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“You either trust . . . your state . . . or you don’t”
May 8th, 2017 by Dr Karma

I’m a federalist.

I’m an American, so I should have the same rights in each state.

Thus, I had a knee-jerk negative reaction to Oklahoma Congressman Tom Cole’s discussion of the Republican health care plan on Morning Edition last Thursday. He did the typical Republican move–demonizing the federal government while making moves to allow the states to deny care to their citizens:

“But at the end of the day, you know, you either trust your governor and your state legislature or you don’t. In my case, I do. And it’s far easier, if they make an error, for people to frankly correct them and — or fire them if they need to, than it is to deal with a sort of faceless, federal bureaucracy that’s in many cases thousands of miles away.”

Having grown up in the South, I don’t trust state or local government more than I trust the federal government. Why was I taught that evolution was wrong in a public school? Because of local decisions. Why was my history teacher forced to pretend that the world was created 6000 years ago? Because of local decisions. Why was my doctor not allowed to talk to me about all my options for care when I was pregnant? Because of local decisions. Why was my aunt not able to get healthcare in the South even though she’s disabled? Because of local decisions.

Of course, I can point to a lot of federal decisions that have been awful too, but there are two important points to consider. First, and this is our fault, voters don’t usually pay attention to or vote in local elections. Second, the federal government–with its constitution–tends to move toward equality–and that’s where my values lie. The constitution says I shouldn’t have been taught Christian b.s. in a public school and recognizes my right to disagree. The federal government’s position is that my queer friends have the same rights that I do, that my Jewish neighbor has the same rights as her Christian ones, that my students of color deserve the same opportunity as their white counterparts, that my disabled staff have equal access to a job, etc. etc. etc.

But the Republican move is always to “let the states decide.” To decide whether your disabled child can go to public school. To decide if you can have access to healthcare. To decide if you can be married to your partner.

We’re American. The “state” I live in shouldn’t decide whether I’m equal to my neighbors. I am.

The end of Cole’s interview really brought the point home for me about trusting the states: “Look, I live in a state where we’re down to a single provider who’s losing money. We have a 69 percent rate increase coming for people that don’t have — aren’t subsidized in the pool. And finally, because we’re not a Medicaid expansion state, you know, we’ve got hospitals taking care of classes of patients that in other places they get compensated for — not here.”

We’re not having those problems in California–because California didn’t fight Obamacare. In other words, it shared the federal government’s move toward equality.

It’s that last line that gets me–he doesn’t live in a Medicaid expansion state, so he’s upset because uninsured patients are costing his state a lot of money.

In other words, his state chose to leave a significant portion of its population uninsured. Each state’s budget office can confirm it would make fiscal sense to expand Medicaid. But states like his didn’t. It left its people in danger. It left itself in a bad financial state. Why?

Because it was “Obamacare.”

No, Mr. Cole, I don’t trust the states to always do the right thing for their people, especially states like yours.

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On the other hand (backhanded, that is)
Oct 15th, 2016 by Dr Karma

This week, one of my doctors and I had to take a moment to just look at each other.
I was in acute pain. He knew how to make it stop. He couldn’t, unless I wanted to cover the entire cost myself.
“I can’t give you the treatment because insurance wouldn’t authorize it this fast. I can’t give you a shot of pain killer to tide you over–I’m your specialist. Your primary can do that, but I can’t.”
We talked about ERs and cabbages and kings.
I have a lot of complaints about my body–I have chronic issues, including chronic pain.
I have a lot of complaints about insurance and the American model of medicine–I’ve written about some of them here–not all of it. In 2017, I should run a ledger: how many hours do I spend on the phone with my insurance company? How many times are my bills wrong? How many times is my medical care (a prescription, a treatment) denied?
It was an expensive week (next week will be too). In addition to my insurance premiums and my meds (so many meds), I paid $200ish in doctor/procedure fees that weren’t about my acute problem. The acute problem added in another $200ish.
On the other hand, I am thankful I have insurance.
On the other hand, I am so thankful for my team.
With few exceptions, my health care team is incredible, and not just because they’re willing to fight for me.
Let’s look at this week.
First, my chiropractor and my massage therapist have worked very hard. On Monday, I couldn’t walk. I managed to get to classes the rest of the week due to people being willing to fight with my muscles and my misalignments.
On Thursday, my PTSD therapist (who works in the pain clinic) got on the phone with my pain doctor during our appointment to explain that my back had gone from chronic to acute and that I needed intervention asap.
Usually, it’s at least a month to get on the calendar. My pain doc is going to try a fun new intervention Wednesday morning.
That same day, my neurologist and I had the conversation discussed above. He has me on his schedule for Monday, as an intentional overboook, in case I couldn’t get in to see a primary yesterday. He called in a prescription for a patch to apply to my back (I haven’t been able to use it–insurance is being difficult).
Yesterday, I was able to get a same day appt with my primary care physician’s colleague. It was his last of the day–4:45. Still, he was thorough and kind. He listened. When I suggested a tweak on what he wanted to do–one kind of shot instead of another–we talked it through.
His PA came in to give me my shot, but so did the building’s shot nurse–a year before, when my back was acting up like this, we had an issue with this shot (for your sake, I’m being vague here). She wanted to check on me, to make sure I was as okay as possible, to make sure this shot went well.
In other words, the people who take care of me are awesome.
Insurance, I have an amazing group of people trying to tackle amazingly difficult problems. Please let them.

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The Year So Far (February edition)
Feb 24th, 2014 by Dr Karma

I haven’t been in the kind of contact that I want to be with most of you. Part of it is that I’m busy. Part of it is that I don’t necessarily want to talk about how I am.

I was really hoping that this year would be better than last. Last year was busy (no surprise), but also difficult due to my gall bladder, an amazing cervical spine headache that started in summer, and a car accident, which resulted in hours of physical therapy each week (it’s only ended last week).

This year hasn’t been easier so far. I’ve already written about my grandmother dying last month. What I haven’t said yet is that, while she was sick, this particular time of death didn’t have to be. What I haven’t said yet is that I’m angry about some of my mother’s decisions and angrier about her refusal to acknowledge them.

Next month, I will return home during Spring Break. My family is waiting to put the ashes in the ground until I get back. I need to try to have a calm conversation in which I explain to my mother that she can’t change my grandfather’s medicines, etc. without notifying the doctor. But she’s going to get defensive, and we’re going to have a fight, and I’m stressing about it.

The other thing I haven’t said is that it really sucks to be the only woman in the world with the middle name Jewreen. Before, there were two of us.

As for myself, three things are going on physically. Today I have a tube going from my stomach, out of my nose, and to a recorder. It’s testing the ph of my acid reflux and also checking to see if some of the reflux ix actually bile, now that we know I have some bile in my stomach. I am very uncomfortable, doubting I’ll be able to sleep tonight, and looking forward to getting it out after my classes tomorrow. Some of what we’ll learn will determine if the doctor thinks I need surgery for the hernia in my esophagus.

My inclination is not to have surgery; however, the drugs I’m on haven’t been controlling my reflux symptoms like they used to. And I’m on the highest dose of things.

I was finally able to see someone at the pain clinic for this cervical spine headache in December. We are looking at doing a nerve burn in my neck–pain medication isn’t doing anything, nor are the non-invasive things like massage, etc. Friday, I had a nerve block, a sort of test to see if the nerve burn would work. The very temporary block had wonderful effects, although I’m sore and swollen from the procedure. My insurance company wants me to have another test block done before they approve the burn, which would be longer lasting.

Lastly, one of the drugs I need, xolair, is expensive and weird. When my insurance changed at the start of the year, I had to try to get reauthorized for it. It’s now almost the end of Feb–I’ve been off my drug for almost two months. Both my nurse and I have spent hours on the phone with insurance and hours on the phone with the specialty pharmacy. It looks like I might finally be able to get back on the drug next week, though my copay will be lots higher. And then the insurance company wants to reevaluate in June. Every dose they can prevent me from having saves them thousands of dollars.

The other big news is that my aunt Mindy is not doing well. She is now basically too disabled to work. She has been living with my cousin for the past few months. My cousin’s husband, however, is getting transferred to Guam. My aunt has been unsuccessful so far in getting insurance, etc. (The Southern States have not expanded medicaid to poor adults.)

The short version of this is that Mindy will be coming to live with me at the end of Spring. It will be a bit tight–I don’t have the money right now to move us to a three bedroom. But I at least should be able to get her the care she so desperately needs.

Work is fine. The students are understanding about papers coming back two days late the week Gma died. They are understanding and sympathetic about the awkwardness of a tube coming out of my face today. My stand-up class is a joy.

I gave a smart and amazingly attended presentation at a Writing Teacher’s Conference in January. Had a good MLA. I’ve applied to be the coordinator for the Upper Division Comp exam. I’ve got a paper coming out on (a)sexuality in Sherlock. The Prized Writing Ceremony went swimmingly–the Chancellor was there for the first time, and she enjoyed it so much that we’ve already scheduled next year’s so she can be there. I’ll present at pca/aca in April (no more conferences for the year, though–too broke). The Margaret Atwood journal is going online. I’ve been contracted by Cambridge for an Atwood collection. The authors are writing now. Denise and I are putting together a Simpsons collection. Melissa and I are putting together a collection of best comp paper assignments. There are and will be plays and movies and, in April, Willie Nelson. Book group still gathers here for food, wine, and cats. When HBO or BBC is doing something good, there are weekly movie nights too. The boyfriend cooks for me and distracts me and pleases me. Alexander is generally in good spirits. He doesn’t love all of his classes. (His classes are part of me being broke.) But we get along well.

Just today, he reminded me that I wasn’t allowed to use the microwave (due to the weird machine I’m wearing). Then, when I thoughtlessly went to the microwave half an hour later, I got the same tone from him that the cats do when they jump on the counter.

My friends are lovely. I miss you and love you all.

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What We Talk About When We Talk About Healthcare
Jul 4th, 2013 by Dr Karma

My job during my frequent trips to London is to try to explain Americans and American policy to our former cousins.

When I was first there in 2006, I had to explain how it was that W had gotten a second term.

Now they want to know about healthcare. About how people can believe that it’s okay to let your fellow citizens die for lack of it. About how we would resist a single payer system when it would cost less and deliver more. About why we think everyone having health insurance (the way all car owners have car insurance) would somehow make us all commies.

I can’t always give answers. I don’t know why members of my own family believe that if you don’t have insurance, due to its expense or due to pre-existing conditions, you should just be allowed to die. But they do. One told me that it was a shame, but it wasn’t his responsibility to keep anyone else alive–staying alive is a personal responsibility, you see.

It was Christmas, and we were told to stop arguing, so I didn’t say that other people’s tax dollars pay for his children’s school, blah, blah, blah.

I can’t explain these positions because I can’t even begin to follow the logic. My mother is furious right now because her sister is ill. Due to pre-existing conditions, my aunt has not had health insurance in decades. No primary care physician in their area will take her. No specialist will see her. Rather than looking forward to January, when the pre-existing condition problem won’t be a problem, or when Florida finally allows its healthcare program for the poor to be expanded, my mother’s response to this situation is to say:

“This is how it’s going to be for everyone when Obamacare kicks in.”

When asked to explain, she says she doesn’t “believe” that my aunt would be able to get health insurance under the new regulations. Instead, she believes that the new rules will mean that because my aunt doesn’t have insurance, the IRS will take away her house.

No, I can’t explain that to people, who, even though they don’t live here, understand Obamacare better than that.

(By the way, I’m not entirely happy with Obamacare. I would rather have a single-payer option. But I think the changes under Obamacare are better than what my family’s political party wanted to do–to blame my aunt and people like her for not having insurance and to watch while she suffers.)

What I can do is explain that many Americans have myths about the British healthcare system. That people believe Brits have to wait forever for care, that they can’t choose their doctors, that the quality of their care is low, that the government makes their health care decisions, and that they don’t like their own system.

These myths surprise my British friends.

The other thing I can do is challenge the myths they have about our system. Most of these myths are about what life is like for those of us with insurance.

Surely, they think, if my company and I are going to pay WAY more for my healthcare than it costs in tax dollars in the British system, I must have it good.

Then I explain some things:

1. My insurance company makes a lot of my health care decisions. These decision come in the form of them telling me that I’m not allowed to have something the doctor wants me to have. Yes, while the other side is terrified of the government deciding which asthma medicine I can be on, they are fine with a company making that choice–a company who bases that choice on their own profit.

2. I have to wait for care. Every time I need to see a specialist, it takes months. Once, when my son really needed to see an ENT doctor, my GP had to mark “urgent” on the referral to guarantee that he would be seen within two months. Insurance doesn’t guarantee prompt care.

3. Although I have insurance, I could still easily go broke due to medical costs. In 2001, I had insurance. I also had a significant health issue that ended in surgery (although the surgery didn’t completely resolve the issue). I spent over 1/3 of my gross income that year on healthcare. As I was a single mother making less than 20,000, it should come as no surprise that I am still dealing with medical debt from way back then.

In May, I was in an emergency room. A doctor came in and said I needed surgery and that he was going to call an ambulance to transfer me to a hospital that could do it. I am now supposed to pay over $800 for an ambulance that a doctor called for me.

This blows my mind. It blows the minds of the Brits.

After I explain how our system works, our cousins don’t envy us. And they don’t just feel sorry for Americans without insurance. They feel sorry for Americans with it too.

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Single Mothers–America’s Punching Bag
Feb 26th, 2011 by Dr Karma

On NPR’s Talk of the Nationthis week, they did a show on the public’s perception of single mothers. The show opened with this:

“The American family has changed. The nuclear family in the house across the street is still there, but different kinds of families live on the block, too: unmarried parents, gay parents, people who choose not to have children at all and, of course, single parents.

“A new Pew Research poll asked Americans about these trends and found almost 70 percent believe that single women raising children on their own is bad for society.

“Of course, there is a wide array of single mothers. Some women choose to raise children by themselves. Others find themselves without a partner through divorce or abandonment. But when seven in 10 believe this is bad for society, it makes you wonder.”

I was surprised that the anti-single mother numbers were still so high. As a single mother, I’ve encountered prejudice. However, few people where I live are willing to voice their single mother phobia. Or perhaps since most people who encounter me now meet me as a scholar before knowing that I’m a single mother, they don’t apply the stereotype of the single mother to me.

When my child was young, my friend Miranda said that people’s perception of me would be completely different if they heard her describe my college work before my motherhood. Some people who heard that I was a young mother first basically said Miranda must be lying about what I’d managed to accomplish and the fact that I was a decent/smart person.

As Talk of the Nation noted, not every single mother “chooses” to be one. I know two women who have chosen this as a path. All of the other single mothers I know are single because of abandonment, divorce coupled with social/financial disappearance, their partner’s death, or because the woman had to flee from abuse. Being a single mother isn’t how we expected our lives to turn out, but this is our life and we’re trying to make the best of it and to do the best for our kids, just like everyone else. Thanks for making it harder by demonizing us, America!

Would it be best to have more than one parent? Probably. I think more than two would be ideal–kids are amazingly exhausting. Of course, having one stable parent is better than having two sucky ones, though. The biggest issue for single mothers–the one that “causes” problems for children and society–is money. The children of financially well off single mothers end up doing just as well as their well off peers. Poor children tend to have a hard life no matter how many parents they have. It might be more productive to blame poverty–to blame a lack of access to healthcare and childcare–to blame the fact that single mothers will inevitably suffer from the sex wage gap we maintain in this country. Don’t fight single mothers; fight inequality.

If you still want to blame people, I can’t stop you. I can, however, suggest that you remember that it takes two people to have a child. Now, it’s not a man’s fault if he dies or if a baby is conceived in a way that leaves him out of social and financial responsibilities, but we all know that a majority of single mother are on their own and struggling financially because a man is not living up to his responsibility.

These men get to live without society’s stigma while the women they’ve abandoned take the brunt of it every day. They don’t have to explain to their bosses why they have to take off because a child is ill. They are free to date without having to find a babysitter. They will miss less work because their kids won’t be bringing home every little illness from daycare. They don’t have to worry about finding healthcare for anyone but themselves. They don’t have to worry about a new boyfriend or girlfriend being jealous or not even going for it because they don’t want to be a step-parent. They don’t get called sluts. If they’re up all night, it’s probably because they’re doing something fun, not because someone is throwing up on them or screaming from nightmares.

Some men are single fathers. I’ve known a few. Their ex-wives are absent for a variety of reasons–death, drugs, jail, etc. If the woman’s not dead, she is routinely dismissed by all the world as the most evil thing in the universe–much worse than a man who’s skipping out on his child. The single fathers are praised by all who know them. It is never assumed that they’re single fathers because of some moral failing. Many women find them admirable and attractive–what an obviously wonderful man!

The Pew poll didn’t even ask people about their attitudes towards single fathers. On the show, the pollster explained that it was because the vast majority of single parent households are indeed run by women. But we all know the other reason–single fathers are never seen as a “problem.”

My son’s father left me when I was seventeen, two weeks before I gave birth. We had been engaged, and I honestly didn’t think I’d have to do this by myself. My son is seventeen now. Those of you who know him know how amazing he is. Have I made mistakes? Yes, starting with not thinking I’d have to do this alone. Of course, we haven’t been completely isolated. My grandparents took us home with them for the first few months when we had no where else to go. Many men who have loved me have loved my son too. My friends have been amazing. They have forged my signature on school forms when I was at a conference. They have become his aunts and uncles. They have gone to music recitals with me both to make sure I wasn’t sitting by myself and because they honestly care about my child and want him to know it. Melissa even taught him to ride a bike when he needed it. No one ever raises a child completely alone.

Thus, I don’t deserve your praise, but I don’t deserve your scorn, either. The problem isn’t single mothers, it’s bad parents of either sex and of any marital status. Please be able to tell the difference.

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In the press today
May 20th, 2009 by Dr Karma

Some blogger believes I “forgot” things; not mentioning things in a non-comprehensive list is not to have forgotten them.  His title is also weird–I distinctly mention that there have been lawsuits, so his claim that they’ve not had them in 20 years is off.  The article is here:  http://reporter.blogs.com/thresq/2009/05/the-simpsons-20-years-of-lawsuitfree-funny.html

My touching tribute to Dom DeLuise (via my matchflick column) is here:  http://www.matchflick.com/column/1946

Was watching last night’s Daily Show whilst doing yoga this morning.  Newt Gingrich claimed that socialized medicine (aka universal healthcare) would be bad because bureaucrats would be making your healthcare decisions.  He said the responsibility for your healthcare (and he seemed to imply fiscal as well) should be on you (and your consultations with your doctor).

My doctor and I do make decisions.  But they all have to be approved by bureaucrats at the insurance company.  Those bureaucrats were forced to take me, but if I were a freelance writer, I wouldn’t be able to get health insurance at all.  Let’s not forget that other bureaucrats make my health care decisions at the law level–whether I can have medical marijuana, whether a doctor can use the word “abortion,” etc.

So there are three problems with Mr. Gingrich’s fear of bureaucrats.

1.  He’s fine with a lot of laws about what my doctor can say or do.  That’s government intervention in health care.

2.  Bureaucrats completely run my health care.  And the really bad thing is that they do so for profit, which means that they are not in any way motivated to make decisions based on what’s good for me or what’s medically better.  They are motivated to deny coverage because that’s what happens in a profit-based system.

3.  For all those without healthcare, they would love to have a bureaucrat deciding whether they can have their cancer treatment.  Right now, there is no “decision” available to them.  At least a bureaucrat might say yes.

Am sick of this “bureaucrat” scare tactic.  WTF do they think we have now, if not bureaucrats?  Who’s living in a place where all the decisions are made by you and your doctor?

Oh, wait, those people in countries with universal healthcare tend to have that freedom.

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