Trumpcare, it wasn’t supposed to go like this…

Where do we go with healthcare reform after months of partisan bickering? We cannot simply ignore one-sixth of the economy and its impact on people’s lives.

This was supposed to be the week when the GOP came back from July recess, ready to vote for the AHCA or the BCRA or whatever they’re calling Trumpcare these days.

REPEAL AND REPLACE DERAILED

But then this happened.

New York Times: Donald Trump, Jr. makes the Russian connection

A meeting during the presidential election between Donald Trump, Jr. and a Russian lawyer came to light. It might have been about the election. It might have been about adoptions. It might have been collusion, or corruption, or something else. Donald Jr. kept changing his story. Then he tweeted out a series of emails about this meeting.

Needless to say everyone’s attention in the news media and Washington, was drawn to Russia and its attempts to influence the last presidential election.

rEVISIONS MADE, BUT ARE THERE ENOUGH VOTES?

So healthcare reform got pushed to the background. But it didn’t go away completely.

After a July recess where GOP Senators and Representatives continued avoiding town hall meetings, Senate Majority Leader Mitch McConnell announced that the August recess was being pushed out two weeks. They simply hadn’t gotten enough work done. One of the things they hadn’t gotten done: repealing and replacing Obamacare.

Today, as expected, the GOP released a revised healthcare bill that includes the Cruz Amendment which they hope will get enough votes to pass.

The initial read of the revised bill is that it’s a lot of the same with some funding to address opioid addiction and fewer tax cuts.

Whether they have the votes, after twisting arms, pulling out some of the tax breaks and softening the coverage requirements, remains a question as the vote on the bill is still expected next week.

PROMISES, ARE THEY MADE TO BE BROKEN?

It is possible that the Republicans won’t be able to keep their promise to get rid of Obamacare.

I wonder what the fallout will be, political and otherwise, of dragging people through these procedural shenanigans. Where do we go with healthcare reform after months of secret bill writing, no public hearings, contentious constituent calls, and plenty of public protest?

Our healthcare system needs reform. We cannot simply ignore one-sixth of the economy and its impact on people’s lives. With Obamacare progress has been made: more people have health insurance and the rate of cost increases has been slowed. But there are people and places in this country where those effects aren’t being felt.

Alice M. Rivlin, senior fellow at the Brookings Institute offers us what I think is a reasonable path. She writes:

In the face of that frightening electoral prospect, they [the Republicans] should abandon their tortured attempt to use the arcane reconciliation process to pass major health reform on a strictly partisan basis and work with Democrats to craft a bill that moderates in both parties can support and defend.

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Device Review: Accu-Chek Guide blood glucose meter

Bottom line: Bluetooth connectivity is what makes the Accu-Chek Guide more than just a standard, reliable blood glucose meter.

Why I’m Reviewing the Accu-Chek® Guide

I received an email offering me a free Accu-Check Guide. All I had to do was register online, get a prescription from my doctor, and go to my local pharmacy to pick it up. Easy.

Honestly, I wasn’t in the market for a new blood glucose (BG) meter. I’m perfectly happy with the one I use regularly. There’s only one thing about my current meter that I’d like to change. The meter I use doesn’t connect to my preferred BG logging app, mySugr. I have to manually enter my BG readings into the app

The email I received said the Accu-Chek Guide connects to mySugr. Not having to manually enter my BG readings? For free? Okay, I’ll try it out and see.

OK, it’s not exactly free

At the pharmacy when I picked up the meter I realized that this little experiment wasn’t going to be completely without cost. I had to buy some test strips. The meter came with batteries, a lancing device and lancets, and a generic carrying case. But it didn’t come with any test strips.

I gave the pharmacist my prescription for test strips, the manufacturer’s discount card, which was sent to me after I registered online, and asked for 100 strips. The discount price for 100 strips is just under $30, or about $0.30 each. But the pharmacy didn’t have that many strips in stock. I could only get a packet of 50 strips at just under $20, or about $0.40 each. I felt a little like I just got gypped by the pharmacy.

unboxing & set up

The Accu-Chek Guide reminds me of my first meter, which I got in 2009, the One Touch Ultra 2.

Both have the same menu system for set up and input. To move between the options on the menu you use the up and down button. To choose an option press the OK button.

Both have the same display screen set up. The time and date are at the top, the BG reading in big numbers is in the center, and any tags set are displayed at the bottom.

The basic process for setting the options is to go through preset menu options using the up and down button and then pressing the OK button to set the option you want. This process went quickly enough, but it felt a bit tedious. After correcting the time and making sure the meter’s language was set to English, the meter was ready to go.

BLUETOOTH

Bluetooth is the reason I wanted to try the Accu-Chek Guide. After all, I want the BG meter I use to be able to connect with my phone and transfer my BG readings to the mySugr app.

Setting up Bluetooth is done through a multi-step process using the meter’s Wireless menu under Settings.

First you connect the Default Device. For me, that’s my G6 cellphone. Choose Pair Device Now and the meter generates a PIN. With Bluetooth turned on, a pop up window appears on my phone with a field for the PIN. You got to be quick when entering the PIN or the pairing attempt times out and you have to try pairing again until it takes. Once successfully paired, the meter displays a big check mark.

Accu-Chek Guide paired with G6

Then you turn on Auto-Send in the meter’s Wireless menu, enabling your BG readings to be sent automatically to the default paired device.

Finally, if you have more than one device paired with your phone you have to set one of the devices as the default.

None of this is difficult. It takes a little time. If you’re not familiar with pairing you’ll have to dig out the instruction book, as there’s no help built into the meter menus. And if, like what happened to me, the devices time out you have to repeat the process.

Bluetooth establishes a wireless connection between the Accu-Chek Guide meter and your phone. For that connection to work, Bluetooth has to be turned on on your phone and your phone has to be within physical range of the meter.

That range seemed to vary. Sometimes it worked fine when the meter was in the bathroom and my phone on my nightstand in the next room. Sometimes not. I suspect this is due to the vagaries of Bluetooth and not the meter. Eventually, the BG readings did transmit to the phone without me doing anything to force it. Once the data transmitted I got a notification message on my phone.

The BG testing process is familiar

Testing blood glucose using an Accu-Chek Guide

The basic process for testing is the same as with any other standard meter.

Insert a test strip into the meter and it turns on. The Accu-Chek Guide has a light in its test strip slot. Which is very handy when testing in the dark.

Wait for screen to tell you to the apply blood to the test strip. The Accu-Chek Guide is very responsive, coming on and prompting for the blood drop almost immediately.

Apply a drop of blood to the strip and wait for the reading. Again the Accu-Chek Guide is really quick to respond.

Once the BG reading The appears press OK to add a comment. The comment menu lists: before meal, after meal, fasting, or bedtime. After pressing OK a second menu appears that lists specific meals that can be added to the comment.

Pull the test strip out of the meter or push the eject button on the side of the Accu-Chek Guide, and dispose of the used test strip properly. And testing is done.

DATA REPORTING IS BASIC

Blood glucose reading on Accur-Chek Guide

On the meter itself you can look at individual BG readings by going to the Logbook under the My Data menu.

First you’ll see a list of today’s BG readings with the most recent one at the top of the list. Scroll through the list using the up and down buttons. To look at a specific BG reading, press the OK button after highlighting the reading in the list.

When looking at the individual reading you’ll see the time, date, BG reading, any tags you set, and whether the reading was above or below target.

You can also see numerical displays of your average BG reading and the percentage of readings that are on target.

The Low/High Data displays a list of all BG reading that were either above or below the Target Range set for the meter.

the look & feel are familiar

The Accu-Chek Guide cycles through its process steps really fast. Insert the strip and the meter instantaneously asks for the drop of blood to test. Put a drop of blood on the strip and in a second or two you see the BG reading displayed on the screen.

As I mentioned above, the Accu-Chek Guide looks very familiar. Compared to the One Touch Ultra 2, it’s slightly more compact and a bit lighter in weight. I didn’t really like the feel of the buttons. They feel brittle to me and at first I had the impression that they might break.

THE INNOVATION IS IN THE ACCESSORIES

Oddly enough it’s in the accessories that the Accu-Chek stands out as innovative.
Source: Accu-Chek

The test strip container is designed to be spill proof. Individual strips are lined up in a track and held in place with tension. Having the strips standing on end makes it easy to pull out one at a time. Because the strips are all lined up the same direction you’re always handling the end that has the blood drop reservoir. I found this handy because I didn’t have to think about which direction the test strip was oriented. I just slid it into the lighted slot on the meter.

 The lancing device is designed to be single click and pain free. Once I got used to the feel of it, I did find it easy to use and generally pain free. Something about having the wide end press against my finger tip felt counter intuitive. The lancets come loaded in a drum that goes into the lancing device so you don’t have to touch them before use. Each drum holds six lancets, clearly the manufacturer understands that people are not using a new lancet every time they test.

MY BOTTOM LINE

It’s an adequate meter: compact, easy to use, reliable. But there’s nothing about the meter itself or its accessories that would compel me to switch over.

There is one thing that does work against switching to the Accu-Chek Guide and that’s the cost of the test strips.

Even with the discount program the cost adds up. Generally, I test before and after meals plus at bedtime. That adds up to 210 tests/month. Add a few sessions of exercise or a couple of days feeling ill and I’m up to 250 test strips in no time.

I would need to buy at least 250 strips each month at just under $60. Which is twice my monthly co-pay for strips through my HMO. This cost is also more expensive than the current monthly fee for unlimited test strips through One Drop or Livongo.


DISCLOSURES:
I got the Accu-Chek Guide meter, batteries, and an Accu-Chek FastClix lancing device with 6 lancets for at no cost by using a promotional voucher from Roche Diabetes Care, Inc. I bought testing strips at a discount using the SimplePay savings card.

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The political theater of Trumpcare

The battle over the latest version of Trumpcare promises all the drama, tragedy, and irony political theater can muster.

After more than a month of hurry up and wait the Senate Republicans released their version of Trumpcare. It’s called the Better Care Reconciliation Act (BCRA). On the fast track for a full Senate vote within a week, it’s name foreshadows all the drama, tragedy, and irony that political theater can muster. And every American, who chooses to to pay attention, has a front row seat.

What happens now?

Act 1, in which everyone rushes to judgement.

A flurry of action takes place across the media landscape.

The news media is screaming out headlines like these.

Winners and losers from the Senate repeal bill

Republican Senators pretend people who get kicked off of Medicaid will just start buying insurance

Poll: Trump’s approval at 40%, only 16% support House’s health care bill

Senators are tweeting and posting to Facebook and broadcasting on Facebook Live their readings of the bill.

Various health organizations have launched campaigns urging people to tell their Senators to vote “no” on the bill.

After taking in the news and social media I’ve come to the conclusion that some people hate the BCRA. Some people really hate the BCRA. And some people just want to spin it. But no one is saying it will provide better care.

Therein lies the irony.

Act 2, in which the people respond.

The people affected take to the political stage and raise their voices.

This response is taking many forms: calling Senators’ offices (again!), taking to social media with the hashtag #HealthcareMatters, and physical protests.

As the BCRA was being released a group of disabled people and their advocates staged a die-in at Senator Mitch McConnell’s office. Dozens of protesters were arrested as they chanted in the hallway “Our lives and liberty shouldn’t be stolen to give a tax break to the wealthy.” Video of Capitol Police forcibly removing disabled people from outside Senator Mitch McConnell’s office, some in wheelchairs others being physically dragged or carried down the hall, made national news.  It’s a video that will likely haunt many Senators in political ads for many election cycles to come.

One of the protest organizers stated that “To say people will die under this law is not an exaggeration.

Meanwhile, the Kaiser Family Foundation Health Tracking Poll shows that Republicans see Medicaid as welfare while most Americans don’t.

Therein lies the tragedy.

Act 3, in which the Senate takes direct action.

The Senate convenes.

So, just what is in the BCRA? Pretty much all the same stuff that was in the House’s American Health Care Act (AHCA). Cuts to Medicaid. but this time they’re rumored to be to the tune of $800 billion. Opt-out options for States to eliminate or reduce essential healthcare benefits and insurance marketplaces. Elimination of coverage mandates. Cuts to taxes on the wealthy, also rumored to be to the tune of $800 billion. Interesting how the cuts balance out.

Will Senators debate for longer than the minimum requirement? Will Senators make procedural moves like introducing amendments to delay action or yield back their time to shorten the debate? Will Senators vote before going on 4th of July recess? Will the Vice President have to cast a tie-breaking vote?

What will be the ultimate political cost to be paid by Senators and by the American people?

We won’t know until that day comes.

Therein lies the drama.

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If Senate Republicans write the healthcare bill in the dark…

Will the healthcare bill ever see the light of day?

How can you vote on a bill that will affect health insurance coverage for 24 million people without reading it first?

It’s been just over a month since Trumpcare (formally known as the American Health Care Act of 2017 or AHCA) passed out of the House and landed in the Senate.

During this time there hasn’t been much to write about because no one has seen the Senate Republicans’ bill. They have a select group of Senators writing the bill, in private, with no discernible input from anyone.

This isn’t how these things normally go.

Needless to say, the lack of information has made a lot of people nervous. Not just Senate Democrats, but also major healthcare organizations, governors, and even insurers. The President himself called the Senate’s bill “mean” and told Senate Republicans to be “more generous.”

In their rush to pass a healthcare bill, Senate Republicans might have killed it.

Senate Democrats are resorting to using procedural rules to slow down, not just the progress of this bill, but the all of the Senate’s work. Democrats hope this tactic will get enough Senate Republicans to change their votes that the bill goes down to defeat.

More importantly, the New York Times is reporting that “not one state supports the Republican health bill” because Senators need to be mindful of their constituents’ feelings. Don’t they?

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Wash Your Hands!

The BG roller coaster. If only I remembered the basics, I could have avoided taking this ride.

It’s grad season here. A busy time filled with celebration, ceremony, and light refreshment. No gathering is complete without some kind of food.

I found myself back home ready to take my dinner dose of insulin after eating dinner. Faced with my BG meter I knew the reading would be high. After all, tonight I was doing this backwards.

But I didn’t expect it to be that high.

It was so high it triggered a text from the CDE. Oh crud. Quickly, I dosed the insulin and took my shot. My phone buzzed.

“Are you okay?” was the text.

I texted back, “Yes, I’m okay. I was out at a graduation and ate before I took my diner meds. Just took my shot.”

Then I looked at my hands. And realized something. I hadn’t washed my hands before testing. And I had eaten pineapple earlier with my fingers. No toothpick. No chopsticks. No fork. Oh, crud.

I quickly washed my hands and tested again. My BG reading was 50 points lower. Still high. But not setting-off-the-alarm high.

I texted the CDE with this update.

And then I realized the dose of insulin I just took was higher than it needed to be. Oh, crap. I had a long night ahead of me. Now I had to monitor my BG to see if it would go too low.

Sigh.

If only I had remembered to wash my hands before testing.

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