Jared & Scott

October 28, 2017

Autumn is officially upon us here in the Northwest and the trail for Jared & Scott’s Mount Hood Engagement Session had some intense colors. So stoked for these two and it was amazing getting to work with them as I had just met them a few weeks earlier at a wedding I was photographing in Portland. I believe engagement sessions should be an experience with no set time limit and climbing a mountain to watch the sunset at the top is always an unforgettable setting to photograph. See more of Jared & Scott’s session in the coming weeks on my Instagram and check out other couples session by clicking here! If you are a gay couple looking for a same-sex wedding photographer for your intimate wedding, elopement or engagement session near Portland or around Oregon, let’s connect! I’d love to hear why you are getting married and the stories that led you both to this point. You can shoot me a message to start the conversation by clicking here.

Mount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement SessionMount Hood Same Sex Engagement Session

For those of you looking into my 2018 Mentorship, this will be one of the locations with hit during Roadtrip Oregon – our 6-day workshop inluded in the Mentorship!


This is a really good tip particularly to those fresh to the blogosphere.
Short but very precise information? Many thanks for sharing this one.
A must read post!

Your comment is awaiting moderation.

Hmm it seems like your blog ate my first comment (it was super long) so I guess I’ll just sum it up what I
had written and say, I’m thoroughly enjoying your blog.
I as well am an aspiring blog writer but I’m still new to the whole thing.

Do you have any tips for beginner blog writers?

I’d certainly appreciate it.
istanbul escort
şirinevler escort
taksim escort
mecidiyeköy escort
şişli escort
istanbul escort
kartal escort
pendik escort
tuzla escort
kurtköy escort

Your comment is awaiting moderation.

Hi there! This is my first visit to your blog! We are
a collection of volunteers and starting a new project in a community in the same
niche. Your blog provided us useful information to work on. You have
done a marvellous job!

Your comment is awaiting moderation.

Ahaa, its nice dialogue regarding this piece of writing here at this web site, I have
read all that, so now me also commenting here.

Your comment is awaiting moderation.

russian roulette
roulette online
casino slot games
best online casinos
american roulette

Your comment is awaiting moderation.

Hi, i feel that i noticed you visited my site thus i came to go back the choose?.I’m attempting to find
things to enhance my web site!I assume its ok to make use of a few of your concepts!!

istanbul escort
şirinevler escort
taksim escort
mecidiyeköy escort
şişli escort
istanbul escort
kartal escort
pendik escort
tuzla escort
kurtköy escort

Your comment is awaiting moderation.

Нi to every , as I am genuinely қeen ᧐f reading this websіte’s
post to be updated ԁaily. It consistѕ of pleasant stuff.

Your comment is awaiting moderation.

Because the admin of this web site is working, no question very quickly it will be well-known, due to its quality contents.

Your comment is awaiting moderation.

906831 322649Delighted for you to discovered this site write-up, My group is shopping a lot more often than not regarding this. This can be at this moment undoubtedly what I are already seeking and I own book-marked this specific site online far too, Ill often be maintain returning soon enough to appear at on your special weblog post. 69312

Your comment is awaiting moderation.

… [Trackback]

[…] Read More: […]

Your comment is awaiting moderation.

The process begins in the uncomplicated activity of the account option. Cherry blossom tattoos represent
different things in numerous cultures. These art reproductions
of paintings printed on canvas sheets or paper and after that framed and hung on walls.

Your comment is awaiting moderation.

Hi, I read your blogs on a regular basis. Your story-telling style is awesome, keep doing what you’re doing!
Hello there! This blog post couldn’t be written much better!
Looking at this post reminds me of my previous roommate!
He continually kept talking about this. I am going to forward this
post to him. Pretty sure he’ll have a very good read. Thank you for sharing!
Hey just wanted to give you a quick heads up.
The words in your content seem to be running off the screen in Safari.
I’m not sure if this is a formatting issue
or something to do with internet browser compatibility but
I thought I’d post to let you know. The design and style look great though!
Hope you get the problem solved soon. Thanks

Your comment is awaiting moderation.

I am often to blogging and i really respect your content. The article has really peaks my interest. I am going to bookmark your site and hold checking for brand new information.I intended to write you a bit of note to finally thank you again for the remarkable concepts you’ve shown at this time. It has been tremendously open-handed with people like you to make extensively what a lot of people could have sold for an e book in order to make some profit for their own end, specifically since you could have tried it in the event you considered necessary. Those ideas likewise served like the fantastic way to know that other individuals have similar dream like my very own to grasp way more when considering this condition. I think there are thousands of more pleasurable instances in the future for individuals who looked at your website.

Your comment is awaiting moderation.

Pozitiv – это негормональный препарат, который помогает вашему организму выработать серотонин и мелатонин, которых так не хватает для радости!

Your comment is awaiting moderation.

Pozitiv – это негормональный препарат, который помогает вашему организму выработать серотонин и мелатонин, которых так не хватает для радости!

Your comment is awaiting moderation.

I’m really enjoying the design and layout of your blog. It’s a very easy on the eyes which makes it much more enjoyable for me to come here and visit more often. Did you hire out a developer to create your theme? Fantastic work!

Your comment is awaiting moderation.

Приобрести можно на веб-сайте

Хотим предложить вам удивительное средство для похудения сироп Мангустина. С ним возможно избавиться от 15 kg за 14 суток.

Растение мангостин произрастает в Малайзии. Плоды этого растения имеют удивительные свойства. В баночке имеется около 20 плодов данного удивительного дерева. Плоды дерева мангостин помогают растопить чрезмерную липидную ткань. А также отлично воздействуют на человека в комплексе. Технология изготовления средства, и специализированная упаковка позволяют сберечь все полезные свойства растения.

Главным действующим веществом сиропа Mangoosteen являются фрукты с растения мангостин, в них имеется большое количество питательных элементов. Благодаря компоненту ксантону, которое в громадных дозах содержатся во фрукте, значительно тормозятся окислительные процессы в теле. Ксантон является одним из самых сильных антиоксидантов. В плодах растения мангустин вдобавок содержатся разнообразные витамины и элементы. Купить сироп Mangoosteen возможно на веб-сайте

Your comment is awaiting moderation. – Christmas Piano

Your comment is awaiting moderation.

кредит предпринимателям получить кредит в банке где можно получить кредит кредит в 19 лет авто в рассрочку экспресс кредит микро кредит кредит на телефон банк кредит москва русфинанс банк кредит киев где взять денег банки кредит кредит по паспорту кредиты физическим лицам

промсвязьбанк кредит – Банк ренессанс кредит белгород автокредит без справки о доходах – Кредит наличными без справок онлайн урса банк – Получить кредитную карту без справок кредит ижевск – Банки украины дающие кредиты наличными потребительский кредит воронеж – Получить кредитную карту связной

оформить кредит онлайн деньги в долг срочно где можно получить кредит где взять деньги в долг кредит саратов банк региональный кредит кредит без поручителя долгосрочный кредит туры в кредит кредит неработающим

юнит кредит банк – Кредитные карты срок выплаты кредит 18 лет – Кредит наличными сергиев посад банк советский – Взять кредит наличными в харькове взять кредит онлайн – Продам номера кредитных карт форд кредит – Кредитная и дебетовая карта

шкода в кредит кредит на землю самый дешевый кредит кредит на обучение кредит на отдых

Your comment is awaiting moderation. – ренессанс кредит украина – кредит под недвижимость – банк кредит онлайн – где взять деньги в долг – банк кредит москва – кредиты наличными – потребительский кредит челябинск – кредит срочно – ауди в кредит – ипотека втб – кредит по интернету – траст банк кредит – онлайн кредит webmoney – как получить кредит в сбербанке – взять кредит или ипотеку – автокредит – приват банк – ренисанс кредит – кредит в интернете – кредит маркет
экспресс кредит банк кредит втб – кредиты потребительские – погашение кредита – автокредит без справки о доходах – кредит на доверии – деньги в кредит – кредит калининград – kredit – кредит русский стандарт – дам кредит – кредит за день – срочный кредит – ренессанс кредит спб – юни кредит банк – кредит неработающим – рассчитать кредит онлайн – оформить заявку на кредит – потребительский кредит онлайн – деньги кредит – потребительский кредит калининград – экспресс кредит онлайн
авангард банк как получить кредит в сбербанке

Your comment is awaiting moderation.

kredyt konsolidacyjny Kraków konsolidacja zadłużenia Zamośc kredyt konsolidacyjny Rzeszów.
konsolidacja kredytów Lublin konsolidacja zadłużenia Jasło konsolidacja dla zadłużonych Kraków.
kredyt konsolidacyjny rzeszów Przemyśl kredyt konsolidacyjny rzeszów Lubaczów pożyczka Jasło.

Your comment is awaiting moderation. – =%3Ca%20href=

Your comment is awaiting moderation.

Перейдите ниже по ссылке, чтобы получить кредит:

Как же оплачивать счета и совершать покупки через яндекс деньги?
Здравствуйте, дорогие читатели блога!
В настоящее время виртуальные операции даже более популярны, нежели рядовые расчеты наличными.
Это связано с постоянно растущим количеством интернет-магазинов и других не менее популярных ресурсов, активно поддерживающих подобный способ оплаты.
Также и современные люди уже не сторонятся виртуальных денег, а относятся к ним с доверием — это уже вошло в обыденность.
Среди существующих сегодня платежных систем поистине народный русскоязычный сервис Яндекс.Деньги – это один из самых безопасных, широкодоступных и многофункциональных методов проведения электронных платежей.
Поэтому, учитывая столь актуальный спрос потребителей, в сегодняшней статье мне бы хотелось рассказать, как платить через яндекс деньги.
Какие товары и услуги можно купить посредством электронных денег Yandex?
На яндекс деньги можно:
пополнить мобильный телефон; купить билеты (на самолет, поезд, автобус); приобрести игры, музыку и программное обеспечение в itunes; произвести расчет за развлекательные услуги онлайн-сервисов; оплатить коммунальные счета, налоги, штрафы ГИБДД, интернет и телевидение; внести пожертвование.
Просмотреть весь перечень предложений, можно на этой странице .
Примечание ! Если на Яндекс счете нет средств, пополните его с карточки, например, Сбербанка.
Как совершить платеж?
На заметку ! Для «анонимных» клиентов, которые зарегистрированы в системе без паспорта, Яндекс ограничивает размер одноразовой оплаты до 15 тыс. руб. Поэтому, если вы планируете приобрести более дорогостоящую продукцию, позаботьтесь о том, чтобы повысить статус аккаунта.
Оплатить приобретенный в глобальной сети продукт можно двумя способами.
Для первого (продемонстрирую на примере покупки игры со steam сервиса) вам потребуется:
Авторизоваться на сайте . На главной странице сервиса слева из списка меню выбрать необходимую функцию – «Товары и услуги».
Активировать раздел «Игры». В списке вариантов выбрать «Порталы и сервисы» > «Steam Wallet» > «Пополнить». Заполнить пустые ячейки (ввести имя аккаунта и сумму пополнения) > кликнуть на «Заплатить». Ввести полученный на телефон код и завершить операцию.
Второй вариант оплаты услуг сторонних ресурсов предполагает предварительный вход в профиль пользователя на сайте интернет-магазина (так, к примеру, можно перевести деньги с яндекс счета на алиэкспресс ).
Выбрав интересующий вас товар в магазине и оформив заявку на его приобретение, вы должны выбрать способ оплаты «Яндекс.Деньги». После этого вам будет предложено перейти на сайт платежной системы, где сможете оплатить свою покупку.
Дополнительный способ расчетов (третий)
Некоторые зарубежные ресурсы, продающие товары русскоязычным гражданам, намерено ограничивают клиентов (как бы ненавязчиво провоцируя их зарегистрироваться в их «родной» платежной системе, как это делает ebay совместно с PayPal). Кстати статья про регистрацию в PayPal находится здесь.
Исходя из этого, для того чтобы рассчитаться за товары в заграничных онлайн-магазинах, вам потребуется предварительно привязать банковскую Яндекс карту с деньгами к кошельку PayPal.
Как отменить платеж?
К сожалению, отменить платеж в системе Яндекс.Деньги нельзя. Как показывает практика, вернуть деньги с чужого кошелька можно только чудом, по доброй воле получателя.
Сервисная служба платежной системы не принимает участия в разборках и не несет ответственности за допущение ошибки при вводе данных (поэтому, пополняя счет через терминал, несколько раз проверьте достоверность внесенных данных).
Если вы отправили деньги на несуществующий счет, тогда есть шанс вернуть их. Нужно позвонить в службу поддержки, продиктовать данные квитанции и указать правильные реквизиты счета, на который сервис и переведет ваши средства.
Желаю вам приятных покупок! Поделитесь информацией с друзьями в соц.сетях, пусть тоже узнают о возможностях онлайн-платежей. Не забудьте подписаться на рассылку. До встречи!
С уважением! Абдуллин Руслан.
Комментарии пользователей (10)
Дрянь этот Яндекс кошелёлёк! Я, как любитель новинок, 2 года назад положила в яндекс- кошелёк 10000р., чтобы купить смартфон. Получилось дешевле купить в магазине по банковской карте. Потратить деньги из кошелька не удаётся, потому что платежи по яндекс деньгам не проходят ни за телефон, ни коммунальные платежи, ни благотворительные взносы. Больше половины суммы так и висит. Назад на банковскую карту — 30%+45р — тоже не отдает. Выдаёт непонятный текст в ответ.
Что-то очень интересное вы рассказываете.
Лично у меня никогда проблем с Яндекс деньгами не было.
Хотя нет, есть проблема, не помню свой пин-код на карте Яндекс денег. Поэтому пользуюсь ей только там, где используется технология paypass.
А я от Яндекс кошелька только номер и знаю, и никакого пин-кода.
У Вас, Руслан, наверное более продвинутый кошелёк.))
Просто у меня пластиковая карта от Яндекс денег.
Да, я знаю про то, что у Яндекса имеются пластиковые карты. Надо будет и себе завести такую пластиковую карту.
Прочитала про проблемы Вероники , и мне подумалось, что Яндекс кошелёк лучше заводить тем, кто зарабатывает в Интернете и использует деньги на разные операции внутри интернета.
Интересно. А что, надо завести кошелек, а потом деньги в него класть ? Как раз Яндекс-кошелек — прекрасная альтернатива распоряжаться теми деньгами, что ты заработал в интернете.
Странно, что текст непонятный. Все-таки Яндекс на русском языке общается Неужели нельзя было выяснить в службе поддержки?
А вот насчет высоких процентов при выводе, это правда. Поэтому эти деньги лучше тратить онлайн.
А мне Яндекс-кошелёк нравится. Правда и денег там немного, поэтому и проблем нет. Но этот кошелёк очень хорошо взаимодействует с картой Сбербанка.
здравствуйте, помогите, пожалуйста, объясните, как платить с помощью яндекс. каждый раз пишет: «Ой! Заплатить не удалось.» Что делать?

Перейдите ниже по ссылке, чтобы получить кредит:

Your comment is awaiting moderation.

Bro, need a hand with one query here.
Skipped few classes at university, trying to acquire back on track.
Stumbled upon this

Appears a little suspicious, but much better than other options I discovered.
Any opinion?

Your comment is awaiting moderation.

My mistake, if not around the topic. I had slightly embarrassment. I randomly missing my essay and I urgently need to create a brand new one particular. I can not write with my own strength, so I wanted to apply for the essay writing service for money. Identified a few articles about this, but I do not know should you can trust these web-sites. Has anyone heard of the ???

I also wanted to ask, did someone encounter such a problem? And what will take place if they obtain out that my essay was bought, and not written by me

Your comment is awaiting moderation.

Heya friends
I say you’re sorry if I write off-topic
But I recently had to seek out a detailed report about techniques to create essays for the university.
I just found an excellent article. Probably somebody else will need to have this knowledge.

In addition, whereas I was seeking this short article, I learned that many people obtain dwelling works, compositions, paperwork and essays. I don’t know how safe it can be and what top quality is often obtained in the end. Who faced this problem, write, you create or invest in? Have been you caught by a lecturer for this?

Your comment is awaiting moderation.

If you decide to absolutely need to “write my essay,” opt for one of the best author and obtain your essay undertaken in three hrs! | Decide to buy essay web and acquire fine quality essay guidance from our authorities.

Your comment is awaiting moderation.

Купить Левитру в России

Даже если мужчина предпочитает придерживаться здорового стиля жизни, постоянно проходит все обследования и анализы и бегает по вечерам, раньше или позже его все-равно ждут проблемы с потенцией: такова неприятная суть старения.

К всеобщей радости прогрессивная наука создала шпанская мушка отзывы , что могут продлить здоровую интимную жизнь на два десятка лет, не вредя при этом здоровью иных систем организма. Речь идет о Левитре дженериках, которые вы сможете приобрести на этом портале

Тут вас ждёт каталог из нескольких десятков препаратов, которые десятки лет производятся в США и прошли все установленные процедуры клинического тестирования. В отличие от простых аптек, в этом онлайн магазине все дженерики продаются по самым скромным ценам и высылаются клиенту в самой обычной посылке, что гарантирует конфиденциальность покупки.

Все распространяемые таблетки изготавливаются на легальных американских фармацевтических конвейерах и сопровождаются всеми легализованными сертификатами. А небольшая стоимость дженериков обусловлена отсутствием лишней цепи посредников, как в случае с классической аптекой.

Your comment is awaiting moderation.

Trying To Find The Best Diet Pill?

Trying to find the best diet pill may seem like an impossible task, especially with the multitude of diet pills available for purchase. Many people purchase a diet pill only to find out that the pill makes them feel jittery, nervous, or often has no effect at all.

Diet pills frequently contain the same or similar combination of ingredients and rarely contain anything new, innovative, or undiscovered to the supplement / weight loss industry. So, how can you find the best diet pill when most diet pills are made with similar ingredients?

One of the most common problems associated with taking diet pills is that the person taking the diet pill is uneducated about the dosage, effects, and promises offered as they relate to each diet pill. The research at website finds that there are three factors that should be taken into consideration when deciding to take a diet pill.

It is important to take the pill exactly as recommended on the product label. Some people choose to increase the dosage thinking that the product will work faster or better. This is not the case, and many people become sick in response to the large dose. Reviewers at website often suggest that the recommended dosage be cut in half to give the body time to adjust to the stimulant in the diet pill. After the body has adjusted, it is fine to begin taking the regular dosage as recommended on the product label.

The effects listed on the product label are there because these are the effects that the product has had on ‘some’ of the test group. Some of the diet pill testers may be fine taking the product, while others may have adverse effects. The diet pill companies print this information to educate the buyer as well as to protect themselves from lawsuits. The consumer needs to read the label and educate themselves before taking the product. Many people who are sensitive to caffeine are surprised when the diet pill makes them feel nervous or nauseous, but this information is likely printed on the product, so with a little research these affects can be avoided.

If you read the fine print on product claims for diet pills and other weight loss supplements, you will see ‘results not typical’ printed very small somewhere where you are not expected to look. The diet pills advertised on television are responsible for some of the most outlandish claims. The results claimed in these advertisements are often unattainable within the given amount of time outlined in the ad. Don’t expect to see results in two weeks like a lot of ads claim.

Wouldn’t it be great if you could read reviews for diet pills from actual users of each diet pill? Diet Pill Reviews website has taken the trouble out of searching for the best diet pill. You can read reviews of over 150 of the most popular diet pills available.

Copyright 2006, Diet Pill Reviews viagra pas cher

Your comment is awaiting moderation.

Wow, what a video it is! In fact pleasant feature video, the lesson given in this video is really informative.
Free Porn Picture Galleries

Your comment is awaiting moderation.

Why are Americans so worked up about health care reform? Statements such as “don’t touch my Medicare” or “everyone should have access to state of the art health care irrespective of cost” are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system’s history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let’s try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let’s look at the pros and cons of the Obama administration health care reform proposals and let’s look at the concepts put forth by the Republicans?

Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life’s major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

A recent history of American health care – what has driven the costs so high?

Key elements of the Obama health care plan

The Republican view of health care – free market competition

Universal access to state of the art health care – a worthy goal but not easy to achieve

what can we do?

First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

To begin, let’s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying.

At this point, let’s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

The Obama health care plan is complex for sure – I have never seen a health care plan that isn’t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.

To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don’t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.

To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.

The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.

The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide “free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney’s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision.

As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to “give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative.

Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn’t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems.

OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience’s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don’t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary.

I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens – health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don’t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition.

Let’s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don’t exercise but we offer a lot of excuses. We don’t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can’t do anything about managing these known to be destructive personal health habits. We don’t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because “health care is there” and somehow we think we have no responsibility for reducing our demand on it.

It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame.

There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, “Google” “preventive health care strategies”, look up your local hospital’s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America’s health care system now and into the future. I am anxious to hear from you and until then – take charge and increase your chances for good health while making sure that health care is there when we need it.

Your comment is awaiting moderation.
Add Your Comment