yet. It's a bit boring after awhile and I needed a distraction.

I can entertain some other talking points.

He has proposed an early buy-in for Medicare for people between 55 and 65. This could work two fold. It could help those people in this age range that don't have affordable options to health care. Plus, it would also help the Medicare fund as these people would be paying premiums. Something to think about.

Plus, his plan also concentrated a great deal on expanding the community health programs. He thinks it would be cheaper to transfer some of the care of the elderly back into the community - ie) funded community medical centers, medical homes, home health programs, etc... as opposed to institutionalizing everyone in nursing facilities. He feels most people would prefer to stay in their homes - and he feels we need to train more health care professionals to care for these people - to give some relief to their families.

And he concentrates a great deal on quality care vs quantity of care. He calls for malpractice reform to get doctor's away from defensive doctoring.

Interesting, while reading his proposal, I found myself a pawn in someone's program - unknowingly so. It seems that some governmental agencies - I believe The Joint Commission and Medicare, in particular - has been experimenting with quality health care measures. It appears that that they have been creating what I'll call, well what they call core measures - which basically are best clinical practices for certain diseases. For example, making sure heart attack patients have aspirin given on arrival to the ER, making sure pneumonia patients have antibiotics started on them within 4 hours of arrival to the ER, making sure patients with CHF have certain tests and medications depending on the outcome of those tests, etc.... Well this is all great stuff - finally someone is making sure we're treating patients according to best clinical practices - practices that have produced better patient outcomes and decreased morbidity. Well that's all fine and dandy- wonderful for patients and the world in general. The only thing I was dumbfounded by was the comment in Baucus's proposal that said Medicare was actually paying hospitals for this. Well no wonder all our yearly bonuses are based on the adherence to these "core measures". Again, it's all good news - it's in the patients' best interest - but I wish at some point, the hospital that I worked for had some transparency on this issue.

So how would you feel if you found out that your yearly bonuses were based on the hospital's reimbursement by the insurance company???? instead of just the mere fact that the facility was on the cutting-edge of health care in best clinical practice???

I guess at first take, I felt a little betrayed for not being told - but in the end, if it's better for the patient, then it's better for us all. And if the new guidelines for payment are going to be based on quality outcomes, it's an interesting concept - and why not be one of the first systems that are using it.

Anyway - more later. Let me know what you'd like to hear about next?

Goodnight.

House Bill - Health Insurance Exchange

2009-09-08T14:46:00.000-07:00

Hi again -

Today's feature will be the first 215 pages of the House Bill. This is the part of the bill that focuses on the Health Insurance Exchange Program. The rest of the bill - about 800+ pages is about health care reform which we'll touch on later.

As you'll see - the key points of the House Bill pretty much match the key points of Obama's Vision, that we discussed earlier.

OK so here we go: Let's start with the basics.

The Health Insurance Exchange will offer an affordable health insurance option for the people who fall through the cracks in our system - those who don't qualify for any other plan whether it's Medicaid, CHIP, Tri-care, VA, Medicare or an Employers'-offered health plan.

It offers an affordable essential benefit plan package with some consumer protections. It would consist of private insurance companies and a public option. For those of you who don't know what a Public Option is - it's basically an insurance plan ran by a government agency - which would have to meet all the requirements of the private insurance companies so as to guarantee a fair playing field.

This health plan would make the individual, the employers, the insurance companies and the government responsible and accountable for insuring all Americans in one way or another.

If you like your current insurance plan, you can keep it. You can keep your doctor as well.
If at any time your employer decides not to provide insurance for you, or if you lose your job, there will be other options. You can shop for a more affordable plan - and odds are the company you're insured with already will have a package available in the Health Insurance Exchange.
Many companies will be grandfathered in - and they will have 5 years to meet the requirements of the Exchange.

The government will be offering subsidies/credits to individuals - those who can't afford the insurance premiums or the co-payments - those too poor to qualify for Medicaid, but those who still can't afford the premiums. Employers who qualify as small businesses who offer health insurance to their employees will also have some tax credits/subsidies - some as high as 50% of the premiums paid. Also a very nice incentive - if after the year is done and all the figures are in, and the Exchange finds out that we actually saved money during the year - ie) a low medical loss ratio - the money will be returned to the people. This is to insure that our health care dollars are used for health care - not going into some fat cat's pockets.

OK - interjection here: speaking of fat cats - did you know that Blue Cross/Blue Shield of Michigan's Executives -just 2 of them - CEO and CFO - gave themselves $1,286,000 in bonuses in 2008 - that's on top of their over $1 Million Salaries - right before laying off 1000s of workers and instituting salary freezes on lower employees in the beginning of 2009. Crazy huh?

Companies will also get money to help convert their medical records to electronic records. You know where I stand on this - everyday we struggle with those darn computers and it's software - but information technology will save so much money in duplication of services and a reduction in medical errors. It will also help us establish best clinical practice standards. Check out some of my figures on the previous subject - earlier in my blog.

Again the companies participating in the Health Insurance Exchange will have to abide by certain rules. They have to be licensed in the State they want to participate in. States can run their own Exchange if they like. They have to participate in risk pooling so that no one company will be burdened with the sickest or poorest population.

Companies must offer a basic plan and may offer an enhanced plan, a premium plan or a premium plus plan. The basic plan must include Hospitalization, Dr's Visits, Clinic Visits, ER Visits, Dr's Fees, Equipment and Supplies, Maternity and Free Well Baby and Preventative Services.

They can't drop or deny any one's coverage for health reasons - pre-existing conditions, use of insurance, age, race, lifestyle, etc... There won't be any lifetime or annual caps on amounts needed for coverage. There is protection for age, family size and geography ratings - at no time can the premiums be more than a 2:1 ratio. Benefits will not be taxed. And the rules can't interfere with Union contracts.

As of governance, there will be a Health Care Commissioner that will be in charge of running the exchange, enforcing rules and monitoring compliance. There will be an Ombudsman who will be there for the people if they have any questions, grievances, etc...

Everyone will have a medical ID card - that may be scannable - so that when someone shows up at a hospital or doctor's office, we'll know they're covered and what kind of coverage they have - who their doctor is, etc...

In year 1 - which is down the road, I think 2013 - only uninsured individuals and small employers with less than 10 employees can join.

In year 2, everyone above plus employers with less than 20 employees can join. Plus anyone who is paying more than 11% of their yearly income in premiums may join.

In year 3, everyone above plus larger employers as determined may join.

So I don't see that there will be a mass exodus of people leaving their current plans to run to the exchange - at least not in the first 3 years.

Now onto the responsibility part - every one sharing in paying for the system - which I'm all for.

The people, us, will have annual out of pocket expenses - a max. of $5000.00 for individuals and $10,000.00 for families. I, personally still think this is too much. I realize that a lot of families are paying much more than this in deductibles, co-insurances and co-pays. I guess I'm just spoiled by the plan I have. Now, this is not to say that your employer will then downgrade what you have already. If you don't have a yearly deductible now, you won't then. This is just a max. that the Exchange companies can ask for. If someone chooses not to be insured, there will be a tax penalty of 2.5% of their adjusted gross income for the year - or the premium amount they would have paid - whichever is less. Now, there is leeway with this penalty - if it's a hardship, there's a loophole.

Employers in the Exchange must pay at least 72.5% of the employee's premium and 65% of the family premium for full-time employees. It will be pro-rated for part-time employees.
There will be a tax penalty for those employers who don't cover their employees. If the employers have an annual payroll of between $250,000 - $300,000, their penalty will be 2%; if between $300,000 - $350,000, it will be 4%; if between $350,000 - $400,000, it will be 6%; and for any company with an annual payroll over $400,000, the penalty will be 8%. This penalty will help defray the additional costs of the Exchange having to insure the people.

And now the big question - where do we get the money to fund all this?

Well I know there is great discussion on this matter. There are some possibilities floating around out there - I think we'll save a great deal in reform - just in electronic records, there may be some redistribution of Medicare Advantage money, the drug companies may be offering to help with the donut hole money, the richest Americans may not get their big tax deductions - and the richest 1% people in America will have an increase in their taxes. According to the House Bill, the richest people in America will be taxed as follows: Now - keep in mind these percentages apply only to the money they make over this limit in Adjusted Gross Income. So, anyone making between $350,000 - $500,000 annually will be taxed an additional 1%; anyone between $500,000 - $1 Million will be 1.5% and anyone over $1 Million will be taxed 5.4%. So if someone makes more than $1 Million in Adjusted Gross Income in any given year, the amount over $1 Million would be taxed by 5.4%. Their first Million would not be taxed further. FYI - according to compiled figures, this tax would only affect 1.9% of Californians. And for my home state of PA, this would only affect 1% of the population. Oh and by the way, this percentage is just part of tax cuts that the Bush administration has given to the richest Americans since 2001 - and it extends until 2010. This richest 1% will receive over $700 Billion dollars in tax cuts before it's over - so I think they can afford to give some of it back. Do you know many of these people?? I sure don't.

OK so lots to process in only 215 pages. Again though, I don't see a lot of bad stuff - maybe the annual limits of $5000 and $10,000. All I know, as a health care professional, is that everyone has to be covered. I don't care exactly how we get there - but we need to. Not only do all Americans need coverage, they deserve it. Our companies and our nation can not continue to compete in the global market without taking the health care equation into account.

Any ideas? You know if anyone out there has any ideas - whether better or worse or how to get there - on paper or money-wise, speak up. Let's do it together.

Take Care - more later. I'm reading Max Baucus's Call to Action plan today. I must say I'm liking what I'm reading so far.

Medical Personnel Roles

2009-09-04T20:55:00.000-07:00

Hi again -

Well, I'm back after a couple of days off again. Seems like I'm starting to need a few days in between to gather my thoughts. I'd like to go off course a little bit from the health care reform issue today.

I think today I'm going to touch a little bit on medical personnel roles in the health care field - education level, job responsibilities, etc.... Then I want to wrap it up a little bit talking about the so-called nursing shortage - and my views on that. And in the end, I want to pay tribute to someone special who we recently lost, someone who had a calling to take care of others and did so so very well- in our ER.

I'll start with some of the ground level positions and work my way up the so-called ladder. Although, I don't want to imply that any position is any better or worse than any other position. It's important to remember that when a person is in the medical field, they land either where their heart lies or where they can afford to stay for the time being. That's why it's such a dynamic field - you can play where your strengths are and move around until you find what suits you best.

How many different hands-on patient care positions are there? To name a few, there are CNAs, Orderlies, EMTs, MAs, Psych. Techs., LVNs, Paramedics, RNs, PAs and NPs. Of course, these positions aren't all inclusive. There are still Techs in other departments - Radiology, PT, OT, Pharmacy, Cashiers, Clerks, Volunteers, etc... We all need each other to take care of patients.

I'll touch base on a few of these positions and their roles.

I suppose the entry level for many new people to the health care field would be the CNA - Certified Nursing Assistant. This is a very difficult job to do and one that requires a very special kind of person. These are the people who are most in touch with the patients - those who work at the bedside, taking vital signs, feeding, bathing, dressing and toileting patients. Although the hourly educational requirement isn't that high -usually around 75 + hours of classroom and clinical training - interpersonal skills are very important. I remember many a time a CNA saved my butt on the floor - coming to me to alert me that something was wrong with one of my patients.

Orderlies, though few and far between anymore, have similar educational requirements and job responsibilities of the CNA. Because a lot of orderlies are males, they also have the added responsibilities of working with equipment and lifting the patients. Ouch, my aching back.

Next we'll go to the pre-hospital side of the fence, the EMT, Emergency Medical Technician. The EMT certification class is usually around 140 hours of classroom, clinical and field training. EMTs in the field have varying tasks depending on what state you live in, where you work and how rural an area you live in. EMTs in the hospital mostly do task-oriented noninvasive procedures - splint applications, dressings, EKGs, lab draws, etc... EMTs in the field usually ride in the back of the ambulances and take care of the patients or assist the paramedics. Tasks may include splinting, dressing wounds, oxygen administration, spinal immobilization, CPR, etc... Many times, they are firemen or police officers as well. This field is very close to my heart. It's where I started - where the medical bug bit me. One summer I decided to take this class just for the fun of it. I thought it would be a great place to meet guys. True. I didn't even like blood, or couldn't imagine taking care of people, but that sure changed fast. It made me want more.

MAs - Medical Assistants again are an integral part of the health care team. Most vo-tech colleges and some nursing schools have MA classes. They can either go for a year - or two years and earn their Associates Degree. These are the people that usually work in clinics and doctor's offices. They are the ultimate assistant. They answer phones, schedule appointments, assist with billing, put patients in rooms, take vital signs, etc.... They can also do other tasks as long as they have been taught those tasks and the doctor they work for assumes responsibility for those tasks- ie) medication administration, blood draws, assisting with procedures.

Now, let's move over to another specialty field - Pysch. Tech. The educational requirement for these licensed personnel is usually around 1500 hours. This is a parallel field to a LVN/LPN with more emphasis in mental health. These people work in psychiatric facilities, spending time daily with the patients, handing out trays, doing classes and activities with the patients and looking out for the patients' ultimate safety when they're out of control.

Next, we'll move on to the LVN or LPN - Licensed Vocational or Practical Nurse - depending on which state you live in. The LVN actually has a license as well and is ultimately responsible and accountable for their actions. LVN School is usually 14 months long and includes classroom and clinical hours. LVNs have different roles in different states. I personally worked in 4 states as an LVN and each state is very different. In most states, LVNs do bedside nursing, have their own teams and are pretty much independent in their duties. There are some restrictions on medication administration - they can't do initial assessments, care plans, IV push or titratable medications. In California, the LVN role is more limited. LVNs usually work in clinics and doctor's offices as assistants. They usually work along side RNs doing more task oriented skills.
Some hospitals do use them at the bedside. Most patients don't realize there is a difference between LVNs and RNs.

Now back to the pre-hospital field. Paramedics, again, have different roles in different states. Some work in doctor's offices doing cardiac tests, some work in ERs or out of ERs as first response personnel. In big cities, paramedics usually run with the fire departments or private ambulance companies. Their course which includes classroom and clinical training varies from state to state again - usually anywhere from 600 - 1500 hours. Their skill levels are somewhere between a LVN and a RN - they can pretty much do everything a LVN is licensed to do, some things a RN is licensed to do, plus they can do advanced emergency procedures, airway management, intubation, needle decompressions, etc.. These people are usually the true adrenaline junkies. There is a high rate of burn out in this field due to all the tragedies they see.

OK, back to home base for me again. On to the RN - Registered Nurse. Now this is probably one of the most diversely educated and employed career of the bunch. RN's work everywhere - public health systems, schools, clinics, doctor's office, psychiatric facilities, hospitals, skilled nursing facilities, home health agencies; they work for private home care companies, private ambulance companies, air transport companies, the American Heart Assn., the American Red Cross, the military, the Motion Picture industry, private employers, etc.... There are so many endless possibilities out there for RNs. The education levels vary as well. You can go through a Diploma program, get your 2 year Associates degree, 4 year Bachelors degree - actually you can also have your Masters or Doctorate in nursing as well. One of the really nice things about nursing is you can find your own little niche, you can move around until you find what you really like, what fits you best. RNs have their own license and a lot of responsibility and accountability for their actions. They are the bedside nurse, the educator, the task oriented person, the assistant to the doctor. They often do research work or even work for the insurance companies. They are the telephone triage nurses. You see them, well, us, everywhere.

And when you want to move further up the ladder, you can - you can become a Nurse Practitioner, a Physician's Assistant or move into Administration or Education with your Master's or Doctorate Degree.

I think that sums up the roles and educational requirements. I hope I didn't put everyone to sleep - at least not yet.

Now, I want to talk about the nursing shortage - or what they call one anyway. Weigh in with me - do you really think there is a nursing shortage. I just listed all these positions - how can there be so many different positions -and be such a nursing shortage.

Well I may be wrong, but I have never really thought there was truly a nursing shortage. I've worked in 4 different states. They're all cranking out many, many classes of new graduate nurses. And nursing is a long career - well potentially anyway. You can be a nurse for 40 years at least - if you want. I've always felt like there are a lot of nurses and ancillary medical personnel. I just don't believe that we all stay in the field. I think we come and go as our lives change so that we can live our lives around that career. It's one that's easy to go in and out of. The pay is good. The hours are fairly flexible. I also am of the belief that facilities just can't afford to hire - or choose not to hire as much staff as they need. We've all worked in facilities where our ratios are ridiculous. I hope the days are gone on the floors where you're 7 - 10 - 15 patients to 1 nurse. It's not safe and I don't believe that it's that way too many places anymore. We all work short for one reason or the other - sick calls, vacations, budgetary restraints. And because of this, we lose a lot of nurses because they're just too overworked, stressed out and just plain tired. They feel under appreciated and choose to change careers. Such a shame we can't covet what we need the most - caring, trained and diligent patient care personnel. People taking care of people.

So they say we're in big trouble as time goes on, as we baby boomers become old - and as the nursing schools don't have enough funding or teachers. So what do you guys think? Is there a shortage - for real - or is it all just a figment of the countries imaginations?

And lastly, I just want to say nurses are not just numbers, we can't easily be replaced with the next one, any one - sometimes contrary to some people's beliefs. Once you find one or two or as many as you can find, you need to nurture them, connect positively with them, shower them with respect, listen to their concerns, and yes, complaints. You need to encourage them with positive reinforcement to get them to the next step. And sometimes, you need to pick them up off the floor and give them a hug and a kind word when things get tough. It's what keeps us here. It's what we need to keep going in such a highly charged emotional and stressful field.

And one more thing, we need to take care of ourselves first - before we can take care of our families, friends or patients. When our bodies are so tired and stressed, we sometimes get sick - physically or mentally - and we just can't go on without recharging. We can't minimize this - we must listen to what our bodies are telling us - and we must look out for each other and encourage self-care first. I fear we let one of our down recently - she just pushed herself too far - further than her body could handle. So to you Trisha, may you rest in peace. You had truly found your calling, your niche - you were a great person, a great ER nurse - good to your patients and co-workers alike. You'll be truly missed.

More on health care reform coming up. I've got to get back to reading that bill - next thing you know, there will be another out.

Federal Employee Health Benefits

2009-08-31T10:41:00.001-07:00

OK - here we are again. I took a couple of days off for the weekend and now am back and feeling refreshed. I wasn't sure which way to go next - so I needed to clear my head a bit.

I thought it was important to debunk one of the health care myths - that the Federal Government would be taking themselves out of the new proposed program for health care benefits. I guess some people think that if it isn't good enough for Congress, than why would we think it was good enough for us. Well the easy answer is they're NOT excluding themselves - they've been excluding us for all these years - and with the new plan, we won't be excluded from an affordable choice of insurance plans anymore.

For the past 10 years, I've considered myself lucky. I work for a company that pays 100% of my insurance premiums. Plus, I have low co-pays for my services and no deductible to meet. I'm very appreciative of this and wish everyone would have that choice. And now, they will.
I'm a true believer that all Americans, not just the rich or the lucky, like myself, are entitled to a an affordable health care choice in insurance plans. And if the company I work for can do it, there's no reason that all employers can't do it - even if they need a little help - which they'll get with the new plan in the form of generous tax credits.

So I did a little homework. I googled the Federal Employees Health Care Benefits web page. I can see why it's such a good plan. So basically, after reading a great deal of the House Health Care Bill (I still have a lot more to read.), I discovered that their plan is actually quite similar to the plan I have at work - actually mine is just minimally better.

For instance, if you go on to the site, you can choose the state you live in. Once inside, you can look at the Plans that are available and the costs of the premiums.

I clicked on CA, there are about 10 plans to choose from. I clicked on PA, and again there are about 12 different plans to choose from. Keep in mind you can choose an HMO, PPO, Fee for Service Plan, High Deductible, Standard Deductible, etc..... You can also use your HealthCare Flex Plan. There are a lot of plans and coverages to choose from.

I ended up just picking a plan to research - the one I'm most familiar with - not the most expensive plan, also not the cheapest plan and here is what I discovered.

This particular company had 2 plans to choose from: a standard option plan and a high option plan. Below are some of the plan benefits and the monthly premiums.

Benefit, Standard Co-Pay, High Co-Pay

Office Visit, 30.00, 15.00
Inpatient Admission, 500.00, 250.00
Preventative, 10.00, 0
Medications, 15.00, 10.00
Vision, NA, 25% Discount
Chiropractic, 15.00, 15.00
Tests - Lab, Xrays, 10.00, 0
CT/PET, 50.00, 0
WellBaby, Maternity, 5.00, 5.00
ER, 100.00, 50.00

Now, I don't know what kind of coverage you all have, but I believe this is an excellent plan - much better than most people have. I have been hearing a lot of nightmare stories of people paying 5000.00 - 10,000.00 a year in high deductibles before their benefits even kick in. This is outlandish. How can anyone afford this on a yearly basis?

OK - now let's take a look at the monthly premiums. Again, I don't know what everyone else is paying, but these seem pretty reasonable to me - and let's remember, these do not take into consideration any one's age or pre-existing conditions. There aren't any exclusions.

Family Size, Standard Option, High Option

Single, 280.15, 647.49
Family, 443.28, 1024.53

Also keep in mind, this employer picks up 75% of these premiums. So the following are out of pocket premiums you pay if your employer chooses this option. My employer pays 100% as yours may as well.

Single, 70.00, 162.00
Family, 111.00, 256.00

So tell me, isn't this a heck of a better plan than most Americans are getting?? I would think so. And again, I've been hearing a lot of nightmares out there from my patients, my family and my friends. Just because you may have a great health insurance plan, as I do, remember there are many Americans out there who are filing for bankruptcy, losing everything they have including their homes. And there are many Americans who die or who get a lot sicker than they need to, just because they don't have adequate health insurance at all. These may be the young adults who just think they won't get sick, and choose to buy a car instead of health insurance. These may also be people who just can't afford health insurance, who have lost their jobs because of the horrible economy now. These may be people who are just falling through the cracks. And most importantly, only because I think people are generally unaware of the under-insured population, these are people who actually have insurance, but don't know they aren't appropriately covered. I believe most people think they like their insurance - because they don't use it much - but when they actually have an illness that requires specialized care or hospital admission, they find it doesn't really pay for the bills they incur. I ask you again, shouldn't all Americans be entitled to some basic benefits - especially health care at an affordable rate with an choice that is right for them and their families?

If you don't think so, tell me why. Let's hear your side.

By the way, are you aware that of all bankruptcies filed, 60+ percent are due to a health care crisis, and of those families, 80% of them had health insurance. Interesting !

If yes, pass this blog around, educate people - spend a little time with your friends, families and co-workers so people really now what's going on.

Take a listen to one of the Reality Check videos on the whitehouse.gov website. I've attached the link below - just click on it. It's only 2 - 3 minutes long. It's a question from a regular person just like you or me.

Have a great day. Give back a little in some way today.

Congress did not vote to exempt themselves from reform | Health Insurance Reform Reality Check

2009-08-31T10:05:00.001-07:00

Congress did not vote to exempt themselves from reform | Health Insurance Reform Reality Check

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Electronic Records

2009-08-27T19:51:00.000-07:00

Let's talk about the paperless chart tonight - the good, the bad and the ugly. Which one should we start with? Well since I'm forever the optimist, let's look at some of the good.

Wow - what would it be like if our medical providers had computer access to every patient's medical record, with the patient's permission of course - their medical history, doctor's notes, their medication lists, their lab and imaging reports?? What if every patient had a scanable medical ID card that had their personal information on it - like what insurance coverage they have, who their Primary Doctor is, emergency contact information and maybe even some important medical information like allergies, DNR status, etc...?

Just that in itself would be pretty amazing!

Just think how much money we could save in repeated tests between providers. Not only can we see what prior tests were done, but also the results of each test. Do you know how much money repeated tests cost the patient, the insurance company, the hospital? A lot. If you think this is not a common occurrence, you would be wrong. Every time, we receive a patient from another facility, we repeat, at the very least, lab tests and x-rays - not to mention the more costly tests like CT scans, MRIs and Echos, Treadmills, Angiograms. None of these are cheap.

As someone who works for a hospital that's already went mostly paperless, The electronic chart is pretty wonderful on many levels.

We're saving trees - and lots of them. No more file rooms - everything is online. Whoo Hoo!

It's nice to be able to read everyone's hand writing. How much time have we all spent standing around a nurse's station passing a doctor's order sheet around so that everyone could try to figure out what he/she had written. How many times have we asked the patient what medications they take because we aren't quite sure what the doctor wrote. This has always been a huge safety issue.

It's also great to be able to see when a patient's lab tests and imaging reports are back so that we can let the patient know - as well as the doctors so they can continue with their patient's care.

Plus the little conveniences of just being able to enter anything in the computer and it's just right there in front of us - an order goes right to the lab, x-ray, the kitchen, other departments. We write the doctor a note. The physical therapist puts their notes in the computer so the doctor can read it right away. No phone calls necessary. We can google disease processes online - print out diets, medication information, discharge instructions, etc.. These are all great time savers.

And maybe the most impressive thing for me about the electronic record - as it should be for everyone - is the amount of medical errors that can be avoided, the amount of people that aren't injured, maimed or killed by a medical error, the money that it would save patients, insurance companies and facilities. I would think, this in just itself, would be a huge cost saving for our health care system. Think of the lawsuits. Multiple studies have shown anywhere from 7,000- - 30,000 deaths occur annually in hospitals alone due to medication and "other" medical errors. Medication errors alone harm 1.5 million annually and cost the Health Care System between $77 - $177 Billion annually. Yikes ! This doesn't even take into consideration the deaths that are caused by hospital acquired infections or medical equipment or supply errors. This is just charting related or medication errors. The electronic record will significantly cut down on these adverse results. The doctor's medication orders now are entered into the computer, they get sent directly to the pharmacy where the pharmacist verifies the medication order. This order goes directly into our medication machine on the unit - the Pyxis. From there, the nurse can only take out medications for that patient - and then the patient and the medication is scanned at the bedside for additional patient safety. The computer tells us if we scan the wrong patient, the wrong medication - and if there is an allergy alert on the chart. Time consuming - yep - but well worth it if it keeps me from making a mistake that could cause a patient harm.

OK - now the bad.

Sometimes the electronic charting has many obstacles - well not just sometimes, but every day and multiple times throughout the day. The carts need plugged in. The batteries go dead. The carts are out of range. The system goes down. We chart on the wrong patient. The medications won't scan. They change the program and don't tell anyone. And there are times when it seems it takes longer to chart on the computer. I'm guessing sometimes the patients feel like we're paying more attention to those darn computers then them. But all in all, we get used to these things the longer we use them. Hopefully, eventually we get more user friendly software programs and better wireless networks.

Then - there's ugly.

I'm guessing that would be the compromising of patient information due to easier access. Of course this is always a concern - and there are a lot of smart people out there who can figure out how to steal private information on computers. And there's also just carelessness on all our parts - leaving our computers unattended. Again, hopefully we all get better at all these things. Maybe eventually all of our records will be encrypted and everyone will carry around a little USB drive that has an key to open the encrypted messages. This could protect everyone's personal information better. As we all know, hospitals, credit card companies, businesses, banks and government agencies have safeguards in place to help protect our privacy.

So anyway, there it is in a nutshell. Did I miss anything - good, bad or ugly??? I'm sure I did. Let me know. Good Night!

A Sad Day for History

2009-08-26T16:08:00.000-07:00

Well here we are again - just sitting down to write a few thoughts.

I think the only appropriate thing to talk about today would be Ted Kennedy - not the death of - but the life of Ted Kennedy - about one of his many causes.

Again, Health Care Reform is just in the forefront of my mind. I just can't imagine anyone today who isn't impacted some way by the inefficiencies of the system. There may be people who settle for the system and they way it works now - but I can't believe, in some way, don't think it could be better - that they wouldn't have to give something else up just to pay a doctor or medication or hospitalization bill.

I was watching Jon Stewart earlier this week - and he was interviewing Betsy McCaughey (She has her PHD in history and particularly the US Constitution.) , a lobbyist against health care reforms during the Clinton and now Obama administrations. First off, she was talking nonsense about the End of Life Issues. But more importantly she actually said - and I mean out loud - that what has changed over the years since 1960 is the amount of "disposable" money people can choose to spend on health care. I think her actual point was that since 1960, families have started to spend less money on food and clothing, a steady amount on housing and therefore this has permitted people to spend more of their disposable incomes on health care. OK - now I think this is surely a flawed concept. Let's just say, some of her words are true - that people do spend less money on food and clothing and more on health care - I would think the opposite - it doesn't permit them to do anything. I believe that because health care costs are rising and people have to pay for them, they can afford to spend less money on food and clothing. And just how sad is that ! Again, I believe this is just one other way some people are twisting words to convince others that Health Care Reform is not needed.

Just another thing to think about.

I'm sure you've heard this quote a million times today and will continue to in the following weeks - but I can't think of anything more poignant or appropriate in times like these.

"The work goes on. The cause endures. The hope still lives. The dream shall never die."

Let's get it done together. Have a great day ! Feel free to weigh in.

2009-08-25T20:05:00.000-07:00

Another day - unfortunately didn't get very far on the House Health Care Bill reading today - only page 50. I'll write more about that after I get a little further.

But let's talk about some of the continued media buzzz - or what I prefer to call it, propaganda, that is circulating on the tube and radio. Shall we call them "The Death Panels" or what they really are - the End of Life Decisions Policy????

Well since there may be some non-health care people reading this blog - let's clarify this a little bit. First off, Pres. Obama didn't mention this in his visionary plan at all. The House bill dedicates 4 - 5 pages of policy with specifics about how doctors/providers will go about discussing end-of-life decisions or life-sustaining procedures with their patients. As we health care providers know, this has already been going on for many years. I consider myself a fairly new nurse, 16 years. Nursing is my second career so I work with many people who have done it much longer than myself. But, for as long as I can remember, all hospitals have been discussing these options with patients. It's a government requirement already - has been for a long, long time. Every time someone gets admitted to a hospital, the patient gets a pamphlet and a doctor asks the patient what their desires are in case something catastrophic were to happen to them.
Do they want CPR, Cardiac Medications, Defibrillation, Intubation, Tube Feedings, Antibiotics or IV Fluids??

By the way, these are only used in cases where a patient is terminally ill. This doesn't mean if you come into the hospital for a sore throat or a hip replacement - and something happens - like a heart attack or stroke - we won't do anything for you. This means that if you are dying of cancer and your heart stops while you're very ill in the hospital, we will respect your wishes if you don't want any more heroic measures done. Or maybe if you've had a massive stroke and you were originally placed on a ventilator and days later, it's determined that you have no brain waves, we could again respect your wishes to have the ventilator removed.

And if the person and or/family change their minds at any time, we then do everything and give them the time they need to work it out.

The only things this bill would add to what we're already doing is:

#1 - There will be a specific policy which dictates the format of education, pamphlets, resources and assistance that will be available to patients.

#2 - The doctor/provider will actually get paid for his consult with the patient - which I believe will allow the doctor/provider to spend more time with the patient discussing these issues.

#3 - The government will keep track of how many patients they consulted with, how many people make living will and when ill, how many living wills are actually abided by.

So in a nutshell, someone will get paid for their time doing what they're already actually doing for free. Simple. Why all the fuss anyway???

So long for now. Sleep tight !

HealthCare Reform

2009-08-24T16:51:00.001-07:00

OK - so here we go.

Last night I finished reading Pres. Obama's Health Care Reform Bill. It was a pretty easy read - 167 pages.

So far, so good - tell me what you think !

For me - the good points are as follows:

I can select my own doctor. I can keep my old plan.

If you have Medicare, Medicaid, Tricare, VA, CHIPS or the Federal Employee Health Plan, you keep that too.

The government can not dictate what happens between me and my doctor. Yep it actually is written into the bill.

No Pre-existing Condition Clause
No Dropped Coverage for being Sick or Losing my Job
No Annual or Lifetime Limits on How Much my Illnesses Cost
A Limit on How Many Out of Pocket Dollars I Spend Annually
Children can be on their Parents Coverage Until they're 26
No Illegal Immigrants Covered
A Big Tax Credit for Employers paying for their Employees Coverage
Money Assistance for Low Income Individuals/Families so they can Afford Coverage
It doesn't Interfere with Union Contract Benefits to Employees

Any Individual or Company can Choose to Enroll - or Not Enroll in the Insurance Co. Exchange

States Can Run their Own Exchanges if they Want and if they Meet Certain Rules

And a New Focus on some Important Things in my Nursing World:

A Focus on Discharge Planning, Chronic Condition Management, Free Wellness and Prevention Services, Best Clinical Practice Standards, Electronic Records, Prevention of Hospital Re-admissions.

And Support for a New Program - Community Living Assistance - to Help the Elderly with Activities of Daily Living. This would mean more money for Custodial Care - which is not covered now.

Anyway, as I see it, it's a pretty good bill. All positives in my mind.

Well maybe one scarey thing - CHANGE - and alot of it all at once. I think that's what we all voted on in the last election - well, at least a big majority did. We need change.

I know it's scarey - but it has to start somewhere. The Health Care system is breaking down - it's been happening for years and it will only get worse. I know I sure don't want to be without insurance in 10 - or 15 - or 25 years. I want to be covered and covered well - just like my parents and grandparents.

How about you??? Let me hear your comments, opinions, complaints ! Have fun with it.

So What's on Your Mind Today? For me, it's This !

2009-08-23T22:31:00.000-07:00

Hi there -

Well for me today is the first day of my Blog - so that's what's on my mind today? How about you?

I'm coming here, to hopefully, encourage some discussions on my life, your life, current events - anything that's on your mind today. So help me launch it.

Tomorrow, I'm going to talk a little bit about the Healthcare Reform Bills - I'd like everyone's opinions, thoughts, feelings, misconceptions and clarifications.

Thanks