Why I am a Democrat

Social Security, National Labor Relations Act (right to collective bargaining and strike), Fair Labor Standards Act (maximum work hours, minimum wage, no child labor), Equal Pay Act of 1963, Civil Rights Act, Voting Rights Act, Head Start, Medicare, Medicaid, National Endowment for the Arts, Clean Air Act, Endangered Species Preservation Act, Fair Housing Act, Supplemental Nutritional Assistance Program (includes WIC, School Lunch, Food Stamps, Meals on Wheels) Federal Emergency Management Agency, Title IX, Lilly Ledbetter Fair Pay Act, Affordable Care Act----

The list goes on and on.

Democrats fought for these rights. I am where I am, because a lot of Democrats in the past were not willing to put up with the status quo, and I want my grandkids to have it as least as good as I have had it, and I hope they have it better.

"I'm a Medicare Patient. Please Don't Hate Me!"

Those who aren't on Medicare might be surprised to discover that it is next to impossible for some folks on the insurance program to find a doctor. If you are a healthy, wealthy senior, you should have no problem. You'll be able to afford traditional Medicare with a traditional Medicare supplement--those will open many doors, especially if you live in an urban area with lots of providers. Or, you can hire one of the concierge doctors, who sign up to treat a handful of people. If you are wealthy enough, you can even go outside Medicare altogether and pay cash---though most rich people that I know are very tight with their money and will try anything before they resort to this one.

However, if you are an extremely sick Medicare patient and/or you are poor---sickness and poverty often go hand in hand in this country---you may find that there are no doctors willing to accept the extremely meager reimbursement that your Medicare so called managed care insurance pays them for coordinating your very complicated and time consuming care. You may find that the only place you can get an appointment is at the local "free" clinic or charity hospital, which is required by law to accept all comers. And you may find that even here, you are not wanted, since most of the poorly paid, overwhelmed physicians would rather see 40 somethings with allergies than spend an hour wading through your medical records, coordinating your care with your cardiologist (heart failure and CAD with Afib on Coumadin), your gastroenterologist (GI bleeding controlled by double dose Nexium), your endocrinologist (severe osteoporosis) and psychiatrist (a whole handful of medications). Did I mention your breast cancer? It's in remission. And your kidneys shut down whenever you get pneumonia which is every winter. Your insurance keeps changing its formulary so you keep running out of the medications that keep you alive, so your doctor's nurse or your doctor spend hours on the phone every month changing your meds or appealing a denial of coverage from your insurer which is doing its best to drive you off its Medicare managed plan and on to its competitor's Medicare managed plan.

Why did you sign up for a Medicare managed care plan if it is so yucky? Because it was the only one you could afford. You are poor. And sick. You really need to use your insurance. Deductibles will kill you. So you chose the plan with the least out of pocket, not realizing that it is also the plan that throws up the most barriers to care in the form of limited reimbursement for providers and limited treatment options---

Does that even make any sense?

Our nation is at war with sick people. Correction, the private insurance industry which makes a bet that it will take in more in premiums than it pays out in claims is at war with sick people. And somehow, the private insurance industry did not just get itself a seat at the table of Affordable Care and Medicare and Medicaid. In some places, it is the table. And the chairs it has reserved for the chronically ill are the ricketiest, flimsiest chairs it could find, and it has its employees stationed behind the chronically ill ready to pull those chairs out from under them at any moment. And pretty soon, private insurance is going to take a chunk out of the VA----the VA's funding, that is. Not the VA's work load. Have you seen Tricare rates?

Where was I? Oh yes. I was vomiting blood into the toilet, because my insurer decided to stop paying for my ulcer drug this month on a Friday and it is Sunday and my doctor won't be in until Monday to change my prescription. I should stop my blood thinner, but if I do that, I'll have a stroke. Here. Let me wipe the blood off my lips. I'm lucky to have a doctor. I waited nine months to get my appointment at the county clinic. No private doctor in my community will accept new patients on my Medicare plan. I had been getting my "care" from the emergency rooms, which can not turn anyone away, but they were getting tired of seeing me. I worry that my doctor has so many patients like me and keeps getting more and more. It is getting hard to schedule an appointment with him. He is booked out two months in advance. My old family doctor, from the days when I was young and healthy, could get you in that same day or at least that same week. And everyone in the waiting room looks like me---prematurely aged, tired, tied to an oxygen cannister and a walker with a huge bag of medicine. Just going through all those drugs must take 15 minutes. Most doctors are in and out of the room in 15 minutes seeing an "average" patient---

Oops. There goes the stomach again. I think I've lost enough blood that the ER doctor won't think I'm a hypochondriac for coming in by ambulance. When the clerk asks for my insurance info, I'll hand her my Medicare card. In the old days, that used to mean you were insured. Now it means that the doctor will groan and think about how little he will be paid for how much he will have to do.

Please, don't hate me, because I am a Medicare patient.

P.S. Edited so that I can remind folks at DU that I'm a doctor and my health is great. This is me sharing some of the things I know my patients would tell you if they could afford a computer and internet access.

In the 2008 primary, Hillary was called....A Suggestion for a Compromise on a Certain Word

In the 2008 primary, Hillary was called bitch, witch, cold, calculating, dyke, lesbian, domineering, pimp, Sybil, Nixonian, Bushian, Monster....

....and c**t. By members of her own party. In her own primary.

I will not bother reminding us which self described liberals and Democratic leaning journalists and writers used these words. You probably remember and if you don't, you can Google it. That is the context for our current discussion of what is being called, euphemistically the "C word." Because, back in 2008, every time some journalist or writer got in trouble for developing a case of potty mouth, the left wing rushed to his or her defense with a great big round of "It's Hillary's fault! She did it! She's using her magic powers/Mafia connections/laser-beam eyes to 'crib death' dissent!"

And that is just plain silly.

It is also dirty politics. Because Hillary is not a witch. She does not have the power to make an MSNBC reporter call her a "pimp" so that she can get him suspended. If the MSNBC reporter decides to call her a pimp so that he can get suspended so that Hillary's detractors can blame her, then she becomes the victim twice over. She does not have the power to make another woman call her a "c**t" so that she can lose her job so that Democrats can revile Hillary for censoring free speech.

Calling Hillary names was only half the game back in 2008. The other half was waiting for the inevitable public outrage over the names chosen---and then ascribing the inevitable outrage/backlash/censorship to Hillary herself, in order to feed the Big Lie that Hillary was an All Powerful Domineering Witch Mafia Godmother who Had Laser-Beam Eyes. And I don't think we want to see that little ploy used again, do we?

If you find yourself getting all hot and bothered at the thought of Hillary taking away your right to free speech, maybe you should take a step backwards and look at the matter in a larger context. In 2008, how many of you would have demanded the right to call presidential candidate Obama a certain other word that begins with the letter N? How many of you would have called the Republican Presidential Candidate Herman Cain the so called N word in 2012? How many of you are convinced that Blacks have suffered but that women have not? How many of you have read Angela Davis's book "Women, Race and Class"? Anyone who answered "No" to that last question is excused to go to Amazon to buy a copy. I'll wait.

You've finished the book? It was good, wasn't it? Ok, here is my suggestion. The so called C word can be used at DU in an abstract sense and to describe an imaginary person and in reference to a part of the female anatomy but not in reference to an actual person----except yourself. I reserve the right to call myself anything I want. When in doubt, ask yourself "Would I use the N word here?" So, for instance, in a post about sociology, you might talk about language and use certain words in order to study them, not to wound---that would be ok. But you do not call Eva Braun a C word. You call her the mistress of a mass murderer. You do not call Ann Coulter a C word. You call her a talentless right wing gender traitor hack.

"(Word With Sexual Connotation) Random Word": What do you think?

Everybody is talking about &quot Word With Sexual Connotation) Random Word". It's a hot topic of conversation on political blogs at the moment. Some of the chat rooms are getting a little bit steamy. On one side there are those who feel that they are being violated. On the other, are those who believe that the Constitution protects all forms of expression, even those of a sexual or deviant nature.

"I mean, adult's have a choice, right?" wrote one anonymous poster. "They can log off."

"It's getting to be a real pain in the ass," posted another. "It's hard to find a decent political discussion these days with everybody going on and on about '(Word with sexual connotation) Random Word'. "

Wrote another "What is '(Word with sexual connotation) Random Word'? Does that even make any sense? Why am I writing about it? Why am I thinking about it? What made me click on this thread? Is there an alien somewhere controlling my mind? I hope he's not going to anal probe me."

Bush/Cheney Were "Entitled" to Their Lives, Now They're Not "Entitled" to Care

Dear Senator Sessions;

When Ex-President Select Bush and His VP Cheney and their SOS Powell got on television and lied about the threat posed by Saddam's WMDs, they called up U.S. military reservists and shipped them off to the Iraqi desert to serve for two or three years of duty at a time. Five thousand men and women lost their lives---for what? So that the U.S. could achieve oil independence? Yes, I read Project for a New American Century. I know that the Bush administration was hustled into office with a secret plan to invade Iraq---and Iran if they could have gotten away with it. I know that Bush-Cheney felt "entitled" to squander the lives of our service men and women, because Bush was Commander-in-Chimp---sorry, Chief , and he thought it was fun to be a wartime president and wear an orange flight suit. The men and women in the Reserves had made a commitment to be there when their country needed them, and though the "need" was questionable, they went.

Now the troops are home. Now, they have post traumatic stress disorder. Now they have chronic pain and disability from injuries. Now they have high blood pressure and heart problems from the physical and mental stress. Now, it is time for the country to honor its commitment. This time, the need isn't questionable.

And yet, you say that you don't think we should fund another "entitlement"? Senator, the next time the nation is really, truly under attack, do you think that you and your state are entitled to U.S. military protection? Do you think that U.S. servicemen and women should be prepared to die or risk disability to protect you and yours? Because, right now, you act as if you do not think that you will ever need to be protected from anything. You act as if the U.S. military is optional---something we can do without. And if that is what you really think, then I propose that we start trimming the fat from the Pentagon budget by closing the five military bases in Alabama. It isn't as if you think that you will ever need them. They are just pork, right?

Poor, Sick…and in Pain

Recently, two very nice physicians that I know said essentially the same thing…

“People who are extremely poor are not good candidates for pain treatment with opiates. They will be tempted to sell their medication.”

Both doctors work with the uninsured and chronically ill. Neither is a monster. Both would be considered compassionate. Neither saw anything objectionable about the comment. To them, it was a simple fact. A person who is poor and needs money for rent or food will obviously consider selling drugs illegally. Obviously. And therefore, a prudent doctor will not give that person the chance to become a prescription drug dealer, no matter how severe the person’s pain. It is the doctor’s obligation to the public, to help fight the rising tide of prescription drug abuse. By assuming that every poor person is a drug dealer until that person proves herself worthy of the doctor’s trust.

I think I may have to ask my husband to build me a wall, so that I have something to bang my head against at times like these.

Before you tell me that our state needs a patient’s bill of rights guaranteeing them the right to pain relief, I must tell you that we already have one. However, doctors exercise their clinical judgment. If they believe that a patient is malingering, they do not treat their symptoms. If they believe that treatment will cause more harm than good, they do not treat. And while doctors are warned against being paternalist, paternalism is the middle name of many physicians—even the women.

By the way, “Trust” is one of the core values that most medical institutions (claim to) embrace. So is “Mutual Respect.” Usually those are right up there at the top. “I will protect you from becoming a criminal” is not typically one of the core values, though certainly no doctor wants to contribute to a patient’s incarceration. That’s why we warn them not to drive under the influence of certain sedating medications like antihistamines and pain pills.

A person who is too poor to eat will do a lot of things. He or she might, conceivably, pawn or sell their possessions, including their medication. But the Viagra that a man receives free of charge from the manufacturer as part of a patient assistance program of the uninsured can be sold just as easily as hydrocodone---and no one has ever said to me “The poor should not be on Viagra. They might sell it.” The albuterol inhalers that they get at the public health clinic pharmacy could probably fetch $15 or $20 on the streets since they cost about $45 at the pharmacy. Birth control pills, hormone replacement therapy, antibiotics, non-benzodiazepine psychiatric drugs---some of which cost up to $20 a pill---all have a “street value”. So, why the rush to deny the poor treatment for their pain? Why do some doctors seem so proud of the fact that they are protecting their poor patients from the temptation of having a bottle of hydrocodone at hand?

The doctors who are reading this will say “It’s the DEA’s fault. The docs are afraid of being audited and shut down.” But, at a public institution for the uninsured, practitioners seldom get in trouble for doing too much for their patients. They are much more likely to be censured for doing too little. Witness the VA scandal.

I have some theories. But I am still puzzled. After all the efforts in recent years to increase physicians awareness of patients right to pain treatment---it is actually on the list of most Patients Bill of Rights that you see posted---why would two seasoned doctors assume that every poor person is a potential drug dealer? I am sure that they have met a few drug dealers. I have a sneaking suspicion that they did not recognize the drug dealers who were white, middle class, conservatively dressed, polite, well educated. And that they may have harbored some false suspicions about others whose only crime was being Black or unkempt (it’s hard to stay groomed when you live in a car) or in need of mental health services that were not available. Because if you enter an examination room with a preconceived notion---like everyone in a “free” clinic is a malingerer who is here to feed his drug habit or get some product to sell—that is what you are going to see.

On the other hand, if you take a step back and consider how that person came to the “free” clinic, if you remember that he once had a job and once had insurance and once paid taxes, until a truck backed over him—on his job---fracturing his cervical vertebrae---and that his employer weaseled out of his Workman’s Comp obligation throwing the patient into bankruptcy and onto the mercy of the public health system, and that while he can walk, he has constant, disabling pain from the bone and joint injuries and from nerve injuries and is going to live with that pain---and the poverty and disability---for the rest of his life through no fault of his own---maybe you can remember that the so called “poor” are people just like you and me---and by “me” I mean the well dressed, well fed, well paid doctors who would be absolutely outraged were anyone ever to tell us “Sorry, but I can only give you Motrin for your pain. You might abuse hydrocodone. The stresses of being a physician in America right now are so high. I must protect you from yourself.”

“A way has to be found to enable everyone to benefit from the fruits of the earth, and not simply to close the gap between the affluent and those who must be satisfied with the crumbs falling from the table, but above all to satisfy the demands of justice, fairness and respect for every human being.” (Pope Francis, Address to the Food and Agricultural Organization, 6/20/13)

Health "Metrics": A New Way to Discriminate Against the Sick and Poor

Imagine two clinics, Clinic A and Clinic B. They are located in the same city. They are part of the same charitable public clinic system. They serve the same low income, uninsured patients. And, they both have to "prove" that they are delivering quality patient care. How do you prove an intangible? Right now, it is all about "metrics." How many of your female patients over 40 have had their annual mammogram? How many patients over 50 have had a colonoscopy. Are people getting their flu vaccines? How many people who fill out surveys rate their doctor as "excellent"? How long do patients have to wait for an appointment? How many diabetics have had an eye exam? Have an a1c under 8?

These "metrics" are important numbers. They determine raises. Bonuses. Who gets promoted. Who gets to take control of large piles of public cash which go to fund health care for the indigent. With so much as stake, you can't blame a savvy clinic director or manager for trying to find shortcuts. It is hard to get a homeless patient who does not speak English to get a mammogram. It is easy to get a low income English speaking computer literate health conscience graduate student to get her health screens done. It is easy to control the diabetes in someone with mild diabetes. It is difficult to keep that A1c under 8---another metric---if the diabetic is blind, has no feet, has no money, and is on insulin he can not afford.

So, what do you do, if you are Clinic B and if you want to prove that you are the clinic that deserves the funding? Do you try harder? Can you really hope to get that blind, double amputee diabetic's a1c down below 8? No. No matter how hard you try, you know that you can't do it. So, you do something much easier. You send the blind, double amputee brittle diabetic to clinic A, your rival. You hold on to as many healthy, borderline poor, compliant, health conscious, normal weight, English speaking literate patients as you can attract, and you find some pretense to send the undesirables away. They were "noncompliant." They missed too many appointments---it is sort of hard for a blind, double amputee to get to the clinic sometimes. You tell a patient "No, you can't have any valium for your nocturnal spasms for your multiple sclerosis but there is a doctor as clinic A who will write that prescription." You say "No, I can't prescribe pain pills for your mother's cancer, but the doctors at clinic A can." You schedule them with doctors at clinic A.

What do you do if you are clinic A and you happen to believe that your charitable clinic system is here to serve the poor and the disabled? Do you send back the sick, illiterate, noncompliant, pain wracked patients that clinic B keeps dumping on you? Or, do you gather them into the fold of your already bursting at the seams practice and try to give them the care they need, too, even though your facility's resources are already stretched to the maximum? Even if it means that your doctors are now seeing too many patients each day, and the patients are mad because they have to wait for appointments, so they write angry evaluations. It's ok. You can put up with the abuse. You have to. Someone has to do the right thing.

Say Clinic A "does the right thing" because Clinic B won't? What happens to Clinic A's "metrics"? That's right. They go into the toilet. What happens to Clinic B's metrics? That's right. They shine. And what happens the next time all the clinics in the system are evaluated? Clinic B is held up as a model of efficiency and quality care, while clinic A is warned sternly that it must try harder. Clinic B's director gets a promotion. Clinic B gets more money. Clinic A eventually gets shut down.

There is no link. This is a 100% real story. I am the eyewitness. I won't tell you in what major metropolitan area it is happening. It is very likely happening in the city where you live. And in the VA where your dad goes. This is what happens when you use something as easily manipulated as a "metric" to determine quality of care.

And it gets worse. Lots of private insurers use them. They know that doctors who are attempting to improve their own "metrics" will quickly realize that the easiest way to do it is to dump all the sick and poor patients. You don't think that doctors in private practice would do something like that? You don't think they could live with themselves if they sent away the sick and the poor in order to increase their own profits? If those who are charged with taking care of the sick and the poor---employees of our public health clinics will resort to such tactics in order to increase their power within a public health system, then anyone will.

Something to think about the next time you are guilty of going to see a doctor while "medically complicated."

McCamy Reports: Bill Kristol’s Project for a NEW New American Century: “Liberate” Cuba’s Doctors

Inside sources report that conservative William Kristol has a plan for easing the nation’s physician shortage which is estimated to reach 45,000 by 2020. Invade Cuba and “liberate” its doctors. Undeclared presidential candidate and GOP front runner Jeb Bush is said to be “intrigued” by the idea.

Rather than increasing funding of medical schools, Kristol proposes that the U.S. borrow a page from the Bush/Cheney administration. “Cuba has the highest number of doctors per capita of any country in the world except Italy. Now, Italy is on the other side of the Atlantic. Cuba is just south of Florida. I propose that we invade Cuba, topple its dictator, liberate its doctors and bring them all back to the United States. Health care provider shortage solved. And since they are all bilingual, we’ll save money on interpreters, too.”

In 1997, Kristol’s group the Project for a New America Century proposed that the United States increase its national security and decrease its dependence on foreign oil by invading Iraq and seizing its oil supplies. The Neo Conservatives were successful in persuading President George W. Bush to carry out their plan. “For the low cost of $1.9 trillion—that’s $6300 per U.S. citizen---Chevron, Shell, Exxon and other companies gained access to Iraqi oil fields. These companies stand to make millions, maybe even billions of dollars---and keep our gas guzzlers rolling for another decade while discouraging green energy research.”

Cuba has more than 68,000 doctors. Though the country is considered impoverished, its health care system is one of the best in North America.

“It isn’t fair for a godless communist nation like Cuba to horde a valuable resource like physicians,” said Christian Broadcasting Chairman Pat Robertson. “When Jesus cured the leper, he signaled that healthcare is the prerogative of good, Christian people. I call upon my country to launch a crusade to liberate those doctors in the name of God and Democracy.”

Executives of national hospital chains have expressed interest in an open auction of the “liberated” doctors. However, the Pentagon says that it has first dibs. “We’ve got to clean up our mess at the VA first,” said a high ranking officer who spoke on the condition that he not be named. “If there’s any doctors left over, the private sector can have them.”

McCamy Reports: Because What's Ours is Ours....and What's Theirs is Ours----That's the American Way

The Ones We Should Be Listening to Have No Voice At All

Lots of Loud voices. Lots of opinions. Lots of anger.



"The day will come when our silence will be more powerful than the voices you are throttling today" August Spies. Nov 11, 1887

McCamy Reports: "Open Carry" Becomes "Crowd Control Inc.", Goes Public, Offers Shares

The organizers of Open Carry announced today that they are forming a publicly traded company and will be offering shares of their new business, Crowd Control, Inc. Says a company spokesman, “We got the idea when the manager of a Super Shell in Buttlick, Texas called us up one day and said ‘Would you boys get on down to the local Super Chevron and stand around with your biggest semi-automatic assault rifles? Me and the manager of that store have a little bet going on to see who can bring in the most customers today, me with my buy one get one free burrito special and him with his half price slushy promotional and I think he’s gonna win. There’s a case of Shiner Bock riding on this one, and I could sure use some help. I’ll split the case with you. What do you say?’”

The local chapter of Open Carry rounded up six members. Each was armed with two semiautomatic assault rifles. They gathered on the sidewalk in front of the Super Chevron and within minutes the store was deserted, and it stayed that way for the rest of the day.

“The police came by a couple of times to ask us to move on,” said Open Carry spokesman, Brick Thick. “But we know our rights. Free Speech, Right to Bear Arms---it’s all there in the Constitution.” He unbuttoned his blue work shirt and revealed a tattoo of the US Constitution on his chest. Part had been blacked out. “That’s the part that says women have a right to an abortion. We think Betsy Ross slipped than one in when the Founding Fathers weren’t looking.”

The new corporation will offer a variety of services. For a fee, they will set up a picket line. “We’ll picket anything. A gay wedding. Your ex-girl’s wedding. Your ex-girlfriend’s mother’s funeral. The company that fired you.” For a larger fee, they will do what they call “Crowd Control.”

“That’s where we get a dozen members to arm themselves up and visit your competitor. We stroll around pushing shopping carts, eying the merchandise, checking out the other customers, making eye contact with the men, smiling at the babies---you know, keeping a high profile. You’d be surprised at how fast a Target Super Center will clear out once we show up. Since the shoppers still need Coke and Huggies, they head on over to the Wal-Mart Super store.”

Demand is so high that the company is selling franchises. "Our biggest problem right now is all the "Control" websites are taken. Control.com, Control.net---we can't find any of them that we can use. We've tried staging our own crowd control at some of those sites, but it just isn't the same when they can't see that they guys bombarding them with spam are carrying Sig Sauer 516 Patrol G2 OD Green Piston AR-15 ODGs. I guess you could say that the Internet is the enemy of the Second Amendment."



McCamy Reports: News That Must Be True, Because It FEELS True