Category Archives: Health Care

Choosing Between Dinner And A Medical Test

As Florida lawmakers far away in the state capital struggle to break their stalemate over Medicaid expansion, Cynthia Louis sees the bus bench advertising “Obamacare” near her Miami home as a reminder of a broken promise: that the Affordable Care Act would help her get the medical care she needs to return to work.

Louis, 57, has been unemployed since fall of 2013. Before then, the mother of three worked for Burger King for nearly 25 years, preparing and serving breakfast and lunch to Miami customers.

Dr. Annelys Hernandez, left, checks out Cynthia Louis in Florida International University’s Mobile Health Center.  (Photo by Peter Andrew Bosch/Miami Herald)

“Work is fun if you like the job,’’ Louis said, recalling years-long friendships with co-workers and customers. “And my job, I loved it.”

When she fell ill at the store on Biscayne Boulevard and Northeast 91st Street in Miami Shores, vomiting and unable to stand from the pain in her legs, Louis could not return to work, losing her job — and her best chance at getting health insurance.

Since then, Louis has learned what it’s like to depend on the healthcare safety net in Miami-Dade County, the one that’s supposed to catch residents before they hit bottom.

Although at times in the past she had been covered by private insurance through her employer, she no longer had that option. And she discovered that while more than 1.5 million Floridians now have insurance through the Affordable Care Act, she falls into a category of healthcare have-nots called the coverage gap.

Too poor to qualify for financial aid to make insurance more affordable under the health law commonly known as Obamacare, Louis and some 850,000 Florida residents were supposed to have been covered under Medicaid — if the state had chosen to expand the program as provided under the ACA.

But legislators in Florida, like those in 21 other states, have chosen to keep Medicaid open only to strict categories: poor children, and adults who are disabled, pregnant or parents with dependents earning no more than $5,500 a year for a household of two.

For Louis, life in the gap means any healthcare she gets will be up to her. And that means the safety net: free clinics, community health centers and public hospitals.

In the year-and-a-half since she lost her job, Louis has found she can usually get in to see a family doctor within weeks of seeking an appointment. And she qualifies for discounts on doctor’s visits, medical tests and prescription drugs through a charity care program at Jackson Health System, Miami-Dade’s public hospital.

But with no income, discounted care often means deferred or neglected care.

In mid-March, Louis learned first-hand the value — and the problems — of the safety net.

A viral infection had settled in her lungs. She wanted to visit her family doctor at the Jessie Trice Community Health Center in Brownsville. But she didn’t have $25 for the co-payment, and instead turned to a free clinic run by Florida International University’s Herbert Wertheim College of Medicine as part of the NeighborhoodHELP program.

The program offers low-income Miami-Dade residents free visits with a family doctor aboard a mobile clinic, along with counseling from a psychiatrist and other social services in exchange for patients’ allowing students to work with them.

The mobile clinic, a blue bus with the FIU logo on it, stops every Tuesday in the parking lot of the Pentecostal Tabernacle Church in Miami Gardens, an area of Miami-Dade with a high rate of uninsured residents.

Inside one of the narrow clinic’s two exam rooms last month, Louis met with Fred Anderson, a family physician and FIU assistant professor who helps run the fleet of three mobile clinics.

Anderson, who has been seeing Louis for about a year, asked if she had yet to get the X-rays of her hips and hands ordered by doctors during previous visits.

“Not yet,’’ Louis said.

Her X-ray referral, she said, had been sent to an imaging center in Coral Gables that charged twice the amount it would cost at Jackson Memorial Hospital — $40 — with her charity care card.

Louis said she had been calling the imaging center every day to have her referral forwarded to Jackson, and she had yet to hear back.

But the referral wasn’t her only obstacle. Louis also did not have the money for the co-payment because, she said, she often must choose between paying for her healthcare and buying soap and deodorant.

Without the X-rays, Anderson was unable to work on Louis’ chronic pain. He prescribed her an antibiotic for the viral infection, telling her she can get a two-week supply for free at a local supermarket. He also has prescribed anti-inflammatories for her pain. But he wants her to see a specialist, a rheumatologist, which means another co-pay she probably can’t afford.

“I would love to have all the X-rays,’’ Anderson said. “That would probably shed a little more light on what’s going on with her diffuse muscle aches and joint pains. But those are also the reasons that we wanted her to be seen by a rheumatologist, to get a second opinion.’’

Anderson said he first wrote the referral for Louis to see the specialist at Jackson Memorial about a year ago. Confused, she went to an orthopedist instead.

Louis said the orthopedist told her to take Aleve for her pain. “But Aleve wasn’t doing me no good,’’ she said.

Since then, Louis has been waiting to see a rheumatologist whom she hopes can chart a course of treatment to get her back to where she wants to be: taking pride in her work.

She’s not giving up. But, she said, “This here is driving me crazy, sitting around the house.’’

Hospital charity care, even at a publicly-funded facility like Jackson, isn’t always the answer for people in the gap.

Louis is enrolled in Jackson’s program, which provides discounted medical care to all uninsured Miami-Dade residents with no other options for insurance. Coverage is on a sliding scale; those with the lowest incomes receive the greatest benefits.

Louis qualifies for the most generous classification at Jackson, the J02, which is for those living below the poverty level of $11,770 a year for an individual.

But it’s not free. For each service that Anderson recommended, Louis will have to cover a $40 co-payment.

Even though she’s sure she can borrow the money from one of her adult children or a friend, the co-pay is only the first hurdle. Then there’s actually getting the services.

The X-ray referral that went to the higher priced clinic in Coral Gables still hadn’t gotten her the procedure at Jackson, a month after doctors prescribed it. Her appointment is in June.

The rheumatologist is taking even longer. Louis said she booked that appointment in January, and was told she can see the doctor in July.

“The waiting is tearing me down,’’ Louis said. “If I can find out what’s going on … all of us can get together and see where we go from there. But when you don’t know, that’s a big problem.”

While she waits, Louis fights the fatigue that feels as though it comes as much from her illness as from her healthcare limbo. She dreads the moments when hopelessness creeps up.

“I pray,’’ she said, “and that helps. It helps a lot.’’

While Louis prays, her doctors wrestle with their own dissatisfaction over the pace of her care.

“I do not feel satisfied with how we’ve been able to really get her on her feet,’’ Anderson said. “She still has significant limitations, let alone medical uncertainty that she’d really like to have resolved so that she can start to really plan her treatment.

“If she had access to a full insurance program,’’ he said, “she would not have to wait six months or a year.’’

Ed O’Dell, a spokesman for Jackson Health System, couldn’t directly address Louis’ case because of privacy concerns. But he said the wait to see a specialist at Jackson can run five to six months or as little as two weeks.

“It depends on the specialties,’’ he said. Urology, pulmonary and ear, nose and throat specialties have the longest waits, he said, because the clinics are only available four hours once a week since they are used for teaching or academics.

Jackson’s charity care program is the largest in Miami-Dade, offering discounted care to an estimated 40,000 uninsured county residents in 2014, O’Dell said.

That’s not only people in the coverage gap. Jackson officials estimate about 6,200 of those charity care patients in 2014 were undocumented immigrants, who do not qualify for any benefits under Obamacare.

Resources to care for the uninsured are scarce, even for Jackson, which this year will receive about $370 million in local sales and property taxes to help fund its mission to care for all county residents regardless of their ability to pay.

Still, some patient advocates say Jackson’s charity care program is not enough to meet the medical needs of an estimated 140,000 low-income residents who fall into the coverage gap in Miami-Dade.

With co-payments for the poorest qualified patients at $6.50 for prescription drugs, $40 for an emergency room visit or $100 a day for outpatient procedures, Jackson’s program is not a replacement for Medicaid, said Miriam Harmatz, an attorney for Florida Legal Services, a nonprofit that provides legal aid to low-income residents.

“It’s not real coverage,’’ Harmatz said. “That is very different from having an insurance card, a Medicaid card, where you would get those services with very minimal co-pays.’’

For eligible beneficiaries who earn less than poverty level, Medicaid charges a maximum co-payment of $4 for outpatient services, and a flat fee of $75 for hospitalization. Preferred drugs are capped at $4.

Harmatz added that Medicaid expansion also would mean hospitals and doctors would be paid for services now provided for free or at low cost to patients in the coverage gap — perhaps allowing those healthcare providers to hire more doctors and improve care.

It’s not just patients like Louis who are frustrated by long waits in the safety net. Doctors are, too, especially knowing that their patients might qualify for Medicaid under expansion.

“People are losing out. Their health is being affected,’’ said Katherine Chung-Bridges, a family doctor who counts Louis among her patients at the Jessie Trice center, a community health center with federal funding where patients pay on a sliding scale.

“You’re trying to get studies done. You’re ordering labs. You’re trying to get tests done, and the patient has to pay out-of-pocket for those tests,’’ she said. “And then the patient might have to decide, am I going to be able to eat dinner today or am I going to get this test done? Those are decisions that people shouldn’t have to make.”

Despite the barriers to her healthcare, Louis is more fortunate that many in the coverage gap.

Even with the long waits and co-payments she often can’t afford, Louis said she feels fortunate to have the safety net. But she also knows that she would qualify for a far superior form of coverage — Medicaid — if Florida legislators were to open the program to nearly all of the state’s low-income adults.

That’s why the Obamacare ad on the bus bench near her home leaves Louis feeling cheated.

“I look at it all the time,’’ Louis said, on a drive to visit her mother in Miami. “ ‘Obamacare. You can get Obamacare. You ain’t gotta be working.’ That’s what it was all at first. Then you get there, and people say, ‘You’ve got to have some kind of income.’ That’s not what you all said in the beginning.”

“Falling into the Gap” was reported with the help of the Dennis A. Hunt Fund for Health Journalism, administered by the California Endowment Health Journalism Fellowships at the University of Southern California’s Annenberg School for Communication and Journalism. WLRN-Miami Herald News reporter Wilson Sayre contributed to this report.

Congress Passes A Bill To Fix Medicare’s Doctor Payments. What’s In It?

Medicare’s troubled physician payment formula will soon be history.

As expected, the Senate Tuesday night easily passed legislation to scrap the formula, accepting a bipartisan plan muscled through the House last month by Speaker John Boehner and Democratic leader Nancy Pelosi. The Senate vote came just hours before doctors faced a 21 percent Medicare pay cut.

(Photo by Mark Wilson/Getty Images)

Under the bill, the current reimbursement schedule would be replaced with payment increases for doctors for the next five years as Medicare transitions to a new system focused “on quality, value and accountability.” Existing payment incentive programs would be combined into a new “Merit-Based Incentive Payment System” while other alternative payment models would also be created.

“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians — facilitating the implementation of innovative care models that will improve care quality and lower costs,” said Dr. James L. Madara, chief executive officer of the American Medical Association. “Patients will be able to get the care they need and deserve.”

The Senate voted 92 to 8 to approve the legislation, which the House passed 392-37.

It now moves to President Barack Obama, who — shortly after the Senate vote — said he would sign the bill, calling it “a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs.”

There’s enough in the wide-ranging measure for both sides to love or hate. “Like any large bill it’s a mixed bag in some respects, but I think on the whole it’s a bill well worth supporting,” Senate Majority Leader Mitch McConnell, R-Ky., said Tuesday.

The bill includes two years of funding for an unrelated program, the Children’s Health Insurance Program, or CHIP. GOP conservatives and Democrats are unhappy that the package isn’t fully paid for, with policy changes governing Medicare beneficiaries and providers paying for only about $70 billion of the approximately $210 billion package. The Congressional Budget Office has said the bill would add $141 billion to the federal deficit.

Consumer and aging organizations also have expressed concerns that beneficiaries will face greater out-of-pocket expenses on top of higher Part B premiums to help finance the way Medicare pays physicians.

But lawmakers said they had struck a good balance in their quest to get rid of the old system. “I think tonight is a milestone for the Medicare program, a lifeline for millions of older people,” said Sen. Ron Wyden, D-Ore. “That’s because tonight the Senate is voting to retire the outdated, inefficiency rewarding, common sense-defying Medicare reimbursement system.”

For doctors, the passage is an end to a familiar but frustrating rite. Lawmakers have invariably deferred the cuts prescribed by a 1997 reimbursement formula, which everyone agreed was broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times.

Here are some answers to frequently asked questions about the legislation and the congressional ritual known as the doc fix. 

Q: How would the bill change the way Medicare pays doctors?

The House package would scrap the old Medicare physician payment rates, which were set through a formula based on economic growth, known as the “sustainable growth rate” (SGR). Instead, it would give doctors an 0.5 percent bump in each of the next five years as Medicare transitions to a payment system designed to reward physicians based on the quality of care provided, rather than the quantity of procedures performed, as the current payment formula does. That transition follows similar efforts in the federal health law to link Medicare reimbursements to quality metrics.

The measure, which builds upon last year’s legislation from the House Energy and Commerce and Ways and Means committees and the Senate Finance Committee, would encourage better care coordination and chronic care management, ideas that experts have said are needed in the Medicare program. It would reward providers who receive a “significant portion” of their revenue from an “alternative payment model” or patient-centered medical home with a 5 percent payment bonus. It would also allow broader use of Medicare data for “transparency and quality improvement” purposes.

House Energy and Commerce Committee Chairman Fred Upton, R-Mich., one of the bill’s drafters, has called it a “historic opportunity to finally move to a system that promotes quality over quantity and begins the important work of addressing Medicare’s structural issues.”

A “technical advisory committee” will review and recommend how to develop alternative payment models. Measures will be developed to judge the quality of care provided and how physicians will be rewarded or penalized based on their performance.  While the law lays out a structure on how to move to these new payment models, much of their development will be left to future administrations and federal regulators.  Expect heavy lobbying from the physician community on every element of implementation.

Q. Will seniors have to help pay for the plan?

Starting in 2018, wealthier Medicare beneficiaries (individuals with incomes above $133,500, with thresholds higher for couples), would pay more for their Medicare coverage, a provision expected to impact 2 percent of beneficiaries.

In addition, starting in 2020,  “first-dollar” supplemental Medicare insurance known as “Medigap” policies would not be able to cover the Part B deductible for new beneficiaries, which is currently $147 per year but has increased in past years. If the policy had been implemented in 2010, it would have affected Medigap coverage for roughly 10 percent of all 65-year-olds on Medicare, according to an analysis from the Kaiser Family Foundation. Based on declining Medigap enrollment trends among 65-year-olds, expect this policy to impact a smaller share of new Medicare beneficiaries in the future, according to the study.(KHN is an editorially independent program of the foundation.)

Experts contend that the “first-dollar” plans, which cover nearly all deductibles and co-payments, keep beneficiaries from being judicious when making medical decisions because they are not paying anything out-of-pocket and those decisions can help drive up costs for Medicare.

The bill also includes other health measures — known as extenders — that Congress has renewed each year during the SGR debate. The list includes funding for therapy services, ambulance services and rural hospitals, as well as continuing a program that allows low-income people to keep their Medicaid coverage as they transition into employment and earn more money. The deal also would permanently extend the Qualifying Individual, or QI program, which helps low-income seniors pay their Medicare premiums.

AARP, a seniors’ lobby group, sought to repeal a cap on the amount of therapy services Medicare beneficiaries could receive, telling senators that it would be a “key vote” for the organization.

“Similar to the SGR debate, an extension of the therapy cap — rather than full repeal — is short-sighted and puts beneficiaries in a dire situation when the extension expires,” AARP Executive Vice President Nancy LeaMond wrote in a letter to senators.  “This amendment is important to the overall success of the Medicare program and the health and well-being of Medicare’s beneficiaries.” The amendment failed.

Q. What about other facilities that provide care to Medicare beneficiaries?

Post-acute providers, such as long-term care and inpatient rehabilitation hospitals, skilled nursing facilities and home health and hospice organizations, would help finance the repeal, receiving base pay increases of 1 percent in 2018, about half of what was previously expected.

Other changes include phasing in a one-time 3.2 percentage-point boost in the base payment rate for hospitals currently scheduled to take effect in fiscal 2018.

Scheduled reductions in Medicaid “disproportionate share” payments to hospitals that care for large numbers of people who are uninsured or covered by Medicaid would be delayed by one year to fiscal 2018, but extended for an additional year to fiscal 2025.

Q. What is the plan for CHIP?

The bill adds two years of funding for CHIP, a federal-state program that provides insurance for low-income children whose families earned too much money to qualify for Medicaid. While the health law continues CHIP authorization through 2019, funding for the program had not been extended beyond the end of September.

The length of the proposed extension was problematic for Democrats, especially in the Senate. In February, the Senate Democratic caucus signed on to legislation from Sen. Sherrod Brown, D-Ohio, calling for a four-year extension of the current CHIP program. A Senate amendment to extend CHIP funding for four years failed.

Q. What else is in the SGR deal?

The package, which Boehner, R-Ohio, and Pelosi, D-Calif., began negotiating in March, also includes an additional $7.2 billion for community health centers over the next two years. NARAL Pro-Choice America and Planned Parenthood have criticized the provision because the health center funding would be subject to the Hyde Amendment, a common legislative provision that says federal money can be used for abortions only when a pregnancy is the result of rape, incest or to save the life of the mother.

In a letter to Democratic colleagues before the House vote, Pelosi has said that the funding would occur “under the same terms that Members have previously supported and voted on almost every year since 1979.” In a statement, the National Association of Community Health Centers said the proposal “represents no change in current policy for Health Centers, and would not change anything about how Health Centers operate today.”

Q. How did the doctor payment formula become an issue?

Today’s problem is a result of efforts years ago to control federal spending — a 1997 deficit reduction law that set the SGR formula. For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors were furious when their payments were reduced by 4.8 percent. Every year since, Congress has staved off the scheduled cuts. But each deferral just increased the size of the fix needed the next time.

The Medicare Payment Advisory Commission (MedPAC), which advises Congress, says the SGR is “fundamentally flawed” and has called for its repeal. The SGR provides “no incentive for providers to restrain volume,” the agency said.

Q. Why haven’t lawmakers simply eliminated the formula before?

Money was the biggest problem. An earlier bipartisan, bicameral SGR overhaul plan produced jointly by three key congressional committees would cost $175 billion over the next decade, according to the Congressional Budget Office, and lawmakers could not agree on how to pay for the plan.

This time Congress took a different path. The measure both chambers approved is not fully paid for. That is a major departure from the GOP’s mantra that all legislation must be financed. Tired of the yearly SGR battle, veteran members in both chambers appeared willing to repeal the SGR on the basis that it’s a budget gimmick – the cuts are never made – and therefore financing is unnecessary.

But some senators objected. In remarks on the Senate floor, Sen. Jeff Sessions, R-Ala., said any repeal of the SGR “should be done in a way that should be financially sound.”

Most lawmakers felt full financing for the Medicare extenders, the CHIP extension and any increase in physician payments over the current pay schedule was needed. Those items account for about $70 billion of financing in the approximately $210 billion package.

Conservative groups urged Republicans to fully finance any SGR repeal and said they would be watching senators’ actions closely. For example, the group Heritage Action for America promised to “key vote” an amendment that the measure be fully financed. That amendment failed.

Some members of Congress seemed pleased to have this recurring debate behind them. “Stick a fork in it,” said Rep. Upton. “It’s finally done.”

Image of Brain under the influence of LSD

Lysergic acid diethylamide, AKA, LSD is probably the most famous hallucinogen. Despite the anecdotes of scary and beautiful trips, and the new age rumors of psychotropic medicinal potential, little is known about the actual, physical effects of LSD on the brain.  The drug has been under-researched, regardless of your stance on it, and in this day and age of legalization and the waning era of a completely ineffectual drug war it is hard to trust public opinion on any recreational mind altering substance. Timothy Leary’s 1960s-era writings and studies of the drug are the last true exploration – until now.

Last Summer, Carhart-Harris presented his findings after being the first UK Scientist to legally administer LSD to  human volunteers. The Misuse of Drugs Act of 1971 outlawed it for public use of any kind, including science. His presentation included a slide showing still unpublished cross-sectional brain images of a volunteer chilling in an fMRI scanner, tripping on acid. This kind of pro-LSD presentation is one of a handful from the worldwide science community that spurred the recent work of British medical researchers, lead by Imperial College London Neuropsychopharmacology Professors David Nutt and Dr Robin Carhart-Harris, who are  recording data as the drug interacts with regular healthy brains with MEG and fMRI brain scans.  It’s England’s first large-scale study of LSD in fifty years, and the first-ever study of this kind with a scientifically respectable sample size.

The study is being performed by The Beckley Foundation Psychedelic Research Programme, after crowdfunding on the website Walacea was extremely successful. The Walacea page says the money help to complete the research study which will present published results later in 2015. The crowdfunding is an important part of the story because university science budgets and government money have been slow to cover the costs of something so stigmatized by negative anecdotes.

‘Despite the incredible potential of this drug to further our understanding of the brain, political stigma has silenced research. We must not play politics with promising science that has so much potential for good’., said Prof. Nutt (Yes, that is his real name.)

LSD is in a restricted class of drugs in England where it is considered a Schedule-1 narcotic. There were a lot of legal requirements to meet before the team could get a license to use LSD on test subjects. They also needed approval from a science ethics committee to administer LSD to human subjects. After jumping through all the hoops, the researchers realized why LSD has gone so understudied. It was expensive, and they found they often had to convince people they were actually doing real science before they could get the paperwork to be taken seriously. The entire process has been slow and well-monitored, as a result.

The relatively sophisticated brain images the study hopes to produce of their subjects tripping on LSD could lead to new treatments for psychological disorders, most likely including obsessive compulsion and depression.

Jonathan Howard
Jonathan is a freelance writer living in Brooklyn, NY

Health Data Breaches Sow Confusion, Frustration

This story was co-published with USA Today.

As the privacy officer for The Advisory Board Co., Rebecca Fayed knows a thing or two about privacy and what can happen when it’s violated.

But when Fayed received a letter telling her that she, like nearly 80 million others, was the victim of a hacking attack on health insurer Anthem Inc., she couldn’t figure out why. Anthem wasn’t her insurance provider.

“I had no idea that Anthem even had my data,” Fayed told a gathering of privacy professionals recently at the National HIPAA Summit in Washington, D.C. “I went running around the house, 2018Why does Anthem have my data?'”

Fayed soon figured out the connection: Her previous insurer, a Blue Cross plan, was affiliated with Anthem in some way. Whoever hacked Anthem’s records accessed names, Social Security numbers, dates of births, addresses and more going back a decade.

Many of those caught up in the recent string of medical data breaches are experiencing similar confusion and concern as they receive notifications from insurers. They wonder what real-world repercussions the exposure of their health care information could bring.

The Anthem breach, announced in early February, affected some 78.8 million people. Premera, another insurer based in the Pacific Northwest, recently disclosed that hackers had accessed records of 11 million people. The plans are offering several kinds of support, including credit monitoring for two years, but consumers must take steps proactively to enroll in that service.

When retailers such as Target and Home Depot have suffered data breaches, they have exposed credit card numbers, which can be canceled, containing the damage. The hacking of health insurance data is more troublesome, revealing the keys to a person’s identity.

Julie Grimley, 46, a content editor for an educational software startup, initially assumed the Anthem breach wouldn’t affect her because her family had coverage through CareFirst BlueCross BlueShield. Then she got letters informing her that her data, along with that of her husband and 15-year-old daughter, might have been compromised.

“At this point, I’m not sure what the best thing” to do is, said Grimley of Gaithersburg, Md. “I really don’t.”

Grimley said she is most worried about her daughter. “She’s already starting the college process,” she said. “Her life is starting. This could be really serious. I should be worried about me too but we’re established. 2026 I’ve read horror stories and think, 2018Oh my gosh.'”

Anthem spokesman Darrel Ng said the company finished mailing letters notifying those affected during the week of April 3. The process took two months because of the number of people affected and to not overwhelm its credit-monitoring vendor, AllClear. “Anthem initially started by sending out 1.5 million letters a day and eventually ramped up to about 2.5 million per day,” he wrote in an email.

Anthem said it has tried to reach people in other ways, including by email and through a website, Ng said he did not know how many people had signed up for the credit monitoring, but anyone can seek help in clearing up credit reports and contesting false charges for the next two years.

Premera also has set up a website with information, It has notified 6 million members in Washington and Alaska affected by the breach and is working to notify members of other Blue Cross plans if they sought care in those states. As of April 1, more than 194,000 people had enrolled in credit monitoring, Premera spokeswoman Melanie Coon said by email.

The Department of Health and Human Services’ Office for Civil Rights, which oversees compliance with federal patient privacy law, is investigating the Anthem and Premera breaches. If the agency determines the insurers did not take adequate steps to protect members’ health information, it could impose steep fines.

Bethesda, Md., resident Eric Forseter and his family managed to fall victim to both the Anthem and the Premera hackings.

Forseter’s wife and son received letters dated March 4 from their health insurer Premera telling them that some of their information2014but not their Social Security numbers2013was compromised in the Anthem breach. Days later, they received additional letters saying they also were victims of Premera’s own breach, which affected not only Social Security numbers, but also medical claims information.

Forseter, 40, who works for an IT security and identity management company, said he doesn’t know how his family’s information got ensnared in the Anthem breach but suspects it may have happened because his son had to see a doctor while in New York. He’s gotten nowhere when he’s called the insurers’ customer- service line for answers.

“I don’t think they really know half the stuff that’s happening,” he said. “Unfortunately they’re reading a canned script and all they want to do is say, 2018Well, sorry.'”

Forseter said he is considering legal action against the insurers for failing to safeguard his family’s information. He called the offer of two years of credit monitoring inadequate.

“If data was stolen then sold and sold many times over, then potentially three to five to 10 years from now, that data could be used and I’d have to pay for my own coverage and I’m at risk,” he said. “I’m responsible for covering it.”

Ann Patterson, senior vice president and program director for the Medical Identity Fraud Alliance, an industry group, said consumers are right to be nervous. Medical identity theft poses a more serious risk than credit card fraud. “You really can’t change your birth date. So when that kind of information is out there, the type of fraud that is perpetrated in the health care sense involves your wellbeing, your life.”

If an imposter attempted to receive medical care using a patient’s name, she said, it could attach a false diagnosis to the patient’s medical records and delay care when the patient really needs it.

Patterson recommends that consumers take several steps if they have been affected. First, they should sign up for the free credit monitoring, which alerts people to possible suspicious activity if it happens. “If you became a victim, you would be notified as soon as possible,” she said, noting that it doesn’t prevent fraud. Beyond that, consumers should review all insurance forms, hospital bills and other medical correspondence they receive. If something doesn’t look right, don’t throw it out, Patterson said; make a phone call to clarify what has been sent.

“Some reason people think, 2018I was not the patient, so why should I call that hospital?’ Definitely call the provider and the health plan to make [sure] both parties know that you are not the patient. You should report it to your local law enforcement so you have a record that it was reported from a legal standpoint.”

For some victims, the Anthem and Premera breaches have been all too familiar.

Bill Speaks, 61, who works in mainframe software for the U.S. Department of Interior in Colorado, said he was also a victim of the Home Depot hacking attack last year, as well as one involving his bank, and he believes he was also a victim of the Target hack. Moreover, he said, his driver’s license was stolen when he had surgery at a hospital about three years ago. That may have resulted in someone opening up an account and running up charges in his name, he said.

Speaks said he’s fed up.

“No one is looking out for us and no one at the higher levels of these organizations are suffering any consequences because of their lax security,” he said.

Fayed’s company provides research, technology and consulting services to health care and higher education organizations, and she said the flow of personal information is essential to delivering medical treatment and to arranging payment. “We as individuals are never going to be able to know every single entity that has our data,” she said.

At the same time, Fayed said her personal experience with the Anthem breach allows her to see it from the other side. “It gives you a new perspective when you’re actually one of the folks whose data is disclosed. It’s a real-life perspective.”

For more on patient privacy, read how federal health officials rarely impose fines even as data braches multiply and check out our interactive tool. Has your medical privacy been compromised? Help ProPublica investigate by sharing your story.

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Cleveland Clinic Reports 40% Drop In Charity Care After Medicaid Expansion

Cleveland Clinic (Photo by KevinMNord via Flickr)
Cleveland Clinic (Photo by KevinMNord via Flickr)


The Cleveland Clinic, one of the largest hospitals in the country, has cut its charity care spending — or the cost of free care provided to patients who can’t afford to pay — to $101 million in 2014 compared with $171 million in 2013.

Hospital officials credited the federal health law for the improvement. “The decrease in charity care is primarily attributable to the increase in Medicaid patients due to the expansion of Medicaid eligibility in the State of Ohio and the resulting decrease in the number of charity patients,” the hospital’s year-end financial statement reported.

That 40 percent drop spotlights a trend in how payments are changing for all providers since the health law rolled out the Medicaid expansion and subsidies that help some lower-income people purchase policies on the new insurance marketplaces, said John Palmer, spokesperson for Ohio Hospital Association.

“Now that you’re starting to see that shift from uninsured or underserved on over into health care programs such as Medicaid and the exchange, that has had a good impact,” he said. “And, obviously, it is reflective of what hospitals are experiencing with uncompensated care in the areas of charity care especially.”

The clinic is not alone. The federal Department of Health and Human Services announced last week that the number of uninsured and self-pay patients has fallen substantially in Medicaid expansion states since the program went into effect last year. In addition, states with expansion saw significant reductions in uncompensated care costs – which includes charity care and bad debt, such as when an insured patient doesn’t pay her share of a hospital bill. Hospitals in those states had an estimated savings of $2.6 billion over that seen in non-expansion states.

Even so, Moody’s Investors Service released a negative outlook for the nation’s nonprofit health care sector. It pointed out that while the increased insured population will funnel dollars into the hospitals, that may not make up for federal cuts in Medicare and other programs.

Ohio is one of 28 states and the District of Columbia to expand Medicaid under the federal health law. More than 492,000 Ohio residents have enrolled through expansion. In addition, another 234,341 people in the state selected or were automatically re-enrolled in a private plan on the state’s federally run exchange.

“This has been good for patients because now they are insured through the State of Ohio’s adoption of Medicaid Expansion and can go anywhere for the care they need,” a spokeswoman wrote via email.

Another financial report, released by the clinic in early March, indicates that total uncompensated care fell 27 percent to $211 million in 2014. That number includes both charity care and bad debt costs.

The clinic, however, announced in the earlier March report that 2014 was an “extraordinary” financial year with operating income up 60 percent to $466 million on total revenues of $6.7 billion.

Dr. Toby Cosgrove, the clinic’s chief executive, noted then that the economic improvement came from a reduction in expenses, with cuts in energy use, employee health insurance costs and staff.

“Everybody in the organization contributed from whether we were turning off the escalators at night or not doing duplication of lab studies,” Cosgrove said. “But it was a total organization involvement in this and it was very gratifying to see people step to the plate.”

This story is part of a partnership that includes WCPN/Ideastream, NPR and Kaiser Health News.

Steroids Almost Drove One Woman to Suicide

This is the story of Jane. A healthy, stable woman in her twenties who, only weeks after moving from a rural town in Wisconsin landed the job of her dreams in the Big Apple, otherwise known as the city that never sleeps. I mention that, because it runs parallel to Jane’s initial experiences in New York: for the first couple of weeks after her uprooting, Jane wasn’t sleeping either. Not only that, Jane was facing a dangerous depression. A meloncholoy that got worse and worse every day, to the the point she found herself spending her days on the couch, immobile to the point she could not even muster up the emotional strength to answer the phone. It wasn’t long before Jane became suicidal and found herself in a hospital after spending an hour or so on the ledge of her building, ready to jump and end it all.


Of course, the big question here is why. Why would a woman who had already undergone the stress of moving from a little town to the most threatening city of them all and on top of that, land her dream job in a well-known advertising company want to end her life? There is one notable glitch: since the move, Jane had developed asthma, an extrememly common occurence among transplants to an urban environment with poor air quality. After multiple attempts at treating her new breathing ailment with inhalers all of which proved ineffective, her doctor prescribed an oral steroid – et voila! it worked.

But that’s when the weird stuff started happening. Just a week or two after beginning the medication, Jane woke up one morning to a sudden rush of overwhelming and heavy sadness – nothing, she explained, like she had ever encountered before. She could not think of anything that would explain this very sudden and very intense despair. Within a day, the funk got bluer. She sat on the couch and didn’t move, and when it was time to go to bed, she couldn’t sleep and therefore resumed her intitial position on the couch. Jane stopped eating and drinking, cried uncontrollably and remained there in a catatonic state, and by the next day, the suicidal thoughts came creeping in. While the idea was a surprise to normal Jane, to depressed Jane, it seemed awfully alluring and relieving. Depressed Jane won over, and before she knew it, she found herself teeterng on the edge of her window sill deciding whether or not to take the plunge. Thankfully, in a sudden state of terror, Jane pulled herself back into her apartment and called 911.


When confronted with Jane’s story, the doctor in the ER was perplexed. Most suicide attempts, as you can imagine, are usually triggered by traumatic events such as a bad break-up, a death in the family, and so on. But in Jane’s case, just the opposite was true. While Jane’s doctor first thought of bi-polar disorder or some type of mania, the diagnosis didn’t seem to fit her case. Although she descried herself as feeling “euphoric” prior to the depressive episode, the euphoria was mild and not accompanied by the disorganized thoughts and behavior that go hand-in-hand with such a diagnosis. Further, her functioning was normal up to the episode, and she had no history of psychiatric illness at all. Jane was then asked what type of medications she’d been on, to which she replied “none”. She explained that she had been prescribed asthma medication but that she was “done with it”. Because asthma is a chronic condition, Jane’s doctor thought her answer to be a little off the mark. With a little more research including a call to her pharmacy, it was discovered that she had in fact been prescribed a high dose of oral steroids for a week along with a second prescription for a tapering dose of the same medication – but Jane never picked up that second prescription.

The medication that Jane had been prescribed was a corticosteroid, alternately known simply as a steroid. Corticosteroids are very powerful hormones produced by our adrenal glands  and physicians are known to prescribe them as inti-inflammatory drugs, in this case to reduce the inflammation in Jane’s lungs that was happening due to her asthma. Steroids have an array of physiological effects, including regulating the immune system and metabolism. When a person is on steroids, her adrenal glands don’t function as diligently as they would were she not on them. The body recognizes these drugs and in response, cuts back on the amount of steroids it would normally produce. Sometimes, it stops producing these hormones altogether. If a person stops taking these steroids, the adrenal glands will wake up, but this waking up process is sort of like trying to get an adolescent out of bed – it takes time, and sometimes, lots of time. Most high-dose steroids need to be tapered over weeks or months to give the adrenal glands time to “get out of bed” and start functioning again. In the case of Jane, it’s safe to say that when she stopped taking her steroids, her adrenal glands got all wonky and needed way more time than was allowed to wake up.


Steroids are also known to alter mood and behavior, sometimes creating extreme happiness, other times creating severe depression – which is what happened to Jane. These medications are so powerful in fact, that they can even trigger psychosis, extreme anger – and yes, thoughts of suicide. It is more than likely that this is what happened to Jane. She had been on the medication long enough to supress her adrenal glands, and when she stopped taking them, the sudden and severe drop in her blood steroid levels was catastrophic enough to cause her to spiral into a deep dpression that led to suicidal behavior.

Jane was monitored by psychiatrists for a couple of days, and when they restarted her on the steroids, it was like night and day. The depressed, desheveled Jane that had been rolled into the ER after a suicide attempt had transformed into a cheerful (nonetheless unnerved), articulate woman who clearly did not belong on a psychiatric ward. She was discharged within a short period of time, after a slow steroid taper to allow her adrenal glands to start working on their own again.

The story of Jane ends here. It is a not only a clear illustration of how a quick analysis of her symptoms could have led to a misdiagnosis of a primary psychiatric disorder, but a lesson about  the danger of medication when not taken appropriately. There are lots of close calls when it comes to medications and their effects – but this one comes a little too close to the ledge.

Can Mac N’ Cheese Make You less Lonely? According to One Study, it Can

Food has played a major role in families and communities around the globe for hundreds of thousands of years. When mom gets a promotion, when Sally gets a A on her math test, when dad’s favorite baseball team wins the World Series, or even when a grandparent passes or other traumatic event happens, it is more likely than not that a family uses the dinner table as a platform for celebrating, grieving or simply talking about their day.

Jordan Troisi, graduate of the Univerisy of Buffalo and lead author of a study conducted alongisde co-author Shira Gabriel who has spent years working with social surrogates (non-human things that make people feel as though they belong) engaged in experiements which found that lots of people, in an effort to cure their lonliness, are inclined to create bonds with their favorite television shows, create “relationships” with ther favorite charactes or celebrities from films they have seen, or even foster relationships with a loved one after weeding through old pictures or mementos and latching onto that “special someone.”

Tossing a monkey wrench into the experiment, Troisi and Gabriel were curious as to whether or not comfort food could have the same soothing effect in a person as would a consolating, “real-life” relationship. To begin, in one experiment, researchers had the initial goal of making people feel lonely. To instill this uncomfortable lack of attachment, researchers had a group of subjects do a 6-minute writing exercise in which they were to write about nothing else but a fight they’ve recently had with somone they are close to. Next, they split the initial groups into smaller groups. Within that larger initial group, one subsequent group was assigned to write about a recent experience eating a “comfort food” (the word comfort being in quotes because the idea of a comfort food depends largely on individual taste). The other group was assigned to write about eating a new food. The last part of the study had all participants answer questions pertaining to their lonliness.

Prior to the experiment, the subjects were given assessments concerning how secure or unsecure they felt in their current relationships. Writing about having a quarrel with a close friend or relative made people feel lonely. However, there was an interesting find: those who had been found previously somewhat secure in their relationships before the experiment were able to untangle themselves from the web of lonliness by writing about comfort food! Says Troisi,

“We have found that comfort foods are foods which are consistently assosicated with those close to us…Thinking about or consuming these foods later then serves as a reminder of those people we are close to.”

In their writings about comfort food, many people wrote about the connection of eating food in association with family, friends, and other close ones.

In a separate experiment, spooning in hearty helpings of chicken soup in a lab made people think more about relationships, but only if they considered chicken soup a comfort food – something they’d been asked before the experiement, along with a series of other questions so that they would not remember that they’d been asked in the first place.

Can comfort food serve as a ready-made, easy resource for remedying lonliness as much as it can be “a cure” for the common cold? Who knows? Only mac n’ cheese and mashed potatoes – and  of course, chicken soup – will tell.

Young Gay Men Are Losing Out On Health Care

Emerging adulthood is a complex time for anyone. It ranges from late adolescence to one’s mid-twenties – ages when we are seeking to establish our identities in social contexts, and transition from childhood to the expectations and responsibilities of adulthood.

For young adults in sexual minorities, this age of transition can be especially fraught. Physical, emotional, cognitive and social development are coupled with the process of coming out and negotiating a sexual identity in a society that is still homophobic. Researchers consistently observe poor physical and mental health outcomes among gay and lesbian young adults, and these outcomes can be further exacerbated by both racism and poverty.

My own research on young men who have sex with men has found that they are not accessing basic primary care that can keep them healthy.

Young sexual minority men have difficulty accessing health care

Early adulthood is a complex time, and sexual minority young men may also have to contend with the confluence of illicit drug use, unprotected sexual behaviors and mental health burdens – all of which can put them at increased risk of contracting or transmitting STDs. In fact, health challenges such as substance use are higher among lesbian and gay young adults than their heterosexual peers.

In 2010, gay and bisexual men accounted for 63% of new HIV infections, and from 2008 to 2010, new HIV infections increased 22% among young gay and bisexual men overall.

But as my colleagues and I have noted before, HIV should be understood as one of the many intersecting and mutually reinforcing health challenges gay men face. This includes STDs other than HIV, as well as substance use, mental health challenges and violence. These are all issues health-care providers must and should address if we are to provide young gay men with the best care possible.

This means that health-care providers need to view the health of young gay men within a broader context of personal health and not solely defined by HIV. But this often doesn’t happen.

It also reinforces the importance of culturally competent health care in which these young men can talk openly about their sexuality and health, without being judged, and where providers are fully knowledgeable about the myriad health issues these men face.

Primary care is important.
Medical record via

Young men aren’t getting the health care they need

I am the principal investigator for the P18 Cohort Study, an investigation of young men who have sex with men, whom we have been tracking since they turned 18. We have found that these young men face a number challenges getting the health care they need.

When we assessed these young men at the onset of the study (ages 18-19), only half of our sample reported a recent sexual health screening, and only 16% reported a rectal screening in their lifetimes, yet all were sexually active. For sexually active men, such screenings should be routine.

More recent data from of our cohort at ages 22-23 reveals equally troubling information. Of the 349 young men assessed thus far, we have found that close to 10% already have been exposed to syphilis, 2% were actively infected with either urethral or rectal chlamydia, and 2% with urethral or rectal gonorrhea. Such data indicate the health burdens young gay men continue to face, and that many are either not accessing care or are not being routinely screened for these infections by their providers.

And in terms of vaccine-preventable disease, less that 10% of these young men report having received the full dosage of HPV vaccination, which in future could protect them from developing rectal and genital warts and certain forms of cancer.

Most alarming is the fact that close to 40% had not accessed any medical care at all in the previous 12 months and some 60% do not have a primary source of health care delivery. Only 20% reported receiving care from a primary care provider in the same time period, despite the fact that most of these young men are insured, with approximately 7% covered via the Affordable Care Act.

Health care for young gay men is often simply defined by prevention and treatment for HIV, despite the myriad other health challenges these young men may face. Comprehensive care includes screening and services for mental health and substance use, cardiovascular health and comprehensive testing for sexually transmitted infections other than HIV. Primary care can also link these young men to state of the art HIV prevention treatments such as PrEP.

Why are these young men having such trouble getting care?

First, men across the age spectrum, regardless of sexual orientation, are less likely than women to access health care.

Second, while a recent study has shown that young adults want and value health insurance, this doesn’t mean that they’re equipped with the tools to navigate our highly complex health-care system.

Third, for young gay men, especially those residing outside large urban centers such as New York or Los Angeles, finding culturally competent care creates yet another hurdle. And while the Affordable Care Act allows young adults to remain covered under their parents’ insurance plans until age 26, this may not be of particular benefit to young gay men who are not out to their parents or who experience homophobia and rejection from their parents. Young gay men who remain on their parents health insurance may be concerned about confidentiality. For this reason advocates have called for privacy protections.

And young men can start to fall through the cracks early – navigating the transition from a pediatrician to a doctor who can look after the needs of an adult can be difficult for this population. As children and adolescents, they might not have been out to their families or to their doctors, and might not have felt comfortable asking for advice about finding a new doctor. Managing the transition from pediatrician to a new doctor is critical. It helps keep these young men engaged with health care and sets them on a trajectory for lifelong health.

Why culturally competent care matters

Whether you are asking your doctor about getting a flu shot, or asking for an STD test, it is critical that you feel comfortable talking with them about all aspects of health. But it is often very difficult for the LGBT population to find culturally competent care. According to a 2011 Institute of Medicine report, this lack of a comprehensive understanding of the health needs of the LGBT population is one of the drivers behind the health disparities this population experiences.

We must ease the delivery of care for young gay men and develop points of entry into the health-care system in environments where young gay men socially navigate, like schools, mobile units near to clubs, bars, parks and recreational facilities, and within LGBT community centers. This would make engagement easier and less intimidating than in a traditional doctor’s office.

The Conversation

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Accidental Discovery Could Turn Cancer Cells Into Cancer-Attacking Immune Cells

Unexpected results are sort of the point of lab experiments. Laboratory studies reveal the unforeseen and if they didn’t, there would seldom be a reason to perform lab studies. It can be problematic when scientists don’t get the results they wanted or thought to expect but other times new data can be the result of the unexpected, and lead to discoveries no one thought to check for in the beginning. Some famous discoveries happened on total  accident throughout scientific history. The latest unintentional discovery might make one of the most aggressive types of cancer more treatable than ever before.

Scientists at Stanford recently discovered a way to force leukemia cells to become mature immune cells do something amazing.  The researchers were actually trying to stabilize cancer cells so they could keep them alive longer in order to study them. The method of keeping the cells alive allowed the cells to develop into immune cells that may one day help the immune system attack cancerous tumor cells!

You can read the study in full at Proceedings of the National Academy of Sciences.

Acute lymphocytic leukemia (ALL) is the name for a particularly rapidly-progressing cancer where the immature cells that should differentiate and become white blood cells or lymphocytes instead become cancerous.  ALL has several classifications based on which kind of lymphocyte (B cell or T cell) the mutated cancer cell originated from.

The scientists were simply investigating a common type of lymphoblastic leukemia, an acute cancer called precursor B cell ALL, aka B-ALL. B-ALL starts as a rogue B cell mutating away from usefulness during an early part of its maturation. The immature cells can’t fully differentiate and become the B cells they were otherwise destined to be. The flawed B cells lack the  transcription factors  required for normal development. Transcription factors are basically proteins that attach themselves to sections of DNA and are then supposed to switch designated genes on or off, depending on the type of transcription factor.  Did you follow that? It’s a bit technical for the layman but most of us understand DNA. Transcription factors are basically a DNA reader than helps the cell decide which part of your DNA it should use to become a specific type of cell.

So, when a transcription factor messes up and activates the wrong section of DNA or doesn’t activate the correct section, it can cause mutations where the cell doesn’t develop or develops poorly. B-ALL is one of the most nasty types of cancer and the  prognosis for victims is not good. The Stanford U team wanted to study this villain but had trouble keeping the cancer cells alive outside of the victims body.

Lead researcher Ravi Majeti reported in the lab’s news release: “We were throwing everything at the cells to help them survive.”

One of the techniques they used to attempt to keep the cancer cells from dying involved exposure to a certain transcription factor. The exposed cells began to grow and change shape, and the new morphology was a type of white blood cell called a macrophage, normally responsible for attacking  damaged, mutated cells or foreign material.

The team recognized the cancerous cells behaved the same as macrophages in various ways such as surrounding and engulfing bacteria. Most notably, the pseudomacrophages from the cancer cells of mice added back into the cancerous mouse did not behave as a cancer cell, and the mice who did not have cancer did not develop cancer after being exposed.

The Stanford researchers believe the newly converted cells are no longer cancerous. Furthermore, they might even help the body’s immune system regroup and attack other, still cancerous cells. It could work because macrophages normally collect DNA tags from abnormal cells they encounter and also mark foreign material so that other cells in the immune system know what to attack. Since the false macrophages were originally cancerous cells, they will, in theory,  already possess the correct signals that recognize the same kind of  cancer.

Now that this principle has been identified as a possible method of treating one cancer, it might open the door to helping the immune system combat other cancers.

Related Cosmoso article: Pre-Darwinian Theory of Heredity Wasn’t Too Far Off

Jonathan Howard
Jonathan is a freelance writer living in Brooklyn, NY

Ancient Egyptians Had State-supported Health Care

We might think of state supported health care as an innovation of the 20th century, but it’s a much older tradition than that. In fact, texts from a village dating back to Egypt’s New Kingdom period, about 3,100-3,600 years ago, suggest that in ancient Egypt there was a state-supported health care network designed to ensure that workers making the king’s tomb were productive.

Health care boosted productivity on the royal tombs

The village of Deir el-Medina was built for the workmen who made the royal tombs during the New Kingdom (1550-1070 BCE). During this period, kings were buried in the Valley of the Kings in a series of rock-cut tombs, not the enormous pyramids of the past. The village was purposely built close enough to the royal tomb to ensure that workers could hike there on a weekly basis.

Paintings on the walls of King Merneptah’s tomb in the Valley of the Kings. Workers living in Deir el-Medina would have worked on tombs like this.
Asmaa Waguih/Reuters

These workmen were not what we normally picture when we think about the men who built and decorated ancient Egyptian royal tombs – they were highly skilled craftsmen. The workmen at Deir el-Medina were given a variety of amenities afforded only to those with the craftsmanship and knowledge necessary to work on something as important as the royal tomb.

The village was allotted extra support: the Egyptian state paid them monthly wages in the form of grain and provided them with housing and servants to assist with tasks like washing laundry, grinding grain and porting water. Their families lived with them in the village, and their wives and children could also benefit from these provisions from the state.

Out sick? You’ll need a note

Deir el-Medina, the place the workers called home.

Among these texts are numerous daily records detailing when and why individual workmen were absent from work. Nearly one-third of these absences occur when a workman was too sick to work. Yet, monthly ration distributions from Deir el-Medina are consistent enough to indicate that these workmen were paid even if they were out sick for several days.

These texts also identify a workman on the crew designated as the swnw, physician. The physician was given an assistant and both were allotted days off to prepare medicine and take care of colleagues. The Egyptian state even gave the physician extra rations as payment for his services to the community of Deir el-Medina.

This physician would have most likely treated the workmen with remedies and incantations found in his medical papyrus. About a dozen extensive medical papyri have been identified from ancient Egypt, including one set from Deir el-Medina.

These texts were a kind of reference book for the ancient Egyptian medical practitioner, listing individual treatments for a variety of ailments. The longest of these, Papyrus Ebers, contains over 800 treatments covering anything from eye problems to digestive disorders. As an example, one treatment for intestinal worms requires the physician to cook the cores of dates and colocynth, a desert plant, together in sweet beer. He then sieved the warm liquid and gave it to the patient to drink for four days.

A sample of the Papyrus Ebers.
Via Aoineko/Wikimedia Commons

Just like today, some of these ancient Egyptian medical treatments required expensive and rare ingredients that limited who could actually afford to be treated, but the most frequent ingredients found in these texts tended to be common household items like honey and grease. One text from Deir el-Medina indicates that the state rationed out common ingredients to a few men in the workforce so that they could be shared among the workers.

Despite paid sick leave, medical rations and a state-supported physician, it is clear that in some cases the workmen were actually working through their illnesses.

For example in one text, the workman Merysekhmet attempted to go to work after being sick. The text tells us that he descended to the King’s Tomb on two consecutive days, but was unable to work. He then hiked back to the village of Deir el-Medina where he stayed for the next ten days until he was able to work again. Though short, these hikes were steep: the trip from Deir el-Medina to the royal tomb involved an ascent greater than climbing to the top of the Great Pyramid. Merysekhmet’s movements across the Theban valleys were likely at the expense of his own health.

This suggests that sick days and medical care were not magnanimous gestures of the Egyptian state, but were rather calculated health care provisions designed to ensure that men like Merysekhmet were healthy enough to work.

Family was a social safety net

In cases where these provisions from the state were not enough, the residents of Deir el-Medina turned to each other. Personal letters from the site indicate that family members were expected to take care of each other by providing clothing and food, especially when a relative was sick. These documents show us that caretaking was a reciprocal relationship between direct family members, regardless of gender or age. Children were expected to take care of both parents just as parents were expected to take care of all of their children.

When family members neglected these responsibilities, there were fiscal and social consequences. In her will, the villager Naunakhte indicates that even though she was a dedicated mother to all of her children, four of them abandoned her in her old age. She admonishes them and disinherits them from her will, punishing them financially, but also shaming them in a public document made in front of the most senior members of the Deir el-Medina community.

This shows us that health care at Deir el-Medina was a system with overlying networks of care provided through the state and the community. While workmen counted on the state for paid sick leave, a physician, and even medical ingredients, they were equally dependent on their loved ones for the care necessary to thrive in ancient Egypt.

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