What happens when we reduce health care funding for poor people?

I put that question to Scott Parker of Western North Carolina Community Health Services this morning.

WNCCHS had 45,000 patient visits last year. It is not a free clinic, although the $10 copay is waived if patients show up for their appointments on time. WNCCHS serves uninsured people and people on Medicaid, the government insurance program for the poor. It receives 40 percent of its funding from the federal government.

Last week, the Republican-led House of Representatives passed a bill that would slash federal spending for clinics by $1.3 billion; North Carolina would lost $6 million, meaning 61,500 people would lost their access to primary care through clinics like WNCCHS.

"Let's say 50 percent of those people get sick and have to visit the emergency room." Parker said. "That would cost us $21 million."

So, we slash $6 million from health care for poor people and it costs us $21 million. How is this fiscally responsible?

The real answer is that this isn't about being fiscally responsible; it's about a social agenda to remove services for poor people.

"These aren't lazy people," Parker said. "A lot of people who come here work multiple jobs and still don't have health insurance. They're hard-working."

Tell me again where Jesus said, "I got mine; get your own."

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.



I was in a meeting yesterday of the advisory group putting together proposed legislation for North Carolina's Health Benefits Exchange, and the insurance companies keep wanting more.

Last month they insisted they should be voting members of the board that oversees the exchange, making them regulators of their own industry in the state. A lot of us disagreed, saying this would be a conflict of interest. To have them as nonvoting advisors would be appropriate, but not as voting members of the body that oversees their practices. They felt persecuted, poor things. One member of the advisory board resigned in protest because he didn't believe insurance companies were getting a fair break.

I don't have a lot of sympathy, considering the 45,000 people who die every year in this country because they couldn't get a break from the insurance companies.

Am I biased? Perhaps. Am I right? I know the facts about the abuses of Big Insurance. If you doubt there's abuse, read "Deadly Spin" by Wendell Potter.

North Carolina has 15 insurance companies doing business in the state. Blue Cross Blue Shield has 81.1 percent of the market; the second highest is Wellpath Select, which has 4.8 percent of the market.

 Of those 15 companies, 14 have asked for waivers of the requirement that they spend 80 percent of what they take in on health care services to their policyholders. Keep in mind that Medicare -- the government's very popular single-payer plan for seniors -- spends 97 percent of what it takes in on direct services.

Not one of the companies doing business in the state sells a policy that covers just children, so if you're a single mom who only can afford to cover her child, you're out of luck in North Carolina. The insurance companies stopped selling those policies because they were being forced to cover children with pre-existing conditions like birth defects or chronic illnesses like asthma.

Several companies have suspended sales entirely in North Carolina, "pending the development of compliant products."

The threat is that if state exchanges don't play ball the way insurance companies want them to, they'll take their policies and go elsewhere.

That's extortion, but it could turn out better for American people. Maybe then the states would take the initiative and offer public plans and people would flock to them, leaving the insurance companies out in the cold.

A couple of states already are mulling the possibility of a public plan. No one would be happier to see Big Insurance shoot itself in the foot than I would.

The Rev. Amy Zeitlow, chief operating officer of the Hospice of Baton Rouge, says in a blog post that nonprofit hospices are being replaced by for-profit businesses at an alarming rate. If you think there's no difference, consider this:

My friend, Andy, was about to be released from Sloan-Kettering Hospital in New York, where doctors could do nothing more for him. He was going home to his sister's house in New Jersey to die.

His sister, Pat, got the call at 4 p.m. on a Monday, telling her he would be released in the morning. They referred her to a for-profit hospice, which would deliver a hospital bed. That's it, just a bed. No sheets, no supplies. Pat was frantic. Where the hell was she going to get sheets, pads and other supplies before morning?

I told her to call the local nonprofit hospice first thing in the morning. She did, and everything was ready so Andy could be comfortable the moment he arrived.

"I was thinking we'd have to put him in the recliner until we could get everything ready," Pat said.

Hospice helped her hire an aide who could care for Andy so she could just be with him.

Hospice is there to help the entire family through the death of a loved one. I could not have cared for Mike at home had Hospice not been there, or if its services had not been free. To me, free service is the very essence of Hospice. Medicaid paid for the equipment we needed; private insurance probably would have covered most of it, but Hospice would have made sure we had what we needed nevertheless.

The nurses, social worker, doctor and counselors were fantastic.

The for-profit "hospice" offered Andy a bed.

No matter what the intention of someone who starts a for-profit hospice, the bottom line has to be the primary concern if the business is to be there for the long-term.  There are basic differences between businesses and nonprofits. In Andy's case, the difference was compassion, a whole lot of necessary supplies, and peace of mind for his family.

Andy died at home last week. His final words were, "I'm fine."

The President has turned his back on some of the most vulnerable Americans by cutting $2.6 billion from the Low Income Energy Assistance Program. That's about what we spend each week to continue the wars in Iraq and Afghanistan.

Scott Rogers, executive director of Asheville Buncombe Community Christian Ministry, said the proposed cut equals about half the program.

ABCCM is one of the agencies that administers the program here in Buncombe County, and Rogers said if the cut goes through, the agency will have to raise $500,000-$700,000 to replace the lost assistance.

This program is not pork. It keeps people warm in winter. It saves lives.

With the unemployment rate still at 9 percent and millions more people underemployed and having a harder and harder time stretching their dollars to meet the necessities, this is what we come up with. This is what is proposed so that we can make up the revenue we lost when we extended the tax cuts for the wealthiest Americans. Apparrently, their ability to buy more unnecessary luxury items is more important than heat for the needy.

The Right would have us believe that poor people are just lazy and that we just can't afford to provide for them at all.

The truth is that most poor people are hard-working and they're losing ground because of all these bad policy decisions.

"This has been proposed before," Rogers said. "Hopefully we can help them understand how devastating this would be to families."

My dear friend Andy Chabra died this afternoon. It's hard to express the sense of loss of a friend like Andy. I met him 28 years ago when we both worked for an "entry-level" paper. What that really means is a word-mill, where we were taken advantage of, overworked and underpaid.

Most of the people at the paper got angry about the circumstances, but Andy found humor in it. He sent an editor scurrying when she tried to pile one too may tasks on him. From the bridge of the nose up, Andy looked a little like David Berkowitz, the Son of Sam killer. He hunkered down behind his computer terminal and gave her the "Berkie look," and she took off and did the task herself. When I asked him how he accomplished it, he put his hand over the lower part of his face and squinted.

"Berkie," he said. "Evil faces down evil."

When I left that paper, I let Andy know as soon as there was an opening on the copy desk at the new paper, and he got the job. When I moved up again, I took Andy with me once more. He was a hell of a good editor, and an even better friend.

He was there whenever things got bad, and when times were good. He loved baseball -- especially the Yankees. I loved him despite his misguided taste in baseball teams.

He made me laugh, often with the same jokes, again and again. In fact, he made everyone laugh. When morale was in the pits, Andy found ways to make us all laugh and forget how evil the corporation was.

Everyone who worked with Andy loved his sense of humor -- I don't think I ever heard anyone say a mean word about him. I think if they had, I would have popped them one.

I was a bridesmaid at his wedding, and I was there to hug and comfort him when the marriage broke up. He was there for me when Michael was at his worst, and he was there to celebrate with me when Mike sobered up.

I don't know how to express my grief at the passing of such a remarkable human being.

He was an amazing, funny, loving, kind and gentle friend, and I miss him terrbily.

United we stand.

This was a hawkish saying in the months after 9/11, but it is appropriate again for people who don't want to see human services and other government investments slashed to keep tax cuts for the wealthiest 2 percent in our society.

If we each stand and insist our little patch of ground be left alone, we all stand to lose. There is more strength in numbers. If we all stand together and insist the government cut its spending on wars and feeding corporations and Wall Street.

We don't each insist on saving all the programs that help people in need, we'll all lose. Already, the government has cut heating aid to the poor. Someone surely will die because of that. Mental health programs have been slashed, and people have died because of that. Do we really want to cut children's health insurance and Medicaid? How many will die from that?

How about rental assistance or disability income? Job training? Minimum wage? Infrastructure repair and upgrading?

Everyone who knows me knows my issue is universal health care. But without a decent education, safe housing, adequate heat and healthy food, a safe place for phyicial activity and a living wage, access to health care won't mean as much.

We must work together -- millions of us. The protests in Egypt set a good example. People didn't riot for the most part. We need to hit the streets and nonviolently insist we want corporate welfare to end and demand that the American people's needs and interests come first.

We don't just need social justice in one area; we need it for all Americans in all areas.