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Monday, January 24, 2011

Cognitive Dissociation

While driving on a major road in the city where I live, I was struck by what the vehicle in front of me was telling me.  The view was a flex fuel pickup truck with disabled veteran license plates and a bumper sticker attached to the rear window that has the Texas State flag with the word SECEDE boldly written across the face of the flag.  As I sat behind this vehicle at a stoplight, I began to wonder if the owner of the pickup really held the belief that Texas should secede from the United States of America. The owner must have at one time taken the oath to serve and protect the United States of America against all enemies foreign or domestic, served in the military for a period of time, was honorably discharged from service and injured severely enough during that service to qualify for the disabled vet license plate, so I had no doubts about how he felt about the US or at least I thought I did.  And yet, he or she also holds the belief that it is a good idea for Texas to leave the republic of the United States.  How is it possible for a person to hold the idea that secession would be good for Texas, having also taken the oath to the United States and served honorable in US military?  I am at a loss to explain this cognitive dissociation, the ability to hold two or more thoughts and the inability to see how these ideas or beliefs affect each other.
 
As I sat there at the stoplight I started to wonder if this person had really thought through the ramification of secession would have on them personally.  At the very least would they still qualify for that disabled vet license plate since they had served in the United States military and not the Texas military.  Where would they get VA healthcare if they need it, since it certainly would not be offered in a separate country if secession succeeded.  I also wondered if they had really thought through the economic impact this action would have if all of the US military bases in Texas closed and all of the jobs both public and private that support the communities around these bases would suddenly not exist or were moved elsewhere.  Having lived just outside of Houston for the past thirty years I wondered what would happen to NASA's Johnson space center and all of the high tech jobs and businesses associated with it, they surely would not stay.  I really could not determine how much thought if any, this person put into the message that the back of his or her pickup was sending or was the addition of the bumper sticker just a whim, without any real consideration of the impact of such a treasonous act they were advocating.

I know where the idea for the bumper sticker came from Governor Rick Perry saying that secession was an option for Texas if Washington DC was not reigned in.  This was done to appease a vocal political group and without any real conviction that it was the right course of action.  http://www.youtube.com/watch?v=z5xTxcFA398  Although the governor did say this and maybe I am being naive to say that I do not believe that he has any real intentions of moving forward with the idea regardless of his words because of the various problems outlined previously.  But what struck me the most was the true failure of leadership the Governor demonstrated.  Rather than saying that although secession was technically possible, he should has said that it was absurd on the merits.  The State of Texas does as little as possible as a government now, it is ill prepared to be a nation.  It causes one to wonder what the Texas budget shortfall would be without all of the federal jobs and funding that flows to the state.  

So by now you might be wondering why a healthcare advocate is blogging on this particular topic.  The answer is that the vision represented by the back of this pickup truck clearly illustrates what went on in the US House of Representatives this past week and the actions of the Republicans voting to repeal healthcare reform.  First let start with the fact that this particular piece of legislation was brought to the floor of the House without any committee hearings, without any real ability for the minority to offer amendments and only several hours of floor debate.  These are things that the minority in the 111th Congress complained about bitterly during the healthcare debate last year and frequently using the phrase "the bill was rammed though by the majority" eerily in lockstep fashion.  The majority of the 112th Congress came in saying that there would be more transparency in the process and immediately chose not to be transparent at all on this bill, this only proves that their actions speak louder that their words.  Secondly, almost on mass the Republicans said that they still want to cover people with preexisting conditions and eliminate annual and lifetime caps but without the personal mandates for insurance coverage.  The reality is that without the mandates there clearly is not the economic case for covering people with preexisting conditions and the elimination of caps, you need the additional healthy people as part of the pool for this to make any sense.  Former Senate Majority Leader Bill Frist made a very compelling case for the GOP to drop their efforts for repeal and rather work to strengthen or correct deficits in the law. (see:  http://www.huffingtonpost.com/2011/01/18/bill-frist-health-care-repeal-gop_n_810345.html )  The GOP in the house and the minority leadership in the Senate are like the vision presented by the back of the pickup truck.  They hold two ideas in their heads without the cognitive ability or effort to see how these two ideas impact one another.

The reality is that the GOP want to repeal healthcare reform without ever having a viable option to replace it with, at least not for those of us with preexisting conditions.  The Republicans will say that their idea of buying insurance across state line is a good idea.  At face value this sounds agreeable until you think about what happen with credit cards.  The credit card companies found states to set up shop in that were willing to regulate them as little as possible if at all, that would allow the companies to charge up to 30% interest on money that they were borrowing at less then 5% and to use every trick and trap thinkable to trip up and then trap their customers on late fee and other penalties.  So given this history by credit card corporations would it not make sense that insurance companies would follow suit and find states with poor or non existent regulation on health insurance to create policies that maybe cheap but when you needed it, failed to provide the necessary coverage or payment for services.  Buying health insurance across state lines is a dive to the bottom and is not a serious solution to healthcare reform, no matter how much the GOP states otherwise.  Holding the view that you can cover people with expensive chronic health condition and eliminate caps without adding the young and healthy to the system is true cognitive dissociation on the part of the GOP.

Tuesday, January 18, 2011

Strange start to the New Year and Healthcare reform

During this past fall insurance open enrollment period, my wife and I were informed by her employer that I would not be eligible to be covered as a spouse under their health plan. This they say was caused by me being eligible for insurance coverage from my former employer. This was in fact true, that as a person living with hemophilia, HIV and for a peiod of time HCV, I did pay for healthcare coverage in the past from my wife's employer, Medicare and my past employer. As a person living with several now chronic illness (if you can afford them) it was better to be over insured then under and I would often offer a quip that "I was insurance poor" when presenting my insurance cards at the doctors office or other medical facilities. Over the course of the past thirty one years I have maintained eligible for the various insurance policies because of fear of reaching the lifetime caps on one policy or better copay options. At the time I went on long term disability, my employer's policy was considered secondary to Medicare. Because my wife's employer has always employeed more then 100 workers their policy was considered primary to Medicare. And so it has been for the past eighteen years until now. This ineligibility to be covered as a spouse after 31 years of marriage has started a strange chain reaction which just took another unforeseen turn.

Now that I was left with just Medicare and my former employer's medigap policy it was necessary for me to evaluate the plan and my options. I looked at my former employer prescription drug plan and found that they would pay 55% of the cost, leaving 45% of the cost to me to pay up to $5,000 at which time they will pay 100%. I was told, I could opt for Medicare part D and that this would be considered my drug plan. I spent several days researching the Medicare website and entering my current list of prescription drugs and found a plan that offered savings over the $5k plus premiums that my former employeer's policy offered. So I opted into the Medicare part D plan only. Since I needed to fill a prescription several weeks ago just after the new year I called the part D plan company and was given the new insurance information over the phone and executed the transaction at my local pharmacy for my HIV drugs. Today I get a suprise in the mail from my former employer that states that because I have opted for a Medicare part D plan to save a little bit of money on my prescription drugs that this action also causes them to drop my major medical coverage from them and that I will not be able to reenroll until the next open enrollment or some other defined live change event (divorce, marriage, birth, etc.) of the policy.

Nowhere in any of the materials provided either on-line or by mail was it stated that my prescription drug plan option would effect the major medical (Medigap) insurance until the letter today which was dated 31 December 2010. So now I am forced exploring if there is a resind date on the execution of my opting for a part D plan or not. It seems strange to me that after healthcare reform that I would have less options to pay for myself then before and I believe the companies involved are misreading or at the very least misinterpreting the healthcare reform law by taking these various positions while waiting for more clarity on the law from federal agencies. Some wiil take away from this tale that this is example of what happens when government gets invovled with reforming healthcare in the country. I would oppose any such point of view being drawn from this current tale of woe because I know full well the fear that one lives under when they have a chronic condition and cannot obtain or retain health insurance coverage from an employer or the open market. And the ecomonic impact that not being flexible in career choices has on one working and living with a chronic condition.

At the very least this strange chain of events should be a cautionary tale to others who may not be as engaged as I have been, to be careful in this period of flux in healthcare reform and try not to be surpised as I have been to these unforeseen consequences.