Here’s a study where Iowa ranks first and New York last, and it’s not about farming opportunities. It’s about being a great place for physicians to work.

If you are a doctor, Iowa is  the best state to practice, while New York fares the worst, according to WalletHub‘s Best and Worst States for Doctors study.

It may seem simplistic, even far-fetched, but WalletHub evaluated many different factors to come up with its findings. The company said it compared the 50 states and Washington D.C. across 14 key metrics, “ranging from the annual wage of physicians to hospitals per capital to quality of the public hospital system.”

Overall, WalletHub data showed the “best states for doctors combine opportunity, compensation and low malpractice odds,” Jill Gonzalez, an analyst with WalletHub, told HealthDataBuzz.

“The (WalletHub) report was conducted from a doctor’s perspective and the states with the best environments in which to practice,” Gonzalez said.

As WalletHub noted in its report,th, physicians are among the highest paid professionals, but they are most certainly in a complicated career landscape.  You name the issues, and iWalletHub addresses them: Healthcare reform, the increasing number of hospital networks, and the surging numbers of Baby Boomers heading into retirement, among other factors.

Putting all those factors together, Iowa fared the best for physicians.

“Iowa should continue to offer great opportunities to doctors with a very attractive medical environment,” Gonzalez said. “New York ranked last because it is a very competitive state for doctors with fewer hospitals per capita.”

Two of the key data areas for ranking the states were “Opportunity & Competition” and “Medical Environment.”

The Opportunity & Competition issue involves a host of issues: annual wages, starting salaries, hospitals per capita, the insured population and primary care provider shortages, projections of the share of the elderly population, current and projected competition, the number of Continuing Medical Education credits required, and what was termed the presence of an interstate medical licensure compact. The Medical Environment includes the quality of the public hospital system, how punitive a state medical board may be,  malpractice award payouts (an amount per capita) and the annual malpractice liability insurance rate, according to WalletHub.

Using those evaluations, WalletHub examined 14 relevant metrics and calculated the overall score for each state.

Iowa, with its overall No. 1 rank, was  listed as No. 2 for ‘Opportunity & Competition’  and No. 6 for ‘Medical Environment.’

Minnesota was No. 2 in the overall rank, (with No. 8 for ‘Opportunity and Competition’ and  No. 1 for ‘Medical Environment.)’ Idaho was No. 3 overall (No. 3 in Opportunity and Competition’ and No. 11 for ‘Medical Environment’ rank).  Those states were followed by Kansas and South Dakota.

The worst states were New York, the District of Columbia, New Jersey, Maryland, Rhode Island and Massachusetts.

Some unusual facts: The Washington DC area has the lowest average annual salary for surgeons – just $121,139 (adjusted for the cost of living while Nebraska is ranked the first with an annual wage of $307,590, according to WalletHub.

That, said Gonzalez, was a “surprise.”

– — Joe Cantlupe

With typical bombast and braggadocio, Donald Trump, on his way to the White House, vowed that he would confidently replace Obamacare, quickly and decisively. From day one.

He just lost. Mr. High-Rise lost to High Ideology.

After Trump and Speaker Paul Ryan late this afternoon saw no chance of getting the votes to pass the GOP version of healthcare reform, Trump ditched it. It was the second day of unsuccessfully trying for a vote.

A few minutes ago, Ryan said he was “proud of the bill” that the GOP produced, and said Trump was “fantastic” about it. “This is a setback, no two ways about it,” Ryan said.

“We just didn’t have consensus today,” Ryan said.  “We were close.”

Ryan  said Obamacare is “collapsing.” Still, it is a “law of the land until it’s replaced. We’re going to live with Obamacare in the foreseeable future,” Ryan said.

Ryan said the GOP will proceed with tax reform and other goals.

Trump withdrew the bill despite cries by the Dems to vote.

The “no vote” ended high drama in the Capitol. Conservatives refused to budge, and moderates weren’t happy with it.

While campaigning, Trump kept saying he had this big plan to replace Obamacare, but he simply hitched a ride with Ryan.

They crashed, politically speaking, as quick as a New York-minute.

President Trump feels like a cough that doesn’t stop, a kind of pre-existing condition since election day that we’re stuck with.

Speaking of pre-existing conditions, remember when  Trump said that he would like to keep some of the “good parts” of Obamacare, as Business Insider reported last year. It recounted Trump’s interview with 60 Minutes, in which he said the Affordable Care Act’s “protection for people under 65 years of age with chronic medical conditions was one of its ‘strongest assets.'”

The Business Insider story said at least 52 million Americans under the age of 65 have pre-existing medical conditions, citing a Kaiser Family Foundation study. Without the Affordable Care Act, these people would have been denied insurance.

Under Trump and the GOP’s  proposed changes in their struggle to get conservatives on board for their American Health Care Act, they contradict Trump’s previous promises to preserve a  requirement that insurers cover for pre-existing conditions. Trump also promised to cover adult children, writes Health Affairs blogger, contributing editor and healthcare expert Timothy Jost. Jost is an emeritus professor at the Washington and Lee University School of Law.

The “thorough” repeal of the Affordable Care Act “would have far-ranging consequences for our health care system that can scarcely be described, much less understood,” writes Jost.

Indeed, many Americans who supported the ACA were holding their breath in hopes of keeping some of the more popular aspects of the law as Republicans continued their assault on the legislation.

As Trump and House Speaker Paul Ryan negotiated with conservatives to try to get as many votes as possible, the pre-existing ban seems to have fallen by the wayside.

“The pre-existing condition ban could be carved out of the repeal, but without the guaranteed availability requirement and health status underwriting prohibition, a pre-existing condition exclusion ban is meaningless – insurers would simply refuse to sell coverage to an applicant with a pre-existing condition,” Jost writes. “Insurers would simply refuse to sell coverage to an applicant with a preexisting condition.”

Other aspects of the proposed bill that conservatives want to delete include a requirement that provides people access to “pediatricians, obstetricians, and gynecologists, and emergency care,” among other issues.

As Jost notes, the conservatives want to target provisions of the Affordable Care Act that requires all health insurers “in the individual and small group market cover a set of ten “essential health benefits.”

Jost says that one of the biggest criticisms of the EHB is that costs of coverage have escalated.

Yet “elimination of the EHB requirement could certainly reduce coverage for certain benefits,” Jost writes.

There are big – humane – issues that should not be ignored, and sometimes these “cost changes” are penny-wise, pound-foolish.

“Removing maternity coverage from insurance coverage, for example, might lower premiums by $8 to $14 per month, but would dramatically raise the cost of coverage for women in child-bearing age, and possibly make maternity care essentially an out-of-pocket expense, costing potentially $30,000 to $50,000,” Jost writes.

“Removing coverage for substance abuse disorder treatment benefits during an opioid epidemic is a questionable decision,” he adds.

So Trump is now being a tough guy, agreeing to withdraw important elements of healthcare protection to see his proposed legislation through, fast, fast, fast.

The man who wrote Art of the Deal is giving us all a headache.

President Donald Trump and House Speaker Paul Ryan scurried feverishly – and unsuccessfully – today to secure enough House support for the Republican healthcare plan to replace the Affordable Care Act, Americans are saying a loud NO to the GOP effort.

Ryan delayed the vote, possibly until tomorrow. He and Trump couldn’t seal the deal.

In the meantime, people aren’t happy with the GOP plan. That’s the finding of a national Quinnipiac University Poll released today. The university is based in Hamden, CT.

“Replacing Obamacare will come with a price for elected representatives who vote to scrap it, say many Americans, who clearly feel their health is in peril under the Republican alternative,” said Tim Malloy, assistant director of the Quinnipiac University Poll in a statement.

In the poll, voters “disapprove” 56% to 17% the Republican health care plan to replace the ACA, also known as Obamacare, the university said. Support among the Republicans is what the pollsters described as a “lackluster” 41% to 24%.

Such a vote wouldn’t be healthy for political futures of Senators or House members who vote for the Republican health care plan, the poll also found. Some 46% said they would be “less likely” to support those members of Congress who opted for the GOP plan.

The poll, of course, was taken before Trump and Ryan began to work feverishly to try to get more conservatives on board for the GOP bill. The conservative wing is seeking a trashing of more elements of the Affordable Care Act, such as insurance coverage for emergency, maternity, prescription drug and other services.  Moderates are resisting.

As an NPR announcer asked today, what’s the point of insurance, then?

— Joe Cantlupe

Sometimes I get the feeling that the Republicans want to give us free cigarettes and see what happens to our health with the proposed bill that President Trump and House Speaker Paul Ryan want to push through. “Insurance for everybody,” Trump once said. Sure, sure. Liar, liar, pants on fire. Maybe he meant Lying Teds for Everyone, a new cigarette brand.

I don’t know if you’ve noticed, but increasing numbers of doctors, medical groups, academics and nurses have been outraged by the plan Congress is expected to vote on Thursday. These are people who are usually restrained in their verbiage. Not this time. They are vociferous, how upset they are. And there is no denying what they mean: this bill can cause great damage to our health, especially older people and those on Medicaid. Take the new healthcare bill and add elements of the Trump Administration budget plan and that potentially could have a devastating impact for years to come, some say.

According to a CNN tally, numerous and powerful physician, nursing, hospital groups and others are drumming up opposition to the GOP plan, including  AARP, the American Hospital Association, the American Medical Association, the American Academy of Pediatrics, the Association of American Physicians and Surgeons, the American Nurses Association, the American College of Physicians and others.

Earlier this month, Nitin S. Damie, President of the American College of Physicians, told a congressional group that the GOP measure would “harm patients by taking coverage away from them.” He added that the bill would  make private health insurance “unaffordable for older, sicker and poorer patients.” The American College of Physicians represents 148,000 internal medicine physicians.

Damie cited the oft-repeated study by the Congressional Budget Office that the number of uninsured would “skyrocket” by 24 million Americans in 2026 compared to Obamacare, and 14 million next year. He also said the proposal “radically restructures and cuts Medicaid.”

“Without health insurance, people are less likely to have access to a regular physician, less likely to get cancer screening tests, vaccinations, less likely to keep up with their medications, more likely to get care in an emergency room and more likely to wait to be treated until their disease has reached a more advanced and less treatable stage,” he said.

Devastating Impacts

Damie offered an example that deeply reflected his concerns.

“I saw a 62-year-old male about two weeks ago who was relatively healthy but had a family history of heart disease. He came in with chest pressure and a change in his exercise tolerance over the past month. I did an EKG and an examination and diagnosed him with a heart attack. He was taken by ambulance to the hospital where he was stabilized and subsequently had quadruple bypass surgery. I saw him again yesterday and he is doing well. He showed me his bill of $150,000. Fortunately, he had insurance or would have had to declare bankruptcy from medical expenses.

A  New York Times editorial today told of the Republicans’ search for enough votes to make “an already flawed bill even worse.” The newspaper also cited an official of the American College of Physicians who tweeted that he “had never seen a bill that will do more harm to health.”

In much starker terms, the Physicians for a National Health Program unsurprisingly blasted the GOP bill as a major step backward. The group said: “Repealing the Affordable Care Act without replacing it, as some conservative hardliners are demanding, would cost a minimum of 37,127 lives over the next two years and perhaps as many as four times that number, according to scientific studies summarized in an editorial in this week’s American Journal of Public Health.”

Sad Fiscal Policy

And let’s not forget the Trump budget plan.

A few days ago, the American Academy of Family Physicians said it urged Congress to “protect the foundation of the nation’s health care system” and reject the administration’s proposed budget.

“The cuts outlined in the document would hurt patients’ health, threaten their safety and reduce their access to care,” said AAFP President John Meigs, MD. “If implemented, these cuts would create a domino effect of damage that ultimately will harm the health of America on both an individual and communitywide basis,” Meigs said.

That domino begins with vast cutbacks at the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Centers for Medicare and Medicaid Services and on and on.

Of the proposed CDC reductions,  Meigs said: “Deep cuts to its budget will decimate the CDC’s ability to prevent and control outbreaks of disease, leaving all U.S. residents vulnerable to emerging, deadly infectious diseases that could easily escalate into a pandemic.”

Care to light up?

— Joe Cantlupe

The World Happiness Report, released today, shows that in this country, well, we’re not happy campers.

Ok, no surprise there.  The data: The U.S. is ranked 14th happiest place in the world, the report says. As the Associated Press reported, “Americans are getting sadder…” Our ranking was down from 13th a year ago.

To come up with its findings, the World Happiness Report does use some measurement indicators, with rankings based on “gross domestic product per person, healthy life expectancy”and other factors such as social support, freedom, corruption and generosity.

Seriously, data? Does it matter where we rank on the happiness quotient? But we are in a funk and need to get out of it, generally speaking.

The report does provide some insight. Too often, the report says, we talk about economics in our “political discourse ” – i.e., money – but that’s not helping us toward happiness, the report says.

“The predominant political discourse in the United States is aimed at raising economic growth, with the goal of restoring the American Dream and the happiness that is supposed to accompany it,” the report says. “But the data show conclusively that this is the wrong approach.”

Here’s the key point:

“The United States can and should raise happiness by addressing America’s multi-faceted social crisis – rising inequality, corruption, isolation, and distrust – rather than focusing exclusively  or even mainly on economic growth, especially since the concrete proposals along these lines would exacerbate rather than ameliorate the deepening social crisis.”

It adds:

“Almost all of the policy discourse in Washington DC centers on naive attempts to raise the economic growth rate as if a higher growth rate would somehow heal the deepening divisions and angst in American society.”

Jeffrey Sachs of Columbia University, a co-author of the report, told the AP that the happiest place – Norway – has a sense of community that is losing ground in the U.S.

“We’re becoming more and more mean-spirited,” Sachs told AP. “And our government is becoming more and more corrupt. And inequality is rising.”

Here’s another thought: by pounding away on the theme of America First — as so often is done by the White House — our happiness quotient probably will move further back of the pack.

–By Joe Cantlupe

After my grandfather would bring a load of New York newspapers home, I couldn’t wait to dive into them.

Besides checking out the Yankee scores, at the top of my reading list was a Jimmy Breslin column to absorb, contemplate, and consider, even for hours later. It wasn’t just the reporting, it was the whirlwind of words, never steering into elongated bureaucratic mumble-jumble, but lines reflected the cadences how people actually spoke, or thought. He was a Hemingway in real life, not just the books.

Becoming a journalist, it became even more important for me to check out Breslin, the columnist and author, who, as the New York Times wrote: “leveled the powerful and elevated the powerless for more than 50 years.” Breslin died Sunday at age 88.

Breslin used simple words, and a boatload of details. Breslin described what motivated him as a writer. “Rage is the only quality which has kept me, or anybody I have ever studied, writing columns for newspapers,” he said, according to the Times.

Rage at injustice. Rage at inequalities.

Newspapers these days are a pale imitation of those in the prime of Breslin’s days, as many have been sliced up by corporate profits. The old paper – the way it let the permanence of the words feel permanent – stays with me, as the words now evaporate after jumping off the computer screen.

Thinking of Breslin reminds me of the old tabloids and the joy I had reading the papers with my grandfather, a gentle man whose only similarity to Breslin was that they smoked cigars.

While Breslin was a journalistic hero to me, the tabloids at that time often were filled with stories and photos of those subjects who were simply “fodder for news” celebrities and others who would amuse us for their ridiculous antics, or stun us – briefly – until we turned the page.

Ironically, Trump was one of those guys. Growing up in the NYC area, I saw him as a secondary act, the New York big-talker with the big bucks and the big buildings. Oh, and there were those Razzmatazzz-ma-Taz  tabloid headlines: Split! There Will Be Hell Toupee! ‘Best Sex I’ve Ever Had! – Trump As Tabloid Fodder.

Little did I know that Trump would become President of the United States.

Years ago, Breslin no stranger to humility himself,  wrote of Trump:

“And I was in one of his apartment buildings, where, if you first look at the advertisements, then at the apartments and ask the price, perhaps you receive a better idea of who he is than you do from newspapers or on television.”

“The man is the best boaster of his time.”

When it comes to Trump, Jimmy Breslin, I’m sure, would want us to be diligent, watch him like a hawk. Let’s keep the rage.

Thanks, Jimmy.

As Dylan Thomas wrote:

“Do Not Go Gentle Into That Good Night.”

— Joe Cantlupe

The Congressional Budget Office’s  review of the Republican’s health care plan — designed to replace Obamacare — shows drastic increases of uninsured people compared to the current law.

According to the estimate released today, 14 million more people would be uninsured under the GOP bill in 2008 compared to the existing Affordable Care Act.  That number would incrementally increase — 21 million in 2020, and then 24 million in 2026.

By 2026, an estimated 52 million would be uninsured, compared to 28 million who would not have insurance under the existing law, the CBO says.

Most of the uninsured increases next year would “stem from repealing the penalties associated with the individual mandate,” the CBO adds. “Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.

The CBO estimates that the proposed legislation would reduce federal deficits by $337 billion over the 2017-2026 period.

“The largest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act’s subsidies for nongroup health insurance,” the office said.