How can I expect to prevail in the face of this?
Friday will be the girl’s first birthday, and in honor of one year as a parent I thought that I would toss together a few things I wrote on the topic (some from way back) and try to make a series of it. The first installment has to do with health care; the wife’s pregnancy was the first time that I had to deal at length with America’s health care bureaucracy. We also had to deal with the fact that my wife changed jobs shortly before the birth of the girl’s, meaning that we needed to shift between health care providers. This post is more about health care than fatherhood per se, but the experience of having kids brought me to a series of revelations about our health care system.
So, last June I was a more or less happy human being with health care supplied by the University of Kentucky. We knew that my wife would soon leave her job, and we knew that pregnancy often involves a variety of health complications, so I decided to change from the cheap-but-adequate plan to the expensive-but-a-good-idea-if-you-might-get-sick plan. I discovered in the process of making this change that, because of a computer error, I’d actually been uninsured for about a year. Fortunately, I failed to get sick. In any case, I filled out the form and added Davida to the plan. When the little dependents arrived, I added them to the plan. Shortly after the LIFE CHANGING EVENT, we moved to Baltimore for the wife’s new job. The insurance plan offered by the University of Maryland was marginally better than the long distance plan offered by UK, so we switched the wife and kids to UM, while I stayed at UK. This required numerous additional forms. In January, we moved back to Ohio, and switched back to the UK plan, incurring reams of additional paperwork. Finally, in May we arrived at the “Open Enrollment” period at UK, in which I was able to change from the super-expensive plan back to the reasonably-priced plan.
Now, all of this sounds reasonably easy and straightforward; however, anyone who’s ever actually dealt with the multiple bureaucracies that make up the US health care system understand that the story could never be so simple. Every change involved negotiation with at least two, and often three, bureaucracies. The first interactions with UK were difficult, but went very well once someone at UK HR took an interest in our case and effectively became an advocate. This person (who deserves nothing but our eternal thanks) really went the extra-mile, giving out her office phone number so that we could have pharmacists call her in order to find out how much our prescriptions should cost. Had we not been so fortunate in finding someone interested in helping us out, we might have been in real trouble.
We had lots of other interactions with these bureaucracies, and not all of them went as smoothly as the UK…
Trying to get ahold of your insurance company means negotiating a bewildering maze of phone trees and webpages. I use Humana, but I don’t have any reason to believe that any other insurers are any different. The key point to remember is that your insurance company DOES NOT want to talk to you. Maintaining a call center is expensive, and the company will undertake whatever means it can in order to force you onto an automated system or, barring that, attrite you into submission. Moreover, the question you have, if answered properly, might cost the company money. This is bad, and the insurance company is going to do its darndest to make it difficult for you to get the information you need. On a couple of occasions I was forced to repeatedly enter my policy ID# in order to move on to the next phone tree, all with the carrot of a “patient care representative” dangling in front of me. At one step, the system insisted that I verbalize my ID#, birth date, and zip code. No matter how clearly I said any of these, I was then forced to punch them into my phone keypad. I was told at one point to represent any letters in my ID# with the star key. I was then dragged through the agonizingly slow process through which the automated system tried to figure out exactly what letter a star represented (“Press 1 for G. Press 2 for H. Press 3 for I”). At another stage in the phone tree, the automated voice refused to accept any number I pressed before it was done speaking. If I made the error of pressing a number before the sentence was finished (and the robot, for some reason, favored long, pregnant pauses), then the system would stop for about 15 seconds before telling me that it didn’t understand what I was trying to say. It would then repeat its entire spiel. When you finally reach “waiting for the next patient care representative” stage, you are invariably treated to ridiculously terribly music punctuated by a voice patiently explaining how useful the website or the automated system would be, with the implication that you’re a moronic ingrate for needing an actual operator. On one occasion, I made it through the phone tree only to be told that the call center was closed.
Perhaps my favorite roadblock was on the (otherwise useless) Humana website. Shortly after creating your account, the website insists that you read a series of statements about the confidentiality of your health care, and that you click “I agree” at the bottom of each statement. If you don’t scroll down and read the entire statement, it refuses to let you move on. Ingeniously, one of the statements didn’t show any scroll bars on the page. It simply didn’t allow you to move forward. Clicking on “I agree” only makes you more angry, with the eventual (I assume) purpose that you will hit your keyboard so hard that your computer will break, thus saving the insurance company any additional difficulty.
None of this is accidental. The point is to irritate and confuse the customer so much that he or she eventually hangs up. It works, too. We would all like to think that we have the wherewithal to fight through the system, but often we don’t. We run short of phone minutes, or we get another call, or we have to do any one of the myriad things that amount to normal, everyday life, and we end up hanging up. This is what the insurance company calls “a win.”
So, all of that was pretty frustrating. Living through the experience made the health care debate (“People in Europe have to wait! In the emergency room! For service!”) some combination of surreal and absurd. Of course, nothing about the health care bill that we actually passed does anything to solve any of this. I can say, however, that if I ever had the choice, I would absolutely leap at the prospect of a public option program; the state bureaucracies were invariably easier to deal with than the private ones. I suppose if there was real competition with a public option the private programs might get better, but I can’t say for sure.
I should also note that I appreciate how fortunate we were to actually have jobs, and for those jobs to have decent enough health care programs. I cannot imagine having done all of this without the level of security that even…. complicate coverage provides. We got the drugs we needed, were able to take the girls to the doctor when we needed to, had Elisha’s helmet (mostly) paid for, and so forth. Taking the girls to the doctor was never a difficult choice for us, as it is for some. When we were concerned about Miriam’s weezing and barfing, we were able to take her to the emergency room without worrying too much about paying for it. All of that was (and is) nice, but it doesn’t require the infuriatingly complicated system that we currently have. I don’t think that we properly factor the complication, aggravation, and genuine irritation of that program into the costs of the system that we currently have, in part because it’s so hard for Americans to properly imagine a different system.
Evidently, the man no longer has a pulse, thanks to the new $200,000 continuous-flow Left Ventricular Assist Device (LVAD, image here) that Americans have generously purchased for the vasculopathic former VP. For the chronic gambler in your family, the following information may or may not be relevant:
Dr. [O.H.] Frazier [who did not perform Cheney’s implant] said he had implanted a total of 170 such pumps as of June 1, more than any other surgeon. Of those, 24 were in patients 65 and older and 11 of the 24 were in patients older than 70. The oldest was 76. Nine of the 24 have died, and seven of the nine did not leave the hospital. Six of the 15 survivors received heart transplants. The remaining nine are living with the pump. The longest survivor at his hospital had an implant in his 30s and has lived five and a half years.
Cheney’s options at this point are:
- Live with the new pump forever, so to speak.
- Throw his 69-year-old name into the pool for a human heart transplant.
A randomized trial in the New England Journal of Medicine recently put the odds of surviving 2 years with a continuous-flow LVAD at about 58 percent. European researchers have found similar results, with one study finding that nearly 70 percent of patients last until “transplantation, recovery or ongoing device support” (though the results of that paper are a little trickier to interpret, since a significant percentage of patients received a device within 6 months of the study’s conclusion.) Best I can tell from scanning the published research, most patients receive an LVAD (continuous-flow or pulsatile) with every intention of eventually receiving an actual heart transplant, though it’s not uncommon for LVADs to be used as “destination therapy” (i.e., a permanent fix).
And in case anyone is wondering, if Cheney did eventually receive a transplant, the organ would come from the Extended Criteria/Alternate Donor list, which means he wouldn’t be redirecting one from the waiting chest cavity of a 20-year-old. Though he’d probably do that if he could. Actually, what I wrote earlier doesn’t seem to be entirely correct; the use of EC-AD lists seems to depend on the center doing the transplant. Regardless, it looks like Cheney would likely be a terrible candidate for a new heart mainly due to his age; the upper limit for those seems to be around 72 years old, and given Cheney’s history of health problems (including kidney malfunctions, aneurysms in his knees, high cholesterol, hot dog fingers, etc.), it would take an especially optimistic surgeon to see Cheney lasting more than a few months with a new heart (and even less so for one drawn from an extended criteria list).
Even so, if/when Cheney croaks on Obama’s watch, we can look forward to a whole new species of wingnut paroxysm.
As any Mets or Giants fans among our readership are aware, Phil Cuzzi put on an umpiring display of the kind I haven’t seen since the late Charlie Williams left the game. Well, actually, it was worse; it sort of combined Williams’ seemingly random strike zone and safe/out calls with Joe West’s even temper. The culmination was a ludicrously blown call at the plate on what should have been the winning run for the Giants. What makes it really special is the justification, which takes attempts to justify the de facto “every play is a force play” rule employed by lazy umpires to a whole new level:
Cuzzi said that he had not yet seen the replay. “I’ll look at it, but I figured I’d eat first,” he said, laughing. “He made a decent attempt to put the tag on him. That’s what it looked to me, and that’s why I called him out.
…does not, in fact, necessarily create any national security benefits.
Tom Scocca’s blog doesn’t seem to get a lot of attention, but to do my little part to encourage the WaPo to take the 80 grand they were apparently paying Kaus and keep Scocca and give Lithwick a raise instead, I thought I’d note three good recent posts:
- Expressing thoughts based on specific and personalized experiences in the second person is indeed pretty much the most annoying thing ever.
- I’m would like to think that the press will be skeptical of the claims of poverty that will be inevitably raised by owners during the next NBA lockout, but I doubt it. During the last near-labor-stoppage in baseball, much of the press took the profit and loss figures released by MLB seriously, although they indicated that the Dodgers were losing money hand-over-fist.
- I have to drive an Explorer when I go home for vacations, so I can confirm that this is accurate. It handles a little less nimbly than an aircraft carrier and accelerates like David Ortiz carrying Cecil Fielder on his back. (And this isn’t any bias against American cars on my part; forced to buy a car for the first time, I’ve been very happy with my Malibu. But the Explorer is the kind of thing that made the bad reputation of American automakers deserved for a while.)
The post below about Rob’s immortalization was somewhat embarrassing for me, as I actually own the album in that “compact disc” format your grandparents may have told you about, but missed the appearance of our blog in the first perusal of the liner notes. I had been waiting for a few more listens to let it sink in before making a point about a classic “cult of authenticity” fallacy, but since it’s timely I figured I’d go ahead.
I can’t say yet if the evaluation of the Pitchfork review is wrong. Well, even a couple listens confirm that the rating number is absurd — even subpar M.I.A. is better than much of the crap that gets respectable numbers and mentions (anyone listen to Ryan Adams’s pretentious-even-by-his-standards 29 lately?) from the Pitchforkers. But the bottom line that this good album is more uneven and less songful than its very good and exceptional predecessors is plausible based on initial listens, and has been essentially conceded even by its defenders. What bugs me about the review is the extent to which the Pitchfork reaction was overdetermined. You could see the review that spent two paragraphs taking the Hirschberg hatchet job and the allegedly troubling questions it raised about her authenticity seriously before it even got to the music coming a mile away, and sure enough. And it’s not just that the Hirschberg thing was puddle-deep and inept (the telltale Truffle Fry was in fact ordered by the journalist, the horrors), but even to the extent it’s true it’s irrelevant. I had no doubt anyway that the now-wealthy artist who married into the Bronfman family isn’t a “revolutionary” — who did think this, I can’t tell you, but I hope I can play high-stakes poker with them some time. But these types of contradictions are utterly banal among artists, especially popular ones. What matters is the work, and even to the extent that /\/\ /\ Y /\ is flawed it’s because of excessive ambition, not millionaire complacence. And if you think that artistic pesonas should have one-to-one correspondence with an artist’s personal life, you really shouldn’t be assessing art for money.
Back from vacation and back on the grid. Hmm, what have I missed in the last couple of weeks?
1) Ooh, looks like the BP oil spill is capped for now. At FP, Joshua Keating provides a sobering look of the world’s other worst festering environmental catastrophes, reminding us not to go and start feeling complacent. He’s right.
2) The fifteenth anniversary of the Srebrenica massacre passed while I was away. On the eve of this event, the ICTY formally recognized the role of propaganda in the event. Mike Kearney’s book on the broader subject is worth noting. So is this NPR analysis of calls for a “ban on war propaganda.”
3) To ban war propaganda you have to define “war.” At the Kampala conference, ICC States Parties finally agreed to a definition of the crime of aggression. Oh, except the new definition is still as ambiguous as any
renegade superpower rogue state could hope. Plus check out the loopholes. Coupled with the imminent release of accused war criminal Thomas Lubanga Dyilo due to irreconcilable procedural differences between the Prosecutor and the judges, many commentators are interpreting this as a bad sign for the court’s credibility. Meanwhile, the ICC has gone ahead and added genocide to the charges against President Bashir of Sudan.
4) In other news, Fareed Zakaria is taking on FP’s “failed states” discourse in a new WAPO op-ed. Glad to see he revives Bronwyn Bruton’s CFR report on Somalia, which I blogged heads about awhile back – some of the most commonsense analysis I’ve seen about what the phenomena of “state failure” means for US foreign policy.
5) Oh yes, and according to Wired: DARPA is giving US troops super-strength.
If People Don’t Bother to Perform Their Own Double-Blind Studies Before Taking Drugs, They Deserve to Die!
In the fall of 1999, the drug giant SmithKline Beecham secretly began a study to find out if its diabetes medicine, Avandia, was safer for the heart than a competing pill, Actos, made by Takeda.
Avandia’s success was crucial to SmithKline, whose labs were otherwise all but barren of new products. But the study’s results, completed that same year, were disastrous. Not only was Avandia no better than Actos, but the study also provided clear signs that it was riskier to the heart.
But instead of publishing the results, the company spent the next 11 years trying to cover them up, according to documents recently obtained by The New York Times. The company did not post the results on its Web site or submit them to federal drug regulators, as is required in most cases by law.
“This was done for the U.S. business, way under the radar,” Dr. Martin I. Freed, a SmithKline executive, wrote in an e-mail message dated March 29, 2001, about the study results that was obtained by The Times. “Per Sr. Mgmt request, these data should not see the light of day to anyone outside of GSK,” the corporate successor to SmithKline.
The heart risks from Avandia first became public in May 2007, with a study from a cardiologist at the Cleveland Clinic who used data the company was forced by a lawsuit to post on its own Web site. In the ensuing months, GlaxoSmithKline officials conceded that they had known of the drug’s potential heart attack risks since at least 2005.
But the latest documents demonstrate that the company had data hinting at Avandia’s extensive heart problems almost as soon as the drug was introduced in 1999, and sought intensively to keep those risks from becoming public. In one document, the company sought to quantify the lost sales that would result if Avandia’s cardiovascular safety risk “intensifies.” The cost: $600 million from 2002 to 2004 alone, the document stated.
Some combination of deregulation and tort reform should solve this problem!
In response to reports that Tim Geithner is trying to scotch Elizabeth Warren’s appointment to the Consumer Financial Protection Bureau (and presumably prefers someone who is sort of willing to overlook the whole “consumer protection” part of the mission), Yglesias and Fernholz point out that the sourcing for the claim is far from airtight.
The real key here, I think, is Tim’s point #1 — it’s Obama’s decision. As Krugman has been fond of pointing out recently (and as we recently discussed without the metaphor with respect to foreign policy), when it comes to appointments the Cossacks work for the czar. Even if the story is right, Obama is free to ignore Geithner’s advice and would have plenty of political support if he chose to pick Warren. So we’ll see if Obama picks Warren, somebody just as good, or somebody not as good, but no matter what the outcome the credit or blame should be directed at the top of the organizational chain. What Geithner thinks about Warren is largely beside the point.