Friday, October 9, 2009

To Life

My siblings and I had the honor of having our parents in our lives for a very, very long time. They truly were always there for us, and in particular, for my two sons, who always knew a life with their grandparents around. My parents revered education, vowing that we all would go to college, which neither of them ever did but we all were privileged to complete. They were loving, supportive, and completely family oriented. The memories of family trips and gatherings and celebrations burn quite vividly, infused with laughter and smiles and love.

But now they are both gone. My dad died in 2005, less than two months before his 93rd birthday, and thankfully, his time in the hospital was brief and his passing peaceful. I wish my mom had had the same. But her recent time in the hospital, following complications of surgery, stretched for weeks, accompanied by a bevy of procedures to help with infections and more. In the end, the infections and age proved too much even for a fighter like my mom. She passed away September 20, three weeks before her 93rd birthday.

They did not go too soon, for which I am thankful, but their being gone leaves a hole that echoes with sadness. Parents are "supposed" to go first, and so we prepare ourselves for that, but none of us can really be prepared for the finality of their leaving. Since my mom was alive when my dad died, the circle was not closed, the generation above was still here. But now that my mom has passed, there is a layer to our lives that is gone as well.

I am grateful that the love always stays.

Tuesday, August 25, 2009

Still Waiting

When last we left the Arizona legislature, negotiations were in full bloom. The majority party wanted numerous tax cuts -- a measure supported by the Governor but one that would cause a shrinking pool of revenue to shrivel further -- and the Governor wanted a temporary sales tax hike sent to the ballot. However, too few Senate Republicans were willing to forgo their "no tax increase" pledge to give voters the option to vote it in or not. The Democrats were treated as superfluous since the goal stated by the majority leadership was that this would be a "Republican-only budget." In the end, the Republicans could not muster the votes to present the Governor with everything on her wish list.

What she got was the same lump of coal of a set of bills she had vetoed July 1. At that time she called them "fatally flawed" and "devastating" to education and more. Lately, her rhetoric has been more toned down as she attempts to get a budget she will approve.

So what's different this time (since it's not the budget)? In the past few days, the negotiating table grew with the addition of the leaders of the minority party. Minority leaders managed to get invites to this dance and presented ideas that they have been talking about for months via web sites and public forums statewide. Furthermore, the Governor is more actively participating in the talks. At this point, the parties know what each wants to bring the votes of their caucus members into the yes column.

But what about those budget bills that were finally transmitted to the Governor? She signed one last week (to ensure that federal stimulus funds going to the Department of Environmental Quality would not be lost) and did nothing with the rest. Had she continued to do nothing through Wednesday, August 26, they would have become law without her signature. However, both chambers ended the latest special session on Tuesday, August 25 -- giving her 10 more days to deal with the bills.

What this maneuver really did was acknowledge the possibility that the current bipartisan talks may produce a balanced budget that a majority of House and Senate members -- irregardless of political persuasion -- will support along with Governor. And then, perhaps, the rest of the state can stop waiting to exhale and know how much money will be expended to educate students, support seniors, pay state personnel, and more. Even when we have to do it all with less.

Sunday, August 16, 2009

Life -- and Death -- Matters

Lost among the lies about government "death panels" -- beyond the fact no bills contained any such thing and no one advocated any such thing -- seems to be the point that many people truly want to be able to openly discuss their thoughts about what they want to happen when their quality of life wanes or the quality of their thought processes grows suspect. They want to remain in control of the decision-making process, providing directives to those they entrust with their care when the time comes.

So the thought was to include the possibility of payment to have that discussion with one's doctor. Some people -- including those who formerly showed support for such an idea with their votes -- resorted to demagoguery against such a provision. And it appears others are now backing off from including such a provision in reform bills.

Why is it suddenly a bad thing to have more information? That seems to be the argument most often used when politicians want to tighten restrictions on abortion and add waiting periods and parental consent and the such. But when it comes to end-of-life issues when people do need to know what "heroic efforts" might mean -- and cost -- or what the consequences of having a "do not resuscitate" order are, apparently that is a meeting of far less importance and undeserving of underwriting according to these folks.

Doctors take an oath to "do no harm" and that includes not subjecting an individual to mounting medical care when the hope for survival is slim and a person has indicated he or she wants no part of it. But first they have to know what the patient wants. It's too bad that payment for such a discussion has become one more victim of politics and appears to have a DNR attached to it. Here's hoping someone puts this provision on life support so that more people can have the ability to have that discussion. Sometimes it is a matter of life and death.

Thursday, August 6, 2009

Resetting the Clock

My previous post outlined Arizona's budget situation, where more than a month into a new fiscal year we stand with no final budget and no actual idea when we will have one. The Senate was set to meet August 4, which it did, when it would hopefully vote on the budget, which it did not.

Instead, the Senate met for a few minutes, after which members of each party went into caucus. The Republicans found themselves with unexpected business on their hands, as the majority whip had resigned her post that morning. Being one of the holdouts on the budget, she felt she was not serving leadership well because it would be difficult for her to round up votes for a budget she did not support. While she is not a legislator with whom I share much common ground, I appreciate her honesty and clarity in this decision.

When the resignation became public, it was accompanied by reports that another senator wanted the job. However, this senator also was a non-wavering "no" vote on the budget. He felt he could round up votes. Given his opposition to the package, one wonders what votes he was expecting to corral.

So did a new majority whip emerge? A freshman senator from northern Arizona temporarily holds the position. His ability to round up votes remains to be tested -- with senators out of town, there will be no votes taken this week.

Come Monday, August 10, the Senate faces more than an increasingly angry state populace -- they are up against what appears to be the final deadline to get a sales tax increase referred to the ballot for the November 3 election. The Secretary of State has moved this deadline a few times but this appears to be the actual drop-dead date for printing and distribution of informational pamphlets and ballots. It's also been reported to be the final deadline to get pro/con statements into the informational pamphlet, but perhaps the deadline gods could smile a little on those who would like to argue for or against the temporary tax hike and give them the same kind of grace period as the Senate.

This evening -- August 6 -- an agenda item for my school board meeting was to approve our district budget. This is not the first time we have done that this year -- by statute, we must approve it before July 15 -- and the legislature has guaranteed it won't be the last. In the past, this has been a multi-step process, but not the dance marathon we are currently caught in.

In the five years I have served on this board and voted to approve budgets, we have never missed meeting the deadlines set by the Legislature. Wish we could say the same for them.

Monday, August 3, 2009

Tick, Tick, Tick....

My favorite page in my high school yearbook is a comic book "cover" with some of us from the yearbook staff working while the storyline for the "issue" reads"25 People in a Battle to the Death with 'THE DEADLINE'" next to a picture of the Grim Reaper.

I actually thrive on deadlines. As a writer, a ticking clock keeps me focused and helps me hone my words. Even after all these years, I find the tighter the deadline, the better the copy.

Not everyone works that way. Take the Arizona Legislature. After convening in mid-January, legislators had a deadline to have a budget in place by June 30. In the Senate, bills were filed but not heard as President Bob Burns kept the budget front and center.

So what happened? Did we have a budget early, say April (as has often happened)? No. May? No. Early June? Try a budget that appealed to the most conservative members of the Legislature that passed in both chambers in the wee hours of June 30. It really was July 1, but Sen. Burns literally turned the clocks off and locked the doors, so time stopped for the Senate.

Did Arizona get a budget? No, because most of the bills were promptly vetoed by Governor Jan Brewer. They contained cuts she did not want and did not refer a sales tax increase to the ballot, which she had requested. So despite the fact that the majority party in both chambers plus the executive branch are all Republicans, the unity of party registration did not produce a budget for Arizona.

A few days later, the Republicans let the Democrats join the talks and some progress was made, with the Governor signing bills to keep some critical areas running. However, holes remained and a full budget was still needed. Leaders from both parties worked together and close to the end of July, they were about $500 million apart but still talking.

Then the talks stopped and the Dems were frozen out when the Republican legislators decided to work out a deal with the Governor. She would get her sales tax referral, but in exchange she agreed to tax cuts for corporations and higher income earners and much reduced funding for education, children, health services, seniors, and more -- funding she had pledged to protect in far larger amounts. And even though the sales tax referral would go through, the revenues realized from it would no longer be dedicated to education.

According to the longest-serving legislator in Arizona, this was the worst deal he had ever seen. So is this the deal Arizona got? Well, not yet. While it eked out of the House, it has not been voted upon in the Senate. They wanted to do this with just Republican votes, and the simple majority of 16 votes weren't there. Out of 18 Republican Senators, two balked at referring the sales tax and a third will only vote to refer the sales tax and nothing else. A fourth appears to be a possible holdout on some bills as well. That's where the situation stood when the Senate adjourned last week.

They reconvene on August 4 and the word is there may not be enough Republican votes present to pass this budget. If so, where does that leave Arizona? No budget, a deeper and deeper hole of decreasing revenues, and a citizenry tired of what feels like a really bad version of Groundhog Day playing over and over again.

We elect public officials to serve the public. We expect them to do so in a professional manner, and that means hitting their deadlines, especially in this, the most important task they have. If the votes aren't there, this budget wasn't meant to be. There has to be one that is. Work together to create it, pass it, and sign it. The clock is ticking.

Saturday, July 25, 2009

Just the Facts, Ma'am

My husband and I have a company that creates medical communications and programming for health care professionals and consumers. We understand many of the intricacies of medicine and the tests and treatments people face -- why, for example, one type of echocardiogram is better than another depending on what is being imaged or which agents impact what sections of the coagulation cascade. With the knowledge and experience we have accumulated, we have been mistaken for doctors, but neither of us has medical degrees and we are not hanging out shingles any time soon.

I also have served on the board of directors for a benefits trust, and in that position spent considerable time reviewing various employee health insurance plans. Although I know far more about health insurance now than before I joined that board, I am by no means an expert on health insurance or health care.

So why do so many folks on radio and television think they are? They are hardly specialists when it comes to most subjects, but when they open their mouths, they expect everyone to accept what they say as fact. That holds true for the current discussions on health care reform.

Not long ago, my husband received the following e-mail message from a friend, who happens to be the publisher of several medical, pharmaceutical, and biomedical publications in Canada. He gave us permission to present his comments, which I am doing so unedited:
I caught a moron named Glenn Beck on the radio. No doubt you've seen him on TV. Horrible piece of sewage. What does it say about the broadcasting industry that they put a defective like this on public display? Anyway, he's explaining to a caller how healthcare works in Canada: "They have a lottery, and if you win the lottery, you get to have medical treatment."

You could write a book about the problems in healthcare here and, fool that I am, I did. But the GOP and its flunkies are offering LSD-fueled fantasies about how a single-payer system operates. Last night I caught Lynn Cheney (!) telling Larry King that you can't choose your own doctor in Canada. The ignorance, the deception, the insistence that poor people need to die from their illnesses, and the middle-class need to be impoverished when they get sick: what manner of monsters are these Republicans?
While I don't believe every Republican or every Democrat or every political partisan is a monster or saint or what-have-you, Mitch makes a very valid point about what category people fall into when they choose to outright lie to scare people into believing something that isn't true. To pretend you have to somehow come up with a golden ticket to get your GI tract checked if you live in a country like Canada has no basis in reality. Neither does the myth of no choice being perpetuated.

And the same goes for the scores of other lies being tossed about to persuade people that reform is evil, that reform is a shortcut to no care and certain death, and that reform will result in everyone losing employer-provided insurance.

Enough. Get the facts. They are available. Just don't go looking to people whose "facts" are fiction and are presenting wholly biased views masquerading as expertise. They are barely one step up from the snake oil salesmen of the past, whose elixirs were surefire cures for everything that ailed you but more likely made you sick. That's what they would like you to think single-payer systems or universal care or public options would do. You owe it to yourself to get a second opinion -- from an expert.

Wednesday, July 22, 2009

Healthy Discussions

Reform (v): make changes for improvement in order to remove abuse and injustices

One of the reasons juvenile correction institutions were originally called "reform schools" stems from the definition above: these facilities existed to protect youths from abuse in adult prisons. The offenders needed to be separated from other kids but placed in a setting that would be rehabilitative, with the goal that they would reform their behavior for the better.

Break reform down and you get re-form, an opportunity to form again. While policies and programs are not Play-Doh and shouldn't be tossed into a new format every time someone grows bored with them, they possess the pliability that allows them to improve. And the passage of time, the excitement of discovery, the changing needs of a group require that policies and programs re-shape, re-vitalize, re-form.

Reform is one of the hot button words of the moment, primarily due to the current push to reform health care. This shortcut term contains some inaccuracies: it is not care that is being reformed so much as access to and cost of health care that could be altered. Changes to care should come from medical professionals. The current overhaul is coming to us courtesy of political professionals -- politicians, lobbyists, and the like.

Does that doom this reform effort as a bad idea? Far from it. People without insurance use emergency rooms for their primary care. That group of individuals is growing as jobs grow scarce and jobs with health insurance benefits even more scarce. Do you have a pre-existing condition? Don't change jobs or you may not get insurance. How old are you -- adding pill bottles to your medicine chest faster than candles on your cake? And when it comes to personal reform, some people use the power of preventive activities improve their health.

That latter group obviously is taking responsibility for their health. But does that mean all the others aren't? Getting a better job seems pretty responsible -- should one turn it down because of a bad back or enlarged prostate? Do we celebrate old age or cut off their meds at age 85? When a self-employed head of a family loses what little insurance he had because premiums sky rocket and then loses his business and home because his child needs extensive medical care, is that being irresponsible?

I raise this issue because in the great reform debate, the word responsibility seems to rear its head constantly, the implication being that anyone without insurance and means to pay for health care is being irresponsible. For some, that's true, but what about all the scenarios above? What about the healthy person who has been turned down by every insurance company receiving her application? What about the person whose insurance doesn't cover a sudden catastrophic event?

What is irresponsible is not seeing that the current system truly needs reform. What is irresponsible is defending the status quo that is the current system. What is irresponsible is pretending other systems (such as the one in Canada) only kill people. What is most irresponsible is erecting roadblocks to reform only to score political points, not because one believes that reform shouldn't happen. (Senator George Voinovich of Ohio recently acknowledged that's the true motivation behind about 50% of the political anti-reform rhetoric out there.)

Many legitimate concerns are being raised about reform. If you're interested, Arthur Caplan has an opinion piece at MSNBC at that helps sort fact from fiction among the claims being made against health care reform. The real ones should be considered, but the false ones, once debunked, should be ignored and left by the road side. Reform will take too much effort to waste any on urban legends and myths.

It is also irresponsible not to admit that the health care system in the United States is already a multi-tier system and will remain so no matter what reform brings. People with means will always have access to the best care. The myriad options being discussed, including a public one, do not preclude private coverage or personal choice.

As a society, we must acknowledge our role in this growing tsunami of health care costs. Physicians order test after test not because a patient necessarily needs them but to cover themselves if sued. We have become so used to bigger and better technologies bringing instant gratification that we expect and demand the same from medicine and health care. We want immediate cures to problems we bring on ourselves. Case in point: the FDA initially considered the anti-obesity drug rimonabant "approvable" but pulled back after a long look at the drug's safety profile. The problem with rimonabant? Its major side effects are suicidality and depression. Seriously. Suddenly a treadmill looks a whole lot more appetizing.

We want all this at the lowest cost possible. While that may not be possible for every test or procedure, surely it is a goal that must be sought. Bottom line -- too many people cannot afford health care. They can't afford insurance, they can't afford medication, they can't afford care. They aren't being irresponsible, they are being beaten down by the expense. Maybe they can pay for a single visit to the doctor, but not the necessary follow-up. Perhaps they can afford most of their meds, but only if they split pills to make them last longer. Maybe they can cover insurance premiums, but the deductibles for hospitalization put coverage out of reach.

Reforming costs and coverage to provide access to health care will require active support and participation from those who profit from health care. It should never mean that they lose every cent they earn, lose their ability to deliver care, lose their capacity to compete. Increased competition is truly needed in this reform -- we could definitely benefit from more insurance companies offering coverage and more clinics and facilities in rural areas, for example.

Health care reform is a complicated but vital mission. It is especially telling that the nudge needed to open the door to reform appears to be coming from many parties, including those in the health care industry itself. Parsing out costs and access will not be easy and all possible permutations should be considered. It will take time and energy on the part of those who will ultimately determine the shape this reform will take. It will benefit from their varying experiences and expertise. What it won't benefit from is the nonstop rhetoric and partisan sniping we have had to consume since these efforts began in earnest.

Access to and cost of health care in the United States can be improved. Bringing about health care reform is truly the responsible thing to do.

Friday, July 17, 2009

And That's the Way It Is

Walter Cronkite was a man of many words, many insights, and many emotions, and we were truly blessed to experience so many of them. I can't really say that I went to journalism school solely because of "Uncle Walter," but he set the standards that I and so many of my peers strive to meet.

If he had done nothing else throughout his extraordinary career, Cronkite will always be remembered for his reporting of President John F. Kennedy's death. It was eerie to see this pillar of objectivity break on camera and make us all realize that he had lost his president along with the rest of us. I was not quite seven when this happened, and those tears allowed me to see that he was not just some newscaster in a box, but could have been anyone I knew -- and so I got to know him better through his newscasts.

He truly was "the most trusted man in America" and we will be reminded that when Lyndon Johnson lost that trust after the Tet Offensive, he knew he had lost any hope of re-election -- and chose not to seek a second term in 1968. What an amazing turn of events because Cronkite said we were "mired in stalemate" in Vietnam.

In the next few days, we will see and hear many words about Walter Cronkite, and we will be reminded about his zest for life, the funny appearances on "Murphy Brown" and "The Mary Tyler Moore Show," the Presidential Medal of Freedom, and more -- tributes all well deserved. But if we recall none of those things, hopefully we remember the man who was a tower of journalistic integrity and unquestionable ethics who helped raise the standards of an entire industry.

Because that's the way he was.

Tuesday, July 14, 2009

Right or Wrong?

Moral (adj): of or relating to principles of right and wrong in behavior

As parents, we try and teach our children right from wrong, based on what our parents taught us. They, like their parents before them, served as the initial crafters of our moral compasses, and we in turn, start building that device for our children. As our children grow older, we hope that moral compass continues to point in the right, not wrong, direction.

Like with everything else, however, individuals still possess different notions of right and wrong. Some people think resistance in the face of law for a cause one supports is moral; others do not. Some people consider taxes immoral; others do not. Stealing is usually considered wrong; stealing to save one's child from starvation perhaps not. Sometimes the black and white of morality goes gray and one's definition of moral may take on a new layer.

And then there is the issue of abortion. In Arizona, a recently signed bill has tightened restrictions on access to abortion care and services. Many people applaud the provisions, many people do not. What some people see as a step in the right direction -- for example, notarized parental consent for girls under 18 -- others see as wrongly requiring these private decisions to become public in a notary's record book.

The word moral actually appears in one of the last provisions of this expanded statute:
A pharmacy, hospital or health professional, or any employee of a pharmacy, hospital or health professional, who states in writing an objection to abortion, abortion medication, emergency contraception or any medication or device intended to inhibit or prevent implantation of a fertilized ovum on moral or religious grounds is not required to facilitate or participate in the provision of an abortion, abortion medication, emergency contraception or any medication or device intended to inhibit or prevent implantation of a fertilized ovum. The pharmacy, hospital or health professional, or an employee of the pharmacy, hospital or health professional, shall return to the patient the patient's written prescription order.

In other words, a pharmacy technician can say no to a woman coming in with a prescription for emergency contraceptives. It would not take too large a stretch to apply this to regular oral contraceptive medicine, since a certain number of regular pills also can be used for emergency contraception. To refuse to provide the meds, all an employee of the pharmacy has to do is have signed a statement that he or she objects on moral grounds.

So not filling a prescription or perhaps sterilizing operating room equipment is now subject to moral grounds, to what is right and wrong. Or at least the practitioner's sense of right and wrong. The patient's sense of right and wrong seems lost in this equation.

In some ways, Arizona should have seen this one coming. According to the first definition in current law, the practice of pharmacy shall be interpreting, evaluating and dispensing prescription orders in the patient's best interests. Interpreting? The law already allows a pharmacist to "interpret" what is in a patient's best interests in regard to prescriptions? So what's next? A pharmacist who doesn't believe in antibiotics for children or who decides no one deserves oral chemotherapy agents?

Pharmacists undergo a great deal of training -- many obtain their doctorates -- and should be considered partners in health care. But while I expect a pharmacist to counsel me on drug interactions and side effects and work with my doctor to ensure these do not occur, I have a difficult time with a pharmacist denying a patient a legal prescription, just as I have with a technician refusing to touch instruments, on "moral" grounds. No matter how one feels about the specific application of this provision in this statute, we face a very slippery slope of interpretation as to how it could be expanded. One hopes those who make the laws will do the right thing, but we all know that things can go very wrong.

Sunday, July 12, 2009

Raising the Curtain

Words, glorious words.

We use them to tell a joke, make a point, express our thoughts, heal a heart. And for more than 30 years, my words also have translated to my livelihood as a professional writer.

Words equal ideas and expressions and meanings; blogs allow us to send those ideas out to the world for anyone who chooses to read them. The amazing part is that no matter what you write, someone will read it. Thanks to cyberspace, a collective creativity permeates the globe.

As this spot grows, you will find plenty of words melded together in a way designed to provide sense and substance. Not everyone will agree with the thoughts that spring from my sensibilities, of course, but my goal is not to incite vitriol but inspire vitality. I am not going to pretend that this blog will bring world peace, but I do hope it generates fresh ideas.

Thanks for taking the time to read my words.