DO YOU NEED something more to worry about? Well, it appears you’ll need a good job and a lot of money to buy and use all the innovative “smart” stuff that is coming our way.

What used to be simple, easy and low cost is now, very technical and expensive. Many of the brilliant new products have even made it possible to eliminate your job. That is how progress is measured in today’s world.

Modern technology has brought us to the point where it takes more gear for a backyard cookout than the pioneers required to conquer the wilderness.

If you are feeling stressed, keep in mind that there are just two days in every week about which we should not worry; two days which should be kept free from fear and apprehension, says this old essay that has survived the test of time.

One of these days is yesterday, with its mistakes and cares, its faults and blunders, its aches and pains. Yesterday has passed forever beyond our control.

All the money in the world cannot bring back yesterday. We cannot bring back yesterday. We cannot undo a single act we performed; we cannot erase a single word we said. Yesterday is gone.

The other day we should not worry about is tomorrow, with its possible adversaries, burdens, large promise and poor performance. Tomorrow is beyond our control. Tomorrow’s sun will rise. Until it does, we have no stake in tomorrow, for it is yet unborn.

This leaves only one day: today. Any man can fight the battles of just one day. It is only when you and I add the burdens of those two awful eternities, yesterday and tomorrow, that we break down.

It is not the experience of today that drives men mad, it is remorse or bitterness for something which happened yesterday and the dread of what tomorrow may bring.

Let us, therefore, live but one day at a time.



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WHEN IT comes to worries about soaring health care costs, the planners and experts in the field point to many reasons, including the evils of risk adjustments and the dirty secret of upcoding.

Dr. Ezekiel Emanuel, a vice provost at the University of Pennsylvania in Philadelphia, Pa., and an architect of the controversial Affordable Care Act (ACA), said risk adjustments are necessary because without them insurers and health-care providers would have a strong incentive to care only for healthy people.

Medical spending is not spread evenly across all people in our society. Do you realize half the population uses just 3% of the total spending? Conversely, 10% of Americans consume about two-thirds of all health-care spending.

The average American, who needs a nominal amount of the health-care services, pays a lot of money each year for their insurance premiums to make up for those 10% who consume the bulk of the health-care dollars.

Emanuel said a big slice of the pie goes for treatment of such illnesses as lung cancer, diabetes with complications, depression and heart disease.

He tells us risk adjustments give doctors and insurers a reason to find every possible diagnosis and make them sound as severe as possible, which raises government payments. That means extra money is flowing for diagnoses that do not imply the assumed increased costs.

Because Medicare cannot police every plan, Emanuel said it enacted an annual coding intensity adjustment, which will reduce premiums by about 5.91%. Ultimately, it does not solve the problem because insurers build the penalty into their premiums.

Dr. Bob Kocher, an adjunct professor of medicine at Stanford University in Stanford, Calif., and an architect of the ACA, said the industry calls these incentives upcoding.

He said upcoding diverts providers and insurers from finding ways to improve care and reduce costs. The coding intensity adjustment actually penalizes honest Medicare Advantage plans.

Overstating the severity of medical conditions costs taxpayers billions of dollars a year in overpayments, according to the Government Accountability Office.

In a column in the Wall Street Journal, the doctors said Medicare Advantage plans urge doctors to do annual wellness visits and code every disease in every patient. There are opportunistic intermediaries hired by health-insurance companies.

Those intermediaries support upcoding by mining patient charts for abnormal lab values or prescriptions indicative of diseases that aren’t billed. Doctors are then urged to make additional diagnoses, which often have no benefit for the patients, but take lots of money out of the system.

Emanuel and Kocher said finding answers to the risk adjustment problem and clamping down on the practice of upcoding would go a long way to making programs more viable and affordable for all Americans.