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Mon Mar 30, 2015 at 11:27 AM PDT

Born This Way

by McCamy Taylor

Why do we choke up when we see a stranger empathize with a gay couple denied service in a restaurant? Being kicked out of a Mexican eatery in Mississippi seems like such a first world problem. There are folks all over the world who are being murdered for their sexual orientation and the color of their skin and their religious beliefs. Why does this little--in the relative scheme of things---bit of discrimination evoke such a massive amount of emotion?

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Sexism is alive and well in the U.S. today. Take my own profession, medicine. A male doctor who is not a complete dick is treated as something special. A female doctor who is not 100% Mary Poppins is a "bitch." Another way to say the same thing: patients will not tolerate a female physician who does not act motherly, but they often respect--and continue to consult--- a male physician who is curt, abrupt or even downright rude---like the one who started a visit by saying to me "I will ask the questions and you will answer the questions and you will not say anything else." Yeah, he was an asshole, everyone knew it. But a man like that can maintain a practice. His god-complex is a sign that he is good at his job.

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Here are how I see the stakes in the next election. We, in Texas---and in a lot of other so called "Red" states--are still suffering from a massive uninsured problem. Take kids. We are supposed to have universal health coverage for kids, right? Not true. A state can offer Medicaid and SCHIP, but if it throws up barriers and makes the process all but impossible to navigate and tells inquiring parents "You don't qualify" over the phone when they really do, that state will not have universal coverage of kids. Texas is one of the states with shamefully high rates of qualified kids who lack coverage. Other red states are the same.

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In Texas, a state legislator put an Israeli flag on her desk and instructed her staff to ask Muslim visitors to swear allegiance to the US. The swearing allegiance part was offensive. Muslims, like Catholics and Buddhists, have come to the US in order to take part in the American dream. They are here to go to school, become doctors and engineers, raise families and live the good life.

The Israeli flag was Bad Math.

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(And yes, there are still a lot of them, thanks to the states that refused the Medicaid expansion like my own state of Texas)

All health care for the poor is not the same. There are two, almost opposed rationales for indigent health care in this country.

Indigent Health Serves the Poor

There are two missions of any publicly funded endeavor to improve the health of the poor. One is a humanitarian goal---help those who are less fortunate than ourselves with their health problems which cause them pain, disability, loss of enjoyment of their family and lives and premature death. This aspect of public health is especially popular when it comes to children and the elderly and is probably why we have had Medicare for so long and why SCHIP was passed a decade before we tackled health care for working adults. As LBJ said back in the 1960s (more or less) it ain't right when Grandma has to suffer needlessly after she spent her life taking care of us. And no one wants to see a child suffer from medical neglect.

In between the helplessness of childhood and the golden years, there are working poor, many of whom are poor precisely because they have inherited diseases such as asthma, arthritis, heart disease, diabetes, sleep disorders and other problems that caused them to be raised in poverty, missed education opportunities, forced them into low paying, no benefit jobs at early ages to support their ailing parents and then struck them in the prime of their life when they had no insurance either, leaving their own families vulnerable. These folks are another excellent reason why bleeding heart you know what's like me believe that we should care for the health of the poor.

And there is a side benefit of showing compassion for those who are poor in an affluent society. Wealth disparity is a health problem in itself. If you tell poor folks "You don't count" their burden of certain stress related illnesses---including mental illness and substance abuse and domestic violence---goes up. Compassion that is true compassion---not crumbs tossed down from on high but a helping hand offered in a sense of brotherhood can go a long way towards showing those who have had some bad breaks in life that they still have something of value to offer. We saw a lot of this during the Great Depression, when the photographers of the WPA showed us a Poor America that looked just like ourselves--- with a family, with a farm, poor through no fault of its own. We held out our hands. We got through the hard times. We created Social Security. As a nation, we got stronger. And richer. The fifties and sixties were times of prosperity for all, thanks to the compassion we showed one another during our worst of times.

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Tue Jul 22, 2014 at 04:18 PM PDT

Don't Panic!

by McCamy Taylor

For two whole hours, folks who had bought their own insurance on a federal-not-state health exchange were faced with a predicament. The DC Circuit Court did what everyone knew that it was going to do and declared "We want to take back your ACA insurance in time to influence this fall's Congressional election!" Yes, that is what they said. You just had to read between the lines.

Luckily, two hours later, another court said "Who are you kidding?" and gave those of us who purchased ACA insurance on federal exchanges back our health insurance.

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I don't have a lot of time today, so I will make this quick. There are more details in "Life Without CPAP" which is still available free today at Amazon for kindle and which I will still send you free as a word document any time you send me your email address.

In 2008, we went into a huge recession/depression that the GOP/Bush/Banksters started. Companies took advantage of the downturn to trim "deadwood". Deadwood turned out to be lots of workers in their 40s and 50s who were almost vested in their pensions and who had some health issues and who also were getting a little bit slower, showing up at work a little bit later, occasionally were forgetting things in a way that they did not do in the past---and basically, fit the profile of the one in twelve Americans over 40 who have obstructive sleep apnea (OSA) but who do not know it. Their employers did not know it either. They just knew that they would save money by firing these folks and hiring someone younger to do the same job under a different title.

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If you have not read my blogs before, I am a family physician, who retired because doctors did not diagnose my sleep apnea. Once my husband (not a doctor) figured out what was wrong with me and I found treatment that was effective for me (I was a CPAP failure), I went back to work--something that is rare in a nation where disability usually means the end of productive life. While off work, I got a Masters Public Health and did several research projects and my thesis on sleep apnea. I have written about sleep apnea. I blog about it online. It is a special interest of mine in clinical practice, though I do not run or own a sleep lab. Indeed, by some odd twist of fate, I have ended up working the last five years at a "free clinic" that does not have enough money to pay for sleep studies or CPAP which has forced me to become creative---

And therefore, I was bit alarmed when I read this piece from 2012, about how a major health insurer appeared to be taking the position that sleep apnea was being overdiagnosed and over treated---and costing the nation too much money in the process, and therefore they want to limit the diagnostic and treatment options that are available to OSA patients who have insurance.

Dr. Fred Holt, an expert on fraud and abuse and a medical director of Blue Cross Blue Shield in North Carolina, says some patients aren't having basic exams done first and are therefore being prescribed expensive tests they don't need. Not everyone who snores has a chronic disorder, he says. In other cases, Holt says, the labs prescribe CPAP machines right away without first suggesting other strategies that could reduce apnea, such as losing weight or sleeping on your side.

Don't health insurers know that if they don't fix the sleep disorder now, they will be paying for the CABG and the stroke rehab a few years from now? Maybe they don't look beyond the next quarter. Maybe they need a family doctor to help them see the big picture---the big health picture and the big financial picture.

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Just in case you have ever wondered why insurance companies and their representatives seem so cocky when dealing with individual physicians, maybe it is because they have so much power. All that money allows them to do things that you might think were impossible---like stifle the doctors who are supposed to be advocates for their patients by usurping control of the regulatory bodies that police doctors.

This is a real story. The next time you hear a physician whistle-blower describe insurance abuses, remind yourself that he or she does so at great personal risk. Where  there is money involved, there are likely to be a lot of unscrupulous people who will stop at nothing to protect that money---especially if the money is coveted by  BCBS, the mega-behemoth of insurers which has been guilty, among other things, of lying about losses so that it can raise premiums and dump sick patients and defrauding Medicare (and yes, the links are easy to provide if you really want them. The NYT covers big stories like those). BCBS, whose Mike (not Keith, sorry Keith) Hightower was one of Bush's Pioneers. BCBS which employees Uncle Bucky Bush. BCBS which was the only non-bankster in the list of top donors to Bush in 2004. Bush---who bragged about the Texas Patient Protection Act (which he vetoed) in a 2000 debate with Gore then had Ashcroft get it struck down in federal court for his good buddies in the insurance industry. Bush, who set back the cause of universal health care for eight years.

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California insurance giant Anthem Blue Cross misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed Tuesday.

As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.
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While HHS has ruled that the Ryan White Foundation and a handful of other charitable groups can make ACA premiums, many other charitable groups find themselves in limbo. Therefore, in May, the National Health Council sent the letter below to HHS. Recall that the health insurance industry opposes third party ACA premium payments, since they believe that these tend to increase their own financial risk by allowing members to qualify for plans which they can not afford---changing the rules of insurance, as it were. Charitable groups believe that without such 3rd party premium payments, some disabled people will find themselves underinsured---with potentially life threatening results. With Congress stuck in gridlock, it can not address the issue, leaving it to the executive branch and the courts to settle.

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Life Without CPAP is about a  public hospital and clinic system that decided that sleep studies to detect sleep disorders such as obstructive sleep apnea and treatments for OSA such as CPAP were ineffective and too expensive. The money spent diagnosing and treating sleep disorders could be better spent elsewhere. And so, the administrators adopted a system wide policy. No county patient would get a sleep study. No one would get CPAP.  Period. If anyone was in danger of dying from untreated OSA, they would be offered a tracheostomy—a surgical procedure in which a hole is cut in the throat and a tube in inserted in the airway. A permanent fix.  And about as appropriate for most OSA as decapitation would be for migraine headaches.

The decision was a quiet one. There was no sign over the door of the hospital advising patients that if they had a sleep disorder, they should probably seek treatment elsewhere. The people being seen assumed that their health care providers would diagnose and treat their medical problems to the best of their ability. Since public awareness of sleep disorders is low, very few of them would have noticed if a sleep disorder was missed or not treated. They were grateful to be getting “free” health care that they otherwise could not afford.

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