Here comes Obamacare

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Seventeen health insurance companies have stepped up and offered New Yorkers four levels of plans (plus an ominous-sounding “catastrophic” category) with standardized contract terms and product offerings. Consumers can now comparison-shop among them. Enrollments for New York’s health exchange marketplace, one of the most important early stages of the federal Affordable Care Act (Obamacare), will begin October 1, and coverage will become effective on the first day of 2014.

How much will eligible persons in the Hudson Valley pay for health insurance? According to the website, premiums for individual New Yorkers for the most comprehensive plan, “platinum,” will range depending on the vendor chosen from $446.25 to $994.34 monthly. Premiums for the plan with the lowest of the four levels of benefits, “bronze,” will be offered from $265.89 to $589.91 per month. Multiply those premiums by 1.70 for the inclusion of children, 2.00 for spouses and 2.85 for families. The rates approved are subject to final certification of the insurers’ participation in the exchange.

The new premium rates do not affect a majority of New Yorkers, who receive insurance through their employers, only those who must purchase it on their own, an article in the July 16 New York Times explained. Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State. State officials estimate that as many as 615,000 individuals will buy health insurance on their own in the first few years the health law is in effect. In addition to lower premiums, about three-quarters of those people will be eligible for the subsidies available to lower-income individuals.

The marketplace has been a long time coming. Governor Andrew Cuomo attributed the expectation that the expensive private insurance rates for individuals will decrease at least half to the influence of the newly constructed competitive marketplace. “New York’s health benefits exchange will offer the type of real competition that helps drive down health-insurance costs for consumers and businesses,” said Cuomo.

Crain’s New York Business provided perhaps the most animated reaction. “When the Cuomo administration gave word last week that individual health-insurance premiums offered through the state exchange to launch in October would be at least 50 percent cheaper than what some New Yorkers pay now, it was like tossing food pellets into a pond of starving fish,” said a Crain’s editorial last Friday. “Groups supporting the Affordable Care Act celebrated the news in TV ads, seeking to beat back Republican efforts to repeal Obamacare. Critics of the law fought back, arguing that the numbers were deceiving or downright false.”

New York has required insurers to cover everyone regardless of pre-existing conditions, but did not require everyone to purchase insurance — a feature of the new health-care law — and did not offer subsidies so people could afford coverage. With no ability to persuade the young and the healthy to buy policies, the state’s premiums to individuals have long been among the highest in the nation.

Body art, safely done


photo by elbragon
photo by elbragon

Around the world and through the millennia we’ve been adorning our bodies with jewelry, sometimes integrating that adornment in the form of tattoos and piercings on our bodies themselves. While it’s an increasingly common form of expression, precautions must be taken before and afterwards to make sure getting either one done is a safe and healthy endeavor.

Tattoos were long the province of sailors and jailbirds, and piercings limited to one in each ear, girls only. Now many, many young people have plenty of each all over. A 2005 article in The New York Times reported that one in 10 Americans had a tattoo; in 2012 a Harris poll said it’s up to one in five. Thirty-somethings are the most likely group to sport them, women slightly more than men. Although some may make snap judgments about a girl with Elvis tattooed on her calf or a guy with studs coming from his nostrils, we’re all getting pretty used to it.

Body art of this kind, especially tattoos, is used for a variety of reasons: self-expression, fitting in, for religious reasons, or to be part of a group, maybe family or military. When I was a kid I wanted my ears pierced very, very badly (49 percent of women have them, although to me the proportion seems much higher), but my parents wouldn’t let me do it. Eventually, at age 17, I had it done against their will, and later added a couple extra holes in my left ear. I wouldn’t be averse to doing an eyebrow, and I’ve been considering a tattoo or two, too, although I may be too old for that sort of thing.

Although many people — very sensibly — let their kids get old enough to decide for themselves first, I pierced my daughter’s ears when she was about six months old, which is common in the Italian culture of her father. At age 11 I let her get an extra set, although I draw the line at the lip piercing she’s requesting.

Cleanliness counts in large amounts

Plenty of precautions minimize health risks. The place where you get your tattoo or piercing should be as clean and sterile-looking as a doctor’s office. Visible dirt and mess are no good. Tattoos and piercings are wounds to the body, and wounds can get infected or be a portal for diseases to enter, including severely disabling or fatal ones.

Before either body alteration, you should be up-to-date on immunizations, especially the hepatitises and tetanus, and have a plan in place for health care should complications arise. People who have immune system disorders, diabetes, heart disease, skin problems, allergies, a tendency to form keloids, or pregnant may need to discuss things with their healthcare practitioner before that skull goes on the arm or the labret on the chin.

Managing Parkinson’s

Hitler had it, and so did Mao Zedong, and others still living or departed: Yasser Arafat, Billy Graham, Janet Reno, Charles Schultz, Salvador Dali, Bob Hoskins and Muhammad Ali. Actor Michael J. Fox is its most prominent spokesperson. It killed my grandmother.

While not necessarily fatal, Parkinson’s disease is incurable, and differs from person to person in its severity and the scope of its symptoms. Its rate of progression varies, customizing it for each of its million-strong sufferers in this country. There are 50,000 or more new diagnoses each year.

For most of us, the symptom that sums up Parkinson’s disease is the tremor, a visible, usually obvious, shaking of the hand, the jaw or another body part. There is also often stiff, slow movements, or changes in speech, handwriting, or the sense of smell.

Because other conditions and medications cause symptoms similar to Parkinson’s, and because there is no definitive diagnostic test, it may go undiagnosed and untreated. People may think they have it when they don’t.

Sometimes symptoms begin on one side of the body only, and travel eventually to the other side. The first sign that something’s up may be when the person is sitting or standing still and a hand starts to shake. Or it may be an arm, a leg, the tongue, chin or lips.

This can be a symptom of other things, however, like other movement disorders or reaction to a medication. This is called Parkinsonism. Another symptom that can mean other things is Parkinson’s slow, shuffling, labored gait, with some sufferers feeling frozen in place, like their feet are stuck to the floor. Arms may not swing properly when walking. Difficulties with balance can lead to falls, forward or often backward.

A stooped posture is another symptom. Difficulty getting up in the morning or out of a chair can mean arthritis or other ills, but could be Parkinson’s. Cramps and pain may be associated with it as well.

With Parkinson’s disease, even minor muscle movements like smiling, blinking, swallowing, gesturing or writing may be impaired. Speech may slur or decrease in volume or inflection. The disease’s effect on the muscles can make the face seem mask-like, with a look that others may interpret as being depressed or vacant.

Down the road, the person with Parkinson’s may also experience irritability, anxiety, hallucinations, insomnia, depression, personality changes, incontinence, constipation, excessive sweating of hands and feet, drooling, oily skin or dandruff. Symptoms typically appear between ages 50 and 60 — and more in men than women — but in rare cases can be much sooner.

What causes this disease, with its insidious set of symptoms? Science is not really sure what makes the nerve cells in the brain that control body movements stop working so well. We’re still not sure whether it’s heredity or environment. If there is Parkinson’s in your family it doesn’t mean you’ll get it. Likely not, though if there is a lot of Parkinson’s in your immediate family your chances may be higher. Some blame viruses or toxins like pesticides, or trauma, such as from boxing or use of illegal drugs. Many experts blame a combination of factors.

A multi-disciplinary approach focused on medication and lifestyle changes is recommended. Helpers include maintaining social contacts, remaining involved in enjoyable activities as much as possible, from classes to travel to community activities, and perhaps a support group. Essential are aerobic exercises like walking or swimming, plus rest and stress reduction, maybe stretching, yoga, tai chi, massage or meditation.

Music therapy and acupuncture have also received accolades as being helpful. Some swear by coenzyme Q10. A healthy, balanced diet is key. Help can come through a variety of experts, like nutritionists, occupational or physical therapists, social workers, and especially a good neurologist who specializes in movement disorders.

The most common medication for Parkinson’s is levodopa, which your brain converts to the dopamine that it has stopped making. It may cause involuntary muscle movements and lose efficacy as years pass. It needs to be monitored closely by a good doctor.

Dopamine agonists like pramipexole (Mirapex) and ropinirole (Requip) mimic the effect of dopamine in your brain and may be prescribed in combination with levodopa. Side effects can include hallucinations, sleepiness, or supposedly, compulsive behaviors such as hypersexuality, gambling and eating. MAO B inhibitors, COMT inhibitors and anticholinergics may also be prescribed, along with other drugs specific to the symptoms. In some cases surgery in the form of deep brain stimulation (DBS) may be tried.

The word Parkinson’s comes from James Parkinson, a doctor who published a paper in 1817 on what he called “the shaking palsy.” While not directly fatal, the debility it causes can lead to dangerous falls or aspiration that leads to pneumonia or other illnesses.

But it’s a dodgy disease. About a quarter of diagnoses are incorrect, even from knowledgeable neurologists. So if you suspect that you or someone you love may have it, get checked out and seek a second opinion if you have doubts. And if you get a reliable diagnosis, please arm yourself with information and a battle plan to manage the malady.

The two faces of GMOs


photo by Newtown graffiti
photo by Newtown graffiti

When I’m wearing one of my other hats, as a nutrition educator for a local natural-foods store, I have dealt with several customers who are horrified about GMO foods, or genetically modified organisms (a.k.a. genetic engineering, or GE). That’s when scientists in a lab splice plant and animal cells into the DNA of an unrelated organism to create something brand-new. Usually depending on your perspective, it’s done for reasons ranging from pure profit to better nutrition.

On May 25 in New Paltz close to 400 people protested the practice, which has been around since 1996. They called out for labeling so consumers could make more informed choices about what they consume.

Marchers dressed as bees and ears of corn and carried signs with messages like “Free the Seed” and “F*** Monsanto.” The march was part of a much larger worldwide protest that day that involved some two million people, which was taking place in 52 countries and more that 436 cities.

As a culture we love to fall in love with or demonize food products. We like chia seeds and hate high-fructose corn syrup. But the fear of GMOs seems to go beyond the good-or-bad duality. It seems more fundamental than that.

Proponents — from large corporations to the federal government — claim that they can improve the nutrition, yield and disease resistance of our foods by genetically engineering them, saving the world from malnutrition. They declare that they can make foods with more iron to treat anemia, that they can increase the vitamin A content of rice and improve health that way, especially in developing nations. They say they can increase the milk production of cattle by putting the right genes in them. They claim their products are robust, healthy, and more nutritious than non-GMO crops.

It goes further. They profess to be able to protect crops from failing due to pests or harsh conditions, such as overly saline soil or drought-prone areas. They also claim to not only benefit our health but the environment as well. If crops are bred to use less space, they reason, less land is broken up. They claim they can reduce global warming by making GMO grass that makes cattle less gassy.

The claims of benefits go beyond even that: GMO crops can need little to no pesticide because it has been genetically spliced into them. The makers assert they can reduce waste by creating products with extended shelf lives. They even plan projects like the creation of useful biofuels from specially bred organic matter. They boast about the creation of wonderful new vaccines and medicines.