A preliminary proposal for an application to the Health Care Innovation Challenge sponsored by CMS. The focus for this proposal is gestational diabetes, maternal obesity, postpartum weight loss, and patient engagement / health literacy.

CMS Health Care Innovation Challenge Grant - Preliminary Proposal

I'm sitting here and wondering what was the purpose of Representative Allen West using a slavery metaphor where he describes Congressional Black Caucus members as  "overseers", the democratic party as a "plantation" and himself as "Harriet Tubman". With the implicit understanding that (in his mind at least) African Americans with a progressive view of politics are "slaves". 

While I'm sure some of Mr. Wests critics will say unflattering things about Mr. West which will then be seized upon by Mr. West and his allies.  I'm wondering where is the outrage at HIS deplorable and disgusting comparison?

In my opinion, Mr. West would do well to make his points without the inflammatory rhetoric which only seem to encourage the most reactionary racist perspectives in this country.

Reductio-ad Hitlerum is a form of ad hominem and logical fallacy that equates a bad thing with Hitler.  It generally has the net effect of diminishing the importance of the holocaust and bringing ridicule to the speaker.

As an African-American who has voted Republican in the past I suspect that it's time for both sides of the political spectrum to stop using Reductio ad Slaverum.

Believe it or not, I actually agree with the thrust of Mr. West's comments in the above clip. But, I would suggest that his methodology is ineffective at best and counter-productive at worst.

Certainly things are better now than in the days of Jim Crow. But, unfortunately, I still feel that there is still a substantial amount or inter-racial racism in our nation that must be addressed. However, it is now intricately linked to class. Frankly, my kids (brought up in a stable two parent family by professionals in what would have been considered affluence based on our backgrounds) have been raised in an enriched integrated society and don't experience much racism at all. (They tell me as much). 

However, for kids on the lower end of the socio-economic spectrum there is still a substantial problem with failing schools, absent role models, single parent homes, institutional low expectations, negative cultural influences and the presumption of criminality from the wider society (white and black). I'm not willing to say this will always exist; rather I feel we should fight hard to erase it.

I suspect Mr. West has some positive contributions to make in this regard. But he failed to make an impact with the statements he made about slavery and the Democratic party. Rather than use his unique position to make an impact on the issues I've raised, he seems to prefer to make inflammatory statements which lead to further polarized arguments which do not address significant concerns. I have higher expectations for him than that.

I am currently reading a report entitled "Investing in America's Economy" which was prepared by  Our Fiscal Security.  The group is a collaborative effort of Demos, the Economic Policy Institute, and The Century Foundation, and is intended to be "A Budget Blueprint for Economic Recovery and Fiscal Responsibility".  A PDF copy of the report can be downloaded here.

I was originally drawn to this report because Maggie Mahar is a contributor and has provided proposals on how to rein in health care spending as part of an overall push towards debt reduction and fiscal responsibility.

And while I certainly intend to blog on the ways in which the control of health care spending can improve the financial health of the nation I was particularly impressed with one aspect of the economic recommendations which (I feel) gets far too little attention in the media.

It's time to end the McMansion Subsidy.

The report suggests that we replace the current mortgage interest deduction with a refundable tax credit of up to 15% of interest on up to $500,000 in mortgage debt.  This step alone would save the Federal government 387.6 billion in the next 10 years.

Mike Konczal (aka Rortybomb) has written about the details in a post entitled "Our Fiscal Security's Fiscal Blueprint: Budget Reform as FinReg" over at Seekingalpha.com.  I strongly recommend reading that post.

Briefly:

Making the deduction a refundable credit would increase the value of the credit for many homeowners. The deductibility of mortgage interest on owner occupied homes is projected to cost $149.6 billion in 2015, or $637.6 billion over 2011-15. We [Our Fiscal Security] propose converting the deduction to a refundable tax credit of 15% of interest on up to $500,000 in mortgage debt, which in itself would save $51.6 billion in 2014 and $387.6 billion over 2010-19.

It can certainly be argued that the credit bubble inflated the housing market in major part due to the subsidies given for extravagantly priced homes.

Mike points out the implicit difference between home ownership vs. home buyership or home indebtedness in his post. The current subsidy creates incentives for indebtedness and leverage in consumers. This is not a good thing.  As it is, subsidizing McMansions is ineffective and highly regressive.

In my opinion it should be abandoned.

And this is coming from someone who (admittedly) lives in what can be called a (sigh) McMansion.

(Image obtained from: AMA-ASSN.ORG )

Let's say you were starting a new industry and I told you that you would have more customers than you would ever be able to service.

How would that make you feel? Overwhelmed?  Anxious?  Motivated?  Or would you choose another industry where the likelihood of finding customers willing to purchase your services would be much more difficult.

While the first three responses seem reasonable, the last one seems highly unlikely in the setting of any business analysis.

This is why I'm perplexed when I hear the doom and gloom perspective from physicians regarding the impending physician shortage. The looming shortage of physicians in the United States is real and has been documented extensively elsewhere. While the changes in the US healthcare system have been significant and the prospect for future changes in the face of an aging population and increased access may feel overwhelming, I don't think that physicians should be discouraged by the outlook over the next 10-15 years.

The shortage of physicians projected in the near future is potentially a serious crisis for patients.  But with every crisis comes an opportunity. I choose to look at the above graph and invoke the rule of supply and demand. Doctors are highly trained professionals who provide a specialized service that cannot be obtained easily elsewhere. If the supply of physicians decreases the value of the services they provide will undoubtedly increase. This is simple economics.

The following facts deserve special attention:

• There will always be a market for someone who wants to avoid Medicaid, Medicare and traditional insurance and open up a boutique operation to provide services for out of pocket fees.


• The increase in patients will open up opportunities for physicians to address patient needs in nontraditional locations.


• Many physicians will choose to hire physician extenders (physician assitants, midwives, nurse practitioners,etc) to deal with the surplus of newly insured patients.


• There will be significant benefits for physicans who seize upon innovative ways to connect with patients utilizing mobile technology that takes health care out of the office and delivers it to the patient via email, the web or smartphones.


• There will be an economic impetus to increase medical education and residency programs.  Particularly in primary care.

Many have already stated that medical field is long overdue for what is referred to as disruption.

The losers in this scenario are physicans who choose to look backward and long for the "good old days". Those days are gone forever.

My hope is that patients do not get lost in the shuffle.  Indeed. Given the market-driven nature of supply and demand and the inevitable innovation which will benefit physicians with the anticipated shortage the biggest challenge will be to maintain optimal care of patients.

I for one am up for that kind of a challenge.

One of the most commonly used medical tools available to a maternal-fetal medicine specialist is bedrest. In many cases, pregnancies complicated by hypertension or preterm labor can be prolonged (to the benefit of the fetus) by restricting the mother's activity. Unfortunately, this can represent a significant physical, emotional and financial strain for the pregnant woman and her family.

As someone who has put his share of women on bedrest, I am so thankful for people like (my friend) Darline Turner-Lee ( http://www.mamasonbedrest.com/ )and services like Better Bedrest (http://www.betterbedrest.org/) for the hard work that they do to support these women.

That is the reason why I'm proud to announce that Darline and the folks at Better Bedrest have teamed up to hold a fundraiser to support pregnant women on bedrest.

You can see the details of the fundraiser below. I encourage you to support this worthy cause. I certainly know that I will.

Thank you.
Chuck

Amplify’d from www.scienceandsensibility.org

Science & Sensibility A Research Blog About Healthy Pregnancy, Birth & Beyond from Lamaze International

Mamas on Bedrest & Beyond is holding a fundraiser to benefit Better Bedrest. Better Bedrest is a non-profit organization that provides one on one phone support to pregnant women on prescribed bed rest as well as micro grants up to $500 to women on bed rest in financial need. Currently, they are the only organization that provides emergency funding specifically and exclusively to pregnant women on prescribed bed rest. Better Bedrest is dangerously close to being out of funds. Without funds they cannot provide their micro-grants. To support Better Bedrest, I am selling a fitness DVD that I produced called Bedrest Fitness for $19.95, and donating $10/DVD sold to Better Bedrest. My goal is to raise $1000 and DVD’s can be purchased at www.mamasonbedrest.com/shop/dvd-fundraiser. (To make a donation directly to Better Bedrest, go to www.betterbedrest.org.)

Much of the strife of bed rest comes from the fact that in the United States there is no mandatory paid maternity leave. There is the Family Medical Leave Act which mandates that employers of companies with 50 or more employees must offer employees 12 weeks of unpaid leave annually for pregnancy and/or to care for a newborn or adopted child, to care for a sick relative or to be treated for a major illness, without threat of job loss. If the employee’s absence exceeds 12 weeks, the employee is no longer guaranteed job protection. If a woman works for a smaller company, she has no job protection unless there are state mandates or internal mandates within the company. Five states and Puerto Rico offer some short term disability through which women may receive a portion of their pay while on maternity leave1. Federal employees have some of the most liberal benefits for leave, some of which may soon be paid leave. H.R.626 – Federal Employees Paid Parental Leave Act of 2009 states, Read more at www.scienceandsensibility.org

This presentation is a rough draft introducing patients to an upcoming trial regarding preeclampsia prediction and prevention. As always, comments and suggestions are welcome.

http://bit.ly/cyaL3N

Sent from my Verizon Wireless Phone

Recently, I had the opportunity to speak at the 30th Annual Nursing Perspectives Conference sponsored by Grady Maternal and Infant Care Project at Lake Lanier Islands Resort.

This was my first opportunity to present a new slide set regarding the perinatal implications and management of obesity in women.

The Prezi for the presentation is located here:

A copy of the lecture has been posted on my Slideshare account.

This is a YouTube video for one of the slides which details the trends in obesity in the United States between 1985 and 2009.

All presentations are provided under a Creative Commons Attribution-ShareAlike License