TBT to an actual American epidemic

For the time being the news cycle won’t let go of Ebola in the US. I’m not interested in that, but thanks to Ebola you no doubt have heard of Dr. Anthony Fauci, the director of the NIAID (National Institute of Allergy and Infectious Disease) at NIH. Dr. Fauci took that post in 1984 and the man has a special place in my heart because of the progress the institute made on his watch thanks to the venerable AIDS activist group, ACT UP.

Really this is just a plug for the best documentary in years and best health-related documentary probably ever, How to Survive a Plague. Watch it and weep. These activists are responsible for the restructuring of the FDA drug approval process to allow fast tracking for AIDS and cancer drugs. They forced their way onto previously closed committees at NIH, creating transparency in the clinical trial process and giving a voice to patients affected by whatever the disease in question. I get teary at the protest scenes outside of the NIH and the FDA and the march at the first AIDS quilt (which I will be forever thankful to my mother for dragging me to though I had no idea what it meant at the time). This documentary stokes the dying embers of my heart. Truth to power. Policies can be changed. Advocacy makes a difference.

Sorry for the preaching but you have to love 80s Dr. Fauci.

Falling into the gap.

Midsummer 2012 the supreme court upheld the majority of the provisions of the ACA, and people like me who had made every major life decision since turning 22 based on where I could get health insurance (hello preexisting conditions) breathed a deep sigh of relief, wept one tear, and took a long nap.

Fast-forward to now and the part of the decision that made it optional for states to decline to expand their Medicaid programs is taking it’s toll. In states where Medicaid was not expanded, the majority of adults making under 100% of the federal poverty level have no options for health insurance. They do not qualify for the incentives available through health insurance exchanges. They cannot afford private coverage. Unethical.

Just for fun, here’s the states by political party in 2013 (source):

governors 2012

Uninsured people will still use emergency departments and be inpatients, putting hospitals in a tough position as part of the ACA takes away the pre-ACA measure of DSH (disproportionate share hospital) funding (federal dollars) that hospitals needed to account for the absence of reimbursement from these uninsured folks. DSH dollars were supposed to be replaced by payments from Medicaid insurance dollars. In states that did not expand Medicaid, DSH dollars are being replaced by zero dollars. IMHO this is on the state–but Obamacare takes the knock. From the patients denied access to affordable care, the hospitals that are in dire straights financially, and the communities that are losing their hospitals (and often largest employers) as they just can’t stay afloat.

I’m working up posts describing how one qualifies for Medicaid in non-expanded states, the state incentives offered by Medicaid expansion, and the burden on local communities with large numbers of uninsured people in poverty. This is a mire, but I can’t think of one more worthwhile to wade through. PARTY TIME!

Women in medicine

Consider this post one of innumerable on women in the medical field.

via www.envisioningtheamericandream.com

The MD-RN dynamic is old saw (sidebar–the no. 1 problem with RN retention at my health system is “I need to move to find a man.” Take heed undergrads, the be-a-nurse-marry-a-doctor plan is not working out). As health systems move toward the team model of care we nursing pups are told that the doc is not your boss. Administratively speaking this is true. In practice getting chewed out by a doc is one of a new grad’s greatest fears. The power differential is entrenched.

One of my classmates brought up a super prescient question this past semester while we had the ear of an old school doc who battled it out in the 1960s as the only female member of her med school class. What is going to happen to MD-RN relationships now that near 50% of med school grads are women? The doc sidestepped the question (which was, of course, a landmine), but did share a thought worth repeating: in the US, as the prestige of being a doctor declines the number of women entering the profession increases. This isn’t coincidence. Either as prestige drops more women are viewing medicine as something that they are capable of OR as more women become doctors the stock price on an MD drops (see teachers, secretaries). To both of those possibilities I give a big eye roll-y OH BROTHER.

Breaking ACA data!!

First let’s be clear: this data describes state-run health insurance marketplaces. It describes plans available through those marketplaces. It does not describe group or employer health insurance plans. But, we (or at least I) can assume that there might be a trend worth following. This is the first year where we get a preliminary look at whether the ACA might push premiums down (and I mean relatively–remember most if not all plans were going up by many percentage points year over year before the marketplace).

Modest Premium Changes Ahead in Health Insurance Marketplaces in Washington State and Maryland – The Commonwealth Fund.

Maryland and Washington (state) are two early reporters, and for the benchmark “middle of the road” silver plan premiums for singles, couples, or families are up by less than 1% in MD or 3% in WA. Singles silver plans are down by 1-2% in both states.

Now it is a little apples-to-oranges to make this comparison, and obvi I am using the same foundation to grab it, but I have to stress that pre-ACA premiums were rising at a crazy rate year over year. This report  (Interactive wow I’d insert it but I don’t want any confusion since it is pre-marketplace) maps hows the increase in employer-sponsored premiums related to percentage of household income 2003-2011. In my home state of VA premiums increased 62% (family) and 49% (individual). Ouchie. Overlay a chart of my increasing depression and you’ve got near identical data.

LAST POINT: for everyone who banking on capitalism to bring prices down (god forbid you bring this up on a long car trip with me), per this report here’s a tasty lick:

One factor behind these modest premium increases may be that new carriers entered the marketplaces in both states, fueling competition among plans. In Washington, one carrier, Moda Health, entered the market, and two, BridgeSpan and  Coordinated Care, increased their plan offerings more than threefold. On the whole, the number of silver and gold plans offered nearly doubled from 2014 to 2015. In Maryland, three carriers—Cigna, United Healthcare, and Carefirst (GMSHI)—entered the marketplace.

Ebola, Epidemiology

So far this semester of nursing school we’ve spent less than an hour talking about Ebola in America. There is legitimate concern for good guidance on PPE. CDC guidelines have been in evolution, which makes health care workers nervous.

PPE(NY Times)

BUT, epidemiology views the population as the patient. And right here right now we are looking pretty healthy. Ebola is an epidemiologist’s dream since you are not contagious until you are showing symptoms (no latency), and the course is long (outbreaks spread from patient to patient relatively slowly). It is fairly easy to find people who may have been exposed and quarantine them before they have a chance to pass along the virus. Contrast these characteristics with those of the flu, and you can see why the CDC isn’t sweating too much.

Also, what does this even mean? No.
cnn ebola

Everything is about the menstrual cycle.


Week 44: Reproductive System: Puberty « A Primer for Women’s Health.

The National Institute for Women’s Health topic of the week is puberty. On a similar note, informal interviews of my peers indicate that women in their 30s also go through hormonal changes, often experiencing breast discomfort, acne, and a dysphoria that makes them wonder what the hell happened in their 20s.