Tag: health care

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Living in Society Social Commentary

Living with the Coronavirus

Lettuce in the greenhouse.

Estimates of how long the coronavirus pandemic will last vary from a couple of weeks to several months. The best guess is we’ll have a better idea once the number of contagious incidents reaches its peak.

Two and a half months after the virus emerged in China the government is beginning to lift the draconian measures implemented in its wake. Public health officials there remain vigilant for a second or third wave of the disease. The pandemic is not over.

In the U.S. we continue to be on the upward slope of the curve, and in our county the case count ticks upward with no indication we have peaked. News media explain we are a week to ten days behind Italy as the viral course continues to develop.

A friend in town displayed symptoms and was tested. He waits for the test results at home in self-quarantine and shut down public access to his place of business for two weeks. The pandemic is pretty close to home and we are just getting started.

The continued shortage of testing obfuscates the path of the vector. If we were testing more, one believes there would be more reported cases. We aren’t so we don’t know.

Given the expectation of a several month pandemic it’s hard to decide what to do about work at the home, farm and auto supply store. They are okay with people taking off work for any illness, but at some point they will need me to show up. They don’t seem aware of the idea that employees might be infected by going to work. They’ve had no discussion about closing the retail store and for the time being, I want to keep the job. I’ll probably go in today after calling off yesterday, and try to maintain a distance from co-workers and customers. We’ll see how that goes.

I don’t know if the coronavirus will be personally life-changing. My outlook is we can avoid infection, although I’m not sure how I came to that conclusion. It’s likely positive thinking of which the coronavirus is unaware. During my sick day yesterday I considered whether this pandemic would precipitate changes that are coming in my life anyway: leaving the regular job, staying home more, and conserving our income. As it runs its course I’ll consider that more. For now we’re sustaining our lives in a pandemic-stricken world and doing our best to survive and thrive.

Categories
Living in Society Social Commentary

Watering Hole

Bar and Grill Parking Lot, March 13, 2020.

By last Friday traffic in bars, coffee shops and restaurants had slowed considerably. It was hard to determine whether it was because of the coronavirus, spring break at the university, or something else.

It made being a guest at the establishments a positive experience with little perceived danger of the virus being transmitted.

Our county now has the highest number of confirmed cases of COVID-19 in the state, 14 of 18 as of this morning. The high number is attributable to a local bank trip to Egypt where returning travelers were exposed to the coronavirus and contracted COVID-19.

The parking lot was packed at a bar and grill on Friday afternoon. From the look of things, it was a popular watering hole for trades workers. When my friend and I entered, every man was seated on a stool around the U-shaped bar drinking beverages, looking at their mobile devices, and talking with neighbors. The bartender was the only woman present. The rest of the bar was empty.

We ordered drafts of Bud Light so as to fit in and chose a table away from the bar.

What speech I made with a friend was not my normal one. The one I know by rote and by heart. The theme that never changes, come what may, “Radix malorum est cupiditas.”

It’s not that the worn phrase has no currency. Many are the emails from political candidates who say we must overturn Citizen’s United, then, in direct order, request a donation. The old saw still cuts wood. This prologue has never been in abeyance or irrelevant despite the waxing and waning of political candidates and their ilk. What’s hard is to listen.

What did I hear? Murmuration among the tradesmen making sense of their lives in a pandemic they hardly acknowledged. Individuals all. Resolute. Of strict father figure families no doubt. Gathered together around the bar in between a career that requires a pickup truck and a home that remained unseen that afternoon.

When we finished our beers and left, most were still present and would be until either the happy hour ended or home beckoned. It was hard to discern, but I suspect the watering hole was the best part of many of their days. So it was for mine.

Categories
Living in Society Social Commentary

Modernity of Social Distancing

Los Agaves Mexican Grill, Iowa City, Iowa at lunch time on Friday, March 13, 2020.

When it comes to “social distancing” Iowans know what to do. We tweak our normal behavior. Many of us are not socially close by nature so it’s not a big step.

Epidemiologists are using the term “social distancing” to refer to a conscious effort to reduce close contact between people and hopefully slow community transmission and spread of the coronavirus.

A grade school friend and I met in the county seat on Friday. His nonagenarian mother lives in an assisted care facility which was quarantined after he arrived in Iowa to visit her. He spoke to her on the phone, but couldn’t pay an in-person visit.

It was a tweak.

More tweaks are coming.

Last night Governor Kim Reynolds’ office issued a press release which said, “The Iowa Department of Public Health has determined, based on the new COVID-19 case and the announcement this evening of community spread in Omaha, Neb., there is now community spread in our state.”

The release continued to explain:

Community spread occurs when individuals have been infected with the virus in an area and cannot specifically identify the source of the infection, or do not know how or where they became infected.

Due to the detection of community spread, there are new recommendations for individuals with underlying conditions, and all Iowans should be prepared for cancellations and disruptions in routine activities.

Mitigation measures should be implemented immediately to have the most significant impact on slowing the spread of the virus.
Leaders of institutions and organizers of events should begin to act on their contingency plans related to large gatherings, including church services. Iowans should not hold or attend large gatherings of more than 250 people, and consider making adjustments for smaller gatherings with high risk groups.

It appears the governor is following Centers for Disease Control and Prevention guidelines which include monitoring the progress of community spread and under certain conditions, making recommendations for social behavior. For now, school can continue, but not church where there are large congregations.

There is a political aspect to the coronavirus pandemic and it appears our state is taking reasonable actions if the federal government is lacking in its response. Regular communication and compliance with CDC guidelines should reflect positively on Reynold’s handling of the global pandemic’s mitigation in Iowa. As a former six-year member of our county board of health I don’t see a benefit to criticizing the governor as the state works to understand the progress of the disease and take appropriate action.

For our small family, it doesn’t take much to be socially distant. Yesterday I decided not to attend a legislative forum 10 miles from our home. I went to town to mail a package. On the way home I stopped at the pharmacy to see if I could buy a bottle of 90 percent isopropyl alcohol. They we sold out of all alcohol and sanitizing items. We’ll make do with what we have. Today I’ll go to the farm for our weekly seeding session.

A late winter snow fell, covering everything except the driveway and roads, which were too warm in this meteorological spring. For a day it was still winter by the calendar and by the weather.

There is never a problem staying busy at home. I completed the U.S. Census on my mobile device after reading in social media our state senator did his. It took ten minutes even after I had to re-do it. Between reading, writing, cooking, laundry, and preparing for planting, there was plenty to do. I put some bird seed out on the front door landing but they hadn’t found it by sunrise this morning.

While we were isolated, it didn’t feel that way. Iowans are used to working in isolation and with modern communications it is easy to stay in contact with friends and neighbors.

The news about the coronavirus from Europe, the Middle East and China is pretty startling. We really don’t know how many people are infected, although public health officials seem to be tracking the number of deaths.

Estimates of the impact of the 1918 influenza pandemic range widely yet are relevant. Global population was between 1.8 and 1.9 billion people at the time. The estimated number of deaths ranges between 17 and 50 million, maybe more. In the United States, the death rate was between 0.48 to 0.64 percent of the population or toward 650,000 deaths at the high end.

If we use the lower number in the range (0.48 percent) to determine how many deaths the 1918 pandemic would cause in the 2020 U.S. population, it would be more than 15.8 million. We are nowhere near that and likely to see only a fraction of that number with coronavirus. There is a modernity today that didn’t exist in 1918, with advanced public health and research organizations, better communications, and a resulting ability to coordinate between government and non-governmental agencies.

The phenomenon of social distancing looks to create a positive result. People will die of Covid-19 and the loss will hurt families. It will hurt us all. At the local level, we do our best to understand the pandemic and live our lives accordingly. We not freaking out. We are learning.

We’re sustaining our lives in a turbulent world that’s becoming infected by coronavirus. This may not be the last pandemic in my lifetime, so I hope we learn from it.

Categories
Living in Society Social Commentary

Influenza, Viruses and Sickness in the Land

Vegetarian Soup Stock

On Monday I went to the Urgent Care clinic for a persistent cold.

After a thorough examination, and many questions about the trajectory of symptoms, doctor leaned against the counter in the small examination room and pronounced, “it’s viral.” It could persist for another two weeks, she said.

I’ve run the course of Benzonate she prescribed for the cough. It is getting better. She wrote a second prescription for Amoxicillin and said hold it to see how things progressed. Later this morning, I’ll get it filled. I’m on the mend, but not well.

At least 43 Iowans died from influenza and viruses this season. Because of the delay in autopsy results, the actual number is likely higher.

At the home, farm and auto supply store employees have symptoms similar to mine. The store manager distributed a couple dozen aerosol cans of Lysol so we would keep everything sprayed down and hopefully disinfected. I don’t know if I gave the virus to others, or they gave it to me, but the whole workforce is coping. We are a sick land this January.

Today is the first time I’ve been able to concentrate on anything, and there is a backlog of post ideas and work delayed. Yet, I’m still here, sustaining our lives in a turbulent world.

Categories
Living in Society

Letter to Iowa Senators on Graham Cassidy

I do not support Graham Cassidy and hope you will ask your senate colleagues to gather more information about the impact of the bill on Iowa populations before scheduling a vote. More specifically,

1. CBO score: Delay holding a vote on the measure until the CBO scores the bill and the public has a chance to evaluate it.

2. Impact on veterans: Elimination of Medicaid, as the bill is said to do over time, would have a disproportionate negative impact on veterans. Many military veterans I know fall within the federal poverty guidelines and it would be wrong to leave them behind by eliminating Medicaid.

3. Impact on Nursing Home Residents: It seems cruel to kick nursing home residents off Medicaid. Like most people, our family is working to live on our own for as long as possible. That’s not possible for people with limited means as their health deteriorates toward the end of life. Ending Medicaid would disproportionately impact seniors who rely upon it. It would be just plain mean and not reflective of who Americans are as a society.

4. Essential Health Benefits: Insurance is by design intended to help all policy holders pay for the medical needs of every policy holder. Changing the basic framework of who is covered and at what cost requires more sunlight than it has gotten thus far. I oppose altering essential health benefits established in 2009 without agreement between all parties involved, including insurance companies, medical personnel, hospitals and clinics, and importantly, members of the general public.

Thanks for reading my message. Good luck in your deliberations over Graham Cassidy.

Regards, Paul

~ Submitted electronically to U.S. Senators Chuck Grassley and Joni Ernst on Tuesday, Sept. 19, 2017

Senator Chuck Grassley’s response:

September 20, 2017

Dear Mr. Deaton,

Thank you for taking the time to contact me. As your Senator it is important for me to hear from you.

I appreciate hearing your thoughts about legislation proposed to replace the Affordable Care Act(ACA), or Obamacare. Obamacare has failed to deliver. While the ACA promised affordable care, Iowans saw their premium payments, copayments, and deductibles steadily rise significantly. While promised to keep plans if they liked them, Iowans lost their plans when Obamacare was enacted. Because of Obamacare’s failures, 72,000 Iowans currently don’t know if they will be able to purchase health insurance for 2018.

I support having the Senate consider the Cassidy/Graham bill. We need alternatives to Obamacare, which hasn’t worked, and that reality has been acknowledged across the political spectrum. Health insurance is much too expensive for too many Iowans. I like that the bill addresses one of the fundamental flaws of Obamacare. It returns power to individuals and states. It’s not perfect, but the bill recognizes that each state has different needs that each state is best equipped to decide how to meet. There’s also a phase-in period and the opportunity to make changes in the future. Keeping Obamacare as is will cause people to go without insurance either because Obamacare has collapsed in a state or face coverage that no one can afford to use.

You can be sure I will carefully consider any legislation that comes before the Senate, and will continue to support access to health insurance for Iowans going forward in my role as senator.

Thank you again for contacting me. Please keep in touch.
Sincerely,

Chuck Grassley

Senator Joni K. Ernst’s Response:

September 21, 2017

Dear Mr. Deaton,

Thank you for taking the time to contact me about the Senate’s ongoing work on health care reform. It is important for me to receive direct input from folks in Iowa on policy matters such as this, especially when they affect people on such a personal level.

As you know, the U.S. Senate considered various legislative ideas regarding health care the week of July 24th. Throughout the debate, I shared how the Affordable Care Act (ACA) is failing in Iowa, with choices dwindling and costs rising. Premiums have increased in Iowa up to 110% since the health care law went into effect. With Medica remaining as the only health insurance provider selling individual market plans in every county statewide for 2018, folks in the state’s individual market will endure another massive rate increase. The reality in our state is that continuing with the status quo is no longer an option.

On September 13, 2017, Senators Bill Cassidy (R-LA), Lindsay Graham (R-SC), Dean Heller (R-NV), and Ron Johnson (R-WI) introduced health care reform legislation, known as the Graham-Cassidy-Heller-Johnson proposal. If enacted, this proposal would give states flexibility to innovate and design their individual markets tailored to the specific needs of their state.

This proposal would also reform the Medicaid program to a per capita allotment for its traditional patient population. As you may know, the federal government’s auditor has identified Medicaid as a high-risk program for more than a decade due to its size and growth. Therefore, it is important that we look at reforms, but also focus our Medicaid dollars on the most vulnerable in our society – the elderly, children, and individuals with disabilities.

To learn more about this proposal, Senator’s Cassidy website has more information here.

Further, Chairman Orrin Hatch (R-UT) announced that the Senate Committee on Finance will hold a hearing on Monday, September 25th to discuss the Graham-Cassidy-Heller-Johnson proposal. While I am not a member of the Finance Committee, I will be closely monitoring the committee’s work and look forward to receiving its analysis of this proposal.

Throughout the Senate’s work on health care reform, I have emphasized how we must pursue solutions that enhance competition, increase flexibility, and constrain rising costs. The ACA is unsustainable in Iowa, and it’s critical that we work together to address the evolving needs of our health care system, and ensure folks have a voice in their own health care decisions – and not Washington deciding what is needed in a health care plan.

At this time, I am carefully reviewing the Graham-Cassidy-Heller-Johnson proposal to see how it could affect insurance availability and affordability, as well as provide folks access to health care coverage. It’s imperative I hear personally from Iowans, such as yourself, on their unique experiences in accessing health care, so that we can secure the affordable, patient-centered solutions our state critically needs. I appreciate your feedback at this time, and look forward to hearing from you further as the Senate continues to work on health care reform.

Sincerely,
Joni K. Ernst

Categories
Home Life

Retirement Milestone

Embers
Embers

Today is my first day on Medicare. It’s no time for rejoicing.

This category of mandatory spending by the federal government garners renewed attention with each new congress. With Republicans having majorities in the House of Representative and Senate, it will continue to be under attack from conservatives and wing nuts. There is little comfort having made it to the next milestone on the road to full retirement.

As with any health insurance, one hopes never to have to use it.

Categories
Work Life

Late Fall Near the Lake

The Carter Family
The Carter Family

The good news about finishing three full weeks at the home, farm and auto supply store is the company offers health insurance that meets the Internal Revenue Service “minimum value standard” for less money than coverage available through the government’s health insurance marketplace or elsewhere.

The bad news is all of the pay from this full-time job will fund health care insurance, co-pays and deductibles for our family if we seek any care. If we don’t need health care once the coverage goes into effect Feb. 1 that will leave us roughly $150 take home pay per week. We’ll need more than that to pay the rest of our expenses.

Ada Blenkhorn and J. Howard Entwistle wrote the song “Keep on the Sunny Side” in 1899:

There’s a dark and a troubled side of life;
There’s a bright and a sunny side, too;
Tho’ we meet with the darkness and strife,
The sunny side we also may view.

Most people know the version Mother Maybelle Carter sang on the 1972 record album Will the Circle Be Unbroken produced by William E. McEuan. I favor the original A.P. Carter version which hearkens back to our family roots in Southwestern Virginia. Dig deep enough and you’ll find we’re shirt tail relatives on the Addington side, which is Mother Maybelle’s maiden name.

Not only may we view the sunny side, keeping there will be the only thing that gives us hope. This first job sets a foundation upon which to build the rest of my worklife.

What else?

In the works are spring at the Community Supported Agriculture project, summer editing at Blog for Iowa, and fall weekends at the apple orchard. These were all discussed during my interview with the home, farm and auto supply company, so getting time off shouldn’t be a problem.

Seed CataloguesThe most excitement I felt in a while was finding the Seed Savers Exchange 2016 seed catalog in the mailbox yesterday.

Someone gave me a packet of their scarlet kale seeds last year and it was a great addition to the garden. Too bad all of my customers are used to getting kale for free, or it could be a source of some income.

It is conceivable I could generate a thousand or so dollars from the garden this year by expanding the planting area and selling excess. Circumstances may have me doing that.

It is a reasonably warm fall day near the lake — a time for hope and getting lost in seed catalogs.

Categories
Living in Society Social Commentary

Filling the Tank

Sunrise
Sunrise

I looked at a live image of the inside of my large intestine on the monitor. It originated from a camera in the tip of a a colonoscope being operated by the physician who performed my first colonoscopy 11 or 12 years ago. It is a humbling and fascinating experience. No polyps, so I’m good for another ten years.

Medical practitioners recommend a colonoscopy for people aged 50 and older as a screening for colorectal cancer, the third most common cancer diagnosed in both men and women in the U.S. With the changes initiated by the Patient Protection and Affordable Care Act, insurance companies are required to provide the procedure without any charge, co-pays or incidental expenses.

The worst part of the procedure is clearing the bowels the day prior to the office visit. As the anesthesia wore off, we were ready for a meal and stopped at Salt Fork Kitchen for breakfast on our way home.

Check that off this year’s to-do list. Now the work begins anew.

I called into the warehouse and got a shift for Saturday. Three days off in a row would have been too much, and we can use the income. I’m also writing three stories for the newspaper and contemplating what else can be done to generate income to pay bills and reduce our debt.

Caesura came between the weary past and tomorrow’s promise with the colonoscopy.

When I get to the warehouse, I’d better fill the tank because we’re not off fossil fuels yet and my Subaru has a few miles left in it before heading to a scrap heap.

Once again, a new day dawns.

Categories
Living in Society Social Commentary

Blogging the ACA

Garden Planning
Garden Planning

When I had my first colonoscopy there was no President Obama, no Patient Protection and Affordable Care Act, I hadn’t begun blogging, and I was on my employer’s health insurance plan.

The company I worked for would have liked nothing better than to present a cash payment to employees in lieu of paying their 65 percent share of health insurance. However, people they asked wouldn’t go for it.

My second procedure is scheduled Friday and I’m curious to see how it will be paid for by the health insurance plan purchased through the ACA marketplace for some $14,400 annually.

The ACA requires health insurance providers to cover recommended preventive services without any patient cost-sharing such as co-pays and deductibles. A colonoscopy is one of these services.

Information is seeping out through administrative cracks in the health care system. It began with a voicemail from the doctor’s office. My insurance company wouldn’t pay for the sodium sulfate, potassium sulfate and magnesium sulfate solution called a “bowel prep kit.” The kit came with two 6-ounce bottles of the solution and a handy plastic measuring cup. I asked our local pharmacist if I could buy it directly as I remembered it was inexpensive. With a $10 off manufacturer’s coupon it would have been $110, making it worth the trip to the clinic in the county seat to pick up a physician’s sample of the brew.

What I am finding in my limited personal health care is the ACA is peeling off add-on procedures that used to be covered by health insurance. No add-ons to physicals, colonoscopies, and other preventive procedures, at least in my experience.

I don’t know, but the change has to have affected gross margin for these businesses and reduced the cost of health care. Whether savings will be passed on in terms of premium reductions remains to be seen, but I doubt it.

While I didn’t receive a bill for my last physical examination, the hospital sent me a bill for lab tests, which I paid. We’ll see if there are any more cracks in the system after my procedure. If there are, I’ll be posting again.

Categories
Home Life

No Winter January

My Cookbook
My Cookbook

We had a brief, light snowfall this month, and that’s it. With four days left in January, it seems unlikely winter as we know it will come.

We have had the scenic vistas, frozen lakes and automobile crashes associated with Iowa winter, but the temperatures have been nowhere near cold enough to kill off pests we want dead come spring.

I’m not an entomologist, however, it’s a problem if bugs over-winter.

On the other hand, even with warmer temperatures, most of life at home is indoors. Drawing down the pantry, preparing to file taxes, reading, writing, budgeting and planning take up much of the desk time. It’s okay, but not as much fun as it may seem.

It is time for the Patient Protection and Affordable Care Act to enter the tax filing scene. Businesses utilizing part time workers in their operations are expected to have a reckoning with the Internal Revenue Service. Depending on what time period is audited, businesses with part time employees with more than 780 hours in six months, or 1,560 hours in 12 months, will be required to pay full benefits. My 2014 totals for the job where this is relevant were 694/1,249, so my employer is in the clear.

This has been a complaint about the ACA It is said to limit how much money part time no benefits people can earn and make it more expensive for employers to add employees. IMHO, those are bad arguments against the law. If the government had provided Medicare for all instead of the ACA, the financial burden would have been much less for everyone.

As it is, the cost of health insurance premiums went up post ACA. I’m not sure this was caused by the law, or by insurance companies using it as an excuse to improve margins.

From a cost standpoint, the ACA made health insurance less expensive only in the framework of what certain lower income people pay for health insurance. There were more dollars, just shifted around with government subsidizing many newly insured people.

What matters more about the ACA is how employers manage their business.Employee costs are always a concern and a key part of any business model. Let’s face it. Small and mid-sized businesses would like to get away with all employees being independent contractors without benefits from the company. The problem is the wages paid are comparable to what used to be offered in the form of wages plus benefits, only without the benefits or the amount of money it takes to provide them.

I’ve heard I will have a reckoning with the IRS in the form of a question on my tax return about health insurance. For 2014, the answer is we had it.

As the sun rises it’s time to turn to other work. Working on newspaper articles, planting seeds and cooking will figure prominently as we work through January hoping winter actually comes.