Obamacare: Looking ahead and not liking what I see

We are barely into the first week of 2017 and The New Unified Republican Government™ has Obamacare in its crosshairs.

We are barely through the first week of 2017 and The New Unified Republican Government™ has Obamacare in its crosshairs.

I’m not going to pretend that the Affordable Care Act (also known as Obamacare) is without its problems. The very first problem is the “affordable” part. For some, that hasn’t turn out to be the case. Higher premiums were announced last fall, just before the presidential election. Some health insurance companies have opted out of the exchanges, reducing options for coverage.

But Obmacare has yielded some good results, particularly when it comes to access to healthcare. According to the White House:

  • An estimated 20 million people gained health insurance.
  • 105 million Americans benefit from the elimination of lifetime and annual limits on insurance coverage and the establishment of annual limits on out-of-pocket spending on essential health benefits.
  • As many as 129 million Americans who have some type of pre-existing health condition, including up to 19 million children, can no longer be denied coverage or have their coverage reduced.

This last point is hugely important to people living with chronic illnesses like diabetes.

You see, it used to be difficult to get health insurance with a pre-existing condition. Obamacare changed that. It made it possible (even if it might be expensive) to get health insurance on your own. And this made it possible for people living with diabetes to have some peace of mind.

No longer do people living with chronic illnesses have to worry that if they lose a job or leave a job or move they will be left without health insurance.

No longer do people living with chronic illnesses have to worry that if they end up in the emergency room they, or their families, will end up in financial ruin.

No longer do the lives of people with chronic illnesses have to be determined by their access to health insurance.

This is about to change.

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“Repeal and replace” is the rallying call among Republicans. But I see a couple of problems with this.

The health care system is vast and complex.

It’s foolhardy to think that you can simply repeal a law that’s taken the better part of six years to implement and everything will be okay. Obamacare touches pretty much everyone in the US in some way.

Repealing it completely will cost the US government $350 billion over the next decade. Hospitals and physicians face uncertainty. Hospitals, especially those providing safety net healthcare services, expect their revenues to drop dramatically. Some healthcare stocks have taken a hit.

No one knows what “replace” means. 

The Republicans have destabilized healthcare in the US by making every aspect of Obamacare uncertain.

There’s a debate about which aspects of Obamacare might be kept. Being able to keep your child on your insurance until they reach 26, removing the prohibitions for pre-existing conditions, and automatic coverage for preventative care have all proved popular.

But can we have these popular benefits without some of the unpopular ones? Like the mandate to have healthcare insurance, for one?

You see, Obamacare was structured so that one part balances out the other. If you chip away at that balance will the financial and structural underpinnings of healthcare in the US be undermined? That remains to be seen, but conventional wisdom says yes.

In the meantime, we’re already starting to hear promises from Republicans and their spokespeople assuring us that no one will lose their healthcare coverage after Obamacare is repealed.

Forgive me for being skeptical.

 

The True Cost of Stigma in Type 2 Diabetes

Published by Diabetic Connect. Because type 2 diabetes is seen as preventable, we are blamed…

Published by Diabetic Connect.

http://www.diabeticconnect.com/diabetes-information-articles/general/2624-the-true-cost-of-stigma-in-type-2-diabetes

Diabetes, it’s a glass half-empty kind of thing

What if we considered the half-empty part of diabetes to be an opportunity to fill our lives with good stuff?

Every once in a while I get asked why I think people with Type 2 diabetes aren’t as active in social media as people with Type 1. We see a strong representation of people living with Type 1 in social media. Type 1s share their daily triumphs and trials, most presenting a defiant warrior-like stance in the face of “ducking fiabetes.” When we look for the Type 2 voices in social media we find fewer and they are often muted.

I used to think it was because of the age difference. Now I’m not so sure that’s the case. There are plenty of people of all ages active in social media over all.

Another thought I’ve had is that for most people with Type 2, diabetes is not central to their sense of identity. They had a whole life before diagnosis. They didn’t grow up being told their lives would be somehow limited by this chronic disease. But now it figures largely in daily routines and visions of the future.

Lately a new theory has entered my mind. It’s the idea that we tend to look at diabetes as a glass half-empty kind of thing. Much discussion about living with Type 2 diabetes centers on all the things that have to be (or should be) taken away. Carb-heavy comfort foods. Carefree daily routines. Worry-free futures that promise good health.

The emptiness of the glass shows us what is gone, never to return. There’s a sense of loss. There’s the feeling of mourning. What will replace it? Restrictions. Complicated medicine routines. Society’s blame and shame.

But what if we chose to fill that empty part of the glass with good stuff instead?

Prediabetes? Ain’t nobody got time for that!

Prediabetes? Ain’t nobody got time for that! The Ad Council’s type 2 prevention campaign misses the mark.

In the first of its kind campaign the ADA, AMA, and CDC released a series of Ad Council public service announcements aimed at preventing type 2 diabetes. The campaign is called So…Do I Have Prediabetes?

Boy did they miss the mark.

The campaign takes on a snarky tone. Now, I’ve been known to enjoy a snarky joke as much as the next person. But this snark is aimed at the patient, that just adds to the blame and shame people living with diabetes, especially type 2 diabetes, already face.

You eat bacon? Well, don’t. It’s a variation on the “Eat 100 candy bars and what do you get?” joke. We’ve all heard the punch line: Diabetes!

Only, it’s not true and it’s hateful. And when people feel blamed for their health or shamed for their behavior that disempowers them to change. Don’t believe that? Listen to what the research of Jane K. Dickinson, CDE has to say.

And what if you’re a busy mom?

Well, this busy mom doesn’t appreciate the sentiment. Yeah, busy-ness is a common excuse. I’ll cop to using it myself once or twice. Okay! I used it for about a million years while I was in pre-diabetes.

The doctor’s response to the patient saying she’s a busy mom made me think of this:

CharlieBrownLucyFootball

Lucy van Pelt pulling the football away at the last moment yet again and the ever trusting Charlie Brown taking a tumble mid-kick.

I don’t want my doctor to be paying a cruel joke on me. And I don’t want to end up the looser in this scenario.

But more damning is the image that comes to my mind when I reflect on what the busy mom says. Her distress is real. And yet her words come off more like this:

Ain't nobody got time for that!

And this is just plain wrong.