To stir emotions the health care reform debate doesn’t have to peel the onion back very far. There are those who could always afford health insurance and are worried that their costs will significantly rise in the attempt to cover the cost of care for those who have gone without. There are those with numerous and expensive to treat medical problems, who have no health insurance or inadequate health insurance coverage and they need relief, now! And there are those who are healthy, have chosen not to have health insurance, and resent a mandate requiring them to “buy-in” or face monetary penalties.The Health Care Affordability Act of 2010 is wide in its scope and goals. First, it moves us to a place where most Americans will be covered by health insurance. This will remove “the” key impediment to “routine” health care services for millions of Americans. Subsidies will insure health care insurance regardless of an ability to pay and just because you have pre-existing medical conditions you will still be eligible for “reasonably priced” coverage. Stated another way, insurers will not be able to reject you or drastically increase your premiums if you suffer from chronic illnesses that generate a high level of claims, nor will they be allowed to set dollar limits on health insurance coverage.To fund these objectives the Health Care Affordability Act requires all Americans to purchase health insurance. There will be subsidies if you are in a low income category and if you have no ability to pay anything you will be eligible for Medicaid as these state level programs will be more accommodating and act as the ultimate safety net. Through its mandates, the law requires millions of healthy individuals to pay into the system. The idea here is that those of us who are not in need of health care will fund those who draw from it. Since any of us can succumb to a health emergency at any time and thus become in need of potentially costly health care interventions those who support the mandate feel that this is fair – we are simply looking out for each other. Next, there are numerous plans in testing phases that are designed to make the delivery of health care more efficient and more cost effective. These pilot programs are being managed by the Center for Medicare and Medicaid Services (CMS) and include the cooperation of health systems throughout the country. These are complex to say the least and in early development stages and until proven, which is years from now, it is not known what their effect will be.I support the attempt by the Obama administration and others to get something done on this pressing national issue. But there is a lack of candor about the cost, where the funds will come from, what treatments and medical technologies will be restricted due to very high costs and how the demand of millions of newly insured patients will be managed in terms of timely access to care and treatments. I have spent forty-one years of my life in a medical technology career that focused on global health economics and reimbursement issues and believe me, something will have to give. In every country outside of America, health care budgets are limited and capped. Fees to hospitals and physicians are set, annually reviewed and kept in check and new medical technology prices and access to them are restricted in subtle and not so subtle ways. And if you think that these policies won’t happen in America – think again, as spending limits are being set and will be set and we will have to live within them!Having said that, let’s continue on with the reforms, some government mandated, some driven by the market place as conservative health policies propose. Just know that we will be dealing with health care reform for a very long time and there are going to be a lot of disillusioned folks along the way, newly enfranchised and otherwise. The emerging health care system will be “more just” but it will require real and noticeable sacrifice from the majority of Americans who heretofore never much worried about the fairness of it all.

Charcot’s foot is one of the many problems which might occur in those with diabetes mellitus. The higher blood sugar levels that stem from all forms of diabetes have an affect on numerous body systems including the eyesight, renal system as well as nerves. In long standing cases, particularly if there has been an unsatisfactory control of the blood sugar levels, you can find problems with the nerves supplying the feet. This will make the feet in danger of issues as if something fails, you don’t know it has gone wrong as you can not really feel it due to the harm to the nerves. This might be something as simple as standing on a rusty nail and that getting contaminated and you are not aware that you’ve stood on the nail. Should it be a blister or ingrown toenail which gets infected and you do not know that it is present on the foot unless you have a look. This is why foot care can be so necessary for those with diabetes and why it will be provided a great deal of emphasis. A Charcot foot is the destruction occurring to the bones and joints if you have an injury and you do not know that the injury has happened.

A way of looking at it could be to consider this way: pretend that you sprain your ankle horribly and you also are not aware that you have simply because you do not experience the pain from it. You then carry on and walk around on it. Picture all of the additional harm which you do by walking about on it. The earliest you may possibly discover that there may be something wrong happens when you take a seat and look at the feet and you observe that one is a great deal more swollen compared to the other foot. This is exactly what occurs in individuals with diabetes who develop a Charcot’s foot. There may be some destruction, such as a sprained ankle or maybe a progressive failure of the arch of the foot and as no pain is sensed they carry on and walk around on it. It should be apparent simply how much more injury that gets done to the original injury prior to the problem is finally observed because of the swelling. At times there is not much swelling, but the Charcot’s foot is picked up from the difference in temperature between the two feet as a result of inflammation related process in the damaged foot that generates more warmth.

The development of a Charcot foot really needs to be dealt with as a bit of an urgent situation since the further it advances the much more serious it’s going to be and the more challenging it can be to handle. The individual definitely needs to quit all weightbearing without delay or at least obtain a walking support so that the damage is protected. For the not too major instances and those conditions which were serious and have improved a really supportive orthotic in the footwear is required to support the feet and the injuries. Sometimes surgical procedures are required to straighten the subluxed and dislocated bones. By far the most critical situations can end up with the foot and/or leg required to be amputated as the trauma has been doing an excessive amount of impairment.