Vol. 169 April 15, 2017 “Free-market Health Care Doesn’t Work”

April 17, 2017

“Nobody knew health care could be so complicated.”
-Donald Trump 2/27/17

Stephen Colbert responded with: “There was at least one person who knew that it was complicated, that tall, thin, greying guy who used to be in your office, Donald.”

Of course, there are lots of people who know how complicated it is. One of them is my old boss, Jim Lyons, founder and past-CEO of Cape Cod Healthcare, Inc. He is retired now and hasn’t lost his knack of making sense of the morass. He did just that in a recent Op Ed piece in the Cape Cod Times, and I’m shamelessly plagiarizing parts of it (in bold) for today’s blog.

“The fallacy [of the health care debate] is that necessary healthcare services is a free-market choice, as with buying a car, a house, or a kitchen table. If you have a stroke, break your hip or have an automobile accident [you don’t make] the same free-market choice for service”.

You could argue that if you want an elective procedure like a new knee, a new hip, or cancer treatment there is the opportunity for more choice, and that is true. Just take a look at the burgeoning advertising budgets of competing medical centers. The say they are competing on “quality”, and they are competing for your dollar, or more nearly correct the insurance company’s and the federal Medicare dollar. So far, in no U.S. health care market region has this “competition” led to lower costs. We recently wrote about the growing “lower-cost” market of medical tourism.

The two biggest reasons that health care costs keep rising are 1) we are all living longer and 2) better medical technology (both electronic and “better living through chemistry”).

 “New technology in health care almost always results in increased costs. In industry, new technology often lowers the cost of production. This is not the case for health care innovations.”

In fact, The Hastings Center estimates that 50% of our increasing health care costs is due to new technology. MRI exams have replaced  CT scans and other x-ray procedures in many instances, even in mammography; coronary surgery is being replaced in some instances by “simpler” medical devices inserted through a blood vessel; newer drugs with marginally better effects for heart disease and cancer are selling at much higher prices; PET scans are becoming the standard of care in certain cancer treatment protocols, etc.

Many years ago I remember the responses of a delegation of physicians and administrators from Great Britain who were touring American medical centers looking at our health care facilities. They were impressed, of course, with the MRIs and cardiac surgery units in Boston, but they “were just like what we had in London.” But, then they saw the same facilities in Worcester, Springfield, even Winchester and Burlington, and impossibly, Cape Cod, and they were impressed.

Efforts to control health care costs continue to be futile. “Republicare” was a political disaster and only attained a 17% approval rate in public polls. “Medicare For All” which calls for an incremental extension of Medicare coverage to those below 65 years of age has been in the House of Representatives (HR 676) since 2015. In Massachusetts there are now no less than four separate bills in the legislature calling for a single-payer Medicare For All in Massachusetts.

“One reason that it’s probably not politically possible to make a change to a single-payer system at this time is the more than 1,000 great buildings for servicing health insurance companies all over the country, full of many workers, many executives, and billions of forms.”

“Whether health care is a privilege or a right, we have made such great progress in the past 50 years that I don’t want to see any new health care plan that slows or reverses our progress. Please remember, health care is not a free-market choice like many of our other important decisions.”


Vol. 163 January 16, 2017 From Zero to $7,500: One Consequence of Obamacare Repeal.

January 16, 2017

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“As a doctor, I will take it and make it my mission
to heal the nation, reverse the course of Obamacare,
and repeal every last bit of it. ”
-Rand Paul

What exactly could happen if Obamacare was taken away? My daughter’s recent landing of a second part-time job offered an opportunity for me to understand the possible result in one case.

As a singer-songwriter, energy healer, and part-time retail clerk my daughter shares a common situation with many on Cape Cod; an annual income of less than $16,000, which is the current federal definition of poverty.  She is therefore eligible for Medicaid in Massachusetts. She pays no premium, has no deductible, and except for some named prescription medicines she has no co-pays. Preventative, pre-natal, and behavioral health services are covered. Her out-of-pocket cost per year is essentially zero. Some Obamacare repealers want to roll back the extension of Medicaid eligibility financed by federal subsidies. In many states that would strip this kind of  coverage from many of those newly covered under the ACA, but that is not a possibility in Massachusetts.

In my daughter’s case her new, second part-time job may push her annual income over $16,000. If so, she will no longer be eligible for Medicaid. As a part-time worker she is not be eligible for an employer-sponsored (and partially paid for) health plan. Her employer’s HR department told her she could buy a basic policy with a $2700 annual deductible for $226 a month through the school. “Co-pays varied and are difficult to predict.”  For her that is a new potential cost of $5400 out-of-pocket per year.

She got married last year and her spouse is in the same “low-income” bracket, so she inquired about a family policy (“for 2”). The answer: $400 a month at the same $2700 deductible amount for a $7,500 potential out-of-pocket cost. A $7,500 out-of-pocket cost “exposure” per year is a big nut for a family earning less than $22,000 a year.

Her other choice (besides going uninsured and paying a fine of $300-$2,085 in 2017 depending on income level) is buying an individual policy through an ACA Health Insurance Exchange. Under Obamacare any individual that is making less than 138% of the federal poverty level (about $22,000) can shop for a policy via a state or federal health insurance marketplace (also called health insurance exchange).  The exchanges can offer federally-financed subsidies of up to 60% of premium for eligible “working poor”. After lengthy website surfing, face-to-face help from the Health Connecter facilitator at a local hospital, and several phone calls with prolonged holding periods, she discovered that she could buy about the same basic policy of $2700 deductible for $226 a month through the health insurance exchange. BUT, despite providing all sorts of financial info they could not tell her…”yet” … what the premium would be and whether she was eligible for a premium subsidy. She was told that “things were in flux”, and that she could get a “call back in a week or two about that”. The enrollment deadline for signing up is January 31.

Just “for the fun of it” and to satisfy my curiosity I masqueraded online as my daughter to experience the health insurance application process via the Mass Health Connector. Over three different days I persisted on the internet and on the telephone to try to get the answer to : ”What would it cost to buy a basic individual health insurance policy?”  After reviewing and clicking on 5 to 7 different logos with unfamiliar company names, after entering the same information on multiple screens, after holding for more than 20 minutes on three separate phone calls, after being passed on to three different “responders” on one phone call, and after twice being hung up on after saying that “I was currently on Medicaid, but was looking for insurance to start February 1 when I would become ineligible”, I GAVE UP THE QUEST WITHOUT AN ANSWER.

Different sites had different definitions of “basic” and most had three or more different levels of benefits (coverage). Descriptions of benefits were quite lengthy and often complex.  For instance, the Bronze (basic) Level of “Access Blue Saver II“ (from Blue Cross; the easiest comparison charts to read) offered a 9 page policy offering no preventative or prenatal care with a $3,350 deductible and $60 co-pay for office visit and $1000 co-pay for an ER visit. Silver, Gold, and Platinum “Access” policies had different benefits. I could not get any information about actual premiums without further phone calls to “licensed brokers.”

Why is this so convoluted and confusing in contrast to the simpler processes of Medicaid and Medicare? One answer is that individual insurance policies are a gamble. For instance, a life insurance policy is really a bet between you and the insurance company. If you lose (die), you win (receive all the premiums back). If you win (out live the term), you lose and the company wins (keeps all the premiums). Another answer is that 400,000 people more than 2015  are flocking to sign up through health insurance exchanges.(1)

Obamacare has not changed the basic premise of individual health insurance policies, and the insurance companies are trying to make their  “best bets”. The betting odds are not as clear as the 1:6 of Russian Roulette, though we know that lack of health insurance can be lethal. The betting odds are more like those of Black Jack. The dealer (health insurance company) is using multiple decks, other players (consumers) at the table can affect your odds, the best odds are not always intuitively obvious, and the dealer (health insurance company) can change the betting rules every year.

Medicaid and Medicare are insurance programs based on large populations and therefore need less of the gambling “tricks of the trade” of writing individual polices. Hence my support for a health insurance program based on a large population, sometimes called a single-payor system. If not “Medicare For All”, then how about state-based programs of “Medicaid For All.” (2)

References:
1. Boston Globe, pg.2, December 22, 2016, from the NY Times.
2. NEJM, 375;26, December 29, 2016, “Maintaining Insurance Access Under Trump – A Strategy”


Vol. 158 November 15, 2016 REAL Health Care Reform

November 15, 2016

Trump 2Mr. Trump (now that he is President-elect we need to show “Donald” some respect) has recently said that he may keep the Affordable Care Act (Obamacare) ban against denying coverage for preexisting conditions as well the extension of parental policies to  26 -year-old children because “everyone seems to like those provisions”. As President-elect Trump begins to soften his bombastic, total opposition to Obamacare (and replace portions of “the Wall” with a fence) the 1.2 trillion dollar question becomes, “what is he going to do next?”

Since passage of the ACA 20 million Americans have gained health insurance coverage. 63% of that gain was produced by expansion of Medicaid in the half of our states that choose that federally subsidized route under ACA. The other 40% of increased coverage came from the federally subsidized premiums on policies purchased through health insurance exchanges. Not every state established health insurance exchanges, and  those states that did establish exchanges were twice as effective in getting people to enroll in health insurance.

The “individual mandate”  that was resisted so fiercely by Republicans as “another government tax” was originally composed by Governor Mitt Romney and  became law in Massachusetts years before the ACA passed. The  ACA 2014 “individual mandate” was  a $95 fine if you did not obtain coverage, and it proved to be fairly ineffective. In 2016 that fine goes up to $695 (or 2.5% of your taxable income), so it may prove more of an incentive this year. (1)

What about the rest of the ACA? We shall see, but just tinkering with the ACA (“repeal/replace” or “fix”) raises the concern that we may waste a lot of time and energy getting entangled in the trees while losing sight of the forest.

Can we get REAL about health care reform, or do we just continue arguing about health care insurance? It just so happens that a physician colleague of mine wrote a succinct, clear, eminently quotable Op Ed column about that question in our local paper yesterday! (2)  I  am going to shamelessly plagiarise* it.

“We have given providers incentive to ration care and collect data while ignoring non-provider stakeholders responsible for major system expenditures.”
.             Like: big pharma that advertises directly to consumers for great profit
.                       medical device companies with excellent, high-paid, effective lobbyists
.                       health insurance companies with more lawyers, consultants, lobbyists, and way more overhead than Medicare.

“We seem determined to jump through ever more hoops to limit provider options while the rest of the industry revels in the lack of any kind of market control.”

“Resources that used to represent [provider] profit or ability to retain staffing are now spent on fighting insurance claims and bolstering hospital advertising budgets.”

New payment-bundling schemes with buzz words like “pay for value”, “pay for performance”, and “population basis” will “transfer unprecedented financial risk to providers.”

“Constraints placed on health care providers cannot adequately repair our system.”
What actions can repair our system according to Dr. Urbach?
.              “expanding the public option should not be politically toxic” when  50% of Americans are already covered by government
insurance;
.               reforming malpractice tort law to save big dollars by reducing the costs of “defensive medicine”;
.               having thoughtful discussions about appropriate use of resources at end of life;
.               allowing Medicare to negotiate drug and device costs;
.               devoting adequate medical resources to the mentally ill rather than putting them in jail.

“We must stop pretending that exerting ever more financial pressure on our doctors, nurses, and hospitals (while ignoring bigger fish) will get the job done.”

Now, Dr. Urbach is not a disgruntled primary care physician who is whining about poor reimbursement and non-appreciation of his skills and talents. He is an experienced, well-respected cardiologist, a specialty near the top of the payment and prestige pyramids, who shared these reflections on the occasion of his son’s graduation from medical school. He prays that his son and his peers “will not only make themselves into great clinicians, but that they will also do what my generation of providers largely failed to do – make themselves into a courageous political force that can effectively force comprehensive reform of the heath care system by demanding sacrifice from all stakeholders, not only the caregivers.”

And I say, Amen.

References:
1. New England Journal of Medicine, 375;17,  October 27, 2016, p.1605
2. Cape Cod Times, November 14, 2016. “Let’s get real about health care reform”; David Urbach, MD
* “When you copy one person’s words, it is plagiarism. When you copy many persons’ words, it is research.”


Vol. 156 October 15, 2016 Adding “DNT” to Your Medical Record Before “DNR”

October 15, 2016

 

Hub thumbnail 2015At our last weekly gathering of the “Over 70 Men’s Breakfast Club” we heard from one of us the following about visits to two of his physicians on the same day a week before:

Gastroenterologist: “Congratulations, your colonoscopy was entirely normal.”
Patient: “Great. When should I schedule the next one?”
Gastroenterologist: “Well ,, er..um .. you are over 75 you know. At your age it …er…um.. wouldn’t make any difference.”

The same day with his primary care physician:

Patient: “I think my urine stream is slowing a bit. How’s my prostate?”
PCP: “Your prostate exam is absolutely normal.”
Patient: “What about a PSA test?”
PCP: “ We don’t do those for men your age. It …er…um…wouldn’t make any difference in the long run. Oh, by the way, who’s your Health Care Proxy, the person who can make you DNR in case you can’t speak for yourself?”

Over our eggs and bacon (one member, our oldest, has oatmeal and berries instead) we reached the consensus that his medical record should be stamped with a “DNT: Do Not Test”.

Here are some of the “unnecessary” screening tests that he and others “of certain ages” should skip:

PSA: Rarely done under 50 yo. or over 70 yo. and now being questioned as of mixed benefit for any man. Screening does not reduce the very, very low death rate from prostate cancer and false positives are common. Further investigations of false positive results can cost at least $1,200 per patient, and treatment of truly positive cases can cause incontinence and/or impotence without any significant medical benefit.

Colonoscopy: rarely done under 50 yo. and never over 75 yo. as a screening test. Repeat colonoscopy after an initial normal one detects cancer of the colon no better than a periodic fecal occult blood (FOB) test on a stool sample done by your primary doctor.

X-ray, CT scan or MRI for low back pain without other symptoms: Back pain usually gets better in a month whether you have imaging done or not. Surgery is often done on image irregularities which have no causal relationship to the pain.

Pap smear: Every 3 years for ages 21 to 30. Every 5 years from 31 years to 65. None after 65 yo. “Abnormal” but non-cancerous cells can be detected by this test, but do not need treatment. Pap smears are recommended even if the woman receives the HPV vaccine (Gardasil) because the vaccine does not cover all viruses that cause cervical cancer.

Vitamin D: Vitamin D is the current “vitamin in vogue”. Speculations about relationships with heart and other diseases are riff, but the data is not that conclusive. Many people have low vitamin D levels (as currently defined) but very low levels associated with real illness are extremely rare. Oral vitamin D treatment has not been shown to reliably raise vitamin D levels. A 10 minute walk in the sun and a breakfast with orange juice and eggs supply more than enough vitamin D. (Note: The blood test itself is not expensive, but in 2011 Medicare paid $224 million for vitamin D screening on seniors.)

Testosterone level:  Despite the plethora (I am told) of late night TV ads selling gels, patches, and pills for low testosterone among middle age and older men, treatable “low testosterone” is rare.  Unless a man has one or two of 9 specific symptoms ( and erectile dysfunction (ED) is NOT one of them) a testosterone blood level screen is not recommended. Even if the level is low (under 10 nmol/L – I’m not sure what these units are either, except that they are very small ) a treatable diagnosis rests on the clinical history and exam, not the blood test.

Bone Density: Never under 50 and rarely over 70 in men without risk factors like fractures, heavy smoking or drinking, or very low Vit. D levels. Women could get one done at age 65, but  “treatment” of low bone density with costly medications (also advertised a lot on TV) has not been shown to have much benefit.

Annual EKG or stress test: Does not add any useful information for the asymptomatic person.

Whole Body Scans: Besides the cost and the large amount of radiation involved, these scans should be avoided because they do NOT find asymptomatic cancer. Less than 2% of the scans find a true mass and most of those are benign or inconsequential. In over 33% of scans “abnormal findings”, sometimes called “ditzels” by radiologists, lead to unnecessary and expensive further imaging tests that do not result in any benefit to the patient. (This test was previously heralded by this blog as a good Christmas present for an enemy)

References:

1. Choose Wisely is a list of unnecessary medical tests complied by the American Board of Internal Medicine from suggestions of numerous other specialty groups and published widely in Consumer Reports and other periodicals.


Vol. 147 May 1, 2016 Why UnitedHealth Group Is The Poster Child For What’s Wrong With Our Health Care

May 1, 2016

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UnitedHealth Group, the nation’s largest health insurer, said Tuesday
that in 2017 it will exit most of the 34 states where
it offers plans on the Affordable Care Act insurance exchanges.

                                                          –Washington Post, April 16, 2016

 

The creation of state health insurance exchanges were incentivized by the Affordable Care Act (ACA) in order to encourage the offering of health insurance policies at competitive prices to individuals not covered by employer plans. Individuals that earned just enough to be ineligible for Medicaid coverage (aka “the working poor”)  could apply for federal subsidies to help pay for exchange health insurance policies. Health insurance companies anticipated that many uninsured people would become premium-paying people resulting in a significant revenue increase to the health insurance companies.  Like any insurance scheme, all the companies had to do was to set “competitive rates” (based on their actuarial estimates) that would bring in more revenue than the expense of what they would pay out for claims.

UnitedHealth Group (UHG) is withdrawing from 34 state health insurance exchanges because the company lost $650-720 million on their exchange policies (aka “marketplace polices”);i.e. claims for medical care received exceeded the premium revenue. Speculations about the reasons for this include:  the companies priced their policy premiums too low in response to the competitive nature of the exchanges (“They screwed up”);  the people who took out these policies were inherently “high-users” of medical services; or the higher than estimated use of medical care represented a backlog of unmet need for medical care.

The fact that the ACA has decreased the uninsured and underinsured in America by 36 million is uncontested.  About 12 million or 33%  of these people gained access to medical services from policies available from the health insurance exchanges.  Close to 87% of those were eligible for and received partial subsidies for the cost of premiums. Most of the rest of the increased access came from expanded state Medicaid insurance subsidized by the federal government under ACA. But 11 million individuals remain uninsured,

“…Depicting the Affordable Health Care Act as a “slippery slope” to single payer is bizarre, given that it relies on private insurance.” (1) Health insurance policies have tremendous influence on medical care delivery by determining who is eligible for what medical service and where. Differential rates, deductibles, and co-pays can favor one type of delivery site (hospital bed, ER, ambulatory center,  provider’s office, home care, or nursing home) and even the type of provider (MD, NP, or PA). Specific coverage for selected medical services (named and unnamed when you buy the policy) can be denied. Coverage of prescribed drugs and even procedures can be unilaterally changed annually by the insurance company simply by mailing to policy owners a fine-print booklet that lists what will be available and at what price for the coming year. In a more positive vein, one study showed that in states that expanded their Medicaid programs under ACA the number of newly diagnosed cases of diabetes increased by 23% as opposed to less than 1% in states not choosing to expand Medicaid. Early diagnosis can be life-saving and cost-effective in a chronic disease with effective treatments like diabetes .

The effect of UHG’s withdrawal will have little real effect on the insurance offered by the exchanges. Premiums for policies from the remaining companies may only increase by 1% or $4 a month. But the UHG withdrawal brilliantly spotlights the profit motive as the basic driver of our health insurance system. Private health insurance has a place in any medical care system, and does exist in most, if not all, of the state-based universal health insurance programs in other developed countries, but only in the U.S. do the profit-motivated health insurance companies have such profound influence on to whom and how medical services are delivered.

Despite what some members of my Monday night pool group may say of me,  I think capitalism is great. It has produced multiple “wonder drugs”, nurtured the widespread distribution of fantastic medical technologies, and can provide the best medical care in the world… for many… but not all.   I also think that is silly to think that profit-motived health insurance will ever be able to provide universal access to medical care, a universal access that could enhance the continued physical and economic good health of our country.

References:
1. The Virtues and Vices of Single Payer Health Care, NEJM 374;15, April 14, 2016; 1401; J. Oberlander, Ph.D.

 

 

 


Vol. 143 March 1, 2016 What’s In A Name?

March 1, 2016

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Few Americans recognize the contributions of IMGs (international medical graduates), or more broadly all foreign-born physicians, to U.S. healthcare.

 

Physicians born anytime in the 1930s – 1950s are more likely to have the surname Smith, but starting in the 1960s the U.S. saw an uptick in diversity, and in both the 1970s and 1980s, Patel topped this list as the most common last name among all physicians. Patel is now officially the last name most frequently preceded by “Dr.”

Rank 1930‑39 1940‑49 1950‑59 1960‑69 1970‑79 1980‑89
1 Smith Smith Smith Lee Patel Patel
2 Lee Lee Johnson Smith Lee Shah
3 Miller Miller Miller Johnson Kim Lee
4 Johnson Johnson Brown Patel Smith Smith
5 Kim Patel Williams Kim Nguyen Nguyen

This trend is likely to continue. Since the 1980s, the number of Asian American med school graduates has increased from almost none to making up approximately a fifth of all graduates . According to the 2014 census, foreign-born doctors now make up approximately 25 percent of all physicians practicing in the U.S.

Current medical student enrollment statistics reflect a similar mix.
Of 86,746 medical students in U.S. medical schools in 2015:

46,108 were men       (53%)
40,634 were women  (47%)
All: 54% white
.      20% Asian
.      8% multiple ethnicity
.      6% African-American/Black
      5% Hispanic
Only 2% of U.S medical students are “Non-U.S. Citizen or Non-Permanent Resident”

These figures confirm that most of the 25% practicing physicians that are “foreign-born” have come to the U.S. after non-U.S. medical school graduation for residency training and have stayed to practice. Foreign born physicians require a J-1 visa from the U.S. government to participate in our residency training programs. In 2011 65% of physicians with a J1 visa (foreign-born) were practicing primary care (internal medicine, pediatrics, and family medicine) compared to 28% of U.S. medical graduates.

The AMA has estimated that once the Obamacare “access to care” elements are fully implemented and as our older age demographic increases we will be about 90,000 physicians short of those needed to maintain optimal physician/population ratios. Much of that “physician shortage” will be in primary care. Interestingly the two most popular specialities for IMGs are Anesthesia and Psychiatry. One specialty does not require a lot of talking to patients. They are asleep most of the time. The other requires nothing but talking! Of course, the highest percentage of IMGs (20%) are from English-speaking India.


Vol. 142 February 15, 2016 Tech Update

February 15, 2016

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A drop of blood for 100+ tests!
A company called Theranos, founded by a Stanford University drop-out, has developed a nanotechnology system for testing a finger prick of blood for anything from standard cholesterol level to still-developing genetic analysis. It is being test marketed in California by Walgreens pharmacy. Theranos plans to charge 50% of the Medicare/Medicaid reimbursement for the tests.

HealthSpot Station : A walk-in kiosk in a mall or drugstore with high-def video conferencing, a stethoscope, a thermometer, and a blood pressure cuff for immediate evaluation of non-emergencies; they accept insurance, including Medicare.

A 3-D printer creates a bioresorbable airway splint for an infant
A two-month old infant with congenital anomalies of the trachea and surrounding blood vessels had a local collapse of his tracheobronchial tree which could not be kept open with conventional ventilation. A hose, similar to the design of a vacuum cleaner hose, but much smaller of course, was fabricated by a 3-D printer. Seven days after insertion, weaning from his artificial ventilation was started. He was discharged from the hospital 21 days later after corrective vascular surgery.

Wearable fitness monitors – a $2 billion business
The early ones only counted steps. In the rush to self-quantify ourselves more and more measurements have been added to these wrist bands that now talk to our smartphones. Three different wrist bands can give three different counts. Sleep scientists pooh-pooh the wrist-worn sleep monitors. But, people buy them … as motivational devices, not scientific ones. If you add on the seductive social networks to share your data with all your friends, you have entered into the realm of what some would call  “fitness by humiliation”. If you subscribe to conspiracy theories you might wonder where all that personal data ends up? Who looks at it? Who owns it? No one knows. No one does, … yet.  In the spirit of full disclosure I admit that last year’s Christmas present of a Fitbit bracelet sits on my bureau, not my wrist.  I discovered that I took about 3000 steps a day, every day. It never changed, and it didn’t count my Pilates exercises well, so I took it off.

Maybe my doctor should have texted me
A Johns Hopkins study showed that 81% of 48 men and women with risk factors for heart disease receiving an automated, “personalized” text message “from their doctor” successfully reached their 10,000 steps a day goal. Only 44% of those in the control group who received no messages met that goal. Sample message: “Jon, you are on track to have a VERY ACTIVE day! OUTSTANDING! We might as well call you LeBron James!” (I kid you not. You can’t make this stuff up.)

First to market telemedicine for profit- aka “Uber for Doctors”
FIRST OPINION – For $9 a month a patient can text health questions to a pre-matched physician any time of day and expect a response in 5 minutes.

TELADOC – Your insurance company offers you a video or phone consult with a physician 24/7.

DOCTOR ON DEMAND  – An app that connects doctors with patients who are sick to help them decide if they have to be seen by a health professional or just need to take an Advil. Medical histories are stored in an encrypted database.

FIRST LINE – For $25 up front and $15 a month you get unlimited consultations by video chat or messaging. New participants get 24 hours (total) of free texting with a doctor anytime between 8 a.m. and 10 p.m. A house call is available for $199. No insurance coverage…yet.

PCP iPhone cartoon

“There’s an app for it” – before you contact a doctor
ResApp – Determines the cause of a cough by listening to you cough into the phone. Has 90% accuracy in diagnosing pneumonia or asthma. (Ed. note: pediatricians have been making these diagnoses over the phone for years; plus croup of course)

Priori – Predicts bipolar episodes before they happen. It is always “on” and monitoring the speed and patterns of the patient’s speech when he/she is using the phone normally. Doctors will receive an alert based on the speech patterns when intervention is needed. In Beta testing this year.

ApneaApp – Diagnoses when the sleeping patient periodically stops breathing by bouncing inaudible sonar waves off the patient’s body back to the phone. The reflected waves are analyzed to determine if sleep apnea is occurring. It was correct in 32 out of 37 tests in a sleep lab, and is about to be tested in the home setting.

In honor of Valentine’s Day – a few random facts about sex (some from the Framingham Study)
Sexual intercourse burns only about 85-150 calories, though it can get your heart rate up there in the “aerobic” range.
Heart rate and blood pressure peak very early in the act.
Having sex is about the equivalent of walking up two flights of stairs.
Men who had intercourse twice a week had a lower risk of cardiovascular events then those who had less frequency.
Having a heart attack during sex is about a million to one risk if you are a non-smoker and non-diabetic.

HAPPY PRESIDENTS’ DAY
I probably should have written about a few Presidential medical fun facts … like Garfield’s death resulting from medical malpractice, etc. … Maybe next year.


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