#also they insurance they were citing was Medicaid
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Sass Talks Books: Thank You for Listening, by Julia Whelan
Basic Plot: An audiobook narrator, who doesn't record romance books (anymore - she needed to break into the industry somehow), is given the financial opportunity of a lifetime...recording a romance book. It's a dual narration book, too, which means working with another narrator. Her recording partner quickly becomes one of the best perks of the project, warm and funny and *real* feeling, despite the fact they've never met. (They've never met, right?)
My thoughts: I really enjoyed this one. The author IS an audiobook narrator, writing a book about two audiobooks narrators, and I listed to the audiobook...narrated by the author. I thoroughly recommend that reading experience, by the way. There's a lot of little moments with the two talented voice actor characters slipping into different accents, talking about tone and inflection, and it's an absolute delight to hear the narrator delivering on the script she wrote for herself.
As for the story itself, I'm not far enough into the romance world to know if this book deviates from the romance novel beats enough that it's drifted out of the category, but I can say that it was absolutely charming and enjoyable. And, that the changes made dulled the edges of the parts of romance I bounce off of the most while absolutely being a very loving send-up of the genre. The connection between the two people was very real, but it wasn't the only (or even, I would argue, the most important) relationship developing and changing in the book.
Every character felt connected in a complicated web of love and relationships with other people - it was a joy. And it was used to explore some toothy things that I normally don't get in a book this fun - grief, regret, how you deal with the losses you can't get back, how you rebuild a life. It stayed warm-hearted and kind as a book, but it didn't shy away from real fights, insecurities, and pain.
A handful of warnings to go along with that: the MC has lost an eye, and deals with ableism, and some negative self-perception. There's some diet-culture-based disordered eating for the MC's best friend (not displayed as a good thing). The MC's relationship with her dad has some brutal fights where there's emotional manipulation happening. There's also a real look at the complications of dementia - discussed below.
The protagonist's relationship with her grandmother is a key point of the story, and the grandmother is dealing with encroachment of memory loss and personality change that comes along with dementia. This part surprised me - I work with older adults in long-term care and lol, was not expecting that my professional life would be relevant to the situation. The author made a few errors with the care system in California (where our grandma is based, and where I work). But frankly, only a few, and the way the dementia progressed wasn't one of them. It was good, and heartbreaking, and one of my favorite parts.
Wow...I wrote a lot about this. Suppose that makes sense, considering it was my experience of the book itself. I expected something light and fun, and while I got it, there was depth there too that was a very welcome surprise.
#sass talks books#thank you for listening#julia whelan#Okay I'll be salty in the tags#the things the author got wrong about assisted living#there's a plan to move the grandma from a building she loves but is expensive to one that accepts insurance#In California there's only one way that insurance pays for an assisted living#and there's a two-year waitlist for the person in the grandma's position#it wouldn't have been a quick solution#also they insurance they were citing was Medicaid#which in California is called Medi-Cal#and if the grandmother was on Medi-Cal#she would not have been able to afford her current assisted living for MUCH longer than the novel's plot sets it up to be#but honestly these are deep in the weeds professional quibbles#Things the book got right about long-term care: the ridiculous expense of care tiers#the services likely provided by the building#and the pain and joy of loving someone with dementia#which makes me think the author DID have someone she loved in an assisted living with dementia#but maybe wasn't in California#or didn't have the same financial issues
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A.B.A. is the only autism intervention that is approved by insurers and Medicaid in all fifty states. The practice is widely recommended for autistic kids who exhibit dangerous behaviors, such as self-injury or aggression toward others, or who need to acquire basic skills, such as dressing themselves or going to the bathroom. The mother of a boy with severe autism in New York City told me that her son’s current goals in A.B.A. include tolerating the shower for incrementally longer intervals, redirecting the urge to pull on other people’s hair, and using a speech tablet to say no. Another kid might be working on more complex language skills by drilling with flash cards or honing his ability to focus on academic work. Often, A.B.A. targets autistic traits that may be socially stigmatizing but are harmless unto themselves, such as fidgeting, avoiding eye contact, or stereotypic behaviors commonly known as stimming—rocking, hand-flapping, and so forth.
Hammond is now the mother of two autistic sons. Her older son, Aidan, who is sixteen, is nonverbal and needs round-the-clock care. When he was young, he attended a traditional school, but teachers, Hammond said, “were literally calling me every single day: ‘Can you please come here and sit with him? Can you please pick him up?’ ” Hammond tried physical, occupational, and speech-language therapy for Aidan, but he was “kicked out of every single one,” she said. Therapists “felt that his behaviors were interfering with his learning, and that he needed to be in A.B.A.” A.B.A. clinicians, she added, “were at least willing to look at my son.”
She drove him to A.B.A. appointments at a clinic about an hour from their home in southwest Texas, but stopped treatment after just a few sessions. This was partly due to the commute and the co-pay, but also to a discomfort with the approach, which required Aidan to spend long periods, over multiple sessions, solving a puzzle in which he matched shapes to the right-sized holes. “He’s having to do this over and over and over again,” Hammond recalled, “and, when he picked the right thing, it’s, like, Ooh, here’s a Skittle! Like he’s a puppy.”
In recent years, A.B.A. has come under increasingly vehement criticism from members of the neurodiversity movement, who believe that it cruelly pathologizes autistic behavior. They say that its rewards for compliance are dehumanizing; some compare A.B.A. to conversion therapy. Social-media posts condemning the practice often carry the hashtag #ABAIsAbuse. The message that A.B.A. sends is that “your instinctual way of being is incorrect,” Zoe Gross, the director of advocacy at the nonprofit Autistic Self Advocacy Network, told me. “The goals of A.B.A. therapy—from its inception, but still through today—tend to focus on teaching autistic people to behave like non-autistic people.” But others say this criticism obscures the good work that A.B.A. can do. Alicia Allgood, a board-certified behavior analyst who co-runs an A.B.A. agency in New York City, and who is herself autistic, told me, “The autistic community is up in arms. There is a very vocal part of the autistic population that is saying that A.B.A. is harmful or aversive or has potentially caused trauma.”
Until recently, the American Medical Association officially endorsed “evidence-based treatment of Autism Spectrum Disorder including, but not limited to, Applied Behavior Analysis Therapy.” Last summer, the medical students’ body of the association proposed that the organization withdraw its support for A.B.A., citing objections by autistic self-advocates. The association did not adopt the resolution as submitted, but its house of delegates eventually approved an amendment removing any explicit reference to A.B.A., and autistic activists spread the word that A.B.A. no longer appeared to have the outright endorsement of the nation’s largest medical society.
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Releasing the U.S. Senate Health, Education, Labor, and Pensions Committee's findings on the prices of weight loss drugs in the United States, Sen. Bernie Sanders on Wednesday ramped up pressure on a Danish pharmaceutical company to lower the "outrageously high" prices of Ozempic and Wegovy, warning that the current pricing could bankrupt the country's healthcare system.
As chairman of the Senate HELP Committee, Sanders (I-Vt.) is leading an investigation into Novo Nordisk's weight loss drug pricing, and the report published Wednesday is the result of modeling his staff completed to show how the medications' exorbitant prices could impact prescription drug pricing across the United States.
The committee found that if half of all U.S. adults with obesity took Wegovy and other diabetes drugs that have recently been approved for weight loss, it could cost $411 billion per year. In 2022, Americans spent $406 billion on all retail prescription drugs.
Medicare and Medicaid would spend an estimated $166 billion per year on the medications if half of the programs' patients used them, rivaling the $175 billion the programs spent on prescription drugs in 2022.
"Today's report makes it crystal clear: The outrageously high price of Wegovy and other weight loss drugs have the potential to bankrupt Medicare and our entire health care system," said Sanders.
The projected costs are a far cry from what patients in Denmark and other European countries would pay for the same drugs.
Americans currently pay $969 per month for Ozempic and $1,349 per month for Wegovy. While the two drugs have the same active ingredient, the former is typically used to treat Type 2 diabetes and the latter is for weight loss and management.
Ozempic costs just $155 in Canada, $71 in France and $59 in Germany. Danish patients pay just $186 per month for Wegovy, while the medication costs $137 in Germany and $92 in the U.K.
Sanders' report says that Novo Nordisk's prices are "especially egregious" considering the fact that the company could make a profit off manufacturing them for less than $5 per month.
"The unjustifiably high prices of these weight loss drugs could also cause a massive spike in prescription drug spending that could lead to an historic increase in premiums for Medicare and everyone who has health insurance," said the senator. "There is no rational reason, other than greed, for Novo Nordisk to charge Americans struggling with obesity $1,349 for Wegovy when this same exact product can be purchased for just $186 in Denmark."
The report cites the North Carolina state health plan's decision last month to end coverage for Wegovy and similar medications.
The plan administrators "estimated that continuing coverage for Wegovy at its current price would require them to double insurance premiums. Faced with impossible choices, the health plan eliminated coverage," reads the report.
The reason nearly 20,000 teachers and other state employees in North Carolina lost access to the drugs, the report emphasizes, "was not because there were not enough drugs to meet demand, but because Novo Nordisk refused to lower prices to make those drugs widely available."
Thirty-five state Medicaid programs do not cover the medications at all, the HELP Committee noted, due to the price.
"As important as these drugs are, they will not do any good for the millions of patients who cannot afford them," reads the report. "Further, if the prices for these products are not substantially reduced, they have the potential to bankrupt Medicare, Medicaid, and our entire healthcare system."
The committee found that if Novo Nordisk made the U.S. price of Wegovy equal to what Danish patients pay, the healthcare system could pay for new weight loss drugs for 100% of adults with obesity annually for less than what it costs to cover just 25% of those patients at the current drug prices.
The healthcare system would save up to $317 billion per year, according to the committee's modeling.
The report was released days after Sanders appealed to the Danish government in the pages of one of the country's largest newspapers, Politiken, calling on officials to force Novo Nordisk to lower U.S. prices.
"As many Danes may know, I have long admired the welfare system that has been built up in Denmark," wrote Sanders. "When I was a candidate for the presidency, I often pointed out that the United States could learn a lot from Denmark in terms of access to healthcare and education, as well as respect for the environment and workers' rights. There is a reason why Denmark is considered one of the happiest places on Earth in international surveys. The Danish people should be proud of what you have managed to achieve."
"So now I want to appeal to the people of Denmark and the charitable foundation that owns this hugely profitable company," he continued. "Help the American people do something about the epidemic of obesity and diabetes we are facing."
Pelle Dragsted, a member of Danish Parliament for the Red-Green Alliance and a democratic socialist, applauded Sanders' op-ed.
"Healthcare is a human right," said Dragsted on Monday. "Having an illness should never be the ruin of anyone. Our message to Novo Nordisk is clear: Choose basic decency and social responsibility over profit—lower your prices in the U.S."
#us politics#news#common dreams#2024#sen. Bernie Sanders#us healthcare#Senate Health Education Labor and Pensions Committee#Novo Nordisk#Ozempic#Wegovy#affordable healthcare#healthcare for all#Medicare#Medicaid#prescription drug prices#Politiken#denmark
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MEDICAID'S PROPOSED WORK REQUIREMENTS
In 2018, the Trump Administration and GOP made several attempts to rescind the ACA and impose federal spending caps on the Medicaid program to cut down costs. These efforts were ultimately unsuccessful; however, a few of the states expanded their Medicaid programs and proposed work requirements during this time.
According to KFF, one out of five Americans receive health care through Medicaid. The program has become the country's largest source of health care coverage and accounts for 27% of state expenses. Due to program expansion and costs, House Republicans revived their push for work requirements over the spring during debt ceiling negotiations with Democrats. They also suggested reforming the work requirements for people receiving food and cash assistance through SNAP and TANF.
The Medicaid work requirement provision did not make it through negotiations; however, President Biden agreed to the expanded work requirements for food and cash support in exchange for a two-year suspension of the debt ceiling. In spite of the outcome in Washington, some states are still pursuing work requirements for their Medicaid programs through special waivers.
Even though Medicaid is a jointly funded government program between the federal government and states, the states are responsible for administering it, and the Social Security Act permits them the flexibility to tailor their Medicaid programs through what are referred to as Section 1115 waivers. These waivers require approval from the Secretary of Health and Human Services and can change eligibility requirements or suspend provisions of federal law under the condition that the projects promote the goals of the Medicaid program.
States first used Section 1115 waivers to implement work requirements in 2017 under the Trump Administration. During that time, twelve states received approval from HHS. Shortly after, the Trump Administration was sued by health care advocates and civil rights groups, rescinding the work requirement legislation in Arkansas and Kansas. Because of this, other states were also restricted from implementing their provisions.
GA's Medicaid Program Work Requirements
Shortly after President Biden transitioned into office, he reversed several other waivers that granted states approval to implement Medicaid work requirements. Georgia was among the states affected by the decision and sued the administration. The District Court for the Southern District of Georgia ruled in favor of the state, citing that the administration did not consider whether reversing the waiver would bring about less Medicaid coverage. Georgia has become the only state with a work requirement for Medicaid eligibility, and the state's strategy, Pathways to Coverage, launched at the beginning of this month.
Work requirements have once again become a topic of debate among health care professionals and government officials. Some see the requirements as barriers to health coverage that go directly against the objectives of the Medicaid program. They argue that Medicaid is designed to provide insurance, not encourage employment. Meanwhile, work requirement supporters say that the program has expanded far beyond its original objective, and states must rein in costs. Presently, state's are navigating eligibility determinations that will significantly impact enrollment. Setting the work requirement debate aside, all states should be looking for ways to improve efficiency and cost avoid in their Medicaid plans to ensure that vulnerable populations receive the coverage they need.
Find out more here.
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Sunday, July 30, 2023
Volunteer Sleuths Are Out Hunting for Your Stolen Car
(NYT) At the end of a quiet residential street in north Portland, Titan Crawford took a calming drag off his cigarette, and then shuffled past the gutted shell of a stolen Nissan pickup truck and into the patch of hulk-filled woodlands beyond. For much of the past year, Mr. Crawford, 38, has led a growing network of volunteer sleuths who scour Portland’s streets, alleys and forests, racing against time in hopes of finding stolen vehicles before they end up shredded for parts. There is no shortage of work to be done. Vehicle thefts in Portland are on track to reach well over 10,000 this year, more than triple the number the city recorded a decade ago, part of a nationwide trend that accelerated during the coronavirus pandemic. In Portland, the brazenness of the crimes, inattention from the police and desperation of residents who suddenly find themselves missing one of their most valuable possessions have led many to take matters into their own hands. Similar groups have popped up and grown around the country as vehicle thefts have soared. Neighbors share pictures of license plates, keep watch during commutes to work and hunt online for reports of stolen vehicles. Nearly every day, the group, PDX Stolen Cars, helps a resident reconnect with a vehicle in Portland or the surrounding suburbs.
Nearly 4 million in U.S. cut from Medicaid, most for paperwork reasons
(Washington Post) The notice arrived in an envelope stamped “important information,” telling Kristin Fortner she needed to prove that she and her husband still deserved Medicaid. She filled out the form within a week of receiving it this past winter and mailed it back. So she was perplexed by a phone call almost three months later from the Arkansas Department of Human Services alerting her that she had neglected to renew the couple’s Medicaid and, unless she sent the paperwork, their health insurance would end. Fortner quickly resubmitted the same form, this time in person. Except Arkansas already had cut them off. She discovered in May that her insurance had vanished as she tried to pick up a prescription for Suboxone, the medicine that helps her stay off opioids. Suddenly, she owed $380. Her Medicaid coverage, the pharmacy’s records showed, had expired. A 33-year-old waitress earning $3 an hour plus tips, Fortner walked out of the drugstore without the pills. She is among nearly 4 million Americans who have been lopped off Medicaid since the end of a pandemic-era promise that people with the safety-net health coverage could keep it, requiring every state to begin a herculean undertaking of sorting out who still belonged on the rolls. Three-fourths of these people have been removed because of bureaucratic factors. Such “procedural” cutoffs—prompted by renewal notices not arriving at the right addresses, beneficiaries not understanding the notices, or an assortment of state agencies’ mistakes and logjams—were a peril against which federal health officials had cautioned for many months as they coached states in advance on how best to carry out the unwinding.
Uruguay/Argentina Drought fallout
(Foreign Policy) The ongoing drought that has plunged Uruguay into a water crisis in recent weeks is also projected to severely hurt neighboring Argentina’s agriculture sector as well as its GDP. Citing the drought, the International Monetary Fund (IMF) lowered Argentina’s GDP forecast for 2023, projecting a contraction of 2.5 percent, a reversal of its previous forecast for 0.2 percent growth this year. Argentina is already struggling to curb massive inflation and repay its outstanding IMF debts. Meanwhile in Uruguay, consecutive years of low rainfall and poor management of a key reservoir have caused water levels to dwindle, worsening the quality of tap water around the capital of Montevideo to a level that may be unsafe for people with hypertension and other medical problems. The government has bought bottled water for some 500 thousand people and is working to engineer new access to water resources from a previously untapped river.
Germany used to be the world’s export powerhouse. Now, it’s not growing. What happened?
(AP) The German economy is still failing to grow, figures showed Friday, as the country that should be the industrial powerhouse for all of Europe struggles with high energy prices, rising borrowing costs and a lagging rebound from key trading partner China. The International Monetary Fund forecast this week that Germany would be the globe’s only major economy to shrink this year, even with weak economic growth around the world amid rising interest rates and the threat of growing inflation. In Germany, the economy has been buffeted by several challenges. Above all, its long-term dependence on Russian natural gas to fuel industry backfired when the invasion of Ukraine led to the loss of most of Moscow’s supply and to higher costs for energy-intensive industries such as metals, glass, cars and fertilizer. Higher interest rates from the European Central Bank have weighed on construction projects that depend on borrowing.
Ukraine’s Stepped-Up Assault Grinds Forward, but Scale Is Unclear
(NYT) Battles raged in southern Ukraine on Thursday, as Kyiv’s stepped-up offensive against the Russian occupation made small gains, according to Russian, Ukrainian and Western analysts and officials, but the scope of the assaults and their toll remained unclear. There was minimal, and sometimes contradictory, information about how many troops and armored vehicles Ukraine had committed so far to its attempt to punch holes through Russia’s daunting defensive network. Crucially, it was also unclear what kind of losses either side was suffering, in soldiers and weaponry. What is clear is that Ukraine has significantly ratcheted up its seven-week-old counteroffensive, along two southward thrusts apparently aimed at cities in the Zaporizhzhia region: Melitopol, near the Sea of Azov, and Berdiansk, to the east, on the Azov coast. In both cases, the Ukrainians have advanced only a few miles so far and have dozens of miles to go. In the short run, success would mean getting behind Russia’s defenses, where its forces would be far more vulnerable, and taking major towns farther south. Longer term, it would mean taking back Melitopol, a major transportation hub, or Berdiansk, an important port, or both—effectively cutting the Russian-occupied territory in half, complicating Moscow’s strategy and logistics.
U.S. to provide up to $345 million in military aid to Taiwan
(Washington Post) The United States will provide Taiwan with up to $345 million in military assistance, using a similar presidential authority to the one in which it sends weapons to Ukraine, the White House announced Friday. The package comes as China continues efforts to increase its authority over democratically-governed Taiwan, which Beijing claims as part of its territory. “The drawdown includes self-defense capabilities that Taiwan will be able to use to bolster deterrence now and in the future,” Sue Gough, a Department of Defense spokesperson, said by email. Systems in the package “address critical defensive stockpiles, multi-domain awareness, anti-armor and air defense capabilities,” she added. The announcement follows complaints from the Taiwan defense ministry over delays in the delivery of U.S. arms that Taiwan already purchased. The new aid package marks the first time the Presidential Drawdown Authority (PDA), which expedites the process of supplying arms and pulls directly from stockpiles, has been used for Taiwan. It has been used dozens of times for Ukraine, under a separate provision allowing for emergency support.
Aid group official warns that impasse at the UN on border crossing puts 4.1 million Syrians at risk
(AP) An impasse at the United Nations over a border crossing with Syria’s last rebel-held enclave is putting 4.1 million Syrian there in danger, the president of the International Rescue Committee warned this week. David Miliband’s comments came more than two weeks after the U.N. Security Council failed to renew the mandate for the Bab al-Hawa border crossing between Syria and Turkey, which secures aid for Syrians in the enclave. The vast majority of people in northwestern Syria live in poverty and rely on aid to survive—a crisis that was further worsened by a devastating magnitude 7.8 earthquake that hit southern Turkey and northern Syria in February. The earthquake killed more than 50,000 people, including over 6,000 in Syria, according to the United Nations. The quake also displaced hundreds of thousands of others. The paralysis comes as donor fatigue has led to aid cuts in aid to both northwestern Syria and neighboring countries hosting millions of Syrian refugees who fled the ongoing conflict, now in its 13th year.
Unhappy With Right-Wing Leaders, Some Israelis Hatch Escape Plans
(NYT) Naama Levin and her partner had always dreamed about taking a break from Israel and going on an extended vacation abroad. But they did not start making concrete plans until late last year, when Benjamin Netanyahu returned to power and formed a coalition with extreme right-wing and religiously conservative partners. In recent months, Netanyahu has put an ultranationalist who has been convicted of inciting anti-Arab racism in charge of national security, taken steps to expand settlements in the occupied West Bank and initiated an overhaul of the judicial system, angering secular Israeli Jews like Levin and setting off months of protests across the country. The passage of the new law was the last straw for some Israelis, who have been struggling with a high cost of living and underfunded schools. Businesses that help relocate corporations and families have seen a sharp uptick in demand in recent days. Financial advisers say they are being flooded with questions about how to move assets overseas and how to establish bank accounts abroad.
Jordan lawmakers move to criminalize some online speech. Rights groups accuse kingdom of censorship
(AP) The lower house of Jordan’s parliament passed legislation Thursday to punish online speech deemed harmful to national unity, drawing accusations from human rights groups of a crackdown on free expression. The measure makes certain online posts punishable with months of prison time and fines. These include comments “promoting, instigating, aiding, or inciting immorality,” demonstrating “contempt for religion” or “undermining national unity.” It also punishes those who publish names or pictures of police officers online and outlaws certain methods of maintaining online anonymity. Lawmakers have argued that the measure, which amends a 2015 cybercrime law, is necessary to punish blackmailers and online attackers. But opposition lawmakers and human rights groups cautioned that the new law will expand state control over social media, hamper free access to information and penalize anti-government speech.
Aided by A.I. Language Models, Google’s Robots Are Getting Smart
(NYT) A one-armed robot stood in front of a table. On the table sat three plastic figurines: a lion, a whale and a dinosaur. An engineer gave the robot an instruction: “Pick up the extinct animal.” The robot whirred for a moment, then its arm extended and its claw opened and descended. It grabbed the dinosaur. Until very recently, this demonstration, which I witnessed during a podcast interview at Google’s robotics division in Mountain View, Calif., last week, would have been impossible. Robots weren’t able to reliably manipulate objects they had never seen before, and they certainly weren’t capable of making the logical leap from “extinct animal” to “plastic dinosaur.” But a quiet revolution is underway in robotics, one that piggybacks on recent advances in so-called large language models—the same type of artificial intelligence system that powers ChatGPT, Bard and other chatbots. Google has recently begun plugging state-of-the-art language models into its robots, giving them the equivalent of artificial brains. The secretive project has made the robots far smarter and given them new powers of understanding and problem-solving.
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Constitution show Amerigroup repeatedly denied services by citing a lack of records the insurer wanted to prove medical necessity. Children who were aggressive, hurting themselves or exhibiting other serious issues were frequently blocked from entering or staying longer at psychiatric residential treatment facilities. The insurer often rejected such expensive stays with the same language citing a lack of medical necessity, frequently saying, “Records no longer show you have these issues.”
Among children denied entrance to residential treatment: an 11-year-old girl who smeared feces in the bathroom of a foster care home and attempted to jump out of a window hours after being released from a psychiatric unit. Amerigroup approved a residential stay months later after the girl tried to both drown and electrocute herself, according to the state’s foster care agency. At that point, no facility would accept her.
Amerigroup also denied a medical provider’s request for a residential treatment of a 13-year-old foster child who was trying to hurt herself and was aggressive toward others. While the state appealed the company’s decision, she tried to overdose on lithium pills and cut herself with glass.
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Parent Involvement in Child Mental Health Treatment
Obtaining child mental health treatment has long been a national priority. The US Department of Health and Human Services' National Quality Strategy aligns financial incentives to promote effective care. However, the number of emergency department visits for children with mental health conditions has increased by 20% for children insured by Medicaid and 10% for those covered by commercial insurance.
In addition, inpatient hospital admissions for kids with mental health conditions have increased by 103% among commercially insured children. Increasing the availability of specialists in child mental health can improve the knowledge base of professionals in these settings. The 2020 CDC report pointed out that the mental health of U.S. children is declining, and a pandemic of the COVID-19 virus has contributed to this trend.
Parents have an important role to play in their child's treatment. The Meridian Adolescent Services have expertise in what works best for any child, and they will contribute to the strategies being used to treat their child. They should be involved in the planning process, and should be able to ask questions. In addition, they should be invited to be part of the treatment team, and they should be provided with a way to provide input on their child's care.
Many standardized assessment tools have been developed to track the effectiveness of child mental health treatment. These include the Parent-Reported Improvement Scale (PRIS), the Children's Global Health Impact Scale (CGIS), the Parent-Reported Impairment Scale (PRIS), the Clinical Global Impression Scale (CGI), the Clinical Global Adjustment Scale (CGA), and the Child Health Questionnaire (CHQ). There are also a number of research studies examining the relationship between parent involvement in treatment and a higher level of parent reported improvement.
Researchers have found that parents are a valuable resource for the treatment team. They can offer insight into the strategies used to treat their child, and they can help the team develop an effective communication plan and treatment goals. For example, when parents are involved in a child's treatment, they are more likely to participate in family-focused therapies, such as psychoeducational group sessions, than when they are not. Parents can choose to be a family's case manager, or they can work with their treatment provider to develop a plan for their child's care.
The most common barriers to seeking child mental health treatment include stigma, unavailability of services, and a lack of information about where to seek help. In addition, parental perceptions of professionals' inability to listen to their concerns and lack of knowledge about their child's condition were cited as major barriers. These attitudes can lead parents to believe that their child's problems are more severe than they actually are, and they may be reluctant to seek help again. Other factors, such as previous experiences of professionals downplaying their child's problem, are also cited as barriers to seeking treatment. Visit the Children's Mental Health center to get their services.
One third of the studies administered a measure only at intake, or only at the end of treatment. In addition, some studies included follow-up intervals that were different from those recommended by the treatment providers. The use of archival data from clinic records illustrates the feasibility of using measures in clinical practice. To familiarize yourself more with this topic, it is best that you check out this post: https://en.wikipedia.org/wiki/Mental_disorder.
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A Telemedicine Secret
Telemedicine has become a critical part of the healthcare industry. During the recent pandemic, this technology was instrumental in the healthcare delivery process. It has also been shown to decrease re-admissions by 44%. Although this technology is expensive and requires board-certified physicians, it is worth exploring.
Telemedicine has played a significant role in healthcare during the pandemic
While most hospitals were already at capacity before the pandemic, telemedicine played a crucial role in reducing the pressure on healthcare facilities. Telemedicine allows doctors to screen patients remotely without having to leave the office. This can reduce hospital wait times and help treat patients who may not be able to travel in person.
Remote Healthcare Challenge
In areas that are remote or where access to healthcare is a challenge, telemedicine can help address some of the most critical challenges in healthcare. For example, people suffering from chronic illnesses may not be able to visit a primary care provider due to lack of protective gear and hospital facilities. By using telemedicine to address these challenges, a physician in a remote location can provide primary health consultations and help people cope with chronic illnesses.
As the pandemic continues to affect healthcare, telehealth may play an increasingly important role in the delivery of care. Many state Medicaid programs have cited telehealth as a crucial tool in maintaining and improving access to care. But the question remains: Will healthcare payers reimburse remote care at parity with in-person care? This remains to be seen, but providers are working hard to help patients navigate their insurance plans and understand the potential changes in payment rules.
It reduces re-admissions by 44%
One of the biggest benefits of telemedicine is its ability to lower readmissions. Telehealth providers can coordinate patient care from a distance, which can help patients follow their medications. Telehealth also helps patients engage in their own care. In fact, a recent study found that telehealth patients were more likely to stick to their medications. The trial had underpowered data to assess hospital readmission rates, but it showed that patients receiving care through telehealth had better health and adherence to medications.
Telemedicine also has an opportunity to help hospitals improve patient satisfaction. It allows a physician to diagnose and treat patients without being in the same place as them. This means that patients receive better care and experience, which can translate to higher customer loyalty and increased net margins for the provider. Additionally, it allows a physician to keep his or her schedule, resulting in better patient outcomes.
It is expensive
A Telemedicine Secret is expensive?
Why does the healthcare industry constantly have to spend millions of dollars on new technology? One reason is that it's a target for hackers. In 2017, 3.2 million people lacked health insurance - 12.2% of the entire population. According to a Secret Shopper study, the average cost of a doctor's appointment for an uninsured patient was $160.
Telemedicine reduces the need for emergency rooms. Telemedicine allows doctors to diagnose and treat patients in the privacy of their homes, saving money and time on transportation. It can also help prevent emergency room congestion. Some solutions even allow patients to send images and seek a second opinion. This can lead to less duplicate testing and improved medication management.
It requires board-certified doctors
Telemedicine, an alternative way of providing medical care, allows patients to receive care from any location. Providers are licensed for their state of practice.
However, cross-state licensing allows telemedicine doctors to provide services in a neighboring state. While this practice is still in its infancy, some states are moving to establish cross-state licensing requirements.
As technology advances, the practice of telemedicine may become more common. For example, telehealth tools such as video chat apps and the internet have become more affordable and accessible. This could increase patient access and reduce the need for emergency room visits.
As technology advances
In addition, telemedicine can make typical doctor visits more efficient. Because the use of telemedicine is rapidly expanding, the field is undergoing significant change. For instance, the AMA is actively advocating for more permanent telehealth advancements.
Some states have made the process easier for physicians. For example, the Federation of State Medical Boards (FSMB) has developed an online application for licensure that streamlines the application process for physicians. States have also established interstate compacts to facilitate licensing of healthcare providers.
These compacts include the Nurse Licensure Compact and the Interstate Medical Licensure Compact. While these compacts do not cover every type of telehealth provider, they can make it easier for doctors to receive multiple licenses in different states.
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so i finally read the arkansas bill so i could form a better argument surrounding it. because i’ve seen so much dishonest framing of it that is super blatant, and i’ve seen complete misinformation being spread (claims that it bans mental healthcare for trans kids, claims that children don’t currently have access to any “gender affirming” surgeries when they literally do with parental consent, claims that there are no side effects or long term health risks of puberty blockers, etc.) but i did want to read the bill itself to make sure it is something i can defend, or at least qualify the parts i don’t agree with... and it’s so completely reasonable and necessary that i’m actually going insane. when you look up “arkansas trans bill” literally every other headline uses the wording “kill trans kids.” just compare that to the name of the bill which is the “save adolescents from experimentation act” lol. both are obviously politically charged but it’s telling that little coverage on this cite the bill’s actual name, knowing it would likely ring alarm bells in the audience that something is missing from the story. i bet most people railing against it on social media havent read it, or if they have they’ve read it very selectively and don’t have any factual evidence to refute the part of the bill that very clearly explain its reasoning and why it’s a matter of medical experimentation in minors incapable of consenting. they also must be selectively ignoring the parts of the bill that state that these restrictions only apply to very clearly defined transition procedures, not mental health care! and do not apply to the treatment of any complications from prior procedures (regardless of the legality under which those were performed), meaning that it is a huge and obvious lie that trans kids will be abandoned by the medical system under this bill.
and i don’t know if i just missed it when reading, or if it was part of a different bill: but where is the part that forces schools to out trans students? because i am obviously against that, since it’s obvious child endangerment and there’s no good argument to legislate against social transition for children anyway—but a lot of media coverage will have you believe that kind of measure is wrapped up in this big evil anti-trans bill, when the bill is actually very specific to medical intervention in minors. if someone actually knows what legislation that was from (because i hope it wasn’t just pulled out of thin air), i’d really appreciate it. and another part of the bill i was a bit unclear on was the medicaid/healthcare coverage section—i gathered that the restriction only applied to coverage for minors, but section 4c seems to generally state that insurance isn’t required to cover gender transition. but i’ll be honest i don’t know the current situation of insurance coverage for transition in arkansas.
also, i do agree with criticisms that this bill could be very damaging to the mental health of trans teenagers already receiving hrt, not from an inflammatory perspective but a common sense one of compassion. there really needs to be robust mental health services and medical observation in place when taking a kid off of hormones, or when cancelling surgeries they’d already scheduled and were putting a lot of hope in. because i’ve read adult detransitioners talk about the uncertainty of coming off hormones, and how their medical providers really didn’t have much knowledge over how it would affect them, how there are withdrawal symptoms coming off of testosterone and many considerations— so imagine that happening to a minor who wants to remain on hormones. and many kids rely on the thought of transition in the future as a big source of hope and a way of coping with present dysphoria and suicidal ideation. so this bill is likely to put them in a very dangerous mental state—and that’s why the trans community’s rhetoric of the inevitability of trans suicidality is incredibly irresponsible right now, because the kids currently facing this absolutely do not need to hear that they will unavoidably kill themselves if not allowed to continue/start transition. but it’s difficult because this legislation is still a necessary step, and the medical negligence was in allowing kids to undergo medical transition in the first place. i just wonder if there could be a more tactful way to go about phasing out medical transition for teenagers already receiving it. (above a certain age, because the use of puberty blockers needs to be stopped immediately.)
i highly recommend everyone read any bill that is being disputed and form opinions for yourself, especially as many states are introducing similar bills that are branded as “anti-trans.” decide for yourself what is and isn’t reasonable. legislation isn’t always inaccessible—a lot is perfectly understandable and written in pretty plain english. and even if you need the help of secondary source news coverage to understand more complicated laws or the issues raised by them that might not be obvious in the text, you still benefit by attempting to read the actual legislation and by reading news coverage critically. it’s typically a good hint if you come away from a critical article agreeing with the criticisms without any understanding of what the bill actually and specifically includes, which most media coverage of arkansas hb1570 is guilty of.
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So, your parents are getting old.
TL;DR
Stuff: start cleaning out stuff they don’t need now. You might read “The Gentle Art of Swedish Death Cleaning” as a guide.
Where to live: research retirement and assisted living options in your parents’ area.
Medical considerations: HIPPA authorization, advanced directives, long term care insurance
Financial considerations: accounts, power of attorney and trusts
Dementia: what to remember when your parents forget.
So, your parents are getting old.
Most of us have parents. Many, if not most, of us will be supporting them somehow as they age. And I read somewhere that most people are not happy with how their parents have prepared for aging (I’d cite it, but I ran across that statistic a couple of months ago and ... you’ll have to take my word for it). I’ve been observing my parents as they age for a while, and in the past two years, my sister and I have become very active in the process of making sure they are safe and cared for. I decided to write a guide to help all of my friends who have parents so maybe you can avoid some of the mistakes my parents made. There are lots of resources out there, so this is by no means exhaustive, but I hope someone finds it useful!
STUFF
This is the easiest way to start, it doesn’t require uncomfortable conversations or lengthy phone calls, but could instead be an opportunity to reminisce and connect with your parents. If your parents have lived in their house for any length of time, they’ve probably amassed some STUFF. My folks lived in their house for 43 years, and they abhorred wastefulness. They also had loads of room for storage - you can imagine how much stuff they accumulated after 43 years! My mistake: I didn’t reclaim items I wanted over the years to the degree that I could have, and had to scramble to get the things I wanted when the time came to move my parents out of their house. So here are some ideas.
Your parents might feel strongly about passing on certain items - find out what these are if you don’t already know. Then you could suggest they give them to you for your birthday or another holiday. This way they get the satisfaction of knowing you have their special belongings while they’re still alive.
Did you leave your stuff at their house when you moved out, and you just never got around to getting it? That’s on YOU! Get it now, or get rid of it, if possible!
As you’re going through your stuff, you might “accidentally” run across items your parents don’t use anymore. Help them by donating these items or throwing them away.
The Gentle Art of Swedish Death Cleaning by Margareta Magnusson is an excellent guide to this process, and a quick read. Read it, and if possible, suggest that your parents read it.
We were able to move our parents’ photo albums, but they had boxes and boxes of unsorted photos and even slides. Encourage them to go through these old memories now and put them in albums - or better yet, digitize them. They won’t have room for all those boxes when they downsize.
If you wind up having to get rid of everything at once, like we did, there will undoubtedly be heartbreak as valued heirlooms get sent to the thrift shop (or the dumpster) and even loss of some income because you won’t have time to drag it to consignment shops. The more you deal with now, the happier everyone will be with the outcome.
WHERE TO LIVE
Aging in place seems like the best option for many people, but it can be quite costly. There’s no deadline by which your parents should move out of their house, and perhaps they never will. This is where you might have a conversation about the future with your parents: what do they envision for themselves, what do they want? This is a great way to phrase it, as it sends the message that you want to know their desires for aging, so you can meet their wishes as best you can. Regardless of what they say, you can do a little homework into options in their geographic area. We didn’t make too many mistakes in this area, but my parents weren’t willing to move in advance of it being a necessity, and then when it WAS necessary in the summer of 2020 … well, who would move their parents into communal living during a pandemic?
Several friends told me how important it is to move earlier rather than later, as it makes it easier to add levels of care as your parents age. Keep this in mind! Find out what is available, and make sure options for living include assisted living, skilled nursing, AND memory care. The last two are not interchangeable: memory care is very specific for dementia patients. If you have time, take a tour of a few places to get an idea of what life might be like for your parents there.
The move to assisted living was very important for our mother. Our father was hospitalized 15 or more times in the past year, and two of those included multiweek stays in nursing rehab - in fact, he’s still there now, and it’s been over 11 weeks (as of 7.24.21). The time alone in the house was difficult for my mother, and she will benefit from routines, social interaction, and 3 meals a day that she doesn’t have to cook for herself ... among other benefits! Moving was so hard for them to contemplate because they didn’t want to leave their community - which is very understandable - but moving gets much more difficult as your parents age, and in my mom’s case, as her dementia has progressed.
MEDICAL CONSIDERATIONS
Helping your parents navigate the healthcare system is difficult. I won’t claim to be an expert in this at all, but will at least tell you what I’ve encountered.
RIGHT NOW: find out if your parents have long-term care insurance. If one or both of your parents has a lengthy stay in the hospital/nursing home, Medicare will eventually STOP covering them, even if they need skilled nursing or memory care. This will easily start costing $350/day, which is $100,000/year. Long-term care will kick in after 90 days in hospital/nursing/memory care, and will cover most, if not all, of the costs.
You will eventually need HIPAA authorization with your parents’ doctors. This allows the doctor to talk freely to you about your parents’ health. Without it, the doctor can listen to your concerns, but they cannot share information. My mother was reluctant to give this to us, but when she finally did, we were able to get her evaluated for dementia and take away her car keys.
If you live close enough to go to doctor appointments with your parents, find a way to do this. When my father returned from one of his earlier but more serious hospitalizations, I requested to join him at his follow-up appointment so I could hear what the doctor had to say and ask my own questions. My father is a reasonable guy and allowed this, and it was really helpful.
Advanced Directives are their medical wishes about resuscitation. It’s a morbid conversation, and you may not want to discuss the details with them, but you should make sure they have their wishes in place.
While you’re on morbid topics, make sure you know their wishes regarding funeral and memorial services and burial arrangements. Some people even want input into their own obituaries. We knew both my parents wanted to be cremated (and where they wanted us to scatter the ashes), but we were surprised to learn my dad did not want any services. Good thing we asked!
FINANCIAL CONSIDERATIONS
For your peace of mind, you will want to know what the state of your parents’ finances is, and you will likely need to manage these finances at some point. Here is what I learned about this realm of the aging process:
Set up autopay for as many bills as you can for them, if they haven’t done so already. As my father’s health situation became more overwhelming, bills got overlooked and they started having to pay late fees. This is an easy step that you can do now and avoid the hassle later.
Suggest your parents simplify things. Do they have multiple credit cards, or multiple bank accounts? Suggest that they consolidate. Again, life gets more complicated with aging, and it becomes harder to manage. Trying to keep track of multiple accounts will be a headache for them, and they could make costly mistakes.
Make sure your parents have designated beneficiaries for all accounts. Apparently the probate process after a person dies is lengthy and annoying, and not something you’ll want to have to deal with on top of your grief when your parents pass away. On active accounts, like checking or savings accounts, try to get your name put on the account. This will help you with managing their finances when the time comes. Banks will literally not talk to you if you are not the account owner or don’t have POA.
Power of Attorney. This document WILL have to be signed, and you will want to discuss with your parents when, not if, they want to do this. The sooner the better. Sign it and scan it, and save it on your phone. This way you can email it to whoever needs it immediately so you can manage all of your parents’ affairs. I needed POA to cancel their phone service, sell their house, sell their car ... you name it.
Finally, if their finances are looking good, read on. Talk to your parents about putting their assets in a trust, especially if you have kids. If you’ve read this far, your parents probably want your kids (and you) to have something of their estate after they’re gone, but they can’t leave anything behind if they haven’t protected their assets. Medical care is expensive, and Medicaid will not kick in until you have only about $1,500 to your name, so protecting assets is important for some people. I don’t know much about this process, but if it is a concern for your parents, encourage them to reach out to their lawyer and financial advisor to take care of this.
DEMENTIA
My mother’s dementia has been the most challenging part for my sister and me over the past several years, but if you think this is in your future, it doesn’t have to be. As a society we’ve gotten better at talking about mental health, and that should also extend to dementia. As with any other health problem, early detection and intervention will lead to better outcomes. In my mother’s case, we attempted to intervene in 2017 but were unsuccessful. My mother was finally diagnosed in January 2021, but at this point she had progressed to mild dementia, and has been unable to process or accept the diagnosis. This has caused her to have worse anxiety because she’s upset about forgetting things, and fewer coping skills because she doesn’t recognize what is wrong with her. While early intervention may not prolong the life of your parent by much, it will lead to better quality of life - which is why you have read this far in the first place, you want your parents to be safe and cared for!
A primary care doctor will do a preliminary screening for dementia, so it is important for this screening to be on your parents’ radar as soon as possible. At this point, it is not automatically done at a certain age; you have to ask for it (which is idiotic, but that’s our health care system, so…). The screening will be important because it will hopefully give you peace of mind that any memory problems are age-related, and not a cause for concern. If not, it will allow the doctor to refer your parent to a specialist and get the appropriate interventions. While there is no cure for Alzheimer’s, there are some drugs that show promise, but also processing and accepting the diagnosis are important for implementing coping skills.
If your parents are diagnosed with dementia, there are loads of resources out there to help. It’s really hard for children to cope with this disease in their parents, as it’s the beginning of the role-reversal where YOU become the parent. Some tips that have resonated with me are that, in dementia, the brain still processes emotions normally, even if memories are starting to erode. So when you inevitably get impatient, frustrated, or even angry with your parent, keep this in mind: they won’t remember why you got angry, they will just remember how you made them feel. Depression and dementia go hand-in-hand because dementia patients get told so often “don’t you remember?” “I already told you that!” and so on. I am by no means perfect in how I handle my mother, but this tip has helped me find patience and calm.
If you’re like me, and you’ve seen both of your grandmothers and your mother decline due to dementia, you have more than a little concern about what the future holds for you. I recommend reading Remember by Lisa Genova (author of Still Alice). The book eased my anxiety about memory lapses I’ve noticed in myself, as lately I regard any lapse as a harbinger of dementia. She also has tips for improving your memory and for preventing Alzheimer’s - which my mother and likely my grandmother had. The number one tip? Sleep.
REACH OUT!!
I was fortunate to have many good friends lend their ears to me while I’ve been in the process with my parents, and several who have been through this and offered their advice and support as well. It was invaluable to have this support system, so I offer that to you. Please reach out if you have questions, want advice, or just want to vent about what you’re going through. If you like, add comments about your own experience below.
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Peach State Health Plan-A Medicaid Failure
The state has crashed one of its current Medicaid managed care organizations with a $3.7 million penalty for denying patients timely access to critical medical services. The fine appears to have prompted a top-level shakeup at Peach State Health Plan. The massive penalty focused on Peach State's failure to grant "prior authorization" for medical assistance within two weeks, the national standard for the time a healthcare plan should decide to grant or deny coverage to a patient.According to sources close to the situation, Peach State was abandoning to meet that target approximately 20 percent of the time, possibly putting patients who needed coverage for medications, tests, or other critical medical services and equipment at risk.
Bowers had all outstanding issues for the prior authorization process for services had been resolved in a prepared statement.It is not the first time Centenehas sustained criticism over the way its subsidiaries do business. Year, 2005 the company agreed to pay $9.5 million to Milwaukee-based Aurora Health Care Inc. to settle a two-year-old lawsuit over recompenses.
The conflict centered on Centene's Wisconsinsubsidiary. Centene-Medicaid also dropped one of the dental care providers. They were preparing to cancel contracts with dental care provider Kool Smiles, Patient Support Center. Peach Health Plan and WellCare within the week and a lawsuit filed against the state by parents of children insured by Medicaid and Peachcare, the Georgia Department of Community Health (DCH) have reported its investigation of allegations of inadequate care delivery from Kool Smiles, according to DCH Director of Communications Amanda Seals.
Seals announced. No child in our Medicaid or PeachCare for Kids programs has lost dental benefits or not covered from the program due to the contract disputes between Kool Smiles. On August 25, 2007, when they issued a decision that Kool Smiles cancel from WellCare and Peach State on August 31, 2007, was carried out demonstrations to oppose the care management organizations (CMOS). August 14 A save Our Smiles rally in Dalton attended together more than 100 parents and community leaders concerned that more than 70,000 children in the state may lose access to quality dental care if Kool Smiles signifies dropped.
The Save Our Smiles campaign has supported Georgia citizens to present messages to Gov. Sonny Perdue in support of intervening. The organization estimates more than 10,000 letters sent within two weeks.The reality that time was running out, parents of children insured by Peach care and Medicaid sued the State of Georgia Wednesday under claims that their children will be dismissed dental care after the contract with Kool Smiles is canceled. Seals responded to this suit by assuring parents that they would still be capable of finding quality dental care for their children.
According to Seals, five percent of current WellCare members and seven percent of current Peach State Health Plan members can have services from Kool Smiles, P.C., citing Georgia Families records. Grievances of parents and other dentists have led the DCH to investigate reported difficulties, such as over-utilization of services, lower use of preventive care, and unusual methods to control patients, according to Seals.Some parents who use Kool Smiles say parents must have looked for alternative dental care for their children, yet were frustrated in finding a provider who accepts Peach care or Medicaid. Provided was dropped, parents believe that through this lawsuit, a federal authority can subdue their health plans to continue their contracts with Kool Smiles so that their children will have a better smile in the future. Medicaid has never been fair to everyone, especially to people who are poor and needy. Seals are still quiet regarding the pending litigation.
"If included in the lawsuit, the State of Georgia will represent by the attorney general's office," reported Seals. "All inquiries should straight there," they stated. Meanwhile, the state stands behind its choice to convert to manage care, notwithstanding initial kinks in the policy.
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“House Speaker Paul D. Ryan (R-Wis.) said Wednesday that congressional Republicans will aim next year to reduce spending on both federal health care and anti-poverty programs, citing the need to reduce America's deficit.
“We're going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan said during an appearance on Ross Kaminsky's talk radio show. "... Frankly, it's the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that's really where the problem lies, fiscally speaking.”
Ryan said that he believes he has begun convincing President Trump in their private conversations about the need to rein in Medicare, the federal health program that primarily insures the elderly. As a candidate, Trump vowed not to cut spending on Social Security, Medicare, or Medicaid. (Ryan also suggested congressional Republicans were unlikely to try changing Social Security, because the rules of the Senate forbid changes to the program through reconciliation — the procedure the Senate can use to pass legislation with only 50 votes.)”
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Reading, PA Makes the News
The following is the New York Times article that Lynn credits with bringing the town of Reading to her attention. It ran in the Times on September 27, 2011:
Reading, Pa., Knew It Was Poor. Now It Knows Just How Poor. - Sabrina Tavernise
The exhausted mothers who come to the Second Street Learning
Center here — a day care provider for mostly low-income families — speak of low wages, hard jobs and an economy gone bad.
Ashley Kelleher supports her family on the $900 a month she earns as a
waitress at an International House of Pancakes. Louri Williams packs cakes and pies all night for $8 an hour, takes morning classes, and picks up her children in the afternoon. Teresa Santiago takes complaints from building supply customers for $10 an hour, not enough to cover her $1,900 in monthly bills.
These are common stories in Reading, a struggling city of 88,000 that has earned the unwelcome distinction of having the largest share of its residents living in poverty, barely edging out Flint, Mich., according to new Census Bureau data. The count includes only cities with populations of 65,000 or more, and has a margin of error that makes it difficult to declare a winner — or, perhaps more to the point, a loser.
Reading began the last decade at No. 32. But it broke into the top 10 in 2007,
joining other places known for their high rates of poverty like Flint, Camden, N.J.,
and Brownsville, Tex., according to an analysis of the data for The New York Times by Andrew A. Beveridge, a demographer at Queens College.
Now it is No. 1, a ranking that the mothers at the day care center here say does
not surprise them, given their first-hand knowledge of poverty-line wages, which for a parent and two children is now $18,530.
The city had been limping for most of the past decade, since the plants that sustained it — including Lucent Technologies and the Dana Corporation, a car parts manufacturer — withered. But the past few years delivered more closings and layoffs, sending the city’s poverty rate up to 41.3 percent.
Jon Scott, president of the Berks Economic Partnership, which helps businesses
looking to stay in the area or move here, said that some of the city’s job losses were in fact furloughs, and that many businesses were considering opening in Reading, including an industrial laundry company at the former Dana site.
According to Mr. Beveridge, employment in the city dropped by about 10
percent between 2000 and 2010.
One of Reading’s more entrenched problems is education. Just 8 percent of its
residents have a bachelor’s degree, far below the national average of 28 percent.
“Without a bachelor’s degree, forget it,” said Ms. Williams, 28, who is taking
classes to earn her G.E.D.. Only about 63 percent of Reading’s residents have a high school diploma, compared with more than 85 percent nationally.
Lower education generally means higher poverty. About a fifth of people ages 25
to 34 with only a high school diploma in the United States were poor last year,
compared with just 5 percent of college graduates, said Yiyoon Chung, a researcher at the University of Wisconsin, Madison. For those without a high school diploma, the rate was 40 percent.
Ms. Santiago, 36, has an associate’s degree from a local community college, but said that employers wanted to see more from job candidates. She lost her last full- time job in 2007, and has worked in low wage jobs without benefits through a temporary agency ever since.
“They even want a degree to be a secretary,” said Ms. Santiago, picking up her 8- year-old son at the center.This city has had a large influx of Hispanics over the past decade. They moved from New York and other large cities, drawn by cheaper rent and the promise of a better life. That raised the flagging population, but also reinforced the city’s already acute problems with education: Just 18 percent of Hispanics in Reading had some college education last year, compared with 30 percent of the city’s whites. Only 44 percent of Hispanics had a high school diploma.
Young men have been particularly hard hit. Because they are having trouble
competing for jobs, they are dropping out of the labor force, leaving women to
support the children.
Ms. Kelleher, 23, said she had been supporting her three children as well as the
father of two of them. She would not be able to survive, she said, without the $636 a month she gets in food stamps.
“For the past five years, it has been me paying the bills,” she said at the day care center, still in her waitress uniform. She wants to get married someday, she said, but only to a partner who is financially stable.
Sixty-two percent of young fathers in the United States earned less than
$20,000 in 2002, according to Timothy Smeeding, a professor at the University of Wisconsin, citing the most recent data available from the National Survey of Family Growth.
Even for young people with a bachelor’s degree, the economy is making life
difficult. Vickie Moll, who runs the day care center, said the number of applications from teachers who have lost their jobs had grown as the waves of budget cuts washed over the state. “We have people in here with bachelor’s degrees making $8 an hour,” she said.
Social services feel the effects, too. The Greater Berks Food Bank — Reading is
the Berks County seat — is on track to distribute six million pounds of food this year, up from three and a half million pounds in 2007, said Doug Long, manager of marketing.
Pat Giles, a senior vice president at the United Way of Berks County, said: “It has really started to snowball. We have a growing population of younger, less educated, less skilled people. On top of that you have the economy going upside down.”
Modesto Fiume, president of Opportunity House, the organization that runs the
day care center, as well as a homeless shelter and a transitional living facility, said the number of first-time families in the shelter was up sharply: of 23 new entries in June and July, 18 were homeless for the first time
“People are here because they honestly and truly can’t find work,” said Delia
McLendon, who runs the shelters. “It didn’t used to be that way.“
In the mid-1990s, welfare reform resulted in more women joining the work
force. At the time, jobs were plentiful, but now work is scarce and low-income
families’ lives have become hectic balancing acts to keep the few benefits they have.
Ms. Santiago loses her subsidized day care if she is out of work for more than 13 days, she said. The loss would take months to reinstate, so she hurries to find any work, whatever it pays, every time her temp job ends. Earning more than $10 an hour means losing health insurance, she said, though her children remain covered through Medicaid.
And jobs just seem to pay less. Ms. Santiago recently took a temporary job at a
candy factory where she had worked more than eight years ago, when she was still in her 20s, before she had completed her associate’s degree. At the time she was making $10.50 an hour. In her most recent stint, her hourly wage was $9.25.
“Eight years ago I said, ‘I don’t want to do this, I have to further my education,’ ” she said. “And now here I am, still packing candy, and making less.”
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New York Expects Health Care Worker Shortages Ahead Of Vaccine Mandate Deadline – NPR
A view of the entrance to Mount Sinai Hospital in New York City on May 14, 2020. Hospital and nursing home workers across New York are required to have at least one dose of a COVID-19 vaccine by Monday, prompting concerns over noncompliance and potential staffing shortages. Cindy Ord/Getty Images hide caption
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Cindy Ord/Getty Images
A view of the entrance to Mount Sinai Hospital in New York City on May 14, 2020. Hospital and nursing home workers across New York are required to have at least one dose of a COVID-19 vaccine by Monday, prompting concerns over noncompliance and potential staffing shortages.
Cindy Ord/Getty Images
New York state officials are bracing for staffing shortages when the state’s health care worker vaccination mandate takes effect on Monday, and could be looking to the National Guard — as well as medical professionals from other states and countries — to help address them.
Gov. Kathy Hochul released a plan on Saturday, outlining the steps she could take to increase the workforce in the event that large numbers of hospital and nursing home employees do not meet the state’s deadline.
“We are still in a battle against COVID to protect our loved ones, and we need to fight with every tool at our disposal,” she said.
That could mean declaring a state of emergency to allow health care professionals licensed outside of New York, as well as recent graduates and retirees, to practice there. Other options include deploying medically trained National Guard members, partnering with the federal government to send Disaster Medical Assistance Teams to local health and medical systems and “exploring ways to expedite visa requests for medical professionals.”
The state’s labor department has also issued guidance clarifying that workers who are terminated because they refuse to be vaccinated will not be eligible for unemployment insurance, “absent a valid doctor-approved request for medical accommodation.”
All health care workers at New York’s hospitals and nursing homes are required to have at least one dose of a COVID-19 vaccine by Monday, according to state regulations and a mandate issued by former Gov. Andrew Cuomo last month. Staff at other institutions including home care, hospice and adult care facilities must be vaccinated by Oct. 7.
The most recent numbers suggest the state still has a ways to go: As of Wednesday, 84% of all hospital employees were fully vaccinated. And 81% of staff at all adult care facilities and 77% of nursing home facility staff were fully vaccinated as of Thursday.
Health care systems statewide and nationally are already struggling with staffing shortages.
Critics of the requirement have challenged it through protests and lawsuits, as North Country Public Radio reports, opposing mandatory vaccination and challenging the lack of exemptions for religious objections.
At this point, health care workers have the option to apply for a religious exemption until at least Oct.12, when a federal judge will consider a legal challenge in favor of such exemptions.
As hospitals readied their contingency plans — which for many includes limiting certain procedures — late last week, Hochul held firm to the deadline. She told reporters on Thursday that there are “no excuses” for workers refusing to get vaccinated, and called the impending shortages “completely avoidable.”
How health care systems are preparing for the deadline
Hospital systems and nursing homes across the state are encouraging their employees to get vaccinated, and preparing for disruptions if they do not. Some are cutting back on elective surgeries, limiting admissions and retaining volunteers.
Northwell Health, the state’s largest health care provider, has been holding meetings with staffers in an effort to persuade “thousands of holdouts,” The Associated Press reports. Some 90% of its 74,000 active personnel had been vaccinated as of Thursday, though the hospital said it’s not expecting full compliance and has more than 3,000 retirees, students and volunteers on standby.
Erie County Medical Center Corporation in Buffalo anticipates that roughly 10% of its workforce (some 400 workers) may not get vaccinated by Monday, according to AP, and is prepared to potentially suspend elective inpatient surgeries, reduce hours at outpatient clinics and temporarily stop accepting ICU transfers.
As NPR has reported, Lewis County General Hospital in Lowville, N.Y., said it would pause maternity services starting this weekend because dozens of staff members quit rather than get vaccinated.
Unvaccinated employees of New York City’s 11 public hospitals (which cites a roughly 88% compliance rate) will be put on unpaid leave but could return to work if they get vaccinated soon, CNN reports.
Some hospital systems are seeing an increase in vaccination rates. New York-Presbyterian, for example, enacted its own mandate with a deadline of midnight on Wednesday, and reported that only about 250 of its 48,000 staffers did not comply.
The University of Rochester Medical Center said in a statement that 99% of professional medical staff and 91% of all employees across its six hospitals were partially or fully vaccinated as of last week.
Dr. Michael Apostolakos, its chief medical officer, said that critical care and many-critical services will continue uninterrupted — but staffing shortages unrelated to the mandate are prompting a pause in some services.
Patients will see longer wait times for routine appointments, some employees will be asked to take on additional responsibilities and beds could be temporarily closed, Apostolakos said in a statement.
One piece of a national conversation
New York is not the only place mandating vaccinations for health care workers — California announced a similar policy over the summer, and the U.S. Department of Veterans Affairs is also requiring front-line health care workers to get vaccinated.
President Biden announced earlier this month that the 17 million health care workers at facilities that receive Medicare or Medicaid funding will have to be vaccinated or regularly tested, with details to be finalized in the weeks ahead.
While such workplace requirements have the support of many public health experts — and more than half of nurses, according to one recent survey — some politicians and hospital officials have expressed concern. And that’s especially true in rural areas, where vaccination rates are low and hiring is already difficult.
Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services, told NPR that the Biden administration is pursuing a mandate because of how stagnant vaccination rates are in the country’s hospitals. She noted that while many hospitals are worried about staffing shortages, employees missing work because of illness or quarantine is an issue of both staffing too — and safety.
“It’s very clear from the data that staff who remain unvaccinated are affecting both the patients who are coming in to the facilities as well as their colleagues,” she said.
It remains to be seen how severe staffing shortages will be, in New York and elsewhere. Though one state has already enacted a health care worker vaccination mandate, and could serve as one data point.
Maine’s governor announced a mandate for health care workers in mid-August, and hospitals are only reporting a handful of resignations so far — though enforcement doesn’t start until Oct. 29.
source https://wealthch.com/new-york-expects-health-care-worker-shortages-ahead-of-vaccine-mandate-deadline-npr/
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Health Care for African Americans
Almost 44 million American citizens are Black or African American, making up 13.4% of the U.S. population. This demographic experiences a long-standing and disproportionate burden regarding health and access to medical care in this country. And while the Affordable Care Act has made securing health insurance coverage more attainable for Black Americans, about half of the 30 million adults currently uninsured are people of color. For those who do have coverage, some significant healthcare disparities still persist.
Contents [hide]
What Are Healthcare Disparities?
What Forces Are Driving These Disparities?
Black vs. White Health Burdens
Preventable Cancers
Caught in the Medicaid Gap
Algorithmic Bias
Racial Inequity and COVID-19
Insurance Access and Maternal Health
Unequal Treatment
Influence of Shared Ethnicities
How TrueCoverage Can Help
Children’s Health
Cardiovascular Disease
Cancer
Mental Health
What Are Healthcare Disparities?
A healthcare disparity refers to differences among groups regarding access to and utilization of care, care quality and health insurance coverage. These disparities are closely associated with social, environmental or economic disadvantages. The Kaiser Family Foundation warns: “Disparities in health and healthcare not only affect the groups facing disparities, but also limit overall gains in quality of care and health for the broader population and result in unnecessary costs.”
And it’s not just a problem for members of the disadvantaged populations; health disparities exact a steep cost on broader society as well. According to a 2018 study by the W. K. Kellogg Foundation, health inequities cause us to lose $93 billion in excess medical care expenditures and $42 billion in unrealized productivity. Estimating that 3.5 million years of life are lost due to premature deaths, the report states that life spans shortened by health disparities cost the economy $175 billion.
What Forces Are Driving These Disparities?
A variety of individual and systemic factors form interrelated and complicated barriers to health and healthcare in the Black community. Among the most significant are:
Providers: Cultural bias, miscommunication, racism
Healthcare system overall: Funding of care, organization
Moreover, a host of other social, environmental and economic determinants interconnect and reinforce healthcare outcomes. For instance, gender, geography, socioeconomic status or sexual orientation may influence one’s ability to obtain quality medical services. Health inequalities among the African American population are also apparent throughout the life course, from the womb to older age.
Black vs. White Health Burdens
The American Cancer Society reports that Black Americans have the highest mortality rate and shortest survival of any ethnic group for most cancers in the U.S. The death rate is also higher among Black folks with respect to hypertension, heart disease, diabetes, stroke, influenza and pneumonia and HIV/AIDS. Life expectancy is lower for Black adults than for White ones. Disparities that persist include:
Children’s Health
2.2 times higher infant mortality rate
1.8 times more likely to be diagnosed with asthma
Cardiovascular Disease
Men 30% more likely to have hypertension
Women 60% more likely to have hypertension
Less likely to keep blood pressure under control
Cancer
Women 40% more likely to succumb to breast cancer
Men 1.3 times more likely to develop colorectal cancer
Men 2.5 times more likely to succumb to prostate cancer
Mental Health
20% more likely to report psychological distress
50% less likely to receive mental health counseling or treatment
Preventable Cancers
The American Cancer Society states that at least 42% of newly diagnosed cancers among Black Americans are among those cases that are considered preventable. Many cancers caused by infectious microbes could also be avoided through treatment of the infection and vaccination. Early detection and screening could help avert cervical and colorectal cancers as well.
Caught in the Medicaid Gap
As of 2017, 58% of the Black population in the United States lived in southern states, most of which have not adopted ACA’s optional Medicaid expansion provisions. Alabama, Florida, Georgia, South Carolina, North Carolina, Tennessee and Texas — all states with significantly large Black communities — are among the 14 states that have not yet expanded their Medicaid programs as of January 2020. In these states, over two million adults who would otherwise qualify for expanded Medicaid programs are trapped in a “coverage gap” in which their incomes exceed Medicaid eligibility limits but fall below the poverty level, the minimum for Marketplace premium tax credits.
Overall, over 90% of adults in the coverage gap live in the South. One-third of these individuals reside in Texas, 17% live in Florida and 11% are in Georgia. These states — and the South in general — have more poor uninsured adults and more limited Medicaid than other parts of the country. Citizens in the South continue to face limited options for affordable health care.
Algorithmic Bias
A 2019 study concluded that a widely used algorithm to allocate healthcare to patients systematically discriminates against African Americans. This algorithm, used to help manage care for about 200 million Americans each year, is less likely to refer Blacks with complex medical conditions than equally ill Whites to personalized care programs. Researchers discovered that Blacks were generally given lower risk scores than Whites. As a result, African American Americans had to be sicker than Whites before receiving referrals for additional medical assistance.
Racial Inequity and COVID-19
The CDC cites mounting evidence suggesting that COVID-19 disproportionately impacts African Americans and other ethnic minority populations. Long-standing inequities and injustices have placed many minorities at a greater risk of becoming ill and dying from this pandemic. The CDC states that social factors such as poverty and access to health care contribute to a wide spectrum of risks and outcomes related to health and quality of life for Blacks.
Insurance Access and Maternal Health
According to a 2020 Michigan Medicine study, almost half of all Black, Latina and Indigenous women had gaps in insurance coverage between pre-conception and post-delivery, compared to one-fourth of White women. Research indicates that two-thirds of pregnancy-related deaths among Black women are preventable. These mothers are 3 times more likely than White mothers to die from childbirth-related complications
Unequal Treatment
Research suggests that Blacks experience more obstacles than Whites with respect to trusting healthcare providers and are often discriminated against by their doctors. In a 2016 study, African American patients reported that clinicians commonly discredit their reported symptoms and do not respect the patients’ perspectives with regard to their own health. These issues pose significant barriers to cultivating productive patient-provider relationships for Black Americans.
Influence of Shared Ethnicities
Given that only 5% of all U.S. physicians are Black, it’s easy to understand why many Black Americans are apprehensive about their doctor-patient relationships. According to Michigan Medicine physician Ryan Huetro, M.D., African American patients are typically more comfortable seeing a Black doctor. He notes growing evidence of several positive outcomes when doctors and patients share the same racial identity:
Improved time together
Improved wait times for treatment
Adherence to medication
Shared decision-making
Patient understanding of health risks
Patient perceptions of treatment decisions
Decreased implicit bias on the part of the doctor
How TrueCoverage Can Help
At TrueCoverage, our goal is to help you find comprehensive health insurance coverage that fits your budget. We are your one-stop insurance shop, serving as a marketplace, personal broker and personal advisor with access to over 50,000 solutions. Our licensed agents are standing by to provide free customer support 24/7 with cutting-edge technology and resources for getting the best plans at the best price. Contact us today for a free health insurance quote to secure the coverage you need.
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Why Do Healthcare Costs Keep Rising?
It’s no surprise that Americans spend a huge amount of money on health care each year. High insurance premiums, high deductibles, co-pays, and other out-of-pocket expenses are just some of the costs associated with health and wellness in the country.
One reason for rising healthcare costs is government policy. Since the inception of Medicare and Medicaid – programs that help people without health insurance – providers have been able to increase prices. The government provides a huge source of revenue to the healthcare providers and a virtual unlimited pool of money. With the implementation of Medicare in 1966, for-profit hospitals began to appear in the early 1970’s to take advantage of this new and unlimited source of revenue.
Still, there’s more to rising healthcare costs than just government policy. Read on to find out how much the U.S. spends on health costs, and which factors shape prices in this industry. Also, I would like to add some more details I have found via the website family health insurance in Lancaster pa.
Key Takeaways
Healthcare costs in the U.S. have been rising for decades, and are expected to keep increasing.
According to a study by the American Medical Association, the U.S. spent almost $3.5 trillion on healthcare in 2017.
The study found five factors that affect the cost of healthcare: a growing population, aging seniors, disease prevalence or incidence, medical service utilization, and service price and intensity.
Overall Costs of Healthcare
Healthcare costs have risen drastically in the U.S. over the past several decades. According to a March 2019 study published in the Journal of the American Medical Association (JAMA), healthcare spending in the U.S. rose nearly a trillion dollars between 1996 and 2015.
The study reported that healthcare spending in the U.S. in 2017 was $3.5 trillion, or about $11,000 per person. By 2027, these costs are expected to climb to $6 trillion – roughly $17,000 per person.
Where does that money go? According to the study, spending can be broken down into 11 categories:
Hospital care (32.7%)
Physician services (15.6%)
Other personal health care costs (15.1%)
Prescription drugs (9.5%)
The net cost of health insurance (6.6%)
Nursing care facilities (4.8%)
Investment spending (4.8%)
Clinical services (4.3%)
Home healthcare (2.8%)
Government public health activities (2.5%)
Government administration (1.3%)
Why Are Healthcare Costs Rising?
The JAMA study investigated how five key factors were associated with healthcare increases over time:
Population growth
Population aging
Disease prevalence or incidence
Medical service utilization
Service price and intensity
The authors found that service price and intensity, including the rising cost of pharmaceutical drugs, made up more than 50% of the increase. Other factors, which comprised the rest of the cost increase, varied by type of care and health condition.
Growing and Aging Population
Health care gets more expensive when the population expands – that is, as people get older and live longer. Therefore, it’s not surprising that 50% of the increase in healthcare spending comes from increased costs for services, especially inpatient hospital care. Nor is it a shock that the two next-highest factors contributing to the increase in healthcare spending are population growth (23%) and population aging (12%).
Increase in Chronic Illnesses
The authors of the JAMA study point to diabetes as the medical condition responsible for the greatest increase in spending over the study period. The increased cost of diabetes medications alone was responsible for $44.4 billion of the $64.4 billion increase in costs to treat that disease. The ability to diagnose disease has also improved as a result of advances in healthcare and technology. It could be that diseases have always been there – we are just better at detecting and treating them.
After diabetes, conditions with the greatest increase in costs were:
Low-back and neck pain: $57.2 billion
High blood pressure: $46.6 billion
High cholesterol: $41.9 billion
Depression: $30.8 billion
Urinary disease: $30.2 billion
Osteoarthritis: $29.9 billion
Bloodstream infection: $26 billion
Falls: $26 billion
Oral disease: $25.3 billion
As you can see, changes in diet and exercise can dramatically reduce the cost of healthcare in the population.
Increased Ambulatory Costs
Of all treatment categories studied, ambulatory care, including outpatient hospital services and emergency room care, increased the most. Outpatient costs rose from an annual cost of $381.5 billion to $706.4 billion. Emergency department costs across all health conditions rose 6.4% over the same time period.
Rising Health Insurance Premiums
How healthcare costs affect your wallet is a top concern. The rising cost of health insurance premiums, deductibles, and out-of-pocket expenses are the biggest concerns. According to the National Conference of State Legislatures (NCSL), the average annual premium for family healthcare coverage rose nearly 5% in 2018 to ,616. With a median household income of $63,179, health insurance costs constitute 31% of total income, higher than any time in history.
The average increase in premium costs in 2018 for people on a private plan or a healthcare exchange was $201. The two reasons most often cited for these increases were government policy and lifestyle changes.
Government programs like Medicare and Medicaid have increased overall demand for medical services, resulting in higher prices. Also, increases in the incidence of chronic conditions like diabetes and heart disease have had a direct impact on increases in the cost of medical care. Those two diseases alone are responsible for 85% of health care costs, and almost half of all Americans have a chronic illness.
Higher Out-of-Pocket Costs
Higher insurance premiums are only part of the picture. Americans are paying more out of pocket than ever before. A shift to high-deductible health plans (HDHP’s) that impose out-of-pocket costs of up to $13,300 per family has added greatly to the cost of healthcare.
(These costs have risen since the study: For 2020, the out-of-pocket maximums under the Affordable Care Act are $8,150 for individuals and $16,300 for families. These limits are up from $7,900 and $15,600, respectively, for 2019.) Most Americans cannot afford these out-of-pocket expenses, and therefore do not seek health care even when they need it. Effectively, they have insurance but cannot afford it use it, so are they really “insured”?
Patients Avoiding Care
Rising costs have created another casualty: People who skip medical care altogether. They do so not because they are afraid of doctors, but because they’re afraid of the bills that come with health care.
A poll by the West Health Institute and NORC at the University of Chicago revealed that 44% of Americans refused to go to a doctor due to cost concerns. About 40% of those surveyed said they skipped a test or treatment for the same reason. In many cases, those who refuse treatment have medical insurance.
Inefficiency and Lack of Transparency
Thanks to a lack of transparency and underlying inefficiency, it’s difficult to know the actual cost of health care. Most people know the cost of care is going up, but with few details and complicated medical bills, it’s not easy to know what you’re paying for.
The Wall Street Journal ran a story about a hospital that discovered it was charging more than $50,000 for a knee-replacement surgery that only cost between $7,300 and $10,550. If hospitals don’t know the true cost of a procedure, patients may have difficulty shopping around.
When it comes to overall transparency, a New England Journal of Medicine survey showed that only about 17% of care professionals believed their institutions had either “mature” or “very mature” transparency.
The Bottom Line
Each of the factors mentioned here contributes to rising healthcare costs. Increasing costs for medical services, caused by both a growing and aging population, play a large role.
But so do other factors, such as the growing number of people with chronic diseases, increased costs for outpatient and emergency room care, higher premiums, and higher out-of-pocket costs. These factors are exacerbated by inefficiency and lack of transparency in the world of medicine.
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