Why getting sick in America is a really bad idea

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May_30_Health_Care_Rally_NP (641) (Photo credit: seiuhealthcare775nw)

One element of living in the United States sickens me to my core — the persistent inequality of access to affordable quality health care, something citizens of virtually every other developed nation take for granted.

Today the U.S. Supreme Court will hand down its decision on the constitutionality of what’s been called Obamacare, a mandate requiring all Americans to purchase health insurance. A CNN/ORC International poll released this month showed 43% of Americans favor the law, 37% think it too liberal, and 13% oppose it because it is not liberal enough.

I grew up in Canada, where health care, paid for through taxes, is offered cradle-to-grave by the government. Yes, it has some deficits, but everyone can see a doctor and go to the hospital without fear of medical bankruptcy, common here.

From this week’s New York Times:

When Wendy Parris shattered her ankle, the emergency room put it in an air cast and sent her on her way. Because she had no insurance, doctors did not operate to fix it. A mother of six, Ms. Parris hobbled around for four years, pained by the foot, becoming less mobile and gaining weight.

But in 2008, Oregon opened its Medicaid rolls to some working-age adults living in poverty, like Ms. Parris. Lacking the money to cover everyone, the state established a lottery, and Ms. Parris was one of the 89,824 residents who entered in the hope of winning insurance.

And this, on how confusing and frightening it can be to receive a fistful of enormous medical bills:

With so little pricing information available, expecting people to shop around for quality care at the lowest cost — something that’s not always possible in emergency situations — is also asking a lot of consumers. “I have always found a bit cruel the much-mouthed suggestion that patients should have ‘more skin in the game’ and ‘shop around for cost-effective health care’ in the health care market,” said Uwe E. Reinhardt, a health policy expert and professor at Princeton University, “when patients have so little information easily available on prices and quality to those things.”

President Obama’s Affordable Care Act, the health care overhaul law passed in 2010, tries to make some improvements (though the Supreme Court is expected to rule whether all or some of the law is constitutional this month). But while the law’s changes help you shop around for insurance policies — specifically through its new HealthCare.gov Web site, a one-stop shop that lists all of your insurance options in one place — it’s still unclear how effective the law will be for anyone comparing medical services.

On February 6, 2012, I had my arthritic left hip replaced. Thanks to my husband’s job, we have excellent insurance coverage, but I knew enough to do plenty of questioning, and negotiating, long before that gurney wheeled me into the OR to avoid nasty and costly surprises later. For example, I needed to make sure the surgeon would accept whatever fee my insurance company offered — decisions and prices I have no control over — but which would come bite me on the ass if I didn’t plan ahead.

I also had to make multiple calls to find out:

1) what the anesthesiologist would charge (about $3,800);

2) what my insurance would pay (about $1,000);

3) who would be on the hook for the difference. Me. (I told the billing manager I’d send my tax return to prove my income; $2,800 is a very big number for me.)

Jose, my husband, offered to look at the medical bills as they arrived, as they would only freak me out, not helpful post-surgery. The hospital — for a three-day stay, with no complications, charged $90,000. No, that’s not a typo.

Did they collect it? Probably not, but they routinely try for whatever they can get.

Then my surgeon billed $25,000. (Our insurance covered it all. Thank God.)

But…what if, like millions of Americans, I had no insurance?

Like my friend R, who is young, broke and lives without it. He recently slipped and fell on a wet sidewalk, needed an ambulance and needs physical therapy then surgery. Worst case, he’ll be paying off a huge bill for years, maybe a decade.

In my 24 years in the U.S. I’ve never lived one minute without health insurance; my mother has survived four kinds of cancer and I live an active and athletic life that also puts me at greater risk of injury. How ironic that being active, (fighting the great American scourge of obesity), can put you at risk of losing your shirt financially…

The cost of buying my own insurance, as a freelancer, left me with few additional funds for fun stuff like travel or nice clothes or shoes or replacing things in my home — air conditioner, dishwasher, computer — I needed and relied on. By 2003, it cost me $700 a month.

Health care is a right, not a privilege. We will all get sick or fall down or suffer a complicated labor or discover a tumor or suffer a heart attack. None of us is immune.

Many Americans cannot even purchase health insurance because they have — in that exquisite euphemism — a “pre-existing condition.” If you’re already sick, tough shit!


Life is a pre-existing condition. Americans, and their elected officials, must deal with this reality more effectively.

The Cost Of Staying Healthy — Or Alive

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There are times I read an article about the hideous, unfair mess of what Americans call their “health care system”and I thank God I do not have a weak heart as my pulse begins to race with fury.

This, from The New York Times business pages:

For example, Hillary St. Pierre, a 28-year-old former registered nurse who has Hodgkin’s lymphoma, had expected to reach her insurance plan’s $2 million limit this year. Under the new law, the cap was eliminated when the policy she gets through her husband’s employer was renewed this year.

Ms. St. Pierre, who has already come close once before to losing her coverage because she had reached the plan’s maximum, says she does not know what she will do if the cap is reinstated. “I will be forced to stop treatment or to alter my treatment,” Ms. St. Pierre, who lives in Charlestown, N.H., with her husband and son, said in an e-mail. “I will find a way to continue and survive, but who is going to pay?”

As judges and lawmakers debate the fate of the new health care law, patients like Ms. St. Pierre or Alex Ell, a 22-year-old with hemophilia who lives in Portland, Ore., fear losing one of the law’s key protections. Like Ms. St. Pierre, Mr. Ell expected to reach the limits of his coverage this year if the law had not passed. In 2010, the bill for the clotting factor medicine he needs was $800,000, and his policy has a $1.5 million cap. “It is a close call,” he said.

It is an obscenity, plain and simple in my view, that every American who pays taxes cannot rely on a seamless, safe, affordable way to stay healthy and, when they become ill, have access to excellent care. Because, you know, they’ve got that all figured out in virtually every other nation on earth.

I am acutely aware of what a sham this “system” is because I grew up in Canada and lived there until I was 30. And my friends and family remain there, using a health care system that is so profoundly different in every respect that it is hard to believe sometimes.

My mother, 76, had surgery yesterday in a major Canadian city hospital. Because her condition , while horrible and uncomfortable, was not life-threatening, she had to wait weeks for it. That was lousy for her and for me. But that is how Canada (and other nations) control their health-care costs.

But by the time she had the surgery, she had already been in the hospital since early November, attended to by a physical therapist, an occupational therapist and a variety of physicians.

There are no bills.

There will be no sudden, surprising charges we did not anticipate. We will not have to face medical bills of five or six figures, or bankruptcy because — like most people — we would not be able to pay them.

It is wearying in every possible way to deal with a relative who is ill with multiple conditions, some chronic. It is even more terrifying if that illness is potentially life-threatening.

But to have to worry about paying for it?

What else is there worth having in this life but our health?

What will it take for American politicians to find the most useful organ in the body politic, and physical — a heart?

Why I Talk To My Pharmacist More Than My Doctor(s)

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Turns out I’m part of a larger trend. Reports The New York Times:

“We are not just going to dispense your drugs,” said David Pope, a pharmacist at Barney’s. “We are going to partner with you to improve your health as well.”

At independent drugstores and some national chains like Walgreens and the Medicine Shoppe and even supermarkets like Kroger, pharmacists work with doctors and nurses to care for people with long-term illnesses.

They are being enlisted by some health insurers and large employers to address one of the fundamental problems in health care: as many as half of the nation’s patients do not take their medications as prescribed, costing nearly $300 billion a year in emergency room visits, hospital stays and other medical expenditures, by some estimates.

The pharmacists represent the front line of detecting prescription overlap or dangerous interaction between drugs and for recommending cheaper options to expensive medicines. This evolving use of pharmacists also holds promise as a buffer against an anticipated shortage of primary care doctors.

“We’re going to need to get creative,” said Dr. Andrew Halpert, senior medical director for Blue Shield of California, which has just begun a pilot program with pharmacists at Raley’s, a local grocery store chain, to help some diabetic patients in Northern California insured through the California Public Employees’ Retirement System.

Like other health plans, Blue Shield views pharmacists as having the education, expertise, free time and plain-spoken approach to talk to patients at length about what medicines they are taking and to keep close tabs on their well-being. The pharmacists “could do as well and better than a physician” for less money, Dr. Halpert said.

I have spent an inordinate amount of time this year at my local pharmacy, run by a veteran named Aqeel, a warm, plain-spoken guy with three daughters. His store is tiny, two aisles wide, and sits two storefronts away from a CVS, an enormous chain of drugstores. But since January, having to take a variety of serious medications for the first time to manage my osteoarthritis — from steroids to Fosamax — I don’t have the time, patience or interest in running back to my doctors every time I have another question about my health.

I first spoke to him a few years ago, when I asked which vitamins to use, and why. He actually sat me down on one of his folding chairs and explained how they work and would affect me. Some people don’t want that much explanation or want to take the time. I loved it. Someone who spoke to me like a fellow adult!

His friendly, open manner, combined with decades of experience, makes me feel safe asking him questions. When I took one drug recently (all of them new to me),  I felt so incredibly lousy — disoriented and highly anxious, this on a weekend — I went back to ask him about it. That side effect was indeed unpleasant, but not unusual, he reassured me.

He’s one of three local merchants in my town I interviewed for my new book about working in retail, “Malled: My Unintentional Career in Retail” (Portfolio, April 14, 2011.)

Patients live a weird existence. Away from the few, hurried minutes with our busy physicians, some of whom are brusque and intimidating, we wander about in a fog of confusion. Yes, I read the accompanying literature so know what side effects to expect. But I didn’t know that, (hopefully) on the second dose of Fosamax, for example, a drug meant to build bone, I might not feel so dopey and tired.

Do you have a pharmacist you like and trust?

Why You Need Backup When Talking To Doctors

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It’s been a fun year so far for me: X-rays, MRIs, steroids, a cane, even a walker. My left hip is a mess, and a surgeon wants me to replace it, now.

While I have been resisting, the bone has gotten damaged, so next month (right after vacation) I’ll start a drug to repair it, putting me on crutches for three months. No more softball this season.

There have been many days I feel overwhelmed by it all. I need backup.

The sweetie has — as anyone living with, and caring for, someone with chronic illness or injury knows — put up with a lot. I walk like a drunken sailor and awaken many nights at 3:00 a.m. with pain. So he decided to take my health into his hands and, while I’m a continent away on vacation visiting family and friends, called my doc, a man often ferocious and intimidating.

But my guy is, too when necessary; we have a meeting for all three of us in two weeks.

The sweetie wondered if he’d overstepped his bounds. I was surprised the doctor spoke to him, but I am relieved and grateful as hell that I now have backup, someone else in the room while the multi-syllabic words pour forth.

When you’re sick or injured and in pain and scared, it’s damn hard to hear clearly and remember everything. I got the news about the latest hip  issue while standing alone in the baggage claim area of Vancouver airport. I was shocked, overwhelmed, tried not to cry in public. (When I learned that my Mom [now fine] needed neurosurgery for a brain tumor, I was standing in an Ohio field with 3,000 shooters behind me in competition. Bad news shows up everywhere.)

This week, it was my turn — as my Mom’s only child, albeit living on the opposite side of North America and in another country — to advocate for her. We went to see her internist so I could find out what she’s doing for my Mom (or not.)

My Mom lives in Canada, and it’s a different game; doctors are busy and some tests and procedures harder to get or get quickly. You can’t push Canadian doctors as hard as Americans because there’s no profit motive driving them to behave better, or avoid a lawsuit.

It was an interesting meeting — it could not have lasted more than 15 minutes. It was tough to cover that much territory so quickly. It went as well as one could hope, but there’s much left to do and to follow up.

Have you acted as someone’s medical advocate? Or had one?

Did it help?

Be Thrifty – Or Else

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Being cheap is the new black, writes Daniel Akst in the Wilson Quarterly (you have to pay for on-line access), quoted in The New York Times:

To be thrifty, after all, is to save, and to save is not only to keep but to rescue. Thrift is thus a way to redeem yourself not just from the unsexy bondage of indebtedness but also from subjugation to people and efforts that are meaningless to you, or worse. Debt means staying in a pointless job, failing to support needy people or worthwhile causes, accepting the strings that come with dependence, and gritting your teeth when your boss asks you to do something unethical (instead of saying “drop dead”). Ultimately, thrift delivers not just freedom but salvation — which makes it a bargain even Jack Benny could love.

Margaret Wente, writing in The Globe and Mail, wonders how anyone — save the fortunate few with defined-benefit pensions — will actually survive retirement without a pile ‘o cash:

Because of imprudence, misfortune, a vast shift in cultural habits, or the sheer financial drain of supporting their kids until age 28, they are facing their old age with no savings, no pension and few assets. I have no idea what they’re going to do. All I know is that there are plenty of them. For the first time since we introduced old age pensions, millions of people who’ve led comfortable, middle-class lives are facing a big drop in their standard of living when they stop working. No more salmon teriyaki for them.

“A large chunk of the baby-boom generation is on the verge of retirement with only the state to depend on for a retirement period that will be, on average, the longest in Canadian history,” writes consultant Robin Sears in the magazine Policy Options. “We were pension pioneers. But we’ve lost our way.”

Whose fault is it that we don’t save like Grandma did? Is it ours, for crashing our savings rate below zero, and not being disciplined enough to resist the siren call of easy debt that’s been relentlessly marketed to us for a generation? Whose fault is it that we’re living longer than anybody has before, and screwing up the actuarial tables? Whose fault is it that the vast majority of us fail to save at least 10 per cent of our earnings starting at the age of 30, the way we’re supposed to? What about the single mom who’s put her kid through university, or the highly creative guy who is stupidly hopeless with his money, or the manager who got laid off at 57 and has to dip into his savings, or the millions of conscientious people who pay shocking fees to the investment industry to mismanage their RRSPs? Should we blame them, too?

You can see the problem here. Saving up for your old age is an individual responsibility. But helping you do it is a social one.

It would be nice if we could be more like the Chinese, who save 40 per cent of their money. That’s because they know they might starve or die from lack of health care if they don’t. The danger is that we’ll wind up like the Japanese, who suffered a huge economic hit in the ’70s and ’80s. Millions of retired folks were forced back into employment to support themselves. Former doctors took jobs as parking-lot attendants.

As someone self-employed, it’s not an issue I take lightly.

It’s a big pile of ifs: If my partner and I stay together, married or not, I’ll be OK, if his pension is still there; if Social Security pays out to us both what our statements tells us it will; if we keep saving 15% -plus percent of our incomes every single year; if our carefully chosen and diversified investments don’t tank; if , when we finally tap our accumulated capital, interest rates aren’t where they are now — a smack-in-the-face 1-2 percent on safe, secure holdings like CDs.

Now there’s a fair recompense for all that thrift!

If we bust up, it’s Friskies and a cardboard box for me! If I still own my home, and the mortgage is paid off, and if I can afford the monthly co-op maintenance fee, my only possible salvation from penury will be a reverse mortgage. Because my writing income isn’t nearly where I want it to be, and I can’t see suddenly doubling or tripling it for the next decade consistently, (believe me, I’m trying), my projected SS income wouldn’t get me through a month right now. There’s a comfy thought.

The old three-legged stool: SS, pension and savings is missing a leg — the pension — for most of us now. The second leg, savings, is a perpetual challenge when gas is $3/gallon and wages are stagnant or, in my industry falling to 1970s rates. Hey, change careers! Assume $10,000 to $75,000+ in student loan debt and cross your fingers that shiny new job market is all perky and welcoming when you graduate, competing with people willing and able to work at half the wages because they’ve still got five decades to save.

If they do save.

I recently interviewed, for my book, a single 51-year-old with a Master’s degree and $40,000 of student debt. Canned from her non-profit job a few years ago, she makes — wait for it — $7.25 an hour working retail. She couldn’t possibly save a dime and lives thanks to hand-outs from her 82-year-old mother. Her life is not quite what she planned.

One friend, 16 years my junior, is scrambling harder and harder and harder, like a hamster on a speeding wheel, to earn what she needs. Like us, she and her partner don’t even have kids. They are stylish and fun, but live very frugally.

Our “old age” is now.

Over 200 women race across the Moroccan desert, no GPS or cellphones allowed

Here’s my kind of driving — a nine-day off-road race across the Moroccan desert.

You can follow them live through this link.

The Rallye Aicha des Gazelles (oh, I want that T-shirt) is  a 20-year-old event that draws women from across the world, reports Caroline Kinneberg in The New York Times. The race ends March 27th:

It is for women only, speed is not the point and no prizes are awarded.

Last Wednesday, 104 teams that had paid up to 14,350 euros (about $19,500) to register embarked on the roughly 2,500-kilometer trek (about 1,550 miles) from Nejjakh to Foum-Zguid. The competitive part of the rally, which includes parts of the High Atlas mountains and the Sahara, ends Thursday…

The competitors aim to reach the five to seven daily checkpoints, marked by red flags in the sandy landscape, while covering the shortest distance. The teams of two — traveling in four-wheel-drive vehicles and trucks, as well as crossovers, motorbikes and all-terrain vehicles — have only maps from the 1950s and compasses to guide them. Global positioning systems and cellphones are prohibited.

As the field has grown, it has become more international, with 18 countries — including Germany, Congo and Cambodia — now represented.Competitors have included a top European model, college students and a 65-year-old grandmother. Annick Denoncin of France is participating for the 14th time.

But about 70 percent of the competitors are first-timers who come for the adventure and challenge.

Anyone game to join me for next year?

Reports Fourwheeler.com:

Off-road ‘Ironwoman’ and Baja 1000 team driver Emily Miller and World Extreme Skiing Champion and U.S. Ski Team Olympian Wendy Fisher have an unlikely common denominator: The 2009 19th Rallye Aicha des Gazelles, the nine-day, all women’s off-road race in Morocco.

Miller, 42, a team driver for Rod Hall Racing, was trained by the off-road racing legend and has had multiple podium finishes as driver and navigator, in addition to being the only female to “ironman” the longest off-road race in North America. But why did the off-road truck racer decide to team up with an icon in the sport of big-mountain freeskiing?

The rally zips across Morocco, an enchanting French- and Arabic-speaking country in North Africa inhabited by friendly people, peculiar tree-climbing goats, and a spectacular desert landscape-a true wheeler’s paradise. Highlighting the arid region are enormous sand dunes; circular 3- to 8-foot tall sand traps (which Miller described as “sand cauldrons”); and unusual, rock-like mounds that resemble harmless giant broccoli crowns. Called “cauliflower plants,” these innocent-appearing obstacles are capable of seriously damaging a vehicle’s undercarriage.

However, there are no race ‘pace notes’ to warn about upcoming hazards. And participants must plot their latitude and longitudinal waypoints using Arabic and French maps dating from the 1950s and 1960s (Miller said they looked more like drawings than maps) using mathematical formulas and “dead reckoning”-the process of deducing the next location by using the course, speed, time, and distance from the last position.
GPS units were not allowed, although car-mounted compasses were; Miller and Fisher were relegated to a hand-held compass, as their vehicle didn’t have an installed unit. This made for many problems with interference due to the vehicle’s sheetmetal and electrical system. Fisher ended up working off of 26 maps, each with about nine quadrants per map that had to be measured.

The event also gives back to the people of Morocco, thanks to a medical caravan. From their website:

But access to medical care is still difficult for rural populations, where there is only 1 doctor per 3,700 people

The people living in these villages are more than 100 kilometres from the nearest clinic or hospital. In addition, a medical consultation and treatment can cost more than 15 days of salary.

Heart of Gazelles, in partnership with the Moroccan Ministry for Solidarity, the Family and Social Development, decided to address an important public health issue by going to the remote regions of southern Morocco.

Since 2001, thanks to the solidarity sponsorship of TOTAL Energy Group and the infrastructure of the Rallye Aïcha des Gazelles, Heart of Gazelles has been organising an annual Medical Caravan, a traveling clinic composed of 8 doctors, 4 nurses, 2 pharmacists, 1 optician and 6 “logistics” personnel.
This centre covers general medicine, paediatrics, gynaecology, optometry and pharmacy.

In 2009:

4,582 people received free medical care

Fat Luck? The Obese Have Very Little Of It

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Interesting essay this week in The New York Times about how and when the seriously overweight feel others’ contempt:

As a woman whose height and weight put me in the obese category on the body-mass-index chart, I cringed when Michelle Obama recently spoke of putting her daughters on a diet. While I’m sure the first lady’s intentions are good, I’m also sure that her comments about childhood obesity will add yet another layer to the stigma of being overweight in America.

Last August, Dr. Delos M. Cosgrove, a cardiac surgeon and chief executive of the prestigious Cleveland Clinic, told a columnist for The New York Times that if he could get away with it legally, he would refuse to hire anyone who is obese. He probably could get away with it, actually, because no federal legislation protects the civil rights of fat workers, and only one state, Michigan, bans discrimination on the basis of weight.

Dr. Cosgrove may be unusually blunt, but he is far from alone. Public attitudes about fat have never been more judgmental; stigmatizing fat people has become not just acceptable but, in some circles, de rigueur. I’ve sat in meetings with colleagues who wouldn’t dream of disparaging anyone’s color, sex, economic status or general attractiveness, yet feel free to comment witheringly on a person’s weight.

The writer, Harriet Brown, teaches magazine journalism at the Newhouse School in Seattle. She also found that doctors…!?…hate fatties:

Some of the most blatant fat discrimination comes from medical professionals. Rebecca Puhl, a clinical psychologist and director of research at the Rudd Center for Food Policy and Obesity at Yale, has been studying the stigma of obesity for more than a decade. More than half of the 620 primary care doctors questioned for one study described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.” (This last is significant, because doctors who think patients won’t follow their instructions treat and prescribe for them differently.)

Dr. Puhl said she was especially disturbed at how openly the doctors expressed their biases. “If I was trying to study gender or racial bias, I couldn’t use the assessment tools I’m using, because people wouldn’t be truthful,” she said. “They’d want to be more politically correct.”

Despite the abundance of research showing that most people are unable to make significant long-term changes in their weight, it’s clear that doctors tend to view obesity as a matter of personal responsibility. Perhaps they see shame and stigma as a health care strategy.

I need to lose weight. My GP wants me to lose so much weight I might as well cut off a leg or two to get started.

I want to lose weight, too — and for the past three months have been fighting excruciating hip and back pain. You can’t exercise when you’re in agony! One of the toughest issues when trying to lose weight is being told — over and over and over — by your family, your doctors and every single women’s magazine featuring anorexic 15-year-old models — what to do, what you must do, what is the smart, healthy choice.

You can be overweight and still have a functioning brain! We’re not deaf, you know.

Telling someone what to do is very different from helping them achieve a challenging goal. We live in a finger-wagging culture, where every self-righteous size 4 feels totally fine telling the rest of us if you just….be like moi!…we’d be fine. Going into stores to buy something pretty, even willing to spend some serious coin, and being told, oh no, we sell nothing larger than a 12 is another smack in the head. Larger sizes? Only on the website, blubber-butt!

I still make money, Ann Taylor, French Connection, J. Crew…

I often feel so totally overwhelmed by my competing responsibilities — and I don’t even have all the additional, relentless and time-consuming demands of kids and/or pets and/or a commute and/or a parent with Alzheimer’s — that going to the damn gym or taking my hour-long 4-mile walk falls right off the list after: earn money (in this recession, freelance, no small challenge), manage whatever money I’ve earned, saved and invested meticulously, get out and drum up more paid work to make sure that next month’s bills are paid, finish my book, work on the next book idea, take care of my partner and our home.

And, oh yeah, take care of my body, spirit and mind.

It is easy to feel hopeless and fed up. It is hard(er) work to do what needs to be done.

Taxes, More Taxes and Even More Taxes — Are You Angry, Too?

Paper money, extreme macro
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I recently got some official mail from New York State, demanding I fill out the paperwork for a new commuter tax. Time for another tax!

Excuse me?

I commute, as one of the nation’s self-employed — now about one-third of American workers — from my bedroom to my living room desk. It takes about 15 seconds, tops. I will be heading into Manhattan, 25 miles south of me, visible from my street, Monday to interview someone for my book, because face to face interviews are always the best.

I do not commute into the city, but go in about once a week for business or pleasure or both. I should be taxed for this?

Why do I need to pay another (*^%#@!! tax?

I get why people are furious, and why a man torched his house and flew his plane into an IRS building in Austin. His actions were insane, but his rage was not. His sense of impotence is deeply and widely felt.

There are six people lined up for any job open right now. Thousands of Americans are losing their homes to foreclosure, living in their vehicles, terrified of the next hammer blow of an economy — and a government — rewarding Wall Street with billions while the rest of us stand there feeling like morons for doing the right thing, paying our taxes over and over and over to governments that give us very little back. Two wars. Bank bailouts. Job creation that doesn’t touch us or anyone, anywhere, we know.

When you work for yourself, paying taxes feels deeply, viscerally personal. That money doesn’t neatly and invisibly evaporate from your paychecks, with maybe a fat refund awaiting you. As if!

We’re expected to pay our taxes quarterly, in anticipation of the rest of the year’s income — as if we know, in this recession, what that will be — in docile agreement. We get zero help when our clients disappear, (I lost one third of my income last year when The New York Times shut down a regional section I wrote for every month), when banks refuse to extend us credit to run the businesses we have spent years building, when credit card companies game the system by jacking up their rates before new laws restrict them from further rapacity.

I know I am not alone right now in this crap economy, scrapping harder than ever for my income, in feeling like a punch-drunk fighter on the ropes, looking through puffy, bloodied eyes for my cut-man. In vain.

I interviewed a 44-year-old local businessman yesterday who runs a store his great-great grandfather founded in 1904. “I’ve never ever ever seen it this bad,” he said. He is surviving, and gracious about it. But, increasingly, I bet others will not be.

The self-employed also pay 15% for the pleasure of not having a boss, or insured earnings (no unemployment checks for us — no matter how badly the economy tanks) or benefits, no paid sick days or holidays or vacations. That’s our money going into FICA, paying full freight for our Social Security.

Every time I write a check to the Federal Treasury, I want to enclose a note: Don’t waste it! Stop two absurd wars! Pass a health care bill!

I grew up in Canada, where taxes are high but the finest and most competitive college in the nation, my alma mater the University of Toronto, charges about $5,000 a year tuition right now. No, that is not missing a zero. Where every single resident of ever single province has access to excellent, free health care, cradle to grave.

Canadians are taxed up the wazoo, even paying tax on stamps. But you see, every single day, where that money goes and its benefits.

I understand the fury and the frustration. I feel it. Millions of us do.

This Is Obscene

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How about an overnight 39 percent rise in your rent? Car payments?

No, just your health insurance:

Senator Dianne Feinstein, Democrat of California, sharply criticized Anthem Blue Cross of California on Tuesday over its plans to raise health insurance premiums by as much as 39 percent, and she said that the move provided a vivid example of why major health care legislation is needed.

“It is unconscionable that Anthem Blue Cross would consider increasing health insurance premiums for Californians by as much as 39 percent, especially at a time when so many people are experiencing economic hardship,” Ms. Feinstein said in a statement. “I can think of no better example of why we need health insurance reform, and this kind of behavior is a stark reminder of why any reform plan should establish a rate authority to keep insurance rates affordable.”

Full New York Times story here.

From Truthout:

In a statement Monday, Anthem Blue Cross said the planned rate hike was due to the “weak economy” and called on lawmakers to “go back to the beginning and get health care reform done right.”

“… As medical costs increase across our member population, premium increases to the entire membership pool result. Unfortunately, in the weak economy many people who do not have health conditions are foregoing buying insurance. This leaves fewer people, often with significantly greater medical needs, in the insured pool. We regret the impact this has on our members. It highlights, why we need sustainable health care reform to manage the steadily rising costs of hospitals, drugs and doctors.”

So people are really sick and desperate will pay more for their health insurance — with, of course, a concomitant 39 percent increase in their paychecks or maybe a 39 percent rate reduction from their car insurance or rent — and the rest of the poor suckers who can’t even afford to buy insurance anymore will simply go without.

Women In The Military Finally Get Access To Plan B

Seal of the United States Department of Defense
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Women in the military now have the same option as their civilian sisters — ready access to Plan B, the birth control method that can be used after unprotected intercourse.

Women’s health advocates had long been pushing the Obama administration to allow the sale of the morning-after pill at military facilities. The same panel made a similar recommendation in 2002, but the policy was never implemented.

“It’s a tragedy that women in uniform have been denied such basic health care,” said Nancy Keenan of NARAL Pro-Choice America, which estimated that the decision would affect more than 350,000 women in the military. “We applaud the medical experts for standing up for military women.”

The morning-after pills consist of higher doses of a hormone found in many standard birth-control pills. Taken within 72 hours of unprotected sex, it has been shown to be highly effective at preventing pregnancy.

Any woman who is raped needs access to Plan B. Reported The New York Times:

Jessica Kenyon was raped twice during her one year career in the US Army, once in basic training and once in Korea. She is now a counselor (http://www.militarysexualtrauma.org) for other veterans who have been raped—women and men. Jessica’s rapists were never prosecuted.

Suzanne Swift was raped repeatedly by her squad leader while they were in Iraq. She was court-martialed for refusing to go back to Iraq with the unit in which the rapist still served. The rapist was never prosecuted, returned to Iraq as a private security contractor and later fired from a position with a law enforcement agency in the Seattle area. Suzanne is now out of the military and in college.

Stephanie (last name not disclosed), was raped at Fort Lewis, Washington. Like the majority of women who have been raped in the military, she never reported it as she thought no one would believe her as the rapist was a senior officer. Stephanie and her husband both served in Iraq. Her husband committed suicide after his return from Iraq. Stephanie speaks frequently on the issue of military suicides. [more]

a. Please click here to download the United States General Accountability Office on the Military’s handling of sexual assaults.
b. Please download the Pentagon’s 2006 report on gender relations that says that more than three quarters of sexual assault victims in the military do not report the abuse.

When rape and sexual assault is sufficiently widespread within the military that the Department of Defense has created special programs to deal with it, this decision is overdue.

The issue of access to Plan B isn’t new, as this Stars and Stripes piece makes clear.

It’s appalling enough that women serving their country face assault within their own ranks, but without a ready solution to a possible unwanted pregnancy, like Plan B, they have been left doubly vulnerable.