Medicare Advantage is an all-in-one managed care plan, typically an HMO or PPO. Advantage plans provide the benefits of Part A and B, and most also include Part D, or prescription drug coverage. Some offer extra benefits not available through Original Medicare, such as fitness classes or vision and dental care.
If you opt for Medicare Advantage, you typically continue to pay your Part B premium as usual, but you will pay little or no additional premiums for your coverage. You generally have copays or coinsurance, but once you reach your out-of-pocket limit, the plan will pay 100 percent of your medical costs covered under Medicare for the rest of the year. The out-of-pocket limit does not apply to prescription drugs or extra benefits.
To keep premiums low, Advantage plans generally require you to get your care from a network of doctors, hospitals, and other providers, and you typically need pre-authorization for specialized care.
Joseph Allen, the “air investigator”, was apparently on board early in the COVID-19 epidemic, stressing the importance of suspended air particulates, less than 2 microns in size, causing transmission of the disease.
His article in Science: “clean indoor air will improve human health and cognition” is well worth reading, or at least inspecting the info graphic. As a practicing allergist, I was aware that inside dust mite particles and mold spores made allergies worse. We had a service where we would go into homes and sample the air. An excess of certain Indoor mold spores, compared with those outside, would indicate a “problem home”. We would then try to find the water leakage source that produced the molds.
I also had a patient who could not tolerate a new house, with its carpets and other artificial materials. The only place where she felt better was in an old seaside house 100 miles south of San Francisco. I thought there were some psychological factors, but who knows? Volatile organic compounds, VOCs, probably affect some people more severely.
Beginning shortly after the energy crisis in the 80s, the “sick building syndrome”, characterized by headache and fatigue in certain buildings, was on the news. The eventual solution was to create better ventilation, with a reduction of CO2 and VOCs in those buildings. In addition, federal agencies began banning certain artificial fabrics that out-gassed VOCs.
There was eventually less talk about sick building syndrome, except for the occasional air system which was contaminated with Legionella bacteria.
The present article stresses accumulation of CO2 and VOCs In the stale air in the individual home or office as a cause of diminished attention and productivity.
CO2 monitors still cost about $200, and so I think I am going to just try to increase the ventilation in my office, where I get sleepy in the afternoon, by opening the windows and sliding doors. I wonder about the indoor CO2 in Scandinavian winters, where depression is increased.
PTSD, post traumatic stress disorder, has been increasingly recognized by the medical community, and was admitted to the status of a psychiatric disorder in 1980. It was first recognized as “shell shock” in combat soldiers.
The movie, “Patton”, featured one such case; abusive behavior of a soldier by Patton hit the newspapers, and he was sidelined for the start of “ operation overlord“. Since the majority of soldiers were not incapacitated , Patton thought the soldier was cowardly.
As an allergist, I was sent one case of PTSD; Believe it or not, the referring physician thought it might be an “allergy”, so little was it understood.
Now, memory consolidation is considered to be one of its dimensions. An incompletely consolidated memory allows flashbacks to be considered the real thing.
PTSD is partly under genetic control, since identical twins are more more likely to experience the condition. Anxiety and other psychiatric problems such as depression and substance abuse can be associated. Women are more likely to experience it. Individuals with low cortisol, elevated norepinephrine or a small amygdala or more likely to develop PTSD. Even children can be involved if they have been abused physically.
Any kind of a frightening experience, especially sexual, can be a cause. Symptoms can include recurrent distressing memories, flashbacks, or nightmares of the traumatic event, or emotional distress and anxiety on exposure to a similar experience.
Treatment can include medication for depression, but benzodiazepines should be avoided. Cognitive behavioral therapy has enjoyed some success, but treatment is generally difficult. Please consult the attached Cleveland clinic article for more information.
Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.
Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.
Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.
Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.
Please refer to the DWWR Posting on “concierge doctors” for my rant on the current healthcare system, which I will not repeat.
The truth is more nuanced. All countries are having trouble of one sort or another with their healthcare systems. This is due to the inherent expense of today’s top flight medicine. The very best care requires costly high technology and drugs that are intrinsically hard to produce. And you have to know where to look. I am very thankful for my medical degree, and that I have kept up with current advances.
You would probably need a Government entirely of physicians to develop the willpower to do something for health, which always starts with PREVENTATIVE MEDICINE, A hard sell, given that you must spend money and effort to block something which will probably, but may not always, occur.
There is low hanging fruit. Why are sugary drinks not heavily taxed, since they produce obesity which causes a lot of costly medical disorders, such as diabetes, inflammatory diseases, and cancer, but not everybody all the time?
Why is efficiency of telehealth not more widely embraced, but stymied by moneymaking lobbiests and lawyer powered difficulties, in addition to Patient’s and doctor’s old habits?
And then there are the jealously guarded American freedoms to do stupid things, such as avoid vaccines and masks, even in a prodigiously expensive and dangerous Covid epidemic.
Given human nature, a complete solution would seem to be impossible, and we should content ourselves with minor victories wherever they can be attained.
Embrace sleep, diet, and exercise, and KEEP HEALTHY.
Across the country, states are shelling out incentives ranging from free beer to $1 million lotteries to encourage residents to get their Covid-19 shots. But is the effort to boost vaccination rates working? And is it worth the cost? Photo composite: Adam Falk/The Wall Street Journal
Timing is important in everything we do, and of course is important to health and how our bodies function. It is a vast subject, and the only thing I can do here is to give you some ideas that might be helpful.
Your body will perform best for you if you have a daily routine; waking up at the same time every morning, and going to bed at the same time every evening keeps your circadian rhythm from getting confused. Of course, getting a good nights sleep is excessively important to your health. If you have trouble going to sleep at night or staying asleep, you can get all kinds of information over the Internet on “sleep hygiene”.
If you are an international traveler, jet lag is very important because the circadian rhythm is disrupted when you change time zones. The Internet is a rich source of information on how you might or rapidly get back into your routines. Timing of bright light and melatonin are involved.
Your metabolism also has a routine, and drugs work by targeting certain receptors, which cycle, depending on when their function is needed. “ Chronopharmacology” is a slowly developing science that will someday-if doctors, perhaps with electronic help, can ever get enough time to properly take care of the patients- be very important. As an example, certain cancer therapies vary significantly in their effects, depending upon the time of day they are given.
When I was a practicing Allergist, I took care of many Asthma patients. In the 60s and 70s there were few drugs to treat asthma, which is predominantly a nighttime disease. Giving medications, such as Theophylline, at the right time was therefore very important.
Finally, if you have any choice, you might arrange for your surgery during the first half of the day. Surgeons make less errors in the morning, when their minds are well rested.
Empowering Patients Through Education And Telemedicine