Tag Archives: Jeffrey R. Ungvary

Lower Back Ache? Be Active and Wait It Out, New Guidelines Say

Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don’t call me in the morning.

On Monday, the American College of Physicians published updated guidelines that say much the same. In making the new recommendations for the treatment of most people with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-line therapy.

Dr. Nitin Damle, president of the group’s board of regents and a practicing internist, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice. “We need to look at therapies that are nonpharmacological first,” he said. “That is a change.”

The recommendations come as the United States is struggling with an epidemic of opioid addiction that often begins with a simple prescription for ailments like back pain. In recent years, a number of states have enacted measures aimed at curbing prescription painkillers. The problem has also led many doctors around the country to reassess prescribing practices.

The group did not address surgery. Its focus was on noninvasive treatment.

The new guidelines said that doctors should avoid prescribing opioid painkillers for relief of back pain and suggested that before patients try anti-inflammatories or muscle relaxants, they should try alternative therapies like exercise, acupuncture, massage therapy or yoga. Doctors should reassure their patients that they will get better no matter what treatment they try, the group said. The guidelines also said that steroid injections were not helpful, and neither was acetaminophen, like Tylenol, although other over-the-counter pain relievers like aspirin, naproxen or ibuprofen could provide some relief.

Dr. Weinstein, who was not an author of the guidelines, said patients have to stay active and wait it out. “Back pain has a natural course that does not require intervention,” he said.

In fact, for most of the people with acute back pain — defined as present for four weeks or less that does not radiate down the leg — there is no need to see a doctor at all, said Dr. Rick Deyo, a spine researcher and professor at the Oregon Health and Science University in Portland, Ore., and an author of the new guidelines.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

From ‘Repeal’ to ‘Repair’: Campaign Talk on Health Law Meets Reality

Asked at a confirmation hearing two weeks ago if he was working with President Trump on a secret plan to replace the Affordable Care Act, Representative Tom Price, Mr. Trump’s nominee for secretary of health and human services, smiled broadly and answered: “It’s true that he said that, yes.”

The committee room, filled with health care lobbyists, consumer advocates and others with a vital stake in the future of the health care law, erupted with knowing laughter at Mr. Price’s careful formulation. For those following the issue closely, it has been an open secret that the fledgling Trump administration is a long way from fulfilling one of Mr. Trump’s most repeated campaign promises.

In a brief aside in an interview with Bill O’Reilly of Fox News broadcast before the Super Bowl on Sunday, Mr. Trump went further than he ever has in acknowledging the reality that any hope of quickly replacing the Affordable Care Act has been dashed.

“Yes, I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year,” the president said.

That admission is sure to be a serious disappointment for the president’s most fervent supporters, who sent him to Washington believing that he would move quickly to dispatch the health law.

Soon after he was elected, Mr. Trump reacted to Republican suggestions of a delay in replacing the health act by insisting that repealing and replacing the law must happen at about the same time.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

How to Close a Gender Gap: Let Employees Control Their Schedules

The main reason for the gender gaps at work — why women are paid less, why they’re less likely to reach the top levels of companies, and why they’re more likely to stop working after having children — is employers’ expectation that people spend long hours at their desks, research has shown.

It’s especially difficult for women because they have disproportionate responsibility for caregiving.

Flexibility regarding the time and place that work gets done would go a long way toward closing the gaps, economists say. Yet when people ask for it, especially parents, they can be penalized in pay and promotions. Social scientists call it the flexibility stigma, and it’s the reason that even when companies offer such policies, they’re not widely used.

A new job search company, Werk, is trying to address the problem by negotiating for flexibility with employers before posting jobs, so employees don’t have to.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Judge, Citing Harm to Customers, Blocks $48 Billion Anthem-Cigna Merger

A federal judge on Wednesday blocked a proposed $48 billion merger of Anthem and Cigna, derailing another effort by top health insurers to reshape the industry by combining.

The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds.

Judge Jackson wrote in her order that she found the Justice Department’s arguments against the deal persuasive, and that putting Anthem and Cigna together would harm customers.

“The evidence has also shown that the merger is likely to result in higher prices, and that it will have other anticompetitive effects,” the judge wrote. “It will eliminate the two firms’ vigorous competition against each other for national accounts, reduce the number of national carriers available to respond to solicitations in the future, and diminish the prospects for innovation in the market.”

Under the merger agreement’s terms, Anthem is obligated to pay Cigna a $1.85 billion breakup fee.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The Right Way to Say ‘I’m Sorry’

Most people say “I’m sorry” many times a day for a host of trivial affronts – accidentally bumping into someone or failing to hold open a door. These apologies are easy and usually readily accepted, often with a response like, “No problem.”

But when “I’m sorry” are the words needed to right truly hurtful words, acts or inaction, they can be the hardest ones to utter. And even when an apology is offered with the best of intentions, it can be seriously undermined by the way in which it is worded. Instead of eradicating the emotional pain the affront caused, a poorly worded apology can result in lasting anger and antagonism, and undermine an important relationship.

I admit to a lifetime of challenges when it comes to apologizing, especially when I thought I was right or misunderstood or that the offended party was being overly sensitive. But I recently discovered that the need for an apology is less about me than the person who, for whatever reason, is offended by something I said or did or failed to do, regardless of my intentions.

I also learned that a sincere apology can be powerful medicine with surprising value for the giver as well as the recipient.

After learning that a neighbor who had assaulted me verbally was furious about an oversight I had not known I committed, I wrote a letter in hopes of defusing the hostility. Without offering any excuses, I apologized for my lapse in etiquette and respect. I said I was not asking for or expecting forgiveness, merely that I hoped we could have a civil, if not friendly, relationship going forward, then delivered the letter with a jar of my homemade jam.

Expecting nothing in return, I was greatly relieved when my doorbell rang and the neighbor thanked me warmly for what I had said and done. My relief was palpable. I felt as if I’d not only discarded an enemy but made a new friend, which is indeed how it played out in the days that followed.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Get Up and Move. It May Make You Happier.

When people get up and move, even a little, they tend to be happier than when they are still, according to an interesting new study that used cellphone data to track activities and moods. In general, the researchers found, people who move are more content than people who sit.

There already is considerable evidence that physical activity is linked to psychological health. Epidemiological studies have found, for example, that people who exercise or otherwise are active typically are less prone to depression and anxiety than sedentary people.

But many of these studies focused only on negative moods. They often also relied on people recalling how they had felt and how much they had moved or sat in the previous week or month, with little objective data to support these recollections.

For the new study, which was published this month in PLoS One, researchers at the University of Cambridge in England decided to try a different approach. They would look, they decided, at correlations between movement and happiness, that most positive of emotions. In addition, they would look at what people reported about their activity and compare it with objective measures of movement.

To accomplish these goals, they first developed a special app for Android phones. Available free on the Google app store and ultimately downloaded by more than 10,000 men and women, it was advertised as helping people to understand how lifestyle choices, such as physical activity, might affect people’s moods. (The app, which is no longer available for download, opened with a permission form explaining to people that the data they entered would be used for academic research.)

The app randomly sent requests to people throughout the day, asking them to enter an estimation of their current mood by answering questions and also using grids in which they would place a dot showing whether they felt more stressed or relaxed, depressed or excited, and so on.

Periodically, people were also asked to assess their satisfaction with life in general.

After a few weeks, when people were comfortable with the app, they began answering additional questions about whether, in the past 15 minutes, they had been sitting, standing, walking, running, lying down or doing something else.

They also were asked about their mood at that moment.

At the same time, during the 17 months of the study, the app gathered data from the activity monitor that is built into almost every smartphone today. In essence, it checked whether someone’s recall of how much he or she had been moving in the past quarter-hour tallied with the numbers from the activity monitor.

In general, the information provided by users and the data from activity monitors was almost exactly the same.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

NY exchange scores F’s on some consumer features

The New York State of Health exchange lacks many of the features that other public Obamacare marketplaces, including Healthcare.gov, have added to make it easier for users to compare plans, according to a report released Tuesday by the Clear Choices Campaign, an advocacy group that seeks greater transparency in health care quality and pricing. Rather than just allowing users to compare premiums, for instance, some exchanges include tools that let users calculate their out-of-pocket costs and search for plans that cover their preferred drugs and providers. The scorecard accompanying the report gave New York an F in several categories. Although the pending repeal of the Affordable Care Act introduces uncertainty into the future of the Obamacare exchanges, a less standardized health insurance marketplace could increase the need for such comparison-shopping tools, said Joel White, president of the Clear Choices Campaign. White is also founder and president of the health care lobbying firm Horizon Government Affairs.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Repeal and Compete

Modern conservatism, at least in its pre-Donald Trump incarnation, evolved to believe in a marriage of Edmund Burke and Milton Friedman, in which the wisdom of tradition and the wisdom of free markets were complementary ideas. Both, in their different ways, delivered a kind of bottom-up democratic wisdom — the first through the cumulative experiments of the human past, the second through the contemporary experiments enabled by choice and competition.

In health care policy, however, conservatives tend to simply favor Friedman over Burke. That is, the right’s best health care minds believe that markets and competition can deliver lower costs and better care, and they believe it even though there is no clear example of a modern health care system built along the lines that they desire.

The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore. A few of them — notably Singapore’s, the beau ideal of right-wing health care wonks — do have distinctive elements that conservatives favor. But mostly they tend to be much more heavily regulated and subsidized than the system that conservative health policy wonks and policy-literate Republicans would like to see take over from Obamacare.

Which is not to say that the conservative health policy vision lacks empirical grounding. There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems.

But still — there is no existing system on a national scale that looks like the health care system that Paul Ryan or Tom Price would design, no wisdom of developed-economy experience that proves that such a system would actually keep overall costs low and prevent too many people from being shut out of insurance markets. So embracing even the smartest conservative Obamacare alternative requires a not-precisely-Burkean leap of faith.

And this, in a nutshell, is why Republicans should give serious consideration to the proposal that Senator Bill Cassidy of Louisiana and Senator Susan Collins of Maine have just put forward as a possible health care reform alternative.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Senators Propose Giving States Option to Keep Affordable Care Act

WASHINGTON — Several Republican senators on Monday proposed a partial replacement for the Affordable Care Act that would allow states to continue operating under the law if they choose, a proposal meant to appeal to critics and supporters of former President Barack Obama’s signature health law.

But the plan was attacked by Democrats as a step back from the Affordable Care Act’s protections, and it was unlikely to win acceptance from conservative Republicans who want to get rid of the law and its tax increases as soon as possible. If anything, the proposal — by Senators Bill Cassidy of Louisiana, a medical doctor, and Susan Collins of Maine, a moderate Republican — may show how difficult it will be for Republicans to enact a replacement for the Affordable Care Act.

Legislation that can pass muster in the more conservative House may not win enough support in the Senate. A bill with broad appeal in the Senate may fail in the House.

Under the proposal, states could stay with the Affordable Care Act, or they could receive a similar amount of federal money, which consumers could use to pay for medical care and health insurance. “We are moving the locus of repeal to state government,” Mr. Cassidy said. “States should have the right to choose.”

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New Contraceptive Regulations Announced by Governor Cuomo

“Governor Andrew M. Cuomo today announced a series of actions to firmly secure access to reproductive rights in New York State. Through regulatory action, the State will ensure that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles regardless of the future of the Affordable Care Act; contraceptives are available in amounts exceeding one month’s supply at a time; and all medically necessary abortion services are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles.”

Links to the circular letter and regulations can be found below.  High Deductible Health Plan deductions will apply to abortion services.

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/ContraceptiveLetter.pdf

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/AbortionRegulations.pdf

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/ContraceptionRegulations.pdf

Jeffrey R. Ungvary President

Jeffrey R. Ungvary