Posted in Current Events, tagged Contraception, GOP, health care, health insurance on February 14, 2012| Leave a Comment »
There is a simple solution for Catholic hospitals, universities, and social service organizations when it comes to the religious liberty claim as it applies to including contraceptive coverage in their employee health plans: hire only Catholics, with Catholic spouses. Then nobody’s religious liberty is being affected.
Oh wait! Most Catholic women use contraceptives. If these institutions hire non-Catholics, what about the religious liberty of those employees?
Posted in Current Events, Politics, Uncategorized, tagged health care, health care as a fundamental right, health care reform, Senator Kennedy, Ted Kennedy on August 26, 2009| Leave a Comment »
Senator Edward M. Kennedy was witness to and participant in some of America’s greatest triumphs and tragedies over the last half century and more, but perhaps the greatest irony is the timing of his final illness and death. His absence during this year’s August recess has been critical. He represented one of the last members of the Senate who understood and practiced the collegiality that characterized that body for most of its history and allowed rivals to work together to accomplish important work. He was an important champion of the little guy. But the singular issue of his public life remains ahead, still to be accomplished.
[Q]uality care shouldn’t depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to.
This is the cause of my life. It is a key reason that I defied my illness last summer to speak at the Democratic convention in Denver–to support Barack Obama, but also to make sure, as I said, “that we will break the old gridlock and guarantee that every American…will have decent, quality health care as a fundamental right and not just a privilege.” For four decades I have carried this cause–from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society. Now the issue has more meaning for me–and more urgency–than ever before. But it’s always been deeply personal, because the importance of health care has been a recurrent lesson throughout most of my 77 years.
– Ted Kennedy Speaks Out on Health-Care Reform in Newsweek
His goal was remarkably simple — quality, affordable health care as a fundamental right, not a privilege. And yet it has eluded us ever since the Great Depression. Every other industrialized nation in the world recognizes health care as a fundamental right. Not just access to health care in the emergency room because you can’t afford or obtain private insurance. But health care that comes with a measure of basic human dignity.
I don’t understand why President Obama didn’t speak early on to the moral obligation we have to the weak among us. That is an obligation that is common to people of faith and to non-believers alike. In a perverse way, that obligation was what Sen. Tom Coburn (R-OK) was alluding to when he suggested that a desperate woman turn to her neighbors for help with her husband, who suffers from a traumatic brain injury. Unfortunately, the needs of her husband are most likely beyond the ability of her immediate neighbors. But we are all her neighbors. And we share in our obligation to her husband and to the millions of other Americans in need. Individually, we cannot do much. But together we can accomplish the goal of a healthy nation.
Senator Kennedy’s Senate career wasn’t about him. It wasn’t about the rich and powerful. It was about the regular guy. Sure, he came from privilege. But he grew up hearing that the very fact of his privilege meant that much was expected of him. Little did he know the extent of those expectations! There are those who discount the impact that Ted Kennedy had on all of us, those who choose to focus only on his failings, especially on Chapaquidick. But we all have failings, and the measure of a man is not just his failings but what he accomplishes despite those failings. None of us is perfect. We all have failings. If we truly believe in the power of redemption, we look beyond the failings to see what comes after. Can we band together, enough of us, to find common ground and make the cause of his life a reality?
Posted in Current Events, Politics, tagged GOP obstruction, Governance, health care, health care reform, health insurance, Medicare, obstruction, Republicans, Social Security on August 25, 2009| 60 Comments »
From what we’ve been seeing from Republicans supposedly “negotiating” on health care reform, it’s reasonable to ask if they are negotiating or obstructing. Negotiating presumes a willingness to compromise. Each side gives something to arrive at a solution. While nobody gets all they want, neither do they have to give up everything. But compromise seems to be operative only among Democrats. Republicans, on the other hand, continue to throw up roadblock after roadblock each time the Democrats show any signs of compromise. Is compromise viewed as weakness among Republicans? It would seem so.
Perhaps this debate has brought into focus a fundamental difference between today’s Democrats and Republicans. I saw the first indications of it during a GOP governor’s first term in New Mexico nearly 20 years ago. But the mantra can be characterized by Ronald Regan’s pronouncement that government is the problem. A Republican who had run a successful business ran for and was elected governor of New Mexico. As owner of a business, he was accustomed to getting his way, to having people do what he asked them to do. After all, if they didn’t, he could fire them. But he quickly discovered that governing is an entirely different activity, requiring both the ability and the willingness to negotiate and to compromise. And therein lies the difference. It appears that Democrats truly want to govern, while Republicans prefer ruling.
The kind and tone of the opposition has made it apparent that the only “reform” the GOPers are interested in is no reform. Oh, they mouth words that say they support reform, but they aren’t contributing anything positive to the debate. They talk privatization, letting the market rule. Well, just look at the financial collapse last fall and you have a really good assessment of how well unregulated markets work. Why, even Alan Greenspan, that beacon of free-market capitalism, has admitted that it didn’t work very well.
Finally, a member of Congress has called it like it is in an op-ed piece in USA Today. He says it’s time to forget bipartisanship and use the tools available to make the large Democratic majorities in both houses of Congress work like they’re supposed to.
The Gang of Six seems to be crumbling. Yesterday there were hints that even without a public option, the GOP members of the group were demanding additional concessions. Sen. Grassley (R-IA) allowed as how he wouldn’t vote for anything but a “perfect” bill. By today he is saying that bipartisanship is impossible. Also today, Sen. Jeff Bingaman (D-NM) suggested that the reconciliation process might be the only path to reform. That is unfortunate, but without cooperation from Republicans, it’s the only way.
It’s time to listen to the American people instead of the corporate shills. The shills have stirred up enough trouble, enough hate and discontent. In case you’re still laboring under the impression that “ordinary Americans” are populating those raucous town hall meetings, ask yourself why they only show up at meetings held by Democrats. Then, look at the chart below, which was published today by the Campaign for America’s Future.
We’ve been waiting for health care reform for decades. It’s time to stop letting Sen. Grassley’s perfect become the enemy of the good. Let’s pass it, see how it works, then tinker with the parts that need improvement. Otherwise, we’ll continue to see the numbers of uninsured rise along with costs. Republicans cried that Social Security and Medicare were socialism. Democrats ignored the naysayers and passed both. Now, they are integral parts of our social safety net, programs that while imperfect, are considered essential by all but the most reactionary people among us.
Posted in Politics, tagged government-run health care, health care, health care reform, public option on August 24, 2009| Leave a Comment »
A number of news stories caught my eye in the last day or two.
I think it’s time to talk about a national single-payer system. It’s simple, easy to administer, and it’s on the table. Just think, it would cover everyone. Think of it as Medicare-for-all with its minuscule administrative costs. People could opt out, provided they obtained private coverage. As with Medicare, you could choose your own doctor and hospital. Employers wouldn’t have to provide health care benefits, so those funds could actually go to the employee as salary — funds that could help go toward secondary insurance to cover the 20% that Medicare doesn’t cover. Secondary insurance costs seniors in the neighborhood of $250 a month, depending on what all it covers. It would mean that our emergency rooms would be returned to serve actual emergencies, not as primary care facilities for the uninsured. By including everyone (or nearly everyone) in the pool, the per person cost plummets because the pool includes lots more young, presumably healthy people.
Let’s stop the trash talking and the intimidation. Let’s stop the lies. It’s time to get on with real reform.
Posted in Current Events, Ideas, Politics, tagged health care, health care quality, health care reform, health insurance, health insurance reform, results-based health care on August 17, 2009| Leave a Comment »
We spent about 8 hours in the ER of our local privately-owned hospital overnight. Arriving shortly after 3 a.m., we were ushered in quickly. An irregular heartbeat with atrial fibrillation tends to get people’s attention. Spouse has employer-based health care and we’ve made use of it in the past, what with a valve replacement and subsequent major complications leading to multiple bionic parts beyond the valve itself. During that entire sequence of events four years ago, including several visits to the ER, we received good to excellent care with truly minimal out-of-pocket costs beyond the usual co-pays for doctor visits and medications. Because last night’s incident didn’t lead to a hospital admission, there will be a co-pay of $100-200 depending on how much they’ve gone up in the past four years. Things are fine, and they sent us home with nothing more than advice to follow up with the regular cardiologist. Whew. Seems it was most likely the result of a drug interaction that is easily avoided in the future through nothing more than timing when to take certain prescribed meds.
But during the time spouse was hooked up to monitors, waiting for the insurance to determine whether we would see the regular cardiologist or one from the HMO, we were able to watch the ambulance entrance while patient after patient was brought in with a series of complaints. Fortunately, none were immediately life threatening. But the delay in being able to determine which cardiologist would be “approved” to see us meant that the bed spouse occupied was unavailable for others. Meanwhile the aisles grew crowded with gurneys and EMTs, who could not leave their patient until a bed was freed up. They assured us that what we were seeing was better than usual. The ER is often so full that the line of gurneys flows out the door into the parking lot — and this in a desert where daytime temperatures in the summer often top 100 degrees, where winter nights are below freezing and where wind speeds often top 35 mph year round! I couldn’t help consider the time and money that those idle EMT’s (2 to a patient) and paramedics represented and compare that to the cost of simply seeing our regular cardiologist, clearing out and freeing up the bed for someone else, which would allow the paramedics and EMTs to respond to other calls. Meanwhile a single ER doc and a handful of nurses tried to tend to the flow of patients in a timely and compassionate manner.
We took the opportunity to talk briefly with the nurses who attended to spouse about our health care system. All agreed that the status quo is unsustainable. Since our area is primarily quite conservative, opinions were voiced carefully, and they varied. But none suggested that we do nothing. The area of difference was confined to whether a full-fledged socialized system like the VA, or a Medicare-for-all system like the Canadian one, or some other solution was the right one. But there was agreement that having insurance companies standing between providers and patients isn’t working for anyone’s benefit but the bottom line of the insurance industry.
We hear horror stories — almost all false — about the Canadian system, which is quite similar to our Medicare system. Our area is experiencing a shortage of doctors, especially primary care and emergency room docs. One of the nurses related how a group of Canadian docs came to this hospital, figuring that the US system would be a financial boon to them. Within a year, all declared bankruptcy and returned to Canada. And yet we continue to hear that we have the best system in the world. We have talented providers, and many of our hospitals have access to great equipment. But that doesn’t equate to good health care. We spend nearly twice as much per capita for care as any other industrialized country but don’t achieve equivalent outcomes. We waste vast sums of money. Drugs in the US are more costly than the same drugs are on the open market in other countries. Yet we cannot legally re-import them nor can the government negotiate lower costs for Medicare Part D, the prescription drug benefit.
This debate is or should be, at its core, about people — millions of people who are not being well served by the current system. Health care should be a right, not a privilege. We should be talking about how to get the best care and the best options to people at a cost that we can afford, both individually and as a society. Societies are judged in the final analysis by how we treat the weak among us, not by how we treat the powerful.
Posted in Current Events, Politics, tagged change, fear of change, government-run health care, health care, health care debate, health care reform, Medicare, protests, single-payer, town hall meetings on August 13, 2009| Leave a Comment »
Watching the increasingly irrational arguments being shouted out at town hall meetings, I can’t help but wonder how the protesters can be so very detached from facts. Their anger seems to go far beyond the health care issue, and they are clearly not swayed by reason. I think there is another source of the rage, whether the protesters are conscious of that or not. Many, if not most, of those trying to drown out the debate are senior citizens — people who are already covered under a government-run, single-payer health care system. Seniors are the only age group in which McCain beat Obama. I tend to think that many seniors are afraid of change in almost any form, even though most of the seniors in my own family welcomed the kind of change that Obama campaigned on. And they are very aware that they are on the downslope of their lives. Why else would the “death panel” canard be so very effective? The majority of the shouters are also white — and whites, while still the largest racial group, are becoming a minority of the entire population. That explains the undertone of racial animus in some of the questions — including the issue of health care for non-citizens, even though most non-citizens are here legally.
Then today, I came across a piece by Bruce Bartlett that helps explain what’s really going on. It makes a lot of sense. Bruce Bartlett. Does that name ring a bell? If you remember the Reagan Administration, it should. Bruce Bartlett was one of the original “supply siders” who was instrumental in shaping Reagan’s economic program. He helped author the Kemp-Roth tax bill. In the years since then, he’s had an opportunity to witness how supply side economics works when it goes from theory to practice. And he has concluded that it doesn’t work very well, except perhaps for the top few percent of the economic heap. In other words, for 98% of Americans, it doesn’t work. Well, Bruce Bartlett has weighed in on the seething rage that has been characterizing so many of the town hall meetings lately. He says that it’s a lot more than healthcare that is fueling that rage. He also says that the rage is misplaced. Because it’s so important, I’m including his article in its entirety as well as providing a link.
Where is the evidence that everything would be better if Republicans were in charge? Does anyone believe the economy would be growing faster or that unemployment would be lower today if John McCain had won the election? I know of no economist who holds that view. The economy is like an ocean liner that turns only very slowly. The gross domestic product and the level of employment would be pretty much the same today under any conceivable set of policies enacted since Barack Obama’s inauguration.
In January, the Congressional Budget Office projected a deficit this year of $1.2 trillion before Obama took office, with no estimate for actions he might take. To a large extent, the CBO’s estimate simply represented the $482 billion deficit projected by the Bush administration in last summer’s budget review, plus the $700 billion Troubled Asset Relief Program, which George W. Bush rammed through Congress in September over strenuous conservative objections. Thus the vast bulk of this year’s currently estimated $1.8 trillion deficit was determined by Bush’s policies, not Obama’s.
I think conservative anger is misplaced. To a large extent, Obama is only cleaning up messes created by Bush. This is not to say Obama hasn’t made mistakes himself, but even they can be blamed on Bush insofar as Bush’s incompetence led to the election of a Democrat. If he had done half as good a job as most Republicans have talked themselves into believing he did, McCain would have won easily.
Conservative protesters should remember that the recession, which led to so many of the policies they oppose, is almost entirely the result of Bush’s policies. According to the National Bureau of Economic Research, the recession began in December 2007—long before Obama was even nominated. And the previous recession ended in November 2001, so the current recession cannot be blamed on cyclical forces that Bush inherited.
Indeed, Bush’s responsibility for the recession is implicit in every conservative analysis of its origins. The most thorough has been done by John Taylor, a respected economist from Stanford University who served during most of the Bush administration as the No. 3 official at the Treasury Department. In his book, Getting Off Track, he puts most of the blame on the Federal Reserve for holding interest rates down too low for too long.
While the Fed does bear much responsibility for sowing the seeds of recession, it’s commonly treated as an institution independent of politics and even the government itself. But the Federal Reserve Board consists of governors appointed by the president and confirmed by the Senate.
Because the president appoints the board, he has primary influence over its policies. This is especially the case for chairmen of the Fed appointed by Republicans because they often have ties to Republican administrations. Chairman Ben Bernanke was originally appointed as a member of the Fed in 2002, serving until 2005, when he became chairman of the Council of Economic Advisers in the White House, a position that made him Bush’s chief economic adviser.
As early as 2002, a majority of the seven-member Federal Reserve Board was Bush appointees, and by 2006 every member was a Bush appointee. While many critical decisions about monetary policy are made by the Federal Open Market Committee, the board’s position always prevails.
The Treasury secretary also has had breakfast with the Fed chairman on a weekly basis for decades. Consequently, most economists generally believe that every administration ultimately gets the Fed policy it wants. Therefore, one must conclude that if there were errors in Fed policy that caused the current downturn, it must be because the Fed was doing what the Bush administration wanted it to do.
To the extent that there were mistakes in housing policy that contributed to the recession, those were necessarily committed by Bush political appointees at the Department of Housing and Urban Development, Fannie Mae, Freddie Mac, and other agencies. To the extent that banks and other financial institutions made mistakes or engaged in fraudulent activity, it was either overlooked or sanctioned by Bush appointees at the Securities & Exchange Commission, the Comptroller of the Currency, the Commodity Futures Trading Commission, and elsewhere.
But in a larger sense, the extremely poor economic performance of the Bush years really set the stage for the current recession. This is apparent when we compare Bush’s two terms to Bill Clinton’s eight years. Since both took office close to a business cycle trough and left office close to a cyclical peak, this is a reasonable comparison.
Throughout the Bush years, many conservative economists, including CNBC’s Larry Kudlow, extravagantly extolled Bush’s economic policies. As late as December 21, 2007, after the recession already began, he wrote in National Review: “the Goldilocks economy is outperforming all expectations.” In a column on May 2, 2008, almost six months into the recession, Kudlow praised Bush for having prevented a recession.
But the truth was always that the economy performed very, very badly under Bush, and the best efforts of his cheerleaders cannot change that fact because the data don’t lie. Consider these comparisons between Bush and Clinton:
• Between the fourth quarter of 1992 and the fourth quarter of 2000, real GDP grew 34.7 percent. Between the fourth quarter of 2000 and the fourth quarter of 2008, it grew 15.9 percent, less than half as much.
• Between the fourth quarter of 1992 and the fourth quarter of 2000, real gross private domestic investment almost doubled. By the fourth quarter of 2008, real investment was 6.5 percent lower than it was when Bush was elected.
• Between December 1992 and December 2000, payroll employment increased by more than 23 million jobs, an increase of 21.1 percent. Between December 2000 and December 2008, it rose by a little more than 2.5 million, an increase of 1.9 percent. In short, about 10 percent as many jobs were created on Bush’s watch as were created on Clinton’s.
• During the Bush years, conservative economists often dismissed the dismal performance of the economy by pointing to a rising stock market. But the stock market was lackluster during the Bush years, especially compared to the previous eight. Between December 1992 and December 2000, the S&P 500 Index more than doubled. Between December 2000 and December 2008, it fell 34 percent. People would have been better off putting all their investments into cash under a mattress the day Bush took office.
• Finally, conservatives have an absurdly unjustified view that Republicans have a better record on federal finances. It is well-known that Clinton left office with a budget surplus and Bush left with the largest deficit in history. Less well-known is Clinton’s cutting of spending on his watch, reducing federal outlays from 22.1 percent of GDP to 18.4 percent of GDP. Bush, by contrast, increased spending to 20.9 percent of GDP. Clinton abolished a federal entitlement program, Welfare, for the first time in American history, while Bush established a new one for prescription drugs.
Conservatives delude themselves that the Bush tax cuts worked and that the best medicine for America’s economic woes is more tax cuts; at a minimum, any tax increase would be economic poison. They forget that Ronald Reagan worked hard to pass one of the largest tax increases in American history in September 1982, the Tax Equity and Fiscal Responsibility Act, even though the nation was still in a recession that didn’t end until November of that year. Indeed, one could easily argue that the enactment of that legislation was a critical prerequisite to recovery because it led to a decline in interest rates. The same could be said of Clinton’s 1993 tax increase, which many conservatives predicted would cause a recession but led to one of the biggest economic booms in history.
According to the CBO, federal taxes will amount to just 15.5 percent of GDP this year. That’s 2.2 percent of GDP less than last year, 3.3 percent less than in 2007, and 1.8 percent less than the lowest percentage recorded during the Reagan years. If conservatives really believe their own rhetoric, they should be congratulating Obama for being one of the greatest tax cutters in history.
Conservatives will respond that some tax cuts are good while others are not. Determining which is which is based on something called supply-side economics. Because I was among those who developed it, I think I can speak authoritatively on the subject. According to the supply-side view, temporary tax cuts and tax credits are economically valueless. Only permanent cuts in marginal tax rates will significantly raise growth.
On this basis, we see that Bush’s tax cuts were pretty much the opposite of what supply-side economics would recommend. The vast bulk of his tax cuts involved tax rebates—which failed in 2001 and again in 2008, because the vast bulk of the money was saved—or tax credits that had no incentive effects. While marginal rates were cut slightly—the top rate fell from 39.6 percent to 35 percent—it was phased in slowly and never made permanent. Neither were Bush’s cuts in capital gains and dividend taxes.
I could go on to discuss other Bush mistakes that had negative economic consequences, such as the Sarbanes-Oxley Act, which imposed a massive regulatory burden on corporations without doing anything to prevent corporate misconduct, and starting unnecessary wars in Iraq and Afghanistan, which will burden the economy for decades to come in the form of veterans’ benefits.
But there is yet another dimension to Bush’s failures—the things he didn’t do. In this category I would put a health-care overhaul. Budget experts have known for years that Medicare was on an unsustainable financial path. It is impossible to pay all the benefits that have been promised because spending has been rising faster than GDP.
In 2003, the Bush administration repeatedly lied about the cost of the drug benefit to get it passed, and Bush himself heavily pressured reluctant conservatives to vote for the program.
Because reforming Medicare is an important part of getting health costs under control generally, Bush could have used the opportunity to develop a comprehensive health-reform plan. By not doing so, he left his party with nothing to offer as an alternative to the Obama plan. Instead, Republicans have opposed Obama’s initiative while proposing nothing themselves.
In my opinion, conservative activists, who seem to believe that the louder they shout the more correct their beliefs must be, are less angry about Obama’s policies than they are about having lost the White House in 2008. They are primarily Republican Party hacks trying to overturn the election results, not representatives of a true grassroots revolt against liberal policies. If that were the case they would have been out demonstrating against the Medicare drug benefit, the Sarbanes-Oxley bill, and all the pork-barrel spending that Bush refused to veto.
Until conservatives once again hold Republicans to the same standard they hold Democrats, they will have no credibility and deserve no respect. They can start building some by admitting to themselves that Bush caused many of the problems they are protesting.
Posted in Current Events, Politics, Uncategorized, tagged health care, health care reform, private insurance, public option on July 21, 2009| Leave a Comment »
A small alteration to the question that purports to guide the thought and actions of Christians, and by extension Republicans… the question, “What would Jesus do?” I’ve chaffed for some years at the seeming inability of Republican leaders to walk the talk — unless applying it to someone else, preferably Democrats. This morning Joe Scarborough applied it to a couple of the GOP Senators who are doing their darnedest to derail health care reform. What would Jesus think about the morality of a country that sees nearly 1/6 of its people without health insurance? What would Jesus think about the morality of a country that sees another nearly equal number under-insured — so that when they are sick or injured, they find that their coverage is totally inadequate or that their insurer cancels their policy? What would Jesus think about the morality of insurance companies who look for every possibly excuse to avoid paying claims? What would Jesus think about the morality of legislators who take millions of dollars in campaign contributions from those same insurance companies and then try to convince the public that there is no connection between the contributions and their opposition to a public option?
The people in power who trumpet the loudest about trusting the wisdom of the market are the same ones who vehemently oppose a public option. Not a public mandate, not single payer, just a choice, competition. They think the people are stupid, that we don’t know. We do know. We do understand that they support only a private solution because a public option threatens their contributors’ bottom line.
During the last push at health care reform some 15 years ago, I was living and working in New Mexico. Our professional association toured the corporate headquarters of a health insurer. While our visit focused on their records management program and facilities, we also toured the rest of the campus. If you remember, the insurance companies were crying poverty if reform was instituted. Yet no expense had been spared to furnish and decorate the offices and provide amenities for their employees. The main office area sported indirect lighting, brand new desks, ergonomic chairs. It was decorated with original Native American art — blankets, hand-woven baskets, pottery, paintings. A huge sculpture greeted visitors to the garden area. The art budget alone had obviously been in the millions of dollars; they had purchased works by the most noted Native American artists and artisans in the Southwest. Employees had an on-site gym and wellness center, complete with a swimming pool on an upper floor of the auxiliary building, a daycare center and preschool. The board room was worthy of a spread in Architectural Digest with the finest woods and most advanced techology tools. The health insurance industry was obviously doing well. Their claims of poverty were not supported by the facts. And nothing in the intervening years has shown that conclusion to have been wrong.
This time, the public overwhelmingly supports a public option. But the members of Congress who oppose it are the ones who get the most support from the industry. No surprise. No longer, it seems, are we a nation “of the people, by the people, for the people.” Our representatives, those who should be beholden to the voters, are beholden to the special interests. If health care reform fails, will we have the courage to clean both houses of Congress? Small donors were the key to Barack Obama’s victory. Yes, there were large corporate donors as well, but millions of people contributed hard-earned dollars, walked precincts and made phone calls. We did it once. We can do it again.
Posted in Uncategorized, tagged aging, health care on June 22, 2009| 2 Comments »
The morning of June 7 as we were preparing to go to a wedding, we got a panicked phone call from my elderly and frail mother-in-law’s neighbor. She had fallen while reaching down for a hose to fill a bird bath, gotten a nasty gash on the head and spent the previous night outside, unable to get herself into the house. The “panic button” she always wore to summon help in an emergency? She forgot she had it on! Don’t even ask what the heck she was doing outside trying to fill a bird bath… She simply didn’t believe that she should no longer be doing that sort of thing.
So, we packed quickly — knowing that bad falls by frail, elderly people often end badly — and hit the road for a seven hour drive. We knew that our trip might well end with planning a memorial service. The cell phone was in use most of the trip as we notified family members and got updates from the neighbor as the emergency docs tried to work their magic. A possible broken pelvis, 11 stitches and 11 staples to close the head gash, great confusion — but almost miraculously no apparent additional head injury. We knew she had suffered a compression fracture several weeks earlier and that there had been indications of an additional fracture. Her bones are little more than shells due to advanced osteoporosis. The spinal fractures don’t show up even on CT scans because there is so little bone mass.
Fast forward two weeks… a procedure to shore up the (now) two vertebral fractures has relieved pain. The head wound is healing. The pelvic crack is stable, and also seems to have occurred prior to the fall. No stroke, no brain bleed, no skull fracture. Clear medical proof that she is, indeed, very hard-headed, even if the rest of her bones are extremely fragile. She’s currently in a rehab hospital for some “sub-acute” physical therapy. And she will be moving into an assisted living group home when her rehab phase is completed.
While we marvel that she survived and that there is hope that she will graduate from a wheelchair to a walker once her pelvis heals, she is mourning loss on almost every front. She is clearly no longer able to live alone. We’d suspected so for some time, but she wouldn’t hear of it — until now. And when the crisis occurs, options quickly become limited by the need for a rapid solution. Probably the source of greatest worry for her has been her little dog. She cannot take him to the group home, but we’ve been able to find a new home for him as well.
So, the lessons learned? While it’s important for aging parents to retain as much autonomy as possible, they may be unaware that their physical decline has progressed to the point where safety is the paramount concern. The older they become, the more likely that the physical decline is accompanied by cognitive impairment, whether due to Alzheimer’s Disease or something as simple as chronic dehydration. Cognitive impairment often occurs slowly, and the signs can be subtle and easily missed. In our case, we became aware in retrospect that the long recitation of the week’s activities and meals had stopped, but because we’d not been interested in that level of detail, we didn’t recognize that the change indicated that she simply didn’t remember. Additionally, her cheery “Hanging in there” response to the question of how she was had masked the reality — that she didn’t want to worry us. Many of us live at some distance from our parents, and our own busy lives combine with the distance to limit contact to regular phone calls and infrequent visits. It’s imperative to establish relationships with people who live close to the loved one — people who can be our eyes and ears and who will honestly report changes without feeling disloyal to the senior. We need to know these things. And our loved ones need for us to know. It’s not disloyal. It’s not “ratting” on the senior. It’s an act of loving concern to let children know that there are concerns of which they may be unaware. If, once the children are notified, there is no increased vigilance from them, then there may be additional issues within the family that put the senior at increased risk.
We are glad that our loved one had interested neighbors and extended family and that we became aware that there were concerns before Mom fell. In fact, we were trying to get some help for her. But getting help takes time unless social workers who know the ropes are involved. Hospitals can be a great source of information on local resources. And speaking of hospitals, we cannot thank the professionals enough. Not only did they provide excellent and compassionate care — well, with the exception of one 1:30 a.m. bath… — but they were able to put us in touch with outside resources who explained options to us, worked with us to identify an appropriate solution, answered a myriad of questions, and supported all of us as we dealt with the changes we were all facing.
UPDATE: After a visit from the psychiatrist, who assured us that she is not clinically depressed but rather mourning the losses — freedom, driving, her dog, her home — we instituted Plan B. Instead of the group home, she will be moving into an assisted living facility on Tuesday. There she will get the care and assistance she needs with daily activities and will have the advantage of numerous activities to keep her mentally and socially involved — far more activities than she would have had access to in the group home. She has made a remarkable recovery. She’s now using a walker at least some of the time. The emotional adjustment will be up to her. She has been consistently kind and considerate of the care-givers, both in the hospital and in the rehab hospital, thanking them for each interaction. We hope that portends well for the next phase. We understand that this is not the way she hoped to complete her life. It’s not what we had hoped for her, either. But it is what it is, and we’re all having to adjust to the new reality.
Posted in Current Events, Ideas, Politics, tagged abortion, antibiotics, artificial insemination, birth control, clinic, conscience, fertility treatment, health care, health care facility, health care insurance, hospital, in vitro fertilization, medical rights, patient rights, pharmacy, reproductive health, reproductive rights, stem cell research, women's health on December 19, 2008| 7 Comments »
The new regulation has an appropriately Orwellian name — “right of conscience,” but the name apparently doesn’t apply to the rights or conscience of those who might seek certain legal, medically approved services. Not surprisingly, the people who will be most affected are women, and especially women who live in rural areas. The Bush Administration has issued a brand, spanking new and very wide-ranging regulation that has the potential to create chaos for Americans seeking health care. Under this new regulation any person working in a health care facility — hospital, clinic, pharmacy, etc. — can refuse to do the job they were hired to do if so doing would violate their conscience.
Just think of the services that might include. Abortion, of course, but also birth control, stem cell research, fertility treatments, antibiotics, blood transfusions, and those are just the most obvious. And it’s not limited to the person actually performing the procedure or service. The person cleaning the medical instruments, the person stocking the pharmacy shelves, the person ringing up the sale, the person filing the insurance claim — all would have the right to refuse to participate.
And, unlike the previous regs, the person “of conscience” no longer has to inform their employer in advance so the employer can provide appropriate accommodation. No longer is either the employer or employee obligated, either legally or otherwise, even to provide information that would allow a patient to make a fully informed choice on the ramifications of her condition or to provide information on alternate providers. The part of this new regulation that seems the most capricious is that access to services and information will depend entirely on who happens to be on duty at the time.
There is no attempt at ensuring consistency. No longer will patients have to choose providers based on competence, or even on whether the provider is connected to their insurance provider, but they will need to know the “conscience” of every person even tangentially involved to make sure they will have access to the medical services they seek. The question then arises — will we have access to that information? And if the individuals are not required to reveal their beliefs to their employers, how can consumers be sure that some minor person — a cashier or a billing clerk — with no direct medical involvement won’t be able to control access, either before or after the fact.
I find this totally unacceptable. It’s one thing to know that certain reproductive services won’t be available at a Catholic hospital. One simply chooses a different hospital or clinic. It’s one thing for an individual physician to refuse for reasons of conscience to perform abortions. And I know physicians who do. But they recognize that abortion is a legal medical procedures and so refer their patients to providers whose consciences don’t prohibit them from performing them.
Abortion is the most obvious reproductive service this new regulation affects. But it also can apply to prescriptions for birth control, infertility treatments, and even rape kits that contain either information about or prescriptions for emergency birth control. We know that the state of Alaska had to pass a law when one town began to charge rape victims for their rape kits because its mayor didn’t agree that women should be provided with INFORMATION about EBC.
Does the new regulation insist that “conscience” be linked to documented religious teaching? Or does anyone now have the right simply to state that they are opposed, for whatever reason, to being even tangentially involved in a legal, legitimate medically approved procedure?
And if so, at what point do the rights and conscience of the consumer count? As someone who lives in reasonable proximity to numerous doctors, hospitals, clinics, pharmacies and the like, I would have options. But what about consumers in rural areas where medical services are already limited by the size of the population being served? If the only doctor in town or the only pharmacy in town has someone who doesn’t believe in birth control, where does that leave women? Do they not become the prisoners of the conscience of the providers?
I am glad to read that the Obama team is looking at how and when to rescind this regulation. It can’t happen soon enough. Certainly, people have a right not to act against their beliefs. But the consumers of medical services also have rights — at least they should! This wide-ranging new regulation seems to place all the rights of conscience on the provide side of the equation and none on the consumer side. A democratic system is designed to balance competing rights. This regulation fails utterly in that task.
More Light Than Heat 