HULK SMASH (part 1 of 2)

Bitter Pill: Why Medical Bills Are Killing Us – TIME

It all started with a single bead of sweat, which gave way to nausea, and then there was the fiery, unrelenting diarrhea. I still remember fondly recalling a clear nasal passageway, but by now I was especially reminiscing with the utmost nostalgia about the days I had if only one well-functioning orifice, just one that didn’t have some blood-instilled, putrid liquid coming out of it, hunching me over a garbage can or toilet. Mind you this had taken place gradually. It was around the moment I woke up face-down on my kitchen floor in a pool of something I didn’t care much to identify, with a fever-induced Osama bin Laden telling me I didn’t look so hot, that I decided to reach over for the phone and call 9-1-1. I was promptly ushered to the nearest hospital and thus began:

THE DAY I TESTED THE MEDICAL CARE MARKET

I rose hours later in a hospital bed, in a room which featured little else than a potpourri on my bedside table, and a picture of a potpourri on the wall. An old TV was playing some kind of daytime TV show where they talk about problems only people who have the time to attend any such show to talk about their problems might possibly have. I was greeted by a semi-attractive, cheerful to the point of being condescending nurse, who stood at a healthy distance away from me, most likely due to the fact that I had not changed in a while, and by now my clothes probably reeked of vomit or fecal matter or both. The day’s event suddenly accelerated as she explained that, upon rummaging through my wallet in order to confirm my identity, they had stumbled upon my health insurance card, and, apologetically, informed me that, quite unfortunately, that particular insurance did not figure on the list of private health insurances that they accepted, and that I now owed the hospital $4300, that’s $932.87 for the ambulance ride that got me off my kitchen floor and to the hospital, $2099.13 for an inpatient stay, and $968 for a cocktail of blood tests, meds and a CT scan. My lavish lifestyle as a professional pancake flipper at IHOP unfortunately precluded me from eligibility for Medicaid, and my youthfulness did not comply with Medicare. As the news of this sizable bill started sinking in, my mind drifted to the unreasonably expensive nature of my irrepressible poker addiction as well as the college loans I had long since, stopped, thinking about actually. This certainly was not good news. The second-story jump of my timely hospital getaway certainly would seem like a rash decision in hindsight, but the anti-inflammatory meds I had just not paid for most likely cushioned the blow as even I was surprised at my renewed energy and subsequent Usain Bolt impression as I made my escape.

I must have blacked out again, because the next thing I knew I was at the wheel of my 2001 Chrysler Sebring rolling to St. Andrew’s Hospital on the other side of town. One may think after my daring/insane escape out of a second-floor window that I had lost all grasp on reality by this point, but I was well aware the clock was ticking. The amount of pus excreting from the sizable warts which had grown to adult size on my perineum was sending that message loud and clear. Something was really wrong with me. I just had to find affordable healthcare somewhere in this town before it was too late. I was most likely hemorrhaging somewhere in my brain by then because what usually is Robert F. Kennedy boulevard suddenly turned into Robert F. Kennedy boulevards, as 2 sister streets plainly materialized before my very eyes. I decided to pick the one in the middle and can only assume I made the correct choice as I finally arrived at a hospital for the second time today. It was not before I had already waited a couple hours in the “reception area” that a doctor informed me that the kind of ‘discount insurance’ I had (for which I paid a premium of $470 a month) would only reimburse about %50 of this hospital’s bills, that my health insurance, Argent, only applied full rate reimbursement in the states of Texas, Missouri and Washington, the combination of which was somewhat baffling. I informed the good doctor of my decision to thank him, but not thank him, and to shop for better prices elsewhere and his face contorted into an expression of horror in response.

‘But sir, your ears are bleeding…’ said the good doctor.

‘Then, I must be quick,’ said I, with an uncharacteristic determination in my voice, probably once again a result of the folly that was gaining on me.

The hospital was legally obligated to keep me from leaving in my current state and thus compelled to charge me obscene amounts of money in the process, and so it was that I was a fugitive of not one but two hospitals that day. I high-tailed it across state lines in direction of the wonderful state of Texas. My quest for the Holy Grail of affordable health care would continue in the Lone Star State, or it would end there.

to be continued in HULK SMASH (part 2 of 2)

HULK SMASH (part 2 of 2)

Bitter Pill: Why Medical Bills Are Killing Us – TIME

continued from HULK SMASH (part 1 of 2)

My Eldorado lay no further than an hour’s drive away, but my blood pressure was nonexistent and oxygen scarce by the time I made it to destination. Thankfully, what awaited me there was the American Dream still alive and true. There I was informed my insurance would pay back all of my bills. Good old red, white and blue, I thought. I spent a week in the hospital, as nurses poked and prodded me all day long and new doctors visited me daily to provide me with their opinion on the morning CT scan before ordering a slew of blood tests. The bills kept piling up, and granted I would indeed have had a rather stern disagreement to voice if Argent, my semi-dependable private health insurance hadn’t been paying for this, mostly due to the $13 per tylenol pill (500 for $10 on Amazon), $137.33 per day for heating my room which did not figure in the $3200 daily inpatient room rate, $600 per doctor who even glanced in the direction of my CT scan, a $35000 bill for a drug called CuReItAlL and a $13000 cost allocated to a category simply entitled ‘COMFORT’, which had such concessions as soap and hot water. The day of my hospital discharge finally arrived and I was informed that my bills had ballooned to a whopping $103,567.

‘I should really send someone at my health insurance some chocolates, or a wine bottle or something,’ I said with one of those awkward smiles I have when I am oddly proud of a bad joke that only I find amusing.

‘Right, but your insurance has an annual ceiling of $40,000,’ answered the receptionist.

My dimwitted smile kept on hanging comfortably on my face for a surprisingly lengthy few more seconds until the gravity of the situation suddenly seized me, and I became very, very serious. My hands began twitching, my muscles were bulging, my veins started protruding, my eyes swelled, green with rage. As my muscles expanded, so my body grew. My pants ripped apart, my shirt was reduced to little more than a thread. I had become the Incredible Hulk. I’m sure I don’t need to describe the look of shock, horror, disbelief that lay on the hospital staff’s overpaid faces, and I suppose it did not make things better when I grabbed one of the senior doctors by the feet and used him as a battering ram to destroy the overpriced hospital equipment, which I was being grossly over-billed for in order to justify their purchase. I then demanded in my highly-testosteroned voice to see the Chargemaster, the mythical being which determines all these hospital prices, that most have only heard of uttered in legends. I sure as hell had their attention now, most likely because their boss was still dangling between my thumb and index, and everyone complied swiftly. We all made our way to the president’s office, where he obediently pushed the big red button under his desk. A picture of Ronald Reagan on the wall slid to the side, revealing a safe. Inside, beside a 9mm handgun, $1 million in cash and a picture of his mother lied an old map that we dusted off to learn the location of the Chargemaster. This search would lead us down to the forgotten underground tunnels.

After dodging arrow trip-wire traps and poisonous spiders, our search brought us to the minotaur’s labyrinth, and after solving that and defeating the bi-pedal cow, we came to the ‘Janitor’s Closet’. The door creaked and whined to reveal a very large computer. The ground started shaking, truly a seismic wave. Parts of the ceiling rifted and fell to the ground. Finally, a voice rang, one so evil it shook us all to our very souls.

‘Who disturbs my slumber,’ demanded to know the unreasonable price setter known as the Chargemaster.

‘I am a patient here, and this is your staff, and we have questions,’ I responded.

‘Make it quick then, my time is money.’

‘Your profit-margin is obviously ridiculously high. What is the rationale and calculation behind these prices?’

‘I am not at liberty to discuss that’.

‘Well would you please explain how you calculate the cost for treating my radiation poisoning?’

‘Your soul + a 300% profit margin,’ said the Chargemaster, barely able to contain an evil giggle.

‘Well I think that’s total crap. I don’t want to pay $74 for a shower curtain. In fact there’s a lot on these bills that I don’t think I should be paying.’

‘Fine,’ said the sarcastic AI, ‘don’t pay, die of radiation poisoning, see if I care.’

And that was that really. Just then I realized what the ace in the hole really was for the Chargemaster. There was no negotiation to be had. I needed him exponentially more than he cared whether or not I paid the price. So then, I paid the price. I sold everything I could to pay my debts, which would only grow since I had to return to the hospital for further monthly consolations. My quest for affordable healthcare had indeed ended in Texas. As I left the hospital that day, a statue of the Virgin Mary loomed over the St. Gregory’s hospital parking lot. Underneath, a sign read ‘Give Us Your Sick And Your Poor’.

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A word of warning: Steven Brill’s article in a recent issue of TIME magazine may have you ripping your hair out from the seams. In it, Mr. Brill describes a situation that makes the bankers charged with gambling with your kids’ college loans seem like cute, fuzzy teddy bears. It depicts a country with a doom machine called ‘The Sequester’ on the way to stabilize the country’s deficit and risk further economic recession, while much of the overspending we as Americans do on a yearly basis is due to hospitals and pharmaceuticals (although more emphasis on hospitals here) seeking anywhere from 400% profit margins for wonder cancer drugs to 1000% margins for Imodium A-D, quite simply because they have a product that the free market cannot say ‘no’ to. If you’re wriggling in pain on the floor because of that poisonous snake bite, and I’ve got the antidote, it’s probably safe to assume that I’ll be the one setting the terms of our business deal, not you. We’re talking about families going home with bills amounting up to hundreds of thousands of dollars because their private health insurance had an annual payout limit, and they just weren’t ruthless enough to leave uncle Eddy, recently diagnosed with pancreatic cancer, on the sidewalk to rot and die. Around the country, hospital prices originate from the chargemaster (not a myth) with very few executives able to explain the calculation behind these final prices, but certainly very able to cash in on their multi-million dollar paychecks. The highest-paid aren’t even doctors. It is because electricity and gas are necessities that their prices are regulated. It is because we cannot let the free market dictate life and death that medical prices in other countries are regulated (albeit still with a comfortable profit margin). Obamacare does not fall short because it will boost premiums for those of us who could previously afford private healthcare, but because it does not act to regulate conflicts of interest between doctors and medical companies who provide the former with incentives to sell their drugs, their medical equipment, consequently having hospitals order more scans/blood tests and disseminate more drugs in order to maximize on their investments. Nor does it reign in price determination. The healthcare industry lobbyists in Washington have played their game so well, that we spend our time debating who should shoulder the price of medical care in this country instead of asking why anyone should be paying this much in the first place. To be clear, even hospitals think what they charge is ridiculous. This why many hospital bills actually constitute something of an “opening bid”, a point where both parties can begin negotiating. Has any doctor ever told you, after handing you a bill, ‘hey why don’t you get back to us and tell us what you think about this’? Most people don’t care to analyze hospital bills or even understand them, because their insurance companies will foot the bill. Others just assume they’re fucked. Executives, it would seem, are more often than not paid extravagant amounts of money based not on the hard work they put in but rather because they have based their entire business model, quite smartly I might add, on the fact that they well know they hold the antidotes. There will be no discounts with Obamacare. The medical companies in the US, are Too Big For Sales.

Note-worthy: “On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.”

HMMM…STAIRMASTERS

Worth all the sweat – The Economist

The commercialization and wholesale of exercising has constituted a recession-proof market no longer tailored solely to the gym rats, protein-shake guzzlers and creepers/lingerers. Soccer moms and weekday ‘hustlers and bustlers’ have long since hopped on the bandwagon and have contributed to the enrichment of this multi-million dollar industry. All accross Manhattan ‘treadmillers’ are practicing their ‘runnin-man‘ exposed as window-shopping, reminding everyone currently not exercising how fat and unattractive they probably are. New research now confirms what doctors have been saying for years, that exercise is the be-all, cure-all Ponce de Leon was looking for, the catch-22 lying in the potential unattractiveness of having to make an effort to acquire it. So turns this cruel world. The magnitude of learning that exercise can not only avert such neurological degenerative diseases as Alzheimer’s but also serve to elongate one’s life span can only be expressed in the fact that there finally seems to be a broader significance to working out than simply getting laid.

The phenomenon has been ongoing for little more than a decade in Europe, more precisely sweeping every country except France which prefers to listen to and exaggerate the ‘glass of red wine a day’ thing. In Germany, a new form of muscle electrode stimulation is garnering increasing success. The company responsible boasts that a single 20-minute session can amount to the equivalent of 8 visits to the gym. The exercise consists in contorting one’s body while the electro-stimulation applies increasing pressure on the muscles, rendering it all the more difficult to move. This blogger tried it out, and could hardly take a seat afterwards, sore ass and all.

Does the future lie in the ‘scientifying’ of exercise? In alternatives to the ‘lonely’ and non-interactive aspects of benching and cycling? Could it potentially lead to biological manipulation and the subsequent simulation of exercise? As the positive results of exercising become increasingly tangible with time, will it finally beckon the remaining straggling Frenchmen (and women) who reserve their exercising for Sundays on the soccer field? Consider me convinced. Cerebral health and Yoda-like endurance supersede the ‘getting laid’ factor, as even with a flabby gut and skinny legs, one can always find ways to get ahead in that department.

Note-worthy: “Most intriguingly of all, it seems that it can slow the process of ageing. Biologists have known for decades that feeding animals near-starvation diets can boost their lifespans dramatically. Dr Levine was a member of the team which showed that an increased level of autophagy, brought on by the stress of living in a constant state of near-starvation, was the mechanism responsible for this life extension.”

HAPPY BIRTHDAY

Long-Term Care Program Needs Changes – NYTimes

Ayman woke up that morning in a foul mood. His back grieved him. His knees irked him. What little teeth he had left pestered him. As he wrestled himself out of bed and eased himself into the adjacent chair, strategically pointed at the TV, he relinquished a distressed sigh. As a gray sky dawned on another morning in suburban New York, he was 84 years old. As per his habitude, he would spend the better part of the day sitting in his recliner, one of the few belongings he had been able to scavenge from his home. He did not like to participate in group activities. He did not enjoy socializing with the other residents. He had few pleasures. Diagnosed early with diabetes, he still allowed himself the odd sweet, which he devoured with relish, a rare glimpse of infantile merriment in his eyes. His liver sporting a rather disagreeable grimace on most x-rays, and against doctors’ orders, he still overindulged in his favorite liquor, which one of the nurses sneaked in for him whenever he would run out. He had two kids, a son and a daughter, now well past the age of needing him in any way for subsistence. They had moved away years ago, even before his wife’s untimely passing. They would sometimes come visit for Christmas. Most years though, they were too busy. They would generally call on his birthday. Sometimes, they forgot. Ayman rarely saw his grandchildren. His daily routine was dependent on his daily TV schedule. The highlight of his day was ‘Jeopardy’. A longtime avid sports fan, he had given up on them after years of watching his favorite teams fall short of expectations. He rarely thought of his mother anymore, who had single-handedly raised him in a house not far from where he now hung his cane. He had long forgotten the buzzer-beating shot he had sunk to beat St. Andrews High School, after which his teammates had hoisted him up on their shoulders. The cute brunette from across the river who first unbuckled his pants and stole his innocence still brought the hint of a smile to his face. He could not, for the life of him, remember her name. The thought of his estranged brother, whom he hadn’t spoken to since their mother’s car accident, oft and again made his eyes swell with tears. He often longed for his late wife’s touch, and felt ashamed that he could no longer quite picture her face, nor recall the very first time he had laid his eyes on hers. He suddenly wished there had been more times, better times. But as gray clouds cast a shadow on another morning in suburban New York, and Ayman relinquished a distressed sigh, it was time.

It is difficult to distinguish which characteristics from the different cultures and civilizations that grace our planet impact a people’s tendencies toward their elders and how they treat their senior citizens. In a western society, though, where our attention span often extends no further than that dog’s from ‘UP’, it is customary to quell one’s conscience simply by making sure their fathers, mothers, grandparents are receiving the best attention money can buy, when in some cases, the best care could never be bought. In the winter of life, a person’s home is sometimes their final grip on the memories they gathered from this world, and for still others a sense of dignity. But where others can afford the luxury of donating their time to their elders, perhaps because the ‘ipad 2’ has not yet been released there or because the I-95 doesn’t jam up around rush hour, most tap themselves on the back and reassure themselves with the comforting thought that their parents realize that their time has come and gone. For although budget cuts from the military are simply infeasible, the nurses who attend to senior citizens in their own homes are considered expendable, but one must understand that a nation must endure some collateral damage to win the war in Afghanistan.

Note-worthy: “Mr. Foster said his analysis showed the program faced “a significant risk of failure” because people who are or expect to be sick or disabled were more likely to sign up.”

IT’S TOASTED

Cigarettes in films: Smoked out – The Economist

The world was our oyster. We were appreciated. We were desired. We were indispensable to the limelight. We had airplanes set aside just for us. In restaurants, we had whole sections reserved just for us. We were accommodated everywhere we went. Others were obliged to live according to parameters we set for the world. We dictated the pace. And the reason? The reason was simple. The reason rested between our index and middle finger. In our hands we held a passport for cool. Between our fingers lied a conversation piece, a magnet for the influential and successful. Our ranks included cowboys, doctors and even Santa Claus hopped on the bandwagon. Life was comfortable at the top. Unfortunately for the most fortunate among us, all good things are doomed to a premature end.

Somewhere along the way, we became the enemy. The fact is, they turned on us, plain and simple. They attacked our reason for being. They attacked our character. The propaganda was methodical, and ruthless. Our eradication was proclaimed, suggesting we would inevitably self-destruct. As our ranks started thinning out, doctors suddenly wouldn’t come down from their moral high-horse. Cowboys could no longer afford being caught fraternizing with the likes of low-lives. Santa no longer had the ‘heart’ for us to remain friends. Just when we thought things could not get any bleaker, they sealed our fate by proclaiming our ‘habit’ was contagious. We were excommunicated from the very places that used to depend on us to define their identities. Bars, restaurants and conference rooms no longer wanted anything to do with us. The mighty had indeed fallen.

You may yet still catch a glimpse of our endangered kind. We now find refuge where we may, congregate where we are still able. Where once we ambled confidently on red carpets and elite socialite functions, we now cower like the castaways that they have forced us to become, reproach branded on our faces, on damp city sidewalks huddling for warmth, stealthily bent over the slightest crack of a window trying our best to remain concealed, or in a seedy alleyway, our frozen fingertips begging for respite, like angry hoodlums wondering when the good times shall once again be rolling. Many cast looks of disgust or even pity in our direction, and it is difficult to blame them. We are shadows of our former selves, and yet Government makes more and more money on our backs as the years pass, taxes and lobbyist bribes much obliged. One can only wonder how worse things can get. For now though, at least we still have Don Draper.

Note-worthy: “Although smokers trying to quit are advised to avoid other smokers, and to remove smoking-related paraphernalia from their homes, it might not occur to them to avoid films in which smoking is depicted.”

[UPDATE – 03/03/2011]  A Smoking Ban Goes Too Far – NYTimes – It’s getting worse!

2 IN TIME OF PEACE 2 IN TIME OF WAR

Marijuana in California: An altered state – The Economist

I wanted to vote today, I did, but, it started raining all of a sudden just as I was getting ready to step outside. I really did want to vote. I mean, it’s legalizing marijuana right? The ol’ ganja, sweet Mary Jane, aunt Mary, the sinsemilla, the bambalacha. But yeah, I mean, my mom has the car and I would have to take two buses just to make it to the polling place, and by that time the line will probably be gigantic, and this Seinfeld marathon is keeping me glued to the couch, granted I have every season on DVD but it’s still pretty cool to be able to watch episode after episode without having to hit ‘next’ on the remote. So yeah, it’s a whirlwind of conflicting circumstances that has led me to being unable to vote today, even though I really wanted to. Although, I hope this doesn’t mean everyone from your waiter to your tax attorney is going to be baked. I would think if everyone were to be high it would slow the wheels of industry considerably. Maybe everyone already is. Or maybe that’s the point. Whoever is smoking will continue doing so as long as they want to anyway, so maybe legalizing it will just make the whole process of buying and selling much safer. But now that I think of it, I kind of like Tommy. I hope this wouldn’t mean he’s out of a job. He always brings the stuff to my place, always on time, always polite to my parents. Would this mean I’d actually have to go out and buy it? Maybe I could hire him or something. Must be hard labor now that I think about it. Going to and fro’, dealing with people who never want to lift a finger to buy your product even though they’ll harass you all day long until you actually pick up the phone. Maybe he would just sell something stronger. Wait does this mean they’ll be selling it in packs? Like cigarettes? And coming up with gimmicky names like ‘Jamaican Gold’ and ‘Kentucky Blue’? I wonder how they would roll them. Would they have a whole lot of people in some warehouse just rolling the day away? That could help unemployment actually. Or maybe they would invent some robot that just shoots them out like those tennis ball machines. I’d like one of those. Probably be expensive though. And what about the alcohol industry? They won’t have the monopoly over getting trashed anymore. Serves them right. They’ve been making way too much money over random hook-ups and late-night hospital visits. Time for the narcotics industry to get a piece of the pie with video game hypnosis and late night YouTube video surfing. I hear that they’re going to tax it even more than tobacco because people are used to forking up a lot of money for it anyway. I should look to get my foot in the door of this untapped corner of the market. I think there are other reasons to vote ‘yes’ to ‘ Prop 19’, other than ‘Schwarzenegger’ being against it. In the Netherlands, the legal status of weed has made it into a commonplace product no more influential than a six-pack, which also means that kids often don’t even bother to seek it out. I guess it’s also about being free, right? I mean, it’s not like alcohol is any better than pot, is it? Quite the contrary I would say. I’d wager good money on alcoholic wife-beaters heavily outnumbering the spouse-slapping potheads. Of course many could overlap. Anyway, whatever helps the Golden State out of the financial gutter is fine by me. I wish I had time to vote…

HAHA George always drops the ball.

Note-worthy: “The proposition has a chance of winning mainly because Californians have become rather relaxed about weed.”

"Just Vote No"