Guest Post: 5 Strategies to Deal With a Negative Person

It’s often said that you are you are who you surround yourself with. When people around you are happy and positive, you’re more likely to feel happy and positive. Similarly, when you’re surrounded by people who are negative we start looking at the world with more, you guessed it – negativity. Even if the negativity isn’t directed at you, it can still have an impact on your own outlook.

Now we all have somebody in our lives who can have a negative impact on us. Sometimes we can let go of these people, but other times (if it’s family or a colleague) it’s harder to simply cut ties.

So to help you dear with those less than positive people in your life, here are 5 strategies to deal with negative people.

1. SET BOUNDARIES

Limit the number of interactions you have with this person whenever possible, especially during stressful periods. It may not be a good idea to make a drastic change. If you speak to this person everyday, start spreading it out to every other day and then gradually to every three days, etc.

2. DON’T FEED INTO IT

You can let the person speak and express themselves, but do not feed into it. Instead of agreeing and engaging in the negativity, try to respond with a simple “I see” or “mmm, hmm.”

3. CHANGE TOPICS

Switch the topic to something else. Try telling them a story about something positive to get them to become more positive too!

4. ADD BUFFERS

If you have to see the person, try to do so in a group setting so the person does not suck all the energy out of you. If you find that you need to see this person, it is much easier to do so in a group setting. That way, you can “spend time” with them without actually having to speak with them very much.

5. BREATHE

When all else fails, it’s important to stay grounded and not get sucked into the person’s negative energy. Try taking some deep breaths, inhaling for four seconds and exhaling for four seconds, or visualize some sort of armour or light protecting you from them.

There are some great tools out there to help you with this if it is hard to get started on your own. Feel free to email me and I will send you some links. Remember taking care of yourself with help you be there more for others too!

I hope you have a stress-free day!
Natalie

The post Guest Post: 5 Strategies to Deal With a Negative Person appeared first on Joyous Health.

from Joyous Health http://ift.tt/1jZwj0F

Uber’s Surge Pricing May not Lead to a Surge In Drivers

Screen Shot 2015-10-30 at 3.43.02 PM

Uber has long stirred controversy and consternation over the higher “surge” prices it charges at peak times. The company has always said the higher prices actually help passengers by encouraging more drivers to get on the road. But computer scientists from Northeastern University have found that higher prices don’t necessarily result in more drivers.

Researchers Le Chen, Alan Mislove and Christo Wilson created 43 new Uber accounts and virtually hailed cars over four weeks from fixed points throughout San Francisco and Manhattan. They found that many drivers actually leave surge areas in anticipation of fewer people ordering rides.

“What happens during a surge is, it just kills demand,” Wilson told ProPublica. “So the drivers actually drive away from the surge.”

When contacted this week, Uber said that their own analysis has shown that surge pricing does, in fact, attract more drivers to surge areas. “Contrary to the findings in this report — which is based on extremely limited, public data — we’ve seen this work in practice day in day out, in cities all around the world,” Uber spokeswoman Molly Spaeth wrote in an email.

The researchers also uncovered a few tips about how to avoid surge prices. They found that changing your location, even by a few hundred feet, can influence the price you get. They also discovered that you can often get back to normal fare levels by waiting as few as five minutes.

“The vast majority of surges are short-lived, which suggests that savvy Uber passengers should ‘wait-out’ surges rather than pay higher prices,” the authors wrote in a new study they are presenting at a conference in Tokyo on Friday.

The Northeastern scientists found that Uber’s price scheme divides cities into “surge areas” and calculates prices for each one independently. The boundaries are not known to consumers. “[T]wo users standing a few meters apart may unknowingly receive dramatically different surge multipliers,” the scientists wrote. “For example, 20 percent of the time in Times Square, customers can save 50 percent or more by being in an adjacent surge area” a block or two away.

The researchers sketched out those boundaries in their paper, and ProPublica has developed them into maps. Uber users in Manhattan can more easily cross from current surging to non-surging zones than users in San Francisco. The areas in Manhattan are smaller, and therefore more walkable; San Francisco’s price areas also tend to surge together.

The Northeastern researchers also found significant differences between the San Francisco and Manhattan markets. While an Uber blog post last year stated that surge pricing “affects a tiny minority of all Uber rides, less than 10 percent of trips,” the researchers documented that the price of Uber in Manhattan surged about 14 percent of the time, and 57 percent of the time in San Francisco. When asked about these findings, Uber said that they sounded unrepresentative, but not outside of the realm of possibility.

Like other online marketplaces in the “sharing economy,” Uber promises efficiency and openness. When using Craigslist, AirBnb, or eBay, for instance, buyers and sellers have the same information about what products are available, and for how much — both sides have a lot of information with which to make price comparisons. Uber is an outlier, these researchers explained, because under the Uber model, neither side of the transaction has all of the information.

“With Uber, the drivers don’t know what’s going on, and the customers don’t know what’s going on,” said Wilson. “There’s an algorithm behind the scenes that determines what the prices are, and you essentially have no idea what’s happening.”

Lauren Kirchner is a senior reporting fellow at ProPublica. She has covered digital security and press freedom issues for the Columbia Journalism Review, and crime and criminal justice for Pacific Standard magazine. She began her journalism career at the Richmond Times-Dispatch in Virginia. She has a B.A. in philosophy from Wesleyan University, and an M.S. from the Columbia University Graduate School of Journalism, where she received the Louis Winnick Prize for reporting and a Pulitzer Travel Fellowship.

from THCB http://ift.tt/1GCoata

Jeremy Hunt: Britain’s Anti-Machiavellian Health Secretary

flying cadeuciiBritain’s health secretary wants to uncharm his way to a revolution.

To galvanize support for a seven-day National Health Service (NHS), which the NHS was before Jeremy Hunt’s radical plans, and still is, he asserted that thousands die because there is a shortage of senior doctors during weekends. This is an expedient interpretation of a study which showed that mortality was higher in patients admitted on weekends. Hunt ignored the fact that patients admitted on Friday night are actually sicker than those admitted on Wednesday morning.

When logos failed, and after briefly dabbling with pathos, Hunt resorted to ethos. He insinuated that doctors were clock watchers (“service that cranks up on a Monday morning and starts to wind down after lunch on a Friday”). This led to a hashtag on Twitter: #ImInWorkJeremy.

Hunt wants to modernize the NHS. Leaving aside whether modernization is modernization, post-modernization or pre-post-pre-modernization, presumably this endeavor benefits from having doctors on board. How has Hunt enticed the doctors? He prophesized that GP’s diagnostic skills could be obsolete in twenty years. He wanted to replace doctor’s clinical judgment with computers, sooner rather than later (he’d just returned from Silicon Valley).

Karl Marx rallied workers to fight machines and capitalists. Hunt’s approach is of a middle manager with a touch of Mahatma Gandhi. “You suck. The computer will replace you. Do you mind hastening your replacement by embracing the machine, preferably without breaking the screen? Thank you, kindly.”

Junior doctors are leaving the NHS in droves. Many serve Australia’s areas of need, such as Mount Isa in Queensland. This allows homegrown Aussie doctors to stay in Melbourne, and intrepid Aussie doctors to move to Sydney. Britain’s tax payers are subsidizing the Australian healthcare, just as the tax payers from the Indian sub-continent once sustained the NHS.

Hunt, tackling the issue with Kissinger’s diplomacy, offered junior doctors a stick with no sight of a carrot. He wants them to work harder for less pay. In return? There are certain things money can’t buy….

History will unlikely judge Jeremy Hunt as the heir to Machiavelli. To be fair, neither is he the heir to Slytherin. He is Ebenezer Scrooge’s fastidious accountant. He wants the NHS to deliver as much as possible with little investing. He’d be a handy companion if backpacking in Thailand on a shoe string budget. Until he embarrasses you at the Hilton by refusing to pay for the premium scotch.

Hunt is in awe of Virginia Mason hospital, Seattle although I am uncertain he will import their entire business model to the NHS. He wants American healthcare at NHS prices. He dreams globally and pays locally.

Hunt suffers from austeritis – he wants the political gains of austerity without the political losses of austerity. He wants his austerity and not have to eat it. His method, uniquely British Conservative – pay less and demonize the workers – once worked in Stalin’s Soviet Union.

There is a chasm between doctors and Jeremy Hunt. Doctors think Hunt is a pantomime villain. This is unfortunate, not only for pantomime villains. The NHS has different issues today. Britain has changed. When the NHS was born, Brits were resilient, and the Daily Mail did not have an online comment box to vent. There were fewer permutations by which death could be deferred marginally. There was tuberculosis. People were grappling with the harms of smoking. And people were told to eat an apple, not a statin, a day.

Furthermore, the emergency department (ED), or whatever it was called then, wasn’t a one stop shop after Saturday night partying. NHS’s crisis is an ED crisis. The ED crisis is a societal crisis. The crisis has been caused, partly, by four-hour targets, which forced the ED to see patients, regardless of the chronicity or absurdity of their symptoms, as soon as possible.

I once worked in an inner city ED with nurses so good that they gave doctors a run for their money in clinical acumen. The nurses triaged and triaged liberally, making some with long-standing symptoms wait eight hours to be seen, all the while ensuring that streppable myocardial infarction was seen instantly.

The eight-hour wait time persuaded the thirty year old with vague belly pain for six months to see his GP. Everyone in the UK has a GP. Everyone. It is their right. The “right to a GP” has become a “right to a GP at my beck and call”. Hunt wants this right guaranteed at no surcharge.

Breeding unfettered consumerism and social justice creates disingenuous public policies. The public wants 24/7 concierge doctors without forking out the dosh. Who would say no to that? Hunt, instead of confronting this arithmetic delusion with honesty, is fanning it.

NHS is the art of the impossible. If Jeremy Hunt was less patronizing, and gave doctors due credit that they can add and subtract, they will deliver more than the impossible.

Instead he, like those before him, has gone for the jugular. Bringing doctors down a notch won’t modernize the NHS. Hunt’s strategy is penny foolish and pound retarded. If doctors abandon the clinical judgment that Hunt so belittles, austerity will be an imaginary number.

Saurabh Jha is skeptical by nature not because he hates you. He can be reached on Twitter @RogueRad

from THCB http://ift.tt/1GPTt3B

How doctors became Subcontractors?

In our healthcare system, the “middleman” is not who you think

During my recent podcast interview with Jeff Deist, president of the Ludwig von Mises Institute, I remarked that third-party payers are not, in fact, intermediaries between doctors and patients. In reality, it is the physician who has become a “middleman” in the healthcare transaction or, as I argued, a subcontractor to the insurer.

Important as it is, this reality is not well recognized—not even by physicians—because when doctors took on this “role” in the late 1980’s, the process by which healthcare business was conducted did not seem to change in any visible way.

When health insurance was first introduced on a large scale in the 1940’s and 1950’s, a patient would see a doctor and pay the bill directly. The doctor would issue a receipt and the patient would submit the receipt to the insurance company for reimbursement. The insurance company was, in that sense, a financial intermediary since it would enable the patient to afford the care and see the doctor.

Overtime, as the cost of medical care began to rise rapidly, a practice evolved whereby physicians would take it upon themselves to submit the claim to the insurance company and would not require patients to pay upfront.

In that sense, doctors were making an advance to patients, and the money they received from insurers could still be considered a “reimbursement.” If the insurer did not pay, or only paid a portion of the bill, the physician could submit the remaining balance on the bill to the patient. The insurer was still a financial intermediary.

The situation changed fundamentally in the late 1980’s when contractual arrangements began to take effect between doctors and insurers.

Medicare abandoned the practice of paying doctors the “usual, customary, and reasonable fee,” but instead imposed a fee schedule and business rules that physicians were obligated to accept in toto.

Private insurance companies followed suit and began to formalize contractual agreements with physicians. These agreements would similarly tie payments for services according to a predetermined schedule of fees.

But these new contractual agreements—which are standard arrangements today—did not visibly alter the practice by which physicians would submit a claim to an insurer after a patient encounter. It continued to be the case that, for the most part, patients would not pay the total bill upfront¹ and that, subsequent to the visit or procedure, a physicians would submit a claim to the insurer.

Since that time, though, the money physicians receive after services are rendered can no longer be considered a “reimbursement.” In fact, that money is truly and simply apayment for a service the physician has provided according to the terms of his or her contract with the insurer.

And to see more clearly how that payment sanctions a sub-contractual relationship between doctors and insurers, consider the overall scheme of healthcare financing as it has been set up since the 1980’s:

In the case of private insurance, employers pay premiums to insurers in exchange for a promise to provide “healthcare benefits” to certain employees. In turn, private insurers hire doctors to enable them to fulfill that promise. The doctors are essentially subcontractors in the healthcare benefit enterprise and the subcontract is typically called a “provider agreement.”

In the case of government insurance, “society” funds the government in exchange for a promise to provide healthcare benefits to certain classes of citizens. In turn, the government hires doctors as subcontractors to enable them to fulfill that promise. The subcontract is called the Medicare (or Medicaid) provider agreement.

The foregoing should make it clear that the persistence of the term “reimbursement” conceals the nature of the relationship between insurer and doctor. The evolved relationship between insurer and doctors also explains why the term “healthcare benefits” and “health care” are frequently conflated:

A “healthcare benefit” is a vague promise to pay for actual healthcare services. But having healthcare benefits in no way guarantees that one will receive anything resembling true care, since the provider agreements do not specify, except in very rudimentary ways, what exactly can be considered “health care,” let alone “quality” health care.

It should be readily apparent that an arrangement where physicians operate as healthcare benefits subcontractors to insurers, and not as primary agents to the patient, is not healthy for anyone.

Michel Accad is a cardiologist based in San Francisco.

from THCB http://ift.tt/1OdyOcp

Chelsea Clinton & US Surgeon General Vivek H. Murthy at Health 2.0 Fall Conference 2015

Chelsea Clinton got the 9th Annual Fall Conference on the right foot sharing the numerous successes of the Clinton Foundation including improving school lunches, providing antiretroviral therapy to millions of people living with HIV worldwide, and advancing women’s health.

//www.viddler.com/embed/7ca67760/?f=1&offset=0&autoplay=0&player=full&secret=53195313&disablebranding=0&view_secret=53195313

The 19th U.S. Surgeon General Vivek H. Murthy issued challenges to the tech industry to use innovation to improve the health of the nation by enabling prevention, making healthy choices easier, eliminating health disparities and making health care more collaborative and inclusive of family, caregivers and other sources of social support.

//www.viddler.com/embed/24d6fc7d/?f=1&offset=0&autoplay=0&player=full&secret=35977331&disablebranding=0&view_secret=35977331

Vanessa leads the marketing team at Health 2.0.

from THCB http://ift.tt/1NbHpLg

ACA Open Enrollment Round 3: The Going Gets Tougher

The third ACA health insurance exchange open enrollment period begins Nov. 1, and things look iffy. The Obama administration this month reduced the estimate of new enrollees for 2016—possibly to lower expectations but also because signs point to the difficulty of luring the remaining uninsured into the fold over the next few years.

It’s time for some fresh strategies to ramp up enrollment and get where we need to go. At the end of this piece I offer some suggestions and invite yours. (This article assumes the ACA will be in place over the next five years even if a Republican becomes president in 2017.)

Health insurance numbers can be confusing (and hyped out of context from both sides of the political aisle), so here’s a quick rundown of the current situation and the Obama Administration’s new projections.

The current U.S. population is 326 million. According to the Census Bureau’s latest authoritative annual report (released in Sept) 10.4% of the population, or 33 million people, were uninsured for the entire year in 2014. That’s down sharply from 13.3%, or 41.8 million people, in 2013. Thus, as of the end of 2014, there were 8.8 million fewer uninsured people, due primarily to Obamacare.

Some details:  66% percent of the population had private sector coverage and 34% had government coverage; 55.4% were covered through their own or a family member’s job; 19.5% had Medicaid; 16% had Medicare; 14.6% had coverage they bought themselves and 4.5% had military coverage. (The breakdown exceeds 100% because of coverage transitions during the year, which affect about 20% of the population.)

As would be expected post-ACA, the biggest change from 2013 to 2014 was in direct-purchase (buy your own) coverage and Medicaid. Direct-purchase (inside and outside the exchanges) ticked up 3.2 percentage points, to 14.6% of the population in 2014 from 11.4% in 2013. Medicaid coverage rose by 2 percentage points to 19.5%of the population in 2014 from 17.5% in 2013.

That brings us to 2015.  Another government survey projected that as of the end of March 15.8 million had gained coverage under the ACA (in the exchanges plus Medicaid plus additional employer or private buy-your-own coverage), reducing the uninsured rate to around 9% or 29 to 30 million people. So, that’s an additional 3 to 4 million covered lives compared to the end of 2014.

HHS and the administration made no update to those overall statistics this month. What they did do was project enrollment numbersin the exchanges—that’s what hit the news and delighted Obamacare opponents.

The bottom line on coverage in the exchanges:  about 10 million people will be covered by late 2016, up from the 9.1 million HHS expects to be covered in the exchanges at the end of 2015.  That’s a potential gain of fewer than 1 million during 2016 open enrollment. (The margin-of-error range is 9.4 to 11.4 million for end of 2016.)

The reason for the hand-wringing (by ACA supporters) or cheering (by opponents) was that the 10 million estimate is half what the Congressional Budget Office (CBO) projected last June as the number of people who would be covered through the exchanges by the end of 2016.  That is, CBO forecast 20 million.

Ouch! Ok, why so much lower? Here’s HHS’s explanation, edited for brevity:

“We adjusted the CBO projections….downward based on employer surveys from Mercer and other industry sources, which suggest that shifts from [employer-based] coverage and the off-Marketplace [exchange] individual market into coverage through the Marketplaces will be smaller than CBO expected and that the remaining uninsured may be harder to reach than in previous years….”

“As Marketplace coverage becomes more widespread and the size of the uninsured population eligible for enrollment in coverage through the Marketplaces shrinks, the remaining uninsured may be harder to reach, slowing enrollment growth. Beyond these factors, there are macroeconomic forces such as changes in population and economic conditions, which are difficult to predict but likely to affect enrollment.”

All logical. Most notable: Fewer people are being dumped from employer coverage, or opting out of it themselves to buy on the exchanges. And fewer people who buy their own insurance already (such as small business owners and the self-employed) are shifting to exchange coverage. The former is probably a good thing; it’s best still to have coverage through your job. The latter may not be so great unless those who are retaining their non-exchange coverage are not eligible for subsidies. (A fair proportion of such people may be self-employed red-state Obamacare critics who just don’t want any part of it.)

What HHS Secretary Sylvia Burwell and her colleagues didn’t say outright, however, is that the CBO projections began to look unrealistic over a year ago given the obstacles to exchange coverage—the main one being cost/affordability.

Thus, on the political front, Republican broadsides suggesting that the downward projections signal an Obamacare failure are not based in any careful or honest analysis (no surprise there, of course).

However, that said, the adjustment is still sobering and worrisome. And the Obama administration has underplayed the “affordability” issue even as it promotesgovernment-subsidized coverage.

In a 16-page brief HHS released alongside the new numbers, the department examines the remaining uninsured population, and obstacles to corralling them into the exchanges (or expanded Medicaid). See that excellent brief for all the juicy details on the exchange-eligible population—19 million people, 8.5 million of whom currently have non-group, non-exchange coverage, and 10.5 million who are uninsured.  Of the 10.5 million uninsured, 80% are low-income and eligible for subsidies; half are aged 18 to 34; a third are people of color/minorities; and nearly 8 in 10 have less than $1,000 in savings.

As everyone now acknowledges, many of these people are hard pressed to pay for coverage in the exchanges even with the subsidies, and they are leery of the high deductibles and co-pays even though they get some help with those, too.  For many, then, it doesn’t look like such a good deal, they have other bills to pay, and there’s the safety valve of emergency room or free clinics.

At the same time, an awareness problem persists. You and I might think someone would have to have been living under a rock these last few years not to hear about the ACA and subsidized coverage.  But surveys by the Kaiser Family Foundation, Commonwealth Fund and Urban Institute all find that from half to 65% of the uninsured are unaware of or do not understand the available subsidies.

HHS says it’s going to ramp up outreach this fall, to include greater use of social media to reach young adults and in-person assistance (navigators) for people who are hard to reach. This new Health Affairs/RWJF brief explains the role of navigators, who are budgeted at $67 million this year. Enroll America, the private sector collaborative, is on the case again this year, but with sharply reduced funding.

That’s all good, but I think more is needed this fall and over the next few years if we are going to reach these folks and hit a target of near-universal (95% or more) coverage by 2021. Here are a few ideas, humbly offered in the face of an admittedly tough problem:

  • Go all out in a targeted campaign to reach the young. Blanket them with social media messages everywhere they work, play, and go to school. Get creative with videos, and engage “tipping point” youth leaders, sports stars, popular bloggers and YouTube personalities in the cause.
  • Create a state-based low interest loan program dedicated to paying for exchange-based health insurance. Yes, that’s a heavy lift because this is a high-risk population financially.  So, convene bankers and other experts to explore whether and how it could be structured.
  • Partner with employers nationwide (large, mid-size and small) to get their uninsured workers (and dependents) covered. Sure, many businesses are not big Obamacare fans, but it’s a bottom line no-brainer for them, or should be:  whether they offer coverage themselves or not, they benefit from every covered worker. Firms that employ a high proportion of low-wage workers are an obvious priority.
  • Fund a contest for filmmakers to create two to three-minute videos on health insurance, the exchanges, and subsidies—with the goal of ending up with 5 to 10 videos (how about $50,000 to $100,000 prize to each winner?) that can be spread around the web and screened in multiple forums.
  • Ramp-up efforts with the best-known national and regional Hispanic/Latino organizations to enhance awareness of the exchanges and subsides.
  • Get celebrities involved! I know that sounds trite but plenty of them donate their time to disease awareness and public health efforts and other civic, and other philanthropic activities. I don’t see any involved in this issue, though I may have missed it.

I welcome your ideas and pledge to package whatever comes in and forward it to folks at HHS, the White House, and in selected states.

Addendum: The Obama administration on Oct. 26 released premium data for insurance bought through the exchanges in 2016 (after the above blog was written).  The data show an average jump in premiums across the country of 7.5%, based on the second-lowest silver plan—one of the most popular.  The range is wide, from 3% to 7% in a batch of states to more than 30% in Alaska, Montana and Oklahoma.  The big winner: Hoosiers; the average rate in Indiana will drop 12.6%.

The administration stressed that between 70% and 80% of people will still be able to buy a plan for less than $100 a month, after factoring in the federal subsidies.

HHS also said its enrollment outreach efforts this fall will focus on Chicago, Dallas, Houston, Northern New Jersey and Miami.  Rate hikes in all those areas were below average: 1.3 percent in Chicago; 3.9 percent in Dallas; 4.9 percent in Houston; 2 percent in Miami; and 5.1 percent in Northern New Jersey.   The agency also noted that with the penalty for not having insurance in 2016 at $695 per adult, many low income families will find it less expensive to get covered.

Steven Findlay is an independent journalist and editor who covers medicine and healthcare policy and technology. 

 

from THCB http://ift.tt/1ScsS1W