More than an opinion piece, this is an update of how the Affordable Care Act is affecting my practice in a rural Oregon community. With the ACA, many more people now qualify for Medicare. They have swamped our clinic and when I should normally have spare time on my hands as a new provider trying to build my patient-base, my schedule fills up almost daily with new patients trying to establish care.
Many of these new patients are ticking time bombs: they have not had health care in years but yet have serious chronic problems. They come to me with long laundry lists of concerns, many are in what I consider to be crisis mode with off-the-chart blood pressures and spilling sugar into their urine because of uncontrolled diabetes. They have moles, bumps, lumps, growths, pain, asthma, COPD, discharge, limited ability to move and so on. It is impossible to review everything that needs to be reviewed within the cushy 30 minutes allotted to each patient.
For these reasons, my schedule is further filling up with follow-up appointments. In an effort to keep these patients out of the hospital, I am seeing a few of them on a weekly basis trying to get them to an acceptable baseline. It is a lot of work. It is also very expensive as many of them need to be referred to specialists at this point. I can't help but to think if they had been treated sooner things would not have progressed to such a demanding state.
It does my heart good, however, that the majority of my patients are very cooperative. I prescribe the medications, make the referrals and provide lots of education and they are listening to me. Maybe I have been in healthcare long enough that I forgot that there are people who do not understand what exercise is, who don't understand the basic food groups, who can't understand the labels on the medication bottle. When I explain these little things to them, they have incorporated them into their daily routine. I love it when my patients beam because they dropped a couple pounds or their blood pressure is "within range"--they are proud that they are doing the right thing. And when they say they feel better--well, my day is made. It is my opinion that people as a whole want to take care of themselves but they do not know how.
That said, I think it is a shame that we have large parts of our population that have been in the dark for so long. It is a huge disparity that should never exist in a civilized, progressed society. Yet we keep insisting that healthcare should only belong to the people that can afford it. We insist that insurance companies with their medical directors making multi-million dollar bonuses for cutting costs and reporting profits to shareholders is the better option.
The people I treat work in jobs like construction, farming, milling and other very hard labor jobs. Very few of my patients are actually unemployed but they could not previously afford health insurance. And these jobs that I listed, these are jobs that the rest of us need to have filled so we can perform our jobs, too. I need someone to build the roads I commute on, to make the paper I put my signatures to, to harvest the vegetables I put on my table.
Such it is: we live in a world where things cycle around. We need a healthy working class and to have that, we all need access to healthcare. I don't think the ACA is a perfect solution as there is still a large sect of working class that is still caught in the middle--not able to afford private insurance but still too "rich" for Medicaid--but many people have benefited. I hope that watching this change will drive us closer to a single-payer system when we can all assume that basic healthcare is part of any decent society.
You can also listen to our podcast at http://www.podcasts.com/reclining-society-9b72cc1ae
Sunday, April 27, 2014
Wednesday, January 29, 2014
Reclining Society Podcast
Maria and I used to podcast under a different name before; these days we are podcasting under our blog name, Reclining Society.
This first podcast is a little unbalanced, but stick with us and offer constructive suggestions if you like what you hear so we can continue to improve our discussions!
You can listen to it here:
http://awscdn.podcasts.com/Reclining-Society-1-b434.mp3
You can listen to it here:
http://awscdn.podcasts.com/Reclining-Society-1-b434.mp3
Here is a list to the articles referenced during our discussion:
http://www.bbc.co.uk/news/world-europe-25939737
And because I mentioned a few amendments from the Bill of Rights:
And because I mentioned a few amendments from the Bill of Rights:
Tuesday, January 21, 2014
Irresponsible Fundraising by Public Education
My daughter attends a high-performing Title 1 elementary school--basically a school with a high level of low-income families. As for my little family, we fair well but we have no relation to Richie Rich and need to plan our budget. Each year I become disgruntled because of what I consider to be irresponsible and excessive fundraising. This year is no exception and a flier attached to my daughter's fundraising packet informing me that we need "to do our part" tipped me enough to talk about it. Here are the problems that I have with school fundraisers:
1) The fundraising projects continue school-year round. From walk-a-thons, to gift-wrapping, to candy sales, it's at least 3 to 4 times a year. Some of these fundraisers involve school assemblies to give the children a motivational rally to sell, Sell, SELL! When the school year is already so limited, spending time motivating children to sell things to earn "cool prizes" is irresponsible. Children should spend as much time in the classroom as possible.
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| Things I DO NOT want my daughter to have. |
2) We are already a Nation of Stuff in a time when I firmly believe we need to start downsizing. These fundraisers are selling overpriced goods that nobody really wants. The companies behind the fundraisers pocket large profits and only give a small portion to the schools. They are bribing our children with prizes that are basically junk and cause clutter. (Part of me wonders how materialistic the schools are seeing as parents have to provide the bulk of supplies to begin with. Do they need all the stuff they claim to need? I am not in the school often enough to know, but I am interested in hearing what those in "the know" think.)
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| $16 for a bowl of pretzels? It can be purchased for $2 at the Quikie Market! |
3) They involuntarily draft the parent to become an active participant. Even if my child does the leg work and solicits the goods, collects the money and then delivers them, I am ultimately responsible for her work. I will be the one to carpool her across town, to take the deliveries to my place of employment, to double-check the money she collects. These are not necessarily hard things, but if you are in a Title One school often both parents are working, there are single-parent families with the parent working, the hours worked by parents are often the "odd shifts," transportation may be limited, some parents are not fluent in the English language. Having said all that, I think it is unfair of the flier to read "We ask that every student do their fair share and sell."
4) It is uncomfortable to circle through your family and friends multiple times in a school year to ask them to open their wallets yet again. It's an imposition at the least. Often these people want to be supportive but again, being in a Title One school, selling things that aren't necessary, and doing this multiple times a year is excessive and inconsiderate.
Please note that this is not a blog about why schools need to resort to fundraising because of government cuts or misappropriation of tax funds or under-funding schools while funding national defense; that is its own topic that is too overwhelming for me to adequately address on this forum. (But if someone else wants to take a stab at it, we welcome guest bloggers!)
Recognizing it is unrealistic to do away with fundraising in schools all together (a noble goal), more effort should be directed to responsible fundraising. Here are some suggestions to make this happen:
1) Before the school year begins, have the various groups (PTA, after school programs, etc) meet to discuss a single fundraising project if it involves selling something and bribing children. Determine the goals of the fundraising projects--new supplies, new computers, the after school activities--and divide the funds appropriately.
2) The above mentioned project should be an event to sell something responsible such as first aid kits, emergency preparedness kits, other needed home items. They are out there and can make a huge impact. To encourage children to sell, work with local businesses to obtain gift certificates for a free ice cream cone or a movie ticket--things that can be enjoyed but do not cause clutter and waste!
3) There should be year-long standing fundraisers that do not cause such imposition to the family. I give the school credit on this one as they are very active with collecting BoxTops throughout the year. They also are involved in Scrip Fundraising, a program where local or online businesses provide gift cards ordered by the school and the businesses donate a portion of the gift card profits to the school while the purchaser of the gift card gets everything they paid for. I feel this is a win-win for everyone as the school gets the profit, the consumer can purchase gift cards for things that they already need (oil changes, groceries, clothing, etc.) and the businesses receive business and have a potential tax write-off. I would like to see these types of programs more heavily promoted by sending home fliers and emails to parents to increase awareness.
Does anyone else experience these same thoughts? Have you had any fundraisers that made you think twice? How do you think we should approach this topic? Any solutions I did not consider?
Thursday, January 16, 2014
The Unintended Student Loan Scandal, written by C. Patrick
Enter C. Patrick., guest writer to Reclining Society and his take on the abuse of taxpayer supported education funding under the pretense of enhancing the collective society. He is a science professor to a major state college.
Today I was notified that I will receive a 3% salary raise owing to increasing income from tuition my college is receiving. Unlike many universities that are generating funds through tuition increase, my college has chosen to open the academic floodgates and increase total enrollment, nearly doubling the number of students in the past ten years. Although a boon to my place of employment and, more recently, my wallet, I have mixed feelings about this policy. While making higher education available to all is a noble idea, the underlying motivations for increasing enrollment and the effects on society are potentially less than ideal. Masked underneath the mantra of providing education for the masses is a more greed-driven agenda on the part of universities and colleges.
Grabbing a piece of the federal education loan pie has become the major priority among most academic institutions which results in increased personal debt for students. Even further, it creates increased pressure to prevent students from failing so the college may maintain its income. Students that probably should not have been admitted, and subsequently, should not have been allowed to continue, are instead bestowed degrees and pushed out the door to make room for the next customer. This has led to a commoditization of college education, and it is now not uncommon to see minimum wage jobs held by college graduates.
Overall we are sliding into a situation where taxpayer dollars in the form of loans and grants are used to saturate the market with college-educated job hunters whose degree has been devalued. I suppose one could argue that increasing the general education of a population is a good thing; however that’s essentially backing the use of taxpayer money on a very expensive social engineering experiment. While there certainly are methods of addressing this problem, including placing restrictions on the college majors eligible for federal loans, none are politically palatable, and most would probably be perceived as attacks on the ability of everyone to receive equal opportunities at higher education.
Today I was notified that I will receive a 3% salary raise owing to increasing income from tuition my college is receiving. Unlike many universities that are generating funds through tuition increase, my college has chosen to open the academic floodgates and increase total enrollment, nearly doubling the number of students in the past ten years. Although a boon to my place of employment and, more recently, my wallet, I have mixed feelings about this policy. While making higher education available to all is a noble idea, the underlying motivations for increasing enrollment and the effects on society are potentially less than ideal. Masked underneath the mantra of providing education for the masses is a more greed-driven agenda on the part of universities and colleges.
Grabbing a piece of the federal education loan pie has become the major priority among most academic institutions which results in increased personal debt for students. Even further, it creates increased pressure to prevent students from failing so the college may maintain its income. Students that probably should not have been admitted, and subsequently, should not have been allowed to continue, are instead bestowed degrees and pushed out the door to make room for the next customer. This has led to a commoditization of college education, and it is now not uncommon to see minimum wage jobs held by college graduates.
Overall we are sliding into a situation where taxpayer dollars in the form of loans and grants are used to saturate the market with college-educated job hunters whose degree has been devalued. I suppose one could argue that increasing the general education of a population is a good thing; however that’s essentially backing the use of taxpayer money on a very expensive social engineering experiment. While there certainly are methods of addressing this problem, including placing restrictions on the college majors eligible for federal loans, none are politically palatable, and most would probably be perceived as attacks on the ability of everyone to receive equal opportunities at higher education.
Tuesday, November 12, 2013
Impressions of Veteran's Day 2013
"Happy Veteran's Day!" I was told via texts from ancient Army buddies. It was obvious those texts were mass messages. "Thank you for your service, Battle Buddies!" I was told by being tagged in a facebook post along with 89 other individuals. In honor of Veterans' Day, any form of social media was plastered in generic well-wishes to service members from... other service members and/or service member families.
Analyzing the posts/texts, there weren't any posts (if there were, they were very minimal) from civilians. It is like we are a group of guys hanging out at the bar rooting for our football team and when our team scores we make our way around the room patting each other on the back. Everyone in the bar wears the team colors and feels that our unity somehow impacts the results of the game. Whether we win or lose, we appreciate the show of support from... ourselves.
It was my impression that service members care about service member issues but the rest of the world does not. And even further, it is my impression that the generic "thank you for your service" messages from my fellow Army friends was more a ploy to turn the attention back to themselves to highlight their own heroism than to actually thank their fellow comrades in arms.
Maybe I'm a cynic about the texts and posts because I don't really feel an expression of gratitude to me is warranted because the Army gave me more than I ever gave it. And it's an ugly truth for me to say, but there are other service members who are just biding their time unable to pass a PT test or using the service for personal gain (tuition benefits, health care, bonuses, etc) so signing the line was really a selfish act. I felt as if I were another number on the roster on some list with those posts. And it's those same lists that have actual veterans who have sacrificed, who have both the physical and mental scars of war, who have actually led and commanded other soldiers, who are role models and heroes, who have performed valiantly under the worst circumstances.
I won't speak for others, and I don't mean to be unappreciative, but personally I don't belong on that list. I know some service members that do, but I refrained from thanking them as it feels hollow and my gratitude would be seen just as insincere as the FB post because it was only on Veterans' Day that I felt inclined to say "Thank you."
One friend suggested that if we are really grateful to Veterans then we should actually start supporting them by becoming aware of Veteran/service member problems that plague the services and give actual time and money to their causes. It sounds like a good plan and I fully agree, but if you return to my first paragraph, the impression is that only service members seem to care about service members and even the actual displays of caring can be a front to glorify the self. I would like to think that Veterans' Day means something, but I'm sad that for most it might really be a bunch of guys hanging out at the bar on game day.
Analyzing the posts/texts, there weren't any posts (if there were, they were very minimal) from civilians. It is like we are a group of guys hanging out at the bar rooting for our football team and when our team scores we make our way around the room patting each other on the back. Everyone in the bar wears the team colors and feels that our unity somehow impacts the results of the game. Whether we win or lose, we appreciate the show of support from... ourselves.
It was my impression that service members care about service member issues but the rest of the world does not. And even further, it is my impression that the generic "thank you for your service" messages from my fellow Army friends was more a ploy to turn the attention back to themselves to highlight their own heroism than to actually thank their fellow comrades in arms.
Maybe I'm a cynic about the texts and posts because I don't really feel an expression of gratitude to me is warranted because the Army gave me more than I ever gave it. And it's an ugly truth for me to say, but there are other service members who are just biding their time unable to pass a PT test or using the service for personal gain (tuition benefits, health care, bonuses, etc) so signing the line was really a selfish act. I felt as if I were another number on the roster on some list with those posts. And it's those same lists that have actual veterans who have sacrificed, who have both the physical and mental scars of war, who have actually led and commanded other soldiers, who are role models and heroes, who have performed valiantly under the worst circumstances.
I won't speak for others, and I don't mean to be unappreciative, but personally I don't belong on that list. I know some service members that do, but I refrained from thanking them as it feels hollow and my gratitude would be seen just as insincere as the FB post because it was only on Veterans' Day that I felt inclined to say "Thank you."
One friend suggested that if we are really grateful to Veterans then we should actually start supporting them by becoming aware of Veteran/service member problems that plague the services and give actual time and money to their causes. It sounds like a good plan and I fully agree, but if you return to my first paragraph, the impression is that only service members seem to care about service members and even the actual displays of caring can be a front to glorify the self. I would like to think that Veterans' Day means something, but I'm sad that for most it might really be a bunch of guys hanging out at the bar on game day.
Tuesday, October 1, 2013
A Case Example Supporting the ACA
Two Mondays ago a patient came into the clinic with complaints of upper right abdominal pain that hurt most when he would take a deep breath in. He had this pain a week ago and it resolved with ibuprofen. Sunday night he became uncomfortable with feeling feverish and nauseous. Monday the pain itself returned and was unrelieved by ibuprofen. The pain radiates to his mid-back and up to his neck. He thought it might be worse with eating, but couldn't affirm it definitively. He is a non-smoker, non-drinker, full-time worker, morbidly obese uncontrolled diabetic on metformin and on blood pressure medications. He cannot afford health insurance and so wanted to keep costs as low as possible. Exam showed tenderness to touch mid-upper abdomen, the rest of the exam was unremarkable but it was difficult to assess some things due to size. My differential diagnosis list included gall stones, hepatitis or pancreatitis. My money was on gallstones and I strutted around telling everyone else it was so. I had labs ordered and sent him for an abdominal ultrasound. (I was so proud of my diagnosis!)
Well, the labs showed elevated liver enzymes, inflammatory markers, and elevated pancreatic enzymes. His ultrasound came back negative for gallstones. It put us back to the beginning with no diagnosis. The other providers at the clinic did not know what was wrong either. We decided to take the watchful waiting approach to see if this would resolve on its own as the patient could not afford even what we had already done.
The next day the patient called after spiking a 102* fever. He was sent to the emergency room. My preceptor kept in close communication with him. She text me last Wednesday to tell me "He has gallstones after all." He was admitted to the hospital due to its severity and the impact it was having on the pancreas and liver. (Admittedly, I was proud my original diagnosis was correct.)
I touched based with my preceptor today to find out how he was doing. He had to have his gallbladder removed. He continues to run fevers so they are concerned that he has pericarditis (inflammation of the heart, probably infectious causes). He is now under the care of a specialist and may need hospitalization.
It makes me sad that he ended up having this experience. The cost of labs, ultrasound, the office visit, the emergency room visit, the hospital stay, surgery, specialists=$$$. He didn't have insurance previously because he couldn't afford it. His job didn't provide it. Because he has a pre-existing condition his premiums would have been unreasonable. Guess what he really can't afford now?
And how many people are like him, walking around not taking appropriate care of their health because of cost? We all will lose to patients in this similar situation. He simply will not be able to pay his medical bills. He will probably make monthly payments of $50 until the hospital writes off the debt. Or he will need to file bankruptcy. Ultimately, it’s the whole population that will shoulder this debt. Had he had affordable insurance and was able to take care of his health under the supervision of a capable provider, maybe none of this would have happened to begin with.
With that, I encourage everyone without insurance to visit their state’s health care exchanges. Find out about the various plans, see if you qualify for subsidies. ENROLL and begin the process of taking care of your health.
Friday, August 2, 2013
Republicans are Missing Out on the ACA
Republicans are missing out on a golden opportunity to make meaningful changes to health care in the United States. I originally was not a supporter of the Affordable Care Act (ACA)—I wanted to go all in with full national coverage—but I have caved to the inevitable. Since the Supreme Court has upheld the legality of the bill I think it is unwise to keep fighting it so zealously.
We know that our current health care system does not work. Health care is provided to those who can pay. The more you are able to pay, the better your “benefits.” While we have Medicare, Medicaid, and state-provided insurances, these programs is only for the poorest of poor and is mired in bureaucracy and restricted treatment options. Studies show that when people have access to affordable health care they will be healthier, when they are healthier they are more productive. Productivity creates a thriving economy with less people draining the welfare systems. (Oh, and providing health care in any civilized society might be the humane thing to do.)
Anyway, the argument for health care reform has been made. Both reigning parties presented ideas to fix it and the Democrats/ACA won. (Although it's technically not a leftist idea since it’s modeled after Romneycare… but I digress.) With the implementation on its way there are currently two schools of thought:
1. Obamacare is doomed to be a failure. Doomed. And we must do everything possible to stop it, to sabotage it. It is our obligation to keep things the way they are (as in broken).
2.Those darn Republicans. If this thing fails, it will be because it never stood a chance with the Repubs kicking and screaming the whole way. All of our energy and resources were spent fighting the opposition instead of focusing on the implementation of the ACA.
Surprising to myself, as I have flipped through all the radio stations and all the news articles, I think the second thought has quite a bit of validity. But I want to introduce one school of thought that I have not heard yet and want others to consider:
3. Switch gears, Republicans. The Supreme Court has said it is legal, stop fighting it. Join the Democrats with its implementation. Find solutions within the goals of the ACA to all the faults you are so quick to point out. Make something work for America for a change. We have clearly stated that we want a working health care system now. Instead of being the guy that “opposed Obamacare from the beginning,” be the guy that said “You know what? I didn’t agree in the beginning and I still have my doubts, but the people have made their choice. I am going to stop thinking about my next campaign talking points and instead try everything I can to make the ACA work because that’s what we need.”
That’s what needs to happen now. If we can accept that the ACA is coming, we can move on to the next step of becoming involved in its success. Right now, the ACA is a strictly “liberal” phenomenon. The Republicans are missing out on some fantastic opportunities. How great would it be if one of the Republicans were able to balance the ACA to meet the needs of the US?
As I have said before, the ACA is great in theory, even Republicans have admitted to it. The only way to prove a theory is to test it and to test under optimal circumstance. I want to encourage everyone to write your representatives and insist that they not only support the ACA, but also become involved in its implementation so that it will represent the health of all Americans.
We know that our current health care system does not work. Health care is provided to those who can pay. The more you are able to pay, the better your “benefits.” While we have Medicare, Medicaid, and state-provided insurances, these programs is only for the poorest of poor and is mired in bureaucracy and restricted treatment options. Studies show that when people have access to affordable health care they will be healthier, when they are healthier they are more productive. Productivity creates a thriving economy with less people draining the welfare systems. (Oh, and providing health care in any civilized society might be the humane thing to do.)
Anyway, the argument for health care reform has been made. Both reigning parties presented ideas to fix it and the Democrats/ACA won. (Although it's technically not a leftist idea since it’s modeled after Romneycare… but I digress.) With the implementation on its way there are currently two schools of thought:
1. Obamacare is doomed to be a failure. Doomed. And we must do everything possible to stop it, to sabotage it. It is our obligation to keep things the way they are (as in broken).
2.Those darn Republicans. If this thing fails, it will be because it never stood a chance with the Repubs kicking and screaming the whole way. All of our energy and resources were spent fighting the opposition instead of focusing on the implementation of the ACA.
Surprising to myself, as I have flipped through all the radio stations and all the news articles, I think the second thought has quite a bit of validity. But I want to introduce one school of thought that I have not heard yet and want others to consider:
3. Switch gears, Republicans. The Supreme Court has said it is legal, stop fighting it. Join the Democrats with its implementation. Find solutions within the goals of the ACA to all the faults you are so quick to point out. Make something work for America for a change. We have clearly stated that we want a working health care system now. Instead of being the guy that “opposed Obamacare from the beginning,” be the guy that said “You know what? I didn’t agree in the beginning and I still have my doubts, but the people have made their choice. I am going to stop thinking about my next campaign talking points and instead try everything I can to make the ACA work because that’s what we need.”
That’s what needs to happen now. If we can accept that the ACA is coming, we can move on to the next step of becoming involved in its success. Right now, the ACA is a strictly “liberal” phenomenon. The Republicans are missing out on some fantastic opportunities. How great would it be if one of the Republicans were able to balance the ACA to meet the needs of the US?
As I have said before, the ACA is great in theory, even Republicans have admitted to it. The only way to prove a theory is to test it and to test under optimal circumstance. I want to encourage everyone to write your representatives and insist that they not only support the ACA, but also become involved in its implementation so that it will represent the health of all Americans.
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