State budgets across the country are still struggling and legislatures are looking for cuts in all departments.

I spoke with NC Secretary Lanier Cansler of the Department of Health and Human Services this morning, and he talked about the hard choices.

"We're having to look more closely at everything," he said. "There is abuse, and we can look to eliminate that."

Following Medicaid patients more closely will allow administrators to pick up cases of pain medication addiction, for example.

People go to the emergency room claiming to experience pain, undergo expensive tests such as CT scans and MRIs and leave with the pain medications they're addicted to.

Getting such patients into substance abuse treatment instead of allowing them to continue to play the system would lower costs and help patients live longer, healthier lives, Cansler said.

Cuts to the proposed DHHS budget last year were so draconian that Cansler said at the time he could lay off every worker in administrative jobs across the state and still not pay for the proposed cuts.

"Things aren't so bleak this year," he said. "The economy is a little better and we do have federal stimulus money. I think we'll have a tight budget again next year, and then I think we'll have a couple of better years."

This year, some of the money that was cut last year has been restored, including $40 million to the local agencies that oversee mental health, developmental disabilities and substance abuse services across the state.

The state also will continue to increase funding for short-term, emergency care psychiatric beds in community hospitals, which will take some of the burden off the beleagured state psychiatric hospitals and allow them to focus on long-term care.

But the state also will lower rates for some of its services that are designed to support people living in the community.

At-home personal care services also will be cut. Cansler said the primary diagnosis of three-fourths of people receiving these services is high blood pressure and the average age is 60.

But that means a lot of people getting these services are older than 60, and even with a primary diagnosis of high blood pressure, they may be too frail to care for themselves well enough to continue to live at home without help. Of those under age 60, they likely have disabilities that prevent them from living without some assistance.

My mother needed help during the day when my sister and my niece were at work. For a long time, her primary diagnosis was high blood pressure, but she was frail and needed help getting to the bathroom and showering. Having an aide there to help her a couple of times a week preserved her dignity and her ability to live at home.

Yes, there are abuses in the system, but Medicaid rates are so low already that many doctors refuse to participate or accept only a limited number of Medicaid patients. That doesn't come from greed but from the fact that the rates don't cover their overhead. When you add in the mountain of required paperwork and the delay in receiving payment, it just doesn't make good business sense.

Rather than tightening the pursestrings on patients, why can't we find a way to streamline the process so it isn't so onerous for doctors and other providers?

Medicaid is a huge portion of the state budget and it's growing.

In 2014, when health care reform takes full effect, the number of Medicaid patients in North Carolina will jump by about 50 percent.

"Actually, I'm really excited about that," Cansler said. "We're going to give access to health care to a whole lot of people who don't have it now. I don't know how we'll pay for it, but we'll figure it out."

Once again, the state budget aims to cut programs, staff and funding to the Department of Health and Human Services, and raise fees for such things as copies of birth and death certificates -- things all people have to have.

When Mike died, everyone, even the cable company and the phone service provider, wanted an original copy of his death certificate just to cancel services that were paid up to date. I sent some of them copies and they were satisfied.

I paid $15 each for originals; now they'll be 24. Had I not refused to send some people originals, I could have spent up to $300. That might not sound like a lot of money, but it can be a big bite out of a budget for a family that has just lost its breadwinner.

Gov. Perdue's proposed budget will continue up to 9 percent cuts in Medicaid, which already is desperately underfunded. Try to find a doctor who is accepting new Medicaid patients. The rates are so low already that most physicians and other service providers lose money.

The same is true for a lot of government-funded programs.

Goodwill Industries had to cut its employment support program because the state paid so little money. In the Asheville area, two programs remain: one at Liberty Corners and one at the Irene Wortham Center.

But Liz Huesemann, director of the Irene Wortham Center, said her program might have to go if the rates fall any lower.

"It's not good," Huesemann said. "It's cming to the point where we might have to cut people or programs, and I hate to do that, but it's coming to that point."

Under the proposed budget, the state would reduce by 7 percent the amount it sends to nonprofits such as the Institute of Medicine, the Special Olympics and Action for Children. It would reduce Community Health Grants by 7 percent as well.

The budget also would reduce programs that help recruit physicians to rural areas where there are too few doctors; it also would reduce the program that recruits psychiatrists to rural areas and to state psychiatric hospitals.

Child care centers would get hit with higher licensing fees, while Smart Start, which funds subsidies for low-income children, would be cut by 4 percent.

It would reduce the AIDS Drug Assistance program for two years and eliminate positions and reduce contracts in the Early Intervention Program, which helps children with special needs before they get to school.

A highly successful program to recruit and retain child protective services social workers will be killed if the budget goes through as is. CPS experiences such a high turnover rate that children can be endangered. The biggest piece is the number of social workers who start in CPS and decide in short order that the work is just too stressful and depressing. Workers who go through the program are more likely to know what to expect and therefore more likely to stay on the job.

That's just some of the cuts.

It seems whenever there's a problem finding money, health and human services get cut first.

No one seems to realize that many of these services prevent the need for much higher-cost community and health services later on.

When you cut the after-school program, kids who have nowhere to go are more likely to find trouble and enter the justice system; when you cut a social services training program, you increase turnover among soial workers and thereby increase training costs.

When you eliminate psychiartic beds in hospitals, people with mental illnesses end up in emergency rooms and jails, where the costs are much, much higher.

Aside from the cost in dollars, though, is the cost in human dignity. We don't place a priority on people, just on the bottom line.

We offer millions of dollars in tax cuts to lure businesses here, but we can't offer anything to people in need.

Our priorities are screwed up; it's time we started to straighten them out.

Access to health care for millions of Americans is a good thing, but it is just a start. 

Life o' Mike is joining with organizations around North Carolina and the nation to help improve the quality of communications and care people receive when they get into care. 

The NC Justice Center's Health Access Coalition, of which Life o' Mike is a member, launches this consumer campaign to ensure the new health care law saves money as it improves quality, 

A new poll of patients 50 or older found that: • Nearly all respondents (95 percent) said it’s important to improve the quality of the nation’s health care services.  • 37 percent of respondents said the quality of health care services in the United States have worsened over the past five years compared to 18 percent who say quality has improved. (African Americans, women ages 50-64, and Latinos were the most likely to say quality has worsened.) • Also, 20 percent of survey participants said they have received conflicting information from different doctors in the past two years. • And a majority (60 percent) of respondents said they have left a hospital or doctor’s office confused about what they were supposed to do when they got home.

For full poll results see: 

http://www.nationalpartnership.org/site/DocServer/Lake_MiniPoll_Media_Report_FINAL.pdf?docID=6242.

The Campaign for Better Care will work with coalition partners and lawmakers to ensure that health reform helps coordinate care and improve information sharing with consumers. That means improved use of electronic medical records, providing better information to patients when they leave the hospital, and strengthening systems like Community Care of North Carolina. NC Health Access Coalition is also collecting consumer stories about coordinating care for older Americans: You can see the stories here:


See the story of Polly Williams:  


http://www.youtube.com/watch?v=YYryV4NJaHw.  


See the story of Gretchen Wylie:  


http://www.youtube.com/watch?v=CQaTNdRvxD8.  


North Carolina partners include: AARP North Carolina, Action for Children North Carolina, Community Health Services (Charlotte), Life O’ Mike (Asheville), North Carolina AFL-CIO, Senior PharmAssist (Durham), and the State Employees Association of North Carolina/SEIU Local 2008.National partners include: National Partnership for Women & Families, Community Catalyst, and the National Health Law Program. The Campaign for Better Care is funded by The Atlantic Philanthropies. 


For more information visit the Campaign for Better Care at: http://www.nationalpartnership.org/site/PageNavigator/cbc_index 

I've been in touch with my state senator's office about how our insurance company delayed a critical medical test and nearly cost him his life.

Sen. Nesbitt's office got in touch with the state Department of Insurance to ask whether what Blue Cross/Blue Shield did was legal. Here was the department's reply:

"Several attempts to contact the Boyd’s have been unsuccessful.  However, the Dept. of Insurance would be unable to assist with any BCBS plan except BCBS of NC.  Mrs. Boyd needs to contact the Insurance Department of the State in which the contract was purchased. 

I hope this information is helpful."

Punctuation error aside, there was no attempt to contact me or my husband. There were no messages on my phone, no e-mails and no snail-mails. They did not try to reach me. Sen. Nesbitt's office forwarded them all my contact information. I doubt they got all three things wrong. I have a feeling the Department of Insurance paralegal who got the case blew me off and then lied about it.

Second, aren't there laws in each state that dictate how business can be done? Even if I'm with Empire State Blue Cross/Blue Shield, don't they have to abide by the laws of each state in which they do business?

If not, why not? Does that mean I can start a business in some other state and do illegal things in this state and get away with it?

I'm not backing down on this. If there are no laws governing how insurance companies do business across state lines (my husband's company, a national corporation, contracts with Blue Cross/ Blue Shield in New York), then we need to change that, and we need to do it now.

Watching a documentary on Woodstock last night, I heard adults my age talking about using pot and drinking at the event, and I wondered what they told their kids.

I didn't drink often when I was young -- I started my glass of wine in the evening ritual about 20 years ago -- but I drank to get wasted the half dozen or so times I did drink before I was 21.

I smoked pot, like a whole lot of other people in my generation.

So, when my kids came of age, I was honest. Yes, I was stupid enough to try these things, and I was lucky I got out without permanent damage. I hoped they would be smarter than I was, I said.

Many of my generation thought the drunken prom night and the pot on weekends were a rite of passage.

We were wrong about that.

By the time Mike picked up his first joint, pot was 12 times stronger than when I was young. Although medical experts say it isn't addictive, Mike always insisted that it is when it's this powerful.

We also know now that the younger a person is when he or she starts drinking or doing drugs, the more likely he or she will experience dependence and addiction.

A drunken prom night can lead to assualt,  alcohol poisoning or death from the drinking or from driving drunk or other reckless behavior.

Mike said he was an alcoholic from the time he took his first drink. He sobered up when he was 22, and he taught me a lot about the harms of underage drinking.

During the documentary last night, I saw a commercial for an outfit that claims it can cure addiction because it's not really a disease. Mike would have gone through the roof at that.

Addiction is a progressive disease and the younger people start drinking or doing drugs, the stronger the hold it has on the brain.

Studies show that alcohol and drug use are increasing among underage people and on college campuses (http://big.assets.huffingtonpost.com/b1kms01k-3.pdf; and http://big.assets.huffingtonpost.com/pk0crebh-1.pdf).

As the abuse increases, so will the death rate. It's up to parents to talk to their kids honestly and to realize that just because we did it and escaped seious damage doesn't mean they will.

Handle the questions however you think is right ... "Just because I was stupid ..." "We're not talking about then; we're talking about now ..." "I never touched the stuff because I saw how stupid it made people act ..." You don't have to be your kid's friend when it comes to this stuff.

As my father used to say, "My kids have plenty of friends; what they need is a parent."

Allowing kids to drink or smoke pot isn't hip; it's wrong.

My boys' father died this morning. He was 62. He survived Stage 3 colon cancer for 10 years, and died what seems to be a preventable death.

Danny had a premonition. He said if he came up for Mike Day his father would die. He was in the hospital being treated for a colon obstruction that was caused by scar tissue and stress.

The doctors there said they would "rest" his digestive system for a few days by giving him IV nutrition. When he showed some improvement yesterday, they allowed him to eat a little and then didn't monitor him. The food came back up and he aspirated on it. They're not even sure what time it happened.

This is a small, understaffed hospital, but wasn't anyone watching the monitors? Apparently not. Apparently, it was too expensive to hire enough people to monitor the patients properly because so many patients are uninsured and unable to pay that the hospital is losing money like mad.

Danny is devastated. He has lost an aunt, a brother, his wife's grandfather, his grandmother and now his dad.

My ex was a good person, although not a good match for me. He was conservative (which is where Danny gets it, I think). He loved to have a plan for everything and I was always ready for adventure. He wasn't as social a creature as I am; his family was his world. The second time around, he found a woman who found all she needed in him. They adored each other.

His youngest son, Scott, seemed to take great pleasure in taking care of his dad. I could see it every time I saw them together.

Hazen's cancer treatment damaged the nerves in his spine and he lost most of the use of his legs. He refused to use a wheelchair and used braces and a walker. Scott was always there to make sure his dad could get where he needed to go. They came up together when Mike was dying and it was touching to see how Scott cared for him.

It's hard to believe he's gone. I suppose it will become real when I get to Georgia to be with the kids.

Yesterday was beautiful for our Mike Day activities, and it was lovely again today, so instead of going into the office, I played in the garden.

The kids left early today, so Rob and I had the day to ourselves. We took a walk at the NC Arboretum, which the kids rarely want to do (except for Trey), and I weeded, mulched and planted the greens bed and the potatoes.

My boys grew up eating food fresh from the garden -- especially tomatoes, peppers, green beans and cucumbers. Mike always knew the difference.

Last night, when we went out for supper, Danny joked that one of us should play Mike and complain about the food.

We reminded him that Mike rarely complained about the food at places other than chain restaurants. With four kids, Danny rarely can afford to go to the kind of restaurants Mike liked to go to. It's always easier to go to chain restaurants with the kids in tow -- you know what to expect and the kids will eat what they're used to.

I took Trey on a tour of the garden yesterday. The peach tree is budding and you can just see buds starting on the blueberry bushes. The raspberries and blackberries are starting to leaf out.

He wants to come back when the blueberries are ripe and eat them off the bush; Peyton thinks it's gross to eat anything off the bush because you never know if a dog or other animal peed on it.

It was good having them around yesterday. They gave me a focus on the day other than Mike's death. We got to talk instead about Mike's life.

And today, life goes on.