Thursday, August 27, 2009
Monday, August 24, 2009
As another example of the people who have fallen through the American system's cracks, here's one of the readers of Sullivan's blog writing in to the dudes caretaking during his absence. This guy's situation resonates with me since he's got asthma like I do. If, God forbid, I were laid off, and weren't able to find a new job before COBRA benefits expired, I'd be in his situation, perhaps paying $800/month out of pocket for inadequate care. Except I'd probably be more expensive, since I'm five years older than the guy.
Friday, August 14, 2009
"End of life counseling" has been framed. No longer is it a neutral phrase that refers to a government-fostered enhancement of the doctor-patient dialog. It is now apparently so polarizing and so toxic now that the Senate Finance Committee is willing to strike a provision from its bill that would add a counseling benefit to Medicare. The Wall Street Journal reports that the measure will be excluded from the committee's mark because it has become controversial. As the Journal notes, "dumping the provision would thwart a broad effort in recent years by doctors and hospitals to encourage patients to plan for end-of-life care." That's as close as a newspaper can come to saying: what a dumb thing they're doing! The issue _is_ touchy -- but in the context of the health care debate, it has become, in just a few days, synonymous with an attack against the entire concept of health reform: that Democrats want to ration care. A question, though, for those Democrats and liberals who'll be angry about this: the response to Palin's remarks about "death panels" as well as to Sen. Chuck Grassley's repetition of the idea was swift and fairly unequivocal: it's not as if the pro-reform side didn't quickly rebut the issue with better facts. My sense is that fear-based emotional appeals set in more quickly than reason-based emotional appeals -- always have.This is idiotic. Granted, there are several different bills right now, between the various committees in the House and Senate (something you wouldn't know to listen to, well, most people), but providing funding for counseling on end-of-life issues is terribly important. I've felt pretty strongly about this ever since the Terry Schiavo lunacy a few years back. Here's conservative Republican Senator from Georgia Johnny Isakson, speaking on the floor of the Senate in 2008:
Isakson recently called the deathers "nuts" for claiming that the language in the bills would be "death panels" or forced euthanasia or anything of the sort. After being name-checked by Obama in his NH town hall, Isakson got some grief from Limbaugh and subsequently distanced himself from the President and the House bill. Now, his more recent statement brings up a more specific question. The language of the House bill (see section 1233, starting on p. 424) is fairly specific, and says that consultation on end-of-life issues shall be covered every five years, and talks about the various options that doctors shall include. Chuck Lane and others, including Isakson in that statement, have suggested that this incentivizes doctors coercing you into hospice care. I don't buy it. But if the problem is that the House bill gets too specific, fine, let's not adopt that portion of the language when this all gets worked out in committee.
I will talk about what we need to do in terms of Medicare eligibility. When somebody signs up for Medicare when they are 65 years old--you are supposed to go in 90 days before your 65th birthday; I am getting close, so I am looking at these things--I think you ought to be required to execute a durable power of attorney when you become eligible.
Eighty percent of the cost of health care to me, to you, and to anybody else happens in the last 60 days of life. More often than not, people are not in a condition to make a decision for themselves. Because of laws, and because we are a compassionate nation, the physician will keep you alive as long as he can. If you had a chance, you might rather say if I am being hydrated and given nutrition but will never become conscious again, I give the doctors the authority to make the appropriate medical decision. The money that would save is in the ``gazillions'' of dollars--if there is such a number. It would help us to manage that cost.
BUT! as Isakson said on the floor in '08, lets make execution of a durable power of attorney mandatory for people signing up for Medicare. Make it clear that patients can say "I don't care how much sugar you have to grow to put in the IV drip that will keep me alive in a storage locker until they figure out how to thaw out Walt Disney and cure whatever I'm mostly dead from - do it!" if that's their desire. Don't remove all consideration of end-of-life stuff. Don't kill reform as a whole. Don't let this issue, especially this specific issue within the issue, be demagogued. Don't screw this up. Please. It's too important.
For more on this, read Jim Fallows' post on the media environment and how despite her history and the fact that the internet exists now, the claims of the (as far as I'm concerned) villainous Betsy McCaughey have once again come to define the debate on health care reform.
Monday, August 10, 2009
Back when I was writing Jeopardy posts, I wanted to make the process of adding links to this blog on my Facebook profile. So, I used the Notes Application to Import this blog. Then, every time I posted here, it was imported as a note on my Facebook profile.
Problem was, it imported the whole text of my post, plus photos, to Facebook. So people were reading it, but not here. Thus I had no way of keeping track of how many readers I had. So, I "un-imported the blog," and started manually adding a Link to each post when I posted it.
But the unimporting didn't take. Now, every time I post, I have to manually add a link and manually delete the Note. But I haven't really been doing it right, because I've ended up only deleting the Notes from my News Feed, but not the actual notes.
So: even though Notes tells me I don't have a blog imported, how do I get it to stop reposting my stuff?
Saturday, August 8, 2009
After about 3 hours I passed one of the [kidney] stones, and with a prescription for heavy-duty painkillers in tow, we left the hospital. Everything was fine until I received a bill 3 months later itemized as follows:
I've seen this repeatedly on lesser medical charges. Head-spinning.
CT Scan: $4294
Emergency Room visit: $4924
The bill was a shock to me for two reasons. First, my insurance was supposed to cover this. After a long round of phone calls - during which a very rude hospital employee could not understand why I was upset at being charged $10,000 when I had insurance - I figured out that my insurance company's check had literally gotten lost in the mail. They sent another check and my bill was cleared. But this led to my second shock.
From my insurance company I received the following "explanation of benefits":
Total charge: $10063.00
Provider discount: $9571.00
Amount Payable: $442.00
How can something that would have cost me $10,063 cost my insurance $442.00 (not counting the $50 deductible that I chipped in). That's a 96% discount! To me, this shows two basic problems with our healthcare system.
1) Costs in our system are neither transparent nor fair.
I get that emergency room care is expensive, but a tray of bad lunch and a painkiller drip cannot cost almost $5000. I only saw the doctor for about 10 minutes total, and the nurse for all of 30 minutes. If I had been told that the CT Scan and the Emergency room care cost $5000 each, I'd have asked for a prescription and been off to the pharmacy. I wasn't told, however. I wasn't even give the option.
Further, the "Provider Discount" is jaw dropping. (Yes, I'll take the powder blue BMW 528i - only $2,000 with my provider discount!) My mother, who is a physician, told me that insurance companies are able to negotiate deep discounts by threatening to take their business (i.e. all the people they cover) elsewhere. This is something individuals can't do, so they get overcharged.
And then there's this:
I work for a national insurance company and it's my job to pay hospitals and clinics for services performed. Now when I say pay, you should think of that in air-quotes. Assume it takes a week for the bill to be routed to the right person in the right department at my company. Once the bill reaches the right desk it heads back out. Because before we pay a bill we send it to a 3rd party company who reviews it to see how much we "really have to pay" for the services. This is because every state has different guidelines about what services should cost. This takes a week. Then the bill comes back to us, and if there are no issues with the hospital's records in our systems we pay the bill then.
However, if there are any issues it comes to me.
It's my job to call the hospital for updated tax forms (because it's not enough that we know their tax id, we have to have a government form showing the number). Then I send the records to another company who updates our database with the information. This takes another week, or longer if I have trouble getting a hold of the right person at the hospital.
Finally, we pay the bill. During this time the hospital has been waiting to get paid X number of dollars. Only instead we'll be paying them Y because that's what the state says is the minimum we have to pay.
So while your readers are being charged $50 for asprin; my company employs an entire department just to shuffle bills around while they decide what they will pay the hospital for that asprin.
I like my job, but I would gladly give it up if it meant that this insanity could stop.
While it's true that the plural of "anecdote" is not "data," I've found this whole series very thought-provoking.
Friday, August 7, 2009
Anyway, there are a number of alarming statements being propagated about the health care bill bouncing around Congress that are false, and I wanted to spread the word in case [you] are confronted by someone who has been alarmed by an alarming falsehood. This largely comes from Salon.com's excellent piece on the subject. I understand also that the White House plans to put together a website modeled on candidate Obama's Fight The Smears site from last summer/fall.
ALARMING CONTENTION: This is socialized medicine, or a single-payer health care system.
ACTUAL SITUATION: It is neither. This is not proposing a British-style system (or for that matter, a Veterans Health Administration-style system), where the government is the sole employer and provider of health care services. Nor is it a Canadian-style single-payer system wherein the government is the only insurer. The bill, broadly put, is intended by supporters of health care reform to do two things: 1. get everybody insured either through private plans or an optional government plan; 2. to reform health insurance practices to improve care. Something to keep in mind is that we are already paying for government-(and rising-premium-)subsidized health care for the poor. It's called the emergency room, and it's way more expensive than getting people some basic preventative services and some occasional prescriptions.
ALARMING CONTENTION: The bill outlaws private insurance.
ACTUAL SITUATION: The bill requires that private insurance plans be sold through a health care marketplace designed to increase competition and help consumers find the best option for them.
ALARMING CONTENTION: The health care bill will spend tax dollars for abortions.
ACTUAL SITUATION: One version of the bill includes measures for paying for preventative care and screening, which may be provided by Planned Parenthood (who are emphatically NOT just about abortions, though a lot of people assume they are). The Hyde Amendment of 1976 prevents any Federal money from being spent on abortions.
ALARMING CONTENTION: The bill will force the elderly to forgo treatment and consider assisted suicide.
ACTUAL SITUATION: This is the one, along with the abortion bit, that I've heard the most of in the alarming rhetoric these last few weeks. It is not true. The bill would require that plans pay for end-of-life consultation if asked for by the patient. Many elderly patients do not have health care directives indicating what they would like to have happen at the end of their life if they are incapacitated and unable to voice their wishes. As such, a lot of time and money is spent keeping terminally ill patients nominally alive. As it is now, Medicare does not pay for patients to consult with their doctors to craft a directive. The bill is aimed at fixing this. Honestly, I feel like this part of the bill, more than anything, is something anyone this side of Bill Frist's cohort in the Terry Schiavo case should support. It reduces waste and is humane, giving the individual some choice in how much they do or do not want done to keep them barely alive.
Anyway, check out the Salon bit above, and if someone is repeating one of these stories, politely challenge them. Calm exchange of information is always preferable in a debate to, well, everything we've seen this week at the town hall meetings.
Also, check out the series of personal stories entitled "The View From Your Sickbed" that Andrew Sullivan's been posting.
Anyway, yesterday I was alerted to the fact that the rules for the expansion had been posted on FFG's site, and that I should look at the second-to-last page. Here's what I found (highlighting mine):
That's a sizeable chunk of the Twin Cities theater & comedy scene, right there. And we got to help them refine this thing. You're welcome, fellow nerds.
Thursday, August 6, 2009
Perhaps that's why Nels got one. Early this evening, just before I left work, he asked me to be the guinea pig for his new number, and help him test out the message-taking feature of Google Voice. You see, if you enable it, GV will act as your message service. It'll record and store your call, transcribe it, and send it to you as an email. Clearly this needed a field test. And a challenging one at that. I left the following stream-of-consciousness message for Nels, including a Battlestar Galactica reference in a raspy voice, my last name, my company's name (initials), and several other proper nouns:
Ohh, Bill... They killed my Ellen. I am calling from [company name] and my name is Fred Beukema and uh, I don't know what else is a difficult word to say. Sonia Sotomayor was confirmed as a Supreme Court justice today which means she should be ready to serve on the court this fall and David Souter can retire to New Hampshire and his little cabin. Uh, bye.Here's what Google thought I said:
yo so they shut my land i am calling from [company name -- they got it accurately] and my name is fred you come home and i don't know what else is a difficult would just say sonia some on your was confirm the supreme court justice today which means it should be ready to serve on the the court this fall and gave it to 210 your tires to new hampshire and we'll kevin byeThey're close, but the algorithm needs some polish, I'd say.
Incidentally, I think Souter's cabin looks like it belongs in an Evil Dead movie.
Until next time, this is Fred You Come Home, signing off.
I'm also in the process of applying to take the PE exam this Fall, which promises to be a rather disruptive event (as it probably should be). I'm turning in my application tomorrow, as a matter of fact. So the first hard part will be over. Much harder parts to come. Woo-hoo.
I'll get back to some more substantial posts, uh, sometime. For now, though, a couple quick ones to cleanse the palate. Coming right up.