Obama v. GOP: Healthcare showdown

When President Obama took office two years ago, the GOP had much more than a mere inkling that a healthcare overhaul was on the horizon.  Fast-forward to the final days of 2010, and an attempt at a repeal may be just around the corner. 

It comes as no surprise that healthcare is still a hot topic - but there is a twist - many did not predict the upcoming degree of Republican control in the House. 

Aside from the mega-issue of healthcare, there are other pressing issues too; national debt; national security; internet freedom; and global warming.  But according to The Hill, the healthcare debate is at the very top of the list as far as points of contention go in early 2011.

The Hill today said Republicans in the House will remain firm with their intentions to repeal Obama’s healthcare law early in 2011.  But the Democrats do maintain control of the Senate, which means that the GOP may have to resort to devices aimed at thwarting the bill indirectly through tightfisted budgetary tactics.     

We reported last week that the Supreme Court will likely have to decide whether the key provision of the healthcare law requiring mandatory insurance is constitutional.  According to CNN, “a new national poll indicates that a majority of Americans oppose that provision in the bill Congress passed earlier this year.”  Only 38% of those surveyed are on-board.

Besides the mandatory insurance uncertainty that will take some time to sort out, what will Democrats do in the mean time to prevent the GOP from hampering the healthcare law? If the law becomes deadlocked, there is a good chance that Americans will still see some form of the bill come to fruition; it just may come with conceded spending cuts elsewhere.   

Image: vitasamb2001 / FreeDigitalPhotos.net Evan H. Farr on Google +

Most likely: Supreme Court will have to decide constitutionality of mandatory insurance

The mandatory insurance debate represents an intersection (or a train wreck, depending on how you look at it) between federal powers, Congressional constitutional boundaries, and state interests.  At issue is whether Americans can be required to buy medical insurance, and if so, whether penalties can be enforced for noncompliance. The states that oppose the multi-trillion dollar reform argue that among other things, state governments would get stuck with the bill in the long run.  Analysts agree that the case will eventually be decided by the Supreme Court. 

Late last week in Pensacola Florida, Obama’s legal team disputed the argument that a mandatory insurance policy would be unconstitutional.  20 U.S. states adhere to the view that such insurance policies would exceed the limits of the constitution. 

Presiding Judge Roger Vinson of the U.S. District Court in Florida articulated the need for patience from both sides.  Commenting on how long it would take to reach a decision, he said “I cannot give you a date certain.”  According to reuters, Judge Vinson made the comment after three hours of testimony. 

Earlier last week, a Virginia Federal Judge opined mandatory health insurance is unconstitutional.  Judge Henry Hudson thinks that Congress does not have authority under the Commerce Clause (Article I, Section 8, Clause 3) to mandate health insurance.  The power wielded by Congress and the Federal government by way of the Commerce Clause is explained by the Court in its’ 2005 landmark (and controversial) decision, Gonzales v. Raich, 545 U.S. 1 (2005):   

The Commerce Clause emerged as the Framers' response to the central problem giving rise to the Constitution itself: the absence of any federal commerce power under the Articles of Confederation. For the first century of our history, the primary use of the Clause was to preclude the kind of discriminatory state legislation that had once been permissible. Then, in response to rapid industrial development and an increasingly interdependent national economy, Congress “ushered in a new era of federal regulation under the commerce power,” beginning with the enactment of the Interstate Commerce Act in 1887 and the Sherman Antitrust Act in 1890. (emphasis added).

The key issue – whether the government can force the public to buy a commercial product – will undoubtedly remain at the forefront of national media coverage until either the Supreme Court issues its view, or when the law goes into effect starting in 2014

.Image courtesy of: http://hubpages.com/hub/inauguration-day-clip-art

Evan H. Farr on Google +

The Perfect Holiday Caregiver: It’s all a state of mind

The holidays are always a wonderful time of year for family gatherings, reflection on what we have and the spirit of giving. The television is packed with specials showing relationships and families coming together for the holidays.

But the holidays can also be a time of stress and sadness for those who are caring for family members that are struggling with health problems, frailty, dementia and loss. Those who care for these individuals may feel overwhelmed, frustrated, depressed or resentful as they watch “perfect” families enjoying the holidays. There are many surveys and documents that show that caregivers are highly susceptible to these feelings. If you are a caregiver, there are measures you can take to avoid this.

First; Remember, that you are not alone.

If you are new to caregiving or have been caring for someone for a very long time, remember that the perfect family on television is not reality for many Americans. You are not the only one with these challenges. A recent study by the National Alliance for Caregiving and AARP found that 44.4 million Americans age 18 or older are providing unpaid care to an adult.   In fact according to the survey provided by the National Family Caregivers Association:

• The typical caregiver is a 46-year-old Baby Boomer woman with some college education who works and spends more than 20 hours per week caring for her mother who lives nearby.
• Female caregivers provide more hours of care and provide a higher level of care than male caregivers.
• Almost seven in ten 69%) caregivers say they help one person.
• The average length of caregiving is 4.3 years.
• Many caregivers fulfill multiple roles. Most caregivers are married or living with a partner (62%), and most have worked and managed caregiving responsibilities at the same time (74%).

Second; Find help.

There are many resources available to a caregiver. Some of these include family members, friends, a local religious group, elder care agencies and homecare providers. The internet provides many great resources and help. The National Care Planning Council offers many articles, brochures and local referrals to help caregivers find the help that they need.

“When my husband’s stepfather was released from the hospital in December of 2009, he called us to give him a ride home. Once he was home, we quickly realized that he was not able to care for himself at all. He lived alone and we found ourselves driving back and forth three or four times a day to assist all of his needs. It was overwhelming and frightening to suddenly become a caregiver to a man we weren’t even that close to. With my husband working full time days, I became his primary caregiver. I would pack up my two little girls every day to come with me to take him to the doctor, do his laundry and feed him his meals, do his grocery shopping and help him with his bills. I had no idea what his finances were like or how to pay his medical bills. He was too sick to care or even understand what I was saying to him.  I quickly realized I was going to have to find help. First I called his children. They were sympathetic, but gave all kinds of excuses as to why they could not help.   Next, I went to the internet. I went to the website for National Care Planning Council www.longtermcarelink.net and found and contacted a Care planner in my area. The Care Planner came to my stepfather’s house and met with the two of us. They helped me get organized and set up time to meet with someone to explain his Medicare services and what my next steps would be. It was such a relief to have a plan and to know what to do.” MH- Salt Lake City, Utah

Most family members are willing to help, but just don’t know what to do. Many caregivers feel that they are the only one who can give the best care. It is important to communicate with other family members about what kind of help you need and let them know specifically what they can do.
A number of organizations and private companies will give you advice and guidance -- many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds. Click here for a nationwide list of agencies.
A good source for professional advice is the rapidly growing business of non-medical home care companies. Most will offer free consultations and will provide paid aides to help you with your loved-one with such things as bathing, dressing, shopping, household chores, transportation, companionship and much more. These people may also help you coordinate adult daycare or other community services.

You may wish to pay for a formal assessment and care plan from a professional geriatric care manager. Even though it may cost you a little money to hire a care manager, this could be the best money you will ever spend. Care managers are valuable in helping find supporting resources, providing respite, saving money from care providers, finding money to pay for care, making arrangements with family or government providers and providing advice on issues that you may be struggling with.
Lastly; it is important to take care of yourself first in order to give effective and loving care.
Stephen Covey tells a story in his book The Seven Habits of Highly Effective People about a man who is sawing a tree. A woman approaches and asks the obviously exhausted man how long he has been sawing the tree. He tells her that he has been there for hours.

She says “Well, I see that your saw is dull, if you would just sharpen your saw you would be able to saw it much faster and with less effort.”
He replies, “I don’t have time to stop and sharpen my saw, I need to chop this tree down now!”
It seems pretty silly that the man just doesn’t stop for a few minutes to make the work easier. It is common for caregivers to do the same thing. They focus on caring for their loved one and run themselves down instead of stopping to “sharpen their saw”.

Covey states that “sharpening the saw” is to take care of yourself by keeping your physical, mental, emotional and spiritual self balanced. There is joy and respite in balancing all of these areas in our life. This is what makes us efficient and happy. Here are some ways for you as a caregiver to sharpen your own saw:

• Maintain a positive attitude. Take time to be grateful for everything that is good in your life. There is always something. Adjust your expectations for the holiday season. If you aren’t expecting that perfect holiday family picture, then you won’t be angry and frustrated that it isn’t something you have right now. It is always possible to change your attitude and perceptions, but it is not always possible to change your circumstances.

• Eat healthy food and be sure to get some exercise. Do this in small increments if it is too overwhelming to plan menus. Drink more water, cut down on sugary snacks, pick up some vegetables and fruit to grab.  Walk or do marching in place. Run or walk up and down stairs if that is all the time you have right now.

• Forgive and let go of frustrations, anger, resentment and guilt. These are common feelings for caregivers. The best thing a caregiver can do for their own emotional health is to clear out these negative thoughts and feelings. Get counseling, talk to a friend or family member or simply write down the negative feelings to get them out of your system. Never take your anger and frustrations out on those you care for.

• Take time to do something you enjoy and give yourself a little bit of rejuvenation everyday. Laughter is a great stress reliever. Find something funny to read or get on the internet and find a funny video to watch.

• During the holidays, be easy on yourself. If you enjoy holiday activities, then get out there and do them. Ask someone to help with your caregiving duties even if it is just for an hour or two to shop or to see a concert or movie. There are day care facilities or home care services available for short term care. See www.longtermcarelink.net for a service in your area.

Being a “perfect” caregiver during the holidays does not have to look like the perfect on-screen holiday family. How you handle your circumstance will be the key to creating your own peace, happiness and cheer during the holiday season. The holidays can be a time of reflection on good things. Your attitude and a little care for yourself can make a big difference in the care that you give in the coming year.

Image Credit:

Image: Simon Howden / FreeDigitalPhotos.net Evan H. Farr on Google +

Evan Farr quoted by Fox News on healthcare privacy

The WikiLeaks security breach has stirred much conversation...but not just regarding the leaked cables themselves. The entire ordeal is raising numerous questions ranging from national security to constitutional issues.

FOX News referenced Evan Farr's article on his Virginia Elder Law Blog. which pointed out that as a result of this massive security breach, an important lesson can be learned in the world of Health IT.

If you missed Evan's latest article, "Should the WikiLeaks Fiasco Raise Healthcare Privacy Concerns," you can read it here.



Image: IMG_4739 - Julian Assange, Wikileaks. - Photo Espen Moe 2010 Creative Commons License Evan H. Farr on Google +

Should the WikiLeaks fiasco raise healthcare privacy concerns?

Read the FULL Article here



With roughly 250,000 documents released by WikiLeaks and with the aid of some popular media outlets, the ramifications of the diplomatic cables will be far-reaching. My initial thoughts were mixed: perhaps this latest WikiLeaks embarrassment will sound the alarm bells for governments and private industries to protect sensitive information more closely; perhaps it will lead to the development of more sophisticated information technology tools and training methodologies. On the other hand, it is impossible to ignore the obvious – that the United States government failed to prevent a massive theft of classified data. As a result, the logical question raised is “how we can expect, in the future, government agencies (federal, state, or local), or even private industries, to keep sensitive data confidential?”

This chart represents the source of the cables

Read the FULL Article here

In my recent article on the importance of Electronic and Personal Health records, I discussed why the electronic storage of medical information is beneficial to patients, and how the use of smart health information technology can save money and lives. There is no denying that we are living in the “information age,” and to resist this transition would be counterintuitive and counterproductive. But, we also are living in the post-9/11 era. Thus, we must strike a balance between our privacy rights & expectations, and our safety.