Medical debt impacts 23 million Americans per Kaiser study

In an article called “The burden of medical debt in the United States” by Matthew Rae, Gary Claxton, Emma Wager, Cynthia Clark, Jared Ortaliza, and Krutika Amin, the results of a Kaiser Family Foundation (KFF) are noted. Per the article, a link to which is below, the following conclusion can be drawn:

“We find that 23 million people (nearly 1 in 10 adults) owe significant medical debt. The SIPP survey suggests people in the United States owe at least $195 billion in medical debt. Approximately 16 million people (6% of adults) in the U.S. owe over $1,000 in medical debt and 3 million people (1% of adults) owe medical debt of more than $10,000. Medical debt occurs across demographic groups. But, people with disabilities, those in worse health, and poor or near-poor adults are more likely to owe significant medical debt. We also find that Black Americans, and people living in the South or in Medicaid non-expansion states were more likely to have significant medical debt.”

Several years ago, I cited a study that noted medical debt was the number one reason for bankruptcy by individuals, so the above result is not a surprise. The groups that are most exposed are non-Hispanic Blacks at 16% and people in the age 50 to 64 demographic at 12%. Some of the reasons for this age group being higher is Medicare does not kick in until age 65, people are getting downsized in that group and employer retiree medical benefits have largely gone away.

I posted a piece from Politico the other day about rural health care suffering. An important reason is the fourteen states who have not expanded Medicaid to those below a certain poverty level. This has led to more rural hospitals closing and exposed people who do not have coverage to higher medical debt or forsaking care all together. The debt comes with people waiting until they are a train wreck before going to the ER, a more expensive place to get care.

One of the things I have found in my consulting experience as well as patient and care taking experience, access to health care is critical to a person’s health. The ability to get preventive care before the train wrecks also lowers the cost while improving one’s health. In the US, one of our warts is we are the most obese country in the world per the World Health Organization. We have supersized ourselves to earn that mantel. We must get ourselves on a better path before it becomes too late.

Access to care is key to getting on that better path, but making it a more affordable journey. When people say we have the best health care system in the world, that simply is not borne out by the data – we have the most expensive health care in the world; we rank in the low thirties in health care outcomes. We must use the system more wisely. All of us.

The burden of medical debt in the United States

Vaccine Booster Done – no worries

Yesterday, I received my COVID booster shot, a third shot from Pfizer. So far, there have been no worries except some expected arm pain, but I will provide any updates later, if circumstances change.

I am aware of several folks who have received the booster, with two experiencing some tiredness. As with the first two vaccines, I encourage folks to get the booster. If people have not gotten the first vaccines, I urge folks to move forward.

Too many folks have died from COVID. And sadly, too many vaccine naysayers have passed away, recognizing only at the end their error in judgement. Are the COVID vaccines perfect? No, as are all other vaccines, medicines and surgeries – just read the possible side effects on any drug description.

Yet, those who have had issues with the COVID vaccines, may seem like a lot, but when compared to the number of vaccines given are a very small percentage. That does not diminish the angst or poor experience of those folks. But, we need to keep these results in context, noting the huge percentage of positive experiences.

As before, please do not take my word for it and check with your own doctor. Be safe. Be healthy. Stay alive.

Social distancing and masking up are musts, even for presidents

With US approaching 210,000 COVID-19 deaths, we learned the president and his wife have tested positive for COVID-19. I wish them well in their recovery. Their testing positive follows a day after Hope Hicks, a key White House staff member who traveled with the president tested positive.

Today, more announcements of public figures testing positive occurred. Republican Senators Mike Lee from Utah, Thom Tillis from North Carolina and Ron Johnson from Wisconsin all tested positive. Also testing positive are former New Jersey Governor Chris Christie, former White House staff member Kellyanne Conway, Republican Party chair Ronna McDaniel, campaign manager Bill Stepien, the president of the University of Notre Dame, and three White House reporters.

In terms of tracing, I heard the tail end of a report that some of these folks may have all been together at the announcement of SCOTUS candidate Amy Coney Barrett. The NPR report noted there was a White House lawn ceremony followed by an event indoors, neither of which followed all of the protocols needed.

This may or may not be the link, but it reminds us that we must be careful. We must avoid large gatherings, especially indoor ones, and follow social distancing and mask wearing protocols. Also, hand washing is essential.

While I am saddened that public people or any one, for that matter, gets COVID-19, what is happening to the president and people who have been near him is not a surprise. Flouting all of the requirements and choosing to not only not wear mask, but being flippant with those who do, is not conducive to cautious behavior.

To be frank, pandemics are not to be trifled with. While those who have to work in jobs that cannot be done from home are most at risk, pandemics truly know no zip code or income status. And, those who are the most fragile have the greater risk, if tested positive.

Let’s wish everyone, including the president and first lady well, but let’s also be smart and following social distancing and mask wearing protocols. Maybe, those who have not, will start to take notice. If we do not have universal compliance, the risk remains, especially as the colder weather force us more indoors.

The pandemic risk is exponential, not arithmetic

I read today in The Charlotte Observer the president called the North Carolina governor asking for full opening of the Republican National Convention (RNC) with no social distancing or masks required. Think about this. He has the nomination. He just needs the delegates to vote on it. Yet, he is advocating the gathering of Republicans which heighten the risk by people who believe him when he says these protocols are not needed.

Pandemics work exponentially, not arithmetically. Let’s just say 0.5% of the people at the RNC get infected. That is 250 people who expose people serving food, ushering, securing, guiding them around Charlotte. That is 250 people who take the risk back to their communities to expose their families, friends and communities. On February 28, a night the president still called the Coronavirus a hoax, we had the first recorded American death due to COVID-19. We now are passed 105,000 on May 31, three months later. The question to ask is it worth 250 people infected in late August, that will cause a much large number of deaths come the day of the election?

I want Trump supporters to realize the risk the president is placing on the Republican party and others just so he can hear applause at the RNC. Yet, many citizens are smarter than this president and other politicians. While masks being worn by Democrats and Independents exceed 80%, 58% of Republicans are wearing masks, which means more are than are not. So, if this convention occurs without limits, will they come? If they do have the RNC, just maybe only the delegates and a few supporters actually show up; that would help the exposure immensely, but not rid ourselves of it.

Let me update a few ratios in closing. As of today, the US has 5% of the global population and 28% of the COVID-19 deaths. Thinking we solved this problem is a huge mistake in overconfidence and is yet more evidence of misinformation to gloss over the problem. Those US deaths tally 105,000 and counting as of May 31. Remember, we just crossed 100,000 last week. The summer weather will help, but we must keep our social distancing, keep good hand washing hygiene, wear masks in stores, in spite of what some influencers may tell you. It is only your and your family’s health we are talking about.

The Good, the Bad and the Ugly – a synopsis

Clint Eastwood’s most famous spaghetti western is “The Good, the Bad and the Ugly.” The title is a common framework to define a series of events, even preceding the movie. Using it one more time, let me frame a few issues with the coronavirus.

The Good

The few silver linings are seeing people going beyond the call of duty to help. The healthcare providers are heroes putting themselves at risk without all of the tools and resources needed. Volunteers and other good folks are doing their best to help through many means. As Mister Rogers said in times of crisis, focus on the helpers.

Seeing people come together to check if people need food shopping done or errands run is inspiring. Some employers are going beyond the call to help.

Another good outcome is the air quality has improved in major cities and carbon ouput has declined. Why? Fewer drivers and less travel. The lessening carbon output is actually noticeable from space in historical problem areas.

The Bad

Being unprepared to start with. I have shared before examples of budget cutbacks causing key staff cuts hindering the ability to help. Then, when a crisis occurs people look back and say how could this happen? In this case, the Global Pandemic team was cut (once again) in 2018. And, in 2019 the tariff war with China caused the elimination of CDC epidemiologists on site in China to be cut.

These absences with the naysaying early on by the US president has left us in a catch up mode. More people have gotten the illness and exposure continues. Fortunately, more active shelter in place and social distancing measures are helping fight the risk led by state, local and now federal leadership. Hopefully, the stimulus bill will pass to open up funds to help.

The Ugly

The uncertainty and those who have lost their lives and loved ones. We are learning more things, but we still do not know as much as needed. We need data, tools, resources and money. We should not take this lightly. The stimulus bill will help, but it will not be a panacea. The financial recovery will take time, but the health risk must be the focus.

People are out of work and companies need customers. Hopefully, the risk curve can be flattened, but safety must be the primary lens. We need to avoid being too impatient and further exposing folks prematurely.

This is a long haul battle. But, the next few weeks and months are critical.

He IS heavy and he’s my brother

Per an article by Mike Stobbe of the Associated Press called “CDC survey finds about 40% of US adults are obese,” Americans are indeed “heavy.” And, some of us are very heavy.

“About 4 in 10 Americans are obese, and nearly 1 in 10 is severely so, government researchers said Thursday.” This comes from a 2017-18 health survey by The Centers for Disease Control and Prevention.

“The survey found that the obesity rate was 42%….The severe obesity rate was more than 9%…But, it’s clear that adult obesity rates are trending up, said the CDC’s Cynthia Ogden, one of the reports authors.”

This should not be news. The World Health Organization has determined the US as the most obese country in the world for at least decade. A former Global Wellness UK based colleague of mine would say to clients, “one of the US’ greatest exports is obesity.” We have exported the gift of high calorie fast food.

The next time you are in McDonalds, Burger King, KFC, etc., read the calorie content on the orders. An average adult man is supposed to intake 2,500 calories per day with an adult woman limited to 2,000 due to size differential. If a fast food meal tops out at 1,250 calories, that is 1/2 a day’s calories. And, don’t even think of super-sizing.

But, it gets worse as we have too many kids with Types I and II diabetes. And, pre-diabetic is the diagnosis du jour for kids and adults. The key culprit is carbs. Bread, potatoes, pasta, rice – think white foods – convert into sugar and lead to diabetes.

So, what should we do about it? Here are a few ideas that worked for me as I shed about fifty pounds over a several years. The key words to remember are “sustainable change.” Whatever path you choose to follow, make it more than a fad change – make it sustainable. Here are a few paths to consider:

– Portion control – put your meals and snacks in a plate or bowl with smaller portions. Make yourself get up if you want more, but resist that urge.
– Less fast food – no or fewer fries (share them) and less fried food
– Less white food – this one is hard, but cut back
– Snack with nuts, trail mixes, and fruits (ripe or dried)
– Read the calorie contents – I might break a breakfast bar in half if it is 200 calories
– Indulge earlier in the day, so you can burn it off
– Walking is your friend

It goes without saying to check with your doctor before you embark on major change. Other anaerobic, core and stretching exercises (yoga, pilates, jazzeercise, calisthenics, etc.) are excellent, but I recommend something you can keep up over the long haul.

Let me close with a comment another wellness colleague who is a doctor used to say. “We are train wrecks waiting to happen.” Being heavy now will haunt you even more later. So, think sustainable change and get off that track.

Misfit foods repurposed

So much of our food is thrown away leading to waste as well as methane producing landfills. On CBS Morning News on Saturday, October 12, two companies were highlighted that are repurposing imperfect or misfit foods. These are foods that get passed over by restaurants and grocers due to blemishes, unusual shapes, or less than expected color. Per CBS:

“USDA guidelines separate fruits and vegetables into grades based on things like size and color. Large volume retailers, including supermarkets, often follow those strict beauty standards. That’s led to 10 million tons of cosmetically imperfect or unharvested food being lost each year.

But one man’s trash has become another man’s treasure for Ben Chesler, who saw ‘imperfect produce’ as the perfect recipe and name for a new business model.

‘The goal was really to fix a part of the food system,’ Chesler said. ‘Starting with produce and then eventually moving into the wider food system, we could solve the environmental impact of all the food going to waste, we could make food more affordable for people and we could start to take a small bite out of this whole problem of food deserts where we could actually deliver healthy produce to people for more affordable than the grocery store.’

The ugly produce movement has grown into a competitive field with companies like Misfits Market and Hungry Harvest all fighting for a share.”

Not only are these repurposed foods saving waste, they are helping consumers save money. Plus, it is a sustainable model. Some distributors threw food away rather than donate it to food pantries because of the trucking and loading/ unloading costs.

From the Imperfect Foods website (see below):

“Imperfect Foods was founded in 2015 with a mission to reduce food waste and build a better food system for everyone. We offer imperfect (yet delicious) produce, affordable pantry items, and quality eggs and dairy. We deliver them conveniently to our customers’ doorsteps and pride ourselves on offering up to a 30% discount compared to grocery store prices. Our customers can get the healthy, seasonal produce they want alongside the grocery staples they rely on, without having to compromise their budget or values. We’re proving that doing the right thing for the planet doesn’t have to cost more, and that shopping for quality ingredients can support the people and resources that it takes to grow our favorite foods.”

From the Misfits Markets website (see below):

“A common misconception is that fruits and vegetables only look strange if something is wrong with them or they are genetically modified (GMO). Quite the opposite: All-natural produce is apt to look funkier than the picture-perfect kind that is engineered in a lab. Unfortunately, misfit fruits and vegetables are often rejected by grocery stores and supermarkets due to natural imperfections or variations in size. A watermelon that has its weight distributed oddly may develop harmless scarring. Carrots grow into each other and look twisted. Peppers get blemishes from the ground. Apples fall and get bruised. All are perfectly normal, nutritious and tasty, and they shouldn’t be discarded. The produce we source may also be a misfit for reasons beyond an ugly appearance. Sometimes a farm’s customers may have over-ordered an item that they requested be prepped a certain way—e.g., just the root without the green—or they can no longer afford to pay for an order of normal produce. We’ll pick up the slack so that farmers still make money from excess produce and nothing goes to waste.”

Please check them out and see if they serve your area.

https://www.imperfectfoods.com/

https://www.misfitsmarket.com/

Yoga is not anti-Christian

It may surprise people that a 59 year old man took a Yoga class with his wife for thirteen sessions. It may also surprise you that I do a short daily routine of exercises after my shower that includes some Yoga stretches and breathing techniques. I mention this next fact as it is germane – I grew up a Southern Baptist and remain a Christian to this day, but must confess I am not a regular church goer.

I have tried on several occasions to encourage my sister to exercise more. On at least three occasions, I have suggested some relative easy Yoga poses and noted the breathing techniques will be of benefit. She noted her breathing has gotten heavier with some unwanted weight gain. But, when I use the phrase Yoga, she shuts me down. Why?

Unlike me, my sister became even more evangelical in her worship as a Southern Baptist. For those not in tune, the Southern Baptists believe strongly that their manner of worship is the only way to find heaven. I know some other religions feel the same, but this is my perspective having grown up with it. People may disagree and that is fine.

She has been taught that Yoga is more about being a mystical religion than it is about improving your body and mind. She has been taught that it is at odds with Christianity. I shared that many Christians do Yoga and if you check out TV commercials about almost any product, you will witness people doing Yoga in the background or forefront. I can count at least 30 commercials that fit this bill.

Yoga is more about being at peace with your breathing, meditation and stretching. Becoming and remaining flexible will serve us all well as we age. But, the breathing is essential as well. It helps oxygenate the muscles as they are used and helps the lung power. People who sing can breathe better because they have to control their breathing between notes. Measured and deep breathing is helpful.

As for the meditation, not everyone does this part. But, it is your brain. You can meditate over any thoughts you want. My wife shared with me a post that spoke of woman starting and building a women’s exercise group at her church. The minister was supportive and appreciated the growing church attendance until he walked in on a class meditating. It was irrelevant that they were meditating over an offered bible verse. The next sermon was on the evils of Yoga and church service declined as a result of his shortsightedness. A link to this post is below.

In my latest suggestion to my sister, that fell on deaf ears, I said let’s don’t call it Yoga, let’s call it George. She laughed but left the Yoga with me. The next time, I will just show her a few different stretches without naming them. My thrust is I want to be able to self-ambulate (walk on my own) until I die. The inability to walk without help is one of the milestones where a person’s demise hastens. Her added weight is causing her concern on this matter, hence her brother’s interest.

I am a Christian. I believe in the overarching theme that we should treat others like we wanted to be treated. Yoga was not mentioned in the bible. So, in my way of thinking, if I am making a suggestion to do Yoga as it helps me, I am following the Golden Rule. I am treating another the way I want to be treated. Yoga is not anti-Christian and don’t let anyone tell it is not.

Note: Here is a link to the post:

https://gulliblestravelsdma.wordpress.com/2014/01/25/southern-baptist-yoga/

Push-ups, Sit-ups and Sprints

When Herschel Walker was asked at the University of Georgia about his weightlifting routine, he had a curious response. He said he had never lifted a weight in his life. For those of you who do not remember Walker, he was an extremely well muscled and fast running back for the Bulldog football team in the early 80’s.

When he was asked how he got so big and fast, he responded “Push-ups, sit-ups and sprints.” He went on to say when he was a scrawny young kid of about ten, he asked a gym coach how to get bigger, stronger and faster and the coach responded with the same answer as above.

What he did not tell the young Walker is how many. So, while watching TV, Walker would do push-ups or sit-ups during the commercials. He said it got to where he was doing about 1,000 of each routine every day. Then, he would go out and do sprints until he dropped.

Walker may have been the finest high school and college football ever to play a down. When I lived in Atlanta, I saw footage of Walker in high school. It is not an exaggeration to say the majority of times he touched the ball, he scored a touchdown, often playing only 1/2 the game as the score was so lopsided. The Hall of Fame quarterback, Fran Tarkenton, said in a guest sports news appearance, wherever Walker decides to go to college, the team will be an “immediate contender for the national title.” Georgia won the national title in Walker’s freshman year and he won the Heisman Trophy for the best collegiate football player.

Walker’s pro career was successful, but he did not stand out as much as he did in high school and college. I think he came up against equally talented athletes, so the margin was smaller. His positives were his strength and speed, but pro football longevity is predicated on elusiveness as well, which he did not need as much in the amateur levels.

Nonetheless, he was a significant player. He was also very humble and polite. Let me leave you with one telling story. After his career was over, a couple was stuck in their car as it was wrecked and rolled over with smoke coming out of the hood. This large African-American man was jogging by, so he immediately went over, realized the dilemma and ripped the door open helping the couple to safety. Then he ran on once he knew they were OK.

He never said a word to anyone what he had done, until a reporter asked him about his role in helping the couple. He shyly admitted he had helped them. He was called Superman by the couple and press.

Push-ups, sit-ups and sprints. We can always better ourselves. I am not saying do 1,000 of each, but a few each day would not hurt. The key metaphor is we have the power to make ourselves better, be it through physical or mental activity. It can be as easy as doing a few push-ups or sit-ups with each commercial.

Walking, Water and Weighing

Since we are the most obese country in the world per the World Health Organization, I was seeking some alliteration to serve as a reminder of three things we each could do. Walking, Water and Weighing. Each of these things would not be difficult to do, but could make a difference.

Walking to better health has been discussed for years. As a former jogger with an up and down history of such, I have resorted to walking and hiking. It is far easier on the joints and can accomplish  many of the same benefits – weight loss, cardio-vascular work, better digestion and improved psyche by being outdoors. And, when you miss walking for a few days, it is much easier to pick back up than jogging.

Drinking more water is the one of the best diet techniques around. I am not advocating drinking water all the time, but try to drink at least a couple of glasses a day. In addition to zero calories, drinking water helps flush out your kidneys and lessens the risk of kidney stones. Plus, staying hydrated is beneficial to good health. Lastly, if you are on a budget, drinking water in restaurants and fast food places is a big saver.

Finally, know your numbers, a key one of which is weight. Weighing once a week is good to know your progress and will encourage you to get that extra walk in or avoid more fried food, bread or desserts the next week. Yet, weighing is a metaphor for knowing your blood pressure and cholesterol counts. These are two examples that can be treated with prescription drugs and better regimen.

I recognize these three things are not earth shattering revelations. But, they are three habits that can easily be implemented and will provide some benefit. Please check with your doctor, if you feel you must, and start slow with the walking.