Snow time in Michigan

November is about to end, meanwhile the snow did its first visit already! We were having aorund 10 degC during the week, so we didn't expect so sudden change in the temperatures, but snow surprised us yesterday during breakfast. But despite of the inconvenience that the cold temperatures bring, the impression we get the first time it snows is always pleasant, as looking at some wonderful magic coming from the skies. Of course, it changes the next minute, when trying to adapt the plans for the cold weather...

We have been living almost 9 months in our home already, and are very happy with it. However, there are some things we didn't see at the beginning. One of the things is the two big deciduous trees. There is a layer of leaves both on the back yard, but mostly on the front yard. This is one of the lessons learned for the next time that we look for a house. No big, beautiful trees whose leaves will end up on the floor every fall :)

This photos were taken some weeks ago. As you can see, the leaves were covering the grass completely.We've learned that this can damage the grass, so you can imagine the entertainment of the last few weekends.

Hard work, but also beautiful to see. As you may know, fall is the most beautiful season in Michigan, because of the bright colors that the leave gradually take. People like to travel "up north", to the Upper Peninsula (UP), and enjoy this symphony of colors. I'll upload some photos from the internet, since this year, with our trip to the southwest, we haven't been collecting a lot of photos from around. 

The leaves on the trees make a gradual change from green to red. We could almost see the difference from day to day, when we were walking around the neighborhood. 

Notice the amazing combination of brilliant red, mustard yellow and pale green. This, together with the reflection effect on the multiple lakes of the state, make one of the most beautiful sceneries, especially on sunny days (which, I must say, were quite frequent).

Yes, indeed the most beautiful season. Unfortunately it is already over, now these snowy and gray days became the norm, together with the coldness and the darkness... The next two photos were take yesterday morning, when we realized it was snowing...

Different from the previous pictures, huh? OK, but before getting depressed, it is important to think what is yet to come. Now we are entering the "holiday season", as they call it around here. This is basically the Christmas time, however joined together with the Advent period, so at the end it is almost one and a half months of celebration. It usually starts with Thanksgiving, which takes place next Thursday. This means that this is a short week, only three days of work! On Thursday, since we don't have our family to celebrate with (and since we are not Americans) we decided to call for an "International Thanksgiving", with some European friends who, like us, came here on assignment. We'll tell you more about that in our next entry, it is going to be fun!

Thanks for reading, 

Lita & Andres

The Healthcare Revolution

It has been in the news all other the globe. The US is changing the Health Care Act, and everybody is going insane. There are people in favor and against it, discussions about where the money can come from, the debt is going to explode... As an European, it's not easy to understand the whole thing. That's why we'd like to write an entry on the Health Care conditions in the US in comparison with other countries, how it has been until now and what the "Obamacare" is trying to achieve. Before I start I must say that this is the vision that we are getting and it might be untrue in some aspects; we apologize if some readers feel otherwise.

How has it been for the US citizens until now? Well, for starters, the US is the only developed nation without a universal health care system that provides for all. The result is that 47 million people (out of 314 million) lack health coverage. That's the Spanish population! There are several reasons why there are so many uninsured, some of them just can't afford insurance, such as the unemployed, or people with serious chronic diseases and such: because of their medical condition, the insurance companies would only offer extremely high-cost plans, so they could not pay it. But there is also a group of young, healthy people that decide to "risk it", because the chance to get sick and need medical treatment is relative low.

One could think that due to so many uninsured, people would actually have less bills for medical care: less people go to the doctor, not so many control appointments etc. At least that is what I thought, but I was wrong. The US is the country that spends more on health care, both per capita and as percentage pf the GDP, as you can see in the picture below.

According to some studies, the US spends 900 billion a year on unnecessary medical treatments. Part of this is due to doctors that order tests that give little useful information to perform procedures that don't heal their patients. This happens for several reasons. First of all, some doctors just don’t know which procedures or tests are useful and which ones aren’t. Some order useless tests because their patients expect or ask for them.  Others do it to protect themselves from possible lawsuits. Second, the prices for the medical treatments are much higher here in comparison to other countries, as an example, a MRI costs more than $1000 in the US, versus $600 in Germany. 

So what are the the goals for such health care revolution? The act wants to cover both points mentioned before: universal coverage, and decrease in health costs. 

For the first goal, it means that everybody that doesn't have health insurance must get insured, or they get fined. There are some exceptions, such as people facing financial insolvency. But the rest will have to. This way, healthy people who don't pay insurance as of now, will help cover the treatments for people that need more medical assistance (sounds familiar, Europeans?).  In order to make this change more attractive, the government has created these insurance exchanges. The idea is to provide access to low-cost insurance if the person meets determined requirements, like for example the unemployed. That way people can "shop" insurance depending on their needs (at least this is the theory, the reality that people are experiencing is that these services from the government administration are slow or unusable).

For the second goal, the idea of to reach single-payer health system can contain costs and streamline clinical management protocols to avoid unnecessary testing and procedures of private fee-for-service. As the single payer, the government needs to prevent disease to maintain a budget, rather than having the incentive of making money from managing a disease (doing procedures, ordering tests) but not preventing it.

Additionally, the act also intends to harmonize the services covered by the insurance. Something that is happening lately to some people is that, depute being already insured, they are getting terminations letters for their plans. What is happening is that some programs don't meet the requirements defined by the government, for example they don't cover preventive care without co-payment, or leave out coverage of maternity care. That means that the consumers had to pay for some services (the out-of-pocket money in the left graphic below), which now must be covered by the insurance. For me, this sounds like a low-cost flight companies, and I would be very scared to be covered with those conditions.

And what is the opinion of the US people? Like always in these situations, there is a variety of opinions. There is a broad impression that such a system that covers everybody can't be sustainable. Rather than that, the Americans look at the Obama Care as not affordable that will only increase the debt. 

Two groups are especially against this: the group that is losing their "insurance", and the "voluntarily" uninsured. The first group feels like the government is putting them in jeopardy. The most criticized matter is that Obama promised that if people were happy with the insurance they were having and paying, they could keep them, which now has shown, is not true. And although these plans were just cheap insurance plans with little coverage, some people did not dislike them, especially because now they'll need to pay more for a new, "real insurance". For the uninsured, this means that they now must get covered, or they will get a fine. And the massive problems that people are having accessing the website to get the insurance, is only making things worse.

But on the other hand, the majority don't need to do any changes: looking at the right graphic above, the employer-sponsored insured and the consumers covered by  Medicare and Medicaid (which are public programs for the elderly and low-income population) may keep their insurance unchanged. That is almost 80% of the population. And the 15% who are uninsured, most notably people with pre-existing medical conditions, will have new access to affordable plans.

In my opinion, Obama and the Obama Care are getting people upset, but it is not because the of the program itself, but because he oversimplified and made promises that couldn't keep, and the government wanted to offer something that is creating unexpected difficulties on the way. But the pre-Obama Care was not a viable option. First, having uninsured must be avoided at all times, it is the only way to ensure a healthy country, and people with serious diseases must have the rights to get affordable coverage, it is not their fault to have a "weak heart". Second, these cheap insurance plans are making people fall into insolvency because of medical bills. Both situations are not the way for a system based on prevention and health protection, but rather high costs treatments for already developed diseases. Although some people were happy with the "Ryanair-like" health programs, maintaining them would be a step back. But I think this is not over, there are more problems to overcome. And if I think of the European system as it is now, having to build something like that in a matter or days would be impossible, since it has been developed for centuries. 

As a last comment, this Medical Revolution aims to mean a step forward in the American Health Care system, but there will surely be more to come. Medical costs will not decrease over night, lots of people will get covered, but the co-payments for certain treatments will remain constant. Besides, there is still a lot to be done for disease prevention, and this doesn't have to do with medical treatment but with the lifestyle. A change of health conception is needed, and this is nowhere to find in the Obama Health Care Act.

We want to finish the entry with humor, hoping you enjoyed reading and didn't fall asleep in between :)

Thanks for reading, 

Lita & Andres