Associated Health Plans, for better or worse

http://www.qando.net/details.aspx?Entry=2292

The above link is a blog of a July 25 Wall Street Journal editorial arguing in favor of associated health plan (AHP) legislation that would allow individuals and small groups to band together for health insurance coverage.

The other side of this argument might be demonstrated in a Georgetown University Health Policy Institute analysis linked here:
http://www.georgetown.edu/research/ihcrp/ahp.html

"Conclusion. The proposed legislation would “exacerbate the current problem of health insurance fraud” and “leave small businesses and their workers unprotected...The consequences are predictable: bankruptcy, delayed or foregone medical care, and loss of coverage for America’s small businesses and workers.”"

I bet even the "self-interested" BC BS Association plans would long to be free from some the expensive and often ludicrous State mandates imposed on policies underwritten in the state. And, even if there are upstart companies eager for an emerging AHP business market, don't you think the likes of United, Aetna, and BC BS plans could easily compete in such a market?

So, why are traditionally republican, conservative, big health insurers against AHP's? Probably has much to do with the findings of the GU analysis.

Here's a scenario. Bob's employer sponsored health benefits costs $585/mo/family. A new AHP comes to town and offers coverage for $400/mo/family. It lacks some benefits versus those offered through Bob's employer, but Bob's family is low risk for needing those benefits anyway. So, Bob and 35 of his co-workers drop employer-sponsored coverage and take the AHP.

Hal, who is Bob's co-worker, has a child with a chronic health condition. He doesn't qualify for the new AHP, or otherwise needs the extra benefits. Because 36 of Hal's healthier co-workers no longer contribute to the employer benefits pool, how much do you think Hal's premiums will rise?

Bob later disputes some medical bills not paid by his new AHP. He complains to the State Insurance Commission. Guess what he's told? Still frustrated, he's about to call Human Resources at work, but then remembers...

Sometime later, maybe Bob needs a bone marrow transplant and, guess what, his AHP plan coverage is limited. (Bob never thought he'd need this coverage.) Who do think now becomes burdened with Bob's medical bills?

A good idea on how to study effects of prayer

On formal prayer studies.

Do the truly faithful need the proof? Do the truly atheist?
Empirically, how do you control for all conceivable variables that could influence a prayer study outcome when the premise for the treatment of the active group is so ill-defined?

There was a religious movement in Japan in the mid 80's that I had first-hand contact with. One way that I understood they used to proselytize new members was a promise. They had (sold) a specific butsadon shrine, a small bell, and a specific chant. It all went like this. You were instructed to think of something small, materially or otherwise, that you wanted. A given example was like $25 (5,000 yen at the time.) Set up the butsadon shrine and meditate every day while repeating the chant over and over again for a deliberate number of repetitions, chiming the bell between each repetition. The chant (or prayer) incorporated the asking for the $25 bucks. The promise was that if you did this precisely, for a precise number of days (usually between 1-3 months), you would find your prayer answered. That is, you would have realized $25 you would not have otherwise anticipated having. Perhaps money owed you, forgotten about, found, refunded, unexpectedly saved, whatever. Eventually, you can start to chant (ask) for greater and greater things you want with the same result. Oh, yeah, it seems you always perform your own chant. If you want something for someone else, perhaps convince them to get their own talisman's and chant for it. Of course you couldn't chant your chronic illness away, at least at first, because that's too big. But, I bet you could decrease a symptom, or effect some other small, but specific thing.

I bet dimes to donuts if they set up a study on this concept, they could report some pretty remarkable sounding results.

dras

This thingy lowers blood pressure

AAmazon.com is offering a RESPeRATE Blood Pressure Lowering Device. http://www.amazon.com/exec/obidos/ASIN/B0007NOY3E/pe%5Fhpc%5Fresju7/002-2073267-1011220
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How absurd. Why would anyone ever think that calming yourself down by practicing a series of slow breaths could somehow lower your blood pressure? Actually, it's absurd that I can't think of ways to make money off simple common sense like this.

I'll attest from years of respiratory therapy practice that breathing coaching does as much or more for status asthmaticus or COPD exacerbation symptoms than the concurrently given bronchodilator treatments. (Well, might have had something to do with principles once observed in Pavlov's dogs as well.)

Here's the RESPaRATE manufacturer's Web site http://www.resperate.com/resperate/consumers_RR_overview.aspx
I think this search of MEDLINE found all the relevant studies:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=searchDB=pubmed

Nothing in the sales pitch or positive clinical studies (albeit the studies are not exactly convincing) can take away the fact that this is but a gadget. Like a thigh-master or reminder feature in your ipod, it's not really necessary to have it in order to achieve desired results.

How about I introduce the authentic CHILL PILL. Guaranteed to settle your nerves and lower your heart rate if you follow the directions: Stand up, take a deep breath, find a secluded, quiet place, sit down comfortably, take CHILL PILL, close eyes, clear mind, listen to self breath slowly for 6-12 minutes. voila.

dras

study: chiro manipulation causes pain in the neck

Spine. 2005; 30(13): 1477-84. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study.Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM.
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This abstract from Spine is really weak on study information. The full article (not available) could clear things up significantly, but the abstract info leads to speculation. First, 336 patients doesn't seem a huge number to outweigh the apparent amount of stratification in the analysis (seriousness of initial injury causing pain, with and without heat or EMS, time of adverse reaction, etc.) Then, apparently only 83% of the 336 patients completed the subjective self-assessment survey after two weeks. Seventeen percent didn't complete the questionnaire (nothing to complain about?), the clinically significant report for adverse events was at 24 hours after initial treatment - but this information isn't reported by the subjects until 2 weeks later. Not knowing all of what and how the patient survey was all about also leads to speculation. Several other uncontrolled factors could have biased the results as well. Patient prior experience with chiropractic, disparity in manipulation or mobilization treatments at the four sites, level of acute or chronic condition of the neck pain, and prior or concurrent treatment. Could 280 participants effectively control for all of this? Also, the abstract report is silent on comparing long-term outcomes (events) and patient overall satisfaction despite adverse effects, and provides no information on several listed data points.I take the publication of this report in Spine as pro-chiropractic as it provides complete inference that chiropractic treatment is mainstay for all neck pains. I am not convinced that the study design and protocols were not unbiased to begin with, but that shouldn't matter, data is data and this is a valid study and the author's conclusions are valid: manhandling versus simply moving a sore neck increases the chances of making it feel worse the next morning, especially if it was really sore to begin with.