A Lesson Before Dying
By CHARLES M. BLOW
One of the great lights of the world went dark on Thursday. Nelson Mandela left this world, having enormously altered it.
And yet, the extraordinary example that he set lives on and provides a lesson — a blueprint — for all of us who still labor for justice, equality and freedom.
Be convinced of your cause. Conviction, character and consistency are sorely lacking in our modern era of fame-chasing, poll-testing and comment-reading. The status quo has a way of lulling the masses into complacency and acceptance. It’s known and familiar. There are always those whose lives are comfortable and whose livelihoods are secure under it.
Upsetting the status quo — or upending it — is always a radical proposition and is often an unpopular one, sometimes even among those who suffer under the entrenched system. Your cause may be unpopular, but history has demonstrated again and again that it will look kindly on the just.
First, be a fighter. Time has a way of rendering history smooth and digestible, of polishing away the rough bits and sweetening the bitter. Mandela was not only a lovely, grandfatherly figure; he was also a freedom fighter, a man willing to commit his life to — or even sacrifice it for — what he believed in.
Mandela’s African National Congress was once deemed a terrorist organization by both his home country, South Africa, and by the United States. And America’s view of Mandela and of South Africa’s system of apartheid cannot be whitewashed, even as we now venerate Mandela in death.
As Noam Chomsky wrote in his 2010 book “Hopes and Prospects”:
“Through the 1980s, U.S. trade with South Africa increased despite the 1985 congressional sanctions (which Reagan evaded), and Reagan continued to back South African depredations in neighboring countries that led to an estimated 1.5 million deaths. As late as 1988 the administration condemned Nelson Mandela’s African National Congress as one of the world’s ‘more notorious terrorist groups.’”
Be brave. Courage is not required to execute that which is easy or convenient. As the Texas progressive author and agitator Jim Hightower once put it, “Even a dead fish can go with the flow.” Courage is drawing up your shoulder and pushing into the resistance. Courage is doing what is unpopular or dangerous or discomforting because, even if you must do it alone, it is the right thing to do.
As Mandela put it: “I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.” We all feel fear. In fact, fear the person who claims that he or she does not. But fear withers under the heat of righteousness. It cannot spread when it is cornered by those of noble conviction.
Remember that no one can divest you of your basic humanity without your submission and allowance. Discrimination and injustice are insidious, virulent scourges that the world is working hard to remedy, but they remain stubbornly resistant to complete eradication. Even as we labor to be rid of them, let us all retain our resolve and rise up in our dignity.
I like to think of it the way Zora Neale Hurston once put it: “Sometimes, I feel discriminated against, but it does not make me angry. It merely astonishes me. How can any deny themselves the pleasure of my company? It’s beyond me.” The person consumed by discrimination morally subjugates himself or herself, as a matter of principle, to the person free of it, leaving the person free of it with the moral high ground.
Never underestimate the power of grace. Mandela’s immeasurable grace and equanimity, his presidency and his efforts at reconciliation in South Africa will forever serve as an example to the world of the true possibilities and power of the human spirit. We so often think of power as force, but there is also enormous power in love, understanding and forgiveness. Demonstrating kindness to those who have treated you cruelly is an act of moral supremacy. It is the most powerful of human exercises, because in so doing, you conquer the self and diminish your enemy.
Finally, remember that all things are possible for those of strong will and unwavering perseverance. Those who can’t imagine change reveal the deficits of their imaginations, not the difficulty of change. As Mandela put it, “It always seems impossible until it’s done.”
Problems continue to plague Mass. health marketplace
One of the great lights of the world went dark on Thursday. Nelson Mandela left this world, having enormously altered it.
And yet, the extraordinary example that he set lives on and provides a lesson — a blueprint — for all of us who still labor for justice, equality and freedom.
Be convinced of your cause. Conviction, character and consistency are sorely lacking in our modern era of fame-chasing, poll-testing and comment-reading. The status quo has a way of lulling the masses into complacency and acceptance. It’s known and familiar. There are always those whose lives are comfortable and whose livelihoods are secure under it.
Upsetting the status quo — or upending it — is always a radical proposition and is often an unpopular one, sometimes even among those who suffer under the entrenched system. Your cause may be unpopular, but history has demonstrated again and again that it will look kindly on the just.
First, be a fighter. Time has a way of rendering history smooth and digestible, of polishing away the rough bits and sweetening the bitter. Mandela was not only a lovely, grandfatherly figure; he was also a freedom fighter, a man willing to commit his life to — or even sacrifice it for — what he believed in.
Mandela’s African National Congress was once deemed a terrorist organization by both his home country, South Africa, and by the United States. And America’s view of Mandela and of South Africa’s system of apartheid cannot be whitewashed, even as we now venerate Mandela in death.
As Noam Chomsky wrote in his 2010 book “Hopes and Prospects”:
“Through the 1980s, U.S. trade with South Africa increased despite the 1985 congressional sanctions (which Reagan evaded), and Reagan continued to back South African depredations in neighboring countries that led to an estimated 1.5 million deaths. As late as 1988 the administration condemned Nelson Mandela’s African National Congress as one of the world’s ‘more notorious terrorist groups.’”
Be brave. Courage is not required to execute that which is easy or convenient. As the Texas progressive author and agitator Jim Hightower once put it, “Even a dead fish can go with the flow.” Courage is drawing up your shoulder and pushing into the resistance. Courage is doing what is unpopular or dangerous or discomforting because, even if you must do it alone, it is the right thing to do.
As Mandela put it: “I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.” We all feel fear. In fact, fear the person who claims that he or she does not. But fear withers under the heat of righteousness. It cannot spread when it is cornered by those of noble conviction.
Remember that no one can divest you of your basic humanity without your submission and allowance. Discrimination and injustice are insidious, virulent scourges that the world is working hard to remedy, but they remain stubbornly resistant to complete eradication. Even as we labor to be rid of them, let us all retain our resolve and rise up in our dignity.
I like to think of it the way Zora Neale Hurston once put it: “Sometimes, I feel discriminated against, but it does not make me angry. It merely astonishes me. How can any deny themselves the pleasure of my company? It’s beyond me.” The person consumed by discrimination morally subjugates himself or herself, as a matter of principle, to the person free of it, leaving the person free of it with the moral high ground.
Never underestimate the power of grace. Mandela’s immeasurable grace and equanimity, his presidency and his efforts at reconciliation in South Africa will forever serve as an example to the world of the true possibilities and power of the human spirit. We so often think of power as force, but there is also enormous power in love, understanding and forgiveness. Demonstrating kindness to those who have treated you cruelly is an act of moral supremacy. It is the most powerful of human exercises, because in so doing, you conquer the self and diminish your enemy.
Finally, remember that all things are possible for those of strong will and unwavering perseverance. Those who can’t imagine change reveal the deficits of their imaginations, not the difficulty of change. As Mandela put it, “It always seems impossible until it’s done.”
Problems continue to plague Mass. health marketplace
By Chelsea Conaboy
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With three weeks left in the year, not one of the thousands of Massachusetts residents who need to enroll in new health insurance plans by Jan. 1 has been able to do so through the state insurance marketplace that was revamped to comply with the national Affordable Care Act.
About 126,000 people enrolled in health plans subsidized by the state have until March to choose a new plan and can keep their current coverage until then. But thousands of others are depending on a new plan to start on the first of the year, and some worry that their coverage will not be ready in time. Their anxiety has only been heightened by stubborn technical problems, such as a snag this week that blocked many people from signing in to the website.
Gina Kamentsky of Somerville has been trying to enroll through the Massachusetts Health Connector for weeks. Her insurance plan, bought through her partner’s former employer, expires this month. Because of expensive medications and a doctor’s appointment she cannot miss, the 54-year-old artist from Somerville said she needs coverage in January. Plus, the landmark 2006 state health insurance law, the model for the national law, requires her and most others to have coverage.
Was Mitt Romney right about US health overhaul?
By Tracy Jan
Republican Mitt Romney warned during the 2012 campaign that Massachusetts’ groundbreaking health reform, which Romney signed into law as governor in 2006, would never work for the country as a whole. Democrats widely dismissed Romney’s comments as politically opportunistic. Now, given the host of problems that have accompanied the rollout of President Obama’s plan, which he modeled after Massachusetts’, insurance and hospital executives, state legislators, and others around the country are raising the question: Was the Bay State, in hindsight, really the best blueprint for the nation?
Enrollment Errors Put Medical Coverage at Risk
By ROBERT PEAR
WASHINGTON — The Obama administration said Friday that the enrollment records for roughly a quarter of all the people who signed up for health insurance on its website in October and November could contain errors, raising questions about whether those consumers would get coverage in time to pay for their medical care next month.
Even now, the administration said, it may be sending incomplete or erroneous information to insurers for one in every 10 people who enroll.
The disclosure added yet another complication to a long list of technical troubles that have hampered the rollout of President Obama’s health care law. A federal website, HealthCare.gov, is the main marketplace that consumers can use to compare policies and sign up for plans.
Julie Bataille, a spokeswoman at the federal Centers for Medicare and Medicaid Services, said the agency was working with insurers to correct the errors and resolve discrepancies in records kept by the government and by insurers.
In some cases, the government did not notify insurers of people who enrolled online at HealthCare.gov. The government refers to these people as orphans because they completed the application process and selected health plans, but the information did not make its way to insurers.
An administration official said the government would do everything possible to “rescue the orphans.”
In other cases, Ms. Bataille said, the government sent more than one enrollment notice for the same person to an insurer. And in still others, she said, the information sent was incorrect. For example, a child may have been listed as a parent, a name may have been misspelled, or an address may have been wrong.
Some people who signed up for a health plan are listed in insurance company records but not in the government’s records, officials said. In those cases, consumers may have chosen a health plan and then canceled the enrollment, but the government failed to inform the insurer of the cancellation.
Health Care Law Providing Relief and Frustration
By JOHN SCHWARTZ and KATIE THOMAS
CHARLOTTE, N.C. — Mike Horrigan is a lifelong Democrat with heart problems who supports President Obama’s health care law because he expects it will help many people obtain better insurance, including himself.
But under the new law, the Affordable Care Act, Mr. Horrigan’s coverage by a state high-risk insurance program was eliminated, then replaced by a more expensive plan. His wife’s individual plan was canceled for being substandard, then suddenly renewed — also at a higher price.
So while Mr. Horrigan, 59, believes the law will improve health care in the long run, its short-term effect has been chaotic and trying for him and his wife, Kay. “It’s more stressful than it needed to be,” he said.
For a measure of the tumult that has accompanied the arrival of the federal health care overhaul, there may be no better place to look than in the politically mixed state of North Carolina, where both the anxiety and the promise of revamping the health insurance system has left hundreds of thousands of people struggling to sort out their options.
Many will end up with better coverage than they had, and may get help paying for it. Others will see their costs rise and are wondering if the change is worth it. And some, like the Horrigans, may find themselves falling into both camps.
The agitation has been building for months. This fall, insurers notified about 260,000 North Carolinians that their individual health plans no longer complied with the law’s more stringent requirements, and many learned that the plans they were being offered as replacements would cost hundreds of dollars more per month. Then, after Mr. Obama said on Nov. 14 that insurers would be allowed to renew their plans for one year, Blue Cross and Blue Shield of North Carolina announced that 230,000 of its customers in the state could keep their own plans — but at prices that rose 16 percent to 24 percent.
Kathleen LaFleur, a broker who works with people who have individual plans at Employee Benefit Advisors, an insurance agency here, said many of the callers to her office had two things in common: confusion and anger. “They are confused before they call,” she said. “After they call, they’re not confused anymore. They’re angry.”
Adding to the confusion is the fact that many consumers have been unable to fully evaluate their options because the federal health care website, which serves residents of North Carolina and 33 other states, did not work very well until recently. Those who qualify for subsidies must sign up through the federal marketplace. Consumers have until Dec. 23 to sign up for coverage beginning in January.
“It has obviously been extremely frustrating for individual policyholders who have received cancellation notices at a time when there’s such a short window for them to decide what their coverage options will be,” said Wayne Goodwin, North Carolina’s insurance commissioner, an elected Democrat.
Published on Thursday, December 5, 2013 by Common Dreams
Army of Rightwing Groups Plan Assault on State Laws in 2014
Internal documents show how state-level affiliates serve national interests of corporations and wealthy, conservative ideologues
- Jon Queally, staff writer
According to internal documents obtained by the British newspaper and published online Thursday, the Guardian reports that more than forty state-level conservative groups are planning a "US-wide assault" on "education, healthcare, income tax, workers' compensation and the environment."
If you want to know how the right-wing State Policy Network—in concert with a network of other national and state-level conservative policy groups—has been able to overrun state legislatures with "model legislation" that carries the interest of the nation's wealthiest corporations and individuals while undermining workers and communities, the ream of grant proposals obtained by the newspaper tell the tale.
"[Groups like the State Policy Nework] appear to be advocating purely local interests but what they are promoting is part of a larger national template to radically remake our government in a way that undermines public institutions and the rights of workers." –Lisa Graves, Center for Media & Democracy
For the second time this week, the Guardian has published internal documents from an influential U.S. conservative organizing group that reveals rare insight into how they operate and the way smaller, local groups vie for portions of the large amount of money made available by people like the Kochs brothers and other funders of the conservative, Tea Party cabal.
According to the Guardian:
Conservative groups across the US are planning a co-ordinated assault against public sector rights and services in the key areas of education, healthcare, income tax, workers' compensation and the environment, documents obtained by the Guardian reveal.The strategy for the state-level organisations, which describe themselves as "free-market thinktanks", includes proposals from six different states for cuts in public sector pensions, campaigns to reduce the wages of government workers and eliminate income taxes, school voucher schemes to counter public education, opposition to Medicaid, and a campaign against regional efforts to combat greenhouse gas emissions that cause climate change.The policy goals are contained in a set of funding proposals obtained by the Guardian. The proposals were co-ordinated by the State Policy Network, an alliance of groups that act as incubators of conservative strategy at state level.
Partnering with local news outlets, the Guardian shared some of the documents in obtained in order to have journalists more familiar with state politics and trends explore the implications of how these nationally-coordinated conservative policies, if enacted, would play out with the communities that will ultimately feel them.
As part of their reporting on the documents, the Guardian published all forty of the proposal sent by state-level groups to SPN for approval.
In the most northeastern state in the country, Maine, a group called the Maine Heritage Policy Center was among the groups who applied (pdf) for a grant through the wealthy national group in order to push a proposal to make the poverty-stricken Washington County a "tax-free zone" in order to promote "economic activity" in the state.
As the Portland Press Herald reports, however, most citizens of the county seem skeptical of the proposal even as Republican legislators in the capital of Augusta and Republican Gov. Paul LePage have begun pushing the idea publicly.
Rebecca Pearce, director of Maryland’s ailing health insurance exchange, resigns
By John Wagner and Lena H. Sun, Published: December 6
The Maryland official who directly oversaw the rollout of Maryland’s health insurance exchange resigned Friday amid continuing technical problems that have hampered the state’s online enrollment efforts.
After an emergency session Friday night, the board of the Maryland Health Benefit Exchange accepted the resignation of Rebecca Pearce, its executive director, and thanked her in a statement for working “tirelessly and with tremendous dedication” for more than two years.
In recent weeks, the lagging enrollment and online glitches have embarrassed the administration of Gov. Martin O’Malley (D) and become a political liability for Lt. Gov. Anthony G. Brown (D). Brown, who is seeking to succeed O’Malley, has taken a leadership role in implementing the federal health-care law in Maryland.
The technological problems with Maryland’s exchange have been particularly problematic because the state was among the earliest and most aggressive in embracing the health-care law.
A senior O’Malley administration official said Pearce was unhappy with changes in the project leadership that were directed by O’Malley, who has pledged to fix the Web site’s problems by the middle of this month.
“We were unhappy that the rollout didn’t go the way we expected it to go,” the O’Malley official said. “And so we made changes to the leadership of the project.”
The official spoke on the condition of anonymity to more freely discuss the matter.
Pearce could not be reached for comment Friday night.
Earlier Friday, Maryland officials reported a modest uptick in the number of people choosing to enroll in private plans through the online exchange and said a new round of data coming next week would show “a marked increase” in total enrollments.
As of Nov. 30, a total of 3,758 Marylanders had chosen to enroll in private plans through the Maryland site, an increase of 734 from the previous week, state officials said. The state, which launched the exchange Oct. 1, has set a goal of enrolling 150,000 people by the end of March.
Carolyn Quattrocki, who heads the governor’s office for health reform, was named Friday night to serve as interim executive director of the exchange.
Pearce was appointed to the executive director position in September 2011. Before that, she was director of benefits administration at Kaiser Permanente. She began her health-care career at CareFirst BlueCross BlueShield.
The Maryland exchange’s rocky start is in marked contrast to some other states running their own marketplaces, including California, Connecticut and Kentucky. Industry officials who are trying to sign up consumers in Maryland say the Web site is improving, but not reliably stable.
But with a little over two weeks before the Dec. 23 deadline to sign up for coverage effective Jan. 1, the state is still wrestling with stubborn technological problems, posting weak enrollment numbers even as other states have signed up thousands of consumers for plans under President Obama’s new health-care law.
Obamacare’s real promise: if you lose your health-care plan, you can get a new one
By Ezra Klein, Updated:
The furor over "if you like your plan, you can keep it" touches on a deep fear in American life: That your health-care insurance can be taken from you. That fear is so powerful because it happens so often: Almost everyone in the country can lose their health insurance at any time, for all kinds of reasons — and every year, millions do.
If you're one of the 149 million people who get health insurance through your employer, you can lose your plan if you get fired, or if the H.R. department decides to change plans, or if you have to move to a branch in another state.
If you're one of the 51 million people who get Medicaid, you could lose your plan because your income rises and you're no longer eligible or because your state cut its Medicaid budget and made you ineligible. You could lose it because you moved from Minnesota, where childless adults making less than 75 percent of the poverty line are eligible, to Texas, where there's no coverage for childless adults.
If you're one of the 15 million Americans who buys insurance on the individual market, you could lose your plan because your insurer decides to stop offering it or decides to jack up the price by 35 percent. And that's assuming you're one of the lucky people who weren't denied coverage based on preexisting conditions in the first place.
Then, of course, there are the 50 million people who don't have a plan in the first place. The vast majority of them desperately want health-care coverage. But it turns out that just because you want a plan doesn't mean you can get one.
Virtually the only people whose health coverage is reasonably safe are those on fee-for-service Medicare and some forms of veterans insurance. And even there, enrollees are only safe until the day policymakers decide to change premiums or benefit packages.
President Obama's critics are right: Obamacare doesn't guarantee that everyone who likes their health insurance can keep it. In some cases, Obamacare is the reason people will lose health insurance they liked.
What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.
It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you'll have a choice of new plans you can purchase, you'll know that no insurer can turn you away, and you'll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.
Health insurance isn't such a fraught topic in countries such as Canada and France because people don't live in constant fear of losing their ability to get routine medical care. A decade from now, that will be true in the U.S., too. But it's not true yet, and paradoxically, that's one reason health reform is so difficult. The status quo has left people rightly fearful, and when people are afraid, change is even scarier.
Healthcare coverage counselor stymied by website problems
Jessie Orozco's efforts to walk people through the process of applying for coverage is hampered by computer glitches. 'It's depressing, it's frustrating and it's disrespectful,' she said.
By Eryn Brown
7:08 PM PST, November 16, 2013
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Passport and tax records in hand, Nela Barboza fiddled nervously with a plastic folding fan as she approached Jessie Orozco's desk. "Buenas tardes," she said cordially. "I'm here to sign up for Obamacare."
Orozco, a benefits counselor at St. John's Well Child & Family Center in South Los Angeles, was thrilled. Around her neck, she wore a badge certifying that she was a state-trained enrollment counselor for California's new medical insurance marketplace — touted as one of the better-functioning parts of the Obama administration's healthcare overhaul.
With a picture of the president tacked to the wall behind her, Orozco noted that Barboza could be the first person she would walk through the process of signing up. "I'm going to celebrate when I get this lady approved!"
The sense of anticipation quickly dissipated. Orozco encountered problems with the state website created for counselors like her. She couldn't find forms in Spanish, the language Barboza best understands. She had trouble estimating the costs Barboza would pay and confirming details of what would be covered.
Barboza became agitated, complaining at one point that she and her husband would be better off if he didn't work because they would get government-paid medical care.
The state has struggled to put enough trained troops like Orozco on the front lines of the healthcare overhaul. Officials say they are catching up and are poised to help millions of Californians reap the benefits of Obamacare.
From the vantage point of Orozco's desk, that hope was tempered by the reality of continuing obstacles. Computer glitches persisted, misinformation and rumors were in the air, and consumers procrastinated, worried about the unknowns of choosing a health plan and what it could mean for their care and their pocketbooks.
::
Covered California, the state marketplace, got relatively high marks last week when officials released initial enrollment figures under the Affordable Care Act.
More than 30,000 Californians had selected insurance plans during the first month of sign-ups, and about the same number chose plans during the first 12 days of November. An additional 72,000 used the exchange to find out they were probably eligible for expanded coverage under Medi-Cal, the state's healthcare program for the poor.
Nationwide, 106,185 people enrolled in Affordable Care Act plans during October, far short of Obama administration goals.
The mix of patients at community clinics like St. John's underscores the complexity of matching people and medical insurance. Many are undocumented and can't participate in the state insurance exchange or receive full Medi-Cal coverage. Another large group is already enrolled in Medi-Cal or Healthy Way L.A., a low-income county program that will be folded into Medi-Cal on Jan. 1. Orozco and her colleagues at the clinic had been successfully signing up people for those programs for months.
http://www.latimes.com/local/la-me-obamacare-signup-clinic-20131117,0,4928018,print.story
OBGYN group has questioned robotic hysterectomies, offered at three Maine hospitals
Back in March, a leading obstetrician-gynecologists group questioned the use of surgical robots for routine hysterectomies, citing a study that found robots led to no better results than other procedures but cost much more.
“There is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives,” James Breeden, president of the American Congress of Obstetricians and Gynecologists said in the March statement.
WIth robotic procedures, a surgeon manipulates tiny surgical instruments using hand controls at a computer system situated a few feet away from the patient. Hysterectomies also can be performed through a large abdominal incision (called an open hysterectomy), or through other less invasive approaches, including a small opening at the top of the vagina (ACOG’s preferred approach), or laparoscopic surgery, in which the surgeon manipulates instruments and a tiny lighted camera through small incisions in the abdomen.
ACOG’s strongly worded statement came as use of robots for hysterectomies, one of the most common surgical procedures, jumped from less than 0.5 percent to nearly 10 percent over the past three years, according to a study in the Journal of the American Medical Association. Three hospitals in Maine perform them.
What Maine can learn from a Blue Hill Peninsula program that helps elders stay at home
By Matthew Stone, BDN Staff
Posted Dec. 06, 2013, at 10:56 a.m.
Two years ago, Kara Janes was a resident of Lakewood Continuing Care Center, wheeling herself around the Waterville nursing home with a limp right side and oxygen tubes strung across her face.
Janes was a healthy graduate student at the University of Maine’s School of Social Work. She was living in the Waterville nursing facility for 10 days as part of a project called Learning by Living coordinated by the University of New England’s College of Osteopathic Medicine.
Janes instructed her family not to visit during her 10-day stay. She avoided using her right side, simulating the mobility of someone who had suffered a stroke. She ate pureed food. Nursing home aides woke her each night and helped her onto the toilet. She replicated the experience of someone living in a long-term care facility.
Two years later, Janes, who has completed her master’s degree in social work, is the program manager for At Home Downeast, a growing, volunteer-driven program that connects 60 elderly residents on the Blue Hill Peninsula with the services they need so they can remain in their homes.
“The common theme with people living [at Lakewood], they didn’t want to be there,” said Janes, 46. “They wanted to be in their own home. They were in there because they lacked a support system to keep them in their home.”
At Home Downeast aims to be part of that support system for its 60 members, whose average age is 82, Janes said.
“It takes creating a physical environment and a social environment in order to age in place,” she said.
The program, which started in February 2012, relies on 85 volunteers, many of them retired or approaching retirement age, who give At Home Downeast members rides to medical appointments and to the grocery store and visit members in their homes, sometimes providing them with meals.
Two registered nurses on staff carry out doctors’ orders in members’ homes, making sure they’re taking their medications. Some volunteers, including retired physical therapists, perform safety assessments of elderly residents’ homes and help to make their homes safe for old age.
At Home Downeast also plans social outings for its members, and Janes said she hopes to plan more — outings to Waterfront Concerts in Bangor, for example — as the program grows. Members call each other to check in. Others send fellow members birthday cards.
“We’ve decreased the numbers of elders with depression,” Janes said. “We’re getting them out of the house, so now they’re not as lonely. They’re not as isolated.
“We want elders to be thriving in place, not just surviving.”
US is wrong to ban pay for bone-marrow donors
By Sally Satel, Special to the BDN
Posted Dec. 06, 2013, at 8:19 a.m.
Two years ago, Doreen Flynn of Lewiston won her case against the U.S. government, successfully arguing that bone-marrow donors should be able to receive compensation.
Flynn, a mother of three girls who are afflicted with a rare, hereditary blood disease called Fanconi’s anemia, has a strong interest in bone-marrow transplantation. At the time of the court ruling, her oldest daughter, Jordan, 14, had already received a transplant, and one of the younger twins, Jorja, was expected to need one in a few years.
Locating a marrow donor is often a needle-in-a-haystack affair. The odds that two random individuals will have the same tissue type are fewer than one in 10,000, and the chances are much lower for blacks. Among the precious few potential donors who are matched, nearly half don’t follow through with the actual donation. Too often, patients don’t survive the time it takes to hunt for another donor.
Allowing compensation for donations could enlarge the pool of potential donors and increase the likelihood that compatible donors will follow through. So the ruling by a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit was promising news for the 12,000 people with cancer and blood diseases currently looking for a marrow donor. (James F. Childress, an ethicist at the University of Virginia, and I submitted an amicus brief in the case.)
Soon after the verdict, Shaka Mitchell, a lawyer in Nashville, Tenn., and co-founder of the nonprofit MoreMarrowDonors.org, began collecting funds to underwrite $3,000 donor benefits, which were to be given as scholarships, housing allowances or gifts to charity.
Mitchell also invited a team of economists to evaluate the effects of the ruling on people’s willingness to join a registry and to donate when they are found to be a match. The researchers were to specifically assess whether cash payments would be any more or less persuasive than noncash rewards or charitable donations.
Now comes the bad news. On Oct. 2, the U.S. Department of Health and Human Services proposed a new rule that would overturn the Ninth Circuit’s decision. The government proposes designating a specific form of bone marrow — circulating bone-marrow stem cells derived from blood — as a kind of donation that, under the 1984 National Organ Transplant Act, cannot be compensated. If this rule goes into effect, anyone who pays another person for donating these cells would be subject to as much as five years in prison and a $50,000 fine.
The problem with this rule is that donating bone marrow is not like donating an essential organ. Indeed, the Ninth Circuit based its decision on the fact that modern bone-marrow procurement, a process known as apheresis, is more akin to drawing blood. In the early 1980s, when the transplant act was written, the process was more demanding, involving anesthesia and the use of large, hollow needles to extract marrow from a donor’s hip. But today, more than two-thirds of marrow donations are done via apheresis. Blood is taken from a donor’s arm, the bone-marrow stem cells are filtered out, and the blood is then returned to the donor through a needle in the other arm.
The Ninth Circuit panel held that these filtered stem cells are merely components of blood — no different from blood-derived plasma, platelets and clotting factors, for which donor compensation is allowed.
The strongest opposition to compensation comes from the National Marrow Donor Program, the Minneapolis-based nonprofit that maintains the nation’s largest donor registry. Michael Boo, the program’s chief strategy officer, says of reimbursement, “Is that what we want people to be motivated by?”
The problem with this logic is that altruism has proved insufficient to motivate enough people to give marrow and, as a result, people die.
Kentucky’s unlikely health care heartthrob
By: Alexander Burns December 7, 2013 07:00 AM EST | |||||
For anxious national Democrats who have pined for a white knight in the health care reform debate, Steve Beshear is starting to look like the one they’ve been waiting for – implausible as that development may be. Amid a torrent of negative national headlines about the Affordable Care Act, the 69-year-old Kentucky governor – a canny Southern operator who’s spent his career at arm’s length from the Democratic base – has charged out of Frankfort as a kind of ambassador-by-default for the controversial law. He has toured the cable networks, appeared on “Meet the Press” and authored a tartly worded New York Times op-ed telling Republican ACA opponents to “get out of the way so I can help my people.” This week, congressional Democrats hosted Beshear at their Thursday caucus meeting to learn from his example on health care. He has even fielded a grateful phone call from the president of the United States. Barack Obama called last month “just to say thank you,” Beshear told POLITICO. And this gratitude comes from the president to a state where he failed to get 40 percent of the vote in the 2012 election. http://dyn.politico.com/printstory.cfm?uuid=8AF2EAE7-A35A-4D73-A50D-99313C8D9E3F
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