Momof3littles
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Posts posted by Momof3littles
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No need to wonder why the insurance companies love ACA.
This is one reason among many I'd prefer a single payer system.
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Smartwool socks
fleece lined leggings
cuddleduds
flannel sheets and or down comforter
uggs or other shearling slippers. I buy the kirkland costco kid ones and use them as house slippers since I have small feet.
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I've read a bit about how so many people insist they or their families members get every possible treatment right before death. Often these are treatments the doctors themselves refuse because they know how lousy the outcomes are. For example, Reader's Digest had an article a few months ago about which treatments most doctors refuse. The ones that I remember were CPR (it said most patients that are revived go on to die soon after anyway or live with a terrible quality of life) and chemotherapy. The doctors are often reluctant to suggest to people to refuse these treatments, maybe because they get accused of only trying to "save money." Other times, the patients or decision makers won't listen.
I think this may be why people wanted to allow doctors to be paid for appointments talking these things out with their patients before they were in the hospital facing the decision. Instead, it sounds like people went nuts talking about "death panels," as if any attempt to educate patients about which procedures they'd probably want to avoid if they knew what they were really like is equivalent to trying to kill old people. It seems like we have a culture where people don't want to let go and think that anything short of trying the newest expensive (and often unproven) treatment is murder or something.
Are other cultures like this? Haven't I read that something like half our healthcare spending comes from trying to keep people alive one more week or month? At some point, some sort of rationing has to be done. It sounds heartless. But no government, group, or insurance company could ever afford to provide every available expensive drug or surgery to every nearly-dead patient.
The same is true of many nurses, physical therapists, physician assistants, etc. across the healthcare system. I have articulated my desires in this realm to my DH, as having a proxy clear on your desires is IMO more important than a "living will" in most cases. I agree regarding CPR, and am open to palliative care, hospice, etc. as I age. If I am close to death, I do not want a feeding tube, for example. I had the privilege of taking a course when I was in school co-taught by an oncologist and his wife, who served as a chaplain and hospice nurse for 35 years. That really shaped my beliefs about end of life care and intervention, in combination with my own personal and professional experience.
It doesn't mean that everyone has to arrive at those decisions, but many, many people do not realize how poor the outcomes are with things like CPR under certain circumstances, do not realize that withholding feeding at the end of life can actually be more comfortable for the patient, etc. I think it would be beneficial for people to be given this information, as I think that we still aren't there. And doctors should be explaining to patients how to articulate their wishes to their family, how to select a proxy, etc so that individuals can have the best chance possible to have their desires honored.
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It is seasonal, but the cranberry goat cheese log is great. I just stocked up :)
The flatbread (Tarte d'Alsace?) is great.
Crackers and cheese varieties in general are usually well priced and many are quite good.
Rosemary marcona almonds are a favorite of mine.
Mint joe joes
The thin pretzels things with white choc and peppermint
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My pediatrician does give out handouts on what to do with a fever. Specifically, not to treat unless the child is uncomfortable, to call if the fever is over such and such, and they will advise you, etc.
Peds who do this definitely exist, but IME it is not a widespread discussion yet in many practices. I was just saying that instead of blaming people for taking their kids to the ER for a fever, PPs should consider whether the healthcare system has done its job in educating parents about fever, etc. in the first place. My point is that I don't fault the parent, I fault the system for not handling the messaging better on things like childhood fevers, which would keep quite a few people out of the ER in the first place. I dislike seeing concerned parents blamed; I'd rather see it as the fault of our system in communicating what is a true emergency with regard to childhood fevers.
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Has this happened for any readers here? I have never had a doc at a routine visit recommend anything other than vaxes and screenings. The standard printouts recommend eating fruits & veggies and exercising. Never any suggestions for at-home care of illness / injuries.
Besides, the folks who go to the ER for these things are not necessarily the folks who take their kids to routine appointments.
I'm talking about a handout I was provided with what symptoms are concerning when accompanied by a fever, what myths there are about not treating a fever, when a fever combined with other symptoms needs to be addressed immediately, etc. Yes, our pediatrician who was affiliated with one of the best children's hospitals in the nation did provide such a handout as part of well visits in infancy. I'm not talking about how to DIY healthcare at home, just a sheet that debunked myths about fevers causing brain damage, what symptoms are in fact concerning, fever in very young infants always needing medical attention from a professional, etc.
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This has no connection to what I was talking about.
But yes, it is controversial whenever the government gets into individual people's business.
I was talking about education and I'm not sure exactly what form it would take. But I was not thinking "mandatory" anything. However, let's say it became mandatory to advise parents during an ER visit for a non-life threatening event that they could do xyz to address the problem at home if it happens again. (Seems like we shouldn't have to have a law to make that happen, but....) That's a lot different from requiring a discussion like "we could save your kid, but we should probably just let him die and reduce the surplus population."
What did I say was mandatory? The proposal was to reimburse MDs for the time spent in helping a patient navigate end of life decisions. It was never going to be mandatory; if you have a source that says otherwise, I'd be curious to see it. To my knowledge, it was proposed as, "voluntary advanced care planning." http://www.nytimes.com/2010/12/26/us/politics/26death.html?pagewanted=all&_r=0
You are worried about the time and cost involved in an MD providing advice during a well visit about routine reasons that do not necessitate an ER visit. The proposal to cover end of life planning was to make sure MDs were paid for their time when they address this with a patient, otherwise it may never be covered during a person's routine visit due to time constraints and MD not being reimbursed for the additional time.
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Or they could have a nurse or nurse practitioner on staff in the ER whose job it is to give exit interviews and educate people on home care for next time. If the MDs do it, that would cost a ton (you'd have to have more MDs on staff in the ER).
You capture more people if you do it as part of a routine well visit. No harm in providing exit advice to parents, but it needs to be addressed at routine well visits for sure.
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Making it mandatory to talk about "it's time to become Soilent Green" (sp) is not what I'm talking about.
I'm talking about kids having a fever etc.
Right, but end of life care is one of the greatest health burdens we face. Addressing that became controversial.
edited to add: MDs could address when it is an emergency requiring ER treatment, etc. better during well visits, and often don't. We have moved several times, so my kids have been with several different MDs and peds over the years. ONE practice, affiliated with a nationally known children's hospital, gave a handout regarding "fever phobia" with accurate info regarding fevers not causing brain damage, when to call your practitioner, when to head right to the ER, what symptoms are deemed concerning along with fever, etc. I have never received the info in print form from another practice, and we've been with 4 since my oldest was born a decade ago. I have talked with our MDs in the past about riding a fever out, etc. because we feel comfortable assessing our kids' overall well being. Our MDs have been supportive. But these discussions have happened only because we've brought it up.
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A lot of things are better treated with basic loving care at home, so yes, I think it would be better for people to get what you call "no care at all" in a lot of cases.
When you go to the ER (or the doctor for that matter), you expose your family and others to infections, make the sick person more uncomfortable, and often medicate something that is better unmedicated. I consider it poisoning when a person is medicated unnecessarily.
It would be nice if parents could be better educated about taking care of sick family members at home. How come the ACA doesn't have any budget for that?
When there was a proposal to cover end of life planning visits, people were up in arms that it was part of a death panel, weren't they?
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Agreed, it was a bad, example and one I was hesitant initially to use. I just couldn't think of a better one at the time. Lovinmyboys post about the tonsils is really more what I was trying to get at. If someone was paying OOP in a similar situation, would they have been a bit more diligent in examining their options before agreeing to a medical procedure?
Oh, I agree with you about encouraging a wise use of what's available to us as patients. I worked in healthcare pre kids, still read journals, etc. and it frustrates me to see how many MDs are still recommending procedures for which there is poor evidence, for example. My mom was recently talking to her MD about a friend who was going through heart issues and they wheel in an ECG at my mom's appt basically to "reassure her" nothing is wrong with her heart, despite the fact she had zero complaints, zero symptoms. My mom left feeling reassured, even though a routine ECG in a case like hers is pretty worthless based on the data. She was merely talking about what a friend's husband was going through with testing, etc. Were they trying to reassure her? Was there a financial incentive in doing this procedure? Was it explained to my mother than if she's asymptomatic, not about to have surgery, etc. it is was unlikely she needed this ECG? No.
People don't want to hear that some of the common screenings may be very poor in terms of having any prognostic value, or any measurable improvement on health. But if that's said by medical personnel, now they are "rationing" healthcare, which draws the ire of some in this country. My MIL is approaching 70, and is still in that mode of thinking of many in her generation that more testing, more screening, more, more, more is better, and if she can't demand any test she wants, she's being shortchanged by having medicare+a supplemental policy. Our citizens are so convinced that more testing, more intervention means better health and better outcomes, and sometimes MDs are happy to play along as it can be profitable, or they can cover their bases and avoid a lawsuit in the very rare chance they are wrong when they didn't send you for a CT for every single complaint.
A lack of scientific literacy is partially to blame, IMO. People simply don't understand in some cases that more is not always better. But I don't fault parents for worrying about their kids, and I don't fault people for feeling certain tests, procedures, and screenings are more effective than they are, because that's the message that's everywhere. I feel that the entire medical community has poorly communicated the messages about the risks of excessive testing and diagnostics, overuse of meds, risk of overtreatment, etc, and that falls squarely on them, not the patient, as far as I am concerned. I think we are starting to hear more about it on occasion (like with respect to PSA testing in men, or annual screenings for things like cervical cancer in women who haven't ever had an abnormal PAP, no HPV, etc.). But IMO, the general public is just not there yet. They are convinced some of these screenings and tests work better than they do to preserve their health, not realizing that excessive diagnosis and over treatment comes with significant risks that may exceed any benefit.
And to be clear, I'm all for appropriate screening, reducing risk factors, preventative care, etc. when backed by science. And I think we should err on the side of caution on some of the screenings we aren't sure about yet in terms of how effective they are long term, or ones we have mixed data on. But when we have years and years of data on certain procedures and tests not being effective or carrying risks greater than the risk of disease, we need to be more judicious. And that's not going to happen until we get more scientific literacy and get medical staff to communicate these issues to the public more clearly. eta: But I disagree with blaming the patient for overuse of procedures, testing, etc. I think this falls to the medical community to convey more clearly (for ex: overuse of CT scans) to patients. It will take time, but I don't think we should blame patients for this.
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I suggest that those of you who are not able to afford to see the doctor consider a chiropractor. They can help with a lot of things and it is a lot more affordable. And they will tell you how much they charge up-front. :)
I have used a chiro in select circumstances and would disagree with this advice as a primary care type of option.
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We let most fevers run their course. There are still many MDs and nurses (let alone parents) who have unsubstantiated fever phobia themselves who will advise treating a fever over X number of degrees, even if it wouldn't be dangerous to let it run its course (not a young infant, no other concerning symptoms, not heat related illness, etc.)
http://www.nytimes.com/2011/01/11/health/11klass.html?_r=0
http://www.ncbi.nlm.nih.gov/pubmed?term=2001%20crocetti%20fever
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165093/
MDs need to be more proactive about explaining this. I don't think it is fair to assess this situation as parents trying to get something for nothing (going to the ER for Tylenol). There has genuinely been a lack of parent education on this topic, some MDs and nurses still go by dated or inaccurate info themselves, and medical staff haven't done enough to work with various groups who still hold strong to their fever phobia. This isn't the fault of parents; they care, that's why they are there for 8 hrs in the ER. They haven't had the right info conveyed strongly enough, often enough, or accurately, or perhaps it hasn't been communicated clearly to them in their primary language if they aren't native English speakers. They are concerned their child will get brain damage, have seizures, etc. from an untreated high fever. Let's get our medical personnel up to speed on clearly conveying this info to parents, regularly and often, in easily understood language, putting the info into the parent's native language, etc. rather than criticizing the parent(s) for trying to get their children care.
SOme MDS will want to cover themselves and may send a family in to the ER if it is after hours, even for "just" a fever. I doubt most parents want to spend 8 hrs in the ER. It isn't fair to blame the families here IMO.
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Several days beforehand, I pop our formal china in the dishwasher (ours is DW safe according to the manufacturer if not put in DW daily), make sure wine glasses, etc. are dust free (we use the same few most of the year, but during the holidays I need to make sure the ones that get neglected are clean and ready to go. If you need to iron table linens or anything like that, do it well in advance (2-3 days before or more).
I prechop what I can a day or two before. Lots of onion and celery. I use the onion in several dishes, and obviously onion and celery in stuffing/dressing (whatever you do). Chop what you can for other recipes in advance. Just look over what your recipes call for and see if you can increase the number of onions, etc. and just chop it all in one shot, then cover and keep in fridge until the day of.
I use some of the onions to do the Mark Bittman make ahead gravy. Love it. I hate doing gravy at the last minute, which can be intimidating if you are new to cooking Thanksgiving. I've hosted for all but one of the last 15 years, and I still dislike making gravy last minute. You just gently reheat and if you want, add some new pan drippings for depth of flavor. I roast a turkey a few weeks before Thanksgiving to make homemade stock to use in the recipe. Depending on how picky you are, you could use a decent store bought stock.
Pies/desserts I make a day or two beforehand.
I made this for the first time this year and I like it. It isn't super sweet; kind of a mix of savory and sweet. http://www.epicurious.com/recipes/food/views/Cranberry-Sauce-with-Port-and-Dried-Figs-105836 It keeps for a week in the fridge.
if you want home baked bread or rolls, I'd do those in advance (prep and freeze if a freezer friendly recipe, rise the day of or night before). I don't usually bother with that :)
The day before I will cut up certain cheeses (that can handle being cut in advance), crudite, etc. to serve as part of our apps.
On your last grocery run, consider grabbing disposable gladware or similar to send home leftovers with guests (if they will want that; in our family this is a given!)
Check that you have enough serving dishes for each dish you plan to serve (platters, casseroles, etc.) Clean, set the table a day or two or three in advance (if you have a formal dining room that you don't need access to daily). Make sure you have enough serving spoons, forks, etc. too.
Consider whether any of your dishes could work in a large toaster oven or roaster oven, or be kept hot in a crockpot or similar. I have a single wall oven and this time of the year always wish we had a second oven.
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My understanding is that the act considers 9.something% of household income "affordable".
Dh's small company option would cost us over $2,000/mo, which is why we purchased our own through the exchange. Our household income doesn't qualify us for a subsidy, but we're able to buy a platinum plan with all the bells and whistles for almost half of the employer option.
And to be clear, it is deemed "affordable" if the *employee's* health insurance is offered at a price that doesn't exceed 9.5% of income. Adding on your family is not included in that "affordability" standard at all, so yes, it can be deemed affordable even if it is *well* over 9.5% to insure your family, provided the *employee's* premium is under that 9.5% number. Insuring a family on an employer's policy can add up very quickly, while still meeting the standard for affordability.
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I had this same problem last year but someone at the marketplace told me how to apply to get around that. It worked.
Maybe I'm missing something. Our income is too high for a subsidy of any type, and our private plan (that we've had for 4.5 years now) has a lower deductible and lower cost per month. As a result, I don't think the marketplace is a great option for us either way.
My husband is offered his insurance paid at 100% (fwiw, they have had to start adding surcharges for smokers, etc. this year to contain costs. DH works for a larger small business of about 50 employees. This doesn't apply to DH, fortunately). It would be 12K to add on our family, so we don't, and go use our private plan. His company kicks back some money into an account since he doesn't take the work insurance, so that buffers things a bit for us. DH's work insurance (if he took it) would not exceed 9.5% of his income, as his premium would be fully paid by the employer.
I don't know any work around, and the marketplace in our case is still pricier for even a bronze plan than (with a deductible of 10K) than what we pay for our private plan with a 3500 per family deductible. For a higher tier plan, we might as well just pay the premium and be added onto DH's work plan.
DH's employer is awesome in every other way, so we deal (for now).
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Are you happy with the results? I have been eyeing that recipe as well.
Yes! I just used whatever figs I could find at TJs, a decent port, and I eyeballed the amount of cranberries because I was using a huge bag.
The amount it makes isn't large, so it depends on if you'll serve other sauces and how big your crowd is. I almost always cook, but this year SIL is hosting for the first time. I have a turkey breast and will make some other dishes on Friday or Saturday so we can have our own Thanksgiving here. I might just save the sauce for then.
It is a nice mix of savory, sweet, etc. I think it is quite yummy. I would like to make it again to serve with pork tenderloin.
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in hindsight the only LA degree I'd recommend is technical writing or editing - big need for both of them.
DH did some technical writing for a local company on a contract basis when he was pursuing his PhD, and it was great to have that option. That company then helped him network his way to his current job, and they've also tried to woo DH back to them.
The company he works for currently is about to hire a full-time technical writer under DH's management, and will pay him about 80K in salary. He'll come in some days, but also work at home some of his hours as he will have a long commute. The technical writer does have a PhD, so that salary is going to be higher than a technical writer with a lesser degree. The nature of the work is such that they wouldn't be much of an asset if they can't look at some complex data and write about it, so the pay is accordingly fairly generous (I assume for a technical writer that's a pretty decent salary, but IDK for sure).
Not a bad skill to have available as an option.
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Cranberry sauce with port and figs:
http://www.epicurious.com/recipes/food/views/Cranberry-Sauce-with-Port-and-Dried-Figs-105836
It can be made a week in advance. I made it yesterday.
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We have rationing of healthcare, limited access to the right specialists depending on insurance, etc. right now under our system. FWIW, my career was in healthcare.
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I don't know, but I get where you are coming from. I think part of it is the increasing blur of work and private life (expectation to answer emails, look at documents, take calls after hours, even in professions where that previously was not the norm). Another contributor IMO is stagnant wages in many fields, coupled with those increased demands from employers. The increased cost to complete many degrees is another issue, as I think it can lead to people feeling "trapped" in a career longer term.
I majored in physical therapy in a time when a master's was required to sit for licensure. it is still a wonderful field, good employment prospects, etc. However, in recent years the DPT (doctorate in physical therapy) as become the norm. It hasn't come with an increase in pay, and DPTs generally speaking don't make more than a MPT. We still have bachelor's PTs practicing since these changes to sit for licensure grandfather in those with the standard degree in their era. What has changed is the cost to complete that degree. When I attended, it was 125K for me to do a 5 year combined bachelor's and master's degree. I graduated with my master's in 01. With the DPT becoming the new entry level degree (almost all programs have now changed over to the DPT), the cost has skyrocketed. It would now cost just under 300,000 with room and board, with no increase in salary. I had a scholarship that covered part of my expenses, but spots are extremely competitive and have been for years. Salary and employment prospects are good; however, it isn't a profession that pays a salary where massive loans wouldn't be a burden. That scares me.
I can think of few employment prospects that pay well, etc. for my kids that don't involve advanced degrees, and then you get into how employable those will be, and what kind of student loans will be involved. I don't think salary is everything, but the cost to benefit of certain degrees is something that I do think most people have to realistically consider on some level.
My husband works in a STEM field, and I still feel positive about that for my children if they are interested. However, I think *many* people have no idea what many STEM degrees actually pay (for something like a bachelor's level chemist or biologist), how cut throat and competitive spots in academia have become for those with PhDs (hundreds and hundreds of applicants for a spot these days, and as some in academia joke, you can choose whatever hundred hours in a work week you wish to work ;) ) My DH's degree is in somewhat of a niche field in an industry that has thrived even during the economic downturn, but many of our friends in STEM are under contant threat of layoffs, cuts to benefits, etc. For years my husband worked in big pharma, and the environment there is toxic in many places these days. In the past, that was a wonderful job, people spent their whole career in the same field, maybe moving companies to get promoted, but overall, it was a great place to be, with great benefits, long term security, bonuses, options, etc., but that is falling by the wayside.
I expect our kids will have to learn to cobble together skills beyond their degree, they will probably have to consider the possibility that jobs in their time may be more contract/freelance type of things, etc.
To the person who asked what is a good gig, I will highly encourage my kids to shadow others in the careers that interest them. I did this, and I think it was a very valuable experience. I volunteered in an outpatient PT place in high school, shadowed the school PT in my school as part of my gIEP, shadowed an athletic trainer, etc. I want my kids to talk to a range of people in the fields that interest them and to really understand both the good and bad of the professions they are considering. That is more meaningful than mom and dad trying to tell them anything. Ideally, I would like them to talk to several people in different settings, as in healthcare, the hours, challenges, patient population, billing, etc are considerably different in various settings (acute care, skilled nursing, outpatient pediatrics, early intervention, rehab, outpatient orthopedics). Ditto things like STEM fields, where private industry vs. academia is quite different, so diverse points of view are valuable. I will highly encourage them to engage in student/faculty research and join their professional organization and attend meetings, etc. while students. Those connections are helpful in guiding their career path, opening doors, and helping them understand the challenges they may face in their chosen profession.
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In the oven, I don't have trouble with it getting mushy. I just pressure cooked two different ones, and both times they were overdone, so I need to adjust my cooking time and figure it out!
When prepared properly, it is definitely not soft like a pasta (like lewber just said above). I like it a lot, but it is not pasta, so don't expect that, kwim?
A great sauce helps with the adjustment. I'm a huge fan, but it needs to be appreciated for being spaghetti squash, not really equivalent to pasta in taste or texture.
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ACA was designed to help the insurance companies keep making money. Don't let anybody tell you otherwise.
My first job that had health insurance, back in 1990, had no coinsurance, no deductible, and a $15 copayment. This was with Aetna, and was a small woman-owned business. As time went on (before the ACA), the copayments rose, the deductibles rose, and then we started seeing coinsurance as well. Before, you'd either have co-insurance or a deductible, but not both.
Of course, then I had gestational diabetes, and found out I couldn't buy insurance myself. That was fun.
The ACA was designed with the input of insurance companies. Otherwise, we'd have single payer...perhaps like Medicare with supplemental plans to pay the 20%.
We live in FL. For our family of six, on a gold plan, it's $1600/month. FL did not participate in the healthcare exchanges. Even with gold, we still have a deductible. Some of the platinum plans do as well. There's still a bunch it doesn't cover. But in many regards, it's better in that there are no pre-existing conditions.
Our health insurance through COBRA that we had with NY was better. 10x better. Each state is different.
Rather than trying to repeal the ACA 50+ times, I'd really like to see the Republicans propose improvements to the existing plan. We can do better. Every other developed country does.
Yep, my husband worked in big pharma for years and we had essentially a cadillac plan. My DH left that company to return to graduate school. Fast forward a few years, and our friends in that company were telling us about how much their employee contributions toward the premium had increased, how much copays had risen, etc. and that was 7+ years ago, before ACA. DH now works for a smaller employer, has a wonderful job, is well compensated, but healthcare would be very expensive for our family through his employer. We've discussed with our friends still working for Dh's old employer, as he's had offers to return there, but financially, it isn't really much different than what we're paying for our private plan or would be paying for Dh's employer sponsored coverage. All of that to say, big increases and an increase in the shifting of financial responsibility to the employee has been going on for a long time IME.
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Have you checked into covering just you and the kids on an ACA plan? Is that allowed?
We looked into it last year and again this year, but the savings for 4 vs 5 people (assuming DH went on his employer's plan) wasn't very significant, and still pricier than our current private plan, which has a lower deductible (and covered things like well visits for the kids even before ACA). We still wouldn't qualify for a subsidy due to our household income, so the cost would still be very high, and the deductible much higher than our current plan's. We've used our current plan for almost 5 yrs; the price has risen in that time, but since we never hit our deductible, they have lowered our deductible each year. We are now down to a 3500/yr/family deductible, which is as low as they will do on our current plan.
Ferguson
in The Chat Board
Posted
I only caught a glimpse but did see a moment where they discussed a KKK member in the crowd. I don't know more than that, but I did happen to catch a moment of the coverage. My tv upstairs gets two channels LOL, so I'm 99 percent sure it was CBS.