Archive for the ‘Health Care’ Category

Annals of Unemployment, Part 5: Kafka’s Castle

June 6, 2014

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Last November I went to the Covered California website to look for health insurance on the exchange. I was told that I qualify for Medi-Cal, California’s version of Medicaid, under the new rules. I filled out the application on the website and submitted it. I was told that my application would be forwarded to the Department of Social Services. I waited a few weeks without hearing anything. I called my caseworker at DPSS and asked her about it. She said that the new rules didn’t go into effect until January 1, and I wouldn’t hear anything until then. So I waited. January 1 came and went. In the middle of January, I called my caseworker. She told me that they were still waiting for instructions from the federal government. Until then, they couldn’t do anything. I would just have to wait until I heard from them.

I waited a few weeks. I called my caseworker again, and she told me the same thing. In late February, I looked at the Covered California site again. It did not say that my application had been approved. I called my caseworker, but she was out of the office. So, I called the DPSS’s information line. I gave the operator my case number. He said that they had never received my Medi-Cal application. I told him that I had applied through the CC website. He told me I should try calling them. So I called Covered California. The person there told me that my application had been forwarded to the DPSS.

So I downloaded another application, printed it out, and filled it out by hand. I then put it in an envelope and wrote my case number and my caseworker’s name on the outside. I then went to my local DPSS office and put it in the mail slot. Several days later, I received a letter from my caseworker saying that she needed proof that I was receiving unemployment benefits, as well as a copy of my driver’s license. So I sent those to her. I waited a while, and then I called her. She said that my application was “pending” and that they would contact me when it was approved. I waited a couple of weeks and called her again. She said that my application was still pending. This went on through March, April, and most of May. A couple of weeks ago, I called my caseworker. A different woman answered the phone. She told me there was something in the computer system that was blocking my application from going through and that they were working on it. After I hung up, she called me back and said that she needed proof that I was receiving unemployment benefits. She gave me a fax number. I had already given this information, but I decided not to argue with her, so I faxed it to her. The next day she called and said that my application had been approved. She said that I would receive my Medi-Cal card within a week.

A week later I received a plastic card in the mail. On it was printed, “State of California Benefits Identification Card”. On the back, it said, “This card is for identification ONLY. It does not guarantee eligibility.” This didn’t sound encouraging to me. I called my caseworker. The woman I had talked to the week before answered the phone. When I asked her about the card I had received, she said that was my Medi-Cal card. When I asked her when would I receive instructions on how to use it, she said that I didn’t need instructions, I just had to show the card to my medical provider. When I asked her if I could get a list of physicians who accept Medi-Cal, she told me I would have to “research” that myself. She said they would eventually send me a list, but they couldn’t do it now.

Today, out of curiosity, I looked at my account on the DPSS website. It said that my Medi-Cal application had been DENIED. What the hell??? I immediately called my caseworker. This time, a third woman answered the phone. When I told her my case number, she said that my Medi-Cal application was still pending! When I asked why the website said that my application had been denied, she said she didn’t know. She said that my regular caseworker will be in tomorrow, and she will have her call me.

It is now June and I still don’t have the coverage that I was supposed to receive back in January. If I had become seriously ill during this time, I would have been screwed.

Yeah, Obamacare is a huge success, ain’t it?

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Obamacare Walks Among Us

March 27, 2014

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Last November, I applied for Obamacare using the Covered California website. I was told that I qualified for Medicaid under the new rules of the Affordable Care Act (ACA). Medicaid is a federal program. However, in keeping with our nation’s passion for inefficiency, it is administered through the states. In California, it’s called Medi-Cal. Every time I call the Los Angeles County Department of Social Services about my application, they tell me that my Medi-Cal is “pending”. They say this is because they are still waiting for instructions from the federal government. The new Medicaid rules became effective on January 1st of this year. It’s nearly the end of March, and the federal government still hasn’t told the states how to proceed with this.

Part of me is hoping that the federal government never does tell them what to do. What many people don’t know is that the state governments have the right to demand that people reimburse them for medical treatment that was paid for by Medicaid. The state can actually seize a person’s assets to do this. Cute, huh? And you thought that Medicaid was a social safety net.

I’ve been told that in California, where I currently live, the state waits until after somebody dies before seizing any of his assets. (Sort of like having your pockets picked by an undertaker.) Apparently, in some states they don’t necessarily wait until you’re dead before they seize your assets. The sign-up site for Medicaid in New York contains this clause:

    I understand that once I get Medicaid coverage, if I am over 55 or if I am in a medical institution and not expected to return home, the Medicaid program may do the following in order to pay for my medical care:
    Take money I already have or that is owned [sic] to me.
    Take money that was made from selling certain things I own
    Take money from people who were legally responsible for me when
    I got benefits.

Nice, huh? Things may be different here in the Golden State, but who knows, our notoriously cash-strapped state government may decide to change the rules at some point.

Because I qualify for Medicaid, I am automatically blocked from applying for subsidized insurance on the exchange. I have been told, however, that I can purchase private insurance at full price. (If I could afford to do that, I wouldn’t have qualified for Medicaid, would I?) Now, here’s a really fun fact for you. Almost half the states have refused to accept the ACA’s expansion of Medicaid. If you qualify for Medicaid and you happen to live in one of these states, you are doubly screwed: not only do you not get Medicaid, but you can’t purchase subsidized insurance precisely because you qualify for the Medicaid that you can’t get. What a brilliant piece of legislation the ACA is! At this point, one has to wonder whether the ACA will significantly reduce the number of uninsured people in this country.

Single Payer is the only rational and humane solution to our country’s health care problems. It is time for us all to admit this.

Obamacare Rolls Out

November 21, 2013

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After hearing all the horror stories about HealthCare.gov, I decided to use California’s exchange site, CoveredCa.com. I must say, it worked well, although it had an annoying habit of asking certain questions over and over again. (I’ve had this problem with websites before. Somebody needs to explain to web designers that it’s only necessary to ask a question once.) Within a matter of minutes I had applied for coverage. Not bad.

So how is it that the State of California, which has its own proud history of corruption and incompetence, was able to do a better job of the roll-out than the federal government was? The Obama Administration had over two years to prepare for this, and they did a lousy job. Perhaps this is a sign that Obama has never really cared about the health care crisis in this country. When he ran for president, he was pressured to come up with a health care proposal, so he opted for an idea that the Republicans came up with to try to derail calls for single payer. No doubt he decided it wasn’t worth the trouble to call for Medicare for All, and besides, that wasn’t what the insurance industry wanted.

Amour

November 18, 2013

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Besides Amour, I have only seen two other films by Michael Haneke: The Seventh Continent and The White Ribbon. On the surface, Amour appears to be different from the others, but it actually deals with similar themes, in particular the question of how it is possible for ordinary people to do terrible things.

Georges (Jean-Louis Trintignant) and Anne (Emmanuelle Riva) are an elderly married couple living in Paris. One day, Anne suffers a stroke. Her doctors perform an operation on her carotid artery, but it is botched, leaving her paralyzed on her right side. For a time, she seems to be improving, but then her condition starts to rapidly deteriorate. Georges is forced to take care of her, which increasingly puts an emotional burden on him. His daughter, Eva (Isabelle Huppert), urges him to have Anne put in a hospital, but he refuses, because he promised Anne that he would never do that.

From the beginning, one can see the tragedy that this situation is moving towards. At times, Georges seems to sense this himself, but he seems incapable of acting any way other than he does. His devotion to Anne becomes a trap both for himself and for her.

This film has an emotional resonance for me. During the last ten years of his life, my father, who suffered from Type 2 diabetes, was almost continuously ill. This put a terrible strain on my mother and on other members of my family. At what point does letting go become the most humane thing to do?

Anti-Vaccination Hysteria and the Rich

August 20, 2013

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Source: http://eideard.com/2013/07/16/anti-vaccine-body-count/.

A recent article in Salon suggests that rich people are more likely to buy into anti-vaccine ideas. The author, Alex Seitz-Wald writes:

    California law mandates that all students get vaccinated, but it also makes it easy to get exemptions for personal beliefs. And parents in tony places like Marin County are taking advantage of it in seemingly growing numbers. One public elementary school in Malibu, an affluent beach town just north of Los Angeles, reported that only 58 percent of their students are immunized — well below the recommended 90-plus percent level — according to Shapiro.

    And it’s even worse in some of L.A.’s private schools, where as few as 20 percent of kids are vaccinated in some schools.

We also learn:

    But it’s not just California. Public health officials see large clusters of unvaccinated children in latte-drinking enclaves everywhere, like Ashland, Ore., and Boulder, Colo., where close to 30 percent of children are exempted from one vaccine or another. In some schools in Ashland two-thirds of the students have exemptions, according to Mark Largent, a James Madison College professor who wrote a book about the vaccine debate last year.

This goes against many people’s assumptions about the world. The rich are supposed to be better educated (although George W. Bush put a huge dent in that belief), therefore they should be more immune to anti-scientific beliefs. Yet the Republican Party’s wealthy donors don’t seem bothered by its support for anti-scientific ideas such as creationism and climate change denial. So, could it be possible that the tendency to have anti-scientific beliefs increases with income? I would be interested to know if anyone has done a study on this.

This is a serious matter. Whooping cough (pertussis), which was nearly eradicated has been making a comeback. Infants who are too young to vaccinate are vulnerable to this disease, which is why maintaining a high rate of vaccination is important. Yet vaccination rates have been dropping.

So why do people who should know better refuse to get their children vaccinated? Seitz-Wald quotes a pediatrician, Paul Offit, who says that these people are “used to being in control of their lives and at their jobs and want to control this aspect of their lives as well.” This is probably true, but I suspect there is probably more to it than that. The idea of vaccinations implies a belief in a common good. (Jonas Salk famously refused to accept money for his polio vaccine.) And these elites of our society have increasingly come to hate the idea of a common good.

The Health Care Feeding Frenzy

February 24, 2013

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The most recent issue of Time magazine features an article by Steven Brill which deals with the question of why health care costs are so much higher in the U.S. than they are in other countries. Brill shows that it basically comes down to greed: hospitals charge high fees simply because they can get away with it. The logic of the “free market” doesn’t apply to health care. If, for example, you’re in a car accident and your leg gets crushed, you don’t have a choice of whether or not to get medical attention. And you don’t have the luxury of being able to shop around for which emergency room has the lowest prices. (This is an argument that we on the Left have been making for decades. It is satisfying to see a mainstream media outlet finally admit that we are right.)

Brill describes how “non-profit” hospitals rake in enormous profits, so much so that their top administrators can receive multi-million dollar salaries. Medicare, Medicaid, and private insurers use their influence to try to keep costs down, but their efforts don’t apply to the millions of Americans who don’t have coverage. What we’re seeing is a sophisticated form of bottom-feeding: hospitals are gouging the most vulnerable members of our society. Brill is also critical of the pharmaceutical industry. He demolishes their claims that research and development justify the high prices they charge.

Brill gives a spirited defense of Medicare. He shows that it is actually run in an efficient manner. (Hospitals are reimbursed more quickly by Medicare than they are by private insurers.) He is, on the other hand, critical of Obamacare. Among other things, he points out that it will likely lead to higher insurance premiums.

Brill suggests expanding Medicare so that it applies to everyone. This strikes me as the most rational solution to our health care problems.

This article on Obamacare by Doug Henwood is also worth reading.

They Call It Myanmar

June 30, 2012

Writer and filmmaker, Robert H. Lieberman, spent two years putting together this documentary about Myanmar (known in the West as Burma). Much of the filming had to be done secretly, because Myanmar has a military government that is highly secretive and suspicious of outsiders. Except for Aung San Suu Kyi, a leading dissident who was awarded the Nobel Peace Prize, none of the people interviewed in this film are identified, for fear of government reprisals.

Myanmar used to be one of the wealthiest countries in Asia. It is now one of the poorest. Lieberman shows us crumbling buildings in Rangoon, the nation’s capitol. The military seized control of the country in 1962. They have mismanaged the economy ever since. The generals are ultra-nationalists who are deeply suspicious of the outside world. The situation is strikingly similar to that of North Korea, except that there is no cult of personality. Instead, the generals rule as a faceless bureaucracy, remote from the people.

The British invaded Myanmar in the early 19th century, and, after a series of wars, took control of the country in 1885. They ruthlessly exploited the people and their country. When the Japanese invaded during World War II, many Myanmarese welcomed them as liberators. Yet the Japanese occupation turned out to be even more brutal than that of the British, and the Myanmarese turned against them. (The parallels to the history of the US in Iraq and in Afghanistan is striking here.) The country was finally granted independence in 1948. Given the country’s history, the xenophobic views of the military actually make some sense.

The World Health Organization has ranked Myanmar as 190th in the quality of its health care. Most people cannot afford to see a real doctor. Many resort to seeing quacks who have little or no medical training. Education is also out of reach for most people. Many of the people interviewed in this film have had only one or two years of schooling. There are free schools run by Buddhist monks, but their quality of education is uneven. Many of them teach only basic reading and math and Buddhist religious ideas. Those who manage to get a college education often choose to emigrate to other countries, with the result that the country doesn’t benefit from their knowledge.

Child labor is common. We see, for example, a young girl who can’t be more than eight or nine years old carrying a basket full of gravel on her head. It’s not unusual for families to sell their children to work as servants for rich people.

Myanmar is a country with a rich culture and history. The countryside is dotted with beautiful Buddhist temples, some of them more than a thousand years old. The film emphasizes the importance of Buddhism in the nation’s culture. However, it says nothing about the country’s Christian, Muslim, and Hindu minorities. I would have liked to learn something about these groups.

There have been uprisings against the government, most notably the failed “Saffrom Revolution” of 2007. Each time these revolts have been brutally supressed. Lieberman tries to end the film on an optimistic note by saying that the young people in the country seem to feel less bound by the government’s sanctioned conventions. It is also proving increasingly difficult to keep out foreign influences. We see, for example, scenes of Burmese punk rock bands performing. Yet it’s not clear whether this will have any political consequences.

Lieberman repeatedly says that going to Myanmar is like going back in time. Is this really so? Here is a country in which a small number of people control most of the wealth, while most people can’t afford an education or decent health care, and in which the military enjoys unlimited power. Is this not the direction in which our own country is heading? Doesn’t Myanmar perhaps give us a glimpse into our own future?

Obamacare Lives

June 29, 2012

I owe John Roberts an apology. I had written him off as nothing more than a right-wing hack. It turns out that he is smarter than I thought. In arguing for the majority in their ruling on Obamacare, he wrote: “The federal government does have the power to impose a tax on those without health insurance.” That’s exactly what the individual mandate is: a tax on people who cannot afford health insurance.

All my liberal friends are high fiving one another over this decision. Yet this bill will not expand the social safety net. True, it does expand Medicaid, but it also makes cuts in Medicare. The result is a zero sum game. Obamacare will not solve the health care crisis. It will merely change the parameters of the crisis.