on this.

With only a few days left until the Affordable Care Act enrollment deadline, The White House pulls a brilliant stunt, featuring a selfie stick, of course.

Post by BuzzFeed Video.

on the potential of technology to revolutionize healthcare or perpetuate inequality

The past two weeks have been crazy (in a good way) for me. I had midterms and new responsibilities in my internship, finished my BA thesis draft, and of course I've been hard at work on my personal health initiatives (which you can follow more on here or on Instagram at @fitgirl_rachaeln). This was all a long-winded way of saying, sorry!! But I'm back and I do have a cool story and accompanying opinions to share today though.

For those of you who are iPhone users, I'm sure you've noticed your Apple Health app. If you're anything like me, it basically serves as a pedometer. But an article in the New York Times last Thursday suggests it may soon be much more than that.

At least 14 of the nation's best hospitals have been testing out pilot programs that use Apple HealthKit as a means of checking up on patients remotely. Using the app, doctors would be able to monitor weight, blood pressure, heart rate, and other relevant conditions in patients with chronic conditions for whom constant hospital visits are not convenient.

The possibilities of this program and those like it would be revolutionary, especially from a healthcare policy and economic standpoint. With daily information, medical professionals could keep patients more accountable and could use the tracking information to warn patients about their statistics before they enter the hospital. This could help reduce the constant, costly re-hospitalizations many patients with chronic conditions face and that are an economic burden on hospitals.

In the past, I've refrained from mentioning my personal healthcare philosophies on this blog, mostly in the interest of keeping it informational. However, if there is any one area where I think American healthcare needs to focus on ASAP, it is preventative medicine. As new technological developments enable computers to do many of the routine tasks humans used to do, it provides fantastic opportunity for implementing preventative measures.

I recently complete a research project where I went over patients who were coded, by a computer for billing reasons, for having chronic kidney disease (CKD) but who had not been diagnosed with CKD by their doctor during their visit, either because they didn't tell their doctor or because no one checked (maybe they came in for a broken leg, etc. and CKD wasn't on the doctor's radar as a possible cause of the infliction). The computer system analyzed the blood work and found the patients had creatinine levels and a glomerular filtration rate (GFR) suggesting they had chronic kidney disease. Though CKD is treatable, many of these patients end up either being rehospitalized, or even dying, from their condition because they don't seek treatment.

An effective use of technology here could potentially prevent these rehospitalizations and save lives. If a computer is able to identify CKD status by itself already, it could likely be programed to scan creatinine levels and GFRs from previous visits to determine if this patient truly has a chronic condition (which was my job as a research assistant). It could then also likely alert patients and medical professionals to look into the issue. Additionally, technology provides a mechanism for doctors to check in on patient compliance, to see if they're attending dialysis appointments, losing weight, eating right, without patients having to constantly visit the hospital. This would be invaluable considering how difficult it is, for a variety of factors, for patients to make numerous trips to the hospital. And you don't have to have an MD or PhD to figure that the harder it is for a patient to comply, the less likely they are to do it.

Yes, technology is causing us to strain our eyes and necks and wrists as we text and type all day and night but I see amazing promise through proper design and implementation of technology that can assist with preventative medicine. I see Apple Health are just one of the first steps in the right direction.

However, Apple Health alone is not the "future" of medicine.  As I have seen in my research, the patients who are least likely to comply and could most benefit from these programs—i.e. those patients who are older, or of low socioeconomic status, or who live in rural areas far from hospitals—are also least likely to own an iPhone and other Apple technology. Apple HealthKit will likely just allow doctors to better serve the wealthy, who are generally healthier, live closer to hospitals, and/or are more likely to be aware of any conditions and how to treat them and thus will only revolutionize healthcare for a small portion of Americans who the system already serves pretty well.

The only way that this is truly going to offer a turning point in the American healthcare industry, which like our education system, has a major gap between poor and rich patients, is if we develop affordable technology that doesn't just cater to our wealthier population.

Technology provides us the opportunity to better serve our lower classes, older population, and citizens with chronic conditions reducing the costs of Medicaid, Medicare, and rehospitalizations. Now it's up to us to demand it and for our government, insurance companies, innovative biomedical engineers, and technology giants to make it happen.

on whether or not baby boomers are baby doomers

The biggest concerns about Medicare currently is the 65th birthdays of the Baby Boomers, the generation born between 1946 and 1964. As mentioned previously, at 65 years old, American citizens qualify for Medicare. The system operates based on the notion that those currently paying into the system—younger, employed workers—will pay for the Medicare costs of the older retirees.

The problem the baby boomer generation poses is that it is a massive generation. Like 76 million people massive.¹ And, to put it bluntly, elderly healthcare is expensive. Bone and joint replacements, medication, and hospice, among other medical needs, make the last decade of life the most expensive. Come 2029, 57% of the population (that's 6% less than in 2011) will be paying into Medicare while 20% (up from ~13 from 2011) will qualify.² Plus, retiring baby boomers means a loss of many experienced medical professionals as well. A government report began circulating that Medicare funds would be exhausted by 2024, raised to 2026 the following year.³

The emergence of these statistics a decade ago caused a state of alarm that today is still echoed in the media from time to time. It seemed inevitable that in order to maintain the Medicare and Social Security budgets, there would need to be either a tax increase for the 18-65 age group or a benefit decrease for the 65+ age group.

However, since 2011 when the first cohort of Baby Boomers turned 65, there has been a deceleration of growth in Medicare spending. In 2012, Medicare spending grew by 4%. In 2013, despite approximately 3 million Baby Boomers became Medicare qualified, spending grew only 3.4%.⁴ Part of this has been contributed to the Affordable Care Act and another part to the inflation of healthcare finally slowing down after a 50 year uptrend (read about that here).

Additionally, the statistics being thrown around are all about the Medicare hospital trust fund, which, yes, is predicted to only be able to cover 85% of expenses in 2030.⁵ The other parts of Medicare are not paid for by trust funds but rather by general revenue and premiums enrollees pay. Therefore, they're not going anywhere.

Bottom line: The Baby Boomers are not going to become Baby Doomers. Medicare depletion is not imminent crisis, though Congress is going to have to come up with a plan for long-term balance, such as government-paid prescription discounts or a way to prevent a return of healthcare inflation.

Have a healthcare question you want answered? A topic you want addressed? Email whatthehealthnow@gmail.com!


1. Vainisi, Mike. "The Quiet Way America Will Really Change in 2015." Attn:. Our Time Media, Inc., 22 Jan. 2015. Web. 25 Jan. 2015.
2. Barr, Paul. "The Boomer Challenge." Baby Boomers Will Transform Health Care as They Age. Hospital & Health Networks, 14 Jan. 2014. Web. 24 Jan. 2015.
3. "Trustees: Baby Boomers Will Exhaust Medicare Trust Fund By 2026." CBS DC. CBS DC, 31 May 2013. Web. 25 Jan. 2015.
4. Leonard, Kimberly. "Health Spending Has Lowest Rate Increase on Record." US News. U.S.News & World Report, 3 Dec. 2014. Web. 25 Jan. 2015.
5. Miller, Mark. "The Truth about Social Security and Medicare, Straight from the Trustees." Reuters. Thomson Reuters, 29 July 2014. Web. 25 Jan. 2015.

on medicare and medicaid

I thought this week I'd return to going over some of the basics of American healthcare, the definitions of the things that are in the news week after week. Since Marilyn Tavenner, the head of Medicare who also helped roll-out the health care reforms in 2013, just announced that she will be stepping down in February, it seemed a good of time as any to talk about what these two programs are and how they differ.

**Please note this is only a condensed description of each program and there are many more complexities than listed below. So, as always, I suggest further research to supplement my introduction.**

Medicare

Founded in 1965 by President Lyndon B. Johnson under the Social Security Act Amendments, Medicare provides health insurance to American citizens 65 and older as well as people with disabilities or end stage renal disease. Interesting to note on the day before MLK day, this Act also promoted racial integration by denying payment to hospitals and physicians that didn't comply with desegregation. As a result, over 1,000 hospitals integrated both their staff and patients within four months¹.

It's also important to note Medicare doesn't take into account income and pre-existing conditions--healthcare speak for previous chronic illnesses or other medical conditions that a patient had prior to obtaining the insurance--when setting rates and generally covers around half of the medical costs of those enrolled.

Medicare is broken down into 4 parts called A, B, C, and D:

A: Covers hospital costs (room, food, tests) up to ~90 days and hospice for those who have been diagnosed with less than 6 months left to live

B: An optional service that provides some assistance with outpatient services not covered by Part A. This could be things like canes, walkers, dialysis, x-rays, just to name a few. Plan B is optional for those who are currently covered by their employer who whose spouse still is.

C: Added in 1997, Part C is all about the Medicare Advantage plans. Through this system, beneficiaries, or those enrolled in Medicare, partake in a plan similar to non-Medicare HMOs and PPOs (if you need a reminder about what those are, click here). Enrollees receive the benefits of Part A and B, but agree to a limited network of physicians near their permanent residence and generally pay a premium (refresher on this can be found here as well).

D: In 2006, Part D was added which covers prescription drugs for Medicare Part A & B enrollees. Part D operated by private companies and, like Part C, is an opt-in service. What one's specific Part D plan covers is variable, and can be limited geographically, by drug type, etc.

Taken from: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/

It's important to note that Medicare does not cover 100% of the costs for beneficiaries but it does provide assistance for senior citizens that have paid into the system during their working life to help manage hefty end-of-life costs. This has become increasingly controversial as the baby boomer generation turns 65, leaving our smaller, younger population to cover the costs of the system. But this will be a topic for another post.

tl;dr-the federal health insurance program the United States provides for citizens 65+ as well as disabled younger Americans or those with end stage renal disease.

Medicaid

Along with Medicare, Medicaid was also introduced through the Social Security Amendments of 1965 with the intention of helping states provide health insurance assistance to low income individuals and families so they can afford primary medical needs. Though states still have individual policies regarding what qualifies for Medicaid, and some do not provide any at all, they must still abide by federal Medicaid laws regarding eligibility, distribution, and service coverage. Thus, Medicaid, unlike Medicare, is not entirely federally funded.

Because Medicaid varies sometimes greatly between states, it's hard to give a very in-depth overview of what it provides. However, general it covers low income residents of all ages, as well as those who are disabled without previous work experience.

Taken from: http://www.cbpp.org/cms/index.cfm?fa=view&id=2223

Most Medicare programs operate through managed care programs in which Medicaid qualifiers are put into private insurance plans that cover most or all of their healthcare costs. The premiums of these plans are then paid for by the state. Thus, unlike Medicare, Medicaid is a social welfare program rather than a social insurance program and, accordingly, offers a lot more services.

tl;dr-the federal health insurance program for low-income Americans

To put Medicare and Medicaid spending into some perspective of general American health care spending:

A graph of federal spending on Medicare & Medicaid versus general healthcare expenditures, taken from a 2012 report from the Center of Medicaid and Medicare Services (CMS) that can be viewed here: http://budget.house.gov/uploadedfiles/fostertestimony_2-28-22012.pdf.

And also general federal spending:

Taken from: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/

Hopefully, this gives you a better idea about the similarities and differences of the two programs. I'll be back next week to discuss some of the controversies of these programs. Until then, enjoy the three-day weekend most of us have and don't forget to remember why we don't have class/work on the third Monday of every year.

Have a healthcare question you want answered? A topic you want addressed? Email whatthehealthnow@gmail.com!

1. Vladeck, B. C., Van de Water, P. N., Eichner, J., & National Academy of Social Insurance (U.S.). (2005). Strengthening Medicare’s role in reducing racial and ethnic health disparities. Washington, D.C.: National Academy of Social Insurance. Read in its entirety at: http://www.nasi.org/sites/default/files/research/Strenthening%20Medicare's%20Role%20In%20Reducing.pdf

on the shortage of physician residencies

As my fellow college seniors receive responses to their medical school application and "match day," the day medical students hear back about residency placements, approaches, I think it's especially crucial to discuss a factor of a poignant concern of American healthcare today: the physician shortage.

During "match day" last year, the Association of American Medical Colleges (AAMC) found that hundreds of medical students did not get placed into residency positions due to a cap on the amount of federal funding available for residency programs. Though medical schools have been increasing their admissions to account for the United States physician shortage, and more students are entering DO programs or are applying for American residency from accredited international programs, Congress has not raised the cap on the amount of federal funding provided for the required residency training programs for the past 17 years. As a result, there are fewer residency positions than medical school students. And, since residency is a requirement of becoming a practicing physician, this shortage of available spots means getting into med school and graduating from med school, after which you are officially earn the title of Dr., may not be enough to actually be a practicing physician in the United States.

Source: https://www.aamc.org/newsroom/keyissues/physician_workforce/

While anyone who knows anything about the MCAT or USMLE can lament for those med students who fail to place, the public policy concern is the fact that a stagnant number of available residency spots over the past two decades is contributing to an overall shortage of American physicians relative to the growing American population. According to the AAMC, one-third of the nations doctors are set to retire in the next decade, leaving us with a shortage of 90,000 physicians, both in primary care and specialities, by 2020¹ and a shortage of 130,600 by 2025¹.

The main issue currently is not that medical schools are sending too many rejection letters (sorry, friends) nor that there is a dearth of applicants. It is that Congress is not providing adequate funding for proportional expansion of residency programs.

And, sure enough, bills have been proposed to Congress that request a increase in the number of residencies (my search of Congress.gov found over 17,000 bills relevant to "Resident Physician Shortage" since 1999, though I didn't look through them all to confirm their relevance).

As of now 26,000 residency positions are available, which will not be enough to cover the students graduating from American medical schools and entering their first year of residency in 2016³  unless Congress raises its cap on the number of residency positions and increases funding accordingly. And does so quickly.

Have a healthcare question you want answered? A topic you want addressed? Email whatthehealthnow@gmail.com!

1. Kirsch, Darrell G., M.D. "AAMC Remains Concerned About Shortage of Residency Positions Despite Successful Match Day." AAMC Remains Concerned About Shortage of Residency Positions Despite Successful Match Day. American Association of Medical Colleges, 21 Mar. 2014. Web. 11 Jan. 2015.
2. Grover, Atul, M.D., Ph.D. "GME Funding and Physician Workforce." GME Funding and Physician Workforce . Association of American Medical Colleges, n.d. Web. 11 Jan. 2015.
3. Ibid.

on the best ways to be healthier in 2015

New Year's Resolutions always seem to be focused on losing weight. Admittedly, I even said a few days ago that was my resolution as well. However, "lose weight" resolutions should be about being healthy. I don't mean to discredit wanting to look good: building self-confidence is an absolutely spectacular healthy goal. But the focus here should really be about changing bad habits and improving overall wellness.

Below I list my top 6 healthy practices everyone should be focusing on in 2015. They're not magic weight loss regimens, but they will make you feel better, help you accomplish more, and build health habits that are sustainable for life. (Bonus: They probably will help you shed some pounds as well.)

1. Catch your ZZZs (but not too many)

If I had a nickel for every friend of mine in college who told me, "I thrive on like 4-5 hours a sleep," I'd be able to buy an inflatable mallet to whack them on the head with. No! It's just not scientifically accurate. Full grown adults should be getting 7-8 hours of sleep per night and children 5-17 should be getting 9-11 hours.¹ This number increases if you are pregnant, have been previously sleep deprived, or are not getting quality sleep (which you likely aren't if you're playing on your computer, exercising, or drinking alcohol before bed.

Those who skimp even by 20 minutes under the optimal sleep number (7 hours) have impaired mental and physical performance the next day compared to those who don't. Sleep no less or more than 7-8 hours a day is connected to health problems such as diabetes, obesity, cardiovascular disease, as well as cognitive impairment.

To learn more, visit these sites:

National Heart, Lung, and Blood Institute (part of the NIH's) guidelines: http://www.nhlbi.nih.gov/health/health-topics/topics/sdd/howmuch

Why Seven Hours of Sleep May Be Better than 8
http://www.wsj.com/articles/sleep-experts-close-in-on-the-optimal-nights-sleep-1405984970

Connections between Sleep and Health 
http://healthysleep.med.harvard.edu/need-sleep/whats-in-it-for-you/health

Connections between Sleep, Learning, and Memory 
http://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/learning-memory


1.National Heart, Lung, and Blood Institute. "How Much Sleep Is Enough?" National Institutes of Health, 22 Feb. 2012. Web. 02 Jan. 2015.

2. Drink more H₂O

The general guideline is that we should be drinking 8 cups (64 oz) of water a day, but I'm just gonna leave this here...

To learn more, visit these sites:

Water: Meeting Your Daily Fluid Needs:

http://www.cdc.gov/nutrition/everyone/basics/water.html

Water: How Much Should You Drink Every Day?:

http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/water/art-20044256

Water, Hydration, and Health (a more technical document):
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908954/

3. Eat out less, cook more

Restaurant food is full of sodium and calories. Portions are often far larger than they need to be and as a result we, the restaurant patron, tend to over eat. Easily cut out calories and still have a satisfying, filling meal by cooking yourself! I find that beyond the taste of the food, cooking it myself leaves me more satisfied with less food than I get in a restaurant.

To learn more, visit these sites:

Larger Portion Sizes Contribute to U.S. Obesity Problem:
http://www.nhlbi.nih.gov/health/educational/wecan/news-events/matte1.htm

Drexel Study Finds an Entire Day Calories Saturated Fat and Sodium in an Average Restaurant Meal:
http://drexel.edu/now/archive/2014/January/Restaurant-Meals-Unhealthy-Choices-Study/

4. Make processed foods "sooo 2014"

Ugh, I know. We're busy and processed foods are so easy. But you know what they're not easy for? Your body.

Processed foods often are chocked full of sugar, sodium, fats, and preservatives and are designed in labs to be...well...addicting. However, processed foods have much less nutritional value than fresh food. And I'm not just talking Twinkies here. White flour pasta, canned foods-these are all processed foods just like packagd cookies, and crackers, and frozen meals. 

Cutting out, or at least reducing your consumption of, processed foods and instead turning to fresh veggies can drastically improve your health and 

To learn more, visit these sites:

The Extraordinary Science of Addictive Junk Food:
http://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html?pagewanted=all&_r=0

Is Processed Food a Pandora's Box for the American Diet?:
http://www.pbs.org/newshour/bb/health-jan-june13-food_04-29/

5. Move it, move it

Okay, so  this may be the most obvious one. We hear it all the time. Exercise more! But really, it is so so so important, for so many reasons far beyond weight control. Cardiovascular exercise and strength training improve blood pressure, mood, energy and can help stave of diseases like osteoporosis and type 2 diabetes, even cancer. And I'm not even talking about running half marathons every month or hitting the gym for 2 hours each day. Just parking further away in the parking lot, taking the stairs, or walking during your lunch break can make a difference. 

To learn more, visit these sites:

Exercise: 7 Benefits of Regular Physical Activity :
http://www.mayoclinic.org/healthy-living/fitness/in-depth/exercise/art-20048389?pg=1

The Benefits of Physical Activity:
http://www.hsph.harvard.edu/nutritionsource/staying-active-full-story/

6. Eat  s   l   o   w   l   y

This is a highly undervalued healthy habit. Chewing our food is the first step of digestion. The more we chew, the longer & slower we eat, the less food we will have consumed by the time our belly sends our brain the "I'm full!" signal.

So how much should you chew? About 40 times seems to be the consensus.

To learn more, visit these sites: 

Study Finds Additional Chewing Reduces Food Intake in Young Adults:

http://www.news.iastate.edu/news/2012/apr/chewing

What are the benefits of chewing food properly?:
http://www.livestrong.com/article/450220-what-are-the-benefits-of-chewing-food-properly/

Chewing Food FAQs:
http://www.berkeleywellness.com/healthy-eating/food/slideshow/chewing-food-faqs


Good luck on all your resolutions! Hope you keep these in mind going forward. Here's to a healthy, happy 2015!

Have a healthcare question you want answered? A topic you want addressed? Email whatthehealthnow@gmail.com!

on new year's resolutions

So, I know it's not Sunday, but I'd like to talk a bit about New Year's Resolutions, or just about goals in general.

Goals are great. Goals are necessary. They can help you be more motivated, more productive, and more accomplished. So, in many ways, goals are healthy, and thus relevant to this blog.

I know there are a lot of mixed feelings out there about New Year's Resolutions. And, it's true, you should always have goals, not just at the start of the New Year. But January 1st can be a great time to reevaluate your goals, which is important, valuable, and effective.

But where people go wrong is that they make big, sweeping, general goals that have no direction or strategy or heart behind them, and as a result they're never accomplished and next January 1st they end up back on the list. One way to prevent this is by setting S.M.A.R.T goals Note: I did not come up with this acronym. But I do use this method both in my work and personal life.

S.M.A.R.T stands for

Specific

Measurable

Achievable

Results-Focused

Time-bound

So if a typical goal would be "lose weight,"  a S.M.A.R.T goal would be "Lose 15 pounds by April 1st, 2015." The S.M.A.R.T. goal is specific in that the number of pounds one wishes to shed is clarified. It is measurable in that I can step on a scale and see if I've accomplished my goal (and check my progress along the way). It is achievable that I am not expecting to move mountains. I am simply hoping to lose about 1.25 lbs a week for 12 weeks, a medically-sound and reasonable number. It is results-focused in that the goal is measuring an outcome. And it is time-bound in that it has a specific deadline. 

What makes them so effective is that S.M.A.R.T goals come built in with accountability and a plan-of-action. By setting your goals S.M.A.R.Tly, you've already given yourself a huge advantage because you've made your goal possible and put yourself in the mindset that you can do it. When a goal is too vague, you can easily push it off, deem it impossible, or have no way to know when it is finished.

Next, I suggest you put your goal(s) somewhere you can see it (them). This can add that extra layer of accountability and ensure you don't lose track of your intentions as January 1st becomes January 2nd, then 3rd, then 4th, and so on. I am going to put mine right here for that exact reason.

1. Lose 27 lbs September 24th, 2015.

2. Finish 52 books by December 31st, 2015.

3. Post 1 blog post per week on Sundays. 

4. Read 10 articles (scientific, economic, or news) per week.

You'll be able to keep up with my progress on at least the first 3. 1 will be documented in my "Personal Health Initiatives" up there at the top. 2 will be tracked on Goodreads. And 3, of course, will be right here! Check back on Sunday for that post I have promised and in the meantime, set your own S.M.A.R.T goals!

Have a healthcare question you want answered? A topic you want addressed? Email whatthehealthnow@gmail.com!