McCamy Taylor
McCamy Taylor's JournalHow Parlkand Helps the Chronically Ill, Low Income Folks of Dallas Get the Care They Need with ACA
By now, most folks have heard about the copper plated ACA insurance plans, the ones with the $5000 deductible and low availability of providers. Some people with chronic diseases like copd, dm, cad have signed up for this coverage because the premiums are so low--they can not afford to move up to silver or gold--even though they can not afford to use this new insurance.
http://money.cnn.com/2015/02/12/news/economy/obamacare-costs/?iid=EL
Have these folks withered away due to lack of access to their insulin, heart specialists and inhalers. Not in Dallas County, thanks to Parkland, the so called "charity" health care system.
Insurance companies are usually pretty good at guessing how much they will have to pay out in care costs for their enrollees. However, ACA was a new type of insurance. Folks with massive medical illnesses like congestive heart failure now qualified for the same plans that healthy people bought. Luckily for the privates, most people with truly devastating illness are on Medicare or Medicaid, However, there are some middle aged people who are quite ill who do not qualify for either, because they are not old enough and not poor enough. These are the folks who benefit most from ACA--and they are the biggest risk for the privates that participate in ACA. The high deductibles, coypayments and limited provider lists were supposed to cut down on insurance utilization.
Despite these measures, insurers under the ACA in Texas are asking for double digit premium increases next year, citing higher than expected utilization of insurance.
http://money.cnn.com/2015/06/02/news/economy/obamacare-rates/
High utilization? Really? How can folks with no money afford these high deductibles and copyaments? How can they find providers?
One way is by getting their health care at places like Parkland in Dallas. Two years ago, some public hospitals attempted to pay their patient's premiums in order to get them enrolled in private insurers which would then reimburse the public for so called charity care. As best I can tell, attempts to pay patient's premiums were thwarted. However, the public hospitals have a new way to help you get more out of your copper insurance plan. Parkland's solution---waive the high deductibles and copayments that are intended to keep patients from seeing doctors except in dire emergencies.
http://www.dallasnews.com/news/local-news/20150213-parkland-memorial-hospital-to-give-insured-low-income-patients-a-break.ece
This is a great deal for someone who has to buy ACA insurance because their income is just barely high enough to qualify but who can not afford a policy that really meets his or her health care needs. And, it allows a public funded hospital district to recoup some of its losses from Texas' decision not to expand Medicaid. However...
When a public hospital and clinic makes it easier for people to bypass the deductibles and copayments which were intended to discourage use of the insurance (and insurance company bills) this is turn leads to higher than anticipated spending by the insurers---and rate increases.
While some may call the rate increases unfair, remember that all urban residents pay for the unfunded care which their counties offer. There is no "free" care for anyone. We either pay more in property taxes or we pay higher insurance premiums. The important thing is that people with chronic diseases like cancer get the care they need.
Of course, in a "perfect" state, Medicaid would have been expanded, the feds would have stepped in to pay for the care of the low income, chronically ill uninsured people whom public hospitals have been treating with funds provided by local taxpayers. This would allow the privates who participate in ACA to focus on the not so chronically ill people who are not guaranteed to generate tens of thousands of dollars of medical bills each year.
So, if you do not like the sticker shock of your health insurance rate increase in Texas, maybe you should apply a little pressure in Austin to accept the Medicaid expansion. Texas cities are not sitting on limitless sources of wealth. They can not afford to pay all the health care costs of all their (older, sicker, poorer) residents. And right now, they are not paying all the costs. Folks with ACA insurance are helping them.
If you know anyone who rejects the Medicaid expansion because they do not want to be forced to pay for the health care of strangers, you might want to remind them that they are already paying. The Medicaid expansion will just make that funding more equitable.
A Hygiene HypothesisTheory about LADA
Someone asked me to repost this here. I am interested in the topic of HLA mediated autoimmune diseases being the result of the absence of parasitic infections to which our ancestors were routinely exposed. In the UK they are conducting trials using hookworm infections in patients with MS to see if the auto-antibodies can be distracted. The theory evolved because of observations that people who grew up in the old south rarely got MS while those who grow up in the new south are just as likely as those who grow up in the north to contract MS. In the old south, hookworm infections were common in childhood due to the habit of running around barefoot outdoors.
I recently speculated that Latent autoimmune diabetes of adults in which adults start out looking like Type 2 but eventually end up requiring insulin could also be an HLA mediated autoimmune condition brought on by the lack of a particular parasitic infection, because there are no cases of the disease in Papua, New Guinea but a fairly consistent rate of the disease in other countries. What if there is a parasite that is still common in New Guinea that has been eradicated in other countries? Here is the link to the original OP:
http://www.democraticunderground.com/114215052
I am beginning to suspect that the culprit might be trichinella, the round worms that you get from poorly cooked pork but also from bear meat, wild game and crocodiles. Trichinella is extremely common in Papua, New Guinea.
http://www.ajtmh.org/content/65/5/553.full.pdf
Here is some general info on trichinella
http://emedicine.medscape.com/article/787591-overview
Obviously, infection would be more common if you hunt wild game, especially if you eat freshly caught wild game before it has been properly cooked, the way that the hunters in Papua, New Guinea do. This raises the possibility that when hunter-gatherer groups like Plains Native Americans were forced onto reservations and switched to a diet low in freshly hunted game, perhaps they were inadvertently deprived of trichinella infections--- good thing, right? Unless the lack of a trichinella infection triggered some of them to then go on to develop LADA or the diabetes that plagues Native Americans.
Not saying we should eat raw bacon. But, maybe there is way to create a derivative of the proteins of round worms to see if it could prevent this type of diabetes.
Oh, and here is an interesting link about how worm "excretory products" successfully treated colitis in rats. Lots of links within the article to other articles about the hygiene hypothesis.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008629/
Please stop telling me I will vote for Sanders because I am a leftist.
I admit it. I am a leftist. Always have been and always will be. No one in Congress is left leaning enough to suit me. No one. They all play the same game---beg for dollars, pander for votes. Some of them are lucky enough to have constituencies (Vermont) that demand that they act like liberals. Some of them were unfortunate enough to have constituencies (New York) that demanded that they protect them from any more terror acts. They did what they did, because it is part of the job of being an elected official in the US. None of them have halos. All of them have feet of clay. All of them. The perfect candidate is one who would never run for office, because he or she is too busy leading protests or running a soup kitchen or raising awareness about an important cause. Everyone who runs for office has something slightly wrong with them. Everyone.
I will vote for the candidate who has the best chance of prevailing in November and who is best able to get the job done. The job being to obstruct the New Federalists and the Tea Party and all the other crazies on the right and maybe even guilt the members of Congress into not acting like total assholes 24-7 . I do not expect a president to single handedly change the structure of our government. He or she will have to know how to use the current system.
I am not looking for Eugene McCarty. I am looking for a second term of LBJ---LBJ as in Voting Rights Act, Civil Rights Act, Medicare. LBJ as in gets the job done. Competent. Crafty. Able to work both sides of the aisle.
Come on candidates. Show me your inner LBJ.
HRC: Real Change for a Change
Payday lending company fined for fraud. When folks in need of money---working people who were feeling the pinch of the recession---logged onto a website that promised to match them with banks that would give them loans, their financial information was sold to the payday lenders. Without signing an agreement, the financially strapped citizens suddenly found themselves with $300 more in their accounts---and then, at regular intervals, $90 was deducted from their accounts, for "administrative" fees. And then, their "debts" were sold to debt collectors who hounded them. These folks who were too poor to pay their bills, much less afford an attorney. Can you imagine how it must have felt, especially when they were told that by doing the query, they were actually agreeing to a "loan" with usurious interest payments? Yes, it is great that a court finally slapped the wrists of the Americans who thought it was just fine to rip off their fellow Americans---
But where is the politician who can change the mindset which says 1) a sucker is born everyday and 2) everything is ok if it makes a profit? This double fallacy has deep roots in our country. Our puritan ancestors claimed that material wealth in this lifetime was proof that one was among the elect. And so, we worship at the altar of money---no matter how that money is made. Donald Trump becomes a realistic presidential candidate because he (sometimes) is rich.
Physician going to jail for giving folks (dangerous) chemotherapy that they did not need, because some of them had cancer that was too progressed to benefit, meaning that he probably shortened their lives and increased their suffering. Others did not even have cancer, and yet he exposed them to carcinogens. "First do no harm?" Nope, in this country, it's "Every man for himself." He was caught and charged---with defrauding Medicare. Yeah! A victory for the common man! But what about the little old man in the nursing home who could not get out of bed, his dementia was so bad, the little old man who got a bright and shiny new hip---and then promptly died from post operative complications? He was never going to walk again, and yet, some doctor saw a hip that could be replaced, and he jumped right in and did the surgery. And billed Medicare. What does it say about our country when the health care providers are always on the look out for a good financial investment---like a diseased joint that can be replaced---rather than the welfare of their patient?
We need economic justice---but we won't get it from the top down. If we cut off one of the hydra's heads, two more will grow back. Don't kid yourself that the evil lurks out there somewhere, on Wall Street. The "evil" is within us. It is the voice which tells us "I am me and a few other people are also me and everyone else can go die for all I care." It is the voice which tells us "First, my needs get taken care. Then, I'll start thinking about other folks." It is the blindness which cannot see that we are all connected, that every "dog starving at his master's gate, predicts the ruin of the state'" (Blake) and that every crying child is shedding our tears, tearing a great big hole in our heart.
We will never excise suffering from our lives, because suffering is part of our life. We will never eliminate all the risks, because life is risky. But we can change how we think. We can open our eyes, take a good, long look at the faces of children who are suffering----
And acknowledge that their suffering is our suffering. That revelation does not fill the empty bellies or take the gun from the hands of the child soldier. But if enough of us look and really see, then the change will come from within us---
And that is Real Change for a Change.
Now, some worry that protecting the human rights of the LGBT community is a luxury that only wealthy nations can afford. But in fact, in all countries, there are costs to not protecting these rights, in both gay and straight lives lost to disease and violence, and the silencing of voices and views that would strengthen communities, in ideas never pursued by entrepreneurs who happen to be gay. Costs are incurred whenever any group is treated as lesser or the other, whether they are women, racial, or religious minorities, or the LGBT. Former President Mogae of Botswana pointed out recently that for as long as LGBT people are kept in the shadows, there cannot be an effective public health program to tackle HIV and AIDS. Well, that holds true for other challenges as well.
The third, and perhaps most challenging, issue arises when people cite religious or cultural values as a reason to violate or not to protect the human rights of LGBT citizens. This is not unlike the justification offered for violent practices towards women like honor killings, widow burning, or female genital mutilation. Some people still defend those practices as part of a cultural tradition. But violence toward women isn't cultural; it's criminal. Likewise with slavery, what was once justified as sanctioned by God is now properly reviled as an unconscionable violation of human rights.
In each of these cases, we came to learn that no practice or tradition trumps the human rights that belong to all of us. And this holds true for inflicting violence on LGBT people, criminalizing their status or behavior, expelling them from their families and communities, or tacitly or explicitly accepting their killing.
Of course, it bears noting that rarely are cultural and religious traditions and teachings actually in conflict with the protection of human rights. Indeed, our religion and our culture are sources of compassion and inspiration toward our fellow human beings. It was not only those who’ve justified slavery who leaned on religion, it was also those who sought to abolish it. And let us keep in mind that our commitments to protect the freedom of religion and to defend the dignity of LGBT people emanate from a common source. For many of us, religious belief and practice is a vital source of meaning and identity, and fundamental to who we are as people. And likewise, for most of us, the bonds of love and family that we forge are also vital sources of meaning and identity. And caring for others is an expression of what it means to be fully human. It is because the human experience is universal that human rights are universal and cut across all religions and cultures.
Secretary of State Clinton speaking on International Human Rights Day, 2011, Video at link
http://www.state.gov/secretary/20092013clinton/rm/2011/12/178368.htm
The Trap of Hero Worship in Presidential Politics.
I have seen disillusionment first hand. From JFK through Jimmy Carter all the way to Barack Obama, I have seen Democrats turn their presidents into Idols and then watched them despair as they realize that their "Idols" have feet of flesh and blood---they are human after all, with human weaknesses, human failings.
When I see words like "champion" applied to a presidential candidate, when I hear folks express the firm conviction that a single man or woman can change the entire system, I feel a little wistful, a little sad, because all of us are like this to start with. All of us imagine that our president will be the perfect father (or mother) who will make it all ok. We all want to believe. We all long to relinquish our duty to be eternally vigilant, to let some all-wise father (or mother) in the sky make all the hard choices. And, Judeo-Christian-Muslim or not, we all hope for the cleansing fires of Armageddon which will purge the earth and return us to paradise. The whole American immigrant scene is about casting off the old and embracing the new----
Maybe it is a necessary Rite of the Springtime of Youth. I once worshiped at the feet of George McGovern. I once nursed the hope that he could win and that our country would be restored, the war in Vietnam stopped, equality under the law become a reality rather than just lip service. I still have my McGovern buttons on the wall. I still remember him fondly as the president who might have been---
And then, I think about those who were not crushed by dirty tricks, those who managed to get elected, and how the office of the POTUS changed the men rather than vice versa, and I know that no single woman (or man) will ever be able to use the office of the President to enact the kind of change this country needs. The system does not allow for it. The president can declare war. Period. Everything else---the executive decrees, the cabinet appointments, the judicial appointments are all subject to the whim of Congress and the Courts and the corporate news media and Main Street and Wall Street.
If you put all your eggs in the presidential basket, you will be disappointed. Real change will only come when every one of us spends every waking moment working for it. In all aspects of our life. How we raise our children. How we shop. How we work----
Here's something to consider. Al Gore won in 2000. Do you think you would like and respect Al Gore even a fraction as much as you do now, if he had been sworn in as president?
The Oval Office is no place for heroes. The Oval Office is for work horses, people who slog through their days, getting the job done with little to no thanks once it is all over. People like Barack Obama. Barack Obama, who, not so long ago, was the mythic hero of the Democratic Party, the embodiment of Change. Had John McCain stolen the 2008 presidency the way that Bush stole it in 2000 and 2004, what would Barack Obama be to you, now? Would he be the perfect president who never got his chance? Would all the glamor of 2008 have survived intact? Would you love him, worship him still? Somewhere, deep in your heart, don't you regret that the myth, the dream had to wake up and face reality and become just a man with a job?
Wanted: a president of the united states. Must be able to work with others. Must be able to compromise. Must be able to plan ahead and see the big picture. Must be willing to accept reality and do what can be done, not waste his (or her) energy trying to accomplish the impossible. Must be thick of skin, because no one gets out of the White House with her (or his) popularity intact. Must be ever vigilant, because those who pretend to support you are always ready to stab you in the back. Must be a lot like Barack Obama---the president, not the candidate.
There is one thing to be said for being a political realist rather than an idealist. I have been pleasantly surprised by the Obama presidency. He has done much better than I imagined he would. Behind all the hype and hero worship, there was someone who was truly capable.
If you have a candidate to sell me, don't tell me that he is the champion or the hero or the savior of his nation. Tell me how hard he works. Tell me that he will keep smiling when the courts and Congress make it impossible for him to do all the things he planned to do. Tell me that he will be ever vigilant. Tell me how he can compromise and make deals. Like FDR. Like LBJ. Like Bill Clinton. Like Barack Obama. If you have another Jimmy Carter or Al Gore, save him. He will be better for his country as a private citizen than as president---
And here is a secret, something that I do not (usually) talk about, because I know that she is our best hope. She outscores all the GOP candidates by double digits. And yet, a part of me would love to see Hillary Clinton spurn the office of the president. I would much rather see her go on to become all that she can be as the universal champion of women and children and the disenfranchised and the oppressed. Hell, if the Dems come up with a candidate who can pull her kind of poll numbers, I would encourage her to drop out. Because, like Al Gore and Jimmy Carter, I suspect that she might be wasted in the office of the POTUS. I think Bill Clinton may have been right when he said that Gore and Hillary were the two most passionate idealistic people he had ever known, meaning that both of them are too good for the office of the president----
Scary thought. But then, hero worship has no place in presidential politics.
"Amnesty, Abortion and Acid" and the 800 Pound Gorilla
The beauty of a politician new to the national scene---he or she can be anything you want them to be. A fresh slate is so welcome when the political climate is unfavorable to the status quo, as it is now. Jimmy Carter and Barack Obama proved that Democrats and then Americans will vote for change, without paying much attention to the details. When you hate your life, feel alienated from your country and are close to despair that you live in the new Roman Empire, change sounds good.
But there is a flip side to everything. When you nominate a new candidate, one who is not well defined in the eyes of the general public, you run the risk that your party's opposition---in this case, the RNC, will use its virtual control of the mainstream media to paint your candidate in an unflattering or even scary light.
Just look at what they did to poor old McGovern. Straight shooting, war hero McGovern. By election day, 1972, America knew that he was the candidate of Amnesty, Abortion and Acid, to paraphrase a quote by Bob Novak, which Novak probably invented himself, but then attributed to an unnamed Democrat (he later smeared Thomas Eagleton, who could not defend himself) in order to paint a picture of a man who was too extreme even for the Dems. And any man too extreme for the Dems must be-----a frigging communist. Or, at the very least, a socialist.
So, what was it that freaked out America over the phrase "Amnesty, Abortion and Acid"? What was so damned scary about letting the boys come home from Canada, giving women the right to choose and decriminalizing drugs? Nothing, if you were a left leaning Democrat. But to the proudly apolitical "independent" vote that wins elections in this country, "Amnesty" meant Privilege---as in "my son/neighbor/husband" was drafted and died and now you want to give some other mother's son a free pass? It also meant Fear, as in "Who will defend us from the violence that we see on TV and in the streets?" What about "Abortion"? Abortion meant run away mothers, women burning their bras in the street, a world in which men were being told that they were the "enemy" simply because they had a Y chromosome. And "Acid'? Acid was the Manson Family, an evil that could turn all-American boys and girls into monsters. Acid was bikers. Acid was your son or daughter hurling himself or herself from a roof. Acid was "chromosome damage" (a lie) that would bring the human race to a dead standstill if it ever caught on. Acid was the road to hell on earth. Even the name, "acid" was scary---acid does not heal, it destroys.
Nixon taught us a valuable lesson in 1972. He had the election in the bag, but his desire to (over)compensate for his narrow win in 1968 led him to pull out all the stops. Tactics which were more or less commonplace (attributing slurs against one Dem to another Dem, interfering in primary politics) were combined with some that were downright illegal (break ins) in a way that made usually apathetic Americans angry---because Americans do not like to be taken for fools, even if many of them vote foolishly.
What else do Americas dislike? Mean spirited politicians. Political dirty tricks----
By the way, has anyone else noticed the 800 pound gorilla in the room, the one that no one talks about? Why is no one talking about it? Let's make an educated guess based upon some recent history. Sen. Sanders has a political weakness, one that will be almost as tough to overcome as being Black was for our current president and being a woman will be for Clinton. Hint: what religion do 7 out of 10 Americans believe in according to the most recent Pew Polls?
So, here is my prediction for the Dirty Trick of Choice in the 2016 Democratic Primary. As much as the RNC would like to see a Jewish, Socialist Anti-American (because he makes no bones about thinking the Western European way is the better way and for most Americans New England is just a hop, skip and a jump from the real England) as the Democratic nominee so that they can have one of their paid media tools call him a Blank, Blank, Blank (and attribute the quote to a Democrat, preferably a Clinton supporter), it ain't gonna happen. Because Dems got burned in 1972, and our political memory is much longer than that of the so called Apolitical Independents. We will never forget "Amnesty, Abortion and Acid." No, we will nominate our first round draft choice, the one that beats all the Republicans by double digits---and then, in the middle of the primary, we will see a replay of the really dirty trick of the 2008 primary season, the one called the Race Memo. The one that almost certainly came from the RNC and was fed to a gullible Obama staffer. Except this time, it will be the Religion Memo. We will see media pundits tell us how the Evil Witch Hillary Clinton is using her opponent's religion to "crib death" his campaign. We will be told "She can't win fair and square so she is going to use poor, honest Bernie's Jewish heritage against him. That b-word!"
It is gonna happen. It is more or less inevitable. Unless we acknowledge the 800 pound gorilla in the room now. So, I propose that we have a frank discussion of religion in the primary. Yes, I know that Democrats do not give two flips about their candidates' religion. If we care at all, we prefer that they not be too religious. But if we are going to discuss gender (which Clinton has going for her in the primary and against her in the general) then we should also discuss religion (which Sanders has going for him in the primary and against him in the general). Not discussing it will not make the issue go away---it will just allow the RNC to frame the national debate in whatever way suits them best based upon the delegate count in January 2016. If Clinton is ahead, she will be the antisemitic she-demon who stole the election from an honest Democrat. If Sanders is ahead, he will be "out of touch with mainstream America" (that's how the mainstream media will put it, along with a nudge, nudge, wink wink.) And either way, Democrats get divided and conquered---and the Apolitical Independents say "Ooo. Dirty politics. This is why I don't vote." And you know which party does better with a low turnout.
New Sleep Apnea book online, you can get it free
New nonfiction at Amazon, the third in my series about sleep disorders. In "Life With CPAP" I discuss the tricky to diagnose and treat CENTRAL sleep apnea (as opposed to the more common but still massively underdiagnosed OBSTRUCTIVE sleep apnea). Sorry if I blinded you with my capitals. I also go over recent advances in treatments of both kinds of sleep apnea and give a critique of the state of medical education when it comes to sleep disorders in this country. Two word: piss poor. Why should you care? Because if you are an American over 40, there is an 8% chance that you have undiagnosed sleep apnea. Would a family physician with a Masters Public Health kid you about something like that?You have more chance of having an undiagnosed sleep disorders than you do of having HIV or diabetes---but I'll bet a lot of you get screened for both every year. If you or someone you love/sleep next to/resides in the next apartment and you can hear his snoring through the walls has 1) elevated blood pressure in the morning 2) unexplained excessive urination at night 3) restless sleep 4) always sleepy and tired 5) ache all over 6) have migraine headaches that never stop 7) can't remember things like you used to 8) have been told you are bipolar even though you have never had a manic episode in your life 9) have angina that wakes you from sleep 10) have mini strokes that wake you from sleep 11) have really freaky dreams about running in slow motion or smothering, 12) had a recent car wreck for no good reason that you can remember----go get a sleep study! All three books will be free at Amazon for Kindle from Friday to Sunday and, as usual, I will send a free word document of any or all three of the sleep apnea books to anyone who sends me an email at McCamyTaylor@earthlink.net. Spread the word! The life you save may be a family of four that does NOT die in a fiery road accident when someone with undiagnosed OSA falls asleep behind the wheel. Remember, people with untreated sleep apnea have the same accident rate as drunk drivers---meaning that 8% of adults over 40 drive as if they were drunk even when sober. If you aren't scared, you should be.
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