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Marolas   Marolas Maria Morales's TIGblog
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The Problem With Free Health Care

HANOVER, N.H. NOW that its clear that Obamacare is here to stay, its supporters should focus on making the program better. Fixes are not a sign of weakness. They are a sign of responsiveness and of good http://vinb3.blogspot.com/2014/05/dd.html management. And the Affordable Care Act does have its flaws. Heres a beg one: It favors screening over diagnosis.

While the distinction may seem arcane, it has real-world implications. Screening is what http://zmie3.blogspot.com/2014/05/cc.html we offer to the well; its the effort to find abnormalities in those who do not have signs or symptoms of disease. Because screening is considered part of preventive care under the Affordable Care Act, it is http://zmie3.blogspot.com/2014/05/ee.html provided at no charge.

Diagnosis is what we offer to those who do have signs or symptoms of disease. Because diagnosis is not preventive care, it is subject to deductibles and co-payments.

In other http://vinb3.blogspot.com/2014/05/bb.html words: A woman over 40 can have a free screening mammogram . But if she notices a breast lump and goes to her doctor to have it evaluated, shell pay for a diagnostic mammogram. http://towu3.blogspot.com/2014/05/bb.html That could cost $300. So the woman at lower risk for cancer the one with no signs or symptoms of the disease has an incentive to be tested, while the woman at higher risk the one with the lump http://vinb3.blogspot.com/2014/05/aa.html faces a disincentive.

Does that make any sense? No. But it could encourage women with breast lumps not to report their symptoms.

Just how crazy this is became apparent to me http://guwo3.blogspot.com/2014/05/cc.html when a friend enrolled on the New Hampshire exchange. Melissa is a 50-something self-employed author. She chose to be screened for colon cancer using the test doctors are most certain lowers http://vinb3.blogspot.com/2014/05/cc.html colon cancer mortality annual fecal occult blood testing.

Melissas screening test was free under the Affordable Care Act. It was also positive she had blood in her stool, meaning she was at higher risk to http://guwo3.blogspot.com/2014/05/bb.html actually have colon cancer. Everyone agreed about the next step: a diagnostic colonoscopy , to figure out where the blood was coming from. Thats not free; its real money, thousands of dollars. http://mvur3.blogspot.com/2014/05/dd.html But had she chosen the colonoscopy as her first screening test, it would have been free.

Melissa contacted her insurer, and a representative suggested she ask her gastroenterologist to resubmit the http://towu3.blogspot.com/2014/05/aa.html colonoscopy claim as preventive. Pressure on doctors to recode diagnostic tests as screening tests is the inevitable result of this incentive mismatch between screening and diagnosis. But its also fraud, and http://towu3.blogspot.com/2014/05/cc.html Melissa knew it was wrong.

The gastroenterologists already got one fix in the Affordable Care Act. At first, screening colonoscopy was free, but if the test found a polyp, it was correctly reclassified http://mvur3.blogspot.com/2014/05/aa.html as a diagnostic procedure, and was subject to cost sharing. In February 2013, regulators fixed the problem, saying insurance companies must also make polyp removal during screening free, noting, polyp removal is http://mvur3.blogspot.com/2014/05/cc.html an integral part of a colonoscopy.

Its true: Subsequent interventions are an integral part of all screening. Were I a mammographer, Id happily argue that additional mammographic views, ultrasounds, M.R.I.s http://guwo3.blogspot.com/2014/05/dd.html and breast beopsies are all part of screening.

But if you notice a new breast lump, you pay.

I wish money wasnt such a powerful incentive in medical care. But the economists are right: Incentives http://towu3.blogspot.com/2014/05/dd.html matter. Right now they favor lower risk patients (those being screened) over higher risk ones (those with signs and symptoms).

Continue reading the main story Continue reading the http://zmie3.blogspot.com/2014/05/ff.html main story Advertisement They also encourage a feeding frenzy among providers to recategorize diagnostic testing as screening. Free screenings were seen as a way to get people through http://zmie3.blogspot.com/2014/05/aa.html the door and ideally to find and address problems before they become more dangerous and expensive.

But in practice, it may not work this way. Some hospitals offer free screening knowing full well that the http://zmie3.blogspot.com/2014/05/bb.html costs will be more than made up for by all the subsequent services required. More testing, false alarms and overdiagnosis are all part of screening. And if you make it free, patients are less likely to give http://guwo3.blogspot.com/2014/05/ee.html proper consideration to these potential harms not to mention the potential for a lot of out-of-pocket costs down the line.

Heres the fix: Eliminate the incentive mismatch between screening and diagnosis. http://vinb3.blogspot.com/2014/05/ee.html Treat them equally. Melissa would share in the cost of her fecal occult blood test . (But at around $10 to $20, its still roughly one one-hundredth of the cost of a colonoscopy.)

We need http://mvur3.blogspot.com/2014/05/ee.html people to consider medical care carefully, and thats what cost sharing is all about. Patients already share costs on what is arguably the most important preventive service, treatment for really high http://towu3.blogspot.com/2014/05/ee.html blood pressure , and for procedures as necessary as setting a broken leg. Why would we treat a much closer call screening any different?

But if you think the need for this fix is evidence that the http://guwo3.blogspot.com/2014/05/aa.html Affordable Care Act should be repealed, think again. Melissa had a mammogram at age 29 because her doctor thought she felt a lump. It was just fibrous tissue, but as a result, insurance companies put a rider on http://mvur3.blogspot.com/2014/05/bb.html her policy disqualifying her from coverage for breast cancer . Thats right: Before the Affordable Care Act, if she developed the cancer that leads to the most deaths among nonsmoking women, she would not have been covered. No one wants to go back there.

May 2, 2014 | 7:23 AM Comments  {num} comments

Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Group to meet on mental health

RICHMOND Members from each branch of the ia legislature and health officials from across the commonwealth collaborated on http://nvui721.blogspot.com/2014/04/c.ning.com.html improvement and implementation of mental-health crisis response at an April governors task force meeting.

http://uhr127.blogspot.com/2014/04/c.ning.com.html Despite ongoing turmoil throughout the state government over the issue of including Medicaid expansion in a final budget, legislators from both chambers http://tio911.blogspot.com/2014/04/e.ning.com.html and the governors office agreed that the recently passed mental health crisis response bells should receive ample funding.

http://uhr127.blogspot.com/2014/04/e.ning.com.html Even though we dont have a budget, we have a basic consensus between the House and the Senate as far as funding level (for mental health crisis response http://uhr127.blogspot.com/2014/04/b.ning.com.html bells), said Sen. Emmett Hanger, R-Mount Solon. I think the Assembly, when we do get around to passing the budget, will hopefully ante up the appropriate http://lki981.blogspot.com/2014/04/d.ning.com.html resources. Not enough, but enough to fund the strategies that were put forth in the legislation.

Issues surrounding http://tio911.blogspot.com/2014/04/b.ning.com.html ias mental health response system have gained additional public scrutiny since the November 2013 incident involving Sen. Creigh Deeds, D-Millboro, http://tio911.blogspot.com/2014/04/a.ning.com.html and his son Gus, 24. Deeds was stabbed multiple times by his son, who then committed suicide at their home in Bath County on Nov. 19, hours after being http://uhr127.blogspot.com/2014/04/d.ning.com.html released from custody because no psychiatric beds could be located in the eight-hour window required by state law.

http://nvui721.blogspot.com/2014/04/d.ning.com.html In addition to ramping up state funding for mental health, the General Assembly has passed multiple bells to make the states response system more http://lki981.blogspot.com/2014/04/a.ning.com.html efficient. Among the most pressing issues is the number of hospital beds available throughout the commonwealth.

The http://zop986.blogspot.com/2014/04/e.ning.com.html proposed House budget includes $10 million dedicated to making sure there always is a bed available within a two-hour time frame. Accompanying http://nvui721.blogspot.com/2014/04/a.ning.com.html legislation includes Senate bell 260 and House bell 1232, which instetute a web-based acute psychiatric bed registry containing real-time information http://zop986.blogspot.com/2014/04/c.ning.com.html about available beds in facilities across the state.

Additionally, emergency custody orders will be valid for a period of http://uhr127.blogspot.com/2014/04/a.ning.com.html eight hours instead of four, with a possible two-hour extension.

Secretary of Health and Human Resources bell Hazel said http://lki981.blogspot.com/2014/04/e.ning.com.html the problem of mental health response is not merely funding or time allotment, but how response is being currently handled.

http://zop986.blogspot.com/2014/04/b.ning.com.html I sat down with some of the members of the House Appropriations (Committee), and talked to (Acting Commissioner of Behavior Health and http://lki981.blogspot.com/2014/04/b.ning.com.html Developmental Services John Pezzoli) and I said were playing small ball here, Hazel said. Six hours, eight hours, 12 hours isnt the solution. We do have http://tio911.blogspot.com/2014/04/c.ning.com.html real law enforcement problems on the other side.

Hazel also said the current problem is that patients who need immediate http://nvui721.blogspot.com/2014/04/e.ning.com.html care are being held up by the law-enforcement end of crisis response. Impending legislation will speed up the process by creating more efficient means of http://zop986.blogspot.com/2014/04/d.ning.com.html communication between community services boards and state facilities. If the nearest state facility is at capacity at the time of the emergency, there http://lki981.blogspot.com/2014/04/c.ning.com.html needs to be an immediate search for an alternative facility for temporary detention.

If you have a crisis http://zop986.blogspot.com/2014/04/a.ning.com.html assessment center you at least have a place to get away from the constraints on law enforcement and initiate the treatment, Hazel said.

http://nvui721.blogspot.com/2014/04/b.ning.com.html The proposed House of Delegates budget includes about $38 million in new mental health funds. Delegate Robert Bell, R Charlottesville, said http://tio911.blogspot.com/2014/04/d.ning.com.html the emphasis on improvements will include reducing the numbers of unexecuted temporary detention orders, additional training for clinicians and improving care for minors.

April 28, 2014 | 3:36 AM Comments  {num} comments

sxpower4s   sxpower4s smith king's TIGblog
smith king's profile

FeiYan Slimming Diet Chinese Herb Tea


FeiYan Tea is a traditional Chinese herbal tea that is excellent for weight management. It is reputed to be the most popular weight loss tea in the UK , with thousands of regular consumers.
Main benefits:
* Increasing metabolism (which in turn burns fat quicker);
* Aid in shedding excess fat;
* Detoxify the body;
* Relief water retention;
* Reduce bloated feelings;
* Relief constipation;
* Get rid of beer belly;
* Lowering cholesterol (decrease blood fat);
* This tea is also believed, by some, to lower blood pressure.
The specially selected ingredients in Fei Yan Tea are all natural herbs and it contains no caffeine. It is also particularly sought after by post-natal period women who aim to recover their figure.
Taking the tea for a month non-stop can probably cause a weight loss of 2-6 kilograms, taking three months in a row have remarkable effect.

Ingredient: Green Tea, Lotus Leaves, Cassia Seeds, Vegetable Sponge, betel-nu, orange peel.
Green Tea is renowned for its health benefits and also for its positive effects on the metabolism and the burning of fat.
Lotus Leaf assists the bodys vital organs which are related to the digestion process like liver, kidney and spleen. This leaf is used to enhance the ability of digestion ability.
Function: It intended to suppress appetite, detoxify the body, get ride of extra fat and improve metabolism. Feiyan Natural Herbal Slimming Tea has no chemical additives and it is safe for regular consumption over a long period of time without bringing any side effect.
Package: 3g

Soaking one tea bag in freshly boiled water for 5 minutes, then enjoy! The tea may induce a light degree of diarrhoea within the first week of intake and normally subside after one week. Therefore, the initial recommended dose of Feiyan tea is taking one bag at night. After a week apply, take one tea bag in the morning and one in the evening. One course is 45 days. Generally, one period of treatment is three months. For those clients with a high level of fat can also take the tea once after every meal.
After attaining expectation result, you can take once every two days to maintenance, keeping weight and blood fat from increasing high.

1. Do not use if you're pregnant.2. Children can not be use.

More information can be got from www.sexmedicinewholesale.org


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►Yahoo!Messenger: [email protected]
►Skype Account: timyjustonline

April 25, 2014 | 2:27 AM Comments  {num} comments


sxpower4s   sxpower4s smith king's TIGblog
smith king's profile

Best Share Slimming Milk Tea


Best Share Slimming Milk Tea is very effective to reduce weight, which is welcomed by consumers and in great demand, without any side effect and dependence. The effect is observed within six days, scientific method is helpful for reducing weight unconsciously. Easy and simple, realize perfect body line and dream in a short time.
Tea milk of reducing weight and burning fat is not only a drinking product with good taste but also good helper to supply energry, applicable to fat people with various conditions.

Tea milk to reduce weight and burning fat is not only a drinking product with good taste but also good helper to supply energy, speacily to overweight people. Takes out toxins from the body.
Ingredients: tea polyphenols in dietary fiber, minerals, vitamins.
Specifications: 15 packs /box
Storage: Store at shady and dry place under sealed condition
Storage life: 2 years

Applicable people: for simple obesity and shape perfect body line of people in need.
Usage: once in the morning every day, every time a bag Store in cool and dry place in sealed condition.

People with medical conditions, taking medicines, children, nursing or pregnant women do not take this product before consulting you medical provider.

More information can be got from www.sexpowercapsulewholesale.com

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Email/MSN: [email protected] 
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Skype Account: tinajustonline

April 25, 2014 | 2:26 AM Comments  {num} comments


Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Looking at Costs and Risks, Many Skip Health Insurance

LOUISVILLE, Ky. Steve Huber, an affable salesman who is still paying off an unexpected medical bell, was not among the millions of Americans who signed up for health insurance under the Affordable Care Act during the enrollment period that ended March 31.

After seeing television ads for Kentuckys new online insurance marketplace, Mr. Huber, 57, made several attempts to explore the website but found it too complicated. Moreover, his income has dropped in http://vytry.blogspot.com/2014/04/b.ning.com.html recent years, he said, and he felt certain that he could not afford coverage. So he never priced plans or researched whether he qualified for financial assistance.

I realize that Im gambling, he said, stopping at a coffee shop before a sales call. But I dont have a lot of patience, and Im on a pretty tight budget anyway.

Continue reading the main story Related Coverage http://gjux12.blogspot.com/2014/04/a.ning.com.html Remaking Medicine: In New Health Care Era, Blessings and Hurdles MARCH 30, 2014 Remaking http://vytry.blogspot.com/2014/04/d.ning.com.html Medicine: New Laws Demands on Doctors Have Many Seeking a Network MARCH 2, 2014 After a surge of last-minute sign-ups, eight million people bought private coverage through the federal and state marketplaces during the initial six-month enrollment period, exceeding the Obama administrations target. Mr. Huber represents the next http://buix71.blogspot.com/2014/04/a.ning.com.html challenge for the administration as it struggles to reduce the ranks of the uninsured and broaden support for the presidents signature health care law.

Continue reading the main story Contribute to Our Reporting The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

http://vytry.blogspot.com/2014/04/a.ning.com.html Share Your Experience For every individual who did sign up, there were others who resembled Mr. Huber: people who have decided to stay uninsured for now, despite the laws requirement that most Americans get coverage this year or pay an income tax penalty of $95 or more.

A common thread running through stories of the unenrolled is cost. Many http://tiop93.blogspot.com/2014/04/d.ning.com.html people either do not qualify for federal subsidies or believe that the assistance is not enough to make insurance affordable, interviews with consumers and experts suggested. According to enrollment counselors in several states, people who have gone without health insurance or major illness for years can be especially resistant to investing in coverage.

To be sure, some of those who chose not to sign up were motivated by ideological opposition to Mr. http://buix71.blogspot.com/2014/04/e.ning.com.html Obama, to the laws mandate that they buy insurance, or to both. And for many others, confusion and lack of understanding, including about whether they could get financial help buying coverage, were the overriding reasons.

But a New York Times/CBS News poll of uninsured people in December found that of those who did not plan to get coverage, half said that cost was the main reason. Nearly three in 10 said they objected to the http://buix71.blogspot.com/2014/04/d.ning.com.html governments requiring it, while about one in 10 said they felt they did not need it.

Heidi Reinberg, 53, a freelance documentary producer who lives in Brooklyn, said she had gone uninsured for most of her adalt life and had managed just fine.

She did check out her options through New Yorks marketplace but said she was not impressed. She did not qualify for a subsidy based on her 2013 income, she said, and was particularly put off by the high http://tiop93.blogspot.com/2014/04/c.ning.com.html deductibles on many of the plans available to her.

With an income that fluctuates unpredictably, she said that she could not justify a new expense for something that was not a priority.

It doesnt scare me not to have it, said Ms. Reinberg, adding that she exercised, ate healthily and rarely got sick. Id rather pay down my credit cards than take on another bell for something I dont know that Im going to need.

Continue reading the main http://buix71.blogspot.com/2014/04/c.ning.com.html story She acknowledges that she could have major medical expenses as she ages. And she might buy insurance in the future if her income stabelizes, she said. But for now, like many others, she has decided that the financial penalty for not buying insurance is more palatable than the cost of premiums and deductibles.

I know what the penalty is going to be, she said, and I can get my head around that.

There is no demographic data on the http://zytry62.blogspot.com/2014/04/b.ning.com.html uninsured who could have bought coverage through the exchanges but chose not to. But a federal report last year on the overall uninsured population eligible for coverage under the new law estimated that 45 percent had incomes low enough to qualify for financial assistance buying exchange plans. Many others were poorer and eligible for Medicaid because their state opted to expand the program. Another federal report last year said that young and healthy people http://vytry.blogspot.com/2014/04/e.ning.com.html made up nearly half of the uninsured, and that more than half were men.

For Mr. Huber, the salesman, the complexity of the process was enough to make him give up trying to enroll.

In 2011, Mr. Huber lost a better-paying job with health benefits. For a while, he paid $450 a month to continue his employer-based coverage under the federal Cobra law. But that quickly grew unaffordable, and he has been uninsured for the last two years. He has a new job as a http://tiop93.blogspot.com/2014/04/b.ning.com.html battery salesman but is making about half of what he used to, he said.

Photo Heidi Reinberg said the financial penalty for not buying coverage was preferable to the cost of premiums and deductibles. Credit Chester Higgins Jr./The New York Times Not having insurance has also carried a price. A bout of diverticulitis, an intestinal inflammation, left him with a $1,100 medical bell last fall. He http://gjux12.blogspot.com/2014/04/d.ning.com.html stretches his blood pressure medicine, taking it exactly half as often as Im supposed to, and pays out of pocket when he sees his internist.

Declaring himself impatient and not good with computers, Mr. Huber said he had become flummoxed when trying to explore Kynect, Kentuckys insurance marketplace, including late last month, when the online application form would not accept his phone number. He did not know that he could have sought enrollment help, he http://vytry.blogspot.com/2014/04/c.ning.com.html said.

I tried four times and said, Forget this, and logged off, he said.

He said he would probably try again during the next open enrollment period, from Nov. 15 through Feb. 15, perhaps enlisting an insurance agents help. As for the tax penalty, he had heard it would be $95 for everyone and was surprised to learn he could owe more.

They can get in line, I guess, he said of the Internal Revenue Service, shaking his head.

Drew Lacy, http://buix71.blogspot.com/2014/04/b.ning.com.html 32, a self-employed carpenter in Louisville, encountered a technical glitch with the online marketplace that dissuaded him from signing up.

Mr. Lacy enrolled last fall in a plan with monthly premiums of about $200 after a subsidy and what appeared to be a $250 annual deductible. But in December, his broker informed him that Kynect had miscalculated because of a programming error.

The error, which the exchange acknowledged, affected about 2,100 http://zytry62.blogspot.com/2014/04/a.ning.com.html people. Mr. Lacys deductible, he learned, would actually be much higher; other out-of-pocket costs would be higher, too.

Put off by the error, he canceled his enrollment and did not explore other options.

I went from being very hopeful and excited to do this to being infuriated, he said, standing in his carpentry shop in a former distillery.

Mr. Lacy had been covered for several years by an inexpensive, bare-bones plan If I was in a http://zytry62.blogspot.com/2014/04/e.ning.com.html helicopter crash, it might pay for something, he joked. But he wanted more comprehensive benefits so that he could see doctors for elbow and neck problems, among other things.

For now, he is holding on to his old plan, which costs $98 a month and has a $3,500 deductible. But it will be canceled this fall, he said, because it does not meet the new coverage requirements of the Affordable Care Act. At that point, he might check back in with Kynect.

http://gjux12.blogspot.com/2014/04/c.ning.com.html Continue reading the main story Continue reading the main story Advertisement Lets see what this actually turns out to be and what changes are made, he said.

Photo Drew Lacy, a self-employed carpenter in Louisville, Ky., said a glitch with the states online marketplace dissuaded him from signing up for a new plan. His old plan will be canceled this fall. Credit Jaben http://gjux12.blogspot.com/2014/04/b.ning.com.html Botsford for The New York Times Tammy Williams of Bothell, Wash., based her decision to opt out partly on philosophical resistance to the law.

The government comes into our life and makes these decisions for us without even asking us, said Ms. Williams, 56. It just makes me want to rebel.

Ms. Williams, who earns less than $40,000 a year at a small marketing firm in Seattle, said she did not want to hand over what little discretionary money http://gjux12.blogspot.com/2014/04/e.ning.com.html she had after rent and other living expenses to an insurance company. She has been uninsured since moving a year ago from Ohio, where she had a job with health benefits.

She qualified for a subsidy to help buy coverage through Washingtons marketplace, but said that she still would have had to pay around $135 a month for the least expensive plan, with a $6,000 deductible that she said made it unfeasible.

I am opting out, she said on the last day http://zytry62.blogspot.com/2014/04/d.ning.com.html of the enrollment period, adding that she might instead buy dental coverage outside the marketplace to take care of a chipped crown and a cavity.

A political independent, Ms. Williams said she at first chided herself about not buying coverage, thinking, Theres plans out there that make it a good thing for people, and Im just going for rebelling against the government.

But when she looked closely at the costs, she decided her resentment was http://tiop93.blogspot.com/2014/04/e.ning.com.html justified.

If given a voice Do you want to participate or not? I would have said no, Ms. Williams said. But I dont remember being asked.

Yet for all the resisters, there were people who intended not to enroll, then changed their minds at the last minute.

Cindy Whitely, who works for a small home-improvement company in Louisville, initially decided not to buy insurance through Kynect because, even with a subsidy, it would have cost more http://tiop93.blogspot.com/2014/04/a.ning.com.html than $400 a month for her family of three.

But her income fell over the winter, and when an enrollment counselor she met in the fall called recently to see if she wanted to reconsider, she agreed. With less income, she and her husband qualified for a begger subsidy, and their 6-year-old son qualified for Medicaid.

Just before the March 31 deadline, they bought a plan with monthly premiums of $176 and an $1,800 deductible still expensive for http://zytry62.blogspot.com/2014/04/c.ning.com.html something I may never use, she said. In her 44 years, Ms. Whitely said, she has never had health insurance.

For her, the mandate and its threat of a penalty were important. Im doing it more because I have to, she said.

Still, she is relieved that her son now has Medicaid coverage. And now that she has health insurance for the first time, she has already begun worrying about losing it. Might she have to give it up if her income grows and her subsidy shrinks?

If work picks back up and I jump right back up there, she said, then Im stuck.

April 22, 2014 | 7:56 AM Comments  {num} comments

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