Amber Cagle has leukemia. She was diagnosed in December and is undergoing chemo at Wake Forest University Hospital.

I don't know much about her except that she's an animal advocate and she needs financial help. Fortunately, she is getting treatment, but the bills will take her the rest of her life to pay off. 

Her friends have put up a facebook page,, and a donation page,, to raise money for her medical bills.Newspapers and TV stations receive requests every day for publicity because, when people see the face, they're more likely to feel sympathy. 

If you can get publicity, you can get some help.

When I was a reporter, I would write about one person and a dozen more would write to ask for help. I couldn't do all the stories.If you look at my friend, Nancy Lindell's, post, it also says "201 like this," meaning there are 201 other Facebook pages like Amber's. It's social media coming of age in America. Newspapers can't so all the stories, so the next best way to go public is Facebook.

Only in America (because every other industrialized country in the world sees health care as a basic human right and provides it to people).When I wrote a column about Mike just before he died, people offered money to help with the bills, although by then, Medicaid was paying and it was too late to save his life anyway. 

The time for help was before he got sick, when his cancer could have been cured -- if it had been found before it had reached Stage 3.

Amber may be luckier than Mike. I certainly hope so.

A column in the New York Times yesterday told the story of a young woman who was dying of cancer. She was the mother of two young children and her husband had done all he could do to care for her.  She was no longer able to do anything for herself, and the cancer had attacked her brain so aggressively, she no longer even knew her own children.

The hospital couldn't do much for her, either, since and aggressive treatment only would prolong her suffering.

Since she couldn't be cared for at home and the hospital could do nothing more for her, the logical move would be to inpatient hospice. But the hospice in her area could only accept her if she had less than a week to live.

Her insurance company would cover expensive, pointless, aggressive treatment in the intensive care unit, but not palliative care in a nursing home.

The woman's medical team took her off antibiotics and the medications that helped her breathe and told the hospice people that she very likely would die within six days. The writer doesn't know whether the woman died within six days, although it was likely that she did.

I consider myself blessed that I was able to care for my son at home until he died peacefully. But that isn't always the case.

Last year, before my friend Andy died of colon cancer, staff at the hospital he was in (a major New York City hospital) told his sister there was nothing more they could do for him and that he would be discharged the next afternoon. They told her a for-profit Hospice would deliver a hospital bed, but she was on her own to get the rest of the supplies he would need.

Pat called me in a panic that evening and asked where she might find sheets, pads, a bedpan -- and what else would she need, anyway? She wanted Andy's last days to be comfortable and carefree, but she didn't know how to accomplish that.

Andy had spent his life trying to help others -- he was a 30-year member of the local ambulance corps. He was always there if anyone needed anything, and now his sister was desperately trying to give him the peaceful death he deserved.

"They've just thrown him to the curb," she said.

I helped her find a nonprofit hospice in Passaic County, NJ, and everything was ready for Andy when he arrived home that next afternoon. He died a few days later, surrounded by family. His final words were, "I'm fine."

First of all, I understand that hospital care is pointless and far more costly than is necessary for someone who is going to die very soon. But there needs to be a resonable alternative for people whose family, for whatever reason, is unable to care for them at home. And there needs to be help for families who opt to care for a loved one at home.

All of the non profit hospice organizations I've dealt with have been excellent. But the for-profit "hospice" Pat was steered to was less than helpful. She was about to lose her brother and all they would tell her was that they hoped they could have a hospital bed delivered to her home before Andy got there. They couldn't even get a list to her of the things she would need. She called me because she knew I had cared for Mike at home.

Fortunately, we were able to get the help Pat needed to care for Andy without the help of the hospital, which apparently, was done with Andy as soon as he was no longer profitable.

How can anyone leave a family in the lurch like that?


Wednesday, Dec. 21, is Homeless Persons Memorial Day here in Asheville. It is observed with a service at the Haywood Street Congregation at noon.

Each year, the list of those who died is posted in the front of the sanctuary, along with the lists of those who died in previous years.

Each of these approximately 20 deaths per year can be attributed to neglect, and to our failure as a society to care for the least of us -- those unable to care for themselves.

These are not bums; they are human beings who, for whatever reason, can't care for themselves. Of those with addiction, half of them were not substance abusers until after they became homeless. Many of them have mental health issues and they can't get the care they need to be able to function in society.

Just before Mike died, while I was caring for him, one of my colleagues at the paper called me to ask where to find people to comment on the death of Tommy McMahan, a homeless man who was turned away from the emergency room and arrested for not leaving. It was a cold night, and he knew he was too sick to sleep outside. He died in his jail cell that night.

I look for his name every year now at the memorial service because I want there to be someone who remembers him. He and Mike both died of neglect. I don't know how long he had lived on the street, but I do know it shortened his life dramatically.

Those who die on the street often die of hypothermia (exposure to the cold), infections, accidents, even murder. There is no safe place for them on the streets. No matter where they try to sleep, they can be arrested for vagrancy. It's against the law to be homeless in most cities now, but there aren't enough beds in shelters to accommodate everyone who needs one.

Most shelters won't admit anyone who has been drinking or using drugs, but there aren't anywhere near enough spots in addiction programs for the people who need them, no matter how badly they want to be clean and sober.

We in the United States are good at blaming the victim and then tossing him or her away like so much rubbish.

Well, these are human beings who are dying. If you want to call yourself pro-life, you need to think about how we help these people.

Here is this year's death toll:

2011 Deaths

George May       11/17/1953-12/23/2010

Vernon Rauch  9/07/1955-1/16/2011

Jesse Bailey        7/12/1960-3/22/2011

Adrian Nelson   4/26/1960-3/31/2011

Ian Pennell         12/10/1947-3/31/2011

Charles Davis     4/23/1959-5/01/2011

Rick Ochoa       8/25/1967-5/27/2011

Clarence Matthews     9/17/1965-5/30/2011

Sharon Ogle      10/17/1955-6/2/2011

Jeffrey Gault      3/07/1968-6/10/2011

Larry Short       Died 5/2011

Sandra Smart     7/12/1956-7/20/2011

Matthew Ratliff      8/09/1965-7/21/2011

Rachel Nesbeth     Died 10/21/2011

Steve Halulko    1989-8/21/2011

William Porter   6/21/1947-8/29/2011

Destiny Reifschneider  8/23/1983-8/30/2011

William Wing      5/18/1965-9/18/2011

Mell Ailes           9/06/1954-11/24/2011

Kelly Metcalf      11/30/1959-12/06/2011

Politifact, the St. Petersburg Times' fact-checking site, has said the biggest lie of 2011 is that Rep. Paul Ryan's plan for Medicare would end the program as we know it.

Frankly, I think the biggest lie out there right now is that it wouldn't end Medicare as we know it.

What was created in 1964 was a single-payer government-funded health program for the elderly and people who have severe disablities. It allows people to see their own physicians, go to any specialist, any clinic or hospital, and the government pays for it.

Of course, we pay into it all of our working lives, just as we do Social Security. Both programs are funded by all of us. They are not gifts, but something we do collectively. To privatize either one would be to end it as we know it.

You can call a giraffe a zebra, but it doesn't mean it is one. If Medicare stops being a single-payer, government-funded system, it ceases to be Medicare. What Rep. Paul Ryan is trying to do is offer "subsidies" to the elderly so they can choose their own insurance. It will be more expensive, because programs that don't have to worry about profits are more efficient and therefore less expensive.

Medicare spends 97 percent of the money it takes in on direct services; private insurance companies balk at having to pay out 80 percent.

In 2003, North Carolina decided to privatize mental health services. The result was disastrous. Nowhere near enough private companies came forward to offer services because the people who rely on state services are very ill and very expensive. Reimbursement rates were so low on many services that providers couldn't even make their overhead.

This is what Ryan and his pals hope to do to Medicaid. They want to take a program that works and dismantle it, which is exaxctly what privatizing it would do.

So, the "biggest lie of the year," is in fact the truth, and the folks at Politifact should know that. Shame on them.


Have we started down the path to a single-payer system?

Well, if you read Forbes Magazine's Rich Unger (, the road starts today with the implementation of the "80 percent rule."

It goes like this: Insurance companies must spend 80 percent of what they take in in premiums (85 percent if they're big group insurors) on direct care. If they don't meet that threshhold, they must issue rebates to policyholders.

The federal Department of Health and Human Services has issues some fairly strict rules about what constitutes services (and no, commissions on sales of policies are not services, even though the companies wanted it defined that way).

Insurance companies have lobbied hard the last three years to kill any regulations or any other kind of reform that would cut into their profits. That's part of why rates have risen so fast in recdent years -- lobbying, marketing and multi-million dollar salaries and bonuses are expensive.

Insurance companies still will make plenty of money, although they won't make the killing they have been making. We are, after all, sending them 31 million new customers with the mandate that everyone buy health insurance.

Unger calls the 80 percent rule (technically, the medical loss ratio), "the bomb" in the Affordable Care Act.

"(T)he medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry," he writes.

"Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most."

If they fail to adapt, a single-payer plan similar to Medicare will grow out of the need for people to have coverage, Unger predicts.

"Of course, those of you who fear the inevitable arrival of universal health care really shouldn’t be too fretful. There will always be a for-profit health insurance industry for those who want to pay for it," her concludes. "The only difference will be that those who cannot afford private coverage will also have an opportunity to get their families the medical care that they need."

I would love to believe he's right, but insurance companies have been very good at wriggling out of restrictions and regulations in the past.


Today we observe 30 years of battling HIV/AIDS, and we can look ahead with hope, although we still have a long way to go to erradicate the pandemic.

A new study shows that three out of four Americans with HIV do not have it under control. That may be because our health care system is so broken that many people with HIV don't have access to treatment. One in five people who have it don't even know.

I remember reading about the new illness in New York Magazine in 1982. It was called GRID then, for gay-related immunideficiency disease because most of its victims in the beginning were gay men. But it became obvious very quickly that the illness was not confined to gays. Suddenly it weas spreading among Haitians and then it began to show up in people who received blood transfusions and in children.

In the late 1980s, Americans got to know Ryan White, a child who had contracted the virus through a blood transfusion. His was the face of innocence; HIV/AIDS was not a punishment from God for being gay or a drug addict. Then pro tennis player Arthur Ashe died from it. In all, 30 million people have died from AIDS since the pandemic began 30 years ago.

Although some people who are HIV-positive still report a stigma attached to having the virus, we have come a long way toward eliminating that stigma. It took the courage of HIV-positive people speaking out and telling their stories to make the progress we've seen. As always, putting faces on the issue makes people understand it a whole lot better.

This morning, President Obama pledged to do more to help battle HIV/AIDS.  In an event this morning, he pledged U.S. support to help 6 million people in some of the hardest-hit countries get access to antiretroviral drugs by the end of 2013, increasing the original goal by 2 million. And he announced plans to boost spending on HIV treatment in the this country by $50 million.

"The rate of new infections may be going down elsewhere, but it's not going down here in America," he said. "There are communities in this country being devastated still by this disease. When new infections among young, black, gay men increase by nearly 50 percent in three years, we need to do more to show them that their lives matter."

Too often, young people who don't remember the beginning of the pandemic and the horrors of the way people died, think AIDS is a manageable disease. That's largely true -- if you have access to care and can affords the co-pays on the drugs you need to control it. But it's always better not to risk getting it. On top of being expensive, the antiretroviral drugs can have unpleasant side effects, and do not always prevent transmission of HIV to another person.

The United States will also try to get antiretroviral drugs to 1.5 million HIV-positive pregnant women to drastically lessen the chances of them from passing the virus to their children; distribute more than 1 billion condoms in the developing world in the next two years; and fund 4.7 million voluntary medical male circumcisions in eastern and southern Africa over the next two years. (Research shows circumcisions reduce the risk of female-to-male HIV transmission by more than 60 percent.)

This is good news, but a promise isn't enough. This needs to happen. When it comes to health care for people who don't have insurance in this country, we are on a par with developing nations. We need to see all people as deserving of care, no matter what their income level, their social status or their pre-existing conditions.