Analysis: Single-payer would drastically change American health care; here’s how it works

Analysis Single-payer would

As Republican efforts to repeal and replace the Affordable Care Act continue in the background, some Democrats are starting to eye a new health policy goal: implementing a single-payer system. Sen. Bernie Sanders, I-Vt., introduced a single-payer bill in mid-September with 16 Democratic co-sponsors — 16 more than he got when he introduced the bill two years earlier. But how is the health care system funded now, and how would “single-payer” change that?

How health care systems are funded

There are three major components to every health care system, single-payer or not: a patient, a payer (typically an insurance company or the government) and a provider. Here’s how money moves between them:

How multipayer systems work

Virtually all health care systems follow this general pattern, but who the payers are can vary widely. In the U.S. private insurance market, patients typically purchase coverage from one insurance company among many competing insurers. Because different people end up with different insurers, there are multiple payers throughout the U.S. health care system.

How single-payer systems work

In a purely single-payer system, there is, as the name would indicate, just one payer — typically the government. This is analogous to how the United States administers some portions of Medicaid: The government provides coverage, and no private insurers are involved.

Sanders’ bill takes universal coverage close to this extreme: The government insurance would cover so many services with such small copays that private insurance would be almost universally unnecessary. Accordingly, it would also be quite expensive — $32 trillion over 10 years, according to an Urban Institute report. That’s more than a 50 percent increase in federal spending — all federal spending — according to spending projections by the Congressional Budget Office. That would be partially offset by people no longer needing to pay premiums to private insurers, however, and the government’s monopoly could allow it to implement cost-saving measures.

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A step towards better health care

 

step towardsToday, we live in an era of customization. Increasingly, customers can modify a product’s appearance, features, or content according to their unique needs or desires. Often, even the news we see in our newsfeeds is customized based off our preferences.

Why, then, are so many aspects of the health care industry still one-size-fits-all?

As doctors, we’ve seen firsthand how this can negatively impact patients who require more individualized care. One particular example is a practice known as “step therapy” or “fail first.”

Now, when patients visit their doctors for a prescription, the treatments they are prescribed are typically based on a variety of personal factors. These factors include their health history, underlying symptoms, and their doctor’s long-term understanding of their condition, such as whether they have already tried certain drugs under a different health insurance plan, if they have other medical conditions that might interfere with the drug’s effect, whether certain drug’s side effects will affect the patient’s ability to perform their job, or if the patient would prefer a drug that has a different ingestion method or dosage form. Treatment plans need to be based on the individual’s needs, and their doctors’ medical expertise and first-hand knowledge of their patients’ overall health.

 However, far too often, what happens next is the problem. When a patient goes to the pharmacy to fill their prescription, they may be informed that their physician-prescribed medicine will not be covered unless the patient first proves that another medication-one of the insurer’s choosing, not their doctor-will not work for them.

In such a case as this, failure is not only an option, it is the only option before getting appropriate treatment.

Under the current system, patients are left with a limited set of options: either try a medication that is not what their doctor recommended for their condition, or pay out of pocket for the treatment they need. For many people, that’s not a choice at all. They are simply forced to fail on a medication other than what their doctor prescribed.

Read More: http://snip.ly/3h8ax#http://thehill.com/blogs/congress-blog/healthcare/356083-a-step-towards-better-health-care

Breast cancer warning from man stunned by ‘impossible’ diagnosis

Breast cancer warning from man stunned by 'impossible' diagnosis.jpg

When you think of breast cancer, you think of a form of cancer that affects only women. It doesn’t.

While breast cancer in men is rare it’s still an issue for the 10 men on average who are diagnosed with it every year in Northern Ireland.

Ian Cranston, 70, was diagnosed with breast cancer in May. Two weeks later he had a mastectomy.

The Portadown father-of-two was given the all-clear in June and has decided to speak publicly to make men aware that it’s a cancer that doesn’t just affect women.

He said “men also need to check their breasts for changes”.

Inverted nipple

In May, Ian’s wife Elizabeth noticed something wrong when he got out of the shower.

Image copyright SPL
Image caption About 10 men in Northern Ireland are diagnosed with breast cancer each year

She told him he had an inverted nipple and needed to see his GP.

“I didn’t know what that meant,” said Ian.

“Men can’t get breast cancer, I don’t have to go to the doctor.

“I wasn’t aware I had breasts. This is my chest, men don’t have breasts, it’s impossible,” he added.

Eventually his wife persuaded him to go to his GP, who referred him to Craigavon Area Hospital.

Image caption Ian Cranston alongside breast care specialist nurse Annie Treanor

The diagnosis stunned him.

“Men having breast cancer, I couldn’t believe it,” he said.

“I couldn’t do or say anything. My wife Elizabeth cried.”

Four days later Ian said he “just broke”.

He has decided to help try and raise awareness of the disease, saying that if his speaking out helped one man, it would be worth it.

“I can understand where women are coming from because I’ve had breast cancer myself,” he said.

How We Need to Keep Growing Up: http://snip.ly/ljoxy#http://www.bbc.com/news/uk-northern-ireland-41616265

Collins: Trump should back effort to resume health subsidy

Collins Trump should back effort to resume health subsidy.jpg

A key moderate Republican is urging President Donald Trump to support a bipartisan Senate effort to reinstate insurer payments, calling his move to halt the subsidies an immediate threat to millions of Americans who could now face rising premiums and lost health care coverage.

“What the president is doing is affecting people’s access and the cost of health care right now,” said Sen. Susan Collins of Maine, who has cast pivotal votes on health care in the narrowly divided Senate. “This is not a bailout of the insurers. What this money is used for is to help low-income people afford their deductibles and their co-pays.”

“Congress needs to step in and I hope that the president will take a look at what we’re doing,” she added.

Her comments Sunday came amid rising attention on the bipartisan bid led by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to at least temporarily reinstate the payments.

Congressional Republicans are divided over the effort. And White House budget director Mick Mulvaney has suggested that Trump may oppose the agreement unless he gets something in return — such as a repeal of former President Barack Obama’s health care law or funding of Trump’s promised wall on the U.S.-Mexico border.

The insurer payments will be stopped beginning this week, with sign-up season for subsidized private insurance set to start Nov. 1.

“The president is not going to continue to throw good money after bad, give $7 billion to insurance companies unless something changes about Obamacare that would justify it,” said Sen. Lindsey Graham, R-S.C., who golfed with Trump Saturday at the Trump National Golf Club in Sterling, Virginia.

“It’s got to be a good deal,” Graham said.

In his decision last week, Trump derided the $7 billion in subsidies as bailouts to insurers and indicated he was trying to pressure Democrats into negotiating an Obamacare repeal, a bid that repeatedly crashed in the GOP-run Senate this summer.

The subsidies are designed to lower out-of-pocket costs for insurers, which are required under Obama’s law to reduce poorer people’s expenses — about 6 million people. To recoup the lost money, carriers are likely to raise 2018 premiums for people buying their own health insurance policies.

Alexander and Murray have been seeking a deal that the Tennessee Republican has said would reinstate the payments for two years. In exchange, Alexander said, Republicans want “meaningful flexibility for states” to offer lower-cost insurance policies with less coverage than Obama’s law mandates

keep enhancing Quality management system

Eight deaths due to ‘seasonal flu’ in Oman, health guidance issued

Eight deaths due to 'seasonal flu' in Oman, health guidance issued.jpg

Muscat: The number of Influenza cases has dropped by almost a quarter compared to 2016, but the Ministry of Health has warned residents to

be vigilant as flu season approaches.

According to the latest report by the MoH, deaths as a result of influenza have reduced over the past three years, with 2017 season seeing eight cases of deaths so far compared to 2015 which recorded 25 deaths.

As a semi-tropical country, seasonal influenza viruses continue to appear throughout the year in the sultanate. The virus starts in early September and can continue until mid-May.

“In 2017, there were 952 cases until the tenth of October of influenza while 2016 saw 1492 cases of influenza,” the ministry said in a statement.

“The Sultanate has recorded 25 cases of deaths in 2015, six cases of deaths in 2016, and eight deaths in 2017, all linked to the flu and most of those cases were among the groups most at risk of high risk of complications of influenza. Despite the high number of cases, it is still within the normal range compared to previous years,” added the ministry.

 

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Flu vaccine: NHS patients wanted to test ‘universal’ jab

Flu vaccine NHS pa

Researchers are seeking about 500 NHS patients to try out a new “universal” vaccine against seasonal flu.

The experimental vaccine works differently from the one currently available, which has to be remade each year based on a “best guess” of what type of flu is likely to be about.

The new jab targets part of the virus that does not change each year.

This means the vaccine should work against human, bird and swine flu, say the team at University of Oxford.

It will offer people better protection, they believe.

Extra protection

Immunisation is the best defence we have against flu but it is not always effective.

Last winter’s vaccine cut the risk of flu in adults under the age of 65 by about 40%, but barely worked in people over 65, despite being a good match for the type of flu in circulation.

As people age, their immune systems are often weaker and their bodies may not respond as well to a vaccine as younger people’s bodies.

Prof Sarah Gilbert and colleagues believe that using their vaccine alongside the current one could help.

It is the world’s first widespread human testing of such a vaccine, according to the National Institute for Health Research, which is supporting the project.

 

Flu vaccine.jpg

Patients aged 65 or older and living in Berkshire and Oxfordshire will be invited to take part in the trial.

Half of the 500 volunteers will receive the usual seasonal flu jab and a placebo or dummy jab, while the other half with get the regular vaccine plus the new experimental one.

Read More: http://snip.ly/dqyht#http://www.bbc.com/news/health-41467097

Program for parents improves ADHD behaviors in young children

Program for parents improves ADHD beha

A program that focuses on strengthening parenting skills also improves symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in 3-8 year-olds, according to researchers at the at the University of North Carolina at Chapel Hill. FPG scientists completed a rigorous review of evidence that demonstrated the effectiveness of the “Incredible Years Basic Parent Program.”

“Prior research already has shown that this program improves behavior difficulties in young ,” said Desiree W. Murray, FPG’s associate director of research. “This review provides new evidence specifically about its effectiveness for ADHD symptoms.”

Murray explained that not only reported sustained improvements for their children’s ADHD behaviors, but also for their social skills and interactions with peers.

She said effective early intervention is crucial for young children with ADHD, due to the unfavorable short-term and long-term outcomes associated with the disorder.

“ADHD in preschoolers can bring conflict with family members, and it carries elevated risk of physical injuries and suspension or expulsion from child care settings,” Murray said. “Negative trajectories over time can include the development of other psychiatric disorders and difficulties with social adjustment.”

Previous studies have also shown that children with ADHD struggle academically, with lower test scores and higher risk of dropping out of high school.

“We can help to prevent the wide array of negative outcomes that are associated with ADHD,” Murray said. “We believe the most effective intervention approaches may be those that target preschoolers with symptoms of ADHD but who have not yet met the full criteria for diagnosis with ADHD.”

Murray and her team, which included FPG research scientist Doré R. LaForett and UNC doctoral student Jacqueline R. Lawrence, screened 258 studies and narrowed their list to 11 studies that met stringent criteria for rigor and methodology. The evidence—primarily parent reports—showed the effectiveness of the Incredible Years Basic Parent Program for ADHD behaviors in young children. The Journal of Emotional and Behavioral Disorders recently published the results of the team’s review.

The Incredible Years Basic Parent Program is designed for parents of high-risk children and those who display behavioral problems. It focuses on helping parents strengthen relationships with their children, providing praise and incentives, setting limits, establishing ground rules, and effectively addressing misbehavior.

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