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Posts Tagged ‘Health Policy’

A psychologist friend once told me that 80% of our lives are filled with duties, things we feel obliged to do, like cleaning the kitchen let’s say. Or visiting a sick friend with a pot of soup. This same doctor told me it’s alright to lower that ratio, to do more of what we really really want to do, and less of all that obligatory stuff. Now that’s a hard pill to swallow for a recovering Catholic school girl, but since our move I figured I’d give it a try.

It’s an age old philosophical question, that may inform some of our political divisiveness today. For instance, Kant wrote about ethical dilemmas that were universally accepted. Is it ever OK to lie? Or, by allowing a society to think that lying (alternative truths) is acceptable, don’t we call everything anyone ever says into question?

It’s the credibility factor, this feeling we Americans have of watching our government implode like an episode of Big Brother or Celebrity Apprentice. For Immanuel Kant (1724-1804), a metaphysical philosopher, morality consists of differing layers of duty:

“…a duty is something that we are obligated to by the Categorical Imperative. In other words, it is something that that we can see as a universal rule for all of humanity necessary for a morally just society.” 

…a perfect duty is one which one must always do and an imperfect duty is a duty which one must not ignore but admits of multiple means of fulfillment. Kant specifies two imperfect duties: the duty of self-improvement and the duty to aid others.

So maybe we could try to get our imperfect duties down to 50% self and 50% others?

For Great Grandma Ada, painting is her time for self-improvement and learning, mixed with friends and fun. For me, the practice of writing weekly, attending workshops and authors’ readings are my ways of self-indulgence. For the Bride, keeping up with her continuing ed credits and practicing yoga to prevent burnout help to improve her life. And for the Love Bug? Well just about everything is about learning these days, but she already told me she loves music class!!

Now when it comes to our “duty” to aid others, this is the divide I’ve noticed in our political life. Since the extreme right Tea Party takeover in the late 90s, there’s been less cooperation in government and more castigation. The whole #MAGA movement held a kernel of truth in its inception. Gone are the days when we were the world leader in democracy. Only Mr T hasn’t really been making us great again, he’s been digging our collective grave.

Few countries look anymore to Trump’s America as a global exemplar, the “city upon a hill” Reagan spoke of in his farewell address to the nation. The German Chancellor Angela Merkel is routinely described as the leader of the free world, the moniker bestowed on the US president since the days of FDR.
The Economist, which trolls Trump almost weekly, has described Chinese President Xi Jinping as the most powerful man in the world. American exceptionalism is now commonly viewed as a negative construct. “Only in America” is a term of derision. http://www.bbc.com/news/world-us-canada-41826022

And partially this fall from grace is due to a new GOP philosophy of individualism – that Ayn Rand sector of old white men. Ronald Reagan wouldn’t recognize it. It’s “all for one” and no one for all. Of course they want to abolish taxes for their richest 1% of donors, and they don’t care about millions losing their health insurance. They’ve become callous pioneers of a myth they’ve sold middle America.

Lately I’ve heard that many of my VA friends, who are self-employed, are losing their Anthem coverage. These people are certainly not impoverished, but they may be if they have to quadruple their health insurance payments. Now they didn’t vote for Mr T, but I wonder what his followers are thinking. It’s funny how the word “entitlement” only applies to others, to “socialists,” until they reach age 65, or have their insurance companies pull the rug out from under them.

If the White House has truly become an “Adult Day Care Center,” we can only hope that Mueller finishes his investigation soon, and that Republicans with a conscience stop quitting politics altogether and step up to the madness before it becomes an existential crisis. I’d like my 5 year old grand daughter to have more days filled with music, and less active shooter drills.

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Today Republicans will be voting on healthcare. Apart from a last ditch effort to blame their inability to “repeal” OR “replace” the ACA on Democrats, at least one Congressman from Texas believes the gridlock is a “repugnant” result of his female colleagues.

“Some of the people that are opposed to this, they’re some female senators from the North East… If it was ‘a guy from south Texas’ who was generating so much discord in the party, I would ask them to settle their differences in a gun fight,”  Blake Farenthold said. One woman senator is from Alaska, but I guess if you count West Virginia with Maine that makes it 2 -1

So it’s High Noon on the Hill?

While it is true that three GOP women profess they will not vote on any bill they haven’t seen or don’t understand, they may also be slightly peeved that they were excluded from the bargaining table in an infamous photo of an all men panel. Or maybe their reticence indicates a deeper truth – that women and children will suffer if Medicaid is cut:

“According to the Kaiser Family Foundation, about half of all births are now paid for by Medicaid, ranging from 72 percent in New Mexico in 2015 to 27 percent in New Hampshire.” Oh, and it also pays for about 62% of all nursing home residents, most of whom are women. So the party who calls itself the party for LIFE, would like to cut the life line of those women most in need of health insurance.

In fact, all their so-called “crisis pregnancy centers” will most likely have to close. The irony of it all…and since Planned Parenthood is under attack, your guess is as good as mine as to where our country will fall on the world’s Maternal Mortality Rates. Oh wait,

U.S. women are more likely to die during childbirth than women in any other developed country, leading the U.S. to be ranked 33rd among 179 countries on the health and well-being of women and children. Women in the U.S. face a 1-in-1,800 risk for maternal death, the worst among the developed nations surveyed in Save the Children’s 16th annual State of the World’s Mothers report http://www.modernhealthcare.com/article/20150506/NEWS/150509941

In 1979 when the Bride was born, the entire hospital bill was $2,600. That included a day in the NICU, which I’d rather not explain since I’m sure that doctor would not like my story. We paid for that bill ourselves because we didn’t have insurance at the time. Due to an ancient and unheard of practice, all my pre-natal visits were free, ie “professional courtesy.” Today, the cost for a C-section (I had a breech birth) is most likely tens of thousands of dollars!

Sen McCain will be returning to vote on some form of a healthcare bill that would affect up to 69 million Medicaid patients – there was an increase in 11 million after the ACA passed. This means 15 million people may lose coverage by 2026. It would have a devastating effect on women, on the elderly and disabled, and patients undergoing opioid addiction services. Is that what the heartland wanted when they elected Mr T? http://www.npr.org/sections/health-shots/2017/06/27/534436521/from-birth-to-death-medicaid-affects-the-lives-of-millions

I’d like to think that just like Gary Cooper, who played the marshal in High Noon, McCain will stand alone and face down evil. He will exhibit compassion by doing the right thing. The producers of the iconic western in 1952 were being pressured by McCarthy’s Red-baiting fears to fire the writer and blacklist Carl Foreman, who was Cooper’s friend. John Wayne was leading the charge against Foreman when Gary Cooper said, “If Foreman goes, Cooper goes.”

“They’re making me run, I’ve never run from anybody before,” Marshal Will Kane said to the neophyte Grace Kelly.

Today is the day to get up and move, to call your senators people. Here are my grandchildren under a wishing tree; what will these senators tell their grandchildren?

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As many of you know, Bob and I have listed our mountain home for sale. Which means when we are not in Nashville, we must vacate the premises periodically for a “showing” to potential buyers. In other words, super-clean the house and pack up Ms Bean for a two hour tour – cue the Gilligan’s Island theme song now!

You might think this is easy.

After all, we have no children in the house; no crumbs, or petrified hot dogs lurking about. A petrified mouse in the basement? Maybe. After all, we are a country house in the forest, with a long gravel driveway and a buried gas tank and a well…sooo, our windows may get dusty but more importantly, our dog gets car sick. Really, really car sick.

The first time we packed Ms Bean up for a ride into town we gave her the Vet’s super-duper anti-nausea pill. It must be given at least two hours ahead of time and costs about $20 per pill. This is the pill she gets for the nine hour ride to TN and the six hour ride to NJ. It lasts about 24 hours and I have to admit can make her a little loopy. We had a great time on the Historic Downtown Mall where dogs are welcome and almost every store is dog-friendly.

The second time a realtor called, we decided to try some people medicine on her, even though the Vet warned us against this tactic. Generic Benadryl costs a nickel for each 25 mg pill. On GoodRx, a coupon site for drugs, it’s half that price; pennies per pill. And its duration would be only four hours, which was more than enough time for someone to walk through our house and find their way down to the river.

It was a hazy, hot and muggy summer day, so we drove just a few miles to a local antique mall. I sheepishly asked the woman at the counter if my dog could come in, or should I leave her with my husband in the car? “She’s a very good dog,” I pleaded. Lucky for us, the woman calculated correctly, that a man sitting with a dog while his wife shops is a Win-Win. Bob was happy and Ms Bean was just fine! There was no foaming at the mouth, Benadryl for the goal!

Yesterday was the third time we had to pack up the dog, and yesterday was the charm. Since the weather was cooperating, dappled sunshine high 70s, we decided to stay in the neighborhood and take her for a walk. And we didn’t medicate her. We drove down the mountain to a development nearby and parked the car. Everything was going according to plan when I thought I saw a bear in the woods. Bean was pulling me hard toward a big black shape stomping through the leaves, but it turned out to be a goat! Mission accomplished. Car-sickness and bear-shaped goats were in our rear-view window.

And Ms Bean was fine! Our little special needs pup experienced no gagging, or foaming, she just curled up and relaxed for the ride.

So in anticipation of more impromptu, realtor-related car trips this summer, I suggested to Bob the idea of a service animal vest for Bean, that would get us out of the heat and into some air conditioning! After researching this a bit, we discovered you can purchase an “emotional support” vest for your dog on Amazon for about a hundred dollars. I mean what dog isn’t an emotional sponge for their owners? Some sites even offer certification, obviously the government hasn’t regulated these things which is why you may see a parrot on your next flight to Disney World.

Still, I’m a basically honest person and it just doesn’t seem right. Instead, I’d like to design a new vest for dogs – the “Shopping Support” vest! I will train my dog to sit and stay when she sees me pick up something I don’t need. If I don’t put it down immediately, she will lay down and not move. A silent protest. I will look down at her, come to my senses, and place the dreaded, overpriced article back on the shelf. This could work for any addiction. A second glass of wine? Walking toward a casino? The OCD dog vest could revolutionize treatment for millions of people.

I wonder if the new Republican Senate Healthcare bill would cover these vests? https://www.theatlantic.com/politics/archive/2017/06/whats-in-the-senate-republican-health-care-bill/531258/

After a long day in the car, Ms Bean rests her weary head on the lookout for rabbits. IMG_0846

 

 

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Now that Bob has retired, we’ve decided it’s time to finally find our dream beach house. Someplace for family reunions, holidays, and maybe even an investment opportunity on AirBnB or VRBO from time to time. The only problem is, what beach?

Of course the island we love is not affordable. So that leaves us with a few options: Outer Banks, too cold; Florida, too predictable (sorry Floridians); Texas Panhandle, nah. Working our way across country, we really loved California, so maybe? But then Hawaii comes to mind.

I was listening to an ER doc from Hawaii on NPR yesterday, he was talking about a new Bill he introduced on the floor of the senate; Josh Green, MD also happens to be a state legislator. After years of practicing Emergency Medicine he said he and his colleagues know by name the homeless people who frequent his ER, and he knows that they suffer from chronic medical conditions that would benefit from simply being off the street. So he proposed a Bill that would give docs the right to prescribe six months of housing, to be supervised by case workers. Treat homelessness as a medical condition. An unusual, intriguing and not a half-bad idea!

A small number of homeless people require a disproportionate amount of medical treatment. According to Green, a recent internal study by a major Hawaiian insurer found that over half of the state’s $2bn Medicaid allotment was consumed by a tiny fraction of users, many of whom are dealing with homelessness, mental illness and substance addiction.

Yet research suggests that healthcare spending for those who have been homeless for long periods and struggle with mental illness and addictions falls by 43% after they have been housed and provided with supportive services. Green said many of the individuals he hopes to house cost the healthcare system an average of $120,000 annually, yet the annual cost to house an individual is $18,000. He thinks that the total savings to the state could be hundreds of millions of dollars a year.  https://www.theguardian.com/us-news/2017/feb/28/hawaii-homeless-housing-bill-healthcare-costs

Surprisingly, just a few days ago, I reconnected with an old friend, a woman who used to be an administrator in Bob’s first ER. After telling me that “Bob and retirement” are two words she never thought she’d hear in the same sentence, she also mentioned that retirement in Hawaii was something she and her husband were thinking about…and for my third coincidental island musing, Hawaii is the first state to file suit against’s Trump’s new “Travel Ban.” Aloha and Mahalo!

For these islanders, the memory of rounding up Japanese citizens after Pearl Harbor is still very real! http://www.bbc.com/news/world-us-canada-39215990

Now I’ve never been to Hawaii, and I hear that each island is different. Maybe it’s time we scheduled a little trip to the Big Island, or one of the medium-sized ones? Of course, our retirement plans may fall apart depending on what the Republicans do to the ACC, and Mr T does to the global economy.

Meanwhile back at home, we’ve been planting some perennials, practicing Hygge, and dreaming of our Purim Princess Warrior!     IMG_0166

 

 

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The bitter cold is back, so I bundled up in my pink pussy hat and gloves. Today was our first day of action as a couple, and Bob and I wanted to stay warm in the wind chill of minus freezing. But first maybe I should back-up.

After the Women’s March on Washington, I was commiserating with Great Grandma Ada about the day. She really wanted to go, but I’m glad she didn’t. Being packed in like sardines for almost eight hours, in a wheelchair, would have been a bit much at 92. Or 82 even. So she listened to my excitement, then calmly told me what her book club was doing about Mr T’s agenda.

She had me Google “Indivisible,”and told me about this movement across the country to basically use the Tea Party’s strategies to further the Progressive agenda and stop Mr T at every turn. You know, the same way they stopped immigration reform in its tracks. This was way before Mr T instituted a Muslim Ban, or kicked the Joint Chiefs out  of the National Security briefings, plugging in his favorite conspiracy theorist, Steve Bannon.

You know the guy, the one who said “Islam is not a religion of peace, it’s a religion of submission.”

Well I submit to you, Bob and I liked what we saw on https://www.indivisibleguide.com so we downloaded the entire manifesto and printed it out. We also joined their Google group; and that’s how we found ourselves sitting in a packed church this past weekend. Bob turned to me and said, “Do I really have to be a revolutionary again?” I said, “Yes!”

Which brings me back to today. I wrote a letter to our GOP Representative, Tom Garrett, about not wanting Congress to throw out the ACA without fixing it, or replacing it. I told him how the Rocker’s old friend had been diagnosed with MS and had no health insurance. Obamacare saved his life. I told him that I knew how local government works, and that health care in this country should not be politicized. We joined a few hundred in front of Mr Garrett’s office, and I hand-delivered my letter to his secretary and spoke with his Outreach Director who declined to come outside..

Meanwhile the Mayor of Cville, Mike Signer, was holding a rally on the Downtown Mall against the latest Travel (Muslim) Ban. The Gold Star father, Mr Khizr Khan was there too, as were hundreds of people to protest the ban on seven primarily Muslim countries. It was a glorious, sunny day when the Mayor proclaimed Charlottesville, VA the “Capital of the Resistance!”

Bob and I just saw ourselves on the local TV news during dinner. I must say that was weird. But I’m proud of our city, the one once called Thomas Jefferson’s Academical Village, and hopeful about the future. We have a real bully in the White House, and he poked the wrong bear.

ps – The Bride and her family marched in Nashville and they are planning on feeding a homeless shelter in April. The Rocker and Ms Cait are planning their wedding, and also visiting LAX. Thank you Grandma Ada, you raised us right.

https://www.theatlantic.com/magazine/archive/2017/03/how-to-build-an-autocracy/513872/

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I have a question I like to ask first time parents: “What’s the most surprising thing you’ve discovered about being a (father or mother)?” When I asked one young dad at a wedding recently, he was stumped for awhile, and admitted no one had ever asked him that question. So he literally asked me to wait while he thought about it; he took his time. His young son was just turning two and he was finishing an MD/PhD program. It was loud and crowded at this reception but eventually he turned to me and said, “His sense of humor!” He never thought he’d be having so much fun laughing at the world with his toddler!

I loved that answer. So we raised our champagne glasses to the new bride and groom, and to laughter!

Well yesterday, after all the amazing speakers and musicians and short films we saw at TEDx, one woman stood out, one woman surprised me. Don’t get me wrong, I had no idea a young man named Kluge, from a formidable Albemarle family, had decided to make dirty water sexy – like the many clean water initiatives throughout the developing world. He started a campaign called “Toilet Hackers” and is determined to make sanitation available to 2.5 billion people. Quite a worthy mission that would impact disease, economic growth and even education world-wide.

But the statistic that surprised me yesterday was 50,000. A beautiful young woman, Dawn Averitt Bridge, walked out on the stage and told us point blank that she had been diagnosed with HIV at the age of 19 in 1988. Normally, this would have been a death sentence, and her doctor told her parents NOT to talk about it or they would risk being ostracized. She managed to qualify for a very early retroviral study, and has devoted her life to fighting the stigma and the spread of this disease. Bridge only teared up when she recounted giving birth to her 2 HIV-free baby girls, and said that tears come every time she talks about that experience. This is her project: http://www.thewellproject.org

With dignity and grace, she urged us all to get tested for HIV, to include testing as a normal part of health screening. Because when we take the stigma out of the disease, when we treat it like any other chronic, blood-born virus, like Hepatitis for example, it loses its power. And the earlier the diagnosis, the better our chance for survival. This made so much sense to me – every year in America 50,000 new cases of HIV infections are reported. Bridge says this is unacceptable. People are taking more risks today, because they are young and think they are invincible, because they think HIV can be controlled now, like any other STD.

And in my opinion, because many states have banned clean needle exchanges for arcane religious reasons – and you know my opinion on mixing ideology with policy…on treating substance abuse as a crime and not a public health epidemic.   http://articles.latimes.com/2013/apr/29/science/la-sci-hiv-screening-20130430

We can distribute nets to halt the spread of malaria in Africa, we can introduce plumbing to the poor in India to stop the spread of dysentery, and in this country we can do one simple thing. We can urge our friends and family to get tested for HIV; and if you don’t want to visit a doctor, you can buy an over-the-counter test at a local pharmacy. Sometimes the most simple intervention, can be the most surprising of all.

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When the news first broke that we’d been spying on some of our closest allies, Grandpa Hudson immediately nailed our collective indignation with this remark, “Skullduggery!” Don’t you just love obtuse and ancient words? I knew immediately I’d have to dig into this Halloween-themed noun which according to the Slang Dictionary comes from an earlier Scottish term, “skullduddery” and means: “deceitful doings; dirty work. :  Without skullduggery, politics wouldn’t be interesting.”

So if the NSA was involved in “tricky behavior” of the “hanky-panky” variety, and we now learn that well, really, everybody’s doing it, spying on each other that is, we can all rest assured that the Bourne  or for that matter, Bond movie machine will live on in perpetuity. I’m just not so sure I can recover from my binge watching yesterday morning of CNN and the public spectacle aka witch’s hunt we now call a “congressional hearing.”

Health and Human Services Secretary Kathleen Sebelius held up rather well under her grueling three+ hours of testimony. Here are some of the low-lights I gleaned from yesterday’s “monkey business.”

A Texas Representative, R- Joe Barton, likened the roll out of the Affordable Care Act to a scene in another classic movie, The Wizard of Oz. Maybe he thought of this because Sebelius had served as the Governor of Kansas or maybe he just likes “hanky-panky.”

“Dorothy at some point in the movie turns to her little dog Toto and says, ‘Toto, we’re not in Kansas anymore.’ Well, Madam Secretary, while you’re from Kansas, we’re not in Kansas anymore. Some might say that we are actually in the ‘Wizard of Oz’ land given the parallel universes we appear to be habitating.”

Another GOP gambit was trying to get Madame Secretary to tell us which health policies covered abortion. A hot mic caught another congresswoman say in a plaintive voice, “Oh, here we go again.” While a NC woman of the right got into a bit of “kerfluffle” over whether single young men should have to buy insurance with maternity coverage saying, “To the best of your knowledge, has a man ever delivered a baby?”

There was more posturing, and posters of college boys doing a keg stand, I’m not sure why; oh yes this “chicanery” lasted well into the lunch hour. Which got me thinking about Niccolo Machiavelli.

“It ought to be remembered that there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new.”

Happy Halloween from one parallel universe to another. I’ll close with a bit of “funny business” from my little trick or treater who adores going to puppet shows in her pachyderm costume! ps the nose is on the hood in back but don’t you just love the Pebbles pony?

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