You’re the Boss

Managing not only an illness but also the doctors and hospitals who take care of you

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May 24, 2013 | 8:05 AM | By

Young Adults Will Make or Break Obamacare in California

By Mina Kim, KQED

David Kim, brother of KQED health reporter Mina Kim, is 29-years-old and uninsured. (Mina Kim/KQED)

David Kim, brother of KQED health reporter Mina Kim, is 29-years-old and uninsured. He is considering whether to buy insurance on the health care marketplace if he doesn’t have employer-based coverage next year. (Mina Kim/KQED)

Most of us know someone who doesn’t have health insurance. In my case, it’s my little brother, David Kim.

David is 29-years-old and recently earned an advanced degree in international relations. He hasn’t been able to land a full-time job with health benefits. The two jobs he has now are temporary, and with such a precarious work situation, he just doesn’t think he can afford health insurance.

“I’m totally aware that if I get sick then I’m doomed financially,” Dave told me over a lunch break. “And maybe that’s not a very financially sound decision to make, but it is nonetheless a risk that, for the time being, I’m prepared to take.”

Young adults —18 to 34-year-olds — make up more than 40 percent of California’s uninsured, though they make up less than 30 percent of the population. And according to many health reform advocates, they’re the ones who could make or break Obamacare.

“If we get only sick people, and don’t get the young, healthy people into the insurance system, it’s going to mean premiums are much higher.” 
“The success of this law really does depend on getting young people insured, and frankly getting everyone insured,” said Larry Levitt, a health policy and insurance expert for the Kaiser Family Foundation.

In less than five months, a key piece of Obamacare will go live: state-based insurance marketplaces, called Covered California here. That means millions of Californians looking for coverage for themselves or their families will be able to go online and enroll in qualified health plans regardless of their medical history. Many will get help from federal subsidies. But if the exchange doesn’t enroll enough young, healthy people, insurers will have to hike everyone’s premiums. Continue reading →

FILED UNDER: Obamacare, You're the Boss, Affordable Care Act, Obamacare, Science, Young Adults
May 22, 2013 | 12:47 PM | By

Powerful Documentary Highlights ‘The Power of Two’

Every 10 minutes, someone’s name is added to a waiting list — a waiting list for a new kidney, heart, lung or other organ. And every day, about 18 people die waiting.

Starting today, San Francisco’s Link TV is screening a remarkable documentary, “The Power of Two.” Twin sisters with fatal cystic fibrosis each received a double lung transplant. In the clip below, they travel to the National Donor Memorial in Richmond, VA.”In a way it was like a pilgrimage to a Mecca,” says Ana, one of the twins. “Because this is the place where our country pays tribute to all the people who have said ‘yes’ to organ donation.”

You can watch the complete documentary online at LinkTV.

And, if you’re not already, you can sign up to be an organ donor.

FILED UNDER: KQED blogs, You're the Boss, Organ Donation
May 22, 2013 | 10:23 AM | By

More Single Boomers Share Homes — and Health Support

By Julie Rovner, NPR

Lorene Solivan moved into the "Golden Girls" house in October after seeing an ad on Craigslist. An event manager at a food company, Solivan says she often cooks dinner for the group. (Maggie Starbard/NPR)

Lorene Solivan moved into the “Golden Girls” house in October after seeing an ad on Craigslist. An event manager at a food company, Solivan says she often cooks dinner for the group. (Maggie Starbard/NPR)

Today more than 1 in every 3 baby boomers — that huge glut of people born between 1948 and 1964 — is unmarried. And those unmarried boomers are disproportionately women. As this vast generation rushes into retirement, there’s a growing concern among experts on aging: Who will take care of all these people when they’re too old to care for themselves?

It’s a question many of the experts take personally. “That is what scares me,” says Sara Rix, who works for the AARP Public Policy Institute, studying the economic prospects of women in the workforce. “Because I am one of those people,” she says, “and I do think about it.”

“Oh, I’ve got wonderful nieces and nephews,” Rix says, noting that’s what a lot of her boomer peers claim, too. “Well, in fact, they’ve got their families. They’ve got their in-laws. They’ve got their parents. And I don’t think it’s reasonable to expect much out of them.”

Kathleen Kelly, who runs the Family Caregiver Alliance and the National Center on Caregiving in San Francisco, says she’s seeing the same sort of concern in her social circle. “I’m in my 50s, and my friends are all talking about, ‘Could we all move in together? Could we buy an apartment building and all live together?’ There are all sorts of permutations of this conversation,” Kelly says. “But it really is something that people are thinking about, particularly women.”

And, because boomers are boomers, some are doing more than just thinking about it. Already, there’s a small but apparently growing movement of boomer women forming group houses with their single peers. Continue reading →

FILED UNDER: You're the Boss, Aging, Boomers, Long Term Care, Science
May 21, 2013 | 4:41 AM | By

Where You Live Affects What Kind of Surgery You’ll Have: Look It Up

(Getty Images)

(Getty Images)

Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you’re having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday.

In health policy, “elective” does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered “elective” because there are a range of options. The California Healthcare Foundation (CHCF) has been following this issue in its “All Over the Map” project. Previously, the foundation has examined variation in heart procedures, joint replacement and c-sections. Tuesday the foundation added a detailed look at geographic variation in treatments for three more conditions: breast cancer, prostate cancer, and back and neck pain.

PIcking out eyebrow-raising numbers was no problem:

  • Men in Indio (Riverside County) receive brachytherapy, known commonly as radiation seeds, to treat prostate cancer at almost five times the statewide average.
  • Women in Healdsburg (Sonoma County) receive lumpectomy without radiation for early stage breast cancer at 270 percent of the statewide average.
  • People in Brawley (Imperial County) are nearly three times as likely to receive cervical fusion, where two vertebrae in the neck are fused together, for neck problems compared to statewide.

CHCF_AllOverTheMap_Banner2_200513_R1SingleLow rates are easy to find, too. To name just one: women in Lancaster, northeast of Los Angeles, with early stage breast cancer receive lumpectomy with radiation at just 26 percent of the statewide average.

The question is why. Maribeth Shannon with the foundation says the variation is “just puzzling to us.” She stressed that the statewide average is not necessarily the “right” rate, but the state average is an estimate that’s easy to use as a benchmark.

In its analysis, the foundation accounted and adjusted for a host of patient characteristics that might skew the numbers. Still, the broad variation is there. Shannon pointed out that it would be “unusual” that patients would differ so significantly in what treatments they wanted, simply according to where they lived.

“It’s much more likely,” Shannon said, “that physicians practicing in that area tend to rely on that course of treatment over others. … It does seem to be more the physician preference than the patient preference.” Continue reading →

FILED UNDER: Policy, You're the Boss, Geographic Variation
May 20, 2013 | 11:32 AM | By

Easy to Do, Inexpensive; Music Calms Some ICU Patients

By Leslie Harris O’Hanlon

(Getty Images)

(Ryan McVay/Getty Images)

The adage stems from the 18th century: music has charms to sooth the savage breast. It’s probably safe to say that someone in an intensive care unit, who needs a machine to help them breathe, is in need of soothing. Usually, doctors and nurses administer drugs, powerful sedatives to help calm patients. Now, a study shows that a different kind of intervention might help: music. The study, published Monday in the Journal of the American Medical Association, adds to a growing body of research on how listening to music has a host of health benefits.

Patients in the music group received 38 percent fewer doses of sedatives.
Researchers at Ohio State University looked at ICU patients on mechanical ventilators for respiratory failure. Those who listened to the music of their choice not only had greater reduction in anxiety but also used fewer sedation drugs and lower doses compared to patients who did not have access to music — they received usual ICU care. Mechanical ventilation, or ventilatory support, is when a patient is connected to a machine, called a ventilator, to help him or her breath.

Researchers call this “patient-directed music” because patients could select their own music and put headphones on whenever they wanted.

The “intervention empowered patients to use music to manage their own anxiety whenever they felt they needed the use of music to help them relax or when they desired some quiet time,” said lead author Professor Linda L. Chlan at Ohio State. “Music does not induce adverse side effects, which are sometimes evident with sedative agents administered to these patients.” Continue reading →

FILED UNDER: You're the Boss, ICU, Music, Science
May 15, 2013 | 5:39 PM | By

What’s a BRCA Gene Anyway?

(Gage Skidmore/Flickr)

(Gage Skidmore/Flickr)

The first thing you need to know about the BRCA gene is that you have it.

Don’t panic. Everyone does. In fact, we all have two of them — the BRCA1 and 2 genes. They are normal genes that “have an important function in the cell. They are involved in repairing DNA damage,” explained Dr. Robert Nussbaum, a medical geneticist at UCSF. “When they’re functioning normally, they do a good job for us.”

We all have two copies of the BRCA genes. Men, too.
The problem is what happens when they don’t function normally. We’ll get to that in a minute. But first, in our call, Nussbaum gave me a helpful primer in basic genetics.

For starters, we all have two copies of each of the BRCA genes. Men, too. We get one copy from each parent.  These genes are “like sentences,” Nussbaum said. ”They are made up of words.” When they’re spelled right, all is well.

But “you can have all kinds of misspellings,” Nussbaum said. “Red becomes reed. All kinds of things can happen that will alter the meaning of that sentence.” Continue reading →

FILED UNDER: You're the Boss, Angelina Jolie, BRCA Genes, Breast Cancer, Science
May 14, 2013 | 12:22 PM | By

Why Angelina Jolie’s ‘Medical Choice’ Is Likely Not Yours

(Foreign and Commonwealth Office/Flickr)

(Foreign and Commonwealth Office/Flickr)

Angelina Jolie lit up social media Tuesday morning with her announcement that she recently had a preventive double mastectomy. She took this route, she says, because she carries a specific BRCA1 mutation — putting her at an 87 percent risk of developing breast cancer and a 50 percent risk of ovarian cancer. You can read everything about her history in her New York Times piece, “My Medical Choice.”

But the key here is a specific BRCA1 mutation. There are many different mutations that can occur in the BRCA gene. Jolie is very careful to walk through all her personal decisions stemming from her unusually high risk, but emphasizes that “the risk is different in the case of each woman.”

About 10 percent of all breast cancers are due to those many BRCA mutations. Dr. Otis Brawley, chief medical officer with the American Cancer Society, explains in more detail what individual women should consider, in a response to Jolie’s piece:

This does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer. What it does mean is women should know their cancer family history and discuss it with their regular provider. If appropriate, they should be referred to and have the opportunity to discuss their risk and their options with a genetic specialist. Continue reading →

FILED UNDER: Tests & Treatments, You're the Boss, Angelina Jolie, Breast Cancer, Mastectomy, Science
May 10, 2013 | 1:41 PM | By

Mark Bittman Talks Up Part-Time Veganism (and Delivers 3 Easy Recipes)

(Getty Images)

(Getty Images)

It all started with a prescription from his doctor, but not for a drug.

“You should probably become a vegan,” New York Times food writer Mark Bittman says his doctor told him. That was six years ago. Then 57, Bittman says he was 40 pounds overweight, and his cholesterol and blood sugar which had always been normal, had moved into the “danger zone.”

Bittman had built his career around food, and being a vegan didn’t appeal to him, as he recounted this week on KQED’s Forum. “I wanted … something do-able, something I could stick with,” he said.

He hatched the idea of being vegan until dinner — “you’re only postponing gratitude” until then.

It seems to have worked. Today, he’s 35 pounds lighter and he says his blood sugar and cholesterol are back in the normal range.

Now he has recounted his experience in a new book, “VB6: Eat Vegan Before 6:00 to Restore Your Health and Lose Weight … for Good.” Continue reading →

FILED UNDER: You're the Boss, Diet, Science, Vegan
April 19, 2013 | 10:37 AM | By

Native American Woman Finds Strength in Spiritual Ceremony

Editor’s Note: In a world where random violence seems to be a constant threat, it can feel like we’re on our own, unprotected and unsupported. As part of our occasional series “What’s Your Story,” Sheila Jumping Bull of Oakland describes how she found strength and solace from a spiritual ceremony called “Wiping of the Tears.”

By Sheila Jumping Bull

Shiela Jumping-Bull records her commentary in a KQED studio as part of the "What's Your Story?" series.

Shiela Jumping-Bull records her commentary in a KQED studio as part of the “What’s Your Story?” series. (Shuka Kalantari/KQED)

Two years ago I was shot in my leg while waiting for the bus. I was in the wrong place at the wrong time. After being shot, I was told that I would never walk again, or that if I did, I’d have to walk with a cane. Being that I had to stay in bed for three months straight, not being able to walk or hold my own baby or do anything for myself, I became depressed. I didn’t want anything to do with life. Mentally, I was not here. I couldn’t believe what was going on. I was angry, confused and hurt.

We have a medicine man that comes to our Native community, once a month. He does ceremonies, sweat lodges, talking circles. He did a ceremony called Wiping of the Tears. I didn’t want to participate in this ceremony, but a lot of people from the Native American community told me that I should because it would help me.

As I prayed and as these songs were being sung, I could feel my spirit coming back.
A Wiping of the Tears ceremony is where you call upon your ancestors and those who have passed before you to come and help heal you — and take away your pain. As the medicine man sings these songs, these sacred songs, these ceremonial songs, you pray, and you ask for their guidance, their strength, their love, and their help. Continue reading →

FILED UNDER: You're the Boss, Healing Ceremony, Native American Health
March 21, 2013 | 11:48 AM | By

Sometimes Three Isn’t A Crowd: Group Appointments with Doctors

You’ve heard of group therapy for mental health issues, how about physical conditions?

By Michelle Andrews, Kaiser Health News

(Courtesy: Kaiser Health News)

(Courtesy: Kaiser Health News)

When visiting the doctor, there may be strength in numbers.

A growing number of doctors have begun holding group appointments — seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.

Some of the most successful shared appointments bring together patients with the same chronic condition, such as diabetes or heart disease. For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse.

“We tell people, ‘You don’t have to say anything,’ But give them 10 minutes, and they’re talking about their sex lives.”

Insurance typically covers a group appointment just as it would an individual appointment — no change in the co-pay amount. Insurers generally focus on the level of care provided rather than where it’s provided or how many people are in the room, says Edward Noffsinger, who consults about group visits. (His website is even called groupvisits.com.)

Some patients say there are advantages to the group setting. “Patients like the diversity of issues discussed,” Noffsinger says. “And they like getting 2 hours with their doctor.” Continue reading →

FILED UNDER: You're the Boss, Group Appointments, Science