Going off the grid: cancelling cable TV.

Cable TV: The "Heroin" of the entertainment world.

This is a departure from the usual Blog posts on Health & Medicine but I felt compelled to share my experience of cancelling cable.

When we think of Comcast, Xfinity, AT&T, Astound and all the other cable providers out there, it is definitely a love/hate relationship. The first image that comes to mind is:

In our household, we have the TV on as background noise most of the time. I'll admit, I use to be addicted to Hardcore Pawn, American Pickers, the Doomsday Preppers, etc. Most of the time, I would watch a movie on Cable that I have either seen multiple times before or already own because it was familiar.

Then it dawned on me. Cable TV is stressing me out. How ? Ever notice the bottom third of your TV, also known as TV real estate:

We are bombarded by advertising throughout the TV show/movie, commercials, etc. Even the streaming news stories constantly alerting us of terrorist threats, mass shootings, political tit for tat fighting, etc. This begs the question, why is Cable not paying me to watch this crap ?

My cable/internet bill started at $90/month, crept up to $160 - $200/month and now I was told I would have to commit to a 2 year contract to have my bill reduced for the first 6 months after which the price would increase in months 6-12 and then again from months 12-24. Oh yeah, I would also be forced to sign up for their "triple play" or bundled package forcing me to sign up for their VOIP phone service (which you would need to rent their special router).

So I researched an OTA (over the air) antenna option. What I got was mass confusion. UHF/VHF ? Indoor antenna vs. outdoor antenna. Where to mount. Where to point.

Luckily, we live in the Bay Area close to the San Francisco, San Jose and San Mateo broadcast towers. Since we rent, an outdoor antenna was out of the question and we decided to purchase an indoor antenna.

After some research, we decided on the Mohu Leaf Plus. This was about $60 - $70 on amazon.com

Next, we had to find out how many channels we would be able to pick up. These web sites give you an idea of how powerful an antenna you need, indoor vs. outdoor and where you should point your antenna:

Antennaweb or TV Fool

Living in the Bay Area, we were able to pick up most of the major networks, PBS, and the local stations. We get about 27 channels, 5-10 Latino stations and about 5 various Asian networks.

Next, we decided that we would "stream" our movies and network TV shows. The two major players out there are: Hulu Plus and Netflix. Each cost about $7.99/month. Since we already have a huge collection of movies, we decided to go with Hulu Plus. In general, Hulu Plus has newer network TV episodes and older movies. Netflix generally has newer movies and older seasons of network TV shows.

Now, you need to be able to "stream" these from a device. Most Bluray players, Playstation or Wii devices allow you to do this. Smart TV's do as well. We purchased a WD Live which is similar to a Roku as our streaming device. We opted for the WD Live since it could play ALL out the codecs (mp4, avi, mkv, etc.) that our movies are stored as.

Of course, we had to keep Comcast internet, which is costing us $49.99/month and adding Hulu Plus is an additional $7.99/month.

We have literally thousands of DVD's, movies and TV shows purchased from iTunes. What do we do with these ? We bought a Network Attached Storage (NAS). Think of it as a mini home server. We can store up to 8 TB of media. So by using a program called Handbrake, we were able to convert all of our DVD's (that we purchased) to a digital format to store on our NAS.

Using our NAS to stream our movies, WD Live to stream Hulu Plus and our Mohu Leaf antenna for our local stations and major networks, we found that not only do we NOT miss Cable TV, we watch quality TV and movies. Also, I attributed a lot of stress to the advertising and the constant "doom and gloom" that our news stations put out. Our bill came down from $200/month to about $57/month.

So, we're taking the money that we are saving and putting it into mutual funds for our sons college fund, using the time to watch quality TV/movies and maybe even doing something constructive with our time like writing this blog article.

For Neck Pain, Chiropractic Spinal Manipulation (Adjustments) superior than Medication, for both short and long term relief.

Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Gert Bronfort, DC, PhD; Roni Evans, DC, MS; Alfred V. Anderson, DC, MD; Kenneth H. Svendsen, MS; Yiscah Bracha, MS; and Richard H. Grimm, MD, MPH, PhD.

For Neck Pain, Chiropractic Spinal Manipulation (Adjustments) yielded superior results than Medication for BOTH short and long term Neck Complaints.

A study in the Annals of Internal Medicine found that Chiropractic Spinal Manipulation yielded superior relief in BOTH the short and long term, for neck complaints.

This exciting study was featured in The New York Times.

A large group of adults, 272 in all, were recruited and were diagnosed with acute or sub-acute, neck pain emanating from the spine and/or associated soft tissue structures. The objective of the study was to compare Spinal Manipulation Therapy, Medication and Home Exercise with Advice for acute and sub-acute neck pain in both the short and long term. This intervention lasted for 12 weeks.

The results suggested that Spinal Manipulation had statistically significant results over Medication at 8, 12, 26 and 52 weeks with pain being the main outcome studied.

Good news for Acute Low Back Pain sufferers, more room for improvement for patients with persistent Low Back Pain.

Back pain improves in first six weeks with treatment but lingering effects at one year. 

A large study published in the Canadian Medical Association Journal (CMAJ) found that for people presenting with Low Back Pain, symptoms will improve within the first 6 weeks but disability may linger for 1 year.

Researchers from Australia and Brazil examined data from 33 studies (11,166 participants) to understand the clinical course of pain and disability in people receiving care for low-back pain. Researchers were able to study the effects of treatment on patients presenting with acute low back pain and with patients presenting with persistent low back pain. 

At one year, the patients who initially presented with acute low-back pain still experienced some pain and disability but it was minimal; the typical improvement in pain intensity was about 90%. 

In contrast, those who initially presented with persistent low-back pain experienced moderate levels of pain and disability at one year; the typical improvement in their pain was only about 50%.

    

Dr. Rommel Hindocha, D.C. is the clinic director at Peninsula Spine & Sports Rehabilitation, located in San Mateo, California. Dr. Hindocha treats acute low back pain stemming from: muscle strains, ligament sprains, joint dysfunctions, sacroiliac joint disorders, non specific low back pain and mechanical low back pain.

Who is to Blame for Spine Care Costs in the US ?

Who is to Blame for Spine Care Costs in the US ?

Where the United States Spends Its Spine Dollars: Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions. Spine: 01 September 2012 - Volume 37 - Issue 19 - p 1693–1701. Davis, Matthew A. DC, MPH; Onega, Tracy PhD; Weeks, William B. MD, MBA; Lurie, Jon D. MD, MS.

Introduction:

Back and neck conditions are associated with considerable costs to the US economy both due to direct expenditures on their management and indirect costs from losses in productivity.

• Between 49% and 70% of all adults will experience a back pain episode during their lifetime, and, at any given point in time, 12% to 30% of adults have an active back problem.
• Back pain is the second most common reason adults consult a primary care provider, following upper respiratory tract infections.

In recent years, prevalence and costs for spinal conditions has significantly increased in the United States despite the little change in outcomes for these individuals suffering from these conditions. It is estimated that approximately $90 billion is spent on the diagnosis and management of low back pain, and an additional $10 to $20 billion is attributed to economic losses in productivity each year.

Therefore the purpose of this study was to examine the US expenditures (costs) on common ambulatory health services for the management of back and neck conditions (spine conditions) for:

• Medical Care.
• Chiropractic Care.
• Physical Therapy. 

Study Design:

A Medical Expenditure Panel Survey (MEPS) from 1999 - 2008 was utilized. Data from US adults 18+ was used with sample sizes for the MEPS during these years ranging from a low of 23,565 individuals in 1999 to a high of 37,418 individuals in 2002; response rates ranged from 56.9% in 2007 to 66.3% in 2001.

Results of the Study:

In 1999, 11.9 million adults had an ambulatory visit for a primary diagnosis of a spine condition. This number increased approximately 15% during the study period to 13.6 million in 2008; however, with population growth, the proportion of all US adults reporting a visit for a primary diagnosis of a spine condition remained constant at approximately 6%. 

Number of visits per specialty:

Medical Care: The mean number of ambulatory visits to medical physicians for a primary diagnosis of a spine condition fluctuated between approximately 2.9 and 3.7 visits per year from 1999 to 2008.

Chiropractic Care: The mean number of visits for chiropractic care fluctuated between 7.2 and 9.3 visits per year.

Physical Therapy: There was more variability among adults utilizing Physical Therapy, the mean number of visits per year ranging between a high of 11.4 in 2002 to a low of 6.8 in 2005.

Annual Expenditures / Costs per Specialty:

Medical Care: The mean inflation-adjusted expenditure increased by 95% (from $487 in 1999 to $950 in 2008). The Mean specialist care costs ranged from approximately $800 in 1999 to more than $1,200 by 2008.

Chiropractic Care: The mean expenditure varied much less, fluctuating between a low of $473 in 1999 and a high of $662 in 2007.

Physical Therapy: The annual inflation-adjusted mean expenditure per user on physical therapy peaked in 2002 at $1543 and apparently contracted thereafter; however, the confidence intervals for physical therapy were large, implying considerable variation in expenditures among physical therapy users.

Conclusions:

According to our estimates, the total annual expenditures on medical care for the management of spine conditions has grown significantly in recent years, whereas expenditures on chiropractic care and physical therapy have not experienced the same growth. Our study suggests that this growth in medical care is primarily due to increases in expenditures on Specialty care services (expenditures on primary care physician services were remarkably stable during the 10 years we examined).  Specialty care services include: Orthopedists / Orthopedic Surgery, Physiatry / Physical Medicine & Rehabilitation, Neurology and Neurosurgery.





Dr. Rommel Hindocha D.C. is the clinic director at Peninsula Spine & Sports Rehabilitation, located in San Mateo, California. Dr. Hindocha also practices at San Francisco Multi-Specialty Medical Group in San Francisco where he enjoys working with his Medical Specialist counterparts. In his San Mateo practice, Dr. Hindocha specializes in chronic back and neck pain, including: Sciatica, Hernaited Discs, Spinal Arthritis, Degenerative Disk Disease and Spinal Stenosis.

Top Hospitals for Emergency Care - Have 40% LOWER Death Rate

From: MedScape Medical news (login required).

More than 123.8 million people in the United States will make an ED visit, and 13% will end up being admitted to the hospital, according to the US Centers for Disease Control and Prevention.

Researchers analyzed more than 7 million Medicare patient records from 2008 to 2010 for 12 diagnoses: bowel obstruction, chronic obstructive pulmonary disease, diabetic acidosis and coma, gastrointestinal bleed, myocardial infarction, heart failure, pancreatitis, pneumonia, pulmonary embolism, respiratory failure, sepsis, and stroke.

Medicare patients admitted to the nation's best-performing hospitals for emergency medicine have a 40% lower death rate compared with all other hospitals, according to a new survey by HealthGrades, a Denver, Colorado–based provider of information about physicians and hospitals.

"If all hospitals performed at the level of the Emergency Medicine Excellence hospitals from 2008 through 2010, an additional 170,856 people could have potentially survived their emergency hospitalization," the HealthGrades release notes.

California
Alhambra Hospital Medical Center	Alhambra, CA
Alta Bates Summit Medical Center - Summit	Oakland, CA
Beverly Hospital	Montebello, CA
Eden Medical Center	Castro Valley, CA
French Hospital Medical Center	San Luis Obispo, CA
John Muir Medical Center - Walnut Creek	Walnut Creek, CA
Kaiser Permanente Woodland Hills Medical Center	Woodland Hills, CA
Mercy General Hospital	Sacramento, CA
Mercy Medical Center Redding	Redding, CA
Mercy San Juan Medical Center	Carmichael, CA
Peninsula Medical Center	Burlingame, CA
including    Mills Health Center	San Mateo, CA
Presbyterian Intercommunity Hospital	Whittier, CA
Saddleback Memorial Medical Center - Laguna Hills	Laguna Hills, CA
including    Saddleback Memorial Medical Center San Clemente	San Clemente, CA
San Antonio Community Hospital	Upland, CA
Scripps Mercy Hospital	San Diego, CA
including    Scripps Mercy Hospital Chula Vista	Chula Vista, CA
Sequoia Hospital	Redwood City, CA
Sierra Nevada Memorial Hospital	Grass Valley, CA
Sutter Auburn Faith Hospital	Auburn, CA
Sutter Delta Medical Center	Antioch, CA
Sutter General Hospital	Sacramento, CA
including    Sutter Memorial Hospital	Sacramento, CA
Sutter Roseville Medical Center	Roseville, CA
White Memorial Medical Center	Los Angeles, CA
Woodland Healthcare	Woodland, CA

In the Bay Area, 6 Hospitals were in the top 5%. 

For other States, please follow this link.

Who will have Health Insurance in the future ?

From: Annals of Family Medicine. 2012;10(2):156-162.

It was previously estimated that the cost of a family health insurance premium would equal the median household income by the year 2025 by DeVoe and colleagues.

In an updated model, it is estimated that this threshold (i.e. the cost of a family health insurance premium would equal the median household income) will be crossed in 2033, with a "best case scenerio" that the PPACA (Patient Protection Affordable Care Act) may extend this date only to 2037.

When did Insurance Premiums rise to these historic levels ?

In the "managed care" era of the 1990's, health care inflation slowed. However, there was a public backlash and many employers had abandoned that model. In 1999, there was a steep increase in health insurance premium inflation, coupled with declining inflation in household incomes.

The passage of the Patient Protection and Affordable Care Act:

Interestingly enough, when there was debate in congress regarding health care reform in 2009/2010, health insurance premium inflation had slowed to levels not seen since the 1990's. Despite this slowing, the annual inflation rate of health insurance premiums still outpaced US household earnings, which stagnated from 2008 to 2011 and included an absolute reduction in average household income from $50,300 in 2008 to $49,800 in 2009. Therefore, as median household incomes decreased, healthcare premium inflation had increased.

The passing of the PPACA in 2010 saw the number of persons without health insurance in the United States rise to a historic high of 50.7 million people after 5 million Americans lost employment-based health insurance in the 2007–2009 recession. The irony of this was that the PPACA was supposed to reduce the number of uninsured. This can be explained by the language of the PPACA which is supposed to take place over several years however.

Model of median household income and health insurance premium increases:

In this model, from 2000 - 2009, health care premiums and median household incomes were compared. The average annual increase in insurance premiums was 8.0%; household incomes rose an average of 2.1%.

If health insurance premiums and national wages continue to grow at recent rates and the US health system makes no major structural changes, the average cost of a family health insurance premium will equal 50% of the household income by the year 2021, and surpass the average household income by the year 2033. If out-of-pocket costs are added to the premium costs, the 50% threshold is crossed by 2018 and exceeds household income by 2030.
  
Factoring in employers contribution:


Since most workers do not pay for the entire cost of healthcare, the model was updated to include employers contribution to family healthcare. The average amount an employee pays for a family health insurance premium plus out-of-pocket family health care expenses was factored in. Without major structural changes in the US health care system, the employee contribution to a family premium plus out-of-pocket costs will comprise one-half the household income by 2031 and total income by 2042.

 What is the effect with the passage of the PPACA:


There is no consensus among experts regarding the effect of the PPACA with regards to increasing or decreasing the costs on private health insurance. Assuming the PPACA actually slows cost growth, this threshold of insurance premiums exceeding household income is delayed only by 4 years.

What are Insurance Companies and employers doing to curb costs:

Employee contributions to insurance premiums and out-of-pocket expenses have grown faster than overall premium costs, suggesting that insurers have slowed the rate of growth in premiums by shifting more costs onto patients. Even though patients no longer face double-digit increases in insurance premiums each year, they now pay higher deductibles and co-payments and receive fewer covered services. 

In a 2010 Kaiser Family Foundation and Health Research and Educational Trust employer survey:

30% of employers reported having reduced the scope of health benefits or increased cost sharing.
23% increased the share of the premium a worker has to pay.

Among large firms (200 or more workers):'

38% reported reducing the scope of benefits or increasing cost sharing, up from 22% in 2009.
36% reported increasing their workers' premium share, up from 22% in 2009. 

Healthcare as a part of our GDP: 

Health care continues to comprise a growing portion of the total US economy. It has risen from 13.7% of gross domestic product (GDP) in 2000 to 17.3% of GDP in 2010. From 1960 to 1999, the growth of national health care expenditures exceeded the GDP by 2.4% per year. This same 2.4% differential occurred from 2000 to 2009. If health care costs continue to rise at current unsustainable rates, it is doubtful that affordable insurance coverage will be available for low-to middle-income Americans in the near future. Further, our model did not include the taxes paid by American workers each year to finance Medicare and Medicaid—nearly $900 billion in 2009—which may increase with the PPACA. 

How does our Healthcare policies affect other aspects of the economy:

It has been observed that expensive US health care increases production costs and makes American manufactured goods less competitive, which results in lower wages and fewer jobs in the manufacturing industry. For example in 2006, General Motors' spent $1,500 more than Toyota in health care costs per car.  

Doctors poll results on Affordable Care Act (ACA) aka "Obamacare"

From: WebMD, MedScape, business of medicine. Log in required.

The ACA is a hotly debated topic. Specifically, the individual mandate requiring individuals to purchase health care coverage. In fact, this will be debated in the Supreme Court this June.

Here are some of the highlights of the poll results from US Physicians:

Do you think it is or is not constitutional for the US government to require individuals to purchase healthcare insurance or else pay a penalty?

44% - Yes, it is constitutional
56% - No, it is not constitutional

Do you think all individuals should or should not be required to purchase healthcare insurance?

33% - It should be required; the ability to fund healthcare reform depends on instituting the individual mandate
14% - It should be required; it is wrong for uninsured persons to seek healthcare at emergency departments and then not pay
34% - It should not be required; the government should not force people to buy a product or service
18% - It should not be required; if healthcare reform cannot succeed without this mandate, then it is not a well-designed plan

Should the Supreme Court strike down the individual mandate but keep all other elements of the Affordable Care Act?

11% - Yes; the other policies of healthcare reform are useful, even if the individual mandate is eliminated
12% - Yes; even though the Affordable Care Act lacks a severability clause, the court can still selectively void inclusions of the mandate
51% - No; the overall economic structure of healthcare reform and the Affordable Care Act depends on the inclusion of the mandate
26% - No, because the Affordable Care Act lacks a severability clause that would preserve the rest of the law

Do you predict that the individual mandate will be upheld?

46% - Yes, it will be upheld
54% - No, it will not

Do you support or oppose the Affordable Care Act?

39% - Strongly support
8% - Somewhat support
4% - Neutral
43% - Strongly oppose
0% - Uncertain