Rollouts R Rocky

There is one lesson from the first chapters of Genesis that should have significance for legislators struggling with the expansion of Medicaid in Virginia.

The story goes that God created Adam and Eve and put them in a marvelous garden, where they should have been happy. Yet these perfect people in the marvelous garden responded to the temptation to eat the one thing they were not supposed to consume. They finally ate the forbidden fruit and God had to tweak his plan for them. It was rather a violent tweak, but it is not my story to edit.

Whether you take the story of Adam and Eve as metaphor or just the fair and balanced factual report of what happened, you should notice that one of the first ideas written down in human history and Christian scripture was that rollouts are rocky.

So just expand Medicaid. Or pass the Senate bill – that is better than nothing, and much better than two more years of study. The template is there, the money is there, and you aren’t going to do any better than God did in the first rollout. It won’t be perfect, but people will be able to go to the doctor when they are sick, and doctors and hospitals will be able to get paid. And that will be a good thing.

Having the Adam and Eve story to draw upon, we can possibly do a little better with the inevitable tweaking.


Live long, and prosper

While God, guns, coal, and fracking remain our salient political issues in the U.S. and we debate whether or not health care is a human right, I hope that young people are hearing about these new technologies and getting as excited about them as I am. I am revising my intent to not live much past 100, just so I can see a lot of this stuff happen:


No war on women here, folks

All the reasons we had a women’s movement, and all the reasons we still need one today, here in one place for your amazement –

Medicaid extension is needed in Virginia

On January 15, Consumers Union Advocacy sent me an e-mail asking me to contact my Virginia legislators about the Medicaid expansion provided for in Obamacare. Virginia’s Governor Bob McDonnell has stated he will not support the extension. I sent the letters, but I did not hear from the Governor or from Senator Bill Carrico. But I did hear back from Delegate Israel O’Quinn. He is concerned about the reliability of government, which I think is odd given that he is government. For what it is, our e-mail exchange:
Sent: Tuesday, January 15, 2013 9:01 PM
To: Israel O’Quinn
Subject: Bring our health-care dollars home!

Jan 15, 2013

Delegate Israel O’Quinn
General Assembly Building, Room 818
910 Capitol Square
Richmond, VA 23219

Dear Delegate O’Quinn,

I’m worried our state will lose out on billions of dollars set aside in health reform to extend coverage to all low-income working people in our state,  leaving our health programs continuing to struggle and missing out on huge economic stimulus and job growth.

Don’t trade Virginia’s health for political advantage. The Affordable Care Act lets our state take back tax money we’ve sent to Washington to extend health coverage to our residents earning little or no income. Say “YES” to this funding, so we don’t leave billions of our tax dollars in Washington and threaten the existence of our hospitals, as they would lose money to cover uninsured patients.

Additionally, this new funding amounts to enormous economic stimulus in the state. With the Federal government fully funding the cost of new Medicaid recipients for three years and then covering 90 percent or more of the cost each year after, we can expect to see a resulting expansion of health-care jobs in the state.

In good times or bad, it is your task to do what is best for the Commonwealth. We are still a part of the United States. Please do not deny our citizens the benefits of being Americans. I live in the Southwest, and believe me, RAM Clinics do not constitute health care. We live in a real world where real people need real health care. Please do not let this opportunity pass us by because of partisan bickering.

As you make difficult decisions during the legislative session, I urge you to support an extension of Medicaid for all low-income working families and others struggling to afford health care. It’s the right thing to do for residents, and it’s the right thing for our state’s economy and hospitals.


Mrs. Sarah Williams

On the 17th, Delegate O’Quinn responded:

Dear Sarah:

Thank you for your message regarding Medicaid expansion in Virginia.  I appreciate you reaching out to us.

I am particularly concerned with issues related to access to healthcare for rural Virginians.  I genuinely appreciate the job our healthcare professionals in SWVA perform, but our residents often have to travel many, many miles to access a primary care physician or a hospital.  Thus, access to healthcare is certainly one of my top priorities.

My primary concern with Medicaid expansion is three-fold.  First, I am concerned about what happens if the federal government cannot meet its obligation for the match money they have promised.  Second, I am concerned what happens if the match money runs out or is done away with and Virginia is left with the entire tab.  Finally, it is no secret that Medicaid needs to be reformed in Virginia and we need to see a serious effort to that end before any expansion can work properly.  Medicaid continues to eat up a larger portion of our budget each and every year and that is concerning to me.

That being said, I want Southwest Virginians to have the best possible healthcare and I will continue to work to that end.

I appreciate your message and thank you for sharing you views.  While this topic will not come through a committee on which I sit,  I will certainly keep your comments in mind as we proceed forward.

Kind Regards,
Delegate Israel O’Quinn
Fifth District

I appreciate the response from Delegate O’Quinn. But the expansion of Medicaid is funded by the federal government 100% for the first three years and would never cost Virginia more than 10%, with 90% funding by the federal government, so I think his concerns about cost are unfounded. And also, hey, 30,000 jobs in Virginia, money for our doctors and hospitals, and medical care for our low-income population. And I do not understand why we need to reform Medicaid and get it perfect before we can at least give people something. So I wanted to share these concerns:

Dear Delegate O’Quinn,

Thank you for the response, and I believe it is vitally important for the access to medical care in SWVA to be foremost in our minds in this matter. Like many others who have dealt with health care concerns, I know that good primary care reduces costs over the long term by preventing many critical situations from developing.

With regard to the federal government living up to its promise of funding, we all have votes. We need to vote for people in federal office who will keep the promises. We are not a poor nation, we are not broke, but we distribute our money unwisely in expenditures that could be more economically and humanely managed by reasonable discussion. The true foundation of good government is reason exercised among reasonable people who look at proofs and likely outcomes.

As this focus on what is reasonable affects Medicaid, the most needed reform to the program — getting medical care to people who do not have it — is being facilitated at this time by the federal government. We need to snap that up and run with it. What great good we could do in the field for doctors and patients, all while we work on the policy questions! It is in my mind like first putting out the fire and then getting the appraisers and electricians and architects in to see what you need to do to fix the faulty wiring. People who disagree with me on literally everything argue compellingly for accepting this money and doing the expansion, notably Arizona’s Jan Brewer in her decision to expand Medicaid in Arizona.

This is money for Virginia hospitals and doctors that will permit them to do what they are trained to do and what we know they want to do. To turn it down because of a distrust of government is unwise. We vote. We are not a despotic regime, either at the local, state, or federal levels. People voted their trust in you, and you have become the “government” because of that trust.  We do need this money and the medical care it will provide, particularly here in SWVA. Our doctors and hospitals need it. I love the doctors who do volunteer services at RAM clinics, but I don’t want to see them doing that. I want to see them able to take care of people as they should be cared for. We need better, and this federal program extends our grasp.

Thank you again for your thoughtful response. I look forward to seeing you again here in Bristol.

– Sarah

I still expect that Virginia will turn down the federal funding and continue to enjoy RAM Clinics. In Virginia, we are so tough we don’t need health care, free is too costly if it comes from President Obama, and we know that it is better to get that faulty wiring fixed before we put out the fire.

Why I am pro-choice

The most emotionally powerful fiction in politics today is that pro-choice is the opposite of pro-life. These positions are not opposites. They are different, but not on the same continuum.

Pro-life is a choice. Pro-choice advocates respect an individual woman’s decision to have her baby – even if she can’t afford it, if she is too young or too old, if it is her husband’s child or if she doesn’t know the father, even if it is the child of her rapist. A woman may choose to have a baby even if she needs fertility treatment in order to conceive. She may choose to have her baby even if doing so will end her career, stop her education plans, and insure her a life of hard work and low wages, and even if the child will live in poverty, subsidized by welfare and taxpayer-funded services. A woman may choose to have her baby even if it will damage her health or kill her, and even if the baby has severe problems that will insure fetal death or a short, painful, and difficult little life. Pro-life is a choice even when it is based on religion, because the woman makes the choice within her own religious and moral understanding. That no one should – or even could – force a religious choice on another person is not only a democratic principle, it is a New Testament Christian principle that a person must freely choose to follow Jesus.

Pro-choice on the other hand is not a choice. It is the assertion that each woman has a right to make her own reproductive choice because it is her body. Abortion in the first trimester is a reasonable choice – not a good choice, but often the least bad one – and an individual woman should have the freedom to make that choice. The pro-choice position protects a woman’s right to a safe abortion as well as her right to have her baby. In China a national effort to control population growth resulted in women being forced to have abortions under a restriction that permitted only one child to a family. Life is complex and unpredictable, as are nations and legislatures. The only good reproductive rights law that any legislature can enact is one that recognizes the complexity of women’s lives and circumstances, their humanity, their love of life and of children, their freely-chosen moral and religious understandings, and their right to choose when and if they will become a mother.


Ken Cuccinelli now says that Obamacare is fine

Virginia’s Ken Cuccinelli, a major force in bringing the constitutionality question on PPACA Obamacare, is now fine with the decision by Justice Roberts. He states that he did not consider the legal position that Roberts put forward in preserving the law. In an interview with The Washington Post, he said “That was not one of the combinations that were even in our top five. That permutation was one that we didn’t spend a lot of time thinking was a likely outcome.”

Why he didn’t think of interpreting the mandate as a tax is not clear, given that many in the GOP were crying that it was a tax. Perhaps he did not consider this interpretation because, if he had, he would not have had a basis for a lawsuit. The good outcome for Cuccinelli in forcing a ridiculous lawsuit into the Supreme Court is that it made his name among the radical right. Without Cuccinelli, perhaps there would have been no constitutional challenge — Lots of money saved, lots of stress averted — but not nearly as many people would know his name. It is difficult not to think he used his public office for political advantage. Regardless of the outcome or the merits of his lawsuit, his opposition to Obamacare kept his name in the national headlines effectively for over a year as a champion of the opposition to President Obama’s signature health care bill. Virginia taxpayers could wish he had thought about that permutation before filing the lawsuit and saved all that expensive ruckus.

The critical link between education and the kind of world we have

I have been thinking for a couple of days about how many MBA and other narrowly “expert” people we elect now to government — engineers, medical doctors, etc., and how this might have produced or aggravated our divisive and gridlocked public conversation. The general idea is that a narrowing of the curriculum to produce experts produces at the same time a tunnel vision with regard to ideas. Then along comes this 18-minute video from Ted Talks:

I do not have to research this phenomenon further.