Action Phase Podcast Episode 18

health insurance marketplaceOn this episode, I sit down with Nancy O’Connor, Regional Administrator for CMS Region 3. We talk about why people without health insurance really need to get some ASAP, why Medicaid expansion is really important, and that if you already have health insurance, you can sit back and relax. Remember: the health insurance Marketplace closes March 31! If you’re visiting for the first time via The Public’s Health, welcome! I hope you enjoy the show.

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As always, you can stream it here, too.

https://ia601202.us.archive.org/13/items/18-NancyOconnor-ActionPhasePodcast/18-NancyOconnor-ActionPhasePodcast.mp3

Friday Five: Marketplace, Olympians’ teeth, Wikipedia, sprinklers, McDonalds

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

The Health Insurance Marketplace is open for business

The day is finally here: the Health Insurance Marketplace is open! I’d hoped to poke around a little and report on what I saw, but the site is so busy I haven’t yet been able to get past this page:

alot_of_visitors

The fact that the site has been overloaded with visitors for the past four days shows us that we are ready to buy insurance and are on board with the Affordable Care Act. We’ll still have to work through some bugs, I’m sure, but I’m glad to see so many Americans are excited about this new option. Once I get past the waiting page, I’ll be sure to let you know how things work in the Marketplace.

Brush and floss twice a day…even you, Olympians!

According to a study just published in the British Journal of Sports Medicine, athletes competing at the 2012 London Olympics who visited the athlete’s village dental clinic had surprisingly bad teeth. Of those people examined, 55% had cavities, 45% had lost some tooth enamel, 76% had gingivitis, and 15% had periodontitis. A full 40% of athletes were “bothered” by their oral health, and 18% admitted their dental problems caused issues with training and athletic performance. While we hold up these Olympians as paragons of health and fitness, their teeth tell us another story. Oral health is an indicator of overall health, and perhaps focusing intently on training is leading them to disregard other important aspects of their health.

Earn credit for editing Wikipedia at UCSF medical school

The medical school at University of California, San Fransisco (UCSF) is offering a unique course to its fourth year students: editing medical Wikipedia articles. They are working with Wikiproject Medicine to add citations and increase the accuracy of the 100 most popular medical articles on Wikipedia. Health care providers use Wikipedia often, and medical students have an abundance of information—so it makes sense for the students to contribute their knowledge for the good of site they’ll use frequently in their practice. UCSF is the first medical school to link Wikipedia’s education goals with course credit. Hopefully, the combined knowledge of the nation’s medical students can be used to help all of us understand the details of razor burn (the #1 most-viewed medical page).

Nursing homes need sprinklers

Medicare and Medicaid require all new nursing homes or additions to a nursing homes to have automatic sprinkler systems. Older nursing homes did not have any regulation regarding fire suppression or sprinklers until August 2008, and they were given five years to comply with the rule. Now that those five years have passed, approximately 1000 facilities have “partial” systems, and about 125 have no sprinklers at all. Considering nursing home residents often have mobility issues, an uncontrolled fire in one of the facilities would be devastating. If you know of a nursing home that does not have a proper sprinkler system, I suggest calling CARIE (I did my summer internship at CARIE; they’re wonderful) and talk with the ombudsmen there to help ensure the safety of the residents.

Happy Meals just got a little happier

This week, McDonalds announced major changes to its menus—value meals can now be accompanied by salad, fruit, or vegetable in lieu of fries, Happy Meals will no longer be promoted with soda but instead with milk, juice, or water, and advertising and packaging for children will encourage wellness and good nutrition. The changes will be made in McDonalds’ 20 major markets across the world, which comprise 85% of global sales. The most important part of these changes is the addition of choice. Adults and children alike will be able to choose salad instead of fries, water rather than soda. Having these choices available—and encouraged—will help fulfill the public health goal of making the healthy choice the easy choice.

Friday Five: Creepy Uncle Sam and Generation Opportunity

This week, the fantastic Phoebe Jones sent me a link to troubling new anti-ACA ads. I got so riled up that this week’s Friday Five is all about Generation Opportunity. Take a look.

http://www.youtube.com/watch?v=R7cRsfW0Jv8

http://www.youtube.com/watch?v=djCftQGTMC8

Of course, I jumped head first into the Generation Opportunity wormhole after seeing those two gems. And lovely readers, I saw some scary things down there. These are five of the more remarkable bits from their sites.

This is how insurance works! The healthy subsidize the sick—and the healthy tend to be young. Unless, of course, you’re insulated from the full cost of your premium because you’re one fortunate enough to be one of the less than 60% of Americans who get their insurance through their employer.

There is no Obamacare insurance. You cannot purchase something called “Obamacare.” We’re still going to dump money into the pockets of health insurance companies, only now they can’t screw us over quite so often. (Pardon my language—you should see my notes for this post.)

This has been debunked for a while now. I just don’t even know what to do with this other than say This Is Still Not True.

That’s all the page says. There’s honestly nothing else on it but the header and sidebar. I’m interested to know what Generation Opportunity means by this—will Obamacare judge quality, quantity, or some mix of both? Is there extra credit?

I would like more information about this important topic. But I sense that Generation Opportunity has a slight obsession with sex and yet can’t quite get their thoughts together about how to link what it loves (horizontal mambo) with what it hates (the Affordable Care Act) and that’s why this page is blank as well.

I’m highlighting the misinformation and combative headlines because we will be able to purchase insurance through the Marketplace (aka websites, phone calls, and paper applications) starting on October 1. This is a big day for the Affordable Care Act, and we will see all kinds of insane stories about how everything is going wrong. We have to remember that many of the reports will be blown out of proportion or just false…but some of the problems will be real. Things will be be rocky for a while. That’s what happens when you make big changes.

One final note: Just to be clear, you cannot purchase something called “Obamacare.” It simply doesn’t exist. If you have health insurance, it will be through Medicare, the VA or other federal programs, Medicaid, or private companies such as Aetna and Coventry. One more time: A plan called “Obamacare” does not exist.

Friday Five: heat, Bloomberg, Texas, heroin, ACA

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Let’s all do the heat wave! Just in case you’ve ignored the Facebook status updates, tweets, and complaints from co-workers, I want to inform you that it is Very Hot Outside. Growing up in Florida gives a person a skewed sense of the appropriate level of summertime heat and humidity, but this week has been tough even for me. In all seriousness, the heat is severe and dangerous, especially because so many people in the affected areas (map) don’t have air conditioning. So follow the heat advisory instructions: stay inside, run that AC (if you have it), drink water, and check in on seniors—they’re especially susceptible to high temperatures. And remember, we’ll all look back fondly this week while we wait for snow plows in January.

Bloomberg’s at it again But this time, he just wants New Yorkers to bypass the elevator and take the stairs instead. Mayor Bloomberg signed an executive order on Wednesday that requires all government building to be laid out using “Active Design” principles in order to promote physical activity like taking the stairs. We often talk in public health about making the healthy choice the easy choice and changing the built environment to encourage physical fitness. Bloomberg’s latest move may spark an interest in healthier buildings. Could Active Design be the new LEED certification?

You haven’t heard the whole story about Texas This was a big week for abortion controversy in Texas, and there’s already extensive coverage of what happened, so here’s some news you may have missed:

  •  You can now purchase Rick Perry voodoo dolls (cultural appropriation isn’t just for Miley Cyrus)
  • Texas Democrat Rep. Harold Dutton introduced a bill that would ban all abortion legislation until the state abolishes the death penalty.
  • The pink running shoes Wendy Davis wore during her filibuster have over 280 positive reviews on Amazon, and not all of them extol the arch support.

What did I miss?

Heroin’s popularity is growing in Northern New England In New Hampshire, the number of fatal heroin overdoses jumped from just seven in 2003 to a surprising 40 in 2012. The increase has also been observed in Vermont, with a 40% increase in heroin addiction treatment, and Maine, which had three times the heroin overdoses in 2012 as in 2011. There are a few factors that may contribute to this growing problem: increased control over prescription painkillers, the relative cheapness of heroin compared to painkillers, and because heroin can be sold at a higher price in rural areas than in urban centers, distributors are incentivized to sell more. Heroin is now taking up most of drug enforcement agents’ time in the area. Controlling infectious diseases like HIV and Hepatitis C will be the next challenge for the area’s public health community.

Curious about what’s happening next with the ACA? Kaiser Family Foundation released a new ACA video starring its charming YouToons. This one, a follow up to 2010’s “Health Reform Meets Main Street,” explains how to “Get Ready for Obamacare.” (Interesting, the change in terminology over three years!) This easy to understand breakdown of the complicated law is accessible to all audiences. Anyone talking to the public should be emulating this kind of clear communication. http://www.youtube.com/watch?v=JZkk6ueZt-U

Friday Five: sterilization, pain robot, brains, surgeons, Sharknado

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Rural women are more likely to be sterilized

Tubal ligation, also known as sterilization or “getting your tubes tied,” is far more common among rural women as compared to urban women. Of rural women, 23% said they had been sterilized; urban women, 13%. There is only speculation about why this difference exists. Some of the theories floating around are: less access to other forms of birth control; piggybacking tubal ligation onto post-partum Medicaid coverage; lower educational level. Importantly, 39% of those rural women regret their decision. We should be asking why they didn’t choose a long-term, reversible birth control such as an IUD or an implant (like Implanon) instead.

Somewhat cute robot helps reduce kids’ pain and suffering during injections

As a needle phobic myself, I was very excited to learn that there’s an innovation in helping kids’ distress during shots. The robot not only talks to the child in order to distract him or her from the scary needle, but encourages exhalation during the injection to help with muscle relaxation (video here). There are two reasons why reducing pain and anxiety for children receiving immunizations is important: excessive worry can make other parts of the exam difficult, and in the future, an adult who had a bad medical experience as a child may be more likely to avoid care. These both have significant health implications. If this robot can help, I say let’s get one in every pediatrician’s office—and maybe in internist’s offices too, for ‘fraidy cats like me.

Brain pathways involved with learning and changing behavior charted

This week the NIH published a study identifying neural pathways associated with learning and changing behavior in mice. The nerves associated with the switch from moderate to compulsive drinking were found to also have a role in learning and decision making. Researchers hope that their insights will be helpful in understanding alcoholism and addiction. Learning more about why some people can use substances in moderation while others become addicted is crucial to improving mental and physical health. Hopefully, these findings will also apply for humans.

Surgery residents operate less often under new rules

Medical residents (doctors who are done with medical school and are completing their practical training) work notoriously long shifts and even longer workweeks. Restrictions created in 2011 limited shifts to 16 hours for first-year residents and 28 hours for the more advanced doctors and everyone’s week is limited to 80 hours. Surgical residents have in turn participated in fewer hours of surgery because of the limits on working hours. Many doctors are concerned that this will put the budding surgeons at risk for not gaining enough experience. There has to be a balance between allowing doctors to get enough rest while also learning enough to practice on one’s own—the question is, how

Kathleen Sebelius may in fact have a sense of humor

Twitter blew up last night with references to Sharknado, a horribly wonderful movie about a tornado that blew sharks into a city. (I don’t know how that works, I didn’t watch it!) Buzzfeed immediately wrote an article claiming “There is no Obamacare coverage for pre-existing Sharknado injuries.” Kathleen Sebelius replied: https://twitter.com/Sebelius/status/355766513334108160 Hey, an ACA joke!

I leave you this weekend with an excellent infographic explaining pretty much everything you need to know about gender, sexual orientation, and the like…The Genderbread Person!

Genderbread-Person

Friday Five: Chicago, ACA, firefighters, prescription drugs, vaccine recall

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Fourth of July shootings in Chicago

This Fourth of July weekend is proving to be deadly for Chicago. Yesterday, eight people were killed and more than 30 were hurt in shootings across the city. The youngest victim is just five years old, and was shot while attending a party in a park with his family. These shootings are a disgrace, as is the lack of national coverage of the violence permeating Chicago. Victims’ stories should be plastered across every news station and website, and the nation should be reviving the post-Sandy Hook gun conversation in light of this inexcusable violence.

 

Another ACA delay

The Obama administration added to the confusion surrounding the Affordable Care Act by pushing the employer mandate deadline back one year to January 1, 2015. Another instance of caving to private sector demands means increased misunderstanding for the public. The law was incredibly complicated as written, and the administrative tweaks, House repeals, and flat-out lies disseminated by the media ensure that nobody has any idea what’s going on. The ACA is the single most important change to health care the US has seen since 1965, and its frustrating to watch it falter. Hopefully, the exchanges will still open as scheduled on October 1.

 

Firefighters killed in Arizona fires

Nineteen elite firefighters were killed on Sunday battling a blaze that is still only 45% contained. Their deaths have reminded us that the people suffering from these fires are not only those who lose their homes, but the people who are willing run into the flames to try to protect those homes. We’re learning about the hotshot teams specially trained to fight wildfires, an aspect of firefighting that was unknown to many people. I’ve been trying to imagine what it’s like to do what these teams do: go out to the fire, live near it for days, battling it while awake and smelling it while you sleep. I am in awe and very grateful.

 

More ‘scripts, more problems

This was a big week for news about prescription drugs. A brief rundown:

  • 70% of Americans take at least one prescription a day, mostly antibiotics, antidepressants, or painkillers
  • The number of fatal overdoses in women quadrupled between 1999 and 2010, and approximately 42 women die daily from overdoses
  • The FDA busted 1600 illegal online pharmacies

 

Hepatitis B Vaccine recall

Merck issued a recall this week for one lot of the Hepatitis B vaccine Recombivax. The issue is not with the vaccine itself, but with the glass vials that may easily crack. Merck is concerned about the sterility of the vaccine, and the FDA assures consumers there’s no need to be revaccinated if a doctor administered one of the recalled lot. The anti-vaccine websites I visited seem to have not picked this up yet, so maybe this vaccine news won’t be misconstrued. We can only hope.

In honor of yesterday's Fourth of July holiday, here's a little Katy Perry to get you dancing:

http://www.youtube.com/watch?v=QGJuMBdaqIw

Friday Five: violence, HPV, obesity, smog, Obamacare

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Global rates of violence against women are alarmingly high

This week, the WHO released a study showing that more than 30% of women around the world have been victims of physical or sexual violence, particularly from their spouse or partner. The report also outlines the health issues associated with violence against women: death, depression, alcohol use, STIs, unwanted pregnancies and abortions, low birth weight babies. The WHO recommends that health care providers take violence more seriously. These findings remind us that violence is not a far away issue that impacts other people—all of the WHO regions have violence rates hovering between 23-38% (map). Whether we realize it or not, we all know women who have experienced violence against them, and we are all responsible for ensuring women have the education and mobility they need to keep themselves safe.

 

HPV rates are lower in teen girls thanks to vaccine

And now for some good news: the prevalence (number of cases currently in the population) of vaccine preventable HPV in teen girls has dropped 56% since the introduction of the vaccine. The ultimate goal is to have 80% of American children vaccinated in order to create herd immunity, meaning that enough people are vaccinated so the virus has nowhere to go. However, only about half of teen girls have gotten the necessary three doses of Gardasil or Cervarix. It’s time to stop stalling. Vaccinate kids and help prevent them from developing cervical, anal, or—as Michael Douglas reminded us—throat cancer.

 

AMA declares obesity a disease

The American Medical Association (AMA) voted this week to define obesity as a disease, identifying it as a complex issue that requires therapeutic medical treatment. They hope to reduce stigma and understand obesity to be a disease because it impairs some body functions. Critics denounced the decision, saying that because obesity is defined using BMI, it is not a precise diagnosis and that obesity has no specific symptoms of its own, only that it a contributing factor to other diseases. Although obesity is often characterized as a willpower and laziness issue, the resolution, as quoted in the New York Times, says:

The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.

Hopefully, the AMA’s decision will lead to increased insurance reimbursement for obesity treatments, including nutritionists and gym memberships, as well as medical interventions and therapy.

 

Singapore is covered with smog

Fires in Indonesia are causing dangerous smog in the country and Singapore. Though no one has fessed up to starting the fires, they are likely due to illegal land clearing practices in Sumatra, which is west of Singapore. Today, Singapore’s Pollution Standards Index (PSI) hit 401, far higher than the “dangerous” level defined by a PSI of 300, and is considered “life-threatening” to the ill and elderly. Smog is a mixture of accumulated greenhouse gases and smoke, and is made worse by the combination of pollutants, sunlight, and heat that creates ozone. Smog causes serious respiratory, eye, and skin problems, and this smog is so thick visibility is seriously impaired.

 

Dems love the term “Obamacare,” Republicans don’t

The Kaiser Family Foundation June tracking poll shows that when referred to as “Obamacare,” 73% of Democrats responded favorably to the Affordable Care Act (ACA), as compared to 58% when the ACA was called “health reform law.” Republicans, however, saw an increase in unfavorable responses when the ACA was called “Obamacare,” from 76% to 86%. Apparently, the pejorative likely coined by none other than Mitt Romney has been successfully appropriated and turned into a rallying point for Democrats in support of the ACA. Obama is a linguistic master, and this shows he can turn even the most negative epithet into a compliment. Take that, Sarah Palin!

It's the first day of summer! This lion knows how to celebrate:

http://www.youtube.com/watch?v=mV1CVTPVAJg