Repost: Dear President Obama

First published July 29, 2010, then again on November 7, 2012, and now brought out again and brushed off on October 6, 2013.

Sometimes it is good to look back, to see how things were, how impossible the situation seemed, and, having come out the other side with only minor wounds, to be grateful.

So let this be a companion piece to today's bookend of rejoicing: Dear President Obama: My Experience at the HealthCare.gov Marketplace.

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Dear President Obama,

This is a follow-up letter to the one I wrote you exactly one year ago.  I thought you might like an update.

It's been a long time since I cried tears of happiness, and I would like to thank you for creating the opportunity for me to sit here like a complete nitwit, boohooing my teeny-tiny brains out.

Truth be told, the occasional blissful moment in an excellent movie can provoke a brief weep -- but tonight, we're talking floodgates, and bitter saline drawn for release from the Secret Inner Pool.

On September 30, 2009, I became one of the many uninsured.  That's no great story, no Big Whoop, as the kids used to say, and I still do.

One of the many things I admire about you and your administration is your willingness to hear individual stories, and to believe in the integrity of the storytellers.  You don't ridicule instances, you don't seem to fear being overwhelmed by them.

Already permanently disabled by a severe case of one of the most severe of pain syndromes, CRPS/RSD [Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy], lupus [SLE], avascular necrosis/osteonecrosis [AVN/ON], and Some Other Annoying Crap [SOAC] -- it was a real blow to my quality, and even hope of, life to come down with osteomyelitis in my prosthetic shoulders and in the long arm bones themselves.

A complicated but not unmanageable situation, given enough Local Talent, and I am blessed with Local Talent Galore.  There are three excellent medical schools within spitting distance of Marlinspike Hall.

The Author of My Story decided to spice things up with plot twists:  Make the offending bacteria be so obscure, nasty, and recalcitrant that it could not be identified by the wily microbiologist's eye and proved resistant to any antibiotic made by mortal man;  Create such a snarl of confusion that even the we-have-seen-everything, ennui-stricken researchers at the CDC threw their hands in the air, preferring an honest Ebola virus to my obscure domestic germs;  Dictate that the conditions under which these bacterial cultures could be successfully grown existed only in the warm, moist, rum-soaked environment of my shoulders.

Each shoulder having previously been replaced, the prostheses had to be removed.  Surgical concrete laced with all sorts of charms and amulets took their place for periods of up to 3 months, and then, most often, had to be replaced with new ones, as surgical concrete, like all other things in my life at this point, tends toward entropy.  Seven surgeries, President Obama, in the space of 18 months.  Five stays in ICU, three stints on a ventilator, and two resuscitations.  A partridge in a pear tree. 

It was not easy.

Lest you think that the drama lessened between sessions in the operating room, I also single-handedly supported a cottage industry of infectious disease warriors, and co-opted all the free time of Marlinspike Hall's Manor Denizens.  Back and forth we went, inserting and tending PICC lines, infusing intravenous antibiotics several times a day, making blood offerings to appease the demanding serum levels of Haute Society Pestilence, and so on, and so forth.

None of this would have been possible, of course, without excellent insurance coverage.  It was thanks to the reluctant involvement of the Grand PooPah of Tête de Hergé's Insurance Commission that I had any coverage at all once our version of COBRA ran out (here, it's THE ASP).  I was already in a high risk pool, but it was an unregulated pool over which the Grand PooPah could only utter tsk:tsk:tsk! 

BCBS of Tête de Herge is a wily enterprise, and my insurance premiums began to rise, rise, and then rise a lot more.  Finally, it was decreed that as of October 1, 2009, I was to pay, in U. S. Dollars, $1513 a month, in addition to the annual $5000 deductible/out-of-pocket expenses.  The cost of being insured would now amount to 96.6% of my private disability income of $1996.20/month, an amount never adjusted for inflation, despite the spiraling costs of Everything, Everywhere.

Of course, we all know that if they would just accept Lumps of Pure Gold Studded With Blue Topaz, there'd be no problem.  It's this Social Contract involving Oblong Green Rags of Value that is screwing everything up.  Some proprietary blend of cotton, silk, and linen is worth more than my Studded Lumps?  I don't think so.

Anyway, a 41% hike in the space of 9 months finally forced me into the scary position of being in the middle of a health crisis without benefit of insurance.

If you read my blog, and we all know you don't, you would read account after account of daily fever, pain, sweats, fatigue, and the certainty that I would need to cheer up to be suicidal.  It's nothing but a broken record, and to make matters worse?  I now write like H. P. Lovecraft.

I almost went permanently insane during the Great Health Care Debate, especially when it looked like the Tea Baggers might succeed in excluding Aliens from Tête de Hergé (très décédé, d'ailleurs).  ArseHoles!

You about lost me as a supporter when you stopped fighting for the Public Option, and at several other murky junctures.  I lost a lot of my natural optimism, my well known spunk. When the package was passed, it was not clear to me what was actually about to happen, if anything.  Everyone said it would be years before the real impact of reform would be felt.

But whispers in the dark persisted, and the word on our unpaved back-country roads was that some sort of High Risk Pool for people labelled uninsurable was going to be available... in July 2010!

Tall tales went the rounds about some website somewhere, rumored to be PCIP.gov, that explained the possibilities in accessible language and without endless complication.

I went, myself, to the fabled site -- I saw it with my own eyes -- It is real, it is real!

There was one hoop through which I had to leap, and leap I did.  The application for coverage by the Pre-Existing Condition Insurance Plan required that a rejection letter based on pre-existing conditions be attached for eligibility.  The letter must date from within 6 months of the time of application.

Last weekend, I spent four hours filling out an insurance application from InHumana, detailing every instance of hospitalization, complication, treatment, diagnostic procedure, and ingrown toenail, and sent it off to Underwriter Land with fervent hopes for swift and complete rejection.

My rejection letter, which Fred is having framed, arrived today.  It is riotously funny, a moment of hilarity in the midst of my Personal Health Tragedy Epic Saga -- every Long Boring Story needs comic relief.

Sincere in my intent to make application to the PCIP, I poured myself a stiff one this evening, downloaded the .pdf file, printed it out, and girded my loins.

Five minutes later, I was done.

My vision blurred as I read about provisions for those who qualify within Tête de Hergé's territory.  I finally made out that my monthly premium would be $495. 

My hands began to shake when I stumbled on this:

In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year.

And it was not long before I was weeping.  Fred, too.  La Bonne et Belle Bianca Castafiore even joined in, though she is well-insured by her operatic company.  Unfortunately, she pays more than your average soprano due to a, uhhh, errr... Cyst Situation.  But we won't talk about that...

I would love to shake your hand and give you a hug, maybe even a kiss on the cheek.  Michelle, too.  The girls and the darned dog, as well.  I don't think the Secret Service would much like that, so please accept the enclosed 2010 ManorFest TeeShirts for you and your whole family, instead.

I hope we guessed right on sizes, as they tend to run small.

Sincerely,

The Retired Educator
Your Greatest Fan




If you have serious medical conditions and cannot get insurance because of them -- this is a good place for helpful information and suggestions: Foundation for Health Coverage Education/Coverage for All.
photo credit: Steve Hopson

29 attempts to pick up 1 peanut

I have not been posting because even mine own ennui has become boring.  Not worth a groan, an utter waste of a moan.  An insult to adjectives, a baseball bat to the knees of my home-grown adverbs, really culled from your community gardens, picked wet with dew, the gourd mature yet not so large as to be tough, too seedy, but packaged under my name -- printed on squares of cellophane, attached with high tech red rubber bands.  Eggplant, cucumber, climbing the vine beans, I want them tender.

Surgery has been put off a bit, again, this time until June 18, something to do with giving more time to yet another humeral fracture to heal.  I don't know where they're coming from, these breaks.  Fred doesn't beat me about the upper arms. Marmy Fluffy Butt has stopped gnawing in an ill-advised attempt to strike tuna in my marrow, and terror in my heart.

I think a lot about dying.  That's right:  the height of ennui.  Fred even said, "I feel like I am just sitting in this chair waiting to die."

These are the dangers of days so hot and humid that we lose hope and our buttocks carve our cushy futures into the cheap styrofoam of way past cool paisley wing chairs and roll-about PETA-sanctioned pleather office furniture.

Between now and June 18, I need to have my right hip evaluated.  Maybe it'd be more accurate to say "located," because I swear it's gone off again, road-trippin'.  It was on my list of things to do, right after "everything else." However, it seems that during my ICU psychosis, I went on and on and on about how effing much my hip hurt.  To ShoulderGuy OrthoWizard, no less.  At a recent meeting, he intoned (and intoned is the only verb that works here), "I was very angry with you for not telling me about your hip."

Far be it from me to avoid repetitive testing that will clarify nothing, eat the stray orts of my checking account (influence of NYT Cross Word Omnibus) from among the other detritus seeding my dirt-strewn floors, or just shout out about insanity, frustration, pain, and crap like biofilm infection....

Good news?  The clonazepam is greatly helping quell the spaz attacks.  I am down to about one visit from the automatic shimmies a day.  The cost is worth it -- I feel very sedated.  Word is, though, that I'll adjust.  Even if I don't, even if I sort of slant-smile and fail to blink my way through religious services and medical appointments, that's fine with me.  God, or someone, finally took me seriously -- I cannot tolerate the dystonia, the jerks, the nadir of me.  Thank you, God, or someone.

There have been some supremely funny moments here at The Manor.  The telecommunications installer who couldn't stay because he was allergic to cats, forgot the protective cones to.... protect himself, and failed to bring the necessary equipment as detailed in the work order... which he'd love to go over with us but he was starting to itch and did I have any Benadryl?  The third instance in as many years of a person asking me if I knew their friend X, who was also in a wheelchair.  My 29 attempts to pick up a peanut off the floor using one of my new grabbers.  I mean, seriously, who keeps going after, say, the fifth time?

Oh, and the doctor whose name I did not recognize from his $1300 bill.  Something made me check his licensure status.  License?  What license?  Absolute giggles set in when I noticed that my insurance company paid his claim, in its entirety, without batting a corporate eye.

just a few of the available assistive devices.
29 attempts, people, to pick up a freaking peanut.

I'll try to write more, and better, soon.

A Calm Acceptance Is Within My Grasp

we did okay yesterday.  at the end of the day, there we were:  accounted for, joking around, a little breathless.

the end of the day jars my memory -- i've never read kazuo ishiguro's the remains of the day. i enjoyed the film adaptation, despite not having much fondness for anthony hopkins. i chuckled nervously just now upon learning that there was a well-received musical version... surely someone is punking moi?

let's steal it as a theme, what do you think? the decline of aristocracy. i see it all about me, i see it in marlinspike hall, in spite of (or because of?) a strict tradition of genetically indentured servitude within the domestic staff's nucleic code.  i see it in the algae colorfully clinging to the edges of the moat, sliming the captain's miniature pink submarine.  all of tête de hergé (très décédé, d'ailleurs) is witness to the fading luster, what with budget cuts to roadside bonsai forests, as well as the recent spate of re-appropriations of museum donations -- primarily of period clothing -- by some of the oldest, most respected, and storied families of the realm.

first on the list yesterday morning was the infectious disease doctor and his fancy-schmancy new infusion center.  we left early, we got there late.  lots of tête de hergé traffic (balloons and the usual signage game play), lots of fender-benders -- but tiny fenders, at least, on the mostly clown cars.  red bulbous noses, yarn hair, voluminous striped britches.  it was hard to be upset in the middle of primary colors and popping jewel tones.  ruby, the honda cr-v, waded through the mess like the champion that she is.

the office had relocated since my last visit, and while the staff was perfectly calm, there were glazed eyes, lost supplies, misplaced charts (doctors' notes were being recorded on pink post-it notes) and rooms piled high with the disparate art work of gone-out-of-business motels.  the few finished walls boasted cooler fare, mostly activist expressions about HIV/AIDS, human rights, amnesty international, as well as small touches in each exam room, like autographed pictures of the docs with magic johnson or anthony fauci.

what they are gonna do with the motel art?  well, dear readers, i respectfully introduce the motel art show series, such as "The One Night Stand At The Ole Miss Motel on September 3, 2009":

Under the direction of photographer Erin Austen Abbott... [of Oxford, Mississippi] the show kicked off in 2007, followed by one in Los Angeles the next year. “I was taking pictures at an old Travelodge-style motel, the type that you drive up and park outside your room, set in a u-shape,” says Abbott. “All the doors had these wooden red hearts on them. I had heard rumors that the walls inside the rooms were brown wood paneling, and I suddenly had visions of T. Model Ford sitting on the edge of the bed, playing his hill country blues while fine art leaned against the furniture or replaced the current art hanging in the rooms.”


Abbott immediately went out and found 10 artist friends who were having a hard time showing their work locally. They made up the first show, and, in 2008, she took her motel art show on the road to Los Angeles. Over a thousand people showed up for “The One Night Stand at The Beverly Laurel Motel,” and the show was featured on Yelp and in the Los Angeles Times...


For art lovers who don’t live near Oxford, Abbott has good news. Next year, the show will be presented by The Yoknapatawpha Arts Council (named after Faulkner’s fictional county) and, in addition to being held in Oxford each October, travel to other locations in the spring and fall. For 2012, the Motel Art Show is scheduled to hit Brooklyn, New York, in May and Nashville in September.

so i am thinking, why not a variation on the motel art show model?  why not "decoration's remains," about medical office leftovers?

i'm jittery this morning, can you tell?

anyway... what i most appreciate chez the infectious disease dude's place are the boxes of tissues placed at intervals of every 2-3 feet.  i am always springing a leak of some sort when i visit.

it was determined that yesterday was day 36 of my 42-day intravenous antibiotic sentence, and that i would, all things being equal, have my PICC line pulled next wednesday after the final dosing of antibiotic tuesday evening.  there were arguments made over then beginning an unending course of oral antibiotic.  i didn't listen very closely -- spasms in the left leg and in the left shoulder (that's a distressing place to have muscles seize, smack dab in the middle of an open wound).  i have nothing to contribute to the conversation.  just tell me what to do.

ever since the head infectious disease doctor dude saved me from an ignominious end a few years back, i've trusted him implicitly.  i was an inpatient, crammed into a shoebox of a room ["it's a private room!"].  trapped by thick beige plastic bedrails, i could just make out the outline of my wheelchair, stashed in the corner by the leaking sink and plywood wardrobe.  a familiar urge overpowered my good sense and i crawled between the burglar bars, landing atop, although also landing askew, one of three bedside commodes. shoving aside four types of aluminum walkers [a rollator, a hemi-walker, a platform walker, and the drive knee thingy] before reaching my power chair.  satisfied sighs as she powered up, no worries in that regard, no need to find a charger midst all that junk.

long story short, yes, of course, now i was trapped in my chair instead of in my bed.  i strove to push my way out of the corner, tried equally hard to plot the path of least resistance in the general direction of freedom.

within five minutes, i was red-faced, hair all sweaty tendrils, cursing and sobbing, à la fois.

enter infectious disease dude, the head dood, in fact.  he's a geeky looking fellow, very tall, bent, kind of a craggy face, but kind. a marvelous sense of humor, but you have to be patient with it -- it's shy. better not to laugh too loud or too much.  in fact, better to arch a simple eyebrow and allow just a hint of a smile in the eye.

the doctors of today don't engage. they see a patient trapped as if surrounded by an ice floe in a room that draws junk to itself like a magnet attracts iron filings.  this doctor, however, fairly leapt over the obstacles, deftly (well, not deftly, but with dreams of deft-itude) piling and reworking the layout.

"there!" he crowed.  "you're free!"  i've been downright fond of the man ever since that liberation.  he laughed with me as i confessed that i really had nowhere to go but back to bed...

i saw a new PA there, my doctor and his usual PAs apparently having been lost among the huge boxes and crates.  [wow, a leitmotif!]  having a new PA was distracting, as she was staring at my feet and hands, her own hands suddenly anxious, her fingers picking at her fingers, now and then twirling a thumb ring.  she had some sort of medical blackberry, some sort of know-it-all electronic resource, and was peeking, picking and pecking, making furious inquiries.

CRPS is oddly symmetrical, i've noted that before.  the latest evidence comes in the form of "matching" pus leaks from below the cuticles on my middle fingers and thumbs.  it is bizarre and has held the attention of many hospital types, usually in lieu of dealing with my screamed complaints about the spasms.

so we all oooohed and aaahhhed over the pus on my hands, how weird, hmmm, and huh, wouldya look at that?

fred and i drove across town, got lost, got found, checked in, finally, at one of the satellite offices of dr. shoulderman, my orthopedic surgeon.  we stared at CNN. i zoned out. fred kicked me, and i was called back into the labyrinth of exam rooms and x-ray cloisters.

the x-ray tech looked very familiar and she positively lit up upon seeing me.  she and her pals had been working the last time i had been there, mere hours before ending up in an ambulance, heading for hell in the icu.  "you were so sick," she said.

"you look a thousand times better," she ended, and i decided she was the most talented and deserving of x-ray techs that i'd ever met.  cute, smart, perspicacious, insightful.

the gist of the visit?  pseudomonas in the wound, which had an unattractive green cast to it, and a smell which the surgeon described as "fruity," but which made moi gag.  he was completely calm, and swore that a vinegar solution, in place of the saline soaked wet-to-dry packing, would quickly solve the problem.

we hope so.

i especially hope that it is easy to do, since the first message on the answering machine upon our return home was my MDVIP go-to-guy's nurse saying that insurance was not covering home health visits and that she'd cancelled their plans for this wound.

my reaction to having compiled yet another huge bit of medical debt was to try and sleep a little bit.

thus far this morning?  the home health agency has called three times, and -- convincingly -- told me that my MDVIP go-to-guy's nursenurse is misinformed.

i don't care. someone is right, someone is wrong, but i just don't care.  i can do this dressing change -- piece of cake! fred, bianca and i have the antibiotic infusion under control; and i am getting stronger, day by day, thanks to not being trapped in bed by wires and tubes, and ignorant assumptions.

i'll let you know if there is any attitudinal shifting once i am faced with the green stinky evidence.

psychologically, i am not in a good place, but i am trying.  if the spasm-meanies will give me a bit of peace, i think a calm acceptance is within my grasp.

FAIL Blog

there are things that just should not be.

someone entering the following searches should not be directed to this piece-of-fluff, navel-gazing blog:

CRPS + facial pain
new wheelchair
laxative XXXporn**
andrea gianopoulos lancaster pa*
andrea gianopoulos and laura beckett, ketamine kills*
scott reuben
tennis undies
severe bras
xxxporn**
belle sex positions**
rsd/crps law suits
fear fire famine foes
crps rsds cure
amputation cures rsd
marqueterie fraud
boobs whishes
lindsey baum
mrsa and paralyzation
crps 10 pain
laura beckett*
rsd on fire
gambling your heart away near the seine
i know where lindsey baum is
wheelchair lift honda
what kind of cancer killed leslie scalapino

and the one that prompted this failed post, in this failed blog -- the one that logged in at 3:03 in the morning, some woman, some man, sitting, nursing a cup of cold, burnt coffee, elbows propped on that red formica dinette table, long in the family, forehead damp from humidity, not heat, god damn it:

doctors in sedalia missourri that takes wellcare

*Months after posting about Andrea, her father and sister wrote me, very angry. In their eyes, I defamed her and said hateful things. They were very hurt by what I wrote, and reminded me how little I actually knew about her, her life, and her death. I have left the posts untouched but want to acknowledge their deep and abiding pain at seeing her name in a silly blog maintained by a silly blogger. Good things will continue to be born through their daughter, their sister, by virtue of the work she did, and the example she set. And Laura Beckett? I wait in pregnant silence for some lecture or outburst about my rude insinuations... but the lectures and the outbursts never come, and that only seals the seams of my knowledge, that only leaves her in unresolved expectancy, that only means she gambled, and she's been punished. I hope to hear of her dancing her way out of the rehab center one day, pain free. More selfishly, I hope the ketamine coma is perfected, and proves to be a real, accessible answer.

**Okay, so I find that kind of... tittilating. La Bonne et Belle Bianca Castafiore, Fred, and The Four-Now-Three Felines cannot stop their giggles, and -- very strangely -- keep checking themselves out in the Roman mirror of blown glass coated with molten lead, that serves as a sort of night light for the passageway to The Laundry Suites. The thing dates from the first century AD and we've no idea how The Captain's family got their sticky little hands on it. Undoubtedly it involved stuff like "swashbuckling," and "booty." I still don't know how to clean it... but have watched enough Antique Roadshow to know that leaving it as is is probably the best thing. Should you know the proper cleaners to use on first century AD Roman mirrors? Leave me a note.

But I digress (because sometimes, most times, that's all I know to do).


[a slightly revamped repost]

Support Rep. Alan Grayson and HR 4789

Representative Alan Grayson may prove to be my next political hero, a role and an honor not frequently filled. He is the author of H. R. 4789 and presented it this way (in case you are stubbornly refusing to watch the YouTube video above!) back on 12 March:

This simple four-page bill lets any American buy into Medicare at cost. You want it, you pay for it, you're in. It adds nothing to the deficit; you pay what it costs.

Let's face it. Health insurance companies charge as much money as possible, and they provide as little care as possible. The difference is called profit. You can't blame them for it; that's what a corporation does. Birds got to fly, fish got to swim, health insurers got to rip you off. And if you get really expensive, they've got to pull the plug on you. So for those of us who would like to stay alive, we need a public option.

In many areas of the country, one or two insurers have over 80% of the market. They can charge anything they want. And when you get sick, they can flip the bird at you. So we need a public option.

And they face no real competition because it costs billions of dollars just to set up a national health care network. In fact, the only one that's nationwide is . . . Medicare. And we limit that to one-eight of the population. It's like saying that only seniors can drive on federal highways. We really need a public option.

And to the right-wing loons who call it socialism, we say, "if you want to be a slave to the insurance companies, that's fine. If you want 30% of your premiums to go to 'administrative costs' and billion-dollar bonuses for insurance CEOs who figure out new and creative ways to deny you the care you need to stay healthy and alive, that's fine. But don't you try to dictate to me that I can't have a public option!"

And there is a way left to get it. By insisting on a vote on H.R. 4789. Three votes on health care, not two. The Senate bill, the reconciliation amendments, and the Public Option Act.

We got 50 co-sponsors for this bill in two days. Including five powerful committee chairman. But we need more.

Sign our Petition at WeWantMedicare.com.

Call. Write. Visit. Do whatever you can do to get you Congressman to co-sponsor this bill, and push it to a vote. Right now, before it's too late.

Let's do it!


Here is the complete text of the full bill:

HR 4789 IH

111th CONGRESS

2d Session

H. R. 4789

To amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States to buy into Medicare.

IN THE HOUSE OF REPRESENTATIVES

March 9, 2010


Mr. GRAYSON (for himself, Mr. FILNER, Mr. POLIS of Colorado, Ms. PINGREE of Maine, Ms. SHEA-PORTER, Ms. SCHAKOWSKY, Mr. FRANK of Massachusetts, Mr. KUCINICH, Ms. EDWARDS of Maryland, Ms. WATSON, and Ms. JACKSON LEE of Texas) introduced the following bill; which was referred to the Committee on Ways and Means

--------------------------------------------------------------------------------

A BILL

To amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States to buy into Medicare.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,


SECTION 1. SHORT TITLE.
This Act may be cited as the ‘Public Option Act’ or the ‘Medicare You Can Buy Into Act’.

SEC. 2. UNIVERSAL MEDICARE BUY-IN OPTION.
(a) In General- Part A of title XVIII of the Social Security Act is amended--

(1) in section 1818(a), by striking ‘or 1818A’ and inserting ‘, 1818A, or 1818B’; and

(2) by inserting after section 1818A the following new section:

‘UNIVERSAL BUY-IN‘Sec. 1818B.

‘(a) In General- (a) Every individual who--

‘(1) is a resident of the United States;

‘(2) is either (A) a citizen or national of the United States, or (B) an alien lawfully admitted for permanent residence; and

‘(3) is not otherwise entitled to benefits under this part or eligible to enroll under this part;

shall be eligible to enroll in the insurance program established by this part. An individual may enroll under this section only in such manner and form as may be prescribed in regulations, and only during an enrollment period prescribed in or under this section.

‘(b) Enrollment; Coverage- The Secretary shall establish enrollment periods and coverage under this section consistent with the principles for establishment of enrollment periods and coverage for individuals under section 1818, except that no entitlement to benefits under this part shall be effective before the first day of the first calendar year beginning after the date of the enactment of this Act.

‘(c) Premiums-

‘(1) IN GENERAL- The provisions of subsections (d)(1), (d)(2), and (d)(3) of section 1818 insofar as they apply to premiums (including collection of premiums) shall apply to premiums and collection of premiums under this section, except that--

‘(A) paragraphs (4) and (5) of section 1818 shall not be applicable; and

‘(B) the estimate of the monthly actuarial rate under section 1818(d) shall be computed and applied under this paragraph based upon costs incurred for individuals within each age cohort specified in paragraph (2) rather than for all individuals age 65 and older.

‘(2) AGE COHORTS- The age cohorts specified in this paragraph are as follows:

‘(A) Individuals under 19 years of age.

‘(B) Individuals at least 19 years of age but not more than 25 years of age.

‘(C) Individuals at least 26 years of age and not more than 35 years of age.

‘(D) Individuals at least 36 years of age and not more than 45 years of age.

‘(E) Individuals at least 46 years of age and not more than 55 years of age.

‘(F) Individuals at least 56 years of age and not more than 64 years of age.‘(d) Treatment- An individual enrolled under this part pursuant to this section shall not be treated as enrolled under this part (or any other part of this title) for purposes of obtaining medical assistance for medicare cost-sharing or otherwise under title XIX.’.

More Close Encounters of the "Bob" Kind

Has enough time passed since the jubilant signing of the Health Care Reform Bill and its necessity of 20 pens that we can settle down and speak the truth?

Like... what a terrible disappointment it is that the public option was sacrificed, when it alone would have made this true reform?

Like... how despicable conservative obstructionists have been? How heartless, and cruel? How manipulative and disrespectful of their own followers, that they have, essentially, abused free speech by inciting to riot, by screaming "fire, fire, fire" in the cramped and dark theatre that is the U.S.A.?

Like... how uninformed and illogical many citizens are, and how driven by out-of-control emotion -- fuming, frustrated anger that has all the hallmarks of a two-year-old's temper tantrum, except that two-year-olds don't usually wield the weapons of bigotry?

And (having taken a quick look at today's news headlines) like... how if the Democrats could adopt just a tiny bit of right-wing anality, the bill would not be subject to a re-vote on the basis of parliamentary mistakes? Just because you have succeeded in doing, in a marginal way, what is minimally moral, does not mean that you should fail at following the rules for governance. Yes, I am a nerd, and often a wonk. Yes, I am frequently appointed to be the Ball Buster Rule Diviner -- often seen as a curse, due to the thankless nature of the work, but that role is necessary to success. I haven't yet scoped out who the House Parliamentarian is... but 30 lashes with a limp noodle might be appropriate.

So I ran across this Emperor Bob person/persona on Twitter, then briefly visited his blog, Emperors Rants and Observations, where he can be found addressing the Various Issues of the Day, from campaign finance reform and climate change to the health care reform initiative and Alaskan politics. He's keen.

Oh, Faithful Readers:
I am so tired this morning.

My internist and I, recognizing an infection flaring in my left shoulder, decided that I should return to my poor orthopedic surgeon. Um, poor in the sense that the man has operated on me eight times since 2005, replacing shoulders, removing shoulders, putting in antibiotic spacers, taking them out, and so on, but has not managed to get any of the bacterial specimens to grow in the laboratory environment. Without identifying the offending bug, the correct antibiotics cannot be applied to the situation.

And now the pain is getting worse on the right side, and... {whisperofdenial} my left hip. Both of those joints have "hardware" implanted, thus making them attractive breeding grounds for germs. But we won't think about that today.

So, Fred loaded me and my super-duper powerchair into Ruby, the Honda CR-V, and we sped off to see said surgeon.

You are a fool if you believe that being without health insurance does not affect the standard of the care you receive, even in the form of advice.

ShoulderMan opined that he wanted another "aspiration under fluoroscopy," which would be the fifth or sixth time we tried that particular trick. It is painful, not particularly dangerous, and expensive. But, for me, the overriding factor was that it has never produced a piece of useful data.

If samples of purulent pus taken directly from my humerus during surgery and rushed to the awaiting petri dishes in a sophisticated hospital lab also cannot produce the identification of the offending organism, why do we keep pretending that these painful and expensive aspirations are in any way superior?

I reminded ShoulderMan that since I had last seen him, I had been priced out of my health insurance -- my Faithful Readers know well that I just could not swing $1513 a month for premiums, plus the $5000 more in deductible, and all of that on top of the thousands not covered. I live on private disability insurance due to the combined effects of CRPS in all my limbs (and now, face), avascular necrosis, lupus, Addison's disease, aortic insufficiency and so on, ad infinitem, ad nauseum.

Believe me, I tried to stay insured. It took the help of my state's Insurance Commissioner for me to have coverage to begin with, once COBRA expired. But BCBS eventually was demanding 97% of my income... and I dare you to criticize me for folding, at that point.

ShoulderMan said: "I don't get it. You ought to have MEDICARE."

{we have had this exact conversation already several times over and over again, not to be repetitive or fall into a déjà-vu sort of iterative redundancy}

Moi: "Yes, Dear ShoulderMan, I ought to. {actually, i tried to pull off an oughtn't i? but couldn't spit it out.} However, I fail to qualify because most of my working years were spent in university systems that did not pay into Social Security but rather into poorly funded and criminally operated pension funds. I lack ONE work credit, in the amount of $830, toward eligibility."

ShoulderMan replied, with a fair amount of dripping condemnation in his voice: "Well, why don't you do some work for a week, maybe tutor some local college kids, and turn that in?"

Moi: "Hmm, wow, I never thought of that." Okay, that's a lie. What I really said was:

"I have been informed by my Disability Insurer that to do so would mean the loss of my disability income, and it would be well over two years before any substantive replacement from governmental sources would kick in."

ShoulderMan muttered: "Oh, well... Okay. So I think we need to get this aspiration done and consult with a new Infectious Disease doctor, maybe over at Charity Hospital. This is the kind of thing that cannot be ignored..."

And he promptly exited, stage left.

His minion, PA Bob, then did something that reduced me to tears. Yep, here I go again, even crying into my laptop.

He came over to me, handed me the official pink and yellow copies of codes for the visit, so that I could check out and pay (which I obviously was prepared to do). As he walked into the crowded hallway, he said, loudly:

"Why, wasn't that nice of Dr. ShoulderMan. Look, he marked the box for 'No Charge' so that you don't have to pay for this consult."

Dr. ShoulderMan, who moves at roughly the speed of light, was long gone and already ensconced in the next exam room, so Bob was not making points with him... Leaving me, once again, to wonder why Bobs, in particular, are so intent on confusing me! For a succinct treatment of my history with Bobs, read this.

I've never engaged in a political dialogue with either PA Bob or his boss, having intimated from various remarks that they are both ultra-conservative and that ShoulderMan may, in fact, be an Evangelical (I intend that to reference the Conservative Evangelical Movement, à la George W. Bush).

Aside: Here is one of the fairest succinct explanations of Evangelicalism that I've run across. It comes from an address by conservative EPPC Senior Fellow Wilfred McClay* entitled American Culture and the Presidency, delivered either in Fall 2004 or early 2005.

As a faith that revolves around the experience of individual transformation, it inevitably exists in tension with settled ways, established social hierarchies, customary usages, and entrenched institutional forms. Because evangelicalism places such powerful emphasis upon the individual act of conversion, and insists upon the individual's ability to have a personal and unmediated relationship to the Deity and to the Holy Scriptures, it fits well with the American tendency to treat all existing institutions, even the church itself, as if their existence and authority were provisional and subordinate, merely serving as a vehicle for the proclamation of the Gospel and the achievement of a richer and more vibrant individual faith.

Anyway, there is nothing abstract in the nature of how being an uninsured (and uninsurable) citizen impacts my life. It truly may contribute to my death, as I have spent the first few working hours of this day on the phone with the aforementioned Charity Hospital -- and the helpful pickings are, let's say, slim. The clinic system there may eventually help me, but there are no appointments to be had anytime soon.

Unbelievably, three times (like Peter's crowing cocks), I was told to go to the Emergency Room!

I have avoided a close rereading of what Obama signed, and what Congress is continuing to work through, precisely because I am not yet convinced of the permanence of any change -- but clearly, I am going to have to dedicate time to it today.

Because if there is no fairly immediate help for me in the legislation, I am close to abandoning all hope. I cannot continue with daily fevers up to 101, the attendant sweats, chills, and pain -- on top of my usual severe pain from CRPS and AVN -- I cannot sit in waiting rooms for hours, especially now that my left hip may have joined with the Infected Skeletal Alliance.

Oh, boo-hoo! What a sob fest this post has turned into! But I am going to leave it as is, if only for its potential to serve as a shaming mirror the next time I decide to whine.

The saving grace here is this YouTube video from Emperor Bob, an amazingly calm rant to which I will return with frequency... Thanks, Bob! [Correction -- a correction which blows the whole Bob Phenomenon to hell, but maybe you won't notice -- that is not Bob on the video. No, the star of that show is one "old fart rants," who has quite the head of steam built up over on YouTube!]






*Wilfred McClay is the 2009-2010 William E. Simon Distinguished Visiting Professor at the School of Public Policy. He is the SunTrust Bank Chair of Excellence in Humanities at the University of Tennessee at Chattanooga, where he is also professor of history, since 1999. He is Senior Scholar at the Woodrow Wilson International Center for Scholars in Washington, DC, Senior Fellow at the Ethics and Public Policy Center, and has served since 2002 on the National Council on the Humanities.

Major sigh, and where is the ibuprofen? "The SunTrust Bank Chair of Excellence in Humanities"?

Prohibit Lifetime Caps

This call to action by NORD (National Organization for Rare Disorders) was forwarded by Jim Broatch of RSDSA. Normally, I wouldn't give it much thought -- I doubt if it would even register as an important issue with me until a few years ago.

However, when I was shifted from one group to another in my coverage with BCBS, the company and I went back and forth, and then, round and round, over the issue of lifetime coverage. The two handbooks they sent me clearly said I was capped at $5 million. BCBS claimed that I had received -- not one, but TWO booklets that somehow contained misprints, since the true cap was $2 million.

And now... it doesn't matter at all, because they proceeded to price me out of coverage -- oh, when was it? I remember! October 1, 2009, two short weeks ago.

In case you think that $2 million was generous on the part of BCBS, think about this: in 10 months -- from August 2008 to June 2009 -- I incurred $500,000 in medical expenses. Granted, that was an unusually crappy time. But, the point is that it happens.

So give this a read, and please consider acting on the suggestions from NORD:


Please Help Us Educate Members of Congress About Lifetime Insurance Caps!
National Organization for Rare Disorders


While NORD has been excited to see the elimination of lifetime caps included in each health reform proposal currently being considered by Congress, the old adage "the devil is in the details" still rings true. Although all of the bills eliminate lifetime caps, in some proposals the provision will be delayed and in others there is no requirement for existing plans. We need you to write your members of Congress to ask for lifetime caps to be prohibited immediately.

The way the bills are currently drafted would result in many people potentially facing lifetime caps, even after health reform is enacted. Individuals with employer-sponsored insurance could face caps until 2018 or possibly indefinitely if their insurance coverage does not change. This is unacceptable. NORD has been advocating for the immediate elimination of lifetime caps in both new and existing plans in all insurance markets.

Congressional leaders are currently working to combine the various health reform bills into House and Senate versions before they can be voted on by each chamber. Now is the time for everyone who wants lifetime caps to be eliminated to contact Congress.

Please e-mail your members of Congress TODAY to ask that lifetime caps be eliminated immediately. Sample letters have been provided (see below) that you can personalize with information about how your family or your members are affected by insurance problems, the annual cost of care and, especially, lifetime caps. If you have hit a lifetime cap, please be sure to include that as well.

To find the e-mail addresses of your Senators and Representative go to:

U.S. House of Representatives
U.S. Senate

Sample Senate Letter

Sample House of Representatives Letter

Thank you for your continued support. In this climate of change, it's VERY important for all of us in the rare disease community to make our voices heard on issues related to health reform.


This E-alert was made possible by the contribution of the members of the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA). To learn more about becoming a member of RSDSA, please click here.

Extreme Unction: Last Rites of the Insured

Here we go, Gentle Readers, setting out on our first LIVE blogging event!

The occasion? If you will direct your eyes to the upper left corner of the page, you'll see a countdown clock, ticking away the seconds until I join the ranks of The Uninsured. See it?

As I write this, it reads: 1 day, 12 hours, 51 minutes, 35 seconds. 34, 33...

And so, down to the wire, with my sour stomach in a knot, I am getting ready to submit for refill as many prescriptions as I can -- because at the moment, I am covered at 100% for medications. That'll drop to zero in 1 day, 12 hours, 48 minutes, and 51 seconds. 50, 49...

Yes, right *now*, I am fulling covered for everything from hospitalization, tests, and office visits to durable medical goods (I'm tempted to try and get a new wheelchair while I can... but don't worry, I won't).

"How wonderful for you!" you may be thinking. Good thing you're not actually here. I might have to hurt you. I might have to explain that in order to reach this level of coverage, I had to bleed many, many dollars -- an amount far beyond what I can actually afford, such that now (1 day, 12 hours, 42 minutes, 6 seconds to go! 5, 4...) I am up the creek without insurance.

The pharmacy I use for all medications except the strong painkillers I take is only a few blocks away, part of a large national grocery chain. The drugs for pain I fill, monthly, in the pharmacy housed in the same building as my pain management doctor, so that the pharmacist knows me or can easily doublecheck my legitimacy. I fully understand -- dispensing methadone and endocet is serious business. I saw the pain doctor last week -- or rather, I saw the PA, who is infinitely more on the ball than he is. She, at least, knows how to keep a small measure of hope alive. Whereas he makes a Pointed Point of telling me, whenever he sees me, that there is nothing more to try in my fight against the pain, primarily from CRPS/RSD and collapsing joints -- except for pharmaceuticals. His average time with me is under two minutes, and given that this includes that Pep Talk? Well, it really is a freaking shot in the arm to talk to that... man. His PA, though, shares information from the conferences she attends, tells me of things other CRPS patients are trying, and tries to resuscitate my flagging faith in the medical arts. Through her efforts, I believe I am taking the appropriate amount of narcotics; When he was running my show, I was overmedicated. I would rather hurt, which I surely do, than be befuddled and vacant. It is a fine line and I am happy to have her help me walk it.

I didn't tell her I was losing my insurance coverage. I sat there, chatting away and panicky inside because I knew time was running out. The way this physician operates, you must make a $195 office visit every month in order to receive pharmaceutical pain management. He is a physiatrist -- a specialty foreign to most people. In fact, most times, when I write "physiatry," I receive kind corrections from people who explain that the correct spelling is "psychiatry." I don't mind. I understand how they might make that assumption! A physiatrist is a doctor specializing in rehabilitation:

Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R).

In other words, my doctor resents like hell being asked by my s.u.p.e.r.b primary care physician to write monthly prescriptions for pain medications. He does not like to treat patients solely with drugs. It's confusing, sometimes, his attitude --which is fairly legible upon his face. He is so resolute about there not being anything else to try -- when common sense might dictate that he would be first in line in favor of alternative, and more permanent, measures.

In fact, he and one of his partners proved to be the roadblock preventing me from getting a Spinal Cord Stimulator or an Intrathecal Pain Pump -- both things that might afford me real relief. And now, of course, as it has turned out -- there is not a surgeon in the world who would agree to implant another foreign body. Until the source of this osteomyelitis is found, it is too risky. Even then, since I am now severely immunosuppressed -- well, blah. And bleck, too.

Now, of course, I have no choice but to tell him and the PA that I'll be paying out-of-pocket. I am scared he will say that he won't negotiate with me -- neither about price nor about frequency of visits. Perhaps he will seize this as an opportunity to finally dump me as a patient altogether.

Sometimes I wish I felt secure enough to tell him how I never take as much pain medication as I am "supposed" to... how I force myself to take drug holidays every few weeks... but I don't think his reaction would be positive.

1 day, 11 hours, 52 minutes, 39 seconds. 38, 37...

Well, there is no putting it off, this list of medication refills. The pharmacy I'm using allows for submission of refills via the internet, so I'm just clicking from this window to another to finally be done with this.

Since the latest Wordle Contest has been such a bust, maybe I should start a "Guess the Grand Total" Competition. The closest to the actual cost paid by BCBS gets The Castafiore for a day! It matters to me, the total, even when they pick up the final tab -- because I pay upfront, and then am reimbursed. I've never had too many problems with them refunding my money (in about 3 weeks or so) but, at the moment? I would not be surprised by anything that bleeping insurance company does...

It can be scary to put all of these things on a credit card every month, trusting that a refund will arrive in a timely fashion. For what it is worth, I pay my credit card balances in full each month. At least, that was my habit.

Here's the list, in no particular order. Last week, methadone and endocet were filled at a cost of $106.28 (remember, too, that these are the negotiated prices).

Prednisone (generic)
Hydrocortisone (generic)
Plaquenil (hydroxychloroquine, generic)
Lumigan
Nexium
Starlix
Glimepiride (generic)
Baclofen
Tizanidine
Amitriptyline (elavil, generic)
Alendronate sodium (fosamax, generic)*
Cymbalta
Lasix (furosemide, generic)
Zofran (ondansetron, generic)
Diabetic testing supplies**

PLUS -- I'll be calling my trusty pharmacist to see if I have any antibiotics with refills, just to have some on hand in case Infectious Disease Dood wants to give any another try.

*I'm filling this instead of Forteo. I mean, scope out how much that costs! I am afraid to charge it this final go 'round, because several times already, BCBS and my doctor have come close to brawling over it. I'll tell you a secret. Shhhh! We are. No, we were giving this daily injectable a shot (sorry) in the hopes that my poor disappearing, "avascular," and infected bones might be reincarnated. I do have severe osteoporosis, but it is as a function of osteomyelitis, severe AVN, and CRPS. If my s.u.p.e.r.b primary care physician had his way, I'd take both Fosamax and Forteo.

**Actually, I may pass on these. I am not technically diabetic. However, due to the combination of steroids and infection, my blood sugars have been too high. I know any doctors and diabetics out there are likely to curse me -- but I prefer not to do a lot of testing. The results don't influence what I do and I think the hemoglobin A1C is superior to my dripping blood all over the damned place. As I lose fine function in my hands? Diabetic testing is not so easy anymore.

There's been quite a lag in between the last paragraph and this one. I'm starting the daily afternoon climb of Febrile Mountain, and that, combined with pure anxiety, has left me acting much like someone hopped up on speed. I've dealt with paying the mortgage, VISA, the electric and gas bills, as well as the phone and internet.

I had a brief internal debate as to whether or not internet service should continue to be a necessity, or whether it was a luxury I cannot afford. The decision -- to keep it -- was based on its capacity to entertain and distract me, lessening the need for breakthrough pain medication. Does that sound strange to you? Hmm. It probably does! Makes perfect sense to moi. Also involved in that decision is the fact that The Fredster, La Bonne et Belle Bianca Castafiore, and
-- though she doesn't think I know -- Marmy, all rely on the internet as well.

I may start passing the hat, though! Uncle Kitty Big Balls is in charge of Feline Accounts Receivable and has hissed in my general direction that some "accomodation" might be possible.

Anyway... so I've been wasting time, trying not to deal with this Final Rite of the Insured. Did you know that "Anointing of the Sick" has replaced "Extreme Unction"?

1 day, 10 hours, 46 minutes, 58 seconds... going, going, gone.

photo credit -- f 128 Simple, Strange, Roots Photography

Geoffe Haney is a photographer that holds a BFA in with a concentration in photography. He enjoys alternative process to make his images. He utilizes digital, pinhole, Polaroid and other methods to create the perfect image to his eye...

Prints are available in limited editions. If you are interested...He can be contacted by writing to geoffe@gmail.com

Helen puts her foot up Joe Wilson's enormous ass

Take it away, Helen Philpot!

I started (and stopped) two different posts on the subject of Congressman Joe Wilson. Somehow, I knew that either Helen or Margaret would take care of business in a way of which I approved.

To wit:

Margaret, I guess if you get enough morons congregating in one particular geographical area, eventually they will vote a fellow moron to represent them in Congress. Kind of like sleeping with your cousin – eventually your offspring are not going to be right in the head. But the idiot parade coming out of South Carolina seems to be getting longer and longer these days.

From where I sit Republican Congressman Joe Wilson’s heckling of the President puts him pretty far down on the moron food chain in South Carolina - well below Miss Teen Lauren Caitlin Upton, but only slightly above Governor Mark Sanford. Which isn’t saying much considering all of them are behind the Osprey, northern pike, perch, bleak, shrimp and plankton. For those of you in South Carolina that is just a fancy way of saying they aren’t worth a pile of shit in my book – except for that little Lauren Caitlin Upton. She couldn’t help herself the poor dear. Everyone knows you can’t be a carnivore and still fit in your pageant dress.

Folks, let me tell you something about healthcare and health insurance. There are a couple of ways to make a buck in the game. One way is to systematically deny coverage to anyone with a propensity to get sick as evidenced by past occurrences. The other way is to spread the risk over the largest population possible effectively minimizing the impact of the most risky. But there is one way for sure to lose a buck – keep increasing the number of people who can’t pay their bill. It’s really quite simple. A public option means insurance companies will report
profits using language like “impressive” and “satisfactory” rather than
“awesome” and ”a buttload of moolah!”

When exactly did we become so enamoured with health insurance companies that we are now so adamantly fighting for their rights to make a buck off our misfortunes? None of this makes any sense to me. The President wants to make a speech encouraging our children to stay in school and study hard and we compare that to Nazi Germany. Doctors talking to patients about feeding tubes and life support machines has become some secret plot to kill Grandma. Making sure a woman can get treatment for her breast cancer is unreasonable. I don’t know Margaret. What’s next? Governor Perry and Governor Sanford fight to see which state secedes from the Union first- Texas or South Carolina? If only…

Someone needs to remind Representative Wilson that he and his family currently have a public option for their health insurance. And while you’re reminding him of that, be sure he understands that the next time his doctor has a finger up his butt all of us taxpayers footed the bill. Come to think of it, maybe instead of paying the bill we can skip the finger and just introduce his ass to my foot. I mean it. Really.

PS. Did anyone else notice the look Nancy Pelosi gave to Joe Wilson when
he acted out? Now there is a lady I would enjoy having over for coffee and pie.

Now, I do have to say that I like South Carolina. South Carolinians can boast of Charleston, The Citadel, Clemson, Myrtle Beach, Converse College, Furman, Newberry, and... Bob Jones University. Ummm. Yes, well. It is not fair to visit condemnation on the whole state for the idiocies of its parts.

Eerie: Fred just emailed me -- and, like Leroy Jethro Gibbs, I don't believe in coincidences -- an article about Congressman Wilson.

Wilson raises more than $200,000 after outburst
Published: 9/11/09, 3:00 PM EDT
By Peter Hamby and Alexander Mooney CNN

(CNN) - Less than a day after Rep. Joe Wilson formally apologized to President Obama over his "you lie" outburst, a campaign aide confirms that the South Carolina Republican has raised "more than $200,000" in the wake of the now-infamous moment. News of that cash haul comes after Wilson directly asked in a Web video for campaign cash to fend off attacks from political opponents and said he's standing by his opposition to Democratic efforts at health care reform.

"On these issues, I will not be muzzled, I will speak up and speak loudly against this risky plan," Wilson said in a YouTube video released Thursday evening. "The supporters of the government takeover of health care and the liberals who want to give health care to illegals are using my opposition as an excuse to distract from the critical questions being raised about this poorly conceived plan."

The congressman disbursed the video via Twitter and asked his followers to "please watch and pass on."

"[Democrats] want to silence anyone who speaks out against it," Wilson also says in the video. "They made it clear they want to defeat me and pass the plan. I need your help now. ... Contribute to my effort to defeat the proponents of government-run health care."

Wilson also sent a fundraising appeal via e-mail, saying he is confident that "my voice is serving as the voice for Americans across the country who are tired of irresponsible government programs that have only worsened our situation."

The appeal for cash came as Wilson's Democratic opponent in next year's congressional race, Rob Miller, reported raking in $750,000 as a result of the outburst during President Obama's address to a joint session of Congress.

Miller ran against Wilson last year, losing by 8 percentage points. It was Wilson's smallest margin of victory in his five elections for Congress.

In an e-mail to supporters Thursday night, Miller said he is aiming to top over $1 million in the next 24 hours, a total that dwarfs the $67,000 he has took in during the entire first half of the year.

Now, maybe I am a tad bit too skeptical... but I get this sneaky feeling that Joe Wilson was being less than honest when he *apologized* for his [unplanned, unorchestrated, apolitical] outburst the other night.

Asystole

CONGRATULATIONS to BCBS of Tête de Hergé!

In April, you raised my premium to $1,327.00 (from $1073.00). That caused many a sleepless night, let me tell you!

And so it is completely in keeping with your absence of soul and your insatiable greed, that you should raise my premium once again, this time to $1,513.00 -- beginning in October.

YOU WIN.

I am, as I type this, falling through the cracks. I cannot pay that amount. When I called to see if there were any options left me? Oh, the Hem-and-the-Haw of it all! I could apply for cheaper coverage, opined the Customer Care Associate... but acceptance will be based on my medical history.

Given that it took the Office of the Governor to get *this* shitty coverage, I don't think BCBS of Tête de Hergé is going to offer me anything else out of the kindness of its corporate heart.

Good luck to the rest of you.

Dear President Obama,

It looks like too little, too late...

I'm just sayin'

I'm home!*

The Good Doctor ShoulderMan worked his magic on Monday, gifting me with a new left shoulder. He had to do some rearranging but he made it work.

But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé) -- well.

Well, on the "deep tissue" stain, we finally found bacteria waving back at us, all gram-positive-y, upbeat, and downright defiant. But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé)-- Wait one freaking minute! (The fog of anesthesia?)

As of Day 2, there was, natch, no growth on culture! My Infectious Disease Dood's eyes are bugging out. Bless his bones, he cannot decide when, and how much, to lie to me -- in his mind, I think, he sees this as "managing" the patient.

Because, you see, I refused insertion of a PICC line. They thought I was just posturing, joshing, when I made the declaration before surgery. But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé) -- arg! Sorry about that, and je vous prie de bien vouloir m'excuser, too -- covering all my bases.

So, Infectious Disease Dood decides that I need Zyvox, a ridiculously expensive antibiotic that just happens to have serious interaction issues with 3 of my meds, as well as some nasty side effects all on its own. The deciding factor? Insurance coverage, as the $1500/week cost doesn't fit my very tired budget. Anyway... Fred and I think it was all a plot. As in, ID Dood was expecting BCBS -- Bull Crap Bull Skeet of Tête-de-Hergé -- to refuse coverage.

I was held hostage, told I could not leave the hospital without either the Zyvox or a PICC line with trusty i.v. med balls full of vancomycin.

[I know that it's overkill for the vanco hyperlink to refer back to this blog, but it astonished me, upon searching, to find out how much vancomycin has occupied my life and mind, and what it has come to signify. Allow me that rare {raspy cough} professorial moment of recommending a read of Macbeth, Act 5, Scene 5. Wunnerful wunnerful commentary --

Life's but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

I'm just sayin'.]

Fools! They didn't know with whom they were messing. Once Fred, all bleary-eyed and pooped, arrived... well, we were hell-bent on leaving the hearsepital. At that point, ID Dood and His ID Minions began weaving tangled webs.

Case managers arrived. All nurses with decision-making capacity suddenly were off the floor, scarfing down lunch. And didn't I wish to order lunch? And, uh-oh, the medication you must take before eating hasn't come up from pharmacy. Let's get a blood sugar and another set of vitals! And then they sneak in: They'll be up to put in the line in about 2 hours, no need to go down to Interventional Radiology, how great is that? [I despise the huge, cold, scary room down in IR.]

They promise a nirvana-inducing insertion, complete with a soundtrack. And lest I scoff, they cite:

PICC the Music and Travel to the Port of Relaxation: Preliminary Results of the Effects of Music on Perceived Pain and Anxiety During the Placement of Ports and PICCs
Journal of Radiology Nursing, Volume 26, Issue 2, Pages 61-62
C. McDaniel, M. Burkett, M. Cormier, J. Duvallm, S. Davis, L. East, G. Gilmer, N. Mahaffey, M. Moran

Giggle.

We left. Politely. Give me a call when you all figure out the antibiotic situation, okay?

Amazingly, BCBS of Tête de Hergé decided to fork over the money and my pharmacist, who inexplicably informs me that "[i]t's like déja-vu," promises that I'll have these ridiculous little white tablets by noon the next day.

My BCBS policy, for which I pay $1328/month [Remember: my (private) disability income is a whopping $1996.20. Without that luxurious twenty extra cents, all would be lost!] -- My policy dictates that I pay for medications and then receive reimbursement of whatever they think arbitrarily fair.

So what a hoot it was to have Discover Card's Fraud Unit calling me, all breathless. Did I know that a $3030.00 charge was just made at the nearby Huge Grocery Chain? That was for a mere 14 days worth, ID Dood suggesting I buy the Zyvox in 2 wk lots, in case I need to stop it for some reason or other. Anyway, to the inquiry about the charge:

"Yep!" said I.

There was a tremendous pause. It was absolutely KILLING the woman on the other end of the line to not be told WHAT I had bought. So she rephrased the question, and, on cue, reiterated the pregnant pause.

"That's right!" I crowed. Her frustration was now palpable.

Why not give her something to liven up the day? Let her imagine an elegant late dinner of lobster and caviar, un petit souper à la parisienne [or A Family of Sans-Culottes refreshing, after the fatigues of the day]. Just a little casse-croûte thrown together by a retired French prof whose purchase habits extended to extravagances of generic yogurt and diet cola. Okay, okay -- I also splurge on almonds and good coffee.

By the time the credit card gods were appeased, the antibacterial troops put all in a ducky row, my clothes 'n sundries put away, urgent emails answered, ablutions completed, phone calls returned? I truly felt like shit. I was febrile to the tune of 101 degrees, sweating, and hurting like the proverbial Dickens ["Fan the sinking flame of hilarity with the wing of friendship; and pass the rosy wine!" -- ummm, any excuse for passing on my favorite Dickens quote].

Alas, poor Yorrick (sic), a quick and easy search about the origin of the phrase "hurts like the dickens" reveals the following:

Posted by James Briggs on December 18, 2001

In Reply to: Re: Hurts like the dickens posted by R. Berg on December 18, 2001

: : My son said this at supper tonight........."It hurt like the Dickens". We wondered if any one knows the origin? I have also heard "scared the dickens out of me". Any enlightenment would be appreciated.

: From the archives, here's a response to the same question.

: Posted by ESC on January 12, 2001:

: "Dickens" is a euphemism for "devil" as in "'what the dickens,'.an
expression common centuries before Charles Dickens was born, having been used by
Shakespeare in 'The Merry Wives of Windsor'." "Morris Dictionary of Word and
Phrase Origins" by William and Mary Morris (HarperCollins, New York, 1977,
1988).

It may be an altered pronunciation of "devilkin"

En tout cas... since then, it's been a topsy-turvy time but anything beats being in the hearsepital. And, thank goodness, we only have to visit ID DoodLand once a week versus the usual three or four times.

My MDVIP Go-To-Guy? He opined in an email: "I'm glad it's over and done with. We are all a bit skeptical that this will take care of everything but please try and keep positive thoughts and prayers as we all are trying to do." I have noticed that since his switch to MDVIP, he communicates much more freely and makes frequent reference to prayer, saying that I am being kept in prayer. At first, I was somewhat taken aback. Now? I am thoroughly appreciative and almost virginal in the prose with which I write him.

However, I will visit Holy Ruin on the first person to suggest removal of this prosthesis.

I'm just sayin'.

*******************************************************************************************

*graphic of huge mouth courtesy of BENBENEK BLOG -- from an entry which consists of the following:

I’m just sayin’…
I’m pretty tired of people using the phrase “I’m just sayin’…”

Be/Loved

Hello, Dedicated Reader Base!

I was discharged from the hospital yesterday afternoon, to the great relief of everyone involved, particularly the hospitalists and nurses. When I am a little stronger, a post on hospitalists and certain types of RN will be forthcoming. I am pretty sure that the three hospitalists (one an intensive care hospitalist, one a pulmonologist, one a whiz-girl at internal medicine) were not "Happy." And I am positive that Happy the Hospitalist (The Happy Hospitalist) would not recognize himself in the performance of these particular three colleagues.

Anyway, the short version:

Surgery went well, although we failed in our goal of putting in a full shoulder prosthesis because the orthopedic surgeon found more infection... that continues to *not* grow in petri dishes. Later that night, I twice went into what we will call respiratory distress -- O2 sats dropped from the low 90s to the 30s within 5 seconds. I learned the meaning of gratitude at that moment, because my nurse happened to have just walked in the room. I mean, being on continuous monitoring doesn't do a whole heck of a lot of good if no one is watching! She stuck to me like glue until a Super-Duper Respiratory Therapist arrived, who then rescued me a second time. We were on our way to Intensive Care before the third episode even had a chance. I don't remember the third go 'round, anyway, as I was, if you can believe these medical types, "obtunded," and they proceeded to tube and then attach moi to a vent.

Yadda yadda -- I'll spare 'ya. [EEGs, CT scans, MRIs, echos, blood sugars and more!]

After some mis / management -- that wasn't all that big a deal, so long as you weren't the patient -- and a few days time, I am home. With the infection still blooming, and the explanations still lacking. We're doing i.v. vancomycin through the PICC line again.

The Poor Fredster. He is sleeping in this morning, and I am so glad. He is lovely, have I told you?

Deninel: A Stream in New Hampshire

I can usually riddle my way through misspellings.

But I am tired of a certain woman's insistence that her husband is in a state of: deninel.

The first time she typed it out, I smiled indulgently (my most obnoxious smile, unfortunately). By the third repetition, I was mouthing deeeee-nigh-yul,deeeee-nigh-yul,deeeee-nigh-yul.

There ain't no damn word DENINEL.

dee-nin-ul? dee-nin-ul?

Do not mess with Retired Educator when she has not slept a wink, nor a nod, and she ain't a' blinkin' none, neither.

Bless this lady's heart. She goes on to write:

"My husband has cirrhosis of the liver and hep c, he is also bypolar! He refuses to take meds and is in complete deninel!!! The stress is about to kill me , my faith is strong but he wears me down!!! We have two children at home 17, and 15 , I have went to work to help support us."

Before I lapse into a pool of melted Jello (somehow I picture a very red mix of cherry, watermelon/kiwi, and raspberry, all pulsating at roughly 120 beats a minute) out of sympathy for her situation, my God, why can't people manage to make verbs agree with subjects? Is it hard? No, it is not.

Sorry, I meant: No, it are not.

She can spell CIRRHOSIS but not bipolar?

Her screenname involves use of one of my favorite words: poot. As in: I pooted, you pooted, he/she/it pooted, we pooted, you pooted (again), and they pooted. This is a Free Poot Nation.

And, of course, in addition to being slang for flatulence, "poot" has a history of diplomatic implementation, because the Venerable Bush preferred "Pootie-Poot" as sobriquet for Putin, the former {*cough*} President of Russia. You know, the guy who is now {looooong *fart*} Prime Minister of Russia? Second-in-command {baritone *belch*}?

Oh, the hilarity, back in February of 2001, when we could afford to yuck-it-up but good:

INSIDERS are admitting that President George W. Bush's penchant for bestowing his own nicknames on close associates has provoked the first crisis of his new administration.

"Internal communications are in turmoil," confesses a high-ranking Bush aide known as Frenchy, though he doesn't know why. "The president says get me Knuckles on the line, or where's The Eskimo, or let Bones and uptown handle this," he laments, "and nobody has a clue as to who he's talking about."

Vice President Dick Cheney, a seasoned Bush handler, refuses to confirm or deny reports that he plans an internal White House telephone hot line where senior advisors, cabinet members and others can call in to find out their current presidential nicknames and those of their colleagues.

But knowing who's actually who among themselves has become a high-stakes guessing game for the Bush team members — as was underscored by a recent trip to Kansas City by a bewildered secretary of state, Gen. Colin L. Powell.

The president had ordered that Bullets be sent to represent the administration at a town meeting on farm subsidies. Assuming Bullets to be Mr. Bush's informal name for the only ex-military figure among his top aides, a member of the White House staff conveyed the word to General Powell. He was halfway to Kansas City aboard Air Force One before the goof was revealed: Bullets is the president's nickname for the secretary of agriculture, Ann M. Veneman. Mr. Bush's response to the snafu was quoted as, "Why for heck's sake would I send Balloonfoot to do Bullet's job?"

The first lady herself is reported to be "baffled" by her husband's nickname for her. "I hung up five times yesterday when he called to ask what was for dinner," said a flustered Laura Bush. "I thought it was a wrong number when the guy kept asking for Stretch."

Meanwhile, President Vladimir V. Putin of Russia is reportedly both baffled and incensed that on his first call to the new American president, Mr. Bush addressed him not as Mr. President or Mr. Putin but Ostrich Legs.

Mr. Cheney, who is said to believe his own Bush nickname to be either Hopalong or Crash-Dive (signed presidential memos evidently differ), has reportedly come to dread full cabinet meetings. "When George W. starts with the `Good morning, Skeezix' and `Let's ask The Undertaker," says one cabinet member, who thinks he himself may be Spinach Man, "they all look over at Dick for help, and he's as lost as they are. And if Dick doesn't know who the president's talking to, who does?"

A White House nickname hot line, should Mr. Cheney set one up, would be helpful but no panacea. High- ranking administration officials are still likely to refuse the call when their secretaries announce it's The Pecos Kid for Snooky. Foreign leaders beyond nickname-hot- line range will surely bridle at being called Nine Pin or Hound Dog by a fellow head of state.

And what of Mr. Bush's intimate circle? One old friend returned as Not Known At This Address a 50- pound shipment of Texas barbecue beef bearing the presidential seal, addressed to "The Big Goober." His name is Darryl.

Compounding the confusion is Mr. Bush's creativity with sobriquets, verging on free association.

"His nickname style isn't anything you can decode," points out a close observer known only as Four- Eyes. "Like, say, calling tall guys Shorty and right- handers Lefty. Why is Attorney General John Ashcroft Snake Hips — or is that Rumsfeld? No, he's Pistol Pete. Wait a minute, maybe Rumsfeld is Chickenman and Pistol Pete is Christie Whitman. Aw, I give up."

Asked by reporters about the impending nickname hot-line project, the president himself expressed surprise at the idea and said he had no information he was aware of.

"For that," he replied, "You'd have to talk to Stilts."

I have been up all night, which explains the incredible profundity of this post, but somewhere in the steel trap that is my mind, an analogy, nay! A causal relationship was forming. Okay so some of it was forced. A lot forced.

NanaPoot (yes, that is this distressed woman's *chosen* moniker)? Meet the man secure enough in his... um, masculinity to come up with "Pootie-Poot," and the Author of Much of My Discontent, and perhaps the Author of Some of Yours. I sincerely hope that you will be able to access some meaningful help for your husband and your entire family.

WTF

I have tried to avoid falling into the blogging trap of "What the Fuck?" postings -- because, really, one could spend all one's time going "What the Fuck?" these days.

Still, this morning's mail provided a great WTF opportunity. I just can't figure this out.

S. Clusterfuck, M.D. -- Medical Director, Vice President of Clinical Programs with Bull Crap Bull Skeet of Tête-de-Hergé -- wrote me the following letter:

Dear Retired Educator,

Maybe you've avoided tests ever since your school days. But did you know that getting medical tests when you need them is one of the best ways to protect your health? Regular checkups can uncover any new developments early in the game. And that gives you and your doctor the best chance of preventing or controlling problems.

To take charge of your health, talk with your doctor about these ideas:

The microalbumin test checks for early signs of kidney damage by measuring the amount of protein, called microalbumin, in your urine. Damage to your kidneys may cause you to need dialysis treatments.

We're available 24 hours a day, seven days a week to help you live a healthier life.

Sincerely yours, and a pat on the derrière to La Bonne et Belle Bianca Castafiore,
S. Clusterfuck, etcetera etcetera...


I ask, with equal sincerity: WHAT THE FUCK?

Medical Bills

Housekeeping, odds and ends.

Today, I received the bill from Pretty Hospital for the last go 'round of surgery: $48,092 and change.

In the same pile of mail was a personalized form letter (you know, they toss your first name into the text here and there for that *special* touch) -- from a former Chairman o'the Board to the same institution, suggesting that $420 would be an appropriate donation toward keeping Pretty Hospital more better.

The hospital bill will be paid by BCBS -- Bull Crap Bull Skeet of Tête-de-Hergé -- to whom I now pay $1300+ a month in premiums. I am exceedingly angry at the recent hike, coming as it does after another hike just 6 months ago. I *know* that I cost them lots of money. I also *know* they are trying to squeeze me out of my coverage.

I paid out all my deductible and out-of-pocket expenses by mid-February -- $5,000+.

Grrrrrr.

Also found in the pile of catalogs and grocery store ads? A bill from the Ecstatic Infectious Disease Group for $2185.11. I cannot explain exactly why, but yes, I am responsible for the full amount despite my excellent insurance coverage.

It surely is a fascinating game, the way the amounts charged receive odd payments here and there, way strange adjustments -- all to end up quivering with expectation in the balance column.

For instance, 08 January 2009 sees a charge of $1995 for VANCOMYCIN HCL 500MG, for which no payments were made, but a whopper of an adjustment is noted -- $1866.06, leaving moi with a line balance of $128.94. Now, THAT is an adjustment.

However, as I scan the dense Statement of Account, I note that, for other things, I am royally screwed: Elastomeric Infusion Devise "cost" $825 on, oh, let's pick... 15 January 2009, with a payment of $192.57 and an adjustment of $549.90, leaving this pauper with a balance of $82.53.

Hmmm -- but back on 01 January 2009, the charge for that self-same Elastomeric Infusion Device schtuff was $770, a charge toward which no payment was made, though there's an adjustment of $513.24, leaving this sucking hole of broke-ness with a balance of $256.76.

Strange and incomprehensible, these jumbled numbers. I do believe that that is the plan! Confound them with numbers and demands for payments. Ah... and there is no sign on the Statement of Account of the four payments I made while at the office, payments totalling over $1100.

Yesterday, I received a fairly chummy letter from Bull Crap Bull Skeet of Tête-de-Hergé, the verbiage of which seems to indicate that they've once again been caught with their paws in the cookie jar.

"As a result of Tête-de-Hergé Safety and Fire Commissioner Benevolent Guy's examination of reimbursement policies involving ambulance services (air and land),
Bull Crap Bull Skeet of Tête-de-Hergé has agreed to review and adjust certain ambulance claims.... " Yes, I am in the group of sickly poopheads who may be entitled to refunds of payments made to various ambulance providers (It is an odd and little known fact that in the villages around Marlinspike Hall, deep deep in the Tête-de-Hergé, 1.4 vehicles out of 3 are ambulances, or former ambulances.)

This is, of course, good news. Except that, as I read on, I am lost in the morrass of instructions about how to go about submitting a claim to get MY MONEY.

Someone somewhere has a sense of humor, though, because if I "have any questions about this letter or an Explanation of Benefits relating to an adjustment for an ambulance claim, please contact our dedicated Customer Service Unit." Ar! Ar! Ar!

Well, it is time to get hooked up to my little medicine balls of daptomycin. I've no idea how much it costs. What am I supposed to do? Decline the recommendations of one of the top Infectious Disease doctors in the region because I cannot spare the odd dollar? On the other hand, he is working in the dark -- assigning various antibiotics to a patient whose nefarious pathogens refuse to grow in the Pretty Hospital lab. I might get just as appropriate coverage by chowing down on moldy bread.

I hate money. Yes, even when I am in good straits, I hate money. It is nothing but a contractual construct, by means of which we condemn a good portion of the planet's human inhabitants to lives of drudgery and need.

Why not go click on the link for the Site Officiel du Parti Socialiste in the Tangent's List to your left? Yeah, that's right -- you've found a live one...

I will close with my favorite medical charge of the *day*: $4,344.00 for the Recovery Room. First off, they don't like it when I call it the "Recovery Room"; No, today it is known as the PACU -- post-anesthesia care unit, or something to that effect. More to the point, I was there for about an hour and a half. Unless they were doing heroic and expensive things while I was still fuzzy, they did precisely... nothing. Yes, they took vital signs and actually did hang a bag of vanco, but beyond that? Nothing. That's a whole lot of nothing.