MEDICARE: A Quickie Tutorial

On Monday, I wrote about Steven Brill's Time cover story, in which he described Medicare as a potential salvation for our healthcare crisis (http://bit.ly/13eZMIN).

Today, I thought it'd help to provide a brief review of Medicare's basic features. There was a good "primer" in the January issue of the Washington Beacon, a local free monthly newspaper designed for people over 50. The following summaries came from that source:

Tips from TIME on "Lowering Your Medical Bills"

Time Magazine, in publishing Steven Brill's expose "Bitter Pill: Why Medical Bills Are Killing Us," added a piece titled "Tips for Lowering Your Medical Bills."

Those tips come from medical billing advocates, healthcare's equivalent of tax-refund specialists. As many as eight out of ten medical bills contain errors, they say.

When you're in the hospital, you should concentrate on getting better and worry about the finances later. But there are cost-saving strategies you can pursue before you're seen by a doctor and after you get the bill.

Medicare: the Hero in TIME's Healthcare Exposé

The heated debate over healthcare reform has focused on who pays the bills. That's like rearranging the deck chairs on the Titanic, says Steven Brill, author of Time magazine's cover story "Bitter Pill: Why Medical Bills Are Killing Us."

This 36-page article, Time's longest ever, asks the question largely ignored in the debate and unaddressed by the Affordable Health Care Act ("Obamacare"): Why are our medical costs higher than those of the next 10 biggest spenders combined?

The article is chock full of facts. I'll focus on just one theme in Brill's report: when it comes to healthcare delivery and cost control, Medicare beats private coverage every time.

The villain in Brill's article is something I hadn't even heard of before. "Chargemaster" is the price list every hospital uses for its charges. Brill says it doesn't make sense, and can't find anyone willing or able to explain it.

But the hero in Brill's report is Medicare.

"Why Does Health Care Cost So Much?" -- Time Magazine's Must-Read Cover Story

The current Time magazine article by Steve Brill is summed up in about three minutes in the video above. Not bad for a story that spans over 30 pages -- the longest article Time has ever run. Here's a link to the text -- http://ti.me/XyMKP4.

It was scheduled to run initially in The New Republic as the cover story in its relaunch, but it got bounced by an interview with President Obama. In a huff, Brill took it to Time.

I can't see how anyone, even a Tea Partier, could watch the video -- or better yet, read the article -- and then argue that health care should be in the free market place, with little or no regulation.

The article should be read in full, but here's a three-part video from the Jon Stewart's interview with Brill where he decribes his investigation and report.

Jon Stewart Interview with Brill

Part 1

The Daily Show with Jon Stewart

Part 2

The Daily Show with Jon Stewart

Part 3

The Daily Show with Jon Stewart

My Bad Back Battle: Progress at Last!

Although I'm dealing with Parkinson's disease and prostate cancer and aging, my primary health concern for the past 18 months has been my lower back pain.

Giving up my beloved biking riding due to my Parkinson's balance problems was bad enough. But then cutting way back on my walks due to the back pain was a real bummer. 

The back pain started with the cracked vertebra I had as a result of my totaling my car in a crash in August, 2011. It's continued with only limited and intermittent relief since then. 

I plan a series of posts next week on the lessons I've learned from my unsuccessful efforts to deal with this. But today I want to focus on the good news.

The Ambiguity of Medical Science: Screening Tests

You know the general axiom: “The more I know, the more I realize I don’t know.”

Where the science of medicine – a focus of this blog – is concerned, I’d reword the adage: “The more I learn, the more ambiguity I find.”

I’ve asked these questions repeatedly: Should we take this supplement? Should we have this procedure? Should we see this specialist? Should we undergo this operation? Should we follow this diet?

Typically, I’ll find as many “yes” as “no” answers. The haze that follows reminds me that – like the rest of life – the science of medicine remains a sea of gray, and not the crisp black-and-white world we find in, say, mathematics.

In the February 19, 2013 edition of the Wall Street Journal, I found another stark example of the conflicting advice we’re likely to find. The headline: “Should All Women Over 40 Get Annual Mammograms?” One expert answers “yes” with clarity and certainty; another expert answers “no” with equal resolve.

Kindness Boomerang Hits Me at Stanley's in New Orleans

On Lundi (Monday) Gras, after checking into the Bourbon Orleans hotel the night before, I set out to explore New Orleans' French Quarter. I ended up at Jackson Square in front of the Cathedral. When I asked someone to recommend a good, casual place for lunch, the immediate response was "Stanley's, on the corner just past the Cathedral."

The wait for a table was 20 minutes, but I could get seated immediately at the counter.

The two women sitting next to me (unfortunately not clearly shown in this photo) were local young professionals. I didn't really talk with them, but we all chatted with our waiter.

They paid their checks and left. When I asked for my bill minutes later, the waiter told me my two neighbors at the counter had already picked up my tab.

Maybe I looked older and more decrepit than usual that day. But I like to think what happened at Stanley's was an example of how "Big Easy" residents practice the "Kindness Boomerang."

Two Ways of Proselytizing the Christian faith at Mardi Gras

I spent Mardi Gras ricocheting between the crowds on Bourbon Street and those in front of the Cathedral. On Bourbon Street, which is like the Castro in San Francisco (Gay Central), the fun was interrupted by:

The Jesus Freaks

By welcome contrast, the crowd in front of the Cathedral joined the fun provided by the group of purple-shirted young Christians who call themselves:

The Bible Stompers 

Here are two much happier examples of Christian youth spreading their message:

Any doubt as to which group is most likely to win converts?

Why Are You, an Introvert, Going to New Orleans for Mardi Gras?

Several friends asked that question last week. I was in New Orleans for Mardi Gras -- that perfect occasion for extroverts -- while posting a series about introverts like me on this blog.

Why? Two reasons:

I Love a Parade . . .

I love participating -- or at least people-watching -- when large groups gather for fun, celebration, or protest. Here are a few memorable occasions I recall:

• Participating in the Martin Luther King March on Washington in August, 1963.
• Joining in many of the marches on Washington: civil rights, anti-Vietnam War, gay rights, women's rights, Million Man March, anti-Iraq War.
• Attending the JFK inaugural concert in January, 1961 at Constitution Hall during a blizzard . . . then being in the stands for his inaugural parade.
• Standing with thousands of others in Lafayette Square -- across from the White House -- the evening of JFK's assassination . . .   later that incredibly sad weekend using my press pass to attend the lying-in-state ceremony in the Capitol rotunda.
• Joining the rallies at Wisconsin & M after crucial Redskin victories in the Joe Gibbs Superbowl years. 
• Twice attending the Last Night of the Proms in London: once at the actual event in Royal Albert Hall, once watching in the rain on the giant screens in Hyde Park.

I'm Intrigued by New Orleans

I've only been to New Orleans a few times and only for a few days each time. It's unlike any other city in America or Europe. The only place I've visited that seems comparable is Cienfuegos, Cuba. 

A Quick Look at Mardi Gras in New Orleans

Introduction to the "Big Easy"

Like so many others, after checking into my hotel -- the Bourbon Orleans -- I headed for the Cafe du Monde 

for, what else? Coffee and beignets:

And the rest of the French Market -- where the Cafe du Monde is located -- offers a good introduction to New Orleans:

GUEST POST: A Cancer Survival Story by Cameron Von St. James

I recently got an email from Cameron Von St. James, who publishes the Mesothelioma Cancer Alliance Blog. His wife Heather is a survivor, after being diagnosed with mesothelioma seven years ago. Cameron wrote: "We struggled through so many hardships during this tough time, but found a way to make it through. I'd love to share our story of hope with your readers who might take something away from it."

Happy to oblige, Cameron. And all the best wishes to you, Heather, and daughter Lily.

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I still remember the day, almost eight years ago now, when my wife Heather was diagnosed with cancer, malignant pleural mesothelioma. It was a surreal moment and a feeling that terrified me to the center of my being. I realized I didn't know much about cancer or what it meant to be someone's caregiver. All I knew was that the road ahead was going to be difficult, and it seemed like we had just been in the midst of bliss, celebrating the birth of our first child, Lily. While we had been making arrangements for her first holidays, we learned that a life might be taken away from our family. 

Being a caregiver for someone with cancer is unlike anything I have had to do before. It started as we were still in the doctor's office. I remember listening to the doctor and thinking what are we going to do, but when I looked at my wife, I had to be strong because she was terrified that this was happening to her. The doctor gave us three options, but he made a point that we needed to see a specialist. There were local hospitals, but neither of them had a special program for this type of cancer. He suggested a specialist in Boston, and that was all I needed to hear. We were going to Boston no matter what it took.

Everything was in disarray for a while after that. I was still working all the time, but I was also taking care of my wife and a newborn. It was difficult and sometimes, barely manageable. I couldn't help but let the fears creep in. I had visions of myself as a widowed single father, broke and raising a daughter who would never know her own mother. I didn't know what we were going to do, and I spent nights awake just dreading the morning and trying to figure out a solution to all of the mounting bills and praying that it wouldn’t all be for nothing, that Heather would pull through and live to see her daughter grow up.

Heather's family came to visit during the holidays, and they helped us with anything that they could. At first, it was childcare, but seeing the toll of treatment upon our finances, they also helped us take care of some of our bills and make it less of a burden. Friends came through for us as well. I'll never forget the way it felt to have so many people support you and desire to help you see a brighter day. For that, I will always be thankful.

After months of intense and grueling treatment, including surgery, chemotherapy and radiation, Heather defied the odds and beat mesothelioma, a rare feat accomplished by far too few people. My prayers were answered and she has been able to see our baby girl grow up into a beautiful young woman. It's been over seven years since we received the terrible diagnosis, and Heather is healthy and cancer free to this day. We now hope that by sharing our story, we can help inspire others in their own battles with cancer today.

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Introverts: Part 4) "Hell Is Other People at Breakfast"

I identify with this quote from Sartre. I could handle business lunches. I even looked forward to them in the days of the two-martini lunch. But I was appalled when people suggested a breakfast meeting.

My No. 1 resolution when I retired was "Never get involved in anything that requires attending meetings." I've never made a resolution that proved easier to keep.

Extroverts Dominate Public Life
Thank God for Obama. Before him, introverts like me were poorly represented in politics. When we look at past presidents, a few introverts come to mind: Calvin Coolidge, Richard Nixon, Jimmy Carter... not our most inspiring leaders.

Introverts: Part 3) Old Age Need Not Be Lonely

Here's a stereotype: College years are happy times. Even introverts make friends there. But old age is a lonely, unhappy time, with few friends.

For THIS introvert, the story is reversed.

My Lonely College Years
My years as a Cornell undergraduate were the loneliest of my life. I was an introvert, and I was shy. Compounding those realities, I lived at home with my family -- not in a dorm with classmates -- and I also had a part-time job... not circumstances that encouraged me to make new friends.

I'd lost touch with local high school chums after graduation. I started at Cornell in the liberal arts college, with thousands of others. I felt "lost in the crowd." The loneliness eased when I ran out of money and transferred to the state-funded School of Industrial and Labor Relations, where the student body was only about 300. After college, I went to Cornell Law School. These smaller schools made it easier for me to make some friends. And it became even easier in law school when I started spending bar-time with my pals.

Introverts: Part 2) My Name Is John and I'm an Introvert

The next few posts will explore how my introversion has played out in my life.

You can blame my pal Donna Ives. I asked her to do a Myers-Briggs analysis for my housemates Bhawana and Nimesh, two young people raised in Nepal and now launching careers in the U.S. When I was human resources VP at BNA eons ago, we hired an executive development consultant to perform assessments on our top executives. The Myers-Briggs personality test was one of the standard tools. Donna, a recent BNA retiree, is trained and certified as a Myers-Briggs analyst.

Most people are familiar with Myers-Briggs. If you're not, you can check the Wikipedia description or The Washington Post's recent 50 years of Myers-Briggs article.

The questions in the M-B tests are designed to show where you score in four categories:

1. Introvert-Extrovert
2. Sensor-Intuitive
3. Thinker-Feeler
4. Judger-Perceiver

In combination, the groupings define 16 personality types.

Introverts: Part 1) Why We Need Them

I stumbled upon a wonderful video about introverts: why we need them, the important contributions they make, the bad rap they've gotten, and why it's so important that we treasure the power of quiet time, alone.

The video below was shot during a TED (Technology, Entertainment, and Design) talk by Susan Cain, author of the best-seller Quiet, The Power of Introverts in a World that Can't Stop Talking. I love that subtitle.

After I watched it, I understood more clearly how my own introversion has shaped my life, and why it has made me more "useful" to family, friends, and work colleagues. I want to talk more about introverts -- and the power of quiet -- in a series of posts I'll publish this week.

A Wikipedia entry explains how Cain's previous work as a corporate attorney led her to write the book:

While still an attorney, Cain noticed that others at her firm were putting personality traits like hers to good use in the profession, and that gender per se did not explain those traits. She eventually realized that the concepts of introversion and extroversion provided the "language for talking about questions of identity" that had been lacking. 

Cain explained that in writing Quiet, she was fueled by the passion and indignation that she imagined fueled the 1963 feminist book, The Feminine Mystique. Cain likened introverts today to women at that time—second-class citizens with gigantic amounts of untapped talent. Saying that most introverts aren’t aware of how they are constantly spending their time in ways that they would prefer not to be and have been doing so all their lives, Cain explained that she was trying to give people entitlement in their own minds to be who they are.

It was her book and video that prompted me to look at the role introversion has played -- and continues to play -- in my life.

I hope you enjoy the video as much as I did.

SAGE Pen and Paper Test for Alzheimer's

This two-minute video describes a simple 15-minute test that could speed diagnosis and treatment of memory disorders like Alzheimer's. It could give healthcare providers and caregivers an earlier indication of what lies ahead... and a key opportunity to begin useful therapies sooner. 

Douglas Scharre, neurologist at the Ohio State University Medical Center, developed the test. In a study involving 254 participants, he compared the reliability of his SAGE (Self-Administered Gerocognitive Examination) test with other techniques -- like evaluation by a neuropsychologist -- to detect cognitive problems. Scharre found that his test identifies 80% of people with mild cognitive issues. His results also showed that 95% of people with normal cognitive function will score normally on his test.

Results of a quick Google search suggest that Scharre's SAGE test is considered top-of-the-line among simple dementia screening tests. Still, no test approaches 100% accuracy. 

Go here for a copy of the test and instructions. Self-administering such tests isn't kosher; we should be guided by professional testers.

(In my initial post of this, I forgot to include this essential: the scoring instructions.)

But of course, I printed it out. It's already 11 pm, so I'll wait and take it in the morning when I'm at my "best."

If you don't hear anything more about this test, I probably flunked. Or maybe I forgot to take it. Or maybe I took it and forgot.

Medical Marijuana: Promising Results

Increasing evidence supports the use of marijuana – medical cannabis – as a therapy for people with cancer, PTSD (post-traumatic stress disorder), ALS (Lou Gehrig’s disease), insomnia, dysphagia (problems with swallowing), pain, tremors, and lack of appetite. 

Zack Klein, a graduate student at Tel Aviv University’s Porter School of Economics, recently conducted experiments with 19 patients between ages 69 and 101 at the Hadarim nursing home in Isreal. For about a year, those patients – a small sample, to be sure – received marijuana therapy (via powder, oil, vapor, or smoke) three times a day.

Seventeen of the 19 elderly participants achieved a more “healthy” weight, perhaps related to the drug’s apparent easing of problems associated with swallowing food and liquids. Many found relief from muscle spasms, stiffness, tremors, and pain. Nearly all slept better and experienced fewer nightmares or PTSD-related flashbacks.

According to an article that appeared in the January 24, 2013 edition of e-journal Science Daily, "Hadarim staff saw an immediate improvement in the participants' moods and communication skills." That particular conclusion will hardly come as a surprise to anyone who remembers the 60s.

Want Medical Advice? Beware of Oprah, Celebrity Docs, and Evangelists

I don't watch much TV. I'd heard of Drs. Oz and Mercola, but didn't realize millions of people get their medical advice from TV celebrities, not from their doctors or other healthcare professionals.

Then, in my online research for this blog, I stumbled upon a surprising video showing how Dr. Mary Newport had begun giving coconut oil to her Alzheimer's-afflicted husband with seemingly miraculous results.

Dubious, I looked for the source for the video and saw -- or so I thought -- that it came from "CBS." I posted the video and a write-up on my blog (http://bit.ly/wX1hsQ).

I was embarrassed and angered to later discover the video aired not on CBS, but rather CBN, the Christian Broadcasting Network, home of Pat Robertson's "700 Club" TV show. (I suspect it's not just coincidence that "CBN" is featured prominently without spelling out what it stands for. I can't be the only one to mistake it for CBS, or for CNN.)

The embarrassment and anger I felt about my goof may explain why I've featured several posts debunking the coconut oil claims. But the more I've researched this topic, the angrier I feel that this unsubstantiated hype has generated a coconut oil craze and raised false hopes for millions of people with Alzheimer's and their caregivers. It's also made big bucks for CBN, Robertson, and Newport (http://bit.ly/UKKbsa).

That story made me take a closer look at other healthcare hucksters on TV.

Oprah, M.D.?
Until Oprah retired from her popular TV show in 2009, her seven million viewers got a steady diet of health tips. She offered some sound advice on diet and fitness, but the program also became a forum for some questionable medical claims.

Jeckyll and Hyde: the Two Faces of Dr. Oz

Yesterday, I talked about Dr. Oz and his huckstering green coffee bean extract as a miracle weight loss pill that works even without making changes in diet or exercise.

It's easy to dismiss Pat Robertson, another television promoter of unproven medical cures. He's just one more in our long line of evangelical charlatans.

But Dr. Oz is not so easily dismissed. A profile on him in last week's New Yorker portrays a man who hosts a popular TV program... and is also a top heart surgeon, specializing in heart transplants.

Background
Oz's parent immigrated to the U.S. in the 1950s after his father, a thoracic surgeon, won a scholarship to study here. He practiced medicine in the U.S. until he retired a few years ago. Then he and his wife returned to Istanbul.

The younger Oz earned his undergraduate degree from Harvard in 1982, where he won an athletic award for leadership. At the University of Pennsylvania, he was president of his medical school class.

After graduating with medical and MBA degrees, Oz moved to the  New York-Presbyterian Hospital at Columbia University.

Another Candidate for Supplement Huckster of 2012 Award: Dr. Oz and His Green Coffee Beans

Last year, I wrote several posts about the unsubstantiated claims for coconut oil as a miracle treatment for Alzheimer's which Pat Robertson aired on his Christian Broadcast Network. (For the most recent post, see http://bit.ly/UKKbsa.) The hype created a coconut oil craze, and sales of the product skyrocketed.

Another super-hyped product in 2012 was green coffee bean extract for weight loss. As you can see from the video clip above, this hype originated with another popular TV huckster, Dr. Oz.

The Study that Dr. Oz Touts
As Oz says in this clip, the claims for green coffee bean extract are based on a study published in the Diabetes, Metabolic Syndrome and Obesity journal. One problem with the study: it involved only eight men and eight women.

Each participant received a high dose and a low dose of green coffee bean extract, as well as a placebo, in three separate six-week experiments.

According to Dr. Oz, participants lost an average of 17 pounds after five months. They were directed not to change their eating or exercise habits.

New Studies Help Explain Why I Am Happier Today Than Ever Before

Earlier this week I was checking Science Daily, which arrives in my inbox every day with reports of the latest scientific studies. I came across this link: Surprising Connections Between Our Well-Being and Giving, Getting, and Gratitude.

I opened the link. As I read the report, a light bulb clicked on. For the first time, I realized:

I am happier now than ever before!

The Scientific Studies
The article pulled together several recent studies on factors that enhance our well-being. Here's a rundown: