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Posts Tagged ‘Obamacare’

This is a morality tale. It’s about trust and medicine and more.

This morning I was trying to figure out what’s happening with Morning Joe? Mika looks mad all the time, and Joe is always elsewhere, thankfully in a split screen from time to time with his audio turned off. When I heard this health writer talk about the rule of 7. He heard a drug rep say that it usually takes 7 visits, face to face, with a doctor in his/her office, before said doctor will trust them…in other words they need to be able to talk about their kids’ soccer games so that the rep can pitch his reasons for prescribing their high priced drug over another. At least that was what I inferred from his use of the word “trust.”

This was an aside, they were talking about the low polling numbers for Obamacare at the moment, but of course Joe had to complain about doctors in general on their iPhones while dealing with patients. About not listening to their patients, about young doctors not looking them in the eyes. Fear and loathing in medicine, that’s the GOP war cry. But let’s extrapolate. If you need to see someone 7 times before they can trust you, maybe a patient also needs to see their doctor 7 times before the patient can trust the doctor?

I didn’t want to write about this, but my MIL Ada thinks I should. She is a lively, active octogenarian. She is still working as a marriage counselor, and traveling the world, but she’s been feeling tired lately, getting leg cramps, and hates to complain. Let it be said, when Ada visits us it’s a whirlwind of activity and her home is usually teeming with friends “dropping by.” So her base level for “tired” may mean she only had one big event this weekend so she decided to clean the refrigerator and invite people over for a pool party. But a recent doctor visit had her worried, her liver enzymes looked high.

So Ada gathered all her drugs in a basket, and went to her pharmacist for a look-see. It turns out, she was double-dosing on a cholesterol medicine. Her internist had taken her off the name brand Lipitor, and prescribed a generic, only Lipitor kept getting refilled right alongside the same exact drug in its generic name!

This, her trusty second opinion doctor/son Bob told her, accounts for the liver problem and her tiredness. And, Bob told her, he sees this ALL THE TIME in the ER. Elderly patients on a cornucopia of drugs complaining of symptoms that to a trained acute care specialist look like drug interactions…and so in ERs all across the country, doctors and nurses are sifting through a patient’s drug record right alongside caring for trauma and stroke and heart attack patients.

I’ve learned that doctors rarely “write” prescriptions anymore – they are emailed to a pharmacy. So where did this system fail my Mother-in-Law? Was Lipitor taken off the doctor’s list of drugs, or did the pharmacist, or pharmacy tech who read the new email Rx just add the generic without thinking? How many other patients are suffering?

Technology is supposed to add fail-safe measures to health care, but how do you build “trust” with a machine? Maybe, just maybe talking and listening to a patient is more important. Here is Great Grandmother Ada, with her “little” doctor.

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No, I’m not referring to the Presidential debate last night. In fact, I’d just as soon forget it.

Kabuki theatre at its best, stylized and predictable; one character claims the other’s ideas as his own, while the other looks down and then lectures the audience. The problem is, running a country isn’t like performing in a play. Leadership depends on character and commitment. We Dems know who to believe, we know who we can trust. The GOP also thinks they have the man for the job. The guy who thinks of healthcare as an entitlement program, and 47% of American citizens as freeloaders.

“What’s the difference between ignorance and apathy? I don’t know and I don’t care.”

The point that rattled me in the debate was when the topic turned to healthcare. Listening to Mitt, one might think he did a splendid job in MA, crossing the aisle and actually “working” with Dems to get his version of affordable care passed. You know that version, the almost identical one to Obamacare, which thanks very much for not meaning any disrespect by using the term…which was the point at which I really started wondering who was in Mitt’s body. Shapeshifters beware, this guy is a natural, he even takes on Big Bird.

Mitt said Obamacare has, “…killed jobs,” and what he would do is “…craft a plan at the state level that fits the needs of the state.” Sirens started going off in my head, state’s rights and all. OK, so introducing all those little ultrasound bills, and TRAP regulations are just fine with him. What’s really fine with Mitt is taking us back to a clear, third-party payer system – getting government out of the doctor’s office and back into the hands of the health insurance industry with everybody making lots of money. Never mind that every other G8 country has a form of universal health care in place for its citizens, Mitt knows that we Americans take care of our poor.

Remember when Mitt said on “60 Minutes” that we Americans don’t let people die in their apartments – we call the ambulance? http://www.huffingtonpost.com/mike-watson/in-ultimate-display-of-ig_b_1910259.html Emergency Rooms (or Departments, as Bob calls them) are his plan of last resort for fixing the problem of the uninsured. Under EMTALA law http://www.acep.org/content.aspx?id=25936 anyone who presents to an ER must be seen, whether they can pay or not. This was one of those smack yourself in the head moments. Mitt thinks it’s perfectly OK to pass those costs on to taxpayers, who presumably can afford medical insurance, but just barely because those costs are skyrocketing…because we have so many uninsured people who cost hospitals and ERs 4-5 digits worth of care per visit, that gets passed onto taxpayers…and the Catch 22 continues.

Listen carefully over the next few weeks. Listen to their debates in the context of what they have said before, so you can see beyond the Kabuki make-up. And while I was going to talk about the weather, and how one day you’re wearing flip flops, and the next you’re wearing a fleece jacket, I seem to have gotten off track. “It’s not good being poor.”

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“Nothing and no one goes unchanged.” If I wanted to write my life story through a music score, this R&B classic would feature prominently. There was a time in my life when this song played non-stop in my car’s tape deck. Written by Benard Ighner in 1974, it was first performed by Quincy Jones, then later in 1977 brilliantly, of course, by George Benson. I most likely was driving through tears over some broken promise – very Dustin Hoffman rushing over the Golden Gate to rescue his lost love.

The biggest recession I’ve lived through was that 70’s show. Post-college and divorce, I filled out the application to be a stewardess for TWA (remember them). My older sister, Kay, was a Lipstick Feminist – flying for National Airlines in the 60’s when she had to ‘make weight’ and could not be married with children. My French was good and I thought I had half-a-chance for an international dream job. But TWA was laying off its pilots and instituted a hiring freeze. People were lining up for gas by the order of numbers in their license plates…that was a pretty bleak time. The Vietnam War was ending, and OPEC decided to quadruple gas prices. It was called “stagflation,” because it was a long period of time (1973-75, and some would argue until 1980) when high unemployment coincided with high inflation. The jobless rate peaked at 9%.

If we compare that time to this prolonged recession, it’s not fair to compare job growth. According to most economists, that number is a “…lagging indicator, which reflects economic conditions in the past rather than pointing to future growth.” Supposedly we’ve come out of a recession in 2009, though you couldn’t tell by most personal narratives. And now we’re heading into a “double-dip” or off the “fiscal cliff!” http://www.huffingtonpost.com/2012/05/23/fiscal-cliff-recession-government-action-cbo_n_1537692.html And here’s the quote that hits home:

“$1.2 trillion in across-the-board reductions in spending on federal programs would begin to phase in as a result of Congress’ failure late last year to find a comprehensive deal to cut the budget deficit.” One point two TRILLION!

What kind of job did I get back then? I took a job that was funded by a government grant. There was a need for mental health day treatment centers when the flood gates opened from ancient, closing mental institutions. Patients were being returned to their communities, patients who had no idea how to function in society after so many years of institutionalization. And I was hired to actually drive a mini-bus and pick them up from their group homes, and design group activities for them in a an entry-level social work position. Less glamorous than flying to Paris, driving through hallucinations in Pequannock, NJ. But it gave me a start when I thought all was lost.

So go ahead and blame Obamacare if you must. Keep trying to repeal it, try 33 more times to vote for selfishness, and corporate greed. Waste another 50 Million taxpayer dollars. http://www.huffingtonpost.com/2012/07/11/health-care-law-repeal_n_1666917.html?ncid=edlinkusaolp00000009 We all know what has to change, and it’s this intransigent Tea Party Congress.

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We’re heading into triple digit territory today. I watered the garden and all my pots, caught a couple of Japanese beetles chewing away on a basil plant, and heard all about the beautiful red fox that was strolling up our hill while Bob was showering. Today is a day to stay home, in the air conditioning, and finish putting napkins away and chairs in their usual spots. To finish reassembling the house, post-party. And to celebrate the SCOTUS decision upholding almost all the principles of the Affordable Care Act.

Why was I nearly crying while listening to Nancy Pelosi talk about Teddy Kennedy? Why did I take this so personally? It’s hard to say. The drunk driver who hit the Flapper head-on in 1949 when I was a baby had no car insurance, it wasn’t mandated back then. And I always thought the analogy for the High Court was more like auto insurance and less like broccoli. Now if a small percentage of the nearly 50 million who are uninsured in this country fail to get health insurance, they will be taxed. OK, and the problem is? Part of being a citizen of these United States is paying your taxes, and did we have a choice when Bush marched us into Iraq? And hearing Mitt talk about not wanting government to come “between you and your doctor,” made me laugh. Don’t the Republicans want exactly that, to mandate ultrasounds and building codes/requlations for out-patient surgeries? To tell doctors they must document a patient’s record in a certain way, to make sure that each patient has been offered the chance to see and listen to a small heartbeat?

It’s Etch a Sketch time again; Govenor Mitt really wanted the individual mandate in MA, but Candidate Mitt wants us to think it’s the end of the world. In fact, for women this is just the beginning since they represent 19 million of the uninsured today. “Up to 10.3 million of the low-income among them will now be covered by Medicaid by 2014 when the law goes into full effect.” http://www.forbes.com/sites/brycecovert/2012/06/28/obamacare-decision-why-women-are-the-big-winners-health-care-supreme-court/
I have to imagine that maybe I would not have been raised by foster parents if our family had not lost everything after my father’s unsuccessful brain surgery and death. If my mother had her extensive physical rehabilitation covered after the accident in our Year of Living Dangerously. And to think that over 60 years later, a devastating diagnosis or an accident could still result in bankruptcy for American families. The rest of the civilized world had some form of universal health care for their citizens by the end of WWII. Maybe that’s why I was crying.

President Obama said yesterday that the ruling was “…a victory for the country, (people would not need to)…hang their fortunes on chance, or fear financial ruin if they became sick.” I truly hope the GOP leadership has some cooler heads going forward, because Mitt, you were right. We don’t want government coming between us and our doctors, just us and our insurance companies. Like the fact that Anthem recently partnered with CVS, what’s that all about? Shouldn’t the FTC look into this? But who am I? I only pay taxes!

Thank you Justice Roberts, for doing the right and proper thing. Thank you for really valuing the American family, in all its myriad forms. I knew that after Gore vs Bush and Citizen’s United you began to see the forest through those tea party trees.

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