Tag: Medicaid

Bongo! The Bipartisan Plan for Single-Payer Healthcare

Two explorers are captured by cannibals. “Death or bongo?” says the chief. “What’s bongo?” ask the explorers, but the chief only replies “Death or bongo?” The first explorer chooses bongo, and (without going into the gory details) it’s so horrible that the second explorer chooses death.

“Okay,” says the chief, “Death! But first… bongo!”

I remembered this old joke when the Census Bureau reported that now more Americans than ever before have no healthcare insurance.

Official estimates by the Census Bureau showing a dramatic spike of 4.3 million in the number of Americans without health insurance in 2009 – to a record 50.7 million.

And…

The jump of 4.3 million uninsured is the largest one-year increase on record and would have been much higher – over 10 million – had there not been a huge expansion of public coverage, primarily Medicaid, to an additional 5.8 million people.

And that is the real bipartisan plan for single-payer healthcare, as more of more of us lose our jobs and houses and sink below the income threshold for Medicaid, and eventually only a thin upper crust remains dependent on private health insurance, which they can easily afford, because they own everything!

“But at least we have Medicaid!” say the millions of formerly middle-class Americans. “Okay,” say the chiefs, “And now we cut Medicaid!”

Bongo!

A Right to Privacy Depends on Privilege

Today I scheduled an appointment with a GP for my yearly checkup. I’m not physically sick or injured at the moment, but I figured it would be worthwhile setting up an appointment anyway. While on Medicaid here in the District, an insured person is required to establish a particular primary case physician.  This PCP is based at a specific location and is, of course, the person one sees in the event of a serious illness.  I had meant to do this long before now and finally got around to it.

Health Care Reform Starts with Those Who Are Willing to Change Existing Policies

I again write today about what has become a completely inadvertent, but nonetheless growing series of personal anecdotes which reveal both the depths of our broken medical system and the shocking limitations and abuses of a system of social services designed to care for the poor and disabled.  In so doing, I have uncovered a tremendous number of objectionable practices that would never be considered acceptable among the more fortunate.  Established policies designed to assist and give comfort instead punish the genuinely needy.  For example, in the process of applying for a variety of safety net programs, I have been threatened with complete termination of coverage if I didn’t follow every step exactly as requested and in a supremely timely, if not obsessively punctual fashion.  In some states and municipalities this sort of conduct would be not just be bad form, it would also be against regulations.  Not here.  

In the District of Columbia, no one apparently sees the problem in treating low-income and disabled residents like criminals.  To make my case once more, let me provide a bit of backdrop.  The District is a very unusual place in lots of ways.  Though technically it is merely the physical location for the seat of national government, it is governed as a kind of odd mix between a state and a city.  Like most American cities, its population consists of an often uncomfortable combination of the affluent and educated, most of whom are relatively financially secure whites, and a core of heavily impoverished and undereducated residents who are usually black.  If DC were a state, and much larger based on surface area alone, there would be more of a middle ground between the have-everythings and the have-nothings, but this is simply not the case here.        

The District contains its own particular system of distributing food stamps, low-income medical insurance, prescription drug coverage, and providing disability benefits to those unable to work.  In roughly six months of trying to work a system that is both ridiculously ineffective and unnecessarily complex, what I have come to realize is that it is also a system based on punitive retribution, which is neither fair to applicants nor particularly effective to everyone.  With every step of the process, regardless of what it might be this time, the necessary paperwork I was provided screamed out in bold, block letters, often capitalized lest I overlook it, that I better fill this latest form out perfectly and as soon as possible, else I’d find myself without anything at all.

The existing system itself is so unwieldy that I have often been provided incorrect, or at best inexact information.  I don’t fault those who gave me wrong information because learning all the particulars takes months, if not years, and turnover in social service agencies is often quite constant based on the fact that the job promises low pay and high stress.  I was, for instance, told that I would only need to re-apply for food stamps once every six months.  However, within two months I received a letter in the mail, one printed so cheaply and faintly that often reading the words was a challenge, specifying that I needed to re-certify how much income I was currently making, else I be denied next month’s allotment.  The return envelope was just as difficult to read and after affixing a stamp to cover the cost of postage, I took the time to write out by hand the return address, else some postal carrier not be able to discern its destination.  

The implication of this was quite clear.  The instant I could be have my monthly allocation reduced, or even trimmed from the rolls altogether, the better.  I do certainly recognize that we’ve all been hurting and will continue to suffer so long as this recession, or at least the lingering effects of it doggedly persist, but I hardly think the solution is in weeding out those who depend on these services, particularly since so many of them are the very definition of working poor with their own children and families to support.  When I had the benefit of an increased income and decent benefits, no one ever made me certify that I still needed them.  I was trusted, for the most part, to not abuse the system.  Now, I am automatically suspect.

The low-income health care coverage I use via the District’s own program is sufficient, but hardly convenient.  After filing for disability, I assumed once granted it that I would also receive Medicaid.  Medicaid, while it certainly contains its own limitations, still provides a greater sphere of coverage than the DC program.  Medicaid would allow me to have my prescriptions filled at a conventional pharmacy like a CVS, Rite Aid, or Walgreens, whereas the only way to get my medications via the other coverage plan is to visit the sole pharmacy in the District that stocks the drugs I require on a daily basis to maintain my health.  It is located in a tremendously inconvenient part of town to get to, based on where I live, and it takes thirty to forty-five minutes via public transportation to arrive.  Often I end up expending the better part of a morning from start to finish once one factors in sitting in a waiting room, trying to be patient while the drugs are filled.  As it turns out, no one told me that according to District-only procedure I needed to apply for Medicaid separately and go through another time-consuming process.  Of course, this is a means of saving money and reducing cost on their part, but in my opinion, it is silly to assume that someone who is DISABLED and has to subsist on a minimal monthly allowance wouldn’t need basic health insurance as well.

To chalk this up to something as relatively straightforward as racism, classism, abelism, or the like would only be confronting a small sliver of a larger problem.  I fault those who set policy in the first place, whomever that might be.  To return to my own struggles once more, I believed originally (and even wrote in an earlier entry) that one of my medications was available to be filled at the low-income on-site pharmacy, though there was often a substantial delay in getting it in stock.  As it turns out, I was once again told wrongly.  The drug is not stocked at all because with it comes the threat of a hypertensive crisis if very specific dietary restrictions are not adhered to exactingly.  Obviously, no one wants the bad press or potential lawsuits that might transpire if a patient had one of these (or if, God forbid, he or she died as a result), and this goes for doctor and District government alike.  But to be deathly afraid of litigation, regardless of how baseless it might be doesn’t so much reflect upon a problematic legal system as a complete lack of basic trust and compassion for our fellow beings.  We could make sure that frivolous malpractice lawsuits were minimal, but unless we get to the reason why people file them in the first place, any legislation passed into law will not achieve its purpose.

Returning again to my medical situation, the particular medication I take is absolutely essential to assure my continued basic functionality and it works so well that the difference between not being on it and being on it is like night and day.  That I am able to manage the restrictions competently speaks partially to my willful desire to stay healthy, but also that I am educated enough to recognize what foods I need to avoid and to do my research accordingly.  The assumption in not stocking the med, regardless of whether or not it could really help someone in need, is that a person with barely a high school diploma, having grown up in utter squalor and with all the problems that result from it might not have the same capacity and level of personal responsibility as me.  Yet again, here we have a punitive, blanket response when basic compassion and an examination of people on a case-by-case basis would be much more effective.  Once more, we opt for the quick fix instead of really examining the full picture.              

As for whether Congress will pass health care legislation, I’ll leave that never-ending speculation to someone else for today, at least.  What I do know is that whatever reform measures we pass will need to take into account whether we treat fellow human beings as numbers, money drains, or as only waiting for the next opportunity to take a mile once we grant them an inch.  We certainly don’t seem to wish to grant anyone who we perceive as other than us the most basic of trust, nor do we take into account that all humans make mistakes, are fallible, and aren’t perfect.  We read about drive-by-shootings, petty crime, and drug deals and think that anyone born into such circumstances must be guilty by association.  Fifty-two years after the film Twelve Angry Men was released, we’re still stuck in that same way of thinking.

 

Juror #8: Look, this kid’s been kicked around all of his life. You know, born in a slum. Mother dead since he was nine. He lived for a year and a half in an orphanage when his father was serving a jail term for forgery. That’s not a very happy beginning. He’s a wild, angry kid, and that’s all he’s ever been. And you know why, because he’s been hit on the head by somebody once a day, every day. He’s had a pretty miserable eighteen years. I just think we owe him a few words, that’s all.

  Juror #10: I don’t mind telling you this, mister. We don’t owe him a thing. He got a fair trial, didn’t he? What do you think that trial cost? He’s lucky he got it. You know what I mean? Now look, we’re all grown-ups in here. We heard the facts, didn’t we? You’re not gonna tell me that we’re supposed to believe this kid, knowing what he is. Listen, I’ve lived among them all my life. You can’t believe a word they say. You know that. I mean, they’re born liars.

  Juror #9: Only an ignorant man can believe that… Do you think you were born with a monopoly on the truth?

What zombie banksters learned from destroying capitalism.

First, they learned that financial markets are hyper-sensitive to steroids, lack of law enforcement, and time-tested shock doctrine principles, and that they can profit mightily from destroying capitalism.


Insert a shitload of obscene charts about here.

Second, they learned that they “own the place,” “the place” meaning “the potemkin government,” “no longer applicable laws,” “the future wealth of all dispossessed generations of slaves, thralls, and hostages;” and “owning” meaning “complete mastery of all worldly possessions unto the end of the earth and beyond.”  Third, they learned that no lies are too big to tell.  Fourth, they now keenly understand that the religion of financial growth is the most powerful Kool-Aid invented, and now it’s just a matter of getting everyone on the plane to Jonestown.

The Poor Need Health Care, The Rich Need to Take Note

The circular firing squad over the defeat of Martha Coakley and what this means for the Democratic Party and Health Care Reform got underway a couple days ago.  I’ve said my bit, and have nothing further to add, but I’d rather address the potential challenges facing reform aside from the loss of a seemingly filibuster-proof majority.  It is now absolutely imperative we push forward and bring a bill to President Obama’s desk.  Our backs may be against the wall, but perhaps it will take abject panic and fear to rouse our complacent, weak-kneed Democratic legislators towards the goal.  If it takes the shock and dismay of a humiliating defeat to break the logjam, then so be it.  I’m not concerned with speculating as to how we got here; I am instead consumed with what we learned from it and how we will use this tough lesson to think of others and their needs rather than ourselves.  

What I have noticed in my own struggles to obtain low-income health insurance is how class and race ensure that government subsidized plans are underfunded and often dysfunctional, but money (or the lack of it) seems to be the most powerful determinant of all.  What many have noted is that basic selfishness is what threatens to derail any efforts towards changing the existing system—namely that people who have always had sufficient coverage do not understand the limitations faced by those who do not.  We can call that privilege if we wish, but that term has always seemed accusatory to no good end to me, and my intent is not to chastise anyone but to make many aware of the challenges in front of us that never get much in the way of attention.  In my own life, I can say that I have now seen how the other half lives for the first time ever, and I noted that they live lives severely impeded by the tremendous limitations and senseless complications of the existing system.

I have been unemployed or at least severely underemployed for several months.  As a result, I had no choice but to file for government assistance.  When I was finally granted food stamps I signed up as well for a local DC funded health insurance plan.  What I have discovered in the process is that since the Recession hit, social service agencies in DC have been swamped by new applications for every existing option currently offered.  According to one worker with whom I spoke, claims have tripled since the bottom began to fall out of the economy.  The system was barely able to manage the number of filings in more stable times, and now it has in large part ground to a halt if not slowed to a trickle.  New claims are supposed to be processed in no more then 30 days from approval, and I was forced to make several time-consuming, additional calls to the proper department to even get the coverage activated.  Those without the time or without the persistence likely will be granted nothing at all and this simply should not happen.  

My great point is that without the infrastructure in place, it doesn’t matter how many people to whom we grant coverage.  Ensuring that everyone can get their teeth cleaned, fillings filled, broken bones set, flu-like symptoms properly treated, diabetes regulated, or depression adequately under control is the ultimate goal, but we must also be sure to build a sufficient number of clinics, medical centers, doctor’s offices, dental hygiene practices, well-stocked pharmacies and all the rest.  They must be built in proper proportion to need and since humankind has never been able to curtail its zeal for making money at the expense of the health of the financial system, we need to devise strategies to build these things for both good times and bad.

In DC, the low-income, government-funded system forces the poor and/or disabled to a handful of centers scattered across the District itself.  Visiting a private doctor or specialist is not an option, since coverage is only granted to those who use these designated centers.  Likewise, pharmacies and medication dispensation function under the same parameters.  Using Walgreens, CVS, Rite Aid, or other commercial medication fillers is not allowed under the plan.  Though there are a score of specific pharmacies which take the DC plan, in my case, there is only one pharmacy in the entire District that fills psychiatric medication, and for me it is a 35 minute trip, one-way via public transportation and then by foot.  The pharmacy itself is attached to a Mental Health services clinic which is the sole site whereby psychiatric care is provided for a city of roughly 600,000 people.

Without enough workers to process claims, grant coverage, manage medical records, or attend to even the most basic of needs the system is essentially worthless or at least incredibly inefficient.  Without enough revenue allocated by governments from taxation or other means, it doesn’t matter how snazzy or up-to-date is any system designed to speed up or modernize the system.  Window dressing is window dressing.  Without the money to properly stock a pharmacy, medications will be obtained on a priority system and as such, meds that are rarely prescribed or are very expensive will rarely be on hand when needed.  For example, one of my medications, Parnate, is an MAOI inhibitor.  Parnate is a very powerful anti-depressant that is infrequently prescribed because with it comes potentially dangerous, even deadly side effects if I do not take care to abstain from eating certain foods.  As you might expect, it is not one of the more common prescriptions, but it is essential to my lasting health and quality of life.  A commercial pharmacy usually has it in stock, or if it does not, it can be quickly ordered or is certainly in stock at some other store in the immediate area.  With the government-subsidized pharmacy I must use, if that particular drug is available at all it is due purely to chance and luck, and if it needs to be ordered, it may be a week or more before they have it in stock.      

Regarding visits with a GP, specialist, or other specific health practitioner, some clinics and centers accept walk-ins or schedule appointments within a reasonable time frame.  Some do not.  For those who need surgical procedures or more invasive treatment, one might be expected to wait months.  When I still lived in Alabama, there was approximately one Medicaid-accepting clinic for the entire state that performed the procedure, and as such when it came time for me to have a very routine, non-invasive treatment, I was booked four whole months in advance.  In more affluent, usually blue cities and states, the wait time is often less, but it can still be a bit on the lengthy side.  As for me, I found to my utter dismay that my coverage was terminated before the procedure could be even performed after the clinic filed and billed Medicaid for the cost of the preliminary screening.  Someone must have realized that to save cost I was not what they deemed a “high-priority” need and thus I could be safely removed from the rolls to save money in what was a system already in danger of being completely depleted of funds.    

An important distinction needs to be drawn here.  The DC-based coverage I have been talking about is different from Medicaid or, for that matter, Medicare.  This coverage augments or seeks to provide coverage to those who either have Medicaid/Medicare or cannot get approved for it.  This is why the rules, parameters, and hoops to jump through are more severe.  Medicaid usually allows a person to pursue more orthodox means of seeking treatment.  Though some medical practitioners do not accept it because it usually pays out less than a gold standard coverage plan through a private insurer, many do.  Again, money is a big factor at play.  If Medicaid were capable of paying out at a sufficient rate, everyone would take it.  If it wasn’t at times forced to pay out much later than a private carrier or even being forced to issue IOU’s when monetary shortfalls and partisan bickering delayed enactment of a satisfactory state budget, then it certainly would be on par with usually employer-based coverage.

Yet, it is very disingenuous at best for those who oppose health care reform to stubbornly dig in their heels and express haughty indignation that they are NOT going to have “the government” take away their right to choose their doctor.  The only way this would ever happen for most is if they lost their insurance altogether, lost all their personal savings, and lost the ability to come up with the money to see a well-compensated physician and/or specialist.  Their worst-case-scenarios and numerous reservations are true only for those living in abject poverty, or at or below the poverty line.  The wealthier among us have any number of lifelines, be they family, co-workers, friends, fellow members of a particular group or club, or other sufficient means.  Those at the bottom have none of this upon which to rely.  Friends, family, and others are just as impoverished and less fortunate as they are, and they have no choice but to take and use what they can get.  And taking what they can get means dealing with a system that is convoluted, needlessly complex, inconvenient at best, and regimented to such an authoritarian degree that even obtaining the minimum often is an exercise in debasement.

If ever we had a need for revolutionary reform and change, now would be it.  Decades after a declared War on Poverty, we still have many battles ahead of us.  We haven’t really given this matter anything more than perfunctory attention, and we haven’t really allocated resources of any significant means to this very pertinent cause.  Doing so would require us to understand exactly how fortunate we are to have been granted, by complete luck and chance, the socio-economic status of which we were born.  For some quirk of God, fate, or nature we do not get the right to choose our parents or to choose our upbringing.  But we do have the obligation to see to it that those for whom daily adversity is not an abstraction have the same rights that we frequently take for granted.  I am not seeking to lecture, nor to hector anyone, but rather to strongly emphasize that our continued success as a people, a party, and a movement demands that we seek to assist the poor and the less fortunate.  Our wallets, billfolds, and bank accounts couldn’t open fast enough to provide aid to suffering Haitians.  If only this were possible for our own poverty-stricken citizens, many of whom struggle through conditions not that dissimilar to those we now view through heart-wrenching news reports and graphic photographs.  After all, it might be you someday who faces the disquieting realization that our health care system is designed for the wealthy, by the wealthy, and in so doing realizes just how much you took it for granted.

Building a Name-Brand Health Care System, Not a Low-Cost Generic Alternative

Much as credit card companies have charged exorbitant interest rates in the period leading up to the passage and enactment of reform, so too have prescription drug companies added more cost to their already prohibitively expensive products.  Afraid that health care regulatory legislation will cut too heavily into their soaring profits, the industry feels no shame, nor any compulsion to give heavily burdened consumers much of a break.  This is a side of the debate that has not gotten the same attention as other areas and one that I have tried to bring to light quite frequently, being that I myself stand to lose quite a bit if out-of-control price increases are not sharply curtailed.  I do not deceive myself into thinking that I am the only one who stands to lose.  Though I do not mind invoking personal experience if it facilitates greater understanding and urgency, I wish it didn’t take the anecdotes of the chronically ill to impress upon a skeptical public the importance of health care reform.          

On the subject of psychotropic medication, something of which I am an amateur expert, I have closely monitored new classes, types, and formulations of prescription drugs in a desire to find the best way possible to treat my condition.  For every new medication that breaks new ground, wins approval by the FDA, and is then prescribed by GPs and psychiatrists across the country, it is a never-ending source of frustration for me to observe the three new offerings which are merely slightly different formulations of existing medications.  This is a covetous process undertaken mainly to reap maximum profit when older scripts are on the verge of losing patent status and thus being offered as generics.  For example, the anti-depressant which is the most recent addition to a family of medications known as SSNRIs has been marketed under the name Pristiq.  Pristiq has a very similar chemical structure and as a result works only slightly differently from an existing drug in the same school, Effexor, that has been around for over ten years.  Sometimes, however, even generics occasionally have limitations.  Though a lower-cost equivalent to Effexor exists, the less-expensive form has been reported to work not nearly as effectively as the name brand formulation.

An article in today’s New York Times reports on Big Pharma’s side of the story.

But drug companies say they are having to raise prices to maintain the profits necessary to invest in research and development of new drugs as the patents on many of their most popular drugs are set to expire over the next few years.

That may be, but before one gets misty-eyed listening to the woe-is-us violin, rest assured that the pharmaceutical industry isn’t exactly hurting for business.  Conveniently they don’t mention the larger picture.  Another example of this kind of infuriating slight-of-hand is the sleep aid Ambien, which has had a sufficient generic alternative for a while.  A relatively new formulation dubbed Ambien CR produces an only a slightly different reaction, mainly by time-releasing the absorption of the drug into the blood stream.  The drug is the same, but the gimmick is different.  Returning to psychiatry, it is either a testament to how little we know about the function of the brain or how unwilling we are to risk radical change that the medications used to treat depression, anxiety, bipolar disorder, and schizophrenia have broken only relatively limited ground in decades.  The best treatment for depression are still a class of powerful anti-depressant known as a MAOI inhibitors, which are close to fifty years old.  They are rarely prescribed, however, because taking them requires strict dietary restrictions that, if not adhered to, can result in serious damage to the body and, in extreme cases, even death.  In treating bipolar disorder, some patients still respond best to Lithium, which has been used in treatment for over a century, but extensively since the Fifties.    

Newer medication often cut down side effects and make the period of adjustment less painful, but do little to increasing the stated objectives of the drug, namely to drag people out of depressive episodes and set them on a course towards health and functionality.  Experimental trials are often plodding affairs proceeding at the pace of a snail, targeting a relatively limited area of the brain, and unwilling to take any unnecessary chances.  Despite this, some medications do pass muster and do end up being taken by who are suffering in the hopes of providing relief.  Even so, the drug makers and those who formulate them sometimes fail to take into account such crucial details as major side effects in a rush to get out the next big thing.  SSNRIs like Effexor, for example, are infamous for producing absolutely awful issues when someone stops taking it.  Though not strictly classified as such, one might even say that such drugs are addictive because the brain acts violently when the medication is discontinued.  These serious matters somehow never find their way onto the commercials on television or the ads inside glossy magazines.  

The difference in cost between name brand and generic drugs is quite vast.  Often it is a matter of several hundred dollars for a one month supply, though it can be as high as a thousand dollars or more.  As one might expect, those with employer-based or individual plans paid for out of pocket have to pay substantially higher co-pays for name brand drugs.  When I had private insurance, the co-pay for generic medications was $10 and for name-brand drugs, it was $60.  Sometimes I had no choice but to take a name-brand medication, which are often treated by insurance companies as something bordering on cosmetic and not essential, when the fact of the matter is that they are highly necessary and highly unavoidable at times.  

Those who don’t have the luxury of private insurance, of course, have it rougher.  Those who have to rely on Medicaid find that they have no choice but to settle for generic medications when a name-brand drug would be a much better fit and work much more effectively.  Medicaid programs vary, but in the state of Alabama, the most expensive medications are only covered if a doctor or specialist one can provide proof that at least two lower-cost alternatives have failed or been insufficient to treat the condition.  Not only must they have failed, one must also work within the confines of a 90 day coverage window.  If a claim to cover a more expensive medication is not filed within 90 days of failing the requisite two medications, then coverage is not granted.  This is ridiculous in lots of ways, mainly that few medications used to treat mental illness work quickly, and many take weeks upon weeks before any psychiatrist or doctor can make a judgment either way.  It’s also ridiculous because it uses a broad brush of convenience, painting all illnesses as basically the same and all treatment regimens as similar.  Some name-brand medications, regardless of the need are not covered at all, since whomever set up the system decided that covering it would unnecessarily drain the General Fund and that it was an unnecessary prescription in the first place.      

Returning to the Times column,

But the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year – $80 billion over 10 years – from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal.

Those who trust Big Pharma do so at their own peril.  

Additionally, The news broke today that, quite unsurprisingly, much misinformation exists surrounding the Public Option™.  As Politico points out,


The debate has placed disproportionate emphasis on the creation of a government insurance plan, raising the expectation that everyone could ditch their employer-provided coverage and enroll in the public option.

But that won’t happen, at least not at the start. The reality is that only about 30 million Americans – 10 percent of the population – would even be eligible.

It could be accessed only through a new insurance marketplace known as an exchange, where consumers would shop for plans. Only certain categories of people could use the exchange: the self-employed, small businesses, lower-income people who qualify for tax credits to purchase insurance and those who are otherwise unable to find affordable private coverage.

This might deflate the hopes of supporters and pacify opponents, but since so much of this debate has been a three-ring-circus based on raw emotion and faulty logic, I sincerely doubt it.  However, as proposed, it is interesting to note that the Public Option™ would be more like Medicaid than anything else.  My hope is that we do not make the same mistakes with the current bill as we do with existing systems it seeks to augment or replace, particularly those in red states who likely would opt-out altogether if provided the opportunity to do so.  Though at least red state residents would presumably have the fall-back of Medicaid, provided they could qualify, the framework is based on ignorance and tunnel-vision of an almost incomprehensible degree.  One cannot simplify the complexities of humanity, nor its diseases, which are as multifarious as its people.  

Returning to the treatment of mental illness, what is often not cited is the disconcerting fact that often African-Americans and Latinos respond much less favorably to medications used to treat the condition.  This is a contentious topic with lots of disagreement, but the argument some advance is that cultural stigma factors in to a very large degree.  If minorities feel shamed or guilty about seeking help for psychiatric needs, they are much less likely to engage in medical research.  Furthermore, many believe that therapy is a more viable option than medication.  Often it is difficult to make any kind of pronouncement when the truth is obscured by so many different interrelated factors.  And though one can easily make a case for mental illness, one could also make a case that minority and low-income residents might be less inclined to visit a doctor for a more run-of-the-mill ailments as well.    

The lifetime prevalence of major depression in the United States is estimated to be 16.2 percent, with considerable social and role impairment evident in the majority of patients. Previous studies found only minor differences in depression rates among African Americans, Latinos and whites. But various studies have found patients from lower social economic groups often have less access to mental health care, are less likely to be prescribed and to fill prescriptions for new antidepressants and are less likely to receive care beyond medications when compared to whites.  

 

This fear and anxiety so many have that resembles to these eyes a case of St. Vitus Dance may not have any basis in reality.  Doesn’t matter how good the system is if no one uses it.  God forbid everyone in this country have a high standard of living and good health.  As the article points out, minorities and low-income citizens often have the highest need for quality care and are apt to put off seeking help until the pain becomes intolerable.  That these are the people most likely to be eligible for enrollment in the government-run (gasp) option, those now building it from the ground up would do well to consider its target audience.  We speak out of our own privilege when we assume that somehow the Public Option™ will directly affect us for better or for worse, when the poor and less fortunate will be the ones who either reap its rewards or suffer from its limitations.  While it is true that middle class individuals and the reasonably affluent have struggled under the yoke of skyrocketing health care costs, I recall going in that I assumed the changes needed and intended were meant to appeal to our tired, our poor, our huddled masses yearning to breathe free.  Somewhere along the way this became all about us.        

Medicaid is No Public Option

The news broke late yesterday afternoon that the Senate Finance Committee sought to broker a compromise measure regarding the Public Option.  Giving each individual state a choice of whether or not to provide a public option appeals to fiscal conservatives and red state legislators whose most coherent reservation regarding health care reform is a concern over cost.  Still, these kind of messy federal/state mandates reinforce substantial inequality.  A Medicaid-style measure like this would mean that those who lived in most well-funded blue states would have superior health care coverage, while those who lived in most, if not all red states would have their health care costs still largely dictated by private carriers, many of which hold near-monopolies in individual states.  If the aim of reform is to level the playing field for every American, this falls well short of the stated objective.  

Today’s Politico contains a brief, but noteworthy column written by Ben Smith, which underscores the controversy regarding Medicaid reform.  


The Medicaid expansion would, in a stroke, add 11 million people to the program’s ranks by raising the income cap, and one key negotiating point at the moment is the share of that cost the federal government will pick up.

The income cap, however, is only one facet to increasing eligibility.  Many states, particularly red states, do not extend coverage to single adults at all, no matter how dire their need.  Coverage is often provided only to adults with children and sometimes Medicaid coverage is granted to children only, leaving their parents with nothing.  As a result of this, many adults are forced to file for SSI disability to obtain Medicaid coverage, since doing on is the only means by which they might attain any health care coverage at all.  However, this removes individuals from the workforce, reduces tax dollars paid into the tax system as condition of employment, and places a drain upon the never-ample General Fund out of which all Medicaid expenses are paid.  Removing these strict qualifying factors might costs more in the short term, but the long term consequences are much more detrimental.  Someone pays the cost when a person goes bankrupt from enormous medical bills or visits the Emergency Room without insurance, having no means to pay at all.  Still, to simplify this unnecessarily as another annoying example of the red state/blue state divide would not be a fair telling of the truth.    

Republican governors haven’t been the only ones raising doubts.

Tennessee Democratic Gov. Phil Bredesen has been an outspoken foe of the plan, and a senior Republican aide notes that two more left-leaning Democrats are also raising complaints.  According to the Columbus Dispatch, Ohio Gov. Ted Strickland “warned on a recent visit to Washington that the ‘the states with our financial challenges right now, are not in a position to accept additional Medicaid responsibilities.’

“Strickland said that he wants a health care package that is inclusive and provides for all citizens’, but he adds that if Medicaid is expanded, he hopes to see the Federal Government assume the greater portion of the costs, if not the total costs.'”

And New Hampshire Gov. John Lynch last week refused to sign a letter than other Democratic governors sent to congressional leaders urging passage of a health care bill this year, because it failed to “address concerns regarding potential cost shifting to the states,” according to a spokesman for the governor quoted by the media.

States do have to adhere to balanced budgets and in times of economic famine like these cannot resort to deficit spending.  However, budget priorities are often disproportionately skewed away from social services and relegated to other matters, which are just as wasteful, if not more so than any pork barrel project pushed by a House or Senate member.  Before Republicans and Democrats criticize Washington for its excesses or its financial demands, they would be wise to start first in their own backyards.  Citing specific instances of pork barrel projects is a rhetoric device which borders on cliche, so I will spare you another retelling of it.  Needless to say, room could be made even in a much reduced year of tax revenue.  The obscene amount of tax breaks and concessions made to foreign automakers in order to entice them to build auto manufacturing plants is a good place to start.  Those states who have never made an attempt to reform their image as little more than an endless supply of cheap labor have shortchanged themselves in ways they seem incapable of comprehending.      

A more streamlined approach would, in my opinion, be best.  Each state sets its own criteria regarding Medicaid in accordance to how the program was set up in the 1960’s and I have no doubt that similarly messy compromises would likely typify the efforts the states willing to institute a public option.  Most red states would opt out altogether, of course.  I will note that a complete reliance on the superior wisdom and judgment of the Federal Government might be naive, but I have rarely seen any state government be more efficient.  What I have seen is a multitude of red states whose efficiency and collective wisdom resembles a Banana Republic combined with a slap-stick comedy routine.  That they are the ones who are so quick to  shoot barbs at Washington, DC, strikes me as biting the hand that feeds you.  Many of these states would have nothing if it hadn’t been for the generosity of Capitol Hill and many of their universities would find themselves without needed funding if they couldn’t achieve Federal Government grants.  So it is here that I’m afraid I can’t muster much sympathy for those Governors who rarely pay more than ten percent of the cost of Medicaid anyway.  The real lesson to be learned here is that long-term gain is much more important than the facade of short-term cost reduction.  

Another Health Care Horror Story: Big Pharma Edition

At the outset of putting fingers to keys this morning, I wasn’t intending to write about this topic. I changed my mind, however, because if one more documented instance of Big Pharma’s greedy, hypocritical, exasperating behavior means that we might all benefit from substantial and lasting health care reform, then I am certainly not above sharing my personal story. In particular, this highly frustrating anecdote refers to the unnecessary hassle it has been to obtain one of the three medications I must take on a daily basis to effectively treat my illness. This forthcoming narrative also underscores the perfidy of the industry itself and, in particular, its automatic assumption that anyone who uses its free or reduced cost services must be trying to cheat the system. It shouldn’t surprise any of us by now that this underlying attitude somehow isn’t portrayed in the self-serving television advertising advancing the program’s merits.

You may have seen the commercial. It was pretty ubiquitous for a good long while. A soothing voiceover, couched in hushed tones meant to intimate gentle sympathy, states that American’s pharmaceutical industry might be able to help those who are uninsured attain their prescription drugs at a deep discount. We are led to believe that an imaginary bus tour is underway, looking for all the world like the kind favored by political candidates on their way back and forth from event to event. A series of different looking people from all walks of life announce proudly their allegiance to their own particular state of residence. A man who once led a daytime TV show which frequently showcased the results of paternity tests and established the true identity of baby daddies smoothly performs his role as spokesperson. That this ad aired constantly in the immediate period before Health Care Reform became a political and ideological football was no accident. The implication was that Big Pharma could regulate itself just fine, thank you, and not only that, the industry was so altruistic as to offer medications for needy Americans without need of government arm twisting. I admit at the time I viewed these ads with much suspicion, but after I unexpectedly lost my Medicaid coverage at the end of July, it was an option I had no choice but to pursue, since paying $700 a month out of pocket for a thirty day supply isn’t exactly an viable alternative.

According to Rumors, Mississippi’s Boss Hog Aspires to Become President

Can you imagine this crook in the White House? No way this is in the cards for America’s future! No way this white supremacist will be allowed in the White House!

Barbour Ignores Budget-balancing Stimulus in Fox News Criticisms

By Bill Minor, 7-19-09

Jackson, Miss – Call it chutzpah, biting the hand that feeds you, or whatever else you might call it when the beneficiary of largesse disdains the one who made the goodies possible.

Gov. Haley Barbour goes on Fox News Channel’s (where else?) Sean Hannity show four days after Mississippi’s Legislature has handed him a balanced state budget without draconian agency cuts or big tax increases, thanks largely to money from President Obama’s $785 billion stimulus package, officially known as American Recovery and Reinvestment Act.

Does Haley tell Sean anything about how the Obama stimulus money plugged gaping holes in the Mississippi budget? He does not.

No, he tears into the stimulus package with all the pat phrases from the Republican Party playbook.

“Too much spending on social policy and not enough on infrastructure,” Barbour repeats, followed by the old GOP standby: “not enough tax cuts.”

Adding, of course, “It would make a lot more sense if they’d given states more discretion over how to spend the money.”

Translation: Give me say-so on where to put the money (we all remember how Barbour shifted $600 million in Katrina money intended to rebuild housing on the devastated Gulf Coast to the Port of Gulfport’s 10-year old expansion plan that includes creating casino-hotel sites.)

What were the “social policy” programs Barbour told Fox viewers were wrongly included in Obama’s recovery package?

Did that apply to the $160 million stimulus money that made it possible to fully fund Mississippi’s K-12 education program, saving 4,500 teachers’ jobs?

Or $133 million ARRA money for Title 1 to aid poverty students or another $122.3 million for school children with disabilities?

Or the $164 million ARRA money that saved the fiscally troubled Medicaid program and its 600,000 vulnerable clients?

Or the $177 million to the Department of Transportation for shovel-ready projects that will put hundreds of Mississippians to work?

At home, a different tune

Strangely, back home in Mississippi, Barbour whistled a different tune about the Obama recovery package in his Web site. It was saying “spending on all three levels of education will be the highest ever” and acknowledged that federal stimulus money made it possible.

On the Hannity show, Barbour sounded more like a hopeful to be on the GOP’s 2012 ticket, veering off into water over his head on foreign policy and military preparedness.

He roundly criticized President Obama’s recent meetings with Russia’s two top leaders, and his agreement that both U.S. and Russia would reduce to 1,600 their nuclear warheads.

The Mississippi governor charged “it is no time to dismantle our nuclear arsenal to have a charm offensive with the Russians.”

Barbour said that his hero, Ronald Reagan, would never have done such a thing, insisting that Ronnie “showed the world the Russians couldn’t compete with us” in nuclear weaponry.

Barbour forgets Reagan

Obviously Barbour didn’t know or conveniently forgot that Reagan, meeting with Mikhail Gorbachev at Reykjavik, Iceland, in 1986, stunned NATO allies and his aides by proposing both the U. S. and the Soviet Union scrap all of their nuclear weapons.

Reagan aides quickly went into damage control, attributing Reagan’s off-handed nuclear giveaway to a brief lapse of memory, and told the Russian team just to forget what he said.

Makes Obama’s nuclear agreement with the Russian leaders small potatoes by comparison.

Barbour’s Fox News sortie into the foreign policy minefield brings to mind his unmemorable 1982 Senate race against aging Sen. John Stennis when he tried to portray Stennis, then one of the hawkish of war hawks in Congress, as soft on standing up to the Soviets in the Cold War.

Mississippians then saw that Barbour was talking pure hogwash and soundly defeated him.

Bill Minor is a syndicated columnist who has covered Mississippi politics since 1947.  

Mike Leavitt is Concerned

So Medicaid is now in trouble, according to this Reuter’s article:

WASHINGTON (Reuters) – Spending on the Medicaid health program for the poor is on a path to grow at a much higher rate than the overall U.S. economy in the next 10 years, officials said on Friday.

Spending on Medicaid benefits will increase 7.3 percent from 2007 to 2008, reaching $339 billion, and will expand at an annual average of 7.9 percent over the next decade, hitting $674 billion by 2017, the U.S. Department of Health and Human Services said in a report.

Over that same time span, the projected rate of growth for the overall economy is 4.8 percent, the report stated.

The report’s release comes at a time of growing worry over the fact that health spending has become an increasing burden on individual Americans, businesses and governments.

And what does our esteemed Secretary of Health and Human Services, the Bush-appointed Michael Leavitt, have to say about this?

“This report should serve as an urgent reminder that the current path of Medicaid spending is unsustainable for both federal and state governments,” Health and Human Services Secretary Mike Leavitt said in a statement.

“If nothing is done to rein in these costs, access to health care for the nation’s most vulnerable citizens could be threatened.”

Let’s take a look at Mr. Leavitt, who is so concerned about the health of poor people.

Let the Sacrificing Begin

Note: This essay is crossposted from BlueRage and was first published before the actual presentation of the budget to Congress.  We’ve had some time to see what it contains and we’ve already heard that it is pretty much DOA.  It’s a lame-duck’s final quack with nothing for anyone.  The issue, “guns or butter,” is not going away and will only heat up as crunch time for the budget approaches this summer.  So..The Post:

It’s time to show our “support for the troops.”  The guns or butter debate will heat up in Congress over the budget for next year.  It seems that in order to support our 600 BILLION dollar defense budget, we face cuts in so-called “entitlements.”  The choice will become clear that we at home, through cuts in the social services that support US, will be asked to sacrifice so that our military will continue to be the biggest, baddest, and most expensive in the world. American Progress reports:

My Covert Media Op to Save Public Hospitals

In early December, I diaried a proposed Medicaid Rules change, which, if it goes into effect in May as scheduled, will result in draconian cuts to public and teaching hospitals.  This is a non-partisan issue: the US v. the Bush Administration.  Representatives Eliot Engel (D-NY) and Sue Myrick (R-NC)  have introduced HR 3533, the Preserve Our Public and Teaching Hospitals Act into the house to block the odious rules change.  Senators Jeff Bingaman (D-NM) and Elizabeth Dole (R-NC)have attemtped to introduce a moratorium on the rule in the senate.

Unfortunately, the good guys have not been able to muster the votes to extend an existing moratorium on the rules change, which would spare our frayed public health care infrastructure a possibly mortal blow for at least another year.

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