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Experience with Ecuador's national health care system was a big mess

When we first arrived in Cuenca in 2012, we were advised by gringos that the prudent thing to do was to get health insurance. oconnoredbw sizedEd O'Connor

Being new, we took their recommendation and opted for coverage. The cost for both of us was $187 monthly and since our monthly income was $1,293, It really put a burden on our budget.

I had serious doubts about its viability. Nothing was ever paid or reimbursed. There was always some mitigating factor that made us ineligible or we would be reimbursed “manana” (tomorrow). We would go to their insurance office every other day and after two months of “mananas,” I indicated to them into what orifice they could place their insurance. So, we went the self-insured route for three years.

Fortunately, we had the choice: We could choose to self-insure, get private insurance or subscribe to national health care. We were not coerced by government threats like you are with O’bummer care.

Was there an alternative? Yes – the Ecuadorean National Health Insurance, which is referred to here as IESS. The price was very attractive — $78.14 monthly total for the two of us. So we enrolled.

I have had degenerative discs since 1980. To relieve inflammation, I take Meloxicam. It was prescribed by my doctor in the United States. Until now I could go to the pharmacy 80 feet from my apartment and buy it over the counter. But now the government here in its infinite wisdom has made it necessary to have a prescription.

It turned in to a six-day odyssey of navigating the IESS system.

On a Monday, I arrived at the IESS doctor, explained the problem, showed him my X-rays and received the prescription. The doctor told me to go to the El Centro (center city) IESS pharmacy for the prescription and then go the main IESS office to schedule an appointment with an orthopedist (which I did not request or want). I was not examined.
We went to the El Centro IESS pharmacy and there I was told that they did not have Meloxicam and I must go to the pharmacy at the IESS hospital. Since I was already in El Centro, I went to the IESS main office to schedule an appointment with an orthopedist. After an hour of sitting around sick people coughing and sneezing, an appointment was made. Now we had to go to a clinic on the northeast side of town.

We get to the clinic, wait in line and get to the window. We are told the paperwork we were given has to be in triplicate, so off we go to find a nearby store to have copies made, then go back in line at the clinic. It is now 1:10 p.m. Finally, at 3 p.m., we get to see the doctor.
Now, he wants to see an MRI, so it is back to IESS El Centro. I am given paperwork to go to a large hospital so an MRI can be scheduled. After that an appointment has to be scheduled to have the MRI read back at the clinic in the northeast area of the city. After seven hours of running around today I still do not have the Meloxicam. Maybe tomorrow.

On Day 2, after spending/wasting another 4.5 hours going to four more IESS offices, doctors, clinics and hospitals, I still did not have the Meloxicam. There is none available at the main IESS hospital and they don’t know when they will have it. I will have to go to a pharmacy and buy the prescription. That is 11 IESS locations, two days and 11.5 hours of running around and have nothing to show for it.

On that Saturday, I had the MRI taken. On Monday, I go back across town again to have the MRI read. The doctor studied the MRI. His diagnosis? He told me to be careful when I walk, gave me a prescription for Flexaril and guess what else? Meloxicam!

With IESS you can get the prescriptions you need at no cost since one is a dues paying member of the system, right? Guess again. To get the medicine I was prescribed twice by IESS doctors and going to two IESS pharmacies which did not have the medication — that’s six days and 16 total hours running the IESS gauntlet — I had to pay for the medication myself.

Is this a great system or what?

I could have walked 15 minutes down the hill from our apartment, gone to my family doctor, gotten the prescription I needed and gone to the local pharmacy. Total time: about 50 minutes and I would have spent the same for a doctor call as I did the six days on taxis and bus fare.

I am really looking forward to my next IESS encounter.

Now my wife is experiencing the same type of running hither and yon with her IESS doctors. Two appointments with not as much as her blood pressure checked. Now the procedure she needs to have done has been finally scheduled — in three months! Her latest appointment was scheduled for 10:25 a.m. and she was not seen until two hours later. Patients who got there after her were seen before her. Not knowing that she understands some Spanish she heard the one nurse say, “The gringa can wait.”

Now we are back to self-insuring but we are keeping the IESS insurance for emergencies or for something catastrophic, just in case. We might need another tour of the city!
On the bright side: The private health care providers we use are great and I feel as confident in their care, if not more so, than I did in central Pennsylvania. And the prices of the office visits are extremely reasonable: family doctor is $20, specialist is $40 and dentist is $20.

They take their time and are very thorough. Olga recently had her yearly physical and the doctor spent 50 minutes checking her. He then sent her for blood work. The follow up visit to review the lab results was free.

Until later from beautiful Cuenca ... Eddy the Expat

Ed O’Connor, a former resident of Middletown and Lower Swatara Township, is an expatriate living in Cuenca, Ecuador.

Last Updated on Wednesday, 07 December 2016 16:31

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Street home was a great fit — for us and our piano

So what made us pick our house at 207 N. Spring St.?gal susannahSusannah Gal

Well, there are lots of things that helped us to decide on this house, not the least of which was our 7-foot grand piano. That’s a hefty piece of furniture that not only needs to fit in one room of the house (hopefully one on a main floor), but it also needs to be able to get into that room.

This lovely black Mason and Hamlin grand piano was my husband’s purchase as he’s the one with the music degree and really plays the instrument. He spent a good deal of time researching what type of piano he liked in terms of its “action” (feel and movement of the keys when you play them) and then trying several out in our area of upstate New York.

12 7 gal piano

He found a Mason and Hamlin in California that was being sold to raise money for the nonprofit organization to which it had been given. So sight unseen (at least in person), we bought it, insured it and shipped it back across the country to our home in Binghamton, New York (I say “back” as the piano was initially manufactured in Rochester, New York). It fit very well in our large family room in our old house and served as the focal point for many conversations, several family band practices and one house concert. Now the challenge was to find a new home that would fit this lovely piece of musical furniture.

We are not really new house people, having had a house in Binghamton that was built in 1915 with a large two-floor addition built in the 1980s that had lots of windows. We like a house with some character, although “character” can also mean “needs lots of work.” We looked at several places and found some that could house the piano though the entryway would have been too tight or had too sharp a turn to allow us to maneuver the instrument in. Too bad as so many were very nice.

I found our house on Spring Street during an open house a month or so after I moved here. At that time, I thought it was potentially too big and too expensive — too big as it was actually bigger than our home in Binghamton and we were now only a family of two since both daughters have moved out. When my husband saw it, he favored it much more than another place in Middletown in part because of the beautiful large living room with lovely wood floors. When he said “we could have dances here,” I was hooked.

The house was built in 1900, by Mr. Roth, who then lived next door in 203 Spring. He built it for his three children. Our house looks like it was built as a triplex with three sets of bay windows both on the first and second floors. Based on the information from our neighbors (who heard it from the previous owner), none of the kids actually lived in the house. I can totally understand that (I can’t imagine living next to my parents in my early adult life).
At some point, it was converted into a duplex, taking the two left-side thirds and putting them together. That’s the side we have. That makes the outside and inside stairs wider than usual and the main living room large enough to able to host dances. We’ve actually used the lovely grand piano to play for several of the dances we’ve hosted. The musicians love it as it has a rich sound.

When we saw the house, it was filled with lots of models of homes, including Fallingwater, designed by Frank Lloyd Wright. This was because the husband of the previous owner was an avid crafter. There is also a wonderfully distinctive mural along all four walls of the dining room. This was painted in 2007 by Theresa Croteau of Rehrersburg for her mother who lived in the house with Mr. Don Greenfield at that time.

Terry told us that she had hiked the Appalachian Trail in sections over several months in 2006 and 2007. Her mother at that point was not able to hike so had to enjoy hearing about it and seeing pictures. Terry decided to paint the mural, which represents two sections of the Appalachian Trail (one in Virginia and the other in Maine), for her mother so she could feel like she was “on the trail.”

12 7 gal mural

Terry also said she painted the mural in part to repay her mother for their family home in the Palmdale section of Hershey where Terry lived at the time. When we asked her about the mural, Terry provided this journal entry she wrote just before reaching the summit of the Appalachian Trail in Maine in 2007:

“I think of all the childhood hikes my mom took her five daughters out to enjoy, eating in the woods or a picnic grove. I realize she planted the seed that grew into the fruit of this moment and I am thankful for her, her love of life and the outdoors. I would love to place her on the top of Katahdin Mountain to welcome me as I approach the summit. She deserves views like that … because she gave me a view of life that allowed me to be here.”
If you want to see our house and the mural in person, it will be open for the Middletown Holiday Home Tour, 1 to 8 p.m. Dec. 10. Contact the Middletown Historical Society to get a ticket. We’d love to see you. Terry Croteau is expected to be here for at least part of the event as well.

I’ll share more about dancing at our house in the new year.

Susannah Gal is associate dean of research and outreach and a professor of biology at Penn State Harrisburg. She has lived around the world and made Middletown her home in July 2015. She can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. .

Last Updated on Wednesday, 07 December 2016 16:14

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Rep. John Payne: Thank you for a wonderful 14 years in House

I would like to take this opportunity to extend my thanks for your encouragement and support during my 14 years in office. I truly appreciate the great opportunity I have had serving the people of the 106th Legislative District.

It has been an incredible experience serving you in the state House and interacting with you at a number of events in the district. I consider myself very fortunate to have had this opportunity to serve as your voice in the state Capitol and to work on your behalf, advocating and advancing the issues that are important to all of you. 

One of the best parts about this job has been meeting residents of all ages and hearing about what’s important in your lives. Many of you have shared your stories with me — and some have even told me the hardships you have faced in your lives — and I have tried to help in the best way I could. I have always tried to do my best, to listen to everyone’s ideas and opinions whether or not I agreed, and to represent your interests in Harrisburg.

Thankfully, I had the opportunity during my time in the state Legislature to work on issues important to me and the people I represent, such as ensuring adequate funding for our local schools and the Hershey Center for Applied Research, where important biomedical research is conducted. I was also glad to be able to successfully secure the largest investment for local transportation projects of any House district in the state. Many of those projects have been completed, but there are many more to come over the next several years. 

In addition to these projects, I’ve worked to ensure we have a fiscally responsible government, a business environment supportive of job creation and expansion, and safe communities for our children and grandchildren.

Over the years, many of you have stopped by or called my district office in Hershey for assistance with a state-related matter, or attended my annual Health Expos, Veterans Breakfasts, Handgun Safety Courses or other events I’ve hosted. I must thank and commend my staff who have worked their magic over the years to be able to help our constituents. 

No matter what the question or how complicated the issue may have been, they have risen to meet the challenge, and I am grateful for their dedication and passion for helping the people of the 106th District.

The 106th District is my home, and as such, I have been honored and consider it a privilege to have served as your state representative for the past 14 years. 

In the future, I plan to spend much more time with my wife, children and grandchildren, as well as travel to some new places. 

With that, I wish you all the very best, and look forward to continuing to see you out and about in our community.

John D. Payne is a Republican member of the Pennsylvania House of Representatives whose 106th District includes Middletown.

Last Updated on Wednesday, 30 November 2016 12:53

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I will happily admit it: I was wrong about Trump’s election chances

When a man is wrong, he admits it. Anything less is cowardly.

That said, I admit I called the presidential election wrong. Here in the pages of the Press And Journal, I predicted Hillary Clinton would emerge victorious. I did multiple times, in fact.

I really thought Hillary would clean Trump’s clock. While I sympathized with the president-elect’s attacks on neo-liberal ideology (free trade, lax immigration standards, enthusiasm for foreign policy interventionism) I didn’t think they would put him in the White House. 

What can I say? Being wrong never felt so good.

But why was I, and so many others, mistaken about Trump’s electoral prospects? Professional pundit, I’m not. Yet so many highly paid observers and reporters had Hillary pegged to win. What did they miss? The very same polls that had Hillary walking smoothly into the White House also predicted Trump’s improbable victory in the contentious GOP primary. Why was one wrong and not the other? And why did Hillary’s masterful use of feel-goody identity politics fail before “Make America Great Again”?

The answer is an enigma. It’s so simple, you’d never think it.

During the campaign, there was a lot of buzz about Trump mobilizing the poor white working class. Conventional wisdom held that if the real estate mogul was going to have a chance of defeating a former first lady, senator and secretary of state, he was going to have to rely upon a segment of the population who rarely votes.

It turns out, that wasn’t enough. Oren Cass of the Manhattan Institute crunched the data. Here’s what he found: Trump’s gain in white voters wouldn’t have been enough to offset Hillary’s minority support, had her support among non-whites been similar to President Barack Obama’s in 2012. Where Trump made the most gains, and thus clinched the election, was among minorities.

That’s right: Trump won by increasing his percentage of non-white support compared to Mitt Romney’s run four years ago.

All the pother about Trump alienating minorities and forever destroying the GOP’s electoral prospects proved shortsighted. As New York Times data-guru Nate Cohn tweeted following the results, “Dems need to grapple with the fact that they lost this election because voters who supported Obama in 2012 voted Trump.”

That still doesn’t answer the question of “why?” Why was Trump able to gain more minority votes than the Republican nominee in 2012? How did he capture presumably Democratic states like Michigan and Pennsylvania?

Here’s where I, and others, really got it wrong. Voters can be fickle people. Their desires, dreams and wants are not easily understood, though there’s plenty of scientific literature out there purporting to understand what makes voters tick.

One measure I’ve relied on was outlined by social psychologist Jonathan Haidt back in 2012. In an article titled “Forget the Money, Follow the Sacred,” for The New York Times, Haidt dismissed the common understanding that voters vote based on their wallets. “When people feel that a group they value — be it racial, religious, regional or ideological — is under attack, they rally to its defense, even at some cost to themselves,” Haidt explained. “We evolved to be tribal, and politics is a competition among coalitions of tribes.”

During the Obama-Romney bout, that understanding made sense. Obama, the son of an absent immigrant dad and hardworking mom, fashioned himself as a rags-to-riches symbol for minorities and dysfunctional whites. 

He was a symbol of hope, and a reaction against greedy Wall Streeters that plunged the country into recession. Romney, on the other hand, was portrayed as a protector of the affluent. 

Both were fabrications, but it didn’t matter in the fiction machine of politics.

Likewise, Trump has spent over a year being attacked relentlessly for his anti-immigration remarks and crude gestures toward women. Every liberal epithet in the book was thrown at him. Yet he still performed better than expected among women, blacks, and Hispanics. The question is: How?

The only answer I’ve come to is a simple one. The promise of jobs. And the promise of financial and physical security. Trump didn’t campaign on esoteric policy or paeans to love. His platform was about stopping the country’s hemorrhaging of manufacturing jobs and keeping criminals from entering our country. Hillary campaigned on a weird mix of warm-hearted cheer and spite for her bigoted enemies; Trump was all about the material.

Bill Clinton, of all people, noticed Hillary’s slipping grip with working class voters and reportedly tried to intervene in the weeks leading up to Election Day. The former president tried to warn his aloof wife that feting with Jay-Z and Beyoncé while ignoring blue collar types would down her campaign. Sam Stein of the Huffington Post reported that Clinton staffers in Midwest states like Michigan and Wisconsin had to raise their own money for canvassers after they were rebuked by Hillary headquarters in Brooklyn.

I don’t think Bill loves being right in this instance.

This election has upended a lot of modern notions about American politics. Media professionals aren’t nearly as smart as they think they are. Identity politics is a potent force, unless your wallet feels thin. And more importantly, the White House is earned and not deserved.

For myself, I ate a heaping pile of humble pie over my shoddy prediction.

Donald Trump will be the 45th president of the United States. We should all hope he succeeds in truly making America great again.

James E. Miller, a native of Middletown, works as a digital marketer in Northern Virginia.

Last Updated on Wednesday, 30 November 2016 12:48

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When it comes to spending money, Elks Theatre is a want, not a need

Back in 1980s, I can remember going into the Elks Theatre as a teenager and sitting in the back row with my friends to watch movies and thinking, “This is great. We have our own theater in our town.”

In 2010, I can remember taking our son to the Elks Theatre as a 4-year-old and he was so excited because it was his first movie.

In 2005, I started taking a true interest in the town I called home for the last 40 years. 

I have seen our town go from all store fronts filled to having very few open. I have also watched Middletown go from a town where people had respect to a town where people don’t even slow down at stop signs let alone stop long enough to say hello. 

Society has changed. We are now a society of fast-paced, immediate-responses-needed, no time to slow down. 

For the most part, families are now a double income family (not that they want to be but it has become a necessity) with both parents working during the day as the child/children are in daycare/school. Once the parents are off from work they are rushing home to get a quick dinner, do homework and drive the child/children to some sort of practice or event that they are involved in.

The weekend of a family like this for the most part does not include going to the movies. It is the cleaning of the house one day and the next day is catching up on family time. Unfortunately, movie theaters have become a thing of the past. 

With Netflix, on demand and Hulu, we all have the movies we want from the quiet and relaxation of our own home. 

I would love to see our little theater make it, but like I said in the past I do not want to see our residents suffer because of it. I voted “no” Tuesday evening, Nov. 15, on accepting the $500,000 grant, and again on Monday. Here is my reason.

If you listen to the video of the meeting, you will hear all of the uncertainties of this grant and what we can or cannot do with it, how we can or cannot pay it back, what paperwork is needed, how much it would cost us if we decided not to proceed, where are we getting the money from and will we need to increase taxes or the electric rate. 

When I ran for council last year, I stated that I would do what I felt was best for our town. 

The vote was hard for me. While some wanted the theater because of its history, I know there are more residents in our town that could not afford to pay higher taxes or higher electric rates. I am watching the Facebook posts and I see that people are saying that there may be ways that we could fund it without these raises, but again that is another uncertainty. I can tell you the facts and what I have learned in the past two months:

1. The library which the borough owns needs a new roof.

2. The library needs a new A/C unit.

3. The borough hall needs a new A/C unit.

4. The police station needs more work to make it functional.

5. We need more Public Works employees. 

6. We need more police officers.

7. The public pool will need repairs before opening next spring.

8. The Middletown Fire Department will need two new trucks. 

9. Ann Street needs to be paved.

10. Our health insurance almost doubled.

11. We need new plow trucks/dump trucks.

And the list goes on and on with the needs of our town. While I hear a lot of people saying they want the theater open, I am also seeing and hearing what our town needs. 

I may have lost a lot of supporters or friends based upon my decision to vote no for this, but like I said last Tuesday night, I have to keep the well-being of 9,000 residents of our town as my first and foremost reason for this vote. 

As for people going onto my private Facebook page and demanding an explanation, I will not engage in demands on my private page. I stated my reasons last night at the meeting and that meeting can be viewed on Facebook. 

You can call me the skeptic’s leader, you can call me the vocal one of the group, and that is fine with me, but at least you know that I am asking questions and trying to figure out what is best and not just going with the flow of things.

I told the residents that I would be there for the majority of our town, not just vote the way the majority of council is going, and I believe I have proved that to you all.

Dawn Knull is a member of the Middletown Borough Council.

Last Updated on Tuesday, 22 November 2016 16:00

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