Cross-Post: How I Spent My Sunday

Cross-posted from The Neophyte Photographer (Originally posted on Monday, March 18, 2013)

Long-time followers know that I photographed the first ever Medical Outreach Response Event (MORE) last year as my final project for my lighting class.   They held the event again this past weekend and I volunteered to shoot the event. They already had a photographer for Saturday so I showed up yesterday.  Sunday wasn’t as busy as Saturday, but there was still plenty of need.   There are no medical services to speak of in our town. Many of these people are working poor, or disabled, and there are so many hurdles for them to jump over and so many cracks for them to fall through, that the problem feels insurmountable.

Here are just a few shots.

Attendees starting the process at intake.  The clients were screened here and directed to the various areas, depending on their need.

They might need dental work, vision care, help with obtaining affordable insurance or low-cost prescription assistance.  Or all of the above. There was also an immunization clinic to get people up-to-date on their shots, mental health screening, three dental vans, and the Mammovan was there to provide breast cancer screening.

 People shouldn’t have to get their health care in the middle of a high school gymnasium or get their teeth fixed in the parking lot. My country has its priorities all screwed up.

They shouldn’t have to wonder if there is something . . .  anything . . .  they can afford.

A young boy attempts to read the eye chart as the Lions Club volunteer looks on.

Immunization clinic.

She’s a bit nervous.

But she came through with flying colors.

More to come.

Consistency. Not their strong suit.

As any regular reader here knows, there is much I don’t like about the new health care legislation, not the least of which is the requirement to buy health insurance through private for-profit insurance companies.  In addition, the measures that sold women down the river have left me livid.

That being said, I cannot figure out what the Republicans are doing.

On the one hand, they vow to “repeal” the legislation.

On the other hand, they are trying to pass legislation that, at least in part, relies on the health care bill to be in place in order to make some sense. See H.R. 3.

And, in some cases. they refuse, to publicly support perfectly sensible research that could ultimately save taxpayers billions of dollars while privately offering assistance to fund that research. 

Dr. David Cull, a prominent vascular surgeon in Greenville, had invented a small valve system that, if it works, could spare 300,000 dialysis patients across the country enormous suffering and save U.S. taxpayers billions of dollars.

But Cull’s hometown senator, Jim DeMint, would not write a letter supporting the surgeon’s application for a federal grant under the landmark health care bill that President Barack Obama signed into law a year ago today.

A hard-core conservative with a growing national following, DeMint vowed in 2009 to make health care Obama’s “Waterloo” and is leading Republican efforts in Congress to repeal or deny funding to the law, designed to provide medical coverage to 31 million uninsured Americans.

Backing a grant application under the law — even for a constituent who lives in the same Upstate town as DeMint — would leave the senator open to charges of hypocrisy, staffers say.

“Senator DeMint opposed President Obama’s government takeover of health care because he believed it would lead to higher insurance premiums, less choices for patients, and that it was unconstitutional,” said DeMint spokesman Wesley Denton. “And that’s exactly what has happened.”

Of course,  some people with very short memories and no critical thinking skills at all will be willing to believe it, and will insist that their premiums never, ever rose until Obamacare (scare quotes!) passed. Horse pucky. Yes, we’ve all seen our health insurance premiums rise, just as they have every single, fucking year for the past umpteen years. We are all so used to getting that annual notice of premium increase with our open enrollment packets, it doesn’t even surprise us any more. That cannot be laid at the feet of the health care bill.

Supporting Dr. Cull would leave DeMint open to charges of hypocrisy? And this wouldn’t?

Cull received a $249,479 grant without DeMint’s help — though the senator’s aides say they provided guidance on applying for it — under a little publicized part of the Affordable Care Act that is aimed at encouraging cutting-edge biomedical research.

To be truly consistent to his “principles,” shouldn’t DeMint have ordered his staff not to assist any of his constituents in applying for any of the funds under the health care bill that he so strongly opposes on super-duper ultra-conservative grounds?

I mean, they think that health care workers who oppose abortion and/or  birth control should be free to exercise their rights to refuse service.

But of course, this isn’t about the bill, is it?

This is about doing anything they can to appeal to each and every one of their whackaloon constituents, if not in whole, then in part. And once they get enough of the rubes to vote for them, they win. And they become a part of dismantling, while at the same time sucking at the teat of, the government they so despise.

And we lose.

Because there is nothing conservative, or compassionate, about a man so focused on making Democrats (or one particular Democrat) look bad that he will not support something that could save “The American Taxpayer” – a mythological creature conservatives continually evoke – literally billions of dollars and untold suffering.

And the sad part? He’ll likely get away with it.

I have never understood is why Americans continue to elect people to run the government who insist that “government is the problem”  rather than people who have a vision for making government work for the broadest public good.

Would you go to a mechanic who had no interest in fixing your car and instead railed against you for owning and driving one?

Pay for performance health care. Does it work?

Apparently not.

Pay for performance fails to boost UK hypertension care/outcomes (requires registration)

Harvard, MA and Nottingham, UK – The pay-for-performance program used in the UK to encourage family doctors to treat hypertension better has had no impact on quality of care or outcomes, a new study has shown [1].

The study, published online January 26, 2010 in BMJ, was led by Dr Brian Serumaga (Harvard Medical School, Boston, MA and University of Nottingham Medical School, UK).

He explained to heartwire that “pay for performance” was introduced by the UK government in 2004, with the goal of improving care of several chronic diseases by motivating doctors to review their patients more regularly and treat to national targets. Based on the proportion of patients achieving certain quality indicators, general practitioners could receive payments as high as 25% of their total income. But evidence showing that this approach works is lacking.

Targets set too lowThe current research suggests the reason that hypertension outcomes had not improved under this program may be because the targets aimed for were not set high enough. Serumaga gave the example that doctors could claim maximum payments if they reviewed 80% of their hypertension patients each year, but they were already reviewing almost that many patients before the scheme was introduced. “So under this program, doctors are being paid a great deal of extra money for what they were doing anyway, without significantly improving the quality of care,” he says. “The setting of the indicator thresholds for maximum payment close to prevailing practice may have provided little incentive for further improvement. Thus, pay for performance may have simply supported existing practice for hypertension,” the authors write.

“Pay for performance was rushed through with no evidence that it would work, and we have now shown that it probably isn’t the best way of improving care,” Serumaga said. He noted that the UK government had allocated £1.8 billion to the program for a six-year period, but because of the overwhelming response from GPs, with more than 99% taking up the payments, it has probably cost much more than this. “Some reports estimate that it will have cost twice as much as originally estimated. And if other areas show similarly disappointing effects as we have seen in hypertension, this could be considered a great waste of money,” he added.

 

UK health care goes the way of the U.S.

And we all know how great our system is.  Read it and weep.

The NHS will undergo a radical pro-market shakeup with hospitals, private healthcare providers and family doctors competing for patients who will be able to choose treatment and care in plans laid out by the government today.

The dramatic shift aims to cull more than 24,000 management staff to reduce bureaucracy and also allow NHS hospitals to chase private patients as long as the money is “demonstrably” ploughed back into the health service. The cap on such income put in place by the previous government will be removed.

The health and social care bill will abolish all of England’s 152 primary care trusts, which currently plan services and decide how money should be spent. Andrew Lansley, the health secretary, said the radical proposals would save the taxpayer more than £10bn over the next decade.

Under the plans, GPs will be responsible for buying in patient care from 2013, with a new NHS commissioning board overseeing the process.

GPs will form consortiums which will take control of 80% of the NHS budget, buying services from providers in the public, private and charity sectors. The health secretary claimed that his policy was already having an effect: with more than 28 milion patients covered by “pathfinder” consortiums mimicking the work of the new GP bodies.

The commenters are livid. Here’s one:

This is an absolute outrage. The government has no mandate whatsoever for dismantling the wonderful NHS – in which manifesto exactly was this? Oh, hang on, it wasn’t, even Cameron didn’t know about this until July.

This is not what patients want. They just want a decent health service nearby where GPs, consultants etc. are focusing on patient care, and not on management or markets or not being sued by the new private providers.

This is not what was needed. Lansley has not bothered to spell out how the NHS was failing because …. it isn’t!

There is no mandate for this. They lied and lied and lied. And they didn’t even win the election.

This wholesale destruction is being carried out by a bunch of trust fund millionaires who think a public service is having your car fixed in the street. When patients start losing out on treatment and dying while the new GP consortia are driving around in BMWs it’ll be too late.

 (H/T Gaius)

What will it cost?

Nancy Imperiale’s post about life without insurance is a must read. She’s also got a link to what our Health Care Reform legislation means for  uninsured people with pre-existing conditions and what they have to look forward to in terms of cost. No, the insurance companies can’t turn you down, but they sure as hell can gouge you.  Following Nancy’s example, I looked up the cost for someone my age with a pre-existing condition (surely my heart issues count as that, don’t they?)  What would I be on the hook for, in the state of Nevada, if I needed to avail myself one of the insurance plans in the “High Risk” pool? Let’s wade in and see…

On July 1, eligible residents of Nevada will be able to apply for coverage through the state’s Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.

To qualify for coverage:

• You must be a citizen or national of the United States or lawfully present in the United States.
• You must have been uninsured for at least the last six months before you apply.
• You must have had a problem getting insurance due to a pre-existing condition.

PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.  All covered benefits are available for you, even if it’s to treat a preexisting condition.

Below are the monthly PCIP premium rates for Nevada by the age of an enrollee.

Ages 0 to 34: $335

Ages 35 to 44: $402

Ages 45 to 54: $513

Ages 55+: $714

In addition to your monthly premium, you will pay other costs. You will pay a $2,500 deductible for covered benefits (except for preventive services) before the plan starts to pay. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

The premium alone  (I am a 54-year-old woman) is $6,156 per year. On top of that, I must pay the $2500 deductible before anything starts getting paid for, making my cost before insurance even start to kick in: $8,656 (or $721 average monthly expense). After that I am responsible for up to $5,950, for a grand total of $14,606 if I stay “in network.” My costs could be more if there is no in-network provider for my medical need. Out-of-network specialists are a not uncommon occurrence here in Nevada. So, they’ll take whatever the patient’s insurance covers, and then charge the patient for the balance. In other words, they get paid every penny they charge, regardless of the patient’s insurance coverage, be it bronze, silver, gold or cadillac.

Yeah, that’s some kind of reform.

Around the tubes: Sick Pay, Oil, Democratic Values

I’d love to see this happen, but given how ardently our Congress supports business interests at the expense of individual Americans, I doubt it will make it out of committee.

Only 25 percent of low-wage workers have paid sick leave, which makes it a financial hardship for them to get sick and miss work. Those who do stay home to heal or to tend to a family member’s illness fear that they could lose their jobs if they miss too many days.

At a briefing Tuesday morning, Terrell McSweeny, domestic policy adviser to Vice President Joe Biden, called the proposal “an issue of middle-class economic security” for struggling families.

Business groups such as the National Federation of Independent Business and the Employment Policies Institute oppose the measure. They say a government mandate on sick leave — especially during the recession — would hurt the very people it’s intended to help because employers would offset the cost of the benefit by cutting positions and workers’ hours.

And if there wasn’t a recession, they’d oppose it too.  This standard reply is just so much bullshit. So the employers are saying that they count on employees to call in sick so that they don’t have to pay them?  I’ve done budgets, and I’ve never seen unpaid sick time calculated into the bottom line. Labor budgets are calculated on all employees being at work every shift they are scheduled to work. Paying them to stay home when they are sick won’t change the bottom line unless they have to pay someone to cover for them. In most cases, when someone is out sick, co-workers just take up the slack, so I’m thinking that this isn’t the great expense our business “leaders” make it out to be.

Yeah, but has it changed Obama’s?

Oil Slick Changes Fla. Gov’s Mind on Drilling

Crist, who opposed drilling off Florida’s coast until softening his stance over the past two years, said there is no question now that lawmakers should give up on the idea this year and in coming years. He has said previously he would support drilling if it was far enough from shore, safe enough and clean enough. He said the spill is proof that’s not possible.

Stan Brock is doing it again.

His first L.A. clinic last year – his largest ever — served 6,334 patients. He expects 2,000 more this year.

“We’ve got middle class people here, we have a lot of working poor here,” said Dr. Natalie Nevins.

People rocked by recession. Mandatory health care reform doesn’t kick in for four years.

“So meanwhile, do we tell those patients to wait?” Nevins asked. “We can’t.”

Even with health reform, the most affordable plan won’t cover adult vision or dental care.

Like Democrats elsewhere and nationally, Democrats in South Carolina don’t get it. If the leaders don’t know what their party is supposed to stand for, then others will continue to “define” them, and all the radio time in the world isn’t going to change that. And this makes my hair stand on end:

“You’ve got a lot of good people who would make excellent public servants but they don’t believe they can win as a Democrat in South Carolina,” said Cobb-Hunter, one of the House’s most powerful Democrats. “Because Democrats are perceived as the party of color.”

Too many working-class whites wrongly view Democrats as the exclusive party of African-Americans and liberals, she said.

The seeds, planted decades ago with the Southern Strategy, are still bearing fruit, she said.

“It was an organized, planned Republican effort that the Democrat Party was not a party that understood or shared white people’s values,” Cobb-Hunter said of the GOP strategy.

As opposed to non-white people’s values?  And holy shit, when your “most powerful” Democrat doesn’t even know the correct terminology, the Democratic Party has a huge problem.

“And what we Democrats did for all of those decades is allow the Republican Party to continue to sell that line and define us – to call us tax-and-spend liberals, to say we had no family values, to define us as the party of color.“

Some Democrats are working to create an S.C. Democratic identity, including Phil Noble, head of the S.C. New Democrats.

He recently sent out 100,000 e-mails to Democrats across the state, asking them to list their top five priorities for the party. “The party needs to say to voters, ‘Here’s what we believe in, one, two, three, four, five,’” Noble said.

Banging head against wall…dude…there is a national party platform.

Heaven, Earthquakes, and Goats

Three not-unrelated stories.

Johann Hari reviews Lisa Miller’s book, Heaven: Our Enduring Fascination with the Afterlife, gives us a brief history of the concept of heaven, asks for evidence of its existence, and ends with The Epic of Gilgamesh.

Heaven is constantly shifting shape because it is a history of subconscious human longings. Show me your heaven, and I’ll show you what’s lacking in your life. The desert-dwellers who wrote the Bible and the Koran lived in thirst – so their heavens were forever running with rivers and fountains and springs. African-American slaves believed they were headed for a heaven where “the first would be last, and the last would be first” – so they would be the free men dominating white slaves. Today’s Islamist suicide-bombers live in a society starved of sex, so their heaven is a 72-virgin gang-bang. Emily Dickinson wrote: ” ‘Heaven’ – is what I cannot Reach!/The Apple on the Tree/Provided it do hopeless – hang/That – ‘Heaven’ is – to Me!”

[...]

Of course there’s plenty of proof that the idea of heaven can be comforting, or beautiful – but that doesn’t make it true. The difference between wishful thinking and fact-seeking is something most six-year-olds can grasp, yet Miller – and, it seems, the heaven-believing majority – refuse it here. Yes, I would like to see my dead friends and relatives again. I also would like there to be world peace, a million dollars in my current account, and for Matt Damon to ask me to marry him. If I took my longing as proof they were going to happen, you’d think I was deranged.”Rationalist questions are not helpful,” announces one of her interviewees – a professor at Harvard, no less. This seems to be Miller’s view too. She stresses that to believe in heaven you have to make “a leap of faith” – but in what other field in life do we abandon all need for evidence? Why do it in one so crucial to your whole sense of existence? And if you are going to “leap” beyond proof, why leap to the Christian heaven? Why not convince yourself you are going to live after death in Narnia, or Middle Earth, for which there is as much evidence? She doesn’t explain: her arguments dissolve into a feel-good New Age drizzle.

True, Miller does cast a quick eye over the only “evidence” that believers in heaven offer – the testimonies of people who have had near-death experiences. According to the medical journal The Lancet, between 9 per cent and 18 per cent of people who have been near death report entering a tunnel, seeing a bright light, and so on. Dinesh D’Souza, in his preposterous book Life After Death, presents this as “proof” for heaven. But in fact there are clear scientific explanations. As the brain shuts down, it is the peripheral vision that goes first, giving the impression of a tunnel. The centre of your vision is what remains, giving the impression of a bright light. Indeed, as Miller concedes: “Virtually all the features of [a near-death experience] – the sense of moving through a tunnel, an ‘out of body’ feeling, spiritual awe, visual hallucinations, and intense memories – can be reproduced with a stiff dose of ketamine, a horse tranquilliser frequently used as a party drug.” Is a stoner teenager in a K-hole in contact with God and on a day-trip to heaven? Should the religious be dropping horse dope on Sundays? But Miller soon runs scared from the sceptical implications of this, offering the false balance of finding one very odd scientist who says that these experiences could point beyond life – without any proof at all.

 And yet, and yet … of course I understand why so many people want to believe in heaven, even now, even in the face of all the evidence, and all reason. It is a way – however futilely – of trying to escape the awful emptiness of death. As Philip Larkin put it: “Not to be here/Not to be anywhere/And soon; nothing more terrible, nothing more true”. To die. To rot. To be nothing. We wouldn’t be sane if we didn’t seek a way to leap off this conveyor-belt heading towards a cliff.  

[...]

So yes, there is pain in seeing the truth about Heaven – but there is also a liberation in seeing beyond the childhood myths of our species. In The Epic of Gilgamesh, written in Babylon 4,000 years ago, the eponymous hero travels into the gardens of the gods in an attempt to discover the secret of eternal life. His guide tells him the secret – there is no secret. This is it. This is all we’re going to get. This life. This time. Once. “Enjoy your life,” the goddess Siduri tells him. “Love the child who holds you by the hand, and give your wife pleasure in your embrace.” It’s Lennon’s dream, four millennia ahead of schedule: above us, only sky. Gilgamesh returns to the world and lives more intensely and truly and deeply than before, knowing there is no celestial after-party and no forever. After all this time, can’t we finally follow Gilgamesh to a world beyond heaven?

 On another note, I’m attending Boobquake! (Facebook page).

Help fight supernatural thinking and the oppression of women, just by showing your cleavage!

“Many women who do not dress modestly … lead young men astray, corrupt their chastity and spread adultery in society, which (consequently) increases earthquakes,” Hojatoleslam Kazem Sedighi was quoted as saying by Iranian media. Sedighi is Tehran’s acting Friday prayer leader.

I have a modest proposal.

Sedighi claims that not dressing modestly causes earthquakes. If so, we should be able to test this claim scientifically. You all remember the homeopathy overdose?

Time for a Boobquake.

On Monday, April 26th, I will wear the most cleavage-showing shirt I own. Yes, the one usually reserved for a night on the town. I encourage other female skeptics to join me and embrace the supposed supernatural power of their breasts. Or short shorts, if that’s your preferred form of immodesty. With the power of our scandalous bodies combined, we should surely produce an earthquake. If not, I’m sure Sedighi can come up with a rational explanation for why the ground didn’t rumble. And if we really get through to him, maybe it’ll be one involving plate tectonics.

Yes, it’s meant to be a joke … and yet…it is about the scientific method. Read these links.

http://www.blaghag.com/2010/04/in-name-of-science-i-offer-my-boobs.html

(For those who want a more serious explanation of the event, please go here: http://www.blaghag.com/2010/04/quick-clarification-about-boobquake.html)

Really, it’s not supposed to be serious activism that is going to revolutionize women’s rights, but just a bit of fun juvenile humor. I’m a firm believer that when someone says something so stupid and hateful, serious discourse isn’t going to accomplish anything – sometimes light-hearted mockery is worthwhile.

Sort of like showing up at Sue Lowden’s campaign office with a baby goat.

Talk amongst yourselves.

What planet does Sue Lowden inhabit?

Aside from the ‘bartering’ with your doctor spiel (and by her context, I don’t think she knows what the word means), Sue Lowden displays some incredible blindness to the plight of average Americans. “If you want to save $20,000 in your health savings plan, pretax, go ahead!”  “Pay cash for your doctor visit!” 

You know, a person MIGHT be able to get a doctor’s visit fee reduced. But who has got the kind of cash laying around to pay for chemotherapy? Or hospital stays? Pacemakers? Emergency room visits?

Clueless. Absolutely clueless.

Edited to add: And note that Lowden does what every rightwinger on television and radio does: she interrupts and talks over the person making an intelligent point. I think they have a school that teaches them to do that. No, really. I think they do.