Fear, Loathing and ObamaCare

I am sitting at a table surrounded by women, nibbling on a brownie.  Tonight is "Ladies Night Out".  It began with a gorgeous antipasto plate with asparagus wrapped in black forest Ham, prosciutto, pepperoni, Kalamata Olives and artichoke hearts.  Next was meatball & spinach soup.  My waistband started to feel a little tight once I had ingested the Raviolis and some form of sausage/meatball with sauce.  And of course wine:  Pinot Grigio with the Antipasto, and Coppola Merlot with the saucy dishes.  I am replete.  I sigh, contented and laughing as the hostess describes being caught unawares while attending to private business in the head (bathroom to you landlubbers) of her boyfriend's sailboat.  All was fine, until the boat sharply heeled and all of a sudden all the screws on the toilet popped off.  Surprise!  Too much information!

Somehow, the conversation turns Medical Care in the United States.  I state that 75% of bankruptcies in the U.S. are Medical Bankruptcies (I was wrong it's 60% or 3 out of every 5).  And inevitably...it comes up...Obamacare.  I swear it wasn't me!  Paula, the 60+ cook extraordinaire who cooked everything except the Tirramasou, states, "Even Nancy Pelosi said that they didn't know what was in the law when they passed it.  How can it help anybody if they don't know what's in it."

"They know now," I say.  "There's websites for it, just google The Affordable Health Care Act."  Everybody rolls their eyes and groans.  

"Like you can get through it."  says Paula.

"No really."  I say.  "When I was canvassing for the Democratic Party this last fall, I had people attacking me about 'ObamaCare'.  I was able to get down the pertinent facts on 2 index cards back to back (I was wrong, it was 3)."

"Yeah, but how small was your writing?"  laughs Vicky.

"I had to use a magnifying glass," I laugh, "And then if anybody threatened me, I was going to tear them into small strips and swallow them."  We all laugh.

Unfortunately, we are unable to keep on laughing.  Two of the attendees are students, one of them has a small child.  The hostess works 3 jobs, but is covered by her ex-husband's Tri-Care insurance.  I am on disability and receive Medicare, Brenda and her husband are also on Medicare.  The two students are mad, angry, steaming and afraid.  They're sure that they're going to have to pay the penalty fee for not buying health insurance that they can't afford.  "The fee is only $95."  I say.  They're sure I'm lying.  I encourage them to read the website.

Tricia, the student with a child pipes up "UPS is going to lay off a lot of their employees because they can't afford   Obama Care."  she states.  She is really angry.  

"I find that very hard to believe."  I say.  "I have friends who work for UPS and they have always provided excellent benefits.  I can't imagine Obamacare asking them to provide more than they're already giving.  I'd be interested in reading that article."  

The party starts breaking up.  Tricia is going outside to say good-bye to Brenda and the other student.  "I know you just think I'm a stupid student," she says, " but I've read the Healthcare Act and I'm going to get screwed."  

I'm aghast.  I feel terrible that she thinks that's what I think of her.  "I don't think you're stupid at all," I say, "just misinformed and scared."

I am frustrated.  The two students are the very people that "ObamaCare" is intended to insure, those who don't qualify for Medicaid, CHIPs or Medicare.  These are the two that are the most angry and the most sure that they are going to have to pay the penalty/fee for non-insurance.  

Tricia comes back in.  We start drinking Cherry Daiquiris and telling silly stories.  We laugh.  Tricia is still talking to me.  When I leave,  I hug everybody, including Tricia, good-bye.

Throughout the discussion, I kept encouraging everyone to go to the official government website which is: 
www.healthcare.gov/law/timeline/index.html  "There are so many lies out there." I say.  "Don't let them terrify you with lies, ascertain the facts."  I encourage you, the reader to do the same.

Most Prevalent Lies

• "UPS is going to lay off a large part of their workforce because they can't afford to provide the insurance at the level that ObamaCare requires."  UPS is not laying anybody off because of ObamaCare.  They're not cutting health insurance.  What they are doing is no longer providing insurance for employee's spouses who are employed and already covered by their own employer's insurance.  This is a cost-saving move that a number of companies have already been implementing far prior to ObamaCare.  UPS, for whatever reason, is saying that the implementation is required because of ObamaCare and the expected increased in health expenses.  (Steven Greenhouse,  The New York Times, Business Day, August 21, 2013)
• "Obama Care is going to establish death panels and choose who receives expensive life-saving medical interventions."  Boards/Panels are going to be formed that having nothing to do with choosing who lives and who dies.  These "panels"  will be made up of appointees consisting of health care practitioners, medical experts, and consumers to identify procedures and interventions that engage in "Best Practice" techniques and procedures which improve patient outcomes, increase efficiency and reduce costs.  They will make these "Best Practices" known to all health care facilities and practitioners.
• "I am going to have to pay a fine because I can't afford health insurance."  The Affordable Health Care Act is designed for those people who could not previously afford Health Care Insurance and did not qualify for Medicaid or Medicare.  Expansion of Medicaid and CHIP will cover a lot more people who previously did not qualify.  If you live in a state that has chosen not to expand Medicaid and you would have been covered, you will not be penalized.  Between Medicaid expansion and the Health Care Exchanges, most previously uninsured people will be covered.  If you still cannot qualify for Medicaid and can't afford Health Care Insurance, you will be exempt from the penalties.  The Fine is 1% of yearly income or $95/yr, $47.50/per child but no more than $285.00 per family.  This is only for people who CAN AFFORD INSURANCE BUT CHOOSE NOT TO.  In addition, they must pay for all their own health care.
•  "Congress isn't going to participate in ObamaCare."  As part of the AHCA, members of congress will be getting health insurance through the Marketplace (Health Insurance Exchange) in 2014.  This is part of the law itself.

 If you do not qualify for Medicaid, Medicare, CHIPS and are not covered by your employer's insurance, or can't afford your employer's insurance, you can purchase your health care insurance on the exchange starting October 1, 2013.  Coverage is required January 1, 2014.  Enrollment for Health Insurance closes March 31, 2014.  Additionally,   in early July, the White House and the Treasury Department announced a one-year delay in a major Obamacare provision that would have required employers with at least 50 full-time workers to provide health insurance or pay a penalty beginning in 2014.  Employees that would have been covered under this provision are exempted from the penalties.  They can also purchase health insurance on the Marketplace if they wish or can afford to.

I have provided that information from my 3 index cards on "ObamaCare" below.  It is taken from the website listed above.  Since we're in CyberSpace, you won't even have to tear up the cards and eat them should naysayers challenge you.  You can just refer them to the same website. 

In Place Now

• 50% Discount for name-brand drugs in Medicare Donut Hole - some coverage for generic drugs
• Expands coverage of parental insurance for dependants to 26 yrs.
• Small business tax credits
• Increases matching Federal funds for Medicaid (The 14 states that are not participating in the expansion are:  Alabama, Georgia, Idaho, Iowa, Louisiana, Maine, Mississippi, North Carolina,Oklahoma,Pennsylvania, South Carolina, South Dakota, Texas and Wisconsin. The 11 states that have not officially declared their intentions are: Alaska, Indiana, Kansas, Kentucky, Nebraska, New York, Tennessee, Utah, Virginia, West Virginia and Wyoming.)
  
  • $250.00 rebate for Seniors in Medicare Donut Hole
  • Changes in Medicare, Medicaid billing has recovered more than $2.5 billion in fraudulent charges
  • Expands coverage for early retirees
  • Online Consumer Info.
  • Preventive Services Covered:   16 for Adults, 22 for Women/Pregnant Women, 27 for children  
  • Prohibits Insurance Companies from Rescinding Coverage
  • Provides for Appeals & External Reviews
  • Eliminates Lifetime Limits
  • Regulates Annual Limits
  • Insurance companies have to justify premium increases of more than 10%  to qualify for $250 million in new grants and participation in Affordable Insurance Exchange 2014.
  • Increased availability of Primary Care Workforce
  • Federal Grants for Consumer Assistance Programs
  • $15 Billion for prevention and Public Health Programs
  • New funding for constructing and expanding community Health Centers
  • Increased payments to rural health care providers
  • Free Preventive Care under Medicare
  • Employer Insurance must spend at least 85% of profit on health care services, 80% for Individual plans, or refund difference to policy holders.  I received such a refund a year ago.
  • Eliminates discrepancies between Original Medicare and Medicare Advantage to $1000 more per individual.
  • Tests new methods to increase quality and decrease growth in costs
  • Community Care Transition Programs, coordinates care, connects patients to community services, and avoids unnecessary re admissions.
  • Individual Advisory Board decreases costs, increases health outcomes, and increase access to high-quality care by submitting proposals to Congress and the President.  This is the supposed Death Panel.
  • More home and Community based services for the Disabled through Medicaid rather than Nursing Homes
  • Provides Physician incentives to coordinate patient care, increases quality of care, prevents disease and illness and decreases hospital admissions.
  • Decreases disparities due to race, ethnicity and language
  • Provides Cash benefits to adults who  become disabled
  • Decreases paperwork and Administrative Costs starting 10/1/12
  • Starting 10/1/12 link payment to quality outcomes
  • Increases preventive coverage to  state Medicaid programs
  • Increases Medicaid payment for Primary Care Doctors
  • Bundles payment to deliver healthcare more efficiently and increase quality of care in Medicare.
  • Expands funding for CHIP to 10/1/13
  
  
  Starting January 1, 2014
  •  Establishes Affordable Insurance Exchanges
  • The Individual is required to buy Basic Health Insurance or pay a fee.  If affordable coverage is not available they are exempt from requirement to buy insurance.  If you are insured, receive Medicare, Medicaid, CHIPS, are covered by Tri-Care or are a member of a federally recognized Tribe, you will not be assessed a fee.
  • Workers who cannot afford employer coverage can take employer funds to purchase a more affordable plan from the Insurance Exchange.
  • Raises Income Requirement for Medicaid to $14,000 for the individual, to $29,000 for a family of 4, 100% federal funding for the first three years to 90% after 2013.
  • Advanceable tax credits for income between 100% and 400% of poverty line for those ineligible for affordable coverage.  This credit is advanceable and can be applied immediately so that it lowers the monthly premium payment and you don't have to wait until taxes are filed in order to receive it.
  • Members of Congress will be getting their health insurance through the market place.
  • Eliminates Annual Limits
  • Ensures coverage for individuals in clinical trials
  • Ensures coverage for individuals with pre-existing conditions
  Starting January 1, 2015
  • Businesses employing more than 50 persons required to provide affordable health care coverage to employees
  • Payments linked to quality of care, not volume.

   
  Admittedly, this is not perfect.  It does not address inequities in billing nor the outrageous costs of Medical Care in this country, but it does try to address access to medical care, inequities in access and delivery and continuity of care.  If all we do is gnash our teeth and tear our hair or refuse to do anything because the proposed changes are not perfect, nothing will ever change.  A journey of a thousand miles starts with the first step.
   
  Namaste'
   
  Kismet  

   Copyright August 2013

Sometimes Life is NOT the Schizz

I am lying in bed.  I'm trying to sleep, but my body has other ideas.  When I lie down, my neck tenses up.  My shoulders tighten, rising up to my ears; a commuter in pain.  My neck feels as if it is enduring the French Revolution.  I am being guillotened over and over again;  a ring of sharp pain.  What is supposed to be a position of relaxation, is a position of torture, of pain.  I struggle to keep my eyes closed.  "Sleep."  I tell myself.  "Breathe, in/out.  Relax."  I lie still.   I become aware of a burning, a pain centered in my knees.  Fire ants on a rampage. They throw a lifeline to the pain in my neck.  It becomes unbearable.  If I were alone and not in bed with my husband, I would be curled up in a fetal position; a knotted mess, rocking back and forth, crying.  In pain.  In tears.  My body burns with pain.  Shoulders tight, onfire.   Forearms singing.  I sit up.

Because I am a mess, I cannot remember what I should be doing.  My stomach growls.  Empty.  I sit on the edge of the bed.  What's next?  "Stand up!" my brain shouts to my body.  I stand.  I am at a loss.  I am standing, at the edge of a world with possibilties, but I cannot think of what comes next.  I am upright; a stanchion against gravity.  I sway.  "Walk!"  says my brain.  "Hungry!'   says my stomach.  "Full!" says my bladder.  "Bathroom" thinks my brain.  I am stiff.  I am the farmer's horse, going to market; hobbledy, hoy.  Hobbledy hoy!  I have reached the bathroom. "What's next?"  we all ask.   Slowly from somewhere, "Pee!"  I sit.  I relieve myself.  Fortunately, movement is programmed in my muscles.  I complete all the necessary hygienic tasks of urinating.  I stand, lost in front of the wash basin.  "Wash your hands."  whispers my brain.   I wash.  I dry.  I stand in front of my towels.  I lean my head forward, against the towel racks trying to plumb my brain for the next step.  "Ah!  Breakfast!" shouts my stomach.  Slowly, I collect the ingredients for an omelet.  I write myself notes:  breakfast, meds, clothes.  Otherwise, I am lost, adrift in an ocean of forgetten intentions.  Circling, always circling.  Moving, but not forward.

I sit.  I eat.  I read.  I breathe.  Thank God there is ONE thing I can do without thinking about it.  I sigh.  No ambition, no knowledge, no thinking.  I just am.  Living, breathing, sitting on the couch.  This is all I can do right now.  All I can be.  I am.  If I am me, it is a grace from God.

I close my eyes.  "Maybe tomorrow will be a better day,"  I think.  The bits and pieces of me are in hiding.  I sigh.  I know that with rest, with energy, I can be myself.  I can do more than just survive.  But for right now, it is all I can do, all I can be.  I just exist.  Me on the couch.  Breathing.  Existing.  Tomorrow WILL be a better day.  Maybe tomorrow, I can LIVE!  But for today, I just survive.  I am alive...but barely.

Namaste.

Kismet

Copyright August 2013

Why "Big Government" and Regulation are the Only Idea

The Tea Party and many Conservatives speak of the evils of Big Government.  They espouse the virtues of Free Enterprise and eschew regulation as stifling economic growth and financial independence.

I have lived in a country that would be called Third World.  They have a minimalist government supported mostly by Financial Aid from Developed Countries.  There is iffy infrastructure.  Things that are considered necessities by Americans, are luxuries in third world countries.  Life is shorter, harder, more dangerous.  Education is not free and conducted in crowded classrooms in temperature extremes with no heating, cooling and often no electricity.  Anybody who has served in any capacity in the Peace Corps, deployed to Iraq or Afghanistan with the military, with NGO's in third world or developing nations, will recognize that what Americans take for granted are not present in much of the world.  These are things that are present and paid for by our taxes and often present only because of regulations which are in place in large part to protect the public and consumer.

Let us walk through a day which is only possible because of "Big Government", taxation and regulation.

The alarm rings.  The electricity is consistent because of oversight by the Public Utilities Commission.  You sigh and put your feet down on the fire retardant rug which is mandated by manufacturing requirements.  The infrastructure of your house is safe and sound, lead free due to manufacturing regulations and oversight by government entities.  If there should be a natural disaster, you will receive support and funds if the Government declares it a Federal Disaster.  You will be able to rebuild if you have purchased Federally sponsored Insurance (both guaranteed by taxation and regulation.)

You stagger to the bathroom and drink out of the faucet.  The pipes from the water treatment plant are built and maintained by taxes.  You can safely drink the water out of the faucet because of minimal standards and regulation by both state and federal entities.  If you've traveled in anywhere outside of the U.S., Canada, the UK and Europe, you know that you NEVER drink the water.  In fact you don't even eat fruits or vegetables because they have been watered with untreated and unsafe water.  You know that there are still places in the United States where clean water is not available and has to be hauled many miles in large tanks on the backs of pick-ups.  You put on make-up and lotion that will not sicken you because it is manufactured under regulations and testing deeming it safe for human use and consumption.  You eat food that has been prepared, grown, cleaned, packaged in settings that are examined regularly for minimal cleanliness and health requirements.  If you have allergies, you can check the labels for ingredients because that food product requires full disclosure of the ingredients as well as allergies.  You know that the factory/processing plant is regularly inspected for cleanliness and safe handling techniques.  You gently strap your infant into the car seat that is required by State Law and manufactured under minimal "regulated requirements", and buckle your school age children into their seat belts.   You get in your vehicle and fasten your seat belt.  The car has been engineered and crash tested to meet Federally Mandated Requirements.  You have a seat belt and air bags because of this.  If you were born before 1975, you remember when cars didn't even have seat belts.  You drive down the road paid for by fuel taxes, cleaned and plowed by City, County, State and Federal Funds.  The street lights (provided by city, state and federal taxes) light the way.  You are thankful for road reflectors (State and Federal regulation) this rainy morning guiding the way to the Day Care Center.  You place your infant in the hands of a licensed and trained caregiver/teacher in a licensed facility.  You drop off your school age children at their school (city, state, federal taxes.)  You are confident that the teachers are qualified (state and federal regulations) as you know that a teaching degree is required and obtained at Private or Public Universities (fully or partially supported by tax dollars.)  Curriculum is mandated and regulated by the State.  You wish perhaps that educational requirements were more consistent state to state, recalling when you taught that children from California are notoriously a full year behind in educational training.  As you get out of your car, you take a big breath and murmur thanks for air is much cleaner and clearer than you  remembered as a child before Minimal Air Standards were put into place.  You remember the year in your childhood when the river caught fire because of the pollutants and manufacturing wastes.  The river now has fish in it due to reclamation through the Environmental Protection Agency.

You catch lunch at a restaurant that is regularly inspected by Health Officials where employees are required to wash their hands between customers and after bathroom visits.  You note the fire exits which are required by law and must be labelled and easily identified.  You ponder the tragedy of the textile workers trapped in the factory fire in Bangladesh.  You watch the news that there is a collapse of a shopping mall constructed with inferior building materials and no oversight in some remote country in Asia.  You can eat your lunch safe in the knowledge that your food has been inspected and prepared to Public Health Standards.

You stop by the Human Resources office back at work to arrange for your Family Medical Leave during your anticipated Pregnancy Leave; secure in the knowledge that you will have a job to return to following the birth of your anticipated child.  After work, you visit your Obstetrician at the Women's Health Center that is supported partially by state and Federal Funds.  You are seen by a Licensed Physician who received his training at a Medical School adhering to guidelines established by Federal and State regulation and overseen by the American Medical Association.  You are thankful for the medical insurance now required by the Affordable Healthcare Act.

On the way home to pick up your children, you stop by the Public Library (city taxes) to pick up a movie, a CD and a couple of books for yourself and the kids.  You make a mental note to download that new bestseller from the library (state funds) onto your e-reader.  At home you pick up the mail in the mailbox (federal taxes).  You think fondly back to last summer and lazy summer evenings spent mosquito and weed free (county weed and mosquito management).

Every part of your day and life benefits from licensing requirements,regulations and tax-supported funding.  You have benefited from all of these if you have ever:

• visited a city, state or National Park
• Hiked on a trail in the National Forest
• bought a car (protected by the lemon law)
• fished in a stream protected from manufacturing waste and run-off
• boated in a public waterway
• hunted on public or private lands
• attended public or private schools
• gone to the emergency room
• served in the military, Peace Corps, UN, USAID
• bought or worn clothing manufactured in the U.S.
• purachased any of a variety of consumer products that are regulated for safety
• you are protected as a consumer from faulty or defective products by regulation
• are injured on the job (workmans compensation), federally state funded Vocational Rehabilitation
• worked anywhere covered by the Occupational Safety and Health Administration
• taken medication (FDA oversight/regulation)
• ridden on Amtrak or commuter trains
• flown on an airplane (minimal safety requirements, Federally Paid Air Traffic Controllers)

You feel safe in the community in which you live because of their well-trained police force and Fire Fighting personnel (city taxes/bonds).

You have only to look in the Blue Pages of the phone book to have impressed upon you the variety and scope of services which are part of local, state and federal government and supported by your tax dollars.  When you retire or if you become disabled you will receive Social Security Benefits and Medicare.  If you become destitute you know that you can apply for SNAP(food stamps) and TANF (Temporary Assistance for Needy Families) if you have children.

There are myriad services that we utilize everyday which we consider essential and are there under the auspices of "government".  Our food, water, air, houses, hospitals, consumer products are safer and functional because of regulation.  So take a moment to allow yourself to imagine what life would be like without these "necessities".  Which regulations would you rescind.  Which service supported by our taxes would you eliminate?