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Posts Tagged ‘Florida’


I know I said I was done with writing on my blog, but now I have to put in my 2 cents on the so-called Affordable Care Act, more commonly known as Obama Care. My own health insurance rates have double in the last 2 years so that I could cover my children (which are over 30 and have been on their own for years), and so I could get maternity care and 2 free breast pumps a year (in my 50’s), and so my deductible for the year would be lower….. my husband and I have been buying our own health insurance for years, basically a catastrophic plan which would cover expenses in case we were hit by the proverbial bus or needed surgery, with a $2000 annual deductible. We are both healthy in general, don’t smoke, don’t drink, get a reasonable amount of exercise, eat pretty healthy and try to keep our weight within reason.

I got a notice from our health insurance company that we would have to “transition” to another plan in August, when we are up for renewal. This tells me our plan meets the guidelines, but that the insurance company can get a lot more money out of us with the new plans set up for Obama care. After a little research (went on the now-infamous website) and found out that only one health insurance company is authorized in our county (so much for competitive rates) and it is the one we have now. Checked on available plans, found one equivalent to what we have now, more or less. This is the so called platinum plan, and it will cost us a whopping 4 times as much as we pay now, frankly, more than the highest mortgage we ever paid. The bronze plan would cost us twice what we pay now, plus a $6000 annual deductible and they pay only 60%????? Say, what???? A 40% co-pay??? Where is the affordable part of the health insurance here? When I went on the health insurance company website, the plan quoted to me on the government site actually costs 50% MORE than the government quoted. 

I was hoping at some point to get a knee replacement as my right knee is pretty much crunching at this point, daily Aleve and repeated steroid injections have kept it going. The average cost of a TKR in Florida is about $40,000. So first I have to pay over $6,000 (that is just my insurance, double the cost for both of us) in insurance premiums for that year, then $6000 in deductible, and 40% of $40,000: $16,000. This is not including the PT I will need afterwards. Cost of knee replacement with “insurance”: $28,000 out of pocket plus PT. Uhm, what is wrong with this picture? With my current insurance, I would pay $2400 for insurance, $2000 in deductible, and that’s it.

Bottom line is I will have to pay so much money for “affordable care” health insurance for me and my husband, that we are not going to be able to save any money at all. I would have to save up $20,000 above the cost of insurance for the surgery. We will be reduced from feeling financially stable and able to save money for a “rainy day” to living pay-check to pay-check. WTF!!!!! Did I go to school for over 8 years for this? I am working in a little town for a single doctor, I am not making a huge amount of money. I love my job, and don’t want to go somewhere else to make enough money to pay for the damn health insurance. This is all F-ing ridiculous. To be honest, I have cried over this. I can’t even begin to imagine what it is like for a family with kids and less income. 

We are already getting many patients who have lost their doctors through retirement (recently, all of a sudden) and due to the insurance companies not coming into this county anymore. 

The politicians are so glib and smug, thinking they are able to FIX all of our problems. Well, they FIXED me all right, and lots of other people.

Honestly, when they said this is all about wealth redistribution and not health care, that was the truth.

“The trick is figuring out how do we structure government systems that pool resources and hence facilitate some [wealth] redistribution — because I actually believe in redistribution, at least at a certain level to make sure that everybody’s got a shot.”

Obama, 2008

 

Well, I make my own shot through hard work, and he is taking it away from me. The shame is, NO ONE is being helped in this restructuring of the government. 

 

“This is also an income shift — it’s a shift, it’s a leveling to help lower income Americans. Too often, much of late, the last couple three years the mal-distribution of income in America is gone up way too much, the wealthy are getting way, way too wealthy, and the middle income class is left behind. Wages have not kept up with increased income of the highest income in America. This legislation will have the effect of addressing that mal-distribution of income in America, because healthcare is now a right for all Americans, because healthcare is now affordable for all Americans.”

US Senator Max Baucus (D-Mont.)

Oh, really?

Sigh, I guess I will never get that knee.

old-woman-cane-18640048

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Well, it is happening. The clinic I work in will be closing its doors soon, partly due to money issues and partly because the physician is retiring, and I am back on the employment search train again. The sad part about this, though the PA I work with is going to try to take as many patients along to the next job (and mine will go with me), is how many physicians won’t take Medicaid anymore. It just doesn’t pay, and the loss of income on each patient, coupled with the impossibility of finding specialists to refer Medicaid patients to, and the restrictions on what we can and can’t order for them, it is not a viable option for a lot of physicians to take Medicaid. On the patients’ side, if they have share of cost, it is often so high, they can’t afford to get healthcare anyway. The whole thing just stinks.

The good news is that there are several options for me and I will not be jobless for long, if at all. The bad news is that things are so up in the air that I haven’t found a lot of emotional space to write in my blog recently, though I did get a new bike, well actually a recumbent trike. An arthritic girl’s best friend! And my dog’s favorite thing, too!

 

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I just posted my last case study and realized that, other than the final exam, I am done with this term. I also realized it was December. Wow, where did the time go? It’s practically Christmas and I had no idea. I guess that is what it means to have no life while in school.

The last week of clinicals is over, I am recovering from the cold/sore throat the little…tots gave me as a parting gift, the site evaluations are done, all my papers are done. I have FREE time. I have studied for the exam and am waiting for it to open on Monday. Once that is finished, I have four whole weeks of no school work.

Of course, I will be boning up on adult stuff like hypertension, and diabetes, and STD’s and heart disease in preparation for the next clinical: Adult Practicum. But that feels different than a paper with a deadline. More relaxed you know.

The other thing I noticed, the whole thing seems more attainable now, in 29 days I can say “I graduate this year”. Two terms doesn’t sound like a long time. OMG, I think I am going to make it!

Sigma Theta Tau sent me an invitation to join. That is pretty special. The National Nursing Honor Society. Wow. It is all falling together. The light is visible at the end of the tunnel.

My next rotation will be at the local health department primary care clinic, then to my own physician’s office, as he has agreed to be my preceptor for the second half of adult, and the family practice portion. I am looking forward to that. The funny thing is, that I was nervous about going to pediatrics, having had almost no experience with peds in my nursing career. Now, the anxiety is about doing the women’s health, what with speculums and birth control and STDs, and the complexities of multiple health problems encountered in the elder population. A strep throat or ear infection is a piece of cake compared to a diabetic with heart disease who needs to control his blood pressure.

The health department will be interesting with the population of patients they serve. I am sure there will be a lot of patients who will have more advanced conditions, like I saw when I was working at the local county jail. It will be a big learning oportunity. There is a local free clinic staffed entirely by volunteers, and I think I will give them some of my time after I graduate. Be a part of the solution.

Well, my muse seems to have wandered elsewhere, and so this will end my post for today. There is time to plan a nice dinner (Cooking is one of those things that slipped away for a while), read a novel, go to the craft store for some yarn for a knitting project I have in mind (I need a shawl for when we eat out. Florida is perverse for having air conditioners and fans blowing directly on restaurant patrons even in the dead of winter), maybe I will even do a small quilting project.

A temporary life. The stone is airborne again.

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In general, living in Florida has some bad points for someone who was raised in a more northern clime. Excessive heat and humidity for 6 months of the year have me hiding indoors in the A/C. I spend my time obsessing over the weather channel’s tropical updates as one tropical system after another forms in the Atlantic and comes our way. Anyone living down here knows what the “cone of uncertainty” is, with uncertain being the operative word.

Every now and then, though, there is a certain moment that is pretty spectacular. The bald eagle swooping down and catching the fish in the lake behind our house was pretty cool. The alligator lurking in the same lake looking for a doggy snack, is not so cool. The bird life here is fantastic.

Gators in the river nearby

I had a really nice moment this week. I was laying in bed reading a novel (yes, I have time for a novel again now that my clinicals are done for the moment, woohoo!) and a wonderful perfume wafted in through the window. My nightblooming orchids were blooming, wow. These orchids have a small and delicate looking white flower and release a perfume at night only.

One of the really cool things about Florida is the ability to grow orchids in your backyard. They turn out to be quite tough plants and give you a lot of pleasure for minimal work. A friend described how to grow a type called Dendrobium: get a giant pot, fill 2/3 full with non-melting packing peanuts, then top with orchid bark, place in a slightly shaded spot, add the plants and water when you think about it. The result:

I love to sit out under our pergola (built by my husband and stepson) and enjoy the view. There are perks to living in the subtropics. As a matter of fact, I think I will go out there for a while with some ice tea and enjoy. I feel bad for those who are in blizzards right now. I’ll get started on the Thanksgiving stuff in a little while.

Happy Turkey day everyone.

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Recently, one of my dogs kept getting a rash on his belly, in his armpits and under his chin. He kept rubbing his face on the carpet until he wore patches of hair off his ears and around his eyes. I was really puzzled by this, he never had any allergies before.

So, I put on my diagnostic hat and started thinking about it. The rash on his belly was red and especially bad under his armpits, the skin around his eyes looked atopic (like eczema) and it was all obviously itchy as he kept chewing at his feet and belly and rubbing on the carpet and shaking his head a lot. The rash was obvious as this dog always sleeps on his back…

Lookit my rash, mom!

I tried to think of what was new in his life recently…..food not changed, no new toys or treats…oh, yes, new treats. But, it seemed so local, this rash, only on his belly and face. Food allergies erupt all over. Flea allergies (not that he has any) show near the base of the tail. Then I noticed an area in the yard with a ground cover called Oyster plant, we had put it in recently and it was doing nicely. Hmmm….A little research on the internet, and I had the answer.

The culprit

Oyster plant, otherwise known as Moses in a Basket and Boatlily, or taxonomically as Tradescantia bermudensis, turns out to be poison ivy for dogs. I saw that the bed had been enthusiastically plowed in the hunt for lizards and other interesting little animals that Elwood loves to find. Too bad, the plant was so pretty and made such a good ground cover for the area. Oh well, the plants were dug out and tossed into the yard waste bin to be hauled away.

Maybe ferns would look nice in that particular spot, but, I wonder if little ferns are toxic to dogs. I will definitely look into it before planting them. Perhaps I should look up the other plants we have in the yard, too. You never know.

Elwood is doing fine after a short course of Benadryl.

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I know I said I wouldn’t post about MDs again, but I just read about this on Clinician 1 and had to pass it on.

Florida is a huge state with many uninsured and underinsured people, and whole swaths of the inner state is populated very thinly with many migrant workers. Medical care is in short supply in these areas, and nurse practitioners would love to fill in the void.

Unemployment is astronomical right now, officially around 13%, but actually more like 18-20% if you take into account all the people who have dropped off the unemployment rolls as their time runs out. I heard recently that 250 people applied for a maintenance job in a trailer park for retirees, to give you an idea of the numbers of unemployed. A friend of mine works at a food bank, where, for the first time, they are running out of food to give out, as the numbers of families needing help has tripled.

The Florida Medical Association seems to be aware that there is a crisis of health care in the state, but their way of addressing the problem is cronyism and defensive legislation to protect their turf, and not trying to solve the problems and needs of Florida’s population.

According to their website: “Whatever the issue, we will work tirelessly to ensure that the interests of our physician members, and most importantly, the interests of our patients are fully recognized and reflected in all health care policies adopted by the State of Florida throughout the year.”

Right.  When tey talk about advocating for the physician’s interest, they are right, but patients? Not so much.

On their legislative page they crow about blocking everything related to increased scope of practice this year for anyone without MD after their name, “While every session sees an attempt by allied health professionals to expand their scope of practice, the battles were especially fierce this year. Optometrists, ARNPs and physical therapists pulled out all the stops to be able to do what physicians are trained to do, but without first going to medical school for the proper training. I am happy to announce that the FMA was able to defeat all of these proposals, and that not one scope-of-practice bill passed.”

They were thrilled to have blocked:

  • Legislation that would have prevented physicians from collecting full payment from out-of-network PPO patients;
  • Legislation that would have ended the use of binding arbitration agreements by physicians;
  • Legislation that would have ensured higher malpractice insurance premiums by repealing the wrongful death exemption;
  • Legislation that would have imposed unreasonable reporting requirements on physicians in relation to impaired drivers;
  • Legislation that would have provided an unreasonable standard for the treatment of foster children with psychotropic medications;
  • Legislation that would have allowed social workers and marriage and family therapists to diagnose autism;
  • Legislation that would have ensured that physicians were paid less in automobile injury cases.
  • They called all this “diverting disaster”. Then they talk about their priority legislation for the year: to “exempt medical malpractice insurance premiums from any emergency assessment levied by the Hurricane Catastrophe Fund for three more years. This bill will save physicians thousands of dollars in the event that the CAT fund incurs a deficit.”

    Lastly they are happy that a bill to restrict “pill mills” (places where drug seekers are able to get massive amounts of narcotics). “The FMA was able amend a provision that would have limited dispensing physicians to a 72-hour supply of controlled substances. With the cooperation of Rep. John Legg, the bill’s sponsor, we were able to restrict this 72-hour limitation to registered pain clinics, and then only to patients who pay by cash, check or credit card.”

    So, these almighty doctors (who are perfect in prescribing narcotics and other controlled substances like cough syrup and diarrhea medication, right) stop a measure to restrict illicit drug use fully  prescribed by MDs, for money.

    The pattern here is clear, I don’t have to spell it out do, I? Well, okay: MONEY. That is what they are about, where is the patient advocacy?

    “There is no such thing as a nurse practitioner who is ‘qualified’ to prescribe controlled substances,” said Erin Van Sickle, a spokeswoman for the FMA on Tuesday. “The Florida Medical Association is extremely concerned about the nurse practitioners’ continued attempts to gain prescriptive authority for these medications. The ability to prescribe controlled substances is limited to medical doctors for a reason: to protect patient safety. Physicians go to medical school to learn how to prescribe controlled substances safely and without interacting with other medications. ARNPs do not.”

    “Florida lawmakers have worked diligently to protect patients from those who would attempt to prescribe narcotics to patients without the training required by Florida law, and that is the safe, accountable, and common-sense thing to do,” continued Van Sickle. “We simply can’t understand why the nurse practitioners would make such an unconscionable attempt to throw away the protections they have put in place.”

    “The bottom line is, ARNPs do not have the training nor the qualifications necessary to prescribe these medications,” she said. “If they want to prescribe controlled substances, we would encourage them to go to medical school and receive the proper training to do so.” 

    I mean, really?!?!  This is just sad!

    Florida is one of only two states who restrict NPs like this, all the other states allow it, with no detrimental effect on the over-use of controlled substances.

    Shame on you FMA! And just so you all know, the FMA does not represent ALL physicians. I happen to know quite a few who don’t agree with some of this crap, but it seems the FMA owns the Florida legislature.

    References

    http://www.fmaonline.org/Council_on_Legislation_Newsletter_04-30-10.aspx

    http://www.sunshinestatenews.com/story/looking-write-controlled-prescriptions-nurse-practicioners-looking-engage-mike-haridopolos

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    I just posted my “Application for Graduation”. Now, that doesn’t mean I am graduating just yet, but the school wanted it at least six months before graduation, so of course, I did it a year ahead of time. It was kind of cool to “write your name as you want it to show on your diploma” and read about the Master’s hood and the ceremony. It just warms the cockles of my heart. Maybe this will actually all come to and end and I will finally achieve my goal.

    This isn’t the first time I tried to achieve this. I started in a FNP program in Pennsylvania back in 2002. It was an RN to MSN program since I had gotten my RN back in the days of the “diploma school”. My husband got sick and we ended up moving to Florida when he recovered. I had racked up enough credits to get my BSN, summa cum laude, thank you very much, and stopped any further classes. When we got down here, I worked for hospice, lived through Hurricane Charlie, and finally taught LPN students. Budget cuts cost me that job and I decided it was time to try again.

    So, finally, I am within a year of achieving that coveted FNP-MSN. I am looking forward to this last year, clinicals will seem so much more real to me than all the book work. Of course, the book work was necessary, but clinicals give you the opportunity to hone skills and actually see patients and help them. That is what I have been wanting to do for so long. Being an RN has been great, but moving up to this new level will be so much more rewarding for me. I anticipate getting back to more patient contact, as the current role of RN is so much paperwork and less actual hands-on patient care. It seems that CNAs and med techs are doing what nurses used to consider part of their job, and RNs are acting more in the administrative capacity and as data collectors for goverment, regulatory agencies and insurance companies. (Don’t let me get started on that.)

    So, bottom line: there is a light at the end of the tunnel! WooHoo!

    PS: Thanks to Frontier School of Midwifery and Family Nursing  for giving me my busiest blog day ever by recommending my blog as interesting to read. Here is a link to their webpage in return: http://www.midwives.org/home.html

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