Elyssa Durant

my.barackobama.com | Oct 27th 2009

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Elyssa Durant Answering the call by asking the right questions...
The Cost & Prevaleance of Chronic Conditions in the US By Elyssa Durant - Nov 17, 2009 10:26:44 AM ET Also listed in: Nashvillians for Obama | New York Action Team Cost & Prevalence of Chronic Conditions in the United States Statistics: Chronic Conditions Costs & Prevalence

Please forgive formatting errors: This document was created in 1996 and Blogger did not enter into my formatting plans... This was one of the most difficult posts for me publish because it was written before I incurred the debt of the population I was studying.

This is where I left off... perhaps someone has an idea where I can pick it back up...

Elyssa Durant/eds. October 27, 2009 13 years from the original date of creation... and life goes on ...

There is no effective system to care for those with chronic conditions in the United States; as a result, much of the care that is available is fragmented, inappropriate, and difficult to obtain. In comparison with acute conditions, chronic conditions call for a different kind of care: an integrated network of professional expertise. Chronic conditions do not always get worse; the health status of a person with a chronic condition can improve, deteriorate, or shift in either direction. The goal of chronic care is not to cure; rather, it should help individuals with chronic conditions maintain independence and a high level of functioning.

Problems encountered by people with chronic conditions

38% Cannot afford a service

19% Service not available when needed

15% Cannot easily get to a service

13% Quality of service so poor, won't use it

11% Cannot find needed medical service

SOURCE: Chronic Care in America: A 21st Century Challenge. The Robert Wood Johnson Foundation.

The disproportionate use of health care by those with chronic conditions is consistent across all age groups, as might be expected given their greater health needs. Almost all (96%) of home care visits, 83% of prescription drug use, 66% of physician visits, and 55% of emergency department visits were made by persons with chronic conditions.

Payers: Over 40% of the direct health care costs for persons with chronic conditions were paid through public funds (Medicare, Medicaid, and other state and local medical assistance programs) in 1987. In contrast, public funds paid for less than 20% of the treatment for persons with acute conditions (Figure 2). Among the chronically ill or impaired, private insurance covers about a third of health care, while it covers 45% of the costs of persons with acute conditions.

Using the most recent data source available, we found that 90 million Americans had one or more chronic conditions in 1987. If the same age- and sex-adjusted rates of chronic conditions are applied, we estimate that the number of persons with chronic conditions in 1995 was almost 100 million.

The magnitude of this figure is important for several reasons:

1. First, because the number of persons with disabilities due to chronic conditions is more commonly and regularly reported in the literature, the total prevalence of chronic conditions has perhaps been minimized. The majorities of persons with chronic conditions are not disabled, but are living normal lives. However, they live with the threat of recurrent exacerbations, higher health care costs, more days lost from work than others, and the risk of long-term limitations and disabilities.

2. Second, persons with chronic conditions are at greater risk for being underinsured, particularly those with more than one chronic condition. Short and Banthin estimate 29 million nonelderly people with private health insurance are at risk of being underinsured defined as a function of a family's risk of incurring high out-of-pocket costs for medical services relative to their family income. We found that a disproportionately large majority of all direct health care services, including physician visits, prescription use, and persons with chronic conditions use costly hospitalizations. Their per capita costs are over 3 times higher than those of persons without chronic conditions are. Consequently, they are at greatest risk of unaffordable high out-of-pocket costs.

INSERT RWJF CHART SUMMARY ABOUT HERE

Persons with co morbidities are particularly at risk of finding themselves underinsured; their per capita costs are 2-1/2 times higher than persons with only one chronic condition are. Furthermore, high utilization rates make persons with chronic conditions less attractive to managed care plans that typically cover more services, including preventive care, with less cost sharing. Depending on the adequacy of their health benefits, even middle-income families (for example, a household income of $40,000) could quickly incur out-of-pocket costs in excess of 10% of their incomes if the only expense incurred in a year was to cover their 10% share for a surgery and hospitalization costing $50,000.

Reference:
Chronic Care in America: A 21st Century Challenge. The Robert Wood Johnson Foundation
The Chronic Care Perspective. The Robert Wood Johnson Foundation
[available: http://www.rwjf.org/library/chronic/chrcare/introfact2.htm]

Figure 1. Categories of disabling chronic conditions

Source: Institute of Medicine, 1991

categories of conditions diagnostic condition codes proportion of people

mobility limitations arthritis, paralysis 38%

chronic diseases asthma, cancer, diabetes 32%

sensory limitations blindness, hearing impairment 8%

mental limitations senility, mental retardation 7%

other conditions 15%

Chronic Care in America: A 21st Century Challenge. The Robert Wood Johnson Foundation.

Figure 2. People with chronic conditions report on their service system.

Source: Unpublished data from The Gallop Organization, 1992.

YES NO DON'T KNOW

Understand services you are eligible for? 47% 47% 5%

Understand how to use the services you are eligible for? 60% 32% 8%

Know who provides what services? 57% 38% 5%

Feel it takes more effort to use these services than they are worth to you? 36% 48% 16%

Mail to a Friend | Link | Comments (0) | Report to Admin Applying Federal Law to Support Mandatory Coverage By Elyssa Durant - Jul 25, 2009 9:59:01 PM ET Also listed in: Nashvillians for Obama Underwriting the Social Contract: Distributive Justice & Health Care Reform

The Problem Statement

As health care costs climbed exponentially in the 1980's, so did the cost of health insurance plans. As a result, employers began to enroll their employees in managed care organizations, and many Americans were forced to leave their traditional indemnity type plans. With the advent of the health maintenance organization, there is a financial incentive for the underutilization of care. (Blumstein, 1996; Davis & Shoen, 1996).

In order to reduce financial risk, health insurance companies have restricted enrollment to individuals in poor health. By covering the minimal standards of treatment and excluding high risk groups altogether, major US insurance companies have realized that the health insurance market can a be an extremely profitable industry. The public sector absorbs the cost of unreimbursed care for chronic care in America (Robert Wood Johnson Foundation, 1996). Based upon these findings, it seems clear that the money being removed from the health care marketplace is fattening the pockets of CEOs and majority stockholders.

Recent trend towards localized government leaves individuals without a financial safety net. This is the least efficient manner to handle health care costs, and evades the premise that medical care is a natural right in a civilized society. Few Americans feel secure within the current system. The rising costs of medical care contributed to the recent market changes in both the administration and delivery of health services. The financial incentive to cover only the healthiest individuals ignores the fact that medical care is a social good.

Health Insurance Portability Act of 1996

Two years after the Clinton Health Plan was defeated in Congress, Senator Ted Kennedy and Nancy Kassebaum introduced the Kennedy-Kassebaum Bill in response to growing concerns about selective enrollment procedures used by health insurance companies in the private sector. In the final version of the Bill, insurance companies must limit preexisting condition clauses to twelve months. It has been estimated that this provision of the Bill will help an estimated 150,000 Americans obtain health insurance coverage.

There are many levels of the underinsured, including those without any coverage; effective policy must address the needs of the total population without shifting costs from one disadvantaged person to another. Kennedy-Kassebaum fails to address the cost issue—the primary concern for those at risk for losing their health insurance. It does nothing to help the uninsured acquire a decent health policy, and then provides no solution to the critical issue at hand— cost

Since Kennedy-Kassebaum does nothing to control the cost of health insurance and medical care in America, the Bill fails to respond to the issue of greatest concern to the citizens of this country: the cost of medical care. The Bill looks towards the states to develop consumer protections and weakens the regulatory role of the federal government. The majority of the American public is unaware of the fancy footwork involved with this legislation, and the demographics of the population it is intended to protect. In order to assess the utility of this Bill, it is critical to identify the populations at risk for loosing health insurance coverage and the underinsured.

Kassebaum-Kennedy focuses on a slim portion of the uninsured population, and those who would be eligible for COBRA continuation (Consolidated Omnibus Reconciliation Act of 1974). Of the 41 million uninsured Americans, only about 150,000 are expected to benefit from this legislation. The Health Insurance Portability and Accountability Act of 1996 is really nothing more than smoke and mirrors since it fails to address the true issue at hand—the simple fact that the cost of quality health care in America is becoming a privilege that only the wealthy can afford.

The Cost of Care for Pre-existing Conditions

An individual with high blood pressure may just require prescription medication. Cancer patients in remission may require chemotherapy, and a person suffering with a degenerative disease may be involved in treatment studies. Each condition requires individualized treatment that cannot be based upon the simple economic/cost-benefit analysis used in the utilization review process by large insurance companies. Clearly, the most effective treatment for one patient may not be the best for another. The time required for utilization review may present additional health risks and complications to a patient suffering from a chronic health condition.

Twelve months without insurance coverage may be financially devastating to some patients, and 63% of Americans have already forgone some type of medical treatment within the last year due to financial constraints. Publicity surrounding Kennedy-Kassebaum has hailed the bill as the "be all and end all in progressive legislation, however, in actuality it will only help about 150,000 people.

Recent studies have found that the majority of the uninsured population simply cannot afford to pay the premiums (Donelan et. al., 1996; Hoffman & Rice, 1996). According to their data, only 1% of the Uninsured population is due to current health status and exclusionary preexisting clauses, yet an overwhelming number of insured respondents reported an inability to receive medical care for chronic conditions. The majority of Americans with chronic illness are covered by some type of insurance, yet they are still subject to the utilization review process and access problems that deny or delay medically necessary treatment (Donelan, et. al., Hoffman & Rice, 1996).

Underwriting the Solidarity Principle

Traditional forms of insurance underwriting required that the contract explicitly state which illness or services are not covered by the policy, in advance. If the underwriter did not specifically state a certain condition in the contract, the insurer was held to the terms of the contract and required to pay for services utilized by the policyholder (Stone, 1994, as cited in Durant, 1996).

Increasing numbers of for-profit and non-profit insurance companies began to control costs by refusing to insure individuals who they felt would utilize more services. Insurers began to require health survey status questionnaires (refer to attachment A), and even began implementing AIDS and genetic testing to identify high-risk individuals (Brunetta, as cited in Gutmann & Thompson, 1996). In the 1980s, large insurance companies began including sexual orientation as a high-risk category, by using actuarial sound criteria. Such criteria concluded that gay men were a higher risk for contracting AIDS virus and refused to write policies for anyone believed to be homosexual, (Stone, 1994 as cited in Durant, 1996).

By limiting enrollment to the healthiest members of society, selective enrollment undermines the solidarity principle of health insurance (Davis & Shoen, 1996; Snow, 1996; Stone, 1994). By eliminating those who were suspect of using more services than their healthier counterparts use, insurance companies are able to offer rock bottom prices for young, healthy individuals. By excluding preexisting conditions and requiring certain individuals to purchase high-risk policies, the number of uninsured and underinsured Americans continues to grow exponentially (Durant, 1996).

More individuals are choosing not to purchase insurance simply because they cannot afford it. Even among those with employer based health coverage, the policies frequently exclude coverage for long-term illness or care of chronic conditions (MSNBC News Forum, 1996). Without a standard definition of preexisting conditions, these clauses serve as "wildcards" since they allow insurers to deny coverage for any illness that "manifested itself before the issuing date of the policy (Stone, 1994 as cited in Durant, 1996).

This statement allows insurers to deny treatment for benefits and services for the policyholder for undiagnosed illnesses or conditions of which they were unaware. As a result, the insurers began to demand medical histories of applicants and their families in order to identify high risk individuals (please refer to attachment A).

Legitimacy of Distributive Justice

While there is a legitimate role of government to distribute scarce resources among the nation's neediest individuals, sadly this is not the cause for the mismanagement of medical dollars in the United States today. There is a big distinction between an individual being denied prescription medication at their local pharmacy due to a cost-effective formulary developed by their Managed Care Organizations (MCOs), than an individual being denied a liver transplant because healthy livers are a scarce resource. While both may have equally devastating consequences, it is more difficult to rationalize a lost life based upon rigid cost benefit analysis and utilization decisions made according to formulas and cost-benefit analysis of treatment protocols.

"The political controversy over the distribution of health care in the United States is an instructive problem in distributive justice. Good health is care is necessary for pursuing most other things in life. Yet equal access to health care would require the government to not only redistribute resources from the rich, healthy to the poor, and infirm, but also restrict the freedom of doctors and other health care providers. Such redistributions may be warranted, but to what level, and to what extent?" Gutmann & Thompson (Page 178).

Blendon and his colleagues have reported similar findings in public opinion polls from 1992 and 1994 (Blendon et. al., 1992; Blendon et. al., 1994). A recent study by the American Medical Association found cost to be of paramount concern to an overwhelming number of Americans (Donelan et. aI., 1996). Of the 40 million uninsured Americans, only 1% attributes their failure to acquire health insurance coverage to their preexisting conditions. Among the uninsured, cost is cited as the primary obstacle in obtaining health insurance coverage. Only 1% of the uninsured attributes their lack of coverage to a preexisting condition.

Based upon these democratic principles of distributive justice, consistent opinion polls demonstrate the legitimate role and public desire for government regulation of the health care industry. It has become obvious that the federal government must intervene in order to protect natural law rights, the social contract, and the Constitution of the United States. Regulation is needed to protect the individual freedoms, liberty, and the pursuit of "health, happiness, and the American Dream."

If America is to be the "Land of Opportunity," then clearly individual health and wellness should be an ideal to reach for. Current models of distributive justice emphasize public consensus as a legitimate role for government intervention. According to a number of studies by Blendon and his colleagues, the public has reported an overwhelming general concern about health care in this country, (1992, 1993, 1994, 1995, 1996).

State civil courts are backed up with cases where HMOs have violated the First Amendment (gag orders), the Fourteenth Amendment (due process), and the rights of protected classes under the Americans with Disabilities Act. Countless examples of "anecdotal" evidence appear as headlines everyday across the country. (New York Times, 1996; The New York Daily News, 1996; Long Island Newsday, 1996; LA Times, 1996; Picayne Times, 1996; Columbia Spectator, 1996; Columbia University Record, 1996; US News & World Reports, 1996; Newsweek 1996; Healthline, 1996; The Tennessean, 1996; The Albany Times, 1996; The Nashville Scene, 1996). In their entirety, these case reports represent the human tragedy that lies beneath the web of the very worst of American capitalism: corporate greed.

Identifying Populations At-Risk

A study by The Lewison Group in 1996 reveals insight into the private individual health insurance market. Clearly, individuals choosing to purchase health insurance policies for several hundred dollars each month expect their health care needs and expenditures to exceed that amount Regardless of health status, a young healthy 25 year old who purchases an individual health insurance policy can expect to pay well over $300.00 monthly for a health insurance policy with Empire Blue Shield Blue Cross (based upon 1996 rates, current rates available from the New York State Insurance Department).

Since individual policies are not addressed in the Health Insurance Portability and Accountability Act of 1996 (HIPA), an individual policy with Blue Cross Blue Shield of Tennessee excludes preexisting conditions for 24 months (enrollment booklet available upon request). The critical markets in need of reform are the adversely selected individual insurance market, and the state's most vulnerable populations: children; the elderly; the chronically ill; the uninsured; and the underinsured.

For the millions of individuals who have lost their employer based coverage, the cost of private health insurance is prohibitively expensive. Many individuals opt out of the individual market and apply for public assistance when the need arises. Those who have retained their health insurance coverage through their employers are being moved into managed care despite their efforts to retain their indemnity style plans (Davis & Shoen, 1996; The Lewison Group, 1996).

Access to Medical Care

As routine practice, HMOs deny or delay care for all services that are not outright medically necessary. Growing numbers of individuals have suffered irreparable harm, and many have died awaiting approval from their HMO's (The New York Times, 1996; Long Island Newsday, 1996; The Tennessean, 1996; Healthline, 1996). It is hardly a secret that HMOs have fallen short of their promise to provide comprehensive health care for the "whole" individual by emphasizing preventative medicine, using medical management to coordinate care. There is substantial evidence that individuals with chronic conditions receive substandard care in HMOs.

A four-year longitudinal study of medical outcomes found that the elderly, the poor, and persons with chronic conditions were in better health when covered by fee-for-service plans compared with a control group covered in HMOs (Ware et. al., 1996). New statistics released in Washington, DC by the American Medical Association and the Robert Wood Johnson Foundation revealed the direct costs of individuals with chronic conditions account for 75% of direct medical expenditures in the United States (Hoffman & Rice, 1996; based upon the National Medical Expenditures Survey; raw data available on CD from the Department of Health and Human Services Washington, DC). 45% of the American population suffers from at least one chronic illness.

If managed healthcare has been found to deliver inadequate care to this population, then we are looking at 100 million individuals who are potentially facing personal and financial crisis as they are moved into managed care. The public already accounts for the largest payment of direct medical expenditures, which means the millions of dollars being made by for-profit insurance companies are not being circulated into the economy to assist in public health costs care. The industry made a 14.8% profit in the 3rd quarter of 1996, however these medical dollars were removed from health care and used to fatten the pockets of CEO's and majority stockholders (Healthline, 1996).

Based upon a new report from the Robert Wood Johnson Foundation, the direct costs for persons with chronic conditions represent 69.4% of national expenditures in personal health care (Robert Wood Johnson Foundation, 1996). Their direct medical costs are estimated at $4672.00 annually compared with $817.00 annually for individuals with acute illness (Hoffman & Rice, 1996; based upon National Medical Expenditures Survey 1987, not adjusted for inflation). This population is the most vulnerable to complications in their health and with their source of payment. Large insurance companies only provide adequate coverage for acute illness (Donelan et al., 1996; Hoffman et. al, 1996).

Medicaid Managed Care

Following Tennessee's lead, many states have enrolled their medically indigent populations in Medicaid Managed Care Organizations (MCOs). In Daniels v. Wadley, (926 F. Supp. 1305), the court held that TennCare violated the Due Process Clause of the Fourteenth Amendment since such procedures eliminate fair hearings and independent medical review of disputes. The court found the pattern of routine denials of care by MCOs participating in the states TennCare program to violate the Medicaid Act since it compounded the problem of institutionalized waiting periods for medical appeals pending independent review by the Medical Review Unit (MRU), (42 U.S.C. § 1396 (a)(8)).

Furthermore, the court ordered federal injunctive protection to participants and beneficiaries because no state law may preempt federal law by depriving individuals of their constitutional rights. The Department of Health and Human Services (HHS) was ordered to revise its utilization review procedures for TennCare recipients in keeping with the Medicaid Act (42 U.S.C. § 1396 (a) (8)) ensuring due process protections for all covered beneficiaries by requiring "services are provided with 'reasonable promptness,'" (926 F. Supp. 1305).

This case is one of 543 civil suits pending in the state courts for violations of the Medicaid Act (based upon a Lexis-Nexis search performed December 26, 1996). With the passing of H.R. 3507 into public law, (The Welfare Reform Bill) private citizens will find little reprieve in the federal courts, so any attempts to hold states accountable for violations of federal law will be feeble at best (Denkeret. al., 1996).

Managed care has shown itself to be a farce of "medical management" in light of all the condemning evidence to the contrary. Timothy Icenogle, a medical doctor in the state of Arizona commented in 1981, "We play sort of an advocacy role. I think the public demands something more from physicians than to just be a blob of bureaucrats, and I think we have to take a stand now and then. Our role essentially as patient advocate, is to tell them, well, just because the insurance company is not going to pay, that is not the end of all the resources," (Icenogle, as cited in Gutmann & Thompson, 1996). Never has this statement been needed more than it is today. Unfortunately, as more insurance companies refuse to pay for medical treatment, fewer resources become available for patients in desperate need of financial assistance. As Judge Kessler eloquently stated as she handed down her decision in Salazar v. District of Columbia, No. 93-452, December 11, 1996, "behind every fact found herein is a human face and the reality of being poor in the richest nation on earth, (936 F. Supp. Slip op. At 3).

Perhaps most distressing is the lack of accountability for mismanaged healthcare and improper denials of medically necessary treatment. HMOs claim immunity under ERISA, and leaving individuals without recourse in a sea contractual language and lengthy court calendars. It is evident that individuals protected under the Medicaid Act are not fundamentally different from other populations entrapped in the maze of managed care. They are simply those who have "had their day in court."

Due Process Protections

Since all Americans are theoretically entitled to due process protections under the constitution of the United States, it seems the federal courts are long overdue for making such a public statement. We are wasting precious time and losing millions in valuable human resources as we await decisions to be handed down from state courts. The Supreme Court of the United States has agreed to hear New York's request for an ERISA (Employee Retirement Income Security Act of 1985) waiver, making health maintenance organizations liable for medical malpractice in the state of New York.

When HMOs deny care from patients, it is ludicrous to hold individual physicians liable for the utilization decisions made by decentralized corporate review boards. It is time to take a serious look at tort reform, and demand action by the Supreme Court as they approach the date of New York's ERISA hearing. A blanket court ruling upholding Daniels v. Wadley, and Salazar v. District of Columbia is desperately needed to avoid an avalanche of liability suits filed in state courts. The court must uphold Daniels v. Wadley, and Salazar v. District of Columbia if further lives are to be saved in medicine rather than wasted away in the utilization review procedures. While we wait patiently for District of Columbia circuit court to order injunctive relief, the number of individuals suffering irreparable harm due to the systematic denial of medical care grows larger each day.

The history of Medicaid Managed Care does not provide a very optimistic look into the future of TennCare recipients and Medicaid beneficiaries in states around the country. Dating back to the implementation of the Arizona Health Care Cost Containment System (AHCCCS) in 1981, there are documented cases where "people reportedly died for lack of medical treatment before their eligibility was determined," (Varley, as cited in Gutman & Thompson, I 996). This leaves me to wonder why the states continue to enroll their most vulnerable populations into a system of managed care that has proven to be a disaster.

Perhaps worthy of comment is that Arizona is the only state to have voted Republican in every election since 1948—certainly provides insight into the conservative morale of the state. Although Arizona was the last state to accept the Medicaid cost sharing incentive proposed by the federal government in 1966, it was the first state to force its medically indigent population into managed care in 1981.

Violating Federal Law

Rigid pre-certification requirements and nonspecific utilization review procedures place strategic barriers to access medical treatment and services in Health Maintenance Organizations (HMOs). Pre-certification requirements are strategic barriers incorporated into the "black box" of utilization review that institutionalizes exclusionary waiting periods and routine denials of medically necessary treatment. According to federal law, "care and services are to be provided in a manner consistent with the simplicity of administration and the best interests of recipients," (42 U.S.C. § I 396a (a) (19)). Clearly, such rigid pre-certification requirements that complicate administrative processing and paperwork on the part of the enrolled beneficiaries is a violation of United States Code.

Furthermore, using primary care providers as a mechanism to limit access to specialists not only complicates administrative processing, but limits enrolled beneficiaries choice of health professionals beyond what is available to the general public in the geographic area (42 U.S.C. § 1 396a (a)(30)(A)). Certainly referral procedures do not "assure that recipients will have their choice of health professionals within the plan to the extent possible and appropriate," (42 U.S.C. § 434.29). Under this provision, it seems that any individual, especially those with chronic health conditions or disabilities should be allowed

Mail to a Friend | Link | Comments (0) | Report to Admin Is A Pubic Option the Only Option? By Elyssa Durant - Jun 29, 2009 7:04:05 AM ET Also listed in: Nashvillians for Obama

At 22 I was diagnosed with a degenerative spinal condition. Yes, there are times when the pain is so terrible, I cannot lifet myself out pf ed or tie my shoes. But far worse is having the knowledge that the level of damage to my spinal cord could have been stopped had I received adequate health care.

Yes, I had insurance. But who was there to make them pay???

14 years later, I finally received surgical intervention, and can feel my hands again-- and as a writer, that has been a miraculous gift.

Through the toughest times in my life, no one told me I was wasting my time and money on an education I would never be able to use.

After all I just wanted a diversion.

Even more disturbing than the damage to my spinal cord, is the realization that I missed mosre than 14 years of my life. So not only did I waste my time and money on an education I will never be able to use, I wasted a window of opportunity. A moment in time when I almost had a world the world at my fingertips.

Without any real place to go after college, I felt I had no other choice than to become a professional student of sorts—you know, the ones who stay in school forever to take advantage of cheap housing, health insurance, and student loans.

Unfortunately, I wandered aimlessly through the system acquiring useless knowledge and letters after my name that do not mean jack in the real world. But it distracted mye from the fact that my spinal cord continued to worsen my physical and emotional health.

So with no prosepects on the horizon-- and so thrilled thto feel my hands today, that the one thing I can do is write. So for now, I write, maybe tomorrow I'll read, but if there is any justice left in this world, maybe someday I will actually live.

http://darknightdurant.blogspot.com/2009/06/how-unemployed-pass-time.html

Mail to a Friend | Link | Comments (0) | Report to Admin Screw The Blues: Reform the Reform By Elyssa Durant - Jun 9, 2009 1:18:38 PM ET Also listed in: Nashvillians for Obama

I did not need another reason to demonstrate the need for immediate action concerning healthcare reform, however for those who feel Obama's current plan for reform is right on target, let me try to convince you otherwise. We need IMMEDIATE intervention.

However for anyone who needs to be reminded that we need to move forward, please read the excerpt below from KnoxViews:

"Blue Cross CEOs gorge on profits from premiums."

"The chief executive officer of Blue Cross of Tennessee got a big salary boost to over $2 million this year. Searches for "salary president ceo blue cross [statename]" will get you the figures for the rest of the states. To keep it simple, though, let's just assume that the 50 CEOs of each Blue Cross operation in each of the 50 states makes roughly what the top guy in Tennessee gets, Tennessee not being exactly one of the wealthiest states. That means we're looking at well over $100 million of our health insurance premiums poured into the homes, yachts, and kids' private schools of a tiny elite instead of going into the provision of health care for Americans."

-Vigil Proudfoot, KnoxViews available: http://knoxviews.mobi/node/11418

To learn that the CEO of Blue Cross Tennessee received a $2 million bonus is really not news at all. It is merely more of the same, and exactly what we can expect if the Healthcare Industry is expected to "curb" their spending. It just ain't gonna happen.

This just goes to show that we MUST have immediate intervention, regulation, oversight, and accountability over the Healthcare Marketplace. Not just the private companies such as Aetna or US HealthCare; make no mistake about it CMS Medicaid and Medicare have plenty of problems that must be addressed those programs are to intended to be the model for the rest of the country.

Obama's plan to come to the table with the Healthcare Industry is being passed off as Healthcare "reform" is a farce. The concept of self-regulation as the newest chapter in healthcare reform effort is a joke and my concerns continue to grow with each passing day. Since that compromise was made, have any of us seen any movement towards reform? Is there any evidence that we are moving toward covering the uninsured, lowering the cost of American healthcare or making it more accessible?

Asking or expecting the health industry to reduce costs through self-regulation without accountability is simply ridiculous. Especially when we see reports such as these that show a CEO salary of several million dollars.

Health care is already completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.

By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.

We rely upon one the ratings of physicians who have self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.

Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.

Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like "Reasonable and Customary Rates" and then choose to pay 80% of that amount. Therefore, by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.

Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.

The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly "priceless."

Good luck to those people who actually purchased supplemental plans they saw advertised on TV, you have been duped. Giving people (especially the infirm and the elderly) a false sense of security is unfair and unjust.

Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate for "just in case" scenario that results in major, catastrophic medical loss.

The administrative cost alone on the part of the "Responsible Party" is probably more costly than the initial service they received at whatever hospital for whatever condition.

You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and should be considered a public good.

We cannot believe or expect health insurance conglomerates will control their own spending and free from government intervention. We need to do something NOW!

Elyssa Durant, Ed.M.

Nashville, Tennessee

"You may not care how much I know, but you don't know how much I care!"

Available online:

http://thepowersthatbeat.blogspot.com/2009/06/screw-blues-healthcare-must-be.html

Mail to a Friend | Link | Comments (0) | Report to Admin Reform Requires Regulation By Elyssa Durant - Jun 7, 2009 9:15:51 PM ET Also listed in: Nashvillians for Obama

I have a serious problem with the most recent health reform effort. Asking or expecting the health industry to reduce costs through self-regulation without accountability is simply ridiculous.

The administrative cost alone on the part of the "Responsible Party" is probably more costly than the initial service they received at whatever hospital for whatever condition.

You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and should be treated as such. Mail to a Friend | Link | Comments (0) | Report to Admin Bredesen is the Wrong Man for the Job By Elyssa Durant - Feb 12, 2009 10:04:35 AM ET Also listed in: Nashvillians for Obama

There are widespread reports that Phil Bredesen of Tennessee is being considered for a position with the Department of Health and Human Services in Washington, DC. As someone who has lived and voted in the state of Tennessee since 1996, I have witnessed several shifts in policy, both on the local and federal levels. I am a recipient of TennCare, Social Security, and I a member of the Daniels Class. Governor Phil Bredesen has no place in Washington. Please remove his name from consideration for a cabinet position with HHS.

Governor Bredesen is currently "holding off in spending" until he learns what federal aid will become available to the residents of Tennessee. I am urging you to take immediate action. PLEASE sign the economic recovery package before it is too late.

Even under of the best of economic circumstances, the state has often been reluctant to release state monies until they are in physical receipt of all federal matching dollars. This delays program implementation and compromises the integrity of the research design. Consistency is a critical component of effective program development and design.

Governor Bredesen had decided to hold back state funds until the final details of the stimulus package worked out, were finalized. Anyone who has followed the healthcare crisis in Tennessee will tell you, Bredesen is not the champion of healthcare we once hoped he would be.

If we hold off on making decisions about the state budgets until the details of this enormous, comprehensive package are finalized, our current programs will suffer as a result. We cannot wait for a determination regarding federal funding before we to determine our state budget while before we of the programs we already are suffering financially.

Let me assure you that when it comes to withholding critical items like food, housing, social services, it adds up exponentially. Withholding medical care simply because of procedure and bureaucratic red tape, is shameful and cruel. The money is there, but it seems there should be a certain level of oversight and accountability if we expect it to be used effectively without delay and without excessive administrative delay and costs.

How do I know this? Because I used to work for the state during the time when they not only made the as they were transitioning to during the transition from I used to work for TennCare, We need to have some level of accountability to ensure the timely and proper disbursement of funds. In my experience, there is little recourse for person's individuals who are caught up in the complicated payment arrangements, complicated language, and the systematic, procedural delay when it comes to the processing and payment of claims.

Let me personally assure you, that there is a very real human cost here as well... and unless there is immediate intervention, much more than just money will be lost. Please sign the bill before any more jobs, homes, and future are ruined by because help did not fast enough. Please release the funds, because we are running out of time.

I am 36, and my spinal cord is damaged from years of delayed, sub-standard medical treatment as I attempted to navigate a system that simply does not work. I owe the federal government $179,982.00 in student loans. When I am able to work, I make $10.46/hour as a substitute teacher in MNPS. That job comes with no security and no benefits.

I have an advanced master's degree from an Ivy League Institution. I am nine credits shy of a Ph.D. in public policy. Despite having maintained a 3.83 grade point average while earning my masters, and just over 3.2 during the three years I was enrolled full time in a doctoral program.

Despite having comparable coverage, the insurance company refused to give me COBRA and would not cover my pre-existing condition even through both Columbia and Vanderbilt Universities used the same underwriter for student medical insurance: Chickering US HealthScare.

I had no break in coverage, and even purchased a private HMO (Oxford) plan that cost several hundred dollars each month just so I could prevent becoming uninsurable before my 25th birthday.

Wrong. Not only did I continue to pay for all three policies, I also had to pay for treatment and STILL wound up on TennCare and Medicaid.

Despite doing all the "right" things, I was still unable to transfer benefits from one graduate school to the next.

When I was twenty-two years old I developed a medical condition, and it quickly became obvious to me that it would be a lifelong struggle to cope and adapt to having physical disability. I purchased three independent policies, and was still covered under a terminal liability clause under a major medical ERISA (federal) plan. As someone who also needed to turn to federal funds and intervention in a crisis, I know that if or when help does arrive, it usually too late.

Where is the safety net? Where is the American Dream that I so diligently chased after for so many years? What was the point of investing so much in a future that I can never enjoy? How can anyone justify spending so money much on an education that will never be used? I understand the how; I just don't understand why.

Maybe one of these days Vanderbilt University and the Department of Education will realize it might just be cheaper to hire me that harass me. I need a real paying job now, but with the skyrocketing unemployment rate, it looks as though I will have a lot of competition.

Throughout the three year process of filing medical appeal after the next, I acquired over 1/4 million dollars in debt in unreimbursed medical care and student loans. I was fortunate enough be able t keep my TennCare that time—only because the state mandated a 30 hour work week, because at 32 hours, your benefits kick in.

Even while in the states employ, I witnessed a pattern of behavior that was reckless and harmful to the citizens of Tennessee. In fact, there were so many changes during short time I was there the time I was there that even my colleagues in the office of consumer affairs did not know about them until we were a formal complaint had been filed by a consumer in crisis.

There was so much chaos in the system because consumers and were not given sufficient information and the state was completely unprepared to respond to the large number of people who their benefits terminated, limited, or transferred. It took several months to update the medical database used to verify insurance coverage, and many more to get that information in sync with pharmacies and providers. Recipients were left in the dark, probably because it was easier that way.

Although I doubt many people, I Tennessee would the harsh policies enacted during the Bredesen administration, his endless assault on the state's poor and infirm is not the kind of man we want in DC. He has demonstrated a wanton disregard for the welfare of his own constituents should not be rewarded with a cabinet position in the new administration.

Now, again, I face losing my healthcare coverage once again. Please do something, and do it quick. I would not wish this experience on my worst enemy,

Unemployment rates in the state of Tennessee are at an all-time high, yet welfare roles have remained stable. This tells us that despite the financial crisis and sad state of the Tennessee economy, people are not able to access emergency aid that we would expect people to receive in times of economic hardship.

What will happen when the state begins the 150,000 members of the Daniels Class? DHS has not been able to process the applications already on file. As the unemployment rate continues to go up, we need to be sure that applications for emergency assistance are processed within a reasonable period.

I have no idea how they intend t handle the growing number of unemployed, uninsured, people in need of emergency assistance given that they are already overwhelmed by the number of applications already on file. Is it a really a good time to start the recertification of the 150,000 members of the Daniels Class.?

Let us hope not, or we are all in trouble.

Sincerely yours,

Elyssa Durant
Nashville, TN

Mail to a Friend | Link | Comments (0) | Report to Admin Please Sign This Petition: Forgive Student Loans By Elyssa Durant - Feb 11, 2009 6:34:07 PM ET PLEASE SIGN THIS PETITION BY CLICKING ON THE FOLLOWING LINK:
http://www.thepetitionsite.com/1/Real-Economic-Stimulus-Forgive-Student-Loans Please circulate to any or everyone you know who may be burried underneath a pile of debt in a really bad job market. Unless Congress can agree on an economic recovery plan soon, we will all be in big trouble. I urge you to contact your Senators and compel them to take action before it is too late. ______________________________
# 9271:
Feb 10, 2009, Elyssa Durant, Tennessee
I am 36 years old. My spinal cord is damaged from years of delayed, sub-standard medical treatment. I owe the federal government $179,982.00 in student loans. When I am able to work, I make $10.46/hour as a substitute teacher in an urban school district. That job comes with no security and no benefits. It does however offer the flexibility I need to receive the bi-monthly epidural injections and other procedures necessary to manage my pain and alleviate the numbness I feel because of the damage to my nerves. I have an advanced masters degree from an Ivy League Institution. I am 9 credits shy of a Ph.D. in public policy. Despite having maintained a 3.83 grade point average while earning my masters, and just over 3.2 during the three years I was enrolled full time in a doctoral program. The graduate school I will not grant me any leniency by extending the amount or time permitted to complete my degree-- or allow me to transfer those credits towards another program at the same institution. Vanderbilt will not even transfer any of the credits I paid for (in spades) towards another degree at the same university since they no longer have the program I was initially enrolled in. I think it goes without saying that I do not have the financial resources available to finish my last semester, take the GREs over again, or pay the associated application fees necessary to make the time spent there worth while. Throughout the three year process of filing appeal after appeal after appeal, I acquired well over 1/4 million dollars in debt due to uninsured medical expenses and student loans. My life will never be the same. My heart will never be the same. So after all this-- now I face losing my healthcare once again. Where is the safety net? Where is the American Dream that I so diligently chased after for so many years? What was the point spending so much on an education that will never be utilized? I understand the how; I just don't understand why. Maybe one of these days Vanderbilt University and the Department of Education will realize it might just be cheaper to hire me that harass me, because unless I find a real paying job soon, their collections department will no longer be able to reach me on that extravagant lifeline my friend, Mr. Brian Lapps, refers to as a luxury. Elyssa Durant, Ed.M. Nashville, Tennessee (former doctoral student in public policy)
Reply to: ed70@columbia.edu Mail to a Friend | Link | Comments (0) | Report to Admin COBRA is Not a Viable Option! By Elyssa Durant - Feb 11, 2009 4:54:15 PM ET Also listed in: Nashvillians for Obama Please be sure to get the word out quickly while we still have a voice in how the money will be spent as they put finishing touches on the economic recovery package. We need to stay informed and in contact while congress decides how and where the money will be spent.

COBRA is not a viable option for most people losing coverage. We need a alternative transitional plan to help those who are at risk of losing coverage in the midst of chaos resulting from the economic crisis.

In our efforts to provide an expedient response to an urgent and growing problem, let's not be too hasty by falling back on those systems already in place that have been not worked for us in the past.

We need a BIG fix to a broken system, and the economic recovery stimulus will not be enough. Consider the options carefully… http://healthcareforamericanow.org

Elyssa Durant
Nashville, Tennessee

Mail to a Friend | Link | Comments (0) | Report to Admin Career in Crisis: Career Confusion By Elyssa Durant - Feb 11, 2009 4:25:20 AM ET ed phoning home ouch
~fl)L~Yl8, 2003

After being rejected from a job that pays $18,000 / year at the
women's prison, a job that pays $21,000 teaching Head Start, getting
fired from Red Lobster (because apparently, I am just not Red Lobster
"material" I decided to go to the Tennessee Career Center to take
advantage of their high speed internet, free printer paper, and ink…

I was hooked up with an excellent counselor earlier this afternoon.
He has two master's degrees-- one in Educational I Career Counseling,
and a second in counseling psychology. This is the guidance counselor
I have been asking for since..., well, since... I was in a school
long enough to have a guidance counselor, but I never got.

Because I simply refuse to take any more of those tests. Not really
an issue any more, since they clearly do not fit into my budget
anyway! Nope. I will not take 'em for Vanderbilt, and I will not
take 'em for law school. Not for Harvard, not for Tennessee, and I
most definitely will not take 'em for DaveCordray (and yes, Dave, you
are still in fact, such an asshole!)

Who gives a shit anymore??? If you told a me a fat bearded lady at the
circus could decide my fate and tell me what direction I should choose
next-- I would take it! and throw in a fat tip for being smart enough
to know that any answer-- no matter how grim, is far better than just
wandering aimlessly through life looking back on what might have
been-- at THIRTY! AT THIRTY! !

I wish I could say that after all this time I developed other ego
strengths and finally felt okay with whom I am, you know.... "just
being me." but I am sad to report that my "condition" (diagnosis) was
amazingly accurate and predictable. just like all the doctors said! I
wonder if they derive joy out of being right— if they crack open a
bottle of aged liquor in my father's office and say, "see, we told you
so. we told you their was nothing you could do. and so nothing he did.
By doing nothing and I do mean nothing-- the illness take will its
course, and I am now, in fact, nothing. Nothing costs nothing (at
least to him) and daddy made another fine investment, on the other
hand, nothing has drained every hope, fear, security— chance-- every
last breath from my body. I might have believed in me. And I know
I'm alive because a tear just rolled down the side of my cheek. I am
home.

I am the exact same 5 year old who needed to win the spelling bee. In
college, I was the one to set the curve, not just make it, break the
rules, and, break [them] I did. There is no glory in being second
best. Second smartest, second brightest, or second anything.

But I still have not learned, for some reason with all of my failures,
I am reminded of in so many ways. Me, myself watch them play out
every time I shut my eyes or open them. Yes- blink, sometimes I ask
myself, how did I get here? How did this happen? What happened to
all of the plans I made for myself~ where did they go? Where did I
go? Constantly replayed over and over and over again in my mind, 1
must be FUCK1NG CRAZY! But at this moment, here, even as I say the
words, I am not truly insane. 1 am merely in pain, what a tragedy
that those two words rhyme-- they ruin what could have been a very
profound misnomer of the human condition and the labels we hold so
dear.

And so my search for mediocrity continues, and I wait for it each and
every day, hoping it will find me beaten and worn from the stoma. All
of the storms, but damn-it it is still there. I still have questions
those damn elyssa questions that made all my professors so proud, damn
ideas, damn thoughts, damn hope.

My mother still calls me everyday to see if I went down to get food
stamps to feed myself, flick her, and her fucking things. Flick
diamonds and couture and fuck that life. I was here mom, the whole
god-damned time. Just not pretty enough with out any surgery. Not
pretty at all with all those damn scars,

I am the exact same 5 year old who needed to ACE the spelling bee, set
the curve, not just make it, break the rules, and, break. them I did.
There is no glory in being second best. Second smartest, second
brightest, or second anything. Being second sucks. it sucks every
god damned second of the day.

Goodnight my dear friends, lets all try to have sweet dreams. Pepe
awaits, as does Alanis and a pack of smokes that 1 can already taste.
I hope you all still love me. I do actually believe that I deserve
love and kindness despite the obvious fact that I am a royal pain in
the ass. I refuse to work in Burger King.

What could have been, what should have been-- what might have been if
you let me be

me.

When in Chinese, the word Crisis is composed of two characters: One
represents danger and the other represents opportunity...

JFK

________________________________________________________________
Elyssa Durant, Ed.M.
Nashville, Tennessee
Reply to: elyssa.durant@columbia.edu

"You may not care how much I know, but you don't know how much I care."

Mail to a Friend | Link | Comments (0) | Report to Admin Work to Welfare: The Hardest Job I Never Had By Elyssa Durant - Feb 11, 2009 4:22:26 AM ET

I remember how difficult it was for me to obtain benefits when I first applied several years ago. I am deeply concerned about how the most recent decision to eradicate yet another class of TennCare / Medicaid recipients (the Daniels class made up of SSI recipients by way of a pending federal waiver) will affect the poor and disabled residents in Tennessee. Without my current level of benefits, I simply do not function.

Before my benefits were stabilized, learning to navigate the system consumed every waking moment of my life. I was unable to work or attend school on any substantial level and I am frightened to see at might happen if I were to stray from my established, stabilized, treatment plan. If I lose my benefits, will I still be able to work? To function? To be productive?

Any new public program requires careful planning if it is to be effective. Recent discussions have not focused on the true impact these changes will have on the "street-level."

Has anyone asked recipients how they feel the new program (safety- net) should be designed, implemented, or evaluated? How will this impact the community and other social service or welfare agencies??? I want access, quality, and outcomes. I want... I want... I want!!!

The massive number of people being dis-enrolled or limited in their access to medical care and other social services will no doubt create significant anxiety, confusion, and chaos for everyone involved in the social service and health care industries.

I remember when Mr. Brian Lapps was somewhere very high up on the corporate TennCare ladder in 1999 when they adjusted the prescription formulary over Memorial Day in 1999. I see Mr. Lapps quite frequently since he now works at the local gas station down the street from where I live.

To this day, he insists that cell phones and TennCare are somehow contraindicated. Perhaps he knows nothing of the population he claims to know just all-too-well... housing conditions that may or may not have electricity, broken families-some riddled with community violence and domestic disturbances. In the hood, your cell phone is your very best friend. 9-1-1.

These people plagued by domestic violence and community instability makes a cell phone the only logical option. How can you find a job with out a phone? How can you find a home with out a job? Yet even 6 years later, Mr. Lapps uses cellular phones as an example how the TennCare program is being abused by lazy, cheap, and unscrupulous second hand citizens who are just shiftless lazy bums waiting around for their next free hand-out.

Anyone who has EVER applied for or relied upon any kind of government subsidy to have their basic needs met, e.g., food, shelter, medical care, dental treatment, etc... let me personally assure you that there has never been a single time where I felt I was "pulling one over" on the government. I am not just one of the poor saps who believed what they told me they in school, I bought it hook, line, and sinker for the mere price of $179,982.00 and not a shred of financial security to show for it.

Even after consolidating my student loans, the interest alone is $10 less than my monthly income from social security.

Tennesseee is in the process of applying for yet ANOTHER federal waiver to eliminate the "Daniels" class of Medicaid recipients-- the poorest and sickest of all. SSI Recipients. Can you live on $623.00 / month? Can anyone?

So what happens now that the state of Tennessee will begin to cut off social security recipients from TennCare? I honestly do not think I can survive yet another re-certification process-- God knows the first one almost killed me. After three years of appeals, my condition had deteriorated so severely that I was forced to drop out of school, lost my home, lost my sanity, and lost hope. In short-- I lost my dignity and my belief in the social welfare system.

By the time my benefits were approved, I had already checked myself in to NYU Psych Ward because simply could not cope with the reality of what my life I had become. I weighed 94 pounds and suffered in excruciating pain that has only gotten worse with time. My extremities were ice cold, and my hands were numb since I went without medical treatment for the spinal injury that was first discovered when I was 22.

I am now 36 years old. My spinal cord is now damaged from years of delayed, sub-standard medical treatment. I owe the federal government $179,982.00 in student loans and when I am able to work, I make $10.46 / hour as a substitute teacher in an urban school district. That job comes with no security and no benefits. It does however offer the flexibility I need to receive the bi-monthly epidural injections and other procedures necessary to manage my pain and alleviate the numbness I feel because of the damage to my nerves. And even though I cannot afford the gas money to get my appointments, pay for all of my medication, or even to get back and forth to work, it does allow me a few weeks of mobility so I can drive, use my mouse or hold a pen.

I have an advanced master's degree from an Ivy League Institution. I am 12 credits shy of a PhD in public policy. And despite maintaining a 3.83 grade point average while completing an advanced masters in social and educational policy at an, "Ivy League" institution; a 3.2 GPA during the 3 years I spent working on my doctorate at a not-quite-so-prestigious Graduate School; The Powers That Beat in that damn Ivory Tower don't will not grant me any leniency by extending the amount or time permitted to complete my degree-- a rule that was changed while I was on a formal leave of absence tending to my health (and my Medicaid appeals!). Not only did they decide 8 years was the rule instead of the 10 it had been previously, I was also told that I could not even transfer the credits I had earned toward a different degree towards another program at the same institution. It has been just over ten years since I first enrolled. What a mistake that was!

The "Harvard of the South" no longer offerers the degree to which I was admitted-- and enrolled so they actually suggested that I pay for a 3rd application to the school (I was admitted into two degrees-- the MPP as well as the PhD program in a separate college) requiring two independent applications, fees, transcripts, test scores, even way back when I was still considered a promising candidate. Now "they" think it is reasonable to ask that I do it all over again??? It goes without saying that I do not have the financial resources available to finish my last semester, take the GREs or GMATs one more time, or even the money to release my transcripts from the Graduate School into any other program at the same University, I guess I am just shit out of luck.

To be clear, WE ARE ALL PAYING for that student debt because I can assure you that their endowment is far greater than any income or earning potential I have given my current financial status and student loan debt! To be clear, YOU ARE ALL PAYING to keep me on Welfare. Yes, all of us are paying some price..... We I want to work. I want to be productive. I want to be a part of something greater than myself. I want to share what I've learned.

So throughout the years I struggled to stay in school, believing somehow that social justice would prevail, and my heart and dedication towards the greater good would show through to whomever, wherever, or whatever that could make my degree worth while-- the Medicaid and disability applications managed to take front seat. So as I filed appeal after appeal after appeal, I managed to acquire well over 1/4 million (yes-- MILLION) dollars in debt due to uninsured medical expenses and student loans. Despite having 3 Major Medical insurance policies, I still went bankrupt applying for Medicaid. Morally Bankrupt.

My life will never be the same. My heart will never be the same. I want to pay my bills on time. I want to get off welfare, but no one ever taught me how to be poor.

So after all this-- now I face losing my healthcare once again? Where is the safety net? Where is the American Dream that I so diligently chased after for so many years? What was the point spending so much on an education that will never be utilized? I understand the how; I just don't understand why.

Maybe one of these days Vanderbilt University or and the Department of Education will realize it might just be cheaper to hire me that harass me, because unless I find a real paying job soon, their collections department will no longer be able to reach me on that extravagant lifeline my friend, Brian Lapps, refers to as a luxury.

If anyone on your staff would like to "trade places" with me for one month-I will gladly assume his/her responsibilities for that position if you can find a writer who is willing to endure and write about the reality of social services in our fine state. I do not want a paycheck from your organization; I just want the opportunity to put the myth of freeloading welfare mother s to rest. Live in my shoes for 30 days. Can you find the out? Can you balance my budget and make it work? Can you get the bill collectors of my back? Can you afford Internet service to file state job applications and apply for services online? Can you maintain pride and dignity without feeling the least bit sorry for yourself and the choices you have made?

When I go to the pharmacy, I am humiliated that I do not have the $3.00 necessary for the co-pay on my covered TennCare prescriptions. At least when it was $40 dollars, I was not so damn embarrassed by my lack of funds.

Remind me again why I went to school. Remind me once more why I bother to speak out. Then remind me right now that that there is somebody listening. I cannot be the only one who actually gives a crap. My contact information is listed below.

Elyssa Durant, Ed.M.

Nashville, Tennessee

elyssa.durant@columbia.edu

(Former doctoral student in public polic Mail to a Friend | Link | Comments (2) | Report to Admin Economic Crisis By Elyssa Durant - Feb 11, 2009 3:56:29 AM ET

I am a resident in the state of Tennessee and I live in the 51st district. I am a recipient of TennCare, and, I am a member of the Daniels Class.

I am urging you to take immediate action. PLEASE sign the economic recovery package before it is too late.

As someone who has lived and voted in the state of Tennessee since 1996, I have witnessed several shifts in policy, both on the local and federal levels.

Governor Bredesen is currently "holding off in spending" until he learns what federal aid will become available to the residents of Tennessee.

Even under of the best of economic circumstances,, the state has often been reluctant to release state monies until they are in physical receipt of all federal matching dollars. This delays program implementation and compromises the integrity of the research design. Consistency is a critical component of effective program development and design. If we hold back state funds until the feds work put the details of this enormous, comprehensive package, our current programs will suffer as a result. We can not wait for a determination regarding federal funding before we to determine our state budget while before we of the programs we already are suffering financially.

When I was twenty-two years old I developed a medical condition, and it quiclky became obvious to me that it would be a lifelong struggle to cope and adapt to having physical disability. I purchased three independent policies, and was still covered under a terminal liability clause under a major medical ERISA (federal) plan. As someone who also needed to turn to federal funds and intervention in a crisis, I know that if or when help does arrive, it usually too late.

That didn't work.Let me assure you that when it comes to withholding criticalitems like food, hosing, social servicdes, it adds up exponentially. Withholding medical care simply because of procedure and beaurocratic red tape, is shameful and cruel. The money is there, but it seems there should be a certain level of oversight and accountability if we expect it to be used effectively without delay and without excessive adminsitrative dealay and costs. We need to have some level of accountabillity to ensure the timely and proper disbursement of funds. In my experience there is little recourse for persons individuals who get caught up in the complicated payment arrangements, complicated languaage, and the systematic, procedural delay when it comes to the processing and payment of claims. And let me personally assure you, that there is a very real human cost here as well... and unless there is immediate intervention, much more than just money will be lost. Please sign the bill before any more jobs, homes, and future are ruined by becauswe help did not fast enough. Please release the funds, because we are running out of time.

I am 36, and my spinal cord is damaged from years of delayed, sub-standard medical treatment as I attemptedn to navigate a system that simply does not work. I owe the federal government $179,982.00 in student loans.

When I am able to work, I make $10.46/hour as a substitute teacher in MNPS. That job comes with no security and no benefits.

I have an advanced masters degree from an Ivy League Institution. I am 9 credits shy of a Ph.D. in public policy. Despite having maintained a 3.83 grade point average while earning my masters, and just over 3.2 during the three years I was enrolled full time in a doctoral program.

I had no break in coverage, and even pruchased a private HMO (Oxford) plan that cost several hundred dollars each month just so I could prevent becoming uninsurable before my 25th birthday.

Wrong. Not only did I continue to pay for all three policies, I also had to pay for treament and STILL wound up on TennCare and Medicaid.

Despite doing all the "right" things, I was still unable to transfer benefits from one graduate school to the next.

I have not been granted any leniency by extending the amount or time permitted to complete my degree-- or allow me to transfer those credits towards another program at the same institution, and ultimately left me finacially devistated and emotionally bankrupt.

Vanderbilt will not even transfer any of the credits I paid for (in spades) towards another degree at the same university since they no longer have the program I was initially enrolled in. I think it goes without saying that I do not have the financial resources available to finish my last semester, take the GREs over again, or pay the associated application fees necessary to make the time spent there worth while.

Throughout the three year process of filing medical appeal after the next, I acquired over 1/4 million dollars in debt due the stuident loans I needed to pay for my unreimbursed medical expenses.

My life will never be the same.

My heart will never be the same.

And now once again, I face losing my healthcare that I fought so hard to get?

Where is the safety net? Where is the American Dream that I so diligently chased after for so many years? What was the point of investing so much in a future that I can never enjoy?

How can the you justify spending so money much on an education that will never be utilized?

I understand the how; I just don't understand why.

Maybe one of these days Vanderbilt University and the Department of Education will realize it might just be cheaper to hire me that harass me.

I need a real paying job, but with the skyrocketing unemployment rate, it klooks as though I will have a lot of competition.

Please do something, and do it quick. I would not wish this experience on my worst nightmare.

Sincerely yours,

Elyssa Durant
Nashville, TN

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