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comprehensive exercise in workforce analytics which employers will have to learn, even if the individual mandate is repealed.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.