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.


  1. Finally, someone has said all the things I've been thinking. Yes, I suppose I'm glad they passed something, but I have serious concerns about it, just like you do.

    And you know what? I don't care if it was a Republican who threw that amendment out there. His motivation might stink, but it's still a good idea. How could any lawmaker DARE allow funding for ED drugs for anyone, let alone sex offenders? Especially while denying abortion coverage?

    And by the by... do we have coverage for birth control? I've never heard that mentioned.

  2. There are already issues with some insurers (GHI in particular) not covering birth control or seriously limiting its availability to women who have medical conditions (not for prevention of pregnancy).

    They already have formularies which specify which drugs/devices can and cannot be covered. For example, certain brands of pills. Some
    won't cover the Mirena IUD because its a bit more expensive though it has less side effects.

    I do not expect this to get better. Which means I will have to spend even more time filling out forms and calling companies and re-writing prescriptions for items that are covered.

  3. Great post Carole! Maybe if more women were involved in this process we might have gotten more out of it. We need to support the women in Congress who believe in women's rights. There are some who are Republicans and should not be there. But support for the good ones is essential. We also need to support organizations that support women's rights.