Category Archives: Politics

Alabama Legislators Want “Blood on the Floor”: Especially the Blood of Children and Grandparents


Well. I heard from a very credible source yesterday that our state legislators are not playing chicken with the budget this time. You know, it seems like every year they expect us to display panic and beg them to fund essential programs– it is so predictable it is almost like we have a set script. We get tired of it, but at the same time we think jeez, if we don’t play our assigned role, maybe they will do the bad thing.

This year may be different, if my source is correct. Their plan this time is to go ahead and pass a severely cut budget, which the governor will refuse to sign, and then override him. Then when there is “blood on the floor” (and I quote), they expect us to come screaming to them to pass taxes and re-fund the state. They do not feel they have support from their base, otherwise.

I don’t know. From my perspective, we already have blood on the floor. People in this state have been bleeding all over the floor for a long time, and it hasn’t mattered so far as the budget. The only blood I think the legislators care about is corporate blood and their own, so maybe the point is that business will begin fleeing the state once Medicaid is defunct and all the people in nursing homes have to move in with their families or be dumped on the street.

Getting even a level budget for mental health would not be a win, because there is major blood on the floor with our current budget. Getting the expected cut to Medicaid ($320 million, taking the federal match into account) would make the floor downright slippery. The cuts to doctors will be so sharp, around 40% cut to payments already well below private insurance rates, that I have personally heard several pediatricians say their plan would be to immediately drop Medicaid. Most practices have overhead in the range of 60 to 75%, so that 40% is at least the entire salary of the physician. There will not be enough of us left to see those suddenly doctor-less kids, even if we worked 24-7 without sleep. The 2 Children’s hospitals will close, because they depend on Medicaid money to fund their specialists. And good luck trying to get programs like that rebuilt to their current level of excellence, once they are gone. It takes decades.

Who will be affected first? The elderly in nursing homes. Children (guess they should take more personal responsibility). Because people of color are disproportionately affected by poverty, this is also a racist move. Some advocates are making a case by reminding legislators and voters that middle class elderly are in nursing homes using Medicaid funds, and that there are more poor white kids than black ones. Why should that even be said, as if poor elderly and black kids matter less? Only a racist and classist audience would need to be told such things.

I asked it there is anything at all we can do to stop this disaster, and my source told me we need to call our legislators. I’m going to add that you really need to talk to your neighbors, co-workers, etc and explain what is about to happen. Because legislators have told me previously that although phone and email contacts matter, they also use their in-house polling results, which are secret. They call their base on a regular basis to check in, and I am betting they are getting the no new taxes response from those voters.

If our legislators were ethical, they would be calling those voters not to ask their opinion but to persuade them– they would be pulling out the stops to stop the bleeding. They would stop putting forward bills that they know will cause us to waste tons of money defending federal lawsuits. The fact that they aren’t doing so says a lot.

I remember the last time this type of cut was proposed, and the legislators came up with a Hail Mary to borrow money for Medicaid– I had prominent progressive friends telling me that I was just playing the game by begging for votes to save the program– that I should let things play out, let the blood flow, call their bluff. So it isn’t just conservatives who are the problem. I do not believe an ethical person who understands these are not numbers– they are human beings– would promote such an idea. We all have our preferred ideas of where the funds should come from, and y’all, we do not have strength in numbers to bicker over that right now. If we do, we will surely lose the farm. I can say that a lottery would come too late and is not a solution for the current funding gap, which could begin as early as June. Otherwise, I’d support whatever taxes they are willing to pass, even though I’d prefer to stop corporate subsidies first.

My source says the fed will not likely permit our Medicaid program to be cut so much without responding. We could be taken into some kind of Medicaid custody. But… the kicker is that they can’t MAKE us write a check, so this is different from school integration. They can put key decision-makers in jail, they can withhold federal funding as leverage, but they can’t issue money from the state, raise our taxes for us, etc.

All that said, I would still call your legislators. I would tell them that level funding is not enough for mental health and that it is killing people as we speak, because of waiting times. And if you happen to have a job opportunity out of state, you might want to strongly consider it, especially if you have children. I’m going to stay as long as I can, but I do have a disabled adult family member who depends on both Medicaid and me, so there will be a limit. I don’t know how long my employer will be able to keep me, if well over my entire salary is defunded. Feel free to share all or part of this post if you think it will help.

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Filed under Alabama Legislative Session 2015, Alabama Politics, Children's Issues, Medicaid

Medicaid and Media in the Alabama Primary: It’s Up to You


Several days ago, I told you about a false choice in the Alabama Primary—Fake Medicaid with Griffith vs No/Fake/Who Knows Medicaid with Bentley. Shortly afterwards, Kevin Bass released a statement to the press outlining his plan for Real Medicaid, with a copy to me in response to my query, and I passed it on to you. Among the corporate news outlets, I can find only ONE reporter who bothered to follow up, at the Tuscaloosa News. Google “Kevin Bass Medicaid” for the past week, and the first two links are his own, followed by the Tuscaloosa piece, and then my blog, and then… crickets.

Stacy Lee George has responded to me as well:  he said, in writing, “Yes, you can quote that I am in favor of Medicaid expansion, not the private option.” Real Medicaid, not Fake. He is opposing Bentley in the Republican primary.

Google “Stacy Lee George Medicaid” for all time, and the first link is his Facebook page followed by my blog. I don’t see a single corporate news article with any specifics about his plan. Yes, I know Google gives different rankings of results for different users. I wasn’t logged in when I searched, and I got a friend to repeat it under her account—same top results. If you get something different, please tell me.

Dr. Jennifer Marsden, who is running in November for State House District 93, took time to comment on my blog, “I support Medicaid Expansion without tricks or gimmicks and asked the Governor to expand it in person last year (he said no). “ I found only two articles mentioning her Medicaid thoughts in any detail—here’s the other. Neither asked how she would structure the program.

Now, I know I’m not a professional reporter.  I’ve never been paid for a blog piece and that’s fine with me. I sometimes go weeks or months without posting, when my work/ family schedule gets hectic. My cross-posts on Left in Alabama do reach a wide audience, however, and my regular blog gets followed by several professional reporters in the state. The first piece on Fake Medicaid got posted on New American Journal, a non-corporate national news site. The information was available for reporters who wanted to find it or who even did a simple Google search.

Even if I had not written about Fake Medicaid, what does this tell you about our corporate media and their role in elections and your policy choices? If you were a reporter, would you have perhaps at least asked other candidates to compare their plans to Griffith’s after he unveiled his specifics? Would you have taken time to educate yourself on the different Medicaid structures and their implications?

If you want others in the state who follow only corporate (fake?) news to know about our Medicaid choices before the primary, it is up to you to spread the word. To exercise choices, we must be aware choices exist. Will you be the media? And will you financially support non-corporate sources like LIA and New American Journal?

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Filed under Alabama Politics, citizen responsibility, Medicaid

Alabama Medicaid and the Primary: Follow-up


I posted two days ago to alert you to Parker Griffith’s plan for Fake Medicaid and to suggest the choice is not between that and fake/no Medicaid from Governor Bentley. There are other candidates, and there is also the possibility of strong pressure convincing Griffith or Bentley to change course if you get busy.

Because I criticized the plans or non-plans of those two, I think it is only fair to let you know about the press release from Kevin Bass yesterday, especially since the corporate media have not mentioned it.  I agree with everything he says, except the part about Fake Medicaid being a Republican plan.  Where these plans have been adopted, it has been in large part due to Democrat support, based on a false choice. I’ll repeat that it isn’t conservative at all, nor is it a better-than-nothing compromise of liberals—it is just a plain scam.

I don’t plan to participate in the primaries.  I don’t support the overall agenda of either party or their general non-responsiveness to voters.  I’m sticking with my intention to support decent independents or write-ins in the general election, and if you want to argue with me about vote-wasting, look me up on Facebook.  If enough of you put your foot down that way, we could see much better choices on our ballots. I do most of my political participation between elections.

I’d love to see a guy like Bass run as an Independent, and if he ever does, I’ll likely vote for him and campaign for him.  If I were a Democrat, I’d vote for him in the primary.  I’ve put a query in to Stacy Lee George in the Republican Primary regarding his position on Medicaid—he’s said publicly he is for the Expansion, but he hasn’t given specifics.  I’ll let you know what he says, if I get an answer.  I can’t even find a website or FB page to contact Bob Starkey, so I don’t suppose he is a serious candidate.  Please let me know if you learn otherwise.

Here is an excerpt from the Bass press release:

“Parker Griffith’s plan to pay third-party insurers to run an expanded Medicaid program in Alabama would waste Medicaid funds that otherwise could be – and should be – used for medical care and could subject them to fees that would discourage them from seeking care, charges Kevin Bass, Democratic candidate for governor.

‘Democrats have challenged Gov. Bentley’s unacceptable refusal to expand Medicaid,’ Bass says. ‘But instead of trying to maximize the funding available to our citizens, Griffith wants to let private insurers line their own pockets by spending as little as they can get away with.’”

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Filed under Alabama Politics, Healthcare reform, Medicaid

Fake Medicaid or No Medicaid? Don’t Buy It


Governor Bentley has persisted in failing to offer hope for the uninsured poor in Alabama, through a Medicaid Expansion or otherwise. Behind the scenes, various insiders are passing rumors not to worry—he really will do it… after the primary. Or after the general election. If the rumors are true, the plan is to apply for a “private option” style Medicaid waiver similar to programs in Arkansas and a handful of other states, and he is making people wait for his personal political interests, without regard to their present needs. If the rumors are not true, one can imagine he might benefit from public perception that he is simultaneously accepting and declining the Expansion.

One of the candidates in the Democratic Primary, Parker Griffith, got supporters by promising to expand Medicaid. Now he has revealed his grand idea: private option Medicaid, the same type of program Governor Bentley is/is not planning.

Except it isn’t such a grand idea.

Private option Medicaid is Fake Medicaid. One writer called it “Conservatives’ Awful New Medicaid Ploy”—and it isn’t even conservative. It is just a way to siphon off federal and eventually state money into private pockets, away from providing needed healthcare. Instead of simply directly adding people to the existing state Medicaid program, to be funded mostly by federal money and with generally about 3% overhead, it uses those funds to purchase private insurance at significantly higher overhead and for profit. It’s a skillful bit of flim-flammery to convince conservatives that this is anything but a scam and liberals that it is the only choice—fake Medicaid or none.

These “new” – what scam is ever really new?—programs don’t just eat up healthcare funds.  They have to limit health services to turn a profit. How?

By charging people with no money premiums and/or co-pays, so they will be discouraged from applying at all or seeking care if they do. You may think $35 a month for a household premium isn’t much—if you do, you aren’t likely poor enough to qualify for Medicaid. Even $3 can mean the difference between filling a prescription and skipping it.

By adding “wellness programs” of no proven cost-savings, an additional time charge for workers without sick leave. See page xix of a large analysis on workplace wellness programs by Rand: “[w]e estimate the average annual difference to be $157, but the change is not statistically significant.” This doesn’t mean $157 isn’t significant—it means the $157 “difference” is most likely due to chance instead of a difference and could just as easily be a $157 loss.

By charging a fine for coming to the ER for a non-emergency, instead of making sure all patients have 24-7 access to primary care and developing better ways to triage and redirect patients to appropriate settings. By charging $50 for the crime of being sick enough to be admitted to the hospital.

Already, just a few months in, Arkansas is finding out how much this fake Medicaid is going to cost them.  Are we really looking to follow their footsteps? If you haven’t read Confessions of an Economic Hitman, I highly recommend it. I suspect we are currently the target of the same strategy used to bring developing countries into debt, except this time it is on our own soil.

Both Bentley and Griffith were practicing doctors. I find it hard to believe they are completely unaware of the harm a private option Medicaid could do to patients and our state’s economy. Even so, it may be worth your time to tell them.

For those who have decided the fake option is better than nothing, it might not be so. Once people get their Medicaid cards, they will no longer be able to visit free clinics, get charity care, or apply for patient assistance programs for medicines. I am not sure how to predict whether on balance more people will be better off. I can say with a fair amount of certainty that a good many people will be actively harmed. Sometimes a false front for a good thing is actually far worse than nothing.

Fortunately, there is no reason to believe the choice is between fake Medicaid and nothing. We have more options. We can support candidates who are supporting the real Medicaid Expansion. Democrats could consider taking a look at Kevin Bass in the primary. Those who are determined to support Griffith could put pressure on him to drop the fake Medicaid idea. Republicans could put Bentley on the spot, and decide not to support someone who is/is not doing—hasn’t done— anything specific to address un-insurance and its economic damage to hospitals around the state. You can speak up against wasting funds in a fake program.

In that same vein, there’s no real reason we need to keep putting ourselves in the position of choosing between only two parties, between private insurance and nothing, or between all manner of pretend reforms and nothing. Some of you reading this are donating substantial sums or time to a lose-lose game. Are you getting what you’ve paid for?

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Filed under Alabama Politics, Bad solutions for the uninsured, Medicaid

Decriminalizing CBD Oil: Let’s Do a Good Deed Together


Complaining about current conditions or worse ones in the pipeline gets tiresome sometimes—nobody really wants to be Debbie Downer. So I’m glad to let you know of a bill in the works for Alabama this year with bipartisan support that could not only actually pass but also truly be a good deed. 

HB 207/ SB 174 would decriminalize the possession of CBD oil from marijuana plants for persons needing it to treat their own medical conditions or their children.

CBD oil, cannabidiol oil, is a natural derivative of marijuana with minimal amounts of THC (the part that makes people high). Although there is not enough THC in the oil to be psychoactive, just the tiny amount present makes the product illegal in our state. Google CBD oil and you’ll pull up rave reviews for treatment of just about everything under the sun. I’m generally suspicious of panaceas—cure-alls, good for what ails you miracle drugs, generally turn out to be fads that get dropped when, surprise, they don’t actually cure it all. I wrote that last line before I found this article with a good description of the endocannabinoid system using almost the same words—by a physician in favor of medical marijuana.

Not all the purported benefits of CBD oil have been seriously studied, but some have. It turns out the research is compelling in animal models of epilepsy. CBD oil has shown strong anti-seizure effects for generalized, partial and temporal lobe epilepsy. We don’t have that level of data for human use, just a few small studies in adults. For children, we do have multiple anecdotal reports of patients with intractable seizures, who didn’t respond to any other treatment, using CBD oil with good results. Some of the stories are enough to make me catch my breath— children with Dravet Syndrome, suffering years of daily prolonged seizures and associated developmental regression, becoming not only completely seizure free or close to it but also showing reversal of their brain damage.

There is one published survey, from Stanford, of 19 parents who tried CBD oil for their children with epilepsy, including Dravet Syndrome. Sixteen of them, 84%, reported fewer seizures, most with 80% reduction or more. The three who didn’t respond did not get worse. The only side effects reported were drowsiness (37%) or fatigue (16%). The authors point out that common side effects of prescription seizure medication—rash (sometimes life-threatening), vomiting, irritability, dizziness, confusion and aggressive behavior did not happen with any of the children.

Animal studies have also not uncovered serious adverse reactions. One paper noted a shift in cytokine production by human cell cultures exposed to CBD, which could be helpful for autoimmune and inflammatory illnesses but might be harmful in chronic infections like HIV. We don’t have good quality clinical data on this question—Cochrane Reviews could not come to a conclusion about long term effects of marijuana or derivatives in HIV outcomes, for good or ill.

The way to find out if CBD will live up to these early reports? More well designed trials, and larger ones.  We need to know if there are side effects that didn’t show up in the smaller groups, the best dosing regimens, and who is most likely to benefit. We need access to oil that will have a reliable concentration of CBD. The FDA has approved sites to study a specific, reliable concentration CBD oil in children, and 7 additional sites will be given IND (Investigational New Drug) approval for compassionate use.

Now I’m at the exciting part. Alabama may be getting one of those compassionate use approvals. I spoke to a respected pediatric neurologist who would be heading the program if done here. She has high hopes that the CBD oil may prove its worth.  She told me it was very important for children to be able to get CBD oil with a known percentage of active ingredient and low THC, because parents had reported inconsistent results from one batch of oil to another with non-standardized products. The problem is that it is illegal in Alabama, standard or not. So parents in the FDA approved program would risk arrest – unless we pass a law to protect them.

The bill doesn’t recommend CBD oil use—both versions are going through their respective Judiciary Committees, not Health. Sure, they leave other ground untouched, like medical marijuana in general or even recreational marijuana. I think it would be inhumane for legal marijuana advocates to ask these children to wait until more comprehensive legislation has a chance. An exhaustive evidence base is not necessary. All we need to do is say CBD oil has no reason to be illegal. I could walk down any drugstore aisle in Alabama, close my eyes, spin around and point my finger, and I’d put money in advance that whatever I’m pointing at would have more known side effects.

When I first spoke to Mike Ball, the House sponsor, he was concerned he might meet opposition from those who are just going to say no to anything remotely related to marijuana. He said it was probably risky to sponsor the bill during an election year, but that after meeting the parents who are begging for help, he had to take the chance. He told me this hill was worth dying on.

I’m a skeptic about politicians, just like panaceas, and I tend to distrust their motives more often than not. Even though Mike and I don’t see certain critical issues the same way, I believe he is an honest man, and I believe he sincerely had his heart touched by these children and their parents. I’m impressed that he was willing to take a political risk for a good deed.

Since we talked, I’m seeing reports that the bill may not meet the opposition he anticipated—that’s good news, and all the more reason for us to pile on. First, we want to be darn sure it passes. Second, we don’t always have to pick only the iffy bills to champion. Sometimes, it might just be good to show an overwhelming support, across partisan lines, for a worthwhile goal. Sometimes, we can all get to be the home team. If you agree with me, please take this opportunity to contact your legislators. No matter what happens in the 2014 midterms or in 2016, we are going to need to find a way to get things done together in Alabama, and maybe it starts with something this simple and sweet.

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Filed under Children's Issues, evidence based medicine

Poop Happens: New Rules for Alabama Medicaid


In the ongoing effort to squeeze more juice out of the budget turnip, Alabama’s Medicaid office has revised pharmacy benefits.  There are new limits on the number of prescriptions per month for adults, and for all ages, the program will no longer cover any over the counter medications as of October 1.

 

Were you aware our Medicaid program covered some (not all) OTC medications if prescribed?  After all, most private insurances do not, and neither does Medicare.  This is an optional coverage by states—we don’t have to do it, and now we won’t.

 

 Most of the OTCs I prescribe for kids are fairly cheap—for instance, 1% hydrocortisone for mild eczema is under $5 a tube.  Others are a little pricier—polyethylene glycol for constipation is about $12 to $36 for a one month supply depending on the dose.  For most of us, that’s still less than the typical pharmacy co-pay anyway, so what’s the big deal?

 

You’d be surprised how many families tell me, as they are leaving the office, that they can’t even afford to buy ibuprofen to give their children pain relief, or a thermometer, or a bulb syringe to suction a baby’s nose.  Children with Medicaid live at the very lowest income levels, so sometimes there really isn’t $5 or $10 for an OTC medicine.  Sometimes, maybe there is—maybe the household budget is out of line and maybe that $5 was spent on something you might judge wasteful or frivolous.  The problem for the kids is that whether their parents could budget differently or not, many will simply not get their medications unless Medicaid covers them. 

 

I wasn’t the only pediatrician who thought the change sounded like a problem.  Several of us made lists of the most commonly used OTC medications for which there is no good or inexpensive prescription substitute.  The list was submitted by an advocacy organization to our Medicaid agency, along with an explanation of our request to have an exception for these limited items.  A few days ago we got our answer—no.

 

We are told this is because of federal rebates for prescription drugs, not available for prescribed OTCs.  I understand how that would work in general, but not for everything.  1% hydrocortisone, for instance, can be used sparingly on the face for eczema (along with a thick moisturizer).  Stronger prescription steroids are not a great idea on the face for extended use.  So our next step up from the $5 OTC is… pimecrolimus or tacrolimus, priced online at $150 or more.  I don’t know what Medicaid pays and gets back as a rebate, but I’d be surprised if it isn’t a money loser by comparison to the $5 product.

 

One of my friends out of state suggested the decision may also be related to Medicaid’s possible switch to Pharmacy Benefit Managers.  If we go with third party, for-profit PBMs, they make their profit on our prescriptions and would likely object to any coverage of OTC meds.  I’ve asked around and have not been able to find out if PBMs are a factor.

 

Now I’m going to talk about poop, so if you are eating or squeamish, skip to the end.  Pediatricians are bad about poop talk in front of nonmedical people, even at parties.

 

Constipation is a common problem in babies and children—hard stools that not only hurt but can even tear the anus.  I’m talking blood.  Children are scared to poop afterwards—they expect pain and they hold back, resulting in more stool buildup and more pain the next time.  Eventually, this pain/holding cycle can lead to encopresis—large amounts of hard stool in the now dilated rectum with thinner, liquid stool leaking around it and out into the underwear.

 

Parents may think their children are not wiping or are having accidents.  The kids are embarrassed.  It smells bad.  They get called names.  Whenever I see “train tracks” in a child’s underwear, I know I need to do a rectal exam and see what’s up in there.  After diagnosing and explaining the problem, I outline a course of treatment in which we need to get the poop cleaned out and then keep it very soft, like pudding, for several months to avoid new tears and recurrent buildup.

 

Treatment is almost always successful.  OTC polyethylene glycol, PEG, (aka, Miralax is the best thing going for encopresis—both for the initial cleanout and for maintenance.  It isn’t absorbed into the body—it pulls water into the stool to soften it.  When I was in training, we had mineral oil—a chore to coax children to drink even with heavy flavoring, and there were cases of aspiration pneumonia when the oil got into their lungs.  Then we had lactulose—better accepted than mineral oil but not quite as effective as PEG and rarely with significant side effects, including obstruction of the bowel.  We had various fiber supplements, which helped inconsistently.  For cleanouts, we often had to resort to milk and molasses enemas.  Finally we started using PEG.  Kids will drink it, it works most of the time, and there are minimal side effects.  Life for constipated kids got much better. 

 

Now, depending on the dose needed, families may have to spend as much as $36 a month to keep treatment going.  Some will manage to do it, and others will not.  Say whatever you want about what the parents “should” do—if it doesn’t happen, it doesn’t happen, and the kid will be the one with a bleeding bottom.  Or in the ER for abdominal pain.  The number one cause of abdominal pain in children who visit the ER is constipation.  Untreated constipation can lead to urinary tract infections.  It can lead to CT scans and repeated radiation exposures in the ER.  Sometimes we have to admit children for cleanouts, with PEG dripped through a nasogastric tube.  I have had kids who got so constipated they vomited fecal material, but not since we’ve been using PEG.

 

I know some of you by now are asking why we are using medication for constipation at all.  Isn’t it a crutch?  Why not fix the diet, try juice, prunes, coconut oil, stop all the dairy products, or whatever your favorite home remedy is.  We do!  If you have been in my office with your child and we haven’t talked about diet, one of us has had memory loss.  The problem is sometimes the same as with the cost of the PEG—reality.  The children are not buying their own food.  And to be fair, some parents really do provide healthy food and the constipation remains.

 

Whatever your thoughts about how children ought to be eating, when they get painful constipation or encopresis, OTC PEG gets them out of misery.  And coverage for it is going away for many of our patients on October 1.

 

I don’t know if our Medicaid will track ER visits for constipation or complications like UTI to see if costs go up. Will we save money on medications only to spend extra elsewhere?  I doubt it will take very long for us to see problems in our practices.   I plan to let the state know if I do.

 

 I want the Medicaid money to stretch as far as it can, so that no one goes without needed care.  I appreciate the state’s creative efforts to work the budget.  This particular change is probably not going to be as bad as the limit on prescriptions for adults, which will land some in the hospital (what do we skip this month—the diabetes medicine, the blood pressure medicine, the heart rhythm medicine?), but it will cause some definite problems.  No matter what insurance system we have, even if we had single payer, we would have to think about this type of decision.  

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Filed under Children's Issues, Medicaid

The Truth Hearing Report: Testimony on Healthcare


As promised, I am reporting back to you about our Truth Hearing held July 31 in Huntsville, Alabama.  It took a little longer than I anticipated—I wanted to be sure you could view all the video segments for yourself.

 

The purpose of our event was to obtain direct testimony from members of the public about difficulties getting necessary healthcare, without adding political commentary that might close off our thinking in regards to solutions.  In that spirit, I am going to provide limited commentary of my own and trust you to form your own opinions.   This will enable you to share it with friends across the political spectrum.

 

We had a few technical glitches—this was definitely a learning experience, and we will know better next year how to avoid similar problems.  I hope to do this event annually, so we can learn what is happening as our healthcare insurance environment changes.  Our volunteer videographer had a broken camera on the day of the event and so was unable to help.  I have to thank my husband, who stepped up to find and hire Brian Pitts of Pinnacle Video Services (does legal video depositions) at the last minute.  The sound was not as good on the first segments, and fortunately Brian realized there was a problem and fixed it.  My friend Sara Crocker and her husband Charlie also volunteered to video, and I used their broader angle for the opening segment. 

 

Here is the opening.  We invited several elected leaders—of those, Representative Laura Hall (Alabama Legislature) and Kenny Anderson (representing Mayor Battle) attended.  Dr. Richard Showers of Huntsville City Council had planned to come but was unable to do so.  Our two US senators, our County Commissioners, US Fifth District Congressional Representative, Regional Health and Human Services Office (will run our state Exchange), Alabama Medicaid Office and Governor’s office declined to attend. All were given the option of attending in person or selecting a proxy.

 

Community leaders who rose to fill the empty chairs:  Benard Simelton (Alabama NAACP President), Sara Crocker (Huntsville’s Human Relations Commission), Ann Denbo (board member National Alliance on Mental Illness, Alabama), and James Robinson (GLBT Advocacy and Youth Services). 

 

I counted 52 in the room, although I may have missed a few who entered after the beginning.  By sharing this blog with your friends, you can help keep attendance at our event growing.

 

I’m going to present the speakers somewhat out of order, in case you only watch a few, because it took us a bit to warm up to more personal stories. 

 

Bonnie Roberts, a fellow poet, told me later she had never imagined she would cry and was not looking for sympathy.  I am grateful that she did feel moved to share her deep feelings with us.  As you will imagine after viewing the video, she received offers of help (and help) after the event—she wanted most for you to know that she is by no means the only person in this situation.  Her story, to me, shows that for extreme medical expenses, most of us even with good jobs will not be able to plan well enough to avoid severe financial consequences.   It’s also a reminder that you may know people who need help and who will not tell you about it.  They are ashamed. Most of us want to be self-sufficient and to be givers, not receivers.  By talking about her situation, Bonnie is giving us valuable information—could this happen to us?  What would we do?  How would you respond to a person in her position? Bonnie has insurance—Medicare.  It did not keep her from having medical debt and ongoing medical expenses so high that she runs out of food at the ends of months.

 

Benard Simelton, in addition to serving on the listening panel, read Callie Greer’s testimony about her daughter’s death from cancer.  Callie so much wanted to attend herself but was unable.  I am grateful that she sent us her words and to Benard for reading them. Callie’s daughter was uninsured—she was sent home from the ER with early breast cancer, no physical exam, and a prescription for pain medicine.   When you hear it said that uninsured people can always get free care from the ER, this is the story you need to remember. 

 

Thomasin Cates told us how her insurance tried to refuse authorization for surgery to remove a football-sized, life-threatening tumor from her chest by saying it was cosmetic.  This sort of thing is more common than you’d think.  Here is the description of the policy that will form the benchmark for Alabama’s Exchange coverage—note page 41 where it says coverage excludes services “we determine are not medically necessary.”  All insurance policies I’ve seen have this clause.  All insurers I’ve worked with drag their feet and deny coverage with it, even when they know they will eventually have to give in.  During that foot-dragging time, illnesses can progress irreversibly.

 

Alix Morehouse has two stories, first about herself and then about her son.  She describes a classic Catch-22 in our healthcare system—she needs insurance to have surgery done which would allow her to work at a better paying job—with insurance.  She could probably get disability—but she doesn’t want to be disabled.  She wants to work.  Her son, who is insured, has had ongoing treatment for precocious puberty denied because the insurer dropped the only drug off their approved list and no longer covers it.  During the appeals process, his disorder has progressed for lack of treatment.  I am seeing more of this problem in my practice—dropping effective treatments off the formulary.  Alix’s son has an insurance card that is broken.  How many of us have broken cards and don’t know it yet?   How will we know?

 

Margaret Melton, who is insured, tells us how insurance rules have created barriers to getting her kidney stones diagnosed and treated and interfered with physician practice.  Her physician has told her that her insurance won’t “allow” primary care doctors to get diagnostic testing for the stones, only specialists.  I can’t speak to this, since I’ve not encountered it for stones—I wonder if the issue has to do with the red tape of getting prior authorizations for CT scans and if her doctor is tired of wasting time and getting denied.  It certainly does happen with me in my own practice for treatment of minor depression and ADHD, where many insurers will not certify me to do what I’ve been trained and licensed to do.  These children must wait for a psychiatrist appointment instead.  Bottlenecks occur at the specialist level, delaying care and saving insurers money.

 

Robert Partlow tells about his struggles to care for his wife through her serious illnesses.  Despite their attempts to be proactive, he and his wife have felt shut out of the process of choosing treatments.  She is now in a nursing home 100 miles away from him. What would have to change about our healthcare system to be more respectful, responsive and inclusive of the Partlows and others like them?  Have you encountered this access barrier of a different sort—inability to find meaningful care where your wishes were sought out and respected?

 

Don Ramsey tells about his difficulty getting healthcare, and his relief at learning he could get high quality care through the VA.  I appreciate his enthusiasm and desire to let others know—certainly any veteran who is eligible should take advantage of the care.  Unfortunately, about 1.8 million US veterans are not eligible for services through the VA.

 

Meg Tilden struggles with insurance that barely allows her to cover her costs and tells of her efforts to help others in our community with their healthcare.  She has encountered the world of Medicare Advantage insurers recruiting patients who then learn that their existing physicians and medications are not covered.   More competition without transparency means more confusion, and healthcare is not like a toaster we can return if it malfunctions.

 

Finally, John Jeter, who was actually the first speaker at the Truth Hearing, tells his story of being diagnosed in his youth with Type I diabetes. Good quality healthcare and personal responsibility have been critical to his survival.  Mr. Jeter puts his medication and hospital charges under much deserved scrutiny and offers his thoughts on healthcare reform.

 

In closing, I want to thank everyone who attended our hearing and who volunteered to help.  We had volunteers to run the sound system, to set up/clean up and to welcome guests.  This event would not have happened without them.  

 

Now you have attended our Truth Hearing.  What did you learn?  Did anything surprise you?  How can we do a better job informing each other of healthcare in the trenches?  What could we do differently, armed with the truth?

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Filed under citizen responsibility, Healthcare reform