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Sunday, August 31, 2008

Broken Arm, Fractured Healthcare System

Last month, my son Zac and his girlfriend Erin left their jobs in New Orleans and moved to Santa Barbara. They found an apartment and then joined Alex (Zac's twin brother), for the annual group camping trip he organizes to Bass Lake, in the Sierras. On the second to last day, Zac calls to tell me he thinks he just broke his arm while wakeboarding. He'd returned to the campsite and was awaiting all the others who were going to continue wakeboarding for a few hours.

It reminded me of the night - when they were about 13 - that I got a call from Zac from the skateboard park in Palo Alto. He reported to me that Alex had taken a big fall, hit his head, and had trouble remembering much of anything. Zac asked if I could come get Alex and after a brief pause, asked if he could stay out later skateboarding.

There was one big difference from this medical emergency from all the previous ones he and Alex have accumulated. This was the first time there was no insurance coverage. It's Murphy's Law that this would occur during the interlude between Zac's job with Habitat for Humanity and whatever he will find in Santa Barbara. He intended to keep his coverage through "COBRA" - a law that allows people to continue their medical insurance policies for up to 36 months after leaving a job, but the COBRA forms had never arrived.

The next day, when he got back to Santa Barbara and went to an emergency room, they stabilized his broken arm with a splint and sling, but told him he needed to see an orthopedic specialist to determine if it required a cast or surgery. That's when he started his crash course on the failings of the US healthcare system.

1. The orthopedic specialist cannot see him without an insurance policy or cash up front.
2. Zac does not qualify for Medi-Cal. Having no income or significant savings no longer counts if you're not a senior, disabled, or a child.
3. The plan he was on in New Orleans was an HMO and the Orthopedic Specialist referred by the emergency docs does not take HMO patients.
4. The COBRA administrators couldn't figure out what plan he is eligible to sign up for in California. He had Blue Shield in New Orleans but "Blue Shield of Louisiana" is considered a different company than "Blue Shield of California."
5. There is no non-profit agency that gives advice to uninsured people who are trying to navigate the fractured U.S. healthcare system.

Finally we found a clinic that operates on a sliding scale basis. Zac will see an orthopedic specialist this Thursday - about 12 days after the accident. If he needs surgery, then we'll pay a Blue Shield doctor up front and get retroactive coverage from the Cobra plan when it kicks in. The COBRA plan is expensive though because (after repeated calls somebody came up with the information) his only option is to continue with Blue Shield of Louisiana and pay "out-of-network" costs. If he doesn't need surgery, then he will probably wait to get a job that offers medical benefits.

Hopefully, we'll see universal healthcare and a single-payer system before long. At least that promise gets a lot of traction in the Democratic campaign speeches. But dismantling the highly profitable web of insurance companies, pharmaceuticals, and doctor pay scales, may be as unlikely as dismantling the firmly entrenched "defense industry." It's probably as unlikely as me being able to order Zac and Alex never to wakeboard, skateboard, or any other kind of board, anymore.

Friday, August 15, 2008

Hooray for Jesse Helms

Former Senator Jesse Helms died last month on July 4th. He was reviled by most anyone with progressive views. During his five terms in the senate, he criticized the Civil Rights Act, school integration, and the Voting Rights Act. He opposed funding for AIDS, funding for the UN, gay rights, abortion, affirmative action, and government appointments of gay persons. His financial support was first and foremost from the tobacco industry.

Yesterday, I read something about him that totally surprised me. Helms was one of five senators who sponsored the Prevention of Genocide Act in September 1988. It was a bill that would have imposed hard-hitting sanctions against Iraq for Saddam Hussein's brutal gassing and genocidal attacks against the Kurds who lived in the rural north. This was before either of the Gulf Wars we fought against Iraq. During his eight-year war with Iran, Hussein demanded all Kurds leave their villages and live in concentrated ghetto towns he constructed further inland from the border. Those who didn't leave their homes were subject to mass executions. The army would take over a Kurd village, round up the men and boys and shoot them. Poison gas was dropped on numerous villages during an eighteen month campaign that extended past the Iraq-Iran armistice. Though the Reagan state department was aware of the campaign, it kept mum because we supported Iraq over Iran. There was no outcry from any quarter to stop the violence as Samantha Power documents in her gripping book, "A Problem From Hell: America and the Age of Genocide."

After the gassing of a large town, Halabja (3/88), the story finally started to become known. The bill was written by a staff member of Senator Claiborne Pell and Pell approached Helms, the ranking member of the Senate Foreign Relation Committee. Power writes in her book that Helms "and his wife had been moved by an encounter with three Kurds who were on hunger strikes to protest the Iraqi atrocities, whom they met through their church."

So for all the evils associated with Helms, there is at least one admirable act of leadership in the other column. I'm glad to know that. I'm glad to know that there is something to like about the Senator and that there was a way to reach him and motivate him to do the right thing.

As for the bill, it was passed by the Senate but killed in the House. The U.S. farm lobby prevailed. They did not want to lose all the revenue from their rice and wheat sales to Iraq. Eighteen months later, Hussein was emboldened enough to invade Kuwait.

Monday, August 04, 2008

"Stop-Loss" bonus dollars

Emiliano Santiago

Last week, a house subcommittee voted to grant a retroactive $500 per month bonus for all the extra months of harrowing duty in Iraq and Afghanistan that our "stop-loss" soldiers are forced to endure. Stop-loss soldiers are those who completed their contractual tours of duty only to be told they aren't done yet.

After I saw the very moving film, "Stop Loss", I did some "googling" and found the court case of a soldier who thought it unfair that his service contract could be extended against his will. Before the Civil War, we had another name for that kind of contract. In 2004, two weeks before completing his 8 year contract with the National Guard, Emiliano Santiago was told he must deploy to Afghanistan. He fought the order all the way to the Supreme Court, but lost at every level. The small print on his contract - since stop loss was invented in 1990 - says that the President can order troops to stay beyond their discharge date if a war or a state of emergency exists. Santiago was shipped out to Afghanistan in June, 2005. I was not able to find any update on how he has fared.

Anyone who sees the film, "Stop Loss," will feel the absurdity of valuing a month of unexpected, harrowing "soldier-ing" in Iraq with a $500 bonus. But we're talking about 160,000 soldiers who've had their contracts changed and about 12,000 extra months of war between them. The total price tag comes to about 600 million dollars. I guess it's easier for stockholders of a big corporation to give their CEO a multi-million dollar bonus since they count it against the profits they've reaped. The soldiers just don't bring us citizen-stakeholders any profits.

Here are the articles and blogs I read:
USA Today 1/2004

Seattle Weekly 3/2005

Blog by a Military Family 4/2005

Armed Forces Journal - 5/2008

Saturday, August 02, 2008

Happy Birthday Mom!

Today would have been Mom’s (Rochelle's) 79th birthday. She’d have had 28 additional years of living and loving than she did. Sally and I will go out for ice cream today as my 25 year-old twin boys, Alex and Zac used to do with me when they lived in Palo Alto. I started the ritual on her “yortzeit” – the anniversary of her death, but the boys said we should switch it to her birthday.

If she were still here, we’d start celebrating as soon as the sunrise streaked the sky in orange, ‘til three stars come out this evening. We’d have whisked her from her St. Louis apartment to a villa in Tuscany and we’d eat a seven-course meal all afternoon, sitting round a table like so many other Saturday afternoons - toasting her with one funny story after another. Josh and Mike (my brothers) would be there too, basking in the presence of the one person who knows and loves each worn and shiny part of us from the inside-out. We’d all state grandiose opinions and then laugh at them. We’d hike past vineyards woven in dark purple grapes, full to the bursting point. She’d have an arm around Zac and the other around Alex and they’d talk over each other in the rush to fill her in on their latest chapters. Not a second would be wasted or taken for granted.