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Obamacare and You

Affordable Care Act, Obamacare, Healthcare Costs

How will the Affordable Care Act, aka Obamacare, affect you?
How will the Affordable Care Act, aka Obamacare, affect you?

Just a few days before the Affordable Care Act, aka “Obamacare” is to be implemented in the quarter before the Jan. 1, 2014 deadline, the news hits us: the budget to fund Obamacare is threatened. Without funding, Americans may not be able to comply with the mandate to have health insurance by the first day of 2014 or risk a tax penalty.

Knowing whether or not Obamacare, mandated in 2010 by President Obama, will be funded only scratches the surface of questions regarding how the new healthcare mandate affects you. Whether you work for a corporation that already supplies a health insurance program or you are a self-employed or contracted employee in need of obtaining health insurance to avoid the tax penalty, it’s time to sort out your options and understand why in many cases you may be paying more for your insurance premiums than ever before.

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Being Responsible For Your Own Health Care

This is part one in a series of posts on the topic of being responsible for your own health care.

Did you notice: something has changed in the way we do medicine. While technology has given some great advances in the 21st century, one of the biggest changes in medicine has been occurring for some time, starting in the mid-20th century. What is that change? Making the client the central person in the healthcare sphere. The way people become healthy – and stay healthy – relies heavily on the client’s motivation to take responsibility for their own medical care. Here’s how you can become the central figure in your health care, and help your medical team help you!

What’s Up, Doc?
Before starting any job for the typical healthcare setting, most employers ask potential employees to supply proof of essential vaccines to protect the patient as well as the employee. When I needed access to my own medical records for immunizations, I called the clinic who would have those records, only to be informed that the records were offsite, archived in a warehouse. When the record was pulled, they verified that records going past 10 years were no longeer accessible. Unless you still possess your yellow, hand-written record of immunizations (now completed with a stamp), you might be out of luck.

Instead of asking the all-knowing physician, “What’s up, Doc?”, you can anticipate answering a more important question that your doctor should ask you: “What ails?” The more you know about what is working for you and what isn’t in regards to your health challenges, needs, problems, and successes, the more you can help your doctor help you. Your knowledge of your health status helps every person who assists you — the customer care representative of your HMO, the MA who takes your vitals, the RN who attends to your shots, minor procedures, and triage, your PCP, and your surgeon or specialist.

Personal Health Record (PHR)

I tend not to remember numbers as well as other kinds of content. Remembering the date of the last time I had an allergic reaction to a medication is harder than remembering the allergen (i.e. an antibiotic, such as sulfa). But do you remember your blood sugar readings from two years ago? Do you know your lowest number? Your highest? The one that made you feel the best? Do you remember the month and year your father or mother was diagnosed with skin cancer? How about the kind of anti-depressant your father positively responded (and that you might have a fair chance at also responding favorably)?

Introducing the concept of the PHP, or personal health record. Instead of your medical record staying in your doctor’s office or an archive, your health record is released directly to you, either on a chip, or in a computer application you can download and access at anytime because YOU set it up. Two companies, Microsoft and Google, both launched applications to encourage savvy consumers like yourself to manage their own health records. Google recently cancelled its program, advising users that it will shut down Google Health by January 2012. Microsoft’s HealthVault is welcoming all users to create an account to store your sensitive medical records for your own access.

And there are other PHR’s from a variety of perspectives. was created by three people when a brother of the founders was diagnosed with ALS. People find communities of others with similar conditions, learn from one another,and even post info on clinical trials of medications. WebMD’s PHR is another very popular PHR, with an impressive transparency about their privacy terms.

How does curating a PHR make you responsible for your own medical care? Because you’re in the driver’s seat. You have access to your medical record, anywhere. You can add additional information as you go, even if your doctor does not send you an update for weeks. You won’t have to deal with HIPAA (Health Insurance Portability and Accountability Act), which functions for the realm of HMO’s but not for a software company (though they have their own privacy TOUA (terms of use agreement) to protect your sensitive information from being misused). When you have access to your own records, you have knowledge at your fingertips. Knowledge is power. With power, you are response-able.

Don’t Want To Be Responsible?

There is always someone who doesn’t like this kind of shift. Why not drive our bodies into the doctor’s office and let all the workers service them like cars? I’d caution you against this mindset. The best medicine is a collaboration between patient and physician, between client and provider. Input in, input out; garbage in, garbage out. Medicine is usually only as good as the motivation of the client to be well and administer the follow up care with attention and dedication towards wellness.

If this kind of medicine seems repugnant to you, my best recommendation is to take the whole — the responsibility of shouldering your own health care — and take small steps toward educating yourself about your health. Start with writing things down. File what you write about your health in one folder, or on one software application or memo. Ask for help in organizing your notes, or try a PHR program such as HealthVault. You won’t have to memorize which asthma inhaler you responded well to, or what diabetes medication worked the best, if you take a more active role in writing down your responses, dosing times, activity levels, and other pieces of information you are privvy to in a way no provider can ever be.

We are approaching 2012 with lightning speed. You decide if it’s time to become more responsible for your own health care and wellness. Once you make that decision, everything can change. Here’s to you, and a healthier 2012!

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How To Find Good Health Care Advice

The Internet busily buzzed when the cancer arm of the WHO (World Health Organization) recently went on record to say there is a “possible” carcinogenic link between mobile phones and brain cancer in humans. While the report puts cell phones in the same category as the pesticide DDT and gasoline engine fumes, the kerfuffle about such reports highlights a problem I encounter often with my clients, friends, and other Social Media savvy people: when there are many voices speaking at once, and all have supposed or assumed authority, how do you find good healthcare advice?

You have a suspicious mole. How can you get reliable information about it before you go to your doctor's office?

The answer to how one goes about finding good healthcare advice depends on your resources and the urgency of your healthcare issue. First of all, I think it’s fantastic if you take the time to know as much about what is going on with your health issue as possible. Writing down notes such as onset of symptoms, reactions, any treatments you’ve tried, and any history surrounding the issue that might be relevant may be very helpful in your search options.

Here are some practical tips for starting your search for sound advice:

1. Triage the problem for its urgency. If you have trouble breathing, have uncontrolled bleeding, heart pain (angina), or someone you are trying to assist loses consciousness, these are all situations where looking up information on the Internet about what is happening are not helpful. Time is of the essence. Call an emergency number such as 911 or your local hospital or fire department.

If you are trying to help someone who is suicidal, there are specific crisis hotlines available 24/7. You an Google your local crisis line number by entering in the keywords, “crisis line” ,and the name of your city. Suicide hotline numbers can also be found by searching “suicide hotline” and the name of your city. The great thing about this is if a friend is in another city and mentions to you that she’s feeling suicidal, you can help by giving her that number and urging her to call while you stay on the computer or phone with her. It truly is the next best thing to being there.

2. For non-urgent but critical issues, turn to your smartphone or computer for help. Some of the best help is available at your fingertips by using your browser to search for everything from signs of pregnancy to moderate allergic reactions to medications. However, some medical advice is better than others. The best are usually attached to places like WebMD or MayoClinic, and articles there are listed with the author and his/her credentials, or links to reputable medical and mental health websites.

Don’t rely on programs like Yahoo! Answers for medical advice, especially if the answers are made anonymously. If you must ask questions on these sites, understand that you get what you pay for (and you aren’t paying anything). Crowd sourcing for answers is a new and novel way to find out the opinions of others, but you probably don’t want to put your urgent medical question up to a vote.

3. Search online newspapers with a healthcare section, and do word searches within the newspaper itself. These newspapers (like CNN) post articles from reputable doctors who stand by their word with their own professional licenses to practice. Their work is researched, and they are often well-published enough to hold credibility in the medical community.

Suppose you want to know more about the practices of doctors who use cellphones. You can search CNN’s health section for Dr. Gupta‘s article describing why he does not hold his cell phone to his ear, and why he has chosen to use a wired earpiece. While his post is his personal opinion, his article presents his thought process on his personal decision, allowing the reader to weigh in on the same research that guided his decision.

4. Pick up your phone and call your health insurance’s hotline. If you work for a large company, chances are you have been given the number for a nurse on call 24/7 for your healthcare questions from diet and exercise to crisis-oriented situations. Some small company insurance plans include a call line for questions of a non-urgent nature.

While we’re on the topic of calling a hotline, many hospitals have an telephonic triage nurse call center that takes your calls and helps determine if you need emergency care, and what kind of care you need even if you don’t need to visit a hospital. Recently, I visited one in the Renton, WA area. The entire room is outfitted with new computers and phones, and the latest triage decision tree software applications. Several nurses, a floating nurse supervisor, and a physician are available for more challenging client calls.

5. If you need professional mental health help, it’s only a phone call or Google search away. I cannot reiterate how thankful my clients have been that I offer some of my services online and by phone. Recently, a friend mentioned how phone counseling sessions helped her through a difficult time, and she chose a therapist over the phone versus meeting with a therapist F2F. This can be really helpful after you’ve done some reading, you’ve bounced thoughts off of trusted friends, and you still feel stuck with whatever you’re dealing with, but F2F therapy isn’t going to work for you for a variety of reasons (cost, convenience, availability and scheduling, commute, etc). This is not surprising news. An article posted online in Psychology Today cited a 2008 launch of a depression treatment program in Japan accessed over a mobile phone, with a drop out rate significantly less than that of F2F psychotherapy. While the article did not state all the factors that reduced the drop out rate (and the link posted went to the 2008 journal that would require me to plunk down some cold hard cash to access information that is now at least three years old), it appears safe to conclude that teletherapy and therapy provided by through the Internet by trained helping professionals are an effective way of providing depression treatment to those who seek it, and it may provide higher compliancy for the treatment time required to see an improvement in mood.

And is there anything you don’t want to be doing when looking for healthcare advice online?

The major thing you don’t want to be doing is self-diagnosis. Even doctors themselves are not allowed to write their own prescriptions for their diagnosed conditions; they also have to submit themselves under the care of another physician or psychiatrist, nurse or therapist. I see this as a good thing.

When you have a troubling, chronic, or fairly new health condition, it’s good to go into the search for answers with a fairly open mind about treatment options. I’m not saying that everyone is going to be miraculously cured by sound treatment using bells and gongs, but then again, many cancer patients and those experiencing long-term illness have received benefit from sound treatment. Consult an expert. Get a proper diagnosis, where possible, and if there is some question to the diagnosis, ask for a second outside opinion. Read up on the lastest research. In essence, knowledge is more than power; it’s empowerment.