While I do not miss the rigors of residency, I do miss my Dansko clogs. Twice now I've completely wiped out when I've twisted my ankle on one of my heels (both times the left one- I've learned that my left ankle is weaker than the right. This knowledge has come both from wearing heels while walking to the Metro and doing yoga.) The first wipe out came when I was running to the last day of the conference. It was a Saturday morning and the light was about to change. I thought, "I can make it!" and I jogged past the intersection. Just as I was approaching the other side to victory feeling like a real city-girl I twisted my left ankle and fell in the intersection. My shoe flew off (like two feet in front of me) and I dropped my bag. A girl was jogging the other way and asked, "Are you hurt?"
"Just my pride", I answered. I gathered up my stuff and got into the conference as quickly as possible.
The second wipe out was on Tuesday. I bought some very pretty Nine West black heels for a great price and was so excited about them! They are mules with about a 2 inch heel. Well, walking down the hill to the metro, again my left ankle turned and I fell right onto my left knee and dropped my bag. This time there was a woman walking behind me who asked, "Are you ok?" and I replied that I was.
As she walked past me I heard her say to the party on the other end of her cell phone, "No, no, the woman who was walking in front of my just fell down." When I got to the office and examined the damage I had skinned my knee pretty good BUT I did not tear my beloved black Express pants! Score! I'll take the skinned knee, it will heal.
So I've learned that my left ankle is weak and that I'm not great in heels, but better honestly than I thought I would be.
I've learned that I hate, hate, hate wind, especially cold wind! I'll take 115 any day over 18 with a blistering wind that rips your face off bit by chilly bit.
I've learned why people get mugged- because you always have to carry cash! For the Metro, for a taxi, etc. When you're not just hopping into your car, you need to have some cash on you.
I've learned that if I have a 30 minute commute to work I'd rather be on a train than on a highway.
Handing out your business card in DC is the equivalent of a handshake. When you walk into a meeting, everyone's card gets passed around. It's the standard greeting.
I've learned that while there are few physicians on the Hill, we are in good hands with our Lobby teams. Every specialty I've seen has been very well represented by their Lobbyists. They are well-versed and truly do work for us.
I'm learning to coordinate clothes each morning and how to not rely on scrubs every day.
Food in DC is incredibly expensive.
Driving in DC sucks.
I like the city (though prefer not to drive myself).
I'm sure I'll think of some more... but here are things I've learned besides politics and legislation.
Friday, February 20, 2009
Thursday, February 19, 2009
State Legislative Activities and Insurance Premiums
Since I have been working these 5 weeks on Federal Issues I haven't had much time to look at individual State issues, even in Arizona. But there is some good information on the ACOG website that I wanted to bring to your attention. Go to ACOG, click on Advocacy and select State Legislative Issues. There are some great talking points on issues such as emergency contraception, contraceptive equity, medical liability reform, and abortion.
Also, h is a great report I found while browsing through some conference materials. It's called premiums vs. paychecks and it shows what families are typically paying for health care premiums in each state. For example, premiums rose 3.5 times faster than median earnings in the state of Arizona, and 5 times faster in the state of Kansas.
Here's the link:
http://www.familiesusa.org/assets/pdfs/premiums-vs-paychecks-2008/arizona.pdf
You can substitute another name in for the state if you want to look at a different state. This is from the FamiliesUSA organization.
Also, h is a great report I found while browsing through some conference materials. It's called premiums vs. paychecks and it shows what families are typically paying for health care premiums in each state. For example, premiums rose 3.5 times faster than median earnings in the state of Arizona, and 5 times faster in the state of Kansas.
Here's the link:
http://www.familiesusa.org/assets/pdfs/premiums-vs-paychecks-2008/arizona.pdf
You can substitute another name in for the state if you want to look at a different state. This is from the FamiliesUSA organization.
Support Prevention First!!
Prevention First is an act introduced by Senate by Majority Leader Harry Reid (D-NV) and in the House by Representatives Louise Slaughter (D-NY) and Diana DeGette (D-CO). The Act is intended to reduce the number of unintended pregnancies in the United States by focusing on successful prevention methods. It aims to do this through 8 separate parts:
- Increase Funding for the National Family Planning Program (Title X)
- Expand Medicaid Family Planning Services
- End Contraceptive Insurance Discrimination Against Women
- Improve Awareness about Emergency Contraception (EC)
- Improve Access to EC for Rape Victims
- Reduce Teen Pregnancy
- Ensure that Federally-Funded Programs Provide Medically Accurate Information
- Provide Comprehensive Sex Education (REAL or Responsible Education About Life)
You can look it up on thomas.gov as we did the previous bills, but this one is pretty long. Anyway, it's got lots of important measures to help us care for women and you can send a letter to your Congress Members in 5 minutes through the ACOG website! Here's how!
Go to the ACOG website and click on the advocacy tab and choose Legislative Action Center
There you will find a green box with information on the Prevention First Act. Read it and while you're here sign up for the Action Alerts above the box.
Click on the green Take Action button. Just fill in the information and click SEND! Just like that you have notified all your Representatives to Congress that you support this Act and encourage them to do the same! It's that easy!
To the right of the green prevention first box there are some other categories worth browsing. The Capitol Hill basics has some tips for writing and visiting your Members.
Finding and Following Legislation, Staying Aware!
I was planning on trying to attack and digest some big issues like Medicare while I am still here in the office and have access to the huge shared drive and the brains of the staff. However, I think since the Women's Health Care Resolution was introduced last week and I met with a couple offices about a bill regarding post-partum depression we should talk about legislation and how to find it and follow it.
If you haven't browsed the Legislative Primer, please do so. Just browse through it while on a plane or over dinner. It's a pretty quick read and will give you the basics. To order a copy click here.
So, you might be as surprised as I was to realize that most of the legislation that is introduced in either the House or the Senate goes no further than a committee. So once a piece of legislation is introduced it is assigned a number (H. 1 in the House, S. 1 in the Senate). The Member who introduces the bill may seek the support of other Members to Co-Sponsor a bill. Let's look at the Women's Health Care Resolution. If you go to http://www.thomas.gov you can find any piece of legislation that has been introduced. The Resolution is H Con Res 48 so click on bill number and type that in your search box. (Later, after you've played on the site a little, just type in women's and see if you can find it without the bill number since many times you will probably not have the actual number). You can see near the top that the bill was introduced by Representative Schakowski and had 10 co-sponsors (though I do know that Representative Kilroy of Ohio co-sponsored also after we talked last week! Whoo Hoo!!) You can see that S Con Res 6 is the related bill in the Senate.
Click on the text of legislation box and read it! It's not that long and it has some surprising statistics and good points in it! This is what we're asking Congress to consider on behalf of our patients so please get familiar with it!
Next click on all congressional actions. You will see that the bill has been sent to the House committee on energy and commerce. That is the committee that has jurisdiction over health issues. Once the bill is in the committee it is up to the chairperson to schedule further consideration. This is often the bill graveyard. Bills die here and any bill still in committee when the Congress ends and a new Congress begins,the bill dies with the previous Congress. If a Sponsor really wants to push a bill they have to work with the committee chair to get it considered and voted on. A nearly identical bill was introduced in the last Congress and died in committee when the Congress ended. If you go to thomas.gov in the middle of the page there is a place to search multiple, previous Congresses. Click here and search the 110th Congress to see if you can find the bill number(s) for the Women's Health Care Resolution introduced in the last Congress! (Hint:search for women's).
While a bill is in committee, there can be a Hearing, where people talk about the bill and related issues, and it can undergo a markup where edits and additions are made. If a bill makes it out of the committee it can go to the floor. In the House, the bill may still die if the Speaker of the House does not give the bill a place on the calendar. In the Senate, it gets scheduled for consideration but it can be placed on "hold" by any Senator which threatens a filibuster.
If the bill gets floor consideration it is discussed and amended by the House or Senate as a whole (and there are lots of rules around this). Then it is voted on. If passed, it must go to the other Chamber. If the two Chambers pass the same version of the bill it goes to the President. If not, it goes to the Conference Committee to be discussed by Members in both Chambers and the new version on is voted on by both Chambers before going to the President who can sign it into law, or veto it. Please note that this is a very watered down version of the process but I have to keep it simple for myself.
If you want to see how the entire process took place to to thomas.gov and type in HR 1, which was the stimulus bill. Click on all congressional actions and you can see how the entire process took place in detail. You can even click the vote record and see how each Member voted. For a quicker version click on Major Congressional Actions rather than All Congressional Action.
Another good use of this website is to look up legislation sponsored or co-sponsored by a particular Legislator. So if you wanted to look up all bills introduced by Senator John McCain of Arizona you can select his name from the Choose a Senator tab. If you want to see what bills he has co-sponsored you can go to advanced search and choose Senator McCain and click on Sponsor and Co-Sponsor. So if you are going to meet with a Member or their Staff you can look up any legislation they have introduced or co-sponsored this session.
Let's try one more. There is a bill asking for funding and treatment support for post-partum depression. It's been called the Melanie Blocker Stokes MOTHERS Act. So type MOTHERS into the search box. Go to the advanced search and see how many times it's been introduced- I found it as far back as the 107th Congress and it hasn't made it out of the Committee. It is amazing how long it takes something to become law. This bill has been reintroduced every Congress since 2001. The language of a bill is also of utmost importance. It can take months to change an "and" to "includes". Every word is important, and a huge package like the stimulus can be 700+ pages. The whole process is amazing.
Here is a list of things affecting the viability of legislation that I got from Nevena.
If you haven't browsed the Legislative Primer, please do so. Just browse through it while on a plane or over dinner. It's a pretty quick read and will give you the basics. To order a copy click here.
So, you might be as surprised as I was to realize that most of the legislation that is introduced in either the House or the Senate goes no further than a committee. So once a piece of legislation is introduced it is assigned a number (H. 1 in the House, S. 1 in the Senate). The Member who introduces the bill may seek the support of other Members to Co-Sponsor a bill. Let's look at the Women's Health Care Resolution. If you go to http://www.thomas.gov you can find any piece of legislation that has been introduced. The Resolution is H Con Res 48 so click on bill number and type that in your search box. (Later, after you've played on the site a little, just type in women's and see if you can find it without the bill number since many times you will probably not have the actual number). You can see near the top that the bill was introduced by Representative Schakowski and had 10 co-sponsors (though I do know that Representative Kilroy of Ohio co-sponsored also after we talked last week! Whoo Hoo!!) You can see that S Con Res 6 is the related bill in the Senate.
Click on the text of legislation box and read it! It's not that long and it has some surprising statistics and good points in it! This is what we're asking Congress to consider on behalf of our patients so please get familiar with it!
Next click on all congressional actions. You will see that the bill has been sent to the House committee on energy and commerce. That is the committee that has jurisdiction over health issues. Once the bill is in the committee it is up to the chairperson to schedule further consideration. This is often the bill graveyard. Bills die here and any bill still in committee when the Congress ends and a new Congress begins,the bill dies with the previous Congress. If a Sponsor really wants to push a bill they have to work with the committee chair to get it considered and voted on. A nearly identical bill was introduced in the last Congress and died in committee when the Congress ended. If you go to thomas.gov in the middle of the page there is a place to search multiple, previous Congresses. Click here and search the 110th Congress to see if you can find the bill number(s) for the Women's Health Care Resolution introduced in the last Congress! (Hint:search for women's).
While a bill is in committee, there can be a Hearing, where people talk about the bill and related issues, and it can undergo a markup where edits and additions are made. If a bill makes it out of the committee it can go to the floor. In the House, the bill may still die if the Speaker of the House does not give the bill a place on the calendar. In the Senate, it gets scheduled for consideration but it can be placed on "hold" by any Senator which threatens a filibuster.
If the bill gets floor consideration it is discussed and amended by the House or Senate as a whole (and there are lots of rules around this). Then it is voted on. If passed, it must go to the other Chamber. If the two Chambers pass the same version of the bill it goes to the President. If not, it goes to the Conference Committee to be discussed by Members in both Chambers and the new version on is voted on by both Chambers before going to the President who can sign it into law, or veto it. Please note that this is a very watered down version of the process but I have to keep it simple for myself.
If you want to see how the entire process took place to to thomas.gov and type in HR 1, which was the stimulus bill. Click on all congressional actions and you can see how the entire process took place in detail. You can even click the vote record and see how each Member voted. For a quicker version click on Major Congressional Actions rather than All Congressional Action.
Another good use of this website is to look up legislation sponsored or co-sponsored by a particular Legislator. So if you wanted to look up all bills introduced by Senator John McCain of Arizona you can select his name from the Choose a Senator tab. If you want to see what bills he has co-sponsored you can go to advanced search and choose Senator McCain and click on Sponsor and Co-Sponsor. So if you are going to meet with a Member or their Staff you can look up any legislation they have introduced or co-sponsored this session.
Let's try one more. There is a bill asking for funding and treatment support for post-partum depression. It's been called the Melanie Blocker Stokes MOTHERS Act. So type MOTHERS into the search box. Go to the advanced search and see how many times it's been introduced- I found it as far back as the 107th Congress and it hasn't made it out of the Committee. It is amazing how long it takes something to become law. This bill has been reintroduced every Congress since 2001. The language of a bill is also of utmost importance. It can take months to change an "and" to "includes". Every word is important, and a huge package like the stimulus can be 700+ pages. The whole process is amazing.
Here is a list of things affecting the viability of legislation that I got from Nevena.
- Number of bill co-sponsors (obviously if you have many people co-sponsoring a bill it will probably get more attention and consideration).
- Bill has been introduced in both Chambers (House and Senate)
- Bipartisan support (this one takes a lot of work and strategy I have learned)
- Grassroots support/pressure on Members by their constituents
- Time of year; in a re-election year Members may be even more sensitive to constituent support or opposition
- Who is the President?
Approximately 400 our of 14,000 introduced bills will become laws during a 2 year Congress!
ACOG has been very involved with the Women's Resolution so I would recommend following that particular legislation. Another way to stay on the issues is to sign up for ACOG's newsletter The Inside Scoop. Click the link to sign up and stay informed!
Tuesday, February 17, 2009
C-SPAN and NASCAR
So watching C-SPAN with Joe is like watching NASCAR with my brother, Jason. I am not a NASCAR fan, don't really get watching the cars drive around and around in circles. The blowouts are cool and I shudder when cars collide for fear that someone will really get hurt but those instances are few and I can't really do anything but sleep for 4 hours straight at a time. However, when I watch NASCAR with my brother it's cool. He explains why a driver took a pit at that time and what they have to do to stay in first, why another driver is changing lanes, and how that blowout affects the race.
So there is a TV in the office to watch C-SPAN. I have (big surprise) never been a fan of C-SPAN. But watching C-SPAN with Joe is like watching NASCAR with my brother. I can ask him why they're arguing, he explains the different rules and procedures for amendments and votes, we laugh when the Senate President has to call the Senate to order 4 times before everyone is quiet. And I have to admit, that last week when Joe was out of the office and the stimulus bill was being debated in the Senate... that I watched C-SPAN... by myself.
So there is a TV in the office to watch C-SPAN. I have (big surprise) never been a fan of C-SPAN. But watching C-SPAN with Joe is like watching NASCAR with my brother. I can ask him why they're arguing, he explains the different rules and procedures for amendments and votes, we laugh when the Senate President has to call the Senate to order 4 times before everyone is quiet. And I have to admit, that last week when Joe was out of the office and the stimulus bill was being debated in the Senate... that I watched C-SPAN... by myself.
Monday, February 16, 2009
What Residents Can Do
The last day of the conference I also heard Steve Hildebrand, Deputy National Campaign Manager of President Obama's campaign who talked about applying grassroots initiatives to health care reform. This lecture was great!
Regarding health reform:
"You all know what you're up against, the
special interests, the powerful groups, the easy messaging that
the opponents tend to always have. I really believe the way we
get this done is not here in Washington and it’s not by a bunch
of interest groups on our side here in Washington, but it’s by
regular people in communities who have stronger voices than
anybody else in this country right now."
"But what if 100 uninsured people came
together built by you, and they called upon John Thune (SD) to meet
with them, and he showed up with a video camera and he
videotaped that entire discussion where John Thune has to have
a discussion with 100 uninsured people. And what if some of
those folks say, you know what, Senator, we appreciate what
you’re doing, but you have health insurance and we don't. And
your health insurance is paid by the taxpayers, and we’re
taxpayers. We want what you got, nothing more, nothing less,
we want what you got."
I think there are so many people in the general public who truly don't know the power they have by being voting Constituents. He discouraged walking in as "We are the X coalition" but rather as voting members of that Congressman's district or state whom they are accountable too. I will definitely watch his talk again and here is the link. Click on the am session, there is also a transcript of the session if you just want to read it.
I approached Mr. Hildebrand after the lecture and asked what could WE do as residents and health care providers. I explained that it had to be the best bang for our time- that when working 80 hours a weeks we barely have time to shop for groceries, but if we could do one thing what would it be? He said for each of us to have a story or two of an uninsured person/family that we've encountered and explain the difficulty for that patient to get the care they needed, or explain the poor outcome that could have been avoided. And then ask, "What do you plan to do about this?" He actually thanked me for being involved and said that the representation on of the health care providers was essential and important.
So let's do it! Dr. Manriquez and I have discussed planning a meeting or two with Members. Get your stories together and join us!
Regarding health reform:
"You all know what you're up against, the
special interests, the powerful groups, the easy messaging that
the opponents tend to always have. I really believe the way we
get this done is not here in Washington and it’s not by a bunch
of interest groups on our side here in Washington, but it’s by
regular people in communities who have stronger voices than
anybody else in this country right now."
"But what if 100 uninsured people came
together built by you, and they called upon John Thune (SD) to meet
with them, and he showed up with a video camera and he
videotaped that entire discussion where John Thune has to have
a discussion with 100 uninsured people. And what if some of
those folks say, you know what, Senator, we appreciate what
you’re doing, but you have health insurance and we don't. And
your health insurance is paid by the taxpayers, and we’re
taxpayers. We want what you got, nothing more, nothing less,
we want what you got."
I think there are so many people in the general public who truly don't know the power they have by being voting Constituents. He discouraged walking in as "We are the X coalition" but rather as voting members of that Congressman's district or state whom they are accountable too. I will definitely watch his talk again and here is the link. Click on the am session, there is also a transcript of the session if you just want to read it.
I approached Mr. Hildebrand after the lecture and asked what could WE do as residents and health care providers. I explained that it had to be the best bang for our time- that when working 80 hours a weeks we barely have time to shop for groceries, but if we could do one thing what would it be? He said for each of us to have a story or two of an uninsured person/family that we've encountered and explain the difficulty for that patient to get the care they needed, or explain the poor outcome that could have been avoided. And then ask, "What do you plan to do about this?" He actually thanked me for being involved and said that the representation on of the health care providers was essential and important.
So let's do it! Dr. Manriquez and I have discussed planning a meeting or two with Members. Get your stories together and join us!
Thursday, February 12, 2009
State Health Facts, On the Issues, My Busy Week!
Hello Everyone! I have not forgotten about the blog, I have just been terribly busy. Those of you who attend the CLC will see my handiwork in the agenda book. I've made state fact sheets for all 50 states and D.C. They include information such as birth rates, percentage of preterm births, death rate from diabetes, obesity, percentage of women who have had pap smears, etc. They are useful when talking to the Staffers or the Congressmen to show them the status of their own state.
Just in case you are interested and have a need or desire to look up an individual state here is the website I've been using:
http://www.statehealthfacts.org/
There is some really good info. Another good website with state-specific numbers that is good for us is the March of Dimes website they have a tab for "professionals and researchers" here:
http://www.marchofdimes.com/professionals/681.asp
and the peristats is a great resource and the medical references has some really good patient information sheets. By the way, the March of Dimes estimates that a preterm delivery costs the private insurer $41,610 for an average stay of 16.8 days. As Anita mentioned earlier, that does not include long term care for the child, production lost from the parent, or take into account the devastation of divorce, depression, etc on the family. But you give that number to someone in Congress and let them know how many preterm births their state had and you get their attention. I figured it out for Kansas and it was over $200 million dollars in 2006.
Now my big project that I will finish tomorrow is putting together information sheets on all the new Congressmen in the 111th Congress- there are about 64 Members so this is a huge project. One website I've used for this is http://www.ontheissues.org/ On this site you can click on your state, then choose a Congressman (or woman) and see how they've voted and read quotes on different issues. I'm trying to put each person's stance on health care reform on these sheets so I've used this especially for new Senators who were previously US Representatives. Another site that I have come to like is Congresspedia.com
http://www.sourcewatch.org/index.php?title=Congresspedia
In addition to these two projects this week I've attended two meetings that the Alliance of Specialty Medicine (which ACOG is a part of) have had with Member's Staff. The biggest topics at these meetings seem to be Health IT and Physician Reimbursement. I went to an International Family Planning Coalition meeting, which I will blog more about. On Wednesday I attended a press conference announcing the introduction of a legislative resolution that was introduced in both the House and the Senate yesterday that ACOG has been a big part of (I'm going to give everyone a link so you can follow the progress of this legislation). I also attended a lunch meeting with several physician organizations and Representative Burgess from TX who is an ob/gyn. Then this morning I attended an AMA event where multiple physician groups casually met with many of the new Freshman Democrats. It was really fun! I got to meet lots of Staffers and several Representatives and it gave me some face time to talk about this new resolution and encourage them to co-sponsor it. I'm finally at a point where I know enough about what is going on that I can speak on my own if needed. Too bad next week is my last week! I would really love to stay longer. Tomorrow I'm going to a Medicaid briefing.
Hopefully this weekend I'll get more time to blog. The posts take me a while because I'm digesting and assimilating information in order to present it. I started a piece on Individualized Health Plans and how they are terrible options for women. It's almost done so look out for it- it's really important stuff!
Just in case you are interested and have a need or desire to look up an individual state here is the website I've been using:
http://www.statehealthfacts.org/
There is some really good info. Another good website with state-specific numbers that is good for us is the March of Dimes website they have a tab for "professionals and researchers" here:
http://www.marchofdimes.com/professionals/681.asp
and the peristats is a great resource and the medical references has some really good patient information sheets. By the way, the March of Dimes estimates that a preterm delivery costs the private insurer $41,610 for an average stay of 16.8 days. As Anita mentioned earlier, that does not include long term care for the child, production lost from the parent, or take into account the devastation of divorce, depression, etc on the family. But you give that number to someone in Congress and let them know how many preterm births their state had and you get their attention. I figured it out for Kansas and it was over $200 million dollars in 2006.
Now my big project that I will finish tomorrow is putting together information sheets on all the new Congressmen in the 111th Congress- there are about 64 Members so this is a huge project. One website I've used for this is http://www.ontheissues.org/ On this site you can click on your state, then choose a Congressman (or woman) and see how they've voted and read quotes on different issues. I'm trying to put each person's stance on health care reform on these sheets so I've used this especially for new Senators who were previously US Representatives. Another site that I have come to like is Congresspedia.com
http://www.sourcewatch.org/index.php?title=Congresspedia
In addition to these two projects this week I've attended two meetings that the Alliance of Specialty Medicine (which ACOG is a part of) have had with Member's Staff. The biggest topics at these meetings seem to be Health IT and Physician Reimbursement. I went to an International Family Planning Coalition meeting, which I will blog more about. On Wednesday I attended a press conference announcing the introduction of a legislative resolution that was introduced in both the House and the Senate yesterday that ACOG has been a big part of (I'm going to give everyone a link so you can follow the progress of this legislation). I also attended a lunch meeting with several physician organizations and Representative Burgess from TX who is an ob/gyn. Then this morning I attended an AMA event where multiple physician groups casually met with many of the new Freshman Democrats. It was really fun! I got to meet lots of Staffers and several Representatives and it gave me some face time to talk about this new resolution and encourage them to co-sponsor it. I'm finally at a point where I know enough about what is going on that I can speak on my own if needed. Too bad next week is my last week! I would really love to stay longer. Tomorrow I'm going to a Medicaid briefing.
Hopefully this weekend I'll get more time to blog. The posts take me a while because I'm digesting and assimilating information in order to present it. I started a piece on Individualized Health Plans and how they are terrible options for women. It's almost done so look out for it- it's really important stuff!
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