Debbie Does Dublin

Yesterday marked me being 33 weeks pregnant. Simple math means I have 7 weeks if I go to 40 weeks or 40 weeks + 6 days if you follow the Dylan schedule of how to be born. I have received a lot of lovely complements about how I look and genuine inquiries about how I am feeling. Obviously, pregnancy #2 is different than #1. #1 didn't come with a toddler so I am a bit more tired and cranky (yes I can always pump out a little more cranky).

That being said, I am super excited to meet #2/Markie Blobbie. Until she arrives, we look forward to a visit from family, a holiday party (well I am not going to get excited about it until I actually am at the party-because you never know when the death illness will strike), NYE and the accompanying ice cream sundae, and watching Dylan open all her presents.

After all that fun stuff, we will get to have a baby (unless the nurses go on strike the day I go into labor-then I will have to hope that Shyam paid attention the last go around)......Oh Ireland, always making life a bit more challenging for no good reason.

It is November again. November in our house brings loads of birthdays and thoughts of Thanksgiving. Obviously, Thanksgiving is a holiday for the States (and Canada). You don’t see advertisements in the grocery stores for turkeys, stuffing, or pumpkin anything and Dylan’s creche’s theme for the month is outer space-not Thanksgiving.

Holidays like Thanksgiving are all about family, friends and food…..things I miss most. The first year we were here, we hit up Rome for an Italian Thanksgiving-and we even got some true celebration at a local Hard Rock Café. The second year I had just given birth to Dylan and did get to enjoy some lasagna. Last year, we had plans to go over to a friend’s house, but the death illness hit the house.

This year we are doing something small to celebrate the holiday but it will still be in Ireland…..in any case, I can still do my “what I am thankful for” list….

….Shyam and Dylan-they put up with whine and grouch all the time and can still be excited to offer hugs and kisses (even if Dylan’s are seasoned with milk)

….healthy family and true friends who always listen-even if they have heard it before-perhaps one day, I can borrow their levels of patience to avoid frustrating myself.

….job…well one in my life that allows me to only complain about living in a foreign country.

I may complain a lot and will always hate Ireland but it has made me appreciate everything I my life…..so sadly, I am thankful for Ireland (but only the parts that have nothing to do with the food and weather).

HAPPY THANKSGIVING!!!!

I believe we are on day 3 of constant rain. One day there was a rainbow for a little bit but then the rain returned. It isn't a drizzle...it is a full on pour down buckets of water. It means that the wind will be coming soon and then the cold. I am sure some people love wet and dreary weather, but I am sure by now you have learned that I despise it.

This is all made difficult by the fact that in December, we will be celebrating the holidays in dreary Dublin. No home for the holidays in the beautiful Valley heat for us. Obviously we are staying for a good reason-the baby-but hearing about everyone's holiday home plans is slightly off putting.

The one bonus of the constant rain is that hopefully the normally loud/illegal/annoying Halloween fireworks might be dampened and there will be one less thing interfering with my already disturbed sleep.

In response to my last post, I was asked about my "85 questions." Admittedly, the numbers I use on my blog are sarcastic; however, I do have a little list with multiple questions that I am truly interested in. If I were to select an insurance company many of these questions would be on my list and after hearing answers, I would probably have more. Many of these questions are based upon my previous American insurance, current American insurance, work in clinics, schools, and hospitals as a nurse, and my Irish experience (including my Irish private insurance and access to public healthcare).

Shyam pointed out that there are 5 plans under consideration in Congress and that many of detailed questions don't yet have answers BUT I think all of these things are worth thinking about. Just saying "I want X" without having details seems meaningless. I was also advised that the public insurance might follow some of the current Medicare guideline-for the sake of diabetics, I hope not.

So.....what up?

Family Planning
1. Are you going to cover abortions?
2. If you cover abortions, what limitations will be present (ex. No terminations after X number of weeks)
3. If you don’t cover abortions, what options will you provide for patients?
4. Will you provide birth control?
5. What type of birth control will you provide?
6. Will you cover elective sterilization for women and men regardless of age?
7. Will clinicians who take the public insurance be penalized for unwillingness (regardless of reason) to participate in prescribing birth control or making referrals for terminations and/or sterilization?
8. What limitations will be set on hospitalization for vaginal labors and c-sections?
9. What limitations will be set on NICU hospitalizations?
10. Will this cover fertility care? How far will it go?

STIs
11. What limitations will be placed on treatments for HIV and AIDS?
12. Will you treat sexual partners of Chlamydia patients without seeing them (if they are covered by another insurance provider)?
13. Will there be limitations on covering pap smears for those individuals who fall outside the ACOG recommended ages?

Illegal Immigrants
14. How will you determine who is legally able to access the insurance?
15. How will coverage be provided for people who present in the ER or L & D who are not covered by private or public insurance-how will that cost be managed?
16. When care is provided to illegal immigrants, what level of follow up will the government provide?
17. What will qualify as an “emergency” to be treated? If someone presents and is assessed to have a non emergent health issue?
18. What about visitors to the States that are going through the steps to become valid residents-how will they be covered and how will their premiums be documented?

Penalties/Taxes
19. What happens if someone can’t pay the penalty that is levied against them when they can’t afford the premiums (while qualifying for subsidies)?
20. What is the period of time before someone will be penalized/punished for not getting insured?
21. To avoid penalties, what will qualify as having health insurance? What is the minimum level of coverage?
22. How will the penalties be levied if someone is unemployed or not receiving an income? Will they take it out of existing benefits?
23. What tax bracket will be hit in order to pay for the subsidies?
24. If the system becomes more costly, are there guidelines regarding how additional taxes will be levied?

Medications/Treatments
25. Will they only pay for generic meds even if your doctor rxs brand name?
26. Are there any types of medications/treatments they won’t cover?
27. Are they willing to fund new evidenced based treatments?
28. Are there restrictions for coverage of treatment when in hospital (such as the payment for blood in Medicare A)?
29. Will there be limits on outpatient therapies even if they are rxed by your provider and supported via assessment of the therapist?
30. Will there be limitations for respite care and what/who qualifies you as “terminal?”
31. Will the city or the insurance cover ambulance transportation in the event of an emergency?
32. Are you responsible for treatments/adverse outcomes from clinical research studies?
33. Will the insurance cover prescription lenses, hearing aids, wheelchairs, specialized car seats, assistive devices for walking, pacemakers, etc.? Are there limitations on the medically necessary replacement of these devices?
34. Will the insurance pay for supplies for children with special physical and educational needs attending school-not limited to medical devices but also including computers and other devices children with LDs need to be able to participate in school (in the event it is not covered by their IEP )?
35. Diabetes supplies? Are there restrictions like with Medicare only covering insulin if it is administered via insulin pump?
36. Will they pay for breast reconstruction and/or prosthetic implants? Cleft lip palate repair? Wigs for alopecia? Prosthetic limbs?
37. Will transplants and related medications be covered?
38. Will private and public hospitals be covered?

Preventative Medicine
39. Will they cover all immunizations-not just ones required in State for school entry?
40. What guidelines will they follow for preventative healthcare-colonoscopies, mammograms, prostate exams, etc. Will they limit it to only the professional organizational guidelines or will they cover a primary intervention if it is indicated?

Mental Health
41. Will individual and group counseling be covered?
42. Will inpatient drug treatment be covered? If so, what restrictions will be placed and will there be a limit to the number of times this treatment can be accessed by an individual?
43. Will home care be provided for in cases of severe mental illness?

Complaints
44. How will complaints be handled about the system if something can’t or won’t be covered? What is the process?
45. How will the federal system interact with the current State’s insurance commissions? Who will prevail in the event of a conflict?
46. What if the State’s insurance’s commissions find a valid fault with how the public insurance handled something?
47. Who will oversee the public insurance? Will it be a board? What types of people will make up the board? Will it be politicians? Will they have a range of healthcare professionals?

Specialist Referrals
48. Can you self refer to a specialist?
49. Will coverage be provided for seeking second opinions?

HIPPA/Records access
50. Will the public health insurance be held accountable to HIPPA?
51. Medicare and Tricare are under the government’s supervision-this is a thinking outloud question, but are providers allowed to give the military or other government officials confidential health history information? Would the same rules for these government programs apply to the public insurance?
52. Would your insurance be filed with your SSN? As you are not required to give this for private insurance and it sets up issues for confidentiality problems and identity fraud-how would your medical information be kept?
53. Would the ICD-9 coding continue to be used? What will the standards be for who is allowed to bill for what in terms of the provider’s license?

Alternative Treatments
54. Will chiropractic and other forms of alternative treatments be covered if performed by a provider who is not a licensed healthcare provider?
55. What will qualify as “alternative treatments?”

Other
Will the insurance cover you outside the States? If so, what are the restrictions?

I am back from a month long visit in the States. It was as expected-warm, sunny, yummy, and fabulous. However, we are now back in less than warm, sunny, yummy, and fabulous Dublin. To be fair to Ireland, we arrived and it wasn't raining (but as I type, it is and has been since early this morning-GOOD TIMES).

Being in Los Angeles, I got the opportunity to read newspapers and catch up on the daily news that people are discussing. Healthcare is a big topic. I have realized in my discussions with people in real life and online that people seem to want to express themselves in either black or white. There doesn't appear to be allowances for anything in between and questions signal either side to become slightly hostile.

My opinion is of basic support to a free/affordable healthcare system for all legal citizens. I know that legal might be a dirty word but since I have had the opportunity to pay taxes in two countries and jump through the hoops of the Garda Immigration Bureau to legally reside in Ireland, I tend feel that everyone else should have to jump through the same hoops. Aside from the dirty word, my questions about the process, management, and administration of the program puts people off-either they aren't familiar with the proposed plans to confidently answer my questions or there is something else...I haven't figured it out. I am a nurse and have worked in a public system with large numbers of people. I like process, procedure, rules, transparency....all that stuff.

My second issue with the whole discussion is that when I bring up my experience in Ireland with healthcare that they are instantly deemed not relevant. Irish healthcare involves both insurance and socialized medicine-as you would expect, in my opinion it is done very very badly. This is basically due to lack of processes, procedures, yada yada yada. Just because something isn't exactly the same as one of the various proposed plans in the States doesn't mean there is nothing to be learned from this experience. People happily bring up the good in Canada, France, and the UK-what about the terrible in Ireland (and I will even say that there a few positives in Ireland-see even I can make concessions).

I am not always right but I am entitled to an opinion. My opinions are based upon my experiences in the States and in Ireland. In order to expand or evaluate my opinions, I ask questions. If you happen to be presented with one of my 85 questions-don't blow me off....it is likely that I agree with you overall but want to talk about the details. Without the details being sorted, the whole grand plan can collapse.