Our last photo of Mike, six weeks before he died. I wanted to delete this, but a friend talked me into keeping it because he really did look this way, thanks to a lack of treatment for so long.
It has been almost four years since Mike died, but as I approach the anniversary, April Fools Day, it seems much closer than that. The grief becomes fresh again.

It was Feb. 26, 2008, when I heard the words no mother should have to hear: "Mom, the cancer's back. There's nothing they can do this time."

Each day between now and April 1, the details come rushing back. On the day we heard the news, my husband and I drove out to Cary, four hours from here, to be with him. He was exhausted, so we checked into a motel. I walked across he street to a shopping center, just to wander, and I was looking at photo printers. I thought about getting one, and it crossed my mind that if I had any questions about setting it up, Mike could answer them.

Then it hit me: He would be gone soon.

I couldn't even catch my breath.

A little later, I got a call from my friend, John, in the newsroom.

"The boss is getting tired of these unexcused absences," he told me.  "That Page One story you did for tomorrow is being cut and run as a brief and you need to do a story on the weather. It's cold." I laughed.

It was cold, and I didn't have a jacket with me, so we went to Target. Every time I saw a mother with a baby, I wondered whether she knew how lucky she was. I wanted to talk to each one and tell them how fragile life is.

I called Michael's father and he sobbed into my ear.

"I never thought he'd die," he said. "I had Stage 3 colon cancer and I survived it."

"You also had the best medical care money can buy from the moment you were diagnosed," I said. "Mike got crap."

I remember being angry because Michael's dad was a Republican and he opposed "government-run" health care. He thought things were OK because things were OK for him. He never realized just how badly Michael was treated until this moment. But this news opened his eyes.

"There must be something we can do," he said.

"We can be with him and comfort him and enjoy him for a few months," I said. "He's going to die."

We didn't know then that the chemo wasn't going to do any good and that we only had six weeks left with him.

Doctors who treat patients on Medicare were facing a 27 percent rate cut next week if Congress didn't act to stop it, and with the way Congress has been working (or, more accurately, not working), a lot of us expected the cut actually would happen before anything was done.

The fix came as part of the same bill that extended the payroll tax cut for 160 million Americans in a rare bipartisan compromise.

Still, the fix is temporaty, set to expire the end of this year, and no one is talking about what to do next because no one wants to even think about it until after the November elections.

The problem stems from a formula devised in 1997, which everyone agrees is broken, but no one seems to want to fix it permanently. So an increasingly discordant Congress needs to act to patch it. In 2010 alone, it was "fixed" five times and now will need to be extended again before the end of the year. So, we'll go through another nail-biting time and hope Congress is still functional enough to act again before Medicare doctors love more than a quarter of their pay.

All this uncertainty is costing the Medicare system already as some doctors have quit taking Medicare patients because of it, and more are threatening to do so. It's getting harder to find a doctor, and it's only going to get worse unless we can give doctors the assurance that we value them enough to make a permanent fix to this formula.

Everyone agrees that doctors who provide care to Medicare patients don't deserve a pay cut, but no one can agree how to pay for keeping levels where they are. The formula was flawed from the beginning, and now the permanent fix would cost about $316 billion.  Naturally, Congress can't agree on where to find that kind of money, and raising taxes on the wealthiest and huge corporations won't even come up in the discussion.

There are those of us who think we could end our wars and pay for the fix, along with a lot of other improvements to health care, education, infrastructure ... Just sayin'.



Thanks to the Affordable Care Act, 54 million more Americans are getting the preventive care they need without cost-sharing (co-pays).

What does this mean? It means breast and colon cancers caught in the early stages, when they're much more treatable. It means regular pediatrician visits and immunizations for children, Pap smears and mammograms for women, colonoscopies for all adults over age 50, flu shots for adults, obesity counseling, depression and diabetes screenings, help quitting smoking before lung cancer or emphysema begin.

According to the Kaiser Family Foundation’s Employer Health Benefits Survey in 2011, 31 percent of all workers were covered by plans that expanded their list of covered preventive services due to the Affordable Care Act.

Before the ACA, many insurance plans charged co-pays and other fees for these services. Colonoscopies, even when they were covered, could cost hundreds of dollars. Be aware, though, if the gastroenterologist has to remove polyps, there will be a charge for that and for the pathology.

Before this provision took effect, people often went without these tests and services, allowing chronic illnesses to get worse and cancers to progress farther. People's lack of ability to afford these tests costs us billions in lost productivity and lost life.

Still, about half of Americans say they want the Affordable Care Act repealed. That number gets a little smaller every time some new provision takes effect, though.
  • Two million young adults who wouldn't have coverage otherwise are allowed to stay on their parents' plans.
  • Insurance companies no longer can refuse coverage to children who have a pre-existing condition.
  • Insurors no longer can cancel your coverage if you get sick.
  • Companies no longer can place a lifetime cap on the price of care you get, nor can they put an annual cap on your coverage.
  • The Medicare "doughnut hole" that makes older Americans pay for their own prescriptions will get smaller each year and disappear altogether by 2020.
Each year, millions of uninsured and under insured Americans face financial ruin, even the loss of their homes because of medical debt.  For many of them, help should be available, but they don't know it's even there, let alone how to apply for it. The Community Service Society of New York released a report this week on hospitals going after patients who should be eligible for assistance.

What makes things particularly bad for so many unemployed and uninsured Americans is that most employers now do credit checks on job applicants and refuse to hire them if the news is bad, so this one event in  life could make someone unemployable.

Columbia Presbyterian, which was mentioned in a NY Times story yesterdsay about a woman who is deeply in debt after receiving care there received more than $50 million last year from the state's Indigent Care Pool to care for people like this woman. A hospital social worker was supposed to inform her of the assistance and help her apply, but this woman tells Democracy Now! that she saw the social worker only briefly and the worker handed her a sheaf of papers without explaining anything.

According to the report by CSS, hospitals receive funds from the state to help people pay their bills, partly on how much unpaid debt they are owed. Some of the hospitals that are least compliant with state law on distributing these funds are getting the most money from the state.

According to the report: "Hospitals that provide the most financial assistance often receive the least amount of funding from the ICP program on a per application basis. For example, St. Barnabus Hospital received an average of $561 in ICP funds for each of the 51,210 financial assistance applications it approved, while Brookdale Hospital received an average of $93,929 in ICP funds for each of the 278 applications it approved."

For the study, CSS sent a letter in June 2010 to the Chief Financial Office of every hospital in New York State, asking for copies of each hospital’s financial assistance application form and policy summary or other pertinent material. CSS reviewed every hospital’s web site and downloaded any relevant financial assistance material. In October 2010, CSS sent additional requests to each hospital’s CFO to either verify the accuracy of the material received or to ask again for information to those hospitals that did not respond or have materials posted online.  Of the 201 hospitals surveyed, 163 responded. Last August, CSS sent a list of the hospitals that did not provide materials and those that asked CSS not to post their materials to the leaders of the two major New York hospital trade associations. One group, the Healthcare Association of New York State, responded and helped CSS's efforts to get hospital financial assistance policies. In all, CSS received and reviewed 181 hospitals' information to determine whether they: (1) complied with the law; (2) complied with the Department of Health’s guidance; and (3) imposed additional barriers to financial assistance.

Of the 181 hospitals reviewed, 120 (66 percent) violate the law, fail to comply with DOH guidance, or impose additional barriers to accessing hospital financial assistance.

In 2010, these hospitals collectively received $463,675,462 in Indigent Care Pool payments.

More than half -- 56 percent -- did not comply with the four requirements of the law. In 2010, these hospitals received $400,025,366 in ICP payments.

More than one-third didn't comply with Department of Health guidelines. In 2010,these hospitals received $204,845,679 in ICP payments.

Fully a quarter place additional financial information verification requirements for financial assistance beyond those laid out in the law and guidance. In 2010, these hospitals received $169,259,198 in ICP payments.

To put it simple, these hospitals are going after money they have no right to charge. They're taking money from the government and still going after people like Hope Rubel.

And this isn't just happening in New York. Most states don't even have laws that require hospitals to tell patients that aid is available. This is federal and state money. We all paid into this pool through our taxes, but hospitals across the country are keeping this money while going after the homes of people who can't pay. Two-thirds of bankruptcies in the US are related to medical bills, and many of them don't need to happen.

To learn more, watch the report by Democracy Now! at http://www.youtube.com/watch?v=cdhvtaSZiWE&feature=youtu.be, or read the story in the New York Times at http://www.nytimes.com/2012/02/13/nyregion/study-finds-new-york-hospitals-flout-charity-rules.html.

To read the CSS report, visit http://www.cssny.org/userimages/downloads/IncentivizingPatientFinancialAssistanceFeb2012.pdf

A new Harris Poll shows that support for parts of the Affordable Care Act are growing. Not surprisingly, those parts that have taken effect already are pretty popular.

For example, 71 percent of those polled now back the law's provision that prevents insurance companies from denying coverage to those already sick. I just question why the other 29 percent think it's OK to allow insurance companies to dump people who get sick.

Part of it, I think, is that people buy into the propaganda put out there by the insurance companies. They believe there will be "death panels," that they'll be forced to buy insurance they can't afford, that seniors still will be affected by the "doughnut hole" in Medicare coverage.

Of course, none of this is true.

Insurance companies themselves have been the death panels of health care, denying lifesaving coverage to people who have ever been sick, dumping people, refusing to pay for treatments patients need ... the list goes on. The ACA ends their ability to dump you, and it forces them to sell insurance to everyone.

As far as affordability, millions of people will receive subsidies to help them pay fpr coverage. For those who really can't afford it, there is a "hardship exemption" in the law. That exemption will allow 20 million Americans to remain without coverage, a loophole I think is unconscionable. However, it is there.

As for the doughnut hole, seniors already are seeing the benefit. More than 2 million people on Medicare saved more than $1.2 billion on prescription drugs—an average of $550 per person—last year alone.

According to the survey, more than half of Amercians agree with the provision that requires employers with more than 50 people to offer insurance or pay a penalty. In addition, more than half of Americans approve of allowing young adults to remain on their parents' plans until age 26. That provision has allowed 2 million more people to have coverage they would not otherwise have gotten.

Still, one-third of Americans want to see the whole law repealed. That says a lot about the success of the propaganda machine.

How much do you know about the Affordable Care Act? Take this quiz to find out. http://www.americanprogress.org/issues/2012/01/aca_quiz.html

The current attacks on Planned Parenthood and on the insurance coverage of contraception are nothing less than a campaign against women's health.

At the turn of the 20th century, women routinely died during childbirth, or they had child after child after child until they wore out and died. I'm not overstating the facts here. Poor women had no access to any kind of birth control and little education to tell them how to avoid pregnancy by methods that were available then.

Planned Parenthood was founded to offer care and education to women, to help save lives. It was not founded as an abortion clinic, and abortion is still only a very, very small percentage of what Planned Parenthood does. It offers health care to millions of women who otherwise would have none, and until we have a health care system that offers access to quality care for everyone, we need Planned Parenthood fully funded and operational.

Without contraception, couples would all look like the reality TV Dugger family, the one with 19 kids and counting. How many families would be able to manage that? Yes, God told people in the Old Testament to "be fruitful and multiply," but God never said to have more children than you can care for.

And not all Americans are Old Testament Christians or Catholics. Most of us (even most Catholics) use birth control to limit the size of our families to the number of children we can care for. Rick Santorum may think birth control is bad, but that doesn't mean he should be able to impose his values on me. He and his wife can have all the children they want and can care for.

If I work as a receptionist for a small Baptist church and they don't want to offer birth control because they think it's from the pits of hell and I'm one of three employees, I can understand not offering birth control. In fact, federal policy says houses of worship don't have to. But if I'm one of 3,000 employees at a huge Baptist hospital, that's another thing altogether. Federal policy now says big religious employers don't have to offer free contraception, but the insurance companies who cover them do.

That's a perfectly reasonable policy, since contraception is legal and it's used by 90 percent of American couples.

If I have a prescription for contraception and you're a pharmacist at CVS, you have to fill that prescription whether you like it or not. If you can't fill it because of religious objections, you need to find another job.  It wasn't OK for me to say I'm pro-choice so I won't cover anti-abortion rallies when I was a newspaper reporter; I did my job whether I agreed with the stands of the people I covered or not, and I did it fairly and with respect for the people who disagreed with me. You're as entitled to your beliefs as I am.

However, the government is not allowed to make laws to force me to follow your religious convictions. That's what the First Amendment is about. Just because a few powerful men who supposedly have never had sex want me to have a baby a year so the Catholic Church can increase its membership doesn't mean our government policy has to follow that.

If you follow that line of thinking, we should never have sent soldiers to Iraq because the Catholic Church opposed that too. Frankly, I wish the government had listened to the church then, but it didn't, and I don't recall hearing Catholic bishops demanding their followers go AWOL instead of deploying to Iraq.

For years, many insurance plans paid for Viagra with no questions asked, but they refussed to pay for birth control pills until the courts made them do it.

Women's reproductive health is important. We will not go back to being barefoot and pregnant. We have the right to control our own bodies, and we will not have that right taken from us simply because a minority of Americans believe God wants them to have a baby every year.

I've said this plenty of times before, but it needs to be repeated, especially since the leader of our NC House said his objective is to "divide and conquer." What he meant was that if he attacks the public systems and structures we all built together, each group will stand up for itself, trying to defend attacks on education, infrastructure, Medicaid, labor rights, etc., he can dismantle all the things that make us a society.

We need to work together to preserve public education, jobs, worker rights, health care, mental health services, the university system, our infrastructure, parks and other public places -- it's all being attacked, and it's all tied together.

Let's say a 35-year-old woman has a chronic illness. In a "right-to-work" state like this one, she can be fired for poor attendance. So, she loses her health care, as do her two children. With Mom sick and out of work, the children start doing poorly in school, partly because they're worried about Mom and partly because they aren't eating nutritious breakfasts. Don't think this couldn't happen because I know it does happen.

I attended an event last night that brought it all together for more than 100 people in West Asheville. It's called the Out-of-Control Tour, and speakers talked about how unlimited campaign contributions by one entity -- Art Pope -- had ushered enough extremists into office to begin dismantling our public systems. A few months ago, our House Speaker actually spoke, in range of a live microphone, saying it would be good to turn people who are on public assistance because of disabilities against people who are poor.

The organization Together NC exists to pull people together for a united fight against these cuts to essential systems that we all built together. Who benefits when schools are de-funded? Certainly not the families who depend on public schools to educate our children. Who benefits from crumbling infrastructure? Well, no one.

How about a decrease in the availability of health care? Well, when I told Mike's story to one legislator, he told me he had no insurance and had to pay out-of-pocket for a colonoscopy once. The gastroenterolgist allowed him to pay in installments. No one did that for my son. In fact, they demanded cash, up front. So, people with good jobs can pay over time, but students can die. And what if this legislator had needed major surgery? How much time would he have needed to pay that off?

Big business would love to get away from paying health care benefits. They also would love to abolish minimum wage and the 40-hour work week. That's why so many jobs have been shipped overseas -- and in the US, when jobs go away, so does access to health care. This element that has taken power in Raleigh seems to want to move us back 100 or more years.

My main issue is health care, but I know that without the other public structures in place, health care will mean little. That's because it's all connected.

Poverty is connected to education, workers' rights, the availability of nutritious food, health care ... every attack on one part of the social structure America has built is an attack on all of us. This is not about choices; it is about living in community. It's about being civilized.

Proponents of complete deregulation would have us believe that regulations are standing in the way of progress, that the so-called free market will regulate itself and result in an industry that will do the right thing for consumers.

Here's the truth: It can't work that way.

And here's why: Businesse are responsible, first and foremost, to their stockholders. The bottom line is the primary concern. That's the law.

So, if insuruing people who are going to be sick and cut into those profits isn't forced on companies, their first obligation being to their shareholders, they must turn their backs on high-risk customers. If the law says they must insure everyone who comes to them, that would overrule the obligation to seek profit first.

The free market has no compassion; it has no moral values. When it comes to health care, that's a big problem.

Here's what health reform does. Once insurance companies can't kick you out because you get sick or refuse to insure you because you got sick once before, people will get coverage, and with it, the access to care that they need.

The reason everyone needs to be in the pool is so that insurance companies can make enough of a profit to stay in business. If you're healthy now, chances are you won't always be. What you lay out in premiums now will get you better care in the future, when the next generation is paying. And so on ...

No business really wants to be regulated; that's why insurance and pharmaceutical companies and others have spent so much money trying to stop reform. They have enjoyed free reign for decades, and 45,000 people die prematurely every year because they can't get access to care.

Even when care is regulated, some things need to be taken on by government, or at least paid for adequately because the private sector can't or won't handle it.

A decade ago, North Carolina "reformed" its mental health system by privatizing services. The mantra was that this would give people "choice." The problem is that someone with severe and persistent mental illness might not be able to make good choices.

Another problem is that services for people with serious psychiatric problems are not profitable. Most people with these illnesses don't have insurance because they are too ill to work. Even when people have insurance, psychiatric benefits are far below others. Patients may find they only are allowed six psychiatric visits a year, and the medications that work best aren't covered.

People with severe psychiatric illnesses are less likely to show up for appointments, especially if they haven't been getting treatment regularly, meaning the provider has to spend the time the person was supposed to be there not making any money.

Service providers say they must spend more time filling out paperwork than they spend with the patient, but they only get paid for the time they spend with the patient -- if the patient shows up.

And with "reform," mental health service provider rates were low, they changed frequently, usually downward, and regulations changed almost weekly. The new system went into effect long before it should have -- Medicaid regulations had yet to be approved by the federal government, reimbursement rates were up in the air. No one knew what was happening or what to expect. Still, the rush to privatize went ahead. Within a few months, service providers were going out of business or abandoning Medicaid or state-funded patients.

Most businesses with good sense never took on severely ill psychiatric patients; others chose only to provide the easiest and most profitable services.

Really good systems cost more up front, and they need to be well planned before they start up, because so many people need so much care. Maintaining chronic illness is far cheaper than letting it get worse and worse. Our public systems are strained so badly because of the number of people who can't get care early on.

If someone with high blood pressure gets treated before he or she has a devastating stroke, we all pay less. If that person has the stroke, however, and becomes debilitated, we pay much, much more.

So, when we tell business it must provide care to sick people and then regulate it sensibly, people get the care they need and costs go down.