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          The Perils of CEO Worship - What Happens When the Leader Becomes Demented?      Cache   Translate Page      
Introduction: the Cult of the CEO

Although the US and most developed countries are nominally democratic, many of us seem to be again yearning for a man on a white horse, and in the current era, the horse ridden is corporate.
On Health Care Renewal, we having been talking about this pheonomenon for a long time. We have written about it in terms of the messianic (or visionary, or charistmatic) CEO, CEO disease, and the imperial CEO.

These concerns are diffusing into the broader media.  For example, from the introduction to a revent Vox article entitled "The Problem with CEO Worship"

Society has always had heroes, be those of war or art or politics. But entrepreneurs are particularly suited for our current moment, in which success in business is our primary marker of achievement. Business acumen doesn’t just get you money anymore; it can make you the most powerful man in the world.

The signs of CEO worship are everywhere: unprecedented venture capital funding for founders, media overemphasis on company leaders, and to use the most extreme and obvious example, the election of Donald Trump.

That article noted that CEO worship may overestimate the importance of leaders; create "secular fundamentalists" out of individuals; perpetuate destructive neoliberal ideologies; encourage CEOs to make worse decisions; and be bad for business

Those are not the only consequences.  CEO worship makes it possible for a progressively impaired leader to go unconstrained. Unfortunately, we may be seeing the ultimate example of this in the US.

Incoherent Verbal Utterances

Even before he was elected, we noted that Donald Trump sometimes was completely incoherent when describing his health policy ideas.  In early 2016 we raised questions about Donald Trump's cognition.  At that time, a conservative columnist labelled as "word salad" Trump's attempts to sketch a position on health care, specifically the "mandate" provision of the Affordable Care Act (ACA).  We found other examples of his utterances on health care policy that could be characterized as gibberish.  This one was short, if not sweet

I want to keep pre-existing conditions. I think we need it. I think it’s a modern age. And I think we have to have it.

How could anyone understand this while listening in real time? A close reading suggests that maybe this was meant to suggest that some people ought to have  insurance coverage for pre-existing conditions. However, Trump seemed to befuddled by that concept.  Furthermore,  note that pre-existing conditions are not desireable, so that one would not want to "keep" them, nor can one choose not to.  To what the word "it" in the second sentence and again in the fourth refers is unclear.  The third sentence seems to be a complete non sequitur. 

We found additional examples of incoherent verbal responses about health care in 2017, and early 2018.  In the last six months, things have only gotten worse.  Examples of verbal incoherence have multiplied, although most were not related to health care. 

In July, 2018, MediaIte reported Trump's incoherent comments at a political rally,

I have broken more Elton John records, he seems to have a lot of records. And I, by the way, I don’t have a musical instrument. I don’t have a guitar or an organ. No organ. Elton has an organ. And lots of other people helping. No we’ve broken a lot of records. We’ve broken virtually every record. Because you know, look I only need this space. They need much more room. For basketball, for hockey and all of the sports, they need a lot of room. We don’t need it. We have people in that space. So we break all of these records. Really we do it without like, the musical instruments. This is the only musical: the mouth. And hopefully the brain attached to the mouth. Right? The brain, more important than the mouth, is the brain. The brain is much more important.

Perhaps this was meant to suggest that the president drew a larger crowd to an arena than did Elton John.  However, note the non-sequiturs: from "Elton has an organ" to "lots of other people helping" to "we've broken a lot of records," "They need much more room, for basketball, for hockey..." Who are the people helping whom are they helping, and to do what? What records were broken by whom, and how is this relevant to Elton John, etc.  To whom does they refer, and why do they need a lot of room? Etc, Etc.  Again, in real time this would have made no sense at all

In September, 2018, CNBC reported that speaking at a meeting about preparations for Hurricane Florence, Trump said

This is going to be a very large one ... It's tremendously big and tremendously wet. Tremendous amounts of water

Maybe he meant to say this will be a very large hurricane, bringing a tremendous amount of rain.  However, he seemed to be unable to convey the concept of rain.

In September, 2017, the Hill had reported that Trump had defended difficulties in providing relief for Puerto Rico after Hurricane Maria thus,

This is an island, surrounded by water. Big water. Ocean water

Again, to be charitable, he seemed to handle the concept of an island in a vast ocean as would a three-year old.

Media articles also suggested that normal people cannot follow or understand what Trump says in real time.  For example,  on November 8, 2018, a Bloomberg op-ed said this about a recent Trump news conference,

In fact, the president was difficult to follow because he simply doesn’t make any sense half the time.

More specifically,

Trump was asked one specific question about health care, and good luck to anyone who tries to figure out what his answer meant. He pretty clearly has just as little idea what he’s talking about on most major policy issues as he did when he first started running for president. On Jamal Khashoggi, waivers on Iranian sanctions, North Korea and Russia, he either ducked the questions with non sequiturs or just babbled.

On November 11, 2018, an article in Slate noted that Trump confused Baltic states with Balkan states in a way that could have foreign policy repercussions,

When President Donald Trump met with Dalia Grybauskaitė of Lithuania, Kersti Kaljulaid of Estonia and Raimonds Vējonis of Latvia earlier this year, he started with a criticism. At the White House in April, Trump opened by chastising the Baltic leaders for starting the war in the 1990s that ended with the breakup of the former Yugoslavia. The Baltic leaders were apparently very confused and it took them 'a moment' to realize that the commander in chief was confusing Baltic states with the Balkans

this case is particularly notable considering Melania Trump is originally from the Balkans. The first lady was born in Slovenia, which gained independence in 1991 at the start of the Balkan wars. As Le Monde wrote, Trump remained 'apparently uneducated in the matter by his wife, Melania, originally from the former Yugoslavia.'

This suggests at best that at times Trump may be unable to distinguish words that sound vaguely alike but have quite different meanings. 

A November 28, 2018, Vox summary article about Trump's recent interview with the Washington Post provided this quote from Trump about economics,

And I’m not blaming anybody, but I’m just telling you I think that the Fed is way off-base with what they’re doing, number one. Number two, a positive note, we’re doing very well on trade, we’re doing very well — our companies are very strong. Don’t forget we’re still up from when I came in 38 percent or something. You know, it’s a tremendous — it’s not like we’re up — and we’re much stronger. And we’re much more liquid. And the banks are now much more liquid during my tenure. And I’m not doing – I’m not playing by the same rules as Obama. Obama had zero interest to worry about; we’re paying interest, a lot of interest. He wasn’t paying down — we’re talking about $50 billion lots of different times, paying down and knocking out liquidity. Well, Obama didn’t do that. And just so you understand, I’m playing a normalization economy whereas he’s playing a free economy. It’s easy to make money when you’re paying no interest. It’s easy to make money when you’re not doing any pay-downs, so you can’t — and despite that, the numbers we have are phenomenal numbers.

The author of the article stated,

I have basically no idea what Trump is talking about here, and I’m pretty sure he doesn’t either.

On repeated close reading, I still do not have any idea what Trump meant.  I would add the following questions:  38 percent of what? Who is much more liquid, and how is liquid defined?  Who is paying a lot of interest? What does "paying down and knocking out liquidity" mean? What is a "normalization economy?"  Note that this was coming from someone who claims to be a brilliant business manager.

Furthermore, consider what Trumps aid about the climate,

And when you’re talking about an atmosphere, oceans are very small. And it blows over and it sails over. I mean, we take thousands of tons of garbage off our beaches all the time that comes over from Asia. It just flows right down the Pacific, it flows, and we say where does this come from. And it takes many people to start off with.

Oceans are "small?" What "blows over and sails over?" Over what? What "flows?" What "takes many people?"

In 2017, StatNews published an article describing how 

STAT reviewed decades of Trump’s on-air interviews and compared them to Q&A sessions since his inauguration. 

To summarize the conclusions.

The differences are striking and unmistakable.

Research has shown that changes in speaking style can result from cognitive decline. STAT therefore asked experts in neurolinguistics and cognitive assessment, as well as psychologists and psychiatrists, to compare Trump’s speech from decades ago to that in 2017; they all agreed there had been a deterioration, and some said it could reflect changes in the health of Trump’s brain.

In 2018, Trump's verbal communications at times are even more garbled.  Parts of the passages above suggest the word salad produced by somebody with fluent aphasia versus the nonsensical responses produced by patients suffering from acute delusional states. That Trump is capable of producing this sort of word salad at times, without realizing he is making no sense, suggests the intermittent symptoms seen early in progressive dementia.  

Lack of Insight About Cognition

Furthermore, Trump appears to lack insight about his difficulties commicating.  

In July, 2018, after the NATO conference,  Politico reported, that Trump seemed to have no insight about why much of what he says appears unbelievable to others.  The article noted
leaders who spent the first 18 months of Trump’s presidency thinking there might be a method to his chaos creation — and struggling to discern what it might be — now seem to have concluded that it’s just chaos, and that Trump himself may not understand what he’s doing.

More specifically, European officials commented on what Trump was saying:

A senior NATO official said leaders had concluded that they simply could not rely on anything Trump said.

'You know the way he speaks, you cannot take him literally,' the official said.

Another EU official echoed the point. 'He speaks a language that doesn’t match with diplomacy,' the second official said. 'We were used to the Brits, who speak a more frank diplomatic language, but this is another thing.'

These officials again seemed to be stating that Trump's verbiage can be completely incoherent, albeit they were doing so diplomatically.  After the conference, however, when confronted with a question about the inconsistency of his remarks,

When a Croatian journalist confronted Trump about his inconsistencies, the president flatly denied there were any, and he repeated a defense of his own sanity that he had made when previously questioned about his fitness for the presidency.

'We understand your message, but some people ask themselves, will you be tweeting differently once you board the Air Force One?' the reporter said.

Trump, speaking at his news conference before leaving the summit, replied: 'No, that's other people that do that. I don’t. I’m very consistent. I’m a very stable genius.'

Not to belabor the point, but the examples noted above suggest neither consistency nor stability.  And true geniuses almost never boast about their intellect.

In September, 2018, The Hill reported an interview with Trump in which he said his personal health and management style were reasons that Republicans might do better than expected in the 2018 elections,

'You know, I took that test when I got my last physical, and the doctor said that’s one of the highest scores we’ve ever seen,' Trump said. 'I did that not because I wanted but I did it, I was always good at testing.'

He continued: 'But if there’s anything great about me it’s stability, and I’m a good manager. Always been a good manager, but you know, I have a vision,'

Note that above Trump was presumably referring to the screening test for dementia he took during his official physical examination.  High scores on the test are common, and do not signify great intelligence, just the probable absence of dementia.

In addition, this interpretation assumes that the test was administered in an unbiased way.  However,  there are reasons to question whether Trump's physical was unbiased.  In retrospect, we now know that soon after taking the test, Trump nominated the physician who administered it to be Secretary of Veterans Affairs.  Later the physician withdrew his name after allegations of his questionable personal behavior appeared (look here).  

At least Trump's boast about having "a vision" does correspond to the language often used by public relations spokespeople to justify their CEOs' lack of accountability and high compensation (look here)

Similarly, in the Vox summary of the November, 2018, Washington Post interview (see above for link), Trump stated
a lot of people like myself - we have very high levels of intelligence

Finally, a November 18, 2018 article in MediaIte described this interchange between Trump and interviewer Chris Wallace on Fox News, starting with his response to a question about how he makes decisions

'I don’t think about them,' Trump replied. 'I don’t think about, you know, how I make them....'

However, he responded to a question about Federal Reserve policy

They're making a mistake because I have a gut, and my gut tells me more sometimes than anybody else's brain can ever tell me

This suggests that Trump has lost insight into his own thinking. 

External Observers Suggested Trump Is Cogitively Impaired

In August, Vanity Fair reported:

More than ever, Trump is acting by feeling and instinct.  'Trump is nuts,' said one former West Wing official. 'This time really feels different.' Deputy Chief of Staff Bill Shine has privately expressed concern, a source said, telling a friend that Trump’s emotional state is 'very tender.' Even Jared Kushner and Ivanka Trump are unsettled that Trump is so gleefully acting on his most self-destructive impulses as his legal peril grows.

In September, 2018, Newsweek reported two instances in which apparent Trump insiders sought psychiatric or medical help for Trump's perceived cognitive problems

[Dr] Lee told Salon that two Trump administration officials approached her after the book was published to express their concern about the president’s mental health, saying he was 'scaring' them because he was 'unraveling.'

In comments to Newsweek over email, Lee said 'it appeared that the officials (if they were officials at all) were at least frequently in [Trump’s] presence.

She continued, 'They were definitely calling from within the White House, which I confirmed by calling back their number. However, I did not ask about their rank. There was no reason for me to doubt they were high-ranking enough to have regular access to the president.'

Lee also said that a 'person [who] was a friend of his entire family, since his childhood” had also been in touch with her at the same time in October 2017, as people in the White House were “stating concern about the president (this was an observation from afar).'

Also in September, 2018, a Politico review of the new book by Robert Woodward based on numerous White House interviews suggested that Trump's inner circle called him a "dope," "idiot," or "moron."


Donald Trump is the chief executive officer of arguably the most powerful country in the world.  Starting during his campaign for the US presidency, we noted that his utterances about health care were at times so incoherent as to suggest cognitive dysfunction.  In the two years since then, especially in the last six months, he has increasingly been noted to be verbally incoherent or confused, has seemed to lack insight about these episodes, and has been observed by close allies and associates to be cognitively impaired.

However, there have ben few, at best, public attempts to link these suggestions of cognitive impairment together, nor to discuss their implications.  The most recent of those that I have found was in January, 2018 (look here and here).  Yet the problems appear to have been getting worse since then.  

While patients with worsening cognitve impairment deserve accurate diagnosis, compassionate care, and access to what few effective, safe treatments may be available for their condition, they obviously should not be in a position to make consequential decisions.  They certainly should not be in charge of large organizations, particularly powerful countries with nuclear weapons.

Yet President Trump's apparent cognitive decline remains anechoic.

For this we may blame CEO worship, which we have too often seen in health care. We have seen many health care leaders praised for their brilliance and paid royally despite leadership resulting in financial distress, threats to the organizations' health care missions, poor patient care, unethical behavior, or even crime. Yet health care CEOs, like other corporate CEOs, and like politicians are just people, sometimes smart, but almost never brilliant.  Promoting them as messianic to bewitch key constituencies, justify the remuneration of other top managers, and the hiring of more public relations flacks is likely to lead to the sort of organizational disasters and system-wide dysfunction we discuss on Health Care Renewal.  The rise of the falsely messianic leader may allow the entry of the most dangerous false messiahs, the psychopathic ones.  (We discussed the likelihood that some health care leaders are actually psychopaths here.)

We must get quickly past our worship of CEOs.  We may not long survive in a world where leaders of nuclear armed nations have no cognitive clothes.

          12/4/2018: REPORT ON BUSINESS: A preventive approach during market uncertainty      Cache   Translate Page      
Analyst and account executive for Inovestor Inc. The health-care industry is viewed as a defensive sector and as a hedge during market uncertainty. Today we look for quality U.S.-listed companies in that sector. THE SCREEN We screened the U.S....
          10 of the Best Health Care Stocks to Buy for 2019      Cache   Translate Page      

10 of the Best Health Care Stocks to Buy for 2019Anyone who invests in the stock market should be curious about the best health care stocks to buy. Along with college tuition, health care is one of the few economic segments where spending has risen far faster than inflation. Both of those trends are fundamentally unsustainable, but until Washington does something about it -- and as long as Americans' own health care bills keep rising -- individual investors might as well profit from the sector themselves.

          VA Health Care Hero Of The Week: Gordon Hayward Erupts For 30 Points      Cache   Translate Page      
Boston Celtics forward Gordon Hayward returned to his All-Star form on Saturday. He exploded for 30 points, 9 rebounds and... Read More »
          Putting the public back in public health      Cache   Translate Page      
The United Kingdom’s National Health Service marked its 70th birthday this year, so this is a good time to reflect on the NHS’s past and consider its future. The NHS has long been a source of inspiration in health-care debates around the world. But if it is not put on a more sustainable footing, it
          Cases of ‘polio-like’ illness that’s paralyzing children appears to have ‘peaked,’ CDC says - Fox News      Cache   Translate Page      
  1. Cases of ‘polio-like’ illness that’s paralyzing children appears to have ‘peaked,’ CDC says  Fox News
  2. Cases of polio-like illness seem to have peaked  Newsy
  3. Overnight Health Care: GOP balks at Trump drug pricing plan | Trump officials' report details lack of health competition | Cases of polio-like illness on the decline, CDC says | TheHill  The Hill
  4. Cases of polio-like paralysis appear to have peaked, CDC says
  5. Polio-like illness AFM 'appears to have peaked' in US for the year  CNN
  6. View full coverage on Google News

          Gut microbiota diversity across ethnicities in the United States      Cache   Translate Page      
by Andrew W. Brooks, Sambhawa Priya, Ran Blekhman, Seth R. Bordenstein Composed of hundreds of microbial species, the composition of the human gut microbiota can vary with chronic diseases underlying health disparities that disproportionally affect ethnic minorities. However, the influence of ethnicity on the gut microbiota remains largely unexplored and lacks reproducible generalizations across studies. … Continua la lettura di Gut microbiota diversity across ethnicities in the United States
          Tissue tropisms opt for transmissible reassortants during avian and swine influenza A virus co-infection in swine      Cache   Translate Page      
by Xiaojian Zhang, Hailiang Sun, Fred L. Cunningham, Lei Li, Katie Hanson-Dorr, Matthew W. Hopken, Jim Cooley, Li-Ping Long, John A. Baroch, Tao Li, Brandon S. Schmit, Xiaoxu Lin, Alicia K. Olivier, Richard G. Jarman, Thomas J. DeLiberto, Xiu-Feng Wan Genetic reassortment between influenza A viruses (IAVs) facilitate emergence of pandemic strains, and swine are … Continua la lettura di Tissue tropisms opt for transmissible reassortants during avian and swine influenza A virus co-infection in swine
          Amino acid residues in five separate HLA genes can explain most of the known associations between the MHC and primary biliary cholangitis      Cache   Translate Page      
by Rebecca Darlay, Kristin L. Ayers, George F. Mells, Lynsey S. Hall, Jimmy Z. Liu, Mohamed A. Almarri, Graeme J. Alexander, David E. Jones, Richard N. Sandford, Carl A. Anderson, Heather J. Cordell Primary Biliary Cholangitis (PBC) is a chronic autoimmune liver disease characterised by progressive destruction of intrahepatic bile ducts. The strongest genetic association … Continua la lettura di Amino acid residues in five separate HLA genes can explain most of the known associations between the MHC and primary biliary cholangitis
          TAMMiCol: Tool for analysis of the morphology of microbial colonies      Cache   Translate Page      
by Hayden Tronnolone, Jennifer M. Gardner, Joanna F. Sundstrom, Vladimir Jiranek, Stephen G. Oliver, Benjamin J. Binder Many microbes are studied by examining colony morphology via two-dimensional top-down images. The quantification of such images typically requires each pixel to be labelled as belonging to either the colony or background, producing a binary image. While this … Continua la lettura di TAMMiCol: Tool for analysis of the morphology of microbial colonies
          Performance of convolutional neural networks for identification of bacteria in 3D microscopy datasets      Cache   Translate Page      
by Edouard A. Hay, Raghuveer Parthasarathy Three-dimensional microscopy is increasingly prevalent in biology due to the development of techniques such as multiphoton, spinning disk confocal, and light sheet fluorescence microscopies. These methods enable unprecedented studies of life at the microscale, but bring with them larger and more complex datasets. New image processing techniques are therefore … Continua la lettura di Performance of convolutional neural networks for identification of bacteria in 3D microscopy datasets
          A comprehensive ensemble model for comparing the allosteric effect of ordered and disordered proteins      Cache   Translate Page      
by Luhao Zhang, Maodong Li, Zhirong Liu Intrinsically disordered proteins/regions (IDPs/IDRs) are prevalent in allosteric regulation. It was previously thought that intrinsic disorder is favorable for maximizing the allosteric coupling. Here, we propose a comprehensive ensemble model to compare the roles of both order-order transition and disorder-order transition in allosteric effect. It is revealed that … Continua la lettura di A comprehensive ensemble model for comparing the allosteric effect of ordered and disordered proteins
          GlaxoSmithKline to Acquire Tesaro for $4.16 Billion      Cache   Translate Page      
GlaxoSmithKline said it would buy cancer-focused drug company Tesaro for about $4.16 billion, positioning the health-care giant in a promising, but fiercely competitive, area of medicine.

          Home health care worker arrested for larceny      Cache   Translate Page      

A Southington woman was arrested today for allegedly stealing from the woman she was caring...

The post Home health care worker arrested for larceny appeared first on Shelton Herald.

          (USA-WA-Seattle) Nutrition Assistant - Nutrition Services      Cache   Translate Page      
**Description:** Swedish Medical Center is looking for a Nutrition Assistant (0.6, Evening) at Swedish First Hill in Seattle, WA. _Swedish_ _Medical Center is looking for a dedicated Nutrition Assistant_ _who will uphold the goals and ideals of Swedish Medical Center in providing excellent care and experience for our diverse patient population._ In this position you will: + Assemble and deliver patient, visitor, and staff meal orders in a high-volume, fast-paced environment to patients’ rooms or designated locations + Visit patients who did not place a meal order and assist them as appropriate + Maintain cash bank and process cash sale orders + Retrieve meal trays from patients rooms **Qualifications:** Required qualifications for this position include: + High school Diploma or GED + Current State of Washington Food and Beverage Service Worker’s Permit + Related customer service experience Preferred qualifications for this position include: + Food service experience About the First Hill Campus: The 697-bed tertiary-care center on the Swedish/First Hill campus is the flagship of the Swedish health-care system. Swedish/First Hill has one of the most active and advanced birthing programs in Washington state and houses a Level III neonatal intensive-care unit. More surgeries are performed each year at Swedish/First Hill than at any other facility in the region; volumes include more total joint replacements than any other medical center in the state. **We offer a full comprehensive range of benefits — see our website for details** **Our Mission** Our nonprofit Mission is to improve the health and wellbeing of each person we serve. Our Vision is to demonstrate the highest-quality, best-value healthcare to all we serve. **About Us** Swedish is the largest nonprofit health care provider in the greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); ambulatory care centers in Redmond and Mill Creek; and Swedish Medical Group a network of more than 118 primary care and specialty locations throughout the Puget Sound. Swedish employs more than 13,300 employees and 3,100 physicians and allied health professionals. Whether through physician clinics, education, research and innovation or other outreach, we’re committed to caring for the people in our region and beyond. Swedish is proud to be an Equal Opportunity Employer. Swedish does not discriminate on the basis of race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. **Schedule:** Part-time **Shift:** Evening **Job Category:** Food Service Attendant **Location:** Washington-Seattle **Work Locations:** First Hill Main Bldg (WA145) 747 Broadway Seattle, 98122 **Req ID:** 208006
          Re: Americans’ Self-Contradictory Views of Socialized Healthcare      Cache   Translate Page      

cont ...
And, why is it that Americans "Love their Government" when it comes to Bombing Poor Innocent "Women and Children" all over Gods Creation with Billion Dollar Smart Abominations; but they just cannot stomach Health-Care for all?

You idiots still looking for Bin Laden?

How many Trillion did He cost You, Fools!

You idiots shot your Health Care into Global Murder for MIC profit and you will be Judged for it. Government could never have done it without YOU.

You idiotic Christians better get your GD heads examined! If you cannot stand up to your government .. How, OH, HOW .. could any, or even "all of you" stand up to the Evil Angelic Powers that oppose God? Translation, You are all Worthless to God.

Those of you who do not like Religion better hit the Books and Study Your Math; because more than 3/4 of America claims to be of a God Believing Faith. I have to go with the Statistics.

          A Children’s Mercy nurse, a patient and a decision that led to 6 transplant surgeries - The Kansas City Star      Cache   Translate Page      
A Children’s Mercy nurse, a patient and a decision that led to 6 transplant surgeries  The Kansas City Star

A nurse at Children's Mercy hospital wanted to donate a kidney to a patient but wasn't a match. So the hospital worked with KU to start a transplant chain that ...

          Cheyenne Couple Gets 37 Months for Health Care Fraud      Cache   Translate Page      
In addition to prison​, the Sinks were also ordered to pay over $6.2 million in restitution and to forfeit over $750,000 in assets traceable to the fraud. Continue reading…
          The Biggest Moments Of 2018 In The Fight For Universal Health Care      Cache   Translate Page      

Even in the face of a fiercely conservative administration, universal health care took center stage in 2018 with the potential to dramatically improve the lives of more Americans than any other social program in our nation’s history. A publicly financed but privately delivered single-payer program, more popularly known as Medicare

The post The Biggest Moments Of 2018 In The Fight For Universal Health Care appeared first on Shadowproof.

          TPJKM versions Prior to 4.1 and reporting Employer Cost of Health Care      Cache   Translate Page      

This video covers another way of reporting employer cost of health care contributions on your W2’s this year. This method will work with all versions of Temps Plus JKM. If you are running the latest version (v.4.1), you should watch the video that covers that method.

The post TPJKM versions Prior to 4.1 and reporting Employer Cost of Health Care appeared first on Bridge Ware.

          #5: TOMY Toomies Octopals - Octopus Number Sorting Suction Squirters Bath Toy - Suitable From 1 year      Cache   Translate Page      
TOMY Toomies
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(Visit the Bestsellers in Health & Baby Care list for authoritative information on this product's current rank.)
          #9: Nuby Fun Watering Can Bath Toy      Cache   Translate Page      
Nuby Fun
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(Visit the Bestsellers in Health & Baby Care list for authoritative information on this product's current rank.)
          #10: Bepanthen Nappy Care Ointment, 100g      Cache   Translate Page      
Bepanthen Nappy
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by Bepanthen

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(Visit the Bestsellers in Health & Baby Care list for authoritative information on this product's current rank.)
          LASG INDUCTS NEW STAFF IN THE PRIMARY HEALTH CARE BOARD      Cache   Translate Page      

The Lagos State Government today kicks off the induction of one hundred and six newly employed staff of the Primary Health Care Board to introduce the new staff to the ethics, ethos, norms and values of the State Public Service. The Induction course, a flagship programme of PSSDC is primarily designed to re-orientate new entrants

The post LASG INDUCTS NEW STAFF IN THE PRIMARY HEALTH CARE BOARD appeared first on Lagos Television. Lagos News. Politics. Entertainment. Events..

          Obamacare study: 25% decline in home delinquencies among newly insured poor people      Cache   Translate Page      

Poor people were not the primary target of Obamacare; as a group, their care is more likely to be "non-compensated" (trips to the emergency room while classed as "indigent" and unable to pay), so insurance shouldn't make a big difference to them, right?


A recently updated study, The Effect of Health Insurance on Home Payment Delinquency: Evidence from ACA Marketplace Subsidies, from finance and business researchers affiliated with both academic business schools and several federal reserve banks, compares the rate of home payment delinquencies (mostly rent payments) among the poorest Americans who received Obamacare through Medicaid expansion with their counterparts in Red States that rejected the expansion and denied coverage to their poor citizens.

The headline finding is that poor people with health-care are 25% less likely to miss rent payments than their uninsured counterparts. That finding is stable year-over-year, too.

The authors argue that the cost of the Medicaid expansion can be offset with savings from evictions, which impose costs in excess of the costs of providing health care.

But of course, those savings are a pittance compared to the national savings we'd realize by eliminating for-profit, private healthcare altogether and replacing it with a national universal healthcare system.

Instead, low-income households may be the most sensitive to healthcare shocks. Her results counter the conventional wisdom that poor people put off healthcare spending; often, they can’t. The study points to an example from Matthew Desmond’s Evicted, which recounts the circumstances of poor renters across Milwaukee. “They had fallen behind [on rent] two months ago, when a neck X-ray and brain scan set Teddy back $507.

Read the rest

          12/5/2018: REPORT ON BUSINESS: Markets summary      Cache   Translate Page      
CANADIAN STOCKS Canada’s main stock index fell, led by health-care and energy shares, while market sentiment was hurt by fading hopes of a swift resolution to the U.S.-China trade dispute. The Toronto Stock Exchange’s S&P/TSX Composite Index was down...
          12/5/2018: CAREERS: I want to be a health-care engineer … what will my salary be?      Cache   Translate Page      

The role: Help health-care facilities, systems and networks solve complex medical and business challenges, using data andalgorithms. Taskscanrangefrompatient intake flow, to optimizing healthcare administration and helping clinicians with decisions...
          Cheyenne Couple Gets 37 Months for Health Care Fraud      Cache   Translate Page      
In addition to prison​, the Sinks were also ordered to pay over $6.2 million in restitution and to forfeit over $750,000 in assets traceable to the fraud. Continue reading…
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          Canada : Proposed bargaining agreement to tackle health-care worker injuries      Cache   Translate Page      
Source: The Star
          Did You Know Dementia Patients Get Agitated When Left Alone?      Cache   Translate Page      

Are you dealing with an Alzheimer's patients that is mean and ornery? Or, sometimes mean and hard to deal with?

Did You Know Dementia Patients Get Agitated When Left Alone?

Did you know that past a certain stage dementia patients cannot be left alone? 

Not even for a very short period of time.

You Cannot Leave a Person Living with Alzheimer's Alone

By Bob DeMarco
Alzheimer's Reading Room

Subscribe to the Alzheimer's Reading Room
Early on in my caregiving career I learned a very important lesson.

You cannot leave a person with Alzheimer's alone even for a very short period of time.

After a while I started noticing that whenever I left Dotty alone, and when I came back she was often mean and angry. This lead to a very bad period. Sometimes this period lasted for hours and sometimes it lasted for days.

I Finally Realized Alzheimer's Was the Enemy - Not My Mom

Basically Dotty was unhappy and I was unhappy. Unhappiness does not breed contentment and cooperation.

How did I discover both this problem and the solution? I finally put one and one together and made three.

Sometimes I would go out to throw out the trash and while out talk to a neighbor. I might be gone for 15 minutes. When I returned I could tell by the look on my mom's face that she was upset.

The Frightened, Angry, Anxious, Mean Dementia Patient

Then, I started noticing that when my mother would talk to my sister at night she would tell her, he was gone all day, I don't know what he is up to. Clearly Dotty was confused. I had been with her the entire day with the exceptions of those 15 minutes.

As should be obvious, when Dotty accused me  of  "being away all day, and being up to something" I would get angry. And yes, I would correct her with a detailed explanation of her "wrong thinking".

Alzheimer's Communication - No More Blah Blah Blah

Of course this didn't work. In fact it only made things worse, and it made our relationship worse.

I also noticed that when Dotty didn't see me, even if I was a few feet away, she would would start saying loudly,

"Bobby, Bobby, where are you"? 

If answered quickly this seemed to

reassure her.

Sometimes Dotty and I would be in different rooms and she would start saying loudly, "Bobby, Bobby, where are you"?

If I yelled from the Florida room, I'm back here in the Florida room, well this really didn't work well. It was not enough reassurance for a person living with dementia, and quite frankly, Dotty probably no longer knew where the Florida room was.

Routine and the Importance of the First Action of the Day in Dementia Care

I soon learned that if I got up and yelled, I'm coming. Then when I arrived where she was - looked her in the eye and smiled, waited for her to smile back at me, and then said, "I'm right here", it seemed to reassure her in a very positive way.

I could tell both by the look on her face, and by how she acted in the aftermath of this situation that everything was going to be okay.

I had finally learned after much heartache and many hundreds of stomachaches that

you cannot leave a person who is deeply forgetful alone.

At a certain point in the progression of dementia you cannot leave a dementia patient alone - even for a very short period of time.

3 Ways to Redirect a Dementia Patient and Embrace Reality

They rely on us so much that they cannot stand to be out of our presence. They become both worried and confused.

If you leave them alone, you will suffer the consequences. Meanness, difficult, and challenging behavior that will ruin your day, day after day after day. If you are having this problem - sudden meanness, challenging behavior, and sudden mood changes pay attention to what has happened right before these types of behavior - pop up.

How to Change Patterns of Behavior in Alzheimer's and Dementia Care

These kinds of situation can be very burdensome for a caregivers. They can make you angry, cause stress and ruin you day.

I did learn one good technique.

I moved the furniture around and positioned Dotty so that when she said, "Bobby, Bobby, where are you?", I could spin around fast in my chair to get her attention, give her the smile, get the smile back, and say, here I am. It worked. Don't forget the smile.

Over time this cumulative reassurance made a big difference in how we related and interacted with each other.

By the way, Dotty often did her Bobby Bobby when she dozed off on the sofa. I actually moved the computer to a strategic position so I could work on the Alzheimer's Reading Room; and then, when necessary spin around so she could see me, and get the reassurance she needed.

About the Alzheimer's Reading Room

You have to learn to listen very closely to a person living with dementia. When Dotty said I was gone all day it was because she no longer had a real sense of time. She believed what she said to be true, and no amount of explaining could change her belief. Explaining to a dementia patient just doesn't work. Thing about it. Does explaining or trying to convince work for you?

How to Listen to an Alzheimer's Patient

Most Alzheimer's patients stick to their Alzheimer's caregiver like glue. They shadow us. They follow us This included Dotty.

They love us, and rely on us so much, they just can't stand to be without us.

The bottom line. You have to learn how to accept the way dementia patients act, and you have to adjust to their behaviors. If you do, you'll have a better day. If you don't you will likely be miserable most of the time.

How to Get Answers To Your Questions and Solutions to Your Alzheimer's and Dementia Problems

I know how that feels. It happened to me and I didn't like it. So I learned how to understand, cope and communicate with a person living with dementia - my mom. Once I did our life improved and we relearned how to get along. That was nice.

Related Articles

Communicating in Alzheimer's World

13 Things Every Alzheimer's Caregiver Needs to Know

Alzheimer's World and the Positive That Comes With It

How to talk and communicate with dementia patients effectively

Topic - Mother wants out of nursing home

Topic - Why do Alzheimer's patients stop ...?

Bob DeMarco is the Founder of the Alzheimer's Reading Room (ARR). Bob is a recognized expert, writer, speaker, and influencer in the Alzheimer's and Dementia Community worldwide.

The Alzheimer's Reading Room is the publisher of high quality expert information and news for the Alzheimer's and dementia community.

Publisher Alzheimer's Reading Room
Author Bob DeMarco
April, 2017
Title:Did You Know Dementia Patients Get Agitated When Left Alone?

You are reading original content the Alzheimer's Reading Room

"The Alzheimer’s Reading Room is what it claims to be – and more.

This comprehensive site is run by full-time caregiver and gifted advocate Bob DeMarco.

Filled with wonderful contributions from a variety of talented writers, this site offers everything you need to know about the challenge of caregiving, learning about your loved one’s condition, and taking care of yourself as well.

Thanks to the tireless efforts of everyone at the Alzheimer’s Reading Room, you have a go-to place for advice, education, and an occasional laugh. Stop by, and start feeling empowered to handle life as a caregiver."

Healthline - Alzheimer's Disease Best Blog 2018

Need Help? Search Our Award Winning Knowledge Base for Answers to Your Questions About Alzheimer's and Dementia

          Roadblocks to Health Care Could Be a Death Sentence      Cache   Translate Page      
The government hides its cruel agenda under layers of bureaucracy.

The post Roadblocks to Health Care Could Be a Death Sentence appeared first on Truthout.

          Staff Accountant      Cache   Translate Page      
MA-Boston, VPNE Parking Solutions is the parking and transportation business partner to the most prestigious health-care institutions, commercial property owners and developers, financial institutions, and hospitality companies. At VPNE we help our clients maximize the value of their parking and transportation assets with our differentiating customer care and our expert, business-driven management services.
          Bernie Sanders and Alexandria Ocasio-Cortez Are Pushing a Bold New Plan to Tackle Climate Change      Cache   Translate Page      

Last week, Donald Trump offered a perfect encapsulation of the political Twilight Zone that is his presidency when he dismissed his own administration’s dire report on climate change, claiming simply, “I don’t believe it.

That report was perhaps the most alarming warning yet of the imminent havoc presented by our climate crisis, predicting stark falls in GDP and economic activity, massive species die offs, flooding, increases in extreme weather events, sea level rise that threatens the very existence of U.S. coastal cities and rising temperatures that could make Chicago’s climate rival that of Phoenix or Las Vegas.

But while President Trump glibly writes off the predictions of over 1,000 experts spanning 13 federal agencies, a newly ascendant progressive cohort in government is rallying support for a bold alternative: A Green New Deal.

That proposal, which calls for transitioning to 100 percent renewable energy through a colossal jobs creation program, has been championed by two of the most well-known insurgents in Congress, incoming Rep. Alexandria Ocasio-Cortez (D-NY) and Sen. Bernie Sanders (I-Vt.). The progressive stalwarts shared the stage together Monday night at a packed town hall event entitled “Solving Our Climate Crisis.”   

The gathering follows previous national town hall events put on by Sanders’ camp in recent years which have focussed on Medicare for All, income inequality and foreign policy. These town halls have frequently drawn over a million viewers, rivaling—and sometimes eclipsing—the viewership of cable news stations.

But besides the topic area of discussion, early on Sanders made clear what made his event distinct from what would be seen on corporate media: “This event is not sponsored by Exxon Mobil, nor is it sponsored or paid for by the Koch brothers.”

This is no small thing. A report from watchdog group Public Citizen earlier this year shows that, on the whole, mainstream media outlets consistently avoid in-depth reporting on climate change. Many of these outlets also receive substantial financial support from fossil fuel companies, whether through corporate advertising, grants or other forms.

Over the course of the 2016 election, mainstream outlets, including ABC, NBC, CBS and Fox, significantly decreased any mention of the issue on their programs compared to previous years. And the 2018 midterms continued to see barely any serious discussion of climate change on cable news. When it is covered, pundits frequently mention climate change only as it relates to Trump’s shifting policies, without offering any type of thorough exploration of the issue and its consequences.

Sanders’ town hall, then, provided something rarely seen in U.S. media: experts and politicians talking in depth about the dangers and potential solutions to the climate crisis. And while the tenor was rightly sober, it did provide a rousing call to arms for those prepared to take on the existential climate emergency we are all facing.

Taking on the fossil fuel industry

The Trump administration’s climate assessment was not the only paper on climate change’s devastating effects to come out in recent months. In early October, the UN Intergovernmental Panel on Climate Change (IPCC) released a groundbreaking report that laid out, among other things, that world governments have just 12 years left to lower fossil fuel emissions by a staggering 45 percent to avoid a global temperature rise of 1.5 degrees Celsius and the resulting risks of devastating drought, extreme heat, floods and mass poverty.

Barring efforts of monumental proportion to slow climate change, the report’s authors predict that we are currently on track to see temperature rises of 3 degrees Celsius, which could spell untold horrors for humanity and all other species that occupy the only known life-supporting planet in the entire vast expanse of the universe.

One of that report’s authors, Dr. Brenda Ekwurzel, joined as the first guest on Sanders’ town hall meeting. Ekwurzel described the major finding of the IPCC report: “Climate change is not some problem in the distant future: It is here, it is now, and it is happening in every part of the country.”

She continued to describe some of the impact of the continuing crisis. “We may be unleashing a destabilization in the West Antarctic ice sheet which could cause massive sea level rise. Most people in the world live near the coasts around the world, which means many places would be inundated.” Sanders’ responded, “It means communities where millions of people live will be underwater. And in terms of national security issues, it means mass migrations of people.”

When it comes to the economic impact, Ekwurzel said, “We find that if carbon emissions continue unabated that the U.S. could endure annual costs of over $100 billion in some sectors.” She went on to explain that by reducing carbon emissions, we could lower that figure by half or even more, while also saving innumerable lives.

When asked how we can individually help tackle climate change, Ekwurzel began by advising to “start with your own life and what you can do,” but then quickly transitioned toward influencing those in power. “Absolutely ask your leaders ‘what are you doing to reduce emissions globally?’” she urged.

Sanders followed up with an even more direct appeal to target the principal perpetrators of climate collapse. “The time is late, and that means countries all over the world are going to have to stand up and take on the fossil fuel industry if we are going to leave our kids and our grandchildren a planet that is habitable. This is a crisis situation. It is unprecedented and we have to act in unprecedented ways.”

Capitalism can’t save us

Such an explanation underpins the argument for a Green New Deal—a wildly ambitious plan that would transform not just the energy sector in the United States, but also the functioning of the entire economy. The proposal would involve modernizing infrastructure, investing in renewables and overhauling food, water and energy systems while creating millions of high-quality jobs.

Based around the goal of achieving carbon neutrality, the plan involves the creation of a Select Committee in the House which would, according to a resolution drafted by Ocasio-Cortez, put together a “detailed national, industrial, economic mobilization plan” to achieve “economic and environmental justice and equality.”

While this may sound like just another functionary task, as Naomi Klein explains at The Intercept, the current plan calls for the committee’s recommendations to be released ahead of the 2020 elections, which could make it a test and rallying cry for all progressive candidates that cycle.

Not everyone is a fan of the plan, however. In the recent Wall Street Journal op-ed entitled “Stopping the Socialist Resurgence,” GOP strategist and former George W. Bush whisperer Karl Rove criticized Ocasio-Cortez’s rhetoric around the proposal as “sounding too much like a Maoist functionary.” Elsewhere in the piece, Rove raises the red flags of increasing support for Medicare for All, student debt relief and increased taxes on the rich, calling on his Republican brethren to prepare themselves to come out victors in the grand battle of ideas.

But while Rove is rightly scandalized by the rise in socialist ideas, he misses that the very policies he hopes to contest in the court of public opinion are already backed by most Americans. When it comes to Medicare for All, 70 percent are on board. Student debt relief is widely supported. Three-quarters of Americans are behind raising taxes on the wealthy. And when it comes to a Green New Deal, Data for Progress found that among eligible and enthusiastic voters, more than half “said they would be more likely to support a candidate running on a green job guarantee.”

Embracing these large-scale progressive attitudes and pursuing state intervention in the energy sector is widely believed to be the only way to stave off the worst effects of climate change while creating equity in our response to the crisis—and the Green New Deal offers a clear path forward.

Beyond centrist solutions

Both climate activists and researchers say we need to immediately wean ourselves off of fossil fuels and leave future resources in the ground. This approach, far more radical than anything seriously discussed in mainstream energy reporting, served as the basis for Ocasio-Cortez’s presentation at Monday’s town hall.

Ocasio-Cortez, an open democratic socialist, began by pushing back against the most frequent criticism of a Green New Deal program: its alleged negative effects on the economy. “It’s just plain wrong, the idea that we are somehow going to lose economic activity. It’s not just possible that we’ll create jobs and economic activity by transitioning to renewable energy,” she said. “It’s inevitable.”

“It’s inevitable that we can use the transition to 100 percent renewable energy as the vehicle to truly deliver and establish economic, social and racial justice in the United States of America. That is our proposal.”

She went on to compare the challenges presented by the current moment to those faced by past U.S. leaders who helped push through major accomplishments under daunting odds. “This is going to be the Great Society, the moon shot, the Civil Rights Movement of our generation,” she said.

Ocasio-Cortez, who last month participated in a protest outside House Minority leader Nancy Pelosi’s office demanding Democrats push for a Green New Deal, presented the case in clear moral terms. “We’ve amassed some of the largest amounts of wealth in American history, but we have never seen so many people struggling and living paycheck to paycheck in the way that we are today,” she explained.

“When we talk about transition, we talk about just transitions. Transitioning to renewable energy that provides justice to all people who are impacted. That includes fully funding the pensions these coal minors are due, of which they’re being stripped. For younger people, that means providing educational opportunities for them to transition to renewable energy jobs.”

She went on to lay out why the type of traditional centrist environmental policies of means testing and half-measures won’t cut it in rising to the demands of this moment. “When we try to solve this piecemeal, we’re not going to get it solved in time. That’s why we’re asking for this really ambitious, singular plan. And I believe that the progressive movement is the only movement with answers right now, that is drawing from the lessons of history.”

That ambitious plan—backed by groups such as the Sunrise Movement and—is beginning to look like less of a fringe idea and more like a policy moving into the mainstream of American politics. In addition to Ocasio-Cortez, 18 other House members now support the creation of a Select Committee for the Green New Deal. And Sanders is gaining support in his chamber as well: On Monday, Sen. Jeff Merkley (D-Or.) signed on board with the plan. 

Of course, any policy along the lines of a Green New Deal will surely be bitterly opposed by the fossil fuel industry and the interests that it benefits. After all, the entire plan is premised on threatening that industry’s profits and its continued domination over the U.S. economy.

Xiuhtezcatl Martinez, an 18-year-old indigenous environmental activist, hip hop artist and youth director of the conservation group Earth Guardians, used his platform at the town hall to lay out why countering the coming attacks from oil and gas companies on bold climate action will require a change in both thinking and in political incentives.

“Historically it has been politically risky to stand up to the fossil fuel industry as politicians,” Martinez said. “I think our generation is very different. Yes, we are the future and have the most at stake, but we are also here now. That also gives us the perspective of pushing the agenda so that it’s politically risky to not stand up to the fossil fuel industry.”

It’s true that a battle between environmental activists and powerful fossil fuel interests has been waged for decades, and time after time, the fossil fuel industry has come out on top. As founder Bill McKibben explained during the town hall, “This has got to be the moment. In the end, what changes things is movements. We won this argument 25 years ago. But the fight so far we’ve lost, because fights are about power and money. And now we’ve got to bring power ourselves.”

The only option is to win

What makes this moment different is that, for the first time in recent memory, there is a growing clarion call for a response that goes beyond the limits imposed by our economic system.

Four years ago, Naomi Klein wrote in her book This Changes Everything: Capitalism vs. The Climate, “We are stuck because the actions that would have given us the best chance of averting climate catastrophe—and would benefit the vast majority—are extremely threatening to an elite minority that has a stranglehold over our economy, our political process, and most of our major media outlets…. Right now, the triumph of market logic, with its ethos of domination and fierce competition, is paralyzing almost all serious efforts to respond to climate change.”

She went on to pose the question of whether our society is up to the task of mitigating the climate crisis and building a sustainable future. “Is it possible? Absolutely. Is it possible without challenging the fundamental logic of deregulated capitalism? Not a chance.”

That confrontation with the forces of extractive capitalism has been made possible by a multifaceted movement of working-class, indigenous and intergenerational activists that, through dedicated organizing, has laid the groundwork for the Green New Deal. From the anti-pipeline protests at Standing Rock to the Sunrise Movement’s demonstration urging Pelosi to back bold climate action, years of creative activism has set the stage for this moment.

And the policy is making progress in the halls of Congress thanks to the leadership of politicians free of oil industry funding who are grounded in working-class, frontline communities—representatives like Ocasio-Cortez, Rashida Tlaib (D-Mich.) and Ayanna Pressley (D-Mass.).

This forward momentum is why, in her recent Intercept piece, Klein calls the Green New Deal proposal “game-changing” and says “I feel more optimistic about our collective chances of averting climate breakdown than I have in years.”

In 2014, the same year that Klein published This Changes Everything, the late science fiction writer Ursula K. Le Guin gave a speech at the National Book Awards where she famously said, “We live in capitalism. Its power seems inescapable—but then, so did the divine right of kings.”

The idea that within four years, grassroots energy and political support could begin coalescing behind a policy that challenges market fundamentalism head on could not have been predicted by either Klein or Le Guin. But such calls to rise to this challenge helped open the political space that has made the current moment possible.

There is still a climate denier in the White House whose Environmental Protection Agency is staffed with fossil fuel lobbyists while the Republican Party on the whole continues to reject science and ferociously fight any legislation that would help protect the climate.

Yet more and more Americans—and political leaders—are beginning to align with the perspective laid out by Sen. Sanders in his recent book Where We Go from Here—Two Years in the Resistance: “To sacrifice the future of the planet for the short-term profits of the fossil fuel industry is unspeakably selfish, outrageous and unforgivable.”

After hearing Ocasio-Cortez’s call for courage in the face of climate change’s existential threats, Van Jones remarked that he had tried to help usher in such a Green New Deal-style approach during his time in the Obama administration, before being derailed by the right-wing. But, he continued, “I think you’re gonna get it done.”

Ocasio-Cortez then turned to the crowd—which included activists from the Sunrise Movement and other climate justice groups—and corrected him: “We’re gonna get it done. We’re gonna get it done.”

          Manager Communications - Yukon Hospital Corporation - Whitehorse, YT      Cache   Translate Page      
And eight (8) to ten (10) years’ experience in progressively senior roles in a health-care setting. Whitehorse General Hospital.... $82,824 - $103,530 a year
From Yukon Hospital Corporation - Fri, 19 Oct 2018 04:30:34 GMT - View all Whitehorse, YT jobs
          8 Creative Ways to Use Up Your 2018 Health Care Dollars      Cache   Translate Page      

Once again, the holidays have snuck up on me. It happens every year – the calendar flips to November and bam – I’m hit with toy catalogues and holiday commercials. While you’re making your list and checking it twice, pencil in some time to think about your flexible spending account (FSA). FSAs are valuable, tax-saving […]

The post 8 Creative Ways to Use Up Your 2018 Health Care Dollars appeared first on The Daily Dose | CDPHP Blog.

          Terrebonne Regional recognized by Joint Commission      Cache   Translate Page      

Terrebonne General Medical Center has achieved The Joint Commission’s Gold Seal of Approval by demonstrating continuous compliance with its performance standards, the hospital said in a news rel

          Obamacare study: 25% decline in home delinquencies among newly insured poor people      Cache   Translate Page      

Poor people were not the primary target of Obamacare; as a group, their care is more likely to be "non-compensated" (trips to the emergency room while classed as "indigent" and unable to pay), so insurance shouldn't make a big difference to them, right?


A recently updated study, The Effect of Health Insurance on Home Payment Delinquency: Evidence from ACA Marketplace Subsidies, from finance and business researchers affiliated with both academic business schools and several federal reserve banks, compares the rate of home payment delinquencies (mostly rent payments) among the poorest Americans who received Obamacare through Medicaid expansion with their counterparts in Red States that rejected the expansion and denied coverage to their poor citizens.

The headline finding is that poor people with health-care are 25% less likely to miss rent payments than their uninsured counterparts. That finding is stable year-over-year, too.

The authors argue that the cost of the Medicaid expansion can be offset with savings from evictions, which impose costs in excess of the costs of providing health care.

But of course, those savings are a pittance compared to the national savings we'd realize by eliminating for-profit, private healthcare altogether and replacing it with a national universal healthcare system.

Instead, low-income households may be the most sensitive to healthcare shocks. Her results counter the conventional wisdom that poor people put off healthcare spending; often, they can’t. The study points to an example from Matthew Desmond’s Evicted, which recounts the circumstances of poor renters across Milwaukee. “They had fallen behind [on rent] two months ago, when a neck X-ray and brain scan set Teddy back $507.

Read the rest

          We Are Libertarians – 004: How to fix health care and Professorial bias in college      Cache   Translate Page      
Chris, Creighton, and Chris discuss healthcare solutions in the wake of oral arguments in the Obamacare case currently in front of the SCOTUS. The guys also discuss what it means … Continue reading
          JoCo woman on fentanyl choked to death on her hospital breakfast, lawsuit says      Cache   Translate Page      
A woman choked to death after staff at Overland Park Regional Medical Center gave her the powerful opioid fentanyl and then left her unattended to eat breakfast, according to a … Click to Continue »
          Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation.      Cache   Translate Page      
Icon for National Institute for Health Research Journals Library

Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation.

Health Technol Assess. 2018 Nov;22(68):1-246

Authors: Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin M

BACKGROUND: Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences.
OBJECTIVES: Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment.
DATA SOURCES: Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017).
REVIEW METHODS: Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000.
RESULTS: A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit.
LIMITATIONS: Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken.
CONCLUSIONS: Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends.
FUTURE WORK: Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions.
STUDY REGISTRATION: This study is registered as PROSPERO CRD42016040190.
FUNDING: The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.

PMID: 30511918 [PubMed - in process]

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