ACA: So Much for Keeping Your Doctor

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It’s new enrollment season for ACA (Affordable Care Act). It’s time to buy new insurance or switch your insurance or make any type of changes to your insurance. It’s also the time when people hope, with baited breath, nothing changes from the previous year.

I’ve just purchased health insurance off the Exchange for my two children at the rate of $360 per month for both of them. It’s a decent PPO plan with a reasonable deductible, with pretty comprehensive coverage. I could have qualified for federal subsidies, but I chose to forego that and claim my deductions at the end of this year rather than upfront so that I don’t run into problems of certain doctors or providers not accepting my children’s on Exchange insurance. My son at the moment is under the care of several specialists on top his usual pediatrician, I need him to be as well covered as I can afford.

The first shock to my system this year is my pediatrician announced that she is no longer taking individual plans on or off Exchange. She’s only accepting group policies as her in-network. So, this makes my carefully curated and selected insurance policy useless. I am now out-of-network despite my PPO plan. For a simple check up and a vaccination for my two children cost me $757 out of pocket, the billing department from my doctor’s office will submit it to my insurance for out-of-network reimbursement and anything they receive they will refund to me or keep as as ‘credit’ at their office for us to use next time. However, unless a miracle happens, I have to meet my deductible before I get any coverage and/or reimbursement, and I haven’t met my deductible yet. Which then begs the question, what the hell did I get for $360 a month PPO plan that is NOT on the Exchange.

One of the hallmarks or the selling points of Obamacare is 1) It will cost less 2) We can keep our doctor or choose any doctor we like 3) Easy and simple to access. None of those are true. It doesn’t cost less and it won’t cost less in the long run as long as privately held insurance companies are allowed to opt out of the Market Exchange. The Obamacare price model was predicated on insurance companies large and small pooling their resources to form one huge group to offer discounted insurance rates and better comprehensive coverage to patients. This model would work in theory, provided if insurance companies can’t willy nilly opt out when the profits don’t go their way. So far in California, a supposed ‘success’ story of Obamacare; UnitedHealthCare, Aetna and Humana all have opted out of the Market Exchange due to ‘infeasibility’ or translation: not making enough money off of sick people. These also happen to be the three best companies in terms of coverage. And they do not offer individual plans to consumers, they only offer big group plans to employers. Another woman with two small children at the doctor’s office the same time I was covered under the NHL Player’s plan offered by Aetna. Her plan was accepted without a problem. So we are back at where we started, people who are lucky enough to be employed with companies that offer health insurance benefits and are covered under a big group policy get the best access to health care. Everyone else sort of languish between not being able to choose or afford the best care they can get or worse, going on state funded insurance, which can be yanked away by President Elect Donald Trump after January 20th, 2017.

We ‘can’ keep our doctor, provided we pay out of pocket for them. My son who has some immediate health issues he needs to address, all the extras will just have to come out of our pockets. I can’t imagine the stress and anguish of parents with children who have special needs, to have to navigate this income and class driven health care must be disheartening. The whole health care industry is a massive collusion between health insurance companies, big Pharma and state governments who serves as a conduit to allocate those services and resources. State agencies and corporate boards get to decide how medications and health services are allocated, not the actual health care providers. This is a deliberately created scarcity so that health insurance companies and big Pharma with the help and collusion of the government can reap big profits at the expense of sick patients. This is why Universal Healthcare needs to happen and it can’t happen soon enough. The ACA was again, typical of Obama, the slimy fence sitter who wants look like the good guy fulfilling the promise he made to his voters but then not wanting to piss off his corporate donors at the same time. He dangled the Single Payer plan for ten minutes to make it look like this was his original goal but due to ‘factors beyond his control’, he’s unable to implement that. It’s nonsense. We do have a single payer system, for people over 65, it’s called Medicare and guess what, its satisfaction rate from both users and providers consistently rate at 90%, so it works. But the only reason why Medicare lasted this long is because its users are the older white demographic, folks who actually bother to drag themselves to the voting booth for every election, local or national. Politicians know this so they can’t aggressively gut the program yet. But with this new administration along with the shifting demographics from a white majority to a more diverse one in forty years or less, soulless conservatives such as Paul Ryan is looking to turn Medicare into a ‘voucher program’, aka, privatization, aka gutting it, which means the poorest, most vulnerable elderly people will die of diseases which can be easily treated or managed, and worse, die in deplorable undignified conditions. And in light of this, the media is focused on Trump and his alleged prostitutes. Maybe its their goal, so we are so distracted we don’t realize what’s happening to our most prized social services.

Got Milk?

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The ‘got milk?’ advertisements were ubiquitous in my childhood. They were everywhere. Park benches, side of buses, billboards, in magazines and even television with celebrity endorsements. We were all told that milk is a good source of calcium (a claim that’s since been disputed) and to encourage our kids to drink milk. Schools give it out with their lunches and breakfasts and poor kids get it for free. What we are never told is excessive consumption of milk can lead to severe anemia, because milk itself is iron bare and over consumption of milk can even block iron absorption from other foods. A fact that is not widely known.

Almost all children, and specifically toddlers all go through a fussy eating phase. Arguably one of the most frustrating phases for parents. This is where the bargaining and negotiating begins at the dinner table. The fussy eating vary in severity, some children just refuse to eat certain foods but will eat most other foods and you have some toddlers who refuse eat most foods except for the few that passes through their very selective palate. Most parents wait out this ‘phase’ as it is really just a phase, and before you know it they will wake up one day and eat everything in sight. This is the approach I took with my son. He is an exceptionally fussy eater. I’ve had a few rays of hope where he ate what I presented in front of him, but they were fleeting. Within a couple of days, he resorted back to his fussy ways. The good thing is, the few things he did eat were obscure but healthy like brown rice, quinoa, occasional broccoli and carrots, some white fish and LOTS OF MILK. He refused to eat any red meat, poultry or beans. I would try ‘trick’ him into eating some of those but it rarely worked.

My boy loves milk. His nickname (one of many) is Milk Monster. I was not concerned because I loved milk too and I drank an obscene amount of milk as a child and I never went anywhere near a hospital never mind an ICU for drinking too much milk. So, I let my boy have as much milk as he liked, continued to introduce different foods to him, prepared the staples that he would eat and left the rest to the toddler-gods. This was a recipe for disaster. All that milk he drank blocked any of the receptors in small intestines from absorbing iron, and over the course of a few months, he became anemic and a routine wellness check up landed him in the ICU. It is still a shock I am yet to process. I can see a headline, ‘Toddler In ICU Because of Milk’.

Over the recent years, with the popularity of healthy eating and veganism; the supposed good qualities of milk have been disputed and the current nutritionist recommendation today for toddlers over the age of 2 is no more than two 8 ounce glasses per day. Children are encouraged to get the rest of their nutrition elsewhere, preferably from fresh fruits and vegetables and whole unprocessed foods.

As I poured out my whole week’s menu and meal planning and my frustrations to the nutritionist who was assigned to me by the hospital, lamenting the fussy ways of my boy; she calmly said, ‘if you take away his milk, he’ll be hungry and he will eat the other foods you prepare, he’s currently getting all of his calories from milk.’ And just like that a lightbulb went off in my head and I thought ‘stupid me, why didn’t I think of that?’ I was so programmed into thinking that children must have milk that removing it from their diet never even crossed my mind. The team of hematologists (yes, the team came to see my son everyday because it’s a research and teaching hospital, when they get a ‘special case’, they get very interested) which consisted of two doctors from India, flat out told me to not give my children any more milk, they don’t need it. Then it dawned on me that a whole subcontinent of over one billion people rarely drink cow’s milk as their diet and they are just fine. Since my son’s major diagnosis was severe iron deficiency due to severe anemia, the hematology department has been assigned as his follow up treatment and care. And the lead attending physician, who is from India, an older motherly figure, said unequivocally ‘no more milk’. So, since his admission into hospital, my son has not had a drop of milk.

Since he’s been force weaned off milk, his appetite just exploded. He’s eaten almost everything in sight. He still won’t eat red meat, it must be the taste or texture, but he’s been eating chicken, spinach, broccoli, carrots, yams, spinach pasta and brown rice. His favorite snacks now are cashews. He chose cashews over potato chips, his usual snack of choice. I am beyond relieved but also quietly reflective at how things got to this point. I take pride in the fact that I feed my family home cooked meals. In fact, I put time and effort into planning my menu and preparing the meals. I spend far too much time in the kitchen for a mom in the year 2016. I avoid processed foods, we have almost no junk food. My children do not eat candy, my daughter still doesn’t know what to do with a lollipop, she threw out the last one she ate because it was so sweet and it tasted like nothing I’ve ever given her. Someone once gave her a Jolly Rancher candy and spat it out, I was never so proud. I am one of those insufferable mothers who monitor what her children eat so they don’t develop a palate for sweets and processed foods. They can eat anything they like, no matter how calorie laden as long as it’s freshly cooked and not processed (carbonara pasta is a good example). Yet somehow, my son ended up needing a blood transfusion.

His pediatrician said it was a perfect storm of events. His milk heavy diet notwithstanding, he also just got over a cold which he caught from my daughter, one of the germs she brought home from school. While she got over it with the sniffles and a few sneezes, my son got a fever and later a cough before it fully went away. The pediatrician said if he was already anemic to begin with (which he was), any virus he gets can put his hemoglobin levels below safe levels. She suspects this is what happened here, as there is no way to confirm this because his levels weren’t checked prior to his cold.

With some new blood (very grateful for blood donors) and a new diet, he’s resuming the healthy bouncing boy in the throes of his Terrible Twos (almost Three) again. There is a new spring in his step, he’s playing tug of war with his sister again; it’s as if none of this even happened whilst I am still ruminating the events of the last week.