Proposed Cuts in Medicaid will Threaten Coverage of Diabetes Pumps

We just received this e-mail:

"Dear JDRF Families:

The state's Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS) recently announced their Benefit Re-Design Proposal in an effort to address Arizona 's significant fiscal challenges and a substantial growth in the Medicaid population. One coverage cut that has been proposed is the elimination of Insulin Pumps for Adults (age 21+) living with diabetes.

This is a grave disservice to the diabetes community and we are asking for your help in fighting this proposed cut. AHCCCS is accepting public comment on this issue until June 26th via email. There is a public hearing scheduled for this Monday, June 15th at the AHCCCS Administration building in Phoenix from 3:00 to 4:30 p.m. We urge you to email Theresa.gonzales@azahcccs.gov with why coverage of insulin pumps is important for adults living with diabetes.

AHCCCS is recommending that coverage for pumps be eliminated for ADULTS ONLY, and though this may not apply to you or your loved one, it is still important that we fight this recommendation. Whether this directly affects you and your family, or whether or not you or a loved one utilizes the pump, allowing AHCCCS to eliminate this coverage will negatively the diabetes community and places access to quality care in jeopardy. When drafting your email, please include specific examples of how insulin pumps have helped your family manage their diabetes. If you or your loved one does not use the pump, please keep in mind the pump has been proven in a number of case studies to 1.) help patients better controlled blood glucose levels, 2.) benefit those suffering hypoglycemia unawareness and 3.) benefit those who are pregnant. Also remember, currently AHCCCS does not cover Diabetes Self Management Training, and that with this cut; AHCCCS will be even greater limiting access to quality care for those living with diabetes.

These recommendations will have to pass through the legislative process and once we have more information on exactly how the recommendations will move forward we will be reaching out again to you for your help in defeating the legislation before it has a chance to go to the Governor for her signature."

This irritates me to no end. We have massive waste in our health care system. But diabetes management is not one of them...

By the way here is the complete list:

Elimination:
- Emergency Dental Services
- Medically Necessary Dentures
- Genetic Testing
- Orthotics
- Insulin Pumps
- Services by a Podiatrist
- Percussive Vests
- Gastric Bypass Surgery
- Allergic Immunotherapy
- Well exams for adults
- Bone-Anchored Hearing Aids
- Cochlear Implants

Limitation:
- Non Emergency Medical Transportation (not available for waiver groups in Maricopa
and Pima counties)
- Negative Pressure Wound Therapy
- Somnography (limit to 1 study/year)
- Physical Therapy (limit to 6 visits/year)
- Durable Medical Equipment (limit to Medicare covered items only)
- Prosthetics (limit non-implantable items to $12,500/year)
- Transplants (selected limitations)

You, yes you, really, really, really need to listen to these podcasts

We are experiencing a historic economic meltdown. Last September 2008, Lehman Brothers collapsed which basically forced a massive collapse in the stock market, a credit freeze, and the most obvious indicator that our economy was in a free fall. The government has been in massive bailout mode ever since.

If you really want to understand what happened, and you really, really should, the best way to do so, to get a nice overview of what has happened in an even-handed non-partison way, you need to listen to these "This American Life" podcasts (or read the transcript):

The Watchmen

This is a very interesting overview about why the regulatory system failed to put a check on the massive risk our financial institutions took on over the past five to six years, and why they were unable to properly regulate.

One of the culprits is the why regulators get chosen and the way they get paid. Unbelievably, regulators are chosen and paid by the banks they regulate. The ratings agencies (yeah those guys who gave all of those now toxic assets AAA ratings) are yes, paid by the people they apply ratings on...

Part of the reason was that the ratings agencies just weren't strong enough to take on the big guys.

Part of the reason is that Congress passed a bill (signed by Clinton in 2000) that made it difficult to regulate the very parts of the financial system that ended up taking down the entire economy.

Finally this page provides links to some very smart and easy to follow radio shows given over the past six months or so that you simply have to listen to.

"The Giant Pool of Money"
This one describes how the quantity of money globally (real money, not fake - the world has gotten richer as we have innovated and have become more globally productive) has doubled the past 6 years. And how a big chunk of that came into the US markets. Couple that with the fact that Greenspan kept interest rates too low for too long just put enormous amounts of investment dollars into real estate, putting horrible pressures to find new buyers of that real estate, very directly causing the massive bubble we have now seen. Which ironically has caused a big drop in our productivity and global wealth. Yep, a big chunk of that cash has disappeared into thin air.

"Another Frightening Show About the Economy"
This is a great overview of what happened right after Lehman Brothers collapsed and AIG nearly collapsed. Why it freaked Bernanke and Paulson out so much. Because banks stopped lending to each other. Money market funds (which are just a shade riskier than savings acconts) "broke the buck" and were at risk of collapse. Lending came to a standstill. Even companies like GE and McDonalds could not borrow money. It was a historic time in our economic history. This show also explains credit default swaps and why they they were so bad and toxic and why the role they played in taking out the economy.

"Bad Bank"
This one has a lot of Simon Johnson in it. It describes the dire situation of the banking situation. How the housing collapse has made many of them insolvent. Quite literally, many banks have already failed, many more would have already if not for the massive amounts of money our government has given them.

"Scenes from a Recession"
This is a really poignant show that describes anecdotally some pretty crazy housing situations some people have gotten themselves into. Condos built complete with granite countertops but literally without a foundation...

Finally, this podcast, "No Map" has one segment in it about how banks are literally not behaving in their self interest.

It would make a lot of sense if they worked with individuals to restructure their loans, but they are not because they can't. They simply do not have the facilities to evaluate the massive amounts of people who could really use this sort of restructuring (maybe cut the loan amount some, drop the interest rates, etc.). As a result, massive amounts of people are walking away from their homes. Banks are forced to hold them and eventually sell them, losing far more money than they could have if they could have worked out a deal to keep the original owners in their homes.

Its a massive tragedy.

I am a regular listener of "This American Life", so this information trickled my way over six or so months. It might be too much to take all at once. So I do recommend spacing this out...

But I feel its vital that you listen to it. There's been a lot of partisan finger pointing in the public space. What I believe is that the blame is wide. Basically, we all had some amount of blame. Its time we worked together to get to a solution that will work.

But to come to a solution, you have to understand the problem. And you, my reader, have got to be part of the solution. So please, get informed.

Die Broke

I'm currently dabbling in this book, Die Broke. The essence of the book, really, can be captured on the front cover:

• Quit Today: Not necessarily literally, but quit the notion that you can derive satisfaction directly from your job. Your job is a means to generate income so that with that income you can derive satisfaction from life.


• Pay Cash


• Don't Retire


• Die Broke

The book is geared largely toward baby boomers. Demographically, it just doesn't make economic sense for people to retire anymore at age 65. The world is too uncertain, there are too many baby boomers retiring all at once, and people are living much longer than they used to. So, this is a paradigm shift. To learn to use work to generate income. Enjoy life throughout your life. This notion of leaving an inheritance to your children is not helping anyone out. Spend money on your kids while you're still alive. And of course, to keep out of debt will provide you the sense of security throughout your life, and will allow you to live flexibly.

In the book, he also talks about why we should avoid this notion of buying starter houses that we can quickly flip into a dream house after two or three house upgrades. Rather, he suggests to make your first house the dream house by saving longer for the down payment, and spending more time to find the house that will meet your needs throughout your life.

One final suggestion was the reverse mortgage, this notion that toward the end of life, after the house is paid off, to take out another mortgage that will allow you to generate income off of the house through the remaining years of your life. When you die, the bank gets the house...

But why leave the house to your kids anyway, it wasn't their dream house it was yours. Let them figure that out for themselves.

All very innovative ideas if you ask me.