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Thursday, August 25

One Day

"That was a memorable day to me, for it made great changes in me. But, it is the same with any life. Imagine one selected day struck out of it, and think how different its course would have been. Pause you who read this, and think for a moment of the long chain of iron or gold, of thorns or flowers, that would never have bound you, but for the formation of the first link on one memorable day."
- Charles Dickens, Great Expectations

Tuesday, August 23

Blue Lagoon

Tο πλοίο θα σαλπάρει το βραδάκι
Πάρε το μετρό για Πειραιά
Μέσα στο γλυκό καλοκαιράκι
να πάμε κρουαζιέρα στα νησιά

Στο κύμα θ' αρμενίζει το βαπόρι
τ' αγέρι θα μάς παίρνει τα μαλλιά
Θα γίνουμε στον έρωτα μαστόροι
κι οι σκέψεις θα πετάξουν σαν πουλιά

Α, α, κρουαζιέρα θα σε πάω
A, α, γιατί σε νοιάζομαι και σ' αγαπάω
A, α, Mύκονο και Σαντορίνη
A, α, σαν ερωτευμένοι πιγκουίνοι

Άσε τον παλιόκοσμο να σκούζει
σε πλαζ, εστιατόρια, πανσιόν
Εμείς με σλίπιγκ μπαγκ και με καρπούζι
θα κάνουμε το γύρο τον νησιών

Γυμνοί θα κολυμπάμε στ' ακρογιάλια
Τον ήλιο θ' αντικρίζουμε ανφάς
Θα σ' έχω σαν κινέζικη βεντάλια
και στο γραφείο δε θα ξαναπάς

Sunday, May 1

For-Profits vs Non-Profits

The debate on whether all healthcare institutions should be non-profit evokes many complex and topical issues. What needs to be examined is whether non-profit hospitals are inherently better than for-profit hospitals, and whether there is enough evidence-based data to support policies dictating ownership.

Not only have the business models of both ownership styles become more and more similar, there has also been a growing number of switches in ownership status between for-profits and nonprofits. The direction of the switches doesn’t suggest a preference for either ownership style. Research suggests that it is not a difference in objectives that dictates these decisions, but rather a strategic analysis of the environment in which the organization operates.

While nonprofits are hailed for their charity work, it is actually a byproduct of their exclusion from paying taxes. Many studies show that often nonprofits do not provide charity comparable to their tax savings, and that for-profits actually give back more in the form by being subjected to taxes. For-profits’ societal contribution occurs within the strict rules of the US tax code, while non-profits operate under more arbitrary conditions which has exposed them to many suits.

Another advantage that for-profits have is the ability to raise more capital through private investors and the stock market. As a result, many nonprofits that have found themselves in financial troubles have been rescued by financially healthier for-profit organizations.

Heleni Smith Dailymotion

Heleni Smith - Etsy
Heleni Smith – Status Updates
Heleni Smith – Travelling
Heleni Smith – Tribute

Monday, April 18

Evolution of Medicaid

Medicaid has faced many obstacles since its 1965 enactment. As a program that was originally viewed as a “lousy program for poor people,” it has managed to not only survive for over 4 decades, but it has become an instrumental part of Obama’s Patient Protection and Affordable Care Act in providing coverage for the uninsured. The program’s resilience lays in the way it is financed and the way it is implemented.

While Medicaid costs $350 billion a year, the financial burden is divided among the states and the federal government. Each state has a special agreement with the federal government on what percentage of the Medicaid bill each pays. The federal government pays from 50% to 80%, depending on the state. The poorer a state is, the more the federal government contributes. This severely lessens the financial burden states face when making Medicaid decisions. This also allows for states and the federal government to spend more when the economy is good, and to cut back when the economy slows down.

Medicaid is administered by the states. This allows for various Medicaid programs across the United States that are tailored to a state’s idiosyncrasies. This flexibility has allowed for structural creativity on a state level, thus avoiding many of the hurdles faced with federal run programs. Its beneficiaries have grown beyond the nation’s poor due to the ambiguous eligibility boundaries set by the federal government. Each state has an autonomy that allows it to turn Medicaid into whatever the state’s population needs.

While the first two decades of Medicaid proved tumultuous, with various disagreements on eligibility caps, during the mid 80’s and 90’s it experienced a rapid growth thus moving it from a program for poor people into a program for low wage and low middle class people. This was mostly due to various state mandates to increase eligibility caps. Also, Medicaid started expanding its coverage of pregnant woman in an effort to deal with the rising problems of infant mortality and high risk pregnancies. This gave Medicaid great political capital, thus making it hard for republicans to legislatively act out on their oppositions to the program’s expansion.

Clinton’s presidency also greatly advanced Medicaid through the enactment of the SCHIP programs. These programs were meant to provide insurance to children and gave states $40 billion to spend in 10 years. Clinton gave the states the option of creating new plans or expanding through Medicaid. This gave Medicaid even more leverage, thus adding to its resilience. By the end of the 1990’s, Medicaid and SCHIP spending accounted for 16% of the nation’s healthcare bill.

Another reason Medicaid has done so well is that it has had a more seamless transition into managed care than Medicare did. This is greatly attributed to the fact that Medicaid is an amalgamation of federal rules and state specific policies, thus allowing for states to more efficiently negotiate with managed care plans.

Medicaid is now facing pressure to lower costs and increase eligibility criteria. It can deal with these pressures by raising eligibility to cover most children through family coverage. It can also raise eligibility while lowering costs by allowing uninsured individuals to buy into Medicaid. If their income disqualifies them from automatic enrollment, they could pay a premium in order to receive its benefits. This would increase eligibility without adding on extra costs, and could potentially generate enough revenue to make Medicaid as a whole more affordable.
Heleni Smith – Last Fm
Heleni Smith – Paper
Heleni Smith – Health Updates
Heleni Smith – Cavafis Tribute
Heleni Smith – Cavafis Tribute 2
Heleni Smith – Good Reads

Monday, April 11

Poetry Corner by Heleni Smith

Thursday, April 7

Heleni Smith Lensmaster

Heleni Smith – Lensmaster

Heleni Smith – Cruise Food

Pictures of the amazing food we had on our last family cruise.

Government Shutdown

Heleni Smith – Related Articles

Check out the following interesting article on the impending government shutdown:

Monday, April 4

Budget Proposals by Heleni Smith

Heleni Smith – Budget Proposals

Republican Representative Paul Ryan, the new chairman of the House Budget Committee, is set to reveal his 2012 budget proposal this upcoming week. The proposal’s anticipated $4 trillion cuts on federal spending include dramatic changes to both Medicare and Medicaid. The Medicare changes would affect everyone bellow the age of 55 by converting the program into a premium support system. This means that by the time the aforementioned individuals reach the age of 65, Medicare will no longer exist in its current form. Participants would have to choose a private insurance coverage for which the government would pay the first $15,000 of premiums. Poorer or less healthy individuals would receive more money. Ryan claims that Medicare is unsustainable in its current form and that these changes are necessary. Opponents to Ryan’s proposal argue that health costs will rise at a higher rate than the proposed government subsidies, thus leaving many elderly with inadequate coverage. As far as Medicaid, Ryan is proposing that the program turn into a block grant program in order to rein in state spending.

Wednesday, March 30

ACOs Continued by Heleni Smith

Heleni Smith Writings
Heleni Smith Blog

As a Public Health graduate student, I’m often asked to elaborate on ACOs. While the catchy acronym has graced many newspaper titles, the public is still hazy on what an ACO would actually accomplish. The best analogy for an ACO comes from Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality & Payment Reform in Pittsburgh. He compares healthcare and ACOs to SONY and television sets. When someone decides to buy a new tv, they buy the entire product in one place. ACOs will attempt to do the same with healthcare. Instead of going to different institutions for various medical needs, patients will be able rely on a one-stop-shop. This will incentivize all stake holders partaking in healthcare to cooperate and reduce costs. This will also tackle the redundancy often observed through unnecessary repetition of exams. ACOs will be launched for Medicare beneficiaries as well as private insurance beneficiaries in January of 2012. Proponents of the creation of ACOs point to the fact that it will lead to cost reduction in Medicare which is a big driver behind the current deficit. While the fee-for-service system will still be in place, savings-sharing incentives will encourage cost reduction and quality improvement.

Monday, March 28

ACOs by Heleni Smith

Heleni Smith Writings
Heleni Smith Blog

ACOs have been generating alot of media buzz in the last few months, although the concept is still a bit foggy to many people. Here is a brief explanation of what an ACO is:
An Accountable Care Organization (ACO) is an entity created in order to tackle healthcare quality and rising costs issues. The main purpose of their creation is to simultaneously address payment methods and delivery reform. ACOs are generally a local entity comprised of at least physicians (primary and specialists) and hospitals that are responsible for the full spectrum of care for specific beneficiaries. ACOs provide financial incentives such as shared savings and bonuses for meeting certain predetermined quality measurements.

Wednesday, March 16

Health Insurance Brokers Update by Heleni Smith

Healthcare reform has many stakeholders beyond government and providers. Case in point-health insurance brokers. Insurance brokers are becoming more vocal about the possible ramifications that the Patient Protection and Affordable Care Act might have on them and are taking their trepidations to congress and state legislatures. Their main concern revolves around maintaining their commissions as well as guaranteeing a position in the new healthcare landscape. There is debate around the effect insurance brokers have on overall premiums. Brokers are hoping to play an integral part in the creation of health insurance exchanges which will take effect in 2014. States seem to be divided on this issue. Iowa and Minnesota have both introduced bills that safeguard the future of brokers, while Maryland and the District of Columbia are drafting bills that would negate the use of brokers. The National Association of Insurance Commissioners is lobbying legislation on the national level that would exclude brokers’ commissions from the new 20% cap on health insurance administrative cap.

Heleni Smith Health Insurance Brokers Update

Monday, March 14

ERISA and Health Reform by Heleni Smith

ERISA and Health Reform by Heleni Smith

While the Employee Retirement Income Security Act (ERISA) was enacted in order to protect employee benefits, it has unwittingly hindered patient rights by restricting the legislation states can enact in relation to employer sponsored health plans. This becomes an even more critical side effect with the enactment of the Patient Protection and Affordable Care Act. Should Congress amend ERISA in order to allow for states to freely experiment with health care reform?


ERISA was enacted in 1974 in order to protect pension plans and create a national set of standards for the administration of employee benefit plans. The uniformity of pension plans would eliminate the legislative variation between states, thus protecting employers and employees. ERISA’s authority over health benefits has been ambiguous, mostly because of Section 514 which includes the preemption clause and the deemer clause.

Due to this ambiguity, many state initiatives have been either stalled or completely derailed because of an ERISA challenge. Examples of this include Maryland’s “Fair Share Act” and California’s “Health Care Security and Cost Reduction Act”. With the Patient Protection and Affordable Care Act enactment, addressing the ERISA preemption problem becomes an even more critical issue in order to allow states to experiment with new programs. Steps need to be taken to either amend ERISA or have the Courts produce a comprehensive ruling.

Continue at...
ERISA and Health Reform by Heleni Smith

Cruise Food!

Thinking about taking a cruise? The food alone is worth it. Check out the photo album of the culinary highlights of my last cruise.

Heleni Smith Cruise

Heleni Smith Public Health Corner

Public Health Corner Heleni Smith

Sunday, March 13

Updates on Health Reform Suits by Heleni Smith

Updates on Health Reform Suits by Heleni Smith
Public Health Blog by Heleni Smith

The 11th Circuit Court of Appeals in Atlanta has agreed to hasten the appeal on the Florida ruling regarding the health reform bill. The Justice Department commented that the expedition of the appeal is warranted due to the nature of the ruling and the fact that it involved twenty-six states. The federal government will have to file its papers by April 4th, while the state of Florida has until May 4th.

Saturday, March 12

So many articles, so little time by Heleni Smith

Surfing the net has become part of our daily routine, but how much of that browsing leads us to topics we are actually interested in? Here are a couple of sites I use that allow you to customize your tastes and then deliver articles based on your ratings.

Health Articles and Posts Found by Heleni Smith

Interesting Posts found on Reddit by Heleni Smith

Cooking Basics by Heleni Smith

Cooking Basics by Heleni Smith

Cooking by Heleni Smith

Check out my blog with tips for beginner cooks. From pasta to stuffed pepper recipes!

Bon appetit!

Friday, March 11

Heleni Smith Page

Heleni Smith Wordpress Page
Heleni Smith

Check out my new webpage on wordpress and You can make one for yourself too!

Heleni Smith on Huffington Post

Heleni Smith on Huffington Post

Join the scintillating discussion on the Huffington Poost website. Real people talking about real issues!

Check out travel pictures by Heleni Smith

Heleni Smith Flickr

Here is a preview from my backpacking trip through Europe. 15 countries in 2 months. Thanks!

Health Law Waivers by Heleni Smith

Bio for the blog entry’s writer Heleni Smith

Waivers by Heleni Smith

House Republican Mike Rogers from Michigan introduced a bill that would allow individuals to request waivers from the Patient Protection and Affordable Care Act requirements. Currently, similar waivers exist for employers and unions. Companies that have already received waivers include McDonald’s. The waivers would also apply to the health insurance mandate which is set to take effect in 2014.

Wednesday, March 9

Block Grants by Heleni Smith

Block Grants by Heleni Smith

A popular item on the republican agenda is turning Medicaid into a block grant program. While this is generating a lot of discussion, it is not the first time the issue has been addressed. President Ronald Regan and President George W. Bush both tried to implement the same changes. What exactly is a block grant program? Let’s begin with a few clarifications. Medicaid is an entitlement program-if an individual meets the eligibility criteria then he or she is guaranteed a spot in the program. It is currently administered by the states and financed by both federal and state government. The government has agreed to co-finance Medicaid as long as states cover specific groups of people, for example children. Switching to block grant financing would restrict the states’ ability to rack up the bill. The federal government would provide annual lump sums, and it would be up to the states to allocate them efficiently. Extra costs would then be the sole responsibility of the states. The democratic opposition fears that such a switch would lead to Medicaid being unable to maintain its current number of enrollees, let alone add more as the health reform bill suggests. If put to a vote, block grants would likely make it through the House, but fail to make it through the Senate.

Tuesday, March 8

Mandate Struggles by Heleni Smith

Heleni Smith Public Health Corner

Heleni Smith Blogspot

The current lawsuits brought against the health reform law are attacking the constitutionality of one of its provisions-the individual mandate. The mandate states that by in 2014, every individual will have to purchase health insurance or be subjected to a monetary penalty. The law also lacks a severability clause; if one part of the bill gets struck down as unconstitutional then the entire bill cannot stand. Congress argued that it had the power to impose the mandate due to the commerce clause which allows it to regulate commerce between states. Under this clause, Congress expressed that it had the power to impose a penalty on uninsured individuals because their inactivity was jeopardizing the health insurance industry. Advocates of the unconstitutionality of the mandate argue that Congress cannot impose penalties on inactivity. While some argue that a penalty is just a another form of taxation-which Congress has the authority to levy-others believe that taxes and penalties are very different. While this seems to be boiling down to semantics, it will be eventually resolved in the Supreme Court.

Monday, March 7

Medicaid Struggles by Heleni Smith

Heleni Smith Blogspot

Heleni Smith Public Health Corner

State budgets are struggling to support their increasing Medicaid bill. Medicaid is an interesting program in that it is administered by the states and funded by both state and federal government. This allows for flexibility in how Medicaid is administered as well as fine-tuning to an individual state’s idiosyncrasies. Various approaches are being taken to address the issue ranging from tightening eligibility requirements to turning Medicaid into a block grant program. These approaches are being met with mixed reviews. For example, Arizona health providers argue that decreasing eligibility will lead to an influx of patients in the emergency room while republican supporters argue that while there will be some negative impact, it will be outweighed by the savings.

Health Reform Update by Heleni Smith

Florida Judge fast-tracks appeal

The Florida federal judge who ruled that the Patient Protection and Affordable Care Act is unconstitutional is trying to speed up the process by ordering that any requests for an expedited appeal be filled with seven days. While the judge had stated that his ruling should be viewed as an injunction, the implementation of the law did not seize. Instead, the Obama administration requested that he clarify his original ruling. The judge responded this past Thursday with a 20 page order requesting that the administration goes ahead with the appeal. Appeals from other similar cases are currently pending appeal.

Organ Donation by Heleni Smith

Interesting article written by a death row inmate on organ donation. Such a shame to see so many potentially viable organs go to waste.

Public Health Corner: by Heleni Smith

The Patient Protection and Affordable Care Act addresses a multitude of health issues ranging from pay for performance initiatives to the creation of health insurance exchanges. For the latest updates on the health reform saga, please visit my Public Health Corner tumblr page for updates on health reform. Brought to you by a public health graduate student. Thanks!

Heleni Smith: Postcards from Paris

Heleni Smith - Postcards From Paris

When Americans arrive in France, jet lag is not the only obstacle they have to overcome. There is a certain stigma that accompanies their passports known as the American stereotype.

When I decided to study abroad in Paris, I knew I would inevitably come across situations in which my nationality would be counted as a fault. I just hoped I wouldn't spend more time trying to improve the American image than I would trying to improve my French.

Many French people think of Americans as materialistic and culturally void, according to Julian Cruz, a 22-year-old French student. "They have a reputation of focusing on image instead of substance," he said.

Harsh as this may sound, the stereotype seems to feed off the mainstream television shows and movies that make their way across the Atlantic and paint the picture of what an American is on their screens.

"When I think of California, I think built and tanned. When I think of New York, I think Sex and the City," said Cruz. "When I think of Florida, I think of sex, drugs and cosmetic surgery, because of Nip/Tuck."

Julien Debrulle, a 23-year-old French student, believes the stereotype portrays Americans as being uninformed and rich, but with bad taste.

"They seem to know more about celebrities than they do about the world," she said.
When it comes to culture, Debrulle said, the term "American" implies lower quality.
"French people say they'll go see an American movie when they don't want to think," she said.

Dotti Sinnott, an American student studying in Paris, believes the image works both ways.

"Before I came here, people were warning me that the French aren't going to like me because I am American," Sinnott said. She believes that it is part of their culture not to be very open and welcoming at first, and that is the impression American tourists leave with.

"Once you've lived here and gotten to know them, you realize they are not really like that - they warm up," she said.

So, is this a case of one impression feeding another and turning into a self-fulfilling prophecy? Just as all Americans are not uneducated, fat and loud, the French are not all beret-wearing, baguette-eating snobs.

Neither Cruz nor Debrulle would apply the stereotype to Americans they have actually met, they said. In the same way, I have only experienced cold shoulders and dirty looks in routine and impersonal interactions, such as crowded metros and grocery lines.

When traveling to a foreign country, Americans should keep in mind that their actions formulate their image. Even though there are many negative qualities that accompany the stereotype right now, Americans should not go on the defense. Instead, they should see it as an opportunity and a challenge to improve their image around the world.

As I walk past the crowded Starbucks every morning, or discuss the latest episode of Lost with French classmates, I realize that American culture isn't being shunned - it is being turned into a guilty pleasure. The stereotype may exist, but it can be shaped and eventually reversed by interactions between the two nationalities - which, despite their differences, have a lot of common ground where the gap can be bridged.

Heleni Smith

For all the people that are interested in doing a semester abroad, here is an article I wrote about my experience in Paris. Additionally, here is a good website where students from abroad have been sharing their experiences. Please feel free to post about your studying abroad experiences! Thank you!