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!

on the rising costs of healthcare, moral hazard, and what this means for you (and the entertainment industry)

Last week, we talked a bit about the basic health insurance vocabulary you gotta know. This week, we're going to make some use of what we learned to better understand a current economic phenomenon.

One of my favorite concepts in health economics is moral hazard–the idea that someone is more likely to undergo a costly or risky situation if they know they are protected by against the cost/risk because someone else will be footing the bill. Putting this in healthcare terms, if you know you have a great coverage plan, you are more likely to seek medical care, or visit the doctor for a sniffle, or undergo expensive but questionably necessary procedures. This is because the cost to you will be severely reduced from what it otherwise would have been because of your insurance coverage.

Moral hazard is a tricky lil bugger, not because it's particularly hard to understand, but rather because it's hard to overcome. One of the ways insurance companies (or employers) are dealing with the rising American healthcare spending is by raising the out-of-pocket costs, mostly deductibles, for consumers and thus reducing the moral hazard that results from healthcare coverage. Thus, we've seen a reduction in the rate of healthcare spending (finally), which helps reduce the federal deficit. However...

These increasing out-of-pocket costs¹ are causing some people to avoid even routine healthcare altogether. They're also having an effect on other markets–Americans are spending less on entertainment, retail, and childcare. ² This only makes sense. If Joe Schmo's bank account were a pie, when the slice that is his out-of-pocket healthcare spending increases, there is less pie available for other expenses.

Healthcare in the United States is expensive, but necessary. While you may not be able to control an increase in your deductible, you can shop around for a reliable doc, research procedures to determine their necessity, and practice preventative measures (washing your hands regularly, eating well, exercising, sleeping!!!) to keep costs low. To start the New Year right, next week I'll discuss some best practices for staying healthy [thereby avoiding hefty healthcare spending] and happy in 2015. And since I won't see you until then, Happy New Year!

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

1. Increased costs of mobile phones are also contributing to the reduced spending in other markets.
2. Knutson, Ryan, and Theo Francis. "Basic Costs Squeeze Families." Wall Street Journal. 1 Dec. 2014. Web. 27 Dec. 2014.

on health insurance 101

Not all health insurance plans are alike. And in order to truly pick the plan that is best for you (or to understand your current plan), it's important to know both a.) what each type of plan entails and b.) what else is out there.

There are three main categories of health insurance plans:

Health Maintenance Organization (HMO)

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

PPOs, followed by HMOs, are the most common type of coverage. So how do they differ?

Under an HMO, you first choose a Primary Care Physician (PCP). This PCP is your home base, so to speak. He or she will need to refer you to any specialists you may need within a network of pre-selected providers. So, let's say you have been having terrible foot pain. You'd first see your PCP, who would refer you to a podiatrist within the network. These network providers, i.e. doctors who have opted to participate in the specific plan, are the often the only ones your insurance will cover visits to. Usually, visits to out-of-network providers will not be covered.

PPOs give you a bit more flexibility in that you don't have to go through your PCP and you are welcome to visit service providers outside of your network. However, out-of-network providers will be at a higher cost, such that you will pay more out-of-pocket if you choose to go outside of your network (hence the origin of the "preferred" part of preferred provider organization). Additionally, you will likely have to pay a deductible during your visit.

Okay, let's pause here and go over the vocab of what consumers pay out-of-pocket. I just mentioned a deductible. This is the amount you pay yourself before your insurance coverage. Once you've paid 100% of your deductible, your insurance plan will cover the rest. In the case of a PPO, seeing an out-of-network provider means you will have to pay a higher deductible.

This premium is your periodic payment into the health insurance plan. Generally, your premium and deductible are inversely related: a higher premium means a lower deductible, and vice versa.

In addition to the deductible and premium there is also a copay. This is the flat rate amount you pay during doctors visit or for prescriptions. For example, on my plan, when I go in for my annual physical, I pay $10 copay during my visit.

Last but certainly not least, there is the coinsurance payment. This is the amount you pay after your copay and deductible and after the insurance company has paid their portion. If my coinsurance is 20% of remaining fees after the deductible, I pay the 20% of the bill that is left once my deductible is paid and my insurance pays their 80%.

Okay, let's move on to EPOs.

EPOs are like PPOs in that you usually don't need a PCP referral, but similarly to HMOs, out-of-network providers are not covered, unless in cases of emergencies.

HMOs, PPOs, and EPOs are only the most common plans, not the only ones available, and the details of each vary a bit based on your specific insurance provider. What works best for you complete depends on what is available through your employer, what you personally can afford, or your personal necessities. If you are rarely sick or injured, a plan with a low premium and high deductibles may work better for you. If you're really into extreme sports and breaking bones, you should probably look into a higher premium that gives you a lower deductible.

Hopefully, this post has given you a little better understanding of health insurance jargon and the most popular plans available. However, if you're picking a new plan, it is still up to you to research what specific plans are out there (and available to you) and to decide what works best for you.

Alright, that's enough for now. Go get back to your families, enjoy your holidays, and check back in next Sunday for a new post!

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

on the unveiling of fluff & stuff 2.0!

I had mentioned previously that the blog was going to be receiving a makeover. I'll be kicking off the new era of Fluff & Stuff with this post. But first, a little background on the who, what, and why...

Who: I am two academic quarters away from B.A.s in Biology and Public Policy, but my main focus for the past year or so has been healthcare policy. In addition to my coursework, I have worked closely with doctors and nurses in the hospital setting as well as conducted my own research into the current healthcare system. While I do not have a formal economics background (though my boyfriend does, and will be assisting if/when he's needed) I have taken a significant amount of coursework, including at the graduate level, in healthcare and behavioral economics. And I've now got brand new Wall Street Journal and The Economist subscriptions as well as access to all my university's resources to help ensure I'm keep y'all up to date with the most accurate information.

What: My goal here is to explain, in an easily digestible manner, aspects of the healthcare industry on a behavioral economic level as well as some of the things anyone entering or already in the market should know, such as, what is a PPO? Each week will feature a different story, be it an explanation of a facet of our healthcare industry, a summary of recent breaking news, or a little healthcare history.

Why?: One thing I've realized is that people are generally un- or misinformed of many of the basics of the health industry, even though it is something we constantly come face-to-face with in our daily life. This blog intends to look at all aspects of the industry, from Obamacare, to what all the difference health insurance plans are, to the history and development of those nutrition labels you see on all your food.

on bad journalism: part II

I have realized recently that very few people understand how to source check. Facebook has become (among other things) a cesspool for ignorant debates of ridiculously biased or misinformed articles.

I don't wish to use this post to spew judgment, but rather want to raise awareness that there is a lot of bad journalism out there and that it is very important, whether posting an article on Facebook or using it in an academic paper, to check your sources.

Just one of the Facebook posts that inspired this entry.

It's important to note that all journalism is biased. News sources get to choose the articles they run, which facts they convey, the language they use. However, reputable journalism is based on well-checked facts and is held to a high standard of ethics. 


PewResearch conducted the Journalism Project to help define the 9 Core Principles of Journalism:

1. Journalism's first obligation is to the truth.

2. Its first loyalty is to its citizens.

3. Its essence is a discipline of verification.

4. Its practitioners must maintain an independence from those they cover.

5. It must serve as an independent monitor of power.

6. It must provide a forum for public criticism and compromise.

7. It must strive to make the significant interesting and relevant.

8. It must keep the news comprehensive and proportional.

9. Its practitioners must be allowed to exercise their personal conscience.
Pew Research. Principles of Journalism. Accessed from: http://www.journalism.org/resources/principles-of-journalism/.

Where I see most of these sensational news sources, such as The Conservative Times, fail is in 1, 3, 8, and perhaps an over-use of 9. These sources have an obligation only towards a truth which serves their political purpose. They do not wholly embrace a system of verification. In fact, their fact checking is near non-existent. These sources pass opinion off as fact on readers who don't know any better or who don't wish to know any better, which is their freedom of speech. As a result, misinformed or intolerant readers stick to these sources that only confirm their pre-existing beliefs. In this way, the sources contribute to an ugly cycle of an ignorant public.

NPR has an Ethics Handbook which perhaps covers the bases of journalistic accuracy in a more digestible way, that can be utilized by readers as well:

Selected Excerpts from NPR's Accuracy Guidelines

Edit like a prosecutor.

Good editors should test, probe, and challenge reporters, always with the goal of making NPR's stories as good (and therefore as accurate) as possible.

Take special care with news that might cause grief or damage reputations.

Guard against subjective errors.

When quoting or paraphrasing anyone  - whether in a blog post, an online story or in an on-air “actuality” – consider whether the source would agree with the interpretation, keeping in mind that sources may sometimes parse their words even though we accurately capture their meaning. An actuality from someone we interview or a speaker at an event should reflect accurately what that person was asked, was responding to or was addressing.Be able to identify the source of each fact you report.

Give preference to primary sources.

(i.e. information directly from a first-hand account, such as a witness, rather than a second-hand source who heard from someone or third-hand source who heard from someone who heard from someone...and so on.)

Don't just spread information. Be careful and skeptical.

Be vigilant about presenting data accurately.

It’s easy to represent data inaccurately or misleadingly, especially in charts and infographics. Double-check your numbers and the way you portray them to make sure you’re imparting the proper information.

Source: NPR. Accuracy. NPR Ethics Handbook. Accessed from: http://ethics.npr.org/category/a1-accuracy/.

Again, no journalism is unbiased. However, some journalism is more accurate than others. When reading articles or preparing to site sources, make sure you are being a critical reader and judging the articles by the same guidelines news sources should be judging themselves. Is it fair? Are they using primary sources who are accurate cited? Are they clearly injecting opinion that is not supported by reputable facts, i.e. primary sources? 

A little education can teach readers tune a critical eye for good, or bad, sources. I don't mean to harp on NPR, but their thorough and publicly available Ethics Handbook makes it an excellent starting point for learning how to read critically. For example, they even list case studies of when they went wrong, including how they went wrong. Studying these examples can give some insight into what a reader should be looking for.

As always, the key takeaway is this: question everything. No single news source has all the information and can give you the entire story. Accurately informing oneself requires thorough investigation of multiple sources with different political viewpoints and perspectives to truly be well-informed. 

Think about it. If you were to, say, get in a fight with your younger sister, would you want Mom or Dad to only ask your sister what happened? Would you even want them to only ask your young brother, who had been standing by? Or, if this hypothetical situation is lost on your because you don't have siblings or have never fought with them because you're part god, imagine if you were accused of a crime. Would you only want the judge or jury to listen to the plaintiff? 

Be smart out there, people!

on time management

With finals season right on the horizon, I thought this post would be particularly fitting. I currently have to prepare a presentation for a client due at the end of the calendar year, have a final on Saturday morning, have a final Tuesday morning, have to submit my final BA thesis proposal before the end of the quarter, am wrapping up my term as my sorority's President, am finishing up a write-up of my research for a fellowship grant due at the end of the calendar year, have to complete the patient interviews for a health policy study I'm assisting on, and I'm applying to jobs for after graduation.

I have never missed an assignment. I have never even turned one in late without obtaining professor approval first. But I have had a lot of stressful days and nights where I'm struggling to get it all done at the expense of my sleep schedule, social life, or sanity.

This obviously is unideal. Poor time management jeopardizes the quality of work produced and burns you out, affecting the effort you have left to give to other assignments. So here are some of my best practices for staying organized and managing your precious time well.

1.) Set daily goals.

Every morning, I wake up and write down 5-10 goals I have for the day. These can be simple little things like "Drop off dry cleaning" or "Email Joann about ______." They can also be much larger, such as "Study physics for 4 hours" or "Finish fellowship proposal." I try to limit myself to 3 big projects a day. I then set these as "Tasks" on my Google Calendar. Then I get to check off each goal as you complete it. I like the app Wunderlist as well. 

2.) Limit distractions. 

If you are working on something that doesn't require being plugged in, do not plug yourself in. Disable Wifi, put on Airplane mode. I am always surprised by how much I accomplish as soon as I stop texting/Facebooking/e-mailing and start working.

3.) Take Breaks

Ah now this is a tricky one, that can be easily abused. Let me clarify. If you are stuck on a, let's say, physics concept and you have now spent a good 45 minutes on it, close your book, stand up, walk around a little bit. I like to do a lap around the 1st floor of the library, say hi to a few friends, and get some coffee before I return to it. Sometimes I'll go complete another assignment or task.  Usually, taking that time to clear my head means I come back stronger and suddenly, something clicks. This also works for me with video games.

4.) Spend less time worrying, more time doing

A common inflicting my friends and I tend to have (and perhaps the entirety of my college) is to spend a huge portion of time fretting over the amount of work we have to complete. Don't do this. Make your list in the morning, add to it as necessary, and get 'er done. The more time spent worrying, the more you SHOULD worry. It takes up time, it affects your work quality...Very bad negative feedback loop.

5.) Reflect upon your day 

Before bed (yes you heard me, go to bed!!), review your day. Admire what you've accomplished, drag tasks you didn't complete onto the next day so you can do them first thing in the morning, and assess what went well or not-so well so you can learn from your mistakes. This is so important, and so rarely done. Self-assessment can be the difference between improvement and stagnation. And it doesn't need to be an official type deal where you sit across a desk from yourself. Hell, do it on the toilet. But do it!

With regard to the last one, some self-reflection has revealed that this blog is going to need a major revamping post finals. COMING SOON: fluff & stuff & more stuff 2.0.

on being skeptical of journalism: Part I

I get it, journalism is hard. Less and less people are subscribing to newspapers and it's no secret that people like cheap thrills. But an article in the Chicago Tribune last week stooped low, far too low to not call them out for it.

The article was about a set of bond deals intended to earn money for the Chicago Public Schools system that ended up doing the opposite. In it, the Tribune went to town on some of the only people attempting, regardless of success, to raise money for our underfunded education system.

I'm not going to pretend that I know much about bond trading, but I know it's kinda like playing the stock market. You win some, you lose some.

Regardless, this post is not about whether the article was worthy of publication or not. This article is about one particularly shitty approach they took to turn their reader against, once again, one of the only people actually attempting to financially assist the underfunded CPS system. But, once again, their objective is besides the point. She could have been raising money for terrorist rings and I would have still found this approach immensely offensive.

Okay, I am rambling. Time to get to the point. Here is a direct quote from the article (appropriately in Courier font) which you can read in its entirety here:

"Cepeda has an MBA from the University of Chicago and spent more than 10 years as a banker before founding A.C. Advisory. She also married into one of the most influential political families on Chicago's South Side. Her late husband, Harvard-trained lawyer Albert Maule, was a grandson of Corneal Davis, a longtime state senator known for delivering black votes for Chicago's Democratic machine. Maule later was appointed to the city's police board by then-Mayor Richard M. Daley.

"Five months before Maule died of cancer in 1995, he helped Cepeda start A.C. Advisory, according to a 2013 Tribune profile. The firm got its first contract with CPS months later, and Cepeda continues to advise the district and the city. A.C. Advisory received about $4.7 million in fees on CPS deals from 1996 through 2013."

Okay, so lets dissect this a bit. They begin with the fact that Ms. Cepeda has an MBA from one of the best business schools in the world and how she spent 10 years in finance prior to starting her business. But, oh wait, don't be fooled, they continue--"she also married into one of the most influential political families on Chicago's South Side." 

And if that isn't dirty enough, they KEEP GOING. "Five months before [her late husband] died of cancer in 1995, he helped Cepeda start A.C. Advisory, according to a 2013 Tribune profile. The firm got its first contract with CPS months later, and Cepeda continues to advise the district and the city. A.C. Advisory received about $4.7 million in fees on CPS deals from 1996 through 2013."

That's right. Now, Cepeda, a Chicago Booth graduate and an accomplished banker, established her firm and got deals with CPS thanks to her husband, who was political royalty in the South Side (Chicago's utter disregard of the South Side in all things political, financial, and otherwise important can be topic for another post). 

But, since they mention it, why don't we go and check out that 2013 Tribune profile, appropriately titled 

Adela Cepeda carved her own path to success

LOL!!!! Yes, you read that right. The Tribune published another article last year in which they praised Cepeda for being a self-made woman. This year, they decided to instead spin her as a husband-made wife. What were you thinking, Jason Grotto and Heather Gillers? But what do you have to say for yourself, Chicago Tribune??

The evidence is much more compelling in your 2013 article. For example, what they don't mention in the recent article is that she met her husband as an undergraduate at HARVARD. Yes, that's right. She was accepted as a Latina female to the most competitive University in the world. Ms. Cepeda came to Chicago to be with her husband whom she met at Harvard, and who was an attorney from Connecticut but had a grandfather who was a state senator from the South Side of Chicago. Cepeda, herself, ascended to Vice President of Smith Barney.

The 2013 article reads:

"Five months before Maule died in 1995, at age 40, he helped his wife draw up papers for A.C. Advisory Inc., a firm focusing on municipal finance."

The recent article says:

"Five months before Maule died of cancer in 1995, he helped Cepeda start A.C. Advisory...The firm got its first contract with CPS months later, and Cepeda continues to advise the district and the city. A.C. Advisory received about $4.7 million in fees on CPS deals from 1996 through 2013." 

You don't have to be a comparative literature major to realize this shows a blatant lack of integrity in the 2014 article, which purposefully implies that Maule used his family's political history to gather clients for Cepeda and that it began a precedent of an unqualified wife handling and receiving big chunks of tax payer dollars. 

The good news is, Grotto is off to Harvard in the Fall, where he, like Cepeda, can study finance, economics, and accounting and can give journalism a rest. I'm still not sure what Heather's excuse for demeaning the success of another woman is, but maybe she got that from her husband as well.

Again, I get it. Journalism is hard and journalists have to try more and more to make a story. But please be skeptical of all that you read, people. And all that you hear, too. 

Over and out,
-r

on the use of cosmetics: part II

This is long overdue, I know. Unfortunately, senior year has offered no chance for a senioritis flare up.

This article was partially never published because it is so personal for me. But because I know so many women and men are struggling with a similar experience, I feel it's time to overcome any insecurity and practice some honest journalism (or whatever this can be called).

My experience with make up, as has been mentioned, is entirely different than that of my sister. Unlike her, I was never drawn to the stuff. In fact, it wasn't until Winter 2012 and the age of 19 that I learned how to properly apply eyeshadow and eyeliner. Until then, eyeliner had been a tool only to hide my trichotillomania.

Unless you don't know what eyeliner does, it may be pretty clear where my trichotillomania manifested. I have a strong memory of being 7 years old, when symptoms of the compulsive disorder began, and playing on the pool deck (a place where my glasses couldn't hide my abnormality) when a friend shrieked "Oh my gosh, you have no eyelashes!!!" Cue me dying of embarrassment but trying to play it cool.

I don't remember my "trich," as it is nicknamed, being a socially crippling problem again until I was about 17. Perhaps swimming, which I did until this age, relieved me of some of the urges or just left me little time to sit alone and pluck.

I want to clarify that trich is a compulsive disorder. This means I wasn't consciously standing in front of a mirror and removing one lash at a time. In fact the opposite is true. I would be taking a test and all of a sudden there would be a lash between my thumb and forefinger. I would spend the rest of the test discouraging these urges, rubbing my finger along my lash line to feel for vacant space caused my "habit," worrying about whether or not it was noticeable and beating myself up for stripping myself of another little piece of my femininity.

That's the irony. Trich is a constant battle of body and mind. The impulse is plucking this hair to release endorphins and give me a rush of comfort during a stressful period and meanwhile, my ego is filled with shame over the loss of some of my attractiveness, or even on a more basic level, my normality.

My family saw it another way. Rather than concern for my appearance, they were disturbed by this self-harm. If they were already disgusted by my nail biting, trich set them over the edge. Especially my sister, who got up close and personal with the proof of my compulsion every time she practiced a new make up routine on me. 

"Oh, look! You have some eyelashes!!" My sister said cheerfully as we sat at breakfast with a family friend in the Autumn of 2012. I got up and left, horrified and humiliated that she would bring it up in public. At this point, I had been concealing my deformity with heavy eyeliner for over a year and struggling daily to resist the urges, spending at least half an hour a day in front of the mirror just inspecting my eyes from every way possible, looking for progress or mourning loss and attempting to assess how bad the damage was.

A few months later, I was home for Christmas break and my sister, seventeen at the time, suggested we go pick up some new make up, and I could get some new eyeliner. As we poked around the counter, the sales lady came by and asked if she could help. My sister quipped, "Yes, we want a make up tutorial for her. The works." 

My stomach dropped. As soon as the sales lady promised she'd be right back to do that, I spat at my sister, "What the FUCK, Lucy!?"

"What? You need to learn. You can hide it better if you learn how to do it right, anyway."

As I continued to spew my anger as ferociously but quietly as possible in the busy department store, my mortification and dread bringing me to the brink of tears, she stopped me.

"Listen, she does this for a living. She's seen everything. Your plucking really not that bad, tons of people have the exact same problem, and you actually have some eyelashes right now. So stop embarrassing yourself, sit down in that chair, and pay attention."

Because my sister is quite terrifying despite being barely over five feet tall, I sat down in the middle of that department store, I shut up, and I learned how to do a full set of eye make up for dummies. My sister sat by, beaming and snapping photos.

Then she dropped the bomb. "She doesn't have many eyelashes so I want her to learn how she can better fill in the lash line." 

I could feel my cheeks redden, confirmed by the make up artist's, "Well, I don't think you'll need any blush..." But then something remarkable happened. It wasn't so bad at all.

"Absolutely," the lady said without hesitation, "You've been doing black but because you have low density, I really think you should do more like a brown. Just will be a bit more natural." She applied a line right above my lightly populated lash line as I watched in the mirror and then moved on to lips.

Turns out, my sister was right. 80-90% of reported cases are women, and it's estimated two to ten million Americans are sufferers of trich (1). Not everyone plucks from their lashes. Eyebrows, arms, and head are popular spots too. But because of my location, make up had a particular importance for me.

It was not about enhancing any feature or looking pretty. I mean, I guess it was a bit about looking pretty. For many, eyelashes are a symbol for femininity. Regardless of biological accuracy, drawings of male figures generally don't have them, while female ones have those three big eyelashes. The thing is though, in the real world, three doesn't cut it. And people notice, though maybe not as much as I imagined in my head.

I used make up as a way to hide my disorder. For me, it returned to me some of the normality I kept shedding unwillingly. I didn't want to leave the house without it, not because I was afraid I wouldn't look as pretty, but because I wouldn't look as normal.

But makeup also relieved me from this prison of self-disgust and mutilation. The enjoyment of putting it on and feeling whole again and doing it in a group setting lead me to seek help and Summer of 2013, I began experimenting with natural cures, eventually coming up with a mixture of the B vitamin compound called inositol and biotin that resisted the urges and repaired the damage (2).

Which is not to say I'm cured. I still sometimes find myself with little black hairs between my fingertips while I'm struggling with homework or taking a final exam. I still tend to run my fingers back and forth along my lash line checking for "bald patches." But I now spend two to three minutes on make up on in the morning, the same routine I learned in 2012, and never feel the need to run to the mirror during the day to make sure my deformity is still hidden. I get to wear mascara like my friends when I get dressed up and I don't have to think of an escape plan when a friend asks to try something new out on me--I no longer avoid social situations in which someone may discover my deformity. In fact, make up has actually enabled the growth that makes me feel comfortable to not wear make up, to talk about and seek help for this infliction. And it's lead me to feel confident enough to share on the internet what I used to not even admit to my family.

What I'm trying to say is not, "make up is a cure all!" But it has lead me to share with you all about my experience with a disease that has probably inflicted many of the readers, since I know it has affected many of my friends who could have been a major source of comfort had I talked about it with them sooner. In these situations, confidence is what one needs to seek help. In my case, exactly the thing that I was using to hide my disease gave me the confidence to fix it. And that--not the long, full lashes--is the beautiful thing.

1. Trichotillomania Learning Center. (2014). Hair Pulling: Frequently Asked Questions. Retrieved from http://www.trich.org/about/hair-faqs.html

2. I'm happy to share more about this!