A Letter From My Buddy Barack Obama

I love it, more Secret Service Envy headed my way!  Having been the only instructor at Major Gothic Wonder Land University to hold a required class on the day Ronald Reagan came to jabber at the undergraduates, and wave at the picketing grad students, I am a favorite of the Secret Service.  What they can't figure out is the "no-make ups allowed" major exam question that equally (always *equally*) excited my students -- made up of 14 upperclass undergrads and 1 relieved Divinity School doctoral student:

Explain, dissect, conjugate, and defend the following assertion:Michael Reagan, son of United States of America President Ronald Reagan will one day serve on the board of The John Douglas French Alzheimer's Foundation.

Of course, this pretty standard "no-make ups allowed" major exam question was in French, as this was a course designed to dunk -- by which I mean, of course, immerse students into French Lit.  As you can tell from the question, we had just finished reading Samuel Beckett's Waiting for Godot.

Oops.  Train of thought problems, yet again.  I was telling you about the letter I just personally retrieved from my private email account -- known only to my best of best Facebook Friends. [Loud guffaw! I have a fake Facebook account and about, oh, two Friends, all the rest being right-wing relatives.  My two Friends are right-wingers, as well, but tolerant.   Very tolerant.]

So, yeah, it was from Barack.  My buddy Barack.

[Look, let me settle this, as I just was barraged, nay, blitzkrieged by two Super Secret Facebook Friends who are actual full-blood relatives and consider themselves, and I quote:  "progressive as hell, girl!" Fine, let them assert their leftist tendencies.  Yes, their leftist tendencies surpass even my own, to the extent that I doubt either of them have ever voted in their entire political adult lives.  Not even for McGovern.  Okay... I'm telling lies now.  Let's just say that they may temper their support for President Obama due to expectations of a shift to the left by a rather large amount.  Not this profderien, no ma'am! I adore, respect, love, admire, and imitate this intelligent sign of life -- and his awesome family -- every chance I get.  Well, okay, so there are a few things, policy-wise, that could use a slight Marxist tweak, but, most days, I'm fine with that.]

That's right. The President, himself, writing to The Moi, care of, admittedly, the Haddock Corporation (now completely divested from Halliburton *).

 * Can you freaking believe that "Halliburton" pops up as a correction in SPELL CHECK?! How screwed up is that?  I mean does "amnety internatenal" show up in spell check? No, it does not, thankyouverymuch!  Jesus.

Cough.  Yes, my friend Barack wrote to thank me -- just me -- for my round-the-clock, high tech multi-year campaign on behalf of the watered-down Affordable Care Act.  I keep referring him to my other dearest pal, Bernie Sanders, but haven't heard yet how that's going (so much to talk about!).

In the past, as many a Beloved Reader of this blog recalls, I have shared a few of my personally keyboarded letters to our President -- never violating protocol, naturally, but always seeking advice from the now deceased Tante Louise on how best to post presidential correspondence. 
Well, okay.  Tante Louise and I may have flubbed a few posts in which my buddy Barack figured, but we toed the, er, red line in the, er, sand when it came to my personal, and by personal I mean one-on-one, tête-à-tête sorts of intimate, soul searching, letters.  The whole Flaubert and Bob Herbert catastrophe.  The admittedly odd basketball post.

Even when you limit a search of this blog to "Obama, ACA," there are just a half-dozen or so weird ones...  I mean, omit blog war waged on Walmart, and the regrettable incident in which I claimed not to be able to support "Obamacare" until Socialism was in place.  I was on drugs.  You can tell, I bet.  I mean, look -- clearly, I say often enough that Obamacare -- the ACA, the PCIP, whatever you like to call it -- saved my life.

Probably, that's all my vast reading public needs to know:  President Barack Obama saved my life.
And then pulls off this comedic email in which he pretends I had something to do with this brave legislative and moral effort [ ::waving:: at teddy!].

That is a true friend, indeed.

Oh hell, there is a man in a terribly plain blue suit that has been tailored, clearly, to hold a spare machine gun and drone in the small of his large back... peeking in the badly leaded hand-poured window panes that stud the upper chamber of the Computer Turret.  I have repeatedly and repeatedly asked Barack, even "cc"-ing Michelle, to have the damned Secret Service "STAND DOWN," already!

Jesus.

Lincoln's Presidential Seal

[Hi there, prof-de-rien!  How're they hanging?]

I had to take a moment to say thank you.

Lisa, you made history.

A long line of organizers fought for nearly 100 years to make health care reform a reality, and now we're seeing the results. Millions of Americans have health insurance today, thanks to reform -- some for the first time in their lives.

The work you did is how real, lasting change gets made, and I hope it will be remembered for years to come.

I'm so happy your name will be there, alongside mine, as part of OFA's permanent record of the people who made health care reform happen.

If you know anyone else who deserves to be recognized, tell them to add their name here:

http://my.barackobama.com/You-Made-History

Anyone who was part of this decades-long fight will tell you it was never easy, but it was always the right thing to do. Teddy Roosevelt knew it. Harry Truman knew it. Teddy Kennedy sure knew it.

No matter how hard it got, the results we're seeing today make it all worthwhile. Millions of Americans now have coverage, and even more have better health care, thanks to the work you did.

Take a moment to let that sink in.

It's proof that when people come together and fight for what they believe in, real, lasting change is possible.

I can't thank you enough,

Barack Obama





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Go-To-Guy Meets Obamacare

CLPS:
Crumpsall Lane Primary School

CRPS:
NOT a primary school in Manchester, Great Britain

Some people think I'm mad for retaining the services of a "concierge" physician when I've successfully run the marathon of applying for coverage through the HealthCare.gov Marketplace, set up by that wonderful bit of legislation known as the Affordable Care Act.

Okay, "Obamacare." Jeez.  A girl tries to deflate the negative connotations of a term by providing and modeling alternative linguistic monikers and is shouted down by her imaginary millions of Dear Readers.

Yes, I've adequate and affordable coverage now, and desperately needed it.  But nothing has changed, really.  Even when I had wonderful but not so affordable coverage under the ACA's early version of Obamacare -- the PCIP (Pre-Existing Conditions Insurance Program) -- that began back in 2010 and saved my miserable self, I was considered mad for retaining the services of my Go-To-Guy and his flat fee service, then under the aegis of MDVIP.  He's no longer with them, he and his partner.  They're Wild Medicos.  They've gone rogue.  They're MDVIP without the corporation around their neck.

Go-To-Guy saw me through several valleys of death, always opining, in his crisp dark suits, understated cologne, funky eyewear, and with all of the surety of a hardheaded grandmother: "This, too, shall pass." When I had no insurance, he kept me on, and kept me OUT of the hospital. Why was I uninsured, being a bona fide State Employee 'n all?  Because my Bizarro World version of BCBS decided it was fair to charge me $1513 a month as a premium, with a deductible over $5,000.  So while it wasn't a game, it might have been a sporting challenge for myself and Go-To-Guy, as he kept dozens of balls in the air, and never let one fall to the ground, not even once. I became dirt poor, got sicker, but did not die, mostly out of a desire to see my staid and superb doctor kick major butt. Undoubtedly a conservative sort, he hooted and hollered and did backflips when Obamacare was passed, because then I could finally get the surgeries I needed, and the medications that he preferred, instead of the ones that Walmart sold for $4.

It was fun introducing him to the real world.  "Really?  You've got to be kidding!" became the standard iterative upon which all of our problem-solving conversations were built.  I doubt he's ever been in a Walmart.

The real Go-To-Guy is a compassionate, insightful, incredibly well-informed physician who decided that he wanted to return to the art of medicine as well as perfecting his scientific approaches to care. He was tired of dealing with insurance companies and rushing through patient visits -- though, having been with him a good decade before he changed his practice model, I can attest to never once having felt that he was timing the visit or needed to be anywhere but where he was. That's not to say he hasn't had his moments of rapidly rising color from chin to brow, complete with beads of sweat, and a cramping hand grip -- moments when I'd touched some nerve or other.

Go-To-Guy believes in the best of people.  He's shocked by any anecdote that relays an example of less than outstanding human behavior.  He's cute that way and I figure that attribute to be an excellent counterweight to my inbred pessimism.

And yes, there's that business of him saving my life a few times, and there's that aspect of acute intuition bolstered by being up-to-date and actually listening to this whiny, bitchy patient with the weird cluster of diseases.  Truth be told, however, the next time he is going over labs or a radiology report, muttering to himself, and I hear... "That doesn't make any sense... but this is Retired Educator, so who knows?" -- I'm going to bop him on his pate.  Well, as my reach is shortening and my strength waning, I probably could only whack one of his bony knees.

But... with the improvements being made in the field of assistive devices, add a flowery cane or a rubber-tipped grabber, and I could infict serious damage almost anywhere on his lanky body.

Right.
So.

I see Go-To-Guy this week for the first time since January.  We maintain an email correspondence, mostly consisting of Q-and-A sessions and my need to vent.  This meeting will be our first when, technically, I have another physician serving as "primary care provider."  And so, I imagine we will still do a soft shoe rendition of quizzing and catch-up, medication reviews, but now he won't be able to order labs or imaging, or write for meds.

What shall I call my new Primary Care Provider, a young, inexperienced, very pregnant, well-intentioned and woefully-unprepared physician in her second year of practice?  Go-To-Guy and I had gleefully thought to outsmart my new ACA Market Place HMO by slipping the list of available providers to his partner's wife, who works as a hospitalist for the same HMO.  We giggled and called her our "mole." The mole eliminated my new Primary Care Provider straightaway, first thing, with nary a hint of hesitation.  Next to my new Primary Care Provider's name, she wrote, in caps, "NO." Then Our Mole underlined her capped "NO."

NO.  Okay. I bolded it and turned it red.

Mole-guided, I picked the guy with sterling credentials, 15 years experience, row upon row of accolades, and the highest approval of the hospitalists with whom he worked.  I made the appointment and the acid levels in my stomach decreased.

And so, of course, at my first "Meet and Greet" appointment with this fine doctor we chose, talented physician dude announced that, unfortunately, his patient load was already too large, and so, like a snake, he transferred me to the medico who had been branded with the capitalized, underlined negatory.  I must have looked like a large-mouthed bass hungry for oxygen as my lips flapped in the overheated exam room.  He did slip in, the sly devil, that she was scheduled to go on maternity leave in May, and that he would probably pick up my care during that time.

Why insist on choosing that facility?  Why there?  I dunno, really. It's brand new and everyone is super nice, super efficient, super interested in customer service evaluations.  There are onsite lab, radiology and pharmacy services.  The truth? I had visions of needing to flee, and hoofing it over to the safety of Go-To-Guy's office, one street over, and the adjacent two hospitals, in case I needed urgent care. Perhaps, too, a compulsion to talk politics might come over me and there's no one better than Go-To-Guy's gatekeeper nurse, Justine, for potty-mouthed dissing of right wing extremist asshats.

Having now had my second "Meet and Greet," I think I will call my new PCP "The 17-Minute Uh-Huh."  This commemorates our first encounter, spent ordering most of my medications, during which "uh-huh, uh-huh" was the response to each medication I pronounced aloud.  Well, actually, the "uh-huh, uh-huh" began to arrive mid-drug name after the first three prescriptions.  I was getting peeved, but then a strobing pink light induced seizure activity as she interrupted a response with: "Our 17 minutes are up!"

The 17-Minute Uh-Huh has many redeeming qualities.  She's cautious.  She can explain the parts of the ear in great detail (I am having that benign kind of vertigo that comes on whenever I turn my head to the right!  "So don't turn your head to the right!").  This was at our second meeting, brought on by a high temp, a high white count, the aforementioned benign vertigo, and a messed up thyroid assessment that kept stomping its little computerized feet and claiming I had both Hashimoto's hypothyroid AND Grave's disease.  Since everything else defied logic (she's new), The 17-Minute Uh-Huh glommed onto ear physiology.

But I will have a hard time getting over her blank look upon hearing "CRPS," and the aha-moment when I offered up the acronym "RSD," instead.  The trigger of a vague memory brought on the explicitly memorable: "Oh, yes!  Something Sympathetic Something!"

Go-To-Guy has this annoying habit of pulling out some electronic device and looking up things he does not know, or to verify information.  He's particular. And he loves learning. He has other habits I've noted through the years, like the first time he saw me after I "developed" CRPS.  Actually kneeling on the floor, he was carefully examining my right foot -- at the time, the only visibly afflicted part of my body, and that was only a subtle blue hue and swelling, despite the outrageous pain there and in my left hand and forearm. Well, my left hand had a "claw" formation, but I don't like remembering it, so I'll forget it again now. He asked permission before touching the thing at the end of my leg -- compare that to Jose "The Turd" Ochoa and his reputation for suddenly grabbing at affected limbs; compare that to the countless doctors, nurses, and aides who have poked, grabbed, and stuck needles in that region without warning, much less permission.  There are two nurses and one doctor who learned the lesson well when I kicked them in their respective midsections -- I was semi-conscious and on a respirator at the time, if that absolves me at all of such violence.  It doesn't, of course, but all three were wonderfully forgiving.

See how I run from what needs saying?

At that time, the day Go-To-Guy first saw the purported foot, the orthopedic surgeon responsible for its pitiable condition, was Dr. Eric Ward Carson?  Let's get philosophical and call him the Thick Necked Truth Deflector.  In the beginning, there was a different word, a different descriptive expression, very stylized, ladylike:  Dr. Doo-Doo Head.  He denied, deflected, referred, mumbled, threatened, demeaned... did everything but diagnose and treat the obvious.  It was after weeks of that barrage of crap that I saw dear Go-To-Guy.

Me:  "Dr. Eric Ward Carson says this will go away, it's not a problem, I'm over-reacting, and that there is no such thing as CRPS.  He says that CRPS is a psychological disorder."

[In desperation, I had seen a partner of Dr. Carson's, someone very trustworthy, who had replaced my right hip the year before, and had referred me to Dr. Carson for the left shoulder replacement gone woefully awry.  This partner took one look at my leg and said, "Oh no, you've got RSD..." He then went on to deconstruct the acronym, and introduce its pal, CRPS, writing it all out on the crinkly paper covering the exam table.  I still have the bit of paper.  It was my first clue to what was causing so much pain and... well, you know my tiresome litany.  He urged me to see Dr. Carson as soon as possible and start treatment.  But, as I said above, Dr. Carson's reaction was to deny the evidence before him.]

Go-To-Guy:  "It is very real, it is not in your head, and yes, you have it. I'm so sorry."

Why am I ruminating on this bad stuff today?  The mail.  In one large envelope, I received a copy of the labs and my "current problem list" from The 17-Minute Uh-Huh.  In another large envelope, I received a copy of my records from the neurologist I can no longer see -- the Hawaiian-shirt sporting genius, in shorts and Birkenstocks mid-winter, who made the "official" CRPS diagnosis in 2003, who ranted and raved about the cover-up operation put into play by Saint Joseph's Hospital of Atlanta, Dr. Doo-Doo Head, with the ample and able assistance of Doctors Leslie Kelman and Steven Sween.

This Stylish Neuro-Guy, seeing my confusion (at that point, pure fatigue), had grabbed a big book, what we love to call a tome, dedicated in its entirety to CRPS / RSD, and flipped to the big, bright, colored photographic section... and there I was.  "See!  This could be you!" He even loped out to the waiting room to drag a sleepy Fred into the exam room.  "See!  This could be her!"

No, that's not how it reads in the medical records.  There, I am an "unfortunate woman." There, I am diagnosed clearly with causalgia, not RSD -- or in the modern parlance, with CRPS Type II.  Why does it matter?  Ultimately, it only changes a bad attitude.  Doctors who still resist the diagnosis of "RSD" will sing a different tune if you change the name to "causalgia." And there are those who do the same if you say, "I've CRPS Type 2, not Type 1."  The difference relies on the identification through EMG, or nerve testing, of nerve "lesions" as the cause of the neuropathic pain in the path of that nerve. Stylish Neuro-Guy identified three separate nerve lesions, two in my right leg, and one in my left forearm -- the original sites of injury.

It's not a cause for rejoicing, this shift in designation.  In any event, now I have both Type 1 and Type 2, as the disease spread from left arm to right, and right leg to left.  The facial involvement was God's private joke.  But there were times I might have been able to shut up some Talking Irritant by producing the EMG results.  It never occurred to me to get copies, as the "treatments," or lack thereof, are the same, no matter the type.  Causalgia / Type II is taken more seriously because it has demonstrable proof, and, I guess, because its "outlook" is more dire.

So that's why this is all spinning in my head.

Because here I am again... reinventing the wheel with "Oh, yes!  Something Sympathetic Something!" and referrals to the same orthopedic surgeons who have already tried their damnedest to save my bones, likely infected at the time I "acquired" CRPS.  Oh, to take that moment back.

Here I am, still fighting bill collectors who are calling to grab illegal "balance billing," stuck in a wheelchair and a freaking hospital bed, reliving the diagnosis with each newbie doctor, repeating tests that do not need repeating and that has done nothing but grind, grind, grind in the reality I'd be best served to forget.

My new Primary Care Physician, The 17-Minute Uh-Huh, still has CLPS listed as Number One on my Problem List. I wonder what that stands for?  A quick search turns up:

CLPS Colipase Pancreatic
CLPS Closest Lattice Point Search
CLPS Criminal Law Policy Section (Canada and Australia)
CLPS Calibration Lamp Power Supply
CLPS Common Logic with Power Supplies
CLPS Center for Logic and Philosophy of Science
CLPS Crumpsall Lane Primary School (UK)

I'm going to go with... "Common Logic with Power Supplies." I definitely have huge problems with common logic, and power supplies?  Don't get me started!

So, heck yes, my mocking detractors, I will forego my one Diet Ginger Ale a day, consider halving my coffee intake, eat canned tuna in lieu of fresh tilapia, cut off television service, sell whatever I have left to sell (a food processor, meat grinder, and a snazzy fondue set), to pay for access to Go-To-Guy, my concierge practitioner, who knows to ask permission before touching the thing attached to the purported limb adjacent to my rotting right hip.  He's my back-up, my reassurance.

He's Go-To-Guy.



2013 L. Ryan
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My First Use of Obamacare: Two Thumbs Up

Dear President Obama:

I thought you might like to know how my first use of "Obamacare" coverage, obtained through HealthCare.gov, went, and whether it was, in general, a thumbs up or down situation.

Two thumbs way up, sir!

I saw one of my new doctors on Tuesday. Due to electronic transmission of records, my daunting list of 20 medications preceded my arrival, so figuring out which ones required immediate renewal was easy.  I needed x-rays of my decrepit bones and got them, immediately - while  my prescriptions were filled.

I mentioned to the doctor that my former internist wanted me to have a hospital bed, with a trapeze (I've always wanted to be one of the "flying Wallendas"!).  I try to follow the Rule of Threes when I see a doctor and only mention 3 concerns or needs.  More than that can be overwhelming.  So, though I mentioned the bed and trapeze, I was not sure he even heard me.

Guess what is arriving at my home this afternoon? That's right!  A hospital bed with trapeze. Two days after mentioning the need in passing, almost under my breath, and voilà.

While writing this letter to you, I got a phone call, scheduling my first appointment with a pain management doctor in March.

I was treated courteously and professionally at every turn.  There were no flashing lights over my head announcing "Obamacare recipient, receiving tax credit assistance with her premium, despite enough medical problems to bankrupt the entire nation." None of that!

I filled 5 prescriptions for $75. I paid a $30 co-pay to see the doctor.  There will be a rental fee for the bed/trapeze, but it goes toward my reasonable deductible.

It almost feels like America again.  I don't feel like a "taker," or someone having great fun with "entitlements." I am paying my fair share, and struggle to live within my means.  I am a "permanently and totally disabled" French prof, who gladly would give up hospital bed and wheelchair to stand in a classroom again, sharing, helping, guiding, working.

This was certainly not how I envisioned things turning out.

It's my birthday tomorrow and this is my first "thank you" note: for the gift of "Obamacare" and the ACA, for the gift of people who listen and hear, for the many people who make a tough life tolerable.

Anyway, that's how my first use of my new coverage worked out.

Excellent work, Mr. President, and thank you.

© 2013 L. Ryan

Dear President Obama: My Experience at the HealthCare.gov Marketplace

Hail to the Chief we have chosen for the nation, 

Hail to the Chief! We salute him, one and all. 

Hail to the Chief, as we pledge cooperation 

In proud fulfillment of a great, noble call. 

Yours is the aim to make this grand country grander, 

This you will do, that's our strong, firm belief. 

Hail to the one we selected as commander, 

Hail to the President! Hail to the Chief! 

Dear President Obama:

Every nerve ending in mine body is frayed, frazzled.

I began the search for coverage via the HealthCare.gov website promptly on September 13.  I know, it didn't go into effect until October 1, 2013, but I was anxious.  At that time, there was but a single insurance company in the bustling marketplace and since easily distraught, I became distraught.  Which led me into the arms of a very nice, calm, optimistic "navigator" -- our helpmates through this process -- Bill Rencher of Georgia Watch.

[Four Ruffles and Fluorishes for him, too!]

Since 1 October, I've been pestering the website dozens of times a day and receiving nothing but the the most polite error messages ever seen in cyberdom.  Repulsed, refused, unrecognized, I had about given up hope, despite the reassurances that the bugs in the system were slowly but surely being smushed into little bug pieces.  A carapace here, long sticky legs there, bulbous eyes strewn about.  Exoskeletons piling up, and with the government shut down, no one to sweep up the entomological detritus.  I say send 'em all to "Cry Me A River" Boehner.

Usually, Mr. President, I give no hints as to my political persuasions.  Yes, I used the plural, for like Whitman I contradict myself, I am large, I contain multitudes.  Ahem.

This morning, at 5 am, revolted by the idea of getting up to do something profitable for the domestic brood around me, I grabbed the computer and hit HealthCare.gov with something like a vengeance, but definitely with weepy eyes and no coffee.

After diddling around a bit, I created a new profile, ditched the old one, and kaboom, shazaam, wowza -- I was in!  Then I screwed up and had to call one of those blessèd telephone helpers, who was also confounded but wished me well.  I think, Mr. President, that she ended up helping out somehow, for a mere half-hour later, the glitch slid into the background of things.  It didn't disappear, but I was able to navigate from screen to screen and ignore the hell out of it.

Navigator Rencher, who helped calm the waters in September, had made several predictions about what my best options might turn out to be, coming from the Affordable Care Act's PCIP program, which ends precisely on 31 December.

He was right on all counts.  If I take up gambling, I'm bringing him with me to the racetrack.

If I could sneak past the First Lady and give you a prim kiss on the forehead, I'd do it in a heartbeat.  But what with all the shooting going on up there, they'd drop me with a head shot, for sure. (Gun control, anyone?  No destruction of the Second Amendment, just no guns for crazy people, registration and permits for all, no assault weaponry or accompanying ordinance, and equal restraint from law enforcement, including the Secret Service and Capitol Cops)

Since I doubt you'd break out into any Al Green on my account, I'll just say this here, in the safe haven of a nondescript blog:  God bless you, and thank you, President Obama.  I am a person with loads of physical woes that are constantly ganging up on my meager finances and limited sanity -- I worry, you see.  I don't want to be a victim, or whine about entitlement.  I don't want to bankrupt this good country.  But damn it, I need help.  My entire work life was dedicated to turning out well-educated citizens, both at university and at the proverbial "urban" high school level. I put my life at risk substitute teaching for the little ones, too, those cagey rug rats!  And I worked in Middle Schools where my status as a rube spread like wildfire, and the tweens often had me cornered between desk and blackboard, forcing me to throw chalk and lob erasers as a distraction.

In all seriousness, I had my life threatened and a student broke my hip in an attempt to escape capture by the kind and courteous police-people chasing him.  When I came back to work, one of my homeroom seniors stole my walker. To this day, I am convinced he was simply finding a novel way to encourage my physical therapy progress...

I was a GREAT teacher, Mr. President.  I loved my subject, I instilled a love for it in whomever the registrars put before me, and my students reveled in the concept of critical thinking and superb writing.  I'm just sayin'.  But these days, living on 60% of my year 2000 salary, no adjustment for the crazed costs of living, I need a little help.

Ted Kennedy would be bear-hugging you about now.

That website is going to drive many a USAmerican bonkers.  People unfamiliar with the terminology and the mathematics of health insurance are going to be breaking the backs of the Emergency Departments around the country as their heads begin to explode. I hope that was worked into the cost analyses.  But, like me, they will figure it out.  They will work with the outstanding navigators in their area, the phone wizards with infinite patience, and the online tech folk who speak plainly and make real suggestions -- even if those suggestions are initially aggravating.

I am now insured -- including a separate basic dental policy -- for less than what ACA's PCIP (a wondrous creation, that!) was charging. There's a whopper of a deductible awaiting me, and some nasty negotiations over medication formularies, and a doctor to switch out (but I've been secretly wanting to lose his Hoity-Toity-ness for some time, anyway).

And then there's the fear that this is all a dream.  That I filled something out wrong.

If I could throw chalk at a few Republicans for you -- I'd be up there in a minute.  But again, Mr. President, I don't want my pedagogical corrective measures to be misconstrued as some sort of attack, thereby ending my entretien with the GOP by a bullet square between my eyes.

Anyway, thanks.

You've done a great thing.

Sincerely,
Me and all the Gang at Marlinspike Hall
Tête de Hergé
(West of the Lone Alp)

P.S.  Should you and your family ever need access to an unmappable, unflappable resort that is impervious to GPS systems, Captain Haddock has ordered us to keep one of our finest wings ready.  He has even offered to ferry you here past the sharp eyes of your protective service, courtesy of an inexplicable undersea network of blackholed miniature submarine passages, all of which end nicely in our moat.

P.S.S. I decided to repost, just under this new letter to you, an older one, so as to aggrandize the scope of my experiences with obtaining heatlh insurance under your administration.  Let's call them bookends.  There are other mentions of you throughout this blog, as you've probably surmised.  My apologies for some of them.  There is even a shot of you in a video made at one of my lowest moments, but even that connection made for a "sí, se puede" rallying cry.

© 2013 L. Ryan

The Affordable Care Act: Info on PCIP (And Some Whoop Ass Thunder Rumble!)

The article below this garbled prologue was written by the good folks at PCIP.  I can attest to its accuracy, having purchased this coverage beginning with its very first month of availability in July 2010.

If I could add anything, it would be to plead with people who feel a responsibility to accuracy to understand that the PCIP program is in no way a charity or an entitlement, and that it is run in an admirable "tight-ship" sort of way under the auspices of GEHA.  My premium has been lowered TWICE since July 2010.  It started out at well over $400/month and is now $338/month.

I have even drooled with appreciation at my exposure to actual customer-oriented customer service representatives, each of whom quickly and efficiently answered my questions and cut through the inevitable red tape of a brand new insurance program.  It helps, I'd assert, that the precepts under which these customer service types work make efficiency easy, as a common sense of fairness seems to be the guiding principle.

Why *yes*, the ACA was created by mostly the same idiots we watched screw the pooch a few weeks ago in their criminal attack on The World Economy.

Screw the pooch is a particularly vile militaristic expression, popularized by Tom Wolfe in the novel, and subsequent film, The Right Stuff:

But now - surely! - it was so obvious! Grissom had just screwed the
pooch! In flight tests, if you did something that stupid, if you
destroyed a major prototype through some lame-brain mistake such as
hitting the wrong button - you were through! You'd be lucky to end up
in Flight Engineering. Oh, it was obvious to everybody at Edwards [Air
Force Base] that Grissom had just f*cked it, screwed the pooch, that
was all.

For those of you fascinated by my constant dabbling in dirt, I did some research and it turns out that the  original form of screw the pooch was fuck the dog.

Umm, also integral to your understanding of the Affordable Care Act, Obamacare, is the distinction between screw the pooch and fucking the duck, though one might be considered the governmental correlative of the other. You'll see this explained in the commentary to the pertinent Jennifer's History and Stuff blog post:

Custer screwed the pooch. Wasting time is another quite profane term. It's 'fucking the duck'. There is, or was, a difference. Nobody buys the farm from fuckin' the duck.

Well, not so.  Had President Obama fucked the duck and given up on any meaningful health care reform legislation, thereby effectively screwing the pooch,  I would likely have bought the farm, as a result.

I'm just sayin'.

And, of course, on to what *really* matters, which would be my actual reference underlying that trite and overwrought "The World Economy" nonsense: the completely undeserved assault-and-battery on Haddock family equities! The Haddocks, they ARE the world!  I mean, if no one takes care of the Haddocks, how will The Captain take care of me and Fred, as well as tend to the upkeep of the miniature Wimbledon All English Lawn Tennis Clubbery? Not to mention seeing to the hygiene of the garderobes of Marlinspike Hall, so necessary to the success of ManorFest?  Infrastructure, people, infrastructure!  Oh, God, just the thought of next year's percolating strains of moat algae...




{hum, hum, hum}

What? Oh.  Right!

To prove my assertion that Obamacare is not Welfare, here's a screen capture of the details of what *I* have paid out in deductible, co-pay, and out-of-pocket expenses (NOT including pharmacy costs).  So the next time someone yammers about "socialism" and "entitlement" in reference to the watered-down health care bill that the President spearheaded, refer them to my actual costs.

What is it, then, if it isn't some welfare "ripoff" perpetrated by a bunch of whiners?  It's FAIR.  My costs are exorbitant -- not so much this year as in the past three when we were actively attempting to stop the infection in my joints and long bones, but still, they are higher than most people's average medical expenditures.  The difference is not some sense that I am deserving or "entitled," no!  The difference is that I am actively *sick* and also deal with severe disabilities and pain brought on by a progressive neurological disorder -- to such an extent that when I was priced out of my private BCBS coverage, no one would offer me a policy.  That's the foundational requirement for eligibility in PCIP -- to have been so rejected!

Medical plan detail

Close window

	In network deductible	Out of network deductible	In network out of pocket	Out of network out of pocket
Current medical plan limits	$2000.00	$3000.00	$5950.00	$7000.00
Accumulated to date	$2000.00	$2098.88	$5950.00	$2199.22

BCBS of Tête de Hergé ended up raising my premium three times in 2009, and finally demanded $1513/month, with a $5000 deductible.  They had also begun to refuse to pay for services that were clearly covered, dragging their feet and making my tending hospitals and physicians request payment many times before moving on to some other delay tactic.

One of my favorites, as well as least-mentioned around here, because it renders me unusually apoplectic, was their assertion that I received not one, but two (and a year apart) policy booklets that had an unfortunate misprint.  That misprint concerned the lifetime cap to my coverage.  My two, year-apart copies both said $5,000,000.  BCBS said, "Au contraire, ma chère!  That was supposed to be $2,000,000." They also scoffed -- in writing, if you can believe their hubris -- at my concern about it, saying that most people wouldn't even have an issue about it, as most people don't max out of 2 million in coverage (negotiated coverage, at that!).  Well, of course, I did.  Max out, that is.  They really do count on us being total hebephrenics.  They do not anticipate things like me turning it all over to the Tête de Hergé Insurance Commissioner... who promptly collected a whole bunch o' "misprinted" policy manuals, including many in their own holdings.

Towanda!

But though they'd lose an occasional battle ("Corporations are people!"), BCBS won the war.  It was highly stressful for all concerned.  It did not exactly improve my health to go a year without coverage, during which time I lost a lot of ground trying to stomp out osteomyelitis. Self pay the $2000+ monthly pharmacy costs for daily meds?  Not likely! Self pay for six weeks of intravenous vanco?  Ya think?  Self pay for removal of a prosthesis and implantation of an antibiotic-laced spacer?  Really?

So... FAIR, to me, is right.  FAIR, to me, is good.  If you must beg to differ, let me know.  We'll talk about it.  Personally, I was profoundly disappointed in the ACA, as the only truly just legislation would have included a "public option."  [Now you may throw words at me!]  To thoroughly confuse you, so long as this country follows the confusion of corporate models with a belief in personal liberty? I am pissed at the people who refuse to pay for coverage but want me to make their health a priority. Who whine and whine about it but don't consider turning off their internet, television, or phone -- who don't move to a more affordable living space -- who consider abusing emergency room services their righteously righteous right, who will pay through the nose for vet services but not "people" assistance. Who eat out on a regular basis, who pay for cigarettes, who put drugs up their nose and in their veins, alcohol in their stomachs and livers, but don't think twice about channeling all that money into health care.  I don't understand people who will not live within their means and are willing to drag others down with them -- children, grandchildren, spouses, live-in lovers -- and us, their neighbors, who end up footing their bills and seeing our own go up as a result.

What truly devastates me?  Watching the mindset passed on to successive generations, watching the belief in the possibility of a better life get actively squashed as a result of a hundred daily decisions to do what is easiest but not best.

Anyway.

Before you have a cow thinking I've betrayed my socialist beliefs -- I've not.  See my original assumption which begins "[t]o thoroughly confuse you, so long as..."  I want that assumption/assertion to change.  But so long as I am stuffed into this ridiculous box of USAmerican denial, yeah, I'm going to go all right wing on your uninsured asses.  Snort!

What's that?  You would if you had a job?  You would if there actually were affordable housing?
My point, exactly.

So "gentle butterfly hugs" all around!  Shazam! [Which is, according to the democratic Wikipedia,  "onomatopoeia for thunder rumble."]


Thunder Rumble!

Please pass this info on to anyone you know who might benefit from it. Thanks!

[If you don't think such people exist in your sphere, well, Towanda, snort, shazam, and thunder rumble.]

***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ 

PCIP offers health coverage, even if you have a pre-existing condition
Many people who have been unable to get health insurance can now get coverage through
the Pre-Existing Condition Insurance Plan (PCIP), created under the Affordable Care Act.
PCIP is provided through the U.S. Department of Health and Human Services and
administered by the Office of Personnel Management through GEHA in more than 20
states.

Choose the plan that fits your needs
PCIP has been improved for 2011, with better premiums, better benefits and a greater
choice of plan options. PCIP enrollees can now choose from three plan options, with
different levels of premiums, calendar year deductibles and prescription copayments. The
HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt
account where you can deposit funds for eligible medical expenses.

Each of the three PCIP plan options provides preventive care (paid at 100%, with no
deductible) when you see an in-network doctor and the doctor indicates a preventive
diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer
screenings. For other care, you will pay a deductible before PCIP pays for your health care
and prescriptions. After you pay the deductible, you will pay 20% of medical costs innetwork.
The maximum you will pay out-of-pocket for covered services in a calendar year is
$5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the
amount the plan pays for your care.

Each of the three PCIP plan options:

Includes all covered benefits, even to treat a pre-existing condition, immediately from
the date coverage begins.

Covers a broad range of health benefits, including primary and specialty care,
hospital care and prescription drugs.

Does not charge a higher premium to individuals with medical conditions.

Does not base eligibility on income.

Are you eligible?
To be eligible for the Pre-Existing Condition Insurance Plan, you must be a citizen or
national of the United States or residing in the U.S. legally, have been uninsured for at least
the last six months, and have a pre-existing condition or have been denied coverage
because of your health condition.

Want more information?
Health care options in all states: www.healthcare.gov
PCIP administered by GEHA: www.pciplan.com, (800) 220-7898
To apply for the Pre-Existing Condition Insurance Plan: (866) 717-5826

USAmerican Style

The price of an extended period of fairly rigorous physical activity, for me, has been some challenging pain, pretty doggone severe edema, and evening flares that include moderately high fevers.  I was tossing back ibuprofen tablets with wild abandon until my stomach rebelled -- not just against the NSAID, but in profound rejection of the antibiotic and prednisone, as well.  The evening I took all three at the same time was brilliant.

"Oh, oh," was the extent of my commentary that evening.  I did the old nibble-on-crackers routine but in the end opted for that god send, zofran.  Generic zofran, to be precise -- ondansetron. 

That stuff is expensive.  Even though blessed with insurance now, I quiz myself closely before allowing myself to dissolve one under the tongue. 

During the period of time that I was uninsured, roughly a year, I was most worried about being able to afford my medications.  I found that, with some hard work researching drugs, prices and myriad details, there are tolerable alternative choices and affordable price tags.  The amount of cost-cutting that we were able to do was amazing. 

Why, then, cannot the insurance companies do the same?  I have tried hard not to revert to laziness now that my costs are again covered -- and I tell every doctor I see that I want them to please continue that work, as well, to keep costs of medicines, tests, and treatments within the Realm of Reasonable.  Still, convenience, like gravity, tends to win out and there are times I simply don't care about details, lost as I am in the forest of trees.

[That was the confessional moment for today.]

I found a 2008 article about a 12-year-old with cancer and her family.  She relied a great deal on Zofran/ondansetron during her course of chemotherapy but her parents struggled with the price, not covered by insurance for some reason.  It may have been because her need for the drug exceeded the amount considered acceptable by some bean counter, some Seinfeldian Zofran Nazi.  No Zofran for you!  Their outrage was compounded when they discovered the tremendous disparity in pricing among pharmacies.  $502 for 20 pills was the first price they paid.  After shopping around -- something very advisable, sure, but not always practical or possible -- they filled the identical prescription for $32 elsewhere.  The article, by an investigative reporter for Portland's KATU, didn't garner much notice -- perhaps because the news in it was not new or at all pleasant to think about -- but the two comments it did get made me snicker.

That's right, snicker.  Arched lip, one flared nostril, a bad attitude.  The first person related a similar experience of price gouging over Zofran/ondansetron, then ranted about boycotting the pharmacy with the highest price. 

I get pissed off easily at USAmericans.  All the blither and blather about "Obamacare" and the evils of socialism, of the left.  Yet, put someone in a situation that is purely and pristinely (i.e., nonsensically) controlled by the much-vaunted conditions of The Market, and it's Whine Time.  Big Pharma and its underlings are simply charging what The Market will bear. 

What?  Oh.  I see.  That's fine when we're talking about something pharmaceutically elective, like an antidepressant (you know, for the guilt ridden liberal without sufficient character to just will himself out of the clinical blues).  That'll work for the floozy leftist feminist who doubtless relies on a near constant supply of antibiotics to fight her slew of sexually transmitted diseases... but in the case of an emergent situation -- say, the upper-middle-class child with a fever of 105 and a proven-by-culture strep throat?  Well, everyone knows that in that case, the pharmacy and the drug company have no right to profit. 

Is health care a special category in capitalist economic systems?
How about foodstuff?  Fuels?  A public education?  Your Mama?

Within categories, do we distinguish between dramamine and ondansetron, insulin and subsidized wellness center memberships, a respirator for me and a respirator for you?  Should my tax dollars buy your family a bag of apples but not, perhaps, applesauce?  A ValuPak of pre-seasoned, pre-battered formed fish fillets versus 3 pounds of fresh extra jumbo black tiger shrimp?  Shall we foot the bill for advanced placement U.S. history classes but draw the line at world history and ESL? Should physical education and recess be done away with in elementary programs to make time for sex ed and the testing instruments -- as determined by best practices -- that monitor our declining achievement?

The Evil Me wants to scream "caveat emptor" to anyone on the right wing complaining about being gouged by their monthly health insurance premium or by the price of their cholesterol-modifying meds and Viagra.  If we fiscally retarded leftists, dipping our wriggling Birkenstock-bred toes in greeny socialist ponds, have to continue to dress up our concerns in the besotted falsehoods of capitalism... well, I'm just gonna spit. 

What am I talking about?  I am talking about how change must be made palatable to be made possible, how if I call you a "capitalist tool," that is widely taken as a good thing and not a cutting disparagement.  Our conversations, such as they have been -- our chatter, really -- about race and gender, have had to be held well outside any context of economic or class analysis, no matter how prevalent or instrumental that context.
Liberal idealism marginalized Marxism, dancing from Marx to Weber...

Oh God, now I have a headache.
You, too, no doubt.

It's just that I feel shut out of important conversations because people are afraid of my favorite words, and like I said, now I just wanna spit.

Yeah, so I don't feel so good at the moment and apparently, I am a little bit crabby, too. 

We love the new floors, my wheelchair, especially, and I've softened up as much of the space as I can by the swift purchase of  seven area rugs.  (I find purchasing swiftly reduces some of the pain inherent in such shopping -- much as a duct tape gag needs a fast and merciless yank to avoid excessive discomfort.)  Left to my own devices, I'd have chosen some far out designs and gone wildly into colors.  Knowing that everything had to pass Fred Muster and not be repellent to any living Haddock, however, I ended up with seven woven testaments to all that is neutral, resistant to dirt, and immune to cat piss.

I find some small comfort in the fact that I, alone, am driving the economy.

Yay, me.  Where'd I stash that Zofran? (Only 5 more days of antibiotics.  For my BONES, damn it!  For my bones...)