Archive for the “health care” Category

I am going to do my best to keep this short and sweet as I am typing one-handed on my phone thanks to a little mishap yesterday with a glass, a visit to Urgent Care, and 17 stitches in my right hand.

Today is Blog for Choice Day 2010, which marks the 37th anniversary of Roe v. Wade. Bloggers across the web are writing about why they are pro-choice so I’ll add my two cents.

I have a hard time with abortion. I’n Catholic and that makes this a complicated subject. Still, that same Catholic faith that feels very uncomfortable about late term abortion is why I’m pro-choice. It’s what has led me to believe the life of a woman who is already here is more important, that we should care for our fellow human beings like Jeaus would. To me, that means valuing a woman’s life over that of a fetus.

I am pro-choice because abortion is a medical procedure and every woman should be able to access it safely without endangering her life.

I am pro-choice. I am grateful to those who fought so hard 37 years ago so I have this right today

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Note: The following is a letter to the editor I wrote that appeared in the Eau Claire Leader-Telegram and Madison Capitol Times (both in Wisconsin). The Stupak-like amendment was introduced in the Senate today by Sen. Ben Nelson (D-NE) and will likely be voted on tomorrow (Tuesday, December 8th) so call your senators at (888) 423-5983 now. The U.S. Capitol switchboard is open 24/7 so when you ask for your senators’ offices you may get voice mail. Leave a message!

Without further ado, let’s Stop Stupak!

Dear Editor:

On November 7th, the House of Representatives passed its version of health care reform, which included an anti-abortion amendment sponsored by Rep. Bart Stupak (D-MI). According to the American Association of University Women, the Stupak Amendment will prohibit “women who receive federal subsidies from purchasing a comprehensive insurance plan that includes abortion services. Private plans that offer abortion coverage would be banned from receiving funding.”

The Stupak Amendment goes far beyond the 1976 Hyde Amendment, which prohibits federal funding for abortion. Insurance companies participating in the new insurance exchange who receive even one dollar of revenue from federal subsidies will be banned from offering any policies with abortion coverage. An analysis of the amendment by George Washington University found it “will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women.”

Abortion is a currently a safe, legal medical procedure. One in three American women will have an abortion by age 45. The risk of death is less than 0.6 per 100,000 procedures here in the U.S. In contrast, 68,000 women die each year in countries where abortion is illegal. (Guttmacher Institute) The Stupak Amendment threatens to take women back to the days of unsanitary back-alley and dangerous self-induced abortions with wire hangers. The Stupak Amendment is not about “unborn” fetuses but saving the lives of women who are already here: daughters, sisters, wives, and yes, even mothers.

Stop the Stupak Amendment. Call Senators Feingold and Kohl. Tell them to vote “no” on Stupak.

Image courtesy Stupak Amendment REVOLT (Facebook)

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Today is World AIDS Day 2009, a day to raise awareness of HIV and AIDS worldwide. We pause to remember the nearly 600,000 Americans who have died of this horrific disease and pledge to help those living with HIV/AIDS. The CDC estimates that more than a million people are living with HIV/AIDS and that number is growing, with 56,300 new infections in 2008 alone.

World AIDS Day is observed on December 1st and has been every year since 1988 when the World Health Organization marked the occasion as a way to “to raise awareness and focus attention on the global AIDS epidemic.”

Every year, we trot out the red ribbons (see above) and alarming statistics. We pay lip service to the cause of fighting HIV/AIDS but are we actually making real progress at fighting the disease?

I know I’m not doing my part.

In middle and high school, I volunteered for the AIDS Resource Council of Wisconsin and was a member of their Teen AIDS Prevention Program (TAPP). TAPP was a small group of peer educators who went to local schools and community groups. We talked to middle and high school kids about what HIV/AIDS is, how you get it (direct contact with blood, semen, vaginal fluid or breast milk), and how you don’t get it (You cannot get AIDS from Sammy peeing in the school pool. Nope!)

We explained that you need to take universal precautions when dealing with bodily fluids that transmit HIV. We explained that giving and receiving blood is safe, that the Red Cross screens all blood for HIV.

We also talked about sex. We talked about the fact that abstinence is the only 100% way of not getting HIV, but if you’re going to have sex, you need to use protection: condoms and dental dams. We demonstrated how to put a condom on using our for-demonstration-purposes-only dildo, Pete the Purple Penis.

Prevention efforts like ours helped. A study at Johns Hopkins found the HIV transmission rate has dropped 33 percent since 1997, the year I left for college and stopped working with ARCW. That’s great news. Still, when more than a million people in the United States and more than 33 million people worldwide are living with HIV, we are not doing enough to stop this disease.

Every day should be World AIDS Day.

Here in the U.S., we need to eliminate abstinence-only funding and teach age-appropriate, comprehensive sex education in every state and every school district. I was lucky enough to attend health classes in the Eau Claire, WI, school district, where health teacher Deb Tackmann constantly fought with the school board and the community to include real sex education in the curriculum: HIV/AIDS, STDs, teen pregnancy and contraception (including condoms).

Everyone needs to know this information. Here in Wisconsin, the legislature is considering the Healthy Youth Act (AB 458 & SB 324). According to Planned Parenthood of Wisconsin, the Healthy Youth Act:

requires schools that teach sex education to do so in a responsible, comprehensive manner that includes information about abstinence and sexually transmitted infections (STIs) and pregnancy prevention strategies, such as birth control and condom use.

If you live in Wisconsin, please contact your state senator and ask him/her to vote “yes” on the Health Youth Act (SB 324).

Another step we can take to prevent HIV/AIDS is to eliminate federal funding for abstinence-only education. After President Obama stripped abstinence-only monies from the federal budget, Senator Reid has included language in the Senate health care reform bill that will re-authorize abstinence-only funding for another five years. Call your representative and senators: Tell them to remove abstinence-only funding from health care reform.

We can also volunteer or donate to a local AIDS service agency. Check your yellow pages for one near you.

There is much more we can do to prevent HIV/AIDS here in the U.S. There’s no excuse; we should be doing it.

To learn more about the global AIDS epidemic and how it affects women, click here.

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During Saturday’s debate on the cloture vote, Sen. Lamar Alexander (R-TN) said the proposed health care reform bill is:

“arrogant in its dumping of 15 million low-income Americans into a medical ghetto called Medicaid that none of us or any of our families would ever want to be a part of for our health care.”

Here’s the video:

I have Medicaid. It is not a “medical ghetto”. Without Medicaid, I would not be walking or talking today. I would not be typing this sentence. I would not be able to swallow food or get dressed by myself.

Medicaid is a good program. It paid for two more weeks of inpatient rehabilitation at the Spinal Cord Injury Center at Froedtert Hospital in Milwaukee, WI, than United HealthCare would have. Those extra two weeks are the reason I’m walking today.

Medicaid paid for as much outpatient physical, occupational and acquatic therapy as I needed when I got home. United HealthCare would have only paid for twenty sessions each per year. Without Medicaid, I would not have been able to go to physical therapy 2-3 times a week for eleven months, occupational therapy 2 times a week for six months and aquatic therapy once a week for five months.

Medicaid has paid for all of my doctors’ appointments. I have been able to see all of the specialists I needed, no questions asked.

Medicaid has kept me alive and put me back on the road to recovery. It is not a “medical ghetto”. It is a vitally important (and yes, imperfect) safety net for millions of Americans.

Senator Alexander, you would be lucky to have Medicaid.

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denied2

On Saturday night, my joy and relief at the health care reform bill being passed in the House of Representatives was quickly wiped out by the fury being expressed on Twitter and elsewhere by feminists and progressives over the Stupak amendment. According to the Feminist Majority Foundation, the amendment “bans abortion coverage even if women pay for it with their own money in the public option or private plans in the insurance exchange.”

This is obviously a big deal. In a press release, FMF’s president Ellie Smeal said:

“Millions of poor and middle class women will be denied abortion coverage. Millions more may lose abortion coverage because currently some 85% of private plans now have such coverage.”

I agree the Stupak amendment is terribly, terribly wrong. It is, as Ms. Smeal said, “an unacceptable, giant step backward for women.” Still, abortion cannot be allowed to derail health care reform. This is far too important to me and millions of other women – and men. Health care reform is about life and death. Out-of-control premiums and medical bills are forcing families to choose between buying groceries for their kids, paying the mortgage or obtaining life-saving medical treatment and prescription drugs.

Health care reform is not about abortion. Bart Stupak and the other “pro-life” members of Congress should be ashamed of themselves for hijacking what may be the most important piece of legislation of our time. This is truly a matter of life and death.

Abortion cannot be allowed to derail health care reform. Still, there is another issue that has been overlooked in the outrage over the Stupak amendment. According to the Kaiser Foundation, 9.5 million women are currently on Medicaid. The federal standard for Medicaid requires abortion coverage only in situations where the mother’s life is in danger or in the case of rape or incest. Thirty-two states and the District of Columbia only provide this level of coverage while seventeen states exceed federal requirements, funding “all or most medically necessary abortions”.

If abortion doesn’t derail the bill and we actually get health care reform passed, Medicaid’s ranks will expand to include 150% of the Federal Poverty Level, including millions more women.

What about poor women? Don’t we deserve abortion coverage as part of our reproductive rights? Where is the outrage for us? It seems like the feminist movement has simply forgotten about the poorest and sickest of women, those who are most likely to be in need of abortion services. Indeed, many women enroll in Medicaid because they are pregnant and uninsured. Our society has created a safety net for low-income women when they get pregnant but that safety net is full of knots and hard to break free of.

Medicaid’s income limits keep women mired in poverty. StateHealthFacts.org reports that 52.3% of non-elderly families receiving Medicaid have at least one full-time worker, which means that worker is working full-time but doesn’t have health insurance through their job. In order to keep their Medicaid, they cannot earn more than the FPL eligibility limits for their state. If they do earn more than the limits, they risk losing their health insurance.

Furthermore, 47.8% of the non-elderly on Medicaid work part-time or not at all. These people are not eligible for employer-sponsored plans and will probably be unable to afford any plans in the new insurance exchange. They will be stuck on Medicaid. Without abortion coverage.

It has been extremely frustrating and infuriating to watch the uproar over the Stupak amendment. It feels like the feminist movement has forgotten about the poor, sick and disabled women who are on Medicaid and only have access to abortion services under the Hyde Amendment.

Those of us on Medicaid deserve the same reproductive rights that everyone else is entitled to. We are not second-class citizens. We’re women.

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denied2In addition to yesterday’s post on the New Office of Women’s Health in House Health Care Bill, I have another National Women’s Day of Action for Health Care Reform postup at the AAUW Dialog blog entitled I Am Not a Pre-Existing Condition. here’s an excerpt:

I have a long list of pre-existing medical conditions, so I have a lot invested in health care and health insurance reform. But even if I didn’t have this crazy, messed-up body with all its injuries, conditions, and surgeries listed in my medical chart, I could still be denied health insurance. At the very least, I would probably have to pay more than a man would.

Why, you ask? The answer is simple. I’m a woman.
Keep reading…

Also, a little National Women’s Day of Action for Health Care Reform link love:

So… have you called or emailed your representative and senators to ask them to vote for health care reform? Do it now!

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Note: This post is part of the National Women’s Day of Action for Health Care Reform. Learn more at A Woman Is Not A Pre-Existing Condition

denied2Being a glutton for punishment, I decided to embrace my masochistic tendencies and try to tackle the (Democratic) House health care bill yesterday. I was searching for information on new regulations that will prohibit insurance companies from using gender ratings to discriminate against women when I came across Sec. 2588 on pg. 1609.

What is Sec. 2588? I’m so glad you asked. Sec. 2588 (under Division C – Public Health and Workforce Development > Title V – Other Provisions > Subtitle E – Miscellaneous)  will establish an Office of Women’s Health (OWH) in the Department of Health and Human Services (HHS). Yes, you read that right. There will be an entire division of the federal government devoted to women’s health.

Among other things, OWH will establish short & long-term goals for HHS and other agencies for women’s health: disease prevention, health promotion, service delivery, research, and public and health care professional education. OWH will be headed up by a Deputy Assistant Secretary of Health and Human Services, which is an appointed position. (Sec. 229, pg. 1609)

The Deputy Assistant Secretary, who I’ll just refer to as the Secretary to make my life a lot simpler, will establish and chair the  HHS Coordinating Committee on Women’s Health. It will be composed of senior-level representatives from each of the federal agencies. Although the bill doesn’t explicitly lay out the functions of the Coordinating Committee, I assume it will be a lot like the White House on Women and Girls, only for health issues.

OWH will coordinate efforts to promote women’s health initiatives in private sector. Additionally, it will set up a National Women’s Health Information Center. This office will serve as a clearinghouse for women’s health information to the public and private sector.

There will also be an Office of Women’s Health established at the Center for Disease Control (CDC). This office will monitor will monitor women’s health initiatives within the CDC and establish short and long-term goals for the CDC relating to women’s health. In other words, this mini-OWH will be in charge of making sure the CDC is researching women’s health – what a concept! (Sec. 310A, pg. 1614)

There will also be an Office of Women’s Health and Gender-Based Research within HHS. This office will keep tabs on the current status of research, identify areas of need for research on women’s health and make short and long term goals for research on women’s health.

There will be an Office of Women’s Health within the Food and Drug Administration (FDA). Again, what a concept. This office will monitor and report on women’s participation and outcomes in FDA clinical trials. It will establish short and long term goals for “adequate inclusion of women and analysis of data by sex in Administration protocols and policies”. In regular person talk, that means they’ll actually have to make sure to include women in their studies and reports. It will provide information to women and health care providers on differences between men and women in FDA studies and trials. Unfortunately, this mini-OWH at the FDA will not have any new regulatory authority. I’m not sure what the possible ramifications are but this seems bothersome. (Sec. 911)

All in all, I am extremely impressed with this new Office of Women’s Health. It appears that it will coordinate women’s health services across all the federal agencies and work to improve women’s health by conducting research, disseminating data to consumers and institutions, promoting prevention and wellness and more. Of course, this will be a brand-new bureaucracy so it will never work perfectly. Still, what excites me the most is the research OWH and its affiliates will conduct. For so long, medical research has been done on men and the results were assumed to be the same for women. This would be long overdue.

There is one very large BUT here. The provision to create an Office of Women’s Health is only in the Democratic House bill. It is not in the Senate bill or the Republican House bill. The House is tentatively set to vote on this bill as early as Saturday. I’m not sure if Sen. Reid is allowing amendments to the Senate bill anymore but if he is, we need to urge our senators to include a similar provision. That way, it will have a better chance of being in the conference bill.

Read the House bill here. The Office of Women’s Health provision starts on p. 1609, Sec. 2588. Make your life simple and use the search function to find it. Oh, and if you notice I read or summarized the bill incorrectly, please let me know: danine@danine.net. Thanks!

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This morning I did yet another BlogHer conference call on health care reform. This one was with Rep. Cynthia Lummis (R-WY). Did you catch the “R” after her name? Yep, she’s a Republican and vehemently opposed to “The Speaker’s Bill” as she put it. I’ll do a quick recap of the call, but long story short, there’s not a snowball’s chance in you-know-where that Congresswoman Lummis will vote “aye” on the Affordable Health Care for America Act.

At the beginning of the call, Rep. Lummis told Republicans are in favor of health care reform. They would just do it differently. She said she didn’t know what the rush was and that Republicans want to “borrow the best of the bills” to reform the system one step at a time. She also said the current health care system services 85% of Americans “very well” so we should focus our energy on trying to help the other 15%.

Rep. Lummis’ proposals for piecemeal reform including high-risk insurance pools that are (supposedly) available in every state. She also wants to establish a tax credit so individuals can buy private insurance policies that would be portable even if they lost their job. Her third idea was to allow consumers to buy insurance policies across state lines.

Rep. Lummis said she was “terribly concerned” about “The Speaker’s Bill” (doesn’t it sound evil?) because it shifts many costs to the states by expanding Medicare.” That’s a direct quote. (Hence the quotation marks.) I’m pretty sure she meant to say “Medicaid” as the bill does expand Medicaid. Nothing recent is coming up on Google for “expand Medicare”.

Here are the calls:

  • Loralee, of the LooneyTunes blog, asked Rep. Lummis to elaborate on her ideas for expanding the high-risk pools. The congresswoman told Loralee she is co-sponsoring HR 3400, which would provide more funding for high-risk pools so individuals could buy into the plans at a lower rate. This would be paid for with unused stimulus funds (which apparently aren’t needed for any of the bridges that are falling down.)
  • Jaelithe, a blogger for MOMocrats.com, told Rep. Lummis “there is a rush” for health care reform. People like her step-father, who has diabetes, are going without health insurance and life-saving medicine, such as insulin. (Which is kind of important to diabetics). Jaelithe asked Rep. Lummis if there was anything explicitly prohibiting insurers from discriminating against people with pre-existing conditions in HR 3400, her go-to bill. To my recollection, Rep. Lummis didn’t really answer that. Instead, she told Jaelithe her step-father could join the high-risk pool in his state. What Rep. Lummis apparently doesn’t know is that high-risk pools are still pretty darn expensive for the average citizen, especially if you’re poor.
  • Nancy from the Sunlight Foundation asked how Rep. Lummis felt about transparency, at which point, I mentally blocked out so I could figure out what question I wanted to ask
  • Next up, Yours Truly: I was really emotional so I’m sure this came out crazy and incoherent but I told Rep. Lummis that I have a rare medical condition and that I am on SSI/Medicaid. I don’t want to be on disability because honestly, it’s demonized. I know I said that twice. (The shaming of people on disability, Medicaid and other “entitlement” programs is a post for another day.) I told her I want to get off those programs very badly and am working towards self-employment but I need affordable health insurance. I need health care reform. With all due respect, the only way that’s going to happen this year is with the Democrats’ plan. I asked her if there was any way she could support the Democrats’ billWithout taking a breath, Rep. Lummis did not answer my question. Well, actually, she did – by not answering it.

    She started immediately listing her Republican talking points about how they would do health care reform: tax credits, high-risk pools and let people buy insurance across state lines. I actually started rolling my eyes while she was talking. She never once said anything about how she could work to find a compromise with the Democrats which means she can’t. Or won’t.

    Also, Rep. Lummis basically told me not to apologize for being on Medicaid and that I was the reason the system was there. I had nothing to be ashamed or guilty about. However, seconds later, she told me both Medicare and Medicaid are going broke and we are saddling our children and grandchildren with back-breaking debt.How am I not supposed to feel guilty about that debt every time I go to the doctor or receive my monthly check via direct deposit? Or how about when Sen. Judd Gregg goes on MSNBC and basically pitches a fit about how health care reform is another entitlement program that will bankrupt future generations, like he did less than an hour before I spoke to Rep. Lummis?

    Needless to say, I was not impressed with Rep. Lummis.

  • I was, however, very impressed with Erin Kotecki Vest who some of you may know as @QueenOfSpain on Twitter. Erin asked Rep. Lummis if she was in favor of expanding Medicare and Medicaid after listening to talk about how wonderful she thought Medicaid was for people like me (more on that in a moment). Rep. Lummis said she was glad I was able to take advantage of Medicaid but said it would be “inaccurate” to say she supports the program as it is. “I’m glad that the safety net is there for the last caller,” she told Erin, referring to me. Still, she said she is an advocate for reforming Medicare. “We must ferret out waste, fraud and abuse.”

Can we please ferret the Republicans out of this debate? I appreciate the bipartisanship that the Sunlight Foundation and Blogher tried to introduce to this conversation but at this point, isn’t the GOP irrelevant? I want to pretend they are, at least, because John McCain and Lindsey Graham’s influence on Joe Lieberman is driving me up the freakin’ wall. If this health care house of cards comes falling down because Joe Lieberman, who was elected vice-president of the United States by the majority of the people in this country in 2000, decides to kill it, I just don’t know what I’ll do.

I just don’t.

UPDATED: 6:09 PM CST

For the record, in case that statement about “what I’ll do” if Joe Lieberman filibusters health care reform sounded weird or could in any way be construed as threatening, let me be clear: The only thing I’ll do is say bad words when no one’s listening so I can pretend I’m still a lady. Or I’ll engage in grassroots lobbying by emailing, faxing and telling my story. Nothing else. Yep, I’m kinda paranoid that anything I write online is considered published and could be traced back to me someday so there. I’ve covered my butt.

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This afternoon I had the pleasure of participating in a BlogHer conference call on health care reform with Sen. Jeff Merkley (D-OR). Sen. Merkley gave a brief statement on the goals of health care reform, saying that it will have an exchange to allow individuals and small business to buy health insurance as part of a large pool. In addition, there will be insurance reforms and investments in wellness and prevention.

After that, Sen. Merkley took questions from members of the BlogHer community. I got to ask the first question, which I have to admit was a teensy bit cool. Here’s what I asked, kinda-sorta verbatim to the best of my recollection:

“I had a spinal cord injury in 2005 and was paralyzed from the neck down. I regained my mobility but I still have a lot of health problems. I’ve been on disability and Medicaid since then. I am hoping to work my way to self-employment but I need affordable health insurance in order to do that. My guess is that the public option will be my best bet. We’ve heard Sen. Reid say that they’re talking about talking about the public option. So what is the status of the public option?”

Sen. Merkley told me that my situation is a good example of why we need health care reform. He said I would benefit from insurance reforms, such as not being denied coverage to a pre-existing condition. He explained I would be able to go to the new insurance exchange, where I could choose from a variety of difference insurance plans, including “hopefully a public option.” Sen. Merkley told me he is working very hard for a public option. “I think the odds are very good”, he said, speaking of the likelihood of a public option being in the final bill.

Looking back at my notes now, I wish I would have asked a follow-up question. I wish I would have asked what the public option would actually do. Who would be eligible? How much would co-pays, premiums and deductibles be? Would there be networks of preferred providers?

Oh well. Maybe I’ll get chance to ask another lawmaker that question. I hope so.

On to the next question: Audrey from Maine, asked why tort reform wasn’t a bigger part of the current push for health care reform. Sen. Merkley explained that tort reform, which has already been done in some states, has not substantially reduced the cost to citizens. In fact, it seems to have had about a 1% (yikes!) impact on the cost to citizens. Furthermore, he said tort reform would take away citizens’ fundamental right to sue for gross negligence.

Audrey also asked why there isn’t a bigger emphasis on health care savings accounts in the current debate. Sen. Merkley replied that most working Americans aren’t able to put money into a health care savings account. “It may be a nice addition to reform… It doesn’t get to the heart of the problem,” he said.

Susan, from Madison, WI, noted the lack of bipartisanship in the current debate on health care, particularly on the public option and wondered what issues Democrats and Republicans are able to find some consensus on. Sen. Merkley said there was bipartisan support for investments in wellness and prevention, disease management, growing the health care workforce and providing incentives to employees to stay healthy.

Sen. Merkley said the biggest difference between Democrats and Republicans is over the public option. Republicans believe in a for-profit health care system but “I couldn’t disagree more,” he said. He explained that he wants a system dedicated to healing people not to profits and shareholders.

Susan asked the senator what it would take to bring bipartisanship back to the issue of the public option. Sen. Merkley explained that some of the compromises currently being discussed might help, such as the opt-out idea, where states can opt-out of the public option if their governor or state legislatures decide to do so.

The final question came from Karalee in California (sorry if I got your name wrong, Karalee). Her family is uninsured and her son was just diagnosed with diabetes. Karalee asked if health care reform is passed, what will fill in the gaps for families like hers until the legislation goes into effect in 2013?

In my opinion, this is one of the best questions of the day (besides mine, of course). Sen. Merkley agreed saying, “It’s an excellent question. Unfortunately, I don’t have an excellent answer.” He went on to say that he has been asking these exactly questions on Capitol. He thinks that states should be allowed to set up their public options and insurance exchanges earlier than 2013 if they’re ready. Stay tuned, he said, because debate on this issue is still underway.

With that, the conference call wrapped up. Thank you, BlogHer and Sen. Jeff Merkley!

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I recently watched this intriguing video on health care reform (via CrissWrites.com) which raises the question: Is health care a privilege or a right in this country?

If health care is a right, like the right to free speech or the right to bring a loaded firearm to a presidential town hall, then doesn’t the government have an obligation to help every American get access to quality, affordable health care?

If it is a right, is the government obligated to guarantee quality health care for every citizen?

I think so.

There is no reason why an American should die because she cannot afford quality health care, whether that’s a Pap smear, seizure medication, chemotherapy or prenatal care.

On Friday, First Lady Michelle Obama eloquently made the case that health care is a woman’s issue. She’s right, of course. The health care sob stories always seem to be about women: someone with MS who can no longer work and is about to lose her house because she can’t pay the mortgage; a woman with breast cancer who is facing bankruptcy despite working full-time and having insurance; a woman who works two jobs and simply cannot afford insurance.

Sometimes I wonder whether we would still be debating the need for universal health care at all if these stories were about fifty-year-old (white) men not being able to afford their cholesterol medicine.

Or Viagra.

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