The State of Healthcare in America

We all know the healthcare system in the US is a mess. Our federal government is broken. And it seems there is a central character in our numerous problems: money. The privatization of prisons, hospitals, universities. It’s become not about people, but the almighty dollar.  Since when have hospitals been For Profit. I thought they were For Care of the Community. Instead we have board members, rich board members, who are getting paid to be on the board. They have no vested interest in whether people have healthcare. Doctors are overwhelmed by the paperwork required, and the limited time the insurance companies allow them per patient. Talk to your doctor, if you don’t believe me.

Ins No

From an article from the National Economic and Social Rights Initiative (NESRI).

“The market-based health insurance system in the United States has caused a human rights crisis that deprives a large number of people of the health care they need.  The most visible problem is the 32 million people without health insurance; the most distressing is the number of preventable deaths – up to 101,000 people per year – simply due to the way the health care system is organized.”

“Since social determinants, such as race, income and environment, strongly influence who becomes ill and who receives access to quality care, the health care crisis disproportionately affects disadvantaged groups and under-resourced communities, such as people living in poverty, people of color, and immigrants.”

Overall, the “health care crisis is the result of the privatization and commodification of the U.S. health system, which reflects market imperatives and profit interests that devalue human needs, dignity and equality.”

According to the article 45,000 people die each year simply because they have no health insurance.  That’s a lot of voters! Apparently since they are poor, non-white, and often, immigrants, our federal government doesn’t see them as citizens. It seems our government doesn’t see them as human.Some 700,000 families go bankrupt each year trying to pay their medical expenses. Even with insurance, high co-pays and exorbitant hospital costs, it’s not surprising , especially when a catastrophic injury or illness hits.  Yet in 2009 the five largest insurance companies had a combined profit of $12 billion. Some of that money could have been used where needed, not to line the pockets of those who already have enough. (There are no poor people on hospital boards.)We also now have fewer doctors and nurses than other high income countries (WHO 2007).  WHO projects a shortage of 44,000 primary care doctors within the next 15 years (WHO, Health Affairs 2008). Fewer doctors because there is too much paperwork and not enough healing. According to an article from 2016 from Forbes:  One study showed physicians spent 27% of their time in their offices seeing patients and 49.2% of their time doing paperwork. Seems lopsided to me. I can’t blame them when many became a doctor to help people, not do endless reams of paperwork. Nurses are already badly needed, but there are too few nursing programs to put enough nurses to work. According to the Bureau of Labor Statistics’ Employment Projections 2014-2024, Registered Nurse (RN) is listed among the top occupations in terms of job growth through 2024. The workforce is expected to increase, providing 439,300 new nurses. However, the Bureau also projects the need for 649,100 replacement nurses in the workforce bringing the total number of job openings for nurses due to growth and replacements to 1.09 million by 2024.

Meanwhile we have the GOP trying to strip most US citizens from receiving even minimal care. We must stop For Profit from becoming the norm in every conceivable business.  Seems the public schools are about the only thing not privatized (yet).

 

For the want of critical thinking, America has succumbed to tribalism

This says so much of what I’ve been trying to say.

Progressive Culture | Scholars & Rogues

Antarctica is cold. I learned that in grade school. The record is 128.6 degrees Fahrenheit below zero set in 1983. Did you know the southernmost continent is also a desert? I know much of the history of the exploration of the continent — the stories of Roald Amundsen, Ernest Shackleton, James Clark Ross, Caroline Mikkelsen, and others. I know the continent’s 5,400,000 square miles are 98 percent covered with ice (although that’s changing, I suppose, as the climate and sea continue to warm).

p-6421-mfatBut I’ve never been to Antarctica. It’s likely that you haven’t, either. So how do we know so much about the fifth-largest continent?

We read books about it. Teachers taught us about it (usually from textbooks and, if you’re my age, “film strips”). We’ve seen movies and videos about Antarctica. We’ve seen the continent on maps and globes. We’ve watched Emperor penguins on basic cable nature specials.

View original post 1,691 more words

On The Realities of Being Poor

I’ve been reading lately:

  • The Heritage Foundation Backgrounder, 19 March 2014 – “Do Federal Social Programs Work?”, by David B. Mulhausen, PhD
  • The Heritage Foundation Backgrounder, 15 September 2015 – “Poverty and the Social Welfare State in the United States and Other Nations,” by Robert Rector
  • Center for American Progress – “The Facts About Americans Who Receive Public Benefits,” by Joy Moses, December 2011.
  • UC Davis Poverty Research Center -“How To Reduce Poverty in the United States”

Poverty, as we all know, is a deep seated problem with no easy answers. The four articles noted above contradict each other on several issues, so it is not surprising that solving the problem is so difficult.

The March 2014 Backgrounder, for example states, “The American Public should have nothing to fear from the elimination of ineffective programs. Now is the time for deep budget cuts in federal social programs.” Some of the programs it suggests terminating include Head Start, which after detailed evaluation found that the program failed to improve the lives of the children, any more than the children who did not attend.  I’d have to agree, the Head Start program may have outlived its usefulness now that nearly all children attend a pre-school for at least a year before starting kindergarten. So, how much is actually spent on Head Start? According to one source: $7 billion.

Other programs the March 2014 article suggests are ineffective are:

  • Food Stamps (SNAP), which “failed to affect earnings and employment outcomes.” Sorry, what? This makes no sense. Were food stamps meant to increase the recipients earnings or employment? Yeah, I didn’t think so. It is a program to ensure better health through nutrition. So I deny that this is a failed or ineffective program based on the faulty testing criteria.
  • Moving to Opportunity (Section 8 housing) was also found to have failed “to produce statistically meaningful results” for the recipients.  This article does not explain the criteria used, but you can go here for more info. I suggest that part of the failure of this program is due to lack of participation of landlords. Applications for the program have actually been suspended for the past 10+ years (at least in Los Angeles), due to the long waiting list and short list of landlords, as well as the limited range; housing is not even offered in most of the surrounding cities. There must be some incentive provided to landlords to participate in the program, and currently there does not appear to be any.
  • The Job Corps program studies show that participants worked fewer hours and received less pay than the control group. I posit this is due to the dearth of opportunities in areas served; i.e., learn all the skills you want, if there is only a job at McDonalds, you will not make more money.  The program isn’t failing, we are. Yes, the program is ineffective, because it doesn’t solve the problem of job availability. Again, we need to provide incentive for businesses to locate in poor communities. Not an easy fix, so I guess it’s easier to just say it doesn’t work and trash it, than say it doesn’t work because it is flawed but could be improved.

The September 2015 Backgrounder discusses the living standards of those people considered poor. The US census (from which most financial data is taken) does not provide an indicator of those who may be using federal aid.  I should think that might skew the numbers, no? One of the criteria for determining poverty (other than income) include whether or not they have air conditioning. Most modern buildings have central heating and cooling.  While I might use my power for heating, I’m less likely to use the A/C because of the cost. So, just because A/C is available to me doesn’t mean I use it. And who says A/C is a luxury? Sure in 1945 it was, but today?

Nearly 75% of those defined as poor have at least one car. Again, who decided that a car was still considered a luxury item. The survey asks “do you have a vehicle.” It does not ask for the age or condition of it.  Two-thirds of the poor have a computer with internet access. Again, not really a luxury item either, now that so much of our lives need that access, especially when it comes to education. They have cable/satellite playing on a wide screen modern TV.  TV is again, not a luxury item. What the survey does not ask is “did you buy the TV or gaming system?” It might be a gift from a friend or relative. All I’m saying is that statistics don’t tell much of the story. Data can be skewed. Information omitted.bad wires

In the end, I know not all our systems work, and some should be dismantled, but others could be streamlined and improved. With each change we make to a system, it is only a patch. Now imagine that as an electrical system? Patch upon patch, always adding a new wire. I’d say it’s a reasonable assumption that this is why our government has become too large, too cumbersome, and too expensive.

And we never really fix the problem because of partisanship. Neither side will let the other side get exactly what they want. When did Party become more important than the People? (Much more on that later.)

The Growing Poor in America

Our GNP has been growing.  Inflation has been rising since the 70s and cost of living has increased.  Yet wages have stagnated.

wages

Most wage increases over the last 20 years have been less than helpful in keeping up a Middle Class.  You can see by the above chart, the lowest incomes have actually decreased in the last 15 years!  Inflation has continued.  No wonder we no longer have a Middle Class.  I’d say Middle Class has dropped into the following categories: Poverty-Stricken, Poor, Middle Poor, and Barely Squeaking By.

Wages
In 1970, minimum wage was $1.60 an hour. Today, it’s $7.25 an hour. That’s a 353% increase over that period of time, which seems like a fair amount… until you actually start looking at how prices have increased.

What about average wages? I couldn’t find a document that laid out full details on average wages per year, but this document from the Census Bureau, laying out some average wage information, shows that average household income has roughly kept pace with consumer prices.

Consumer Prices
In January 1970, the Consumer Price Index was 37.8. In January 2011, it was 220.223. That’s a 482% increase over the period we’re looking at.

In other words, for every dollar increase in the minimum wage since 1970, the price of an average item has gone up $1.36. Even adjusting for inflation, a dollar today buys less than it once did for low income earners.

So, for a person freshly out of school, the initial income outlook is worsethan a fresh graduate in 1970, but after some career advancement, their salaries end up being comparable given inflation.

Education
In 1970, a year of tuition at a public university cost $1,207. In the most recent year of data available, 2007, a year of tuition at a public university cost $11,034. That represents an annual average increase of 6.2%, which, if you applied it to the 2007 price, gives you an estimated 2010 cost of a year of education as being $13,216. That’s a 994% increase in the cost of a four year degree.

So, let’s say you’re earning minimum wage and trying to make it through college.

In 1970, you could work 755 hours at a minimum wage job over the course of a year to earn enough to pay for a year of schooling at a public institution – about 14 hours per week.

In 2010, you would have to work 1,823 hours at a minimum wage job over the course of a year to earn enough money to pay for a year of schooling at a public institution – about 35 hours per week.

Source: http://www.thesimpledollar.com/a-dose-of-financial-reality/

 

Most people I know are in the Just Barely Squeaking ranks.  They own houses with large mortgages, have car payments, and credit card debt in excess of $10,000, lots of that is student loan debt.  Adult household members work at jobs they probably hate, and don’t pay near enough.  Jobs they have taken mainly for the insurance benefits, which have decreased steadily over the past 15 years.  Ever since the Reagan Era “Trickle Down” theory.

We pay more for homes, cars, and groceries than ever before, and are (for the most part) no better off than their Middle Class upbringing.  Why?

Technology.  It’s expensive.  Lot’s of techies make lots of money, but it doesn’t trickle down very far.  Maybe it trickles to their housekeeper, gardener, grocer.  (All of whom make 1/4 of what the Techie does.)  Technology, that god I heard about ever since I can remember.  That thing that would give workers more leisure time.  That thing that has replaced people with computers and robots.  Remember the old Secretarial Pools?  Large documents would be typed up by a bevy of women with each one typing a section over and over.  It took more people to do the typing because at that time Xeroxing was new, time consuming, messy, and expensive.  Now one person can type entire documents. Granted this didn’t happen over night, but computers have eliminated millions of jobs.

Health Care.  It’s expensive.  Insurance costs for such care is beyond believable when you see hospitals charge $1,000 for Tylenol.  Doctors charge over $300 per 15 minute visit. Luckily most of us can still see a doc for under $50 co-pays, but not all of us.  God forbid you have a serious health problem like cancer, Parkinson’s, Huntington’s, Progressive MS or ALS.

Housing.  It’s expensive.  Greedy people have driven up the cost of homes to unprecedented heights.  New York, Paris, London, Los Angeles; all the major cities are virtually unaffordable for the Barely Squeaking.  In my city the cheapest homes you can buy are $500,000 fixers, for which you need another $200,000 to make repairs or alterations.

Gentrification of Poor Areas.  Rich Man buys apartment building occupied by 20 families each making less than $30,000 per year.  Rich Man evicts all 20 families.  He spends millions to rehab and improve his investment.  Who can blame him? So he puts in expensive carpet, wood floors, guts the bathrooms and kitchens and adds stainless steel appliances, granite counters, fancy pedestal sinks, and low-flush toilets and showers. The evicted families were paying less than $1500 per month for their 2 bedroom 1 bath apartment.  The newly finished building now houses only 10 units, minimum 2 bed/2 bath over 1500 square feet of living space (as opposed to the original 700 sf 2 bed/1 baths).  There is now underground parking, and a concierge.  The units are now to be sold as condos, starting at $750,000.

Improving the poor areas, right?  No.  It’s just relocating the poor by force.  Those 20 families now struggle to find a new apartment that they can afford. Usually they find something farther from their jobs.  Making it more difficult for them to keep those jobs. Likely a job will be lost simply because they can’t make it to the second job on time riding the bus.  Bus service is slow, cabs or Uber are expensive, cars even more so.

Many people with such low income work two part time jobs.  Neither of which will provide health insurance coverage if the worker puts in less than 30 hours.  So mom and dad work two minimum wage jobs without health insurance.  Their only health care provided by ERs across the nation, thousands of which have been systematically closed down by the Board of Directors of hospitals, because the ER is not cost-efficient.  Why? Because 90% of those in an ER have no insurance and no means to pay for their visit. ERs are required to treat a person, regardless of their ability to pay.  It’s no wonder they aren’t cost effective.

That says a lot when discussing a National Healthcare Insurance.  ERs would no longer be crowded with people with ear infections and colds, and could return to the intended use for accident victims.  Thereby decreasing costs simply by eliminating those without means from incurring debt they cannot pay.  It’s not Socialism, at least not in the bad sense of the word, it’s common sense with some compassion tossed in.

Do rich people really think I want to be borderline poor?  What is this lingering hate toward the poor (and the homeless)?  It’s been with us thousands of years, ever since “income” became a necessary part of life.  The poor in this country will continue to fall further behind and end up on Welfare (another GOP-hated social assistance).  The number of homeless will continue to increase.

Don’t those in power and/or with money care at all about us down here on the bottom row of the pyramid?  We built the fucking pyramid, we should not have to be buried by it.

Well Beyond Nixon

People have mentioned the corruption in our current administration as “Nixonian” in scale.  Watergate has nothing on our growing Russiagate investigation.  In fact, Trump’s administrational misdealings, illegal activities, and lies make Nixon’s activities look like child’s play.  It’s more than just admiration of and fawning over dictators and despots like the Philippine President Duterte, Putin, Kim Jong Un (CNN-Jake Tapper).  It’s all his other great plans for our nation that takes him well beyond Nixonian.  We’re reaching Orwellian proportions here.

About the only dictators Trump hasn’t personally approved of are Hitler and Mussolini. I’m guessing he considers them both losers, since they didn’t stay in power for decades. He called Un a “smart cookie” for having his uncle killed to gain the NK throne! He’s ok with Putin and the murders he’s complicit in.  “The US isn’t innocent,” Trump said in an interview.  Is he implying our President’s have murdered people for personal gain? I think if any US president had ordered a hit on someone history would’ve revealed it by this time. He seems to feel a dictator is a more competent, stronger leader than someone merely elected by the people.  Neither of which applies in this case.

He’s complicit in Russiagate, spending all his time covering up or burying as much information as he can.  Setting up one person at a time to take the fall.  My only hope is that he takes out the wrong guy and all the republicans turn on him.

He wants to revise the Constitution!  The First Amendment in particular so he can remove the Press from its protection.  Of course he had been talking about doing this throughout his campaign.  It seems to be getting more important to him.

He wants to keep us ill!  Healthcare Bill.  His budget proves it as well.

He wants to keeps us stupid!  Have you seen anything on his new budget?  He plans to cut $11 billion from education.

Trump’s an embarrassment everywhere he goes.  Pushing people aside to be front and center.  Saying ignorant things.  Acting inappropriately. Being happily ignorant of other cultures.

And my country elected this mess.  The world is totally screwed until we impeach this beast.

Drug Abuse & Brain Damage

Right now I hope my son is using something, because if he isn’t, he has permanent brain damage that may require hospitalization or institutionalization. I’m scared.  He has spells of normal behavior then suddenly he turns into this psycho who cannot articulate what he means to say–he uses the wrong words.  Nouns elude him.  He also gets obsessive and damn near impossible to communicate with.

He got lost coming home from his ex’s the other night.  She lives just one town over, about a 25 minute drive on surface streets.  She has lived at this location for five years.  The other night he ended up on the freeway going north into South Los Angeles.  A fairly unsafe place for a confused long-haired white guy.  It took 10 minutes of talking with him to get him headed in the right direction.  Stay on This Road, I told him, and it will bring him home.  5 minutes later he calls back.  He’s lost again.  Husband figures out where Son is and tells him to wait, that he will come lead him home.  Another 15 minutes and he calls, they’ll be home in just a minute, Son was right behind him, and they were 2 blocks away.  Unbelievably Son called about 10 minutes later.  Now he is headed south on a different freeway some 35 miles from home!

When he get’s home, it’s not much better.  He’s in and out of the house.  Front yard, back yard.  He comes into our room looking for various items, usually something that we would not have in our room, like the car.  He won’t go to his room, he won’t lie down.  He returns to our room repeatedly, goes into the bathroom 4-5 times in an hour.  He took two showers.  One less than an hour after the first.

It’s like having an extremely mobile 3 year old.  So afraid thinking about him driving on the freeway, probably speeding, considering how far he got from home in just a few minutes.  How am I supposed to deal with that?  What is that?  What is happening?  He gets single-minded and resolved to a particular action and seems unable to stop.  He listens, but he doesn’t hear.  He speaks, but he makes little sense most of the time.

Here is a sample of some things he said today:

“If I want to pick a fruit, just let me pick a fruit.”

“I’ve got to go to Armstrong’s (a gardening store) to get a thing, a, a, a, rope for my my my, the, that, my couch.”  He  meant he needed to go to Best Buy for a new charging cord for his iPad.

“It won’t work and no one will help me.”  This about his iPad, which isn’t the problem so much as he can’t sign in to any of his accounts, his passwords no longer work.  This happens each time he has one of these episodes.  I cannot do this any longer.  Husband can no longer handle this.

“You guys do so much for me, too much.  But I need help and you’re not helping.  All you do is yell at me.  And I’m not allowed to be to be upset or get mad.”  At times his anger feels like a physical presence and I am acutely sensitive to it.

One doc diagnosed him with schizoaffective disorder.  A scary mix of schizophrenic and bi-polar symptoms.  He fits some of those guidelines.  I also came across something called semantic dementia.  A truly horrifying illness with a limited lifespan.  He fits some of that criteria as well.  The only information I really find on these illnesses is a description of symptoms and prognosis, or I end up on some rehab site that tells me nothing except ‘drugs bad’.

I have an appointment to see my therapist with Son tomorrow afternoon.  I need someone I trust to give me an opinion as to what is going on.  I think he needs to be hospitalized, properly diagnosed and treated before returning home.  Except that won’t happen because there are too many mentally ill or addicted individuals in the area.  There are not enough facilities for all the mentally ill.  Not enough beds, nurses, doctors. The help is not free, does not take most insurance.  What are poor addicts supposed to do then?  What options do we provide them?  None.  What help do we provide to the families of those with serious mental health issues?  None.

None.  And with the new Trump NonCare it will only get worse for people like us: Sad losers (to use Trump’s words) who never caught a break in life.  How can people not understand the allure of suicide?

Doctors

Doctor #1

Saw my neuro this week.  She doesn’t think I have MS.  Just because certain diagnostic tests don’t show the expected results, my flares have been documented.  I had one flare that lasted 6 months.  I was treated with the standard MS flare meds by IV for three days, every month for three months.  If that wasn’t MS, tell me what is, doc.

Yet she continues to treat me, because my diagnosis came from UCLA, which has a specialized MS program.  Still she has me coming in every six months.  When she asks me about new symptoms, she dismisses them as not MS-related, and therefore not her problem. I guess if I’m not blind or in a wheelchair, I’m not worth her time.   She will be replaced.  I can see someone else in that office.  Why did it take three days for me to realize this?  Why didn’t I say something to the Doc?

Doctor #2

I’ve been having an eye problem where it felt like my eyelids were sticking to my eye balls. This has been going on for a few months, and wasn’t getting better, but not a real big deal, eye drops seem to work. So brought it up to my GP.  So she looked a little more closely at my eyes, and had me read the eye chart. I’m really shocked. If you measure by number of lines of the chart, my vision has consistently been only one line apart; my right eye is a tad better than the left, which has an astigmatism. This time it’s 4 lines! I can only read the second line of print with my left eye. I’m a little concerned and say as much to my GP and she gets me a rush referral to the Ophthalmologist.  I really like her.  I want her for my new GP, my old one is moving.

Doctor #3

I couldn’t get into the Optho until mid-March, so they referred me to another office.  I call and get an appointment for the next morning!  Wow, cool.  The doc examines my eyes, pretty much a routine exam, I read the eye chart, he dilated my eyes. He seems thorough. He tells me that I have an issue with glands in my eyelids not working.  I never knew there was anything except lashes on my lids.  These glands are supposed to secrete oils necessary to keeping eyes naturally moist.  He gives me a script for Restasis, and gives me a list of three more eyedrops I’m to use everyday for the rest of my life.  Four different types of drops, basically I’m to put drops in my eyes about every two hours.  Ok, it’s inconvenient, but not really something I can’t adapt to.

That’s when I ask him, “What about the sudden decrease in the visual acuity in my left eye?”  He shrugs, looks at my chart and sees I got new a prescription in my glasses Nov. 2015, so I should wait till this November, when my insurance OK’s new glasses.  I’m not really thrilled, but I figure he’s the doc, I trust that it’s not a big deal.  I go home.

Then yesterday, I’m updating my calendar and find the doctor’s card, which I just grabbed and put it in my pocket as I left.  I only read his name, not his title.  This time I read the title.  He’s an optometrist.  I had a referral specifically for the ophthalmologist. When I made the appointment, I assumed since they knew I couldn’t see the ophthalmologist in my office until March, that I would be seeing theirs.  I could have seen our optometrist, who I’ve been to before.

It’s been two weeks using all the eyedrops and my vision in that eye seems to be getting worse. My vision seems blurry, colors seem to merge and shift?  Can’t describe it. Suddenly I can’t properly identify a certain size or shaped or colored object until I am two feet away. This is not normal for me.  I’m worried this is not the dry eye issue, this might be the Fuchs Dystrophy I was told I had 20 years ago.  It’s a slowly progressing problem in the cornea.  When it gets bad enough the only option is transplant, but that’s still years away for me.  I hope. (Hmmm.  How likely is it that Medicare will pay for that by the time I need it?)

Then I talk to my brother, who I haven’t seen in 25 years and he mentions one of my sisters.  Says shes going blind.  Now I’m worried again.  I haven’t spoken to A in 25 years either, but I’m going to have to talk to her.  I think since my referral is good for two visits, I’ll just keep the appointment in March with the ophthalmologist.

What the hell is wrong with me that I don’t notice these things?  I used to be so thorough.   But I never asked the office what type of doctor I was seeing, something I once would have made sure of.  I used to speak up for myself, and I honestly don’t know when that disappeared.