A side note: your digital profile

Have you ever tried googling yourself to see what could be found about you? Try looking up a username or maybe that past cringe-worthy username from middle school.  What do you find? What information can someone find out about you?

Fortunately for me, besides on facebook, my name is almost impossible to find on google.  My name and my usernames are too similar to daily life words to find easily.  So it may be fortunate for me for the most part.

However, for many, they do not have this luxury and often times face the ramifications of having an easy to find digital profile.  With the increasingly connected internet, our society will have to face the consequences of having such easily accessible public information.

The Classic Examples

Anyone of employable age all heard the advice, "Be careful of what you put on your facebook! Your employers could find it and use it against you!"  There are also the classic examples where someone pisses off the internet and receive grand retribution for it.  There are also the typical story of stalking and finding their information on facebook and what not.

Even for those that plan carefully for complete anonymity are not complete safe.  In China, there have been instances of internet crowd sourcing in finding different individuals.  Using the collective information of different individuals, they are able to find information that aren't even on the web.  If interested, look up "Human Flesh Search Engine" or 人肉搜索.  

In these cases, you could probably argue that they deserved it (maybe not the stalking).  As long as you do not do anything bad, anonymity is not that big of an issue.  However what happens when it completely isn't the fault of the victim.  Their names happen to be mixed up with someone else due to bad reporting, then what happens?

Mistaken identities

In June 2009, an Iranian woman named Zahra Soltani was shot and killed and became the iconic figure of a demonstration in Iran.  Did I say Zahra Soltani, because the real name of the person who was shot and killed was actually "Neda Agha-Soltan".  Zahra Soltani was a completely different Iranian woman who is still very well alive right now, who just happened to have the nickname of Neda.  The media reported the wrong name  and wrong facebook picture.  As a result, Zahra Soltanihas been harassed by the media, oppositions, and the government.  The Iranian government even claimed there was a conspiracy and "Zahra Soltani" never died.  Well, Zahra obviously never died since it was never supposed to be her in the first place.  To read more, check out the New York Times article on it.

Another story which just happened recently was the tragic CT shooting.  I am sure you are familiar with the shooting and I do not wish to dwell much further on the subject.  However, an unfortunate side story about mistaken identities came through it.  The media reported the name of the wrong brother in the story.  Soon after the wrongly accused brother was flood with facebook messages yelling at him for all the evil that he has done.

Afterthought

These types of events remind me from time to time the vulnerabilities of my information online.  Most likely, these types of events would never happen to me, but you never know.  A bigger concern is more on what kind of information is out there.  What information can other people easily find about me?  For some information, such as my work history on Linkedin, I would love to have employers find out about it.  If I made a very successful blog, I wouldn't mind that as well.  I definitely would not want others to find my middle school blog though.  As for Facebook, there are some information that I wouldn't mind others knowing about, but then some other information that I would rather keep private.  I don't think I have any discriminating information out there, but I'm sure for the risk-adverse like me would rather play it on the safe side.

For now, I can still hide behind the simplicity of my name and being relatively unsearchable on google.  If I become more famous in the future, I will have to control the information that rises to the surface.

A side thought: what type of name should I name my kid?  A common one so no one can find them?  Or a very unique name with a very unique spelling that is easy to find?  The world will definitely be even more connected and digital...

How much does the ACA Cost?

How much does the ACA cost?
Two years ago, the PPACA (Patient Protection Affordable Care Act) or AKA Obamacare was passed.  There was a huge bipartisan divide over that issue over the past few years.  After braving the threat of the supreme court decision and the 2012 election, the ACA is here to stay.  For this post, I'll focus on the cost of it.  The Republicans say it is too costly and is not affordable like it says in the name.  Democrats believe the changes made in the ACA will balance each other out.  So who is right?  The honest answer is nobody really knows, but I will get into the reasoning for both sides.  I will be only covering the Medicaid expansion portion of the ACA, but there are many more important components to the ACA.

Republican View
The ACA is mostly dependent on the expansion of Medicaid (poor people insurance).  More people will be eligible for Medicaid and that will obviously cost more.  Also, there is already a safety net to protect those in the time of need (the ER for life-threatening situations).

Democrats View
The Democrats party's view is that the ACA is actually balanced out in its cost.  There are cost deductions from increased taxes and reduced payouts in Medicare (old people insurance) that balance it out.  Having insurance is much better than not having insurance.  The safety net does not do enough.

Majors points of Republicans and counter points

1) More Eligibility in Medicaid (Medicaid Expansion): More people will be eligible for Medicaid, so it will cost more money, a lot more money!
Counter point: With cuts in the cost of Medicare (old people insurance) and increased taxes on various health care spending like taxes on higher income insurance holders, it will be balanced out.  The CBO projects that the cost will be balanced overtime as shown in this beautiful chart!

But the projection really is up in the air.  It depends on the projections based on the number of predicted enrollees and the average cost per enrollees, which could greatly change the predicted cost.  At least so far according to the great minds at the CBO, the cost should be balanced out.  But they could be wrong!

Also, most of the current Medicaid spending is for the disabled and elderly.  They make up 28% of those on Medicaid while spending 66% of the total cost.  Most new medicaid enrollees from the ACA will be parents and and in general healthier (and definitely not old people).  So some people may use current average medicaid spending to predict the cost which is definitely incorrect.

2) Medicaid is increasing rapidly in cost: In general healthcare costs are taking an increasingly larger percent of our GDP every year.  Medicaid was already a costly program that cannot stay in its current state.  The ACA makes it even worse by covering more people.

Counter Point: There really is not one.  This is actually a very true issue.  Medicaid and Medicare will keep on increasing in cost to the point where we may no longer be able to afford it if it is not changed.  The ACA does have a few cost cutting experiments (like ACO!) that may cut the cost.  And technically the ACA should balance itself out, so it would not have changed the status quo of impending doom (or at least not having it come quickly).  There definitely needs to be more change in the future!

Conclusion!
So ... yeah... nobody can be sure of what the actual cost is going to be.  If it helps you feel any better, CBO says it will be okay.  But even if that is the case, we still have to worry about the impending doom of the Medicaid program.  Although, I believe that is more due to the increasing cost of the healthcare system in general.

But further questions to consider are...

• Is covering all the new uninsured worth it?
• Is making people buy insurance necessary?

Until next time!

The trinity of health and why use health insurance?

Let's begin with the basics!

The holy health trinity (three P's!)

Patient

Provider

Payer

Patients are YOU and other consumers of health.  Unless you are one of the other two.. 

Providers are the ones that 'provide' medical care (e.g. hospitals, physicians)

Payers are the insurance companies or just anyone that takes your money and then pays the providers (e.g. the government in medicaid/medicare using your tax money, blue cross blue shield, kaiser permanente)

Patients pay Payer

Payer pays Provider

Provider treat Patients!

So you may be wondering, why do we need payers (health insurance) to be our middle men?  Couldn't we just directly pay the providers?
Our new relationship would be:
Patients <--> Providers

Well, let's answer this by examining it in parts by splitting insurance into two different components: primary care and catastrophe care.

1. Primary Care: This includes all of the basic check ups and related preventative care components (e.g. pediatrician, general physician).  Having health insurance for primary care is actually more expensive than directly paying the providers.

Imagine 10 people wanting the service of a yearly check-up with a general physician.  They each pay $100 a year to the health insurance company/payer.  The health insurance company takes that money and then pays the provider.  However, they don't pay $1000 to the providers, since the health insurance company needs to take a chunk of that money to pay themselves for handling your money.  They may end up only paying $90 to the physician for each person that gets the annual check-up.  Ideally everyone will go get their check up, so only $900 total.

Couldn't we have just paid $90 directly to the physician instead of $100 through the insurance company?  It would be cheaper for us to cut out the middle man.

Why get insurance for primary care?
The reason is because as a society, we believe that getting your yearly check-up is a good thing, so we want more people to purchase it.  It's like wanting children to eat their broccoli.  Some kids may like it but other kids may not, but we do want them to eat it.  With insurance and the way US insurance is provided (employer insurance), it seems much cheaper to the patients when in reality it is more expensive.  Pretty much we are tricking patients into thinking their broccoli is an airplane.

Imagine that the 10 people pay $8.33 per month to the insurance company.  In a year, they are paying ~$100 for only $90 of service, but it seems a lot cheaper to them since they are paying only $8.33 at a time. And when they go to the physician, they don't pay anything upfront so it looks like they are paying nothing (or very little if there is copayment).  If they had to pay $90 up front instead of receiving it through insurance, less people would purchase it.   So its pretty much disguising their broccoli like an airplane.

2. Catastrophe Care: This is the care you hope you will never have to get, but sure are glad its there when it happens.  It could be covering a bone fracture, going to the ER, coming down with a terrible strain of tuberculosis, and etc.  Anything that cost a lot of money and if it happened to you, many of your friends would be telling you "I am so sorry that happened."

Usually these treatments are very expensive, but fortunately do not happen that often.  If 10 people are interested in protecting themselves from a terrible unspeakable disease that costs $2000.  If each person pays $200 and the disease only has a 10% chance of happening, then this form of catastrophe insurance would totally be worth it.  With the insurance, it will prevent you from going bankrupt when it happens.  We need an insurance company as a middle man to collect and handle the money to distribute out, unless you trust all of your friends to pitch in for you when you're sick.

Wrap-up
Health insurance is usually made up both components.  The first part, primary care, has the goal of trying to convince you to improve your health.  The second part, catastrophe care, has the goal of preventing you from going bankrupt.  This question become much more complicated, when we as a society try to decides
1) Who should receive it?
2) How much should they pay for it?
3) How can we pay for it?
4) How effective are the health insurance in improving health?
5) How do we convince someone to get it?

As a result, this becomes a very politicized issue that is still being resolved.  There are some really interesting research regarding these questions.  So until next time!

A reference for definitions used

Here will be a reference for all of the different definitions used so far.  Maybe I should just call it the glossary and start making a textbook.

Patient: the receiver of medical care

Payer: the one that collects money, invest money, and then pays the providers
Provider: the ones that provide medical care

A beginning

Hello!

I am currently a health policy masters student at a public health school.  My goal for this blog is for several folds: To Record, to Share, and to Improve.

1) To Record what I have been learning: there's so many interesting things that I'm learning everyday.  I can honestly say that I enjoy every single one of my classes.  I'm sure in a few years, I will forget a large portion of it, but I hope to retain as much as I can.
2) To Share what I have been learning: I really enjoy what I am learning and I hope to share it with others.  Also, the health system is something that impacts everyone yet so many people know so little about it since its so complicated.  I hope to be able to present the basics in a helpful manner!
3) To Improve my writing abilities: To improve it to be more concise and better.  I sometimes wonder why I am pursuing a field that has so much emphasis on writing, something which I hated in high school.  It has definitely improved over the years and I am beginning to enjoy it much more.  So hopefully in the future I can look back and really see the improvements I have made.

I will do my best to provide as good of an explanation as possible and as unbiased as possible.  So please do let me know if I fail to do so...

What will I be covering? Pretty much anything to do with health.

• Health systems: how does it work?
• Public Health: what does that entail?
• Why public health is so awesome?
• Why you should get a MPH degree as well

Thanks for reading and stay tune!