Thresholds has many programs for the mentally ill. One of them appears to be community centers like the Dincin Center. I’ve gone there twice.

It doesn’t have its own website and its daily calendar has errors all over it. The building is really old and the offices dreary. However, the staff have been nice, the members odd but not unfriendly, and they serve free cooked food.

To get a case manager you have to attend groups and come in several times a week. After this, you can become a member, and then get assigned an employment specialist. I wanted to jump straight to employment by have been told “no” by several different people so I guess I’m stuck.

Going in several times a week is difficult as that costs money (public transportation costs) and I’m still having difficulty leaving the apartment. For a while I was walking the dog several times a week and now I’m back to only playing with him outside in the “backyard” area. The fact that it’s been grey outside for the past couple of days doesn’thelp.

Despite not being able to go straight to employment help I’m trying to hold onto some hope that the place will be helpful. One thing that they’re trying to stress to me is that the members have already gone through trying for public aid and know the system pretty well. Still, I’d rather just get a job, or better, have my husband get a job, then fight with Illinois.

In addition, if I can get myself to go, I can try volunteering there, thereby addressing the giant gap in my resume.

Now to see if I can leave the apartment.

It’s been ages since I’ve written here. I figure I’ll do a post on my current situation then do posts on what has happened since I’ve last written.

Employment

We’re both still unemployed and appear no closer to getting a job than when we first moved here. I was reminded the other day that one of the reasons I may not be getting any call backs is the two year gap in my resume. At the same time though, the person recounted her own difficulties with finding a job despite all her volunteer work. In addition, my husband doesn’t have a huge gap in his resume like I do and he’s having as much trouble as I am.

Financial

My mom finally came through and agreed to give me a sizable loan. I had to beg her for it though and she didn’t offer it to me despite my keeping her updated on all the debt I was running up and having to take out a cash advance at a hefty interest rate. She also found a way for the loan to not come out of her pocket at all. It’s from a credit card offer.

My husband’s mom in the meantime has been tapped dry. The money and loans she’s given us have come out of her own pocket. The different between our parents is striking. Then again, it’s my mom who has OCPD, not his.

As part of that OCPD, my mom is suddenly putting restrictions on the loan. Originally, she was going to give us the whole thing at once. When I asked for the loan in stages, she now has an idea of what I’m using it for and has declared it cannot be used on my husband. Huh? Somehow, my credit card bills to pay for his food and rent to pay for his housing is ok but wanting to use the money for his bankruptcy lawyer is not. This happened yesterday. It stressed me out so much that I couldn’t see straight and had a massive headache. We ended up just going to bed because of the stress she’d caused us.

I’m going to try again today, using a lie to get the money to cover my husband’s bankruptcy. I don’t have enough in the bank to pay for it outright, that’s part of the reason I originally asked for the loan!

Eye Strain

I finally have new glasses. Hopefully my eye strain will be less and I won’t need to take naps as often. Damn astigmatism.

My husband says that stress can increase the pressure in my eyes and I’m feeling it even now. I used to be able to read for hours without a problem. Bleh.

Uninsured

We’re still uninsured and see no way of getting around it. Stroger is now where we have to go for health care. We’re not even sure if our Medicaid denial can be successfully appealed without first getting Social Security which can take who knows how many more months. We seriously moved to the wrong state.

Graduate School

I’m researching graduate schools and trying to start the application process. It’s been a very long time since I started on and completed a project. I keep having doubts about whether or not I can actually do the application, never mind do a graduate school program. My self-esteem is shot and that’s all there is to it. Right now, I’m looking at two schools and three programs. The applications are a lot simpler than I expected. When I first started doing research, I was expecting crazy application essay questions like the ones I got for undergrad. Now it’s just simple “Why do you want to attend our program” questions. When I first started looking I was too early, now I fear I’m too late. The graduate schools are already accepting applications. If I don’t try though, I’ll never know.

I have two main hurdles, getting recommendations from people I haven’t talked to in over three years and taking the GRE. I’m terrified of the GRE because of the cost and because I perform so badly on standardized tests. I’m trying to avoid stress and to keep the depression at bay.

When did I become so fucked up? When did I start to see myself as disabled? As intrinsically different and limited? Bleh. I’m hoping that going to grad school will help alter my perception of myself. While most people can get a BA and certainly anyone can be unemployed, not everyone can get a Master’s degree. I need something to make me feel better about myself and my station in life.

Where I live Everybody Else has White Teeth. My service dog goes with me to the dentist. Everybody Else pets him. They don’t understand what it is like to work if you are a dog.

Maybe I need to see a dermatologist instead. The oozing lesion on my jaw might be sensitive skin. Xrays look good. I can petition the state for another full body bone scan no one can read or use. It was good to know last time we scanned my bones that I had a bone infection. I am not sure why it was good to know.

Like most Everybody Else in my country I have no dental insurance. I have teeth. I have some teeth in my mouth. They are part of the organ that takes in food talks breathes smells tastes. They are just the teeth through which my life passes. I am Alive. My sinuses drain into my intestines. The oral surgeon confirms this.

I explained I have difficulty using the postal service. The dentist’s bookkeeper thinks this is funny. I have worked at online bill pay. She thinks this will solve my problems. I can request a State Hearing for assistance to set up bill pay with my bank. I think this is Unnecessary Trouble because I am not allowed all the Online Money I need to pay bills. If I put too much money in the bank to pay for White Teeth they will hurt me. It’s the law.

Eventually I will let my teeth go. For now, I can have White Teeth too if I don’t eat for two months. On the Port Gamble – Talkeetna Trail some things are lost and some are found. At the foot of the Great One a small offering from the Heart is as good as White Teeth.

PS. The American Dental Association has an online form. They want your ideas. If you don’t have any ideas, please send them mine. I could not access their online form.

Democrats= "The Party of Liars"

Either Obama and the Democrats are lying or it simply must be everyone else. Even Democrat Howard Dean has admitted that ObamaCare will cost several trillions of dollars and the Dems are not being honest. Want better news?

Well, the libertarian think-tank, Cato, went through the ObamaCare bill and said the Dems are using gimmicks to keep the cost below the magic threshold of $900 billion…

One gimmick makes the new entitlement spending appear smaller by not opening the spigot until late in the official 10-year budget window (2010–2019).  Correcting for that gimmick in the Senate version, Sen. Judd Gregg (R-NH) estimates, “When all this new spending occurs” — i.e., from 2014 through 2023 — “this bill will cost $2.5 trillion over that ten-year period.”

Another gimmick pushes much of the legislation’s costs off the federal budget and onto the private sector by requiring individuals and employers to purchase health insurance.  When the bills force somebody to pay $10,000 to the government, the Congressional Budget Office treats that as a tax.  When the government then hands that $10,000 to private insurers, the CBO counts that as government spending.  But when the bills achieve the exact same outcome by forcing somebody to pay $10,000 directly to a private insurance company, it appears nowhere in the official CBO cost estimates — neither as federal revenues nor federal spending.  That’s a sharp departure from how the CBO treated similar mandates in the Clinton health plan.  And it hides maybe 60 percent of the legislation’s total costs.  When I correct for that gimmick, it brings total costs to roughly $2.5 trillion (i.e., $1 trillion/0.4). …

When we correct for both gimmicks, counting both on- and off-budget costs over the first 10 years of implementation, the total cost of ObamaCare reaches — I’m so sorry about this — $6.25 trillion.  That’s not a precise estimate.  It’s just far closer to the truth than President Obama and congressional Democrats want the debate to be.

If this bill passes, the bill will be pushed down to the generations under us. The Democrats, lead by the proven liars like Obama, Nancy Pelosi and Harry Reid, know that this bill will cost more than the $849 billion price tag that was put on it. The purpose of this bill is to extend Medicaid, which just happens to be another multi-trillion dollar, unfunded, government-run program.

Libertarians, Republicans and Independents are all lying of course. The Democrats will say that everyone is racist, wants people to die in the streets and loves the insurance companies. They tend to say this often so they can continue telling their lies. We should call them the “Party of Liars,” because this is the only thing they have successfully accomplished since 2007.

To President Obama and all 535 voting members of Congress:

It is now official you are ALL corrupt morons:

 The U.S. Post Service was established in 1775 You have had 234 years to get it right and it is broke.

Social Security was established in 1935. You have had 74 years to get it right and it is broke.

Fannie Mae was established in 1938. You have had 71 years to get it right and it is broke.

War on Poverty started in 1964. You have had 45 years to get it right; $1 trillion of our money is confiscated each year and 45 years to transferred to “the poor” and they only want more.

Medicare and Medicaid were established in 1965. You have had 44 years to get it right and they are broke.

Freddie Mac was established in 1970. You have had 39 years to get it right and it is broke.

The Department of Energy was created in 1977 to lessen our dependence on foreign oil. It has ballooned to 16,000 employees with a budget of $24 billion a year and we import more oil than ever before. You had 32 years to get it right and it is an abysmal failure.

You have FAILED in every “government service” you have shoved down our throats while overspending our tax dollars AND YOU WANT AMERICANS TO BELIEVE YOU CAN BE TRUSTED WITH A GOVERNMENT-RUN a  HEALTH CARE SYSTEM?? 

Folks, keep this circulating. It is very well stated. Maybe it will end up in the e-mails of some of our “duly elected officials” in Washington !!

These thougts are floating about the web, thanks CK for sharing the input.

Take back our country and hold the highly paid officials accountable NOW!

 (Thanks CK for voicing the outrage and anger of so many Americans….)

Dean: Obama Care is a Bailout That Makes AIG Look Cheap

Corrupt Judges Jorge Alonso & Kathleen Pantle cause death of innocent defendant Psychological Counselor Vernon Glass http://tr.im/FWJv

Scott Meeker’s well-composed article in Thursday’s Joplin Globe was about a courageous 26-year-old, Curtis Almeter, from Anderson, who is preparing for a double lung transplant to counter the ravages of cystic fibrosis, a genetic disease he shares with his 18-year-old brother, Tim.

The article focused on Mr. Almeter’s ability to maintain his love for photography while struggling with his disease, but I want to focus on this:

Last week, Almeter went active on the transplant list. He and his mother are staying at Barnes Lodge [at Barnes Jewish Hospital in St. Louis] and will soon move to a duplex near the hospi­tal. The call informing him that a donor has been found could come at any time. Today, perhaps, or maybe a year from now.

On a TV near where the mother and son sit, U.S. Sen. Pat Roberts of Kansas is talking about his thoughts on the health care reform bill.

Almeter qualifies for Medicare and Medicaid, which will cover much of the transplant cost.

“We didn’t know that initially,” says Karen Almeter [Curtis' mother]. “It was good news…one less thing to stress over.”

God only knows what this family would do, were it not for those magic words, Medicare and Medicaid, which will cover most of the estimated $600,000 cost of the lung transplant.

Those “magic” words, which, of course, are really just the product of our collective agreement that folks like the Almeters shouldn’t have to choose between treatment and bankruptcy on the one hand and suffering and death on the other.

But these days, in the minds of some, those words, Medicare and Medicaid, stand for bloated, wasteful, “socialist,” government programs, and are used as props for intense criticism of Democratic efforts to reform our health care system.

At least part of those Democratic reform efforts are directed at people who don’t qualify for Medicare and Medicaid—people who fall between the cracks of our system—who have jobs but no or inadequate insurance, and who have to worry about bankruptcy when faced with their own $600,000 bill for medical treatment or who simply have to waive treatment and suffer through until the end.

And, of course, many do suffer through until the end, as studies show.  Thousands of Americans die each year for lack of health insurance, and we need to fix the system that tolerates such outcomes, instead of carrying swastika-emblazoned placards to tea parties and singing the word ”socialist,” as part of the Pale Face Choir.

Since Scott Meeker’s article referenced Republican Sen. Pat Roberts, our Kansas neighbor, who not only opposes the Democratic plan, but who happened to enjoy more than $500,000 in contributions from “medical interests,” in his last campaign, I thought it would be nice to watch Stephen Colbert adeptly skewer the senator, a few months ago: 

[Globe Photo: Roger Nomer]

I couldn’t say it any better, so I just highlighted the salient points.

God Bless

A National Nightmare, Indeed

By David Limbaugh
November 24, 2009

In a Democratic fundraising speech in Iowa over the weekend, Vice President Joe Biden told party loyalists that opponents of the Obama administration’s agenda “should be worried about us, for we are their worst nightmare.” Duh.

Finally we can agree on something, Joe. Even the liberal New York Times reports that at the current level of federal spending, the annual interest on the national debt will exceed $700 billion by 2019 — compared with $202 billion this year. Some forecasters predict it will be much higher. This additional half-trillion dollars a year in interest is more than our current combined expenditures on education, energy, homeland security and the wars in Afghanistan and Iraq.

Oh, and the Times isn’t even factoring in the cap-and-trade nightmare you and Barack have in store for us, Joe — you know, that urgent legislation to catapult the nation back into Third World status based on hysteria generated by fraudulent science and corrupt zealots and politicians.

Nor is the Times including in its calculations the additional debt that would result from Obamacare.

Joe, when The New York Times is sounding the warnings over the exploding national debt, you and Barack insist not only on not reversing your disastrous course but also on making it worse. How can reasonable people assume anything other than that you are trying to run this nation into the ground financially?

Don’t dare keep telling us your hyper-ambitious spending is a necessary evil required to deliver us from a financial crisis you inherited. Whatever crisis we face is debt-related, purely and simply. Everything else is manageable. Yet you all are deliberately increasing our indebtedness as far as the eye can see, without the slightest pretense of scaling back in this millennium. In fact, you are laboring to establish further entitlements and institutional changes that would generate exponential burdens on our debt and would be enormously difficult for any responsible and financially sane successor to undo, much less reverse.

Adding insult to injury, you are spending this money not to improve (“stimulate”) the economy — which even the most politically and economically illiterate should now realize — but to restructure American society, dismantle our free enterprise system and impose in its place a command-control economy and political system — in which life’s decisions, including over our private health care, are dictated from Washington.

But while you and Barack are hoisting your wrecking ball, could you please spare us the pseudo-sanctimony and transparent populism in telling us that it will take “grit and determination” to outlast the “special interests” on Wall Street and the insurance industry to pass your destructive agenda?

You both know better. When you have to bribe Sen. Mary Landrieu, D-La., with a larcenous $300 million addition to your Senate bill (I know, you’re pretending it’s just Harry Reid’s bill) that’s specifically earmarked just for her state — at the expense of the rest of the states and the national interest — something smells to high heaven. You could at least have the decency to admit this provision to raise the bill’s cost by increasing Medicaid subsidies for “certain states recovering from a major disaster” is not even motivated to help Louisiana, but to buy Landrieu’s vote. And you want to talk to us, Joe, about the corruption of special interests?

Special interests, Joe? Is that how you describe 56 percent of the American people, who now oppose Obama’s plan? And that’s without even knowing the half of it. Or maybe you would describe them as dangerous protesters or domestic terrorists?

But, Joe, I do applaud you for your candor in telling your fawning supporters, “I can tell you with absolute certainty: (Barack’s) resolve has never waivered for one instant.”

Bull’s-eye, Joe. You and Barack believe you know better than the American people what is good for them, and you only care what they think to the extent that it makes your job more difficult when they oppose you.

But if you told the truth about your plan — that it would cost dramatically more than you pretend (especially considering that the benefits wouldn’t begin to be paid until 2014 and that taxes would increase almost immediately); that the public option would subsume private care; that the federal government would ration care; that medical choice would be drastically reduced; that you are still trying to secure federal funding for abortion; that you intend to cover currently illegal immigrants; that after all your hype about promoting this bill to achieve universal coverage, millions would remain uninsured and penalized, to boot; that medical quality would be seriously reduced; and that overall costs would increase — your support for the bill would be in the single digits.

So keep chanting it, Joe; you are indeed a national nightmare.

—

David Limbaugh is a writer, author and attorney. His book “Bankrupt: The Intellectual and Moral Bankruptcy of Today’s Democratic Party” was released recently in paperback. To find out more about David Limbaugh, please visit his Web site at www.DavidLimbaugh.com.

I’ve been thinking about welfare lately.  You know, with the push to socialize more and more of the United States, I thought it would be nice to think about our current socialist institutions.  And my grandparents are out of money and can’t live on their own anymore, so they’re applying for Medicaid (which requires that they be poor enough for welfare). 

That’s an interesting idea, isn’t it, that before we’ll give financial aid to people who can’t make ends meet, they have to be so poor they’ll probably never recover.  For example, my grandparents own a house.  It is possible that in the next year or so, they may be able to live there again.  At which point their cost of living would be a lot cheaper, in a house that is paid off: no rent, no mortgage.  Instead, before welfare kicks in with Medicaid coverage for long term medical care in a nursing home, they have to sell their house.  So they will be irrevocably government-dependent, and the government will have to pay more money to find them a place to live. 

I don’t even believe in welfare; I don’t think my grandparents should have applied.  But if the government is going to offer it, couldn’t they use common sense and try to make the program efficient? 

To God be all glory,
Lisa of Longbourn

Flawed Health Reform Could Hurt Dems in 2010—Part I – Working In These Times

Congressional Longevity Record Falls

Thursday, November 26, 2009. The white noise coming from Capitol Hill lately is so red hot that it was easy to miss a significant milestone last week.  Senator Robert Byrd of West Virginia became the longest-serving member of Congress in history, passing the previous record of former Sen. Carl Hayden of Arizona.

Fifty-six years, 326 days and counting for those of you keeping score at home. That’s more than a half century, sneaking up on six decades. One more election and the good senator’s term of service could qualify for Social Security. Byrd has been roaming the halls of Congress longer than ten of his current colleagues and President Barack Obama have been walking this earth.

An amazing set of circumstances must come together to allow this kind of achievement. Personal health, energy and desire to keep serving play into it. Hayden actually retired four years prior to his death in 1972 or he might still hold the record.

The ability to keep winning elections is certainly a large factor. Former Senator Frank Church of Idaho was fond of saying “Your friends come and go, but your enemies accumulate.” Church served four terms in the Senate before the accumulated enemies resulted in his defeat. His 24 years of service fall substantially less than half of Byrd’s, Hayden’s and quite a few others’.

A member has to be very right for his state or district to start with, and then be able to change and adapt with a changing society.

Byrd’s adaptation is perhaps his most interesting characteristic. He was, after all, boys and girls, a young man and former redundant member of the Ku Klux Klan as a young man. His record is strewn with apologies, but it also contains a filibuster against the Civil Rights Act of 1964 and a vote against the Voting Rights Act of 1965. He did vote for the Civil Rights Act of 1968 and has called his earlier segregationist actions — based on a commitment to states’ rights, or not — among his biggest regrets. Ok. I’ll take him at his word.

For my purposes today, the more salient point is that he was present for these votes. In 2005, Roll Call newspaper brought together a panel of liberal and conservative congressional scholars to determine the most important legislation of the previous 50 years. Beginning with the National Defense Education Act of 1958 at number six, and reaching to the Patriot Act of 2001 with an honorable mention, only Byrd and Representative John Dingle of Michigan were members of Congress for all the votes on the list.

Number three, according to the Roll Call panel, are the Medicare and Medicaid Acts of 1965. Compared with Social Security in their impact on American life, these programs have enjoyed broad bi-partisan support from their inception, as did all of the top bills on Roll Call’s list.

House Speaker Nancy Pelosi recently compared the House’s passage of health care reform legislation with passage of the Medicare and Medicaid Acts. I love her passion and understand her excitement, but this assessment is, at best, premature. Medicare and Medicaid passed both bodies and were signed into law. Health care reform has not.

Then there’s that pesky bi-partisan thing, which will continue to elude  health care reform if Republicans stick to their current strategy. Medicare passed with a majority of both parties in the house and 40 percent of Republicans in the senate. The history of significant legislation suggests such bi-partisan support may be needed to produce a law that the nation will embrace.

This country is a different place than it was in the mid-sixties. So is Congress. The entire political system is so much more polarized that achieving bi-partisan support for significant change may not be possible. If this is so, and if the Democrats succeed in passing health care reform over the dug-in heels of the Republicans, we’ll get a chance to see if a one-party bill can be the kind of game changer that Medicare and Medicaid have been.

One thing is for sure — it is risky money to bet against Robert Byrd being around for whatever happens next.

Congratulations, Senator, and thank you for your service.

A Milestone in the Health Care Journey

by Ronald Brownstein

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. “The bottom line,” Nichols says, “is the legislation is sending a signal that business as usual [in the medical system] is going to end.”

Both the Senate bill’s priority on controlling long-term health care costs, and its strategy for doing so, represents a validation for Senate Finance Committee chairman Max Baucus (D-MT). When Baucus released his health reform proposal last September, after finally terminating months of fruitless negotiations with committee Republicans, Democratic liberals excoriated his plan as a dead end. And on several important fronts–such as subsidies for the uninsured, the role of a public competitor to private insurance companies, and the contribution required from employers who don’t insure their workers–Reid moved his product away from Baucus toward approaches preferred by liberals.

But the Reid bill’s fiscal strategy, and its vision of how to “bend the curve,” almost completely follows Baucus’ path from September. Baucus’ bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that’s the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas’ for shifting the medical payment system away from today’s fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus’ most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that’s just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.) Most of the other big ideas for controlling costs (such as medical malpractice reform) tend to draw support primarily among Republicans. And since virtually, if not literally, none of them plan to support the final health care bill under any circumstances, the package isn’t likely to reflect much of their thinking.

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end “Cadillac” insurance plans; to pursue “aggressive” tests of payment reforms that will “provide incentives for physicians and hospitals to focus on quality” and provide “care that is better coordinated”; and establish an independent Medicare commission that can continuously develop and implement “new efforts to improve quality and contain costs.” Finally, they said the Congressional Budget Office “must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter.”

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.)  “Let’s use the metric of that letter,” said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. “Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar.”

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag’s assessment of it. “It has got all four of those elements in it,” McClellan said in an interview. “They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go.”

Reid gave ground on one Baucus proposal that the economists identified as a priority-taxing high-end insurance plans. Like many health reformers, the economists who wrote Obama argue that such a tax “will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount.” Amid intense opposition from unions, Reid raised the thresholds at which family plans would face that excise tax from $21,000 to $23,000. But given all the pressure from labor, the more striking thing may have been that Reid didn’t increase the thresholds even more; the CBO calculated the proposal, which the House excluded from its bill, would still raise $35 billion annually by 2019. “They held pretty strong,” said one administration health care expert. “It’s not like unions haven’t been making the case that it shouldn’t have been a much higher number.”

On delivery reform, Reid stayed even closer to the Baucus blueprint. The Finance bill laid out a series of measures to change the way providers are paid for delivering care to Medicare recipients; the hope was that once Medicare instituted these reforms, private insurers would also adopt many of them. “The goal here is that the things we do in Medicare will translate over into the private sector, and there is quite a bit of historical precedence for that,” said one Democratic aide involved in drafting the package.

The Baucus delivery reform ideas revolved around two central aims. One was to reward Medicare providers who deliver care more efficiently and penalize those that don’t. The Reid bill upholds the major proposals Baucus offered to advance that goal. For instance, hospitals under current law must report on their performance in treating patients for common conditions like heart problems and pneumonia; under the bill, their Medicare payments, for the first time, would be affected by their ranking on those reports. Hospitals would also be penalized if they readmit too many patients after surgery or allow too many to acquire infections while in the hospital itself. Another provision would begin the process of applying such “value-based purchasing” toward other providers like hospice providers and inpatient rehabilitation facilities.

With physicians, the Reid plan takes a step back from the Finance Committee bill but still a long step beyond current law. The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as “a death panel by proxy”-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a “values based payment modifier” that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. “It will, we believe, have the same net effect [as the original proposal],” said the Democratic aide. “It should change behavior around that threshold.”

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led “accountable care organizations” to more comprehensively manage patients’ care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of “bundled” payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.

Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that’s attracted the most attention is an independent “Medicare Advisory Board.” Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or “ration care,” and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry). Given the limitations imposed on the commission, an equally important means to expand these reforms might be a second institution the legislation creates: a Center for Medicare and Medicaid Innovation in the Health and Human Services Department. Though this center has received much less attention than the Medicare Commission, it could have a comparable effect. It would receive $1 billion annually to test payment reforms; in a little known provision, the bill authorizes the HHS Secretary to implement nationwide, without any congressional action, any reform that department actuaries certify will reduce long-term spending. While the House bill omitted the Medicare Commission (a top priority for Obama) it included the innovation center.

No one can say for certain that these initiatives will improve efficiency enough to slow the growth in health care spending. Some are only pilots; others would affect only a small portion of providers’ revenue from Medicare. CBO typically evaluates them skeptically: it generally scores little or no savings from most of them. Former CBO director Robert Reischauer, who signed the November 17 letter, says that’s not surprising. “CBO is there to score savings for which we have a high degree of confidence that they will materialize,” says Reischauer, now president of the Urban Institute. “There are many promising approaches [in these reform ideas] but you…can’t deposit them in the bank.” In the long run, Reischauer says, it’s likely “that maybe half of them, or a third of them, will prove to be successful. But that would be very important.”

While generally supportive of Reid’s approach, McClellan, the former Medicare administrator under Bush, offered several specific ideas for strengthening it. He says the Senate should improve the capacity of HHS to more quickly evaluate whether the payment reforms are working, and also to provide data and technical assistance to new physician groups like the accountable care organizations that will be attempting to better coordinate care. “Ideally you’d both be able to tell the organizations involved and Congress what is working or not, and give the organizations the feedback and data they need to know whether they are doing a good job,” he says. McClellan also believes that the plan needs sharper sticks-tougher penalties on providers who don’t provide efficient and effective care. “There are a lot of carrots and not so many sticks,” he maintains. Of course, tougher penalties might provoke more opposition from provider groups like hospitals and physicians now tenuously supporting the legislation.
[[McClellan stands at the forefront of centrist Republican thinking on health. Even the more ideologically conservative health care thinkers to his right generally don’t oppose long-term reform ideas like bundling payments (John McCain promoted that during his presidential campaign). But they tend to view them as insufficient or tangential to the real problem. Their view highlights a fundamental difference between the parties’ on health care. To save costs, Democrats mostly want to change the incentives for providers. Republicans mostly want to change the incentives for patients by shifting toward a model where insurance covers only catastrophic expenses and people pay for more routine care from tax-favored health savings accounts. In essence, the Republican view is that the best way to hold down long-term costs is to directly expose patients to more of them. Few Democrats accept that logic though and it has little influence on either chamber’s legislation.

Another Republican cost-containment priority missing from the bill is meaningful medical malpractice reform. (The bill only encourages states to think about it.) Nichols, of the centrist New America Foundation, would like to see that included as well. Its omission is one reason he says he gives the plan a “b” rather than an “a”; the other is he’d like to see mechanisms to more quickly diffuse into the private insurance system reforms that show promise in Medicare. Democratic sources say a group of centrist Democrats led by Virginia Senator Mark Warner is trying to devise a package designed to do just that, perhaps by expanding the role of the independent Medicare advisory commission.

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn’t able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. “One never knows whether we’re turning the corner or if this is just playing the same old game for another inning,” he says. “But I sense there’s something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve.” If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

From the makers of bankrupt Social Security, indebted Postal Service, broke Fannie Mae, deteriorating Medicare and Medicaid, and broke Freddie Mac, comes health care.

Stimulus dollars have not reached all sectors.  For 25 years in the state, Options for Individuals, Inc. has served and supported the local Louisville community by keeping those with cognitive disabilities in their homes and out of institutions, where possible.  In fact, it only takes one-third of the taxpayer dollars to do so, versus institutional care.  Nationwide, those with cognitive disabilities represent about 3 percent of the population.  Medicaid rates have not risen for these services in six years, and still funds have been cut.  These funds support speech therapy, adult day training, occupational therapy, and transportation to and from medical care.  In June, at the federal level it was announced that approx. $387 million would be taken from the Medicaid budget.  90 percent of Options for Individuals budget comes from Medicaid.  “There’s alot of concern as to what is going to happen to our Medicaid waiver, since it comes out of the total state Medicaid budget,” said Michelle Linville, Executive Director of Options for Individuals, at a recent speaking engagement of the Governor.  “As the economy grows worse, more people qualify for these services.  So, we are going to outside resources for funding,” she said.  The agency serves adults and there is a waiting list to be served.  Sponsors to date include YUM, Brown-Forman, Texas Roadhouse, Buckheads, and the Dollar General Foundation.  At this time, the goal is set to raise $50,000 in the next year.  Those interested in supporting the organization’s mission can call Michelle Linville, Executive Director of Options for Individuals at 502-636-9198.

Watching this reform process, at least for me, is now like watching a Ping Pong match or a Nascar race (sorry Nascar fans); back and forth and round and round.  Even for someone who watches and interprets health policy for a living, this stuff is getting boring, monotonous and frankly, now somewhat nauseating, content wise.  Maybe the intent is to literally “mind numb” all the people like me who analyze, consult and write about health policy with the goal of shutting us up or in my case, the goal of disconnecting my brain from my fingers so that I can no longer write about the insanity that is “health care reform” in Washington.

Getting to the meat: The Senate, namely Harry Reid, is working feverishly to buy votes, cajole fellow Democrats and to obfuscate the details in his (the Senate’s) 2,000 plus page, Nancy Pelosi light, reform bill.  I say “Nancy Pelosi light” because the Senate remains, even though Democratically controlled, moderate enough not to blindly drink the policy Kool-Aid produced in the House.  This past Saturday, via a host of back room deals and pay-offs to fence-sitting Democrats, Reid cajoled a cloture avoidance vote, sending the reform bill to the floor for debate.  This mid-level stall tactic buys Reid additional time to arm twist colleagues and to literally, buy votes.  Without this Chicago-style tactic, Reid knows the votes for passage are non-existent in the Senate.  In reality, the votes for passage in its current form may still be non-existent regardless of the price offered due to the taxation issues within the legislation, the abortion issue and the government option issue.

Looking at the Bill in detail (I’ll admit that I haven’t read the whole thing as of yet and frankly, I may not as I have now mastered the trick of speed reading these monstrosities, getting to the heart and soul and avoiding the painful tedium that is the politically and socially engineered garbage which consumes hundreds of pages), one quickly sees that key similarities with the House version are imbedded albeit with a more moderate twist in order to appeal to the more moderate Senate membership (if that’s possible).  For example, the government option is actually a state option, triggered only by the states that desire to introduce a government option (however that should work).  The payment methodology incorporates greater taxation options and fees (such as a 5% tax on cosmetic surgery) including on benefit plans – absent in the House bill.  The Senate bill still does not require all employers to offer health insurance while the House bill does although it does require all Americans to purchase insurance or face fines and penalties. Both the House and the Senate bills call for wholesale expansions of Medicaid as a means of providing coverage to lower-income individuals.  The House bill prices in at $1.2 trillion (not including the costs of the recently passed Doc Fix legislation) while the Senate bill weighs in at just under $900 billion and is mute about the doc-fix issue.

Before the fog of cynicism creeps fully into my brain and dulls all of my senses, I’ll finish this post with a few succinct and brutally honest comments on the Reform process.

• I can’t say it any more plainly or write it any more plainly, what is happening now is not Reform.  Neither the House bill or the Senate bill does anything to reform how health care is delivered in this country or to frankly, improve it.  The incredibly antiquated, bureaucratic and inefficient programs of Medicare and Medicaid remain essentially untouched save for their funding mechanisms.  Medicaid, a horribly structured program rife with individual state bureaucracies and excessively varied benefit plans is being expanded but not reformed – a recipe for wholesale disaster for the millions of new beneficiaries who will enter a system incapable of providing adequate and decent care for the current beneficiaries.
• The economics of all numbers attached to the reform discussions is literal, laughable dog “doo doo” (substitute if desired, B.S., crap, garbage, cow chips, etc.).  No person who can do simple math and apply any basic economic principles should buy for a moment that either plan (House or Senate) is capable of reducing the deficit, being deficit neutral or not ultimately deleterious to the U.S. economy.  The smoke and mirrors financing techniques applied in both bills (start with the revenue for a few years then gradually add the expenses) is alchemy of the poorest kind; a brew that no sane human should swallow.  Both bills will add billions to the deficit, increase taxes across the board and become an entitlement and bureaucratic monster unlike any that has ever been seen before in the lifetime of mankind.  If this sounds harsh, consider the following.  The Constitution of the United States, the seminal document of U.S. governance is sixteen pages in actual content, inclusive of all amendments and the Bill of Rights.  The House bill and the Senate bill are 2,000 plus pages in length, each costing the U.S. taxpayers over $1 trillion ($1,000,000,000,000), and neither substantively reforms Medicare or Medicaid or assures that any citizen will receive better health care despite the enormous price tag.  If that isn’t bureaucracy “Washington” style, I don’t know what is.
• In spite of polls that show less than half of all citizens are in favor of the present course of reform (and a trend that continues to move lower), the elected officials in D.C. plow on their present course.  Someone once told me that the definition of insanity is when, in spite of not getting something correct, you continue to do the same thing over and over again, hoping to get a different result.
• The U.S. debt load (deficit) now totals $12 trillion and change and the total GDP of the U.S. economy is $14 trillion.  Adding more debt, which both bills will certainly do, is preposterous and economically incomprehensible.  Granted, the economy will return to a growth pattern but no reasonable economist will assume that future GDP growth could possibly outstrip the present growth of Washington deficit spending or for that matter, be aided during recovery by additional deficit spending to the tune of $1 trillion or more.
• In spite of the rhetoric and the foolish fodder from Washington, Medicaid and Medicare will geometrically expand and their growth will be unconstrained by either bill.  Medicare will be cut in the short run by $500 billion damaging providers and beneficiaries temporarily but Congress will come to the rescue, abandoning most of the painful cuts, restoring funding and adding more to the deficit, all in the shadows of their post-reform victory dance.  Trust me on this one as I have been involved in healthcare and health policy now for almost three decades and it is a cycle that constantly repeats.  For those that are even skeptical, look at the House’s bill for the physician payment fix.  In Washington, the squeaky wheel gets the grease and when the election cycle heats up, seniors, hospitals, doctors and any other interest group with voting blocks will be pounding the corridors in search of “Benjamins for votes”.
• There are no winners in this process save a handful of special interests and the usual D.C. elitists and certain political classes.  The losers are too many to count but at the top of the list are individual tax payers, individuals with current health insurance, the poor without insurance (they ain’t seen nothing yet until they take their new Medicaid insurance in a state like Mississippi and try to get decent healthcare), companies that presently provide benefits, anyone with a HSA, and of course, anyone who owns or thinks about starting, a small business.  Again, if you think I’m full of you know what, read the gosh darn bills.

I try to avoid ranting in this Blog because I do find it somewhat counter-productive and often, overdone.  Personally, I am not really a ranter anyway as I rely generally on intellectual discourse and analysis to pose my point and to beg the questions.  In the end, I suppose I have found my breaking point for the moment courtesy of Harry Reid, Nancy Pelosi and President Obama, all I have never met and if I did, I would probably enjoy chatting with – maybe even over a cold beer.  Just not today.

I’m almost officially out of the first trimester. Apparently the guidelines changed while I wasn’t looking, and the first trimester now lasts 13 weeks.

I worked from 8 to 5 yesterday and it kicked my ass. How am I going to do this later in my pregnancy?

This is my Thanksgiving break from school and I plan on getting a ton of stuff done to get myself caught up and relieve some stress for the rest of the semester. I have to do schoolwork, turn in applications, look for a house… bleh.

I have bad news on the VBAC front. I have decided that my gut feeling that the doctor I love and trust will not let me really try a VBAC is something I will not ignore. I refuse to settle for a doctor who does not fully and wholeheartedly support my decision, and guaranteeing that I will end up in surgery is not encouraging or supportive in the least. I decided to have a consultation with another doctor but had to wait to see the office’s Gift of Life care coordinator, which didn’t seem right. I called the office and spoke to the coordinator yesterday and explained I was already enrolled in Gift of Life (the tri-county Medicaid program, FYI) through another office and just wanted to talk to the doctor. She informed me of Medicaid’s rule that I may only switch doctors once in my pregnancy, and that this would be my swap if I wanted to come to that office. I just want to talk! I explained to her that I just want a consultation, and she informed me that Medicaid doesn’t allow consultations. Now I have to make the decision of whether to take a huge chance seeing a new doctor, who might say no VBAC, and then being stuck there. She said that if I didn’t like the new doctor either, I could file a grievance explaining why I am dissatisfied with my care, and a panel will review it and decide whether I’m allowed to swap doctors again. How much do you want to bet that me not wanting a c-section will not be an acceptable reason to switch? I am very upset about this, and in fact cried at work while washing dishes because I am basically trapped. I’m going to try SOME MORE tomorrow to call OB’s offices and see if there is any way at all that I can speak to these doctors (you can’t even speak to a goddamn nurse without being a patient) without being forced to become a permanent patient. I just hate feeling like being on Medicaid so severely limits my options that I don’t have the right to not be strapped to a bed and have my child cut out of me. Nobody should make that choice for me, especially when there is no way to predict what will happen in labor. UGH. I think my only choice is to fork out $650 for a doula to make me more comfortable laboring at home and then act as my advocate in the hospital for delivery. We do not have $650 that is not already dedicated to bills… like, say, rent and electricity? I’m sorry to complain about this so much but I never imagined I would have to feel like this– like my body is at the mercy of a group of strangers and the birth of my child will be fully dictated by people who don’t give a shit about my wishes. My life is revolving around this.

Babyreese is over two inches long, and has developed almost all of her features. She will now continue to grow. She can feel pain and respond to stimulation of my uterus. She may be sucking her thumb and swallowing amniotic fluid to pee. Here’s what she looks like:

And the lady at the pregnancy clinic I went to initially for my “proof of pregnancy” for Medicaid gave me this weird little rubber doll that is an actual-size representation of a 12 week fetus. I’ve saved it all this time because it makes Babyreese seem so real.

That's inside of me! Inspiring, no?

But it's still fucking weird.

[Those pictures were taken at 7 am. And that is my newly brunette hair, since I don't feel comfortable bleaching at all during pregnancy. Bummer.]

I am feeling much better, hardly any headaches or sickness. No complaints really, except I wish I could sleep 12 hours a night. And take a nap. And poop. That would be nice. I am definitely absolutely showing now and my clothes are definitely absolutely uncomfortable. Yay for winter and sweatshirts. Maybe even sweatpants until I can get some looser pants. I’ve been eating a little more lately and not drinking water like I should (I am so sick of peeing!) but this week I pledge to do better. I can’t be gaining weight this early in the pregnancy. I’m just eating because I feel like I have an excuse. My weight today is 121 pounds naked. Last night before I went to sleep the scale was up above 125 thanks to dinner at Natalie’s school, which I had a second helping of. I’m starting to get congested in the mornings, and I pray that it’s just a seasonal fluke and this isn’t the return of the everlasting sinus infection, because I won’t take medicine for it now.

This morning’s belly shots:

belly shot 12 weeks

belly shot 12 weeks

It is everywhere today – the healthcare debate.    I did not realize this until we sat down to pay bills this week, but we are in a unique situation in this household when it comes to this issue. 

The state provides us with medicaid for the two youngest girls.  They are covered due to their “foster” status with us.  The rest of the family is privately insured.  We pay not only a monthly bill to remain covered, but we have co-pays, and limited vision and dental coverage.

The girls have it all:  orthodontic, vision, dental, medical and even mental health.  We do not pay a dime for them.  No copays at all – not even on medicine.  We were able to choose from a list of participating doctors and eye care centers.  In many cases the same doctors who offer private care that our family is seeing with our own insurance.  The only “downside” if there is one is more paperwork and we have to “recertify” the girls every six months.

I can see the need for healthcare reform.  Our current cost per month for our family is $600+ before co-pays.  We do pay more due to pre-existing conditions (migraine headaches and a few of us are outside of the insurance weight guidelines), and we opted for  premium plan that resembled what we had while insured while working for large companies.

What I do not see is the need to scrap everything we have today to recreate the wheel.

There are a few points I can agree on.  The majority of people in this country do need affordable prescriptions.  Most people can pay to see a doctor, but the drug expense is so over the top, often preventing them from following the recommended treatment plan.  This is not a healthcare issue, but a big business issue.

We need to stop thinking doctors make more money than the President.  They do not.  Most doctors stopped earning the really big dollars when HMO’s were introduced.  And specialists who do make the big dollars are worth the money.  Would you really want a person who was only earning $45 k a year and worried about paying their bills performing brain surgery or working on your heart?

We need to focus on affordable and accessible well-care treatment.  If we are going to increase spending, increase the investment in public health departments.  These very important local institutes are running on less money with more patients.  If you want to stop the flood of expenses for unnecessary care in ER rooms, increase the staff and service hours at public health departments.  These community centers are better at outreach and are often working in neighborhoods that need the extra care.

We do not need to focus nearly as much about senior citizens being the drain on our healthcare system, but instead worry about the number of unwed mothers and drug addicted children born into NICU centers.  Again, well-care and community centered medical centers can provide the needed support and assistance to families and individuals who need crisis intervention long before they need expensive medical treatments.

We need to also call for a return to common sense.  There is no responsibility for one’s care without an investment in it.   And yes, I think if you weigh more or smoke or are abusing drugs your cost should be higher.  You are an increased risk to spend more and cost more to the overall system.

We do not need “sin taxes” if you want to smoke then you should.  The consequence is a higher insurance cost.  If you want to drink soda, or drive on the second Sunday of every month or even if you want to shoot heroine, this is your right as a citizen of this country.  There are consequences for every action and as such you should expect the fees to be higher for you.

We need a 10 page bill for reform.  Not 1,000 pages or more.  We do not need anything hidden or stuffed into this package.  We need competition for the drug companies and current insurance companies.  We should choose private or public insurance based on what best fits our families needs. 

Doctors should make care decisions, not people sitting behind desks who do not have medical degrees.  If the federal government wants to get into private business, then the government should hire an outside business to manage oversight and look for fraud. 

None of this is “easy”, nor can it be rushed.  We need deliberate and careful thought that is more about the people and less about checking off campaign promises.  Until this pending package if passed, you still have time for your voice to be heard.  If the bill does pass, then I encourage you to think very seriously about who you vote for in the future.