#dBlogWeek: More Than Diabetes

Life, an unalienable Right

Today’s Diabetes Blog Week prompt:

 Share an interest, hobby, passion, something that is YOU.  If you want to explore how it relates to or helps with diabetes you can.   Or let it be a part of you that is completely separate from diabetes, because there is more to life than just diabetes!

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I feel like I’ve been writing outside the lines all week. So, I guess I won’t stop now.

What is my passion?

Policy.

I’m a policy wonk.

I believe that politics matter because government can do good for the people—or it can do bad.

My voice and my vote is how I influence my government to do good.

Politics and government are difficult subjects to bring up in polite company. Especially these days when the country if so polarized and seems to be experiencing collective PTSD over the legitimacy of those in power.

Why is policy so important to me?

Maybe it’s because I’m the grandchild of immigrants who came to the US to escape a bloody revolution.

Maybe it’s because members of my family experienced poverty and that poverty was relieved by government programs.

Maybe it’s because I worked on education reform in the hope that my children would receive a quality public education.

Maybe because deep down I’m an idealist whose heart is still stirred by these words:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed…”

What does this have to do with diabetes?

Right now? Everything.

In Washington we have a Congress hell-bent on repealing the ACA (a.k.a. Obamacare) and replacing it with tax breaks for the rich.

In the pharma industry we have companies who one week brag to their investors how profitable their insulin business is and the next week invite diabetes patient advocates to call out PBMs (Pharmacy Benefit Managers) for price increases.

We have people turning to crowdfunding sites to pay for their medication. And when that fails, their friends and family update their pleas to pay for a funeral.

It shouldn’t be this way. That’s why policy matters to me. And that’s why I advocate for health care affordability and access.

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What now, that Trumpcare is on its way to the Senate?

Can we talk about single payer now?

A week ago my head was swirling with the news that Trumpcare had passed out of the House by the slimmest of margins. Not only had the Republicans revived the AHCA, but they got the votes needed by adding the draconian MacArthur amendment.

And then Congress went on recess, returned to their home districts, and faced their constituents. Things didn’t go smoothly for everyone.

Rep. Labrador’s (R-ID) town hall went viral when he was filmed claiming that “Nobody dies because they don’t have access to health care.

Rep. MacArthur (R-NJ) had a five-hour town hall meeting where the crowd was hostile and the news media well represented. Kind of hard to blame his constituents for their strong reaction. After all, the amendment that bares Rep. MacArthur’s name is expected to make healthcare for prohibitively expensive for millions of people. People who didn’t realize that giving birth or having gone through a c-section or experiencing postpartum depression put them among those with preexisting conditions. People who rely on expanded medicaid coverage that could be undermined by their state opting out of some provisions. People who are in their 50s or 60s, or one day will be. People who now fear that they won’t be able to afford health insurance for themselves or their families. They’re not happy about that. And they’re letting their members of congress know that.

Just yesterday Budget Director Mick Mulvaney suggested that people should pass the “Jimmy Kimmel test” to get health insurance. He also suggested that people with diabetes wouldn’t pass this test.

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It’s one thing to deny someone a right or privilege. It’s a whole other thing to take away a right or privilege after it’s been given.

Obamacare, which remains the law of the land, gave Americans the right to access health care.  It doesn’t matter if you are living with a preexisting condition, you cannot be denied or priced out of coverage. It doesn’t matter if you’re a man or a woman, you cannot be charged more for insurance just because of your gender. You can expect to have the ten essential health benefits covered.

We’ve been living with these assurances for a couple of years now. Long enough to feel the effects on our personal health. But not so long that we’ve forgotten what it’s like to be denied health insurance because you were unlucky enough to be labeled with a preexisting condition, like diabetes. Not long enough to forget how expensive prescriptions can be when you have to buy them retail. Not long enough to forget how a single trip to the emergency room can put you on the road to bankruptcy.

The argument for the AHCA is an economic one: the country can’t afford to pay for everyone to have health insurance. Healthcare costs are on an upward trajectory. Chronic illness is epidemic.

The argument against AHCA is an economic one: the country can’t afford to have its productivity and GDP undermined by a chronically ill population. Chronic illness is epidemic.

Where these two sides diverge is in their preferred solution. One wants the individual to pay. The other wants the group to pay. The result is stalemate.

So, where do we go from here?

Can we discuss single payer now?

I think we’re going to have to ask the thirteen male GOP senators who are writing the Senate’s version of the healthcare bill.

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Hey Rep. Ryan, it’s clear you don’t see me as a person

Looking at Speaker Paul Ryan’s argument against Obamacare it’s all about money. Not about the people or healthcare, for that matter.

As I mentioned before, it’s been a couple of wild months filled with whirlwind activity on healthcare reform.

I wasn’t really surprised at the political shenanigans in Washington, DC. After all, this isn’t my first political rodeo.

But, I was surprised by how this one felt. This one was different.

This one felt…personal.

Not personal, in the sense that it is important to me personally or will have a direct effect on my life. Although both of those things are true. But personal in the sense that it felt like I, as a person who needs health care and insurance, am being targeted for punishment.

It all started with the budget

As with many things, it all started with money. In this case, the federal budget. How much tax money are the feds going to spend on health care?

Looking at Speaker Paul Ryan’s argument against Obamacare it’s all about money. Health insurance premiums are higher. Deductibles are higher. Subsidies are going up. Not to mention the effect this is having on the budget deficit.

Budget reconciliation was the first phase of Speaker Ryan’s three-pronged approach to “repeal and replace.” And as a tactic, it was brilliant. The process moves fast. The bill must remain focused, with no “extraneous matter.” And the American Health Care Act had a fast, focused life—going from its introduction, through committee and floor debate, to its death in just four days.

But it doesn’t end there

Once the American Health Care Act was introduced and the details became clear, the circus ring turned into a boxing ring. And I, as a patient, became the punching bag.

Each day, as another detail became clear or another analysis surfaced, i felt another body blow. Another anxiety-provoking change. Another unbelievably cruel twist.

No denial for preexisting conditions was promised. But, if there’s a gap in coverage your insurance company can charge you a 30% penalty on your annual premiums. BOOM!

No more individual mandate was declared. But, if you’re an older person insurance companies can charge you 5x the premium they charge younger (presumably healthier) people. And the individual tax breaks got a lot smaller while insurance industry tax breaks got a lot bigger. BOOM!

No more funding for Medicare expansion. States will get to decide whether to include mental health and addiction services. And the CBO estimated as many as 24 million people could lose their health care insurance. BOOM!

Really? It’s okay for 24 million people to loose health insurance? It’s okay to cut health services?

I was left punch drunk.

Where did all the good stuff go?

The American Health Care Act was all about the balance sheet. How did those figures look? More money to the insurance industry. Less money to the states.

What happened to essential health benefits? You know, the part of Obamacare that says health insurance needs to cover things like check-ups, maternity care, pediatrics, and mental health. They were nowhere to be seen.

Less coverage for the individual.

Just what kind of health insurance were people going to end up with? Who knows? Surely there would be some kind of affordable health insurance, even if it didn’t cover much of the services needed to regain or maintain health.

There. Just don’t get sick and you’ll be okay.

And if you’re already sick? Well, you’ll just have to pay for it.

 

 

The first, of what’s sure to be many, health care reform battles

It’s been a whirlwind couple of months filled with political intrigue and maneuvering. And still, Obamacare stands–for now.

Last Friday the GOP leadership in the House did the unthinkable. They pulled their health care reform bill, the American Health Care Act (AHCA), just before it went up for a vote.

As a patient advocate, I had naively believed I could track the health care reform efforts in Washington, contact my legislators to urge them to vote to preserve health care coverage, and write blog posts about it along the way. I was wrong.

Political intrigue and maneuvering

It’s been a whirlwind couple of months filled with political intrigue and maneuvering leading up to the introduction of the AHCA. It started with Trump’s inauguration day signing of an executive order calling for Obamacare to be dismantled by the federal government. This was followed by a lot of speculation about which plan the Republicans would propose to replace Obamacare. Once the bill was ready the draft was locked-down in a meeting room and made available to select Republican House members. Then the bill was rushed through two committee hearings before the Congressional Budget Office (CBO) could issue it report on its impact. Once the bill was leaked to the press, the mad scramble to read and analyze the bill began.

As soon as it became available, I started reading the analysis and reporting on the bill. I read analysis from the Washington Post, the Kaiser Family Foundation, the CBO, and many others.

Nothing good to say

No one had anything good to say about the bill. Not the American Medical Association. Not health insurers. Not even the White House’s own analysis, which said the results would be even more devastating than what the nonpartisan CBO reported.

The contents were disastrous for anyone who needed health care and didn’t have deep pockets to pay for it. The CBO reported that 24 million people would lose health insurance. So much for the promise to keep everyone covered.

A call to action

Then something very amazing happened.

People took action.

Constituents showed up at town hall meetings and district offices. And they were vocal. A video of Representative Chaffetz (R-Utah) being shouted down with chants of “do your job!” went viral. So many vocal constituents showed up that it was reported that some legislators feared for their safety. It was Tea Party tactics, only this time people who wanted governmental protections were using them.

Constituents called their legislators’ offices in DC and in their district. And, again, they were vocal. So many calls were placed that the Capital switchboard busied-out. So many calls were placed that every staffer ended up on phone duty. Various legislators said that the calls tallied were by-and-large against AHCA. Rep. Daniel Donovan (R-N.Y.) was quoted as saying the calls to his office were 1000-to-1 against.

Facing reality

Last Friday, when it became clear that they didn’t have the votes to pass even after Trump issued an ultimatum to House Republicans, the Republicans bill was pulled before the vote. Speaker Paul Ryan appeared before the press and said that the Affordable Care Act (ACA), aka Obamacare, remains “the law of the land” for the foreseeable future. There were reports that Trump was ready to move on from health care reform.

Patient and health care advocates breathed a collective sigh of relief. A bill that would be disastrous for millions of Americans went down to defeat.

But here we are four days later and Speaker Ryan is quoted as saying, “We are going to keep getting at this thing.” This “thing” being overhauling health care.

The battle might have been won, but the fight is not over.