Thursday, May 19, 2011

Health Care Reform in America

In my previous post, I wrote about my recent cataract surgery and pending corneal transplantation surgery. I consider my healthcare costs to be very high, easily equaling half my income. But at least I was able to get my eyes operated on and perhaps my vision will be saved before it's too late. What about those without insurance? What about those who delay care or never see an opthamologist and must accept blindness? I will not accept that in the world's richest and most advanced country that we have this as the sad reality, that more than 30 million people do not have health insurance nor access to the medical care they need.

I'd like to make an analogy to help explain Healthcare in America before the Affordable Care Act (so-called "Obamacare") was passed last year. If you have used airline travel since deregulation in 1978 when all government controls over routes, fares, and market entry were removed, you know it is very difficult to understand the costs and services for air travel today.  The consumer cannot compare costs and services very well because there is little or no transparency. Most of us use middlemen (travel web sites or Travel Agents) to book our travel and,  like insurance agents, they get a piece of the ticket price.  Corporate/business flyers who travel the most get a lot of bang for their buck including Frequent Flyer Programs that bring them free additional air travel. People of moderate income or those who travel less, are confronted with different levels of confusing rates and lots of additional expensive fees for baggage, meals, legroom and the like.  One airline passenger will often fly for an inexpensive discount fee of $200 right next to a full fare traveler paying $600 for the same distance, seat, and service (kind of like the middle class consumer who may have employer-provided health insurance or who must purchase health insurance individually).  Of course, there are those who can't afford to buy the airline ticket at all and they must be satisfied taking the bus or train, taking a while longer to get to where they need to go or passing up on the trip altogether (like small businesses, the poor, and those with no health insurance at all).  Then there are those on the "No Fly List" (equivalent to health care consumers with "pre-existing conditions")  who cannot fly at any price.  They end up "thumbing for a ride" hoping that maybe someone will pick them up and get them all the way to where they need to go.  That, in a nutshell, was how healthcare in America has been working.

For those who know me or have read previous posts from me on health care, you know that I am a supporter of the Patient Protection and Affordable Care Act of 2010 and that I follow legislation on insurance companies and on health care reform very closely. During my life, I have experienced military healthcare (back then, it was US Navy Hospitals and clinics) as a dependent of a career Marine, college student on-campus health clinics as part of my student fees, community clinics and Planned Parenthood clinics on a sliding scale basis, no insurance at all when employed by small businesses, employer-provided medical insurance where I paid 0-20% of the premium, Health Savings Accounts (HSA's), COBRA Insurance Continuation Plans where I paid 102% of the insurance premium, and finally a State Plan for people with pre-existing conditions unable to obtain an individual insurance plan. I have also negotiated with employers and insurance companies as the chief negotiator of my labor union for healthcare and dental insurance benefits. In addition, my father-in-law was a physician as is my sister-in-law. I currently have a daughter without medical insurance on a waiting list for State Coverage Insurance (SCI) because enrollment is full. She pays for her few doctor's visits with cash or goes without medical care or has had to go to the UNM Hospital emergency room for emergency care,  waiting for as much as 11 hours and leaving without treatment. My husband is a disabled veteran and gets free medical care from the Veteran's Administration using the VA Hospital and doctors here in Albuquerque. He has recently signed up for Medicare - Part B after delaying for 6 years, so now he can get medical care in non-VA facilities for a monthly low premium and co-pay.

I mention all this to illustrate that I am very familiar with the state and cost of health care in America on a personal and first hand basis. Due to an abundance of misinformation about the Affordable Care Act, most people are ignorant of the provisions and benefits of the new health care law. An easy to understand website and navigating tool to help families, small businesses, and individuals currently without health care select the health care option that fits your needs under the Affordable Care Act is here.  The new law, passed a little over a year ago,  is comprehensive reform of insurance-based medical care and government-run programs like Medicare and Medicaid,  implemented over a four year period. Among its many benefits, the law creates transparency for the consumer on costs and quality of care, provides tax incentives and assistance to help small businesses and low income persons and persons with pre-existing conditions to obtain medical insurance, insures that medical pools are large enough to keep premiums in check, reduces or eliminates student debt for those who obtain medical training and degrees and agree to serve in high need community clinics, increases the number of community medical clinics, stops insurance companies from denying individuals insurance because of pre-existing conditions, prevents insurance companies from cutting off patients with serious medical conditions, implements cost-saving initiatives that reduce costs and fraud while improving care, and provides financial incentives for early retiree reinsurance for employers whose employees (age 55-64) retire before Medicare benefits start at age 65.

Unfortunately, there are such partisan divisions in our country so that healthcare reform is struggling against a tide of well-financed propaganda .  During 2009-10 when health care reform was being discussed and legislators conducted Town Hall meetings to explain elements of pending legislative bills, Americans for Prosperity helped organize inflammatory rallies that created and perpetuated myths about  health care reform comparing it to genocidal campaigns of Stalin, Hitler and Pol Pot.

Americans For Prosperity is bankrolled by the Billionaire Koch brothers that tries to paint the Affordable Care Act as "socialized medicine" and Republican politicians are trying very hard to undo and unfund the Affordable Care Act. In my State, the Republican governor vetoed the establishment of a Healthcare Exchange passed by the State legislature. Her veto rejects $1 million from the federal government to help New Mexico set up a marketplace of existing insurers for consumers to compare and purchase healthcare insurance products in preparation for the full implementation of the Affordable Care Act in 2014. This kind of thinking that "if we don't pass any laws preparing for ACA, it won't happen" is not only short-sighted, but is irresponsible to the majority of citizens of New Mexico who seriously need affordable healthcare. Indeed, 25% of New Mexicans have no medical insurance at all.

There has been plenty of criticism of the new health care law from both sides of the political spectrum. Many voters representing the left wing of our country were disappointed that the health care law passed in 2010 was not Single Payer or Universal Health Care and they bemoan that private insurance-based medical care will continue to raise premiums to enrich corporations.  Other voters of the right wing and the Tea Party criticize the new health care law as another "big government program" that puts government controls on our relationship with our medical provider.  Given the extreme political divide in Congress and among the voters, it is my opinion that compromise is the only means to make meaningful changes in reforming health care today.  To do nothing at all would have been unacceptable given the huge medical cost that eats up our national budget as well as family budgets.   Further, it is unacceptable that our wealthy country has so many citizens who cannot get health care at an affordable cost or even at any cost at all.  After years of doing nothing because of intimidation by the health care industry, finally our leaders in Washington acted to craft reform.  They ought not to be castigated, but instead, they should be applauded for their courage to act.

Wednesday, May 18, 2011

Regaining My Sight

This posting is about my adventures in navigating the world of medical diagnoses and treatment in my advancing (but still pre-Medicare) years. For the past three years, my vision has steadily deteriorated. This has affected my life in many ways. 

At 60 years old, my eyes have problems

 Driving any great distance has become difficult after a few hours so that I no longer travel alone when I drive out-of-state.  After driving for a while, road signs become difficult to read and the field of vision resembles a "white-out".  At night, headlights flare up and blind me, the sides of the road are so dim I fear that a person or animal might be hit by my car if they are in the road.  I drive with my bright headlamps whenever possible.  Other ill effects are the loss of acuity and bright color that have affected my art and photography hobbies. My interest and time spent on reading has diminished as my eyes tire easily.  Driving any great distance has become difficult after a few hours so that I no longer travel alone when I drive out-of-state.  After driving for a while, road signs become difficult to read and the field of vision resembles a "white-out".  At night, headlights flare up and blind me, the sides of the road are so dim I fear that a person or animal might be hit by my car if they are in the road.  I drive with my bright headlamps whenever possible.  Other ill effects are the loss of acuity and bright color that have affected my art and photography hobbies. My interest and time spent on reading has diminished as my eyes tire so easily. 

My mother had Macular Degeneration and eventually went totally blind in the last year of her life.  She lived alone and loved to read, crochet, and play cards and so her quality of life was very much affected by this debilitating disease.

My mother at age 76

 She continued her reading interest through the help of audio books for the blind available from the federal government for free.  She finished over 500 audio books in her last two years of life. Macular degeneration has become a major cause of blindness among the over 60 age group. Currently, 6.5% of adults over age 40 are estimated to have macular degeneration. You can use an Amsler Grid to help you identify and monitor this condition.

Amsler's Grid
I have worn glasses or contact lenses for my near-sightedness since I was about 11 years old.  After I reached 50 years of age, I had to get bifocals as my near sight became worse so that I could not read fine print nor thread a needle.  In 2008, I began to notice a film or curtain-like blurring of my vision, particularly in the morning, gradually clearing during the day.  Naturally, I feared getting macular degeneration so I went to an opthamologist in April, 2008 who diagnosed me with Dry Eye Syndrome and prescribed over-the-counter eye drops to moisten my eyes and suggested I take ICaps, a vitamin and mineral dosage formulated for eye health. There was no evidence of Macular Degeneration and I started using Systane eye drops and ointment and ICaps (both quite expensive). My vision only got worse over the next year and in February, 2009, I went to an optometrist for new glasses.  He informed me that I had scarring on my cornea and that I should see an opthamologist to investigate possible eye diseases and disorders (he wrote down a few possibilities such as Blepharitis and Fuchs' Dystrophy). I saw a new opthamologist at Eye Associates in July, 2009 and gave him the note from the optometrist suggesting possible eye disorders but the new doctor did not discuss these with me.  He confirmed the Dry Eye diagnosis and said I could have a choice of treatments: silicone plugs inserted into my tear ducts or a medicine called Restasis.  He discussed neither option with me regarding their effectiveness nor their costs to me.  I selected Restasis eye drops. The Restasis immediately cleared my vision much more effectively than Systane.  However, I was unprepared for the high cost of this medicine for which there is no generic formulation.  The retail cost was $238 for one month.  Because I have the "privilege" of paying a private medical insurance plan premium of $633 per month, my insurance co-pay for Restasis was a "mere" $75 for one month.  Restasis comes in single use vials for which you use one drop per eye and discard the rest.  You use two vials per day.  Although there was enough medicine in the vial for two doses, the instructions tell you to throw away the unused portion for fear of bacterial infection. In January, 2010 I saw my opthamologist again and told him the cost of Restasis was too high and he inserted the silicone plugs (took 5 seconds: $600 billed to my insurance company, $50 co-pay for me).  He also told me that I could "save" the unused open vial of Restasis by refrigeration in a plastic bag, thereby getting twice as much medicine than before.  (Now he tells me!)

In March, 2010, I sought out my opthamologist again, having no relief to my blurry vision, pain in my eyes, and my vision was getting worse.  He examined my eyes and announced that I had possibly "Fuchs' Dystrophy" and he referred me to a specialist in Fuchs' at Eye Associates for a corneal transplant.  Well, I was sort of in shock.  I didn't know what to ask. I knew nothing about Fuchs.  I figured that I would discuss this diagnosis with the new doctor, Dr. Kenneth Himmel.  The next appointment available was more than 6 months away, in September.  I went home with so many questions and felt like I was blind-sided.  I began to search "Fuchs Dystrophy" on the Internet to answer my questions.  After discovering that this was an autosomal dominant genetic disorder, I wondered if my mother had been misdiagnosed with macular degeneration, or if my father was undiagnosed as he had many of the symptoms I now have but such symptoms were subjugated by his more serious diagnoses of Alzheimer's Disease and Parkinson's Disease.  I found an Online Support Group and began to teach myself about the disorder and it's outcomes. Since Fuchs' is a problem with too much moisture in the cornea, I couldn't understand why I had "Dry Eye" treated by adding moisture.  I called my doctor who explained I had "both" disorders.

In September, 2010, I was examined by Dr. Himmel who said I definitely had Fuchs' Dystrophy as well as mild cataracts in both eyes. My left eye was 20/25 with corrective lenses and he suggested I return in 6 months.  Eventually, I would have to have a corneal transplant, but not yet.  But in January, 2011, I felt my eyes were getting much worse and I scheduled an appointment with Dr. Himmel and found my left eye was now 20/40 corrected.  He suggested that I have cataract surgery followed by a corneal transplant 4-6 weeks later.  He said it was up to me and my comfort level as to when I should have the surgery -  now or later.  Otherwise, he'd see me in 6 months for follow-up.  I left thinking I would wait but after thinking about the surgery, I decided it was better to go ahead rather than to wait until I couldn't see to drive or work at all.  I scheduled the cataract surgery for May 16 and the corneal transplant for June of this year. 

 On Monday, May 16, I had the cataract surgery on my left eye at the Albuquerque Ambulatory Eye Surgery Center where the procedural cost without insurance is apparently about $3600, purportedly the least expensive cataract surgery in town.  I was in at 6:15AM and out by 8:30AM. The procedure was efficient and painless with only a slightly bruised and swollen hand where the IV was.  Insurance co-pay was $350. Co-pay for eye drop prescriptions: $95.  My eye was blurry for a day and a half. Now the vision is crystal clear.  Everyone who has had cataract surgery, including my husband, informed me that it is "a piece of cake" and I would be quite happy with the results.  Eventually, I will get a new eyeglass prescription but I must wait until I have the corneal transplant and recover from that. I'll see Dr. Himmel next week, and we'll discuss my prognosis.

Meanwhile, my neighbor and good friend, Cathy, thoughtfully brought me flowers (smile)  and my husband took very good care supporting me during the whole routine (love).  Good medicine to be sure!

My friend, Cathy

I hope all goes as well for the future surgeries on my eyes.  The corneal transplant is a lot more involved and riskier.  For now, for the first time in three years, I'm hopeful that I will recover my full vision.   
Me and my youngest daughter, Mary, on Mother's Day, 2011
Post Script: After seeing my doctor May 24th for follow-up on the cataract surgery, we decided to postpone the corneal transplant surgery.  My vision (corrected) now is 20/40 in the left eye and 20/25 in the right eye.  I think I can live with that for a while.  We'll evaluate the vision in June, and see if we proceed with cataract surgery in the right eye or the corneal transplant in the left eye in the near future.

P.S.S. Saw my doctor December 5, 2011 and am now scheduled for the DSAEK Corneal Transplant for late January, 2012.  I'll keep you posted on the results.

Tuesday, May 10, 2011

Waging Terrorism and the Bitter Fruit It Yields

Many people are happy that Osama bin Laden has been killed.  He was the symbolic and literal leader of a radicalized Islamic movement for the past 20 years.  His message spread violence and false aspirations among some of the world's most oppressed people.  His political goals were hatred and intolerance for any person who did not support his interpretation of Islam. This led to the loss of life for thousands of innocent people, mostly Muslim.  How did this man come to be such a contentious symbol  -- hated and loved, feared and revered -- by hundreds of millions of the people on this earth? And how does his death teach us important lessons?

Osama bin Laden was a wealthy son of a Yemeni porter who, despite humble beginnings, was able to build a great business fortune in Saudi Arabia through his connections with the powerful Saud and Faisal families. His father gave him everything he needed except perhaps a close, loving relationship.  He was the seventh son of 50 children.  Biographies of Osama report that his father had a dominating personality and insisted on very strict discipline with his children.  Osama's father died when he was 13 years old.  The great family wealth allowed him to marry early (at 17), pursue a comfortable life while completing a degree in Public Administration in 1981, and to travel throughout the Middle East where he became an activist in the jihad against the Soviet Union's invasion of Afghanistan.  He was able to collect money from wealthy Muslims and bring construction equipment to aid the fight against the invaders in 1982.  By 1984, he was well established among the Mujahedeen (Afghan Freedom Fighters) and built camps to help train fighters.  By 1988, he created a more disciplined and organized infrastructure called Al-Qa'edah to facilitate communication.  When the Russians were defeated in 1989, he returned to the Kingdom, calling for a new Jihadhi front, agitating against Saddam Hussein and warning of a potential Iraqi invasion. Embarrassed with his rising agitational influence against Iraq that was currently a friend and not a foe, the Kingdom prevented him from traveling at that time.  But after Saddam Hussein invaded Kuwait in 1990, Osama bin Laden was seen as prophetic in his call to fight Iraq. He sent letters to the Saudi King offering military advice and the assistance of the Arab Mujahedeen.  He was ignored and when the Americans came to the Kingdom in January, 1991, to fight Iraq, Osama was outraged and humiliated.  It was after this that he began his Jihad against America and the West, establishing base camps in Pakistan and Afghanistan to train fighters against the western "invaders".  His radical agenda for Al-Qa'edah was now to organize a world-wide terror network.  He trained impressionable young men who had no personal freedom or future in their own countries headed by dictators who appeared to have sold out to western powers and allowed American military bases to be established on Arab lands. Within 10 years, with numerous successful terrorist attacks under their belt, Al-Qa'edah completed their greatest attack in the heart of America on 9/11/2001. 

I repeat some of this highly simplified history only to remind us that Osama bin Laden was an opportunist who was able to develop a great following for his radical philosophy because of a number of factors: dictatorships and absence of democracy in the Middle East and Africa being primary, but also:  inequality, lack of economic opportunity, corporate greed, the Cold War, ignorance and poverty, American complacency, disregard of good foreign intelligence in the Middle East, and last, but not least, some really bad foreign policy decisions by the USA.  Hopefully, American foreign policy and our application of military solutions to the complex problems of the Middle East  is changing under President Obama.  The Arab Spring is a sign that the people who have suffered the most because of the above, have now taken things into their own hands and are demanding democracy and self-determination.  We Americans need to support their aspirations.  We need to stop using military solutions as our first response.  We need to "trust" that the people in the Middle East and Africa truly aspire for those very things that inspired the birth of our own country:  freedom, equality, and self-determination.  Osama bin Laden and the strategy of terrorism found acceptance among opressed Muslims because larger and more powerful Nations ignored this simple fact.  On the other hand, terrorism did not deliver the sweet fruit promised to its followers.  The false ideology resulted in hundreds billions of dollars spent by wealthy nations not to support democracy, equality, education and economic development in poor and opressed nations, but rather for national security, military armaments, and war. The bitter fruit that terrorism provided did not nurture the souls or bodies of the hungry millions of people in Afghanistan, Pakistan, Yemen, Sudan, and the like.  Indeed, it is ironic that after 20 years of Al-Qa'edah's campaign against Western ideas and for the destruction of dictatorial rule in Islamic countries, that the real destruction of these dictators was by the uprising of ordinary people who aspire for democratic rule and equal rights, and that it was largely accomplished via non-violent protests by unarmed young people wielding their cell phones.

Now that Osama bin Laden is dead, I hope that a new chapter is starting for Islamic nations that brings new hope and true reforms within their countries.  I also hope that we Americans continue to develop a new foreign policy that relies on mutual respect and interdependence rather than military solutions to resolve differences.  I hope that we support nascient democratic institutions in the Middle East and Africa with financial and material support. I hope we withdraw our troops from Afghanistan starting now.  I hope we use all our influence to support a  peaceful resolution to the Palestinian Question.  Most of all, I hope that the people who are valiently fighting for freedom and democracy in the Middle East and Africa do win their struggle and that men and women achieve full equality and that each individual is forever more treated with dignity and may achieve their life goals.  That will be the sweet fruit yielded from a democratic revolution.

Thursday, May 5, 2011

May Musings: Wildflowers and Mother's Day

Hedgehog Cacti - Monte Largo Mountains, New Mexico

It's May.  Almost Mother's Day.  The Hedgehog Cactus is blooming. Hiking the trails in the Monte Largo Mountains behind Sandia Knolls where I live, you can find these Claret Cup or Hedgehog Cactus blooming profusely this month.  The elevation here is about 7000 ft. Most wildflowers are sparse due to a very dry Spring but the conditions are fine for these xeric plants. They do best on sunny southern-facing exposures of rocky soil and protected from strong winds beneath pinon pine (Pinus edulis) and juniper (Juniperus monosperma) trees.

Other wildflowers along these trails include the following:

Lambert's Locoweed

Perky Sue

Sierra Blanca Bladderpod

Baby Asters, also known as White Asters

This is probably a Crescent Milkvetch
Cutflower Puccoon
Foothills Paintbrush
"April showers bring May flowers" is a saying that doesn't quite apply this May.  Wildflowers are sparse due to our Spring drought.  We got a bit of snow and rain earlier this week.  So I am hoping that this helps. 

You can join an experienced Wildflower Guide  for a wildflower walk each Saturday morning June through Labor Day Weekend. Contact the Sandia Ranger Station to confirm the hike location (Tel. 505-281-3304) or for more information for all Saturday morning wildflower walks throughout the Summer. I will lead the wildflower hikes in the Sandia Mountains the first two Saturdays of June.  If you'd like to join me, we will meet at the Sandia District Ranger Station in Tijeras 11776 Hwy 337, Tijeras, NM , at 9:00AM on Saturday, June 4 (possible hike location may be Ojito Open Space or Cienaga Canyon Trail) and June 11 (possible hike locations may include Tree Spring Trail,  Cienaga Canyon Trail or Tecolote Trail).  We will then drive (car pool encouraged) to the trailhead.  Bring water, wear a hat/sunscreen and comfortable shoes for hiking, and bring your camera. Location of the hike may change, so please meet by 9AM at the Ranger Station in Tijeras. There is a parking fee of $3 in the National Forest (no fee for Ojito Open Space), or you may use your interagency annual pass, your America the Beautiful annual pass, or your Golden Age Passport.

Brunch on Mother's Day 2010 at Greenside Cafe

May 8th is Mother's Day.  I will get to spend it with my two daughters, Amanda and Mary, Matt and my husband Ron.  We will barbecue and maybe take a wildflower walk. 

Matt and Ron at Mother's Day Brunch 2010

I received a lovely orchid ...

...and a yellow rose.

And to all the Mothers in the world, may you be treated with respect and love, each day of the year.