National Health in Portugal: Specialty Care

Portuguese National Health Service Remains Strong

by Mike Tolochko

Based on the post Dictatorship Constitution, the Portuguese National Health Service was established in 1979. Over 90% of the population uses its system of public hospitals and salaried physicians. This needs to be said, because recently, the directives of the European Union, followed too closely by the governing Socialist Party, has allowed some of the funding for the NHS to deteriorate. This opened the door to the insurance monopolies.

This has resulted in the selling of private insurance policies to some people. On the other hand recent attempts to regionalize the NHS were soundly defeated. The struggle continues.

Abortion Rights

Under the NHS, and since a couple of years ago, there are full abortion rights up to 10 to 14 weeks. This being a Catholic country, these rights are all the more significant. It took mass pressure to uphold the rights of women in this regard. In Spain, there are full abortion rights for over 20 years…there the law allows abortions up to 12 weeks.

Personal Medical Records on Data Base

There is a national database of individual medical records so that everyone in the system can have their records pulled up when traveling to any part of the country. This is still a dream on the U.S.

When traveling out of the county and when health services are needed, the cost of the services are fully reimbursed upon return.

Specialized Care? ORGAN TRANSPLANTS

Since 1979, again the new Constitution, organ transplants are a common medical procedure. Under the law, in accidents and similar occurrences, all organs are made available. Only, if people specifically reject this possibility will the organs not be removed. That is the kind of default system that works.

Cost? NO COST AT ALL AT THE TIME OF THE SURGERY AND ALSO THE FOLLOW UP MEDICINES THAT STOP ORGAN REJECTION BY THE BODY.

There is a National Registry of Organs.

As the U.S. goes through its latest struggle to beat off the insurance carriers, medical device, supplies and equipment companies; drug companies and the banks; here in Portugal the people enjoy full health care rights.

Maybe the U.S. needs a constitutional Amendment for the right to health care like what was needed for other crisis and important economic and social issues?

Insurance and Risk

The health insurance refom debatemakes it worth revisiting some basic questions about insurance. Insurance is about pooling risk and hedging risk. The individual hedges risk with insurance, by asking someone else to absorb the risk for a fee. The insurer pools risks of this kind. So, for example, I pay $x/year rather than face the small but nonzero of losing my house to fire and having to pay to fix it. The reason individuals get insurance is not so much to rationally hedge risk as to transfer intolerable risks to those who can bear them. That is worth repeating. The reason I pay fire insurance is that I can't afford to fix my house. If it burns down, I am homeless. So I am not weighing the value of insurance payments vs. the cost of fixing the house, I am weighing the insurance versus destitution. See the profit potential there, do you? Because of a lack of capital, the risk *to me* of the house burning down is far greater than the risk *to the insurance company*. It need merely pay $200K to rebuild it (or whatever). I and my family would be homeless.

Health insurance is a tougher bargain. The threat of dying from a car accident without being able to afford treatment is too much to bear. You would obviously pay big profits to insurance companies to avoid that. To avoid the worst effects - people dying on hospital steps untreated because they can't pay - the federal EMTALA law requires that emergency rooms treat patients even without payment. The EMTALA law was the worst thing we ever did in one sense, and the best in another. It was merciful in that it saved a lot of lives, but it also (1) created the most expensive and least-effective health-care delivery system for the uninsured you could imagine by treating all serious ailments at the worst possible time and in the most expensive way and (2) removed the very misery that would have prompted health care reform at an earlier date. I have heard Republicans say just in the past few weeks that "everyone gets treatment today." What they mean is that people who end up in emergency rooms are not turned away. The fact that nobody will change this doesn't seem to enter into their minds.

The other reason to have insurance is to protect others against harms you may cause them that you cannot afford to fix. This is liability insurance. If, as a result of a banana peel I negligently leave on my front stoop, the mail carrier becomes a paraplegic, I cannot afford to compensate her for her injuries. So I have insurance. Health insurance would take care of many costs, but it would not, for example, replace the lost income to her family. Disability insurance would help to easy my burden in that situation, or should. If I don't have the insurance, I will suffer and lose what little money i have, but the mail carrier won't get enough compensation forthe injury. This is why American lawyers then sue others (the maker of the concrete stoop, the banana manufacturer) with "deep pockets" and, oddly, why juries let them collect. Someone's gotta pay, right?

Obviously we start asking the question: who should be buying which insurance? New Zealand has experimented with a generalized social insurance where all such risks are paid for out of a single national pool through taxation. For all the "moral hazard" arguments that can be thrown at it, is it really such a bad idea? You would need far fewer lawyers. That's a start...

The 10 Nutrition Rules of Weight Loss

Nutritionist Nancy Clark shares ten tips every runner should know if they want to lose some weight.

1. To lose 10 pounds of body fat a year, you need to eat 100 calories less per day. Cutting too many calories from your daily intake will sap your energy level and increase your hunger, making you more susceptible to splurging on high-calorie foods.

2. Don't skip breakfast. Eat within two hours of waking.

3. In fact, eat more breakfast than you think you should. Trade in some of your dinner calories for more calories at breakfast.

4. Don't allow yourself to get hungry. Eat at least every four hours, and split a meal in half to make sure you properly fuel up pre- and postrun. For example, eat part of your breakfast before your morning run (a banana) and the rest of your breakfast afterward (a bagel with peanut butter).

5. Eat at least three kinds of food each meal from these four categories: breads, cereals, and grains; fruits and vegetables; low-fat dairy and soy; and lean meats, fish, and nuts. Breads, cereals, and grains should be the foundation of each meal, with protein as an accompaniment.

6. Shoot for a gradual loss of body fat. You're more likely to put the weight back on (and more) if you drop weight too quickly.

7. Liquid calories add up fast and can lead to weight gain. Minimize the amount of sodas, juices, store-bought smoothies, sports drinks, coffee drinks, and alcohol you consume.

8. Eat closer to the earth, enjoying fruits, vegetables, and whole grains. Minimize the amount of processed foods you eat; they tend to offer less fiber and are less satiating.

9. If you can't resist fast food, ask for nutritional information before you make your choices (or check in advance via restaurant Web sites). Avoid any menu items with the words "fried," "crispy," and "special sauce," which are guaranteed to be high calorie.

10. Remember that the calories in the energy bars, sports drinks, and gels you consume during a run add up, even though you're running. Consume them only as needed.

Health Tips – Super Fruits

This is a good source of potassium, magnesium, Vitamin E & fibre. It’s Vitamin C content is twice that of an orange.

Apple : An apple a day keeps the doctor away?
Although an apple has a low Vitamin C content, it has antioxidants & flavonoids which enhances the activity of Vitamin C thereby helping to lower the risks of colon cancer, heart attach & stroke.

Strawberry : Protective Fruit
Strawberries have the highest total antioxidant power among major fruits & protect the body from cancer causing, blood vessels clogging free radicals.

Orange : Sweetest medicine
Taking 2 –4 oranges a day may help keep colds away, lower cholesterol, prevent & dissolve kidney stones as well as lessen the risk of colon cancer.

Watermelon : Coolest Thirst Quencher
Composed of 92% water, it is also packed with a giant dose of glutathione which helps boost our immune system. They are also a key source of lycopene – the cancer fighting oxidant. Other nutrients found in watermelon are Vitamin C & Potassium.

Guava & Papaya : Top awards for Vitamin C
They are the clear winners for their high Vitamin C content. Guava is also rich in fibre which helps prevent constipation. Papaya is rich in carotene, this is good for your eyes.

Are You Getting Enough Calcium on the Raw Vegan Diet?

Many people still believe dairy to be one of the best sources of calcium available. While it is true that dairy products are somewhat calcium-rich, one should keep in mind that they are also rich in animal protein. Because animal protein has an acidifying effect on our organism, calcium has to be leached out of our bones to restore the optimal pH balance.

photo by gokoroko

Even according to the National Dairy Council, “Individuals who consume a low-protein diet, such as some vegetarians, may require less calcium than omnivores or individuals who consume a higher protein diet.”

As a result, dairy products may provide our bodies with calcium, but they also take some away in the process. While the effect is small, there are healthier and more efficient ways of getting enough calcium; many plant foods are alkalizing and filled with many nutrients besides being calcium-rich, low in saturated fat, and devoid of cholesterol.

A similar calcium-leaching process may also happen during pregnancy. The developing fetus needs calcium for proper development, and if the mother’s diet does not contain enough to meet its needs, it will end up being taken from her bones. Unlike other nutrients such as iron however, the calcium requirement does not increase during pregnancy. It is now estimated to be about 1,000 mg per day, but many studies have found this amount to be greatly exaggerated, especially for men. A diet rich in calcium-rich plant foods, coupled with weight bearing exercises, is likely to provide enough calcium easily.

Besides, ingesting enough calcium is only half the battle. There are many nutrients that help with its absorption, and are just as critical in a healthy person’s diet. Such nutrients include vitamin D, magnesium, phosphorus and potassium.

photo by sateda

Still, someone looking for animal-free sources of protein may be a little lost at first, but within a short amount of time, finding high calcium sources will become as easy as recognizing other foods for being high in vitamin C, iron, or other nutrients. Some of the most calcium-rich plant foods include:

− Sesame seeds (27%/ounce)
− Chia seeds (18%/ounce)
− Almonds (7% per ounce)
− Leafy Greens (kale: 10%/cup, collards: 5%/cup)
− Seaweed (kelp: 21%/cup; dulse: 6%/cup)

Tahini and Fruit Spread
My dad used to make me tahini and jam spreads all the time growing up. For a raw jam, blend fresh fruits with agave nectar until sweet and of a consistency similar to cooked jam.

Ingredients:
− 2 T tahini (sesame seed butter)
− 2 T raw jam

Directions:
Stir the tahini and jam together until they are somewhat mixed but you can still see streaks of each ingredients. Eat on raw crackers, sprouted bread, or with a spoon!

photo by Cyanocorax

Chia pudding
Chia puddings can be made in a variety of way. Here are a few combination that have been proved to be popular by many:

Sesame chia pudding:
The combination of chia and sesame seeds makes this pudding extremely calcium-rich. This recipe is adapted from the one (http://www.tonyakay.com/phpbb3/viewtopic.php?f=5&t=1875) Tonya Kay was served while giving a talk on raw foods in Dallas. Chia pudding has since become one of her staple foods, and this particular version fulfills nearly 50% of our calcium requirement.

Ingredients:
− ¼ cup sesame seeds, ground
− 1 cup water
− 2-4 T honey, more or less to taste
− 2 teaspoons vanilla extract
− 1 teaspoon cinnamon
− 3 T Chia Seeds

Directions:
Combine ground sesame seeds, water, sweetener, vanilla and cinnamon in a blender and blend well. Pour the contents of the blender into a strainer over a bowl. Add the chia seeds and stir. Put the mix in the fridge and take it out to stir every 10 minutes or so until the chia seeds have finished releasing their yummy gooey goodness. It shouldn’t take longer than 1/2 an hour to be fully ready to eat.

Generic Chia Pudding:
This pudding is a base that can be altered any way you want. Try adding cacao, goji berries, lucuma, spices, etc.

Ingredients:
− 4 T chia seeds
− 4 T ground coconut
− 1-2 cups water or nut milk, depending on how thick you like your pudding
− Sweetener to taste, about 2 T, or soaked dates

Directions:
Blend the coconut, liquid and sweetener in a blender. Stir in the chia seeds by hand, and stir the mix twice every 10 minutes. Keep in the fridge.

photo by JWilsher

Mixed Vegetable Salad with Sea Weed
This salad can be kept at room temperature for a while without a problem. I often make it if I have to eat outside the house and know I won’t have access to healthy food. This salad contains about 25% of our calcium requirement, and is also exceptionally high in iron (50% of the RDA), phosphorus (20%) and potassium (30%).

Ingredients:
− ½ cup finely chopped kale
− 3 large lettuce leaves, shredded
− 1/2 a ripe avocado, cubed
− 1 small tomato, diced
− 3 small portobello mushrooms, sliced
− 1/3 cup dulse
− 2 T finely chopped kelp
− 1 T hemp seeds

Directions:
Mix everything together, and keep at room temperature for about an hour to let the seaweeds soften a little. You can mix in the dressing right away (before waiting), or just before eating. Mixing it later will ensure the lettuce stays crisp. You can add in anything else you like, such as carrot sticks, cubed cucumber, etc for added nutrients and variety.

House Introduces ‘Comprehensive’ Health Care Reform Bill

On Tuesday, July 14th, the U.S. House of Representatives introduced the American’s Affordable Health Choices Act (AAHCA). This bill lays out the House’s blueprints for comprehensive health care reform legislation. Three Committees with jurisdiction over health policy – Energy and Commerce, Education and Labor, and Ways and Means - claimed that the bill would reduce out-of-control costs, encourage competition among insurance plans to improve choices for patients, and expand access to quality, affordable health care for all Americans.

The bill has a major impact on our LGBT loved ones and while it is not perfect, we are happy to note that it does include some of the items we have been lobbying for over the past few months. Below please find a few highlights from the bill as it relates to our LGBT loved ones:

• Semi-Inclusive Definition of Family. Throughout most of the bill’s text, it refers to “family” and “family coverage” in a way that does not exclude same-sex couples and their children – a very positive step. Due to the Defense of Marriage Act’s restrictions, it frames certain programs, taxes, and benefits around the term “spouse,” which has a limited definition of being a husband or wife in a different-sex marriage.
  

• Data Collection and Health Disparities. The bill creates a new Assistant Secretary for Health Information at the Department of Health and Human Services and charges them with ensuring the proper collection of critical health data – including, for the first time, data on sexual orientation and gender identity. This collection of data is a major step for our government in taking a vested interest in the health and wellbeing of LGBT individuals. The bill falls short, however, of including LGBT people in provisions focusing on populations with significant health disparities.
  

• Discrimination Protections. The bill includes important protections for LGBT people from discrimination by insurance companies or health care providers based on personal characteristics that are unrelated to the provision of quality health care. Presently, federal law does not offer protections against discrimination by insurance companies or health care providers on the basis of sexual orientation or gender identity. Without such protections, LGBT people face serious disparities in receiving adequate care, healthcare services and access to insurance benefits.

PFLAG National continues to work in coalition with our community partners to advocate congress members and key committees to include the important provisions laid out by Representative Tammy Baldwin’s (WI-2) Ending LGBT Healthcare Disparities Act – H.R. 3001 – which was a bill introduced earlier this summer to address the health disparities experienced by LGBT Americans, to eliminate the barriers they face in accessing quality health care, and to ensure that good health and well-being is accessible to all. If you have any questions regarding our involvement with this work, please be sure to contact us.