According to Chronicle News Services, Arizona’s cash-strapped Medicaid program is considering charging patients $50 per year if they smoke, have diabetes, or are overweight. They say the tax is intended to push patients to take better care of themselves. The fee would apply only to childless adults.
Not sure how far down the line of “consideration” those folks are…so let’s just process the concept for ourselves. The State Health Care Cost Containment System, the ones who are floating this idea, presumably has records of potential tax-ees already. They already know who reported himself to be a smoker, or who, during his last office visit, tipped in with a bulbous Body Mass Index. They surely can sort out who they’re treating for diabetes.
But do their records reflect childless adults? Really? No, I didn’t think so. Folks will have to respond to a questionnaire to get themselves in line for the dun. That’s sure to go well. A lot of folks will raise their hands and step forward. “Tax me! Tax me!”
The Cost Containment folks must compile the responses to their surveys and scan their records in search of offending parties. OK. Here’s a list of overweight, smoking, sick, empty nesters receiving Medicaid --- because they’re also poor. Let’s go ahead and send them a bill.
Now, will that be $50 per offending condition? Or will there be a two- or three-for-one sale? If I’m a diabetic smoker, for example, do I get a deal? Seems like a fleet discount might be in order except that the enforcers are of a mind to make some dough, er, my mistake - they’re encouraging these folks to take good care.
We can’t deny there could be some logic to this. When I get a ticket for a faulty muffler, it encourages me to get my muffler fixed. If I pay my taxes late, the penalty encourages me to pay them on time next year. But if I’m already spending, let’s say conservatively, $2 a day to the nicotine monkey, totaling $730 a year for an addiction some say is as relentless as a heroin addiction, I’m not sure I wouldn’t just pony up the added 14 cents per day the proposed fine represents.
(I knew a woman once who paid herself $3 a day for every day she didn’t smoke after she corralled the compulsion. Bought herself a diamond ring. Now that’s encouragement.)
Could this tax help make a person thinner? We’d have to look at the cost per calorie index for our amortization of this effect. Let’s see, here it is: If a person needed to lose 20 pounds to exit the “This is for Your Own Good” penalty box within the first year of paying said penalty, he would need to eliminate about 192 calories per day for an annual reduction of 70,000 calories. So, he’d need to lay off his daily box of Junior Mints, or take a brisk two-mile walk each day, every day, for 365 days to burn those calories. Either that, or of course, he’d have to pay that onerous 14cents instead.
The one that really gets me is the diabetic. Arizona would penalize, oops, sorry, encourage the diabetic with this $50 tax. But what exactly can a diabetic do to improve his lot? Can he behave his way out of diabetes? Once you have it, doesn’t it have you? You control it or contain it, but it doesn’t go away just ‘cause somebody says, “Do better.”
But of course! Here’s the giant loophole that will put the kybosh on the whole shebang: No one has to be childless. Even my favorite relative, known affectionately among the Okies back home as “Fat Grandma,” can have kids in the house. Heck, in today’s economy, it’s not uncommon at all to have kids at home, underfoot, and in the fridge until you’re underfoot yourself. Be gone Medicaid penalty!
What truly grates is the condescending deception used to package the proposal. Just tell the truth. The underlying problem in Arizona and the rest of our country is the cost of providing health care to the poor. But Arizona swaddles its proposal in a false premise: encouragement.
In fact, it may not be unrealistic or unfair to charge a smoker more than a non-smoker for services. After all, he costs the system more. So do diabetics and heavyweights. Maybe we should just call it what it is.
If I were a stout smoker, I might not like the extra charge, but I’d be less able to argue with it.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Wednesday, April 6, 2011
Friday, February 4, 2011
Who's Putting Whom Out of Bed?
A new study out of the University of California, Berkeley, says that we should put our pets out of the bed. They’re germ-laden and will cause us more illness. So says the UC.
Not only do I protest this weak science, my cat does.
My cat will be 21 years old in June: Susan. That’s almost 140 in people years. Though she eats well, she’s thin and demanding. She spends her days on the deck in the sun, and her nights under the covers, cozied up to the small of my back.
She works the system and gets pretty well whatever she wants---unlimited petting, space on the lap, love, admiration, and amazement.
Susan’s always been small. She peaked at about 6 pounds when she was five or six years old, long ago. She’s tiny now, barely 5 pounds. When people first see her, they invariably think she’s a kitten.
Once, when she was young, I saw her whip a big white fluffy cat who dared to look comfortable in our back yard. She watched him with her head low. She growled long and steady to give fair warning. At this, he turned and gave her a lazy look, underestimating the force of her will.
In a flash, Susan leapt on him and they had a cartoon cat fight. A frenzied cloud rose before my eyes with only the occasional paw or ear identifiable as they screeched and yowled in a wild, wild scramble. Then they separated, landing face to face for an instant before the white cat broke and ran for the fence.
Susan watched him for a moment, then decided he wasn’t exiting fast enough to suit her. She lit into him again, catching him on the haunches just before he bounded up and over the enclosure with one last howl.
She sauntered back to sit at my feet, smoothing her coat and pulling tufts of white fur from between her toes, never looking in the direction of the interloper.
In her prime, she killed a bird every day, quite disconcerting for a bird lover like me. I used to come home to the scene of the crime. She brought the slow and the weak to my bedside time after time, dismembering them, eating bones, feathers and all. Mostly I would find feet, beaks, a smudge of blood, and the occasional entrail. Now she watches birds from the windows, occasionally chattering at them, more often showing only detached interest.
She killed a squirrel once, leaving him stretched out in the center of our bedroom with only a hind leg missing. We discovered him after an appraiser had surveyed the entire house, including the bedroom, without mentioning the gruesome scene. (In spite of this, the house appraised well, and we refinanced successfully.)
Back in the day, Susan had a favorite toy, a catnip mouse with pink ears and a leopard-print body. She played with him daily, crouching behind chair legs to ambush him in the hall, sliding across the kitchen floor with him in her jaws, tossing him in the air. She traded that mouse once for what she seemed to perceive as my favorite toy, a furry trinket from Alaska she saw me fawning over after our first trip there. I came home from school to find her leopard-print mouse sitting on the shelf where the souvenir had been, and later found the trinket in the kitchen next to her dish.
Susan rode with us in our big black Chevy Blazer when we moved here from Oklahoma, adjusted to two more changes in residence, supervised two Labrador retrievers, and still travels with us when we go for weekends on the coast or a week in Oregon. She’s a wise old friend and respected confidant.
And not once, in all these years, has she made me sick.
Put her out of the bed? I don’t think so. I prefer to rely on the long-standing, well-established research that says human contact with cats (and dogs) enhances our lives, reduces our stress, diminishes the blues, and brings us joy. That matches my experience with the venerable Susan.
Besides, I’m a little intimidated. If she knew about the research, she might put us out of the bed!
Not only do I protest this weak science, my cat does.
My cat will be 21 years old in June: Susan. That’s almost 140 in people years. Though she eats well, she’s thin and demanding. She spends her days on the deck in the sun, and her nights under the covers, cozied up to the small of my back.
She works the system and gets pretty well whatever she wants---unlimited petting, space on the lap, love, admiration, and amazement.
Susan’s always been small. She peaked at about 6 pounds when she was five or six years old, long ago. She’s tiny now, barely 5 pounds. When people first see her, they invariably think she’s a kitten.
Once, when she was young, I saw her whip a big white fluffy cat who dared to look comfortable in our back yard. She watched him with her head low. She growled long and steady to give fair warning. At this, he turned and gave her a lazy look, underestimating the force of her will.
In a flash, Susan leapt on him and they had a cartoon cat fight. A frenzied cloud rose before my eyes with only the occasional paw or ear identifiable as they screeched and yowled in a wild, wild scramble. Then they separated, landing face to face for an instant before the white cat broke and ran for the fence.
Susan watched him for a moment, then decided he wasn’t exiting fast enough to suit her. She lit into him again, catching him on the haunches just before he bounded up and over the enclosure with one last howl.
She sauntered back to sit at my feet, smoothing her coat and pulling tufts of white fur from between her toes, never looking in the direction of the interloper.
In her prime, she killed a bird every day, quite disconcerting for a bird lover like me. I used to come home to the scene of the crime. She brought the slow and the weak to my bedside time after time, dismembering them, eating bones, feathers and all. Mostly I would find feet, beaks, a smudge of blood, and the occasional entrail. Now she watches birds from the windows, occasionally chattering at them, more often showing only detached interest.
She killed a squirrel once, leaving him stretched out in the center of our bedroom with only a hind leg missing. We discovered him after an appraiser had surveyed the entire house, including the bedroom, without mentioning the gruesome scene. (In spite of this, the house appraised well, and we refinanced successfully.)
Back in the day, Susan had a favorite toy, a catnip mouse with pink ears and a leopard-print body. She played with him daily, crouching behind chair legs to ambush him in the hall, sliding across the kitchen floor with him in her jaws, tossing him in the air. She traded that mouse once for what she seemed to perceive as my favorite toy, a furry trinket from Alaska she saw me fawning over after our first trip there. I came home from school to find her leopard-print mouse sitting on the shelf where the souvenir had been, and later found the trinket in the kitchen next to her dish.
Susan rode with us in our big black Chevy Blazer when we moved here from Oklahoma, adjusted to two more changes in residence, supervised two Labrador retrievers, and still travels with us when we go for weekends on the coast or a week in Oregon. She’s a wise old friend and respected confidant.
And not once, in all these years, has she made me sick.
Put her out of the bed? I don’t think so. I prefer to rely on the long-standing, well-established research that says human contact with cats (and dogs) enhances our lives, reduces our stress, diminishes the blues, and brings us joy. That matches my experience with the venerable Susan.
Besides, I’m a little intimidated. If she knew about the research, she might put us out of the bed!
Thursday, January 20, 2011
Don't Make Me Stop the Car!
When my brother and I were growing up, we tussled as any pair of siblings might. I remember once when the two of us rode with our mom on the spacious bench seat of her beautiful baby blue and white 1957 Mercury Turnpike Cruiser.
We squabbled back and forth over something as important as who ate the last Popsicle, with counterpoints as erudite as, “Did not!” and “Did too!” until she got sick of it and directed us both to keep quiet, which we did. With arms crossed, chins out, and jaws set, we established a battle free zone for her sake.
But then my brother, God love him, stretched his fingers under his arm and across the space between us to my skinny upper arm (where my triceps would have been), and gave me a hard pinch.
It was on! Where we had exchanged inane pre-adolescent barbs ‘til kingdom come (as mom would say), we now engaged in full tilt physical war. I think she stopped the car…
Could be that’s why it’s so hard to feel confident about the newest claims from our lawmakers in Washington, D.C. With contrite expressions, representatives from both parties hit the airwaves this week with proclamations of a new way of business in our nation’s Capitol - cross-party collaboration. They feel sure they’re going to be more successful this way. Hallelujah and amen.
Why, they’re going to quit being rude and combative with each other. They will even sit next to each other! My oh my! What big boys and girls!
Okay, okay, I’ll tone down the attitude. I want to be sarcastic about our lawmakers and their resolutions to be nicer to each other. It’s easier and yes, more fun to be mocking and cynical about their late but well-meaning declarations. But someone has to provide them a role model.
Honestly, I applaud them for stepping up and taking responsibility for the acrimony they have created. They have, in effect, confessed to being vitriolic and venomous. They must have made themselves miserable, along with the rest of us who depend on them for thoughtful leadership and support.
In fact, I appreciate their symbolic gesture of mixed seating for the State of the Union address later this month. (Though it begs the question of why some felt compelled to proceed with the equally symbolic repeal of the Health Care Reform Bill when in their magnanimous mode only moments before, they acknowledged that the whole bill shouldn’t be scrapped. Specific elements are valuable as written and enacted; other elements should be reviewed, tossed out, or improved.)
In the interest of cross-party collaboration, they should dispense with party seating altogether. A rotation of seating might be enlightening and productive for them. This week, let’s seat them alpha by last name. Next week, alpha by state. After that, brown eyes - blue eyes. Anything to get them out of their packs and into the true mix of the needs and interests represented there.
Maybe if our political parties weren’t so well-insulated from each other, they might listen to and learn from each other. In their long-standing segregated practice, too many seem not to listen to anything once the party line is established. Like the penguins in Antarctica, they close ranks, backs to the storm, and wait out the winter of intellectual challenges.
It’s easy to see that when they return to their well-worn, still–warm, and familiar seats, they’re more likely to return to their well-established and unproductive custom of group-think. Common sense and human nature tell us that getting out of the old neighborhood is one of the best ways to get out of an old habit. It’s too easy to blend in, vote with the pack, and avoid controversy and even retribution, when the party is closed around you.
It’s darn near impossible to break from the pack when you’re surrounded by the pack.
It doesn’t seem likely that the seating arrangement planned for the State of the Union will endure beyond its ephemeral symbolism. Too bad.
I hope I’m wrong, but my guess is that ultimately, someone will reach across the aisle and pinch the other guy. Congressman Anthony Weiner, Democrat, New York 5th District, came close with the tone of his "half time report" during the Health Care repeal debate.
Soon we’ll have another partisan battle in the hundred year war, replete with volleys of, “He started it!” “Did not!” and “Did too!”
I just hope we don’t have to stop the car, or the country, for it.
We squabbled back and forth over something as important as who ate the last Popsicle, with counterpoints as erudite as, “Did not!” and “Did too!” until she got sick of it and directed us both to keep quiet, which we did. With arms crossed, chins out, and jaws set, we established a battle free zone for her sake.
But then my brother, God love him, stretched his fingers under his arm and across the space between us to my skinny upper arm (where my triceps would have been), and gave me a hard pinch.
It was on! Where we had exchanged inane pre-adolescent barbs ‘til kingdom come (as mom would say), we now engaged in full tilt physical war. I think she stopped the car…
Could be that’s why it’s so hard to feel confident about the newest claims from our lawmakers in Washington, D.C. With contrite expressions, representatives from both parties hit the airwaves this week with proclamations of a new way of business in our nation’s Capitol - cross-party collaboration. They feel sure they’re going to be more successful this way. Hallelujah and amen.
Why, they’re going to quit being rude and combative with each other. They will even sit next to each other! My oh my! What big boys and girls!
Okay, okay, I’ll tone down the attitude. I want to be sarcastic about our lawmakers and their resolutions to be nicer to each other. It’s easier and yes, more fun to be mocking and cynical about their late but well-meaning declarations. But someone has to provide them a role model.
Honestly, I applaud them for stepping up and taking responsibility for the acrimony they have created. They have, in effect, confessed to being vitriolic and venomous. They must have made themselves miserable, along with the rest of us who depend on them for thoughtful leadership and support.
In fact, I appreciate their symbolic gesture of mixed seating for the State of the Union address later this month. (Though it begs the question of why some felt compelled to proceed with the equally symbolic repeal of the Health Care Reform Bill when in their magnanimous mode only moments before, they acknowledged that the whole bill shouldn’t be scrapped. Specific elements are valuable as written and enacted; other elements should be reviewed, tossed out, or improved.)
In the interest of cross-party collaboration, they should dispense with party seating altogether. A rotation of seating might be enlightening and productive for them. This week, let’s seat them alpha by last name. Next week, alpha by state. After that, brown eyes - blue eyes. Anything to get them out of their packs and into the true mix of the needs and interests represented there.
Maybe if our political parties weren’t so well-insulated from each other, they might listen to and learn from each other. In their long-standing segregated practice, too many seem not to listen to anything once the party line is established. Like the penguins in Antarctica, they close ranks, backs to the storm, and wait out the winter of intellectual challenges.
It’s easy to see that when they return to their well-worn, still–warm, and familiar seats, they’re more likely to return to their well-established and unproductive custom of group-think. Common sense and human nature tell us that getting out of the old neighborhood is one of the best ways to get out of an old habit. It’s too easy to blend in, vote with the pack, and avoid controversy and even retribution, when the party is closed around you.
It’s darn near impossible to break from the pack when you’re surrounded by the pack.
It doesn’t seem likely that the seating arrangement planned for the State of the Union will endure beyond its ephemeral symbolism. Too bad.
I hope I’m wrong, but my guess is that ultimately, someone will reach across the aisle and pinch the other guy. Congressman Anthony Weiner, Democrat, New York 5th District, came close with the tone of his "half time report" during the Health Care repeal debate.
Soon we’ll have another partisan battle in the hundred year war, replete with volleys of, “He started it!” “Did not!” and “Did too!”
I just hope we don’t have to stop the car, or the country, for it.
Monday, January 18, 2010
Emergency Room
I didn't exactly cry in the Emergency Room. I was a visitor after all, not a patient.
Still, sitting on a rolling stool in the ER while the doctor set up to perform an ultrasound on my neighbor, I was overcome...by fear.
I can feel my chin soften, my lower face sag. My eyes fill with tears. I look down to hide my struggle. I remind myself that I am not the first fearful person to cry in an ER.
Doctors and nurses and orderlies (Do they still exist?) pass me in an array of pastel with business on their minds. A Candy Striper (Okay, a Comfort Service Volunteer) asks if I'd like some water. Yes! She brings water with that wonderful hospital crushed ice and a cellophane-wrapped packet of graham crackers. Pathetically, I drink, peel back the cellophane and eat on the stool, distracted, feeling a little better. Another patient rolls through the sliding glass doors, morose, an EMT pushing his wheelchair.
The doctor draws the curtain back and smiles at me. I can return to my neighbor's side. She smiles at me too. "They've ruled out gall bladder," she says waving the arm with the blood pressure cuff, not the bruised one with the IV drip and the shunt.
When she speaks she lifts her head off the pillowless bed and the monitor behind her shows a fluctuation in her pulse. I watch her blood pressure rise on the screen from moderately high (in my estimation) to high...what number will finally trigger an alarm?
I go out again when technicians come with a portable x-ray machine, set up, step away, tell my neighbor not to breathe, and to breathe.
One of my neighbor's friends arrives. Seventy-five, creased pants and a cashmere V-neck over starched white shirt, YSL glasses. The three of us chat. Movies, shopping, home maintenance. Care in this hospital. "Oh, they're very attentive," says my neighbor. "They're very thorough."
"I remember sitting in this Emergency Room with Ed before he died," says her friend. "We were here 12 hours before they put him in a room. Twelve hours and I became quite a bitch," she says with a rueful smile. "Then they moved him."
It grows dark outside the double sliding glass doors. Drizzle falls on the EMTs readying their van for the next outing.
I decide to hand my neighbor off to her friend. "I think I'll go," I say. "I've got to go to the store and fix dinner."
"Oh, thank you so much! Thank you for coming. Thank you. You have my keys? Would you turn a light on in the house tonight? Oh thank you!"
As I walk toward the double doors I keep my head down. Sooner than I expect they hiss open and I fairly run to my car.
Still, sitting on a rolling stool in the ER while the doctor set up to perform an ultrasound on my neighbor, I was overcome...by fear.
I can feel my chin soften, my lower face sag. My eyes fill with tears. I look down to hide my struggle. I remind myself that I am not the first fearful person to cry in an ER.
But I'm not afraid for my neighbor. I'm afraid for myself.
My neighbor is 75, widowed, alone, belly full of radiating pain. Only a step-son on her list of contacts.
I am not even 60, married, happy, in a rewarding career. I live in a warm house with a caring husband, a dog and a cat. (His son, my step-son, is 24 and living with his mother---another story.)
What have I got to be afraid of?
Doctors and nurses and orderlies (Do they still exist?) pass me in an array of pastel with business on their minds. A Candy Striper (Okay, a Comfort Service Volunteer) asks if I'd like some water. Yes! She brings water with that wonderful hospital crushed ice and a cellophane-wrapped packet of graham crackers. Pathetically, I drink, peel back the cellophane and eat on the stool, distracted, feeling a little better. Another patient rolls through the sliding glass doors, morose, an EMT pushing his wheelchair.
The doctor draws the curtain back and smiles at me. I can return to my neighbor's side. She smiles at me too. "They've ruled out gall bladder," she says waving the arm with the blood pressure cuff, not the bruised one with the IV drip and the shunt.
When she speaks she lifts her head off the pillowless bed and the monitor behind her shows a fluctuation in her pulse. I watch her blood pressure rise on the screen from moderately high (in my estimation) to high...what number will finally trigger an alarm?
I go out again when technicians come with a portable x-ray machine, set up, step away, tell my neighbor not to breathe, and to breathe.
One of my neighbor's friends arrives. Seventy-five, creased pants and a cashmere V-neck over starched white shirt, YSL glasses. The three of us chat. Movies, shopping, home maintenance. Care in this hospital. "Oh, they're very attentive," says my neighbor. "They're very thorough."
"I remember sitting in this Emergency Room with Ed before he died," says her friend. "We were here 12 hours before they put him in a room. Twelve hours and I became quite a bitch," she says with a rueful smile. "Then they moved him."
It grows dark outside the double sliding glass doors. Drizzle falls on the EMTs readying their van for the next outing.
I decide to hand my neighbor off to her friend. "I think I'll go," I say. "I've got to go to the store and fix dinner."
"Oh, thank you so much! Thank you for coming. Thank you. You have my keys? Would you turn a light on in the house tonight? Oh thank you!"
As I walk toward the double doors I keep my head down. Sooner than I expect they hiss open and I fairly run to my car.
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