Posts with the tag Medicaid

Lack of DENTAL care

Connie — Fri, 16 Oct 2009 10:10:17 EDT

Being disabled,I also qualify for SSI, Medicare & Medicaid based on a yearly income of $7,104. Yes, I 'survive' on $592. income per month! I'm a cancer patient, 54 years old & still have my youngest son at home, dependant, while he is struggling, financially, to get through college. Barely able to keep up with medical appointments, my teeth are paying the price from lack of care. This morning, tooth #3 broke off while I was struggling to eat my breakfast. Being ill, I have already lost 25 lbs., I'm now down to 110 on a good day. (I'm 5'6" tall.) With the dental issues, it is a struggle to eat anything that isn't 'soft.' Now, my mouth is hurting, I reach out to find help, anywhere that I can. The local Health Department! Yes! We do have a dental clinic ~ we only charge $50. for each extraction & $100. if they have to be surgically removed &, of course, that HAS to be paid when you come in to have the work done. O.K., $300. just to have these 3 broken teeth removed. WHERE am I supposed to come up with that?? My income is only $592. & I DO have bills to pay. Then again, IF I did manage to be able to have them removed, I would then be, Toothless. Meaning, having NO teeth to eat with. Yeah, I know, that's where false teeth come in at. IF I don't have the money to have them removed, I certainly don't have the money to replace them. And, guess what? Medicaid nor Medicare will cover ANY dental bills! Why do you think my teeth are as bad as they are?? What the heck am I supposed to do?

What the heck am I supposed to do??

Human Rights & Health Care Reform

Dr. Julien Arbor — Wed, 14 Oct 2009 06:35:27 EDT

Hello:

My name is Dr. Julien Arbor and I have an Acquired Brain Injury that was the result of such over-the-top medical malpractice and human rights violations that it is inconceivable to me that such a thing would occur in the United States!

A bit about my background:

I am a Licensed Clinical Psychologist specializing in Health Psychology, experience in evaluating and working with patients with TBI, a Wellness Counselor, a Natural Healing Consultant, a Researcher, an Author, and a 7 year Volunteer Health Educator & Moderator for one of the largest natural health websites on the internet.

I am also currently disabled and dealing with the challenges of a form of TBI known as an Acquired Brain Injury. The circumstances surrounding the development of my ABI have provided a tremendous opportunity to conduct extensive research that indicates that the psychiatric diagnosis of PTSD is actually a form of an Acquired Brain Injury that results from an acute and severe metabolic disruption that is brought about purely by extreme and traumatic stress. I have done an extensive review of the scientific literature and also gathered data for the past year and will be completing a single case research study as soon as I have undergone my own treatment and rehabilitation that will allow me return to work.

There is already considerable research that demonstrates changes in brain structure in those who have been diagnosed with PTSD. However, this will be the first study that provides quantitative evidence that suggests that it is an underlying metabolic disruption following extreme and traumatic stress that results in damage to the brain. Furthermore, this research also points to treatments that will successfully address the symptoms, halt their progression and also suggests a means of preventing this condition from developing.

This research will also suggest an explanation for connections between a diagnosis of PTSD &/or TBI and a growing number of life-altering, chronic and costly health conditions that are highly correlated later in life such as depression, emotional challenges, hypoglycemia, diabetes, hypertension, heart disease, epilepsy, headaches, migraines, chronic pain, sleep disturbances, debilitating fatigue, sensory changes, aggressive behavior, weight problems, skin conditions, hormonal imbalances, sexual dysfunction, respiratory problems, cognitive and memory impairments, substance abuse, skin conditions, balance and gait disturbances, increased susceptibility to infection and cancer. This will point to a large number of additional areas for research as a follow up to this study.

I am also devising a safe, natural, effective and cost-efficient treatment protocol that is a truly holistic integration of mind-body medicine in order to address the underlying metabolic dysfunction as well as address the resulting brain damage.

Medical Reform

Susan — Thu, 24 Sep 2009 20:36:07 EDT

After 40 years spent working, I developed serious medical problems. Because I put money into the social security system, I receive $1400 a month to live on from them, stripped down to $1308 to pay for medicare and medication. My cost of living I've managed to get down to $950 a month by cutting out everything but rent, phone, unilities and transportation. $684 gets spent on medical expenses and medication not covered by Medicare. Until now, the extra $326 has been coming out of savings but savings is almost gone.

Next month that $684 figure will jump to $1,238.00 because medication is only paid for up to a certain dollar amount.

When is a public option not a public option?

Douglas from South Gate, CA — Mon, 14 Sep 2009 16:27:31 EDT

I just read this in the New York Times online, in a article titled, "Take Public Option 'Off the Table,' Snowe Says":

Max Baucus, the Democratic chairman of the Senate Finance Committee, has said in recent interviews that he cannot get the committee to support a government-run health plan. Instead, he said, the committee is coalescing around a bill that would expand Medicaid coverage to several income brackets above the poverty level and require all American[s] to be insured through private plans or through the existing public plans of Medicare and Medicaid. Subsidies would be provided for those who could not afford medical insurance.

http://www.nytimes.com/2009/09/14/health/policy/14talkshows.html?th&emc=th

Unfortunately, the polls continue to show that public support for a new public option has been severely eroded ...

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/13/AR2009091302962.html

... after the "full frontal assault" by mobs incited in large part by the insurance industry fearing a nonprofit competitor. So this proposal to use the existing public insurance plans of Medicare and Medicaid to "fill the gaps" of coverage at first sounds intriguing. But there are several important requirements, in order to make that compromise do what a new public option would, in terms of controlling costs as well as filling gaps. Among those considerations, not stated by anyone in that article above, are the following.

Health reform outside the box!

Forrest — Sun, 30 Aug 2009 02:33:04 EDT

I am writing this somewhat wordy but pragmatic letter and hope it gets in the hands of someone who can make a clear evaluation and find it helpful or at the least noted as to one perspective to the current Health Care Debacle taking place and under careful consideration, could actually prove very beneficial and part of the future solution. I feel the Democrats are out to make a clear change for the good of the country and the Obama Administration is shaping up to be the best Administration I believe I have seen in my lifetime; however is having a clearly difficult struggle battling the concerns over healthcare. I voted for Obama and even made a contribution to the campaign which was the first time in my life to do so because I believe in his overall vision for the country. Currently I live in Tokyo, Japan, and am exposed to a very different healthcare system as well as have many friends from other developed nations who have socialized medicine, i.e. England, Canada, Australia, etc. I have had various debates and have a good understanding of these systems from the standpoint of their basic citizens and the rights thereof from these systems. Of all the countries, Japan has the most hybrid system between socialized medicine and our current system; however would not be a good political strategy to mention as a talking point. Actually these ideas should be applied as original ideas from the Obama administration to the public and will close this healthcare debate once and for all.

To get directly to my point, I feel the Democrats are doing what they always do, bring a good idea to the table (bring the right idea to the table) but back down based on pole numbers and a clearly, historically based fact, of not managing the emotions of the populous. With that being said, I feel many of Americas fears are superficial in nature and may not address a simple premise of government spending, influence and size. I pose the question, “if you add something, you take something away”, such as adding a public option and taking away the obviously broken, inefficient and burdensome Medicare system. This would have an overwhelmingly favorable impact on republicans and the right compromise with democrats and the masses of people who are looking for that right tax cut would be dancing in the streets. I understand we will be cutting a huge tax generator for the government but we will also cut off and stop the hemorrhaging of a government appendage that is infecting everyone as a whole. It is possible to subsidize those in the current system with the public option, under some “special program” and the democratic party has 3 years to win the Medicare constituency over, plus everyone will be satisfied to know they are not contributing to a possible other welfare system and the welfare system of others, and everyone can take care of themselves. The revenue generated in the public option should closely account for the loss of cutting the program, especially if there is a system where it is an availability for every small business, and for those who may not necessarily be able to purchase the public option program all the time can still fall under a special subsidization program under the public option program but maybe with premium adjustments in time. There could be grandfather clauses to alleviate the “the government is trying to pull the plug on granny“ debate. In order to offset the loss in tax revenue, include a tax incentive for those who have proof of insurance for the tax year and be adjusted accordingly if that is a concern with a favorable adjustment for those who do and an unfavorable adjustment for those who don’t; however if it is going broke it may be best just to cut the losses on it. The IRS has the people and infrastructure and can also be included in the debate to validate proof of insurance. That last point is a little complicated to wrap your head around but could make huge in rows in appealing to those who don’t like any of the current systems, who don’t like picking up the tab from one average American to another and don’t see a clear solution. I feel confident that in 3 years the Administration can satisfy its Medicare constituency and its proponents and this type of drastic change will, and I emphasize WILL, have a huge favorable reaction with the American populous as a whole.

As an additional selling point, Americans should be able to “double down” on their health insurance and drastic changes need to be set in motion as to insurance regulation reform. This is a version of the Clinton play book in areas such as telecom, etc; which WILL be good for the health insurance industry, and everyone as a whole and would probably have them off the governments back for a while because they will be too busy creating/selling and purchasing new products and helping to “stimulate the economy” in many many ways. This is not a non-manageable endeavor, just a little unorthodox. That is one good point about Japan’s current healthcare system, to include insurance products such as hospitalization and rehabilitation remuneration, double coverage, etc. People, in general, like to know they can get something back when paying so much into a system that does just that and actually make some money in the event of such a challenging time in their life and this adds a great since of security and satisfaction in those moments. By the way, this is a homerun idea that will leave a lasting hurt on the republican party and brand because everyone benefits as a whole but carries some of their self-reliance and capitalistic ideals. To add to this point and to expound on the “pre-existing” condition problem of the current system, legislation should also include a wide range of other procedures that are deemed not a necessity and allow coverage of these programs at a price to include allowing the private sector to compete for these dollars and to compensate for the losses they will be incurring with having to cover pre-existing conditions. This could even include aesthetic procedures with a regulatory consultation practice. Deregulating that industry but with the right quality of care in the minds of everyone involved is good for everyone. Personally, I don’t like the whole system but these are the right decisions for everyone as a whole.

I don’t quite agree with this but also monetary penalties could be put in place and deemed necessary by the doctor in the advent of non-life threatening problems clogging the emergency room system. A doctor is qualified to make that decision and should, which would help all commercial entities in the system and help the system as a whole in this day and age in curbing the mass influx of those who use the system. On another point with that debate, people have to work and can’t afford to lose a day’s work when their child has the flu and they sacrifice their sleep and wellness in order to go to work the next day but ensure their child is seen, diagnosed and put on the right treatment regimen. With that being said, maybe a system that rewards afterhours care facilities should be looked at such as a tiered payment system by the industry to the facilitators that addresses this.

I have a few other points to add about this and I don’t want to sound like I’m pulling only the positive points of other systems without recognizing the negative points, yet being that so many systems have been in place and for such a long period of time, I think we can get it right and my points could aid it.

A clear plan needs to be outlined with someone reading charts and tables, pros and cons, and an informative debate needs to be made with a clear vision. There is enough time to regroup and get this done this year and not to be rushed and to have people put in the corner on the issue without all the CLEAR facts. Open debates should be held with the public having easy access to make informed decisions and people should be thinking outside the box such as this letter. I have read the top 5 myths about the new reform and the stats on people polled regarding this debate. I would like to make a statement to the Democratic party as a whole that I am ashamed to see that they cannot debunk the death panel debate and strategically, they should look at and put resources into how to overcome this and future situations such as this. I’m sure they can get a good team of psychiatrists and marketing gurus to look at how their messages get drowned out by basic human emotions of fear and distrust. To add, the immigrant debate is a valid one but no one seems to be showing that who pays into the system only helps support the system in revenue, etc. and should get treatment accordingly. We can look at the Denver Olympics at those facts and it would actually be good for the system for allowing as many of those who can pay into it, do so; to include people with student visas and short term visas, etc. The new program should be run like a private system alleviating people’s fears of the government keeping tabs on them and regulating what they have and don’t have and maybe compare it to the postal system or collegiate education system.

In conclusion, thank you for taking the time to read this and would personally like to see how these above mentioned points would not work. I have solutions for some of the other internal problems plaguing the system but can’t remember them all at the time I’m writing this; however many of the new options are definitely headed in the right direction. I just felt compelled to offer my “.10¢” after seeing the reform offered getting slaughtered by the American public in the news and it seems more people are buying into the stats shown to them, therefore buying into some of the current falsehoods. By the way, if the right person reads this and finds it beneficial and would like to ask my opinion on other problems facing the system, please feel free to do so or debunk my points.

PUBLIC HEALTH CARE - CONCISE IN A NUTSHELL

GREG KLINE — Mon, 08 Jun 2009 13:56:11 EDT

There are roughly 306 million Americans, more than 47 million of whom have no health insurance. That's 1 in 6 Americans, who only seek medical attention in Emergency Rooms, when their stuation is dire. They do not receive preventive care, which is ultimately a fiscal disaster. 60 million Americans have inadequate access to primary health care. 100 million don't have dental insurance. Last year, 116 million ailing Americans fore-went care because they couldn't afford the deductables, were under-insured, or had a lapse in coverage. In 2008, over a million Americans lost their homes, directly attributable to medical bills. Did you know that 2/3 of all personal bankruptcies are related to medical bills? Who pays in the end? We all do.

The US spends $2.3 trillion each year on health care, 16 percent of our GDP. Americans spend $7,129 per person on health care, 50 percent more than other industrialized countries (including those with universal care). Canada spends 10% of it's GDP on health care, England 9%, and France 11%. Yet, we rank roughly 37th in the world, in regard to the quality of our health care (France ranks #1, England #18, and Canada #30). 30% of every insurance dollar goes to paperwork and administration fees. Still, in 2006, the six largest insurance companies made $11 billion in profits, even after paying for direct health care costs, administrative costs, and marketing costs. The number of health insurance industry bureaucrats has grown at 25 times the growth of physicians in the past 30 years. We all know that much of the industry profits come from the arbitrary exclusion of "pre-existing conditions", and terminating people's insurance once they experience a serious illness.

Barack Obama's health insurance plan purports to reduce insurance costs by 30% (more than $350 billion per year, enough to provide comprehensive coverage to every uninsured American). He plans to eliminate "pre-existing condition" restrictions. And most criticaly, provide a public health care option. The current Republican tactic, is to call this plan socialism, because it is a loaded term, calculated to scare people. The fact is, police and fire departments are socialized. And your health is a more fundamental right than both of those. Sooner or later, we will all need help from social safety nets, such as Social Security. With health insurance, what we are effectively talking about, is broadening the OPTION of a form of Medicare and Medicaid to everyone. This will cause private insurance companies to respond more reasonably to their clients, and to reduce their rates to be more competitive. The GOP says that Medicare is expensive. The fact is, that Medicare's administrative costs are far lower than any private health insurance plan. The GOP also complains that government run programs are a disaster. Funny they don't feel that way about the government run insurance plan that Congressmen have.

Keep in mind, that privatised health care, introduces the model of profit (with expensive ads that we ultimately pay for). The whole point of profit, is to give as little as possible, for as much as possible. That's no way to address your health. Fun fact: The pharmaceutical industry is the single largest advertiser in America. This might be why the health care industry is spending 100 MILLION DOLLARS (1.4 million dollars a day) to lobby against and kill the public health care option. Their latest tactic is the "trigger option". Don't buy it.

And don't be fooled. Public health insurance DOES work well in Canada, England and France. Yes, one can always find an exception to harp on for political ends. When you research it, it becomes clear that the vast majority of people in these countries are quite satisfied with their health care. Notice that the opposition to public health care, is all about fear, scare, pessimism, status quo, defeatism. Ask about alternative ideas, and you hear silence. Fact is, approximately 73% of Americans want some version of a public health care option "like Medicare/Medicaid".

Another Republican talking point, suggests that a public healthcare option would take health care out of the hands of patients and their Doctors. In fact, that's exactly what we have now. We all know that insurance companies routinely deny coverage for tests, surgeries, and medications. I have personally experienced insurance company kangaroo appeal decisions, where they are the sole arbiturs of a judgement. As I write, though I'm insured by Aetna, I have to wait 6 weeks to see a neurologist that will accept my insurance.

You want to put a human face on this? My daughter was born this past September 28th with a recessed jaw. Her medical bills thus far are over a half MILLION dollars. She easily has another half million in surgery ahead of her. This is insanity. My 6 month old daughter should not be forced to live an obscene legacy of helplessly and unwittingly running her family into poverty. It simply breaks my heart.

It is woefully overdue for people to have a public health choice available to them. Yes, lobbyists and other rats are lining up to fight it, because lower costs, means lower profits for them. It's time they stop running the show. People have suffered enough. My wife and I have suffered enough. Damn the politics. It's time to act civilized. It's time for decency. People need to support Barack Obama's public health option, NOW.

But no person, including Barack Obama, can do this alone. He needs the will of the people. This means that he needs your two cents. A "letter to the editor", blogging, signing petitions. Many people putting in two cents will create the foundation, momentum, and mandate that Barack needs to press his case. We can do this historic thing. Yes we can. Let's go get em.

All Good Things,

Greg

PS - How countrys rank in health care;

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei
41 New Zealand
42 Bahrain
43 Croatia
44 Qatar
45 Kuwait
46 Barbados
47 Thailand
48 Czech Republic
49 Malaysia
50 Poland

Easy Health Care Reform is Hard

Chris from Plymouth, NH — Mon, 18 May 2009 13:07:38 EDT

No matter how you slice it, dice it, or price it health care reform will look like one of these two options.

A) The Federal Government uses dollars from all taxpayers to subsidize for-profit insurance company with rates few can afford. (this also includes additional taxpayer contributions to finance public health care coverage private insurers will not provide)

For example:

"STATES ALLOW SMALL-BUSINESS EMPLOYEES TO GET COBRA BENEFITS

"So far, 40 states have passed "mini-COBRA" legislation, which allows people who have been laid off by businesses with less than 20 employees to hold on to their employer-sponsored coverage and benefit from the federal government's offer to pay 65 percent of their COBRA premium costs for nine months, and Pennsylvania may be next, reports the Philadelphia Inquirer."

http://www.philly.com/philly/business/personal_finance/44347382.html

B) The Federal Government uses dollars from all taxpayers to finance health care all can afford.

For example:

H.R. 676"

"The United States National Health Insurance Act, is a bill to create a single-payer, publicly-financed, privately-delivered universal health care program that would cover all Americans without charging co-pays or deductibles. It guarantees access to the highest quality and most affordable health care services regardless of employment, ability to pay or pre-existing health conditions."

http://www.johnconyers.com/hr676faq

It's a matter of holding lawmakers accountable for how your tax dollars are used. Many politicians don't understand life on Main Street; all understand political pressure in the back street.

Now, we must set aside process differences in order to bring enough people together to exert the pressure needed to get the reform we want. That reform is the hard part and may prove much more difficult.

NATIONAL HEALTH CARE PLAN - PART 2

Queen E — Sun, 26 Apr 2009 11:17:59 EDT

April 26, 2009

National Health Care System - Part 2

Yes, to all of you who has responded to my letter on National Health Care Plan, your points are so valid and real. Thank-you.

I still say to you all and to our President and Congress that it is not that hard to implement a National Health Care System in these United States.

Because it already exists; Its called Medicaid and Medicare.

You only need to revise the policies on membership, on salary requirements, on assets, on whatever rule is blocking others to become eligible and to include All people.

That’s it. That is so plain and simple. No exceptions to the rule.. Leave out the exceptions and grant Medicaid and Medicare across the Nation to All People.

Deduct some amount from All Worker’s salary to pay into the Medicaid and Medicare System. Small Business would only need to be concerned with implementing a payroll deduction for the National Healthcare Plan just as they withdraw Federal and State Income Tax payments.

It is not that complicated. It really is not that complicated but people seem to want to make it complicated.

No, HMOs or Private Clinics or Private Practices would have to close down. They only need to ACCEPT the new Medicaid and Medicare patients.

Yes, Blue Cross and other Insurance plans will have to scramble to create a way to become inclusive and join the National Health Care System.

I SUGGEST THAT They do this by contracting to the Federal Government to assist with Oversight and Management.

IT IS NOT THAT HARD FOLKS. Please stop adding to the deficit by creating more insurance plans, more health care systems. STOP!

Make the administrative revisions to Medicaid and Medicare and let’s get on to other issues in the community.

Letter To Congress & President on Health Care

Queen E — Tue, 21 Apr 2009 16:17:22 EDT

Dear Citizens, Congress and Mr. President:

It is not that hard to correct the health care system. Our health care system is very correctable and the correction can be instantaneously implemented. Why are we making this harder than it truly is, why?

Is it because the perception of change out there is so negative and will meet with opposition that you won’t allow yourselves to try something new?

Is it because the opposition is blurting out the negative rhetoric to protect their interests and profit margins?

Is it because the Drug companies will have to relinquish their investment on some private health care practices that push drugs for them in spite of the drugs in ability to really heal and correct the illness?

Or is it really because of the cover up of the Pharmaceutical’s perpetrated fraud and lie about their colorful, purple, green, red and yellow pills that they have been pushing onto our sacred Doctors and Patient’s for over 20 years? I told my Dad, may he rest in peace, back in 2000 not to take that purple pill for his indigestion and just drink some ginger ale soda to make him burp. And I told my 84 year old mom today, that she can take a glass of wine and take vitamin E to help work on her hardening of the arteries, but she still has to take her prescription for high blood pressure although she told me to eat a piece of raw garlic to get the pressure down and that it cleans the blood. My dear Citizens, Congress and Mr. President, I am tired of being lied to and I want change.

Our National Health Care System right now can work this way; read the following:

1. Revise Medicaid and Medicare to include all people of all ages; Medicaid for newborn to middle age and Medicare for middle age to Senior Citizens.

2. Deduct from ALL wages, from ALL employers’ wages an amount towards the payment of Medicaid and Medicare. (Like my wage is already being deducted for Medicare in addition to my private health plan)

3. Make it a requirement to all private hospitals, health care clinics to ACCEPT both Medicaid and Medicare. If Blue Cross & Blue Shield, Kaiser Permanente, Humana, Veterans Hospital and others don’t want to accept the National Health Care patients, FINE, we will go where they will accept it and get just as good treatment. (Oh you want competition, huh? Hello. HMOs, here’s your chance to step up to start treating Medicaid patients, you don't have to close).

4. PHASE OUT: All citizens, who want to change and opt out of their current health plan for the National Health Care System, allow them to do this. I will drop my private health plan for the National Health Care System in a heartbeat Or - I will remain a patient of my private plan if they accept my Medicare and just charge me an office visit fee like they are doing today.

It Is Not That Hard -- To Make The Change. Why are we spending money to create another health care plan? CHIP-Children Health Care…What? Why? Who are you afraid of upsetting, The Pharmaceutical Drug Corporation? Why do they have so much power and authority over us Citizens? Why? Let's open their Pandora's box, Freedom of Information, FOIA to find out their investments and what the Pharmaceutical's accounting book ledger will reveal, huh?

MEDICAID AND MEDICARE is recognized and automatically accepted in hospitals across this nation. It is your National Healcare system that only need to be administratively revised to include ALL people.

I'm not bothered by any old stigma or perception that Medicaid carried from years back. I just want to be treated for my illness no matter what the name of the new National healthcare plan is called. I just want good doctors and good health care.

Please tell me and reveal why we should not make this kind of change to, "NATIONAL HEALTH CARE" Why? Sincerely, Esther Mayberry

State Judge Overturns Medicaid Code - Denies Mental Health Care to Illinoisans on Medicaid - Ensures Conviction of Dr Shelton

Dr Linda Shelton — Thu, 12 Feb 2009 09:30:37 EST

Dr Linda Shelton, who has devoted her life to service of others and particularly to providing medical and mental health services to the poor will be completely destroyed in two weeks with a false conviction for Illinois Medicaid Fraud simply for trying to help people on Medicaid obtain mental health care. Please read the following and help any way possible. I thank anyone who will help me.

This is a story epitomizing government corruption and greed, retaliation against whistle blowers, and gross government incompetence brought on by decades of fraud, patronage, and nepotism in Illinois.

Judge Jorge Alonso ruled on my pending criminal case where I am charged with Medicaid fraud that “substitute billing is illegal”. This is where a doctor sends a bill to the insurance company for services performed by his employee such as the service of a nurse administering a vaccine or a psychologist administering a psychological test, or a cast technician applying a cast. In my case the Illinois Attorney General claims that if a doctor bills Medicaid for counseling (for drug addiction, post-traumatic-stress disorder after rape, obsessive-compulsive disorder, depression, dementia, etc.) if the counseling or psychological testing was done by an employee and not directly by the physician then it is a felony crime.

If substitute, also known as incident to, billing is illegal than ALL doctors in Illinois are guilty of a felony crime of fraud! God Help Us! Judge Alonso is so eager to railroad me and convict me that he is violating his oath of office to uphold the laws of the land and the constitution. Due process, guaranteed by the Bill of Rights REQUIRES that he follow the law. He is BLATANTLY violating the law, either maliciously or ignorantly due to his arrogance, incompetence, bias to run and support the alleged prosecutor AG Lisa Madigan, or his ego.

Physicians are NOT trained to do psychological testing for personality disorders or mental illness. Psychologists at the master’s and Ph.D level are trained to do so. These tests are invaluable in helping determine the right diagnosis and the right course of treatment. Judge Alonso has ruled that those on Medicaid are not eligible for this type of evaluation and treatment as a result of his illegal and unconstitutional ruling.

Many non-physicians are licensed in Illinois and all states to provide Psychiatric & Psychological Services:

1. nurses 225 ILCS 65,
2. clinical psychologists 225 ILCS 15,
3. licensed social workers 225 ILCS 20,
4. licensed clinical professional counselor 225 ILCS 107,
5. licensed marriage and family therapist 225 ILCS 55 and 68 ILAC 1283

Judge Alonso’s illegal ruling denies all of these people the RIGHT to practice their profession and denies the citizens of Illinois on Medicaid the Right under the Federal Medicaid Act to access to care equivalent to the care provided in the community.

Federal Judge Joan Lefkow ruled in August 2004, at the end of a 12 year civil rights class action suit that “Illinois Medicaid Policies and Procedures are in Violation of the Federal Medicaid Code because they Deny Access to Care” to children on Medicaid. This ruling is applicable to all Medicaid patients but the ruling only applies to children. It needs to be expanded to cover all Medicaid patients.

The Federal Medicaid Code, 42 U.S.C. 1396A(a)(30)(A), [regarding adults and children covered under Medicaid and the EPSDT program] REQUIRES any State Medicaid program funded by the federal government to provide care equivalent to that obtainable from private insurers in the community to Illinois Medicaid clients.

Therefore, Judge Alonso’s ruling is unconstitutional, unfair, illegal, and amounts to his ruling to overturn the Federal Medicaid Code as well as Illinois Statutes licensing non-physician providers of mental health services. As > 80 % of mental health services are provided by non-physicians this essentially shuts out mental health services to all but a few in Illinois who are poor.

The Federal Court and U.S. Attorney should intervene as this is illegal and also a violation of the Americans with Disabilities Act in terms of discrimination.

As to my case, I am charged with billing for mental health services never done and substitute billing for mental health services between June 2000 and April 2002 while “working” at Right Frame of Mind & Associates (RFOM). Over the last six months when I obtained access to the old business records for RFOM I discovered the fact is that the year before I started working for a group practice called RFOM, part-time providing chart review for quality, consultation about medical and psychiatric policies and procedures, and limited patient care, two woman, who were partners with the CEO and without the knowledge of the CEO, in 2000 fabricated hundreds of patient encounter forms (filled out by doctors or therapists as to what patient they saw, the diagnosis, and what service was provided), that are later translated into bills or invoices by the billing agent, for services they never did. These two women, Itadel Shalabi and Nareman Taha never met me as they were fired before I started working there in 2001.

I had major neurosurgery in July 2000 due to a congenital spinal problem that was crushing my spinal cord and leading progressively towards quadraplegia. I was incapacitated for six months and heavily sedated with narcotics and other drugs for much of that time. I had agreed in early 2000 at the request of the CEO to be one of a dozen or more part-time medical directors to oversee quality of care, screen for medical disorders mimicking psychiatric disorders, help train the counselors to write better notes (many were foreigners with good counseling skills but a little difficulty with English writing), advise the CEO on best medical practices and standard of care, and provide physician services to patients needing medications.

I or my staff while I was in hospital gave the CEO my Medicaid provider number and other necessary documents so that the company’s billing agent Louise Moore of Data Medical Works could sign me up with Medicaid as a provider for the group so that they could bill for my services when I began to work, if I recovered, in 2001.

Ms. Moore I never met at the time was a sweet lady who is ignorant of a lot of things. She held herself out to be a expert at medical billing and she signed a contract with the CEO in early 2000 to set the group up legally to bill Medicaid. Nothing she did was actually proper, but it was not her own fault. She failed to tell the CEO he would be paid more if he had his group certified as a community mental health center. She was totally ignorant of the concept of community mental health centers (or the drug addiction and alcohol treatment centers - another center with its own enabling State Statue).

Under the Community Mental Health Service Act mental health groups that become certified bill Medicaid under the Center’s name and not under the doctor’s name. They also contract with the Illinois prisons, and/or DCFS (Illinois Child Welfare) or other agencies to provide comprehensive mental health services. They must have at least one medical director, but the director is an administrator and doesn’t have to see patients. Ph.D. psychologists or doctors or licensed mental health providers can supervise non-physician mental health service providers and bills can be sent in to Medicaid under the center’s name for all these services.

Ms. Moore ignorantly thinking (falsely) that her contract allowed her to sign the names of Right Frame of Mind employees on to any form signed my name in August and December 2000, without my or the CEO’s knowledge or consent, on a power of attorney form, an alternate payee form, and a blue cross/blue shielf electronic partner trading agreement form, which are all required to allow her to translate the patient encounter form to an electronic invoice and send it over the wire to BC/BS for adjudication, who then sends it to Medicaid, who then pays abut 30-40 cents on the dollar to the Alternate Payee (in this case RFOM).

Ms. Moore had spoken to the Medicaid Provider Service Unit about how to register the non-physician providers to bill Medicaid. She was told that non-physicians cannot bill Medicaid, was NOT told that a better way to bill was as a community mental health center or how to sign the group up as a community mental health center, and told that all bills (invoices) had to have a doctor’s name as the provider.

Then Ms. Moore, without my or the CEO’s knowledge changed the provider name in preparing invoices from Itadel Shalabi’s and Nareman Taha’s fraudulent patient encounter forms to my name so she could bill under my Medicaid Provider Number. I don’t believe that Ms. Moore had ANY knowledge of the fraudulent nature of the Patient Encounter Forms made by these two women.

Therefore the ghost billing charge is a result of ID Theft, resulting from both fraud by these two women and a comedy of errors by incompetent people advising Ms. Moore in the Medicaid Provider Service Unit, as well as her own blundering ignorance. I am totally innocent having not participated in any way in generating these bills or in receiving or using the money paid for them by Medicaid.

Ms Moore unfortunately is also guilty of mass fraud in all the work she has done in the past decade or more. It is illegal for an insurance biller to bill Medicaid based on a contract where they are paid by the percentage of funds received form Medicaid by the provider. Ms. Moore charged around 8% of all billings. This is illegal and considered fraud as it ties the billers service, which has nothing to do with the medical care provided, with the doctor’s service. Therefore, if she billed for a $100,000 procedure by a heart surgeon she would be paid $8,000 for sending in one bill, while when a family doctor bills $100, she would be paid $8. Providers of services to doctors are NOT ALLOWED to tie their services to the income from the actual medical provider. She MUST BILL ONLY by the piece of work such as $8 per bill. However, she has not been indicted for Medicaid Fraud and has not been sued by RFOM for Fraud in holding herself out to be an expert on billing when she was not.

The second aspect of the charge is substitute billing. I signed a Power of Attorney Form and Alternate Payee Agreement in August 2001. I was informed by the CEO sometime in late 2001 or early 2002 that the group was told by Ms. Moore that the counselors’ and psychologists’ services had to be billed under a doctor’s name so that bills on patients I had seen, but for dates of service when they were seen by a non-physician were being billed under my name. I had assumed that the billing agent was competent and doing the billing properly. I had assumed that substitute billing for employees services in mental health care was as legal as billing Medicaid for my nurse giving a patient a vaccine. I had no idea at the time that anyone considered substitute billing illegal. I had no knowledge that Ms. Moore had actually sent in tens of thousands of dollars worth of bills under my name before August 1, 2001 based on documents she forged and the fraudulent patient encounter forms from the above two women. Therefore, I told the CEO that was fine. I was not involved in billing or administration of the group except to fill out patient encounter forms when I saw a patient. I had a good faith belief that all was well.

I had also had an agreement that being part-time the business would limit my patient panel to 200 patients as I did not feel that part-time doctors should supervise the care of any more patients than this number.

Since Judge Alonso has unconstitutionally and illegally ruled that substitute billing is illegal I will be found guilty and likely sentence to prison for 4-15 years, as well as forever lose my medical license and reputation, along with my livelihood, future, friends, health as medical care is inadequate in prison and I am disabled with several serious medical disorders, and will to live. I have informed the U.S. Attorney, FBI, at the time Senator Obama, Senator Durbin, and now Senator Burris along with a lot of Congressmen and other Sentators and State legislators. I am receiving no assistance to solve this problem and restore mental health care in Illinois to those on Medicaid.

In late 2001 Ms. Lovett, Ms. Collins and others from the Office of Inspector General Medicaid contacted the RFOM and claimed that they needed to review some charts as a “standard review of a new practice to help us comply with the rules”. We completely complied and Ms. Lovett came out in 2001. She told the CEO the charts were well done and she would give us a report in 90 days. The CEO was actually very happy about this review because he wanted to make sure that our group practiced with the highest quality and had the best quality charting in the business. They never gave us a report or any feedback and their only response was to initiate a felony prosecution which culminated in the indictment of selectively me (and not one other of the dozen or so medical directors doing the same job - perhaps because only the CEO and I were whistle blowers about Illinois Governement Corruption and mistreatment of children in foster care and on Medicaid by the State) and the CEO.

After a number of months with NO feedback and strange comments from the Illinois State Police Medicaid Fraud Unit (part of the Illinois Attorney General’s Office), where the CEO had gone to inform them that he was concerned abut the integrity of our medical records because he had fired Itadel Shalabi and Nareman Taha for other administrative misconduct and inappropriate behavior with patients and they stole a hundred or so medical records (eventually returning parts of them) I began my own investigation of the rules of Medicaid. The State Police have not arrested them yet.

The CEO, I had learned over about a year was much more naive than I thought about running the business. I had assumed that he was qualified as an administrator and found out he was not. Finding out about the stolen charts and the lack of feedback from the OIG-Medicaid on this “routine review” concerned me. I was also concerned because in April 2002 the CEO told me that Ms. Collins at OIG-Medicaid had informed him to talk to Mr. Brown at Medicaid because there was a problem with the way our group was set up. Mr. Brown told the CEO that RFOM could not be a proper alternate payee under their rules and he apologized for misleading the CEO when the group was originally set up in 2000. He told the CEO that Medicaid could not continue to pay the group unless it was owned by the doctors. The group was the sole proprietorship of the CEO a master degreed psychologist. The CEO said OK, hired an attorney, and asked several of the doctors to be the officers of the group as it changed to corporate status. The corporation was set up so that the doctors would not actually profit from the corporation but were only paid by the hour for their work. The CEO was going to make a profit from managing the corporation. However, no profit was ever made as all the income went to overhead, particularly paying the counselors and doctors their salary and/or hourly rate. The CEO actually put in $100,000 of his own money to meet payroll before he closed the business as no viable financially. My total income from the group was about $5000 over all the time I worked there from 2001 to 2003. I always told the CEO to pay the other employees first and my work was only very limited and part-time.

Beginning in 2002, I researched the Federal and State Medicaid rules, policies, and laws so that I would be able to meet my fudiciary duty to participate in running the corporation at least from an advisory point of view. I discovered the following and this is why I told the CEO in mid 2002 and maintain this belief, that substitute billing is perfectly legal and actually REQUIRED by the Federal Medicaid Code as well as NOT PROHIBITED by Illiniois Statutes or Illinois Adminstrative Rules:

Federal and State Medicaid laws are extensive, complex, and immensely confusing. The State of Illinois is misusing them to indict doctors, psychologists, administrators of psychiatric and psychological practices for “Medicaid Fraud” when they are actually following federal law and providing needy services including counseling, drug treatment, suicide prevention, etc. Attorney General Lisa Madigan and Jim Ryan before her have targeted especially those groups run by whistle blowers, in order to falsely claim they are tough on fraud, to prevent Illinois from paying the bill for mental health services for the poor and needy on Medicaid, and reduce the bottom line.

A claim of “tough on fraud” will help AG Lisa Madigan win election as Governor. Failure to provide mental health care including drug addiction and alcoholism treatment leads to increased crime as drug addicts, alcoholics, and those that are so out of touch and mentally ill find alternatives to legitimate work to feed their habits or survive. Failure to provide adequate mental health care at the front end leads to much higher costs in the long run.

Code of Federal Regulations 42 CFR 414.34 states:
“Payment for services and supplies incident to a physician’s service”
“(b) Services of non[-]physicians that are incident to a physician’s service. Services of non physicians that are covered as incident to a physician’s service are paid as if the physician had personally furnished the service. “

United States Code42 U.S.C. § 1396d(a)(5)(A)
requires reimbursement for “physicians’ services furnished by a physician.”

Code of Federal Regulations 42 C.F.R. § 440.50
The HHS rule implementing the Medicaid Act defines “physician services” to include services provided:
“(a) within the scope of practice of medicine or osteopathy as defined by State law; and
(b) by or under the personal supervision of an individual licensed under State law to practice medicine or osteopathy.”

United States Code42 U.S.C. §1396a(a)(32)(C)
Congress further authorized substitute billing under Medicaid for services furnished:
“by, or incident to the services” of another physician

Federal Regulation66 Fed. Reg. 55268
HHS makes clear in its preamble to this rule that it does not restrict the type of auxiliary personnel who may perform a given “incident to” service: “We deliberately used the term any individual so that the physician (or other practitioner), under his or her discretion and license, may use the service of anyone ranging from another physician to a medical assistant.”

Code of Federal Regulations42 CFR 411.15
“Particular services exclude from coverage” specifically states that:
“(m) (3) Exceptions. The following services are not excluded from coverage:
…
•(iii) Nurse practitioner and clinical nurse specialist services…
…
•(v) Qualified psychologist services,”

FEDERAL PREEMPTION SUSTAINED BY FEDERAL 2ND CIRCUIT COURT OF APPEAL
•A Federal suit for a psychiatrist against the New York Medicaid Program based on its refusal to approve Medicaid was agreed to for reimbursement for services provided by his employees under his supervision. Yapalater v. Bates, 494 F. Supp. 1349 (S.D.N.Y. 1980), aff’d, 644 F.2d 131 (2d Cir. 1981), cert. denied, 455 U.S. 908, 102 S. Ct. 1255 (1982).
•The court determined that the federal Medicaid rule at 42 C.F.R. §440.50 defining “physician services” unquestionably included supervisees other than the physician, just as the same rule must apply here to vacate Plaintiffs’ indictments. Id. at 1363-64.

State Medicaid must Provide Services 42 U.S.C. 1396a(a)30(A)
•Federal Code clearly mandates that State Medicaid plans must provide services to recipients of Medicaid and payment to their service providers equivalent to care and services provided to the general population by private insurers
•Private insurance pays for psychiatric services provided by counselors and psychologists
•RFOM CEO and other employees, besides the physicians were licensed counselors, nurses, psychological therapist, or social workers, per CEO

42 U.S.C. 1396a(a)30(A)
“A State plan for medical assistance must –
Provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan . . . to assure that payments are … sufficient to enlist enough providers so that care and services are available under the plan … at least to the extent that such care and services are available to the general population in the geographic area“,

Ambiguous State Laws Must be Interpreted to Conform to Fed Law
•The Federal 7th Circuit Court of Appeals has also construed ambiguous state regulations to conform to federal Medicaid requirements,
•an approach worth revisiting here with respect to Sections 140.411 and 140.413 of the Illinois Administrative Code.
•See Evanston Hosp. v. Hauck 1 F.3d 540 (7th Cir.1993), cert. denied, 510 U.S. 1091 (1994).

I (SHELTON) CONTINUES HER OWN INVESTIGATION OF BILLING PRACTICES – 2002-2005

•Shelton discovers that Physician Medicaid Manual has inconsistencies, in one place stating bills for employees billed under doctor’s name, and in another place stating that no psychiatric services can be billed for non-physicians, yet in another place stating that non-physicians may provide psychiatric services and Medicaid may be billed. She also discovered the Illinois Community Mental Health Center Code.

Illinois Administrative Code (IAC)
89 IAC 140.12
“Services Not Covered by Physician”
DOES NOT MENTION psychiatric services by non-physicians

Illinois Administrative Code
89 IAC 140.400(a)
“Payment to Practitioners”
“2) A practitioner may bill only for services he or she personally provides or which are provided under his or her direct supervision in his or her office by his or her staff.”

Illinois Administrative Code
89 IAC 140.411
“Covered Services by Physicians”
“The Department shall pay physicians for the provision of services not otherwise excluded which are:
. . .
c) Provided by the physician or by a member of the physician’s staff under the physician’s direct supervision

Illinois Administrative Code
89 IAC 140.413
“Limitations on Physician Services”
that “limitations” on physician’s services include that psychiatric services will be paid for if they are “. . . provided by a physician . . .” [It does not exclude non-physician services and it is a reasonable inference to conclude the definition of "physician" include the services of non-physician employees, under the doctor's supervision as defined in 89 IAC 140.400 & 411]

How does this negate previous definition of “physician services” which include incident services by his employees?

UNCONSTITUTIONAL STATE CLAIM
State falsely claims use of word “physician” in 89 IAC 140.413 negates definition of
“physician services”, which includes incident services by physician’s employees as defined in 89 IAC 140.400(a), 89 IAC 140.411

State falsely claims that federal law does not apply and statutory construction rules don’t apply
Judge Alonso previously illegally ruled that the Federal Medicaid Code does not apply in this case despite the fact the Illinois Medicaid is a joint federal/state program partially funded by the Federal Medicaid Code!

IAC TOO VAGUE
•Criminal Laws are invalid if too vague to understand (”void for vagueness doctrine”)
•Illinois Administrative Code too vague in sections:
89 IAC 140.12,
89 IAC 140.400,
89 IAC 140.411, and
89 IAC 140.413
Illinois Administrative Code
•Why should 89 IAC 140.413 have more weight than 89 IAC 140.12?
•Why should the definitions of physician services in and 140.411 not apply to the term “physician” in 89 IAC 140.413?

STATUTORY CONSTRUCTION RULES REQUIRE (Regarding interpretation of conflictin State Statutes)
Specific Controls over General
•89 IAC 140.400 & 89 IAC 140.411
more specific “physician services” includes non-physician employee services
•89 IAC 140.413 general word “physician” with no definition of what services this includes cannot by exclusion negate previous more specific definition of services provided by physician

Federal Law Rules
42 CFR 414.34
Services by Physician’s staff are billed as IF the Physician Performed the Services Himself

If State and Federal Law conflicts, Federal Law Rules
Due to the Supremacy Clause of the United States Constitution

FEDERAL LAW REQUIRES PAYMENT FOR EPSDT SERVICES
•The Federal Medicaid Code requires that State Medicaid programs pay for periodic mental health screening and treatment of any defects in mental health for children under 21:
• 42 USC 1396d “Definitions For purposes of this chapter
• (r) Early and periodic screening, diagnostic, and treatment services
•
•The term ‘early and periodic screening, diagnostic, and treatment services’ means the following items and services:
• (1) Screening services –
• (A) which are provided –
•(ii) at such other intervals, indicated as medically necessary, to determine the existence of certain physical and mental illnesses or conditions;
• . . .
•(5) Such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.”

STATE LAW REQUIRES PAYMENT FOR EPSDT SERVICES
•89 IAC 140.485 states:
•“Healthy Kids Program
•Program Description
–The Healthy Kids Program is the Early and Periodic Screening Diagnostic and Treatment Program [EPSDT] mandated by the Social Security Act (see 42 U.S.C. 1396a(43), 1396d(4)(B)(Supp. 1987)). The goals of the program are to:
•Improve the health status of Medicaid-eligible children ages birth through 20 years through the provision of preventive medical care and early diagnosis and treatment of conditions threatening the child’s health
•…
• Treatment. The Department shall pay for necessary medical care (see Section 140.2), diagnostic services [i.e. psychological testing], treatment or other measures medically necessary … to correct or ameliorate defects, physical or mental illnesses….”,
•The Illinois Public Aid Code [AKA Medicaid Act], 305 ILCS 5/19(f) requires that EPSDT screening and mental health treatment be provided to children in the Medicaid program:
•“5/19. Healthy Kids Program
•(f) Covered Medical Services. The Illinois Department shall provide coverage for all necessary health care, diagnostic services, treatment and other measures to correct or ameliorate defects, physical and mental illnesses, and conditions whether discovered by screening services or not for all children eligible for Medical Assistance under Article V of this Code.”

Dr Shelton was a Medicaid Registered EPSTD Provider

Therefore ANY REASONABLE person would conclude that the law permits substitute billing for mental health services whether it be another physician covering for the doctor, or a non-physician supervised by the doctor or her colleagues. If you don’t agree than the void for vagueness doctrine should clearly negate and prevent any criminal charges for substitute billing.

God Help Me! I am innocent and destroyed. This is my reward for devoting my life to service particularly of the poor and needy. If you want to help, contact the Illinois Reform Committee and flood them with letters. Contact the U.S. Attorney and FBI and flood them with letters. Contact your legislators and Congressmen and flood them with letters. Come to the trial on February 17, 2009 which will last two weeks and fill the gallery so that the judge knows your opinion. Contact the press. Donate to my legal fund anything possible. I need tens of thousands of dollars. Shelton Legal Fund, C/O Albukerk & Associates, 3025 W. 26th St. 2nd Floor, Chicago, IL 60623. Thank you if you help.

A Message to Secr. Designee Daschle - How to Reform our Healthcare System

Dr Linda Shelton — Mon, 05 Jan 2009 22:58:22 EST

Health Care reform needs creative thinking. Policies and procedures of the past just won’t do. We can’t just copy Canadian health care systems. Nor should we just leave everything to the “free” market. Free market theory ASSUMES one is ABLE TO make a choice for the most competitive service provider.

First we should analyze what is the meaning of health care. In America we have fire and police departments, public road maintenance, and other public services where the employees provide services to the captive public for a salary. How well they do their work or how much work they do is not tied to their salary. When a burglar confronts you with a gun, or there is a fire at your house, there is no ability for the person in this “captive” market to shop around. I believe that Americans think that fire and police protection, garbage collection, etc are a right.

These are not areas where there are super exorbitant profits for those that supply the fire engines, police cars, and garbage trucks or who man the fire engines, garbage trucks, etc. Competition for services and supplies is somewhat limited. Therefore, the principles of the free market capitalist system just doesn’t work well.

The questions is do Americans now believe that health care is a right and not a privilege as I do? I don’t believe that exotic and futile health care however, is a right. Half our health care dollars (my estimate which may not be completely correct) are spent on futile health care at the end of life or the beginning of life. We need clear guidelines as to when a person at public expense will be placed under hospice care and taken out of the ICU and guidelines for other such end of life decisions. We cannot give every possible treatment to stretch out misery and suffering to the very last moment, nor keep brain dead people “alive” on ventilators at public expense instead of using that money to help those that can be saved!

If one believes it is a right then WHY do we allow pharmaceutical companies, high-tech health equipment and supplies manufacterors and suppliers the right to set exorbitant high fees without competition in a captive market? Executives of health insurance companies and HMOs, executives of “not-for-profit” hospitals, physicians who perform more procedures than others (heart surgeons, orthopedic surgeons, opthalmologists, etc.) bill exotic fees and make hugely outrageous incomes in the millions to tens of millions of dollars (in comparison to the President of the United States - $400,000, the average family practitioner or pediatrician $150,000, or the executive of other non-profit agencies) when the patients are a captive market who have only limited abilites to shop around. How can a person shop around when they are being taken to a hospital by ambulance for a heart attack and need bypass surgery? A captive market is NOT a free market. The Milton Friedman model does NOT work with a captive market where people obtain life-saving and essential services. When only one company makes a PET scanner, how can a hospital shop around for competitive bids?

Pharmaceutical companies spend an estimated 50% of their expenditures on advertising. They convince doctors to prescribe marginally “better” drugs at great cost when the doctors could prescribe cheaper and just as effective medications. Yet we allow Medicaid and prisons medical facilities (who provide a LOT of health care in the US) to limit drugs in a ridiculously strict fashion that amounts to medical neglect. The disparities are astonishing in terms of availability of appropriate drugs and the use of unnecessary drugs.

We have 200 times (my estimate) the number of employees as countries with national health plans in the health care/industrial complex just to push around invoices for medical care and collect money from patients who can’t pay. Hospitals charge 3 Xs reasonable fees to make up for the lack of payment from those who cannot afford to pay and are brought to their hospitals in dire straights unable to choose a cheaper facility.

Employers are expected to pay for medical care and our economy is driven into the ground by this when companies cannot compete due to this “benefit” package.

Lets be reasonable. We need the following and we need creative ways of obtaining it and a national dialogue about how much medical care is a right and how much profit should be allowed to be taken out by greedy people (executives, a minority of doctors, high tech product suppliers and manufacterers, pharmaceutical company executives and stockholders).

1 - remove health care from ties with employers so when you lose your job you dont’ lose your health insurance and to prevent employers from pushing out employees with chronic health conditions that make the companies insurance too costly,

2 - consider excess gradated taxes on advertising of drugs and high tech products to discourage inappropriate use of new expensive drugs, while increasing grants to pharmaceutical companies and research scientists to develop new drugs,

3 - consider either putting doctors and health care executives on a salary, a partial salary, or imposing a steeply progressive excess income tax (say 50% tax on portions of income over $400,000) or some creative variation of this, coupled with free education for physicians and nurses, which would be similar to free education for firemen - this will produce huge savings - why should the CEO of an HMO going out of business get $40 million in a golden parachute as the company goes under - these dollars should be used for health care and NOT TO ENRICH EXECUTIVES OF PHARMACEUTICAL COMPANIES, HEALTH INSURANCE COMPANIES AND HIGH-TECH MEDICAL EQUIPMENT COMPANIES, AND DOCTORS,

4 - regional health care plans instead of employer based plans, which would have to compete against each other,

5 - subsidies or tax benefits for companies that are very small and employ a lot of low paid workers, for the disabled, and the poor to help them pay any premiums,

6 - reduce paper and standardize electronic medical records so there is inexpensive access to information, so that disasters don’t wipe out records, so that services are not duplicated when results are lost, and so that erros are reduced - this will produce huge cost savings that can be used to fund the system instead of increasing taxes,

7 - a VA like health care system that people can choose instead of the private insurance companies,

8- don’t leave the decisions only to the legislators, the AMA, the powerful, and the elite, let those of us on the front line have a say - by being in every working group and on every board concerning any aspect of health care.

America, The dream and The Realities:

ballyvalleygirl — Mon, 15 Dec 2008 17:28:45 EST

Dear President Elect, Mr. Barak Obama:

First of all, congratulations are in order, and secondly, Happy Holiday wishes to you and yours...

It is with great respect and an every increasing sense of what this country is, that often chime in with tid-bitts, antics and rhetoric. Today is no different than any other, except that Im formally addressing you as our leader, commander in cheif and cheif executive officer of the USA.:WHen iv got an ugent message I often ciruclate it in our government. THis is no different.

Thank you for your service, because civil service is a noble profession....

The following is an article in today's newsobserver.com.

I am awe-struck that debates still flow endlessly log-jamming the legislative process, keeping full benefits from the most needy and the persons working with disABILITIES>

It appears that the "Working while disABLED buy in program is not being promoted in your state.
It is upsetting to think that some may choose not to work, to resign to be disabled and not work, due to the constraints on the availabilty of workers medicaid coverage.

NYS is number one in the nation I understand as a state with many many disabled workers. We extend the coverage, which is somewhat generous to the working folks.

You already know that, I suppose?

Let me submit the article im referring to which has been circulated around government as much as i am able.

Here it is....

SUbmitted to: Mr. Biden, Mrs, Clinton, Mr. Kennedy, THe healthcare committee and Mr. Patterson of NY...
(Mr. Obama's name is off the roles of congress...this will go to his online site too.

This is something that Im circulating in regard to Medicaid coverage, the extension of benefits and qualifying. It is in response to an article today in the newsobserver.com.

I hope that you will help: get the word out that working doesnt necessarily end coverage with medicaid and that persons, like yourself play an important part of society. Hence they should never be discouraged to work.
As an aside:
Ive heard people, 40 - 45 years old say they dont want to work because its too expensive, discouraging prospects and depleting coverage.
Some of us need expensive medications, services and supports that arent quite conducive to work immediately.
However, we fight the good fight, do what we can and remember: theres always somebody somewhere doing worse then we...

Heres the article.

FIRST, AND FOREMOST, "THANK YOU! AND HAPPY HOLIDAYS TO OUR ARMED FORCES WORLDWIDE"

My Dear Ladies and Gentlemen of DC HealthCare Committee Et Al…

IVe shared this article and my thoughts on it already with Mrs. Clinton, Senator, Mr. Biden, VP ELECT, Mr. Kennedy, Senator and you.

The idea is: MEDICAID IS A NEEDS BASED PROGRAM…we know that, Rosemarie?Medicaid is coming up to speed with the new issue of “Medicaid for folks working while disabled…spend downs are enormous, almost ruling out managing one’s medical expenses. IVe spoken about this elsewhere. To be a worker with a disability is to accept a challenge few can delineate, understand and fathom circumspect. You probably agree, but there are always a few who ruin it for the rest of us…the disABLED.

My figures are screwy but its about $46,000.000 per year, maximum income for a worker with a disability to maintain Medicaid medical coverage. They have expenses other workers who are not ill often don’t. IE>impairment related work items & C…the premium is approximately $50.00 per month. Few Medicaid workers know about the buy in. They’ll respond: “Spenddown?” You say no, they say, What? I know one person who filled out the paperwork, hunted down the coverage , spoke to everyone and anyone who would listen and FINALLY AFTER MUCH A DO, GOT THE COVERAGE. Luckily and fair-enough, it is still a needs based program: You cannot have more than $10,000.00 in the bank and still qualify. I thought that $10,000.00 was a generous limit.

These programs are meant to maintain us, medically, when we cannot keep up with out medical costs.

It is fair enough to cut benefits completely if someone is making $46,000.00 and has $10,000.000 in the bank. The system will have served him well and he is on the way to living “The American Dream” Loosely: Someone to love, Something to do and Something to hope for” (Youre home, family and sustenance).

These are my comments and the article that sparked my address is below.

I thank you for listening, hopefully Im not too verbose.

Have a happy holiday season! And remember, Civil Service is a noble profession.

I caught an article in "newsoberserver.com"

I understand that Medicaid is a needs based Federal Program open to low income and disabled persons, 'last I checked.

THis article was of particular interest because it is not promoting health, help and genuine concern for the (in this case) disABLED worker.

Concisely: medicaid is now extended to those who earn up to $10,800.00 per year. HOwever, no meniton has been made of 'THE WORKING WHILE DISABLED PROGRAM FOR WORKERS WITH DISABILITIES.

IN NEW YORK WE HAVE A BUY IN PROGRAM, GLOSSED OVER AND NOT DISCUSSED IN THIS ARTICLE.

to HEAR IT, THERE IS A CEILING OF $10,800.00 AND THEN BENEFITS ARE CUT OFF?

what kind of coverage is that? It saves money on one hand because less coverage is extended, but ER and hospital stay expenses are higher.

North Carolina has to step up and deliver services, information about service options and extend up to $46,000.00 (Thereabouts, check the EXACT figure, please..) before losing benefits.

The federal government is servicing North Carolina too, is it not?

The jist of the program (for workers with disabilities) is: work, make up to ?46,000?

and pay a "buy in" premium, which is very cheap: perhaps $50.00 per month for individuals & more for families...and your covered.

Im told by workers with disabilities that the application process, the fact that you cannot have more than $10,000.00 in the bank and the

fact that NO ONE Really knows about this buyin,

is discouraging.

People who work go to work to make a contribution, a needs based program like Medicaid keeps people off the streets, above the poverty level and living healthier happier lives as AMERICANS.

As an aside: I have often said, Thank God Im safe and free in America, perhaps in the East, Like India Id be living by the side of the road begging bread.

Please be patient and read this through Ive pasted the article below.

The contact persons in NC Are:

Wake County Human Services at 212-7000 or departments of social services in other counties.

I thank you for your time, attention to detal and industry.

Sincerely,

Rosemarie DUndon

_______________________Heres the article...

Thomas Goldsmith, Staff Writer

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For Richard Miller, a crucial rung on the financial ladder is no longer missing.

Under a new state program called Health Coverage for Workers with Disabilities, Miller, 30, can increase his hours and pay at a hotel switchboard in downtown Raleigh without losing the Medicaid health insurance that pays for his kidney dialysis.

The idea behind bending the usually strict Medicaid income limits is to nudge capable people with disabilities toward working, and eventually into paying for more of their health-care costs, social service experts said.

"If you can allow me to make more income and still receive some benefits, that's going to be a great situation," Miller said Tuesday.

An outgrowth of the Clinton-era "Ticket to Work" legislation, the new Medicaid guidelines will affect an estimated 1,200 North Carolinians and cost $1.2 million statewide in the first year. As other benefits are threatened by shrinking state revenues, the Medicaid changes are expected to cost $7.4 million by the program's fifth year, even including offsetting fees and deductibles to be charged people with higher incomes.

"The bottom line is that people feel that it is the right thing to do," said Kathleen Thomas, a researcher at the Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill who studied the program as it developed.

"For people with disabilities, the expectation of having a career is an important part of community involvement. In the long run, they should have employment that results in their paying taxes and also participating in the cost of their care."

Under guidelines in effect until Nov. 1, Miller and other people with disabilities could earn only $10,400 a year before making too much to qualify for Medicaid. Those limits could prevent qualified people from taking better-compensated jobs, or in Miller's case, from working more hours.

"What changed for me was my amount of work that I was doing, which caused me not to qualify any more," Miller said.

The new limit is $15,600 for a single person.

For taxpayers, a partial payback will come in a year or so, if and when earners with disabilities such as Miller start making even more money. At an annual income of $20,800, such recipients would start paying premiums and co-pays for the health insurance.

"You might have someone who is paraplegic but might be able to go to work, say, in the computer field, and still qualify for Medicaid," said Carolyn McClanahan, chief of the state Medicaid Eligibility Unit.

Counties are still getting the word out about the eligibility changes, but Miller and about 20 people with disabilities have already qualified. Dozens more have applications in the pipeline, McClanahan said.

Elizabeth Scott, director of adult economic services for Wake County Human Services, said the new program covers workers ages 16 to 64.

"The idea is to try to allow people who are able to work to do so without the fear of losing their benefits," Scott said.

"Medical benefits are not easy to replace -- a lot of jobs may not offer them.

"If they lost eligibility for full Medicaid, they would have had to meet a deductible, and that could be thousands of dollars over a six-month period."

More than three dozen other states already have Medicaid buy-in programs, but North Carolina's was held up because of required state legislation and technical difficulties in processing payments in the Medicaid system.

President Bill Clinton signed the Ticket to Work and Work Incentive Improvement Act into law Dec. 17, 1999, laying a foundation for states to extend Medicaid coverage for working people with disabilities.

In North Carolina, the new standards also allow Medicaid recipients with disabilities to hang onto a higher level of holdings without "spending down" as other recipients must.

"If someone is disabled and they want to go try to go work to improve their situation, they should be able to do it," McClanahan said.

thomas.goldsmith@newsobserver.com or 919-829-8929

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Caregiver's Unite!

Melissa Rowley — Sat, 06 Dec 2008 09:16:40 EST

I am one of the 50 million caregivers in the United States who want to see the new administration give more credence to the necessary changes for us. We need support for tax credits to taxpayers who incur caregiving expenses for their parents or grandparents who do NOT live with them, services such as adult day care centers, expand treatment services for Alzheimer's patients, provide income tax credits, additional long term care tax relief, establish a family and medical leave insurance program for employees. Yet I am just 1 of 50 million, and we need to unite so that our voices in Washington are heard. Caregiver's Unite!

Reforming the Welfare System

LaToya from Nesbit, MS — Fri, 31 Oct 2008 12:41:19 EDT

What you are about to read may be upsetting, but it's the life that I saw others live, and it upsets me. To date, Mr. Obama has not said much about this, but I'm sure he'll get around to it.

I am a graduate student getting my Ph.D. in English. People usually don't have a clue about how hard it is to work, support yourself, pay your own bills, go to school full time, read about five books per week, teach class, and attend class. In addition to that, I have had a little boy and gotten married.

Now, I'm not complaining about my plight. I chose to go back to school, walking away from a pretty good job. I chose English, which means a life of penury! I chose it because I love people. And I love reading about the relationships of people with one another. I also love teaching! I love teaching at the community college level because I see so many nontraditional students making the same choice that I made, and they are simply trying to improve their employment prospects. They are trying to be examples for their children, and teach the benefits of receiving an education. I also chose English for a selfish reason: one day, if I'm blessed, I'll be half as good a writer as Toni Morrison.

What I am upset about is all of my peers who chose to do nothing. These, young, healthy women and men don't even work. That's because they don't have to pay rent. That's because they receive Section 8. That's because they grew up on Section 8 and food stamps. That's because every time the benefits ran low, their mothers just had another baby!

I'm so sick and tired of this. I see people who abuse the welfare/Section 8/Medicaid benefits in Mississippi every day. And I'm not just talking about Black people...whites, too. It breaks my hear to see a whole generation being raised on these things fraudulently. Under the Bush administration, these people have been allowed to slip beneath the radar, and have received even more benefits. I once had a student from Chicago tell me that her folks drive to Indiana to receive Section 8 vouchers because they are easier to get there. I know people who make their children behave badly in schools so that they can get $375/mo in mental health benefits. I know people who claim to homeschool their children so that they can receive more funding, and they don't teach these children a damn thing. I know people who pretend to have eating disorders for money. I know people who doctor shop and get very expensive prescription medicines, only to flush them down the toilet because they are not really sick. I know workers in small towns who tell their friends how to behave to get a "crazy check," when nothing is wrong with them. I know people who get over $500 in food stamps and buy mostly processed food and junk for their children, and complain that that amount of money just won't feed them. I know a young lady (30 years old) with five children by five different men, who simply refuses to get married or to help herself to some birth control because it would lessen her benefits. To enhance the pain of this slap in the face, Mississippi has birth control medicaid. They can give you what you want for free!

It hurts me because somebody like Ms. Lena, a 91-year-old-woman in my neighborhood, really needs these benefits, and cannot receive them. They constantly tell her that she owns her own home, and that puts her over the guidelines for ownership allotment. Meanwhile, this lady has diverticulitis, and arthritis. She takes about six medicines per day. She does not receive full benefits from the federal government because she worked as a maid. At the time, maids did not receive pensions and other benefits that we expect today, neither did construction workers. So, there are many people, from our Greatest Generation, out there struggling while young and healthy people continue to sit on their butts and do nothing. Many college students that really need to use public healthcare (because their parents' insurance may have dropped them, or if they are nontraditional students they may be too old), and cannot get it because they may own a car. Maybe they need supplemental insurance, because many schools offer only a discounted plan to graduate students. That is not enough for students with families. Some of my students who could really use food stamps, often do not receive them because maybe the case worker has a chip on her shoulder.

In short, the very old and the very young are being victimized by this system, or they are being denied access to it.

And when you try to turn abusers in, either by letter or phone call, nothing gets done about it. Nothing. Under the Bush administration, it has become very easy to skirt the system. Nobody seems to care about it, but it costs us tremendous money in taxes. The Republicans talk much about this, but do nothing. The only president that attempted to rectify the situation was Bill Clinton, a democrat! I know that Mr. Obama, having seen his mother, a hard-working single mother, try to tough it out with private insurance companies, can understand how I feel. She had to tough it out with a job and fuss with insurance companies while somebody else, who is fraudently receiving benefits, can afford to flush prescriptions down the toilet. His mother encouraged him to be all that he can be, while somebody else's mother encourages him to be a social deviant. His mother ensured him a bright future, while somebody else's mother sold her child's future out for $375/month. That is a crying shame.

So, I propose that, barring the very old and the very young (babies), everybody gets three years. Three years. Three years of government housing, food stamps, child care, and other benefits, unless you are gravely, gravely ill. Think of what you can do in three years. Finish a degree. Get several trade certificates, get a graduate degree, find a better job. The possibilities are limitless. We now live with a system that does not put a time-constraint on these people. And it is hurting those of us who are trying to go to school, or trying to raise our children to value a dollar. It is hurting people like Ms. Lena, who really need these benefits, but cannot get them the way this system is set up.

Three years. It does not matter if you decide to have another baby at the end of those three years to renew your benefits. Three years.

Does anybody else experience what I experience?

Sarah Palin as Special Needs Advocate

Andrew Dzeguze — Sat, 06 Sep 2008 04:07:58 EDT

I wrote what I think is a compelling post earlier, but I labeled it more than slightly intemperately. I used the "pimping out" phrase as a conscious homage to the mini - storm when an MSNBC host used it to describe Chelsea Clinton's campaigning. I'm not going to change the title - it is what I wanted to say then, and I do think that calling out a slepping infant for political points pretty much meets the connotation of pimping someone in the sense of shamelessly using them for your own gain. Anyways, it would be dishonest to retreat now. But I do want to take another look at Gov. Palin's assertion she would be an "advocate" for people with special needs - or at least some of them.

Initially, I'm not sure anyone is well served by high profile advocates whose only known qualification is the biological fact of having a child with special needs. I know that some parents are falling all over themselves at the idea of having "someone like them" in office. Personally, though, I have seen zero indication that Gov. Palin actually knows what the issues she will face as a parent of a DS child are, much less any grasp of the needs of people accross the special needs spectrum. Without that knowledge, power can often become a way of multiplying ignorance rather than enlightenment.

In fact, her own words show a pretty low level of knowledge about the people with special needs she claims to want to help:

"To the families of special-needs children all across this country, I have a message: For years, you sought to make America a more welcoming place for your sons and daughters. I pledge to you that if we are elected, you will have a friend and advocate in the White House."

There are at least three problems with that statement. First, many people with special needs object to the phrasing she uses. These aren't special-needs kids, or Down Syndrom kids, or autistic kids - they are kids with special needs, kids with Down Syndrome or kids with autism. That might seem like a little thing, but people centered language is one of the key issues to advocates in this area, as it grants people with developmental disabilities the same sort of basic dignity you would confer on any one else. They are, after all, kids first, and any condition they've been diagnosed with comes second.

Second, its technically the people with special needs, regardless of age, who need an advocate, not the parents. Parents are tremendous fighters for their kids, but they aren't looking for something for themselves. Rather, what they want is a better present and future for their kids. At the end of the day, it is the child or adult with special needs who should be the focus of any government attention, rather than making them supporting players in their own struggles. Again, putting the family over the child or adult suggests that they are somehow not people first.

Third, children with special needs do eventually become adults with special needs. They don't stop having needs or needing advocates, though. To the extent they can, they often advocate for themselves, but they need assistance at 22 (and 33, and 44) every bit as much as they do at 2. Arguably, even more so, since by that age many of them will no longer have parents around to help them in their struggles and the world tends to be far less generous to adults with behavioral or developmental problems than it is to children.

I really don't know what to think about the narrow nature of this statement. Is it a reflection of ignorance, or does she really think children are the only people at issue here? Maybe her speech writer Mike Scully just doesn't have a clue how to discuss the issue? No matter the reason, the implications of this cramped understanding of the issue bothers me.

Assuming for the moment that her whole focus is children with special needs, that doesn't suggest she'll be a good advocate for that community, either. I don't doubt her commitment as a mother. I'm sure she will fight for her kid tenaciously, as virtually all parents do, and parents of kids with special needs almost universally have to in order to get a fair shake in a world that still doesn't like to acknowledge that a person with special needs is a person first. I also don't doubt, given her willingness to be so open about his condition (unlike so many other issues she has been questioned on) she will raise the profile of Down Syndrome. However, I doubt the ability of anyone in a McCain administration to effectively advocate for the needs of special needs children, much less the special needs community as a whole. Doing so would require a wholesale reversal of fundamental tenets of the GOP, central policy goals of the McCain campaign and McCain's own words.

Initially, the GOP is known as the party of "small government" and "states rights." Ignoring the areas in which this isn't true (defense, social restrictions, etc.), a typical GOP approach will make advocacy for folks with special needs at a federal level pretty pointless. Right now, states are the primary aid deliverers for special needs people, not the Federal Government. The states get matching funds under Medicaid, but they have to commit to the initial funding levels. As a result, whether you get services at all, how quickly and at what level, is a local issue, not a national one. Some states can and do offer 40 hours a week of therapy for most kids with autism in their state, but may have nothing for kids with other developmental disabilities. Indiana has a 8+ year long waiting list for core services for children with autism, despite having dedicated funds for that category of person. Moreover, once people hit 18 ("age out" in the parlance of the system) the availability of the services they had as children is subjected to a different set of factors and calculations, oftentimes resulting in significant alterations in the level of care provided. Barring a complete reversal of the core Republican belief system, I can't see how a McCain adminsitration could ensure a level playing field for all people with special needs.

Owing to the lack of any universal provision of services, one of the things people in the special needs community, especially parents, are constantly fighting against are threats to their insurance coverage. Insurance companies consider most developmental disabilities "pre-existing conditions" and unless there's a state mandate in place, won't cover people with conditions like autism or Down syndrome at all. They are in business to get more from you in premiums than they pay out in care, after all, and that just doesn't happen when you are dealing with people with special needs. When companies do cover these conditions - typically because they are forced to by state law - the key therapies that help children and young people with these conditions often aren't covered, or only at a level that isn't effective according to prevailing research. The one way I know of right now to get decent coverage is if you are lucky enough to work for a company with good benefits, where the cost drain of your kid averages out with everyone else.

John McCain's central healthcare reform would make this harder, not easier. He wants to tax company insurance benefits to encourage people to seek individual plans. By comparison there is a tax credit if you give up your employer credit and buy your own, a blanket number that is about half the current cost for a "typical" person. The stated rationale for this plan is that it will eventually lower costs for people by increasing competition in the private market. If all people were equally attractive to insure, true competition might occur. However, there will be no incentive for companies to compete to cover people who are less than desirable to insurance companies as clients, at least not without charging them much more. While Elizabeth Edwards has pointed out the general problems with this model for people with pre-existing conditions, the problems for people with special needs are arguably more acute. I have yet to meet anyone from an insurance company that wants to cover, much less compete to cover, children or adults with special needs. There is no mandate in McCain's plan to force companies to cover everyone or some kind of Federal alternative. Instead, he wants states to create last gasp coverage plans like they have for high risk drivers. There doesn't seem to be any good model for these systems, or any one blueprint that states would be expected to follow. At best, a lot of people with special needs who don't get Medicaid funded services right now would wind up confronting a system just as crazy-quilted and inconsistent as the people who do have such services. At worst, people will die from inadequate care and lack of access to services. It really is that simple and horrifying.

McCain's educational policy is also troubling for people with special needs. While he does claim to support fully funding IDEA (the statute that is supposed to fund special ed in America) that hasn't happened in the entire time the law's been on the books. Republicans seem to always find a way to cut, rather than enhance, special ed funding at a Federal level. Because IDEA isn't fully funded, the services public schools legally have to provide for students with special needs often come out of general funds. Given this fact and the budgetary pressures schools are currently under, schools will push to limit special ed costs whenever to they can - which is just about any time a parent doesn't insist on the services legally required. Coupling that with his advocacy for vouchers and "school choice" creates a truly scary scenario. While he hasn't actually proposed to fund vouchers anywhere but in DC (because after all that would be "fiscally irresponsbile"), if such a plan were to become widespread it would likely mean that special education funding would be crippled further. That's because private schools typically won't take kids with behavioral problems or who need special assistance in accessing the curriculum - i.e., children with special needs. While there are schools geared towards these kids, most parents just can't afford them with or without vouchers. So in most cases there would be a higher concentration of kids with special needs in public schools with fewer funds to pay for them. Vouchers are an idealogical tenet of the GOP, and again I see no reason Gov. Palin would or could change that.

While John McCain just lambasted the failures of Washington, there's no indication the way No Child Left Behind treats kids with special needs is one of those failiures in his book. Because the system is geared towards rewarding school mandatory test scores and not looking at progress generally, schools are under pressure to boost their averages. Right now, they can and do try to excuse children with special needs from taking the tests, typically under a claim the child can't fully access the curriculum. However, if a child is thus excluded from a mandatory test, in many states the child cannot graduate from high school (they get a certificate of attendance, not a diploma), even if they otherwise have passed required subjects. That, in turn, bars the child from most higher education programs, including both college and vocational schools. Limiting the career options of people with special needs to protect a test average is hardly in keeping with the core belief underlying NCLB that we need to enhance educational opportunities. Again, though, the GOP has resisted calls to move away from the all or nothing test model, and I have no confidence in McCain to suddenly change the one thing Republicans have succeeded as selling to many people as a domestic success in the last decade.

Finally, there is one critical area of advocacy for people with special needs, primarily adults, where proposed Federal assistance would really help. Unfortunately, John McCain is personally and unequivocally on record as opposing that assistance. For a long time, getting state services with the highest level of care meant a person with special needs had to be placed in what are called State Operated Developmental Centers. For example, children would become wards of the state, taken from their families and placed in these centers where they would stay for the rest of their lives unless the family or the adult person with special needs chose to forego the care. I can only imagine the gut wrenching choice it had to be for parents to put minor children in these settings, and for adults to have to stay there.

SODCs were the state of the art in their time, based on prevailing understanding of the capacities of people with special needs. However, their time has generally passed, as our society has become much more aware of the potential of such people to be vibrant, full members of the communities they live in. SODCs are not the type of setting most people would ever want to live if they had another choice. Residents typically live in dormitory type settings, with severe restictions on their privacy and the personal goods they can have. Since Medicaid limits the income they can have, this only enhances the limitations on creature comforts. They eat in mess hall/cafeteria settings with limited input into their dietary intake. They have lockdown at night for security reasons and the grounds are typically fenced and patrolled. While family can certainly visit, they are not typically allowed to stay overnight. Residents also typically don't have individual caregivers, but rather are collectively assisted by a rotating staff. That, in turn, limits the ability of any person to individually go anywhere off grounds, because the institution can't spare staff to make sure they get back. Imagine, for example, being an adult who just wants to go across the street to a convenience store and buy a snack for yourself, and being told you can't because you can only run errands when a group goes on an outing. For that matter, imagine being someone with an average or above average intelligence, as many people with special needs are, and being told you can't walk to the end of your street, much less take a bus to a job or meet a friend for lunch. If this sounds a little like prison to you, imagine how it feels for the residents.

There is supposed to be a training element to SODCs, too, but it typically isn't focused on life skills that would help someone live in a community setting or have what most of us would consider a "real job." Rather, in many cases the institution will run what is known as a "sheltered workshop," where menial tasks are done day after day. These are things like stuffing envelopes for mass mailings, or putting together piecework under private contracts. While it is work, and something to do, it hardly expands the minds of the residents or challenges them. The residents do get paid, by the way - but not even the minimum wage. Again, not exactly what most people would choose. But the states argued for years that the residents had no choice - they either had to accept residential services or get nothing at all.

This practice of a one sized fits all model with no provision for choice by the individual was struck down by the Supreme Court in the Olmstead case several years ago. As a result, in theory states are supposed to have to place a person in a setting of their choice, so long as it costs the same or less than placing them in the facility would. Some states create a pool of money and let the person use it as they and their case manager feel best fits the person's needs. Others have contracted to provide enough group homes that they have managed to shut all their SODCs. Still others, though, are just beginning the process of creating transition plans and beginning to create a full spectrum of choices. Sadly, many states lacking the political will to do anything have had to be harried along by lawsuits to even make partial progress.

Just as sad has been the lack of assistance to states by the Federal government in carrying out this transition. While the ADA mandates that people with disabilities and special needs be given reasonable accomadations and treated in the manner that creates the least intrusive environment, there has been no funding to back this up and really give states a push in the right direction. Tom Harkin, the primary author of the ADA, has sought to rectify this. In a bill called the Community Choice Act, he, joined by Sens. Obama, Spector, and about 20 others, lay out provisions to enhance Medicaid funding for community based settings (to get for folks out of both SODCs and Medicaid funded nursing homes), create funding for state pilot programs and otherwise provide the foundation so that maybe, just maybe, the life a person with special needs can live and the basic dignity they can have won't be tied to their state of residence.

John McCain, who did help pass the ADA 18 years ago, is on record as opposing this bill. He was asked about it by a self advocate in one of his town halls and was less than pleasant in rejecting it. He offered no reason for his opposition at the time. On July 26 of this year, despite suggestions from staff that he had come around on this issue of basic dignity, he took the opportunity on the 18th anniversary of the ADA to again reject the bill.

The reason? Cost.

Never mind the savings in shutting down out of date institutions. Never mind the cost in lost productivity and wages people with special needs could help generate for our economy. Without any meaningful analysis of the full ramifications of the situation, he simply rejected the idea of federal money being spent in this manner as too costly.

This is an amazingly callous view, given McCain's oft repeated story of his own confinement. He has movingly described how the loss of his freedom drove him to the very brink of despair and thoughts of suicide. Yet he apparently has no compassion for the toll similar restrictions and confinements impose on people with special needs every day. It is said a society is judged by how it treats the least powerful of its members. In John McCain's view of America, the cost of treating people with special needs with basic dignity and respect costs too much. Given that view, and the fact that he has repeated his position in the face of fervant advocacy by people with special needs, I don't see how the mere fact that Gov. Palin is the parent of a child with special needs can make her or a McCain Administration the sort of advocate people with special needs deserve.

Physician Crisis #1 - insurance companies forcing patients to be discharged

Dr. Craig Marshall, MD — Tue, 02 Sep 2008 19:10:25 EDT

As a practicing physician for a large "non-profit" Northeast Ohio Hospital System, I frequently participated in an increasingly tragic situation: Social Workers employed by my hospital would call me and tell me that I had to discharge patients from the hospital because their insurance company decided that they would no longer pay for their hospitalization.

And I was forced to do it!

On occasion the Chief Medical Officer for the hospital or the Social Work Department Supervisor would call me into their office to "discuss" the financial repercussions of not complying with the insurance companies' demands. One of our hospitals would not even accept Medicaid patients to specific units because they knew that the hospital would not be reimbursed for the patient's bill. Everyone that I have discussed this crisis with has agreed that it is has been worsening over the past eight years. So this is my first professional crisis, and my reason #1 that Eight is Enough!

Aging America Can We Afford It?

Health Care Consultant — Tue, 08 Jul 2008 15:58:05 EDT

In America, of course we can afford anything, if we all work and pay the escalting bills in spite of our other human needs and realistic expectations. Just like the cost of climate and energy let it go and then panic when we are out of money. But never fear the academics have come up with another catch all solution for the 77 million Baby Boomers hitting 60 - Aging in Place - where everyone basks in the safety of their own home. "Aging in Place," according to the intellectuals, means that the culture of the past is the home of the future. It is the $64 trillion dollar question. Who is going to pay for unhealthy Americans when one third of the work force retires and the providers and politicians waste one half the money on the pursuit of money? If Aging in Place is to have a chance at ever working, many changes must take place in the home and in our society: 1) Fitness and nutrition must be put in place and adhered to.2) Chronic disease needs to be prevented.3) Work life cannot end at 65.4) The home must be set up to accept some disabilities.5) Transportation for the disabled must be designed for ease of use.6) Health care insurance must pay for preventing disease and preserving health.7) The government needs to standardize what they are going to pay for and honor the commitment, regardless of the economics.8) Wasted resources must be removed from health care practices using technology, payment incentives and care planning.9) Politicians should not have the final call on allocation of resources.10) Performance must be the basis for payment, supported by evidence of what the payment is pursuing and attainment of a positive outcome. The idea that Aging in Place means every home must be a nursing home, an emergency room, a doctor's office and a place to die is not a feasible or rational solution. Here's why (see extended blog):

McCain and his pledge to Balance Budget By 2013

Inspired in Florida - a Recovering Republican — Tue, 08 Jul 2008 12:52:13 EDT

Snipped from AHN

The campaign of Sen. Barack Obama (D-IL) sent an emailed response to McCain's proposal, saying, "The Congressional Budget Office (CBO) projects that the unified budget deficit will be $443 billion in 2013 assuming that expiring tax cuts are extended. To balance the budget in that year John McCain would have to pay for all of his campaign proposals plus cut another $443 billion of spending."
"To give a sense of why this pledge is not credible, cutting spending by $443 billion would require: cutting Medicare by 81 percent, or cutting Social Security, Medicare and Medicaid by 33 percent or cutting non-defense discretionary spending - which pays for education, veterans, air traffic control and justice - by 79 percent.," the statement added.

Medicare Part D(efraud)

Jerod Poore — Wed, 18 Jun 2008 16:06:39 EDT

For some time I've been writing about how the insurance and drug companies have been screwing us over when it comes to Medicare Part D. Here's a study that backs me up.

Read on...

Can you believe in this? And Healthcare for All...

SRG_Legal — Wed, 11 Jun 2008 10:58:10 EDT

Mother of 8 battles failing health, Medicaid

By ANDY MILLER
The Atlanta Journal-Constitution
Published on: 06/11/08

Every evening, instead of bringing her dinner, one of her daughters attaches a long tube to a catheter that dangles from Sabrina Holloway's arm. A pump delivers nutrients into a vein for 16 hours, as Holloway lays in bed at home.

Holloway cannot eat or drink. She has been fed intravenously since January, when doctors removed most of her small intestine. The mother of eight needs an intestinal transplant, according to her doctor, Ian Katz, a general surgeon in Decatur. Without that surgery, Holloway likely will not live long, Katz says. "Two to three years, I'm guessing.''

http://www.ajc.com/services/content/metro/stories/2008/06/11/transplant_medicaid.html?cxtype=rss&cxsvc=7&cxcat=13

Am I Bitter?

Nickie — Tue, 15 Apr 2008 00:10:00 EDT

Here is my take on this:

I am an Obama supporter. I want to say, I'm 42 years old, female, educated but still paying - DEFAULTING - on my student loans because I couldn't get a teaching job after I graduated. I am certified to teach theater and history. NO ONE WAS HIRING DRAMA TEACHERS. The whole time I've been out of college, Bush has been in office. GUess you can figure out what I feel about no child left behind. Obama has a doable awesome plan for people to not only pay for college, but also he wants to help teachers get more pay, and bring the arts and all manner of subjects back into the classroom. Maybe after Obama gets elected I'll actually be able to get a teaching job.

During Clinton's administration, my husband became very ill. He was diagnosed with lymphoma, and started undergoing chemotherapy, and then the insurance money ran out. He had the student health insurance.

We had applied immediatly upon his diagnoses for disability, the only option for us, and he was turned down because the diagnoses stated that he had a good chance of recovery if you can believe it. He has to be at the point of dying, before he would get aid.

Needless to say that we had to obtain a lawyer and petition the system. It was many months but he finally was approved. We were on our way out the door when Medicaid called and said that because he had received his settlement, he now made too much money to receive medicaid. They used their own settlement, against his income. You see medicaid is proactive from the date applied. So if I applied for disability today, and it took a year for them to approve it, I would get a lump sum of money from the date of application.

They tried to bully me, but I threw such a stink, they immediately realized I was a law suit in the making, and we were able to get my husband the bone marrow transplant. His body, however had been beaten down so much that by this time, it was too late. He died of complications.

This happened under Clinton's administration. This happened because it was the policy of that government to let people with expensive medical related problems to slip through the system. If was more cost effective to let him die than it was to do anything about it. Am I bitter?

Now years later, I can not afford health care, my children are thankfully on medicaid, but I am not. I think I have breast cancer, but can not go to the doctor, because I already owe $11,000 in unpaid medical bills. Am I bitter?

There is only one candidate that I believe will change this. Barack Obama.

National Health Care Crisis Already??

John From Cape Cod. Ma — Mon, 03 Mar 2008 08:42:53 EST

Here is an article from the NY Times dealing with the current problems concerning Medicare/Medicaid. Read and comment please.

http://www.nytimes.com/2008/03/03/us/politics/03qhealth.html?ex=1362200400&en=3c0b2e0989de1752&ei=5088&partner=rssnyt&emc=rss

I know all news "stories" are biased point of view stuff.

What do you think of this story?

Bush Proposes Nearly $200 Billion in Medicare, Medicaid Cuts

Nancy from Embarrass, MN — Mon, 04 Feb 2008 14:13:55 EST

from American Hospital Association News Now, February 4, 2008

President Bush today unveiled a fiscal year (FY) 2009 federal budget proposal that would cut an unprecedented $182 billion from Medicare over the next five years, and $17 billion from Medicaid.

The budget would freeze Medicare updates for inpatient and outpatient services, inpatient rehab facilities and long-term care hospitals from 2009-2011, with updates of market-basket minus 0.65 percent each year thereafter. In addition, indirect medical education (IME) payments to hospitals for Medicare Advantage beneficiaries would be eliminated; the IME adjustment would be reduced from 5.5 percent to 2.2 percent over three years; hospital capital payments would be reduced by 5 percent in FY 2009; and hospital disproportionate share payments would be reduced by 30 percent over two years. The proposal also would establish a value-based purchasing program that would result in an overall cut to hospitals; lower the base payment rates for inpatient rehab hospitals for five post-acute conditions; and eliminate payment for so-called "never events." A detailed breakdown of the president's Medicare and Medicaid proposals is attached, and also is available at http://www.statenewsfeed.com/anemail/content/Scan001.PDF.

The president's budget blueprint would have a disastrous impact on the health and health care of millions of patients and their communities. At a time when America's economy is faltering and the demand for hospital services is rising, these unprecedented cuts would jeopardize hospitals' ability to provide important services to those most in need - America's elderly, children and disabled.

First Blog Entry--I am new here

theirmom99 — Wed, 09 Jan 2008 03:57:29 EST

Hi All,

Welcome to my blog. I am a middle-aged, college-degreed, Mom of a large family.

I am fairly new to this blogging, so bear with me.

My family has seen some of the main campaign issues personally affect us in the past few years, with Health Care being a big issue. I have no health insurance, and cannot afford it at the prices they want for someone with the major health problems I have. I had Medicaid because I was seriously ill, but our Missouri governor Matt Blunt took away Medicaid for 90,000 people (including myself) in 2005, yet kept his own state-funded medical care for he and his family (had that been a young mother in the city and her family on Medicaid, they would have called it a "cycle of dependency" and welfare; **however** for Governor Blunt, he just thinks he and his family are **entitled** to it).

I have been sick for 6 years, there is no cure, but there are treatments that do help, so I am in the hospital on a regular basis. Without insurance and without money I can no longer see the doctors I had, who knew my medical history. I also have problems getting my medicine. It is several hundred dollars a month but without it I die.I have been running my finances into the ground by putting it on my credit card.I also had to have a tumor-removal surgery and put it on my credit card.Before I lost my Medicaid I had excellent credit. I was brought up to *not* run up bills you can't pay.But when it is a matter of life or death what are my choices???!!!??? As of late, I have been very lucky to find a hospital in the city with their own clinic, who will take me without insurance, and they charge on a sliding scale based on your income. It is a long ride to get there, and usually a long day there (they are always very, very crowded), but I know that and I try to come prepared with a tote bag of magazines and a bag lunch with drink. I really am grateful to that clinic/hospital, I was so fortunate to find out about that, it truly was a Blessing.

I feel that it is unfair that (otherwise responsible) people and families should be ran into the ground financially and bankrupted for the simple reason that someone got sick. It is a horrible, horrible, stressful thing to go through at a time when you are seriously ill, and/or recuperating from hospitalization. Then you find out that your credit rating also affects your home and auto insurance (which both go up too). Simply because you got sick--something you couldn't help.

I am hoping and praying that Barack Obama wins the presidency, and things will get better. I like his ideas on Health Care, and that is a big issue amongst me, my family, and my friends. Senator Obama, I am hoping and praying that you will win, and I am proud to drive the Mom Van with the (cute) bumpersticker "Mama for Obama". My Mom wants one now too.... :) There will be a few driving around North County!!

Thank You for Listening,

theirmom99

A simple step to address pharmaceutical costs

Lisa Beyer — Sat, 15 Sep 2007 04:25:14 EDT

What are your thoughts on this opinion?

The Hill: A Simple Step To Address Pharmaceutical Costs, By Ted Slafsky, September 11, 2007

_________________________________________________________________________________

Thank you,

Lisa Beyer

Precinct Deputy Captain in Las Vegas Precinct 6475

Why I Support Barack Obama for President
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One Patient's Run In with "The System"

Jon @ my policy health discussion central — Thu, 13 Sep 2007 12:54:56 EDT

Just read the story of Shirley Loewe and her run in with the health care system (from the front page of the WSJ today) by clicking through to the full version of this post. Incredible job by the Journal in capturing this. If you are not appalled by what is going on out there, you are not paying attention.

Case studies of our broken education and health care systems

Alyson Rice — Wed, 27 Jun 2007 19:16:28 EDT

I am a special education teacher, working in a program for students with emotional and behavioral disabilities in a relatively well-off mid-Atlantic district near the nation's capital. Because our programs are inadequately funded by the federal government (according to our county officials), I am required to spend time billing Medicaid for doing my job--meeting with parents, making phone calls, writing progress reports and education plans. When the billing is not done, and Medicaid funds lag, our staff ends up spending personal funds to provide needed supplies for our program. I refuse to allow this Medicaid paperwork (which is extremely inefficient and redundant, by the way) to interfere with my real job (teaching, planning, phone calls, parent conferences, and the special ed paperwork--as if that wasn't overwhelming enough!). Instead, the billing gets done now, at the end of June when all the students are gone and vacations have started.
That wouldn't be so bad except for the tragic irony of this very messed up system:At the same time that I was supposed to be billing Medicaid for work that has nothing to do with medical services, a 6-year-old student of mine was spending the last month of school periodically writhing in pain from two giant exposed cavities that have gone untreated because there are so few dentists who will take Medicaid. And a 7-yr-old student stays in an unsafe home with a meth-addict mother because moving in with grandma would mean losing medicaid coverage and the medications that help him to control his impulses and aggression.
The system is completely backwards and is doing harm to our children. I want a president who will see that NO student of mine or any child in this very wealthy nation of ours ever wants for medical care or educational resources again. I know that's a lofty aspiration, but I believe that with the policy proposals he has offered, Barack Obama will get us as close to that goal as any president can.

universal healthcare

mf9 — Mon, 26 Mar 2007 16:37:00 EDT

Would like to add my two cents' worth to the suggestions list for Obama's healthcare position: Since a poll now shows that a majority of Americans are willing to accept a tax increase in order to achieve universal healthcare, understanding that higher taxation may be preferable to the costs and uncertainties of the present system (or non-system), this may be the moment to propose extending medicare to all Americans from cradle to grave. For the most part, Medicare now pays 80% of medical bills for those enlisted with the individual responsible for the remaining 20%. For those eligible families in low income brackets, medicaid kicks in for the remainder. A universal plan could pay 80% for most people but 100% for those at low income level, thus eliminating need for medicaid (God, would the states like that!). This suggestion does not, of course, directly address the waste and unnecssary medical expenses in the system. Those need to be seriously discussed and dealt with. But progress in that direction can more easily be implemented in a single payer system.
Michael Field, M.D.

It all comes with a price...

IlianaCatsPawn — Sat, 17 Feb 2007 15:21:49 EST

The federal government wants my best friend to become a criminal. What sort of criminal is up to her apparently, but nevertheless she must somehow produce monies she does not possess or face eviction from her Section 8 apartment.

Here's how this works. "Lee" has lapsing and remitting Multiple Sclerosis. Unlike progressive MS the lapsing and remitting kind doesn't give you a road map to a wheelchair followed by a miserable death ala Richard Pryor. It's much, much worse. Ask Montel, he suffers from the same brand of nightmare illness.

This version comes with temporary blindness which may last 5 minutes or 5 months, temporary paralysis in various parts of the body. The same for hearing loss, memory loss, vertigo, asthma, incontinence, fatigue and excruciating pain every minute of every day. And it's all unpredictable.

Under Bush's new rules HUD requires anyone living in public housing, no matter your financial status, to cough up $50 a month in rent. But under the Bush Administration Lee has been unable to obtain SSI for the past 5 years because she has a college education and it is assumed that she must be able to work.

Hmmm. Let's see. She's got a Masters in Abnormal Psych with specializations in diagnosing Serial Killers and Mass Murderers. This does not qualify her to treat families and children. And would anyone go to a psychologist who might forget key portions of a case file, be suddenly unable to see or hear them, begin speaking in a foreign language when they think they're speaking English or urinate on themselves? Ask yourselves if this scenario would inspire confidence in you.

So, what else is she qualified to do? According to Social Security she can work at McDonalds! Yup! I want this woman who sometimes can't hold her own utensils to hand me a cup of hot coffee. Or maybe misjudge the distance of the hot oil in the fryer to her hand due to vertigo and file a workers comp case against my restaurant.

Well then, she can take a "sedentary" job answering phones. Right. I want this woman who cannot be depended upon to show up every day because she can't stand, can't see, can't hear or can't remember it's 2007 -- not 1997 -- to work in my office. Wow! I can just imagine how productive this individual is going to make my company when everyone else has to pick up the slack for her.

And if she does make it to work I certainly want her answering my phones while having an episode where she's speaking one of the 7 languages in which she is fluent. Hey, I'm her friend and it drives me nuts when she unexpectedly starts with the Russian, German, Yiddish, Hebrew, Japanese or Italian. Or worse, starts speaking Elvish at me!

Now we come to the fun part. She has NO income because of a lovely little loophole that under the Democrats was closed. In those days, if you applied for Social Security you were granted food stamps, a small amount of financial aid and a Medicaid card until your case was settled one way or the other. Under the Republicans it seems that until Social Security admits you are disabled DHS (Department of Human Services) is under no obligation to believe you actually have a disability and therefore will give you nothing.

So, what can Lee do to acquire $50 a month? Well, she could ask me, but as I am already paying her phone bill so she can call an ambulance if she needs one, helping out on the electric so she can see, and giving her money for dry goods like toilet paper -- all of which comes out of the pittance I get from Disability, I think I'm doing more than enough by living on less than $150 a month after my bills and hers are paid, don't you?

What are Lee's options when no government or charitable agencies will help her? Crime. Prostitution. Identity theft. Whatever gets the job done, I guess, because she's still got to cough up that $50 a month even though they know she, and thousands of others like her through no fault of their own, do not have an income.

Of course she's fighting this ruling, she doesn't want to become a criminal. She just wants access to the safety-net she spent her whole adult life paying taxes for, even though she never thought she'd need it. Neither did I, but then I was lucky enough to get sick during the Clinton Administration.

Welcome To My World

IlianaCatsPawn — Fri, 16 Feb 2007 13:51:05 EST

I've always thought it a bit presumptuous to blog about subjects I know nothing about. Therefore, I'm going to keep this blog (as much as humanly possible) about how political decisions effect me, my family and my friends on a very personal level.

It isn't all that difficult to do. I live in public housing, receive food stamps, Medicare and Disability. A decision made in Washington can certainly effect how much rent I pay or if I will even have a place to live. It can also effect whether I can eat a healthy diet, visit the doctor, get needed medications, pay my utilities or abide safely in my home.

In future posts I want to talk about how I feel that my civil rights as an American, and guaranteed by the US Constitution, have been systematically stripped from me and those I care about, solely because we are either poor, members of a minority, or both.

Stop the Raid on Medicaid!

Eli Corp — Sun, 11 Feb 2007 20:17:50 EST

Stop the Raid on Medicaid

Feb 11th, 2007 at 7:46 pm EST

Also listed in: Campus Progress Blog by Eli Corp.

"Potentially Devastating", that's how Rich Umbdenstock president of the American Hospital Association describes the President's Budget Proposal in a recent interview. Medicare and Medicaid finds itself under attack as the President sets out his agenda of budget priorities. The President spoke of the need to improve the healthcare system in his State of the Union address, but again his words are nothing more than the same tired rhetoric. In typical Bush style, the things he says and the things he does appear to be two separate things altogether.