In Medicare, medical bills are paid from trust funds which those covered have paid into. Tax payers pay certain percentage of their income to fund the trust. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.

Medicaid is the federal/state program where it gets the fund from federal state and local tax to serve the low income people of any age. This means the tax payers pay the health care of the poor and low income people who most of the time doesn’t pay taxes. If your income is not qualified to get the Medicaid, you have to get your insurance from the private insurance companies. These are several types of private insurance companies and most come is Blue Cross Blue Shield (BCBS).

If you’re rich you don’t have problem in getting the better private insurance plan. But if you are a middle class and your income is barely above the lower income group then you may not afford for any kind of insurance. Even if you can afford to get certain type of private insurance your pocket expense will be very high if you or family members get sick.

In US emergency care charges 3 or 4 times more than the regular clinic visit. For example if you don’t have the insurance and you take your child to a regular clinic for runny nose, the cost of seeing a physician will be around 60 dollars. But for the same condition if you go to ER it will cost you 250- 300 dollars.

I would like to categorize how different income level plays a role in the healthcare system in USA

Poor and lower income:

Insurance: Medicaid plan-Paid by the Tax payers
Emergency care: No need to pay. Fully covered by Medicaid plan
Tax: They don’t pay taxes even if it is they pay it should very small
Pocket expense for sickness: None
Medications: No need to pay – Medicaid pays
Surgery: No need to pay – Medicaid pays
Seeing a specialist: No need to pay – Medicaid pays

Contributing to their future insurance-after 65years (Medicare): None

Lower- middle class:

Insurance: Most of the time they cannot afford any kind of private insurance
Emergency care: Pays from pocket
Tax: Pays tax
Pocket expense for sickness: A lot
Medications: Pays from pocket
Surgery: Pays from pocket
Seeing a specialist: Pays from pocket
Paying insurance for others (Medicaid) by paying tax: Yes
Contributing to their future insurance-after 65years (Medicare): Yes

This group doesn’t have the insurance of their own but they have to pay the insurance for poor and lower income people via Medicaid. They also have to contribute to their own federally funded insurance program- Medicare for which they can be eligible only after 65years of age. These group most of the time suffer without any health care and they go bankrupt very often.

Mid middle class:

Insurance: Some kind of private insurance with high co pay
Emergency care: Depends on how much insurance covers. Most of the time
they pay significant amount from their pocket.
Tax: Pays tax
Pocket expense for sickness: Depends on how much insurance covers. Most of
the time they pay significant amount from their pocket
Medications: Depends on how much insurance covers. Most of the time they
pay significant amount from their pocket
Surgery: Depends on how much insurance covers. Most of the time they pay
significant amount from their pocket
Seeing a specialist Depends on how much insurance covers. Most of the time
they pay significant amount from their pocket
Paying insurance for others (Medicaid) by paying tax: Yes
Contributing to their future insurance-after 65years (Medicare): Yes.

Even though this group has some kind of insurance they still pay a lot for their health care cost and even some of the goes bankrupt in this group because of their healthcare cost.

Upper Middle Class:

Insurance: Good Insurance-Private
Emergency care: Pay less from the pocket depends on the insurance
Tax: Pays tax
Pocket expense for sickness: Fair
Medications: Covered mostly by insurance. Pays a little from pocket
Surgery: Covered mostly by insurance. Pays a little from pocket
Seeing a specialist: Covered mostly by insurance. Pays a little from pocket
Paying insurance for others (Medicaid) by paying tax : Yes
Contributing to their future insurance-after 65years (Medicare):Yes

Upper Class:

Insurance: Very Good Insurance-Private
Emergency care: Pay less from the pocket depends on the insurance
Tax: Pays tax
Pocket expense for sickness: Almost none
Medications: Covered by insurance. Pays a very little from pocket
Surgery: Covered by insurance. Pays very little from pocket
Seeing a specialist: Covered by insurance. Pays very little from pocket
Paying insurance for others (Medicaid) by paying tax : Yes
Contributing to their future insurance-after 65years (Medicare):Yes

Note: There is no clear income definition for middle and upper class in US

How we got into it ?

To qualify for Medicaid your gross income should be less than 13,000 dollars/year i.e. you should be below 133% of poverty level. For better private insurance you need a gross income of $70000-90000 dollars/year. Average American gross income is 50,000 dollars per year- as of 2007 income data. These means most of the American don’t have good insurance. Lot of them doesn’t have insurance at all but still they have to pay for the poor and low income people. To me this is unfair. You pay for others but you don’t have one for yourself. It is like you have to put your money in a pot to keep it full all the time but it has been constantly drained and enjoyed by people who don’t contribute to that. You may go bankrupt because of your healthcare cost but you have to still take care of others healthcare who don’t even pay a single penny to it.

Why healthcare cost so much?

In this country most of the time physicians are not free to think and do what is right for the patient. This is because people sue the physician for everything. Physicians are constantly under the watch by the lawyers for the malpractice. Since there is always a fear of malpractice sue among the physicians, they ordered bunch of lab test to avoid any malpractice sue even if it is not needed. Doctors charge more because insurance pay them back less than what they asked for. Moreover they also have to pay for their malpractice insurance. They have to bill all these expenses on the patient .In addition to that, drug companies don’t want to let their drugs go generic or reduce the price of their branded drugs All these expenses fall on the patient’s pocket and ultimately to the society

What do we do about it?

There are no real solutions to these issues. This is what I think we can do to make the healthcare system better. There should be a federally/state/locally funded universal health care available for every American irrespective of their income. Option of choosing a private insurance instead of universal health care should be offered to every American. But everybody has to contribute whether they want to participate in the universal healthcare system or not. This way tax payer gets their benefit of paying the tax by getting healthcare for themselves instead just paying for others. That funded program should act like Medicare to all age group.

Currently everybody has to contribute to Medicare which pays the health care to seniors 65years or older irrespective of their past and present income. In current Medicare you can supplement your coverage by buying more private insurance. Same kind of principle should apply to the all the age group under the universal healthcare. This way people have the option of choosing either the universal health care system as their sole insurance or supplementing their universal health care system with other private insurance.

Universal health care means is healthcare for everybody but also giving the choice supplementing it with other insurance. It should not be literally free otherwise people started abusing it. Every body should be charged some kind of co-pay to the clinic visit, ER visit and prescription based on the income status. Even for lower income have to pay some co-pay. For ER visit co-pay should be higher than the regular clinic visit this way we can avoid flooding the ER for just simple health condition which would have been treated next day in the outpatient clinic. If you charge even 10 dollars as a co pay for ER visit to the lower income you will dramatically reduce the healthcare cost burden.

Malpractice lawsuit should be regulated. Malpractice amount cap should be imposed. To avoid lab errors and doing unnecessary labs, universal electronic health record system should be implemented. Universal electronic health record makes the any doctor anywhere in US to access the patient’s record. This will reduce repetitive test and labs on a patient.
Doctors doing unnecessary lab test should reimbursed less on their payments and good doctors should be rewarded with better reimbursement. Universal healthcare should pay only set number sick visits to the clinic and ER. Extra visits and other privileges can be supplement by buying additional private insurance. More emphasis should be placed on yearly screening.

Usually it comes in the school age children. Head lice are nothing to do with hygienic. Head lice can occur in any socio-economic population.

Symptoms:

Most common symptom is itching of the head especially behind the ear and back of the neck. But child can scratch their head for several other reasons. Diagnosis can be confirmed only by finding a visible live head lice. Nits (lice’s egg) can remain on the hair of your child for months but do not indicate an active infestation.

Checking for lice:

Make your child sit under a bright light. Using a fine toothed comb part the hair and look for any white to yellow-brown specks. It may be firmly attached to the hair shaft. Nits can be easily seen in the hair near the neck and ears. If you don’t see any visible lice or nits, comb the hair. After each comb through wipe the comb with wet paper towel and look for any nits or lice.

Treatment:

Medications:
Lot of over the counter shampoos are available for killing the head lice. Always over the counter shampoos are preferred as a first choice of treatment than the prescription drug shampoos. Most of the lice medication may have 1% permetherin cream as a rinse. These are very effective. Apply these products on the dry hair and keep it on the hair for full time as recommended. Medicated shampoos may not always kill the lice eggs. Hence reapply the shampoo after one week to kill all the lice that are coming from unkilled eggs. Comb the hair after the treatment to get rid of the nits.

Hair Dryers:

Recent study shown that 85% lice can be killed only by using the hair dryer. Off course you have to use moderate heat setting on the hair dryer to avoid burning of your child’s skin. I would use the hair dryer after treating your child’s hair with medicated shampoos. This will make sure you will kill almost all the lice.

Washing the hair every 2-3 days and drying it with hair dryers reduces the risk of getting the head lice.

Home medication:

Some people use home remedies for head lice such as mayonnaises olive oil petroleum jelly e.t.c. It works by suffocating the head lice by direct application on the hair. As long as it is not toxic to the hair or to the child it is safe to practice those remedies. Success rates are variable and they are not scientifically proven.

Prevention:

You don’t have to throw all your child’s toys and belongings after the lice infestation, but you can follow these prevention tips:

*Wash all their clothes bed linens hats e.t.c with hot water.
*Vacuum the carpets and couch.
*Items of your child that you cannot be washed, such as stuffed animals, can be placed in a tightly closed plastic bag for 2 weeks. Lice will die in 2 weeks without a human host.

Treat everybody in the house if they have been infected with lice too and do the same thing as above for their belongings.

Source : http://www.aap.org/publiced/BR_Lice.htm

As a first step in dealing with your child’s sucking habits, ignore them! Most often, they will stop on their own. Harsh words, teasing, or punishment may upset your child and is not an effective way to get rid of habits. Instead, try the following:

1. Praise and reward your child when he does not suck his thumb or use the pacifier. Star charts, daily rewards, and gentle reminders, especially during the day, are also very helpful.
2. If your child uses sucking to relieve boredom, keep his hands busy or distract him with things he finds fun.
3. If you see changes in the roof of your child’s mouth (palate) or in the way the teeth are lining up, talk to your pediatrician or pediatric dentist. There are devices that can be put in the mouth that make it uncomfortable to suck on a finger or thumb.

No matter what method you try, be sure to explain them to your child. If they make your child afraid or tense, stop them at once.The good news is that most children stop their sucking habits before they get very far in school. This is because of peer pressure. While your child might still use sucking as a way of going to sleep or calming down when upset, this is usually done in private and is not harmful. Putting too much pressure on your child to stop may cause more harm than good. Be assured your child will eventually stop the habit on his own.

Content from
AAP PARENTING CORNER Q & A: THUMB SUCKING AND PACIFIERS

How do I know if my child has a food allergy?A food allergy happens when the body reacts against harmless proteins found in foods. The reaction usually happens shortly after a food is eaten. Food allergy reactions can vary from mild to severe. Because there are many things that can be confused with food allergies, it is important for parents to know the difference.
Symptoms of a food allergy

1. Hives (red spots that look like mosquito bites)
2. Itchy skin rashes (eczema, also called atopic dermatitis)
3. Swelling
4. Breathing problems
5. Sneezing
6. Wheezing
7. Throat tightness
8. Nausea
9. Vomiting
10. Diarrhea
11. Circulation symptoms
12. Pale skin
13. Light-headedness
14. Loss of consciousness

If several areas of the body are affected, the reaction may be severe or even life-threatening. This type of allergic reaction is called anaphylaxis and requires immediate medical attention.

Not a food allergy

Food can cause many illnesses that are sometimes confused with food allergies. The following are not food allergies:

1. Food poisoning—Can cause diarrhea or vomiting, but is usually caused by bacteria in spoiled food or undercooked food.
2. Drug effects—Certain ingredients, such as caffeine in soda or candy, can make your child shaky or restless.
3. Skin irritation—Can often be caused by acids found in such foods as orange juice or tomato products.
4. Diarrhea—Can occur in small children from too much sugar, such as from fruit juices.Some food-related illnesses are called intolerance, or a food sensitivity, rather than an allergy because the immune system is not causing the problem. Lactose intolerance is an example of a food intolerance that is often confused with a food allergy. Lactose intolerance is when a person has trouble digesting milk sugar, called lactose, leading to stomachaches, bloating, and loose stools.

Sometimes reactions to the chemicals added to foods, such as dyes or preservatives, are mistaken for a food allergy. However, while some people may be sensitive to certain food additives, it is rare to be allergic to them.

Foods that can cause food allergies

Any food could cause a food allergy, but most food allergies are caused by the following:

• Cow milk
• Eggs
• Peanuts
• Soy
• Wheat
• Nuts from trees (such as walnuts, pistachios, pecans, cashews)
• Fish (such as tuna, salmon, cod)
• Shellfish (such as shrimp, lobster)

Peanuts, nuts, and seafood are the most common causes of severe reactions. Allergies also occur to other foods such as meats, fruits, vegetables, grains, and seeds such as sesame.
The good news is that food allergies are often outgrown during early childhood. It is estimated that 80% to 90% of egg, milk, wheat, and soy allergies go away by age 5 years. Some allergies are more persistent. For example, 1 in 5 young children will outgrow a peanut allergy and fewer will outgrow allergies to nuts or seafood. Your pediatrician or allergist can perform tests to track your child’s food allergies and watch to see if they are going away.

Content from
AAP PARENTING CORNER Q & A: FOOD ALLERGY

FUN IN THE SUN:
Babies under 6 months: * The two main recommendations from the AAP to prevent sunburn are to avoid sun exposure, and dress infants in lightweight long pants, long-sleeved shirts, and brimmed hats that shade the neck to prevent sunburn. However when adequate clothing and shade are not available, parents can apply a minimal amount of suncreen with at least 15 SPF (sun protection factor) to small areas, such as the infant’s face and the back of the hands. If an infant gets sunburn, apply cold compresses to the affected area.

For Young Children: * Apply sunscreen at least 30 minutes before going outside, and use sunscreen even on cloudy days. The SPF should be at least 15 and protect against UVA and UVB rays.

For Older Children: * The first, and best, line of defense against the sun is covering up. Wear a hat with a three-inch brim or a bill facing forward, sunglasses (look for sunglasses that block 99-100% of ultraviolet rays), and cotton clothing with a tight weave. * Stay in the shade whenever possible, and limit sun exposure during the peak intensity hours – between 10 a.m. and 4 p.m. * Use a sunscreen with an SPF of 15 or greater. Be sure to apply enough sunscreen – about one ounce per sitting for a young adult. * Reapply sunscreen every two hours, or after swimming or sweating. * Use extra caution near water, snow, and sand as they reflect UV rays and may result in sunburn more quickly.

Content from
AAP – Summer Safety Tip Sheet – 2009

1. Don’t use scented soaps, perfumes or hair sprays on your child.
2. Avoid areas where insects nest or congregate, such as stagnant pools of water, uncovered foods and gardens where flowers are in bloom.
3. Avoid dressing your child in clothing with bright colors or flowery prints.
4. To remove a visible stinger from skin, gently scrape it off horizontally with a credit card or your fingernail.
5. Combination sunscreen/insect repellent products should be avoided because sunscreen needs to be reapplied every two hours, but the insect repellent should not be reapplied.
6. Insect repellents containing DEET are most effective against ticks, which can transmit Lyme Disease, and mosquitoes, which can transmit West Nile Virus and other viruses.
7. The current CDC and AAP recommendation for children over 2 months of age is to use 30 percent DEET. DEET should not be used on children under 2 months of age.
8. The concentration of DEET in products may range from less than 10 percent to over 30 percent. Ten percent DEET only protects for about 30 minutes – inadequate for most outings.
9. The concentration of DEET varies significantly from product to product, so read the label of any product you purchase. Children should wash off repellents when back indoors.

Content from
AAP – Summer Safety Tip Sheet – 2009

As per CDC If the influenza A comes positive on the flu test then we have to send specimen to the health department and they will do test for swine flu on that specimen. As for yesterday they called doctors office back and said swine flu can be still positive even if the Influenza A is negative in the flu test. This means even if the flu test is negative for Influenza A you will never know whether the patient is positive for swine flu or not. They are asking the doctors to go ahead and give Tamiflu if the symptoms look like flu even if the flu test is negative for Influenza A. Basically the doctors can give Tamiflu based on symptoms without doing flu test.

Constipation will occur during this period because the child is scared of the potty and may try to hold the stool. Give them plenty of juice during the training period that way you avoid the constipation. Because once the child is constipated they feel the pain in the rectum when they attempt to defecate in the potty. Then they wont do it and it will make the constipation worse. After that they will get scared of the potty, thinking that they will have pain every time they sit and poop in the potty.

Wait and sit next to the child until they defecate. It may take 30-40 minutes before he/she attempt to sit on the potty. Some of them refuse to sit even if they have the urgency to poop. I would wait until she /he poops in the potty. Some of the children accidentally poop in the floor while they refuse to sit. If it happens don’t make big deal of it but make the child proud that he/she did it. Once they see and realize the pooping is nothing they will do it in the potty. It is all about overcoming the fear. When the child is refusing to sit and you know he/she has the urgency to poop right away I would not give up and let the child to put the panties back. Even though they are crying and breaking your heart, try your best to let the child to poop in the potty or even in the floor instead of giving their diaper or panty back. If the child poops in the potty even after all the cry and refusal, the child will see the end result and happiness that comes out of it. It is like running the marathon and your letting the child to give up 10 ft before the finish line. Once they hit the finish line they feel the happiness and proud. Let the child to feel that way. If you think he/she is not ready you can always wait for 4 weeks.

Most of the time the parents know when the child is ready to be potty trained. Children will give clue body and facial gestures while they are urinating in the diaper secondary to their feeling of the wetness. It is always best to put under pant/panty when you decide to potty train your child. Wearing underpants/panties make the child recognize of their wetness better while and after they urinate. Personally to me pull-ups are like diapers. It does not make big difference in feeling the wetness. Pull-ups are very helpful during the travel.

Child may throw a tantrum when you encourage wearing the panty instead of diaper. Give them reassurance. Again most of the time a child wearing a panty/underpants will get the potty training faster than child wearing diaper or pull up all the time. For few days your child will urinate in the panty/under pant. During this time when they urinate, they will get scared of feeling of their wetness in their panty/under pant. Keep on reassure your child. Tell them they don’t have to pee in their legs if they sit in the potty and urinate. She/he may not understand what you talking about but they will understand eventually.
Keep the potty in the living room so that she/he may not feel that they are getting punished sitting in separate room (bathroom) for urinating in the diaper/panty/under pant. For several days they will cry and refuse to sit on the potty. You have two options. Either you assume that he or she is not ready yet and start the process again in 3- 4 weeks or be consistent and keep on give the reassurance until the child sit in the potty.
Once they urinate in the potty appreciate the child with stuffs like stickers and treats. Some of the child sits in the potty just to get the appreciation from parents. Those children will potty train faster.
Giving sticker/ magnet sticker after they made an attempt to sit on the potty will defiantly encourage the child to continue to try to urinate in the potty. You have to show that you’re very proud of your child while they are making an attempt. Once they urinate in the potty let the child to see what the urine looks like in the potty and make them to flush.
I would not spend lot of money on buying fancy potty. Get nice comfort one, which you can take anywhere while you are traveling. During the potty training you have to consistent to let the child to try to urinate in the potty. Consistency is the key role. For boys you can let him urinate in the real commode with a stool.

Note: Don’t make big deal if the child urinates in the floor/ carpet. They may get scared and will never try again.