Time Again

It seems that I am down to writing one blog a year in this space. It's"Heart Awareness" Month. I just read last years post again and it's pretty good in making the case for long term care. If you are reading this, please read that one again. I suprise myself sometimes, though I've yet to take my own advice and take the plunge into obtaining a policy. This year was particularly tough medically. I never really saw past the forest for the trees or something. The Hepatitis C, that I have failed to beat all these years, finally manifested in my being diagnosed with stage 4 liver cirrohsis. I was thrown into a downward spiral vortex with many specialists painting bleak scenarios. I even got advice to get on a liver transplant list. Thru tenacity, love from my partner Catherine, friends and family, AND some luck, it appears that I have achieved the best outcome I could ask at this point. I was able to get into a stage three trial for new Hep C drugs at the Texas Liver Institute in San Antonio Texas. I have been traveling back and forth for over a year. The care has been stunning and the results profound. I will always be indebted to everyone there for walking me thru every aspect of the treatment for which I am still in follow-ups. Within 2 weeks of beginning treatment I was completely virus free and I have maintained that for the past 9 months. It is believed that in 98% of the cases with this result you are likely cured. This will allow my liver to regenerate itself a bit and for me to have dodged a certain bullet. I was able to achieve the result for a couple of specific reasons. I had the means to travel, seek out several opinions, had magnificent physician friends who advocated on my behalf and many loving caring people around me to hold my hand. I'll give myself some credit as well because I alone know what I had to sacrifice, but the point here is that many people with the same diagnosis could not have done the same and would be in a very precarious position. I make the case again for the Affordable Care Act. But what does this all have to do with Heart Awareness Month? Along the way of this year in treatment, I developed heart arythmias. In light of my heart history it was a bit scary not being able to climb steps or exercise as I had been doing for years. This brought back many of the old fears of becoming a heart invalid. I needed to live with it until I could stop the medication regime to make sure the drugs were out of my system as it may have been a reaction to one of the meds I was taking. At that point, my cardiologist who had been tracking me the entire time performed a cardio-conversion and shocked my heart back into it's normal rhythm. It has held and I am back to my routine. The year has changed me again. Gave me deeper perspective into the world and people around me and a greater appreciation of those I love. I had immediately begun a diet regime when I was diagnosed with the advanced cirrhosis and will always maintain it as it benefits overall health. I don't expect health challenges to diminsih at this point in life, but I see that the work of healing pays results. Maybe this year I'll get longterm care. I might be around for awhile.

Heart Awareness Month 2013 and Future Plans

                                        Heart Awareness Month 2013 and Future Plans

I am in the process of reviewing Long Term Health Care for myself. A number of small seemingly insignificant events have intersected and I expect to make a decision soon as to whether to take a policy.  Heart Awareness month reminds me that, as a heart patient, I always have in the back of my mind the thought that someday my health may be diminished and I will need help at home or in an assisted living facility. All of this I am prone to unrealistically deny in the recesses of my psyche. I claim to my friends that when I am at that stage I want to be put down. Out of my misery and the inconvenience I will cause those still around me. I am not making the case for physician assisted suicide here (which I support) as it is a more serious subject and not to be treated frivolously. Rather the thought of living a far diminished lifestyle is difficult for us all to imagine and apparently no amount of exercise, diet, preventive medical regimen will be able to keep the creeping fingers of older age away from our ankles. So how do we prepare? Or do we shoot from the hip when the crisis begin? I’ve been down that road and, as a survivor, have weathered the storms and come out the other side, but is there an easier way? Probably. I just wish it didn’t seem like I was being sold a used car by the broker, prodded with the 7% increase for LTC that kicks in on my next birthday and warnings that California will soon be one of the last States to implement a premium increase with my carrier.

As an un-married man in a loving long term relationship who can’t visualize his partner having to move him, change his diaper, cook and whatever else will be needed to maintain a life, a childish immature voice squeals in my head. "Blah, Feh. Not for me."

But the last words of the insurance broker as he walked out my door are what remain. “Let’s age with grace, dignity and common sense. “ That seems reasonable and doable with a little forethought, discipline and sacrifice. If you don’t make plans to care for yourself, who will?

People Do Die Waiting

                                                             People Do Die Waiting

This is the argument I’ve been making since I heard Mitt Romney make the comment that “ We don't have people that become ill, who die in their apartment because they don't have insurance" I think most of us know older Americans with lille or no health insurance, who live sheltered lives and are slowly dieing for lack of better care. It's an important reality for our aging society to address and for any society morally. Paul Krugman makes the argument better than I and at sometime in the future when people come to this blog they may just see the note “see Krugman” With time running down until the election that will decide the direction we take as a country here is: Mitt Romney doesn’t see dead people.

Death By Ideology, by Paul Krugman, Commentary, NY Times: Mitt Romney doesn’t see dead people. But that’s only because he doesn’t want to see them; if he did, he’d have to acknowledge the ugly reality of what will happen if he and Paul Ryan get their way on health care.

Last week,... Mr. Romney declared that nobody in America dies because he or she is uninsured: “We don’t have people that become ill, who die in their apartment because they don’t have insurance.” This followed on an earlier remark by Mr. Romney — echoing an infamous statement by none other than George W. Bush — in which he insisted that emergency rooms provide essential health care to the uninsured.

These are remarkable statements. ... Even the idea that everyone gets urgent care when needed from emergency rooms is false. Yes, hospitals are required ... to treat people in dire need, whether or not they can pay. But ... you will be billed, and ... fear of huge bills can deter the uninsured from visiting the emergency room even when they should. And sometimes they die as a result.

More important, going to the emergency room ... is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among uninsured Americans — a trip to the emergency room can all too easily come too late to save a life.

So the reality, to which Mr. Romney is somehow blind, is that ... lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths... But that’s not a fact Mr. Romney wants to admit, because he and his running mate want to repeal Obamacare and slash funding for Medicaid — actions that would take insurance away from some 45 million nonelderly Americans, causing thousands of people to suffer premature death. And their longer-term plans to convert Medicare into Vouchercare would deprive many seniors of adequate coverage,... leading to still more unnecessary mortality. ...

So let’s be brutally honest here. ... Mr. Romney and Mr. Ryan are proposing trillions of dollars in tax cuts for the wealthy. So a literal description of their plan is that they want to expose many Americans to financial insecurity, and let some of them die, so that a handful of already wealthy people can have a higher after-tax income.

It’s not a pretty picture — and you can see why Mr. Romney chooses not to see it.

Hope Again

This week the campaign season for President has taken off with the completion of the GOP convention. Next week we will see President Obama's response and hopefully hear hear his plan for the future in specifics, so that a debate can commence on which the direction the country will move and what values it will embody. 

In watching the GOP convention this week I was not surprised to find Paul Ryan and Mitt Romney embrace their families. I am certain they love them very much and want only the best for them. I am less certain of their concern for our families and it begins with their avoidance of the truth and the facts. 

"The truth will never hurt you" is something I believe. Sometimes truths are difficult to unearth. It's often simpler with facts. Hopefully in the months ahead more light will be brought to bear on the issues facing the country and an intelligent choice will be made for our leaders. It's our duty to our family and country to become informed.

OP-ED COLUMNIST

The Medicare Killers

By PAUL KRUGMAN

Published: August 30, 2012 533 Comments

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Paul Ryan’s speech Wednesday night may have accomplished one good thing: It finally may have dispelled the myth that he is a Serious, Honest Conservative. Indeed, Mr. Ryan’s brazen dishonesty left even his critics breathless.

Fred R. Conrad/The New York Times

Paul Krugman

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Blog: The Conscience of a Liberal

Related

• Times Topic: Paul Ryan

• Ryan Speech to Focus on the Economy, With Shots at Obama(August 30, 2012)

• Rousing G.O.P., Ryan Faults ‘Missing’ Leadership (August 30, 2012)

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Some of his fibs were trivial but telling, like his suggestion that President Obama is responsible for a closed auto plant in his hometown, even though the plant closed before Mr. Obama took office. Others were infuriating, like his sanctimonious declaration that “the truest measure of any society is how it treats those who cannot defend or care for themselves.” This from a man proposing savage cuts in Medicaid, which would cause tens of millions of vulnerable Americans to lose health coverage.

And Mr. Ryan — who has proposed $4.3 trillion in tax cuts over the next decade, versus only about $1.7 trillion in specific spending cuts — is still posing as a deficit hawk.

But Mr. Ryan’s big lie — and, yes, it deserves that designation — was his claim that “a Romney-Ryan administration will protect and strengthen Medicare.” Actually, it would kill the program.

Before I get there, let me just mention that Mr. Ryan has now gone all-in on the party line that the president’s plan to trim Medicare expenses by around $700 billion over the next decade — savings achieved by paying less to insurance companies and hospitals, not by reducing benefits — is a terrible, terrible thing. Yet, just a few days ago, Mr. Ryan was still touting his own budget plan, which included those very same savings.

But back to the big lie. The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem.

Moreover, the vouchers almost certainly would be inadequate; their value would be set by a formula taking no account of likely increases in health care costs.

Why would anyone think that this was a good idea? The G.O.P. platform says that it “will empower millions of seniors to control their personal health care decisions.” Indeed. Because those of us too young for Medicare just feel so personally empowered, you know, when dealing with insurance companies.

Still, wouldn’t private insurers reduce costs through the magic of the marketplace? No. All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs.

I know this flies in the face of free-market dogma, but it’s just a fact. You can see this fact in the history of Medicare Advantage, which is run through private insurers and has consistently had higher costs than traditional Medicare. You can see it from comparisons between Medicaid and private insurance: Medicaid costs much less. And you can see it in international comparisons: The United States has the most privatized health system in the advanced world and, by far, the highest health costs.

So Vouchercare would mean higher costs and lower benefits for seniors. Over time, the Republican plan wouldn’t just end Medicare as we know it, it would kill the thing Medicare is supposed to provide: universal access to essential care. Seniors who couldn’t afford to top up their vouchers with a lot of additional money would just be out of luck.

Still, the G.O.P. promises to maintain Medicare as we know it for those currently over 55. Should everyone born before 1957 feel safe? Again, no.

For one thing, repeal of Obamacare would cause older Americans to lose a number of significant benefits that the law provides, including the way it closes the “doughnut hole” in drug coverage and the way it protects early retirees.

Beyond that, the promise of unchanged benefits for Americans of a certain age just isn’t credible. Think about the political dynamics that would arise once someone born in 1956 still received full Medicare while someone born in 1959 couldn’t afford decent coverage. Do you really think that would be a stable situation? For sure, it would unleash political warfare between the cohorts — and the odds are high that older cohorts would soon find their alleged guarantees snatched away.

The question now is whether voters will understand what’s really going on (which depends to a large extent on whether the news media do their jobs). Mr. Ryan and his party are betting that they can bluster their way through this, pretending that they are the real defenders of Medicare even as they work to kill it. Will they get away with it?

A version of this op-ed appeared in print on August 31

There is Hope

A few weeks ago the Supreme Court of the United States (SCOTUS) took its first vote on the constitutionality of the Affordable Health Care Act. It's momentous in that the final decision will immediately effect the lives of 30-40 million Americans, their families, tax payers and countless others working in the health care industry. It is the beginning of a decision that will become a touchstone for the well-being of generations to come.

I recently read a quote from Horace Mann in an interview of Kirk Douglas when he was asked what still motivated the octogenarian artist and activist. " Be ashamed to die before you do something for humanity". The message resonated with me because I have found my greatest satisfaction is in giving to others. The coming elections are an opportunity to do something for humanity and it is incumbent upon us to be actively involved in the process. For many the elections hold little result or consequence upon the daily experience of their lives. The have jobs, families, healthcare, homes and savings. Sure they may be taxed more or less and see their social benefits increased or decreased, but by and large they have the opportunity to educate & provide for their families and live secure lives. For others, the decisions that will be made in voting booths next fall can become matters of life and death. Not being able to obtain healthcare, even preventative healthcare that could lead to early detection of catastrophic illness or obtain student loans to prepare for upward employment.

Dr. Richard Carmona, the former Surgeon General of the United States, is running for U.S. Senator in Arizona, a state very much in the news for a variety of issues. Dr. Carmona is committed to preserving Social Security and Medicare and stand up for what's right for the American people. It is men like Rich Carmona that are woven into the fabric of America throughout history. Men from humble beginnings that have achieved much with the opportunities they were given and look for the chance to give back and preserve the values that have made America great.

I'm encouraged by his entry into the political fray, as I am by Kirk Douglas still trying to do something for humanity after having given so much throughout his career. Men entering the last acts of their lives with hope for us all. There is hope if we choose to participate and act.

Heart Awareness Month 2012

February is Heart Awareness Month and next week is Valentine's Day. It's the first time I've put the two events together in my mind. So it's timely in this month to not only check out our heart health from a medical perspective, but to go deeper and look at the personal, spiritual and romantic relationships we have and how they are possibly affecting our heart health and well being.

As I reflect on the dozen years since my open heart surgery and convalescence, I am keenly aware of the role my loving, heart relationships played in my healing on every level. The care and unconditional support I was given by my late wife Valerie in the months preceding, during and after my surgery gave me the life connection that propelled my resurgence. The need to regroup to be there for her in her time of need as she battled lung cancer was a natural impulse that gave me the gift found in giving and completed our life together. Then the new, strong and mature love I fortunately found with Catherine, for what is coming up to be 10 years in March, helped me to emotionally heal and re-discover the world of living. She is a blessing and partner who I felt was sent to me from the moment I first looked in her eyes. Of course all relationships require attention and perhaps "work" but love is love is love. I believe in that intangible feeling of warmth, security and strength that centers in my chest when I look at her and know that nothing is as important to me as her well being and happiness. I love her and am healthier for it.

It's been known for a long time that heart health is closely linked to romantic love, family security and happiness. Stress in personal relationships is a contributor to illness. Dr. Mimi Guarneri says this far better in her anecdotal book "The Heart Speaks", which not only demonstrates the complex and enormous power the heart has to heal, but also it's medical vulnerability to loneliness and emotional pain. I recommend the read.

This Heart Awareness Month give yourself a Valentine and love-up the one's you love.

Valerie 2011

Valerie 2011

My wife Valerie died ten years ago this summer. I have been spending the quiet moments between my work remembering her. This summer is no different than any other. I think of her all the time. It’s momentous that a decade has passed since she left. Her bright hazel eyes and endless smile leap forth. Her laugh and passionate tears hum in the trees. Her super human strength and goodness inspire my work. She left a hole in my heart that can’t be filled and yet I go on connected to her eternally, forever.

Valerie died from Mesothelioma. She fought hard to overcome the disease. The grace she displayed during a struggle that explored all curative options was profound to witness. In her honor, I have committed to undertaking the professional and personal challenge of fulfilling my potential even at this later stage of life. I follow the prayer I say for her when I ask for the elevation of her soul and the ability to fulfill her wishes, strengthen her legacy and take guidance from her life and spirit. As she told me in her last months, “Make the most of each day, love up the ones you love and put other people first. I think I’ve done a pretty good job." I am trying.

So now I turn the page, celebrating Valerie, who made such a big difference to so many lives and to mine.

Remember. Remember and hold on tight. You will be challenged and distracted and the appeals of your lower self will arise, but extinguish those desires with the flush of love and hope. Never give up. Never give in. Do the best you can because it’s good and believe in what you know and what you’ve lived. It was and is real and true. Guard and pursue truth. It is the blood of relationships and in the end these are what matter. S’aggapo Aggapimu. I love you my love.

Dr. Jack Kevorkian died 10 years to the day after Valerie. There’s a synchronistic irony that they should be linked. As weird a personality as he was, I know she would have liked to have met him at the end of her life. It’s funny what you choose to remember or not remember about someone you love who is gone. I’m choosing to remember it all. The last nine days of Valerie’s life when she chose not to eat because she knew she was only feeding the tumors that were causing her so much pain and killing her slowly. She “Wanted out now!” Kervorkian could have helped. This was not a hypothetical case. This was my wife,who I would have given my own life for to free her of pain or misery. I supported her decisions then as I support those of individuals and families who make them now.

“As a result of his advocacy for the right of the terminally ill to choose how they die, hospice care has boomed in the United States and physicians have become more sympathetic to their pain and more willing to prescribe medications to relieve it “

Kervorkian was seen by a world trying to make sense of how best to care for loved one’s at the end of their life. Valerie was seen by those closest to her as she bravely chose to end her life. We witnessed her grace, dignity and strength and we will always remember her joy and love. Always ready for everything life had to offer. She wanted it all.