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When Facing a Serious Diagnosis, 'AfterShock' App Can HelpReceiving bad health news can spark great upheaval. It is a time when nothing seems certain and the future may look dark. Since its release this summer, the free AfterShock: Facing a Serious Diagnosis app has provided users with a basic roadmap through the first few days and weeks after a serious diagnosis, providing concise information and trusted resources to help regain a bit of control during this turbulent time. As one reviewer wrote, the AfterShock app is "a standard for empowered patients"...
Taking Risks With Needed Drugs Due to High CostMore than 44 percent of Americans regularly take a prescription drug. And according to the 2013 Consumer Reports Best Buy Drugs Prescription Drug Tracking Poll, 57 percent of people reported taking steps in the last year – some of them potentially dangerous – to curb high medication costs: not filling a prescription, skipping a scheduled dose, and taking an expired medication. Why? And what can be done to help?
A Difficult Pill to SwallowI am a pharmacy student and was recently sent home with a prescription to treat a very painful earache. I do not recall the name of the medication, but I do remember my reaction when I went to pick it up. I was shocked that the drug would cost me over two hundred dollars! I could not afford the medication, so I went home without it...
We Don't Ration Health Care in America. Or Do We?As narrower insurance networks begin to limit where we can get our care and contradict the American notion of abundant choices, I thought about the Canadian health care system and rumors of its long waiting lists that grab U.S. headlines. Yet, narrow insurance networks, sky-high deductibles, co-insurance and co-pays are ways of controlling our medical expenditures. Instead of rationing with waiting lists, America rations with price...
A Patient's Perspective on the High Cost of Cancer DrugsMany cancer therapies now cost over $100,000 a year. Obviously, this expenditure is not sustainable for the majority of patients. At age 64, I am approaching Medicare coverage. Will I have the 20 percent co-pay to shoulder? As more people survive cancer and remain on ongoing medicines, the U.S. has to have a fair and open discussion about the cost of these medicines...
Shopping for a Medicare Advantage Plan — Once Again!I have just done something I said I would never do: shop for a Medicare Advantage plan to cover my gaps in Medicare. The usual flyers and brochures from sellers of Medicare Advantage plans began to arrive in the mail with their enticing sales pitches, and one nearly fooled me. Short of having a Medicare representative on the phone, you're stuck in an information swamp. No wonder studies show that beneficiaries are not eager to shop around even if they can get a new policy with a smaller monthly premium...
Who Chooses the Medicines You Get – Your Doctor or Your Insurance Plan?A friend of mine suddenly learned the importance of patient engagement a few weeks ago when a matter affecting his pocketbook grabbed his attention. For the last several years the mantra has been "buy generics" as a way to lower the cost of drugs for consumers but also for the nation. For a while insurers did that. Not anymore...
Expanding Medicaid Increases Rural Health Care Access and UseA new study in Health Services Research reveals that expanding Medicaid to cover more adults boosts health care access and use in rural populations.
'Be a Prepared Patient' Gets a New LookFinding good health care and making the most of it is critical for each of us. Yet all too often, reliable, unbiased information is hard to find and understand. On the redesigned Be a Prepared Patient website, we have collected trusted resources and tips to help people navigate their way through health and health care decisions and experiences...
The Harm to Patients From Two-Tiered Generic DrugsAs we head into health insurance enrollment season, which opens in November, consumers/patients will face yet another challenge in selecting the best health plan...
Another Strategy in the Health Care Reimbursement GameAmerican health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers...
What Health Care Consultants Told CFAH About Patient Engagement"At the end of the day, there is a growing recognition that we need people to take better care of themselves. Too much money is being spent on the consequences of unhealthy choices and on health care. We don't think that patient engagement is just the flavor of the week. The concept of how we can take more responsibility for our health and health care is not going away." – Janice Prochaska, PhD, President and CEO of Pro-Change Behavior Systems in South Kingstown, RI
Stress Is US"Reality is the leading cause of stress among those in touch with it," Lily Tomlin once quipped. So it's no surprise, then, that one-half of the people in the U.S. have had a major stressful event or experience in the last year. And health tops the list...
What Patients Told CFAH About Patient Engagement"There's a prevailing attitude on the side of clinicians that looking for and using [our own] information is not good behavior on our parts. I think that attitude is a big barrier; people don't want to be seen as troublemakers for asking too many questions, disagreeing with a clinician, or bringing information to the table." – Kelly Young – Patient Advocate, President of the Rheumatoid Patient Foundation, and Founder of Rheumatoid Arthritis Warrior blog
Consumer Choice Clashes With the Affordable Care ActRecently the Department of Health and Human Services proposed that most of the federal health exchange policyholders be automatically re-enrolled next year in the same policy offered by the same company. That's right, no shopping around...
Seniors Face Barriers to Critical Dental CarePoor oral health can have a negative impact on seniors' overall health and well-being, but for many, there are significant barriers to visiting a dentist, finds a new report in the American Journal of Health Behavior.
An Advantage for Medicare Patients or Just for Health Plans?That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles, even if much of the public remains unaware…
What Health Insurers Told CFAH About Patient Engagement"Most health plans view engagement as important and want to support it. But they recognize that they are only one (relatively weak) factor in supporting patient/consumer engagement... Their customers want their insurance premiums going to medical care, not a bunch of mailings about things they already know they should do..." – Arthur Southam, MD – Executive Vice President of Health Plan Operations, Kaiser Foundation Health Plan, Oakland, CA
Self-Reported Health Information Predicts High-Need Medicaid PatientsJust three types of simple self-reported health measures can predict which Medicaid-eligible adults are more likely to access intensive and costly health services over the next year, a new study in Health Services Research suggests.
What Employers and Purchaser Representatives Told CFAH About Patient Engagement"Employers have an opportunity to reduce barriers and support engagement because they sponsor health plans and can provide access to information, tools, technologies, incentives, and more. Employers have more ability to influence engagement than they often believe they have." – Michael Vittoria, Vice President, Corporate Benefits, MaineHealth, Portland, ME
Medicare Changes Lower Hospital UseA recent study in Health Services Research based on 15 years of hospital data suggests that cuts in Medicare prices under the Affordable Care Act may slow the growth in overall hospital spending.
Patient-Centered Medical Homes Reduce CostsAs the number of patient centered medical homes has increased, a new report in the journal Health Services Research finds the model offers a promising option to reduce health care costs and utilization of some health care services.
Facing a Serious Diagnosis? 'AfterShock' Now an AppReceiving bad health news can spark great upheaval. It is a time when nothing is certain and the future looks dark. The new, free app 'AfterShock: Facing a Serious Diagnosis' offers a basic roadmap through the first few days and weeks, providing concise information and trusted resources to help you regain a bit of control during this turbulent time...
Ingenious Hospitals Find a New Way to Snag PatientsA mother takes her teenage son to an urgent care center that is part of her insurance plan's network. A clerk quickly refers him to the emergency room, across the street, which just happens to be part of the same hospital system as the urgent care center. Is this UCC sending some patients to its related hospital ER, clearly a place of high-priced care, to gin up revenue for the system's bottom line?...
What Community Health Leaders Told CFAH About Patient Engagement"When I think of patient engagement, I think of a partnership where people work together to figure out what the patient wants and how to support the process. Engagement is the knowledge base, working through the decisions and helping people to become full partners in their health outcomes." – June Simmons, MSW — Founding President and CEO, Partners in Care Foundation, San Fernando, CA
Early Palliative Care Cuts Costs for Critically Ill PatientsPalliative care delivered early during hospitalization can help cut costs for critically ill patients, finds a new study in Health Services Research.
What's Wrong With Health Insurance Policies That Cover Less?Insurance companies and a group of senators headed by Alaska Democrat Mark Begich think they have a great idea for getting more young people to sign up for health insurance...
Patient Engagement: Here to StayWhat is patient engagement and what does it take to accomplish? With the support of the Robert Wood Johnson Foundation, CFAH set out to explore this concept as it was viewed by various diverse stakeholders. Our interviews with 35 key health care stakeholders lead to an impressive unity of opinion...
Seamless Health Insurance Coverage Still IllusoryFor ages we've all known that the U.S. health insurance system works splendidly for those who have good employer-provided coverage, slide smoothly into Medicare when the time comes and seldom get sick. But evidence is beginning to trickle in that this seamless pathway for some people who've signed up for Obamacare insurance may be more illusory than real...
Beware Those 'Average' Premium Increases – or Decreases!Never before have I seen such intense interest from the press about health insurance rates, normally considered a snoozer of a story. For the public, this may be a good thing. If the stories are done well, consumers might learn something about the mix of factors that go into determining the premiums they will pay. But in the last couple of weeks, some stories have been downright misleading...
Class and Insurance Stigma Are Barriers to Good Health CareSome low-income, uninsured and Medicaid patients report feeling stigma when interacting with health care providers, finds a new report in The Milbank Quarterly.
Pushing Back Against the High Price of PrescriptionsAre we finally doing something about the high prices of prescription drugs? Maybe. At the end of May, the Washington-based National Coalition on Health Care launched "Sustainable Rx Pricing," a campaign to "spark a national dialogue" about the high cost of drugs. Will it work?
A Doctor's Strategies Helped Mom Pay for MedsBewildered, panicked and disheartened, I watched my mother's eyes dart back and forth as she read the pharmacy's prescription cash price list, knowing she could not possibly afford her monthly medicines. We drove home, not saying a word, but I knew she was deeply distraught. When we arrived, she began cutting each tiny elliptical or rounded tablet into halves and quarters...
Misunderstanding Health Insurance Leads Some to OverspendUninsured adults who didn't understand health insurance tended to have trouble selecting plans that aligned with their stated needs and spent more money, finds a study in Health Services Research.
Society of Behavioral Medicine Announces Inaugural 'Jessie Gruman Award for Health Engagement'Dedicated to promoting behavioral medicine research and the application of that knowledge to improve the health and well-being of individuals, families, communities and populations, Society of Behavioral Medicine created this award to recognize an individual who has made a pivotal contribution to research, practice or policy in the field of health engagement.
Insurers Reap Rewards of Medicare Advantage PlansA couple weeks ago, the Obama administration handed sellers of Medicare Advantage plans an increase in government payments for next year. While this may seem like a good thing for the 16 million beneficiaries who have MA plans, it may not be good for Medicare as a whole.
Insurance Status Affects Where Young Adults Seek Health CarePerhaps due to a lack of or inconsistent insurance coverage, young adults age 18 to 25 tend to go to the doctor's office less often than children or adolescents, yet have higher rates of emergency room use, finds a study in the Journal of Adolescent Health.
Co-Insurance for Medications: A Troubling Trend for ConsumersAs the health care system changes in the coming years, one particular trend that will negatively impact consumers' out-of-pocket costs is the use of co-insurance (instead of a co-pay) for expensive specialty medications. Approximately 57 million Americans rely on these drugs to maintain their health, and it is disheartening to learn that many people are suffering because their medications have become too expensive...
The Medicaid Gap Hits HomeA few days before the recent deadline for Obamacare sign-ups, I visited with one of the exchange navigators in Colorado, a state that expanded its Medicaid program and is working hard to enroll uninsured residents. This visit got me thinking of the millions of other people who live in states where they can't get access to Obamacare because they are too poor and yet are also not eligible for Medicaid...
Costs Complicated Dad's Cancer Care"I walked in a person, and out a cancer patient," my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine – the side on the exam table or gurney, as opposed to the one standing over it. In time, it became clear we were running out of money...
My (Un)prepared Patient StoryI'm impressed with the health care that is now available to treat diseases that – even a decade ago – were a death sentence. And I'm so very grateful for them. But we and our doctors and nurses often overlook just how much the success of these tools depend on our active, informed participation. And many of us don't fully understand what it takes to participate well in our care...
The Dilemma of Canceled Insurance PoliciesBy now it's hardly a secret that insurance companies have canceled the policies of millions of Americans whose old coverage did not comply with new benefit requirements of the Affordable Care Act. But after hearing all the backlash and requiring people to buy newer and, in the eyes of ACA supporters, better policies, the administration took another U-turn and changed the rules once again...
Cost of Health Care a Burden for Most U.S. HouseholdsSince 2001, health care costs have become more burdensome for almost all Americans, at every income level and in every geographic area, finds a new study published in The Milbank Quarterly.
Patients Are Loyal to Their Doctors, Despite Performance ScoresPatients with an existing relationship with a doctor ranked as lower performing were no more likely to switch doctors than patients with higher performing doctors, finds a new study in Health Services Research.
Look Who's Coming Between You and Your DoctorOpponents of health care reform, especially those who resist moving to a single payer system like Canada's, have often used a very powerful argument to sway public opinion. Any significant changes, they warn, to America's private insurance system would mean that the government will come between patients and their doctors by making decisions about the care Americans receive. But what if it's not the government that is inserting itself between you and your doctor?
Better Benefits Help Medicaid Recipients Quit SmokingExpanded smoking cessation benefits offered under the Affordable Care Act (ACA) should give more people the opportunity to quit, finds a new study in the American Journal of Preventive Medicine.
Obamacare Websites: Not Just a .Gov ProblemShoppers searching the Internet for health insurance coverage can be forgiven if they are confused.
Engagement From Patients' Perspective: Different Than Docs, Employers, Health PlansThe Prepared Patient Blog published over two hundred articles in 2013 about what it takes for people to get the most from health care and how the system can be improved to make it feasible for us to do so. Here's a recap of what engagement looks like to us – whether we are sick or well, whether we are caregivers or loved ones: Engagement is not easy and we can't do it alone. Patient engagement is not the same as compliance. It is not a cost-cutting strategy, and it is not one-size-fits-all.
'Me' Versus 'We' in ObamacareThe Obama administration and Affordable Care Act supporters have not bothered to explain how the law includes cross-subsidization, missing an opportunity to talk about the "we" aspects of the law. As one 58-year-old woman put it: "The chances of me having a child at this age is zero. Why do I have to pay an additional $5,000 a year for coverage that I will never, ever need?" Here's how it works...
Patients Unlikely to Deliver on the Promise of Price TransparencyThe idea that knowing the price of our care will encourage us to act like wise consumers is a hugely popular topic on blogs, in editorials and in the news. But relying on access to price information to drive changes in our health care choices is full of false promises to both us and to those who think that by merely knowing the price, we will choose cheaper, better care...
Backlash Against Narrow Provider Networks BeginsSeniors are starting to realize that fewer doctors and hospitals may be available to them if they select a Medicare Advantage plan. Restricting these choices – in theory – is a way to control the price of health care. There's just one problem: Consumers still want to choose their doctors or stick with the ones they've got...
Why Low-Income Seniors Fail to Get Help Paying for Health CareA couple weeks ago, the Medicare Rights Center, a well-known New York-based advocacy group, released a report card showing that seniors on Medicare are struggling to pay for their health care. This finding brings up an important question: Why aren't seniors using the variety of state and federal programs that have been set up to help people in this situation?
N=1: My Experience With Cost, Care and InsuranceDuring my senior year in college, with medical school acceptance letter in hand, I was diagnosed with metastatic testicular cancer. Early in my treatment I received a letter that my health insurance had been exhausted and I would no longer receive any health benefits. Needless to say, this was a problem...
Tiered Insurance Networks: Complicating Obamacare or Controlling Costs?Last fall, a Pennsylvania woman, frustrated by the snags and snafus of healthcare.gov, turned to the website of Independence Blue Cross, the biggest insurance carrier in Southeastern Pennsylvania, to make sense of her health insurance choices...
Finding the Price of Health Care Services Remains ElusiveIt's unfair to advise people to find out the price of a treatment when the price-transparency deck is stacked against them. So who will help patients find reliable price information and (hopefully) bring down the cost of care?
Why Does Our Health Care Cost So Much?We know that the U.S. has the most expensive health care in the world. But beyond noting that dubious achievement, we seldom ask why...
Hospitals Serving Elderly Poor More Likely to Be Penalized for ReadmissionsHospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties, finds a new study in Health Services Research.
Lack of Access Still to BlameWhat's the key to reducing costly emergency room visits and readmissions? People who lack convenient access to a health care provider, with or without insurance, return to the emergency department or hospital out of need and desperation...
More Funding for Community Health Centers Improves Access to CareIncreased federal funding for community health centers has helped low-income adults get access to primary and dental care, according to a new study in Health Services Research.
Advice for People New to Health Insurance (Part 4): How Much Will Health Care Services Cost?In part four of our series, we look at a few ways to estimate the cost of your care ahead of time so you can make the best choice for you and your loved ones. Our 'Be a Prepared Patient' resources offer trusted websites and tips to get started...
Advice for People New to Health Insurance (Part 3): Understanding Insurance TermsIn part three of our series, we look at insurance terms that are used most often to describe or explain how much you'll pay and what your benefits are. Our 'Be a Prepared Patient' resources clarify these common phrases...
Advice for People New to Health Insurance (Part 2): Medicare and Medicaid ExplainedIn part two of our series, we look at the difference between Medicare and Medicaid. Our 'Be a Prepared Patient' resources can help you figure out if you qualify for either of these or other special health care programs...
Advice for People New to Health Insurance (Part 1): Getting CoveredIn part one of our series, we look at the basics of picking a health insurance plan that's right for you, your family or a loved one. Our 'Be a Prepared Patient' resources can help you find the best coverage at the best price for your health needs...
Admitted for "Observation"? Watch Out for Big Medical BillsPatients who are placed in observation instead of being admitted to a hospital may face high out-of-pocket costs for treatment, finds a new study in Health Services Research.
Is Shopping for an Exchange Policy an Impossible Task?Last week at a New York City meeting of the Association of Health Care Journalists, Elisabeth Benjamin, a vice president of the Community Service Society, tried to explain the New York health insurance exchange to a group of skeptical journalists who had more than a passing familiarity with the topic...
Massachusetts Residents Healthier After Health Care ReformResidents of Massachusetts saw small gains in health status following the enactment of a state-wide health insurance mandate in 2006, finds a new study in the Milbank Quarterly.
Where, Oh Where Are Those Insurance Summaries for Consumers?Buying health insurance through the state shopping exchanges was supposed to be a breeze — like buying an airline ticket from Travelocity. But it isn't, and the reason why has nothing to do with the technical glitches of HealthCare.gov...
The Costs of Being a Patient and a DoctorMy ultrasound came back "likely benign" with the recommendation that I follow up in six weeks to be sure. Over the next few weeks, I received one bill after another that totaled $1,000. Unable to pay, I felt abandoned by the system to which I had committed my career and did not call to schedule a second ultrasound...
The Great Canadian Experiment to House the HomelessAt Home/Chez Soi, a Canadian program for the mentally ill, is built on the concept that providing housing is the first order of business. An approach that reinforces the truism that good health is more than swallowing the latest wonder drug.
My BlogTalkRadio Interview: Patient EngagementLast week, I was interviewed by Dr. Pat Salber and Gregg Mastors on their BlogTalkRadio show, This Week in Health Innovation, about patient-centered care, patient engagement, shared decision making and the cost/quality trade-offs involved, and what all of this means for health care delivery.
The Latest on the Usefulness of Hospital RatingsOn Monday, Charlie Ornstein of Pro Publica provided the latest word on the usefulness of hospital ratings, an issue that seems never to disappear despite the growing body of work that raises questions about the methodology used to create them, their conflicts of interest with sponsors, and most importantly, their usefulness to the public.
Beware of Claims That Patient Engagement Cuts CostsIt's a widely accepted truism that increasing patient engagement in health care leads to lower costs and better outcomes. And really, it shouldn't be a problem to convince us to act on our own behalf and engage in the behaviors that support health, right? I see two problems with this viewpoint and with the assertion that patient engagement will lower the cost of health care...
Choosing an Exchange Policy: What's the Rush?Will all the White House messages, the stream of breathless Twitter updates on the number of hits and enrollments, and the press hype surrounding opening day send the uninsured public into panic mode?
I Want My Doctor to Care About CostsIn a lecture hall of fellow clinicians-to-be, I was told that my job as a physician is not to be concerned with costs but rather to treat patients. What an odd message. Does medicine's unique role of saving lives exempt it from keeping an eye on the register?
How Do We Know If the Price Is Right (If We Can't Find Out What the Price Is)?For most of us, the "cost" of health care isn't what brings us the most anxiety. It's when we're patients or helping a loved one find care that so many of us are deeply concerned about the price of our health care: what we – personally, individually – pay to acquire the services, drugs and devices we need...
Getting Health InsuranceDon't have health insurance? Here's advice on how to find the right insurance for your needs.
Health Insurance: Glossary of Common TermsDon't know a deductible from a premium? Here's a helpful guide to health insurance terms.
What Are Medicare and Medicaid?Learn more about the U.S. government's health insurance programs for older adults and people with low-incomes and resources.
How Much Will Your Health Care Cost?It can be hard to figure out how much your health care will cost ahead of time. Here are some tips for preparing for the cost of your procedures.
Paying for Prescription MedicationsPrescription drugs can be expensive. Here's how to get help paying for them and finding lower cost options.
Handling an Insurance DisputeWhat to do if your health insurance denies you coverage for a procedure.
Low Premiums, Narrow Networks and the Ideal of Consumer ChoiceWe want to have choices about the health care we get and who provides it. Many of us think we have that now...
Paying for and Managing Your MedicationsWhat people pay for medicine can vary widely. And a recent study found that 20% of Americans take five or more prescription medications. These 'Be a Prepared Patient' resources can help people pay for and manage their medications.
Price Shopping Pharmacies Is the Key to Saving on MedsSumanah was a 26-year-old event planner in New York City when she was suddenly diagnosed with congestive heart failure. After learning that some pharmacies can be upwards of 16 times more expensive than others, Sumanah was able to price shop for the right pharmacy and save a lot on her prescription costs. You can too...
The Consumer's Ongoing Dilemma: Making Sense of Hospital PricesHospital charges are essentially like car sticker prices. Insurers use them as a starting point to negotiate what they actually will pay providers on their policyholders' behalf.
Political Football Season Starts for MedicareIt's the silly season again for Medicare. It comes around whenever a political campaign is about to begin as it is for next year's mid-term elections….Politicians love to play ball with benefits for seniors.
The Meaning of Another Obamacare DelayThe media has discovered another delay in another provision of Obamacare, and the new delay affects consumers' pocketbooks directly...
Patient Centered BillingMy husband and I returned from a weekend away to find a message on our answering machine saying that we owed money to the hospital and that if we didn't pay it within 10 days, they would send the bill to a collection agency.
Who's Left Out of Obamacare?The main purpose of health reform, the president said at his press conference last Friday, was to provide health insurance to people at affordable rates…Whether that coverage will be affordable or comprehensive for families remains to be seen.
The Cost of Missing Health Care PricesPeople continue to struggle finding information on how much health care services cost. Toni Brayer, Barbara Bronson Gray and Ray Burow weigh in.
High Lifetime Costs for Type 2 DiabetesA person with type 2 diabetes spends on average more than $85,000 treating the disease and its complications over their lifetime, according to a recent study in American Journal of Preventive Medicine.
Can You Choose Your Doctor? Well, Yes and NoThe specter of loss of choice and freedom to select the doctor you want haunts again. This time it's being raised on the airwaves with an ad from Americans for Prosperity…
Unemployment Linked to Reduced Use of Preventive Health CareFluctuations in the unemployment rate affect people's health care choices, finds a new study in Health Services Research.
Who Wins or Loses from the Delay in the Employer Health Insurance Mandate?It's hard to say it was a surprise last week that the Obama administration delayed implementation of the employer mandate — that pillar of health reform requiring employers with more than 50 employees to provide health insurance or else pay a fine.
The Limits of Consumer Driven Health Care – A Trip to the Car MechanicAs health care becomes increasingly unaffordable, many believe quality would improve and costs would decrease if we treated health care like other consumer-driven markets...If only that were true...
Haggling for Health CareI'm not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor's service have been mostly unsuccessful. There's always that nagging feeling that the seller is laughing with delight once I'm gone, thinking, "I really pulled one over on that rube!" And so it has come as somewhat of a shock to me that medical care has become the new garage sale, as far as haggling goes.
Consumer-Directed Health Isn't Always So HealthyGiving health consumers more skin in the game doesn't always lead to them making sound health decisions.
It's Medicare Versus Medical Supplier in Controlling CostsOn July 1, Medicare begins a second round of competitive bidding for medical equipment and supplies, such as diabetes testing strips that beneficiaries use to check their blood sugar levels. There's nothing remarkable about any of this except that the industry is fighting to make sure that competitive bidding does not happen...
Nursing Homes with More Black Residents Do PoorlyNursing homes with higher proportions of Black residents do worse financially and deliver lower-quality care than nursing homes with few or no Black residents, finds a new study in Health Services Research.
Cheap Insurance Premiums Come at a PriceYesterday the blog of WIFR-TV in Rockford, Illinois, featured a small story about community groups in the state applying for federal grants to help educate customers coming to the new health exchange in October.
Are Health Insurance Rates Going Up or Down — A Cautionary Tale?Will consumers buying coverage in the new state shopping exchanges find lower or higher rates? On one side are those who say the newly insured will see lower premiums for coverage.
Rehabilitating the Image of the Emergency RoomMaligned over the last decade as places to avoid because of the price of the care they delivered, last week's release of a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms.
Rationing MedicationsIn America, the conventional wisdom is that we don't ration health care. But we do, and there's no better example than patients rationing themselves when it comes to the medicines they take.
Are We Finally Getting Closer to Price Transparency?The revelations by the Centers for Medicare and Medicaid Services on Wednesday that hospitals vary widely in what they "charge" for the same procedure—sometimes as much as 10 or 20 times more than Medicare reimburses—confirms what health policy wonks have known for a long time. There's no consistency in pricing for health care services…
Is "Guaranteed Coverage for Life" in the Cards for Medicare Seniors?A few days ago, Empire Blue Cross Blue Shield sent me one of those Medigap sales brochures that seniors usually expect during the fall open enrollment season.
Credit Card Debt Leads Some to Skip Medical CarePeople with outstanding credit card or medical debt were more likely to delay or avoid medical or dental care, finds a new study in the Journal of Health and Social Behavior.
Is Health Care One Gigantic Consumer Problem?One could easily make a case that health care is today's biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.
How the President's Medicare Proposals Affect Seniors' PocketbooksThe president's budget proposals released last week call for more seniors to pay more money for their Medicare benefits. While the president's plan to require beneficiaries to pay higher premiums came as no surprise to Washington insiders, it probably was to people who will feel the pinch.
Is Health Insurance Sticker Shock for Real?Wherever you turn, there are complaints about health insurance rates. A Pennsylvania woman tells me her monthly premium will soon be $100 more than it used to be. A New Yorker finds the premium for retiree coverage rising 24 percent...
Health Care Consumers Are Compromised By Complex InformationAmericans have embraced their role as consumers in virtually every aspect of life: making travel plans, trading stock, developing photos, and purchasing goods like cars and washing machines. That is, in every aspect of life but health care.
Making Seniors on Medicare Have More Skin in the GameThe movement is growing, it seems, for making people who rely on Medicare have more skin-in-the-game. In the minds of some, seniors and the disabled pay too little for their health care and their Medicare benefits…
Those Confusing EOBs…Once Again!Let's face it. Despite all the rhetoric about health care transparency, most health care providers really don't want patients to know the price of their products and services.
Buying Health Care from a BoutiqueSomehow, I don't think of money-back guarantees when I think about going to the doctor. Yet as textbook marketing principles creep into health care, a few medical providers are beginning to look like sellers of toothpaste and detergents.
Does the U.S. Get Value for Its Health Care Dollars? – Part 2It turns out Japan has much to teach us about improving health…In many ways, Japan scores much higher than the U.S. when it comes to the health of its population.
Getting Your Operation at a Cut-Rate Surgery CenterConsumerism in health care is coming to mean patients must shop around for the best price — for a doctor's visit, Cipro, health insurance and maybe even your next operation.
Coping With the High Costs of PrescriptionsAs patients pay more for their prescription drugs, many people decide to cut their pills in half or opt out of taking the drugs altogether. But there are safer ways to cut costs than skimping on — or skipping — the medicines you need.
Retail Clinics: What's in Store for Health CareYou're sick, but your doctor's office says the next open appointment is in two weeks. Or you're traveling, don't have a primary care physician or don't have health insurance. For all these reasons and more, potential patients are turning increasingly to retail clinics to cure their minor ailments.
Does the U.S. Get Value for Its Health Care Dollars?It's hardly a secret that the U.S. is spending close to 18 percent of its GDP (or $8,362 per person) on health care — more than any other country. So it's fair to ask exactly what we're getting for our money.
Pay for Your Health CareSeek insurance and manage the worrisome chores of arranging and paying for care.
What the Next Fiscal Showdown Has to Do with Health CareThe New Year'??s Day deal between the White House and Republicans postponed the long-awaited debate over cutting Social Security and Medicare. But in the next few weeks, Beltway talk will again turn to slicing these interrelated social insurance programs.
How to Find and Use Health InsuranceWhether you have a preexisting condition or not, are new to shopping for insurance or trying to figure out what coverage you do have, there are resources to help with this often complicated but important purchase.
Sick at WorkMost people don't have the luxury of letting work slip, even when serious illness strikes. What happens when you have a chronic condition or disability and the time off you need exceeds your number of sick days?
Is Raising the Age for Medicare Benefits a Good Idea?The twists and turns of recent political conversations over the federal deficit have explored a variety of changes to Medicare. The most likely ones are raising the eligibility age for benefits to 67 from 65.
When it's Time to Drop Your Medicare Advantage PlanCurrently, Medicare Advantage sellers are engaged in heavy marketing due to the MA open enrollment period that ends on December 7th. The ads don't say much but give enough clues to tip you off that you must ask lots of questions and dig deep to find out what you're getting.
A Bogus Mass Mailing about Medicare That Just Won't DieLast week, the health care and political pollster Humphrey Taylor received a scary email about rising Medicare premiums from a friend. He was skeptical and wanted to know what I thought. It turns out I knew a great deal and had seen a similar version a few months ago.
May I Please See the Prices on the Menu Before I Order?I am embarrassed. I am a specialist taking care of patients with inflammatory bowel diseases...Until recently I thought I was doing a pretty good job at this. However, I've had an awakening that I've been ignoring an entire aspect of the patient's decision. The aspect of cost.
Do Seniors Want So Many Medicare Choices?Seniors need more Medicare choices, or do they? The answer depends, of course, on who'??s doing the asking.
Guest Blog: Health Insurance Decisions Still Tough for ManyAmericans find health insurance decisions the second most difficult major life decision, only behind saving for retirement and slightly more difficult than purchasing a car. Why are health insurance choices so tough?
Trolling for Insurance Prospects on TwitterSelling health insurance on Twitter? Yes indeed. Not long ago a simple tweet about a blog called Medicare Made Clear alerted me to this new way to find sales prospects for Medicare Advantage Plans and Medigap policies
How Do We Know If the Price is Right (If We Can't Find Out What the Price Is)?"Health care costs are sky-rocketing!" "The percentage of the U.S. GDP devoted to heath care costs is the highest in the world." "The cost of Medicare is unsustainable." For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn't what brings us the most anxiety.
Seniors Will Be Paying More for Their Health CareI was reminded of a conversation I had a few years back with Marilyn Moon '?¦.. The best advice she gave for people not yet on Medicare was to '??Save, Save, Save'?? because even with Medicare, seniors would be paying more for their coverage and for their health care. Moon was right.
How Retirement Income Relates To Health CareIf you don't have enough money for retirement, from income and assets, you probably are going to have trouble paying for medical care.
Consumer Ambivalence About Health Engagement ' Will OOP Costs Nudge Us to Engage?In some surveys, U.S. consumers seem primed for health engagement, liking the ability to schedule appointments with doctors online, emailing providers, and having technology at home that monitors their health status.
After the ACA Ruling---What's next for Employer-Based Health Plans?Buzz about the recent Supreme Court's health reform decision has hovered mostly over the individual mandate---the requirement that everyone carry health insurance---and over push back on Medicaid expansion....But what about the 160 million Americans who have coverage from their employers?
In the Dark on Costs of Care'If gas stations worked like health care, you wouldn't find out until the pump switched off whether you paid $3 or $30 a gallon." ' Consumer Reports
Prepared Patient: Do I Have to Go to the Dentist? Oral Health Starts EarlyMany of us have vivid memories of tying a thread to a loose tooth and wiggling it back and forth with our tongue all the time hoping for a profitable visit from the Tooth Fairy. Facebook is full of school and family photos of kids with cute, gap-toothed smiles. But increasingly, children are losing their baby teeth not due to the budding of their permanent teeth but to the ravages of early decay and cavities. There are a number of reasons kids and adults don't make it to the dentist regularly. For some parents, it's a lack of understanding about the importance of oral health, even at an early age.
Selling Dental Services Like ChevroletsMailers from a New York City dentist piqued my interest last week offering zero percent financing ' the same come-on that car manufacturers have used for years to entice you to buy Chevys and Toyotas.
Guest Blog: How Much Does It Cost to Have an Appendectomy?A few years ago, a good friend of mine who holds bachelor's and law degrees from Ivy League schools lost his job and became one of the estimated 50 million medically uninsured persons in the U.S. Over the course of several days, he developed increasingly severe abdominal pain, fever, and vomiting.
More Confusion about Those Insurance EOBs. This Time from MedicarePeople have a right to receive in plain language a summary of what doctors bill, what insurers pay and how much they themselves must pay.
Guest Blog: High Health Cost Does Not Guarantee QualityThe new buzzword in Medicine these days is "value based purchasing". It's not a new concept...everyone wants to get their money's worth, whether it is a new car, a meal at a fancy restaurant or the best medical care. Without clear information on quality, however, many patients assume that more expensive care is better care.
Do I Have to Go to the Dentist? Oral Health Starts EarlyIncreasingly, children are losing their baby teeth not due to the budding of their permanent teeth but to the ravages of early decay and cavities. For some parents, this is a result of a lack of understanding about the importance of oral health, even at an early age.
Worried about the Cost and Quality of Health Care9 out of 10 sick people, (those with a serious illness, medical condition, injury or disability), are worried about the costs of medical care according to a new poll from RWJF/Harvard, 'What It's Like to be Sick in America'.
'Death Panels': Beliefs and Disbeliefs in Health CareVirginia was particularly concerned that she would not get medical treatment after she turns 75. She had heard at that age, 'they send you a letter. They are going to start sending you literature on death.'
What to Do About Long-Term Care InsuranceThe decision to buy long-term-care insurance and how long to keep it is among the toughest people make as health-care consumers. The product is difficult to buy'confusing, complicated, and costly.
Prepared Patient: How to Find and Use Health InsuranceSeveral years ago, DeAnn Friedholm had to shop for her own health insurance. The prospective insurance company discovered she had had a couple of benign tumors more than a decade before and so denied her coverage because of her preexisting condition. Just like that, Friedholm had no good option for insurance in case she needed to see a doctor. Whether you are like DeAnn with a preexisting condition, are new to shopping for insurance or trying to figure out what coverage you do have, there are resources to help with this often complicated but important purchase.
The Supreme Court's Health Care Decision and Your PocketbookLast week's drama at the Supreme Court and most of the media coverage that followed omitted crucial information: how a decision either upholding or junking the Affordable Care Act (ACA) will affect ordinary Americans. Because the health reform law is not well understood by most people, it's worth recapping what might happen.
Medicare Games: When Is a Stay in the Hospital Really a Stay?If you or a family member is on Medicare, you would assume that if they are in the hospital their care would be covered under Medicare's Part A hospital benefit. Right? Well, not always.
Hospital Games: Luring Patients to the ERYou may have seen the billboards or gotten a message on your smartphone: Come to our emergency room; our waits are short.
Costs of Care...and Coercion?Nora, a third year medical student, came to me in moral distress. Ms. DiFazio, one of the hospitalized patients on her Internal Medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.
The Government Meets the Jolly Green GiantLabels describing key features of health insurance policies will become a reality this fall fulfilling a provision of the health reform law that called for more disclosure and transparency. The idea was to copy the labeling for food products'
Health Care's Curtain of SecrecyI'm skeptical that price transparency about health services will make the health care market more competitive, more honest, or less dysfunctional. After all, health care simply does not work like other markets.
Prepared Patient: Young Adults Taking the Health Care ReinsYour parents still might be willing to do your laundry, but if you're over 18, they can't make your medical decisions. Are you ready to navigate the adult health care system? This updated Prepared Patient feature offers advice for young people who are just starting out in managing their health care, including information on important provisions from the Affordable Care Act.
What Consumers Don't Know About Their Health InsuranceOn a chilly New York day, a sales agent for UnitedHealthcare stood on a noisy street corner in Spanish Harlem pushing Medicare Advantage (MA) plans. He was engaging in table marketing a way to snag new customers, converts from other MA plans, he hoped.
Young Adults Taking the Health Care ReinsYour parents still might be willing to do your laundry, but if you're over 18, they can't make your medical decisions. Are you ready to navigate the adult health care system?
Cash Rewards from Your Health PlanHarvard Pilgrim Health Care has moved deeper into the business of transforming health care into a commodity governed by the rules of the marketplace. Plan members can get cash rewards'.if they use facilities for outpatient medical procedures and diagnostic testing recommended by the health plan, not their doctors.
The Price of PaperworkIt's said that time is money. In this case, health care insiders argue that Americans and U.S. health insurers are spending too much of both.
How Much Does it Cost to Have a Baby?My wife and I are expecting our third child, and our new insurance plan requires us to pay 20% coinsurance for all non-preventive care. Given the rapid rate of health care inflation, we thought it prudent to find out how much it would cost this time around. So, we asked for an estimate of the charges. It seemed like a reasonable enough request'
Guest Blog: 10 Sex Tips for Better Looking Health InsuranceIt's always interesting to watch health reform concepts move from policy shops and peer-reviewed papers into the mainstream. Provider report cards have surfaced in venues as diverse as Martha Stewart Living and The Examiner, a supermarket tabloid that promised to reveal 'America's 50 Best Hospitals.'
Revisiting Those Explanations of BenefitsKatie Ryan-Anderson, a health reporter at the Jamestown Sun in Jamestown, North Dakota, had a question. What did all that gobbledygook on the Explanation of Benefits (EOBs) from Blue Cross Blue Shield of North Dakota mean?
Who Gets Preventive Care?Who doesn't think preventive health care is important? Probably nobody if you ask this question abstractly. But when it comes to getting it - well that's a different matter.
What's the Price on That MRI? Patients and the Price of Health CareA couple of weeks ago, I was asked to speak as a patient about 'consumers and cost information' while being videotaped for use in the annual meeting of the Aligning Forces for Quality initiative funded by the Robert Wood Johnson Foundation. Here's what I had to say.
The Rocky Adolescence of Public Reporting on Health Care Quality: It's Not Useful Yet, and We're Not ReadyThe American people, long protected from the price of health care by insurance, are now forced to act as consumers. This situation is a free marketer's dream.
Health Reform's First CasualtyThe Obama administration has dealt a mighty blow to one part of the health reform law by effectively killing off the CLASS Act, which was to be a baby step in the development of a national program to pay for long-term care.
Health Reform LoopholesA couple weeks ago I walked the streets of Lincoln, Nebraska, talking to men and women about whether they thought Washington was listening to their economic concerns. Jeff Melichar manages his family's Phillips 66 gas station on the city's main street, and one of his big financial problems happens to be health insurance.
Guest Blog: Price Tags and Haggling in an Exotic MarketWhile shopping in a market on an exotic trip, a friend of mine picked up an appealing item, but the price seemed high. When she paused to consider the purchase, the shopkeeper asked, 'Don't you want to know if I can do better?' But with health care, we can't predict what the final negotiated payment will be without knowing who is paying and what kind of bargaining position that person is in.
Cigna's New Ad Campaign Aims to Snag New CustomersCigna launched a $25 million 'GO YOU' national branding campaign last week signaling that they are gearing up for tons of new customers as health reform rolls towards 2014. That new business will come from the millions of Americans now uninsured who will start getting government subsidies as an encouragement to buy health insurance coverage.
Turning 65: A Medicare SnafuI didn't expect to write a sequel to my seven-part series about signing up for Medicare. Just when I thought I was on the program, and all was fine, it wasn't. After I submitted two bills for routine exams, I learned Medicare would not cover them as my primary carrier. That threw me into a tizzy. All my years of reporting about the program taught me that once you retire Medicare is primary.
Health Insurance, Meet the Jolly Green GiantIt's official now. The government has proposed that descriptions of health insurance policies will resemble those nutritional labels on canned and packaged foods'the ones you look at to find out how much sodium there is in Birds Eye peas versus the A&P brand.
When the Insurance Company Says 'No'Blue Cross just advised a twenty-six-year old woman I know that it will cut off payments for the physical therapy that was making it possible for her to sit at a keyboard for eleven hours a day. Her thirty sessions were up.
Bad Language: Words One Patient Won't Use (and Hopes You Won't Either)"There is a better way - structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace." Rep. Paul Ryan (R-WI) August 3, 2011. The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services. But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.
'Is a Cheaper, Effective Option Available?' An Important Question to AskThe Costs of Care blog, "Hidden Costs of Medication", reinforces the importance of asking, 'How expensive is this treatment?" and "Is a less expensive option available?'
Turning 65: Medicare's Future and MeI once thought that when I signed up for Medicare, I would never again have to worry about paying for health care. But I will. Medicare's future shape and substance is uncertain.
Health Insurance Doesn't Always Protect People From Medical DebtA new study confirms that having health insurance coverage is no guarantee against accumulating medical debt for working-age adults.
Turning 65: Making the ChoiceEven though I have written about Medicare for many years, it wasn't until I actually went through the process of selecting an option to cover Medicare's gaps that I realized seniors have an extraordinarily difficult, if not impossible, task. You can't make a perfect decision because so much depends on your future medical needs and no one can predict those with certainty.
Conversation Continues: Young Adults and The Affordable Care ActSara Collins of the Commonwealth Fund and veteran health care journalist Trudy Lieberman look at how the Affordable Care Act is and is not helping young adults stay covered.
Turning 65: Finding a Medicare Advantage PlanAh, those Medicare Advantage (MA) plans! The government can't seem to decide if it loves or hates them. On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. So it seemed like I was being encouraged to select an MA plan.
Turning 65: Finding a Prescription Drug PlanIf I were to choose a Medigap policy to supplement my basic Medicare coverage, I would still have to buy a separate plan for prescription drugs, since Medigap sellers can't include drug benefits in those policies.
Turning 65: Finding a Medigap PolicyThe first step after reading my collection of Medicare Advantage, prescription drug, and Medigap sales brochures was to find a way to fill in core Medicare coverage gaps'the deductibles for hospital stays and doctor care and the coinsurance for physician visits, lab tests, and hospital outpatient treatment that could really leave me with an unwelcome bill. I would have to pay 20 percent of those bills if I didn't have supplemental coverage.
Turning 65: The Sellers Were After MeEven before I officially signed up for Medicare, sellers of Medicare Advantage plans, prescription drug benefits and Medigap policies began stuffing my mailbox with marketing brochures and lead cards'the kind that ask for your name and address and tell you that a salesperson will call if you return the card. Since the first of the year, I have received five lead cards asking for personal information, four solicitations for Medicare Advantage plans, two for stand-alone drug plans and three for Medigap insurance.
Mayo Finds Heart Patients Skip Meds Due to Costs; Self-rationing in Health ContinuesHealth economist and management consultant, Jane Sarasohn-Kahn, discusses a Mayo study which found half of people in the study stopped taking their statins due to cost. Sarasohn-Kahn says, 'Welcome to world of self-rationing in health, where even the lucky health citizen receiving the best acute care money (and third-party health insurance) can buy doesn't follow through with the recommended self care at home.'
Turning 65: It Was Time for MedicareThis is the first in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future.
How Code Creep Boosts the Price of Health CareAbout 30 years ago I had my first run-in with code creep. A urologist I had visited for a garden-variety urinary tract infection billed $400 to determine that this was what I had. The price seemed excessive, and then I looked at the bill. The good doctor has 'unbundled' his services. He charged for every single thing he did'inserting a catheter, taking a urine sample, writing a prescription and finally adding a fee for a general office visit. I had thought all those things were part of the office visit. I protested. He reduced his charges, and I never went back.
Will Medical Bankruptcy Be a Ghost of the Past?During the health care debates, didn't you hear the president repeatedly tell the crowds that reform would mean that people would no longer be forced into bankruptcy because of illness? Insuring people who previously had no insurance does give them a cushion of protection and will mean that some of them will avoid bankruptcy court'but not all.
Reform Is Not To Blame For Rising Health Care CostsIn a development so predictable that it hardly merits being called news, American health care costs continue to rise and opponents of the new health reform law say the Obama plan is to blame. Some small employers report massive insurance premium increases.
Patient Perspectives: Paying for Health CareThis week's roundup features the patient voices of Brad Wright and Monte Jaffe and the decisions they made when faced with expensive health care costs.
How the Cost of Health Care Creeps Up and UpIn a previous post, I talked about what happens when a radiology practice goes digital for mammography, even though there's scant evidence that more-expensive digital is better than cheaper film for detecting cancer in older women. Yet the higher-priced costly procedure is winning out. That's pretty much the norm for U.S. health care, for instance, when ThinPrep replaced the conventional method for doing Pap smears. I used to pay $9 for the test; the one I had last summer cost $250.
Vanishing Health Care ChoicesAsk someone what he or she remembers Obama promising during the great health reform debates, and the response might be: 'We can keep the insurance we have.' The president did offer assurances that there would be no socialized medicine with the government dictating where you could go for care. He did not mention, though, that many insured people already have little say in what kind of coverage they get and who can treat them.
The Dilemma of Digital MammographyThe rapid changeover from traditional mammography'pictures taken with film'to the new digital imaging technology poses a thorny dilemma for women, especially those over 65. The scientific evidence suggests that digital mammography does not improve the detection of breast cancer in older women.
When You Have an Insurance DisputeWhile access to health insurance is a critical component of finding good care and making the most of it, being insured is often just the starting point for frequent users of health care services.
Selling SicknessSomeone I know who is just over 65 received an unlikely solicitation'from The Scooter Store located in New Braunfels, Texas, on Independence Drive no less. The outside of the envelope promised a free personal mobility assessment. This person is totally mobile and hardly needs a scooter.
Dicker With Your Doc? Not So Fast''How to Haggle With Your Doctor' was the title of a recent Business section column in The New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, commonsense recommendations about how to respond to the urgency many of us feel ' insured or uninsured ' to reduce our health care expenses.
Prepared Patient: Coping With the High Costs of PrescriptionsCost-cutting measures are creeping into the medicine cabinet. We split pills in half or take the drugs every other day to stretch our doses. We stop filling the prescriptions for our most expensive drugs. We buy prescriptions from online pharmacies with questionable credentials. As patients pay more for their prescription drugs ' whether it's through higher insurance co-pays or shouldering the full costs ' many people decide to opt out of taking the drugs altogether. But there are safer ways to cut costs than skimping on ' or skipping 'the medicines you need.
Inside Health Care: Are Patients 'Priceless?'An inside look at the cost of health care: a physician confused by the transparency of Medicare reimbursements and a patient in San Francisco unable to afford treatment for an enlarged prostate.
Assessing Risk: Medicare Advantage vs. Medigap vs. Drug Coverage OnlyAs Medicare's open enrollment season draws to a close, it's a good bet that seniors are still sifting through all those brochures and flyers that have come in the mail the last several weeks. My husband received 22. Here's a simple rule to make the sifting go a little faster.
Mini-Med Policies: Is the Government Telling Us Something We Don't Already Know?The new health reform bureaucracy at the U.S. Department of Health and Human Services has announced that it will now require employers, health insurers and union welfare benefit funds to disclose to policy holders that the health insurance they have may not be real health insurance at all. They now have to tell us if their coverage does not meet minimum benefit standards required by law and by how much they fall short. So those who have mini-med policies will now get a notice telling them that their policies cover very little. As if people don't already know.
Health Reform: Elections, Politics and PatientsHealth care reform is a hot topic with yesterday's court ruling that a portion of the Affordable Care Act is unconstitutional.
Finding a Medigap Policy on the Web? Better Think TwiceOh, those clever insurance agents, always on the prowl for new customers. This time they are using the current period of open enrollment for Medicare to snag customers for other insurance products'products that consumers may not need or want.
Assessing Your Risk: Buying a Policy That Doesn't Cover MuchMy friend Ariane Canas, a New York City hairdresser, was eager to tell me about a new health insurance policy she had come across. It was cheap very cheap as such coverage goes. I knew that she and her husband, who is also self-employed, had gotten a notice this fall from their current carrier advising of a 33 percent rate increase.
Does Long-Term Care Insurance Have a Future?The decision by Metropolitan Life to stop selling long-term care (LTC) insurance once again calls into question the viability of that product as a way to pay for nursing home, assisted living and home care needed by the growing number of elders. MetLife was a solid company'big and reputable, with a knack for selling policies to workers whose employers offered the coverage as an extra benefit. It was a name that people trusted in an industry characterized by many small sellers, some of whom became insolvent.
Unaffordable Housing Might Lead to Poor HealthPeople who cannot afford their housing are more likely to suffer from poor health, according to a new study, which also found that renters consider themselves less healthy than homeowners.
What You Need to Know About Your Health Insurance PolicyFederal and state government officials and their opponents in the insurance industry have been busy as beavers these days chewing on that perennially vexing problem: how to disclose insurance information so consumers will be wise shoppers. Since we have a market-based model of health insurance, that's not a frivolous question. What works best, what doesn't, and what do consumers acting as shoppers really care about?
Who's Afraid Of The Big Bad Blues And WhySome broad questions about how bad it is to be big are raised by the government's new antitrust suit against Blue Cross Blue Shield of Michigan, which allegedly used its market dominance to force hospitals to charge other insurers a third more than the insurance giant paid. One can see how this could help the nonprofit Blues control the market, but it is difficult to determine how this was in the public interest ' or even advantageous to those it was covering.
What Can Health Care Professionals Do About Poverty?A colleague of mine, Cheryl, has been trying to help a solo physician address a thorny issue. Through the use of 'How's Your Health', an amazing Web-based suite of health and practice tools, the physician realized that many of her patients struggled with maintaining an adequate income. Cheryl went looking for some ideas for the physician, and she came across this: Health Providers Against Poverty, an Ontario-based group that has a toolkit to help primary care professionals address poverty issues.
Revisiting Those Puzzling EOBs: New York Penalizes Aetna
Selecting Health Insurance? Help from Around the Web:In his most recent blog, "How to Pick Good Health Insurance - Your Life Depends on It," Dr. Davis Liu emphasizes how important is it for us to evaluate carefully our health insurance plans. Liu points out that, unlike other companies or products whose efficacy may impact our lives modestly ' your car wash, dry cleaners and choice of movie theater ' the ranking of your health insurance plan relative to others impacts your life greatly. And not all health plans are created equal.
The Medicare Sales Season Begins: As Always, Buyer Beware!
Adding an Adult Son or Daughter to Your Insurance
Matt Seeks Health Insurance, Part 2: The Runaround Continues
A New Way for Hospitals to Make a Little Extra'Tax the SickDianne Cooper Bridges, a feisty health reform activist in Massachusetts, recently found herself in the hospital for a routine consultation with no tests or procedures. Because Bridges, a self-employed designer, refuses to buy the required health insurance in her state, she has no insurance and occasionally pays a fine. That means she shops carefully for medical care, which she pays for in cash. When she called the University of Massachusetts Memorial Medical Center and asked how much her consultation would be, the hospital quoted her a price between $100 and $200.
Matt Seeks Health Insurance: A Young Adult Falls Through the Cracks of Health Reform
Sorting Through the Indecipherable 'Explanation of Benefits' Is Becoming a Required SkillA young friend showed me her Explanation of Benefits from Empire Blue Cross Blue Shield. "I don't really understand it," she said. This woman has a master's degree from the London School of Economics but couldn't comprehend what her insurance carrier was telling her...
More People Choosing Consumer-Directed Health Plans---Pitfalls and All
Chicago Doctor Reveals Hidden Health Care Pricing'.
Paying to Participate
Lead Us Not into ExpectationsHave you noticed that when health experts discuss the high cost of care, they often assert that our demands for more and more advanced -- care are driving the upward trajectory of its cost?
How Can We Pay Less for our Health Care?I just completed a series of radio and TV interviews about the extent to which people participate in their health care you know, those three-questions-in-90 seconds blips that currently constitute news for the viewing/listening public.
Is Choosing a Health Plan Like Buying a Car or Canned Goods?Do consumers buy health insurance like they buy canned peas? Or should they? That's the big question market place advocates have been trying to answer now for more than a decade. The government and others have thrown gobs of money at this vexing problem trying to figure out the best combination of stars, bars and other symbols that will catch the shopper's eye.
Some Honesty about Medicare Advantage Plans, PleaseObama administration officials and the president himself have been on the road selling the benefits of health reform.' The other day in Maryland the president was touting the $250 rebate sent this week to some three million Medicare beneficiaries whose prescription drug expenses have reached the infamous donut hole where there is no coverage.
Will You Be Helped by the New High-Risk Health Pools?The new health reform law is what I like to call an 'over-the-line proposition' because undoubtedly, someone is going to be left out. ' What passed the Congress will not bring universal health coverage to America; nor does it assure that everyone is entitled to health care as a matter of right.' It simply adds more people to the current system by giving them subsidies to buy insurance they couldn't otherwise afford.' In such a system, there will always be people over the line'they won't qualify for this subsidy or that program either because the government limits its spending on them, or it wants to encourage people to use private insurance to keep those markets strong.
Can You Really Choose the Best?
How Safe Is Your Insurance, Really?Throughout the long debate over health reform, the president told us if we liked the insurance we had, we could keep it.' No government would come between us and our health coverage!'
The Squeeze of Mail-Order Drugs for People with Chronic IllnessDo you have your prescriptions filled through a mail-order pharmacy? You are not alone.
Not just about Mom and Dad's Health Insurance...In the past two weeks I have visited two college campuses---one in Brooklyn and one in Wisconsin.' Large numbers of students turned out to hear about the new reform law and wanted to know what it meant for them.'
|Patient Engagement Is Here to Stay
Jessie Gruman | January 15, 2015
|Center for Advancing Health Announces Two New Awards to Honor Jessie Gruman
Center for Advancing Health | January 7, 2015
|Six Things Health Care Stakeholders Told CFAH About Patient Engagement
CFAH Staff | December 23, 2014
|Patient Engagement – We Have Become Our Parent
Kate Lorig | December 19, 2014
Urban Parks and Trails Are Cost-Effective Ways to Promote Exercise
Military Culture Enables Tobacco Use
Physician Behaviors May Contribute to Disparities in Mental Health Care
Depression and Dementia in Older Adults Increase Risk of Preventable Hospitalizations


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Charleston Wedding Weekend
Hey friends! Happy Tuesday! I've sat down to start writing this Charleston wedding weekend post multiple times and I was just not feeling it until now! Currently it's 8am on Monday and I don't have a patient until 9. So this felt like the perfect time to get cracking on this recap. Now I'll have more time to watch "The Originals" with the husband tonight! Ha!
Ordinarily, I write Tuesday's post over the weekend, but like I mentioned, I was having some writer's block. I think it's likely due to the extended break I took from the blog over the holidays. It's just taking me a bit of time to get back in the swing of things! I know it's certainly not that I am disinterested in this post. Ladies and gents, I am PUMPED to talk about my sister's Charleston wedding weekend! Eek!
Now, this is more of an overview of the Charleston wedding weekend. If she let's me, I will do a more detailed post of her wedding once she has professional photos back. 🙂
Disclosure: This post contains affiliate links. The price is not affected should you chose to shop through the link, however, I may receive monetary compensation.
Thursday, December 27
Jarrett and I hit the road around 6:30 am on Thursday to make the 6.5 hour drive to Charleston. Little did we know that it would actually take over 8 hours! Guys, I would not have worn jeans had I known I would be stationary for that long.
We eventually made it to my sister's apartment, met her adorable dog, Romo, and then drove into downtown Charleston for a quick walking tour! My sister works for the College of Charleston, so she walked us around the charming campus and then down King Street for a bit.
Once we heard that the rest of our family was almost to the hotel, we hit the road and met them to check in. That was followed up with a nice pizza dinner and finally celebrating Christmas with my family! Siblings/spouses drew names and my sister ended up getting me the softest "lounge wear" and cozy slippers! Definitely one of my favorite gifts this year!
Friday, December 28
Friday morning began with a girls trip to the cutest nail salon I had ever been in, Mylkbar. That was then followed by another walking tour in downtown, this time with about 30 of my extended family members! I'm sure we were quite the sight and probably looked like ducklings following their mother. Ha! I for sure know that we walked too slow and took up the entire sidewalk. Apologies!
Our tour took us around the waterfront and down Rainbow Row of course. We then somehow all got seated at the perfect patio picnic tables at Blind Tiger. I had the heirloom burrata salad and it was incredible!
Early afternoon, we made our way back to the hotel to get freshened up for the rehearsal, rehearsal dinner, and after party later that evening.
My sister's in-laws had rented an Airbnb for the week and decided to home-cook a low country boil for the rehearsal dinner. It consisted of shrimp, sausage, corn, and potatoes. Dessert was homemade strawberry shortcake, and I could not have been more stuffed at the end of the night.
To continue the party, everyone from the rehearsal met all out-of-town guests at a local bar/restaurant called Red's Ice House. Luckily the weather was warm, because the main feature of the bar is a large outdoor deck! It was however, raining, and the tin roof really didn't cut it. People were definitely kept on their toes as they had large rain drops splash on their faces, down their backs, or in their drinks! It was comical to say the least! Eventually, we returned to the hotel to prepare for wedding day!
Saturday, December 29: Wedding Day!
My mom and I woke up bright and early to drive to my sister's apartment. My sister forgot to pick up her cake on Friday, so we grabbed that on the way. Ha!
The morning consisted of getting ready, eating a lot of food, pouring some mimosas, and relaxing. Elli had the best ladies for hair and makeup and we all felt picture-perfect by the time they were done.
Elli got us the silkiest robes to get ready in and gifted each of her bridesmaids with a coordinates bracelet from where she first met each girl! How cute!
We drove from her apartment to the reception site, The Creek Club at I'On, for Elli and Brandon's First Look. Now, we probably weren't supposed to peek, but everyone watched their sweet first moments from the porch! This was followed with family and wedding party pictures, before making our way to the ceremony site, the I'On Meeting House. The ceremony itself was perfect. Aside from my sister's veil getting stuck on a chair and pulling out of her hair on her way down the aisle. Yikes! I honestly cannot wait to see the pictures though…
Once they were officially Mr. and Mrs. Pippin, we hit the road to celebrate and party! The southern appetizers, consisting of pimento grilled cheese, crab cakes, and chicken & waffles, were a huge hit for me. And the dancing of course.
Sunday, December 30
Sunday was more relaxed, as everyone was recovering from a great wedding! We just had breakfast at the hotel, before heading back into downtown with some family to stretch our legs before making the drive back home.
Just prior to hitting the road, we had lunch at Locals. This was right next door to Elli and Brandon and highly recommended by the pair! I had really good sushi and Jarrett had a big bowl of breakfast items that he also enjoyed.
All in all, it was a fantastic Charleston wedding weekend celebrating my sister and her now husband! Like I mentioned, if Elli and Brandon don't mind, I will share details of their wedding and reception. So, if you are planning a wedding and want some info, stay tuned!
If you are interested in our wedding weekend, be sure to check it out here!
Want to know more about Elli's wedding festivities? Check out her bridal shower and bachelorette. 🙂

subset: commoncrawl


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TIP: In order to be a sponsor, you earn more that %125 of the poverty line (about $20k/year). You most likely cannot meet this requirement if you have been working abroad for several years, since you will prove your income using U.S. tax returns. The reason for this requirement is that spouses cannot go on welfare while they are being sponsored because they are not supposed to burden the American economy. If you do not meet that requirement, you can get around it by having a joint sponsor who does have that income. A joint sponsor has legal obligations to support you if you should need it, so if that's your plan make sure you have discussed the options with whoever is helping you.
-Police records need to also be sent with the sponsorship forms, so make sure you have records from all the countries where the applicant has lived. Once all of the needed documents have been received, you will be able to move on to the interview.
TIP: We had a terrible experience with this step, because the NVC asked us for a document that applies only to Moroccan citizens (which my husband is not). We called, emailed, and sent letters, most of which were completely ignored. We lost more than three months in the process. It seems that applications are read by a machine, not a person, so if the NVC does make a mistake, keep sending in complaint letters and emails as often as you can!
-Once your documents are all received, you will be given an interview date at your local embassy. You do not get to make any choices about your date, so you just have to be ready for anything. Once the interview is scheduled, you might have more documents to gather, and you will have to do a medical exam at an approved physician.
The Interview!
I had heard a lot about how the interviewer asks a lot of questions to determine if your marriage is real, but this was not the case at my husband's interview. They did not ask for photos, proof that we live together, or receipts from vacations taken together. Perhaps if you are actually married, it is obvious enough. They do, however, require every original document, and not having one will postpone getting the visa. If you do have all of the documents, you will find out on the spot whether you have the visa.
Finally, the visa can be picked up. In Morocco, it is picked up at an agency called Aramex and is supposed to take two weeks from when all your documents are in. This is the step we are currently on; we were missing one document in the interview so we were not told whether we had the visa, but now the documents are in and Aramex said to wait 14 days. So far it has been a very, very long eight days….


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We are so excited about WELL RAY 2017! Join the Del Ray Business Association on Saturday, June 24 from 9am to 1pm for a celebration of health and wellness and Livin' Good in the Neighborhood. All classes, speakers and exhibits are FREE and open to all; bring your own mat and water and be ready to MOVE! Walk-ups are welcome at all classes, though we encourage you to pre-register to reserve your spot.
2213 Mt. Vernon Avenue
9am-9:30am: Morning Yoga Wake Up with Yoga in Daily Life. Register here9:30am-10am: Pilates Boot Camp with Mind the Mat Pilates and Yoga. Register here.
10am-10:30am: Fitness Interval Training For All with Fit4Mom. Register here.
10:30am-11am: Yoga with Mind the Mat Yoga and Ease Yoga & Cafe. Register here.
11am-11:30am: CrossFit for Kids with CrossFit MVA. Register here.
11:30am-12pm: Foundation Fitness Workout with Foundation Fitness. Register here.
12pm-12:30pm: Heart Rate Monitor Interval Training with Orange Theory Fitness. Register here.
12:30pm-1pm: Kids Yoga with Downward Dye. Register here. 1pm: Closing ceremony for Soar interactive art project by We Live Big
There's truly something for everyone -- all ages and fitness levels are welcome. The event is rain or shine; for weather updates and more information, visit www.wellraydelray.com.
A complete list of events:
WELL RAY LOTBehind United Bank, 2401 Mt. Vernon Avenue9am-9:30am: 5 Rhythms Dance Class with Ann Kite Dance. Register here.
9:30am-10am: Kids Dance Class with Tippi Toes. Register here.
10am-10:30am: Karate Class for Adults and Kids with Potomac Kempo. Register here.
10:30am-11am: Pilates Apparatus Class with Studio Body Logic. Register here.
11am-11:30am: Parkour for All with PK Move. Register here.
11:30am-12pm: Celebrity Bigwheel Showdown hosted by Velocity Bicycle Co-op
12pm-12:30pm: Skate & Safety Demo with DC Wheels
12:45pm-1pm: Closing meditation
ASCEND CYCLE DECKBehind United Bank, 2401 Mt. Vernon Avenue9am-9:30am: Well Ray Ride with Ascend Cycle. Register here.
10am-10:30am: Well Ray Ride with Ascend Cycle. Register here.
11am-11:30am: Well Ray Ride with Ascend Cycle. Register here.
12pm-12:30pm: Well Ray Ride with Ascend Cycle. Register here.
PAT MILLER NEIGHBORHOOD SQUAREIntersection of Mt. Vernon & Oxford AvenuesEXTENDED FARMERS' MARKET HOURS! The Del Ray Farmers' Market will be open from 8am to 1pm!
Ongoing: Cooking demonstrations & discussions with Ironman & Chef Will Artley, Evening Star Cafe Chef Keith Cabot, and The Switch Doctor's Chris Dunning
SPEAKERS' ALLEYBehind United Bank, 2401 Mt. Vernon Avenue9am-9:30am: Safe Summer Fun with Pediatric Associates
9:30am-10am: Live Courageously with Vessence
10am-10:30am: Understanding Your Back Pain with Healing Tree
10:30am-11am: Essential Oils For Wellness with Wise Light Wellness
11am-11:30am: Running Injury Free with Solutions PT
11:30am-12pm: Minding Your Mental Wellness with Running Brooke & Rob Krupicka
12pm-12:30pm: Discovering Your Why for Exercise with Walter Lewis Fitness Solutions
12:30pm -1pm: Feldenkras Method Demonstration with Vital Body Mind
HEALTH & WELLNESS INFORMATION & DEMONSTRATIONS, FEATURING...Ann-Kite Dance // Arbonne Independent Consultant // Ascend Cycle // Beautycounter // Caring Acupuncture // Casa Sophia // Chrysalis Chiropractic at The Wellness Center // City of Alexandria GO Alex // Core Wellness & Physical Therapy // Counseling of Alexandria // CrossFit MVA // Cyclebar // Del Ray Animal Hospital // Del Ray Psych & Wellness Associates // Del Ray Smiles // Dental Excellence // Doggiewalker // Downward Dye // Ease Yoga & Cafe // Fit4Mom // Foundation Fitness // Four Directions Wellness // Galley Foods // Icon Undies // Juice Plus // La Clé // LucidArts // Mind the Mat Pilates & Yoga // Mom's Organic Market // Mount Vernon Family Therapy Associates, LLC // Neighborhood Pharmacy of Del Ray // NOVA Women's Health Collective // Orange Theory Fitness // Pediatric Associates of Alexandria // PK Move // Potomac Kempo // ProFlex Physical Therapy // Purium // RunningBrooke // [solidcore] // Solutions Physical Therapy & Sports Medicine // South Block // Starz of Alexandria // Studio Body Logic // The Switch Doctor // Territory // The Board Bus // The Healing Tree // Tippi Toes® Dance // Velocity // Vessence // VITAL Body & Mind // Walter Lewis Fitness Solutions // Washington Nationals // Waxing the City Alexandria // Whole Foods // Wise Light Wellness // Xtend Barre Old Town // YMCA of Alexandria // Yoga in Daily Life
All activities are free and open to all; participants are encourage to make a donation to Running Brooke, an organization that inspires at-risk children in the City of Alexandria to move. For more information about Running Brooke and to donate, click here.
For more information, visit www.wellraydelray.com
Copyright ©2015 Del Ray Business Association | 2308 Mt. Vernon Avenue, #727, Alexandria, VA 22301
This website was made possible in part by a grant from the City of Alexandria Marketing Fund.


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Brooklyn, cardboard boxes, coffee, DUMBO, food, history, Industrial Revolution, John Arbuckle, New York City, Robert Gair
It is hard to believe that our coffee-drinking habits can be attributed in part to a man from Allegheny City, Pennsylvania with a vision. Brothers John and Charlie Arbuckle moved to Brooklyn in 1881 to become the greatest coffee roasters of their generation in the 1860s. Arbuckle invented a machine that efficiently roasted, ground, and packaged coffee into small bags for mass distribution throughout the country. Prior to this innovation, coffee beans had to be sold unroasted from barrels and were easily spoiled. These beans burnt easily as they were roasted at home. Their first national brand was patented under the name "Arbuckle Ariosa".
Arbuckle patented a unique egg-and-sugar glaze that prolonged the freshness of their coffee beans as they were transported west. In 1887, Arbuckle launched a sugar refinery at 10 Jay Street when Havemeyer Sugar refused to lower prices for their biggest customer. Havemeyer went into the coffee business in response, resulting in depressed coffee and sugar prices for years. Arbuckle eventually built up much of the real estate along Jay Street in what is now the DUMBO section of Brooklyn.
Instead of donating money to charities, John Arbuckle took it upon himself to find solutions to societal ills. Noticing the overcrowding and poor air quality in the tenement slums of New York City, Arbuckle renovated ships into floating recreational centers for the poor. These ships offered areas for dining and physical activities for those who could not escape from the filth and noise of the city. Although he had good intentions, Arbuckle's ideas did not last but the ships continued to provide low-cost meals and job training sites for people with little means.
By the 1940s, most of Arbuckle's buildings in Brooklyn were being used by other businesses. Today it's not hard to imagine what Brooklyn manufacturing must have looked like at the height of the Industrial Revolution. Visitors walking around DUMBO can find large warehouses made of brick and concrete. The Empire Stores Warehouse continues to exist as a dilapidated site, but developers are hungrily eyeing the building while the court system determines who has rights to oversee its transformation.


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ATHLETIC STRAIGHT Italian Selvedge Denim Pitch Black
Regular price
Rs 6,900
This 13.5oz heavy weight selvedge denim has the deepest shade of black. Woven from 100% cotton yarns, on being broken-in the pair will be supple and comfortable, for all occasions.
Our Latest addition to the fit portfolio for Athletic men with built out thighs and glutes! The fit has an ample seat with a lot more room in the silhouette thigh downwards. Tapered from the Knee to Bottom it is a smart straight leg pair. All our jeans are #singletailorsewn from 100% organic cotton threads.


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Is it me or are these stories turning up with monotonous regularity?
This latest one is a very depressing case as it concerns a young girl of eight who was found in her "filthy bedroom" hanged by a cord after being effectively "abandoned to her fate" (neglected) by her parents, according to the Daily Mail. I won't go into the detail here as you can read it on the Daily Mail website.
This poor girl was appantly well known to social services and other welfare officials. Indeed, the Mail reports that a "serious case review is being carried out into the case because the family were well known to the welfare officers." But its a bit late now surely.
Obviously I am in no position to pass judgement on the circumstances surrounding this case, but I can't help but think that this poor child has been failed by the very system that is supposed to protect these vulnerable members of our society.
Its so damn depressing.


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By DAVID GREEN
Fayette village administrator Steve Blue isn't using the phrase "the end is in sight," but he will go so far as to mention "light at the end of the tunnel."
Fayette's sewer separation project is moving along quite smoothly, Blue said, but it's a big project and seems to be taking forever—especially with all the dust blowing through town. Even that situation has improved, he said, with recent rain and watering efforts by the construction company.
"We're getting there," Blue said. "Most of the pain is over, but there's still some left."
Nearly all of the main sewer lines have been laid, Blue said last week, leaving only a few shorter areas yet to tackle. That includes the Ohio Street water line that wasn't initially included in the project.
"We aren't unique in having to do a sewer separation project," Blue said. Several other communities in the region are tackling the work through pressure from the U.S. EPA. Morenci's sewer separation project was completed in the early 1990s due to combined sewer overflows in which raw sewage occasionally poured into Bean Creek.
The word "combined" refers to a situation in which septic sewage flows through the same pipes as storm water. Following heavy precipitation events, the water flow can breach control structures and send raw sewage into creeks. When Fayette's project is completed, the septic sewer lines will lead to the treatment lagoons and the storm lines will empty into Spring Creek.
The village's sewage should no longer have a negative impact on Lake Erie, Blue said, and there will be a positive impact at the lagoons, where the water level often reached capacity before a discharge could be scheduled.
The next step in the project involves "tap crews" to connect residential sewer lines to the new septic lines. Some of that work was handled when the line was laid, Blue said, such as along Main Street. The work can get more complicated at some locations where one sewer line comes from the front of the house and another travels out the back. In that case, the two lines will be combined into one.
The clean-up phase includes leveling the ground, repairing broken sidewalk, planting grass and addressing any other repair needs.
Finally—the step residents are waiting to see—the damaged streets will be repaired.
"The pavers won't be staying and doing it all at once," Blue said, but he doesn't yet have any scheduling details. He's fairly certain U.S. 20 will be handled first as the crew faces a deadline from the state to put the road back in order.
Although residents aren't likely to agree, Blue wouldn't mind seeing the paving delayed because rain and traffic will aid in settling the disturbed soil. A vibrating compactor wasn't used in many locations for fear of breaking the village's old water lines. If settling isn't complete, the new pavement will be damaged and the trenches from the sewer work will be obvious.
Some areas, such as Walnut and Lawrence streets, did not have much of a base to begin with, Blue said, and some rebuilding of the street surface will be needed.
Blue expects bids to be sought soon for paving the remaining village streets—those not affected by the sewer project—and for the street widening project at the corner by the TRW plant.
Earlier in the project, the two main sewer interceptor lines—one from the north side of the village and one from the south—were lined to provide a better flow, to shut off leaks, and to prevent infiltration into the line. Manhole areas are nearly all lined, as well.
Blue said the main line between the lift station (where sewage is pumped) and the lagoons appears to be in need of cleaning. He believes this condition is largely due to the project, particularly to the lining work where debris was pushed into the main.
"We think cleaning needs to be added to the project," Blue said, "but we're not yet certain. Cleaning will put less strain on the pumps."
It's likely that two 90° turns in the force main will be changed and additional access areas for cleaning will be installed.
The contractor's early estimate pegged early August as the completion date for the project, but that was changed to mid-August at a progress meeting in early June. The next meeting is scheduled in early July and Blue said he wouldn't be surprised if late August was now projected. Overall, he thinks the project is progressing well.
"We're starting to see light at the end of the tunnel," Blue concluded.


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It is the dream of many to become self-employed and start a business. If you are passionate about crafts and you love to make them, then you should consider starting a craft or art business. You definitely will agree that business is not all sunshine and rainbows; you are definitely going to face challenges from time to time. But if your business has a solid foundation you will triumph.
Before starting a craft business, there are some important things you must first do. In this article, we are going to be looking at some of those things.
Get practical experience
Running a crafts business is not as easy as you may think. It is not something you just wake up and decide to do. You are definitely going to have to make some preparation and do some research before going into it. Also, if you want your craft business to thrive, you need to have experience in basic design.
Hone your skills
Before starting a crafts business, it is important that you hone your skill first. You can choose to take classes in a field of craft to upgrade your basic skill. You are going to learn a lot from your instructors and peers. They may show you a better way of setting things up or may get you a referral to a popular vendor. It is also a perfect way to network.
Identify your customers
Try identifying your potential customers before hitting the drawing board. Learn a thing or two about your target audience, like their buying pattern. You have to also figure out exactly the kind of product your potential customers are interested in.
Don't focus on everything or try to make different crafts or art items (especially the ones you are not good at). Give your thoughts to what you can do perfectly well and expand slowly from there.
Learn from your competition
Don't be discouraged if you have too much competition; try developing a niche that is not yet saturated. On the other hand, if you have zero competition, you should be glad. It could mean that there is not enough craft or art in the market.
Final note
These are not the only steps you should take when starting a craft business. But if you follow the steps that have been listed in this article, you are going to succeed.


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Florida State Archives
The Aquabelles in 1947. Newt Perry taught the girls to do aquatic ballets. Watch them eat and drink underwater in the video below made from a 16-mm movie shot in 1952.
This picture by fashion photographer
Toni Frissell was published in Harper's
Bazaar in 1947.
Newton Perry, an ex-Navy frogman, created the attraction but he had to remove rusted junk from the spring first. Locals had used it as a dumping ground. Perry invented a way to breathe underwater from a free-flowing air hose supplying oxygen from an air compressor. He had an 18-seat theater built and submerged six feet below the surface of the spring.
Perry trained young women to use the air hoses so they could stay underwater seemingly effortlessly to do the shows. He taught them how to smile underwater, and to drink and eat and do aquatic ballets there, too. The air hoses were hidden behind scenery.
Then he put a sign out on U.S. 19. In those days, U.S. 19 was not heavily traveled. It was paved but none of the other nearby road were, and there were few amenities. You could drive for miles without seeing a gas station or grocery store. And convenience stores hadn't been invented yet.
It was a pretty desolate place, and it's a wonder anybody came. There were so few cars that the performers ran out to the highway when they heard a car coming and waved travelers into the parking lot. Then they jumped into the spring to perform.
A couple of months after the attraction opened, Harper's Bazaar magazine published a photograph of a woman wearing a long evening gown floating in the spring. The photograph was by Toni Frissell, a well known fashion and portrait photographer in New York.
ABC bought the attraction in 1959, and then it really took off. ABC promoted it heavily on television. Arthur Godfrey, Don Knotts, Esther Williams and Elvis Presley all visited the attraction.
Today Weeki Wachee is a Florida State Park. Its general manager is former mermaid Robyn Anderson.