Category Archives: current events

Ombudsperson

I know it’s a childish thing to expect, particularly after practicing law for ten years, that there would be a fair arbiter you could appeal to to uphold basic fairness.   It’s like expecting there to be a record, and making statements for the record.  You know, when the appeals court looks over the record, you dig, they’ll see I’m right and the judge was wrong.  You think there’s really a record?   Heh.

“Watch out for that weasel,” a colleague once warned me about a certain judge.  “They have a foot switch that turns the recorder on and off so he can edit what goes into the record on the fly.  If the tiny red light on the side of his name plate goes out, you are not being recorded.   So when he takes a long pause and says ‘so, you refuse to answer the question, counselor’, right after you’ve answered the question, he already has his proof of your refusal to answer because what you just said was not recorded for the record.  You have, in fact, already refused to answer, on the record.  So don’t speak unless that red light is on, and ask him why you are off the record if the red light is off.”

“Damn,” I remember thinking, though, on reflection… duh! 

While I was dismayed, and a little angry, to finally learn that there is no corporate Ombudsperson at the Allen Pavilion to visit with a stack of Obamacare bills, some of which I owe, some of which I don’t, some of which have the wrong payment amount demanded in them, one of which is currently in collection, I am not really surprised.   That Ombudsperson would be overwhelmed, her job impossible to keep up with, the billing irregularities under the complex new law are as numerous as the stars in all the galaxies.   The guy at the billing window at the Pavilion tells me I have no idea how many problems patients have been having with multiple erroneous and ridiculously high bills.  

Want to make a record?  A better idea than worrying about that is to simply go fight City Hall.  Or practice until you find your way to Carnegie Hall.  Or go back in a time machine and buy a cheap suit from Robert Hall.   Next guest!

Don’t Take It Personally, Man

You may be correct to feel that not being told the price of a medical service until after you’ve bought it is like going into a store and not being told, until after you make the purchase, the nonrefundable price, which you are 100% responsible to pay.   Or, like a restaurant where the bill is secret until after you’ve eaten, a policemen waiting to take you in if you refuse to pay whatever the restaurant demands.  Seems unreasonable, un-American, but according to the Patient Protection and Affordable Care Act, the practice is neither of these when it comes to medical services. 

Critics will be critics, and some critics ignore the facts in their zeal to score points, but a few things about the flawed step forward that is Obamacare (The Patient Protection and Affordable Care Act– PPACA) are beyond dispute. Systemically, it is an improvement over what existed before.   The elimination of the grotesque loophole of “pre-existing condition” exclusion from coverage alone was worth the fight.  Giving the medical industry financial incentives to prevent disease rather than continuing to profit off billions in late in the game testing and end of life treatment is another long overdue step in the right direction.  It can’t be denied that millions more Americans have health insurance under the PPACA and access to preventive care, many for free.

 Those things said, huge problems remain with this compromise, authored by a health insurance industry insider,  that keeps the private health insurance and pharmaceutical industries firmly in charge of seeing their profits undisturbed.    Millions are still uninsured under the PPACA and tens of thousands of Americans will continue to die preventable deaths every year from treatable diseases discovered only in their fatal stages at ERs across the country.  

 Individuals may find also find themselves among a few million in an income category a little too high for free service, and too low to qualify for and afford the premium service members of Congress receive.  Such persons will, unfortunately, be a bit screwed by the details of the PPACA.  

The high deductibles, outsize charges for routine services, billing irregularities and other unappealable indignities may cause these patients to feel unprotected and that the mandated health care they pay for each month is sometimes obscenely unaffordable.   These Americans must take solace from the fact that it is truly nothing personal.

 Yes, it’s your individual problem, true, since the bills will be enforced by lawyers sent to collect all charges, but take courage in knowing that you are not alone in being partially unprotected by the Patient Protection and Affordable Care Act, an otherwise wonderful program.  It’s nothing truly personal, surely you can see this.  It affects millions, so stop your belly-aching!

 If you consult for twenty minutes with a physician’s assistant, for example, who has never heard of the symptom you report, repeats your google research while you sit there, and who orders a blood test to rule out certain things, you may have a little sticker shock when you get the bill for $507.   This sticker shock comes about because there is apparently no provision in the law that the patient be informed of cost prior to receiving a service.  Call your insurance company and they will tell you the doctor must first bill them for the service and then the price is determined, according to negotiated rates, and sent back to the doctor, who will in turn bill the patient the deductible amount.  

It’s all right there on the bill:  consult with physician’s assistant:  patient’s responsibility– $180.   Subsequently reduced, without explanation, on a follow-up bill thirty days later, to $110.   Blood test:  $641.  Patient’s responsibility:  $327.   Insurance, oddly, paid the corporation representing the doctor $314 for the blood test.   $437 for a visit to a physician’s assistant?   Call to ask about these charges and you will be told the charges are all correct, sir, all the proper codes were entered, these are the legal rates your insurance company agreed you would pay.   You can take it up with the attorneys who are handling the collection matter for the doctor’s office.  

 Have a nice day and, please, keep in mind that this is strictly legal, enforceable and absolutely NOTHING PERSONAL!   Only a baby would take it personally, though plenty of folks, apparently, are squawking like babies about their treatment under this inarguably great step forward. 

 To be fair, though, would you rather be treated unfairly with the right to be hospitalized (at no expense beyond your premiums and deductibles) when you finally have a stroke or without that right?  You’d have to be a fool not to see that this is a no brainer.   

 

Email to my sister

In the score one for madness column, this email to my sister:

I know the “review” of Tekserve is too long.  Brings to mind the famous Mark Twain apology for the long letter (sorry, I didn’t have time to make it shorter)… I have to just be done with it and get to the next task.   Each of these tasks contains some measure of frustration— which makes the entire menu a bit unappetizing.  
 
I figure if someone goes on Yelp to check reviews of Tekserve, sees zero stars and the first paragraph, fine, my job is done.   If you want more details, click “read more” and get the whole ugly story, see if I’m just being a pissy crybaby or not.   The guy who owns the company will get the whole thing emailed to him, the long, detailed YELP.  Done.  I don’t expect the prick to do anything to change anything anyway.  
What could he do at this point to make it right that his store dicked me around for a total of over 9 hours of wasted time for me (days after I dropped $2,500 there)?  And glared at me and told me silently to go fuck myself at the end?  A guy who runs a store with a culture like that is unlikely to do anything in any case, and fuck him anyway.  You know what I’m sayin’?
 
Spent 28 minutes on the phone with Columbia Doctors this afternoon, two different Patient Services numbers, both insist the $507 for the 20 minute meeting with the useless PA is what MY insurance company agreed I have to pay.  Take it up with insurance, with my senator, with The United Nations.
 
Fit to be tied, then, work keeps getting complicated with new learning curves on the new macBook, plenty of frustrations with the enormous changes they’ve made in the new operating system to all the programs the kids use.  If I brought this new macBook into a classroom, though its 4 times more powerful than the one we use now,  I couldn’t run the workshop with it.  The geniuses at Apple have finally defeated my child-friendly design for a student-run production studio with radical “improvements” to make the macBook more closely resemble an iPhone or other IOS device.  
 
Being right, having an innovative program that could help many kids, being subjected to unfairness nobody should have to put up with, none of it means anything in our corporations-are-people-too society.  Listen to Obama talk to Marc Maron on WTF– the coolest, most relaxed, reasonable guy in the world, certainly the coolest president.   Look at the details of many of the things Oybama’s doing — hoy boy, Cheney would be smiling– if only Obama wasn’t a… you know.  
 
Obamacare, his signature achievement:  Is it better that pre-existing conditions are gone, that millions more are insured, that fewer Americans will die unnecessarily every year to preserve the obscene profits of the American health care industry?   Absolutely.  Isn’t it progress?  OK, it’s a step in the right direction.  Is it perfect?  He readily admits it’s not– now we have to fix it– without unfairly upsetting the profit expectations of those private corporations who expect to keep making billions.  That this corporate calculus, admittedly (though you’ll never hear him say it) necessitates fucking a certain number of Americans, hopefully only a few million… well, that’s unfortunate for the people affected, although millions of others are still far better off than before.  Let’s not talk about the millions of Americans still not covered, OK?  Don’t let the perfect be the enemy of the good.
 
As he talks about all the progress we’ve made, his administration has made, I kept thinking of the children of recently freed slaves, born in 1868, free blacks under the amended US Constitution.   Was it better to be born free than a slave?  Absolutely.  Was Jim Crow and lynching and Black Codes for 100 years bad?  And the Supreme Court continuing to rule, until 1954, that all this was perfectly legal under the Constitution?   Yes, it was very bad.   But, on the other hand, if that baby born in 1868 lived to be 147 years old he’d get to see a day when people started realizing that flying a Confederate battle flag over a U.S. government building is the same as flying a swastika flag over a German government building.   And we don’t publicly use that terrible word anymore, we say “the n-word”, right?  And the son of an African man and a white woman as president?  See, that’s progress?  No?   You can’t say it’s not, can you?
 
After today’s rant about Obamacare Sekhnet told me, once more, to write an editorial for the NY Times on the theme of  “Don’t take it personally”.   Systemically Obamacare is an improvement over what existed before, the elimination of the grotesque loophole of “pre-existing condition” alone was worth the fight, giving the medical industry financial incentives to prevent disease rather than profiting off billions in late in the game testing and treatment, also, good idea.  Millions more Americans have health care, many for free, and if you find yourself among a few million who are fucked by the details of the Patient Protection and Affordable Care Act, feel unprotected and that the care you are mandated to buy is not affordable, you must realize that it’s nothing personal.  Yes, it’s your problem, true, but take courage in knowing that you are not alone in being fucked by this wonderful program.  It’s nothing personal.
Look at it this way: would you rather be fucked with the right to be hospitalized (at no expense beyond your premiums and deductibles) when you finally have a stroke or without that right?  Hmmmm?   Think about it.
 
Got to somehow finish the 90% done marketing stuff relating to my program, though it feels impossible to gracefully dance off that last 10% in the current mood I’m in.  
“Success is the ability to go from failure to failure with no loss of enthusiasm,” said Winston Churchill, getting drunk as a skunk and sleeping til noon.  “But the question is– what does it take to remain encouraged?”
I’d go out and walk a couple of miles, keep my streak going, but there’s a thunderstorm pissing down at the moment.
 
Wee wee wee!
Biting my own foot off,
Nnnnnngggggg

Political bite of the day

From my congressman, who recently voted against giving this and the future president the authority to negotiate international trade deals in secret and have them voted “yes” or “no” in a fast track toward his or her desk for signature:

While I voted YES on the Trade Adjustment Assistance (TAA) to extend AGOA, I am not fully supportive of the trade package which I believe should be more inclusive to ensure our workforce is better equipped with education, jobs training and modernized infrastructure. I will continue to fight for measures that will make certain Americans are globally competitive.

And let us sign his name to it:

Sincerely,

Charles Rangel

What is TAA?   Let’s see:

WASHINGTON (MarketWatch) — The House of Representatives passed a bill Thursday that would aid workers who lose their jobs due to international trade deals. The measure previously passed the Senate and now goes to President Barack Obama’s desk. Obama has said he wants to sign the worker aid bill and the “fast track” trade authority bill. Fast track has already cleared Congress. Just six House Democrats voted no on the aid bill. Most Democrats voted against it two weeks ago to slow the fast track bill, but were ultimately unable to defeat the trade authority sought by Obama.

Granted

That you have, with increasing cunning, greatly limited the chances of any but a few for having anything like that prosperous life advertised constantly on TV, movie, smart phone.

Granted, you have planted bitter hopelessness in the lives of millions, while smiling and taking bows, and praising your own exceptional greatness and generosity.  

Granted some of your most generous ilk made $45,000,000 last year, mostly in speakers’ fees, speaking off the cuff, and you are very droll and charismatic.

Granted, those fated to have almost nothing will get ever less and the three hots and a cot in a privatized facility will begin to look good as a free alternative to grad school.  That or going for the glory and ending in a hail of bullets.  

Granted, a family of one cannot actually live on $400 a week, but that is way too much to expect successful people to pay for unskilled, menial help.

Granted, the rantings of one silent, solitary voice here don’t amount to a hill of beans in this crazy mixed up world.

I don’t know where this song comes from, I certainly don’t recall choosing it among all the songs in the world.  But while there is breath here to sing it, sing it I will.

Patient Protection and Affordable Care Act Update

I have been getting calls, and now collection letters, regarding an unpaid $81 toward a discounted $131 deductible (a savings of $119 over the list price!)  from a quick pre-colonoscopy consultation I was required to have last October.  I’d been told the procedure was fully covered as preventive care, except, apparently for the visit to the gastroenterologist to shake his hand and give his receptionist my $50 copay the week before.  There were also a few hundred in fees, it turns out, because a polyp had been sent to the lab for analysis.  Lab fees, obviously, have nothing to do with the preventive procedure.

“Why am I required to pay $100 by check on the day of the procedure if the procedure is fully covered by the premium I pay every month?” I asked the woman at the hospital.  She didn’t know, but the procedure would not be done without the payment.  I paid.

Fast forward eight months, calls to the insurance company regarding charges, conversations with the doctor’s office.   Eight months of demands and threats and finally another letter from a lawyer who specializes in collection.    My position is that I’ve already paid the $81 in the form of that $100 check nobody can seem to justify.  

Out of the blue, yesterday, another envelope from the hospital.   Without any explanation, a check, written out to me, for $100.

cold breeze in Cyberia

Facebook, which we’re told is indispensable for any business or would-be business, allowed me to quickly set up a page for my would-be business.  I had a kid managing it for a while, then it went fallow for a year or so.  I was able to update it when I wanted, but didn’t do it often.  If I’d managed to whip up excitement among 10,000 followers it would have been much easier to raise money through crowdfunding, but I had a few dozen and the effort of raising its facebook profile felt mostly wasted while I needed to work on so many other things.

I got a notice from Facebook a few months back informing me I wouldn’t be able to manage or administer the page I’d put up unless I signed up for a personal page.  I did this with reluctance and had “friend requests” from a few dozen people, some I’d known decades back.  

A friend request, it strikes me now, is such a poignant thing to call this transaction.   “Will you be my friend?”  cue visual of adorable little bear, bashful and wearing some kind of cute hate.  

Since I’ve set up my personal page I’ve been unable to post on my own business page, despite having done what facebook’s instructions had told me to.  “You do not have permission to do this,” it tells me.  Or, it lets me post something as a visitor, with my own first and last name visible. 

Taking a break from other things, I had an idea for a work around.  Create a new email address “loves to draw” or “dances with voles” and make that person an administrator.   Then “animation rules” could post to the page, instead of me personally, with my birthday 58 years ago also displayed.  It took only a few moments to find the “settings” tab referred to below and I set off to follow these seemingly simple instructions:

How do I give someone a role on my Page?

You’ll need to be an admin to give someone a role on your Page. If you’re an admin:

  1. Click Settings at the top of your Page.
  2. Click Page Roles in the left column.
  3. If the person is your Facebook friend, begin typing their name and select them from the list that appears. If the person isn’t your Facebook friend, type their email address.
  4. Click Admin to select a role from the dropdown menu.
  5. Click Save and enter your password to confirm.

Page Roles never came up on that settings page.  The left column, yes.  The next step I needed to follow?  No.   Must mean I am not an admin.    

Sekhnet, who has never been on facebook, suggested I call someone at facebook for help.   A friend who is active on facebook laughed, as I would too, if I were not busy gathering my coat around my neck as the cool breeze from the Cyberian tundra whips in.

America, America

I must find something to occupy me more productively during the long working day. Come home after work too tired to think, with a feeling of accomplishment or even just relief to be done, get a paycheck.   This unpaid uphill life I’m living is too challenging.  

Having a simple, self-evident and overdue idea: that kids in trouble need to be listened to, need to be allowed to play, make creative and editorial decisions in relation to their learning — testing it a hundred times, watching it succeed everywhere — what the hell is that balanced against its failure to thrive, against the vast landscape of intolerable annoyances that can only truly be surmounted by unqualified success, or, in the meantime, a dedicated spiritual practice or an all-consuming job?  That it might well help every child it touches?  Succeed against the odds or shut the fuck up, loser.  

Why for example get worked up about the details of the new trade bill President Obama is trying to fast track through Congress?   Up or down vote, you don’t need to debate the details, it’s bipartisan.  

Personally, I have other things to worry about, like the $507 bill for last month’s twenty minute session with the Nurse Practitioner ($180) and a blood test ($327).  I have to take a walk and arrange a meeting with an ombudsman or patient advocate at Columbia Doctors, see how far I can negotiate it down to a reasonable number.

“Sir, $327 for a blood test IS a reasonable number, approved by Empire Blue Cross under the terms of the PPACA, as is $180 for a consultation with a medical professional who, arguably, should not have been on Google perplexedly searching for ‘pink mucas’ for the bulk of your short meeting, shouldn’t have offered to do a rectal exam she knew — when asked– would tell her nothing, and who should probably have asked about your recent diet, stress, changes in life, exercise, sleep and so forth instead of just making a referral to a specialist– particularly since the questions she didn’t ask turned out to be keys to solving your bowel problems, as you did on your own. But your bill has been negotiated on your behalf and approved by the insurance company and is legal, mandatory and collectible under the PPACA.  If you have a problem with it, talk to your congressman.  You owe us $507 and since you have insurance your argument about being treated as uninsured, and allowed the discount we often give to such patients, is flatly absurd.  Unless you’d like the bill turned over to our debt collector, like many before it, pay it now.  How would you like to pay, cash, check or credit card?”

I don’t know, for the life of me, why I’m not making a call now to make arrangements to have that fun discussion instead of tapping here.

The Trans-Pacific Partnership Agreement is no doubt a massive and complicated bill.   The president gets hot when he’s accused of keeping it secret.  It is not secret, he insists, any member of Congress can make an appointment to go read it.  They simply may not bring staffers with them, may not photocopy any part of it or remove it from the restricted reading room, may not make notes or discuss its terms with anybody with clearance who hasn’t seen it.  That’s what fast-track means, up or down vote — “yes” or “no”– there’s no need for debate.  Plenty of Republicans are already on board to vote “yes”.  What the hell is the problem with the liberal wing of the president’s own party?

Maybe it’s the lack of public debate?  I don’t know.  Secrecy, and even semi-secrecy, has a bad smell in a democracy where an informed electorate is supposed to be involved in the decisions made on its behalf.  We all know this is a bit of a myth, but still, secrecy is a slap in the voters’ faces, and it smells bad.  

When Vice President Cheney and President Bush could not stall the 9/11 Commission beyond November 2002, they set conditions for speaking to the commission. They would go before the commission together, not be sworn to tell the truth, nor would they testify, no notes, no recordings, everybody on the commission was sworn to keep whatever they said secret.   Struck me as a deal a couple of mafia dons would make, if they owned the court system and the police force.  Sunlight is the best disinfectant for abuses of democracy, as well as hateful free speech, except, apparently, when it shines into the dark side where it doesn’t belong.  Some things are best kept secret from a skittish electorate that can’t handle the truth, is the theory.

Think of the stink that would have engulfed us if the enhanced interrogation program had not been kept secret, except for those members of a Congressional committee who got restricted access to secret memos, after agreeing, under the penalties for treason, not to disclose their classified contents. The memos, it turns out, justified everything by arguing that each enumerated torture technique was not torture if a doctor was present to make sure death did not result from it.  Imagine the outrage if the public had been let in on the details of that program!

We’re just finding out now about guys hung by chains naked, submerged in ice water, kept in cages half the size of a coffin, kept awake for days on end, in cold, and heat, and menaced by snarling dogs, and look how pissed off some of us feel.  Imagine if we’d known while it was being systematically done to hundreds, or possibly thousands, of suspected bad men held without charges in secret prisons scattered around the globe?  Imagine if we’d known that $81,000,000 in taxpayer dollars had been paid to two rogue psychologists to oversee this controversial, failed experiment in counter-terrorism?

The Trans-Pacific Partnership Agreement  has at least one provision that some people will get upset about, rightly or wrongly.   I don’t know how we know about this provision, since the contents of the trade agreement have never been made public, but nobody seems to be denying that this is one of its provisions.  Ah, I see some traitor has apparently leaked a section of it, to Wikileaks, natch.

Corporations whose profit expectations have been diminished or damaged by laws or regulations of member states will be able to sue those state, local or federal governments, in special Investor-State Dispute Settlement tribunals.  The judges in these tribunals will be lawyers who have experience in the area the corporation works in, be familiar with the nuances of their profit expectations.   Many will have, without a doubt, worked for, or even still work for, these corporations.

“But it’s the same with the Security and Exchange Commission,” you will argue, correctly.  “The government lawyers there charged with catching financial shenanigans are the minor leaguers, the best of whom will get to work for the corporations they regulate for many times their government salary.  That’s the world, why be a weak little whiny bitch about it?  Make some money, you’ll feel better.”

The conspiracy theorists among us imagine the worst.  Alarmists and weaklings, one and all.  After all, NAFTA turned out fine.  And the draft provision for the Investor-State Dispute Settlement tribunals (see linked Washington Post article) includes, ironically, clear transparency rules, requiring that all cases brought under the TPP must be public.

The enhanced interrogation program, or torture program, if you’re being a pain-in-the-ass stickler for accuracy, even though it was far more extensive than admitted, even though evidence of some of the more medieval abuses was deliberately destroyed, even though it must be admitted that little or no actionable intelligence resulted from this widespread, systematic trampling on decades of evolving human rights law and the anti-torture treaties we championed, well, no harm no foul.  You can understand the need to keep that kind of shit top secret, just look at the harm the after-the-fact revelations have been doing.

Barack Obama is a good man, a brilliant and witty man.  He’s a funny, cool guy with everyone’s best interests at heart.  If he says this bill needs to be fast-tracked, who is a nation of obstructionist ignoramuses to say no?   Finally he has a truly bipartisan bill he’s trying to sign into law and stubborn members of the president’s own party are standing in his way.  Many Americans hate him simply because his father was African and, under the time-honored American code of racism, he is considered a black man.   I rest my case.  Fast track this shit.  Father knows best.

“Get a job, you bum!” a witty fan yells at the ump.