I think I have passed the age when I make resolutions based on a calendar date, but I can't help but reflect on the year just ended and wonder how I can make the coming year better.
Another year gone
The years seem to go by faster and faster. How can it be 2013 already when I just got used to writing 2012 on my checks?
I think I have passed the age when I make resolutions based on a calendar date, but I can't help but reflect on the year just ended and wonder how I can make the coming year better.
I have spent a lot of time answering questions about the new health care law, dispelling myths and helping people understand what new rights they have already. I was more involved in political campaigns that ever before because of the importance of health care policy. I found myself educating candidates about the potential of the Affordable Care Act.
I spent the first half of the year with fingers crossed about how the Supreme Court would handle the case and was pleasantly surprised with the result, and most of the second half worrying about whether the Affordable Care Act would be repealed.
Still, the states are left to decide whether they will expand Medicaid and offer access to care for everyone whose income is less than 133 percent of the federal poverty level. Even though it won't cost states a dime for the first three years, and then just 10 percent of the total cost , several states have said already they won't expand Medicaid. The hopeful thing for me is that only six states opted into Medicaid when it became law in 1865.
It seems wherever I go, the talk turns to health care, as it has since Mike died. It will be five years April 1 and some family members and friends are still waiting for me to get back to "normal."
But losing a child changes you. The old normal is gone and it doesn't matter how many years pass, it isn't coming back.
So, this new year brings some changes -- the health benefits exchanges have to be ready for people to enroll beginning in October. Before then, "navigators" who will help people choose the right plan for them, will have to be trained and certified.
I will stay committed to working toward access to health care for every American.
I might lose a few pounds, keep the house tidier, ride my bike more ... but the most important thing in my mind is social justice for people in need -- a living wage for people who work full-time, safe and affordable housing, safe and nutritious food, and of course, access to quality health care for everyone. I don't think any number of years passing will change that.
And of course, here's wishing a happy and healthy New Year to
20 more names
These aren't the names of children; they are the names of people our society didn't care enough about to save.
Some struggled with mental health issues or addiction, others lost jobs or became ill and then lost their homes.
These 20 names don't mean much to most people. Only about 100 people attended a memorial service for them this morning.
Whatever you might think, these lives were as precious as yours or mine in the eyes of God, and except for better luck than they had, you or I might have been in their shoes. This year there were 20 names of people who were homeless who died; there were more who were not named.
On this, the shortest day of the year, people gathered in the chapel of First Baptist Church here in Asheville, as we do every year, to honor the lives lost from among our homeless.
I used to cover this service when I was a reporter and I continue to attend each year as a health care advocate and as a person who believes everyone deserves a safe place to sleep at night.
I go because four years ago, when we learned Mike was dying and raced to be with him in Raleigh, another man I never met was dying.
Tommy McMahon had gone to the emergency room the night before with a respiratory infection. He had been there before; the staff knew him. The doctors there gave him antibiotics and an inhaler and discharged him.
But Tommy knew he was too sick to go back out into the cold and wind and he refused to leave. Someone called the police and Tommy was offered the chance to go to jail for the night. He was arrested.
Sometime during the night, Tommy died, and an editor called me in Raleigh to ask who a reporter might interview for a story. As I gave the names and telephone numbers of a few people, I knew my precious son would die surrounded by love, and he did just six weeks later.
Tommy, on the other hand, died alone in a jail cell.
This season always brings Tommy to mind as much as it does a baby born in a stable and placed in a manger. I wonder if anyone loved Tommy, whether he had family and if they had given up on him. That happens a lot with homeless people -- they burn through all their family members before they're turned out onto the street. Did he have a mental illness that should have been treated? Was he addicted to drugs or alcohol and not able to get the help he needed to sober up? Did he become homeless because of an illness or a lost job?
I wonder whether anyone grieved him as I do my son and I grieve for him just in case. I pray for his soul to be at peace. I do that for each of the homeless people who die every year, but especially for Tommy McMahan because he is forever connected to my son in my heart.
Tommy's death made me understand that we are all connected, that we are responsible for each other. I got to say goodbye to my son; Tommy's mother didn't. Both men died because of injustice. They died because no one who could save them cared enough to do so.
This year, as the names of the dead were read, a little about each one of them was shared -- at least something about the people that someone knew and could speak about.
Several states have chosen to opt out of the expansion of Medicaid, and it is not in the best interests of their people or their health care businesses, especially hospitals.
The Affordable Care Act cuts the amount of money hospitals receive to compensate them for the care they provide to people who can't pay. The logic was that the expansion of insurance coverage, especially the expansion of Medicaid, would cut down on the amount of uncompensated care hospitals need to give.
But the Supreme Court threw a wrench into that plan when it decided that states don't have to expand Medicaid. Several states have said they won't expand Medicaid, but the law still provides for cuts to the money the federal government pays to hospitals for uncompensated care.
Although some are calling for an increase in federal money for hospitals in those states that refuse to expand Medicare, others are saying the states that refuse to cover more people under Medicaid shouldn't be rewarded -- especially because the expansion costs states nothing for the first three years and then the costs to the state rise to 10 percent of the total cost of the expansion. In other words, federal money is already available to these states and if they choose not to take it, that's their problem; the government shouldn't reward them with money from somewhere else. Here is the solution. Get on board or not, but those are your only choices.
When Medicaid was enacted in 1965, few states wanted anything to do with it. But eventually, all 50 states saw the advantages of a centralized system to care for people in need.
Those states that refuse to get on board will face a lot of pressure from hospitals, which will be less able to care for the poor, and probably from voters who don't understand why people in their state can't get care when it doesn't cost the
This isn't just politics
Let me start by saying I'm tired of the politicization of life-and-death issues in this country. Twenty children and seven adults are dead in Newtown, Conn., and people are screaming about politics.
It's political because lobbyists pay billions to make it so.
We can't talk about gun safety without being political. I noticed the same thing during the health reform debate.
I know what it is to lose a child who shouldn't have died and I'm trying to wrap my heart around all of those families in Connecticut. I at least got to say goodbye to my child.
This is a tragedy beyond my ability to even comprehend. I have spent much of the time since hearing the news praying for healing that I know will never really come completely. Losing a child is not something you ever get over.
This is about people's lives, and gun manufacturers have made it Republican vs. Democrat. They have many of us believing that guns are perfectly safe; it's people who are dangerous.
Well, it's people with guns who are dangerous. Not all of them, mind you, but enough of them to cause havoc every few weeks.
This is not a simple problem with a simple solution. This is not just about guns, although guns certainly play a huge part.
I see this as a three-pronged problem:
And on and on ...
Without going into all the anti-gun rhetoric, let me just say 20 children and seven adults were killed yesterday. Three people died in a mall in Oregon less than a week ago. The bodies are piling up and we're still arguing instead of talking.
We as a nation regulate cars more than we do guns -- we require a licence that has to be renewed periodically. We have more laws regulating the manufacture of teddy bears than we do guns.
It's well past time to have some sensible regulation of guns, including banning of assault weapons and background checks of everyone who wants to buy a gun -- even at a gun show.
The reason so many "nut cases" go on killing sprees is because they have a chronic illness that gets worse when it isn't treated, and we keep cutting funds for mental health. People with serious mental illnesses don't often have insurance because they can't hold a job and our access to care is tied to employment. In addition, most insurance policies don't cover much mental health care, although that will change in 2014, thanks to the Affordable Care Act.
I have watched as our mental health system in North Carolina has imploded because of state "reform," which privatized much of the system. Add to that the defunding of the system in recent years and you have a disaster.
So, people with severe and persistent mental illnesses don't get the treatment they need, and their illnesses get worse, just like any untreated chronic illness.
Until we address this problem, we will continue to see "nut cases" with guns going on shooting rampages -- unless, of course, we make it more difficult for them to get guns.
We can demand improvement in our mental health system, and we will see it if enough of us demand it. Call your legislators and let them know you won't back down.
Finally, we have a love affair with violence in this country. We adore it. It's in our movies, on TV and in the games we play. The military uses violent video games as a recruiting tool -- go to the Army's web site and play for free.
Every year, the special effects in our entertainment get more grisly and realistic and the violence more graphic because it takes more to shock us. We've become desensitized to it, and there's some good scientific research to back that up.
I do not advocate censorship, but I do think parents should try to protect their children from it. If we don't buy the violent video games or go to the grisly movies, they won't be profitable so they won't be made.
We are the ones who drive the market.
We are the ones who can make change.
Now is the time -- before the pain of this loss of innocent life diminishes.
While our hearts are still broken, let's honor the victims by being the force of change needed to prevent another massacre.
Close the gap now!
As happens most days, I got a call this morning from someone who needs health care information. She recently lost one son to cancer and another son is ill, was recently injured and now needs rehabilitation services.
Because this son only recently got SSI disability, he has to wait two years for Medicare to kick in. Because he has a 401K savings plan from when he was able to work, he isn't eligible for Medicaid. He was planning to buy a small mobile home with that money, but now he has to spend it down -- even though he can't withdraw it without paying a penalty because he isn't of age yet.
There is no reason to make people who get disability wait two years for health coverage; the reason they get disability is because they can't work, and in this country, health coverage is tied to work.
This is not an unusual situation; thousands of people are caught up in this gap every year. Many lose their savings and their homes and some die. Four years ago I interviewed a family caught in this gap and they received four calls from the bank during the two hours I was there. The woman told me they were getting eight to ten calls every day. Their power had been turned off once and the woman couldn't find a dentist who would take care of her infected teeth, which were damaged by the drugs she was taking for another condition and causing her a great deal of pain.
She had nowhere to turn.
The same is true of this family I spoke with this morning. If they can't pay for the bed in rehab, the man will be sent home, where there is no one to care for him properly.
If someone has Medicaid before getting disability, they often lose eligibility for Medicaid when they begin receiving disability checks because the $400 or $600 a month they get puts them over the income threshold in their state. In Texas, someone making just 12 percent of the poverty level can be kicked off Medicaid. And a single male adult isn't eligible, no matter what.
Congress could fix this easily by making anyone on disability eligible for Medicare immediately instead of making them wait two years.
If states expand Medicaid to over anyone with an income less than 133 percent of the federal poverty level, people won't lose eligibility for Medicaid so easily. But a number of states have said they won't expand Medicaid even though they won't have to pay a cent for it for three years and in the long run will only pay 10 percent of the cost.
Only Congress can change this, but they haven't been inclined to do so. It seems they haven't been inclined to do much to help people in need in recent years.
It seems to me this family has been through enough, but there are those who would call them moochers because they need help because of circumstances beyond their control
More reasons not to buy corporate beef
The Kansas City Star just completed a yearlong investigation of the beef industry, and it's worth reading if you care about what you and your family are eating.
The industry was reformed somewhat a century ago after Upton Sinclair's book, "The Jungle" was published in 1906. Although the writing style is dated, the book is worth reading because government regulation seem to have regressed back to that time.
The problems are different today, though, and it makes the meat much more dangerous.
Beef cattle are pumped full of antibiotics, which make the bacteria that survive extremely virulent. Plus, the antibiotic we ingest with our burgers makes those very drugs less effective when we really need them, increasing the number of antibiotic-resistant infections. When these cows' manure is used to fertilize crops, bacteria in the soil can strengthen and become resistant to antibiotics. The Star details the story of children in Joplin, Mo., getting antibiotic-resistant infections following the tornado there because dirt with resistant bacteria got into their wounds.
But animals that have no infections are still being pumped full of antibiotics and there aren't likely to be laws against it any time soon, thanks to the lobbying power of the beef and pharmaceutical industries.
Cattle also are given beta blockers to make them grow faster and fatter, and the residual amounts of the drugs we get with our meat can cause cardiovascular problems. They're also given growth hormones, which cause them to grow faster, but also are found in the meat we eat.
The way cattle are kept before being slaughtered is nothing short of revolting. They stand in feedlots, shoulder-to-shoulder, sometimes knee-deep in their own feces, eating things cows were never meant to eat, including corn and ground up bone meal from other cows.
The new machines used to tenderize the meat push dangerous pathogens (including e. Coli) into the middle of the meat, which is less likely to be cooked to a high enough temperature to kill the bacteria. The same is true of ground beef.
To combat this, some of the meat -- the stuff once deemed unusable -- is processed with ammonia. The resulting mush, called pink slime, is added to ground beef. Almost every frozen ground beef patty in America contains some of this slop.
Regulations in this country are so lax that if federal inspectors find bacteria in meat, they can't even force a recall -- recalls are voluntary. Fortunately, meat processors still have to worry about adverse publicity, so they do recall bad meat.
The retailer Costco has more rigorous inspection criteria than the US government, although even its inspections don't find every bad batch of meat. According the the Star, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the US Department of Agriculture does nationwide at all other beef plants combined.In fact, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the USDA does nationwide at all other beef plants combined.
And it's not just the beef industry that's troubling; pork and chicken share many of the same problems.
The solution is to buy pasture-fed beef, pork and chicken, and buy it from local producers. Meat that's pasture-fed is lower in saturated fat and cholesterol, so it's healthier, and it's tastier. It's more expensive, but you get what you pay for. It probably won't hurt you to eat less meat.
I had an e-mail from a surgeon this morning from a physician who said he wanted some help getting the word out that any woman who has had a mastectomy is covered by insurance for breast reconstruction. The insurance company can't turn you down.
I know people don't know their rights under the Affordable Care Act, but this law was passed 14 years ago. I looked it up.
Nearly 300,000 people (mostly women, but a few men as well) face breast cancer every year. A generation ago, women routinely got a radical mastectomy with their diagnosis. You signed the permission before the biopsy, so you woke up minus a breast and a whole lot of muscle tissue if the pathology lab found cancer. There was no discussion because doctors offered no alternative to this body-mangling surgery.
Studies found that the survival rate was just as good when only the breast was removed, and that just removing the tumor and some surrounding tissue was also adequate in many cases.
Women lobbied to be given the choice of lumpectomy or simple mastectomy. Doctors, mostly male at the time, resisted, but women didn't back down.
Fewer women today get mastectomies, but it is indicated in many cases, and these women can have reconstruction, either at the time of mastectomy or later. Either way, insurance companies must cover the procedure.
Not all women want to have reconstruction, and no one should have it done without getting all the information available. This document by the American Cancer Society is a good place to start gathering information:
Your decision will depend on your age, the stage of your cancer, whether you have enough extra tissue to construct the new breast (very thin women sometimes don't have enough), even whether you smoke.
Each case is unique. However, if you and your surgeon decide breast reconstruction is best for you, insurance coverage (IF you are insured) is not an issue. It's covered.
Is football bad for your brain?
One of the things Bob Costas talked about in his 90-second commentary Sunday was whether possible brain damage caused by football head injuries was partly responsible for Jovan Belcher's uncontrollable rage.A new study published in the medical journal, "Brain," shows that contact sport athletes like boxers and football players are more likely to develop chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes who suffered injuries to the head. Symptoms include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia. (Read more about the study at http://www.medicaldaily.com/articles/13390/20121205/study-shows-former-football-players-suffered-brain.htm#03CHcX6u4pXeBQwP.99).The study, by researchers at Boston University School of Medicine, looked at the donated brains of professional athletes, war veterans, and others likely to suffer head injuries, found evidence of CTE, which occurs "as a consequence of repetitive mild traumatic brain injury."
They found evidence of CTE in professional along with college and high school football players, as well as in hockey players, boxers, and a wrestler -- and the families of the deceased reported troublesome and irregular behavior leading up to their deaths, including memory loss and personality changes.
Throw a handgun into that mix and you have real trouble.
Until recently, football players were sent back into the game if they said they were OK. With endorphins coursing through a player's system, he might not realize he's not OK, and a mild concussion could go undiagnosed and untreated. When that happens a few times, it can add up to CTE, and the symptoms might not appear for years.
Costas expanded on his commentary last night on The Last Word with Lawrence O'Donnell, talking about the mixture of possible brain damage and guns.
Men who play football at the pro level tend to be strong and aggressive to begin with. Throw in a handgun and a little CTE and you have an extremely volatile mix.
Of course, National Rifle Association president, Wayne LaPierre said during a radio broadcast that Belcher's girlfriend should have had a gun to protect herself, and he thought Bob Costas' comments were disgusting.
Right, Wayne. There's a real solution: more firearms. And God forbid anyone should talk about any kind of regulation of firearms.
Handguns have become a national public health issue, and so have brain injuries from sports, although no one wants to talk about that. We Americans are so obsessed with sports that we ignore what the players sacrifice to entertain us. We immerse ourselves in statistics, standings and fantasy leagues and forget about the human cost.
Football and hockey players as young as high school level show signs of damage from repeated blows to the head.
I like football. I enjoy watching it. But I think something has to change. Already, the NFL is looking more closely at head injuries and not allowing players to go right back into the game.
But by the time players get to the NFL, some have suffered enough head injuries already to develop CTE regardless of NFL rules. We need to look at changes in the game for the youngest players and follow through to high school and college. Teenagers take risks as part of their growing-up process. They don't think long-term. It's up to the adults in their lives to make sure their risks don't lead to permanent damage.
How much do your drugs cost?
An article in Sunday's New York Times reminded me that even with the Affordable Care Act, our system has some pretty serious problems, and one of the worst is the cost of medications.
The pharmaceutical companies here have free rein when it comes to setting prices on their products. Unlike other countries, we don't cap their profits because the companies claim they won't be able to do research and development of new drugs.
Thing is, they're not doing nearly as much R&D as they did in the past. Their biggest research projects are based on finding a new angle on older drugs before their patents expire. It's about making as much and spending as little as they can get away with.
Look at what happened when the cholesterol-lowering drug Lipitor's patent expired. The company offered the name-brand drug at the same price as the generic to keep people buying Lipitor and not the generic. That's $4 a month for many consumers and Pfizer, the manufacturer, is still making money on it. Before it went off patent, the average cost was $160 per month.
Insurance companies covered Lipitor as a "tier 2" drug. Tier 1 drugs are usually generics and co-pays might be $10 or $15. Tier 2 drugs are ones that are on the insurance companies' formularies, and they might cost the consumer $25 to $30; tier 3 drugs are generally the newer and more expensive drugs and might cost $75, $80 or more.
When I took Ambien after Mike died, it cost me $85 for a three-month supply, but only if I ordered through the mail; otherwise it was $85 per month. As soon as it went generic, it was $15 for a 3-month supply, and it came from a different manufacturer. I could get it now for $4 a month at my grocery store pharmacy.
What Pfizer did was make the name brand's price competitive with the generic to try and keep market share.
In Sunday's New York Times, Frank Lalli wrote about trying to find out what his cancer drug would cost in the new year, when his insurance plan changes its prescription coverage plan. The drug, Revlimid, which is manufactured by Celgene, retails for $524 a pill, or $132,000 a year.
Lalli didn't know how much of that would be covered by his insurance plan, so he set out to find an answer.
It took him more than a week of calling his insurance provider, the human resources department at his former employer, the drug company and Medicare before he got an answer, which he demanded be in writing because he wasn't certain he could trust it.
My question is this: How much does it cost Celgene to make Revlimid? How much of a profit does its manufacturer make?
All too often, the profit is completely unreasonable.
When Mike needed chemo, he applied for Medicaid, the government plan for low-income people. He discovered he would have to leave his wife to get it. He applied for disability, hoping he would still be able to live on his own and not have to move back in with me. He was denied twice before he was put on the waiting list for a hearing.
In the end, the pharmaceutical companies were paid more than $500,000 for his chemo drugs. He got nothing; his first disability check came nine days after he died. Obviously, we put profit before human life in this society.
The drugs we take are sold at a fraction of the cost in other countries and the pharmaceutical companies are still making money, but those companies have made sure it's illegal for us to buy drugs from Canada. The excuse was that you never know what you're getting if you buy from elsewhere. But those drugs coming from Canada were made here in the United States; it's illegal to re-import them because the pharmaceutical companies want to protect the obscene profits they make from the prices they're allowed to charge here.
It's time to stand up to Big Pharma and regulate its prices. That alone would put a big dent in the rising costs of health care.