I'm not reprinting it w/ all the links: go here

However it concisely sums up my opinions on the healthcare reform. WTF people.

1. Add a robust public option open to all Americans.
2. Remove the rollback of a woman’s right to choose.
3. Repeal the anti-trust exemption for private insurance companies.
4. Add early Medicare buy-in.
5. Add a real employer mandate.
6. Fix the excise tax that would reduce the quality of many Americans’ insurance. This can be done by properly indexing it so that it forever remains only a tax on “Cadillac” plans.
7. Move up the start date of reform to as soon as possible. Three years is too long!
8. Increase the affordability tax credits to individuals.
9. Expand Medicaid to 150% of FPL.
10. Reduce the maximum annual out-of-pocket limit to 5% of income.
11. Move up state waiver for innovation to 2014 and add ERISA waiver. The state waiver for innovation is a good idea, but having it start in 2017 creates a bureaucratic nightmare of putting in place one reform only to replace it a few years later. We need to fix our system now, not have states start working toward a real solution a decade from now.
12. Give states that set up “basic health programs” 100% of the money, and allow them to use the program for people above 200% of FPL.
13. Allow for drug re-importation so Americans can get cheaper drugs from Canada or Europe.
14. Give Medicare the power to directly negotiate for lower drug prices.
15. Give the government the power to negotiate for lower drug prices on behalf of all Americans (like every other industrialized country does to bring down pharmaceutical prices).
16. Create a national exchange with a strong regulation enforcer instead of state-based exchanges with weak local insurance commissioners.
17. Force all non-HMO insurance plans on the exchange (or at least on the new OPM exchange) to work with the exchange commissioners to collectively negotiate a single provider reimbursement rate for all insurance plans (as it is in Switzerland, Belgium, and The Netherlands.)
18. Add truly strong risk adjustment mechanisms to force competition based on quality instead of trying to dump sick customers (as is done in The Netherlands).
19. Increase the actuarial value of the minimum qualified plans offered on the exchange and base subsidies on the gold level (80% actuarial value) instead of silver level plan (70% actuarial value).
20. Force all insurance companies on the exchange to offer at least one precisely designed high quality insurance plan. This will allow true apple-to-apple comparisons, and make it harder for insurance companies to game the system.
21. Greatly reduce the amount of plan design leeway given to insurance companies to reduce their ability to game the system.
22. Make it illegal to sell basic health insurance for profit, like in almost every first-world country on Earth.
23. At the least, allow only non-profit insurance plans to take part in the new exchanges (or OPM exchange).
24. Reduce the community rating based on age to at most a 1:2 ratio with age rating bands. (one price for all 18-30 year olds, one price for 30-45 year olds, and one price for all 45-64 year olds).
25. Make minimum medical loss ratio 92%. (Try to do this in way to get around the CBO.)
26. At the very least, remove the MLR loophole for the individual market.
27. Allow state and local governments to apply for grants from the CO-OP program.
28. Allow the co-ops to sell insurance to anyone, not just the small group and individual markets.
29. Allow undocumented immigrants to buy health insurance with their own money on the new exchange.
30. Make all legal immigrants eligible for all public health care programs right away, instead of creating a five year wait.
31. Eliminate direct-to-consumer advertising for prescription medication.
32. Provide enough money to give every American access to a community health care center.
33. Follow the FTC recommendations and create a real pathway for biosimilars to create generic forms of the most expensive medications in this country.
34. Create a Government-run HMO option modeled on the VA system.
35. Scrap the whole bill and replace it with a single payer “Medicare-for-all” system.

And more:

1. Extend everyone’s COBRA coverage until the reform kicks in (like in the House bill).
2. Better define the term “medical loss ratio” in the bill to prevent insurers from gaming the regulation.
3. Give the IRS power and duty to enforce insurance companies’ MLR regulation.
4. Remove the six-month wait for the temporary high-risk pools for people with pre-existing conditions. If you can’t get affordable health insurance, it is immoral that the bill makes you go uninsured for six months before you get care.
5. Set up the exchange and all corresponding regulations for small business as soon as possible (a few months). They delayed the exchange because the regulations in the individual market require the expensive affordability tax credits. The small business market will not get expensive affordability tax credits, so there is no reason not to start the exchange just for the small group market as soon as possible.
6. Let insurers in the new exchange use a reimbursement rate based on Medicare plus some percent. (This idea from Jacob Hacker would have similar cost controlling effects as my previous suggestion of having the exchange commissioner force all insurers using PPO’s to negotiate one standard provider reimbursement rate.)
7. Use the OPM exchange to replicate something similar to the Swiss or German system. (Only allow only new CO-OP plans to take part. Mandate a 93% MLR, precisely define benefit packages, and have them collectively pool their negotiating power with providers and manufacturers. Make all co-ops on the OPM exchange share provider networks, reimbursement rates, and forms for PPOs plans or out-of-network charges. Create a robust internal risk adjuster and give all plans in the OPM exchange the power to reimburse at Medicare rates plus 10% for the first several years while the co-ops and OPM exchange gets off the ground.
8. Allow people below 190% of FPL, but who are not poor enough to qualify for Medicaid, to buy in to the program.
9. At least allow people who were on Medicaid but have incomes that increase just slightly above the Medicaid qualification cut off to “buy in” to Medicaid so that they can keep a seamless coverage despite minor fluctuations in income.
10. Fully Federalize the whole Medicaid program.
11. Provide serious special benefits to insurance plans that score very high on precisely defined sets of metrics (MLR, cost effectiveness, consumer reviews, survival rates, speed of claim reimbursement, easy of appeal process, customer retention, etc.)
12. Encourage states and local governments to find a way to merge their state employer insurance exchanges with the new exchange as long as it can be done in a way that does not reduce the quality or increase the cost of coverage for state employees.
13. Encourage community health care centers to work together to create new fully integrated, cost-effective health care plans to cover individuals in Medicaid, the new “basic health program,” or on the new exchange. (like the Community Health Network of Connecticut)
14. Have all insurance plans that provide coverage for young children have zero cost sharing for the health care of the child.
15. At least make all health insurance plans covering children have extremely low co-pays, deductibles, and out-of-pocket limits for the coverage of the child.
16. Have all young children in the country without insurance coverage, regardless of legal status, automatically enrolled in some form low out-of-pocket public health care program. (No child on US soil or anywhere else on Earth should ever die due to lack of access basic affordable health care.)


Not infinitely

I am patient, but not infinitely so. I am caring, but not without my limits. One of the biggest criticisms I get is that I love too much too deeply & accept far too much from those I love. I accept this too. The truth of the matter is that the line between in my love & out of it are so far back that most friends never get close to it. There are so few things that actually cross those lines. Acts of sexual predation, some murders, abuses, violence against children, extreme things like that. And of course: Lies. Lying to me, lying about me, lying in general that I find out about. That lil devil in all of those details: That I find out about. I find out. I always have, I most likely always will. It is strange when the actions of others force me to eliminate them from my life or from my heart. It is strange watching others I care about pretend to go along w/ people I see as untrustworthy. These are my musings this early early morning. I slept last night, have hot strong tea in my mug & a smile on my face.



I generally don't regret. I weigh my decisions & interactions, my choices in general very carefully. Not stops me in my tracks paralyzed w/ fear trying to pick a path sort of way, but you've met me, simple fast blink decisions. I screwed up. I was a poor judge of character. I let emotions get involved with the facts presented to me & I chose to believe in someone who should not be believed. It has come to my attention recently that a trusted friend should never have been that at all. In fact I feel awful. Not because I made that mistake. People (including myself) make mistakes, they screw up & that is acceptable. Once a mistake has been made, once it has been realized to be just that; everything then looks to how one handles themselves. Do they come clean & own up to their mistake & attempt to rectify things with the wronged parties? Do they begin damage control in the fear that others have noticed their mistake & attempt to control perceptions about themselves? Do they attempt a character assassination upon the person who pointed out their mistake in the hopes to discredit this individual?

I've chosen to come clean. Since last spring I have believed someone who has been lying to me. Most of the lies have been about other people. I did not step up on behalf of these others because I did not know them well enough to know I was being told lies. Instead I allowed these lies to influence how I approached & thought of these people. There were truths in the lies. But I realize now that I participated, however unwittingly, in the character assassination of others. I deeply regret that.

It happens when you enter a new group of friends that people talk, they give you insights, they share with you the details of the relationships you are witnessing. This is an important function of the social dynamic. I have found that I have given ear to someone, who is not so bright that they see all the ramifications of their lies (I'm saying this person is NOT a mini-Machiavelli), however they are bright enough to think they can control perceptions of themselves & others. Upon finding out the sheer magnitude of the lies I was told I am in utter shock. It was uncomfortable for me to be told things that people did not want the person they spoke of to know. I accepted it as a part of how this person chose to live, shrouded by secrets, they painted themselves as a public figure that people gossiped about. I've found it has less to do with that, so much more to do with attempts to control perceptions.

Think of this less as complaint or reveal and more as a confession. I've been lied to & lied about. BUT I perpetuated the lies by not stopping them. I feel awful about that. I regret that. I'm sorry that I put my name up in defense of this person instead of the people that were being vilified. Out of the darkness and into the light. Sunlight is the best disinfectant. And all that rot, rather all that growth.


A Love Letter to my friends

Dearest friends,

I love you for accepting me the way that I am. For allowing me to change & grow but not labeling me or putting me into a static box. You respect me & the hard choices I make. You treat me with respect, answer when I call, come when I need, aren't afraid to expect the same from me.

I love you. I love the ways you trust me. The truths you tell me. For calling me on my bullshit & reminding me when I'm staring at the line just how far I am from it. For loving me when I call you on your bullshit. For helping me to be honest to myself.

I love you for believing in me & supporting me in every imaginable way. Regardless of the situation, you help me process, to see all sides. You listen to me & tell me what you think & give me the freedom to make my own mistakes while still supporting me as myself.

The support you've given in the last few months has been immeasurable. You've kept me sane, kept me here, kept me in one solid piece. Without you...(insert ridiculously sappy Rent lyrics here)

For singing songs beside the graves, for touch, for understanding, for compassion, for talks til 0400 that never seem to end and yet have just begun, for laughter, for tears, for warming me better than a hot tub, for cooling better than the cold side of the pillow.

Thank you.

I've been writing that for weeks now - I feel it is as ready as it can be - of course - there is sooo much more.


Sweet lord...

Scares me oodles. Seriously everyday the world gets a lil more scifiscarelicious - though i've stopped chanting 1918 for a while.