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Sunset Lake, Asbury Park. By Stephen Goldfinger, BF Asbury reporter ©

Sunset Lake, Asbury Park. By Stephen Goldfinger, BF Asbury reporter ©  April 17, 2016.

 

PATTI LuPONE    (live)   “Meadowlark”  from the (flop) Broadway show The Bakers Wife,  1976.  It’s a cult favorite.   Stephen Schwartz is the composer, and this recording is from Patti LuPone’s show “On Broadway” 1997.  (Patti chats with the audience at the end.  We will try to find the song from Oliver that she references.–PG)

“Come along,
fly with me, my meadowlark,
fly with me on the silver morning,
past the sea where the dolphins bark
we will dance on the coral beaches,
make a feast of the plums and peaches
just as far as your vision reaches
fly with me.”

Patti LuPone speaks to the audience and introduces a song which we will post shortly—from Oliver.

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Nearly 9 million Americans gained health coverage last year according to  Census Bureau reports.  The New York Times (9/17 ) reports that the number of Americans without health insurance dropped by 8.8 million last year, to a total of 33 million.

The Census Bureau reported Wednesday n its annual report “on income, poverty and health insurance coverage, and that the percentage of people without insurance was 10.4 percent last year, down from 13.3 percent in 2013.” According to the Times, officials attributed much of the change to the Affordable Care Act.
The Washington Post (9/17,) reports on its front page that the new figures from the Census Bureau “are the most solid evidence to date of the impact that the Affordable Care Act has had since its main coverage provisions took effect in 2014.”
The Washington Times (9/17, ) reports that Medicaid coverage “saw an uptick of 2 percentage points and now covers nearly one in five Americans.”
The Wall Street Journal (9/17)  reports that the findings also reveal the extent of the health law’s impact for some groups that have historically had lower rates of health coverage. In 2014, the insured rate increased by about 4 percentage points for Hispanics, as well as for blacks and Asians.
The Los Angeles Times (9/17, Lee) says analysts “expect the nation’s overall share of the uninsured to drop further as more people become familiar with the mandate and the federal and state marketplaces.”

Blogfinger Medical Commentary. Paul Goldfinger, MD, FACC

One of my former partners had been working part time as a cardiologist at a free clinic in Georgia.  Recently the clinic closed because there weren’t enough patients without health insurance.  I have no doubt but that the increased numbers of insured patients are straining the healthcare system significantly.

Among the indicators:  long waits to get an appointment with a doctor, rushed care at in and out patient settings, stressed /burned out physicians and nurses, especially among ER and primary care doctors, under-staffing in hospitals terrorizes nurses trying to do their jobs correctly, difficulty getting to speak to a doctor on the phone, inappropriate substitutions of nurse practitioners for doctors, assigning clerical people in medical offices to triage medical complaints, inability to get doctors to see patients who are acutely ill,  difficulty finding a primary care doctor, long waits to schedule surgeries and tests, barriers at doctors offices that make it difficult for patients to get care, indifference by some doctors who are frustrated in their rolls as employees of corporate entities,  doctors rushing to get through busy office hours,  a greater risk of sloppy care and mistakes in offices and hospitals, frustration over electronic medical records by doctors and nurses , doctors going bankrupt and/or closing their practices, etc.

This is all anecdotal now, but I predict that this will become a huge story once some data rolls in. The emphasis on the bottom line has become the top priority which supersedes quality care. Too many bureaucrats in the healthcare field are making wrong decisions as physicians and nurses are becoming marginalized.  Watch for an uptick in malpractice cases.

Healthcare professionals:  What do you think?  Comment below:

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From the American Medical  Association:  (Note the links below)

The AP (6/4, Tanner) reports, “Alcohol problems affect almost 33 million adults and most have never sought treatment,” according to a study published online June 3 in JAMA Psychiatry. The research conducted by investigators at the National Institute on Alcohol Abuse and Alcoholism also suggests that “rates have increased in recent years.”

NIAAA director George Koob, PhD, “said it’s unclear why problem drinking has increased but that many people underestimate the dangers of excessive alcohol.” Koob also pointed out that effective behavioral treatments and medications exist to help people overcome problem drinking. He said, “There’s a lore that there’s only Alcoholics Anonymous out there and that’s not true.”

TIME (6/4, Sifferlin) reports that the study examined “the prevalence of drinking issues based on a new definition for alcohol use disorders in the” American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). That “definition classifies problem drinkers as those who have two of 11 symptoms including continuing to drink even if it harms relationships, drinking harming performance at work of school, or inability to quit,” with problem severity being “classified by the number of symptoms a person has.”

Newsweek (6/4, Main) reports that “researchers surveyed more than 36,000 Americans and asked them about their drinking habits,” also finding that “binge drinking is becoming more common and intense.” Koob said, “There has been this cultural shift – people are drinking more when they drink.”

Yahoo! News (6/4, Chan) quotes Koob, who said, “These findings underscore that alcohol problems are deeply entrenched and significantly under-treated in our society.”

The NPR (6/4, Hurt, Shute) “Shots” blog points out that “Native Americans face the greatest risk overall” for problem drinking, “and men are still drinking more than women, with 36 percent of men reporting alcohol use disorder at some point in their lives, compared to 22.7 percent of women.” Among young people, “drinking problems were worst…with 26.7 percent of young adults under 30 saying they’d had trouble in the past year, compared to 16 percent of 30- to 44-year-olds.”

Blogfinger Medical C0mmentary:    Paul Goldfinger MD, FACC, Editor @ Blogfinger.net

The 5th edition of the DSM of the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders) was released in 2013.  This is the “bible” for mental health workers to use for diagnostic nomenclature.  The alcohol data was gathered in 2012 and 2013 by the National Institutes of Health, looking at adults 18 and older.   The 18-29 year old group is particularly affected, and not only do many have drinking problems, but the amount of drinking has been going  up.    DSM-5_Cover

The section on “alcohol use disorders:” —AUD is very important because it recognizes that 14% of adults in the US currently have a drinking problem  (33 million) and that 30% of the population has had an AUD at some time in their lives. They now recognize that most people with AUD have not sought treatment and that AA is not the only treatment option.   There are medications and there are behavioral therapy methods.

The devastation caused by AUD is huge:  It is disabling to individuals, and its effects harm families, work places, and, overall, the national interest.  And don’t forget the physical issues:   acute alcohol intoxication during binge drinking can cause death; even mild impairment (with alcohol level below illegal) can  cause auto accidents; and long term use can cause cancer, heart disease, brain damage, and liver disease.

A big concern is that many won’t admit that they have a problem, and those around them may not recognize a problem either.  The new criteria help define the diagnosis and the degrees of involvement—spelled out in the handbook.

You can buy a copy of the DSM-5 Handbook on line  (eg Amazon.com)

DANISH NATIONAL CHAMBER ORCHESTRA.   Drinking songs often glamorize alcohol intake—-eg all those Irish drinking songs. Here is  Verdi’s “Drinking Song—Libiamo” from the film The Quartet   (and here is ourBF  2013 movie review:  Quartet movie  )

 

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The New York Times (3/11, Pear, Subscription Publication) reports the Obama Administration said Tuesday that 11.7 million Americans now have health coverage through the Federal and state exchanges, with 86 percent receiving government subsidies. A new report showed that about three-fourths “of people with marketplace coverage — 8.8 million consumers — live in the 37 states served by HealthCare.gov, the federal insurance exchange.” HHS Secretary Sylvia Burwell “underlined the importance of subsidies for people in states using the federal exchange — subsidies that could be withdrawn if the Supreme Court rules against the Obama administration in a pending case.”

According to the Los Angeles Times (3/11, Levey), the report from HHS showed that up to 7.7 million could be affected if the Supreme Court rules against the ACA’s subsidies. In many states that rely on the Federal marketplace, “consumers are getting subsidies that top $300 a month on average, according to the data.” The AP (3/11, Alonso-Zaldivar, Vineys) adds that the 7.7 million Federal marketplace customers receiving subsidies “are getting an average of $263 a month to help pay premiums.” According to the AP’s estimates, that “works out to around $2 billion a month.”

McClatchy (3/11, Pugh, Subscription Publication) reports that 53 percent of people who selected plans on the Federal marketplace “were new consumers who didn’t have marketplace coverage last year.”

USA Today (3/11, O’Donnell) reports that more than 4.1 million people under age 35 “picked Obamacare health insurance plans so far in this open enrollment period, a small increase compared with the end of the 2014 period, the Department of Health and Human Services said” yesterday. The increase from 3.3 million people ages 18-34 who enrolled last year “is good news for the law, which needs more younger people to offset costlier and less healthy older enrollees.”

However, the percent of black and Latino Americans “signing up for ObamaCare remained largely the same as 2014,” The Hill (3/11, Ferris) reports.

Blogfinger Medical Commentary:   By Paul Goldfinger, MD, FACC

It’s important for everyone to try and understand what is at stake when the Supreme Court rules on its latest case regarding Obamacare.

Although the legalities that are being considered by the court seem like they are straight forward, if you get into the weeds you will find out why the court is closely divided.

But getting past the legalities, it is interesting that the average subsidy is nearly $300 per month per each person who receives a subsidy and it is also revealing that 86% who are covered through federal exchanges get subsidies.  So this decision will have huge implications for the future of the ACA.

Also, regarding affordability of insurance,  keep in mind that many of those who have gotten subsidies through ACA exchanges are facing more daunting financial challenges other than paying monthly premiums.  Many of them have deductibles that could be $5,000.00 or more per year which is out-of-pocket spending that some will not be able to afford.  The dropout rates may become substantial.

It’s also interesting that many who had no insurance before still have no coverage because they still can’t afford the costs despite the subsidies. but they do not qualify for Medicaid, which is free insurance provided by the states together with the feds.  Obamacare has been expanding Medicaid eligibility, and some states are resisting that expansion because eventually it will put a significant dent in their budgets.

If the Supreme Court rules against Obamacare, the government will have to come up with a “fix” to prevent loss of coverage for millions who are now covered through the federal exchanges.  Maybe the law could be changed to allow subsidies on all exchanges.

 

 

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The CBS Evening News (1/30, lead story) reported on Friday that “the CDC said that the flu season in much of the country appears to have peaked.” However, “the flu is now widespread in all but six states and it’s sending Americans 65 and older to the hospital at the highest rate in at least a decade.”

NBC Nightly News (1/31, story 3, 0:25, Williams) reported that the high number of hospitalizations is “being blamed on this particularly nasty strain of flu this year and a vaccine that, sadly, has proven only about 23 percent effective.”

Bloomberg News (1/31, Cortez) reported, “The annual outbreak, already in its 10th week, has extended beyond the lower bound of a normal flu season and isn’t showing signs of easing, said Lyn Finelli, chief of surveillance and outbreak response at the” CDC. In a telephone interview, she explained, “‘While the flu may have peaked in many areas of the country, there is a surge in other areas,’ including New England, the Northeast and the West Coast.”

 

Blogfinger Medical Commentary:  Paul Goldfinger, MD, FACC

The influenza pandemic 1918-1919 killed 20-40 million people worldwide.  This gives you an idea of the potential virulence of this viral illness.  During the last ten years, the CDC has been recording hospitalization rates for citizens over age 65 in the US.  The elderly are the most vulnerable group to having serious consequences after catching the “flu.”  This season, which began in the fall, is the worst in ten years.  The A(H3N2) strain is dangerous, and “genetic drift” has made it resistant to the current vaccine.   There is no cure for this illness.

The epidemic has peaked now, and although hospitalizations are still very high, outpatient visits are falling off.   Hopefully we will see a marked drop in a few weeks.  Meanwhile, if you have early symptoms  (cough, fever and sore throat,) call your doctor to see if you are eligible for an anti-viral drug such as Tamiflu  (oseltamivir). This drug should shorten the length of the illness by a day or two and may reduce serious complications. There is some controversy about the use of Tamiflu  (or the two others on the market), but the CDC has advised doctors to use the drug as needed.  I remember one recent flu season where the drug was sold out because individuals were stocking up on it, and even this season there have been spotty shortages.

 

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NBC News (11/26, Fox) writes that a new report from the Centers for Disease Control and Prevention says that while most Americans with HIV know they’re infected, “just 30 percent…have it under control.” CDC director Dr. Tom Frieden said, “Today’s study shows too many people with HIV aren’t getting the care they need.” The article calls the issue “frightening” because medication can keep those with HIV healthy and, as Frieden noted, “less likely to infect others.” While the report doesn’t go into why people aren’t being treated, “navigating the red tape of the U.S. healthcare system may be one major factor.” The CDC found that in 2011 1.2 million Americans had HIV, 86 percent of those knew it, just 40 percent were seeing a healthcare provider about it, 37 percent had a prescription for medicine to treat the condition, and “and only 30 percent actually had the virus controlled.”

The Hill (11/26, Ferris) reports Frieden said, “We’re not reaching nearly enough people.” He added, “Good care and treatment are good prevention.”

Reuters (11/26, Steenhuysen) reports the CDC found that just 13 percent of those with HIV between the ages of 18 and 24 achieved viral suppression, possibly because under half of those with HIV in that age range have been diagnosed. Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, said in a statement, “There is untapped potential to drive down the epidemic through improved testing and treatment, but we’re missing too many opportunities.”

HealthDay (11/26, Thompson) reports researchers said that “a combination of indifference and lack of access* to medical care appeared to outweigh ignorance as a driving factor in cases of uncontrolled HIV.”

Blogfinger Medical Commentary: Paul Goldfinger, MD.

That so many cases of HIV are going untreated or inadequately treated  is really bad news, because HIV has become a chronic disease with a multitude of good drugs to keep the infection under control. The drugs work by different mechanisms, but there are now easy to take medications which include several anti-viral drugs, working in different ways,  rolled into one tablet.

The idea that “lack of access to medical care”*  is a factor is alarming.  If the government can rally an urgent response to Ebola in Africa, surely they can use an executive order to do something to improve that “access” in the US. Thousands of new cases of HIV continue to be occur each year, and the fact that only a small minority of cases in the 18-24 age group are being treated is frightening as is the fact that half of those young people with HIV have not yet been diagnosed.

As noted, these treatments can help prevent transmission when infected people have sex with uninfected partners. This is called a “mixed-status relationship,”

 

 

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