Left of the Dial

Family Values

And by that I mean placing absolutely no value upon the concept of "family," if it butts up against Big Business. 

What a complete and total jerk. 

Health State of the Union

Oh, sure. Nothin' broke here: 

With median annual compensation of more than $12.4 million, C.E.O.’s at the big health-care companies make two-thirds more than their counterparts in finance and are the highest paid of any industry. The health-care industry’s total annual profit has grown to an estimated $200 billion, and it doled out nearly $170 million in campaign contributions in 2007 and 2008. It now spends more than any other industry lobbying the federal government—$3.5 billion over the past decade and a record $263 million in the first six months of this year. That’s six lobbyists and nearly half a million dollars for each member of Congress. It’s been a good year on K Street, too.

It should come as no surprise, then, that we spend 17 percent of our G.D.P. and more than $7,500 per American per year on health care. That’s 50% more than any other industrialized nation. Meanwhile, the quality of care we get in return has fallen to embarrassing lows. According to the World Health Organization, our health-care system ranks 37th in overall quality and fairness, placing us between Costa Rica and Slovenia. We rank 41st in infant-mortality rates, alongside Slovakia and Serbia, and dead last among 19 leading industrialized countries in preventable deaths. Nearly two-thirds of personal bankruptcies in the U.S. are caused by illness, yet more than three-quarters of those people actually had health insurance when they fell ill. In other words, we’re all getting ripped off.

Portesting Refrom

So here's the thing. It's easy to make fun of someone for a typo. Left of the Dialian DT, for instance, although an excellent writer, can rarely go more than five sentences without one, often with unintentionally hysterical results. 

But, really, who amongst us hasn't laid down a typoe or two now and again. (Other than the otherworldy Top Management, of course.) My usual email program has an autocorrect function, and it's the rare sentence I write nowadays which doesn't force the spellcheck to kick into overdrive. 

So. Living in a glass house as I do, I try not to throw stones when it comes to typoes.

Still, being human and therefore inherently flawed (again, except for the wondrous Top Management), it's a bit hard not get a chuckle when it comes to such a mistake, not in an email or a manuscript, but on an actual handprinted sign. Such as this classic. 

So when I first saw another such sign as today's 9/12 rally, along with the small smile it brought, I couldn't help but think, "hey, it happens." 

But then two things made me realize my initial thoughts were perhaps a bit off base. The first is the lettering style. I mean, I love those curly letters. Used to make them myself. I haven't since about sixth grade, and don't think I've seen anyone else use them since then either, but it really adds weight to the sign, I think. 

The best part, however, has to be this: 

Click on the photo to get a slightly larger version in a new window. Now check out the upper left hand corner. 

The sign maker misspelled the name of this great nation of ours. 

Now that is impressive.  

Blunt Lies about Health Care

So. Senator Roy Blunt (R-MO) said recently: 

"I'm 59. In either Canada or Great Britain, if I broke my hip, I couldn't get it replaced."

This is what's known in polite society as "untrue." It is also what's known as "absurd." How absurd? 

Glad you asked. This absurd:

At least 63 percent of hip replacements performed in Canada last year and two-thirds of those done in England were on patients age 65 or older. More than 1,200 in Canada were done on people older than 85.

It is so absurd, in fact, that it makes one wonder whether the speaker is an idiot or a liar. I mean, here's the thing: he's a United State senator who's been studying health care. A U.S. senator making a statement like that is assumed to have some idea what he's talking about. When he's that wrong? It's either remarkable incompetence or outright lying. 

Rescission

A follow-up to yesterday's post: 

The way insurance companies make a profit is by accepting the money you or your company pays them for your policy, and then denying you care when you actually need it. This is understandable, from a business point of view. It is of course inhuman, from a moral point of view. 

They've perfect many forms of this horrific practice, but perhaps the worst of all is rescission. 

Blue Cross of California encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses, Rep. Bart Stupak (D-Mich.) charged at the start of a congressional hearing today on the controversial practice known as rescission.

[...] one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

"When times are good, the insurance company is happy to sign you up and take your money in the form of premiums," Stupak said. "But when times are bad, and you are afflicted with cancer or some other life-threatening disease, it is supposed to honor its commitments and stand by you in your time of need.

"Instead, some insurance companies use a technicality to justify breaking its promise, at a time when most patients are too weak to fight back," he said.

The committee investigation uncovered several rescission practices that one lawmaker called egregious, including targeting every policyholder diagnosed with leukemia, breast cancer and 1,400 other serious illnesses. Such investigations involve scouring the policyholder's original application and years' worth of medical and pharmacy records in search of any discrepancies.

In November 2007, The Times reported that insurer Health Net Inc. paid bonuses to employees based in part on their involvement in rescinding policyholders. According to internal corporate documents disclosed through litigation, Health Net saved $35 million over six years by rescinding policyholders. The disclosures were part of the evidence that led a private arbitration judge to levy $9 million in damages against Health Net in a case involving the company's rescission of a woman diagnosed with breast cancer.

You want to talk about death panels? There's your death panel, right there. The difference is, this one is real. And it's the way the system is designed. 

A Quick Health Care Reminder

Just because it's a central fact and it sometimes gets obscured:

The way insurance companies make money is by accepting your money and then denying you care. The more care they can deny, the less they have to pay doctors and hospitals, the more money they make. 

A health insurance company's business plan is set up to figure out a way to not actually pay for any care you might need. 

Pre-existing Conditions

Such as, say, living. 

So. Sarah Palin wrote recently: 

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil.

As someone who has spent an unusual amount of time dealing with insurance companies—although only the smallest fraction of the time Top Management has spent—I couldn't agree more. Such a system is indeed downright evil. 

Where the former governor is confused on this point, however, is this: that's the system we have currently.

Palin is sort of right on one point -- there are people who weigh whether children like Trig are worthy of insurance.  They're called insurance companies, and they have decided that these children are not in fact worthy of coverage.  That's because Down Syndrome is a "pre-existing condition." 

In other words, if Palin didn't have insurance through her husband's job—I assume she's no longer on the state's insurance plan, as of a few weeks ago—and tried to land it through the private market, she would not be able to get health insurance. Because of Trig. Because that's the way the invisible hand of the market works; after all, kids with Down's Syndrome are wicked expensive, and it doesn't make even a shred of sense, from a business point of view, to insure such children. So insurance companies don't. Which means the kids and their families are utterly screwed. Unless the government steps in, and either forces the insurance companies to cover such individuals, or the government covers them themselves. 

Margaret Demko, the mother of three-year-old Emily, testified before the Ohio Finance Committee on February 27, 2008, on how waiting for health care coverage has impacted Emily and her future. Emily was born with Down Syndrome. After receiving Emily's diagnosis, the family decided that it was important for Margaret to stay home in order to best meet the needs of their child. They explored numerous options after losing their employer-sponsored coverage, but due to Emily's pre-existing condition, the Demkos were denied private coverage. Luckily, they qualified for Medicaid. However, by their 6-month reauthorization meeting, the monthly family income was $135 over the allowable limits.

The medical bills, in excess of $3,500 a month, were devastating, forcing the family to make difficult decisions regarding therapy. Emily's medical condition requires orthotic shoe inserts, physical therapy, and corrective eye treatments, as well as hearing and blood tests. The Demkos cannot afford to incur all the expenses at once. 

So. We sort of need to ask ourselves some basic but hard questions: do we care about children with Down's Syndrome if they're not ours? Do we feel like paying a few extra bucks per year so a family a few thousand miles away we don't even know can get their kid the therapy he or she needs? Is it, in fact, in our best interest as a society to help each and every member of that society reach his or her full potential? Does our self-interest dictate that in the long run this is to our own benefit? And is it simply the moral thing to do? And, in either case, are we willing to pay for it? And, if so, how much? 

These are tough questions, and they're not really getting discussed. Because people with billions of dollars are paying other people to go to town halls to gin up false outrage over absurdities like "death panels," rather than get to the heart of the matter: do we believe we should continue to be the only industrialized nation without universal health care? Do we believe that children like Emily Demko should be on her own, left to sink or swim? Is that the right thing to do? Is it the smart thing to do? 

I suppose I should mention that there's at least one other problem with Palin's statement, and that's the fact that it's a lie. There will be no "death panel" under any health care plan passed this year. One has never been proposed and one never will be proposed. For a high-ranking politician, even a former one such as the former governor, to make such a statement is simply absurd. There are two choices: stunning ignorance or simple lying. I'm going to give her the benefit of the doubt and say she's lying. That's actually the more generous of the two options. 

Wait Times

So I heard some one yell about wait times the other day. And I thought, "...really? That talking point? Still?"

Every time I've tried to make an appointment with a doctor in the past decade, I've had to wait at least a week and more often up to a few months. And specialists? Please. I had a dermatologist tell me that it'd be six months before they could get me in. 

It's not so much the oddness of the long wait times—though it is that as well—as the total disconnect between the reality I've observed and the stuff I've heard spewed. Which is what I thought when I read this from James Fallows, an Atlantic Monthly writer who just returned to the States after three years living in China. 

I think the US consumer economy would still be in free-fall if we hadn't come back. We show up from China needing new of everything. Clothes. Camera. Two computers, plus monitors and backup drives. Housewares. Shoes. At least one fridge, probably a stove. Radios/sound system. TVs. You name the item, and the version we have is road-worn, obsolete, broken, or gone. (Sadly for Detroit, not cars: Our two, vintage 1999 and 2000 respectively and stored with friends, still seem just fine. Sorry!) Our house needs to be repainted-- and re-roofed, and re-drivewayed, and its trees trimmed. That's just a start. Good thing we saved up in those days of 20RMB noodle/dumpling dinners. And, yes, many of the items we're getting were made in China. You just can't buy them there.

Here's the surprise: We call to get service appointments, and people show up right away. Air conditioning not working in 90-degree DC swelter? We make a call one evening, and the next day it's all fixed. Plumbing clogged and leaky? A few hours later, it's not. Need the car looked at, after three years in the shed? Call the service place and the only question is: do I want to bring it in this afternoon? Or wait till tomorrow? On a Sunday, we see that a tree is dying in the back yard. By Monday afternoon, it is converted into neatly stacked wood.

These are all people and services we'd dealt with before, but in those days we learned to plan weeks in advance for service calls. America still looks incredibly rich and lush. But this little indicator suggests lots of slack in anything considered a discretionary purchase. Not startling in principle, but impressive to encounter first-hand.

Only exception: I call to get an appointment for a physical exam with our doctor -- a good but "normal" doctor, not some fancy physician to the stars. First available slot, mid-November. I have no theory for this anomaly.

So. We have wait times. It's similar to the way folks are still using the "if you like the post office, just wait until the goverment takes over all health care!" line. Because apparently polls show people really like the postal service. 

And with good reason. It's cheap and efficient and reliable. And the tunes? Fugheddabout!

A Little Too Late

So because I am the very epitome of the patriotic American, I took the Rose to Target this President's Day, since nothing expresses my admiration for GeoWash and Honest Abe like handing over many many many pieces of paper plastered with their visages.

(I exaggerate, of course: I am American, so I put it on the credit card.) 

I have one purchase in mind: some jeans for my extraordinarily petite 10-year-old. The only pants she has that fit in the waist are Size 5s which, not surprisingly, only come to about mid-calf. But thanks to the wonders of the adjustable bands they've got inside waists these days, we find some new Size 7s which are only a little too long for her. 

Naturally, having scored sartorially in about ten minutes, we spend another hour stocking up on everything we could possibly imagine needing at some point in the next decade. Including new cucumber and green tea-sented baby wipes. Good try, folks. But if there's one area that you just can't make seem yummy or healthy? Yeah, that's the one. 

Anyhoo, the Rose is unbelievably delightful company on these sorts of trips, chattering along oh so pleasantly, remarking on everything, skipping occasionally, and mainly conveying with every cell in her body how much she truly wishes she were an only child. 

So we get to the checkout just as the person in front of us is pushing her cart away, lucky ducks that we are. I start unloading our copious treasures onto the conveyor belt, and see the cashier sigh heavily and push her hair off her forehead. "Tired?" I smile understandingly.

"No," she says, taking another deep breath and letting it out in our direction. "I just don't feel very good." 

As she says this she grabs the first of my things and starts scanning it. I look at my now mostly but not entirely empty cart, and back at her. She does one of those sorta kinda inside burps and clears her throat, scanning and bagging my goods (although I'm no longer thinking of them in nearly as positive a light as that term would tend to convey) all the while. Too late to grab the stuff and shove it back in the cart and find another lane open, one whose guardian is not infected with the bubonic plague. 

But hey, maybe she's just hung over, says the ever optimistic part of me. So she finishes up and I swipe my card and sign my name (well, sorta: these days I almost always actually draw a little smiley face or, if the occasion seems to call for it, as today's clearly does, a sad face) on the keypad. And then I push my cart past and start grabbing the bags and loading them into the cart. 

And that's when the smell of vomit hits me. 

I look up at her, but she's just leaning against the register, waiting for another hapless victim to show up. I look at the floor, the cart, around. No sign of any regurgitated material. Yet the odor lingers, to put it mildly. Pizza Hut Express is a dozen feet away; perhaps someone has gone insane with the parmesan, a substance which is, in my opinion, identical to your garden-variety spew. 

Who can say? Despite, or perhaps because of, any clear evidence, I rush the Rose out the door, and she's delighted to have to sprint for the car through the pouring rain. Before we're a dozen steps from the cashier, however, I hiss at her that if she so much as gets a fingertip near her eyes, nose or mouth, she's out of the will. She points out that the likelihood of any of my brood inheriting anything is roughly on par with my winning the Nobel prize for physics. I concede the point, and raise the stakes: touch a mucus membrane and I will force her to watch me eat the entire cherry cobbler her mother made this day. She is persuaded. 

We get home and both scrub our hands like we're prepping for surgery. Will it be enough? Only the oracle knows. Lacking a Magic 8-Ball, I turn to the next best thing.

Thanks, George, for helping create a nation where such creatures can serenade us all so sweetly, and to you, Abe, for holding it together. 

Grrr

Doctors drive me insane, even the good ones.

As I have written about at some length, I love doctors, responsible as they are for saving the lives of two of my chillens. But they’re human and sometimes I swear I buy into the whole God complex thing. Or maybe they’re just so damn removed from the plane of existence where the rest of us live.

Had some dental work done today by an endodontist who seemed to know her stuff—although, really, how would I know? (Another thing wrong with McCain’s health care “plan,” as it places the burden of knowing what treatment is needed upon the patient—I mean, if we knew that, we wouldn’t be at the doctor’s, now would we?) But she was friendly and explained what she was doing.

And when she was done, she wrote me out a pair of prescriptions, one for an antibiotic, just in case, and one for pain relief, and advised me I was really going to want to take that before the anesthesia wore off.

So I get ‘em filled and I’m walking out and I look at the bottles, one of which says “ibuprofen.” And I say...is this just Advil or is there some, you know, good stuff mixed in there? And the pharmacist says, no, it’s just Advil. But it’s 800 mgs. Advil’s just 200 mgs.

And I think, right...so you take four of them.

And I do some math in my head and compare and contrast a bottle of Advil with the ten bucks I spent for the twenty pills here and realize these lil puppies cost twice as much per milligram.

Why the HELL didn’t she just tell me to take Advil?