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

Cheat Sheets

I'd like to think that actually participating in one of the ACA's already enacted programs -- PCIP -- gifted me with lots of useful info and insight into the health insurance and health care access crisis in this country.  You'll have noticed, Dear Readers, that I mention it often enough.

But my official cheat sheet has often been Shadowfax over at Movin' Meat.  His Blogger "about me" consists of:

I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

I think it's the "progressive politics" that hooked me, along with a healthy respect for an excellent wonk.

Anyway, take a look at two of his latest posts if you are just now starting to give this whole crisis stuff a thought.  Shadowfax is a good place to start, and then to continue, and then to hone your critical thinking skills -- you may have to jump around the blog a bit but that's no waste of time, either.

Here's one:

OBAMACARE DEFEATS TRUMAN

So this is great news and a great day. My quick reactions: 

First of all, CNN & FOX. Once again proving that being first is a higher priority than being right. How embarrassing. At least their soon-to-be-fired producers will be able to get health care coverage. 

Second, Roberts: I have to give him a little credit. I fully anticipated him to be a partisan hack and invalidate the law. Perhaps the burden of history weighed heavily on him, perhaps the delegitimization of the court influenced him, or perhaps the sheer radicalism of Scalia's dissent drove him to uphold the law. Regardless, he got it right. Make no mistake, though, he did what he could to advance his long-term agenda by slowly restricting the reach of the commerce clause. 

While most of the focus centered on the the Heritage-Foundation-developed mandate (aka the greatest threat to liberty ever), it's important to note that the 4 conservatives wanted to invalidate the entire law, and there is far, far more than the mandate in Obamacare. 12 million Americans will get rebates from their insurers this year based on the ACA's insurance regulations. Rescissions of policies is now prohibited. In a couple of years, pre-existing conditions will be covered under the guaranteed issue provisions, and the moribund individual market will be resuscitated by the insurance exchanges. All of these huge reforms survived and will transform healthcare in a good way. 

The mandate itself may work, or people may prefer to pay the "tax" penalty and go without insurance. We will see. If enough people opt out and insurers are experiencing serious adverse selection in a few years, perhaps the partisan rhetoric will have died down enough that Congress can tweak the incentives at bit. One can hope, anyway.  [READ THE REST HERE]

And here's the other:

 Defending the Mandate and its Tax/Penalty

From a contributor at the Daily Dish: 

This. This is exactly the right approach.

I do not understand why Democrats don't embrace the newly defined "tax", saying: you bet we raised taxes, but not on the hard-working, responsible middle class. This is a tax on those deadbeats who don't pay for their own insurance but still expect care when they show up at emergency rooms. It's a tax, all right, and I think we should agree to raise it even higher so they have more of an incentive to buy their own damned insurance and leave the rest of us alone. Let the Republicans protect the rights of deadbeats; Democrats are fighting for people who play by the rules.  [READ THE REST HERE]

As I said, peruse the dood's writings on health care policy, they're instructive, they're even-handed, I agree with them, and so, they are right.  [Hey, I've had a rough day!]  A big "thanks" to Shadowfax for sharing his inside info and his insightful analysis, too, on this... schtuff.

Rivulets of Pluckiness: My Psychopathology (WITH UPDATE)

In the week since sending off my application for health insurance under the Pre-Existing Condition Insurance Plan * , I am feeling much worse.  In the course of the day, my mind wanders back to my last conversation with one of the world's most talented shoulder surgeons -- and my ludicrous questions to the very patient man.

"How will I know if it gets worse, if I need to come in?" and another 5 permutations of the same inquiry were met with a muttered:  "You'll know." 

Eyes downcast. 
No charge for the office visit.
Orders for joint aspiration under fluoroscopy -- the sixth -- which the hospital refused to schedule due to my lack of insurance.

My Teacherly Self has assured you many times, Faithful Reader, that there are, indeed, stupid questions.  My question'to ShoulderMan, however obtuse it might sound to you, was not stupid. It just didn't have an answer.

Given that fever, pain, sweats, and fatigue are daily occurrences, nothing to write home about, and certainly nothing to call the doctor over, how am I supposed to gauge... change?  That's one version of my question.  The throbbing, throbbing version?  How much can I stand?  How much, in the Name of God, should I stand?  What am I worth?

For instance, what am I to do or think when the pain begins to have that unmistakable infected ::twinge:: again, when using my left arm to do anything beyond putting a masterful grip on a paperback (currently The Cider House Rules by John Irving) causes an increase in fever and pain, even brings on The Febrile Shivers, when my hair is plastered to my head by what can only be called RIVULETS of salty sweat?  I confess that I cannot squelch the feeling that something ought to be done, that there ought to be some sort of response.  Hello?  Hello?

If you would like to make a call, please hang up, and try again.

Hey... I just noticed something:  It's a sign of my innate PLUCKINESS that I came up with RIVULETS.

[Possibly from Italian rivoletto, diminutive of rivolo, small stream, from Latin rvulus, diminutive of rvus, stream; see rei- in Indo-European roots.]

So, Friend.  What kind of psychological disorder is this, then?  Are my mind and my body in collusion? Are psyche and soma permitting a worsening of things now that addressing this bone infection won't q:u:i:t:e ruin me financially?  Or is it that now I am allowed, by a hyper-protective subconscious, to perceive just how bad things really are, and have been?  Whatever the underlying psychology, psychopathology -- I don't want to go down this road.  I don't want things to get harder. 

Yes, I hear that annoying high-pitched whine, too. 

I cannot go on like this -- this daily descent into Hell.  Have I garnered no new skills?  Why can't I look the other way, play the Polyanna Glad Game? 

I haven't phoned in my distress, nor emailed my Go-To-Guy Internist, because the one detail that never quite leaves me is the one where both ShoulderMan and Go-To-Guy cough-and-blurt that there is nothing more to do, except to remove my prostheses.  Permanently.

I can see how that would prevent the hardware from serving as petri dishes for further bonzo-bacteria... but it doesn't address the little buggers already in the humerus... Y'know? 

Impending Implosion Warning.  Impending Implosion Warning.  Impending Implosion Warning.

Thanks for the space and time to vent. 

{you know i want to apologize.  you know i do.  and so i ask myself:  whose blog is it anyway?  hmmm?}

* AUGUST 12, 2010: If you happen to be sporting your Dancing Shoes, prepare to do the Happy Dance! 

Today's mail included a slender envelope from the Pre-Existing Condition Insurance Plan, Administered by GEHA. 

 I admit that Fred was asked to pray before I opened it -- not some wimpy WASP-y mumblejumble, no!  Fred incorporates kippah, tallit, and tefillin -- and he looks quite fetching in his spiritual armor -- while he performs an impeccable High Mass in medieval Latin.  To cover all bases, we set out large baguette-shaped baskets full of French Existential classics, a sort of tired homage to Christ as the Bread of Life, and a nod-with-a-wink to actual bread to keep the actually living... alive. 

La Bonne et Belle Bianca felt it imperative that she don a long, white linen tunic, à la Isadora Duncan, and run on her tippy-toes -- in a weird crisscross pattern abbreviated by what might have been S.O.S. signals -- while waving smoking fronds of sage.

Marmy Fluffy Butt, after her great swath of tail was sufficiently poofed, led Dobby and Uncle Kitty Big Balls in a decorous purred rendition of Hymn of Hope, the famed devotional commissioned for the 150th anniversary of the First Baptist Church of Lapeer, Missouri.  Marmy is particularly keen on the musical notation for the piece that dictates it be done "reverently with quiet strength."

Thus fortified, I carefully slit open the envelope, hands trembling.  It was a flashback to the long ago days of college acceptances, with the significant improvement that the word approved was greatly bolded.

 As in:  approved approved approved !

When the sage ash settled, and the sacramental music faded into a bit of impressive jazzy scat, a few inconsistencies between the promised item and the item delivered were noted -- the monthly premium that was only to change when one shifted from one age bracket to another now may possibly change due to "market" forces; the deductible paid between now and the end of the year does not appear to be applied to next year's due, and a few other odd notes.  Each problem may be resolved by the more complete language of the full policy, which I haven't yet received.

Anyway, Dear Reader -- dance!  Dance with abandon, dance with joy -- I am insured! 

President Obama?  Thank you!