Tag Archives: health care

DEFICIT LIVES,By Louise Annarino, October 14, 2012

14 Oct

DEFICIT LIVES, By Louise Annarino, October 14, 2012

The effort to make Americans fear deficit-spending could be better used discussing what we should do to stop deficit-living. Core areas of our cities, small towns and rural areas are struggling to survive. Poverty has dug a hole, a social and personal deficit, in which large groups of our populace reside. The stimulus has stopped the slide into the hole for most, offered a hand up and out for many, but too many see no way out.

How did we get here, with holes so deeply torn in our social fabric that the middle class has fallen through those holes along with the impoverished? When we did we stop building and strengthening America so all of us could keep the American Dream alive? Instead we allowed charlatans in the think-tanks, lobbyist firms, and the media to paper over the holes, and keep us entertained so we would not notice that the pretty prints they used were mere paper. It started out slowly, but with fall after fall widening the holes entire sections of the fabric split wide open, until the entire fabric was in danger of slipping out of our hands. President Obama took a firm grip, and sewed stimulus patches made of strong material over the holes, all the while warning us that the cloth was worn and need to be replaced; that the holes had so weakened the fabric that major change was needed,and that the fabric could otherwise tear again. But those who met secretly during his inauguration to plot his own down-fall through those holes, pledged to keep them open.

Republicans blocked President Obama’s efforts to select and install a new fabric to support our lives. Many confuse this fabric with the ‘safety net’ strung below it; but, it is not just the safety net which is in danger from Republican policies and the Romney-Ryan Budget, it is the entire fabric strung above the net. Yes, the safety net is struggling; but, not because it was not well-designed, nor well-built, but because it is overloaded by those who fell through holes in our social fabric. It was never intended to hold so many of us. The one way we can relieve stress on our safety net is to replace the social fabric and pull as many Americans off the safety net and back up into the middle class as we possibly can. This is what President Obama intends to do, what he has been doing, and what he will continue to do if re-elected. We must cast our vote to re-elect him president, and cast our vote to elect Democrats to the U.S. House, U.S. Senate, and to state offices who support his vision and will work with him to get the job done. What we do not need are those who insist we cannot replace nor repair the whole cloth; but, must simply remove people from the safety net through privatization of medicare, social security etc.

The National Poverty Center reports that the poverty rate was  22.4 percent, or 39.5 individuals during the 1950’s. “These numbers declined steadily throughout the 1960s, reaching a low of 11.1 percent, or 22.9 million individuals, in 1973. Over the next decade, the poverty rate fluctuated between 11.1 and 12.6 percent, but it began to rise steadily again in 1980. By 1983, the number of poor individuals had risen to 35.3 million individuals, or 15.2 percent.” http://www.npc.umich.edu/poverty/.

I still recall the photos of starving children, eyes wide with uncertainty, on the porches of Appalachia and the Mississippi Delta which stirred President Lyndon Johnson to declare a War on Poverty in the 1960s, which led to the decline of poverty. President Ronald Reagan’s stance in the 1980’s was that we had lost the War on Poverty;and, that social safety net benefits did not justify its cost. We soon saw poverty levels increase.This Reaganomics view of poverty prevails today. But a new paper from Bruce D. Meyer and James X. Sullivan says it’s missing everything. “We may not have won the war on poverty, but we are certainly winning,” they write. When they looked at poorer families’ consumption rather than income, accounted for changes in the tax code that benefit the poor, and included “noncash benefits” such as food stamps and government-provided medical care, they found poverty fell 12.5 percentage points between 1972 and 2010.” In effect, they are explaining that the safety net does work.

The problem is NOT the safety net but growing income inequality in our social fabrichttp://www.businessweek.com/articles/2012-09-12/record-u-dot-s-dot-poverty-rate-holds-as-inequality-grows During the last decade the highest quintile of earners saw their real income rise 1.6% and the top 5% saw their incomes rise 4.9%, while the middle class saw their incomes decline 1.9%. The very lowest incomes, those in the safety net, saw their incomes stay the same. None of this data means the income of those in the safety net is adequate. Nevertheless, the extremely poor (those with less than 1/2 of official poverty level earnings), remained at 6.6% of the population. The middle class has not fallen that low because President Obama’s policies stopped the fall. As more people returned to work in a steady rise over the past nearly 4 years, the fabric of America grows stronger as well.

More is yet to be done, as President Obama reminds us. We cannot reduce the deficit and continue Bush tax breaks for top earners. In fact we must increase their income tax rate,including an increase on capital gains. The estate tax must not be eliminated but increased for those at the highest earning bracket, who are the only persons currently required to pay estate tax, it having been eliminated for lower income earners decades ago. And we must end the round of ceaseless war which benefits military contractors, and corrupt government officials at home and abroad. President Obama, as Vice-President Biden affirmed in his recent debate with Congressman Paul Ryan insists that American troops will be out of Afghanistan in 2014. He suggests that we instead, rebuild America’s education and transportation systems, repair and further develop American infrastructure, invest in small business development and manufacturing, research and develop green and innovative technologies, reduce and redesign our military capabilities for more cost effective security at home and abroad.

We can do all this and reduce the economic deficit. But, we must also end our willingness to overlook poverty, especially for those most greatly affected by it, our women and children.We cannot grow our economy when our children are not given the tools they need to compete and succeed. The National Poverty Center reports: “The poverty rate for all persons masks considerable variation between racial/ethnic subgroups. Poverty rates for blacks and Hispanics greatly exceed the national average. In 2010, 27.4 percent of blacks and 26.6 percent of Hispanics were poor, compared to 9.9 percent of non-Hispanic whites and 12.1 percent of Asians.

Poverty rates are highest for families headed by single women, particularly if they are black or Hispanic. In 2010, 31.6 percent of households headed by single women were poor, while 15.8 percent of households headed by single men and 6.2 percent of married-couple households lived in poverty. (See the U.S. census chart below)

“There are also differences between native-born and foreign-born residents. In 2010, 19.9 percent of foreign-born residents lived in poverty, compared to 14.4 percent of residents born in the United States. Foreign-born, non-citizens had an even higher incidence of poverty, at a rate of 26.7 percent.” http://www.npc.umich.edu/poverty/.

Children Under 18 Living in Poverty, 2010
Category Number (in thousands) Percent
All children under 18 16, 401 22.0
White only, non-Hispanic 5,002 12.4
Black 4,817 38.2
Hispanic 6,110 35.0
Asian 547 13.6

SOURCE: U.S. Bureau of the Census, Income, Poverty, and Health Insurance Coverage in the United States: 2010, Report P60, n. 238, Table B-2, pp. 68-73.

Those like Paul Ryan who argue we must reduce the deficit by reducing the safety net, decreasing income and benefits, weaken labor unions, reduce the size of government and lay-off government workers, privatizing government responsibilities as means to reduce government costs are “whistling Dixie” in more ways than one. Paul Ryan voted for unfunded Medicare Part D, which President Obama, unlike President Bush, has now included in his budget and improved through Obamacare by closing the donut hole. Including this expense within the Obama budget is really a disclosure of previously hidden Bush budget expenses. This is also true for the costs of the Iraq and Afghanistan wars which were passed as emergency measures, not budget items; included by President Obama in his budget and added to official budget deficit figures, but not done so by President Bush.

One must also note that Bush war-funding was historically unprecedented. To pay for World War II, Americans bought savings bonds and put extra notches in their belts. President Harry Truman raised taxes and cut nonmilitary spending to pay for the Korean conflict. During Vietnam, the US raised taxes but still watched deficits soar. President Bush did nothing to control the burgeoning deficits of war. Republicans and Democrats, unwilling to leave troops in the field without funding, settled with uncompromising Republican leadership and allowed this strategic undercounting of the deficit to go unabated and continued to vote for emergency war-funding, outside the regular budget bills. The willingness to kick the can down the road has become a hallmark of Republicans as they block every Democratic bill to increase jobs, reduce deficit, and stimulate the economy during the Obama administration. They are not ashamed , but proud of this tactic in their strategy to make  President Obama a one-term president. In the recently released video of Mitt Romney talking with his well-heeled donors in May he takes this tactic a step further,when he said the Palestinians were not interested in peace, the chances of a peace agreement was remote and the whole issue should be kicked down the field. Kicking problems down the field seems to have become an accepted Republican strategy. The Bush tax cuts added some $2.8 trillion to the national debt, according to the Congressional Budget Office. Congressman Paul Ryan voted for those cuts. To his credit, Ryan also backed the Troubled Asset Relief Program bailout, most of which has been paid back, and the auto bailout.http://www.theatlantic.com/politics/archive/2012/08/is-paul-ryan-really-a-fiscal-hawk/261170/. I mention this because it is disingenuous and hypocritical to blame the deficit on President Obama and democrats in Congress.

I first noticed this Republican disregard for current reality and for balanced budgets during 6 months of debate over Medicare reform in early 2003. I had falsely believed that Republicans were fiscally more conservative than Democrats. Clearly,I was wrong. Reagan, I was aware, had little to no regard for fiscal responsibility, but he had once been a Democrat after all !

Like many others, I saw the need for prescription coverage for seniors and hoped new legislation would allow the government to negotiate for lower costs and formulary control similar to V.A. cost-control efforts. Big Pharma lobbyists blocked, and continue to block such an effort. The bill came to a vote at 3 a.m., just minutes before it was scheduled to close, the clock was stopped for 3 hours with the bill losing, 219-215 while Republicans on the floor, and including President Bush by phone, strong-armed congressman to change their vote. “Then-Representative Nick Smith (R-MI) claimed he was offered campaign funds for his son, who was running to replace him, in return for a change in his vote from ‘nay’ to ‘yea.’ After controversy ensued, Smith clarified no explicit offer of campaign funds was made, but that he was offered ‘substantial and aggressive campaign support’ which he had assumed included financial support.” http://www.theatlantic.com/politics/archive/2012/08/is-paul-ryan-really-a-fiscal-hawk/261170/.

At about 5:50 a.m. the bill passed the House 220-215. The bill itself was finally passed in the Senate 54-44 on November 25, 2003, and was signed into law by President George W. Bush on December 8. Now, Romney and Ryan threaten to eliminate Obamacare and its improvements of medicare, including Part D; plan to privatize medicare and social security. If these programs are more costly than they need be it is because of Republican refusal to rein in excess costs businesses extract from the program.

Medicare Part D did provide prescription coverage but did not reduce costs as much as it could have because of what it failed to include: it prohibits the Federal government from negotiating discounts with drug companies, and it prevents the government from establishing a formulary. It did, however, provide a subsidy for large employers to discourage them from eliminating private prescription coverage to retired workers (a key AARP goal). Obamacare now provides subsidies to small businesses which makes their overall provision of health care insurance affordable. Efforts to include negotiating costs for drugs under Obamacare was blocked by Republicans.

Clearly, it is not Obama’s efforts to reduce medical and insurance costs which makes these medial social fabric programs a drain on government coffers, but the effort of Republicans to protect and expand financial gain of private service providers. President Obama and Congressional Democrats do not seek unfair advantage over private providers; but seek to stop unfair advantage, fraud and abuse by such providers. Obamacare is already predicted to save medicare $716 billion in such provider and insurance company abuses. That money is being channeled to provide more preventive, cost-free health care services for medicare users. This is how we create a stronger social fabric for the middle class. Improving and increasing medicaid coverage is another part of strengthening American fabric.

During an economic downturn, individuals lose jobs, incomes drop, state revenues decline, and more individuals qualify and enroll in Medicaid which increases program spending. However,data indicate that declines in state revenues were a much more significant factor for state budget gaps than increases in Medicaid spending. “Total state revenues dropped by 30% in FY 2009 compared to total Medicaid spending increases of about 7.6% in that year,” http://www.kff.org/medicaid/upload/7580-08.pdf.

Today, 50 states plan or are implementing a new policy to control medicaid costs in multiple areas. State revenues have shown positive growth fro the last 7 quarters, as the unemployment rate continues to drop (now 7.8%) and the GNP continues to improve. States must continue to make delivery of service changes designed to improve care and control costs, thanks to Obamacare. Its “maintenance of eligibility” requirements generally prohibit states from restricting Medicaid eligibility or tightening enrollment procedures. Obama’s focus on wise and educated restructuring of programs for maximum efficiency and best practices in care delivery are another part of strengthening the American fabric.

But, and this is important, these improvements take time. They must however occur if the American Dream is to survive. While government works to  balance budgets, streamline and improve services, reduces fraud and waste it must never forget the impact of income inequality on those African-American, Latino and immigrant single-mothers. we must help them raise their children out of the safety net and up onto the social fabric of the middle-class. We must provide preventive health care, women’s reproductive health care, and children’s health care to everyone in America. We must be certain every child is well-fed, provided with stimulating day-care and pre-schools to ready them for a top-notch education. They need warm clothes for winter, safe after school and summer programs, neighborhoods free of crime and violence. We must not only show them a way out of poverty, but strengthen and empower them to follow the path. I am reminded of the United Negro College Fund motto “ A Mind Is a Terrible Thing  to Waste.” Our American middle-class motto must be “ A Child is a Terrible Thing to Waste.”  President Barack Obama and Vice-President Joe Biden would weave this motto into the fabric of America. They will not kick American children down the road, until the deficit is paid off. They will not continue and increase income inequality with tax relief to those who don’t need it. They will reduce the economic deficit AND the human deficit, by reducing income inequality.  That is how we strengthen the American fabric for all of us.


IT MUST NOT BE RAPE IF A WOMAN GETS PREGNANT,By Louise Annarino,August 20,2012

20 Aug

It Must Not Be Rape If A Woman Gets Pregnant,By Louise Annarino,August 2o,2012

As I write this I am listening to Tchaikowsky’s Sleeping Beauty Suite via Spotify, thanks to a helpful young nephew who downloaded it to my computer.Little girls love the story of Sleeping Beauty. Even those of us who are feminists to the core dream the most beautiful dream of all, finding our prince.  A few of us are lucky enough to have found him. Then there is rape, the stuff of nightmares.

Students moved into residence halls at The Ohio State University this week-end. Some of them will be raped; 1out of 4 is a commonly cited statistic. Another is that 90% knew their rapist; and yet another that 60% of male college students “indicated some likelihood of raping or using force in certain circumstances”(see more at http://www.crisisconnectioninc.org/sexualassault/college_campuses_and_rape.htm).

As a 19 year old student and Resident Advisor or RA at OSU I spent many nights in the University Hospital emergency room comforting such young women; and, sometimes comforting those who were hemorrhaging from a back-alley abortion. Abortions were then illegal. Sleeping Beauties, these young women, who sought to make a dream come true, woke up in a nightmare. Every 21 hours a woman is raped on a college campus.

It is not only college women, those uppity females who believe they are as smart and as competent as men, and able to compete with them who face sexual assault. Rape crosses all economic and sexual barriers. In a department of Justice Study 1 in 6 women and 1 in 33 men experienced rape or attempted rape. Yet, a 1992 report from the National Victim Center ( see more at http://www.911rape.org/facts-quotes/statistics )called rape the most underreported violent crime in America; with one in six victims reporting the rape. The 2000 FBI Uniform Crime Report states that a rape occurs in the United States once every 5 minutes.

The young are more likely to be sexually assaulted than adults. In the 1992 study the National Victim Center reported the following breakdown by age of victims:

29.3% were less than 11 years old
32.3% were between 11 and 17
22.2% were between 18 and 24
7.1% were between 25 and 29
6.1% were older than 29
3.0% age was not available

Getting lost in statistics? Each one is a human being just like you,your wife,daughter, mother,sister,niece. Rapists live among us as family, friends, neighbors. Rape is a violent crime not because of the nature of penetration, the level of force used, nor the behavior of a woman prior to the rape. It is because sex is used as a weapon to injure,maim,even kill a woman; body, heart and soul. Rape is meant to denigrate and defile a woman. To show her how worthless she really is. It is not a sexual act but a violent act using sex as the weapon.

While working on a graduate level project at a maximum security men’s prison in Ohio I discovered that most rapes are planned; inmates often described to me how they selected their victims. The reason most women report knowing their rapist is because he sets up potential victims by making innocent and deceptively friendly contact with her hours,days,weeks in advance; often, by simply asking for the time or directions and making conversation. Those women who respond favorably and kindly are selected. Those who ignore or showed distaste for the man’s advances are bypassed as likely to be a “problem”. I was told (women in the helping professions) teachers,nurses and social workers are particularly sought out. Since then, I am most unfriendly to any man I do not know and give a glaring look if asked for directions etc. Not very ladylike; I have no illusions about, nor dreams of being a princess.

I understood rape,finally, despite the hours I had spent with women who had experienced it, when I was nearly gang-raped while walking across the OSU campus in daylight, walking with two female roommates. I had taken several self-defense courses and like many women mistakenly believed I could take-down or escape a rapist, never imagining the possibility of pair or gang-rapes. 85% of rape survivors report they tried unsuccessfully to reason with the man who raped her. 55% of campus gang-rapes are committed by fraternities,40% by sports teams,and 5% by others.(http://www.oneinfourusa.org/statistics.php) In my case it was the intervention by the OSU football squad which saved me. GO BUCKS!

Which brings me to the Teapublican fraternity of men in the House and Senate who show their disdain for women by submitting bills to control them, deprive them of needed health care, and pay them less than men doing the same job. Recently, Representatives Todd Akin (R-MO) and Paul Ryan (R-WI) co-sponsored H.R. 3“No Taxpayer Funding for Abortion Act,” which initially included language which changed the definition of rape to forcible rape. Later,public pressure forced the bill’s supporters to remove that unacceptable and narrow definition. Perhaps Mr. Akin meant to say forcible instead of legitimate while defending his extreme anti-choice view because he believes some rapes are legitimate, and/or not all rapes are forcible. Either way the idea of rape held by Mr. Akin, Mr. Ryan and other Teapublicans is misguided. They discuss rape as if it were a sexual act, as if some sex is legitimate and some not; as if some sex is forced and some not. Rape does not illustrate a woman’s willingness or unwillingness to exert her sexuality. It can never be legitimate. It is inherently a use of force meant to denigrate and harm a woman. Rape is a weapon against women.It is a criminal act; and they don’t get it.

His very words over during a recent interview illustrate the Teapublican Akin’s failure to understand the problems women face: “First of all, from what I understand from doctors [pregnancy from rape] is really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.” Why is he talking with doctors about rape? Why is he not talking with criminal experts? Why is he talking about pregnancy resulting from rape? Why is he not talking about the injuries sustained by women resulting from rape? Why? Because he is not interested in rape. He dos not respect a woman’s right to be free of criminal attack when sex is the weapon.He is interested in stopping ALL abortions, even those resulting from rape. Abortion is his raison d’etre. SInce a woman who gets pregnant could not have been raped, there is no need to add an exemption for rape victims in legislation denying funding for abortion. This was no slip of the tongue;this is Teapublican policy espoused by candidates running on the Republican Party tickets across the country.

How would Akin and Ryan decide which rapes are legitimate or forcible, and which are not? If Akin’s scientific analysis is correct, any rape resulting in pregnancy would NOT be a legitimate rape since a legitimate rape “would shut that whole thing down”. If “that whole thing” did not shut down, then the rape must not be legitimate rape. The woman should not be protected nor her abortion/health care needs funded.

I resent having my female reproductive health system described as “that whole thing”. Akin and Ryan talk about God and religion so much one would expect a little more sanctity and appreciation for God’s design of women’s bodies. One would expect them to respectfully learn the truth about sexuality and reproduction. One would expect them to respect women and protect them from criminal violence;not parse such violence against women for political gain.

The Akin-Ryan denigration of women from the floor of congress and their campaign trails is painful and frightening to all women, but especially to those of us who have had to learn to overcome the hatred and disdain of the men who attacked us. Now,  presidential candidate Romney selects Rep. Paul Ryan to run as Vice-President. Mr. Akin, Mr. Ryan and Mr. Romney wound us anew. Of course they frighten us. They are the stuff of nightmares which have never gone away.



ObamaCare: Not a tree, But a Forest

30 Mar

ObamaCare; Not a Tree, But a Forest.
Louise Annarino
March 30, 2012

“The Best Time To Plant A Tree Was Always 20 Years Ago. The Second Best Time Is Always Today.” ~ Old Chinese Saying  

While every other industrialized nation has already assured universal health care for its citizens, the United States has not. Other presidents tried unsuccessfully to enact universal health care. It took President Obama’s pragmatic efforts to get the country this far. We still have far to go. It does not make economic sense to continue hi-tech health delivery system underpinned by a profit motive. A single payer system, removing the profit motive, is more efficient and cost-effective.

Dr. Atul Gawande’s insights caution us to not focus on cost over care. http://www.npr.org/2011/01/19/132931975/lowering-medical-costs-by-providing-better-care . His influence was written into ObamaCare, which offers free preventive care, researches and pays for quality outcome rather than billable minutes. ObamaCare is controlling costs by controlling quality, while extending coverage. An amazing accomplishment.

If allowed to become fully implemented ObamaCare will continue to shift what Evan Falchuk calls our misguided focus. “The misguided focus on saving money over good medicine means we get neither.  The surest way to save money is to make sure that patients get enough time with their doctors, who need to be able to use their training and judgment to help their patients make the right decisions.  It’s a global problem, but America suffers from the most exaggerated version of it.” Warning: Graphic Politics By Evan Falchuk, http://www.seefirstblog.com/2009/12/25/warning-graphic-politics/

Spending more money does not guarantee a better outcome. As of 2009, the “US still shows a dramatic divergence from the other countries, spending more than twice as much for a slightly below average life expectancy.” Graphing The Cost of Health Care by Jon Peltier,December 30th, 2009 Peltier Technical Services, Inc., Copyright © 2012. See chart at:Graphing The Cost of Health Care | Peltier Tech Blog | Excel Charts http://peltiertech.com/WordPress/graphing-the-cost-of-health-care/#ixzz1qceLwkVw. ObamaCare includes on-going reviews to determine what does/does not improve treatment outcomes; assessing quality while reducing costs.

In 2010 an analysis by Drs. Orszag and Emanuel in The New England Journal of Medicine summed up the multifaceted approach which makes ObamCare so promising and so confusing.”The ACA not only will extend health care coverage to millions of Americans but also will enact many policies specifically aimed at reducing the amount we are spending on health care and, by changing the delivery system, reducing the rate of growth in health care costs over time. Indeed, one of the essential aspects of the legislation is that unlike previous efforts, it does not rely on just one policy for effective cost control. Instead, it puts into place virtually every cost-control reform proposed by physicians, economists, and health policy experts and includes the means for these reforms to be assessed quickly and scaled up if they’re successful. By enacting a broad portfolio of changes, the ACA provides the best assurance that effective change will occur. Moreover, by taking a multifaceted approach that includes hard savings plus the mechanisms for creating a dynamic health care system, it enables physicians, hospitals, and other providers to consistently improve outcomes, boost quality, and reduce costs as health care evolves.” http://www.nejm.org/doi/full/10.1056/NEJMp1006571

Whatever the U.S. Supreme Court rules, I am convinced we will have universal health care soon. For reasons both humane and cost effective, we cannot afford not to do so. A single payer system, medicare for all, would best serve both purposes. The second best time to press for universal, single payer health system may be now. We should have planted this tree long ago. The U.S. Supreme Court may uproot or prune the sapling. We will continue to plant. ObamaCare is not a single tree, but a forest.


28 Mar

Louise Annarino
March 27,2012

What is health care? it is more than curing the sick or saving the dying.It is also preventing disease and enhancing wellness. In fact, Medicare has 3 parts: hospitalization, in office medical treatment and preventive care, and pharmaceutical coverage. The oral arguments both sides made today, and the questions of the Supreme Court Justices pivoted about a conception of saving lives through emergency treatment. it is easy to see how this happened. In arguing for the ACA (Affordable Care Act) one might think it best to stress the harm the ACA seeks to prevent in the strongest fashion, i.e. preventing the deaths of Americans. The opposition arguing against would argue that hospitals do not refuse treatment, and no one will die from lack of treatment even if they are uninsured since emergency rooms don’t refuse treatment. Focusing on emergency care is shortsighted.

Justice Scalia engaged in a conversation with General Verrilli who argued in support of ACA,each falling into the trap of distilling health care down to ER care:

GENERAL VERRILLI: No. It’s because you’re going — in the health care market, you’re going into the market without the ability to pay for what you get, getting the health care service anyway as a result of the social norms that allow — that — to which we’ve obligated ourselves so that people get health care.

JUSTICE SCALIA: Well, don’t obligate yourself to that. Why — you know?

GENERAL VERRILLI: Well, I can’t imagine that that — that the Commerce Clause would –would forbid Congress from taking into account this deeply embedded social norm.

JUSTICE SCALIA: You — you could do it.

It is time for a history lesson. “In 1946, Congress passed a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area. The program stopped providing funds in 1997, but about 200 health care facilities nationwide are still obligated to provide free or reduced-cost care.” – http://www.hrsa.gov/gethealthcare/affordable/hillburton/

I am familiar with this case, having assisted in enforcing its provisions while a Columbus Legal Aid Society Lawyer,1978-83, when local hospitals were failing to notify eligible patients of the program; denying care to those unable to afford treatment and/or suing them for unpaid charges which should have been covered under Hill-Burton. Is there a societal norm to treat those in need of medical care? Perhaps, but it is not consistently applied; and in the case of hospitals, did not exist under the law until hospitals needed the latest technology and machinery but could not afford it without help from the federal government. The competition between hospitals to have the latest and best drove this bill. Hospitals improved their competitive edge. To get the federal money to do so, they agreed to not turn away those seeking emergency room treatment. They agreed to stop the bleeding, restart breathing, sew up or put in a cast those in need of emergency care. What happens after the emergency is over, i.e. the person will not soon die is not part of the pact. Once one survives the emergency, further treatment is not assured. If one has no insurance, he must pay out-of-pocket. I am concerned the next step will be to repeal Hill-Burton requirements. Justice Scalia would have no problem doing so.

Justice Scalia spoke correctly. Not only could we imagine a system where hospitals and doctors are not obligated to provide health care; we were operating that way until 1946. We still are except for emergency care in the ER, and a percentage of reduced-cost hospital services for income eligible patients. Hill-Burton applies only to participating hospitals (not every hospital participates), and only to hospital costs. It does not apply to doctor’s services.

To focus on emergency care, a saving lives paradigm, and hospitalization needs is too limited a discussion. Health care is so much more.

Justice Kennedy expressed his concern that healthy young persons are mandated to pay for care they don’t need. He assumes more old persons than young persons die. Of course! But health care is about more than saving persons from death. Justice Scalia expressed a belief persons could buy health insurance when they go to the hospital, no need to mandate it beforehand. Again, he focuses on emergency care, hospital care; not health care.

I wonder if the arguments would be better presented by women. After all, we need health care no matter our age. We bear the babies while young, and we take the kids to the pediatricians. We also push the men we love to go to the doctor they strenuously avoid admitting they need to see. We understand health care as much more than emergency care.


13 Mar


Louise Annarino

March 12, 2012

We were walking home from the library; a visit to the library a daily event. My mother Angela would allow me to roam the library for books to read to myself, as she read to my younger brother. We bundled into our heavy sweaters and stuffed our check-out books into the pouch on the back of the stroller,tucked a blanket around my brother Michael and headed home. I had been disappointed that my 6 year old older brother Angelo was able to go to school, but I would have to wait until I was older. The library visit was one way to appease my hunger for knowledge.

The library was a magnificent and, to me, magical building of brick and granite, with Doric columns and huge multi-paned windows. The architecture became less impressive as we walked to the South-End, under the railroad trestle, to the house my Great-Grandfather had built from used materials. The wood was so old and dense that it was nearly impossible to hammer a nail in the wall. Holding onto the handle of the stroller, chatting with Mom, noting the changing demographic markers from rich to poor as we walked home, I asked Mom, “Are we poor?”

“No”, she said, “I have been poor and we are not poor. We have plenty of food to eat. You have your own bed with blankets to warm you. You have dolls to play with and books to read. There will always be someone with less than you, and others with more. Never compare yourself to anyone else.”

“Well, I don’t see why we don’t put all the money in the world into one big pile and just let everyone take their share. Then, no one would be poor,” I offered.

“Oh yes, they would,” Mom replied. “Some people would grab more than they should. Others would not be fast enough to pull out their share. Some would spend their money foolishly and end up with nothing. Others would steal from people or trick them into giving up their money. And, we would end up right back where we started.”

Well, that was an education in economics I was not happy to learn. But, Mom was right, as usual. She told me to work hard, study hard, and not waste my money on cheap clothes, nor useless items. And to “NEVER follow a fad.” She said that fads made people spend money on things that were poorly made, not meant to last, and easily discarded. In other words, a total waste.

Politics, as well as other arenas of American cultural activity, has become a fad for too many Americans. They are “dittoe-heads” who watch hate mongers for entertainment. They don’t take the time to search for lasting solutions, for policies which are “well made” and fit the needs of the country’s long-term economic growth. Unexciting but sound ideas make poor “sound bites”. They look for cheap fixes such as denying women contraceptive health care.They would end the Affordable Care Act, instead of improving it as single-payer health care, which is the most cost-effective health care delivery system. They deny LGBT community its civil rights. They tell immigrants to “self-deport”. They love the latest fad constructed by Karl Rove or the Tea Party.

The voters follow the fads of wall street and hedge fund investors, and commodities and oil traders; instead of regulating their activities, and despite the fact their un-regulated trades and investments brought this country to near-bankruptcy.

The approval rating of  President Obama rises and falls with gas prices, despite the fact he has increased US oil production to an all-time high, his policies have reduced the demand for oil, and he has expanded the development and use of alternative energy sources. Oh, and while he was doing all this, he saved the entire world from a second “great depression”. His administration is not a fad.

Thanks to Angela, I never follow fads. I look for sound economic policies with lasting impact. I am voting for President Obama.

Those who refuse any support for President Obama’s economic policies should have taken a walk with Angela.


14 Feb


Louise Annarino


Hopefully, this is the last time I shall have to discuss the Roman Catholic Church and the opposition of its Pope and its most conservative of Bishops to progressive political theory, and at times, to President Barack Obama.

I will not discuss the church’s theological positions. It is none of my business. Catholic women are not part of the church hierarchy and have no positional power within its ranks. Some may have personal power with particular members of the church hierarchy; but, personal power is ephemeral at best. Therefore, I am not entitled to any opinion on theological teachings. That has been clear since my baptism.

However, as an American, I am entitled to an opinion on its espoused political positions, and its corporate climate. I am also entitled to question whether as a religious institution it has any right to take a political position. Jesus’ response to his religious hierarchy “Render unto Caesar that which is Caesar’s, and to God that which is God’s”, Matt 22:21, is not simply a basis for the separation of church and state; although, one could argue such. It was his brilliant repost to a group of rabbis trying to trick him into taking a political position, or to discredit himself as a rabbi. Jesus himself had made it clear he was not a political Messiah, John18:36. The Pharisee rabbis were trying to prove otherwise. The Roman Catholic Pope and Bishops would be wise to follow Jesus’ lead. They are not political Messiahs. They are behaving like Pharisees. Their objective is political and financial power, in the guise of religious freedom. No one has asked them to deny their religious teachings, or practice their faith as they see fit. Giving them the benefit of the doubt, President Obama adjusted the political and financial demands of women’s preventive health care to eliminate any possible religious entanglement argument. The church has been outed;it’s outcry was never about religion. It has always been about politics.When the Bishops met 7 months ago to prepare an attack on President Obama’s health care mandates, they behaved like Pharisees, trying to protect their turf from the President they view as the usurper.

Let’s be clear, a church hierarchy which has treated women and children as second class citizens and done little or nothing to protect them; and, has in fact attacked them with impunity ( witch hunts, pedophilia) posits it should be able to deny any woman, Catholic or non-Catholic, comprehensive preventive health care. Really? For, now that the issue of providing insurance coverage for such care is off the table, the only thing remaining is the health care itself. The Bishops’ continuing opposition is simply opposition to women’s comprehensive preventive health care, period!

Thank you, President Obama, for making it so clear. Now, let us ignore the Pharisees and move on.

At age 10 I wrote a letter to then-Senator John F. Kennedy, and received a personal reply. I sent him several pages  listing American Catholics from pre-revolution through 1962 who had served America without becoming a tool of the Catholic church. Presidential candidate Kennedy was deemed an unacceptable candidate since many believed the Roman Catholic Church would try to use him to foster its own agenda, in violation of the separation of church and state. Senator Kennedy used my research in his debate with Richard Nixon. He was the first Catholic elected President of the United States.We know from history that it is dangerous to mix church and state. Millions have died over the centuries as the church imposed its will on the state. Many fled to the wilderness of America to avoid oppression resulting from merger of state and religion. President Kennedy had to overcome this perceived threat. Now, politicians struggle to affirm their willingness to be guided by religious institutions in matters of state. The backlash, should this not be prevented, has a long and bloody history. Women have never fared well under church dominated state action.

I am weary of those arguing the state is denying them the right to practice their religion. They have no right to force me to practice their religion! I have a right to the same comprehensive preventive health care as any other woman, no matter who is my employer; just as I have a right to minimum wage, unemployment benefits etc. Religious belief has no place in determining who is eligible for employment benefits.