Tag: Health Care

[The conversations represented here took place over the last week and are compressed for your reading pleasure. My husband and I are real people and said the things represented here. The rest of the dialogue is provided by intentionally fictionalized characters that are not meant to represent any one person. All sentiments and facts expressed here are genuine to the best of my recollection, but the characters saying them were selected by drawing names from a hat. I, alone, am responsible for this content.]

The Quickening

“They canceled Andrianna’s tubals yesterday,” I inform Steve in the hall outside the conference room. “They didn’t even give her a whole day’s notice so she could talk to her patients before they did it.”

“I got virtually no notice either when they canceled mine on Monday,” he replies.

“Really?” I am shocked by this. I have never heard of a hospital canceling cases so abruptly without involving the surgeon. “Who ordered the cancellations like that?”

“Don’t know. We’re only told the surgery scheduler, but someone gave her the order.”

We enter the conference room to find Norm waiting for us. The other gynecologists filter into the room. Both the hospitals the Sisters of Orange own are represented: the hospital in my town, St. Joseph’s, and the one south of us, Redwood Memorial.

“We had hoped this would blow over but the sisters feel backed into a corner.” Norm starts. “They have no choice but to get tough on this issue.”

“What brought all this on?” Steve asks.

“The edict came down from the new Bishop in Santa Rosa,” Norm says, “but we got targeted when they pulled the diagnosis codes for the hospital. It was obvious we were doing more sterilizations than they were in Southern California.”

“In Southern California you can go down the street from any Catholic institution and run into a secular hospital.” I try to defend us. “The Catholic Church bought almost all the hospitals in this area. For the last six years they’ve been trying to drive the last secular hospital under.”

“Never the less, we were doing a lot of tubals for ‛psychological’ reasons.”

“We were hardly doing a lot of sterilizations,” I say. “Other hospitals preform far more tubals a year. The stigma the Church gives the procedure already curtails many woman from asking for sterilization.”

“So what’s the plan?” Steve says, rescuing the meeting from disintegrating into complaints about the Church.

“Nothing.” Norm states. “This is a game we can’t win. The more public pressure the Catholics face, the more they will dig in. We have to keep quiet and wait. That will take the pressure off the nuns. When you’re approached by the media, and you will be approached, my advise is to refer them to the CMO. That’s what he gets paid for. Don’t talk to the media, or write letters to the editor. Don’t talk to your patients about it. We need to keep the lid on this to stop it from blowing up.”

“Too late. The patients already know.” I inform him. We all know there was an article in the local alternative paper, The Journal. The “real” paper in town, the Times Standard, has been silent on the issue. “I spent half an hour at a Pap smear today with an irate woman who vented the whole time about how this was unreasonable and unfair.”

“I wouldn’t encourage her. And don’t talk to your staff about this either,” Norm says.

“How am I going to do that? I’m taking my patients to Mad River. They all know why I stopped operating at St. Jo’s.”

“What do you say to the patients?” Steve wants to know.

“The truth. I don’t think it’s fair to deny all the women in an entire county a procedure on religious grounds. And the patients agree with me. I have an eighty year old woman who lives as far south in the county as you can go. I told her why I was taking my patients north, but seeing where she lived and considering her age I told her I would make an exception for her and operate on her at St. Jo’s. She told me, ‛Don’t you dare. I don’t want to support that any more than you do.’ This octogenarian wants to drive past the two hospitals the Sisters own to have her surgery at Mad River Hospital.”

“This hospital is facing hard times right now.We’re barely holding on ourselves. We can’t afford to lose any patients. We don’t want to lose patients or doctors.” Norm seems genuinely alarmed.

“Great. Go back to the way it was, and I’ll bring my surgeries back to St. Jo’s.” I feel for Norm, but I will not be moved.

“Look, if they made us take all the hysterectomies to ethics committee, the way they threatened to, then I would do the same thing.” Wendy said. “But it’s just the tubals.”

“The only reason they didn’t is because they found out the insurance companies already reviewed all our hysterectomies and would not pay without an adequate medical diagnosis.” I tell her. “They weren’t being magnanimous. They just didn’t want to duplicate the work.”

“You can’t take your surgeries to Mad River.” Quinn, always the practical one, tells me. “I’ve looked at the labor numbers. St. Jo’s is hemorrhaging money in Obstetrics. The hospital will take the Laborist program away. The only reason you came here was for that program. You don’t want to see it die, do you?”

“I don’t.” Everything he says is true. Medicaid doesn’t even cover the cost of deliveries for most hospitals. The one wing devoted exclusively to women is a loss leader for most hospitals in the nation. Obstetricians get treated like the red-headed-step-children of the family of physicians because we don’t make the hospital any money. Having a Laborist program is a rare luxury. It meant I could sleep through the night for the first time in years, watch a whole movie in a theater, have a conversation with my husband–uninterrupted by the other woman…one with vaginal discharge. I do desperately want to keep that indulgence. “It’s not just about what I want. If they take the Laborist program, there’s little reason for me to be at St. Jo’s at all. I’ll not just take surgery to Mad River, I’ll take my labor patients as well.”

“If we don’t support the hospital it won’t be there to care for us.” Wendy says. “I for one want a hospital here when I retire.”

“Not taking care of the needs of half of the population is not caring for us.” I can feel my control slipping. “If they are unwilling to serve half the population’s health care needs, what are they doing in the business in the first place? They should sell the hospital-preferably back to the community to be run cooperatively.”

“This happens every seven years or so.” Elroy, the oldest member of our tribe, says. “The last time it was a new nun sent to take over the hospital. She had all the tubals canceled too.”

“How did that get resolved?” I ask.

“She died and it got forgotten.”

“So we’re waiting for the Bishop to die? Or just waiting for him to change his mind?” I say with more than a little heat. “The Bishop isn’t the only one with strong feelings on this.”

“The hospital can make it hard for you.” Adrianna has arrived late to the party due to her patients. “Remember Tony? He got in that spat with the hospital and started talking to people-even people in the Foundation. It got back to the Board of Trustees and they dragged him into Medical Executive Committee. Now he has that mark on his record forever.”

I know she is trying to warn me. I’m no stranger to this tactic. Though I have not seen it used at St Jo’s, I’ve seen it used elsewhere to strike fear into doctors. A hospital will use its power to remove incompetent doctors on a doctor who is medically competent but has a disagreement with the hospital. They sacrifice one physician, ending his or her career, to scare the other physicians into compliant silence. There are even courses for hospital administrators instructing them how to do this effectively. I’ve avoided such abuses of power so far, but I’ve seen it used time and again on colleagues.

“Look, it’s not just our patients. I was already scheduled to talk about this subject on a national level. I can’t act like it’s not happening to me on a personal level as well. You see, I’m an editor of this blog…”

Welcome to the Stars Hollow Health and Fitness News weekly diary. It will publish on Saturday afternoon and be open for discussion about health related issues including diet, exercise, health and health care issues, as well as, tips on what you can do when there is a medical emergency. Also an opportunity to share and exchange your favorite healthy recipes.

Questions are encouraged and I will answer to the best of my ability. If I can’t, I will try to steer you in the right direction. Naturally, I cannot give individual medical advice for personal health issues. I can give you information about medical conditions and the current treatments available.

You can now find past Health and Fitness News diaries here and on the right hand side of the Front Page.

For home cooks with a sense of adventure, experimenting with aromatic and flavored oils can transform a dish. But deciding which type of oil to use isn’t always easy.

This week, Martha Rose Shulman explains all in a primer on the various oils that can be used in cooked dishes and baked goods and drizzled on salads, fish and vegetables. She also singles out a few new favorites, including rice bran and wasabi oils, as well as tried-and-true varieties, like canola and extra virgin olive oils. Here’s her report, followed by five new recipes using oils from walnuts, peanuts, rice bran, coconut, wasabi and sesame.

Welcome to the Stars Hollow Health and Fitness News a weekly diary. It will publish on Saturday afternoon and be open for discussion about health related issues including diet, exercise, health and health care issues, as well as, tips on what you can do when there is a medical emergency. Also an opportunity to share and exchange your favorite healthy recipes.

Questions are encouraged and I will answer to the best of my ability. If I can’t, I will try to steer you in the right direction. Naturally, I cannot give individual medical advice for personal health issues. I can give you information about medical conditions and the current treatments available.

You can now find past Health and Fitness News diaries here and on the right hand side of the Front Page.

It’s hard for me to resist buying spinach at the farmers’ market this time of year. The bunches are plush, and the leaves and stems, pale pink at the base, are tender. I’d almost forgotten what mature spinach tastes like, since I’d gotten into the habit of buying the bagged baby spinach that you don’t have to stem; at my Iranian market they sell three-pound bags at a very good price. But fresh, locally grown bunch spinach is definitely worth revisiting, even if it does require more prep time. ~ Martha Rose Shulman

Welcome to the Stars Hollow Health and Fitness News weekly diary. It will publish on Saturday afternoon and be open for discussion about health related issues including diet, exercise, health and health care issues, as well as, tips on what you can do when there is a medical emergency. Also an opportunity to share and exchange your favorite healthy recipes.

Questions are encouraged and I will answer to the best of my ability. If I can’t, I will try to steer you in the right direction. Naturally, I cannot give individual medical advice for personal health issues. I can give you information about medical conditions and the current treatments available.

You can now find past Health and Fitness News diaries here and on the right hand side of the Front Page.

Throughout the Mediterranean, springtime is the season for spinach and other greens, artichokes and fava beans, and these vegetables make delicious appearances at Passover meals. There’s much in the way of healthy produce to choose from, and olive oil is the only fat you’ll find.

It would seem that there really are rational Republicans in elective office. Thank you to Louisiana Attorney General Buddy Caldwell who recognized that the Patient Protection and Affordable Care Act neither protects the patient or makes health care affordable. The only thing that will do that is single payer and that isn’t in the bill. Single payer health care spreads the cost of health care across the spectrum, covering everyone, and insures access to care from birth to death. So, AG Caldwell is suing the Obama Administration because he trusts the government more than the greedy, profit driven insurance companies.

ThinkProgress spoke with Louisiana Attorney General Buddy Caldwell outside the Supreme Court on Wednesday. Caldwell opposes Obamacare and the individual mandate, but for a different reason than most of his fellow litigants: it props up the private health insurance industry. “Insurance companies are the absolute worst people to handle this kind of business,” he declared. “I trust the government more than insurance companies.” Caldwell went on to endorse the idea of a single-payer health care system, saying it’d “be a whole lot better” than Obamacare:

   KEYES: You don’t think the subsidies for low-income people are going to be helpful?

   CALDWELL: No, no. The worst thing you can do is give it to an insurance company. I want to make my point. All insurance companies are controlled in their particular state. If you have a hurricane come up the east coast, the first one that’s going to leave you when they gotta pay too many claims is an insurance company. Insurance companies are the absolute worst people to handle this kind of business. I trust the government more than insurance companies. If the government wants to put forth a policy where they will pay for everything and you won’t have to go through an insurance policy, that’d be a whole lot better.

I don’t know about the rest of Mr. Caldwell’s politics but I wish there was a Democrat in the White House that agreed with him on this.

Reprinted from: Daily Kos

In an unprecedented move, we are delaying the publication of our regular Anti-capitalist meet-up diary to bring you a special report.  Four hours ago, several hundred US citizens and residents, reportedly members of OWS (Occupy Wall Street), occupied both chambers of the United States Congress.

Corporate media sources have refused to report the event until control can be reestablished by authorities. However, according to Al Gazeera, who just started running a live stream an hour ago, the occupiers entered both houses and forced the Senate into the House of Representatives Chamber for a joint session.  We can only speculate whether the occupiers used guns to force the Senators into the Chamber or simply took over using the force of their numbers. We understand they dismantled the microphones in the chamber and began a General Assembly using the human microphone.

Welcome to the Stars Hollow Health and Fitness News weekly diary. It will publish on Saturday afternoon and be open for discussion about health related issues including diet, exercise, health and health care issues, as well as, tips on what you can do when there is a medical emergency. Also an opportunity to share and exchange your favorite healthy recipes.

Questions are encouraged and I will answer to the best of my ability. If I can’t, I will try to steer you in the right direction. Naturally, I cannot give individual medical advice for personal health issues. I can give you information about medical conditions and the current treatments available.

You can now find past Health and Fitness News diaries here and on the right hand side of the Front Page.

It was just a coincidence that I had decided to broaden my repertory of vegetarian burgers for this week’s column and was busily testing recipes on the same day that a new Harvard School of Public Health study linking red meat consumption and early death was released. Then there was the news about pink slime in ground beef used in school lunches. The timing couldn’t have been better.

Martha Rose Shulman

Today the Supreme Court heard arguments about the severability of the individual mandate in the Affordable Health Care bill  and the expansion of Medicaid.

The day after the Supreme Court suggested that President Obama’s health care law might be in danger of being held unconstitutional, the justices on Wednesday turned their attention to the practical consequences and political realities of such a ruling.

The justices seemed divided on both questions before them: What should happen to the rest of the law if the court strikes down its core provision? And was the law’s expansion of the Medicaid program constitutional?

The two arguments, over almost three hours, were by turns grave and giddy. They were also relentlessly pragmatic. The justices considered what sort of tasks it makes sense to assign to Congress, what kinds of interaction between federal and state officials are permissible and even the political character of the lawsuits challenging the law. One justice dipped into Senate vote counting.

The court had in other words, on the third and final day of a historic set of arguments, moved from the high theory of constitutional interpretation to the real-world consequences of what various rulings would entail.

The arguments on severability, which hinged totally on whether the mandated stays or goes, boiled down to three points:

1. sever only the mandate, allow the rest of the law to stand and let Congress sort it out;

2. sever the mandate along with insurance regulations like guaranteed issue and community rating, to prevent what the government argues would be an insurance death spiral;

3. or throw out the whole law, which did not include a standard severability clause.

The Justices seemed divided over point #2 and #3 rather than #1. For the most part, the discussions and comments were reflective of the consequences of overturning the entire law or any part of it:

[..] A common reaction, across the bench, was that the Justices themselves did not want the onerous task of going through the remainder of the entire 2,700 pages of the law and deciding what to keep and what to throw out, and most seemed to think that should be left to Congress.  They could not come together, however, on just what task they would send across the street for the lawmakers to perform.  The net effect may well have shored up support for the individual insurance mandate itself.

The dilemma could be captured perfectly in two separate comments by Justice Antonin Scalia – first, that it “can’t be right” that all of the myriad provisions of the law unrelated to the mandate had to fall with it, but, later, that if the Court were to strike out the mandate, “then the statute’s gone.”  [..]

Justice Anthony Kennedy, who is considered the swing vote on the individual mandate, expressed concern “possible unintended consequences in the form of huge costs to insurance companies if the mandate – which would bring millions of healthy young people into the healthcare system and spread out costs – was invalidated alone”:

“We would be exercising the judicial power if one … provision was stricken and the others remained to impose a risk on insurance companies that Congress had never intended,” Kennedy said. “By reason of this court, we would have a new regime that Congress did not provide for, did not consider.”

The four liberal justices expressed deep reservations about tossing out the sweeping law that has hundreds of other provisions, some of them already in effect.

Justice Sonia Sotomayor, one of the four and an Obama appointee to the court, asked whether the court should allow Congress to decide what to do next. “What’s wrong with leaving it in the hands of people who should be fixing this, not us?”

Justice Ruth Bader Ginsburg went further. She said many parts of the law had not been challenged in court. “Why make Congress redo those?”

On the matter of Medicaid expansion a majority of the justices were inclined to support the government’s role in prodding states to expand the state-federal Medicaid healthcare program for the poor, providing coverage for an estimated 17 million Americans:

The court’s more liberal justices all expressed puzzlement about why there should be a problem with the expansion in light of the fact that it is almost entirely to be paid for by the federal government. The states say they are being coerced into participating because a decision not to may cause them to lose not only the new money but also existing funds.

Justice Elena Kagan described a hypothetical program only slightly different from the real one. “It’s just a boatload of federal money for you to take and spend on poor people’s health care,” she said to a lawyer for the states, Paul D. Clement. “It doesn’t sound coercive to me, I have to tell you.” [..]

He (Chief Justice John G. Roberts Jr) said the court’s decision on the Medicaid expansion should be informed by the reality that the states have “since the New Deal” cheerfully accepted federal money.

“It seems to me that they have compromised their status as independent sovereigns because they are so dependent on what the federal government has done,” the chief justice said.

Justice (Antonin) Scalia addressed the political realities of the litigation itself, asking Mr. Clement whether there was “any chance that all 26 states opposing it have Republican governors, and all of the states supporting it have Democratic governors?”

Mr. Clement responded, “There’s a correlation, Justice Scalia.”

In her last article on Wednesday’s sessions, Slate‘s Dahlia Litwick gives her assessment of the last three days:

Amid all the three-day psychodrama, it’s easy to get confused about what’s happened and what hasn’t. Court watchers seem to generally agree that the individual mandate is in real peril and will rise or fall with Chief Justice Roberts and Justice Kennedy. Court watchers also agree that 19th-century tax law-while generally adorable-will not prevent the justices from deciding the case by July. And they also agree that they may have counted five justices who appear willing to take the whole law down, along with the mandate, and the Medicaid expansion as well.

But the longer they talked, the harder it was to say. A lot of today’s discussion started to sound like justices just free-associating about things in the law they didn’t like. That doesn’t reveal all that much about the interplay between the four separate challenges-what happens when they all have to be looked at together-or anything at all about what will happen at conference or in the drafting of opinions. Could the five conservative justices strike down the entire health care law, and take us into what Kagan described this morning as a “revolution”? They could. Will they? I honestly have no idea anymore. As silent retreats go, this one was a lot less enlightening than I’d hoped.

Constitutional law professor Jonathan Turley discussed the hearings with Keith Olbermann on Countdown, calling this case a “game of chicken” that “can be deadly.”

Can the government force you to eat broccoli or buy a cell phone? Those were some of  the questions asked during the first two of three days of hearings before the US Supreme Court over whether it is constitutional for the government to mandate an individual to buy health care insurance from a private company or face a “penalty” to be collected by the Internal Revenue Serve. Candidate Barack Obama opposed a mandate but changed his mind, including it his “signature” [Affordable Care Act , taking single payer and then the option for a public sponsored insurance off the table. At this point, the majority of the public is opposed to the mandate and about a third want the entire bill scrapped, even though it has a few good provisions such removing pre-existing conditions as a reason to deny coverage and the implementation of lifetime caps on what the insurance company will pay.

Dahlia Lithwick, a senior editor and legal correspondent for Slate, gives her analysis of the first two days:

One thing was clear after the two hour session (pdf) at the Supreme Court on the constitutionality of the Affordable Care Act: The outcome of President Obama’s signature legislative achievement probably rests on the shoulders of two men-Chief Justice John Roberts and Justice Anthony Kennedy. Or, to put it differently, everyone else seems to have staked a clear position. [..]

In the beginning, all eyes were on Kennedy who opened his questioning by asking Solicitor General Donald Verrilli to “assume this law is unprecedented.” (Gulp. That isn’t the way Verrilli wanted this to begin.) Both Kennedy and Roberts pressed Verrilli to enunciate a limiting principle on the congressional power asserted here. Or as Kennedy put it, early in the argument: “Can you identify any limits on the commerce clause?” [..]

Kennedy had serious doubts and Verrilli appeared unable to allay them. The odds on a 5-4 vote to strike down the law looked good. Kennedy asked far fewer questions of the challengers, although near the end of the morning he said, in his inimitably oblique style that young people are “uniquely, proximately very close to affecting the rates of insurance and the cost of providing medical care in a way that is not true in other industries.” That may suggest he believes that the health insurance market really is unique in some ways. [..]

My sense is that we saw only a part of what the justices were really thinking today. We heard Roberts and Kennedy expressing doubts about each side of the argument. But we didn’t get to hear them think aloud about what it actually means to strike down a monumental act of congress. We can assume that is weighing on some of the justices, nonetheless. The other thing we didn’t hear much about today was case law. Justice Stephen Breyer pointed out more than once that the justices weren’t there to debate whether or not they liked the bill. But it may be worth counting up the references to forced gym memberships, cellphone purchases, and broccoli mandates, and tallying them up against references to actual court cases. That’s either because the mandate is so unprecedented that precedent doesn’t matter. Or, because precedent just doesn’t matter.

What we do know is that an individual can survive very well without broccoli or a cell phone but at some point that individual will need health care. In another article by Ms. Lithwick she points out that the conservative argument that this is about freedom has a very dark side:

It’s always a bit strange to hear people with government-funded single-payer health plans describe the need for other Americans to be free from health insurance. But after the aggressive battery of questions from the court’s conservatives this morning, it’s clear that we can only be truly free when the young are released from the obligation to subsidize the old and the ailing. [..]

Freedom also seems to mean freedom from the obligation to treat those who show up at hospitals without health insurance, even if it means letting them bleed out on the curb. When Solicitor General Donald Verrilli tries to explain to Justice Scalia that the health care market is unique because “getting health care service … [is] a result of the social norms to which we’ve obligated ourselves so that people get health care.” Scalia’s response is a curt: “Well, don’t obligate yourself to that.” [..]

Freedom is the freedom not to rescue. Justice Kennedy explains “the reason [the individual mandate] is concerning is because it requires the individual to do an affirmative act. In the law of torts, our tradition, our law has been that you don’t have the duty to rescue someone if that person is in danger. [..]

Freedom is to be free from the telephone. [..]

Freedom is the freedom not to join a gym, not to be forced to eat broccoli. It’s the freedom not to be compelled to buy wheat or milk. And it’s the freedom to purchase your health insurance only at the “point of consumption”-i.e., when you’re being medivaced to the ICU (assuming you have the cash). [..]

Some of the members of the court find this notion of freedom troubling. Justice Ruth Bader Ginsburg notes that: “Congress, in the ’30s, saw a real problem of people needing to have old age and survivor’s insurance. And, yes, they did it through a tax, but they said everybody has got to be in it because if we don’t have the healthy in it, there’s not going to be the money to pay for the ones who become old or disabled or widowed. [..]

Sotomayor, again pondering whether hospitals could simply turn away the uninsured, finally asks: “What percentage of the American people who took their son or daughter to an emergency room and that child was turned away because the parent didn’t have insurance-do you think there’s a large percentage of the American population who would stand for the death of that child if they had an allergic reaction and a simple shot would have saved the child?” {..]

This case isn’t so much about freedom from government-mandated broccoli or gyms. It’s about freedom from our obligations to one another, freedom from the modern world in which we live. It’s about the freedom to ignore the injured, walk away from those in peril, to never pick up the phone or eat food that’s been inspected. It’s about the freedom to be left alone. And now we know the court is worried about freedom: the freedom to live like it’s 1804.

My biggest problem is that forcing people to buy insurance from a private company that does not insure access to care and cost controls or without an inexpensive public option, like buying into Medicare, is just a financial gift to the insurance companies. Without a public option, this bill is a major failure and unlikely to be fixed in the future, as so many Obama supporters claimed, or be replaced if SCOTUS declares the bill unconstitutional.

Welcome to the Stars Hollow Health and Fitness weekly diary. It will publish on Saturday afternoon and be open for discussion about health related issues including diet, exercise, health and health care issues, as well as, tips on what you can do when there is a medical emergency. Also an opportunity to share and exchange your favorite healthy recipes.

Questions are encouraged and I will answer to the best of my ability. If I can’t, I will try to steer you in the right direction. Naturally, I cannot give individual medical advice for personal health issues. I can give you information about medical conditions and the current treatments available.

You can now find past Health and Fitness News diaries here and on the right hand side of the Front Page.

   Last week I couldn’t believe the size and beauty of the cabbages one farmer was selling by the piece. I bought one for $2, took it home and weighed it: five pounds on the dot. It made five terrific meals, all with ingredients I had on hand.

   I’ve been covering a lot of brassicas lately – those healthy phytochemical-rich cruciferous vegetables like kale, kohlrabi, broccoli and cabbage. That’s what we have plenty of at this time of year, and there’s no reason to be bored with them. I stuffed the tough outside leaves of my big cabbage, quartered the rest and made a pizza, a pie, a stir-fry and the most wonderful baked beans I’ve ever eaten.

Martha Rose Shulman