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Chronically ill Americans suffer far worse care than their counterparts in seven other industrial nations, according to a new study by the Commonwealth Fund, a New York-based foundation that has pioneered in international comparisons. It is the latest telling evidence that the dysfunctional American health care system badly needs reform.

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Well, did you all watch? Do you agree with the “MSM” that she won–not because she won, but because expectations for her were so low, and she managed to fill the air with words while smiling the whole fucking time? No matter that she flat didn’t answer questions, talked about a mysterious General “McClellan,” and couldn’t/wouldn’t come out and say that no, she isn’t for civil rights for gays and lesbians. And for all those hard-working teachers and the like out there: your reward will be in heaven. Just ignore how shitty your life is now.

I watched the debate at the 20th Century Theatre last night, along with a few hundred other Democrats. At least two of the local snooze stations were there, and when I came home to see the coverage, I learned that Republicans were right across the street in Oakley having their own watch party.

How did I not know this at the time? There were only about thirty people there.

Do you think the news mentioned this basic fact–that hundreds turned out on the left, and dozens on the right? Not a word. Oh, they showed pictures that told the story, sure, but there were intermingled, so if you don’t know the interior of either place, you wouldn’t know who had the big turnout. Yeah, it was the Democrats. About 10 times the number of people were there. Good reporting, folks. Heckuva job.

It was nice being around a large group of “like-minded” people last night. I use the scare quotes knowing full well that the like-mindedness is largely a myth–a hopeful one, but a myth nonetheless. My political views are much further left than the Dems, and I even felt sympathy for the Nader supporter standing outside the theatre telling us “Open up the debates! Don’t let Obama steal the progressive vote!” Well, he’s stealing mine, but circumstances are simply too dire for anything but a pragmatic vote.

I voted for Nader in 2000, thinking that (A) someone as stupid as George W. Bush could never actually be elected; and (B) we need to break the two-party hegemony. Naive? Yes. I was 20; I apologize. I have nothing but admiration for Ralph Nader, but I think he’s a more powerful force for change outside of formal politics. Take Al Gore as an example: Since losing the election* his cultural capital has risen dramatically. He can potentially do more for environmentalism outside the White House than he ever could’ve inside. So I couldn’t vote for Nader again, but I still wish my vote was going to a genuinely more progressive ticket.

That said, I like Obama. I like Biden. As individuals, I think they’re a good force for change. I’m monumentally disappointed in the Democratic Party, overall, but the thought of another four years of the same conservative garbage makes me ill. This doesn’t sound like a ringing endorsement, so let me speak to some specifics.

Health care. Since primary season began, my top issue has been health care. I supported Clinton in the primary mainly because her position on universal health care was stronger, and I believed (and still do) that she had the experience and knowledge to really do something about our crumbling health care system. Obama’s position–without mandates for adults–is weaker, but is still so much better than the McCain plan that it’s hardly fair to even compare the two.

McCain wants to do for health care what the conservatives have done for banking. And we see how that’s worked for them.

Taxing health insurance benefits from an employer as income. Giving Americans a $5,000 check–wait, scratch that–giving insurance companies a $5,000 check in your name, forcing you to buy an independent policy if you lose your job or your employer drops health insurance coverage.

Pre-existing conditions?

Do you know that one visit to a psychiatrist to deal with anxiety issues will cause an insurance company to deem you uninsurable? It happened to my boss’s husband. Their 4-year-old daughter is uninsurable because she was born with–and has already has surgery to fix–a cleft palate. They both own their own businesses. They have no health insurance. They can’t afford to offer employer health insurance benefits, and they can’t afford to pay for an individual family policy–which wouldn’t even cover all of them, because of pre-existing conditions.

Yeah, a tax break should help. Let’s open up the health insurance market.

Health insurance and health care are too connected in America to really talk about them independently. You can be denied health care if you don’t have health insurance. That’s legal in America. If you try to get health insurance but have received some kind of health care in the past, you can be denied coverage. That’s legal in America. If you have health insurance but become ill and receive some kind of health care, your health insurance company can significantly raise your premium or entirely drop your coverage. That’s legal in America.

So, what’s the Republican plan, again? Regulate insurance companies, forbid them from discriminating against the seriously and kinda-sorta-maybe ill? Create real competition, by allowing Americans to buy into a government policy if they choose?

Tax your current benefits and give money to the insurance companies?

You choose.

*Is it fair to say that Al Gore lost the election? If the Court hadn’t intervened, he probably would have won. But he didn’t win his home state of Tennessee. He should’ve done that, at the very least. Still, it’s tough to say, with certainty, that he lost.

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15 Minutes…

Is all the time you need to contact the Department of Health and Human Services to express your opinion (outrage) about the proposed rule to “protect” health care workers,” while seriously undermining a patient’s right to unbiased medical opinion and treatment. I’ve pasted today’s Op-Ed below, though it doesn’t tell you how to contact the department.

But how to contact them? The department hasn’t exactly made it easy (a sure-fire sign they don’t really want to hear from you). You can send a message through the ACLU here, or directly to HHS here (note: it looks like a comment page for the usability of the website, but is actually the only way to send the dept. a comment). Or, give them a call at 202-619-0257 or 1-877-696-6775. Better yet, do both. It’s too late to mail a letter–there are only 6 days left of the open comment period.

September 19, 2008
Op-Ed Contributor

Blocking Care for Women

 

 

LAST month, the Bush administration launched the latest salvo in its eight-year campaign to undermine women’s rights and women’s health by placing ideology ahead of science: a proposed rule from the Department of Health and Human Services that would govern family planning. It would require that any health care entity that receives federal financing — whether it’s a physician in private practice, a hospital or a state government — certify in writing that none of its employees are required to assist in any way with medical services they find objectionable.

Laws that have been on the books for some 30 years already allow doctors to refuse to perform abortions. The new rule would go further, ensuring that all employees and volunteers for health care entities can refuse to aid in providing any treatment they object to, which could include not only abortion and sterilization but also contraception.

Health and Human Services estimates that the rule, which would affect nearly 600,000 hospitals, clinics and other health care providers, would cost $44.5 million a year to administer. Astonishingly, the department does not even address the real cost to patients who might be refused access to these critical services. Women patients, who look to their health care providers as an unbiased source of medical information, might not even know they were being deprived of advice about their options or denied access to care.

The definition of abortion in the proposed rule is left open to interpretation. An earlier draft included a medically inaccurate definition that included commonly prescribed forms of contraception like birth control pills, IUD’s and emergency contraception. That language has been removed, but because the current version includes no definition at all, individual health care providers could decide on their own that birth control is the same as abortion.

The rule would also allow providers to refuse to participate in unspecified “other medical procedures” that contradict their religious beliefs or moral convictions. This, too, could be interpreted as a free pass to deny access to contraception.

Many circumstances unrelated to reproductive health could also fall under the umbrella of “other medical procedures.” Could physicians object to helping patients whose sexual orientation they find objectionable? Could a receptionist refuse to book an appointment for an H.I.V. test? What about an emergency room doctor who wishes to deny emergency contraception to a rape victim? Or a pharmacist who prefers not to refill a birth control prescription?

The Bush administration argues that the rule is designed to protect a provider’s conscience. But where are the protections for patients?

The 30-day comment period on the proposed rule runs until Sept. 25. Everyone who believes that women should have full access to medical care should make their voices heard. Basic, quality care for millions of women is at stake.

Hillary Rodham Clinton is a Democratic senator from New York. Cecile Richards is the president of the Planned Parenthood Federation of America.

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Sound familiar?

From today’s Times. Exactly the problem I’m facing: marrying without good health insurance is impossible. I hope I’ll be financially able to marry in the not-too-distant future.

August 13, 2008

Health Benefits Inspire Rush to Marry, or Divorce

LAKE CHARLES, La. — It was only last February that Brandy Brady met Ricky Huggins at a Mardi Gras ball here. By April, they had decided to marry.

Ms. Brady says she loves Mr. Huggins, but she worries they are moving too fast. She questions how well they really know each other, and wants to better understand his mood swings.

But Ms. Brady, 38, also finds much to admire in Mr. Huggins, who is three years older. He strikes her as trustworthy and caring. He has a stable job as a plumber and a two-bedroom house. And perhaps above all, said Ms. Brady, who received a kidney transplant last year, “He’s got great insurance.”

More than romance, the couple readily acknowledge, it is Mr. Huggins’s Blue Cross/Blue Shield HMO policy that is driving their rush to the altar.

In a country where insurance is out of reach for many, it is not uncommon for couples to marry, or even to divorce, at least partly so one spouse can obtain or maintain health coverage.

There is no way to know how often it happens, but lawyers and patient advocacy groups say they see cases regularly.

In a poll conducted this spring by the Kaiser Family Foundation, a health policy research group, 7 percent of adults said someone in their household had married in the past year to gain access to insurance. The foundation cautions that the number should not be taken literally, but rather as an intriguing indicator that some Americans “are making major life decisions on the basis of health care concerns.”

Stephen L. J. Hoffman, an officiant at a wedding chapel in Covington, Ky., said he was no longer shocked that one of 10 couples cite health insurance as the reason they stand before him.

“They come in and say, ‘We were going to get married anyway, but right now we really need the insurance,’ ” said Mr. Hoffman. “There may be an unplanned pregnancy, or there is an illness, or they’ve lost their job and can’t get insurance.”

Though money and matrimony have been linked since Genesis, marrying for health coverage is a more modern convention. For today’s couples, “in sickness and in health” may seem less a lover’s troth than an actuarial contract. They marry for better or worse, for richer or poorer, for co-pays and deductibles.

Bo and Dena McLain of Milford, Ohio, eloped in March so he could add her to his group policy because her nursing school required proof of insurance. Corey Marshall and Kim Wetzel, who had dated in San Francisco for four years, moved up their wedding plans by a year so she could switch to his policy after her employer raised premiums

Ms. Brady and Mr. Huggins concede that their discussions about marriage have been freighted with cost-benefit analysis.

Ms. Brady learned three years ago that she had end-stage renal disease and after two years of dialysis received the transplant in May 2007. Her medical costs remain substantial and unpredictable. The demands of dialysis forced her to give up a much-loved job as a store manager for the Body Shop, and she eventually lost her insurance.

She now receives a Social Security disability check of $1,181 a month, and spends $95 of that on premiums for Medicare, the federal health insurance program for the elderly and disabled, which insures kidney transplant patients for up to three years.

With Medicare covering only 80 percent of most charges, however, Ms. Brady still has been left with thousands of dollars in bills.

Until this spring, Ms. Brady filled the gaps with a supplemental policy bought from State Farm. In April, she received notice that the premium was more than doubling, to $2,621 a quarter, from $1,180.

“ ‘I’ve got to cancel it,’ ” Ms. Brady said she told her agent. “I’m running out of family members to pay for it.”

That is when Ms. Brady and Mr. Huggins started talking about marriage. They reasoned that if they wed, Mr. Huggins could add her at modest cost to the group policy he buys through his union. That policy, combined with Medicare, would provide full coverage.

“I told him, ‘Let’s just do it. Can we do it without family?’ ” Ms. Brady recalled. “I felt the only way I could get around this was to marry him.”

As Ms. Brady has weighed her marital doubts against her medical needs, the couple has shifted wedding dates four times, most recently to Oct. 11. Her instincts tell her to delay. But each time the bills mount, she feels pressure to act sooner rather than later.

“I love him a lot, and I want to marry him,” Ms. Brady said. “I just don’t want to be forced to marry him early for insurance purposes.”

Mr. Huggins asks only that he have enough time to invite a few family members to the ceremony.

“I know I love her,” he said, “and I know I want to spend the rest of my life with her. The reasons and how fast we do it, that’s just secondary.”

In some instances, the need for insurance may prolong unhappy marriages.

When a mammogram confirmed in April 2007 that Sherri Parish had a lump in her breast, she panicked not only because of the devastating health news, but also because she was two weeks from a court date to finalize her divorce. Across the ups and downs of a 20-year marriage, her husband, Jonathan, had insured her through his job as a construction foreman in Noblesville, Ind.

“It was a devastating time for me,” Ms. Parish said. “I wasn’t sure what was going to happen with either the prognosis or the financial side of it.”

A nurse and mother of three, Ms. Parish, 47, had had little contact with her husband since they separated a year earlier. Through lawyers, she asked Mr. Parish, 49, if he would consider a delay so she could pursue treatment. He agreed.

“He didn’t want me to be without health care coverage because I’d never had it without him,” Ms. Parish said. “He’d always been the breadwinner, and I always worked two or three days a week and raised the children.”

Other couples, like Michelle and Marion Moulton, are forced to consider divorce so that an ailing spouse can qualify for affordable insurance.

Ms. Moulton, 46, a homemaker who lives near Seattle with her husband and two children, learned three years ago that she had serious liver damage, a side effect, she believes, of drugs she was once prescribed. She is trying to get on a transplant list, but the clock is ticking; her once slender body has ballooned, and her doctors say her liver could give out at any time.

Mr. Moulton, a self-employed painting contractor, maintains a catastrophic coverage plan for his family, but its high deductibles and unpredictable reimbursements have left them $50,000 in debt. Without better coverage, a transplant could add unthinkable sums.

Two years ago, Ms. Moulton looked into buying more comprehensive coverage through the Washington State Health Insurance Pool, a state-financed program for high-risk patients. She found the premiums unaffordable, but noticed that the state offered subsidies to those with low incomes. As their debts and desperation multiplied, it occurred to Ms. Moulton that divorcing her husband of 17 years would make her eligible for the subsidized coverage.

“I felt like I had done this to us,” she said. “We had worked hard our entire lives, and if this was all the insurance we had, we could become homeless. I just said, ‘You know, we really need to sit down and talk about divorce.’ ”

Mr. Moulton would not consider it — at first. “From a male point of view, you want to be able to fix things, you want to be able to provide,” he said.

“Then you start looking at what things cost and what someone with no assets can get in terms of funding, and you have to start thinking about it.”

The conversations ebbed and flowed with the family’s financial pressures. They talked about the effect on their children and where they might live. They weighed the legal and financial risks against the prospects of bankruptcy.

The debate continued until this summer, when Mr. Moulton’s father offered financial help. “I know we don’t take charity from anyone,” Mr. Moulton told his wife, “but I’m not going to divorce you and I’m not going to let you die.”

Though grateful for the lifeline, the couple remains unsettled by how close they came.

“Nobody should have to make a choice like that,” Ms. Moulton said. “What happened to our country? I don’t remember growing up like this.”

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It’s Official

Unemployment, that is.

Yup, the institution of “higher” learning that’s been paying my rent since 2003 majorly fucked up and had to let go *all* adjunct comp instructors for the spring. Not having a job is bittersweet, though. I’ve been in the vicious circle of wanting to find something else, finding I have no relevant experience for work outside the academy (and not enough education for any gainful work inside), agreeing to teach for fear of uncertainty, and doing little aside from not enjoying teaching. Maybe I’ll finally find something that I enjoy…

In other good news, the feeling I’d attributed to winter time, possible S.A.D., possible depression, teaching, fatigue, and general malaise turns out to likely be magnesium deficiency. Who knew?! The doc said a level as low as mine could cause heart palpitations and muscle weakness. After a couple of doses of magnesium oxide, I already feel better. In hindsight, I had easily describable symptoms–especially the increased heart-rate–but find it endlessly difficult to trust what my body tells me. I immediately blame myself for my symptoms (not enough sleep, not enough vigorous exercise, etc.). Good to know it isn’t always my fault.

Finally, on an entirely unrelated note, yesterday I watched/fell asleep during the worst movie: The Grifters. I found myself asking, time and again, “Is this supposed to be funny?” Well, is it?

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