Holla at your representatives that you don’t want to fund abstinence-only sex ed.

Act at http://capwiz.com/advofy/utr/2/?a=12162006&i=92217564&c=

This is what I wrote:

I am very concerned about the safety, health, and happiness of youth in Indiana and across the nation.  So, I am writing to ask you to end funding for ineffective abstinence-only-until-marriage education programs including:

* Title V Abstinence Education program, Section 510 of the Social Security Act – (state formula grants), funded at $50 million

* Community-Based Abstinence Education under Title XI of the Social Security Act – (direct grants), funded at $116 million

* Adolescent Family Life Act (Title XX of the Public Health Service Act) abstinence-only grants, funded at $13 million

GRAND TOTAL: $179 million per year

It is my hope that by de-funding programs that don’t work, we can provide support that will help youth in Indiana, and across the U.S., safer, healthier, and equipped to make the best choices in their lives.

I know that my local school district has an abstinence-based curriculum and not an abstinence-only sex education curriculum.  However, the pressure of funding programs that do not fully discuss contraception, STI prevention, and acknowledge the reality that youth in Indiana (and around the US) are sexually active, regardless of whether this is the best choice or not, means that many youth in my community do not have the information they need to be safe and healthy and to encourage their peers to make safe, healthy life choices.

I have first-hand experience working as a volunteer doing presentations about healthy relationships, sexual assault, and domestic violence in Bloomington-area middle schools and high schools.  I have found that, because of the local school district’s and Indiana’s emphasis on abstinence and reluctance to talk about even the biological mechanics of sex, many youth lack the basic information they need to participate in a comprehensive discussion about preventing sexual assault and relationship violence.

This is just one local and personal example about how non-comprehensive, abstinence-only-until-marriage education sex education is failing to make Hoosier youth safe and healthy.  However, there is ample additional evidence at the dangerous shortcomings of such approaches.

Here are the facts:

• In spite of their receiving over 1.5 billion dollars in federal funds since 1996, not a single, sound study has shown these programs to have a beneficial impact on young people’s behavior.

• Recent studies show these programs can create harm by undermining contraceptive use when young people in abstinence-only-until-marriage education become sexually active.  In one study, abstinence-only-until-marriage program participants were one-third less likely to use contraception when they did have sex compared to students not receiving the restrictive abstinence-only education. Nationally, over 60% of young people will have had sex before graduating from high school.

•  Over 135 national organizations, including the country’s major medical organizations like the American Medical Association and the American Academy of Pediatrics, belong to the National Coalition to Support Sexuality Education and strongly believe in teaching young people both abstinence and contraception.

I know that issues around sex and youth can be controversial, but I believe that I stand with the majority of Americans who want comprehensive sex education for their young people.  A 2004 survey by National Public Radio/Kaiser Family Foundation /Harvard University Kennedy School of Government found that 86% of voters want young people to receive a comprehensive approach to sex education that includes teaching about both abstinence and contraception.

By voting to end the 179 million dollars per year funding for the following failed programs, you will be sending a clear message that you support science and common sense.

Both fiscally and in terms of public health, we cannot afford to continue funding this unproven, dangerous approach. Young people’s health and lives are at risk.  We urge you to side with public health, with the medical community, with parents, young people and teachers and oppose any new funding for the abstinence-only-until-marriage programs.

Feedback for sexual assault prevention in indiana

Reposted from Chiara:

i know i am kind of a broken record because i talk about the same things all the time, but here is the deal:
indiana is finally trying to implement a broad sexual asssault prevention plan, and insted of having random “professionals” decide what is best, they are asking hoosiers to fill out this survey to get an idea of what really affects people in their life and how to push for positive change.

it’s all online at : http://www. in. gov/isdh/23820. htm

even if you fill out a couple of questions it’s still helpful///

ok, hope to see ya all soon!

Healthcare and the state update

Healthcare and the State continued

There are few feelings better than knowing that someone’s got your back, or at least is looking out for you, or at the very, very least is holding up their end of being accountable to you.  So, I was really excited when my primary medical provider’s office called me and told me that, while the surgeon I had originally been scheduled to see didn’t accept the Healthy Indiana Plan insurance, they had scheduled an appointment with another surgeon.  They couldn’t find a dermatologist who accepted the HIP in Bloomington, but I could see one about the wart on my hand in Indy, in December.

Today I went to see the surgeon.  I had to wait an long time, or what seemed like a long time, but the receptionist was friendly and clear.  Being fairly healthy, and fairly irresponsible, I haven’t used healthcare services in a long time.  So, I feel like I have few points of reference to evaluate the quality of care that I’m receiving.  I think this is a common problem with folks who haven’t been able to see healthcare providers in a long time – you don’t know what to expect, so it’s hard to hold doctors, insurance providers, and paramedical staff accountable.  The surgeon was to the point, but moved through what he wanted to tell me really fast.  He was glad I didn’t smoke (it saved him a lecture), I had a sebacious cyst which was the result of a natural glogging of the sebacious glands, since it seemed inflamed and was on my neck where infection could easily spread to dangerous places like the spine it should be removed, I could choose to have it removed under local anesthetic at the office or by going under at the hospital.  The first option would be faster and cheaper, but bad if I had a low pain tolerance or an aversion to shots.  The doctor paused only briefly to allow me to make my decision. I chose the local anasthetic because I didn’t want to spend my day at the hospital, and, as I understand it, I am only covered for up to $1100 in healthcare expenses, so I need to watch costs.  The doctor prescribed some generic antibiotics (covered by the HIP, but they would have only cost me $4 out-of-pocket) to get rid of any infection of the cyst and scheduled a date for the surgery.
All in all, I’m happy with how things are going so far, but would be really nervous if I had to deal with more serious or complex medical issues.  I get this sense that I’m being herded through a big system, as efficiently as possible, and that I’d have to really struggle to make my concerns known and have my questions answered.

A tail of different healthcare experiences

I went to my first doctor’s appointment under the Healthy Indiana Plan yesterday, and went to the Volunteers in Medicine (VIM) clinic to get my records from the checkup I had there a year ago.  I wanted to write about these experiences and it seemed convenient to frame it in the metaphors of ‘a tale of two cities’ or of ‘hell and purgatory’ (sadly, there’s no healthcare heaven to be found in either of these places).  I realized though, that this such framings don’t do justice to the many different experiences that people can have with healthcare, all of which need to be improved.  A race to the bottom or a game of “who’s got it worse” isn’t very productive.  Having no experience is a kind of healthcare hell.  So is working a job with inadequate wages to maintain health coverage.  So is having state subsidised healthcare for your kids, but no support for keeping you as a parent healthy.  So is having insurance, but it not covering important and neccessary procedures.  So is not being able to select health providers that respect your experience and values.  Sitting in the VIM clinic, I realize that even though I’m subject to many of the same shortcomings of a volunteer-run community clinic that everyone else in the waiting room is facing, the simple reality that my job doesn’t particulary care when I come into work that day makes my health care experience dramatically different than others.  It also reveals that giving people mobility with their health and care is inseperable from mobility with employment, childcare, and a bunch of other things.

The VIM clinic is clean and pleasant, but a sense of stress permeates the reception and waiting area.  I think the VIM clinic is a necessary community resource and respect all the physicians and other volunteers who make the place go, but it is a band-aid and not a cure for the health care needs of Monroe county.   The times that I have been in there have always seemed hectic.  Patients become quickly frustrated when their records are lost, information about appointments was ambiguous, or expectations about timelines and procedures weren’t clearly communicated.  People working the counter try to respond politely and empathetically, but seem on the verge of cracking after being faced with the constant questions and demands that seem beyond the clinic’s available resources to coordinate all the records, appointments, and volunteer providers.  The woman in line in front of me is asking about what seems to be three different appointments.  She was supposed to get a call back about one last week, but never got the call.  She is told that a doctor can see her today, but that since she is a walk-in, she will have to wait.  The woman periodically returns to the counter asking if they can give her any idea of what time a doctor will be able to see her.  She is told she will just have to wait and she returns to the seats, looking nervously at her watch.

I once heard a cocky critic of universal healthcare say that it was totally unreasonable for Americans to expect both the same quality of healthcare they had been receiving and that it be available to everyone.  He also said that the quality of healthcare in the U.S. is so much better than that in countries with nationalized healthcare.  What little I have seen of foreign nationalized healthcare systems seems similar, in some ways, to what I see at the VIM clinic.  Doctors have strange hours, and you might have to get bounced around a few times before finally getting to see the correct doctor.  It seems amazing sometims that such a system works.  And, despite high taxes (and attempts to evade them), and some inadequacies with the care, people do get healthcare, and it’s free.  I think the biggest difference with with more universal care, though, is that the experience is more universal.  When there are problems with the system, there is a collective knowledge about how to navigate around them.  It seems more likely, too, that problems are recognized as systemic and there is more posibility of a socio-political push to remedy them.  In the U.S., with the “beggars can’t be choosers” ideology that underlies so many of our systems, health care consumers are too often blamed for the quality of their healthcare.  We struggle to find a better health care situation for ourselves and our families, and in doing so, have little time or energy left to learn how to be health care advocates for ourselves and others, or to understand exactly why the system is so broken and what we need to push for to improve it.  The frustration experience of dealing with disorganization or waiting to see a doctors at free clinics or the total lack of accountability and run-around that one gets dealing with institutions like Indiana’s now-privatized Family and Social Service Administration is one more way that our culture punishes those whose lives do not match up with the equation of “hard work equals prosperity” that underlies our American mythology.  Sadly, more and more people in America are finding that they’re left out of this rosy picture.

The complex that houses the offices of my primary medical provider that I chose (with a lot of effort) seems more like a hospital.  It is a large and sprawling and awash with muted pastels, potted plants, and out-of-date sports magazines.  I get lost trying to find my backpack before I realize that the reception desk and waiting room where I’m looking is identical to the one just down the hall where I left my backpack.  It doesn’t feel particularly friendly, but it also seems like it just works in a way that the VIM clinic doesn’t.  At least, I don’t feel the same sense of stress here.  The woman that takes my information at the counter seems busy, but collected and she greets me pleasantly enough.  I’m at the right place, they’re expecting me, and despite the trouble I had getting assigned to this doctor, they take my insurance card without complaint.  This is a relief because, for the past two weeks I’ve been more and more worried about the cyst on the back of my neck that managed to double in size and become inexplicably tender at the end of August.  It surely must be infected and its time to have it removed.  I go to see the nurse and then the doctor and both seem competant enough but spend more time entering information into a database on their laptop than examining me.  The doctor takes a quick look at my neck and says that I’ll have to see a surgeon.  She warns that many providers in town don’t accept the Healthy Indiana Plan insurance, so finding one might be tricky.  With that, the exam is over.  It seemed prefunctory, but I can understand that in today’s healthcare system, the role of many doctors is just to redirect patients to other specialists.  An appointment is made with a surgeon and I’m happy that things are finally moving along. It’s nice to just not feel a sense of collective nervousness in this place.  However, when the person scheduling my appointment calls the surgeon, she finds that they don’t accept the HIP.  She says she’ll call the HIP and find out what to do an call back if the surgery needs to be rescheduled. I’m relieved that I don’t have to try to negotiate this myself, but I’m still nervous that she might not call back.  If I want one thing from the healthcare that I receive, I want to feel like others are looking out for my well-being and that I don’t always have to be suspicious or my own constant advocate.  I guess I’ll continue and wait and see if I’m any closer to that reality.

A PMP, finally

Working a lot with computers, acronyms have become second nature – lately it’s been SIP and DID and PBX and a slew of other ones.  Somehow though, I’m surprised when I realize that they don’t just exist in the realm of computer technology.  I’m more surprised when, in these other contexts, they no longer seem like par for the course, this arcane language that one can take pride in navigating, but instead a frustrating impediment, a needlessly oblique interface to tasks that should be simple and painless for everyone.

Getting healthcare for the first time on my own and not through school or family health insurance and getting it through the state subsidized Healthy Indiana Plan has introduced me to an entirely new set of acronyms.  A primary medical provider, that is a family doctor, is a PMP, and your recipient ID number is a RID.  And while cold, technical terms for the participants in a network are fine when we’re talking about computers, when I think about it, it’s a little uncomfortable being reduced to a “recipient”.  Even without the acronyms, the language to describe getting healthcare quickly becomes unintuitive.

After having to change my doctor, or should I say PMP, twice because both my assigned doctor and one I picked from a list of doctors with an “active” status in the MDWise system were not accepting new patients, I ended up just calling most of the doctors on the list provided by MDWise and asking if they were accepting new patients.  It was hard to figure out what to say.  I tried using the PMP term, since that is what was used on the MDWise website, but it just seemed to confuse the seceretaries.  More confusing was when I asked if any doctors in their office were accepting patients.  Most of the doctors that are available through the HIP, with MDWise, in Bloomington are part of a large organization called Internal Medical Associates (IMA) that seems to have around 5 locations and, at least according to their on-hold message, around 60 physicians.

So, it was difficult to figure out which doctors were connected with which location and which phone number corresponded to the office of which doctor.  When I was told that a particular set of doctors wasn’t accepting patients, I was often transferred to another location without really knowing where my call was going.  One location asked me if I had to see a doctor, or if a nurse practitioner (a nurse with at least a master’s degree in nursing) would be okay.  I said either and was able to schedule an appointment with a nurse practitioner  only to then find out from MDWise that only appointments with doctors are covered.

Eventually, I found a doctor who was accepting patients, though not until September, and was able to schedule a physical.  I called MDWise and switched to this doctor and was told I would receive a new insurance card in the mail.  When I told the person on the phone that I had never received my original card, she said that there had been some delays, but that I should expect my new card shortly.  This whole process made me feel happy that I have a job that is flexible enough that I can take the time to make a bunch of phone calls during business hours.  It also made me hope that I will never have to fully master all the acronyms associated with getting healthcare in the U.S., particularly state provided healthcare.  It seems that those who have finally figured out how to navigate the system, to whom the acronyms are second nature, have done so only after a dire struggle to get themselves or their loved ones the care that they need.  I hope that I can stay healthy enough that the frustrations of figuring out how to get health care are an occasional occurence and not a constant reality.  Still, it is important to remember that people already facing the challenges of a state of health that requires more consistent care shouldn’t have to have the additional burden of wading through a bog of acronyms, redirected phone calls, and confusing or unknown information.  I can better understand why some people work jobs just for healthcare.  The idea of being able to get the care you want, when you need it, and to be treated with respect and dignity as you work through the process of that care now seems so amazing, almost luxurious.

I don’t think quality health care should be a luxury.  Perhaps I am naive enough about the logistics of providing health care to expect that everyone could have personal attention, respect, and advocacy for working out problems or questions, but I feel strongly that this should at least be the goal, the benchmark by which the heated issue of healthcare is measured.  I don’t think this is the case right now.  A friend recently made the observation, correctly I think, that the Healthy Indiana Plan is, in fact, a rather conservative proposal.  It seems designed, with it’s coverage of preventative medicine, to reduce the costs of the state from uninsured people using the emergency room and not being able to pay for it.  While it’s certainly true that using the emergency room as one’s primary medical care is not in the best interest of the patient either, my experience with the Healthy Indiana Plan suggests an ultimate goal of cost reduction and not of a positive and healthy experience for the patient.

I’ll continue to write here about my experience with healthcare, with the hope that others in Indiana can share their experiences and together we can identify problems and propose solutions to the state’s healthcare approach. Perhaps we can help share ways that we’ve been able to better navigate the system.  Finally, I want to express the way in which the idea of healthcare has become real for me and not just a topic of presidential debates or news stories.

Switching Doctors Failed!

I tried calling the doctor I selected last week to schedule an appointment.  The receptionist said they were no longer accepting new patients, even though I selected this doctor from a list that an MDWise rep gave me of doctors that, according to their system, were accepting new patients.   The receptionist at the doctor’s office said that they hadn’t had very much luck with the HIP so far and that I should try calling the doctors on the list to see if they are accepting new patients before switching through MDWise.

Healthy Indiana Plan: Scheduling a Physical

I have gotten my information packet from MDWise but I had to call to get my RID number and assigned physician. Today I got my second POWER account bill from MDWise, but it said I didn’t owe anything. I tried to call my physician to schedule a physical and they said that the doctor was no longer accepting additional patients and that I would need to call MDWise to work that out. So far, my experience with the HIP has been one of a lack of communication, clarity, and knowledge by the people I’ve talked to both on the FSSA side and the MDWise side.

Update:  I called MDWise and was able to speak with someone pretty promptly.  She told me that I would have to pick another doctor and pointed me to the list (actually a search) on the MDWise web site.   She had some trouble pronouncing the doctors names which wasn’t a problem because I had the web page in front of me, but would have been really confusing if I was just on the phone.   She had to list the names because not all of the doctors were accepting patients.  She said that I should pick a doctor and call MDWise back.  She said it would take 3-5 business days to make the switch and notify the doctor’s office and that I couldn’t call the doctor I chose to make an appointment until after that.

Healthy Indiana Plan Update

I still haven’t gotten my introductory literature from my health provider (MDWise) or my second month’s bill for my POWER account.  I called MDWise and they said they were behind on sending them but that I should receive them “soon”.  The rep also said that I shouldn’t worry about being late on my POWER account payment because of the delay in sending out the bills.  Finally, I was able to get the name and # of my assigned doctor and my Recipient ID (RID) number so I can go and receive healthcare.  So, if anyone else has the HIP and hasn’t heard from them, call MDWise or Anthem and see if you can get your info.  You can call Anthem at 1-800-553-2019 and MDWise at  1-877-822-7196 or 317-822-7196 if you are in the Indianapolis area.

More on healthcare

I just wanted to post a link to an old post about the Healthy Indiana Plan because it’s got some recent comment activity that might be of use to some.  You can find that post here.  I believe that the point of contact for the HIP is the FSSA, so many of the issues discussed in the previous post about the FSSA forum can also be seen in trying to navigate through the HIP system.

Also,  I heard a story on NPR this morning about a report that even insured people were experiencing less access to healthcare.  I couldn’t find a link to the story, but I did find a Reuters article on the report.

From Insured losing access to healthcare – US study:

 About 20 percent of the U.S. population delayed or were unable to get access to medical care when they needed it in 2007, up from 14 percent four years earlier, a study released on Thursday found.

About 9.5 million more people went without medical care in 2007, compared with 2003, the nationally representative survey released by the Center for Studying Health System Change, a nonpartisan policy group, found.

In a striking finding, the survey said although those without insurance were more likely to report going without care, those with insurance had a greater percentage increase in unmet medical needs.

Healthy Indiana Plan application status

So I’ve been tracking my application to the Healthy Indiana Plan on this blog and I recently got a comment asking if I had heard anything about the status of my application.   I haven’t yet heard anything back about this plan, either through regular or electronic mail.  I will post more as I find out more about the process.