Today we continue a never-ending journey, to bridge the meaning of those words with the realities of our time. For history tells us that while these truths may be self-evident, they have never been self-executing; that while freedom is a gift from God, it must be secured by His people here on Earth. The patriots of 1776 did not fight to replace the tyranny of a king with the privileges of a few or the rule of a mob. They gave to us a Republic, a government of, and by, and for the people, entrusting each generation to keep safe our founding creed.For more than two hundred years, we have.
Through blood drawn by lash and blood drawn by sword, we learned that no union founded on the principles of liberty and equality could survive half-slave and half-free. We made ourselves anew, and vowed to move forward together.Together, we determined that a modern economy requires railroads and highways to speed travel and commerce; schools and colleges to train our workers.Together, we discovered that a free market only thrives when there are rules to ensure competition and fair play.
Together, we resolved that a great nation must care for the vulnerable, and protect its people from life’s worst hazards and misfortune.
Through it all, we have never relinquished our skepticism of central authority, nor have we succumbed to the fiction that all society’s ills can be cured through government alone. Our celebration of initiative and enterprise; our insistence on hard work and personal responsibility, are constants in our character.
But we have always understood that when times change, so must we; that fidelity to our founding principles requires new responses to new challenges; that preserving our individual freedoms ultimately requires collective action. For the American people can no more meet the demands of today’s world by acting alone than American soldiers could have met the forces of fascism or communism with muskets and militias. No single person can train all the math and science teachers we’ll need to equip our children for the future, or build the roads and networks and research labs that will bring new jobs and businesses to our shores. Now, more than ever, we must do these things together, as one nation, and one people.
This generation of Americans has been tested by crises that steeled our resolve and proved our resilience. A decade of war is now ending. An economic recovery has begun. America’s possibilities are limitless, for we possess all the qualities that this world without boundaries demands: youth and drive; diversity and openness; an endless capacity for risk and a gift for reinvention. My fellow Americans, we are made for this moment, and we will seize it – so long as we seize it together.
For we, the people, understand that our country cannot succeed when a shrinking few do very well and a growing many barely make it. We believe that America’s prosperity must rest upon the broad shoulders of a rising middle class. We know that America thrives when every person can find independence and pride in their work; when the wages of honest labor liberate families from the brink of hardship. We are true to our creed when a little girl born into the bleakest poverty knows that she has the same chance to succeed as anybody else, because she is an American, she is free, and she is equal, not just in the eyes of God but also in our own.
We understand that outworn programs are inadequate to the needs of our time. We must harness new ideas and technology to remake our government, revamp our tax code, reform our schools, and empower our citizens with the skills they need to work harder, learn more, and reach higher. But while the means will change, our purpose endures: a nation that rewards the effort and determination of every single American. That is what this moment requires. That is what will give real meaning to our creed.
We, the people, still believe that every citizen deserves a basic measure of security and dignity. We must make the hard choices to reduce the cost of health care and the size of our deficit. But we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future. For we remember the lessons of our past, when twilight years were spent in poverty, and parents of a child with a disability had nowhere to turn. We do not believe that in this country, freedom is reserved for the lucky, or happiness for the few. We recognize that no matter how responsibly we live our lives, any one of us, at any time, may face a job loss, or a sudden illness, or a home swept away in a terrible storm. The commitments we make to each other – through Medicare, and Medicaid, and Social Security – these things do not sap our initiative; they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great.
We, the people, still believe that our obligations as Americans are not just to ourselves, but to all posterity. We will respond to the threat of climate change, knowing that the failure to do so would betray our children and future generations. Some may still deny the overwhelming judgment of science, but none can avoid the devastating impact of raging fires, and crippling drought, and more powerful storms. The path towards sustainable energy sources will be long and sometimes difficult. But America cannot resist this transition; we must lead it. We cannot cede to other nations the technology that will power new jobs and new industries – we must claim its promise. That is how we will maintain our economic vitality and our national treasure – our forests and waterways; our croplands and snowcapped peaks. That is how we will preserve our planet, commanded to our care by God. That’s what will lend meaning to the creed our fathers once declared.
We, the people, still believe that enduring security and lasting peace do not require perpetual war. Our brave men and women in uniform, tempered by the flames of battle, are unmatched in skill and courage. Our citizens, seared by the memory of those we have lost, know too well the price that is paid for liberty. The knowledge of their sacrifice will keep us forever vigilant against those who would do us harm. But we are also heirs to those who won the peace and not just the war, who turned sworn enemies into the surest of friends, and we must carry those lessons into this time as well.
We will defend our people and uphold our values through strength of arms and rule of law. We will show the courage to try and resolve our differences with other nations peacefully – not because we are naïve about the dangers we face, but because engagement can more durably lift suspicion and fear. America will remain the anchor of strong alliances in every corner of the globe; and we will renew those institutions that extend our capacity to manage crisis abroad, for no one has a greater stake in a peaceful world than its most powerful nation. We will support democracy from Asia to Africa; from the Americas to the Middle East, because our interests and our conscience compel us to act on behalf of those who long for freedom. And we must be a source of hope to the poor, the sick, the marginalized, the victims of prejudice – not out of mere charity, but because peace in our time requires the constant advance of those principles that our common creed describes: tolerance and opportunity; human dignity and justice.
We, the people, declare today that the most evident of truths – that all of us are created equal – is the star that guides us still; just as it guided our forebears through Seneca Falls, and Selma, and Stonewall; just as it guided all those men and women, sung and unsung, who left footprints along this great Mall, to hear a preacher say that we cannot walk alone; to hear a King proclaim that our individual freedom is inextricably bound to the freedom of every soul on Earth.
It is now our generation’s task to carry on what those pioneers began. For our journey is not complete until our wives, our mothers, and daughters can earn a living equal to their efforts. Our journey is not complete until our gay brothers and sisters are treated like anyone else under the law – for if we are truly created equal, then surely the love we commit to one another must be equal as well. Our journey is not complete until no citizen is forced to wait for hours to exercise the right to vote. Our journey is not complete until we find a better way to welcome the striving, hopeful immigrants who still see America as a land of opportunity; until bright young students and engineers are enlisted in our workforce rather than expelled from our country. Our journey is not complete until all our children, from the streets of Detroit to the hills of Appalachia to the quiet lanes of Newtown, know that they are cared for, and cherished, and always safe from harm.That is our generation’s task – to make these words, these rights, these values – of Life, and Liberty, and the Pursuit of Happiness – real for every American. Being true to our founding documents does not require us to agree on every contour of life; it does not mean we will all define liberty in exactly the same way, or follow the same precise path to happiness. Progress does not compel us to settle centuries-long debates about the role of government for all time – but it does require us to act in our time.
For now decisions are upon us, and we cannot afford delay. We cannot mistake absolutism for principle, or substitute spectacle for politics, or treat name-calling as reasoned debate. We must act, knowing that our work will be imperfect. We must act, knowing that today’s victories will be only partial, and that it will be up to those who stand here in four years, and forty years, and four hundred years hence to advance the timeless spirit once conferred to us in a spare Philadelphia hall.
My fellow Americans, the oath I have sworn before you today, like the one recited by others who serve in this Capitol, was an oath to God and country, not party or faction – and we must faithfully execute that pledge during the duration of our service. But the words I spoke today are not so different from the oath that is taken each time a soldier signs up for duty, or an immigrant realizes her dream. My oath is not so different from the pledge we all make to the flag that waves above and that fills our hearts with pride.
They are the words of citizens, and they represent our greatest hope.
You and I, as citizens, have the power to set this country’s course.
You and I, as citizens, have the obligation to shape the debates of our time – not only with the votes we cast, but with the voices we lift in defense of our most ancient values and enduring ideals.
Let each of us now embrace, with solemn duty and awesome joy, what is our lasting birthright. With common effort and common purpose, with passion and dedication, let us answer the call of history, and carry into an uncertain future that precious light of freedom.
Thank you, God Bless you, and may He forever bless these United States of America.
I didn't want to call him back today. What should I say when I do? My mom thinks I will never be able to reach him. Thomas thinks they will approve my twice daily nexium for 3 months and then make me go through the whole fiasco again.
I think I'm going to try and go more public with the letter (and then pray that the rest of my claims don't all get denied from here on out).
Below is a letter I personally wrote on my own behalf as a patient as an appeal to my health insuranc e company. I believe the issue it addresses can be broadly applied to the above situation and feel that this issue simply must be addressed.
Grievance and Appeals Department
PO Box 14546
Lexington, KY 40512-4546
Appeal of most recent decision of 2/17/12 regarding Nexium twice daily for feckalyn (Member ID: 666666666).
To whom it may concern:
I am writing you to protest a number of recent denials passed down by your pharmacy (3 to date but I expect more).
I am a new customer to Humana. While trying to get my prescriptions shifted over to you I have come up against the most frustrating brick wall I have encountered in years. I take 40 mg of Nexium twice daily. I have taken 40 mg of Nexium twice daily for nearly 10 years because in 2002 I was diagnosed with erosive esophagitis. After a multitude of drug failures (Prevacid, Prilosec, Protonix, Propulsid, Zantac, Tagamet, Dexilant, Prevacid 24 hour OTC, Pepcid, and a variety of OTC antacids in a multitude of combinations with these drugs) and lifestyle changes (I increased exercise, cut out coffee and carbonated beverages and spicy foods and other irritants, ruined two bed frames raising the head up 30 degrees, chewed non-mint gum religiously after meals, completely stopped drinking alcohol, and never lie down after eating anything for at least 2 hours) my provider and I finally found that 40mg of Nexium twice a day (along with the above lifestyle management techniques) essentially alleviated my erosive esophagitis and its symptoms. I have done everything the doctor ordered and then some (the chewing gum thing was a journal article I found on my own) to try and avoid writing this letter to you begging for your mercy but obviously none of it has worked because you keep blithely deny my health care providers’ requests.
In the last 10 years I have had a number of different health insurance carriers and plans and NEVER have I been outright denied 40mg of Nexium twice a day. I’ve had to have prior authorizations completed in the past but the drug was always approved after one request. The last two plans I had didn’t even require a prior auth for the twice daily dosing. Over the years I have become very aware of Astra Zeneca’s patient assistance programs because I have also had periods of being uninsured and this drug is astronomically expensive. Sadly the “Purple Program” is not available to people with any sort of insurance who can’t afford the medicine. They offer co-pay assistance for the insured but for those of us with substandard coverage they have no mercy. Nexium is one of Astra Zeneca’s ‘blockbuster drugs’, making them billions of dollars annually. I suspect that in 2014, when Nexium is (supposedly) slated to go generic, you will not waste your ‘medical decision maker’s’ time fighting claims like mine. You will be better served financially to take on those gastroenterologists who dare to try and prescribe Dexilant twice a day because that will actually save you money.
I am followed closely by a gastroenterologist for my condition. I have had 3 esophagogastroduodenoscopy’s (EGD) since the one that showed I had erosive esophagitis in 2002 and they all indicated that the 40mg of Nexium twice a day was helping by showing the erosive esophagitis had resolved. Unfortunately I continue to have daily refractory gastroesophageal reflux disease (GERD) symptoms if I don’t take 40mg of Nexium twice a day. When I have erosive esophagitis I can barely function. When I have severe refractory GERD symptoms I am not much better. It’s an anxiety-inducing cycle; which is vicious for me because increased anxiety leads to increased stomach acids. It’s painful but it’s also infuriating and disenheartening not to be able to control the pain through lifestyle modification and affordable medicines.
At this point you may be questioning my audacity in wording my letter in this manner. I am questioning your audacity in having a ‘medical decision maker’ rotely deny a medication based on nothing more than a company policy set to save you money. How dare you pretend you can outweigh my medical providers of the last 10 years and their experience with me as a patient and the thousands of other patients they have treated. How dare you blithely suggest that I try another medication, completely dismissing the gargantuan effort I’ve made for years to try and find another medication combination that works for me so I don’t have to write letters likes this? You deny me my medicine three times based on a prescription request and a single EGD (that seemed to be summarily ignored after I spent hours tracking it down and getting it to my GE doctor).
When I call to speak to someone at your company I am constantly accosted by how much Humana cares about me and my health. The soft toned woman assures me that I matter to you, that you want me well and that my premiums are being sent to a benevolent caring company. Yet keeping me from redeveloping erosive esophagitis, an extremely painful condition, that could potentially lead to me having barretts esophagus and cancer seems to be of no concern to you. Are you so short sighted that you can’t see that the prevention far outweighs the cost of the cure? Or do your actuarial tables tell you that I’m likely not going to have this policy long enough for you to end up treating any negative health sequelae I may experience due to this denial?
You’ve also suggested that my doctor can call and discuss his rationales with your ‘medical decision maker’. How do you expect my busy gastroenterologist to stop his day to have this ‘peer to peer’ conversation with your ‘medical decision maker’? He can’t even bill you for this time. This surely is just a tactic to keep me from getting this expensive prescription because you know that most providers are not able to make these sorts of calls on the daily basis that companies like yours are asking that they make them.
At this point, frankly, I have next to zero faith that anything I, my trusted health care providers, or even Jesus Christ himself say to you is going to change your mind. I am venting; I find myself wondering why I’m even bothering and why I’m remaining so civil. Do not think that I don’t understand that you would not remain in business if you gave every drug to every provider/patient that requested it. But please don’t continue to insult my intelligence with these asinine denials, pedantic automated phone calls, and supposed requests for further information/action on my part that could sway your ‘medical decision maker’s’ mind. Just tell me to go away and suffer in silence because that’s what you really mean.
Obviously this letter is written from an emotional and personal perspective; it's long and a bit messy and imperfect. My dual roles as a provider and a patient in need of care has brought the issues of our for-profit (and broken) health care system right into my living room. I fear that, with the new Affordable Care Act requirements that insurance companies cut their overhead costs and actually spend 85% of our premiums in providing care for us, that we as patients and providers alike will be hearing stories like mine more and more often. Money has to be made somewhere otherwise the insurers (or the drug companies or us providers) would just give up entirely and then where would we be?
Pediatricians fed up with parents who refuse to vaccinate their children out of concern it can cause autism or other problems increasingly are "firing" such families from their practices, raising questions about a doctor's responsibility to these patients.
Medical associations don't recommend such patient bans, but the practice appears to be growing, according to vaccine researchers.
By comparison, in 2001 and 2006 about 6% of physicians said they "routinely" stopped working with families due to parents' continued vaccine refusal and 16% "sometimes" dismissed them, according to surveys conducted then by the American Academy of Pediatrics.In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.
Most pediatricians consider preventing disease through vaccines a primary goal of their job. The Centers for Disease Control and Prevention and AAP issue an annual recommended vaccination schedule, but some parents ask if their child's immunizations can be pushed back or skipped altogether, pediatricians say."There's more noise among pediatricians, more people willing to argue that it's OK to do this versus 10 years ago," said Douglas Diekema, a professor of pediatrics at the University of Washington in Seattle. Dr. Diekema wrote the AAP's policy on working with vaccine refusers, which recommends providers address the issue at repeated visits, but respect parents' wishes unless it puts a child at risk of significant harm.
Parents often voice concerns about autism or that their child's immune system may be overwhelmed by too many vaccines at once. Worries about a link between vaccines and autism arose because some parents noticed their children regressed, or lost some skills, around the time of their vaccinations at two years of age. Another concern centered on the former use of mercury as a vaccine preservative.While rates for several key inoculations in young children rose between 2009 and 2010, according to the CDC, lower immunization rates have been blamed as a factor in U.S. outbreaks of whooping cough and measles in recent years.
Numerous studies since have dispelled these concerns among scientists. Rather, scientists say, it is more likely that autism symptoms begin showing up around the same age children are vaccinated.
The rise in patient firings reflects another factor. As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients, said Arthur Caplan, a bioethics professor at the University of Pennsylvania. In addition, doctors may feel financial pressure to see more patients and so have less time to contend with recalcitrant ones.
For Allan LaReau of Kalamazoo, Mich., and his 11 colleagues at Bronson Rambling Road Pediatrics, who chose in 2010 to stop working with vaccine-refusing families, a major factor was the concern that unimmunized children could pose a danger in the waiting room to infants or sick children who haven't yet been fully vaccinated.
In one case, an unvaccinated child came in with a high fever and Dr. LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. "I lost a lot more sleep than I usually do" worrying about the situation, he said.
"You feel badly about losing a nice family from the practice," added Dr. LaReau, but families who refused to vaccinate their kids were told that "this is going to be a difficult relationship without this core part of pediatrics." Some families chose to go elsewhere while others agreed to have their kids inoculated.
Pediatricians disagree about what their duty is to these families. "The bottom line is you should try to do whatever you can to maintain the family in the best care," said Michael Brady, chair of the pediatrics department at Nationwide Children's Hospital in Columbus, Ohio, and a member of the AAP's immunization committee. "If they leave your practice, they're probably going to gravitate toward another practice with unhealthy practices."
Other physicians say they rarely have had luck persuading vaccine opponents to change their minds.
David Fenner and his 20-plus colleagues at Children's Medical Group in Rhinebeck, N.Y., discuss vaccine concerns but ask families to leave if they don't comply by a certain point.
Dr. Fenner said he tells new families, "You've been bombarded with information before you came here, some accurate and some not." Iif a family refuses to vaccinate after a discussion of the issue, he tells them "there are so many things we're not going to see eye-to-eye on."
So far, the practice has fired a couple of families per year since it implemented the policy about five years ago.
Pamela Felice, who lives in an Atlanta suburb, had difficulty finding a pediatrician for her two children though they have waivers from a previous pediatrician exempting them from school requirements for immunizations. Her older child had gastrointestinal trouble and regressed development after receiving vaccines, she said, which she believes were related to the shots.
Ms. Felice received a letter from her pediatrician a few years ago stating that because the family chose not to vaccinate, it needed to find another doctor. She called four or five other practices but none would agree to an appointment after she told them she was opposed to vaccines. The family ended up with an elderly family doctor who said he had "seen it all" and was willing to treat the children if they got sick, Ms. Felice said.
"A doctor should feel obligated to discuss [potential vaccine] risks with any parent who wants to discuss them," said Ms. Felice.
Write to Shirley S. Wang at email@example.com
Starting a list of my favorite books/authors. Making it public because I am in that kind of mood. If an author is on this list it means I love them and probably have read every word they've published so if I don't mention all their titles I probably disapproved of the unmentioned ones on some (potentially minute) level.
( Here's the books. )
( No wonder Oprah has spent over $2 million bucks to lose weight and is still heavy )