Monday, August 24, 2009

Anti-texting-while-driving road safety film

This will freak you out. . .

Leatherback Sea Turtle's Mouth


New Yorker Cartoon


Humpback Whale and Diver

The View From Your Sickbed 4


The View From Your Sickbed
by Patrick Appel

A mother describes her family's struggle to keep their daughter Sophie insured:

In fall of 2005, we decided to switch from our private, self-employment insurance that we had used for years to Blue Cross. There was a week long gap between the policies - something that we didn't think anything of, because we simply did not know better. Just as our Blue Cross plan was set to start, we received a notice from them stating that they considered Sophie to have a pre-existing pulmonary problem (due to the amount of doctor's visits for pneumonia), and that while they would cover her in general, they wouldn't cover any pulmonary/respiratory issues until she had gone two years without needing medication or problems.

Our reaction: OMG. Actually I believe it was OMFG. All of a sudden, Sophie was without coverage for pulmonary problems. This was absolutely terrifying. What if she got sick?! What if she needed to be hospitalized?! We spent the next couple of months researching every insurance company that we could, begging them to take Sophie. Nope, it wasn't going to happen.

And then our biggest fear came true: Sophie got very, very sick.

And I'm ashamed to say that although we knew that she was incredibly ill, we actually considered keeping her home from the doctor's office, as we knew that this would be yet another strike against her getting insurance. Luckily we pulled our heads out of our asses and took her to the doctor anyway, and it's good that we did, because Sophie was so critically ill that she was sent straight from the doctor's office to ICU. She was so sick that we couldn't even wait for an ambulance; they helped me throw our limp, blue daughter into our car, and I drove like hell to get her to the hospital next door.

Let me state that very clearly one more time: we almost didn't take our baby girl, who was in severe respiratory distress, to the doctor because we knew that it would hurt her chances of getting insurance.

I realize that your reality of living in the U.S. and of health insurance is likely very different than this. But I'm going to ask you to sit for a moment and imagine being in our shoes in that situation. Imagine the shame and guilt of almost keeping your child home from the hospital until it was too late, and then imagine the horror of seeing your child naked in ICU, hooked to many different machines. There is no way to describe how this felt.

One night in ICU? $10,000, not covered by insurance.

After this hospitalization, we were approached by a hospital social worker, who suggested we apply for SoonerCare. SoonerCare is Oklahoma's Medicaid program for kids. Luckily I'm a social worker who was working for a non-profit at the time, so we had no problems meeting financial criteria. (Ha ha. A little social work humor there.) SoonerCare does NOT exclude kids for pre-existing conditions, and it covers Sophie's medications and treatment 100%.

Since that horrible October in 2005, Sophie has needed hundreds of thousands of dollars worth of treatments, hospitalizations, surgeries, medications, testing, and interventions in order to stay strong and healthy, and in some instances, to stay alive.

She has required three bronchoscopies, the middle section of her lung removed, extensive genetic testing, cardiology work ups, dozens of x-rays, CT scans, and a two week trip to a pulmonary hospital in Denver. When she's healthy, she requires three steroids, twice a day, and when she's sick she is usually on five steroids, twice daily. She's been diagnosed with right middle lobe syndrome (though not anymore, since she had it removed), a genetic mutation of cystic fibrosis, severe uncontrollable asthma, and severe sinus disease.

Since SoonerCare is the only insurance that will accept Sophie, we have to meet their financial criteria, which means living at or below the poverty level. I have had to quit wonderful jobs because I made too much money to qualify for SoonerCare. At this point I can only work either part-time, or for a very small salary, because we CANNOT afford to lose Sophie's healthcare coverage. It's the most important thing in our lives. We structure every single financial and professional decision we make around staying eligible for SoonerCare.

And while we'll gladly continue to live at the poverty level in order to provide our daughter with the healthcare that keeps her alive, we SHOULDN'T HAVE TO. We would happily pay outrageous premiums and co-pays, and do whatever else it took to get Sophie covered by regular health insurance. But you know what they all tell us?

She has to go two years with no pulmonary medications and no doctor's visits because of respiratory problems before anyone will accept her. Sophie can't go two DAYS without her medications, let alone two years.

Pearl Jam - The Fixer

Directed by Cameron Crowe! Good stuff!

Monday, August 17, 2009

Sunday, August 16, 2009

Fredo Viola - The Sad Song


The Sad Song from Fredo Viola on Vimeo.

The Avett Brothers - Glory Days

Avett Brothers doing the "Boss" Bruce Springsteen. New CD is coming out next month! Should be interesting. I heard the banjo might be missing. That will be a great disappointment!

Some Guy Playing PJ's "Present Tense"

This is nice!

Wednesday, August 12, 2009

The View From Your Sickbed III


The View From Your Sickbed III
by Patrick Appel

A reader writes:

I wanted to second the reader who identified the non-transparency of health care costs as a huge part of the problem. He recited the issues with his wife's pregnancy receiving minimal coverage even though they had private health insurance.

My sister recently had a similar situation, when a needle she used for her insulin injection broke off in her thigh. She had to have it removed surgically in a brief outpatient procedure. She has good health insurance through her husband's job, but she wanted to know the cost of the procedure, to determine her copay. She asked the doctor's office how much the procedure would cost and was told between $5,000 to $6,000. (Don't have your heart attack yet over the insanity of $5000 for a simple outpatient surgery plus xray or scan to determine the location of the needle. As Dylan said, "Now ain't the time for your tears".) She had her uneventful surgery and got the bill for $15,000. For an uncomplicated outpatient surgery. After being quoted a price 1/3 that price.

Why did she even ask the price of the procedure if they were going to be off by 250% or more? If my sister wanted to call around to surgeons to get a better price (and she would, to reduce her copay, if nothing else), what would be the point? What if my sister had been uninsured - how would she plan to reduce her costs based on such misinformation? The price of health care procedures is nothing but a dart thrown at numbers on a dart board. The insurers, the doctors and the hospitals all have blame in this process. Unfortunately, the uninsured and the poorly insured - and both groups are gaining in numbers daily - pay these outrageous prices.

Why Did You Bring A "God Damn Gun" To A Presidential Event?

The View From Your Sickbed II

11 Aug 2009 11:09 am

The View From Your Sickbed
A reader writes:

A comment from this reader finally got me to write out my experience.

“To me, the worst part of the American health care financing system is that you can't tell what your treatment will cost.”

Amen to that. I am a graduate student at a large state school in Illinois. My wife and I wanted to start our family before graduating. Her biological clock was ticking, so she said. The first thing we did in planning was look into health insurance. The school provides insurance to its students at a low, subsidized rate. However, if a student wants to add a spouse, the rate jumps to about $1200 per semester (less for a child). Pretty high percentage of a grad student stipend, but at least it would cover a pregnancy within one year of purchasing the policy (nothing else I found would). It is a typical 80/20 plan after deductible. Naively, we thought this meant that after the deductible was met, they would pay 80% of the remaining cost. Not so. They pay 80% of what they call the “usual and customary” charges for whatever procedure you have. Anything over that magical number is completely your responsibility. How do you find out if your hospital/doctor/surgeon will charge you at or below this number? For all intents and purposes - you can’t.

This is how it was explained to me: There is a code for each procedure in every region of the country. And this code is the only way an insurance rep can look up what they deem usual and customary. They cannot look up the procedure name, only the code. So if you really want to know what, say a pregnancy is going to cost, you somehow have to get the hospital/doctor office to tell you what the insurance code is for every possible procedure you may have – a separate one for everything from a simple blood test, to an ultrasound, to a c-section surgery - and then tell you how much that procedure costs. Just imagine how much work this would be for everything associated with even a routine pregnancy. I certainly don’t have that much time to spend on the phone (assuming you can find someone who knows the codes and is able/willing to tell you). Then after all that, you have to call the insurance company and ask them what the usual and customary charges are for the codes and compare that to what you got from the doctor. Of course I have yet to mention that you have to figure out if there is a discount negotiated between your doctor and the insurance company (probably), which changes everything. We really had no idea if the prenatal visits and delivery would end up being thousands of dollars above the usual and customary amount. Maybe a vaginal delivery would be under, but a c-section wouldn’t. You don’t know. And what about emergencies? You’re supposed to do all this after realizing you’re having a heart attack so you know which hospital you should have the ambulance take you to?

Now here’s some irony for you. My wife had to quit working when she was put on bed rest at 28 weeks. This lowered our income enough that we qualified for Illinois’s All Kids program (thank you ex-Governor “Blago”). The entire pregnancy ended up costing us nothing. Now, a year later, we are extremely happy with the All Kids care my wife and son are now on. The money we save on medical costs just about make up for her not working.

Monday, August 10, 2009

Fox News & the GOP


The tension between the business interests of the conservative-industrial-complex and the Republican party is real. There is a huge amount of money to be made by selling to a segment of the country that alienates the critical middle that every party needs to occupy to remain a national force. And so the success of the movement risks the failure of the party. And the failure of the party - its permanent isolation from power - only fuels the resentment and alienation that make so much moolah.

This is the GOP's Fox problem. You ride that fox; it eats you in the end.

Sunday, August 9, 2009

"Is Your Bubble Bursting?"


A reader writes:

Your obvious shock and dismay at the sheer angry ignorance of the health care teabaggers reiterates my largest problem with your rosy immigrant's view of America. You have often underestimated just how poisonously dangerous the American populist right is.

I don't blame you. You came to America after the rise of Reagan. Most of your life in America, you have lived under different Republican presidents who placated these folks with platitudes and campaign rhetoric. The one period when the populist right didn't feel they had a fellow traveler in charge was when Bill Clinton was elected(thanks to the reactionaries splitting their votes). You remember, no doubt, the level of crazy Clinton had to defuse and dodge, and this was a man who had the advantage of being a Southern bubba who has dealt which such people all his life.

For most of your time in America, this insanity has been muted by the success of
conservative politics. Since you live in Washington, you probably saw daily the
face of the successful conservative political establishment that milked the
populist right, and by milking them kept their bitterness at a manageable level.
That safety valve was stuffed up by George Bush's failed presidency.

So now, these people are facing their worst fears; actual change. A political and demographic re-alignment is happening before their eyes, and they are reaching back into their old bag of tricks of intimidation, violence, and apocalyptic fearmongering. You are British, Andrew. You love this country, and we love you for it. But you didn't grow up around these folks, and you don't realize what a permanent and potent part of the American political landscape they are.

They have always been with us, the people who believed in manifest destiny, who delighted in the slaughter of this land's original inhabitants, who cheered a nation into a civil war to support an economic system of slavery that didn't even benefit them. They are the people who bashed the unions and cheered on the anti-sedition laws, who joined the Pinkertons and the No Nothing Party, who beat up Catholic immigrants and occasionally torched the black part of town. They rode through the Southern pine forests at night, they banned non-European immigration, they burned John Rockefeller Jr. in effigy for proposing the Grand Tetons National Park.

These are the folks who drove Teddy Roosevelt out of the Republican Party and called his cousin Franklin a communist, shut their town's borders to the Okies and played the protectionist card right up til Pearl Harbor, when they suddenly had a new foreign enemy to hate. They are with us, the John Birchers, the anti-flouride and black helicopter nuts, the squirrly commie-hating hysterics who always loved the
loyalty oath, the forced confession, the auto-de-fe. Those who await with baited
breath the race war, the nuclear holocaust, the cultural jihad, the second
coming, they make up much more of America then you would care to think.

I'm always optimistic about America. We're a naturally rich and beautiful place. Every generation we renew ourselves with a watering of immigrants committed to the American dream, immigrants like you. But please, Andrew, do not for a second underestimate the price in blood and tears we've always paid here for progress.

I voted for Obama with my fingers crossed, because I knew that as the populist right lost power, they would become more extreme, more concentrated, and more violent. As to dismissing them as only a quarter or so of America, please remember that it only took a quarter or so of Americans to actively support the Confederacy.

Pearl Jam - Speed of Sound (new song demo)


The View From Your Sickbed



The View From Your Sickbed
A reader writes:

Our twins are preemies - born at 34 weeks. While there were
no complications, it was cold-and-flu season when we brought them home. Their
health was a very precarious affair. We were under strict orders to keep them in
the house, to limit visitors, to always wash hands after coming back into the
house, etc. When we went to the pediatrician, she scheduled us on on a Saturday
afternoon when the office was empty in order to minimize potential contact with
other sick children.

At our first visit, she recommended a vaccination
for a common virus. This is a virus that everybody gets, and is generally mild.
With preemies, however, it can be quite severe and commonly results in
hospitalization and even death. It should have been done in the NICU, but it had
been missed. She scheduled us for the following week. She had to order the vax
since it was quite expensive (a total of about $16K.) Two days beforehand, she
notified us that our insurance company had denied the coverage as too expensive.

We then proceeded to try to get the insurance company to cover the vax.
Our doctor called. The NICU doctor called. We had conference calls with them and
the insurance company. We worked up the chain of command at the insurance
company. We had it done and paid out of pocket. What choice did we have?
Finally, we pulled in a specialist and managed to get high enough up the chain
to get it approved. By this point, it had become something of a crusade for the
various doctors involved. Two weeks later, my company's health insurance
premiums went up 30%.

Coincidence? Who knows. But when people talk about
rationing under socialized medicine, I always think, "You know, we have
rationing now, it just hasn't effected you. Yet." And mine was one of those
highly-vaunted "gold-plated" private health insurance policies.