January 15, 2014

"Life After CPAP" A physician's experience with OSA, e-book available free.

Hi, longtime, no see, DU. I am not writing political journals very much, now that we no longer have our Selected President Bush. I spend my days practicing medicine and writing an occasional piece about health disparities along with a lot of fiction, which is what I prefer to write (when we do not have a Supreme Court coup).

Below is a link to the e-book I Just wrote, "Life After CPAP: A physician's experience with Obstructive Sleep Apnea, the Most Commonly Missed Common Diagnosis in the U.S." I am a family physician working at a large urban public clinic. I also have a Master's Public Health in the area of health education. I wrote this book as first person narrative, because I think that many readers will recognize themselves, and health ed messages are more effective if the target/reader thinks "This applies to me!"

I was disabled for ten years, unable to work as a physician, because it took three years for my doctors to figure out that I had sleep apnea. And they only solved the mystery after my husband (not a doctor) made the diagnosis. It took me several more years to get my OSA under control.

The e-book is free for Kindle for five days, then I will have to start charging for it as per Amazon policy. If you don't have a Kindle and are broke because you can't work because you don't know that you have OSA or can't get it treated without insurance but you do have a computer---which probably applies to everyone here---I can also send a free word document to anyone who e-mails me at McCamyTaylor@earthlink. net. This is intended to be a health resource, not a money making venture. This is NOT a screed against CPAP. CPAP works great in about a quarter to a half of the people with OSA. It didn't work for me---and in the book I spell out exactly why it did not work for me and I go over a lot of other treatment options that work. I have done research (physician surveys) about why primary care doctors are so bad at diagnosing sleep disorders. I have a few suggestions for how we can improve our doctors' diagnostic skills. Most of them involved increased public awareness--which is another reason I have written this. This book is also an attempt to make the initial diagnosis easier, because if you don't know you have sleep apnea, you will go around chasing your tail treating all the complications. Sleep apnea is now a particular area of interest of mine in practice, since so many of the disabled uninsured that we see got that way because when they had insurance, their doctors did not notice that they had a sleep disorder, and the complications of untreated sleep apnea got them fired. If they had only known about their health condition, they could have kept their jobs by getting treatment and taking advantage of special laws that protect the disabled until their OSA improved. I also see a lot of people who qualify for Social Security disability but who keep getting turned down, because they do not know that they have OSA--a condition which the government considers disabling if it is severe enough. If you get Social Security, you (eventually) get Medicare--and then you get treatment and get back to being your own self and maybe even back to work, the way that I did.

If you have fibromyalgia, migraine headaches, hard to control BP, ED, nocturnal angina and mini-strokes, depression that does not respond to medication, poor driving skills, memory loss, over 40 sudden onset "ADD" and doctors can not tell you what is wrong with you, there is a very high chance that you have an undiagnosed sleep disorder. OSA--obstructive sleep apnea--is the most common of these.



http://www.amazon.com/Life-After-CPAP-Physicians-Obstructive-ebook/dp/B00HUISHVE/ref=sr_1_13?ie=UTF8&qid=1389806861&sr=8-13&keywords=McCamy+Taylor

October 26, 2013

The Tea Party's Big FU to Its Middle Class Base

When the Tea Party decreed that no self respecting red state would be caught dead expanding Medicaid, its middle class base agreed. Poor folks don't deserve to be coddled. Poor people are poor because God hates them and He wants them to suffer. The Tea Party's middle class base was not about to spend any of its heard earned tax dollars paying for mammograms and blood pressure medications for people who were better off seeking (uncompensated) care at the local ER for metastatic cancer or massive stroke. Anyone who dares to draw a breath while poor deserves what he or she reaps.

Well, now the Tea Party has taken things one step further. It has decreed that none of its wealthiest members' hard earned tax dollars should be spent paying for the middle class's mammograms or blood pressure medications. According to the fat cats who finance and run the Tea Party, Middle Class America is better off seeking (uncompensated) care in the ER for its own metastatic cancer and massive stroke. Any middle class American who dares to draw a breath while middle class deserves what he or she gets.

Sound far fetched? Here is the link:

http://www.latimes.com/nation/la-na-healthcare-glitch-20131025,0,5402697.story#axzz2iruzq3cu

In case you can't read the link, the same lawyer who denied the poor health care in red states is now attempting the deny the middle class health care, too. He is arguing that anyone who signs up on one of the federal exchanges (as opposed to a state exchange) is not eligible for federal subsidies. And many states do not have their own exchange. Many Red states.

Who, you ask, is this lawyer who seems intent upon giving the Tea Party's Middle Class base the big Kiss Off? Meet Michael Carvin:

http://www.jonesday.com/macarvin/#

Mike Carvin focuses on constitutional, appellate, civil rights, and civil litigation against the federal government. He has argued numerous cases in the United States Supreme Court and in virtually every federal appeals court. These cases include the recent constitutional challenge to the Affordable Care Act and the decisions invalidating Sarbanes-Oxley's accounting board, preventing the Justice Department from obtaining monetary relief against the tobacco industry under RICO, overturning the federal government's plan to statistically adjust the census, limiting the Justice Department's ability to create "majority-minority" districts, and upholding Proposition 209's ban on racial preferences in California.

Mike was one of the lead lawyers, and argued before the Florida Supreme Court, on behalf of George W. Bush in the 2000 election Florida recount controversy. He also has represented state governments, financial institutions, telecommunications, and energy companies in "takings," First Amendment, civil rights, and statutory challenges to federal government actions.

Which states will get the shaft? Here is a map:

http://www.commonwealthfund.org/Maps-and-Data/State-Exchange-Map.aspx

Everyone in a dark green state---relax. You are getting federally subsidized health care. If you have a big family and your wife stays home meaning that you have to live off a single $50-$60 k income---you know, traditional right wing Christian family values---in a Blue state like New York or California, your kids will have health insurance next year. You wife will be able to get a biopsy of that breast lump. They will catch the cancer early. She will have a lump-ectomy and survive to raise your kids into adulthood. Your blood pressure will be controlled and you will not leave your kids orphaned due to a massive stroke.

If you live in one of the light green states where the feds and states are running exchanges together--keep your ears open. Or better yet, contact an elected official and suggest that they relabel their exchange "state run". Blue state officials in places like Illinois and Michigan may listen to your pleas.

Now, check out this map:

http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/10/eligibility-for-assistance-and-projected-changes-in-coverage-und.html

This one is important. Note that in those states that have chosen to exclude the poor, a relatively small number of people stand to benefit from the health care law. These are the working class. Working stiffs. Working stiffs in states where working stiffs tend to vote Red, because the GOP knows that they are better than Black folks and Poor White trash and Hispanics.

Oh, sorry. Did I say that working class voters in Red states stand to benefit. I meant to say they stood to benefit.

Listen up you 30-40% of folks in the South who thought that you would be getting insurance while the Black folks on the other side of the track and the poor White Trash in the trailer parks and the Hispanics who work at the mill would have to do without----you are not going to like this. You don't get insurance either. Not unless you are willing to fork over the entire premium yourself. Now, if you have lupus or a bad heart, I am sure that you will find a way to make that premium payment. But if your health has been good up until now, ask yourself, which is more important? Making the car payment or buying insurance without any subsidy? And if only the people who are sick sick sick sign up in your state, you know what that is going to do to health insurance premiums in your state, don't you?

And the best part? If you don't spend ten thousand dollars out of your own pocket for insurance, you get to pay a $1000 fine. Like Christmas in April!

So, kiss your hopes of health insurance goodbye, working folks in Texas, Alabama, Mississippi, Georgia, Florida etc. You will have the unique privilege of paying for health insurance for all the folks who live in Blue states---and traitorous Red states like Kentucky--- while you will get nothing. Jesus will be so proud of you! You are almost assured admittance to Heaven--where you will be heading a little bit earlier than planned thanks to that metastatic cancer and that massive stroke.

March 8, 2013

Prepare to Cry.

We all know that lack of access to health care has condemned millions of children and adults in this country to jail. Kids whose parents can not afford to get them inpatient treatment for diseases like schizophrenia and bipolar disorder are told to have the courts declare them truant or unruly. Once they are locked up, the families are told, their child will be eligible for "free" mental health. They hear the same story when it comes to a suicidal brother or aunt or neighbor. "Let the criminal justice system take care of it."

We all know that the mental health services offered to these people while in custody are poor. Sometimes, there is no mental health care at all. Getting any type of medical care while in prison requires a clear head and perseverance. If you are a bright prisoner with a bad heart, you can probably get your state penitentiary to refer you to a cardiologist by threatening to sue them if they do not. But if you are not even sure who you are or where you are or what is wrong with you, then you can never hope to jump through the hoops the criminal justice system will set between you and the medical care you need.

We all know this. But a story at ABC allows us to feel what it is like to be mentally ill in a country that is more willing to incarcerate than it is to offer medical treatment.

Stephen Slevin, 59, was depressed in 2005 when he decided to drive across the country, with no particular goal or destination in mind, his lawyer Matt Coyte told ABCNews.com. After being pulled over in Dona Ana County, N.M., on Aug. 24 2005, Slevin was arrested on aggravated DWI charges, and for driving a vehicle that he did not own. He was brought into the Dona Ana County Detention Center.

From there, his long nightmare began.

"To find out what happened was difficult," Coyte said. "His mental health was so compromised from his time in jail, he had very little memory of his stay there."

http://abcnews.go.com/US/prisoner-left-solitary-years-receives-155m-settlement/story?id=18677197

Jail officials, recognizing that the patient suffered from mental illness, decided that looking him up in solitary for two years would be an adequate treatment. He was allowed access to mental health treatment for a couple of weeks in those two years, immediately got better---and then was forced back into solitary as he was awaiting his trial.

You caught that last part, right. He was awaiting trial. He was never convicted of anything. Prosecutors decided not to press charges, because he was not fit to stand trial. But he was considered fit to spend two years locked in a box where his mental status and health deteriorated.

This story does not have a happy ending. While he got a $15 million settlement, he is now dying of lung cancer. Would that cancer have been caught early enough to treat if he has not sent two years locked in a box? Probably not. The US denies all health care, not just mental health care to its uninsured citizens. But maybe his last few years of life would have been better if he could have seen a psychiatrist and gotten treatment rather than seeing a policeman and getting solitary confinement instead.

March 3, 2013

How Citizens United Encourages Corporations to Break the Law Like Enron

Surprise, Surprise, Sheldon Adelson's lawyers just admitted what we have known all along. His company used illegal bribes to get its Macau casino built.

http://www.nytimes.com/2013/03/03/business/in-filing-casino-operator-admits-likely-violation-of-an-antibribery-law.html?hp

Last year, Adelson spent a measly $60 million of his $25 billion fortune attempting to unseat Obama and install a Republican---any Republican in the White House. In retrospect, it probably seemed like a good deal to him and his accountants. Remember what happen to Siemens? They settled their foreign bribery case for $1.34 billion. A gambling man, Adelson must have reasoned that $60 million spent to save $1 billion was a good bet. And though he lost the crap shoot, chances are if he had it to do over again---the bribes, the campaign donations--- he would. Because the Supreme Court has made it very profitable to ignore federal law.

Imagine what would have happened to Enron if Citizens United was already the law of the land in 2000. Ken Lay, Karl Rove and Antonin Scalia managed to get Bush selected. Their party controlled the House. However, the GOP had only a razor thin margin of the control in the Senate, and they lost that when one Republican turned Independent. Because the Senate was in Democratic hands, the bill which the House wrote and the White House endorsed to give Enron a huge infusion of taxpayer money in the wake of 9-11 was not passed. Enron's house of cards collapsed, much like the war that was lost for the want of a horseshoe nail in the nursery rhyme. Had Ken Lay been free to spend sixty million dollars shoring up the Senate in 2000, he would still be the head of the world's "biggest" company---

That is what Citizen United is all about. Giving corporate criminals like Ken Lay the ability to buy elections so that their crimes go unpunished and their debts get paid by you and me. The Supreme Court ruled the way they did in Citizens United because five of the Justices never, ever want to see any of their rich business buddies dragged through the mud again. Jail is for poor folks and minorities. The rich are different. If they sin, they buy a papal pardon. If they break the law, they buy a politician and get a bailout. It is the Neo Conservative American Way.

January 31, 2013

Kids of the Working Poor to Remain Uninsured Under "Health Care Reform"

Looks like the working poor just got screwed again. A portion of the new law which was supposed to limit the out of pocket for a family's employer sponsored insurance to less that 9.5% (a huge chunk if you are skating on the edge of poverty) is now being interpreted by the IRS as limiting the family's out of pocket to 9.5% of the income for the worker's insurance only. This is a big win/win for both health insurers (who like to insure workers, because, hey, they are healthy enough to work, so there can't be much wrong with them) and employers (who want their employees to get well as fast as possible so they can get back to work). However, it means that if your employer offers family coverage that will eat up 20% of your paycheck and you think you can't live off 80% of what you used to bring home, the government is not going to help your spouse or kids get insurance. In some cases, it will mean that the kids will no longer be eligible for SCHIP--meaning that the new law is costing them insurance.

The IRS has graciously decided not to charge the children of the working poor a penalty for being unable to afford insurance. Aw, how sweet of them.

At the risk of offending administration supporters, I smell a big, fat carrot/rat. As in health care is still being used as a carrot to get voters to the polls. The working poor (whose kids will be unable to get check ups, get asthma treatment etc.) will be told "It isn't our fault. Our hands are tied. Congress has to fix this loophole in the law. But the Republican House won't."

Which begs the question, if the IRS can unilaterally decide not to tax the kids who can not afford insurance, why can't the IRS decide that the 9.5% was supposed to cover both workers and their kids?

30 million people will remain uninsured in 2016---and many of them will be children. Stop playing politics with the health of our kids! Declare a national healthcare emergency, open Medicare up to all children. Then stand back and watch how quickly the privates drop their rates for coverage of children.

http://www.nytimes.com/2013/01/31/us/politics/irs-to-base-insurance-affordability-on-single-coverage.html?ref=health

December 17, 2012

Damaged Medicare

Damaged Care was the term for the problems that arose from Managed Care, the experiment during the 1990s in which health insurance companies took all comers regardless of pre-existing conditions and then found novel---and sometimes unethical ways---to get the sickest folks off their insurance plans. Their number one way to retroactively cherry pick was to pay doctors to limit care. When the doctors did not limit care enough, the HMOs penalized doctors for prescribing necessary care. They did this in such a way that doctors who cared for the sickest members of our society were forced off the HMOs--taking their costly patients with them. Since poverty and minority status are linked to poor health, the patients affected were often poor, sick minorities and the doctors who served them. Managed Care was a huge disaster---and it fell out of favor. Now, it is just a bad memory for most.

However, in an attempt to control rising Medicare costs, the nation's managed Medicare plans---aka Medicare Advantage plans---and the federal government are embarking upon a "new" payment policy for physicians that is just Damaged Care all over again. In the very near future, if you are on Medicare, your doctor will receive bonus payments if you 1) have well controlled diabetes 2) fill all your medication prescriptions 3) do not have to go back to the hospital soon after being discharged among other things. If you are a patient who can not control your diabetes because you also take steroids for your life threatening asthma, your doctor will face a financial penalty. If you are a patient who can not afford to fill your prescriptions because you are too poor, your doctor will face a financial penalty. If you are a patient with a disease like congestive heart failure, inoperable coronary artery disease, cancer, multiple sclerosis and you are in and out of the hospital, your doctor will....

You get the picture.

Financial incentive and penalty plans like this are only fair if all doctors have the same relative proportion of "well" to "sick" Medicare patients. As a family physician, I can tell you with absolute confidence that each doctor has a different type of practice. The primary care doctor whose patients are wealthy retirees who hang out at the country club stands to make even more money from this system. The family doctor who has a lot of poor, minority and rural patients and the family doctor who specializes in taking care of those with chronic severe illness will find his already low Medicare reimbursements cut.

What does this mean for patients? If you are one of the lucky ones who retires because you can afford to, not because your health gave out, and you live in an affluent part of town and have transportation, you will have no trouble finding a primary care doctor. If you stopped working because of illness, or if you live in a minority or poor or rural community, or if you can not drive and so you have to find a doctor whose office is on the bus line, you will find very few doctors taking new Medicare patients.

"Managed Medicare" is in its embryo stage. It may not turn out as badly as Managed Care (HMOs). The federal government may realize that instead of promoting disease prevention, it encourages family doctors to cherry pick the healthy and turn away the poor and sick. However, the worst care scenario is 1) traditional Medicare drops the bonus/incentive plan while 2) private Medicare keeps the bonus/incentive plan (under guise of encouraging disease prevention). If this happens, all the sickest geriatrics in the country will be on the federally funded program, while the privates will reap a windfall as they collect premiums for folks who don't need care----

And Medicare costs will rise rather than falling.

(This thread also posted in Health/Chronic Illness)

December 17, 2012

Damaged Medicare

Damaged Care was the term for the problems that arose from Managed Care, the experiment during the 1990s in which health insurance companies took all comers regardless of pre-existing conditions and then found novel---and sometimes unethical ways---to get the sickest folks off their insurance plans. Their number one way to retroactively cherry pick was to pay doctors to limit care. When the doctors did not limit care enough, the HMOs penalized doctors for prescribing necessary care. They did this in such a way that doctors who cared for the sickest members of our society were forced off the HMOs--taking their costly patients with them. Since poverty and minority status are linked to poor health, the patients affected were often poor, sick minorities and the doctors who served them. Managed Care was a huge disaster---and it fell out of favor. Now, it is just a bad memory for most.

However, in an attempt to control rising Medicare costs, the nation's managed Medicare plans---aka Medicare Advantage plans---and the federal government are embarking upon a "new" payment policy for physicians that is just Damaged Care all over again. In the very near future, if you are on Medicare, your doctor will receive bonus payments if you 1) have well controlled diabetes 2) fill all your medication prescriptions 3) do not have to go back to the hospital soon after being discharged among other things. If you are a patient who can not control your diabetes because you also take steroids for your life threatening asthma, your doctor will face a financial penalty. If you are a patient who can not afford to fill your prescriptions because you are too poor, your doctor will face a financial penalty. If you are a patient with a disease like congestive heart failure, inoperable coronary artery disease, cancer, multiple sclerosis and you are in and out of the hospital, your doctor will....

You get the picture.

Financial incentive and penalty plans like this are only fair if all doctors have the same relative proportion of "well" to "sick" Medicare patients. As a family physician, I can tell you with absolute confidence that each doctor has a different type of practice. The primary care doctor whose patients are wealthy retirees who hang out at the country club stands to make even more money from this system. The family doctor who has a lot of poor, minority and rural patients and the family doctor who specializes in taking care of those with chronic severe illness will find his already low Medicare reimbursements cut.

What does this mean for patients? If you are one of the lucky ones who retires because you can afford to, not because your health gave out, and you live in an affluent part of town and have transportation, you will have no trouble finding a primary care doctor. If you stopped working because of illness, or if you live in a minority or poor or rural community, or if you can not drive and so you have to find a doctor whose office is on the bus line, you will find very few doctors taking new Medicare patients.

"Managed Medicare" is in its embryo stage. It may not turn out as badly as Managed Care (HMOs). The federal government may realize that instead of promoting disease prevention, it encourages family doctors to cherry pick the healthy and turn away the poor and sick. However, the worst care scenario is 1) traditional Medicare drops the bonus/incentive plan while 2) private Medicare keeps the bonus/incentive plan (under guise of encouraging disease prevention). If this happens, all the sickest geriatrics in the country will be on the federally funded program, while the privates will reap a windfall as they collect premiums for folks who don't need care----

And Medicare costs will rise rather than falling.

November 23, 2012

The Fallacy of Cutting Public Health Funds to "Save Money"

Question: Why does the United States spend twice as much per person on health care as any other industrialized nation but achieve results on par with Mexico?

Answer: Because we refuse to invest in disease prevention, aka public health.

So, what do Republicans want to trim from the federal budget? Public health spending. Even though public health dollars pay for themselves many times over in reduced disease, time off work, disability and health care costs. And, if the press is to be believed, the Democrats are willing to negotiate on this part of health care reform in order to insure as many people as possible.

http://tpmdc.talkingpointsmemo.com/2012/11/the-three-most-likely-obamacare-cuts.php?ref=fpa

Why the short-sightedness? Votes. The GOP hopes to gather the votes of the already insured who will be happy to vote for the party that "reined in Obama-care." The Democrats hope to gather in the votes of the newly insured.

Part of the problem is folks do not always know what "public health" does for them. Public health keeps your water clean so that you don't have to worry about cholera, a big killer in the old days in urban areas. Public health wiped out small pox and has virtually wiped out polio, rabies, tetanus and a bunch of other old time killers from industrialized nations. When you invest pennies to pay for mosquito curtains to prevent malaria deaths, you are investing in public health. Pap smears have helped doctors reduce the rate of cervical cancer, a big killer in the 19th century. Back in the 19th century, one out of three of us would die of tuberculosis, too. And syphilis was the number one reason people were put into insane asylums.

If you want to know what "public health" is doing for you now, check out any war-torn or natural disaster ravaged country. Want to live like the folks in Haiti post earthquake? Eliminate all public health spending.

Under W. public health took a beating. Dollars that should have been spent on things like raising the levees in New Orleans (flood control is also part of public health) were spent instead getting tiny towns in the middle of no-where ready for an Al Qaeda "dirty bomb" terrorist attack that was never, ever going to come. We have had one Al Qaeda attack on U.S. soil. We have many hurricanes every year in this country. For several years before Katrina, those in the public health profession were talking about the risks of flooding in that city. Did the federal government listen? No.

Certain industries would also prefer that the U.S. reduce its public health spending. The biggest preventable cause of illness and death is tobacco use. Eliminate smoking and the nation's health care spending would fall dramatically. But that would also make R. J. Reynold's profits fall. Overeating is causing an epidemic of obesity, sleep apnea, degenerative arthritis----resulting in massive spending on knee and hip replacements, cardiac surgery, medications and obesity surgery. Simply tackling America's taste for sugary beverages would save a ton of money---and help us live longer, healthier lives. But the fast food industry does not want that.

And, sadly, portions of the medical industrial complex want us to "just say no" to disease prevention. I am referring to drug companies, the manufacturers of prosthetic joints, hospitals with big ICUs and surgical suites. Their ideal economy is one like we have now----lots of disease, lots of insurance to pay for treating that disease.

One of the essential functions of the government is to pool tax dollars and figure out ways to spend them that provide a benefit for everyone at low cost. Money invested in public health helps everyone---the rich have no special immunity to cholera---at pennies to the dollar of the cost of a hospital. Make that pennies to the thousands of dollars of the cost of a hospital.

So, please, don't sacrifice our nature's health and economy for a short term political gain. If we don't do something now to make people healthier, in a few years we will see a small number of healthy young workers supporting a huge number of retired/disabled middle aged and elderly Americans. And that is going to hurt much worse than any vaccine.

November 7, 2012

Can We Get a Time Out from T & A?

Today we have 20 women coming to the U.S. Senate. We have a female Secretary of State---the third one in this country. There are eight other women in the cabinet including the Secretary of the Department of Homeland Security. There are two women on the Supreme Court. Women have been to space. Women perform cardiothoracic surgery. And yesterday, the Fort Worth Star Telegram had a feature in the Life and Art’s Section asked “Which will be the first lady of fashion?”

http://www.star-telegram.com/2012/11/02/4384227/who-will-be-the-first-lady-of.html

Mama mia!

Before I comment on the article, a word about “Life” and “Living” sections of local newspapers. When I was a girl back in the 1960’s, these were the “Women’s” sections. Then, someone realized that women do more than cook and buy clothes and change diapers. They invest in the stock market (the business section), they bet on football (the sports section). They even---have mercy!---vote (local and national news). So, newspapers changed their “Women’s” sections to something more gender neutral to reflect changing times. Too bad they did not change the way they look at women.

From Dolley Madison's ostrich-feather turbans to Jackie Kennedy's French-designed dresses, first ladies have long taken a leadership role in matters of national style…(O)nly one woman can hang her coat in the White House closet. Here's how we cast our votes for election-season fashion.

Dear Mary! Did we learn nothing from Eleanor Roosevelt? Were we asleep during Bill and Hillary? How far have we regressed that we judge the wives of presidential candidates on their ornamental value?

I grumbled over the article then dismissed it. I had more important things to think about, namely the election which would determine the health of my nation. And the patients in my office, who needed diagnoses and prescriptions and referrals. And my latest short story. And bird feeders that needed filling. And cats that needed feeding.

But today, as I was at the gym trying to improve my cardiovascular fitness, I got another look at the way America looks at women. The television in the changing room was tuned to Dr. Phil. He was advocating for a young woman who insisted that she could not be a good mother to her five children without breast implants and a tummy tuck. Her husband disagreed. The husband was shot down. It is, according to Dr. Phil, perfectly normal for an American woman to want to spend tens of thousands of dollars stuffing saline filled sacks under her breasts and having someone chop out a piece of her abdomen so that she can feel good about herself.

Idiocracy is not the future. It is now. And, according to the entertainment media, every woman is still just a piece of Ass (you know, the award winning movie within the movie), no matter how she spends her days.

November 7, 2012

Yeah! Now, On to 2014 and Healthcare Reform

Right now Karl Rove is telling his Super Pac Pals that it will all be different in 2014. Without Obama on the ballot, minority turnout will be low and angry white male voter turnout will be through the roof. He is promising them the Senate and maybe even hinting at Brother Jeb in 2016 to turn it all around for the party he crashed.

But we Democrats know better. In 2014, millions of Americans who have been priced out of the health insurance market---or have had the door slammed firmly in their faces due to “pre-existing conditions” or “age”---will be able to afford health insurance. States that have stubbornly refused to create their own pools will find their citizens offered insurance choices by the federal government.
One of these could be Medicaid, which will be expanded. Medicaid may be a good choice for those on fixed incomes, since it typically has no deductibles, low copayments and good (i.e. 100%) drug coverage. Now that Social Security income will no longer be counted towards determining Medicaid eligibility, lots of disabled people who are being nickeled and dimed---or $100ed and $1000ed--- by their Medicare copayments may get relief. Some states have indicated that they will resist the Medicaid expansion. However, this will mean turning away lots of federal money, at a time when many states are strapped for cash. Medicaid pays for such popular items as nursing homes and prenatal care. Does the Tea Party have the guts to paint itself as the enemy of the elderly and pregnant women? I don’t think so. I expect to see the red states hold out their hands and say “Gimme!” the way they always do, since what blue states give in increased productivity and taxes, red stakes taketh.

For those making too much to qualify for Medicaid, there will be private insurance plans which will no longer be able to discriminate against those with risk factors for disease or medical conditions. Why the change of heart at United and BlueCross? The private insurance industry is salivating at the thought of collecting premiums from healthy 20 something men who never get sick. They hope that the tax penalty for those who are uninsured will persuade lots of healthy people to sign up. The Tea Party is hoping that the tax penalty will get the angry white male voting block so riled up that they will turn out in record numbers in 2014. My advice? The IRS should “slow walk” the penalty part of the law. Give folks a two or three year grace period to look around and find the insurance that is right for them. This will force the private insurers to write affordable policies that will attract the cherries they want to pick. This will encourage more folks to become insured. And, it will remove the sting from the law, so that in 2016, Affordable Care will be win/win for the Democrats.

Using its executive powers, the Obama administration and HHS should be able to overcome any GOP roadblock. As a last resort, offer Americans the same insurance that federal employees get. Or, better yet, tackle the health care crisis by announcing open enrollment in Medicare. An “emergency” is anything the administration says it is. And millions of Americans dying needlessly through lack of health insurance is the biggest ongoing crisis we face---much worse in scale than any hurricane or any terrorist attack. It is moral crisis, that tests our nation’s vow to stand together. It is an economic crisis which strains hospital emergency rooms, decimates the work force and increases disability.

The GOP claims that Affordable Care is a job killer, but I think we will see the exact opposite. Folks who used to look for jobs with big companies, because they needed the insurance, will now be able to work for small businesses. Or even start up their own small businesses. Small businesses are the big employers in this nation---and they are unlikely to move to China. Strengthen small businesses and you increase jobs.

Healthcare spending is also a job creator. Not quite the job creator that education spending is, but much, much better than military spending and tax cuts and about equal to infrastructure spending.

This election was a huge crap shoot for the Tea Party and its corporate backers. I have no idea how much money Karl Rove wasted, but I hear that $150 million was spent for Romney in the last three weeks alone, so I am guessing a couple of billion went down the toilet. Why are the Koch Brothers of the world so determined to strike down Affordable Care? Because they get rich by keeping American workers poor, uneducated, sick and desperate. If your choices are Dixie Cup or the poor house, you will, reluctantly, choose Dixie Cup. But who will slave in a Dixie Cup factory when she or he can get a skilled job with better wages and benefits? No one.