Dear Gov. McCrory,
I didn't vote for you, partly because I didn't believe you were a moderate Republican. You can prove me wrong.
Soon now, you will announce whether North Carolina will expand Medicaid to about a half-million people in the state. The action won't cost the state a dime in the first three years, and then we'll pay just 10 percent of the cost each year after that.
I urge you to stand up to people who for ideological reasons alone would allow 500,000 people to be denied basic health care.
People who make less than 133 percent of the federal poverty level can't afford even the most basic care, so they don't get checkups and they can't manage chronic illnesses. 
So, let's look at the logic here. If we deny them care, we will pay a whole lot more down the road as people show up in the emergency room in renal failure or with a massive stroke or heart attack, or with cancer that has progressed beyond the point of any hope for a cure.
People who don't have access to care are much sicker by the time anything is done for them, and by then it may be too late to save their lives.
That's what happened to my son, Governor. He couldn't get insurance because a birth defect was a pre-existing condition, and without it, he couldn't get the screening tests he needed. He got sick and he got sicker and was finally admitted to the hospital weighing just 110 pounds (he was 6 feet tall). He was so sick it took them five days to stabilize him, and his cancer was stage 3. He had to leave his wife to get Medicaid, and his chemo cost about $600,000. That's just the chemo, not the two surgeries, the radiation, the other medications and the loss of his tax revenues. So, by cheaping out on his care, we probably spent more than $1 million.
My son would be an attorney now, making decent money and paying his fair share in taxes.
Multiply that by 500,000 people, and I'm just talking about the financial cost. 
How about the emotional cost? How about the cost to our souls as human beings?
Have you ever lost a child, especially one who shouldn't have died? I wished my own heart would stop when his did, and many days I still do.
You have the chance to save thousands of lives of people in this state. I know your buddy, Art Pope, is advising  you to let those poor people fend for themselves, but I hold out hope that you have more character and compassion than that.
Make no mistake about it, Governor, we are talking about letting people die just to make a political point.
If that isn't evil, what is?

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.

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.

• Fred Blevins, who perfected the sport-coat-over-a-bare-chest look.
  
• Paula Jean Gump Chrishawn, a mother of five whose battles with mental illness and addiction caused her to lose all of them because she couldn't care for them. She loved the color purple, and she finally won her battles. She was one week away from moving into her own apartment when she died in September.
• Douglas Dillingham
• Dennis Gillette, an outgoing "gentle giant."
• Floyd Hill, an accomplished storyteller with a deep mountain drawl and a veteran.
• David Isles, a veteran who smiled often.
• Herman Lee, a veteran known as "Buffalo."
• Andrew Marsh, called Sammy, was known for his generosity.
• Dan Mason, who fancied himself a bodybuilder, even as he became increasingly weakened by illness.
• Joseph Metcalf, a soft-spoken native of West Asheville.
• Kenneth Myrick
• Rebecca Plemmons, a mother who was just rekindling her relationship with her daughter.
• David Pounders, a kind man who divided his time between his beloved mountains and the coast of Florida.
• Donna Ray, a woman of kind and gentle spirit.
• Jeff Reynolds, a young man still struggling to navigate the world.
• Delois K. Smith, a kind and gentle soul with a great sense of humor.
• Jackie Todd Stipes, a former carnival worker who bragged that he often let the rides go longer than they were supposed to because he enjoyed the looks on the children's faces.
• Grace Teague, who adored cats.
• Luzella Whittemore, who was firercely independent.
• Ivie Ward Yearns, called by his middle name, was a large man and quiet.

If you have time for a prayer today, please include these 20 souls and the people who loved them.

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:

• The ease with which people can get guns and ammunition;
• The lack of diagnosis and treatment for mental illnesses;
• Our country's love affair with violence.

This is a public health issue and an education issue. The gun lobby has too much power and it has billions of dollars driving that power. A lot of the talking points I'm hearing come from those dollars.

• We shouldn't regulate guns because then only criminals will have them.
  
• We should put guns in the hands of more people so they can shoot back.
  
• We should honor the victims by not discussing gun laws.
  
• Guns don't kill; people do.
  
• Only crazy people go on rampages so we all need guns to protect ourselves from them.
  
• People will find other ways to kill if we take away their guns.
  

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.

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.

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. 

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.

The Annie E. Casey Foundation released its 23rd annual  Kids Count Data Book, which looks at a variety of measures of child well-being in four areas: Economic, Education, Health and Family and Community.
Overall, the number of children in poverty has risen by 16 percent in the last five years;  the number of children whose parents lack secure employment is up by 22 percent. The number of teens not in school and not working has risen by 11 percent and 41 percent of American children live in  families with a high housing cost burden (more than one-third of total income).
There is good news, though: The number of children who have health insurance has risen 20 percent despite the number of parents who lost insurance because they lost their jobs, thanks to increased government coverage for children.

Today began my sister, Ellen's, favorite season. From Thanksgiving until mid-January, Ellen decorated, cooked and entertained.
It was right about this time -- late afternoon the day before Thanksgiving -- that I called her every year.
Me: So, how many are you cooking for this year?
Ellen: 24, I think. You?
Me. Ten.
Ellen: Amateur.
She was born the day after Christmas, 1949. I came along three years later and we had a fierce sibling rivalry that became a half-joke when we became adults. She was the consummate practical joker, and she loved the holiday season more than anything. She loved a challenge, she loved camping -- if that's what you want to call going into the woods in a 30-foot house on wheels. She loved good beer and cheap wine, crocheting and knitting and gardening.  
After my father died in 1990, the family winter party moved to her house in mid-January, the perfect way to wrap up the season.
Ellen died of lung cancer six years ago this past July, and the day before Thanksgiving is changed. In fact, it really didn't hit me full in the face that she was gone until the day before Thanksgiving that year. I came home from work and started working on the apple pie and the cranberry bread and it just felt empty.
When Rob came home and asked how I was doing, I just fell apart.