You must be able to recognize proper food portions to estimate the amount of calories you are eating each day.  Look at the food label and then look at the portion size you actually eat.  Use the following measurements to determine your portion size and your calories.  Keep in mind, if you eat a larger portion then appears on the food label, you need to do the math. For example, 1 ounce of ready-to-eat cereal  is about the size of a large handful;  ½ cup is similar to the size of an ice cream scoop;  1 medium apple or orange is about the size of a tennis ball;  1 cup raw leafy vegetables is about the size of a women’s  fist; 1 ½ ounces natural cheese looks like a pair of dice or pair of dominos  and  2 – 3 ounces of cooked lean meat, poultry, or fish is about the size of a deck of cards. 

Health Care Reform: What it Means for You and Your Family

The recent ABC News Special, “Prescription for America,” provided President Obama with a platform to present his health care plans. During the program, he said, “We are getting a lot of quantity [health care] but we’re not getting the kind of quality that we need.” 

The Office of the Majority Leader Steny Hoyer’s report stated over 45 million Americans are uninsured. But, included in these numbers are nine million children who are covered under SCHIP. In addition, 30% of the uninsured could get health insurance but choose not to pay the premiums (13.5 million) and 10 million are in the U.S. illegally. So, that leaves about 13 million uninsured Americans. The entire transcript can be found at www.abcnews.com.  It’s truly an enlightening read.

 Should Health Insurance Pay for Everything?

Several years ago I attended a workshop where Humana CEO Mike McAllister talked about the history of employee health insurance. He said employee-based health insurance began after World War II and was offered to employees as a benefit rather than a higher salary.  Initially, he said, health insurance was designed to pay for catastrophic illnesses like cancer or the treatment of chronic heart disease.  However, in today’s environment, Americans expect their health insurance policy to pay for everything related to health.

Why are premiums so high now?  Here’s a reality check: When my sons were babies in the 1970s, our health insurance did not pay for well-baby check-ups or immunizations. Those were out-of-pocket expenses.

 Private Insurance – No Changes?

My husband and I have a health insurance plan through the Kentucky Dental Association pool; it costs about $11,000 per year for the two of us.  However, our premiums rise each year because insurers in Kentucky are assessed annually to help fund Kentucky Access (www.KentuckyAccess.com), which is a program set up for Kentuckians who are in need of health insurance coverage.

We have been reluctant to switch to less expensive health insurance due to the pre-existing conditions clause. But, if the government-run option slashes pre-existing conditions and costs less than $11,000 a year, we will likely be on board.  While I am not unhappy with our provider, cheaper is good, right? I wonder how many other people covered under private insurance companies will also change to the public option. 

 Simplifying and Cutting Waste

A whole new infrastructure will be needed to manage and enforce the new public option for as many as 13+ million people. This army of government administrators will have to act as the traffic cops for all the new regulations. The government promises to streamline health care by simplifying and standardizing the process.  Has government ever streamlined anything?

President Obama says another way to fund government-run health insurance is to save more than $900 billion in Medicare and Medicaid by making them more efficient – cutting waste and fraud.  With all the financial problems facing both programs through the years, why hasn’t our government already streamlined these programs?

 Quality vs. Quantity

In a Consumer Reports article called, “A Prescription for Health Care,” a family doctor in Philadelphia suggested a physician needs to spend at least 15 minutes with each patient.  The public option promises quality. With that in mind, consider this: 34 patients can be seen by a family practice physician each eight-hour day if he sees each patient for 15 minutes and takes a half hour lunch break (that’s 8,500 patients in a year if the physician takes two weeks for vacation).  That’s not many patients when you consider 13+ million more may need to be seen. The reality is many patients will have to be seen more than once a year – maybe be even once a week depending on their health status. 

Do we have enough doctors? This is another challenge that needs to be dealt with before 45 million people have access. Adding greater numbers into an already bulging health care system could decrease quality care for quantity care.

 Forcing Health Insurance for All

Under the reform, everyone would either be on Medicare, Medicaid, private insurance, employer health insurance or the government public option plan.  According to the Affordable Health Choices Act of 2009, a comprehensive health reform package released by House Democrats, individuals who decline affordable coverage “will pay a penalty of 2.5% of modified adjusted gross income above a specified level.” I’m not sure what that means.

On the campaign trail, President Obama promised accessibility to affordability – but what about accessibility to care?  A Health Planning Board will determine what expensive tests, drug therapies and procedures to ration to ensure the public option remains affordable. 

It sounds as if the 30% who are currently uninsured because they choose to put their money elsewhere will be forced to pay for the health insurance public option.  If these people don’t go the doctor or can’t be seen for months or at all, the government stands to make money. For example, if the government mandate is $100 per month for the health insurance option, that’s $1,200 per year. Multiply $1,200 by 25 million (including those in the country illegally). Then, the government pays a small amount to doctors, hospitals and for prescription drugs. The cost to the government is nominal, but the program could potentially generate lots of money.

 Will Physicians Accept the Low Reimbursement Rates? The next question becomes – will physicians accept the government’s public option patients?  Numerous reports have suggested the physician reimbursement will be the same as Medicare. Under the current reform plans, Medicare reimbursement rates to physicians were to be cut by 40% of the low rate. While the American Medical Association has endorsed the House Health Care Reform plan, only 20% of practicing physicians actually belong to AMA.  Currently, many health care providers have opted not to accept Medicaid or Medicare patients because of the low reimbursement rate.  If they accept public option patients, physicians will have to see twice as many patients for the same amount of money. Could this further jeopardize quality health care? Concierge Physician Practices

Under the government program, having access to a health care professional in a timely manner could become a challenge. For people who can afford it, a concierge physician practice might be the answer.  These practices provide preventive and personalized health care. The annual cost locally is $1,500 - $4,500 per patient or $5,000 - $6,300 for a couple. Armed with the doctor’s contact information, patients have 24/7 access. Many concierge practices limit their individual patient numbers to between 300 and 600. (Internal medicine doctors may have 3,000+ patients).  Currently, the fee is tax-deductible both on the corporate and individual basis and may be paid from a Health Savings Account.    

By switching from our private health insurance program to the government-run option, my husband and I could potentially save enough to sign up with a concierge-type practice.  This strategy would assure us of total accessibility to a health care professional.  A concierge doctor will be an advocate for you and could help you to gain access to a specialist.  Hospital accessibility will be a major concern for everyone whether you are in a private insurance or public option. How will free enterprise deal with that issue?

 What Does Prevention Mean?

President Obama insists that prevention is necessary to manage health care costs. Are the prevention strategies routine blood pressure, cholesterol and blood sugar checks, plus screening techniques like mammography and PSAs or is he saying Americans need to be educated on how to manage their own health?  I have been teaching wellness and disease prevention by lifestyle choices for over 20 years. While some people buy into the idea, just take a look around. Americans, young and old, are overweight – 33% of Americans are overweight/obese and the number keeps rising. Diet and exercise are all over the media, but the advice is obviously not working. Kentucky ranks 7^th in obesity with 29% of the population being overweight or clinically obese, according to the CDC based on data collected from 2006 to 2008. The Agency for Healthcare Research and Quality (AHRQ) recently announced $300 billion was spent in 2008 on obesity-related illnesses.

I’m not sure politely asking Americans to take control of their own health is ever going to work. Unless it costs money out of their own pocket, they may be unwilling to make lifestyle changes for their health. What if health insurance rates were based on certain health markers – weight, cholesterol, blood pressure, blood sugar, smoking? Would this strategy help Americans get on board with managing their health in a more positive manner?

 Who Will Pay for Health Care Reform?

President Obama has suggested that 2/3 of the money needed for health care reform will come “by re-allocating dollars that are already in the health care system; taxpayers are already paying for it, but it’s not going to stuff that’s making you healthier.”  He also said, “We spend $177 billion over 10 years on providing subsidies to insurers [for the Medicare Advantage Plan subsidies].  If we take that money and use it to train young doctors for primary care, to provide more coverage, to improve prevention and wellness, that’s a good way of spending money we’re already spending.”  According to the CDC, about $300 billion a year, or 1/3 of U.S. health care costs, are spent on older Americans 65+. Unfortunately, discontinuing Medicare Advantage plans will decrease accessibility to health care to older Americans.   

The Congressional Budget Office (CBO) estimated the cost over a 10-year period would be over $1 trillion. “On a preliminary basis…the proposal’s provisions affecting health insurance coverage would result in a net increase in federal deficits of $1,042 billion for fiscal years 2010 through 2019.”  The CBO said that even if the price tag holds to $1 trillion, more than 80% of the costs will hit in the last five years.  Will tax payers be hit with higher costs after 2019? 

Progressive health care protocols often come with a higher price tag. Will the government option allow patients to take advantage of the new technologies and treatments despite the higher cost?

 Take Your Time & Do It Right

My hope is that health care reform is carefully crafted to effectively bring about quality health care for the masses without bankrupting our country in the process.

I fear the government will rush the health care reform process just to mark a task off their list. I’d like for them to show us the money saved by fixing Medicare and Medicaid. Because reimbursement for the public option will likely be based on the Medicare model, stopping the fraud and waste before forging ahead is imperative. Plus, a longer timeframe could allow time to train more health care professionals and workers so access will not be a problem. 

How much dietary fiber should I eat each day?  The National Academy of Sciences’ Institute of Medicine recommends that men 50 and younger should eat 38 grams of dietary fiber each day whereas women should eat 25 grams per day.  Men over 51 should eat over 30 grams of fiber and women over 51 should eat 21 grams.  There are two types of dietary fiber: insoluble and soluble. Insoluble fiber is found in 100% whole wheat products, wheat bran, nuts and many vegetables.  Soluble fiber is found in oats, peas, beans, apples citrus fruits, carrots, barley and psyllium.  Whole foods are better sources of fiber because they also provide other nutrients as well. You can find dietary fiber information of the food label.   A high fiber diet can help to prevent constipation, lower blood cholesterol levels, control blood sugar, plus it aids in weight loss and can lower your risk of digestive disorders like irritable bowel syndrome and diverticular disease.    Barbara Day, M.S., R.D., C.N., is a Lifestyle Nutrition & Wellness Specialist

I have heard the local Health Department may ban trans fats in restaurants.  Why is this so important?  Trans Fats are created when hydrogen is added to liquid vegetable oils to make them more solid.  Another name for trans fats is “partially hydrogenated oils.” Companies use these fats because they are inexpensive and help increase the shelf life of many products. Many restaurants use trans fats to deep fry foods because they can be used many times before the fat needs to be changed.  Trans fats are found in French fries, doughnuts, pastries, cookies, stick margarine, pie crusts, crackers, biscuits, or pizza dough.  Trans fats raise your lousy cholesterol (LDL) levels and lower your helpful (HDL) cholesterol levels.  Eating trans fats increases your risk of heart disease, stroke and diabetes.  Eat less than 1% of your total calories from trans fats per day. Example, 2000 calories/day, no more than 20 calories from trans fat which is less than 2 grams per day.   Barbara Day, M.S., R.D., C.N.

My pediatrician wants my child to lose about 30 pounds.  Where can I start? Childhood obesity is a family affair.  The first strategy is to get back to the basics by instituting the family meal.  Portions can be monitored for everyone – not just the child in need.  Rather than eat school lunch, the parent can prepare a bag lunch with a determined number of calories. Make sure to plan the meal with your child to ensure they will eat the lunch. After dinner, go for a family walk together. Controlling food portions plus increasing activity will spell success. An excellent resource for children (6 – 11 years) which details nutrition and activity strategies is   http://mypyramid.gov/kids/index.html.  Children 6 – 11 years old need between 1400 - 2200 calories depending on how active they are. For children 2 – 5 years old, you can go to http://mypyramid.gov/preschoolers/index.html.  Children 2 – 5 years old need between 1000- 1600 calories depending on how active they are. This website offers many helpful tips and resources for families.  To determine how many calories your child needs, you can go to http://www.mypyramid.gov/downloads/MyPyramid_Calorie_Levels.pdf.   Barbara Day, M.S., R.D., C.N.

Vegetables: How can I get my kids (and me) to eat them? Vegetables are typically low in calories and high in nutrients.  Eating fresh vegetables like carrots, broccoli, cucumbers,  and peppers are great snacks and can be dipped in low fat dressing like ranch dressing or low fat yogurt.  Vegetables can be hidden in foods like spaghetti sauce.  Throw some broccoli, peppers, spinach or other vegetables into the blender.  This puree can be added to an assortment foods like soups, hamburger, chili, etc,  to help boost the nutritional quality.  If you need a recipe,  The Sneaky Chef by Missy Chase Lapine or Deceptively Delicious by Jessica Seinfeld are excellent resources (www.amazon.com).   Kids love French fries.  Try making your own fries with thinly cut sweet potatoes, carrots, peppers or parsnips.  Put the vegetables in a plastic bag with 1 tablespoon of olive, a favorite spice, some sea salt and shake.   Spread on cookie sheet. Bake at 450 degrees for 30 minutes or so until tender.  Barbara Day, M.S., R.D., C.N.,

Joe Friel has recently updated his The Athlete’s Training Bible which can be found at www.velopress.com.  It’s his 3rd edition.  It’s an excellent resource but does not really have much information on the nutrition approach.  Two really great resources for nutrition for multisport athletes are Sports Nutrition for Endurance Atheletes by Monique Ryan and Endurance Sports Nutrition by Suzanne Girard Eberle.  Both authors are registered dietitians who also compete.  You can get both of these books at amazon.com. Correct nutrition strategies will help you achieve your multisport goals. 

 What is the best way to lose weight? Diets don’t work.  Calories count. Keeping track of your daily caloric intake each day is critical. Making time of be active for at least 30 minutes a day up to 60 minutes a day will spell Weight Loss SUCCESS as well weight loss maintenance.  To find out how many calories you need each day go to: http://health.discovery.com/tools/calculators/basal/basal.html To determine how active calories you burn each day go to: http://health.discovery.com/tools/calculators/activity/activity.html   By eating 250 calories less each day and burning an extra 250 active calories a day you will lose a pound a week  (500 calories X 7 = 3,500 calories and a pound of weight loss). Keeping a Food and Activity Journal each day and making an active lifestyle a daily priority will help to ensure a permanent weight loss.  

Today I attended the Louisville Bike Summit II.  Lots of really great things are going on in Louisville with the Louisville Loop and the 21st Century Parks project (www.21cparks.org).  About 250 people attended the Summit.  As I was listening and taking notes, I was bummed because all this information would have been great in Kentuckiana HealthFitness Magazine but …guess the community will hear about the details in another format.  If you don’t know about a website bikeclick.com this might be a good time to check it out.  Steven and Suzanne Webster, both cyclists, have developed a really great website to connect cyclists whether you are a racer, commuter, newbie or a mountain biker, you will find something to help you connect with other cyclists in our community.  I am sure the Websters will post a lot of info about the bike summit.  You can also go to BikeLouisville.org to get the full report on the specifics from the Bike Summit.  Stay tuned.  More to come about our communities next strategies on making our community more Bicycle Friendly.

The next issue of Kentuckiana Healthy Woman Magazine will deal with In Vitro Fertilization.  It’s amazing that a single woman would even consider IVF when she already has 6 kids and lives with her parents.  What is she and her doctor thinking?  I think the physician who did the implantation should be required to pay all the expenses personally of raising the 8 children until they are of age - 18 years old. His malpractice insurance should not pay a penny because that would affect all the other physicians as well. The mother, ofcourse, is going to expect the state of California to pick up the cost of raising these children because the mother can’t afford to raise all 14 of her children. How could she even work?  The child care cost would be very expensive.  The other alternative would be for the mother to put the 8 children up for adoption.  How many childless couples would love a child to raise.  As a grandparent, I feel for this woman’s parents.  Apparently they have been chosen to take care of the mother and all of her children as well. Her father will never be able to retire since he’s been strapped with raising his daughter’s children and taking care of her as well.