If Obamacare goes, women lose

Lots of us were disappointed with the healthcare bill: I wanted single payer (but never held my breath about that,) the “death panel” fiasco cost us a critical piece of coverage… but here we are. At least we got a bill.

And “Obamacare” the Patient Protection and Affordable Care Act, has been a boon to women. It’ll be even more so, if the Supreme Court doesn’t send us back to square one. Jessica Arons outlines just a few of the ways the act has benefited women in a recent article for the Center for American Progress.

“Thanks to Obamacare,” Arons writes, “more than 45 million women have already taken advantage of recommended preventive services, including mammograms, pap smears, prenatal care, well-baby care, and well-child care with no cost sharing such as co-pays and deductibles. Starting this August, millions more will be able to obtain contraception,
annual well-woman care (a visit with a gynecologist), screening for gestational diabetes, breastfeeding counseling and supplies, and screening for sexually transmitted infections, including HIV and the Human papillomavirus—again at no extra cost.”

Add to these the millions of women now (or soon to be)  avoiding discrimination over things like pre-existing conditions, including the condition of having been born female.

If the Supreme Court doesn’t strike it down, Republicans swear they’ll do it. The war on women is no illusion.

Palin, Pelosi & the politics of scorn

Much ado is being made over two lady politicos these days, Sarah Palin for her six-figure fees and Nancy Pelosi for her legislative expertise. Both are commendable — depending on how one chooses to commend — but unfortunately they are continuing to feed the politics of scorn. Which is unlikely to lead to bi-partisanship or collegiality any time soon. Maybe both are dead.

Palin’s usefulness to her party is a matter of dispute. According to two prominent speakers at a Wednesday breakfast sponsored by the Christian Science Monitor (as reported by Monitor writer Dave Cook), Palin’s rise is great good news for the Democrats.

“Look at this dynamic that is produced with Sarah Palin,” said Stanley Greenberg, chairman of Greenberg Quinlan Rosner Research. “You have John McCain having to have Sarah Palin to save him [in a primary election race]…”

In the aftermath of the passage of healthcare reform, the ongoing discussion is “Barack Obama against Sarah Palin on healthcare,” he said.

Mr. Greenberg, who served as President Clinton’s pollster, argued that “The face of the Republican Party to the country is not the ‘tea party,’ it is Sarah Palin.”

James Carville, President Clinton’s campaign manager and the other speaker at Wednesday’s breakfast, suggested a test to the assembled journalists. “Do me favor. Call five Democratic consultants and leave a message and say I am doing a story on Sarah Palin and call five Republicans, and see who returns the phone call. I think we all know the answer to that. The Democrats will be on the phone so fast.”

Much as some of us do not admire Sarah Palin, the sneer factor employed by her detractors can be oppressive. (Come on, if you’re an anti-Palin, think of the slurs you have slung her way.) She is, herself, a master of derision in a by-golly sort of fashion, and it is this that brings loud huzzahs from her audiences when she takes on the Democrats.

Not to be outdone, Speaker Pelosi (whom I appreciate and respect) was heaping scorn upon the Republicans in speeches to California audiences this week,

… saying they “have nothing to sell” to the American people except a crude caricature of her as the midterm elections approach.

Pelosi, D-San Francisco, was surrounded at the Phillip and Sala Burton Center by ardent advocates of health reform, who cheered when she was cheerful and roared when she was defiant. And she was proudly defiant.

“I couldn’t care less,” she said of GOP efforts to use her as campaign fundraising bait. “I should be thanking them. … It really helps me with my fundraising.”

The issues are real, and occasionally that is made clear:

“This is a bill about the middle class. This is a bill about small businesses. This is a bill about affordability,” Pelosi said.

Still, Pelosi warned Democrats that the fight isn’t over, saying Republicans “are unabashed in wanting to rid us of this … and one way they think they can do it is by making gross misrepresentations to senior citizens” with what she called a “campaign of fear.”

Appearing before a crowd dominated by seniors carrying signs of appreciation – “Thank you, madame speaker” – Pelosi was lauded by a parade of admirers, including Rep. George Miller, D-Martinez, doctors and senior advocates who praised her tireless push for the measure.

Admittedly, Pelosi was in friendly territory this week, as Palin has been in recent days herself.

Palin last weekend put Pelosi and Democratic Senate Majority Leader Harry Reid at the center of her campaign-style speech to Tea Partiers attending a rally in Searchlight, Nev., Reid’s hometown. “You’re fired,” she said of the two Democratic standard-bearers.

This may be the way politics works. But wouldn’t it be nice if occasionally, some way could be found for opposing sides at least to be civil in the interest of the common good.

Defiant Pelosi scorns Republicans.

American rage: We the People, and our legislative leaders, are out of control

On the floor of the U.S. House of Representatives, Rep. Randy Neugebauer (R-TX), angered by Rep. Bart Stupak’s (D-Mich) support of the health reform, called the bill a “baby-killer.” Protesters screamed racial epithets at Reps. John Lewis (D-GA) and Andre Carson (D-Ind) and yelled anti-gay slurs at Representative Barney Frank (D-Mass.) This comes not that long after Rep. Joe Wilson (R-SC) shouted “You lie!” at the President of the United States during a speech to Congress.

Just in case anyone is inclined toward civility, the Rush Limbaughs (“we must defeat these bastards”) and the Glenn Becks (only “losers” need help…) of the world are fanning every little flame around. The rants and rages are not limited to right-wingers, it’s just that those are the most prominent these days, what with congressmen standing on the balcony whipping up the crowd — while anti-anti-reformers shout their own epithets.

All this rage may not be healthy. A recent ‘Personal Journal’ piece in the Wall Street Journal explored the idea that anger is, in many cases, an illness unto itself.

Scream at the boss? Snap at a colleague? Throw your cell phone into your @#$%%&* computer monitor? If so, you may find yourself headed to anger-management classes, which have become an all-purpose antidote for fit-throwing celebrities, chair-throwing coaches, vandals, road ragers, delinquent teens, disruptive airline passengers, and obstreperous employees.

Demand for such programs is coming from courts seeking alternatives to jail sentences and companies hoping to avoid lawsuits and office blowups. Aware that high-pressure jobs can make for hot tempers, some professions offer pre-emptive anger management. A few state bar associations now require “civility” training for lawyers renewing their licenses. And as of last year, hospitals must have programs for “disruptive” physicians as a condition of accreditation.

Programs run the gamut from $300-an-hour private therapists to one-day intensive seminars, weekly group sessions or online courses with no human interaction. Many advertise that they satisfy court requirements—even if all they offer is six CDs and a certificate of completion.

It’s not clear if the programs work, as few studies have analyzed their effectiveness. There are no licensing requirements for anger-management trainers—anyone can open a business. And since participants don’t usually sign up voluntarily, trainers say it’s possible to complete a program without actually changing one’s behavior.

Part of the problem is that professionals can’t agree whether a pattern of angry outbursts signals a mental illness or simply a behavior issue. As a result, people who need psychiatric help may instead get shunted into a short-term anger-management course. Employers and courts may not adequately evaluate people before sending them for anger interventions, nor provide sufficient follow-up.

There have been some notable failures—the Columbine shooters, for example, attended anger-management classes before their 1999 killing spree. Amy Bishop, the University of Alabama biologist who allegedly killed three colleagues and wounded three more last month, had been advised by prosecutors to take anger-management classes after an earlier incident in 2002. Her lawyer says he doesn’t know if she did.

It is hardly the same, but the rage that exploded into these tragedies is still akin to the shouted obscenities of recent political scenes. Maybe all those shouters aren’t mentally ill, just badly behaved. Maybe they are protected by the First Amendment. Maybe the anger and ugliness is, as more than a few defenders maintain, perfectly excusable in response to “totalitarian tactics” or other perceived wrongs. But does that make it right? Or worth the loss of civility?

Maybe a little anger management — and civility — would be a good idea.

Demand for Anger -Management Grows. But Does It Work? – WSJ.com.

Health reform: a start

Victory finally came, but only for those who were hanging onto the shreds of earlier wishes, and it wasn’t ever pretty. Watching C-SPAN on Sunday, in fact, was a little like watching grass grow, with every other blade sniping at the blade just around the corner. But at least that much is over.

Congress gave final approval on Sunday to legislation that would provide medical coverage to tens of millions of uninsured Americans and remake the nation’s health care system along the lines proposed by President Obama.

By a vote of 219 to 212, the House passed the bill after a day of tumultuous debate that echoed the epic struggle of the last year. The action sent the bill to President Obama, whose crusade for such legislation has been a hallmark of his presidency.

“This isn’t radical reform, but it is major reform,” Mr. Obama said after the vote. “This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction. This is what change looks like.”

Minutes after thebill was approved, the House passed a package of changes to it and sent it to the Senate. The Senate majority leader, Harry Reid of Nevada, has promised House Democrats that the Senate would quickly take up the reconciliation bill with the changes in it, and that he had secured the votes to pass it.

But while the Senate is bracing for a fierce floor fight over the reconciliation measure, the landscape was permanently altered by passage of the original Senate bill. Should the reconciliation bill, which cannot be filibustered, collapse for any reason, the core components of the Democrats’ health care overhaul would move forward. Indeed, Senate Republicans were quickly faced with a need to recalibrate their message from one aimed at stopping the legislation to one focused on winning back a sufficient number of seats in Congress to repeal it.

It was mean and divisive and ugly, and will surely get more so, but at least it’s a start. We can finally begin to reform what is a cruel and unworkable system. And maybe, just maybe, there will some day be access to health care for all. Does anyone remember when there was no Social Security or Medicare?

House Approves Health Overhaul, Sending Landmark Bill to Obama – NYTimes.com.

Catholic nuns urge passage of health bill

There’s hope. The U.S. Conference of Catholic Bishops may be trying to sink health reform because they feel they know best about women, but a few thousand good sisters are raising their own voices. And not just your everyday sisters.

Catholic nuns are urging Congress to pass President Barack Obama’s health care plan, in an unusual public break with bishops who say it would subsidize abortion.

Some 60 leaders of religious orders representing 59,000 Catholic nuns Wednesday sent lawmakers a letter urging them to pass the Senate health care bill. It contains restrictions on abortion funding that the bishops say don’t go far enough.

The letter says that “despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions.” The letter says the legislation also will help support pregnant women and “this is the real pro-life stance.”

This space, a space which claims several priests as good friends despite our frequent and vehement disagreements, hereby sides with the sisters. And offers a sincerely respectful three cheers.

Catholic nuns urge passage of Obama’s health bill – Politics – Wire – TheState.com.

Anthem Blue Cross 'doing the right thing'?

In testimony before the California Assembly Health Committee yesterday, Anthem Blue Cross President Leslie Margolin said of her company, “I think we do the right thing, and we try to do the right thing every day.”

What that means is, turn a profit for the company every day. If you are in business to make money, that is the right thing to do.

On the other hand, when Margolin says the company’s goal is to provide “care, comfort and coverage to those in need,” that is simply not true. Physicians and health care professionals provide care and comfort. Anthem provides coverage which sometimes pays for these things and often does not, if they can help it.

Is there no way to connect those dots? Care and comfort for those who need and deserve it — i.e., every human being — are not going to happen until we get the coverage people out of the equation.

OK, not going to happen any time soon. It could happen in California, except for Governor Schwarzenegger‘s probable veto. It should happen in Washington, except for the money and muscle of the coverage people. In lieu of those realities, a health bill that takes a tiny step in the right direction would be welcome.

New idea: patient-centered healthcare

American health care, with or without the reform so desperately needed, seems headed in the direction of comprehensive care. For us patients — those of us fortunate enough to have coverage allowing us to be patients — part of this is having one doctor who really knows and follows your general condition. A century ago, before costs went through the roof and access to care went out the window, American health care worked that way.

At the California Wellness Foundation‘s Healthy Aging Conference in Los Angeles earlier this week the talk was all about “medical home“. Unwilling to risk a blatant display of ignorance I spent much of the morning frantically searching the speaker’s handouts for a clue about what a medical home might be. The speaker, it being early on in the event when my bewilderment arose, was keynoter John Rother, Executive Vice President of Policy and Strategy for AARP.

Though it was not in the handouts — the audience consisted largely of health professionals who presumably knew all this — I will clarify the medical home business here. With a little help from Wikipedia: “an approach to providing comprehensive primary care… that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.”

Rother’s power-point presentation, billed as “Moving Past Talk: the Challenge of Wellness” reviewed the state of U.S. health, health care and endangered health reform before getting to the medical home issue. When he did, he characterized the medical home as “more personalized delivery of services,” adding that the concept envisions that “someone’s in charge.” It enables hospitals and doctors to work more closely together, Rother said, and provides extra payments for primary care doctors.

Kaiser has this. Many of us enjoy this. Could we please find a way for the healthcare homeless of America also to find a medical home?