So what will Obamacare cover?

Here I thought Obamacare would just cover abortions and euthanasia.  (Kidding!)

It is among the health-care law’s most important — and most daunting — questions: What health-care benefits are absolutely essential?

California legislators say acupuncture makes the cut. Michigan regulators would include chiropractic services. Oregon officials would leave both of those benefits on the cutting-room floor. Colorado has deemed pre-vacation visits to travel clinics necessary, while leaving costly fertility treatments out of its preliminary package.

Policy experts expected the Affordable Care Act to establish a basic set of health benefits for the nation, but the Obama administration instead empowered each state to devise its own list. When all Americans are required to purchase health insurance in 2014 or pay a penalty, they will find that the plans reflect the social and political priorities of wherever they live.

That nationwide patchwork highlights the difficulty of agreeing on what constitutes good basic health care, as well as the tricky balances that states face in weighing coverage vs. cost.

“I want a benefit package that gives people viable protection but not necessarily a Mercedes,” said Arkansas Insurance Commissioner Jay Bradford, who is still deciding what options to pick for his state.

If insurance plans cover too much, premiums could become prohibitively expensive. But if they skimp on coverage, the states could fail to deliver on the health law’s basic promise: extending quality health coverage to 30 million Americans.

States do have guidelines to work within: They must cover 10 broad categories outlined in the Affordable Care Act, including doctor visits, maternity care and prescription drugs. They also must use an existing health-insurance policy as a template, such as a small-group plan or the package for state employees.

Eleven states have settled on packages of essential health benefits or are close to doing so, according to the consulting firm Avalere Health. Twenty others are still in the process of choosing a plan.

While benefits for hospital care and doctor visits tend to look similar, coverage for alternative medicine and mental health services varies widely.

via Is acupuncture essential health care? Weight-loss surgery? Under Obamacare, states choose.

So some states will pay for fertility treatments, stomach-reduction surgery, and other elective procedures and some won’t.  (I wonder if my cataract surgery would have been covered.  I think I’d hesitate to make a claim for fear of getting the attention of the death panels.  [Kidding!])

Here are the ten areas that must be covered:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management, and
  10. Pediatric services, including oral and vision care

So dental and vision will be covered for children, but not for adults.  Presumably, health insurance plans at work can still offer those and other benefits.  The question is whether the Obamacare mandates will have a flattening effect on insurance offerings.

A big problem with Obamacare is that it’s so complicated and no one knows what it will really do.

But now I see

Things have hard edges.  The leaves on a tree are distinct from each other.  Each pieces of gravel on a path is separate from the others.  Faces in a crowd don’t blur together.  Who knew?

Those who think there are no boundaries between right and wrong, true and false, beautiful and ugly; the blurrers of distinctions; those who think there are only shades of grey; the Hindu sages and New Age gurus who think “all is one”–these people are not just making philosophical errors.  They just need cataract surgery!

Back under the knife

Having completed several weeks of recovery from cataract surgery, we do it all again starting today, as my left eye gets operated on.

Despite the forced inactivity, I was able to keep the blog going pretty well, so I hope can do the same this time.  This eye, though, will be corrected for near vision–the other one was for distant vision–so this operation may affect me more in reading and blogging, at least for a few days until the vision stabilizes.  When that happens, I should see really well in both eyes.  But if I’m not able to blog at my normal pace, you’ll know what has happened.

The plan, after taking out the cataracts, is to put in new artificial lenses that will correct my vision so that I might not even need glasses.   But it will work like this:   My right eye will be for distant vision. My left eye will be for near vision.  My brain supposedly will work the board, cutting from one camera/eye to the other.  This is called “monovision,” and I’m told that quite a few people with contact lenses have this arrangement.

But isn’t “stereo” better than “mono”?  If I just use one eye at a time, won’t that throw off my depth perception?  Will I be able to see 3-D movies?  If not, I don’t really mind, since I have never seen 3-D effects in a movie that I liked, with the exception of the Michael Jackson short film at Disneyland, and this will save me a lot of money in extra ticket prices.  But I’d sort of like to see 3-D effects in real life.

Would glasses let me use both eyes together?  I haven’t been wearing them since the first surgery since the prescription isn’t valid anymore, and I realize that I feel weird not wearing the things.  I actually like wearing glasses.  I hate to give them up, especially since the styles I first wore in 7th grade have finally come back in fashion and are defined as “hipster” frames.

I know, I know, I should have asked my doctor about all of this, but I always want to get out of the doctor’s office as soon as possible.

Cataracts

Things started looking kind of blurry, so I figured it was time for some new glasses.  It turns out, I have cataracts!  I have surgery this morning.

I had assumed that they just peel the cloudy film off.  It turns out that they take out the lens inside the eye.  But then, these days, they replace it with a lens implant that actually corrects vision!  The doctor told me that after all of this is over I might not even need glasses!  Which would be for the first time since around seventh grade.  I am astounded and kind of excited about it.

The operation is reportedly no big deal to go through, nothing to worry about.  My only concern is my vision between the first surgery and when it is all over–three weeks later, they’ll do my other eye, and then it takes a few more weeks to heal and for the brain to get used to the new optic signals–so I may have some visual limitations for a month or more.

I’m thinking that after today I’ll have one really good eye, adept at distant vision, but my other eye will still be bad and my glasses will be useless.  Will I be able to read?  Fool with the computer?  Later my other eye will get a new lens for close vision and all will be well.  (Realistically, I might need glasses for reading, though those reading glasses you buy at the drug store may be all I’ll need.)  But what to do until then?

I’m pretty sure I’ll find a way to function.  I’m not supposed to do anything for a couple days after the procedure, which I’m looking forward to also, an enforced rest without guilt.  I’ll probably keep up the blog–that surely doesn’t count as “anything”–though I might have trouble seeing for a day or two.  So if I miss some days of posting, you’ll know why.

Antibiotic woes

In today’s scientific livestock industry, cattle are often given antibiotics. Not as medicine but “to fatten them up.”  Apparently the drugs kill beneficent bacteria in the animal’s digestive system that causes them to put on weight.  Now the light has dawned in the minds of some medical researchers.  Could the heavy use of antibiotics among human beings be a factor in our obesity problems?  Are we fattening ourselves up like drugged cattle in a feed lot?  See Early use of antibiotics linked to obesity, research finds – The Washington Post.

In other antibiotic news, a “superbug“–a strain of bacteria completely resistant to all known antibiotics killed six people at the National Institute of Health’s Clinical Center.  The linked article estimates that 6% of American hospitals are infested with this thing.  (This doesn’t seem to be a case of what scientists have been worried about, bacteria that have developed a resistance to antibiotics because of their overuse and evolved into something that cannot be killed.  [That wouldn't be evolution, by the way, just natural selection, which I don't think anyone denies.  Faster animals outrun predators, animals adapt, and the fittest do survive.  What Darwin did was insist that natural selection eventually turns one species into another.]  Anyway, this superbug is normally one of those friendly bacteria that inhabits our bodies, but when a person’s immune system goes wrong, it turns into a monster.

The great soda grants

George Will describes how a stimulus program that became part of Obamacare shelled out millions of dollars worth of grants to lobby lawmakers against soft drinks:

Because nothing is as immortal as a temporary government program, Communities Putting Prevention to Work (CPPW), a creature of the stimulus, was folded into the Patient Protection and Affordable Care Act of 2010, a.k.a. Obamacare. And the Centers for Disease Control and Prevention (CDC), working through the CPPW, disbursed money to 25 states to fight, among other things, the scourge of soda pop.

In Cook County, Ill., according to an official report, recipients using some of a $16 million CDC grant “educated policymakers on link between SSBs [sugar-sweetened beverages] and obesity, economic impact of an SSB tax, and importance of investing revenue into prevention.” According to a Philadelphia city Web site, a $15 million CDC grant funded efforts to “campaign” for a “two-cent per ounce excise tax” on SSBs. In California, an official report says that a $2.2 million CDC grant for obesity prevention funded “training for grantees on media advocacy” against SSBs. A New York report says that a $3 million grant was used to “educate leaders and decision-makers about, and promote the effective implementation of . . . a tax to substantially increase the price of beverages containing caloric sweetener.” The Rhode Island Department of Health used a $3 million grant for “educating key decision-makers to serve as champions of specific . . . pricing and procurement strategies to reduce consumption of” SSBs. In government-speak, “educating” is synonymous with “lobbying.”

Clearly some of the $230 million in CDC/CPPW anti-obesity grants was spent in violation of the law, which prohibits the use of federal funds “to influence in any manner . . . an official of any government, to favor, adopt, or oppose, by vote or otherwise, any legislation, law, ratification, policy, or appropriation.” But leaving legality aside, is such “nutrition activism” effective? . . .

Research indicates that overweight individuals have “reasonably close” to accurate estimates of the increased health risks and decreased life expectancy associated with obesity. Hence the weakness of mandated information as a modifier of behavior. A study conducted after New York City mandated posting calorie counts in restaurant chains concluded that, while 28 percent of patrons said the information influenced their choices, researchers could not detect a change in calories purchased after the law.

Other research findings include: A study of nearly 20,000 students from kindergarten through eighth grade found that among those with easy access to high-calorie snacks in schools, 35.5 percent were overweight — compared with 34.8 percent of children in schools without such snacks. Nutrition policy is replicating a familiar pattern: Increased taxes on alcohol and tobacco mostly decrease consumption by light users, not the heavy users who are the social problem and whose demand is relatively inelastic.

The robust market in diet books, weight-loss centers, exercise equipment, athletic clubs, health foods — between 1987 and 2004, 35,272 new food products were labeled “no fat” or “low fat” — refutes the theory that there is some “market failure” government must correct. But as long as there are bureaucrats who consider themselves completely rational and informed, there will be policies to substitute government supervision of individuals for individuals’ personal responsibility.

As the soft paternalism of incentives fails, there will be increasing resort to the hard paternalism of mandates and proscriptions. Hence the increasing need to supervise our supervisors, the government.

via George Will: Why government needs a diet – The Washington Post.

Another thing, besides it being illegal for the government to fund efforts to lobby the government.  Who is getting these grants, and how are they spending that $15 million?  Educating  policymakers should require some handouts, a PowerPoint set up, and maybe some coffee and doughnuts.  How could that cost $15 million?


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