A couple of stories caught my eye this week:
A young Canadian skier who was gravely injured in an accident here in the US and ultimately died. The Utah hospital that tried to save her then billed her family some $550,000 (That's one estimate of the amount; others are as low as about $280,000).
An 18-year-old young woman with leukemia has joined the Occupy movement because her family's insurance company refused to pay for treatment, saying she likely had leukemia before she was insured.
The skier, Sarah Burke, was 29. She was training for an event that wasn't sanctioned by whatever powers sanction such events. That's important because there would have been coverage if the event had been sanctioned. Still, she would have had full coverage in Canada, which offers health care to all its citizens.
Some 700,000 Americans face the choice to get treatment and go bankrupt or to die and save their families the trouble. Those who try to pay off the bills are saddled with staggering debt that takes a lifetime to pay off. Fortunately for Burke's family, people have donated money to help and it looks like the bills will be covered. But had it not been for the publicity, the family would have faced that debt alone, as do millions of American families.
Miran Istina has decided to spend the end of her life advocating for economic and social justice by joining the Occupy movement. Istina is from Oregon, and when she was 14, she was diagnosed with chronic myelogenous leukaemia.
"They denied me on the terms of a pre-existing condition," she told the British newspaper, The Guardian. "Seeing as I had only had that insurance for a few months, and I was in early Stage 2, which meant I had to have had it for at least a year, they determined it was a pre-existing condition and denied me health care."
Istina needs a bone marrow transplant, chemotherapy and radiation therapy, which would cost hundreds of thousands of dollars. In some places, hospitals will look to charities to pay for such treatment, but Istina has traveled the country looking for help and been unable to find it.
When she dies, she won't even be included in the statistics of 45,000 deaths a year from lack of insurance because her family has insurance; the company is simply refusing to pay. Perhaps now that she has made the news people will step forward to help.
This is not the way to do things. Sure, once the Affrordable Care Act takes effect, insurance companies won't be able to deny coverage, but Istina may not live long enough to see that day; and even if she does, it may be too late for effective treatment.
I want to know how people who call themselves "pro-life" but oppose the ACA rationalize that. Our country has THE worst preventable death rate in the industrialized world. We are 37th in health care outcomes. We do NOT have the finest system in the world; we might, though, if health care were made accessible to all.
Sarah Burke might well have died in a Canadian hospital too; in fact, she probably would have. But her family would not be left hundreds of thousands of dollars in debt.
Miran Istina's family probably won't have a pile of debt but they won't have their daughter either.
I know there are people who will judge her family harshly because they didn't go into debt and then go bankrupt to save her life, but I can understand the decision, even though it might not be the one I would make. It might be her own decision for all I know.
The crime is that any family should have to make this decision in a country that has as much as ours does.
She has decided to spend the time she has left fighting corporate influence in government.
"The corporate influence on politics influences just about anything that happens, seeing as politicians write the plans that healthcare has to follow," she told The Guardian. "It directly links the fact that insurers only pick and choose those who are actually worth it [financially]. I just happen to not be one of the ones they wanted to be around much longer."The decision was absolutely influenced by some corporation or some bank saying, 'we can't afford her. She's not worth our money.' In end terms, corporate greed is going to cost me my life."
A new poll by the Kaiser Family Foundation finds that 44 percent of Americans have an unfavorable view of the Affordable Care Act; 37 percent have a favorable view.
But the people who want to see the law expanded or kept in its current form (50 percent) is still larger than the percentage of people who want to see it repealed outright or repealed and replaced with a Republican-backed alternative (40 percent).
What this means is that most Americans want to see the health care system fixed. A number of people who disapprove of the law as it has been passed do so because it doesn't go far enough.
The law will offer about 31 million Americans coverage beginning in 2014, and the access to care that comes with it. Another 20 million will remain uninsured, and millions of those who get insurance will have high-deductible plans that keep them from getting the routine care they need to stay healthy.
The official stand of Life o' Mike is that we want a system that offers access to quality care for all Americans, and we don't care what it looks like asd long as it works. No matter what I think might work personally, I will advocate for anything that will work.
On my desk sits a Tibetan singing bowl that reminds me an American dies every 12 minutes from lack of insurance. I have used that bowl in memorial services for the millions who have died over the last 25 years because they lacked insurance, chiming it every 12 minutes. I used it at an informal Congressional hearing where people told their health care horror stories. Every 12 minutes, when I chimed the bowl, the chamber fell silent. Someone else had died. The effect is chilling.
The Affordable Care Act is a step forward, but it is too often misunderstood because of the misinformation perpetrated by its opponents. Many of the people I talk to don't know there will be subsidies for people who can't afford to pay for insurance or that many poor people who haven't been eligible for Medicaid because they're single adults (Mike was forced to leave his wife to get Medicaid, but he had metistatic cancer by then) will be eligible under the law. And the threshold moves up to 133 percent of federal poverty level. That means that people who are unemployed and have been forced to take part-time work at low wages will be able to see a doctor when they get sick.
There are plenty of people who still believe there will be death panels. In fact, the law will abolish the insurance company death panels that exist now.
I'm all for free enterprise, but not when it allows 45,000 Americans to die every year. I want the system to work for all Americans, not just the ones who are lucky enough to be able to find a job with insurance benefits. We need to balance capitalism with morality; the market won't do that by itself.
So, we start from a place that says the system needs fixing, that the so-called free market is not equipped to handle the unique needs of a health care system all by itself. Where do we go from here?
The poll also found that 59 percent of Americans believe that members of the Supreme Court will decice the case based on their own ideology and not on the facts of the case.
North Carolina's Secretary of Health and Human Services, Lanier Cansler, resigned from his post recently, effective Jan. 31.
When Gov. Bev Perdue was elected, I ran into Lanier at a party and asked if he was going to be the next HHS secretary. I got an odd stare in responsse, and then he smiled and said something to the effect of "nothing is impossible."
Cansler, a Republican who once represented Asheville in the state legislature, had been deputy secretary when Mike Easley was governor, but he was frustrated with the damage being done to the mental health system by "reform," and the refusal to fully fund programs that help people with disabilities. He advocated for a computer system that would connect the state's 100 departments of social services, something that still hasn't happened.
He resigned from that post and lobbied for improvements to the system. So, when Perdue was elected, the idea of Lanier Cansler being appointed HHS secretary wasn't too far-fetched.
I spoke to him before the GOP took the legislature, and he was worried about Medicaid funding then. But his worst fears were confirmed when the legislature began the squeeze. Among other things, they tried to end personal services to people with disabilities. A judge overruled that attempt, but the funding for DHHS is so tight, there's no way the department can meet its legal obligations. Medicaid alone has a nearly $150 million shortfall and the legislature is insisting DHHS has to find places in its budget to make the cuts.
Ten years ago, Lanier Cansler told me he realized that the first place government cuts in a shortfall is human services:
"They ask us to trim the fat," he said. "Then they ask us to trim the fat again. There's only so much fat before you start cutting into meat, and frankly, we're getting pretty close to the bone now."
That was during the budget crisis that followed major flooding from Hurricane Floyd. This budget crisis has no real cause other than the view that taxes need to keep being cut, no matter how badly people are suffering.
Cansler told NC Policy Watch that the legislature reneged on a promise to help close the budget gap. I guess that was the final straw for him.
He also said, “I think the legislature wants to keep pressure on the administration to try to continue to squeeze the Medicaid program.”
Cansler added that after three years of cuts, DHHS doesn’t have discretionary funding to shore-up Medicaid, which serves more than one million people statewide. All this comes after a report found the state has saved nearly $1 billion on Medicaid costs by implementing some innovative policies such as finding Medicaid recipients a "medical home" where their care can be coordinated. This keeps people outy of emergency rooms and helps them stay healthier with preventive care and chronic illness management.
Still, the NC Legiuslature appears to want more. DHHS saves a billion and its reward is to have more cuts demanded of it.
This latest shortfall follows a budget mandate by the N.C. General Assembly last summer that Health and Human Services eliminate another $350 million from its bottom line.
Medicaid isn't the only program DHHS administers -- there's also child and adult protection services; food stamps; mental health, disability and substance abuse services, foster care, oversight of county health and social services departments and more. Cuts to those programs can mean people with real needs going hungry or being abused and even killed.
It seems the focus is on education, which also is being slashed, but we need to talk about human services too. We need both departments to be healthy to provide any kind of quality of life for our citizens.
I was filling out a grant letter of intent this morning with one of my board members. She was looking up the numbers and I was interpreting them, and they're pretty dismal.
For one thing the two top causes of death here are suicide and infection -- both largely preventable.
An estiumated 40,000 people in Buncombe County, NC are uninsured or underinsured according to numbers from the Western North Carolina Medical Association. According to the county's annual Community Health Priorities, nearly 9,000 residents report having no insurance at all; about 30,000 receive Medicaid.
With its recently published Community Health Priorities for 2012, the county is trying to address some of the health care issues. Among its goals:
*Increase appropriate use of emergency rooms*Increase capacity of the mental health care system
*Increase percent of residents with insurance coverage
*Reduce prevalence of chronic diseases
*Increase early detection of disease
*Increase longevity for those with chronic diseases
*Increase level of insurance coverage for mental health care
*Reduce costs associated with chronic diseases
All of these will require that those 70,000 or so people who are on Medicaid or who have little or no insurance coverage get access to quality care. First, each person needs a medical "home," a place where he or she can get regular care, where medical records are maintained and where a person can get follow-up care.
Emergency room care does not offer early diagnosis of anything -- people go there when they already have symptoms. Nor is the emergency room equipped to follow up on care to make sure patients actually filled their prescriptions or that they understood the doctor's instructions.
Proper care of chronic illness requires regular medical supervision, and it takes a medical "home" to do that properly.
As the Affordable Care Act is implemented, more people will get insurance, but there is no guarantee they will be able to afford care, especially if the only policy they can afford has a $10,000 deductible.
Until there is a national plan that really addresses access to quality care for all, we will continue to see needless deaths from causes like suicide and infection.
Despite the rises in the poverty level and the cuts to programs that help people in poverty, some on the Right would have us believe that you can't be poor if you have a refrigerator and a TV, or even if you have indoor plumbing.
There are plenty of people whose refrigerator came with the rental of the crumbling single-wide they live in, but they don't have the money to fill it.
For a family of four, the official poverty level in 2011 was $22,314. That's less than $430 a week.
Here in Asheville, by far not the most expensive place in the country, an average two-bedroom apartment rents for about $875 a month. That's $10,500 a year, or nearly half of the poverty-level income. In Attleboro, Mass., the average monthly rent is about $1,000. In Augusta, Ga., it's $695. In Woodbridge, NJ, it's $1,545. Financial counselors say a family's housing and utilities should come to about 30 percent of total income, although 40 percent is acceptable. Anything more is dangerously high.
So, that puts a whole lot of families in the danger zone, and most of those also face food insecurity, meaning they may not be able to afford enough food for the family, especially during winter, when utility costs are higher. Even if this family has a good health insurance policy, the $25 co-pay to see the family doctor and the $15 or higher prescription co-pay could throw off the entire budget.
Since 2000, the poverty rate in the US has risen from 11.3 percent to 15.1 percent in 2010. Some 46.2 million Americans now live at or below the poverty level.
For children, the figures are even worse: In 2000, the poverty rate for children under age 18 was 16.2; in 2010 it was 22 percent. That's more than one in five children living in poverty.
Yes, most of these families have a refrigerator -- if they have a home.
At the same time, income is falling for most Americans. Median household income was $49,445 in 2010, which is a statistically significant decrease of 2.3 percent from 2009.
So, what happens to people in poverty? Well, they're more likely to become ill, especially with diseases that stem from improper nutrition, and they're less likely to have access to medical care, so they're more likely to have complications from common illnesses. They are more likely to suffer from depression and to self-medicate with drugs or alcohol. People in poverty are less likely to finish high school, or even enter college, let alone graduate, consigning them to a life of low-paying jobs. They are more likely to experience homelessness, and more likely to face incarceration.
People who have never experienced poverty, or been close enough to someone in poverty to feel its effects, tend to see it as a moral failing, when in reality, the moral failing is ours as a society for failing to deal with the root causes of poverty.
Let's face it, poverty isn't caused by the poor; it's caused by the comfortable ignoring the plight of the poor and refusing to lend a hand to help people out of poverty. It's caused by an I-got-mine-get-your-own mentality.
We can fix this, but not with more tax cuts to the wealthy and to corporations. We the people, who collectively operate through our government (of, by and for the people), can do this, IF we stand up and demand an end to corporate influence over our government.
To learn more about the numbers of poor in the US, visit http://aspe.hhs.gov/poverty/11/ib.shtml
Happy New Year, everyone. This promises to be an historic year, either in that We the People take back our Democracy or that it succumbs to corporate interests. Across the country, corporate interests are trying to subvert the election process with laws that place obstacles in the paths of voters -- especially those voters who would oppose the corporate takeover of our government.
Media are avoiding this and other big stories that would sway voters away from the corporate-sponsored candidates and instead take the money for ads that are completely lacking in issues, and often in truth. That's because most of the media in America are owned by huge corporations and they have an interest in keeping things the way they are. Real campaign reform would mean millions, perhaps billions, lost in advertising revenues.
Each time I speak about some of the health care law provisions that have taken effect, people are surprised. They didn't know that their insurance (those who have insurance) must cover 100 percent of wellness care, including immunizations and screening tests for various cancers, for example. Insurance companies no longer can dump you if you get sick, and they can't put lifetime caps on coverage. They can't refuse to cover children with pre-existing conditions such as birth defects. They have to justify rate increases. New procedures have been implemented to prevent fraud and abuse in Medicare, Medicare and the Children's Health Insurance Plan. Plus, more than 2 million young adults have insurance because they can stay on their parents' health insurance plans until age 26.
And we still have more to come.
The Affordable Care Act has a lot of holes in it, most notably a public option -- the ability for those of us younger than 65 to buy into the popular government single-payer plan known as Medicare. However, there are some good things in the law, and millions of Americans will benefit.
Still, some 20 million Americans will remain uninsured, even with the mandate. That's a lot of people without access to care.
So this year, I resolve to push harder to get access to quality health care for all. I can't do it alone, but I will do my part.
I have a big mouth; I resolve to use it.