Saturday, December 25, 2010

'Tis the Season for Compromise, And to Stand Up for Moral Choices

'Tis the season for compromise. Or political oneupmanship. Or staging. No matter what you think, and what your beliefs, it's hard to deny the past year distinguishes itself as one of the most egregious examples of party politics and special interest pandering in recent memory.

I'm really happy Don't Ask Don't Tell has been repealed, but did we need a big ceremony to flaunt it? You'd think the Democrats learned some lessons after the circus performance when the Affordable Care Act (one of the biggest betrayals the President Obama has executed and thus imposed on his former loyal supporters and the American people) was signed. You remember, the Vice President's Big F-ing Deal.

Does the sludge trickle down from the President, who, along with the cabinet and advisers all share the same lack of focus and leadership and accountability? Or does the stench waft up from below, from a pit of legislators who have just spent too much time filling seats with lead bottoms and campaigning for their own re-elections?

All our elected officials allowed a deeply flawed health care reform bill to pass. No one without insurance due to job loss or other financial difficulties will see any relief until 2014 while health care insurers rig up new exchanges that meet their needs, not those of patients.

Second, instead of calling out Republican special interests in repealing tax cuts for the rich, those concessions were made to allow extension of unemployment benefits. How are those two issues linked, except in the world of politics?

At the eleventh hour, my two New York State Senators, Schumer and Gillebrand, who caved on the Affordable Care Act, stood up for the rights of first responders in desperate need of assistance due to life threatening illnesses they are suffering after doing their public and civic duty in the aftermath of 9/11. How can anyone who lived through that day, and the succeeding events deny the unprecedented sacrifice those men and women made, and deny them the needed medical care they deserve? Republicans, it seems, are not human. Or reneged on the vow to "Never Forget."

How does this game playing affect real people?

A 35 year old single mother and police officer confided with me December of 2001 how the horror of 9/11 had seriously affected her, physically and emotionally. "It's far from over," she whispered, sadness and fear in her eyes as well as her voice. In February of 2002, she was dead of a lung ailment no one yet understood, her ten year old son an orphan, in the care of an aunt, devastated.

Another police officer friend is battling lung disease, trying valiantly to stay on the job to support his wife and three kids. He's losing.

Women have already had their constitutional rights trampled by the express prohibition of abortion services in any exchange plan, a precedent likely to be adopted by all insurers.

Now, women are at risk of having their access to birth control severely limited clearly a measure that prevents the expense and possible adverse health effects of undesired pregnancy, taken away. A bunch of celibate old men on the Conference of Catholic Bishops has expressed their opinion, yet have not weighed in on treatment for erectile dysfunction. This is blatant sexism, blatant disregard for our Constitutional Rights, and Separation of Church and State.

To see how absolutely devoid of reason the Bishops are, consider that one believes a hospital's decision to allow an abortion of an 11 week pregnancy in a dying woman was grounds for removal of the Blessed Sacrament from the hospital's chapel. It seems that if the mother had been allowed to die along with her 11 week fetus, they would still be able to celebrate Mass and receive Communion on hospital grounds. Hmmm. What would Jesus do? What would He say about that?

Congratulations o the doctors, nurses and administrators who did the right thing in that horrible situation--one which I have found myself involved in many times. In my opinion, there is no moral grounds for allowing someone to die for the sake of a religious belief, turning a tragedy into a travesty.

Kudos to all of us who went to the polls on Election Day and jettisoned the worst of offenders in Washington, as well as those in City and State government. But there are still more that need to be called out, and thrown out. Here in New York City we saw how close Mike Bloomberg came to being booted, after he flaunted term limits and declared himself too important to be allowed to step down as required by law. Bill Thompson might have won, if more disgusted voters had cast their vote.

We need to stay vigilant and in control. Credo has organized a campaign against more indignities being perpetrated against women, and it can't be any easier than one click to send a message, and one click to post the message to Twitter and Facebook about keeping birth control available to all women under the Affordable Care Act.

I suggest subscription to their newsletters with timely legislative action updates.

All the greetings of the season , no matter what you celebrate!

Thursday, November 25, 2010

What I'm Thankful For Today: Endless Possibilities

A long thread running through Someday I'm Going to Write a Book: Diary of an Urban Missionary is the story of my great grandmother, Jacinta, a/k/a Jenny Bruno. She was as a midwife, and I have the license and instruments to prove it, in the early 1900s (her certificate is dated 1911 which makes next year her centennial), tending to the women (and their families) of the Southeast Bronx, not coincidently, the same ones I am tending to right now.

There are many similarities between us so I feel comfortable concluding Jennie probably didn't love running out of the house at all hours of the night, leaving her eight kids (our of the thirteen she had) to fend for themselves, though I'm sure leaving her purportedly abusive husband and providing for them was driving her along.

My husband isn't abusive, in fact, I'm more likely to hit him someday than he is to ever hit me. Money is what keeps me in this insane business--three kids to put through college, my daily coffee, their daily bread, and some sense that there is a mission in all this. Some overlying need to persist despite the anguish and frustration.

The brick walls I run into day after day, erected by a broken health care system, big government and big institutional barriers, insurance companies, the economy, poverty, racial and ethnic discrimination, and yes, the patients and their families as well, show no signs of coming down. I chip away at the mortar; look for ways to sneak through, over, and around. Am nabbed from time to time for what Mark Legnini, DrPH described as "doing the right thing" instead of "the right thing to do." Get a leg up now and then, so I can climb over, pulling my charges along with me, though some can't hold on or aren't willing to take the risk of falling.

This is deliberately vague, for privacy as well as a myriad of privacy and compliance regulations. But this is a time of year to focus on what we have and give thanks. This article is very long, but its description of the overall mission of the hospital I work for made me proud to be a long time member of its staff. One of the very small dots on the southernmost point of the map is the health center in which I toil, day in and day out. And I've worked in several of the other hot spots over the years with some of the most talented and dedicated doctors, nurses, patient care techs, and other support staff on the Earth.

As an overview, the worker bees aren't acknowledged in the Commonwealth Fund Report. As usual, only the doctors are championed though much of what being done is accomplished by those of us without MD degrees. But coming at a time when I often wonder what it's all about, this affirmed I'm in the right place.

So I'm thankful for my health and family, without which nothing else would matter. But also my job, my co-workers, the patients who continue to place their trust in me and for the knowledge that I've made real difference. And to Jennie, who I have to believe is the little voice that guided me to where I am supposed to be and straightens me out with a kick the ass when I'm ready to give up.

This tribute to her, an excerpt of Someday I'm Going to Write a Book, was published last year in This Path.

Happy Thanksgiving.

The night seemed full of endless possibilities, like life thirty-five years ago. I stood in the lobby of the posh Marina Del Rey at the 75th anniversary of the Saint Frances de Chantal grammar school, Bronx, New York. The '50s vintage dress that called to me at an antique show fit like it had been custom made. I thought I looked pretty good with the gray dyed out and six pounds lighter than last year. Those anti-wrinkle creams seemed to work. They sure cost enough. 

The dawn of the AIDS epidemic and the horror of working in the hospital on September 11, 2001 book ended a career during which time speaking up made me part of the enemy camp, not the liberating forces. 

Video clips of domestic violence deaths, child abuse, infanticide, rape, incest, and the degradation of women played over and over in my mind. My theoretical model for dealing with families in crisis was of little use at 2 a.m., standing in between the guy who just beat up his pregnant wife, the woman bleeding to death, and the clerk getting insurance information before we could get blood for transfusion.

I had bargained with the gods to keep the demons away but no good deed goes unpunished. They stole my soul and reneged. Divorce from my high school sweetheart, the inevitable loss of beloved family members, and my own personal health challenges gave me pause to ponder the endless impossibilities of life.

I focused on my family, thankful for the second chance at marriage and motherhood. I once battled sexism, racism, conservatism, and elitism. Well into my third life and tired of fighting, I moved past activism into escapism.

I'd never attended a high school reunion but instead was drawn way back to my grammar school days. I remember only a few names and faces, most notably, Marianne. We don't see each other often, but just like tuning into a soap opera you haven't watched in years, we easily pick up the story line and move on.

I waited for her, watching the lights of the Bronx-Whitestone Bridge glimmer like tiny beacons over cold, dark Long Island Sound. I moved across the bridge to Queens seventeen years ago. I still work the streets of the Bronx but death, distance, or the ravages of time have broken all ties to friends and family. Alone, mesmerized by the tinkling fountain, I held back tears remembering when this neighborhood was an innocent idealist's only view of the world.

 The cell phone bleated. "Sorry, I'll be there in a minute, got stuck in traffic." Marianne rushed in from the parking lot and gave me a hug. "You look fantastic."

 We studied the collage of old class pictures. Marianne picked me out: the girl with a headband and hair in a pony tail, tights, uniform dress with a bow tie, and a big smile. We sipped drinks, nibbled hors'd'oeuvres, and found the "Class of 1971" table.

John, one of the two "boys" who had been my close friends, smiled when he saw me. "Hi, Carole Ann. You haven't changed a bit."

Sister Mary Lucille, at least eighty, peered at me and waved a gnarled, bony finger. "You're one of the Moleti girls, and none of you took French." Nuns never give up.

"That's right, Sister," I said, "but Spanish serves me well."

George suggested we take the few surviving sisters for a boat ride in the dark and dump them overboard to get even for all those bruises. We laughed, reminisced, and tears flowed on my way home in the pouring rain as I crooned Streisand's tune "The Way We Were."

I drove over the bridge, from my first life, past the second, and into the third. I let the dog snooze on the couch and walked through the dining room where Jennie was still smiling at me. The kids were tucked in; the cat warmed my side of the bed. I snuggled next to my sleeping husband and lay there in the dark and quiet thinking about all the stories still to be told.

"Get back to work," Jennie said.

And I did.
Copyright 2009 by Carole Ann Moleti

Saturday, October 2, 2010

Bad Spells and Broken Dreams

It's been a long time since I posted, but I just crawled out from under my rock. To think of the time and energy I expended last fall working to get the health care reform bill passed—all wasted. I still haven't recovered from the betrayal of the Democratic party when it stooped to the worst political pandering I have personally witnessed, producing a watered down version of a bill that is likely to cause more problems than it solves.

Between the health care mess, the continuous assaults and lack of meaningful action on endangered species, environmental concerns, climate change, the economic situation, which is not getting better for anyone I know, and the circus that is New York State and City politics, I would love to vote every single Democratic Senator and Representative out (take note Mr. Schumer, Ms. Gillebrand and Mr. Ackerman) if the Republican contenders didn't scare me as much as the kook, Carl Paladino, who just won the Republican nomination for Governor. He attacked a New York Post editor who asked him a perfectly reasonable question about the alleged out of wedlock daughter he fathered, at the same time as Mr. Paladino was slamming his opponent, Democrat Andrew Cuomo, for having extramarital affairs.

David Patterson, our current governor, has had his own affairs, interfered with the handling of a domestic violence incident perpetrated by one of his staffers, and even joked about his fall from the throne on Saturday Night Live. Two of the state senators responsible for the grid locked session last year (both from the Bronx) have been found guilty: one for misappropriation of funds and the other for domestic violence. And both were drop kicked by voters when they tried to get back into office by running in the primary for another post.

So both sides have a lot to be proud of, including Sarah Palin, “mama kill those grizzlies,” whose daughter is now on Dancing with the Stars while Bristol Palin's erstwhile "baby daddy" struts his stuff in a different venue.

They're all a bunch of clowns, and even my conservative Republican cousin and I agree they all need to go. I have now added every mailing list from the Democratic National Committee and Organizing for Change to my block list as spam. The only thing political I read are updates from Creedo, an organization whose sense and sensibility reflect not only honesty, and integrity, but sanity when it comes to the major issues we're facing: I strongly suggest if you care, subscribe. They do not abuse subscribers by sending fluffy thank you notes from the President which end with a button to donate more money.

I'm going back under my rock for now, spending time at my day job taking care of children and families in the Bronx who desperately need health and educational services being slashed and hacked by budget cuts, while the City prepares to spend millions replacing all the street signs to "better reflect light and be easier to read." How about not worrying about the motorists (I can see the signs just fine) and give the kids some decent conditions in which to learn and help them learn to read?

Since I'm in a decidedly apocalyptic mood, I'm taking notes for the next chapter of Someday I'm Going to Write a Book, and immersed myself in writing fiction. My novel, The Widow's Walk, a paranormal romance set in a haunted house in Cape Cod is nearly finished. It's a sequel to Unfinished Business, continuing the story of Liz and Mike, a young widow and widower who fall in love, then discover they've been down this road before, and must battle the ghosts who fear they'll make the same mistakes the second time around.

Next up, will be an urban fantasy series being kicked off by Boulevard of Bad Spells and Broken Dreams, set in the near-future Bronx engaged in an epic battle between dark and light magic, which has been waged since the late 1970s.

So now you see what I mean by the slogan that my first love is science fiction and fantasy because walking through walls is less painful than running into them.

Check out all my writing related news at or follow me on or Twitter or my new Facebook Fan Page.

Saturday, March 27, 2010

Of Back Rooms, Back Alleys, Clowns, Roulette, Magic Mirrors and Viagra

Here are a few meandering thoughts on what I call health care deform. And of of the most egregious examples of the nonsense that went on during reconciliation.

By 57-42, Democrats rejected an amendment by Sen. Tom Coburn, R-Okla., barring federal purchases of Viagra and other erectile dysfunction drugs for sex offenders. Coburn said it would save millions, while Sen. Max Baucus, D-Mont., called it "a crass political stunt."

Hold that thought.

I don't think I'm the only one baffled, bamboozled, and disgusted with the carnival known as health care reform. Back room deals, under the table nudges, and whispered expletives have exposed the true reflection of our President and Vice-President, Senators, and Representatives. Magic mirrors fill the Fun House of Representatives and they’ve relied on dizzying spins to gain political advantage.

Politics should have nothing to do with health care, and all we've got now is a big, fat bunch of deals that change with every spin of the wheel. Where it stops, nobody knows. What cheap prize they will hand the American people in this bait and switch game?

This law doesn't meet the criteria President Obama set for health care reform back in the days of reason and clarity of purpose. The days I was on board. The days I wasted writing letters, blogs, Tweets, making phone calls, and annoying all my Facebook friends imploring them to join me in supporting the cause.

There is no public option. This plan doesn't eliminate all pre-existing conditions. Now being female of childbearing age eliminates a person's right to obtain a legal abortion-a right guaranteed by the Constitution.

It forces people to buy coverage from the very companies who have been ripping us off all along, shunts coverage of children to their parent's policies, and leaves the most vulnerable and medically neglected (read: poor) people with decisions about whether to buy inadequate coverage or pay for food, clothing and shelter and be fined.

It might increase costs. Even if you are a number cruncher and like to play games with statistics, ignoring the realities of life, the cost of abortion is a lot less than the cost of pregnancy and delivery care, or the cost of caring for a preterm baby, neglected, abandoned or abused child. The number hasn't come up for tort reform and how to handle the role of malpractice claims in the exponential rise of costs.

Mirror, mirror on the wall, the view I see isn’t fair at all.

• The insurance companies now have a guaranteed source of new meat.
• The lawyers still gross big money on "pain and suffering."
• Pre-existing conditions.
Appears to be all show, smoke, and mirrors to me.

I was willing to compromise for the sake of the greater good. But this offers no benefit to me or to my patients:

• If I lose my job I can get health coverage. But it won't cover abortion, and I'm likely to lose that coverage even if I keep the job since the private insurers will likely now exclude all coverage for elective procedures since they are simply "following Federal standards." I'm not planning on losing my job, and I'm also not planning on having an abortion but shit happens.

• My teenage sons will have coverage until they are 26. Now they have a perfect excuse not to get a job. And I'm really worried about my daughter and her friends because their reproductive rights have been trampled.

• I will pay more for my benefits and might lose the tax advantage of health care spending account (the roulette wheel is still spinning on that one).

• As a health professional who cares for women and children, I have a whole new set of regulations to follow. I still have to worry about what money goes where, and what can and cannot be spent on who (illegal immigrants) or what (abortion). Where can I refer patients who need services? In these days of budget woes will New York City and New York State be able to subsidize the uninsurables like they do now? Will private companies still have grant funding to help out those who fall through the cracks?

• What happens in emergency situations when we can’t worry about insurance or someone dies? How do I prove the thirteen-year-old is an incest victim even though she doesn't know what that means, or is afraid to tell the truth to a bureaucrat? What if the strain on a pregnant woman’s damaged heart, transplanted kidney or out of control lupus will kill her, in which case I will have to work up the supervisory chain of insurance company clerks trained to just say no?

The Republicans just said no, and the Democrats refused to do the right thing, but tough shit ladies, someone had to compromise. I don't think the elimination of Viagra prescriptions would have been a bad trade-off. No one ever died from erectile dysfunction, less women would get pregnant, they cost big money-lots of cost saving there. No more preposterous than suggesting since abortions don’t cost too much so women should just accept the fact they’ll have to pay for their own mistakes.
But those old geezers in Washington D.C. grabbed their balls and called that a "political stunt." People in glass houses shouldn't throw stones. In my dictionary the definition of sex offender applies to quite a few public officials, especially if you use the term broadly.

Just say no might work in politics, but it doesn't in real life. The roulette wheel spins on. What will happen when the dust clears? Big effing deal indeed.

Wednesday, February 24, 2010

What Will Happen to Health Care Reform?

What will happen to health care reform? Nothing, or a worsening of the situation unless the politics are left out and the Republicans stop using obstructionist tactics to derail this and just about every other initiative the President undertakes.

The Democrats aren’t blameless either. Their willingness to stoop to backroom deal making and concessions just to get a bill passed have resulted in the loss of two vital provisions: the public option and the threat of serious limitations on women’s reproductive services which, I maintain, creates another pre-existing condition the bill was envisioned to eliminate.

The insurance companies and pharmaceutical companies will do anything to maintain their profit margins. Witness Anthem Blue Cross raising rates in California in anticipation of a bill's passage.

Here’s what else can happen if people are forced to buy coverage from the very companies ripping us off now. Without a public option, if you lose your job and have a family to support, perhaps the only insurance you can buy will be on a private exchange. Even if you can't afford it, you’re required to buy coverage. How will you pay for that, as well as mortgage/rent, utilities and food? If your spouse makes too much for you to qualify for Medicaid (or an exemption from the mandatory coverage) this is all too possible.

And here is an example of the convoluted way reproductive health services would work: In the military, where men no doubt can obtain condoms, women can’t get emergency contraception. Most health plans will follow the Federal guidelines and likely exclude birth control abortion coverage unless you pay out of pocket. The argument: "It's a rather small expense." My argument: "Pay for your Viagra, penile pumps and other treatments for erectile dysfunction. If you can't afford it, not having sex won't kill you."

Here's an editorial from The New York Times on this issue: Showing Respect for Women In Uniform

How about respect for women in general? I'm sick of my body being divided into pieces deserving of care and parts that are "my responsibility" or "my irresponsibility" depending upon whose opinion is being voiced. It takes two to tango, as they say.

Meanwhile, yet another hospital here in NYC (St. Vincent’s) is bankrupt due to bad debt and charity care and lowered insurance reimbursement. They just had a layoff and more are likely. If they close, surrounding institutions will have to absorb the volume-and that means longer waits, understaffing which endanger patient safety and affect infection control measures (more crowding, less cleaning).

What about tort reform and provisions to address the malpractice morass? Lawyers are still advertising no fee unless we win, wasting money on frivolous cases, many of which have not merit but are settled to avoid costly litigation.

I have a great insurance plan, and would likely have to give up some perks, like my health care spending account funded from pre-tax payroll deduction. But my optical benefits have already been reduced and I must go to one vision care provider. I must fill all prescriptions at certain pharmacies to get that benefit.

We’re all going to have to give up something. But unless the health of the American people is put first, not ideology, politics and vengeance there will be no meaningful reform.

Without a viable public option, protection for women's health care services, and changes in the legal system reform is not going to reform anything.

Finally, this is a very intelligent op-ed from The New York Times on how the GOP can fix health care.

It contains proposals for health care reform written by conservative Republicans. If they can write such reasonable suggestions why can't the House and Senate come to some consensus? The answer: politics.

Tuesday, January 19, 2010

No Matter Who Wins, We All Lose

If Martha Coakley loses the Senate race in Massachusetts, health care reform is doomed, right?


Health care reform was doomed when politics and deal making became the goal, rather than health care reform. Why else would House and Senate Democrats "celebrate" the passage of a bill that discriminates against women and tramples their rights? And force people to buy health insurance from the very companies that are ripping us off already? And make deals to allow states to "opt out" when the American people can't. And eliminate the public option? And not address in any meaningful way tort reform and the liability insurance crisis which continues to drive costs higher.

Was I wrong to trust the Democrats and President Obama to do the right thing regarding health care reform? And that they heed the advice of experts from almost every major health care professional organization. Appears so.

Are the Democrats solely to blame? No, the obstructions put up by the Republicans have more to do with discrediting the Democrats in general, and the President in particular than anything else.

Is this politics as usual?

Yes, which is why most Americans are so disgusted with all our elected officials.

I worked very hard with Organizing for America during the initial efforts. Back and forth communication was great, the updates timely, and I felt like I was part of something wonderful. All that changed after the House sneaked through a bill eliminating any possibility of abortion coverage for women. The sight of Nancy Pelosi beaming for the cameras celebrating the deal still sickens me.

Then the communication stopped. No acknowledgement. No explanation, no justification, no strategy. All I get now are requests for money. Senator Gillebrand has never responded to any of my communications. Neither has Congressman Ackerman. Senator Schumer was tripping over himself apologizing, but he still voted for the bill eliminating the public option.

OFA invited me to a strategy session this weekend, but I can't face it. Politics is not my thing. I'm unsubscribing from OFA and am subscribed to Creedo Action, which is much more in line with my political views, and like me, not afraid to open their big mouths and complain.

I hope this bill is defeated because it's bad for women, it's bad for health care in general, and it's bad for cities like New York who have always picked up the slack and offered coverage for those who fall through the cracks. I'm sad, but that's the way it is.

And as for Martha Coakley, the Democrats need to see this as a warning. The American people are fed up with this process.

But no matter who "wins", we all lose.