Your Weight: When Less is More

Here are some things YOU can do to lose weight and keep it off sensibly:

• Make good eating habits part of your life long health maintenance plan.  Avoid yo-yo dieting.  This often results in recurrent weight gain - each time!
• Learn good eating habits.
• Eat small portions.  Five small meals a day will be less caloric and give you more energy with less hunger.
• Enjoy foods you like that may more unhealthy less frequently. 
• Exexrcise routinely.  Frequent intervals of 10 minutes 2 to 3 times a day a few times a week is adequate.  Start slow like with five minutes for first week.  This will help encourage a positive attitude and more activity.

Ask your primary care health provider to refer you to dieticians and nutrition specialists for more details.  Weight loss surgery is an option that can be considered if obesity is causing and making other health problems more serious; however, serious side effects can occur and you can gain the weight back.  Talk to a doctor that specializes in bariatric surgery for details.

Healthy weight is always great. It is one time when less is more.

Best health!

Healthcare Deja Vu Come True?

As health care access decreases and costs increase, we must look ahead to improving it for everyone.  In 2011 employers paid an average of $11,000 for employees and their families, while yearly insurance premiums rose from $13,000 to $15,000.  The following is an excerpt from "Building an American Healthcare System" released in 2002 when the average premium paid by employers was $6500. While proposing ways to decrease cost and access, one is able to see that good healthcare can be deja vu come true.

One stop shopping for medical care is in order. By having more clinics, easy access to care will help people to get what they need in a timely manner. Waiting to see the doctor is one of the reasons our health care is out of control. The Public Health facilities will be a setting in which health care providers will employed and compensated as in the private sector. It will be just as prestigious to work for the Public Health as the private sector. In addition, permanent protection of physician incomes can be guaranteed by the government much like the recent ruling in Britain (British Medical Journal, April 5, 2003). The concept of second rate, low paying health care for the low income associated with Public Health Service must be changed and amplified. We must be proud to work for our country’s health system, and to obtain top notch health services! In this set up, the uninsured are insured and objectives of the Fair Care to the Uninsured Act of 2003 will be met. This is very important. Those without insurance are sicker, die younger and receive less care for many conditions. The risk of illness increases the longer one is without insurance.


More emphasis from the USPHS for education, prevention and screening, eldercare, disabled care, chronic condition care/ chronic multisystem illness (CMI), health awareness, and education is needed. The Public Health clinic will evolve from the barely visible building or little trailer in the field to highly visible, easily accessible structures. Vacant malls and warehouse buildings can be bought and transformed to mini-medical facilities that provide it all. Pre-existing clinics in the area can be merged, or remain as satellite facilities. The goal is to have health care at every corner much like the neighborhood convenience store. The era for traveling 100 miles to your doctor, waiting half a day or more only to spend the average 5 minutes with your health care provider must cease.

Minnesota has set up a system that covered about 95% of its residents under 65 in 2001 (86% in 2000). It uses government and private insurance together to achieve insurability.  "Approaching Universal Coverage: Minnesota’s Health Insurance Plans" by Debra Chollet & Lori Achman of Mathematica Research Policy, Inc.states that it has been successful at serving "all populations in need at all levels of income". Coverage is included for the "medically uninsurable" like the person with chronic multisytem disease, or pre-existing conditions. Its GAMC and MA plans includes coverage for expenses that occurred in the 3 months prior to application, and do not have premiums or co-pays. Minnesota's programs have been, or are currently used in other states, and can be used to help lay the foundation for health care uniformity. The Commonwealth Fund has several publications that look at other states' health systems, and universal health coverage.

The effort to consolidate the American health system is a priority. Karen Davis' summary, "Time to Change: The Hidden Cost of a Fragmented Health Insurance System", states that the present system "is not up to the challenge of ensuring a healthy and productive nation because it is 'fragmented' ". The focus of her summary exemplifies how lack of uniform health services costs more with less results.


Attention must also be placed on employer health provisions.  In 2002 companies spent an average of $6500 per person for health care. This does not include the patients' out of pocket payment for services. The pages of uncovered services listed in many insurance handbooks grows longer. About 41 million employed by small business pay directly for services at prices compatible with the Medicare and Medicaid models. Through the leadership of the Public Health Service all businesses are uninsured primarily because it is unaffordable. Congress is presently looking at a concept called an Association Health Plan (AHP) as part of the Small Business Health Fairness Act. This would allow small business owners to offer large corporation health discounts. It would also be uniform nationwide. The AHP is in use in some states, and has come and gone in some. Last year 16 states closed down 48 AHP plans. This would be a great opportunity to "phase in" national coverage. As employer health programs are phased out, patients should be offered the option to obtain national insurance. Each person preventive and screening will be done without charge. Eventually this will lead to a healthier people, and health system at a much lower cost.

  

Health Education Affects Your Health & Care

Care systems can be set up based on the prevalence of disease and proven preventive measures. For instance, heart disease kills about 1 million/ year, and about 1.5 million hospitalizations occur as a result. We can build on existing programs that focus on guidelines and evidence-based data for the most prevalent conditions, and implement them in our clinics. The USPSTF is dedicated to this type of service. The USPSTF recently found evidence that early detection (with bone density tests), and treatment of osteoporosis in women without symptoms reduced the risk of fractures. Globally speaking, the recent World Cancer Report by WHO has found that cancer may rise by 50% by 2020. One third of these can be prevented. That is very significant! The following table lists (British Medical Journal, March 29, 2003) the costliest conditions to treat.

The 15 costliest treatments (and number of people with diagnosis) in 1997 Heart disease $58bn (17 million) Cancer $46bn (9 million) Trauma $44bn (37 million) Mental disorders $30bn (20 million) Diabetes $20bn (10 million) Hypertension $18bn (27 million) Cerebrovascular disease $16bn (2 million) Osteoarthritis $16bn, (16 million) Pneumonia $16bn (4 million) Back problems $13bn (13 million) Kidney disease $10bn (2 million) Endocrine disorders $10bn (18 million) Skin disorders $9bn (20 million) Infectious diseases $6bn (16 million)

Alongside the USPHS is the HHS which has in place the ACHI, Association for Community Health Improvement. This group focuses on communities
networking together for better health. It is in 42 states (D.C. and Canada), and is composed of people from different areas of medicine. This is a valuable resource to use in developing health system uniformity because it is almost nationwide, at the local community level, and very diversified. HHS has 300 programs that help in "protecting the health of all Americans and providing essential human services". The Medicare program is the largest health insurer in the nation. In April 2003 HHS had a national
summit, "Steps to a Healthier USA: Putting Prevention First" that addressed prevention and promotion of healthy lifestyles. Funds ($15 million) for “Healthy
Communities” will help communities do their part. The ODPHP works to promote disease prevention and healthy living. Their program, Healthy People 2010* is "the prevention agenda for the Nation". It outlines health objectives for the Nation.

Providing more health information is vital. TV is the most powerful, and most accessed way to get information. Almost everybody watches TV, has a TV, and talks about what is on TV (even if they say they don't watch TV you can be sure you will be asked, "Did you see on TV..."). In addition to public service announcements, more television programming on health issues can be added to the daily schedule on existing channels. Eventually Public Health TV will be available with daily medical news, and basic health information. After all, we have 24-7 dedicated channels for theology, sports, news, finance, cartoons, and music, to name a few, yet basic health programming is still in its infancy.

More basic health information should be available. Health TV channels now tend to focus on lifestyle changes (cooking, exercise, etc.), and reality shows focusing on emergencies, patient procedures, etc.. In the news media there is an occasional mention of the latest outbreak of the disease of the month, and maybe a mention of a profound medical study. This is good, but there is a need for more basic information programming that lets me know about this hypertension that I have, or the headache that won’t go away, or what doctor should I see for what I have. We need to know all the risks and complications as well as the different treatments for what we have so a more informed decision can be made. Like going on the Internet, or to a textbook, there will be a program that addresses a particular health concern. A daily health news show highlighting the latest medical developments is greatly needed. The Internet provides such information.
There are webcasts on the Internet that are becoming more accessible for professionals and the public. Some managed care providers have treatment guidelines for enrollees and doctors to view on their websites. The mantra for the 21rst century will be, "If
doctors don't educate themselves, patients will educate them".  Most people have a TV so what better place to start. In the future, computers will be in almost every home, too. With the Internet patients are able to access the same information as their doctor.

Providing educational materials that are easy to read and understand, i.e. at the lowest grade level possible, are essential, and key. This includes audio and visual learning - books, television, tapes, CDs, computer - as well as direct teaching. This is available
on the Internet with health sites just for kids like www.kidshealth.org and www.bam.gov . Health literacy systems can be of more use for distance learning technology via webcast teleconferences, and television programming. Learning in the home is effective and convenient.

Let your health home schooling begin!

*now Healthy People 2020

How Health Education Affects Your Health

Over the long term prevention saves lives and money. Preventive care should have a primary focus from cradle to grave. Studies to prove its efficacy in combination with evidence-based guidelines deserve attention. A study to determine if the history and physical exam, lab tests, body scan, and other diagnostic tests helps in the prevention, diagnosis, and treatment of disease would probably show us better overall outcomes as well as less cost than if the conditions were not detected early.

EDUCATION BEGINS AT HOME. Public education begins at home, in schools, and in the community (e.g. medical facilities, church, stores). Education focused on self management of asthma has been shown to improve clinical outcomes (British Medical Journal, June 2003). Basic medicine should start formally at the preschool level. Thereafter, basic classes in medicine and interactive education such as a student presenting a medical project, or volunteering in a medical capacity, should also be available. This can be used as education credits in high school and college. Our children are our future and our inspiration. Let's see their medical visions for America’s health system today!

EDUCATION SHOULD BE FREE. In Qatar this is the case.  Incidentally, health care is free there, too. They have developed a relationship with several of our medical schools, and have actual campuses. Let’s build on this, and in turn study with them to see how we can make our system better...and free. We live in a nation where many choose military service to get a free education. This is an enormous commitment to make for something everyone is entitled to.

Modifying the education process hopefully will provide more doctors, and make more want to be doctors. Funding a study on the correlation of the length of medical training with quality of job performance after training would tell if three years of medical
school be as good as four. If so, this will lead to earlier entry into the actual job as doctor with less cost for university and student = more appealing for people to seek this as their occupation = more doctors, and other health care workers. It should be easier for a health care worker to "upgrade" to a doctor. For example, a physician assistant that wants to be a doctor should not be expected to study another four years. The high cost for education becomes a large debt to be paid back on a lower salary while training. The cost for medical school is approaching $100,000*. An option is to expand the scope of practice for health providers that are experienced with clinical skills near the physician level to provide the same services. These will be the "diagnosticians".

The IOM report "Health Professions Education: A Bridge to Quality" (April 2003), has found that health care professionals "are not being adequately prepared to provide the best and safest medical care possible, and there is insufficient assessment of their ongoing proficiency". They propose that the education process will be focused on five areas: delivery of patient-centered care, working as a team member that is interdisciplinary, use of evidence- based protocols, the application of quality measures, and the use of IT. Oversight by groups that license, accredit, and certify will be used to improve education for health providers. New standards that accurately assess proficiency of skills are being developed and used. As this is developed, the licensing system should be addressed to ensure uniformity. It would make sense for health care professionals to have one license for practice in all states. Standards for licensing should be the same in all states. This allows for a seamless integration of health provider service and care, as well as a more effective use of these services. Like providers, patients should be able to obtain medical care in any state. That way a patient has the choice of going anywhere in the USA if they are unable to get the care they need in a timely manner in their state of primary residence. The European Union will allow patients to seek free medical care in any of the countries in its union effective 2004 (Canadian Medical Association).

As the population ages there will be a greater need for those with more experience in geriatrics, and chronic multisystem illness.  Medical schools and the federal government will need to increase focus in this direction. The CDC notes that the people over 65 years old will increase from 35 to 70 million by the year 2030.

Baby boomers start retiring in 2011. This is about 12% of
population increasing to 20%. The Alliance for Aging estimates a need for 36,000 geriatricians (now there are about 9,000 with an estimated drop to 6,000 by 2004). Changes in the medical education process must be made to increase the overall number of qualified health care workers necessary to provide for all.

by J. L. Richardson, M.D.
excerpt from "Building An American Health System", 2003

*average debt for medical school in 2010 was $158,000 http://bit.ly/RA0QQZ