Pre-Existing Conditions Can Start at Birth

Cited: ABC News

The parents of Houston Tracy, 12-year-old boy who has survived a rare birth defect, being tube and open heart surgery, found out that the term “pre-existing condition” can apply the moment a person is born.  Now they are waiting to see if their battle with the insurance company will be successful.

“When he came out, he made one little cry and he didn’t really cry much,” said Houston’s father, Doug Tracy, 39, of Crowley, Texas.

Tracy cut the umbilical cord and watched the hospital staff clean his son. But before his wife Kim Tracy, 36, could touch their son doctors got worried. “We could tell there was something wrong by the way they [the doctors] were acting,” Doug Tracy said.

Houston’s skin wasn’t turning a shade of pink like most newborns because, somehow, his blood wasn’t getting enough oxygen. Doctors rushed Houston, with Tracy riding by his side, in an ambulance to Cook Children’s Medical Center in Fort Worth, Texas.

Within hours the Tracy family would learn their son was born with a heart condition called d-transposition of the great arteries, meaning the primary aorta and pulmonary arteries are transposed where they should meet the heart. Doctors wanted to operate within days to save his life.

“In Houston’s case he would not have survived had he not gotten the care,” said Dr. Steve Muyskens, pediatric cardiologist at Cook Children’s Medical Center, who treated Houston. “Most children with this [would] have demise within days to months in life.”

Muyskens explained that with the aorta and pulmonary arteries switched the system creates two separate pools of blood — a small amount that travels from the heart to the lungs and back to the heart and another pool of blood that travels from the body to the heart and back out without ever reaching the lungs for oxygen.

“The red blood just circles on one side and blue blood circles on the other,” Muyskens said. All of Houston’s organs, including his heart, would soon die without red blood.

Even if doctors could stabilize a child with Houston’s heart condition they would only have a short window to operate.

One Surgery Could Save a Life

“The Gold standard is surgery — arterial switch procedure,” said Dr. Daphne Hsu, division chief of pediatric cardiology at Montefiore Medical Center in New York. “The procedure has to be done before the child is 1 month old, because then the heart starts to change and adjust to the circulation, and the pressure in the heart drops.”

Houston was born on Monday, March 15. By Friday that week, doctors operated successfully. Muyskens expects Houston will have a normal life, and likely won’t even need medications.

“Everybody’s nicked named him Rocky around there because he’s a fighter,” said Tracy.

But by March 24, the Tracy family formally heard their son was denied health insurance.

“We don’t have health coverage on ourselves because it’s too expensive these days and because of the economy,” Doug Tracy said. The couples are small business owners and would have to buy individual policies, which they have for their other children Cooper, 4, and Jewel, 11.

Doug Tracy said the family had no idea there was something wrong with Houston before he was born.

“Prenatal, every doctor visit was perfect, his heart beat was fine,” he said. But Tracy said he called Blue Cross and Blue Shield of Texas twice in preparation of Houston’s birth, and he asked if they could get a policy on his son before he was born.

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“They said we can’t do that because he wasn’t born yet, but as soon as the baby’s born go online and fill an application out,” he said. Doug Tracy applied for Houston’s insurance March 18, and the first month’s premium of $267 was charged to his credit card, he said.

“Wednesday, the 24, is when I got a letter of decline — they declined it the day after the [health insurance] bill was signed,” Doug Tracy said.

Yet the provision in the health insurance reform act that prohibits health insurance companies from denying coverage to children with a pre-existing condition will only take effect six months after the bill was signed into law.

Family Searches for Insurance Coverage

Blue Cross and Blue Shield of Texas declined a phone interview with ABCNews.com about procedures to enroll newborns and their policies in light of the new health care reform act.

But the company was willing to e-mail a prepared statement.

“We share the public’s concern for this child and for uninsured children across our state. As you may know, federal privacy laws prohibit me from releasing any information about members or potential members of Blue Cross and Blue Shield of Texas [BCBSTX],” Margaret Jarvis, senior manager of media and public relations at Blue Cross and Blue Shield of Texas, wrote in an e-mail.

Jarvis said Blue Cross and Blue Shield of Texas would automatically cover newborns of parents who already had a policy with them for 31 days. After that time parents could opt to include their baby on their plan whether or not the child had health issues.

“For children whose parents are not BCBSTX members, who want child-only coverage, we offer individual policies, beginning at the age of 60 days,” wrote Jarvis. “BCBSTX has spoken with the father of this child, and we are exploring all available alternative coverage options.”

“I don’t hate them [Blue Cross and Blue Shield], they’ve done well for my other two kids,” Doug Tracy said. “I just want them to do the right thing.”

The Texas Health Insurance Risk Pool is an alternative family found to get their child coverage.  This policy will cost $277 a month, only $10 more than the premium on the policy he tried to get for his son through Blue Cross and Blue Shield.  However, he is just a little bit confused since he still has to go through Blue Cross and Blue Shield of Texas to get the new insurance coverage of Texas Health Insurance Risk Pool.

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My Take: I do not understand!  How can something you were born with be considered a pre-existing condition when your insurance company starts your policy at birth.  There is no way you can call it a pre-existing condition unless something is discovered during pregnancy.  There is one example I can think of that occurs at birth that is not a pre-existing condition and that is a cleft palate.

Any Tallahassee FL plastic surgeon can tell you that this is not a pre-existing condition.  I know that some insurance companies have tried to call this cosmetic surgery and is not covered, but it is not just cosmetic surgery it is reconstructive surgery that requires cosmetic surgery.  You can talk to Pensacola plastic surgeon and keep the same answer, it is not cosmetic surgery.

It is a wonder that the insurance companies have not refused to pay for weight loss products prescribed by a doctor because obesity is a pre-existing condition.  They should’ve made this new law effective immediately.  Then when a doctor prescribes colon cleansers for someone who needs to lose weight, it’s not refused because it is a pre-existing condition.

I can understand them refusing to pay for something like herbal Viagra because you can buy it over the counter.  In fact, safe impotence treatment, nowadays, can be done with herbal remedies and the insurance company has nothing to say about it.  But get real, a burst the fact is a pre-existing condition, how ridiculous can you get?

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Is Social Networking Source of Medical Misinformation?

Cited: ABC News

Social networking site websites like leader have become powerful tools in the search for information opinions that include things from celebrity gossip to natural disasters.  However, a new study that shows such sites could be potentially dangerous when it comes to medical advice and misinformation being given to millions of people.

A new study in the American Journal of Infection Control shows that over a four-month period in 2009, hundreds of Twitter users posted casual misinformation about antibiotics — which, in turn, reached more than a million of their followers.

“When we looked at tweets … we found that there are some basic categories like general mentioning of antibiotics or complaints about side effects and things like that, but there was also a category that was pretty interesting, where people were indicating misuse or misunderstanding of antibiotics,” study co-author Daniel Scanfeld told “Good Morning America.”

“And we found that to be really interesting, because one tweet indicating misuse of antibiotics could be spread potentially to hundreds of thousands of people via the Twitter network.”

While overall around 2 percent of the studied tweets contained misinformation, Scanfield said that even a single inaccurate tweet is broadcast on average to “tens of thousands of people.”

For example, Scanfeld said one tweet about antibiotics for a cold — which is not their intended use — reached around 850,000 people. In other cases, the study found people often tweeted about not finishing their antibiotics or offering to share them with others, a big no-no when it comes to medications.

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How to Avoid Misinformation on the Web

Tip 1: Confirm All Medical Information with a Reputable Source.  It’s fine to look online for answers to medical questions, but it’s crucial to verify what you find with a reputable source, such as your doctor.

Tip 2: Be Wary of Any Posting That’s Selling Something.  Be extra cautious if any postings or tweets are selling something. Some product claims have no basis in reality.

Tip 3: Know the Source!  Take a look at the Web site ending. Remember that “.com” Web sites are for-profit, “.edu” are educational sites and “.gov” are from the government. Many disease specific Web sites or medical association Web sites are “.org”. Get to know a few sites and bookmark them so you can go back easily.

Tip 4: Check Legitimate Web Resources.  Some online resources can be good sources for basic information you can consult in addition to talking with your doctor.

“GMA” Healthy Living http://abcnews.go.com/gma/healthyliving	Mayo Clinic http://www.mayoclinic.com/
WebMD http://www.webmd.com/	National Institutes of Health http://www.nih.gov/
Center for Disease Control and Prevention http://www.cdc.gov/az/a.html	National Institutes of Health http://www.nih.gov/
U.S. Food and Drug Administration http://www.fda.gov/ForConsumers/default.htm	American Academy of Pediatrics http://familydoctor.org/online/famdocen/home.html
American Academy of Family Physicians http://familydoctor.org/online/famdocen/home.html	American Cancer Society http://www.cancer.org/docroot/home/index.asp
American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=1200000
Tips for finding credible information on the Web http://patients.about.com/od/researchandresources/tp/internetguide.htm
More tips for finding credible information on the Web http://www.bma.org.uk/patients_public/finding_reliable_healthcare_information/healthinfonet.jsp

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My Take: I do not like Twitter.  The reason is very simple, social networking like Twitter takes a personal touch out of human relationships.  I wonder, if somebody does get bad advice on Twitter, could they be sued?  If they can, people are going to be looking into Portland OR injury attorneys a lot more.  I think people who do not have a medical license and give bad medical advice should be held accountable in one way or another even if it means hiring Tigard OR personal injury attorneys to get compensation.

Just because somebody has a computer, it doesn’t mean they have to be giving advice on anything.  You do not know who you are talking to or what kind of situation they are in to be able to give them good advice.  Maybe it should be the NYC computer service or host server that should be held responsible.  That would be a matter for legal brains to figure out.

Getting medical advice over the Internet is just as bad as asking for computer help New York from someone who doesn’t know anything about computers.  Would you actually trust someone you don’t know to give you advice about your computer?  Then why would you ask someone you don’t know format will advice that affects your life?

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Which States Benefit from Healthcare Reform?

Cited: ABC News

The nation’s Medicare system will grow under the nation’s healthcare warm and is one of the main organizations to implement the goal of expanded medical coverage.  However, some states will be winners and some will be losers in this new arrangement where money is concerned.

Here’s a look at why some states may stand to benefit.

The biggest winners, state officials and Medicaid experts say, could be those states that have already taken an important step toward expanding their own Medicaid programs: covering childless adults.

The reason for the coming windfall: These states are already paying for something that the new healthcare plan will soon mandate, and as the law’s provisions begin to kick in, the federal government will actually pick up much of the burden that these states are now bearing.

The winners: 11 states plus D.C.

The 11 so-called “expansion states” states are: Arizona, Delaware, Hawaii, Maine, Massachusetts, Minnesota, New York, Pennsylvania, Vermont, Washington, and Wisconsin, plus the District of Columbia.

Currently, states that cover childless adults receive a 50% reimbursement for their costs. But the federal share of that reimbursement is set to increase, according to the bill of healthcare fixes, which tweak some of the numbers in the healthcare bill already passed and signed by President Obama.

The fixes bill was passed by the Senate and the House Thursday and now goes to Mr. Obama to be signed into

In 2014, the federal government will pick up 75% of the costs. By 2020, the fed’s share will grow to 93%.

By contrast, states that have not yet begun to cover childless adults will get federal reimbursements to cover 100% of their programs to start, but over time they will have to start paying for a portion of the cost. In other words, their expenses will eventually grow, while those of states that got a head start will gradually shrink.

Although it’s hard to quantify how much these states will save as a result of the changes, it will total in the billions of dollars annually.

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Sitting pretty: New York, Maine

For example, since the year 2000, New York State has been providing Medicaid healthcare benefits for childless adults and parents at the federal poverty level ($10,800 for a single adult; $14,570 for two adults). As of February, there were 388,000 people in that program.

Under the healthcare fixes – officially known as the reconciliation bill – the state would see a net gain of $2.1 billion, estimates Rep. Jerrold Nadler (D) of New York.

“The reconciliation bill does give financial benefits for the expansion states,” says Robin Rudowitz, Washington-based associate director of the Kaiser Commission on Medicaid and the Uninsured, part of the Kaiser Family Foundation.

Maine is another state that stands to benefit from the fixes bill. According to Rep. Mike Michaud (D) of Maine, the state, which already insures many childless adults under its Medicaid program, will receive an additional $154 million in federal financing from 2014 to 2019.

In other states, however, the exact value of the benefit – or whether there is a benefit at all – is in doubt because of the complexity of the issue.

Confident: Wisconsin, for instance, has only a limited program to cover childless adults under Medicaid.

Buffeted by the economic downturn, the state wanted its Medicaid money to cover as many adults as possible since many had been laid off. But that meant offering each recipient less money than the federal government benchmark for reimbursement. Moreover, the state had so little money to put toward the program – and the need was so great – that the enrollment limit was filled within three months and there is now a waiting list.

With all these variables, how much will the new federal healthcare plan help? “We are in the process of working on the numbers but we are confident they will come out net to the good,” says Karen Timberlake, Secretary of the Department of Health Services in Madison.

Confusion: Arizona

Arizona demonstrates no how fluid the numbers are. Four Arizona Democrats in Congress say their state will get $2.5 billion in new Medicaid funding under the new plan. But Gov. Jan Brewer, a Republican, estimates it will cost the state $1 billion in both 2012 and 2013.

The discrepancy has its roots in Arizona’s decision to expand its Medicaid coverage to poor childless adults in 2000, adding an estimated 310,000 people to its rolls.

Faced with a large budget deficit in recent years, the state tried to cut its Medicaid coverage. But because it previously accepted federal stimulus funds – which included a Medicaid adjustment – it was not permitted to do so. The terms of the new legislation also make backing out difficult, if not impossible: The state cannot cut current services without risking lawsuits.

Governor Brewer’s $1 billion estimate is based on the expansion of the program in 2012 and 2013. She calls the healthcare bill “financially devastating” to the state, which proportionately has one of the largest deficits in the nation.

“Hyperbolic and completely unfounded,” is what four Arizona Democrats in Congress have called Governor Brewer’s estimates of the added Medicaid costs.

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My Take: Where Arizona is concerned, I think Governor Brewer doesn’t know what she’s talking about.  Recently, all she’s been doing this fighting with state officials about a state budget.  Needless to say, it was barely passed in time before the deadline.  It seemed like she was more interested in getting something like a free car insurance quote than anything else.

I don’t think car insurance quotes are more important than the state budget or whatever it is she was concentrating on.  I do know one thing, the state should purchasing and not its firemen or police.  If they need a copy machine they should buy used copy machines and not new ones.  In fact, they could probably purchase Canon copier accessories cheaper online.

Never fear, government officials will always be able to afford their sports tickets!  They would rather lay off government employees like firemen and police officers.  They would never consider taking a pay cut themselves because that might interfere with getting their concert tickets for their Alexandria cleaning service.  Same thing goes for guys in Washington, they need their maid service DC.

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Count Money and Make Yourself Happier

Cited: Time

Did you ever see Donald Trump stand in line for anything after he got rich?  I do not think so.  Money makes you happier.  It allows you to buy the luxurious things in life like sports cars and mansion homes and necessities like groceries and clothes.  It also get to that preferential treatment that Donald Trump gets.  There is actually psychological benefits to just counting money!  Psychological Science, published a new study that says thumbing through your cash can reduce emotional and physical pain as well as increase feelings of internal strength, fearlessness and confidence.  Of course, the flipside to that is when people are reminded of their spending they also report higher levels of both psychological and physical distress.

Focusing on the symbolic power of money, the study’s authors, Xinyue Zhou of Sun Yat-Sen University, Kathleen Vohs of the University of Minnesota and Roy Baumeister of Florida State University, started with a simple hypothesis: reminders of money can alter how people experience social interactions—especially social acceptance and rejection.

To test their idea, the researchers took the following approach: 84 students at a Chinese University, were divided into two groups. One group counted 80 large denomination bills; the other group parceled out 80 pieces of plain paper. All participants then played an online video game where, using game controls, they could throw a video ball and play catch with other internet players. But the game was rigged so that after 10 throws half the students would no longer get the ball thrown to them, while the rest of the students continued to play catch. When the game ended participants who’d been excluded from the second round of catch rated their level of social distress and how strong they felt. Those who had counted money before being socially excluded reported lower levels of social distress than those who had counted only paper. Additionally, the participants who had counted money also reported greater feelings of inner strength and self-sufficiency.

To see if counting money also reduces physical pain— previous research indicates psychological and physical pain are experienced in a similar way —the researchers repeated the earlier social exclusion test, except this time they replaced the ball game with a pain-sensitivity task, in which half the participants were put in a moderate-pain condition (their hands were immersed in warm water) while the other half were subjected to a high-pain condition (hands were immersed in very hot water). Again, those who had counted money reported lower levels of pain.

To complete their study, the researchers conducted additional experiments. Their other findings: Reminders of having spent money aggravated feelings of social distress; and both social rejection and ideas of physical discomfort fueled participants’ desire for money as well as made them less generous.

So what does any of this mean for people in the real-world—especially in this down and out economy? One implication, not entirely surprising, is that a job loss may pose an additional challenge. A layoff is a kind of rejection and that could increase a person’s desire for money at the very same time he or she has less than before, explains Kathleen Vohs, co-designer of the study. Put another way: “The recession can make [people] crave what they can’t have,” Vohs says.

Fortunately, the research also offers a possible solution for landing a new job. “It might be handy to sit down and count a stack of money before going out to the job interview,” says Roy Baumeister, one of the study’s authors. Another option? “Set up a screen saver that shows money,” says Vohs. “That might help ameliorate some of those feelings of being rejected.”

Believe it or not, counting money may help you find that special person even though money cannot buy love. “Maybe young men who are going out to bars to try to meet women should count money,” muses Baumeister. “I gather they have to approach a lot and get rejected a lot. I am not a specialist in bars but it would make the men feel strong and probably make them less bothered about being rejected over and over.”

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My Take: In the human society today, everything revolves around money including emotional and physical health.  There is no way to get around it, if you have money you definitely feel better about everything.  As for just counting it making you feel better, I would have to hear more about that.  I wouldn’t feel better counting somebody else’s money, I would just want it.

I would imagine that the Alexander Technique New York would make me feel better than counting money.  At least the Alexander Technique benefits would be more apparent in my physical condition.  The same goes with Pilates exercise, it would do me better to exercise than to count money.  Of course, you do need money to buy Pilates workout equipment.

Maybe the next study they do should incorporate people who work in a bank and count money every day and compare that to people who work in jobs where they do not handle money.  They just might get more people to believe that counting money makes you happy.  Of course, if you count your own money, you are definitely going to be happier, she don’t have that much.

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Senate Panel Sends Healthcare Reform Bill to Floor

Cited: MedPage Today

During the 5th week of deliberation on the Healthcare Reform Bill, the American Medical Association endorsed package that came out of two House of Representatives committees.  Meanwhile the Senate Health, Education, Labor and Pensions (HELP) Committee finally completed markup of its own bill.  Passed health care reform bills have been stalled by the doctors group that sent a letter to the three House committees working on a bill saying that it approves of it.

“This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform,” said AMA President James Rohack, MD.

The group lauded provisions in the bill to reform the sustainable growth rate formula used to calculate Medicare physicians’ payments, and to add additional payments for primary care physicians without reducing payments to specialists.  President Obama, who asked the AMA to support reform at its annual meeting last month in Chicago, thanked the group for backing the House bill.

“I am grateful that the doctors of the AMA have chosen to support health insurance reform that will lower costs, expand coverage, and assure choice and quality healthcare for all Americans,” Obama said in a statement.

Although the AMA’s endorsement was good news for the reform effort, the House bill had a setback on Thursday when Douglas Elmendorf, the director of the Congressional Budget Office (CBO), told the House Ways and Means Committee that the bill is not budget-neutral, which has long been the promise of the president.

“The coverage proposals in this legislation would expand federal spending on healthcare to a significant degree, and in our analysis so far we don’t see other provisions in this legislation reducing federal health spending by a corresponding degree,” Elmendorf told the tax-writing committee.

Meanwhile, a contingent of Democrats on the House Education and Labor Committee spoke in support of a single-payer system — a marked difference from the Senate HELP panel, on which only Bernie Sanders (I-Vt.) backed single-payer.

The system is unpopular on the Hill and was never seriously discussed — at least not publicly — as a potential part of a reform package.  But in the first day of the House Education and Labor Committee’s markup, several Democratic members said while they back the bill, they wished it included single-payer plan rather than introducing a government-run public plan to compete with private plans.

“It’s not perfect because it’s not a single-payer plan,” said Rep. Lynn Woolsey (D-Calif.)

Rep. John F. Tierney (D-Mass.) also said he supports the single-payer approach, as did Rep. Dennis J. Kucinich (D-Ohio).  The House bill “further entrenches the for-profit insurance based system,” Kucinich said. What isn’t much different between the two chambers is GOP bashing of the Democrat-produced bills.

Rep. Tom Price (R-Ga.), a physician, said he “left the practice of medicine . . . for precisely this moment in public policy,” but said that the current bill would result in a system “built on mandates, rationing, bureaucracy, and taking healthcare decisions away from patients and their physicians.”

But neither dismay over the lack of a single-payer plan, nor partisan squabbles held up progress. On Friday, the Education and Labor Committee sent its portion of the bill to the floor with a 26 to 22 vote, and the Ways and Means Committee passed its portion of the bill in a 23 to 18 vote.  The Energy and Commerce Committee still must approve its portion of the bill.

In the Senate

Also in the 5th week, the HELP Committee sent its final bill to the Senate floor, although it won’t likely be up for a vote until the Senate Finance Committee reports out its own bill, which could be a while considering the panel has yet to introduce a formal bill.

After a nearly month-long markup, acting HELP chairman Chris Dodd (D-Conn.) said he was disappointed that no Republicans on the committee voted for the bill, but said that “a good bill is more important that a bipartisan one.”

In a week 6, President Obama was defending his healthcare reform effort on national TV.  The push for legislation slowed on Capitol Hill as senators postponed any action until after the August recess.  However, the House appeared poised to take a vote on its bill in week 7.

The House is scheduled to begin its recess on July 31, a week before the Senate.  Two House committees — the Ways and Mean and Education and Labor — have finished work on the bill and sent it the full floor for a vote.  But the effort hit a snag in the third committee responsible for Health Care, Energy and Commerce. That panel stopped short in its markup process after approving amendments on Monday night.

Fiscally conservative “Blue Dog” Democrats oppose the cost of the bill and have said they’d vote against it if the total price tag is not significantly reduced. The plan would cost more than $1 trillion over 10 years. But on Friday, various media outlets reported that Commerce chairman Henry Waxman (D-Calif.) had announced a “breakthrough” in negotiations and said his committee might have the votes necessary to report out the measure.

However, if the Blue Dogs stand firm in opposition, Waxman said the committee might discharge the measure and send it to the floor for a vote without its endorsement.  House Democrats plan to meet to decide their next step.

Meanwhile, President Barack Obama, who has been campaigning hard for healthcare reform in the face of Republican attacks and doubts within his own party, called a press conference and spent all but a few minutes of it promoting the plan or dealing with questions the subject.

According to J. James Rohack, M.D., president of the American Medical Association, the congressional recess will be a critical period in determining the fate of health-care legislation.

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My Take: I just wish they would hurry up and get their asses in gear and come to a decision that everybody will benefit from, namely the average citizen.  The Senators, Representatives, Congressmen and the President do not have to worry about their medical or dental because it is provided for them.  It is the rest of the nation that has to worry.  Well actually, not the whole nation just those that can afford medical or dental.

I am on disability and I get Medicare through an HMO.  I was amazed when Medicare was started to authorize money for glasses and hearing aids and thankful at the same time.  I just wish they would authorize dental care.  I need to see a dentist so bad it hurts!  If I would have had access to regular dental checkups, I would not be in this situation.

However, the government does not think dental care is needed for adults, because they will not pay for it.  They must believe that adults do not get toothaches, break teeth or need dentures.  They do seem to realize that people move do need to see and hear things around them.  When are they going to get the idea that people need to be able to chew their food properly?  Maybe they just expect people to gum it!

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