Sunday, 15 May 2016

Princess Health and  Rogers says House Republicans want $622 million for Zika; McConnell, Senate plan $1.1 billion; Obama wants $1.9 billion. Princessiccia

Princess Health and Rogers says House Republicans want $622 million for Zika; McConnell, Senate plan $1.1 billion; Obama wants $1.9 billion. Princessiccia

UPDATE, May 16: The Republican package totals $622 million. May 17: Obama calls that "woefully inadequate," says he would veto it.

House Republicans' funding to fight the Zika virus will be about half the $1.9 billion President Obama requested, but still "adequate," U.S. Rep. Hal Rogers of Kentucky's Fifth District, chair of the House Appropriations Committee, said Friday.

Dierdre Walsh and Ted Barrett report for CNN, "Ever since they sent the request to Capitol Hill, the White House has complained that Republicans are ignoring a public health crisis and need to sign off on more money soon, especially before the potential risks from the mosquito-borne virus increase with the summer months."
    Rogers told reporters the bill he plans to introduce Monday will provide "less than a billion" for Zika but will be "adequate funding to face the problem." Also, "the money will be targeted for agencies to spend right away," Walsh and Barrett report. Rogers said the House could vote on the bill as early as Wednesday, May 18.

    "Rogers and other congressional Republicans said they hadn't acted before now because the Obama administration wasn't giving Congress the details on how they would spend" the money, CNN reports, "and they were working through their own analysis on how much the various agencies needed to deal with the immediate needs. House conservatives also demanded that any new money for Zika needs to be paid for with cuts to other programs."

    His bill is "fully offset" with cuts, Rogers said, but he declined to say where, "saying his committee was still finalizing those details," CNN reports. "But the White House and congressional Democrats argue in these cases Congress doesn't traditionally specify cuts to pay for additional funding. An unnamed Democratic aide on the appropriations staff told the network, "We don't offset emergency funding, period. And this is the definition of a public health emergency."

    Meanwhile, Senate Majority Leader Mitch McConnell, R-Ky., and Democrats in that chamber "worked out a bipartisan $1.1 billion Zika proposal that they plan to attach to a separate spending bill" and scheduled it for a vote Tuesday, May 17, CNN reports. "The Senate will also vote on two competing proposals -- one from the two Florida senators, Bill Nelson, a Democrat, and Marco Rubio, a Republican. It would fully fund the President's request. The second is from Sen. John Cornyn, R-Texas, that would provide about $1 billion and be offset with cuts elsewhere. Those last two proposals are not expected to pass."
    Princess Health and  Air ambulances save lives in rural Kentucky, but are costly; Junction City buys Air Evac memberships for everyone in town. Princessiccia

    Princess Health and Air ambulances save lives in rural Kentucky, but are costly; Junction City buys Air Evac memberships for everyone in town. Princessiccia

    Medical helicopters are especially important to rural Kentucky because they get people to the medical care they need quickly, but this service comes at a cost that many can't afford, Miranda Combs reports for WKYT.

    Air Evac Program Director Donald Hare told WKYT that "the average cost of a flight is around $32,000 and insurance pays, on average, $8,000 and $12,000 of that cost," Combs writes.

    "About 14 to 16 percent of our flights are people with no insurance whatsoever and don't have the ability to pay for that flight," Hare said, noting that they try to work with people to set up a payment plan in this situation.

    Jim Douglas, the mayor of Junction City, told Combs that his city council has decided to buy memberships with Air Evac Lifeteam, which has a hub in the Danville Airport, for everyone in the city to cover them if they need to use the service. He said more than 60 people were flown out of Boyle County on a medical helicopter last year.

    "It could be a lifesaving thing," Douglas told Combs, and said it will "cost the city just under $12,000," Combs writes. And while he said he fully expected some people to use the service for non-emergency reasons, he asked,  "But who's to make the call? I wouldn't want to."

    Michael Bentley, a paramedic, assured WKYT that most of their transfers are emergencies.

    "We generally get called out to the sickest of the sick patients. We're generally not going out to 'Joe that stubbed his toe on the refrigerator at home.' Our patients are major trauma type patients or cardiac events that have happened to these patients," Bentley told WKYT.

    Adam Tubbs, an EMT in Nicholas County, told Combs that medical flights were important because it takes "precious time by ground to get to an emergency call" in such a large rural county. He noted that, on average, they call for air ambulances several times a week. The Nicholas County Hospital closed more than one year ago.

    The cost of these air transports has become such a problem that Rep. Tom McKee, D-Cynthiana, filed a bill during the last legislative session calling for a study of air-ambulance charges. The bill passed out of the House, but did not make it out of committee in the Senate.
    Princess Health and New Jersey Confidential: the Almost Secret Membership of the RWJ Barnabas Health Board. Princessiccia

    Princess Health and New Jersey Confidential: the Almost Secret Membership of the RWJ Barnabas Health Board. Princessiccia

    A Hospital System Tries to Hide its Board of Trustees

    The US Internal Revenue Service mandates disclosure of the membership of boards of trustees of non-profit corporations.  Nonetheless, as reported by New Brunswick (NJ) Today, the leadership of the newly formed RWJ Barnabas Health system has been doing their best to keep the membership of its board of trustees secret.

    The new organization created to function as the state's largest hospital chain is refusing to tell the public who serves on their Board of Trustees,...

    To elaborate,

    The two hospital networks officially combined to form a new conglomerate, the state's second largest employer, in a deal that was finalized on March 31.

    But since then, the new group has refused to identify its board members, after stalling for nearly two weeks.

    'Thank you very much for your interest. It is a policy at RWJBarnabas Health not to share the names of the Board of Trustees" read a peculiar April 12 email response from an anonymous address affiliated with Barnabas, B4@barnabashealth.org.

    The anonymous email address has not responded to follow up inquiries from this newspaper, including one urging them to make the 'smart choice' and 'be transparent.'

    This goes against at least the spirit of the law.

    'If the organization has been recognized by the IRS as tax-exempt under one of the subsections under 501(c), there are a number of documents that organizations must make available that would include board lists,' said the leader of the Center for Non-profits.

    The initial application, and the three most recent annual filings, must be made available for inspection or copying by members of the public at their place of business, according to the IRS.

    In general, any organization that files a Form 990... must make its three most recent Form 990's and its Form 1023 available for public inspection without charge at its principal place of business,' reads the Center's website.

    'All parts of the return, schedules and attachments must be made available during regular business hours at the organization's principal office and at any regional offices having 3 or more employees.

    There is an exception to the requirement if a non-profit chooses to make the documents widely available by posting them on the internet.

    The anonymous email address that cited the policy of having a secret board, and the media contacts listed on the press release announcing the merger between RWJ and Barnabas, have not responded to questions about whether their healthcare organization is in compliance with the IRS rules regarding making the forms available to the public.
    This obviously also is a remarkable rebuff to those in health care who advocate maximum transparency.

    A Futile Attempt at Secrecy

    Some good investigative reporting by New Brunswick Today penetrated the flimsy veil set up by hospital system leadership. The system chairman turns out to be one Jack Morris:

    Documents provided by the NJ Department of Treasury show that controversial developer Jack Morris was made the Chairman of the RWJ Barnabas board.

    Morris is a close friend and ally of former State Senate President and convicted felon John Lynch, Jr., who ruled New Brunswick as Mayor from 1978-1990, and some contend still is a key player in statewide politics.

    Morris had previously served as Chairman of the Robert Wood Johnson University Hospital (RWJUH) Board of Directors. Morris is also tied to Cooper Hospital Chairman George Norcross, the state's most notorious unelected political boss.

    The vice-chairman is actually Marc Benson.

    another real estate mogul was named the RWJ Barnabas board's Vice Chair, according to the documents, which were filed with the State Treasurer in November 2015, nearly half a year before the merger was finalized.

    Marc Berson founded the Millburn-based 'Fidelco Group' in 1981, a 'private investment owner-developer of residential, commercial, retail, and industrial properties in New York, New Jersey, Florida and Ohio,' according to a press release announcing his election as Chairman of the Barnabas Health Systems board in 2014.

    As for the rest of the board, they are,

    The other 18 secret board members are:

    Robert L. Barchi, (Rutgers University, New Brunswick)
     James C. Salwitz, MD (Robert Wood Johnson University Hospital, New Brunswick)
    Murdo Gordon (Bristol-Myers-Squibb, Princeton)
    Susan Reinhard (AARP Public Policy Institute, Washington, DC)
    Nicholas J. Valerani (West Health Institute, La Jolla, CA)
    John A. Hoffman (Wilentz, Goldman, & Spitzer, Woodbridge)
    Alan E. Davis, Greenbaum (Rowe, Smith & Davis LLP)
    Robert E. Margulies, Esq. (Margulies Wind, Jersey City)
    Kenneth A. Rosen (Lowenstein Sandler PC, Roseland)
     Lester J. Owens (J.P. Morgan Chase, New York, NY)
    James Vaccaro (Manasquan Savings Bank, Wall)
    Albert R. Gamper, Jr. (Caliber Home Loans, Inc., Far Hills)
    Anne Evans-Estabrook (Elberon Development Corporation)
    Gary Lotano (Lotano Development, Inc., Toms River)
    Steve B. Kalafer (Flemington Car and Truck Country, Flemington)
    Brian P. Leddy (former Chairman of RWJUH Rahway, Cranford)
    Joseph Mauriello (formerly of KPMG, Chester)
    Richard J. Kogan (formerly of Schering-Plough Products, Inc., Short Hills)
    Why the Futile Effort to Make Board Membership Secret?

    It is certainly striking that a big non-profit hospital system would try to conceal the membership of its board of trustees.  One might think the leadership should be proud of the board members, and the board members would be happy to advertise their community service.

    This did not seem to be the case here.  Once more we see how the new overlords of health care reflexively seem to choose secrecy over transparency, deliberately creating the anechoic effect which we have frequently discussed.

    Perhaps the board wanted to avoid undue attention to the political connections of its new chairman, one of which  was to a"convicted felon," and another of which was to Mr Norcross, whose apparent conflicts of interest in his role in the governance of a former UMDNJ hospital were discussed here. Parenthetically, an article in NJ.com on the merger noted that this new hospital system is a descendant of the now dissolved University of Medicine and Dentistry of New Jersey, UMDNJ (look here), an organization whose extensive troubles kept Health Care Renewal very busy in past years.

    Perusing the list of the members of the board reveals two people with pharmaceutical connections that could be conflicts of interest, a few people with health care affiliations, but no obvious affinity for the patients and public in New Jersey whom the new hospital system is supposed to serve, and many lawyers and business people with no obvious affinity for the values of health care professionals.

    However, as summarized by the National Council for Nonprofits,

    the board of directors have three primary legal duties known as the 'duty of care,' 'duty of loyalty,' and 'duty of obedience.'

    ...

    In sum, these legal duties require that nonprofit board members:

    Take care of the nonprofit by ensuring prudent use of all assets, including facility, people, and good will; and provide oversight for all activities that advance the nonprofit�s effectiveness and sustainability. (legal 'Duty of due care')

    Make decisions in the best interest of the nonprofit corporation; not in his or her self-interest. (legal Duty of loyalty')

    Ensure that the nonprofit obeys applicable laws and acts in accordance with ethical practices; that the nonprofit adheres to its stated corporate purposes, and that its activities advance its mission. (legal 'Duty of obedience')

    So it is not obvious that these board members are particularly familiar with the nuances of the mission of a large academic hospital system, which includes delivering excellent patient care that puts individual patients first, particularly ahead of board members' self interest, and of its academic role, seeking and disseminating the truth.  One wonders what sort of governance this sort of board will provide.  Maybe the hospital leadership wanted to forestall such questions by keeping board membership as obscure as possible.

    Speaking of the anechoic effect, while the new RWJ Barnabas Health system will be a very major player in NJ health care, and while trying to keep the board members of a non-profit health care system is rather a remarkable action, so far, only one local newspaper, and now your humble blogger seem interested.  This is yet another example of the anechoic effect.

    Comments

    We have been writing now for a long time about the tremendous and growing dysfunction of US health care.  Some now obvious reasons for its problems are poor leadership of ever larger and more powerful health care organizations, and failure of existing governance bidues to exercise stewardship over these organizations.  We have discussed numerous previous problems with boards of trustees of non-profit health care organizations here.  We have noted that board member may have conflicts of interest, and are often rich business executives who may be more interested in preserving the power and wealth of their fellow executives, including those generic managers who know often run large health care organizations, than defending vulnerable patients.  These problems are compounded by the anechoic effect: information and opinions which might offend those currently in power and who stand to benefit most from the current system is kept very quiet, treated as a taboo subject, that is, made to have no echoes.  This new case again suggests that these problems are not going away.

    How many times must we say this?....   True US health care reform would vastly increase transparency, not just of prices, but of leadership and governance.  True US health care reform would put the operation of US health care organizations more in the hands of people who have knowledge and experience in health care, and are willing to be transparent and accountable to support health care professionals' values.  Furthermore, oversight and stewardship of these organizations should represent the patients and public which the organizations are supposed to serve. 


    Saturday, 14 May 2016

    Princess Health and  May 14th, 2016 Short Questions-Long Replies. Princessiccia

    Princess Health and May 14th, 2016 Short Questions-Long Replies. Princessiccia

    May 14th, 2016 Short Questions-Long Replies

    Before I recap this day, I'm starting tonight's edition with a few great questions:

    Lori asked:
    "Have you ever gone over your calorie limit and do you plan ahead?"

    Reply:
    Great question about the calorie budget! I'm sure I've gone over before--BUT, not intentionally. I use a digital food scale at home and work and that gives me accuracy 85% of the time-- when I'm out at a restaurant, I'm relying on my experience in weighing everything to guide me through the best approx.amounts... Room for error? Certainly, but it's super close. I often test my perception at home and work by giving my best guesstimate prior to weighing things--and most of the time it's super close, if not spot on. I've nailed it, many times! With my #lastfoodofday, I enter the food in MFP to determine the amount I need to hit goal--then I prepare accordingly.

    For me, it's very important to enter the food in MFP PRIOR to eating--during preparation or during some kind of pre-planning time (most of the time I do the entry just prior to eating). A few times, I've waited on the entry until after--and was surprised by a super high count.

    Here's the most important point: Maintaining the integrity of my calorie budget is super important, always--not because I'm worried about the physical consequences of a couple hundred extra calories--in most cases, a little bit over isn't going to make a big difference...physically. BUT--It makes a HUGE difference mentally. If I disregard the importance of maintaining my budget's integrity--then I'm starting something of a progressive weakening of my entire plan. It's the slippery slope thing...

    If I intentionally violate the budget once, it would be easier and easier to justify doing it again and again. I find myself in a hard earned and very fortunate position. My metabolism works more efficiently now than ever before, so my maintenance mode budget is a generous 2300. However, maintaining its integrity is still just as important as it was at 1700, during weight loss mode. And if I need a higher budget--I must officially set it higher, otherwise, from a mental dynamic perspective, the budget must be held in the highest--And if it isn't, I will relapse/regain, period.

    Caryl asked:
    "I really enjoy reading your blog. What was your motivation to start one? Was it to keep yourself more accountable or to reach out to others?"

    Reply:
    I started the blog on Day 1 100% in an effort to build my own personal accountability and support system. I instinctively knew how what I was sharing might resonate with others, but I had no idea how that part would develop over the years. Still, to this day--the number one goal of my blog is to help me stay accountable, in support and to help me further explore/learn along the way.

    If/when it helps someone else, it's a wonderful blessing of a bonus to me. And trust me, that part feels good, but truly--sincerely, I do my best to stay present and mindful of the importance of its original purpose.

    The difference is this: I'm never immune to relapse/regain. It doesn't matter how many days, months, years or epiphanies I experience--It doesn't matter how much I develop my personal weight loss philosophy and techniques--It doesn't matter how passionate I am about sharing these things--I am the same as you or anyone else working hard to navigate through what this is all about.

    We all have different circumstances, different experiences--completely different everything--and yet, regardless of the method used for weight loss, we can most usually relate precisely on the most critical emotional/mental elements--and those are the things that every single one of us, if we desire the deeper transformation, must face in our pursuit of continued positive progress.

    In my opinion, the long term morbidly obese (like me) becomes and stays morbidly obese for long periods of time as a physical side effect of these deeper mental/emotional/psychological dynamics. With that firmly in mind, then, I believe we must ask ourselves--is the method/plan we're choosing treating only the side effects? And if so, and if it's focused exclusively on the method to lose--without focusing on the deeper elements, the roots--then is its success sustainable? I've often referred to this as "calling in a plumbing crew to clean up the mess--but not fix the leak."

    Do we spend the rest of our lives constantly cleaning the mess--or do we get super real with ourselves, patch the leak--then monitor it daily in an effort to keep it patched?

    Okay--that was way more than what you asked. I kind of got carried away. Thank you for the question, Caryl!

    Renee writes:
    "I enjoy the Tweets only posts just as much as the others because of the way you make the food look so appetizing! Always a "treat" (no pun intended, I try to abstain from refined sugar) to peruse your blog."

    Reply:
    Renee, thank you! I sincerely appreciate this! I do make it important to enjoy the process of planning, preparing and enjoying what I eat--and that effort, to me, is an important part of embracing my plan. Thank you so much for your continued support and loyal readership!

    ---------------------------------------
    After falling asleep sitting up at my desk, trying to write--I dropped into bed last night and slept nice and deep. I needed it. Today was a busy one.

    I had two back to back location broadcasts on the schedule, one from a library--the other from a grocery store fifteen miles north of here. I planned one of my "on-the-go" lunches of almonds, cheese and fruit and I planned to grab a coffee in between broadcasts, but ran out of time. Kristin came to my rescue with a mid-afternoon coffee (see tweet below), just the way I prefer. She knows me well! It was an incredibly nice thing to do. She's awesome!

    I grabbed a nap late afternoon because I knew full well that my plan was to stay up late working on some things--so I needed to be able to do that without falling asleep at my desk, again.

    I stopped by my oldest daughter's new house and visited briefly with everyone. My son-in-law's parents were in town visiting. Irene and Allen were both there along with my youngest daughter and Noah. I made plans to pick up my grandson Noah midday Sunday for some good times. Noah and I plan on visiting mom as a belated Mother's Day get together. We'll be dining out with mom tomorrow night.

    That planned restaurant visit tomorrow night is precisely why I changed course tonight. The original plan was to meet Kristin at a restaurant for a late on-plan dinner. Instead, I offered to cook dinner at my place. Kristin enjoyed the meal--and so did I! I cook for just me 98% of the time--so it was nice to prepare a meal for someone else. I recently did this for mom at her place and at Amber's place, too--and I'm looking forward to doing it more often!

    Tomorrow is the two year anniversary of my "Epiphany Day." The self-worth/identity epiphanies and subsequent exploration of my personal happiness code is still with me, as strong as ever--two years later. I'll be highlighting "Epiphany Day" in tomorrow night's edition. In the meantime, if you haven't had a chance to read--May 15th, 2014 and May 19th, 2014--both are in the archives listed along the left hand sidebar, those are two days I highly recommend. Those explorations have made and continue to make a profound difference in my life.

    Today's Live-Tweet Stream:
















































    Thank you for reading and your continued support,
    Strength,
    Sean

    Princess Health and Tips for staying healthy and safe on Kentucky's waters. Princessiccia

    Brad Molnar on Taylorsville Lake
    (Courier-Journal file photo, 2003)
    The state Division of Water and Department for Public Health offer tips to help Kentuckians stay safe and healthy as they go boating, fishing, swimming or otherwise recreate in the state's waterways this summer:
    • Avoid ingesting or inhaling the water.
    • Thoroughly clean hands and other areas that have come in contact with the water.
    • Avoid allowing open wounds to have direct contact with the water.
    • Avoid areas where swimming or harmful algal bloom advisories have been issued.
    • Avoid water with obvious odors or surface scums.
    • Avoid getting in water after heavy rainfall, especially in dense residential, urban and agricultural areas.
    • Avoid areas below wastewater-treatment outfalls, animal feedlots, straight pipes or other obvious sources of pollution.
    • Restrict pets and livestock from drinking the water if a bright green or blue-green surface scum is present.
    James Bruggers, environmental reporter for The Courier-Journal, reminds us: "The Clean Water Act of 1972 declared that all waterways in the United States were to be 'fishable and swimmable' by 1985. We've made progress, but we have a long way to go. Be safe out there."
    Princess Health and  Doctors, medical students and others in Louisville say America needs a system of single-payer health care. Princessiccia

    Princess Health and Doctors, medical students and others in Louisville say America needs a system of single-payer health care. Princessiccia

    A group of physicians, medical students and others in Louisville said May 10 that the U.S. needs a national single-payer system of health coverage because "health care in America costs too much and too many people go without it," Deborah Yetter reports for The Courier-Journal.

    "The Affordable Care Act has helped," said Dr. Barbara Casper, a University of Louisville professor of medicine and chief of internal medicine. "But we still have a significant number of people falling through the cracks."

    The event, held at U of L by Kentuckians for Single Payer Healthcare, "follows the recent call in the American Journal of Public Health for a single, national health care system similar to that of most industrialized countries. It was signed by more than 2,200 doctors nationwide," Yetter reports.

    Physicians and medical students at the event said they see too many patients "who lack coverage or can't afford the costs of their health plans, such as high deductibles and copays," Yetter writes. "Brandi Jones, a U of L medical student and past president of the group, said she supports universal coverage because as a future physician dedicated to healing people and saving lives, she can't 'condone a system that allows people to die'."

    Dr. Syed Quadri of Elizabethtown said his free clinic "sees many working people who make too much for Medicaid � the government plan for the poor � but can't afford private plans that often come with high costs."

    The speakers "acknowledged it will be a tough political battle to sell a national health plan, possibly by expanding the current Medicare system to all Americans," Yetter reports. "Dr. Morris Weiss, a cardiologist who said America spends far more of its gross domestic product on health care than European nations such as France, Germany and Italy � with far less to show for it. When it comes to health outcomes, 'We're one of the bottom countries of all the industrialized nations,' he said."

    Friday, 13 May 2016

    Princess Health and  May 13th, 2016 Tweets Only. Princessiccia

    Princess Health and May 13th, 2016 Tweets Only. Princessiccia

    May 13th, 2016 Tweets Only

    Super long day.

    It's been a long time since I had a true Tweets only post.

    I'm overdue and plum exhausted.

    I was planning on writing about this crazy day--and then I fell asleep sitting here at my desk. And that's when it dawned on me-- actually--it didn't dawn on me right away--I slept for a little while, but when I woke up--yeah, that's when I had the thought: I might need to go to bed, now. :)

    My plan integrity: Maintained.

    Tomorrow's goal: Do it again.

    Today's Live-Tweet Stream:
































    Thank you for reading and your continued support,
    Strength,
    Sean