w00t w00t booyah

 

I've gotten a few swift kicks to the head lately, courtesy of folks I only interact with via Twitter and LJ - kambriel  remarked on Twitter the other day how passing strange it is to attend an estate sale (and it is), and almost on top of that I heard that a dear creature named Melissa Mia Hall had died alone in her home, too concerned about the cost of seeking care for pain, lest she lose everything she held dear.  Pain from a heart attack that killed her.

Pain like that, they give you morphine for - if you're hospitalized.  Which you should be, all things considered.  You've paid your taxes to fund research into preventing and treating these things, after all.  I could go on - I'm sure you've heard it from more legitimate voices than mine.

I wish I'd known.  I would have demanded she be seen.  Yes, hang it all and risk everything - you better believe it.

This is not a demand that anything you have is forfeit or should be, in the case of basic medical care - far from it.  In a country as rich as ours, as developed and smart and accessible as our medical skills are - keeping anyone who has paid their due from it is criminal.  And gee, that's everyone.

I can remember when hospitals grew their own food.  I remember hospitals before Medicare...and after.  Before Roe v. Wade - and after.  Before paramedic programs - and after.  We can do amazing things today, and talking with my mother who graduated from nurses' training in the mid 40's during WWII only confirms that.

We all deserve the benefit of those years.  Now, put that to the side.

I am here to talk about The Things.

If you are truly concerned about losing everything in case you get Something Expensive - take a look around for a moment and tally the worth you think your Things are worth.  Then cut it by 2/3'rds.  I've had three house fires, I know how this works - what you have is not worth what it cost you to get it.  Always insure for replacement value, not actual - for that reason.

If what you have won't even see you through an ER visit, put losing The Things as a worry out of your head.  Because you won't.  Losing your things won't even put a drop in the bucket, so don't even go there.  You couldn't possibly sell everything anyway.  Some things can help and some assistance programs require you to go to poverty to qualify for them - if you're concerned about needing them, read up on just what that would look like in your world and think about how you would accommodate those standards.  You can't qualify for help if you don't have a place - so assuming you would be getting assistance only by living on the streets isn't realistic.

So you aren't going to lose your home.  You are going to pay your home costs first.  Those dollars don't have any assistance available to them, so they get the money first.  Ditto the food, the lights and anything that will allow you to keep working.  You will negotiate your medical expenses, because at the very bottom?  There is always assistance available  You wouldn't believe it on this side of the Styx, but I tell you from experience.  I once had a heart-to-heart with a social worker when Cliff was in long-term acute care in 1997 - his Medicare lifetime benefits were almost all used up and the hospital accounting department had charged her with informing me that his care was soon to begin being 'uncovered' - so to speak.  After giving her the list of things I had available to take the place of Medicare (at the age of 34, ESRD qualifies you and nobody else will cover you), which included the MRM California has, and the workmans comp case he was part of (with two companies as his employer had been sold twice since he had been terminated disabled).  The two of us talked.  Suddenly, Medicare stopped being an issue - and I walked over to the county offices and applied for Medi-Cal/Medicaid.  With that onboard, the concerns eased.  I paid the rent, the utilities, the insurance policies, bought food and kept working.

You don't want to get into debt, I can completely understand that.  Don't  then - if anyone wanted me to get a workup done that wasn't covered by my insurance plan and I couldn't come up with out of pocket?  I go back to them and tell them to find a way.  You think it's medically necessary?  Fine.  You make it happen.  If you can't?  Well, guess you weren't serious about that then, were you?  If there is a risk of something Bad happening to you because they couldn't get the knowledge they needed about your condition?  The responsibility is now on them - you didn't go AMA on something because you didn't want to lose everything.  I can't guarantee the results on this - but it certainly has shifted the blame away from the patient who is the perfect innocent in these cases.  It also tends to reduce unnecessary medical tests.

Did it work for me?  Hell, yeah.  It's not my fault and I have no compunctions about negotiating a way, even if means shifting the liability responsibility back onto the provider.  They carry malpractice insurance, after all - something you don't have and can't get.  I'm not interested in being a very good girl when the deck is that stacked against me.

I'm not going to tell you it isn't terrifying.  It is.  I know.

Not saying you won't feel like dirt and worse.  I know.

You will be hounded by collection agents - I fear none of them.  BRING IT.

Hope you can eat a lot of ramen and pasta, because you will.  My favorite save-the-money-for-the-drugs diet is still a box of pancake mix, a dozen eggs and a pound of bacon, maybe with syrup.  That at least has some fat in it.  I used to make sourdough bread in the breadmaker.

But you will not lose everything.

It will SUCK.  Harder and longer than anything you ever knew.  

But I tell you to do this.  Why?

Let me go back to The Things.

I grew up in a town where most of the residents had gone there to die.  Seriously - everyone has a grandparent or two in Hemet, or had one, as the case may be.  They shipped them in from the midwest, from Oklahoma and Texas and other points outside of California.  Moved them in, with their Things to keep them company (and little old people tend to hoard, I might add) and left them there.

I grew up surrounded by the Things they left behind.  Estate sales and yard sales and 'antique' stores by the buttload.  'Junking' wasn't something you avoided - it was a national pastime.  I remember the stacks of 78's I used to listen to, right alongside my Beatles 45's.  We used to do crafts with doilies and old linens, costume jewelry and empty jars.  Every drama department had closets full of period clothing from the 30's on up - so full, you couldn't put anything else in there.  Things were donated all the time.  We put them in boxes and stacked them to the ceiling.  I love Depression Glass.  All of us have considerable collections, and only Mom's pieces are younger than she is.  I have rehomed more books than I own and that's saying something.  You should read some of the pieces I kept as touchstones - the racy 'The Maiden Widow' is amazing, something like 1921 or so as the copyright.  Racy in the terms of 'how DOES one become a widow and remain a virgin?  HMMM. CHICKEN OR THE EGG!'

You touch these things and you can almost feel how much they were loved and treasured by someone who just isn't here anymore.  Over and over again.

I would much rather have them, than their Things.

You want to know what happens to your Things, if you aren't here?  Check the video on top.  It's ghoulish.  And yeah, I grew up with that.  Passing strange, indeed.

So - lose The Things.  If it costs you your life if you don't risk that - you lose everything.  I've had three house fires, and if we count the two burglaries?  Guys - you can replace Things.  You can even get the chance to get them back, worst case - if you die trying to preserve your ownership of Things, what have you done?

And like it or not, none of us are going to get out of here with our Things.  Not a single one of us.  Now or later.

Not many faith systems fail to touch upon this, the Buddhist tradition hitting it harder than most of them.  When in doubt, divest.  Dump it, get rid of it, do without it.  No Thing is worth your life.

Keep your outrage about your fears of paying for medical care - they are valid and you aren't smoking crack about it.  Stay angry when you hear about some patient discharged from a hospital bed to a street outside a homeless shelter - it's wrong.  Be as fair and up front as you possibly can when dealing with your health care providers.  Work as hard as you can to cover the costs, that's only meet.

Always do your best.  Your life has an impact on others.

But know this.  Nobody gets my life - or my Things - without one hell of a fight.  I will NOT go quietly, and that's a promise.

 

I've gotten a few swift kicks to the head lately, courtesy of folks I only interact with via Twitter and LJ - kambriel  remarked on Twitter the other day how passing strange it is to attend an estate sale (and it is), and almost on top of that I heard that a dear creature named Melissa Mia Hall had died alone in her home, too concerned about the cost of seeking care for pain, lest she lose everything she held dear.  Pain from a heart attack that killed her.

Pain like that, they give you morphine for - if you're hospitalized.  Which you should be, all things considered.  You've paid your taxes to fund research into preventing and treating these things, after all.  I could go on - I'm sure you've heard it from more legitimate voices than mine.

I wish I'd known.  I would have demanded she be seen.  Yes, hang it all and risk everything - you better believe it.

This is not a demand that anything you have is forfeit or should be, in the case of basic medical care - far from it.  In a country as rich as ours, as developed and smart and accessible as our medical skills are - keeping anyone who has paid their due from it is criminal.  And gee, that's everyone.

I can remember when hospitals grew their own food.  I remember hospitals before Medicare...and after.  Before Roe v. Wade - and after.  Before paramedic programs - and after.  We can do amazing things today, and talking with my mother who graduated from nurses' training in the mid 40's during WWII only confirms that.

We all deserve the benefit of those years.  Now, put that to the side.

I am here to talk about The Things.

If you are truly concerned about losing everything in case you get Something Expensive - take a look around for a moment and tally the worth you think your Things are worth.  Then cut it by 2/3'rds.  I've had three house fires, I know how this works - what you have is not worth what it cost you to get it.  Always insure for replacement value, not actual - for that reason.

If what you have won't even see you through an ER visit, put losing The Things as a worry out of your head.  Because you won't.  Losing your things won't even put a drop in the bucket, so don't even go there.  You couldn't possibly sell everything anyway.  Some things can help and some assistance programs require you to go to poverty to qualify for them - if you're concerned about needing them, read up on just what that would look like in your world and think about how you would accommodate those standards.  You can't qualify for help if you don't have a place - so assuming you would be getting assistance only by living on the streets isn't realistic.

So you aren't going to lose your home.  You are going to pay your home costs first.  Those dollars don't have any assistance available to them, so they get the money first.  Ditto the food, the lights and anything that will allow you to keep working.  You will negotiate your medical expenses, because at the very bottom?  There is always assistance available  You wouldn't believe it on this side of the Styx, but I tell you from experience.  I once had a heart-to-heart with a social worker when Cliff was in long-term acute care in 1997 - his Medicare lifetime benefits were almost all used up and the hospital accounting department had charged her with informing me that his care was soon to begin being 'uncovered' - so to speak.  After giving her the list of things I had available to take the place of Medicare (at the age of 34, ESRD qualifies you and nobody else will cover you), which included the MRM California has, and the workmans comp case he was part of (with two companies as his employer had been sold twice since he had been terminated disabled).  The two of us talked.  Suddenly, Medicare stopped being an issue - and I walked over to the county offices and applied for Medi-Cal/Medicaid.  With that onboard, the concerns eased.  I paid the rent, the utilities, the insurance policies, bought food and kept working.

You don't want to get into debt, I can completely understand that.  Don't  then - if anyone wanted me to get a workup done that wasn't covered by my insurance plan and I couldn't come up with out of pocket?  I go back to them and tell them to find a way.  You think it's medically necessary?  Fine.  You make it happen.  If you can't?  Well, guess you weren't serious about that then, were you?  If there is a risk of something Bad happening to you because they couldn't get the knowledge they needed about your condition?  The responsibility is now on them - you didn't go AMA on something because you didn't want to lose everything.  I can't guarantee the results on this - but it certainly has shifted the blame away from the patient who is the perfect innocent in these cases.  It also tends to reduce unnecessary medical tests.

Did it work for me?  Hell, yeah.  It's not my fault and I have no compunctions about negotiating a way, even if means shifting the liability responsibility back onto the provider.  They carry malpractice insurance, after all - something you don't have and can't get.  I'm not interested in being a very good girl when the deck is that stacked against me.

I'm not going to tell you it isn't terrifying.  It is.  I know.

Not saying you won't feel like dirt and worse.  I know.

You will be hounded by collection agents - I fear none of them.  BRING IT.

Hope you can eat a lot of ramen and pasta, because you will.  My favorite save-the-money-for-the-drugs diet is still a box of pancake mix, a dozen eggs and a pound of bacon, maybe with syrup.  That at least has some fat in it.  I used to make sourdough bread in the breadmaker.

But you will not lose everything.

It will SUCK.  Harder and longer than anything you ever knew.  

But I tell you to do this.  Why?

Let me go back to The Things.

I grew up in a town where most of the residents had gone there to die.  Seriously - everyone has a grandparent or two in Hemet, or had one, as the case may be.  They shipped them in from the midwest, from Oklahoma and Texas and other points outside of California.  Moved them in, with their Things to keep them company (and little old people tend to hoard, I might add) and left them there.

I grew up surrounded by the Things they left behind.  Estate sales and yard sales and 'antique' stores by the buttload.  'Junking' wasn't something you avoided - it was a national pastime.  I remember the stacks of 78's I used to listen to, right alongside my Beatles 45's.  We used to do crafts with doilies and old linens, costume jewelry and empty jars.  Every drama department had closets full of period clothing from the 30's on up - so full, you couldn't put anything else in there.  Things were donated all the time.  We put them in boxes and stacked them to the ceiling.  I love Depression Glass.  All of us have considerable collections, and only Mom's pieces are younger than she is.  I have rehomed more books than I own and that's saying something.  You should read some of the pieces I kept as touchstones - the racy 'The Maiden Widow' is amazing, something like 1921 or so as the copyright.  Racy in the terms of 'how DOES one become a widow and remain a virgin?  HMMM. CHICKEN OR THE EGG!'

You touch these things and you can almost feel how much they were loved and treasured by someone who just isn't here anymore.  Over and over again.

I would much rather have them, than their Things.

You want to know what happens to your Things, if you aren't here?  Check the video on top.  It's ghoulish.  And yeah, I grew up with that.  Passing strange, indeed.

So - lose The Things.  If it costs you your life if you don't risk that - you lose everything.  I've had three house fires, and if we count the two burglaries?  Guys - you can replace Things.  You can even get the chance to get them back, worst case - if you die trying to preserve your ownership of Things, what have you done?

And like it or not, none of us are going to get out of here with our Things.  Not a single one of us.  Now or later.

Not many faith systems fail to touch upon this, the Buddhist tradition hitting it harder than most of them.  When in doubt, divest.  Dump it, get rid of it, do without it.  No Thing is worth your life.

Keep your outrage about your fears of paying for medical care - they are valid and you aren't smoking crack about it.  Stay angry when you hear about some patient discharged from a hospital bed to a street outside a homeless shelter - it's wrong.  Be as fair and up front as you possibly can when dealing with your health care providers.  Work as hard as you can to cover the costs, that's only meet.

Always do your best.  Your life has an impact on others.

But know this.  Nobody gets my life - or my Things - without one hell of a fight.  I will NOT go quietly, and that's a promise.

I am seriously considering dropping any payments to a health care system that does not DIRECTLY fund infrastructure - hospitals, doctors, nurses, pharmacists...care. Period.

I will happily pay premiums to a system like Kaiser that in turns uses those funds to build, maintain and staff facilities for its members.

Funding a system that works to provide profits while banking my bucks - and doing nothing more with them - is looking like a worse idea all the time.

So say we all. Enough, already.

And I got stuff to get back to.

..it's also possible that something else was at work: galloping elitism. Vick may not have had many advantages as a small boy, but he's had every advantage since then. From the instant he picked up a football he was over-praised, overpaid and excused by idolatry. The truth is that athletic prowess can breed a kind of coldness. We hold star athletes to be more valuable than other people -- and we literally pay them as if they are worth more than others. Roy Baumeister, scholar of social psychology at Florida State, theorizes in his book "Evil: Inside Human Violence and Cruelty," that heinous acts may not come from a lack of self-esteem but rather from egotism, a surfeit of self-regard.

This is a lovely piece of work, for no other reason it's succinct and to the point without getting too wrapped up in personal opinion (which, is arguably the point of this kind of column in the first place). But it gave me a term I could wrap a number of news items up in.

"A surfeit of self-regard."

I'd like to enhance the buzz word 'entitlement' with this statement. As is, where does it come from?

Let's consider this with regard to two of the biggest stories in health care this week:

As of Oct. 1, 2008, Medicare will no longer reimburse hospitals for the extra costs of treating injuries from eight preventable conditions. Medicare officials said they plan to add three more conditions to the no-pay list next year.

The eight conditions are patient falls, pressure ulcers, urinary tract infections, vascular-catheter-associated infections, mediastinitis, air emboli, removal of objects left in the body during surgery, and injury caused by use of incompatible blood products.

Moreover, the rule change also prohibits hospitals from billing the patients for "any charges associated with the hospital-acquired complication." *

And -

The Bush administration has adopted new standards that would make it much more difficult for states to extend health coverage to children in middle-income families, The New York Times reported on Monday.

Rushing towards socialized medicine? Not so much - because, look - these are actions taken to gut the one-payer plan we do have.

Who benefits from these changes?

Well, if Medicare doesn't pay - the patient, or the patient's insurance provider does. This does not immediately translate into more claims, per ce. But it certainly ups the ante towards your perceived need for the beast, doesn't it?

Better have that coverage! If Medicare thinks your claim is bogus because someone Oopsed - you'd better be Prepared!

Buy more insurance!

And the second one? The story itself tells the tale - "Administration officials said the changes were aimed at returning the focus to low-income children and to make sure the program did not become a substitute for private health coverage, the Times said."

You tell me.

Why does insurance have such pull?

Well, you can invest in it, like any other company. And in this case - if they make money, so do you. Simply put.

How the heck can anyone expect socialized medicine with this sort of thing in place? It's making people money. LOTS of it. Sadly, the providers don't see any benefit from this - unless they are tied to selling insurance (HMOs, largely), and balance their books against what they take in premiums vs. costs to operate.

And as long as some people can keep paying the costs of this cycle - while making that money to do it in the process - I don't see any motivation to change a thing.

We'll socialize - to a single payer plan like AT&T does telecom.

How do they sleep at night.

"A surfeit of self-regard."

I got mine - screw you.

..

I don't need to tell you how easy it is to make medical 'mistakes' with regard to pharmaceutical issues, do I?

And I got stuff to get back to.

..it's also possible that something else was at work: galloping elitism. Vick may not have had many advantages as a small boy, but he's had every advantage since then. From the instant he picked up a football he was over-praised, overpaid and excused by idolatry. The truth is that athletic prowess can breed a kind of coldness. We hold star athletes to be more valuable than other people -- and we literally pay them as if they are worth more than others. Roy Baumeister, scholar of social psychology at Florida State, theorizes in his book "Evil: Inside Human Violence and Cruelty," that heinous acts may not come from a lack of self-esteem but rather from egotism, a surfeit of self-regard.

This is a lovely piece of work, for no other reason it's succinct and to the point without getting too wrapped up in personal opinion (which, is arguably the point of this kind of column in the first place). But it gave me a term I could wrap a number of news items up in.

"A surfeit of self-regard."

I'd like to enhance the buzz word 'entitlement' with this statement. As is, where does it come from?

Let's consider this with regard to two of the biggest stories in health care this week:

As of Oct. 1, 2008, Medicare will no longer reimburse hospitals for the extra costs of treating injuries from eight preventable conditions. Medicare officials said they plan to add three more conditions to the no-pay list next year.

The eight conditions are patient falls, pressure ulcers, urinary tract infections, vascular-catheter-associated infections, mediastinitis, air emboli, removal of objects left in the body during surgery, and injury caused by use of incompatible blood products.

Moreover, the rule change also prohibits hospitals from billing the patients for "any charges associated with the hospital-acquired complication." *

And -

The Bush administration has adopted new standards that would make it much more difficult for states to extend health coverage to children in middle-income families, The New York Times reported on Monday.

Rushing towards socialized medicine? Not so much - because, look - these are actions taken to gut the one-payer plan we do have.

Who benefits from these changes?

Well, if Medicare doesn't pay - the patient, or the patient's insurance provider does. This does not immediately translate into more claims, per ce. But it certainly ups the ante towards your perceived need for the beast, doesn't it?

Better have that coverage! If Medicare thinks your claim is bogus because someone Oopsed - you'd better be Prepared!

Buy more insurance!

And the second one? The story itself tells the tale - "Administration officials said the changes were aimed at returning the focus to low-income children and to make sure the program did not become a substitute for private health coverage, the Times said."

You tell me.

Why does insurance have such pull?

Well, you can invest in it, like any other company. And in this case - if they make money, so do you. Simply put.

How the heck can anyone expect socialized medicine with this sort of thing in place? It's making people money. LOTS of it. Sadly, the providers don't see any benefit from this - unless they are tied to selling insurance (HMOs, largely), and balance their books against what they take in premiums vs. costs to operate.

And as long as some people can keep paying the costs of this cycle - while making that money to do it in the process - I don't see any motivation to change a thing.

We'll socialize - to a single payer plan like AT&T does telecom.

How do they sleep at night.

"A surfeit of self-regard."

I got mine - screw you.

..

I don't need to tell you how easy it is to make medical 'mistakes' with regard to pharmaceutical issues, do I?