Suburban Guerrilla

U.S. Rep. Paul Ryan, the Ayn Rand fanatic, never tires of trying to shred the government safety net. His latest scheme involves reaching across the aisle — all the way to the Senate, actually — to a so-called Democrat who shares Ryan’s passion for privatization:

Sen. Ron Wyden (D-OR) is teaming up with Paul Ryan, the House’s top budget guy and the author of the GOP’s controversial budget which proposes phasing out traditional Medicare and replacing it with a private plan… The move makes Wyden the first elected Democrat to endorse creating a premium-support system to compete with traditional fee-for-service Medicare…

The policy… allows insurers to compete with traditional Medicare turning Medicare essentially into a public option on a private insurance exchange. Wyden and Ryan would give patients subsidies that could be applied to either private insurance or fee for service Medicare…

Unlike previous plans, those subsidies would rise and fall with the cost of the plans themselves — not at a fixed rate below the explosive rate of health care inflation… This plan relies mostly on the theory that competition among insurers could hold down costs — a proposition with little evidence behind it — and would therefore save the government much less, if any, money at all.

The talking points for selling the Wyden-Ryan plan sound a lot like Mitt Romney’s plans for Medicare, so don’t be surprised if Ryan endorses Romney for president. Let’s hope voters can see past the smoke and mirrors of these cold-blooded frauds.

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Gov. Corbett is perfectly okay with throwing sick people off Medicaid, but can’t bring himself to tax Marcellus Shale drillers. This is your sociopathic Republican party at work:

Since August, the Corbett administration has cut off more than 150,000 people – including 43,000 children – from medical assistance in a drive to save costs. That purge far exceeds what any other state has tried, health policy experts say, and officials may be walking a fine line between rooting out waste and erecting barriers to care for the poor and disabled.

When most states were experiencing flat or rising Medicaid enrollment from the economic downturn, stepped-up eligibility reviews in Pennsylvania began producing a decline over the summer. The pace of cuts picked up in November, with 90,000 cases, or 4 percent, dropped in a single month. In New Jersey, enrollment increased by 391 the same month.

The Department of Public Welfare in Harrisburg says most of the people cut were dead, had moved out of state, or were found to be ineligible, but it could provide no breakdown. Advocacy groups, clients, and representatives for caseworkers paint a different picture. Pressure to quickly review a backlog of files and close cases overwhelmed the system, they say, as reams of paperwork were lost and computer programs automatically ended benefits when patients’ responses had not been entered by preset deadlines.

The Pennsylvania experience, while extreme, illustrates the difficulty of reining in increases in health-care costs nationwide. For the short term, the cost of providing public insurance ballooned as people lost their jobs and employer-provided benefits, while states’ belt-tightening reduced the workforce that processes applications.

Marie Stopa of Holmesburg received a letter Sept. 15 saying her four children would be cut off Sept. 19 if renewal paperwork was not received. She says she sent it the next day, but benefits were cut off anyway. Her 10-year-old son, Marek, has landed in emergency rooms twice since then for asthma attacks Stopa believes would have been avoided had he remained on the preventive medication she can no longer afford.

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“If it wasn’t for Joe Lieberman, we probably would have had a public option.”

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Just got a call from the GI clinic – they have to cancel my appointment this Friday and move it to January. Aren’t you glad we live in America, where people don’t have to wait for medical treatment?

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Maybe I’m not as nice as I used to be. Because when I read this, I’m not so happy:

Which brings me to my apology. I was pretty mad at Obama before I learned about this new insurance plan. I had changed my registration from Democrat to Independent, and I had blacked out the top of the “h” on my Obama bumper sticker, so that it read, “Got nope” instead of “got hope.” I felt like he had let down the struggling middle class. My son and I had campaigned for him, but since he took office, we felt he had let us down.

So this is my public apology. I’m sorry I didn’t do enough of my own research to find out what promises the president has made good on. I’m sorry I didn’t realize that he really has stood up for me and my family, and for so many others like us. I’m getting a new bumper sticker to cover the one that says “Got nope.” It will say “ObamaCares.”

As you already know, I frequently criticize President Obama’s policies. And the mere fact that I will get to make use of the Affordable Health Care Act’s preexisting condition plan to get the surgery I desperately need doesn’t do a damned thing to help all the other people who aren’t eligible, or who can’t afford it. (I couldn’t afford it if not for a tiny nest egg left to me by my mother – one I was counting on for car repairs.)

Spike Dolomite Ward sounds like a nice middle-class lady — one who can afford to make a small monthly payment, even if it’s a stretch. I, on the other hand, know far too many people my age who are now members of the long-term unemployed, people hanging by a thread. For various reasons, they’re not eligible for programs like Medicaid – but there’s no way in hell they can afford a monthly premium.

Good for Ms. Ward that she can afford it. But her story annoyed me because it sounds like her disillusion with Obama’s policies (and her subsequent reconversion experience after she got finally the help she needed) was rooted only in her own middle class experience. That bugs me.

Don’t get me wrong: The preexisting condition option is an absolute lifesaver for those who can afford it. It’s subsidized by the federal government to keep premiums low (mine will run slightly under $300 a month, as opposed to the $600+ a month I paid into COBRA while I was still on unemployment). The original version required you to prove you’d been turned down by an insurer, or to show documentation that the premium was so high, you couldn’t afford it. When the enrollment numbers turned out to be rather low, they loosened those strict requirements. (In Pennsylvania, I only had to list which pre-existing conditions I had.)

The numbers are still low, and the original reason I wanted to write about this was to urge readers to look into their own state’s program. (Some are run by the state, others by the feds. Ask Mr. Google how to apply where you live.)

As some of you know, I’ve been suffering with gall bladder disease since July, and last month was also diagnosed with a nasty case of diverticulitis. The latter was treated with major-league antibiotics and a liquid diet; the former hasn’t been treated because, well, I don’t have insurance.

It hasn’t been fun, these late-night cab rides to the ER. (911 takes me to the local Medicaid mill, which misdiagnosed me the first time around. I’m not going back for more.) Rolling around on the floor for hours because you’re in excruciating pain is never fun; knowing a simple outpatient surgery could fix the whole thing is just plain infuriating.
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And a British Guardian reporter now understands exactly why our for-profit health care system is so fucked:

Socialised healthcare is in my blood but, unfortunately last Wednesday, so was a hefty dose of spider venom and several billion extra bacteria – the unfriendly sort that make an infected limb sweat and swell like a rotten root vegetable. I had travel insurance, but no idea if it stretched to the snacking habits of urban arachnids. So I uttered the words familiar to any uninsured or precariously insured American: “I’ll just wait for a little bit and see if it gets better.”

Had I waited another 24 hours, I might have lost my arm. By the time I was persuaded to go to the emergency response unit at Beth Israel hospital I could no longer move the limb, which was developing worrying purple track-marks. The triage nurse sent me straight through to ER, where I was given a bunk next to a groaning man in his mid-30s who, like me, had been so worried about the cost of treatment that he had allowed an infection to spread, in this case from a rotten tooth. He was already missing several teeth. He told me he was a postal worker with no health insurance, and that he wouldn’t have come for treatment had his girlfriend not driven him to hospital when he collapsed with a fever.

Compared to the accident and emergency unit at my local London hospital, the waiting period was civilised; it was a mere hour before a stern-looking registrar arrived to take my money. He explained the covering clauses of my travel insurance and showed me where to sign on several complicated forms. When I explained I was unable to do so because my arm wasn’t working, he gave me a look that suggested I’d have had to find a way to sign even if I’d come in with all four limbs off. I signed with my left hand.
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Digby on the NYTimes editorial board coming out in support of Medicare vouchers:

I don’t understand what world these people live in. Do these people honestly believe that the elderly, most of whom are already sick in one way or another or are destined to become so (after all, it’s a rare person who stays perfectly healthy and then dies peacefully in his sleep at age 92) should be forced into a more complicated system than that which already exists? It’s as if they are being accused of irresponsibly running up big bills and must be taught a lesson in prudence before they die.

I would love to know where this penchant for making the health care system even more complicated and unworkable comes from? And why does everyone have to be a “consumer?” We are citizens and human beings and when we get old we get sick, period. Making elderly people shop around in order to live is utter nonsense when we know that the only reason to do so is to keep our “privatized” system reaping profits every step of the way.

It’s the abstraction in all these debates that drives me crazy. People, not statistics. Patients, not consumers. Yes, health care costs are high and are absorbing more and more of our GDP, but the sick people are not the problem. Getting sick can happen to anyone and getting old is something that will happen to everybody (if they’re lucky). Treating being human as a problem is the problem.

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They told me at the ER that I had to get a family doctor, something I’ve been putting off because it’s expensive and there’s a lot of paperwork to deal with. So this morning I went to see a guy who pretty much nodded his head and said, “I understand” no matter what I said (I don’t believe he did – understand, I mean) and wrote me a gazillion scripts I have no intention of filling.

I already told him that. I said I wasn’t interested in taking statins or anything for high blood pressure — blood pressure that’s spiked by the ER visits and lack of sleep. Once I lost weight, my blood pressure reverted to its normal low status. It’s high right now from being sick and the lack of sleep.

As to statins: Well, I’m not impressed as to their safety and effectiveness in women.(And the last thing I need is a drug that increases memory loss. Hello?)

There were a couple of other things, too. But basically, I wasn’t thrilled. It’s nice when you have a doctor you can trust, but this guy doesn’t strike me as one of those. The big plus in his favor? He’s right down the street.

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I just got off the phone with someone from the insurance company and they’re going to give me a January 1 effective date for the state pre-existing condition insurance pool created under Obamacare — which means I can have the gall bladder surgery once it kicks in. I don’t mind telling you: tears of relief.

And thanks to Natalie, the constituent services staffer from my (Republican) state rep’s office, John Taylor.

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Hopefully they’ll just take the damned thing out.

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They wouldn’t have these problems!

Instead, the administration has to make sure the wimmenz are punished for having the sex by getting pregnant because a bunch of people from an institution that’s been protecting child rapists thinks birth control is “sinful.” Sounds like a science fiction movie, doesn’t it?

For Christmas this year, I think I’m going to send Obama one of my balls.

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Let’s make the best government program we have into an inefficient cash cow for the insurance industry! Dean Baker:

The NYT claims that plans that could raise the cost of Medicare equivalent policies for seniors by $34 trillion are gaining increasing support in Congress. These plans involve replacing Medicare with a voucher. This leads to higher costs both because the administrative costs of private plans are far higher than Medicare and they are likely to be less effective in controlling costs.

The Congressional Budget Official projected that a Republican plan along these lines, that was approved by House earlier in this year, would raise the cost of Medicare equivalent polices by $34 trillion over the program’s 75-year planning horizon. While this plan would save the government money by reducing its payments for Medicare, it would mean that future generations of workers would pay far more for health care in their retirement. The cost of Medicare equivalent policies would far exceed the typical retiree’s income by 2050.

It would have been helpful if this article had pointed out that these proposals imply both a huge increase in health care costs to beneficiaries and an increase in costs to the country as whole. Virtually all research shows that these sorts of plans will make the country’s health care system considerably less efficient.

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Spent the entire day at the hospital – first, for an appointment with a gastroenterologist, then such a thorough probing of my eyes that I didn’t think it was possible outside of a movie about Nazi medical experiments, and then a meeting with the lovely financial services staff. (The counselor told me I could have gotten a referral from the city health center, but since that would have involved me standing outside in a long line in the cold when I could barely stand to begin with, moot point.)

“Fortunately” (and I use the term in the most ironic way possible), if you don’t have insurance and you need surgery, you can sign a financial contract with them to pay off surgery, should it be necessary. And yes, they tell me, it appears likely I will need to get my gall bladder out. I have to go back to the hospital tomorrow (I feel like they should give me half a bureau drawer and half a closet, I’ve been there so many times in the past five days) to get an ultrasound. The GI doctor seemed a little bit upset about how the hospital I was previously taken to handled it; he pursed his lips, shook his head and said, “I can’t comment on your treatment there.”

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But they did switch my medication, they did an ultrasound of both eyes and found NO signs of vitreous or retinal detachment, and referred me to the ophthalmology clinic ASAP to rule out any other problems. If they don’t find anything, I guess it’s off to neurology!

The receptionist told me she sees more people without insurance than she does with it. “I’ve worked here eight years part-time, hoping to get brought on full-time with benefits, but it hasn’t happened. I needed emergency surgery, and they told me to take all my money out of the bank and put it in a safety deposit box so I’d qualify for Medicaid, but that didn’t work,” she said. “Finally, they agreed to do it for me for free — but only because I worked here.”

She said she’s been going to school and finally got an LPN, “so maybe I can get health insurance somewhere.”

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So I spent the day in the hospital and discovered I have (tah dah!) diverticulitis! (Or, as my dad would say, “I always said you were full of shit.”)

Anyway, blogging will be a little more sporadic because 1) I feel like shit and 2) I have to take not one, but TWO powerful antibiotics for ten days. So there you go.

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