What Parts of Obamacare Go Into Effect on January 1, 2013?

The Patient Protection and Affordable Care Act (PPACA) or "Obamacare" is being rolled out over a period of years.  The provisions which are going into effect as of January 1, 2013 are:

Preventive Care Coverage:  New funding for Medicaid for States choosing to provide preventive care services.

Payment Bundling: Expands authority of hospitals, physicians and health care providers to bundle payments for items and services, by providing incentives and shared savings among providers and Medicare.

Medicaid Payments Increased for Primary Care Physicians:  States are to pay PCPs no less than 100% of Medicare 2013 and 2014 rates for primary care services delivered to Medicaid patients.

What's in a Quote?

 

I recently happened upon a quote on a motivational speaker’s website: “When men know not what to do, they ought not to do they know not what.”- Abigail Adams. As it turns out, Abigail Adams didn’t say it, but her husband did, Second President of the United States, John Adams. In one of his love letters to Abigail dated July 2, 1774, Adams relates that his barber said that all Tories are “bribed to be a Tory,” with such goods as rum, sugar, wine and flour. John Adams wrote:

I thought the barber’s observation as just and as memorable as Parson Moody’s doctrine “that when men know not what to do, they ought not to do they know not what”

(Adams 1774).   As for “Parson Moody’s doctrine,” a letter written a few days earlier by John to Abigail identifies Parson Samuel Moody as the former revered Church Parson of York.  Adams wrote:

But the best story I have heard yet was his doctrine in a sermon from the text: “Lord, what shall we do?” The doctrine was that when a person or people are in a state of perplexity, and know not what to do, they ought never to do they know not what. This is applicable to the times. He brought his people into a remarkable submission and subjection to the spiritual rulers, which continues to this day.

(Adams 1774). Samuel Moody (not to be confused with American Evangelist Dwight Lyman Moody) graduated from Cambridge University, and lived from 1675 to 1747.  Parson Moody’s sermon “Lord, what shall we do? ” may reference 2 Kings 6:15-17:

 When the servant of the man of God got up and went out early the next morning, an army with horses and chariots had surrounded the city. ‘Oh, my lord, what shall we do?’ the servant asked. ‘Don’t be afraid,’ the prophet answered. ‘Those who are with us are more than those who are with them.” And Elisha prayed, ‘Oh, Lord, open his eyes so he may see.’ Then the Lord opened the servant’s eyes, and he looked and saw the hills full of horses and chariots of fire all around Elisha.

Under 2 Kings 6:15-17, when we are surrounded by trouble, we need not be afraid. If we open our eyes in faith, we will see that we are protected by the powerful presence and love of God who is fighting for us. (Cavin 2012). 2 Kings 6:15 is about an attack by the kingdom of Aram (Syria) on Israel, whose leaders relied upon the advice of the prophet Elisha. According to historians, 2 Kings spans about 265 years and takes place at the end of the kingdom of Israel, when its capital was destroyed by the Assyrians in 722 B.C.

“Elisha” means “God is salvation” in Hebrew. Elisha, who was the son of Shaphat, a farmer in Galilee, lived during the reigns of Joram, Jehu, Jehoahaz, and Joash, around the last half of the 9th Century, B.C. He was the disciple of the prophet Elijah, anointed to succeed him in 1 Kings 1:16-19. (Cline 2012). Elijah lived around 865 B.C., a time of great conflict. (Keathley 2012).

Where did the prophets Elisha and Elijah obtain their wisdom?  Prophets’ words are the words of God, as God told Moses in Deuteronomy 18:15-18 (Rittenbaugh 2004). :

I will raise up for them a Prophet like you from among their brethren, and will put My words in His mouth, and He shall speak to them all that I command Him.

So, the quote from the Motivational Speaker in 2012, was not by Abigail Adams, but was written by her husband, President John Adams, Second President of the United States, in a love letter he wrote on July 2, 1774 to Abigail, who in turn was quoting Church Parson Samuel Moody, who was born in 1675, graduated from Cambridge in 1697, and died in 1747, from his sermon which quoted 2 Kings 6:15-17 which quoted a servant living sometime around 722 B.C., who relied upon the Prophet, Elisha of around 700-800, B.C., who was the disciple of the Prophet Elijah, of 865 B.C.  

What is in this quote?  After traveling back in time almost 3000 years, the quote was inspired by a prophet, who was speaking the words of God.

References:

Adams, John, York, 2 July, 1774, “Founding Love Letters”, available at foundingloveletters.com/category/letters/love-letters-letters/john-abigail/page/2/.

Adams, John, York, 30 June, 1774, “Founding Love Letters”, available at foundingloveletters.com/category/letters/love-letters-letters/john-abigail/page/2/.

Cavin, Daintha, “Daily Bible Journey: Angel Army,” available at www.scripturemeditations.com/journals/db0610.html

Cline, Austin. 2012. “Elisha: Profile & Biography of Elisha, Old Testament Prophet and Biblical Figure,” About.com, available at atheism.about.com/od/biblepeopleoldtestament/p/Elisha/htm.

Keathley, J. Hampton, III. 2012. “Introduction and Historical Setting for Elijah,” available at bible.org/seriespage/introduction-and-historical-setting-elijah.

Rittenbaugh, John W. 2004. “Elijah and John the Baptist,” available at http://www.bibletools.org/index.cfm/fuseaction/Library.sr/CT/RA/k/868.

Social Media May Help You Get Fit

The social media explosion has spread to almost every sector of business.  (Lewis 2011, 44-48).  In a 2011 Study published in the American Journal of Health Education, health educators were polled to determine their acceptance of use of social media as a viable instructional method.    The study, which was based upon a random online survey of Certified Health Education Specialists, revealed that social media was regarded by the health educators as an effective means of enhancing health education, provided that it followed best practices and guidelines.  It appears now that social media may also enhance education on fitness and nutrition, including instruction on such topics as weight training, diet and supplements.  Personal trainers such as former gymnast and fitness champion Kristy Lee Wilson are now training online, and doing it in a way that allows a more frequent and consistent interaction with their clients.    Clients may receive instruction from highly qualified personal trainers at their own convenience from any location.   Virtual fitness instruction may include weight training videos which clients may play back over and over again to learn proper form, and clients may ask the trainer questions on the website and receive quick answers, rather than have to wait until their next training session.  As technology advances, it will likely help us in many aspects of our daily lives, including helping us to get fit and lead a healthy lifestyle.

Reference:  Lewis, Michael.  2011.  Social Media Leadership: How to Get Off the Bench and Into the Game.

To Tweet or Not To Tweet: That Is the Question

 
 
     Under Zuckerberg’s Law, the amount of content being posted on Facebook doubles every year.  This flood of incoming content has inevitably led us to ask “who owns what?”  Twitter is at the center of this social media thunderstorm. Companies are becoming concerned about Tweeting on the job, and may prohibit Tweeting, or may request disclosure of Tweets about work. They have not been completely successful in preventing employee Tweets.   To make matters more complicated,  some companies encourage employees to use corporate Twitter accounts, like HomeDepot and Best Buy.

      Therefore,  whether Tweets are happening behind office doors,  or are an encouraged part of the job description, employees are Tweeting.   They are Tweeting for themselves and for corporate America. The consequence is inevitable-a  tug of war between the corporate desire to protect its proprietary interests and employees’ rights to own their Tweets and followers.
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      But, we may have to take a step back and reframe the question.  As one attorney so aptly explains, no one actually has the right to “own” Twitter followers.  (Gabe 2009).  Followers are people and people cannot be owned.  A better and more salient question is: (1) who owns the right to access and maintain the list of Twitter followers; and (2) who owns the content of the Tweets.  (Gabe 2009).  Although the courts are just beginning to address the subject, it may take years to come up with a workable solution.  Twitter rights may rise or fall according to the following brainteasers:

1.     Did the employee have the Twitter account before the date of hire?

2.     Were the Tweets during work hours?

3.     Did the employee use the Twitter account to Tweet about work or personal matters?

4.     Is the employee required to disclose the corporate Twitter account user name and password, and if not, are the employee’s Tweets about work open to review by the company?

5.     Did the employee read and acknowledge acceptance of a corporate Twitter policy?

6.     Does the corporate Twitter policy discuss in detail what happens to the employee’s user name and password, list of Twitter followers and Tweets if employment is severed?

7.     Was there a corporate Twitter policy in place and did the employee review it and sign it prior to using the Twitter account?

We do not know what kind of Twitter standard will ultimately be established by the courts.  In the meantime,  detailed Twitter policies (along with other social media use policies) can educate employees on company expectations and the rules of engagement.  (Solis 2011, 136-137). Likewise, employees may want to think about what they are Tweeting, when they are Tweeting and ask their employer if it has a Twitter policy.

References

: 

Gabe, Glenn.  2012.  “Lawyers, Guns and Twitter-Who Owns Your Twitter Account.” Search Engine Journal. Available at http://www.searchenginejournal.com/lawyers-guns-and-twitter-who-owns-your-twitter-account/10612/ (accessed May 29, 2012).

Solis, Brian.  Engage. 2011.  Hoboken, New Jersey: John Wiley & Sons.

"Why Do You Blog?"

  The other day a friend of mine asked me “why do you blog?” At first, the answer seemed so simple. Because I just do, I thought.  This was like asking “why do you get up and get dressed in the morning?” But, the more I thought about it, the more I realized that not only was it a good question, but it really was an absolutely critical one for me to answer.  In order to do so, I knew that I first must define blogging. Not the dictionary definition, but my personal one. Blogging, to me, is:


Writing. Blogging is not just writing, but writing online in order to communicate effectively, by selecting words carefully to talk to my audience.

Concisely. I want to say it in as few words as possible. I tend to want to write too much, explain way too much and analyze things into oblivion.  So, I have to develop a blogger's consciousness.  I have to remind myself that you are extremely busy, and do not have the time to read a dissertation. I have to capture your attention in a few precious seconds.

To You. This may sound trite, but you may be from another county, another state, another nation, or another country.  You are part of today’s world audience, diverse in culture, religion, perspectives, views and visions. You are from all walks of life, earn a paycheck in countless ways, and have an infinite number of life experiences which have molded you and made you who you are today. You collectively are a potential giant, powerful and fierce in your shared vision. Yet, at the same time, each one of you is unique with something different and important to share.

About What You Care About. My blog is not a private journal locked away somewhere for my children to muse over after I am gone. It is writing to you about something which you care about. How do I figure out what is meaningful to you? I admit that I am often guilty of choosing my own topics. I do take the liberty of pimarily staying within the boundaries of health care law, policy and ethics, and fitness.  But, at the end of the day, this really is about you. I must figure out what you are thinking, saying to each other, and feeling. What gets under your skin or sticks in your craw. What either sinks you into darkness or lifts you up into a better place.

That is Happening Right Now. In one of my favorite books, the Joy of Living by Yongey Mingyur Rinpoche, Rinpoche tells us that we must live in the present,  Otherwise, he explains, we become prisoners of the “tyranny of time” with our thoughts about the past and future dominating our existence.   I love the way Rinpoche jolts us into this reality by saying "You can break down the present into smaller and smaller increments, but between the instant of  present experience and the instant you identify that instant as “now,” the moment has already passed. It’s then."  (Rinpoche 2007, 87). What is on our minds as people today may be old news tomorrow. I need to find the present and stay there. I must steep in the “now,” so that I can discover what is dynamic, raw and fresh.

With effective visual tools. I have at my fingertips hundreds of blogging techno delights: widgets, gadgets, buttons and high tech multi-media effects. It is like picking a color out of a virtual Crayola Big Box of Crayons with the built in sharpener. If you will indulge me for a moment, I decided to do a little research on the history of Crayola Crayons.  Crayola started out with 30 colors in 1905, 64 colors in 1958, with fluorescent colors added in 1972 to make 72, and now has 120 Colors, with “specialty sets” of Silver Swirls, Gem Tones, Magic Scent and Silly Scents. Even so, when I was a child, I remember filling in my coloring books with a few favorites like "burnt sienna", "midnight blue", "sunset orange" or "peach".   Today, Im the same way.  I will probably not discover, or even know how to use, most of the ever expanding list of gizmos in the blogosphere. Hopefully, however, I will choose a few which speak to you, rather than overwhelm you.

So, here is my answer to “why do you blog.” I want to talk to you about something which you care about. I hope to do more than create the proverbial echo in cyberspace canyon. I would like to start a conversation.   I am glad that my friend asked me this question. I hope that this is a step toward better blogging.
Over 120 Crayola Crayon Colors

Health Care Reform: Three Different Perspectives

 Health care reform, as enacted by the Patient Protection and Affordable Care Act of 2010 (PPACA),  is a hot topic on the presidential campaign trail. The Supreme Court is presently considering the repeal of the "individual mandate" provision which requires the purchase of health insurance.   There are so many opinions floating around on PPACA  that it is difficult to weigh its pros and cons.  Below are three videos which may assist you.  While each presentation is different, I found myself asking a two part question. 

1 .If we could have our way, is it better to  repeal the individual mandate only OR toss the entire statute?
2. If PPACA is struck down in its entirety , do we want to return to the pre-health care reform days?  If we do not, what shall we do instead?

Health Care Reform: 2012 Update is an hour long video for the tolerant audience who wants to know the gritty details.  This has an excellent discussion of the dilemma of repealing the individual mandate or the whole statute.  The presentation also has a necessary but painfully comprehensive exercise in workforce analytics which employers will have to learn, even if the individual mandate is repealed. 

The Top Four Innovations in Heath Care Reform is a short and sweet list of four pros of PPACA:  a new system for health insurance, covered preventive care through the primary care physician, hospital and health system affiliations to share electronic records and to operate more efficiently, and nurse personal health coaches.  There is no discussion of the individual mandate constitutionality problem, the difficulty of administration or the projected cost of implementation.  

CNN Explains: Health Care Reform is a short review of the pros of health care reform:  that it eliminates the problem of the uninsured, bars denial of insurance based on preexisting conditions, allows children to stay on parent insurance policies until age 26, eliminates lifetime limits on insurance coverage, and expands Medicaid coverage.    The presentation implies that we all must pay for uninsured Americans who need medical care. However, the cost or constitutionality of the individual mandate is not mentioned.

If I had a crystal ball, I might predict that the Supreme Court will strike down the individual mandate as unconstitutional.  There are many provisions of the law which are "inextricably intertwined" with the individual mandate, so if the mandate provision goes down, it may take down the entire ship with it.  That sounds harsh, but the Supreme Court may not want to engage in the alternative of  performing a mind boggling rewrite of a gigantic piece of legislation.  I do know that I do not want to go back to the way things were before PPACA.  So if the law is repealed, we will be back to square one on our broken health care system.  We may want to prepare for a reopening of  Pandora's box if the Court decides to throw away the whole statute.

How Much Physical Education Is Required of Georgia Students?

Percentage of High School Students Who Were Obese* Selected US States, Youth Risk Behavior Survey 2011,  Center for Disease Control and Prevention. 2011. “Obese Youth Over Time,” available at http://www.cdc.gov/healthyyouth/obesity/obesity-youth.htm.

In the wake of the passage of Georgia's new SHAPE Program, I started wondering just how much physical education is presently part of the Georgia public school curriculum.  SHAPE,which went into effect on May 23, 2012, was passed by the Georgia State Legislature in 2009.  It is designed to address childhood obesity.  It establishes an annual fitness assessment for students who are enrolled in a physical education class in public school.  However, many Georgia high school and middle school students are not enrolled in physical education classes, since physical education is not mandatory for Grades 6 to 12.  So, to sum it up, many teens are not required to flex one muscle, other than their brains, during school hours. Recent research like the 2010 Kaiser Family Foundation Study on Media Use by Children and Teens confirms that teen media use, an undeniably sedentary activity, is up dramatically.  According to the Center for Disease Control Statistics on Teen Obesity, teen obesity has virtually tripled over the past 30 years, increasing from 5% to 18% for children ages 12 to 19 from 1980 to 2008.  While there is controversy over whether there is a link between media usage and teen obesity, we may need to consider a school curriculum change for teens across the country, including Georgia.   Consider  The Georgia State Board of Education Physical Education Rules which require "90 contact hours" of health and physical education per year (about 30 minutes per day) for Grades K-5.  Students in Grades 6 - 12 are only required to have health and physical education made "available" to them.  The SHAPE Program is a start in the right direction.  Lets carry the baton to the next milestone and figure out a way to assess teen fitness in Georgia.  And, maybe we could go even further and start an initiative to bring some fitness instruction back into the middle schools and high schools.

Health Club and Spa Owners: Prepare for the New Swimming Pool Regs!

US Army Second Lieutenant Melissa Stockwell, her left leg blown off by a roadside bomb in Baghdad, competes in the 2008 Bejiing Paralympic Games, Fox News, 2008. "Decorated  US Army Veterans Look for Medals at  Paralympics," available at http://www.foxnews.com/story/0,2933,418002,00.html.

The new health care reform legislation, the Patient Protection and Affordable Care Act of 2010 (PPACA),  has impacted almost every type of business.   The US government continues to roll out explanatory rules and regulations on the provisions of PPACA.  Health clubs and spas are another part of the business world which must pay attention.  The Department of Justice issued Revised Regulations on Accessible Pools on May 24, 2012 on the accessibility requirements under Title III of the Americans with Disabilities Act for swimming pools.  There are some tricky parts of this law, including its potential application to smaller private swimming pools which may open themselves up to public use.    The law applies generally to newly constructed or modified pools.  Larger pools may require two accessible means of entry, while smaller pools may need only one.  Under Title III of the Americans with Disabilities Act, physical barriers to access by the disabled must be removed if they are "readily achievable."  Note the magic words "readily achievable.  Sloped pool entrances or swimming pool lifts may be needed for compliance.  The Department of Justice will evaluate on a case by case basis if it will exercise its "prosecutorial discretion" in enforcing the access rules.  The Department will consider several factors in making this evaluation, including the nature and cost of the modification and the available resources of the entity which owns the pool.  A parent company's resources may also be considered, depending upon the corporate structure of the spa or health club. 

Navigating Your Way Through the Health Care Blogosphere

 If you are navigating your way through the health care blogosphere, you will come across a wide variety of blogs on health care, including hot topics in health care, health care law, and health care policy, .  Here is a sampling of health care bloggers, who differ dramatically in background, style and purpose.  Below are blogs from the Speaker of the House. a composite of miniblogs from Wall Street Journal staffers, and a blog from the Department of Health and Human Services. 

 

Speaker of the House Boehner's Blog on Health Care Reform

     Republican Congressman John Boehner, Speaker of the House of Representatives, and US Representative from the 8^th District of Ohio, makes a case for the repeal of Obamacare.    Boehner is an important figure on Capitol Hill, since he is second in line to the Presidency behind the Vice President, and is an influential voice in Washington.   Congressman Boehner gives several reasons for repeal of the Patient Protection and Affordable Care Act of 2010:  that it is unconstitutional, too complex to implement, unreasonable for small businesses to administrate, and that it actually increases costs.  Senator Boehner credits himself and the Republicans with a recent trail of legislative actions which have successfully defunded and dismantled several bureaucratic parts of Obamacare.  However, there is no raw data or statistics in the blog showing that Obamacare will raise health care costs nor is there a presentation of an alternative health care plan which is easier to administrate and less costly.

Health Care Blog By Wall Street Journal Staffers

     This composite blog is a collection of mini blogs from journalists from the Wall Street Journal.  It successfully raises our consciousness about the hottest topics in health, such as the perils of the marketing of prescription medications online, or the use of hormone therapy after menopause.  The mini blogs are informative, but sometimes lack content.  For example, in a blog by Robert Lee Hotz, the science writer for the Wall Street Journal, there is a hyperlink to the actual FDA warning, but no comment from Mr. Hotz on the depth or severity of the problem of online prescription drug sales.  The FDA warns of the online sale of phony pills of the prescription drug Adderal, commonly prescribed to teenagers for treatment of Attention Deficit Hyperactivity Disorder and daytime sleepiness.    The FDA says that the pills are being sold on “rogue websites.”  The fake pills have not shown any harm, but obviously will not treat the patients.    I was left wondering about the demographics of persons buying prescription drugs on “rogue websites,” the names of the sites, and how this problem is being addressed.

Two other blogs make an effort to shed light on the everlasting controversy over hormone replacement therapy (“HRT”) for women.  One blog highlights that HRT is not recommended for post-menopausal women, while another blog from another WSJ staffer highlights that HRT may benefit women at the onset of menopause.    If this is the most current and correct view, this would be an unfortunate truth for many women who are past menopause seeking effective therapy.   I would welcome a uniform and consistent opinion from the experts on timing of HRT. 

US Dept of Health and Human Services Blog on Exercise

     The 2008 Physical Activity Guidelines for Americans is the first time ever that HHS has published an official statement on the amount and nature of exercise needed for Americans.  The publication, although sometimes overly general in nature, has a noteworthy theme:  that physical exercise benefits all age groups, ethnicities and special populations, including people with disabilities.  This is a small step toward development of a national initiative toward better health prevention and awareness.  The blog includes a wide variety of topics on physical exercise which is easy to follow and comprehend.   Americans are constantly flooded with conflicting opinions about the type, level and amount of exercise recommended for a healthy lifestyle.  The result has been a confusing conglomeration of opinions from physicians, personal trainers, and nutritionists, who disagree on many levels.  This governmental blog will hopefully identify consensus among the experts, and evolve into a more specific catalogue of age and disability specific work out regimens and philosophies.   Since chronic disease management is a key concern for the immediate future of Americans, especially the aging baby boomer population, the blog could provide more leadership on exercise suggestions for diabetes, heart disease and other common chronic illnesses.