Susan Sontag is the one who alerted us we should pay attention to the way people talk about illness and, by extension, their bodies. It’s no doubt to her I owe my mind’s wanderings after talking to two friends on medical diets who each delighted in telling me what they were allowed. When my mother was diagnosed with diabetes, our household lived in fear of what was forbidden.
In some ways, the different responses are similar to how people notice if a glass is half full or half empty. They indicate states of mind that outsiders roughly translate into optimism or pessimism, happiness or sadness, tranquility or depression. Beyond that, they indicate how people react to limitations and how those reactions affect their long term health.
The first woman has been overweight as long as I’ve known her and seeing specialists who tried to help her deal with a diabetic condition with diet. To no avail. She remained overweight but constantly talked about what she was told to do.
When I noticed it looked like she had lost weight, she said she had recently had her gallbladder and uterus removed. She was now fully diabetic, and again she told me about what she was allowed to eat. In addition to her three meals, she believed she could snack all day on nuts. It was in this context that she said she was allowed so many nuts a day and had them stashed in different places in her office. She sounded like a happy gerbil who didn’t pay attention to the warning that she could only eat so many calories a day, composed of foods from the list. She took the list to be a list of what was permissible within her traditional dietary patterns and was always confused that nothing ever changed.
The second woman has also been overweight as long as I’ve known her, and suffering from stress or emotion triggered symptoms like severe rashes. At one time she was told she was pre-diabetic, and I remember then she shopped the internet until she found some kind of bran muffin that tasted good and met her dietary restrictions. She allowed herself one in mid-morning.
Her conditions never really change. When I saw her this time, she mentioned all the medicines she was taking and noted she was back on Prozac. This time she has a gluten allergy which limits what she can eat, but it was when she was discussing her dietary list and mentioned what kind of chocolate she was allowed, that I asked was she still pre-diabetic. She looked at me as if she didn’t understand the question.
I was about five when my mother was diagnosed with diabetes. At the time, the early 1950's, diabetics were put on strict diets. She ate a poached egg and whole wheat toast every noon. Our dinners usually were some meat leached of all fat (and nutrients) and boiled, canned vegetables, usually peas, corn or string beans. When I later talked to other diabetics and learned even corn and peas were too starchy, I realize my mother’s condition was serious enough to warrant giving herself a daily shot of insulin, but not severe.
Like many diabetics, she was obsessed with the forbidden, and would indulge in fudge or other chocolate when she thought she could. She looked on the times my father was away on business as periods of freedom when we could go to the local drive in. Still, she had some kind of internal monitor because I only remember a few times when her biochemistry was off and she needed a quick dose of orange juice.
The difference between focusing on what’s permitted or what’s forbidden, however, may be more than a difference of individual psychology. Since I was a child, organizations representing diabetics and individuals like Mary Tyler Moore have been arguing that diabetes is a disease that can be treated, not some contagious or debilitating condition that requires special handling by society.
I was reminded of the reasons for such campaigns when I got my driver’s license renewed a few weeks ago. The form asked if I was a diabetic, alcoholic, drug user or had heart problems. No one is going to voluntarily admit to being a member of that quasi-illegal group. When I asked the clerk about the reason, he said diabetics might pass out. I didn’t say, so might I if I had a fever and was driving to the drug store to fill a prescription.
There is a profound difference between saying someone with a disease should be treated equally by the Department of Motor Vehicles, and saying they, in fact, are like others. The attempt to convince society to treat diabetics as normal has morphed into a belief by some diabetics that they are normal, and that their dietary lists are simply menu choices not clarions to change behavior.
My working friends will probably outlive my reclusive mother simply because they are more active, but I doubt they’ll live so many years with diabetes. The first women I mentioned is probably around 50, and I’ve heard her complaints about ill-health for about 10 years. The other women is a little older, and she’s been on a physical roller coaster the 15 years I’ve known her.
My mother, although a deeply unhappy woman who died just before she would have turned 60, managed to live 25 years with diabetes with no concerns about her weight and, until her heart attack in her mid-50's, no dramas of physical malaise.
Living with the forbidden may actually have been healthier than exploiting the permitted.
Thursday, December 31, 2009
Sunday, December 27, 2009
South Carolina - Nation State
I didn’t realize until this past year how fragile is the very idea of a nation state. I sat through all those hours of undergraduate history classes dutifully remembering names and events in the Thirty Years War and the Hundred Years War and the Louis of France without much comprehension.
It turns out, this wasn’t all my fault. Steven Pincus believes it was the consequence of an English politician, Thomas Macaulay, who wanted people to think their past had been a bland, inevitable progression from the Magna Carta to the Hanovers who ruled when he was alive.
However, Bernard Bailyn, in his review of Pincus’ new book, argues the second overthrow of the Stuarts in 1688 was the consequence of competing views of a nation state, one dominated by a single man who inherited his position, and one dominated by a merchant elite. While men who favored a state argued about the form, he suggests there were still a great number who simply rejected the very idea of centralized power.
Except for New England, organized by merchants and dominated by Puritan congregations, many of the men who migrated to the colonies still held the medieval view of landed property owners as sovereign. Richard Dunn suggests none of the Caribbean colonies accepted the legitimacy of their proprietors, the Stuarts or Cromwell, and worked through their assemblies to defy any authority. Within the Macaulay tradition, most of these disputes have come to be described as instances of modern Englishmen demanding representation instead of medieval barons refusing to submit.
The proprietors themselves tended to see themselves as medieval barons in the tradition of the Bishop of Durham, Anthony Bek, who was granted extraordinary powers in exchange for protecting England on the Scots border in the late thirteenth century. The Earl of Carlisle, James Hay, demanded the vulnerable Charles I delegate similar powers to raise maintain an army, shire the land, and collect taxes, duties and quit rents in Barbados in 1627 that had been granted to William Alexander in Nova Scotia in 1621.
When Anthony Ashley-Cooper, the most active partner among the South Carolina proprietors, drew up the Fundamental Constitutions of Carolina in 1669 he assumed he had the same powers as Durham to organize the colony. The colonists simply refused to ratify it, and continued to reject every revision. Unlike the colonists who came with William Bradford to Plymouth, they didn’t propose an alternative constitution. They simply rejected any contract for government.
After Ashley-Cooper died in 1683, the Carolina colonists abandoned any pretense of accepting central authority. The large areas of settlement argued with each other, and people within the settlements quarreled among themselves. In 1719, the colonists simply took power from the proprietors and asked to become a royal colony, not for the benefits of order, but to ensure they were legally free of any existing rules or obligations.
Today, we call countries like Afghanistan run by territorial barons cum war lords failed states, when, in fact, like many of the Caribbean and Carolina planters they never entered into the world of nations. It was a fragile concept when James II was trying to implement it, and it remains so today.
Notes:
Dunn, Richard S. Sugar and Slaves, 1972.
Macaulay, Thomas. History of England, 1848-1855.
Pincus, Steven. 1688: The First Modern Revolution, 2009, reviewed by Bernard Bailyn in The New York Review of Books, 29 November 2009.
It turns out, this wasn’t all my fault. Steven Pincus believes it was the consequence of an English politician, Thomas Macaulay, who wanted people to think their past had been a bland, inevitable progression from the Magna Carta to the Hanovers who ruled when he was alive.
However, Bernard Bailyn, in his review of Pincus’ new book, argues the second overthrow of the Stuarts in 1688 was the consequence of competing views of a nation state, one dominated by a single man who inherited his position, and one dominated by a merchant elite. While men who favored a state argued about the form, he suggests there were still a great number who simply rejected the very idea of centralized power.
Except for New England, organized by merchants and dominated by Puritan congregations, many of the men who migrated to the colonies still held the medieval view of landed property owners as sovereign. Richard Dunn suggests none of the Caribbean colonies accepted the legitimacy of their proprietors, the Stuarts or Cromwell, and worked through their assemblies to defy any authority. Within the Macaulay tradition, most of these disputes have come to be described as instances of modern Englishmen demanding representation instead of medieval barons refusing to submit.
The proprietors themselves tended to see themselves as medieval barons in the tradition of the Bishop of Durham, Anthony Bek, who was granted extraordinary powers in exchange for protecting England on the Scots border in the late thirteenth century. The Earl of Carlisle, James Hay, demanded the vulnerable Charles I delegate similar powers to raise maintain an army, shire the land, and collect taxes, duties and quit rents in Barbados in 1627 that had been granted to William Alexander in Nova Scotia in 1621.
When Anthony Ashley-Cooper, the most active partner among the South Carolina proprietors, drew up the Fundamental Constitutions of Carolina in 1669 he assumed he had the same powers as Durham to organize the colony. The colonists simply refused to ratify it, and continued to reject every revision. Unlike the colonists who came with William Bradford to Plymouth, they didn’t propose an alternative constitution. They simply rejected any contract for government.
After Ashley-Cooper died in 1683, the Carolina colonists abandoned any pretense of accepting central authority. The large areas of settlement argued with each other, and people within the settlements quarreled among themselves. In 1719, the colonists simply took power from the proprietors and asked to become a royal colony, not for the benefits of order, but to ensure they were legally free of any existing rules or obligations.
Today, we call countries like Afghanistan run by territorial barons cum war lords failed states, when, in fact, like many of the Caribbean and Carolina planters they never entered into the world of nations. It was a fragile concept when James II was trying to implement it, and it remains so today.
Notes:
Dunn, Richard S. Sugar and Slaves, 1972.
Macaulay, Thomas. History of England, 1848-1855.
Pincus, Steven. 1688: The First Modern Revolution, 2009, reviewed by Bernard Bailyn in The New York Review of Books, 29 November 2009.
Sunday, December 20, 2009
Cost of Staying Healthy
There are times when I think I’m the only one who cares if I remain healthy.
Once I start drawing social security, the actuaries know the sooner I die the less I draw from what I’ve contributed.
Insurance companies certainly don’t want me to stay healthy. If I never had another physical, I could have a heart attack or fall from weakened bones when I’m 75. It would cost someone to treat me, but I probably wouldn’t last long, and my total costs past age 65 will be relatively modest.
As it is, I insist of staying healthy. It turns out not to be a decision many can afford. This year it costs 21% of my gross and 27% of my actual take home pay. The percentages will be slightly smaller when I draw social security.
My health program is simple. An annual physical, which is not covered by today’s medicare part B, supported by blood work which may be covered. Every other year, I see the eye doctor, which is not covered by any insurance option, have a bone density test which is covered by medicare, and a mammogram, which currently is only 80% covered by the government and the rest by medigap J.
The prescription drugs I take are preventive, rather than life sustaining, and in that sense voluntary. In addition, I take vitamins for my bones, including calcium citrate, magnesium, and vitamin D, along with fish oil. They cost something like $30 a month.
I need exercise for my bones and to keep my cholesterol levels low. Only some medicare advantage programs cover the cost of a gym or wellness center. One I used was $30 a month, another $60. I tend to get bored by them, and keep promising myself I’ll do more on my own. Simple walking is supposed to be enough.
Diet is another factor. My preference for dried lentils, rice and frozen vegetables is relatively inexpensive. If I chose the recommended healthy diet with fresh fruits and vegetables, more meat and fish, my food costs would be more than I could afford.
I look at what I pay to stay healthy, and think about an Indian woman I worked with. For some reason, her husband, then in his early 30's, had undiagnosed diabetes. When he finally saw a doctor in August, he checked himself out of the hospital because his mother was ill. By Thanksgiving, he couldn’t walk. When his wife got him to the doctor, his organs were shutting down and nothing could be done. He died before Christmas, leaving two young children.
His death was costly to his family, but only cost insurance programs a few days in the hospital. It may be the ideal for a capitalist concern, but as a child of a diabetic I expect more for myself.
Once I start drawing social security, the actuaries know the sooner I die the less I draw from what I’ve contributed.
Insurance companies certainly don’t want me to stay healthy. If I never had another physical, I could have a heart attack or fall from weakened bones when I’m 75. It would cost someone to treat me, but I probably wouldn’t last long, and my total costs past age 65 will be relatively modest.
As it is, I insist of staying healthy. It turns out not to be a decision many can afford. This year it costs 21% of my gross and 27% of my actual take home pay. The percentages will be slightly smaller when I draw social security.
My health program is simple. An annual physical, which is not covered by today’s medicare part B, supported by blood work which may be covered. Every other year, I see the eye doctor, which is not covered by any insurance option, have a bone density test which is covered by medicare, and a mammogram, which currently is only 80% covered by the government and the rest by medigap J.
The prescription drugs I take are preventive, rather than life sustaining, and in that sense voluntary. In addition, I take vitamins for my bones, including calcium citrate, magnesium, and vitamin D, along with fish oil. They cost something like $30 a month.
I need exercise for my bones and to keep my cholesterol levels low. Only some medicare advantage programs cover the cost of a gym or wellness center. One I used was $30 a month, another $60. I tend to get bored by them, and keep promising myself I’ll do more on my own. Simple walking is supposed to be enough.
Diet is another factor. My preference for dried lentils, rice and frozen vegetables is relatively inexpensive. If I chose the recommended healthy diet with fresh fruits and vegetables, more meat and fish, my food costs would be more than I could afford.
I look at what I pay to stay healthy, and think about an Indian woman I worked with. For some reason, her husband, then in his early 30's, had undiagnosed diabetes. When he finally saw a doctor in August, he checked himself out of the hospital because his mother was ill. By Thanksgiving, he couldn’t walk. When his wife got him to the doctor, his organs were shutting down and nothing could be done. He died before Christmas, leaving two young children.
His death was costly to his family, but only cost insurance programs a few days in the hospital. It may be the ideal for a capitalist concern, but as a child of a diabetic I expect more for myself.
Thursday, December 17, 2009
Tales of Eviction 2
When our tenants start to complain about one another, I have no idea who to believe.
My boss and a friend bought a house to subdivide into three apartments. When they discovered they had different business expectations, they split the investment: my boss took the back yard and his friend kept the house. I handle the rents as a favor.
One of the tenants had worked for us a cleaning woman, but not a particularly competent one. The apartment owner said he might as well keep using her, since he no longer had anything worth breaking.
She reminds me a bit of the stereotypic lace-curtain Irish, only with a Mexican twist. She wants both middle class respectability and to be the hacienda patroness cum catina proprietor entertaining her neighbors. One of the neighbors, who works as a bouncer, simply tries to politely refuse her invitations to sit around and drink on the patio.
The ice cream man’s a different story.
One of our former employees, who has a rental property, sent him to us. He told me he’d planned to have five men in the house, each contributing to the rent, but could only get three. So we got him.
I got the impression that the others worked for him with push carts, while he sold ice cream bars from a truck. During the summer, they got drunk and loud a few times. The woman I think of as Maggie complained, but as the bouncer said, she was also willing to drink with them, until she wasn’t.
I shrugged. What can you expect when you have a group of men living and working together in an unairconditioned apartment in the heat of summer with no women? I was wrong about one thing. At some point, a woman had moved in with the group.
Things simmered along until a few weeks ago when Maggie and her 12-year-old daughter came in to report they’d called the police the night before. They said things were noisy, and when the police arrived, one of the men had a cut cheek. The ice cream man apparently talked back to the police, and spent the night in jail.
The owner of the house called to ask what had happened. Apparently, Maggie had called him in the night to ask permission to call the police.
I talked to the bouncer the next time he came in, and, by then, Maggie was telling his wife and the ice cream man’s woman that it wasn’t she who’d called the police.
He confirmed it had been noisy, and when the police were around he and his wife had stayed low in their apartment.
His wife was told by the ice cream man’s woman that the police had broken in the back window, found the man’s “employees” hiding in the bathroom, beat up the one and fled. The ice cream man then called 911 and got abusive when the police returned with paramedics.
The bouncer was in an expansive mood, and said the ice cream man did have a temper. He’d come to the bar where he worked, and gotten ugly when he refused to let one of the “employees” enter with a fake ID.
He also said the day after the police visit, he’d seen a woman he knew from the bar at the apartment. She’s in her seventies and comes looking to drink and dance with young men. Since she pays the bills and is well-behaved, they treat her as one of the regulars.
Apparently, she’d bought a cell phone for one of the ice cream man’s “employees,” and he hadn’t paid the bill. She was trying to collect money and threatening that, if she wasn’t paid, she’d report them to her brother who works for immigration.
I have no idea what happened that night, but doubt the police were the ones who broke in. My guess is that they were either henchmen for the good-times girl or someone else who’d been gypped and they may have said they were the police to scare people. I suspect the victim was probably the intended target.
Of course, by the time my boss got there to investigate, everyone had moved out and the ice cream man blamed it all on Maggie. My boss went through his male bonding routine, offered him a better apartment for the same rent as an apology, and yelled at me for suggesting he should be evicted.
When the ice cream came to pay his rent, he brought an interpreter to demand the promised two-bedroom apartment. Since the family in the apartment by boss had promised weren’t moving after all, he demanded the one where the abused woman had lived. I told the interpreter that young children lived in that building and he’d already been too noisy for a family building. When she asked how noisy, I mentioned the police.
The ice cream man came in the next day to pay the rent in another man’s name. I rather suspect the interpreter represented the man he’s to whom he promised to rent the second bedroom and the mention of the police was a surprise.
My problems aren’t over. When the bouncer came in with his rent, he said his 12-year-old son had just moved in with him. Maggie’s daughter’s the same age
My boss and a friend bought a house to subdivide into three apartments. When they discovered they had different business expectations, they split the investment: my boss took the back yard and his friend kept the house. I handle the rents as a favor.
One of the tenants had worked for us a cleaning woman, but not a particularly competent one. The apartment owner said he might as well keep using her, since he no longer had anything worth breaking.
She reminds me a bit of the stereotypic lace-curtain Irish, only with a Mexican twist. She wants both middle class respectability and to be the hacienda patroness cum catina proprietor entertaining her neighbors. One of the neighbors, who works as a bouncer, simply tries to politely refuse her invitations to sit around and drink on the patio.
The ice cream man’s a different story.
One of our former employees, who has a rental property, sent him to us. He told me he’d planned to have five men in the house, each contributing to the rent, but could only get three. So we got him.
I got the impression that the others worked for him with push carts, while he sold ice cream bars from a truck. During the summer, they got drunk and loud a few times. The woman I think of as Maggie complained, but as the bouncer said, she was also willing to drink with them, until she wasn’t.
I shrugged. What can you expect when you have a group of men living and working together in an unairconditioned apartment in the heat of summer with no women? I was wrong about one thing. At some point, a woman had moved in with the group.
Things simmered along until a few weeks ago when Maggie and her 12-year-old daughter came in to report they’d called the police the night before. They said things were noisy, and when the police arrived, one of the men had a cut cheek. The ice cream man apparently talked back to the police, and spent the night in jail.
The owner of the house called to ask what had happened. Apparently, Maggie had called him in the night to ask permission to call the police.
I talked to the bouncer the next time he came in, and, by then, Maggie was telling his wife and the ice cream man’s woman that it wasn’t she who’d called the police.
He confirmed it had been noisy, and when the police were around he and his wife had stayed low in their apartment.
His wife was told by the ice cream man’s woman that the police had broken in the back window, found the man’s “employees” hiding in the bathroom, beat up the one and fled. The ice cream man then called 911 and got abusive when the police returned with paramedics.
The bouncer was in an expansive mood, and said the ice cream man did have a temper. He’d come to the bar where he worked, and gotten ugly when he refused to let one of the “employees” enter with a fake ID.
He also said the day after the police visit, he’d seen a woman he knew from the bar at the apartment. She’s in her seventies and comes looking to drink and dance with young men. Since she pays the bills and is well-behaved, they treat her as one of the regulars.
Apparently, she’d bought a cell phone for one of the ice cream man’s “employees,” and he hadn’t paid the bill. She was trying to collect money and threatening that, if she wasn’t paid, she’d report them to her brother who works for immigration.
I have no idea what happened that night, but doubt the police were the ones who broke in. My guess is that they were either henchmen for the good-times girl or someone else who’d been gypped and they may have said they were the police to scare people. I suspect the victim was probably the intended target.
Of course, by the time my boss got there to investigate, everyone had moved out and the ice cream man blamed it all on Maggie. My boss went through his male bonding routine, offered him a better apartment for the same rent as an apology, and yelled at me for suggesting he should be evicted.
When the ice cream came to pay his rent, he brought an interpreter to demand the promised two-bedroom apartment. Since the family in the apartment by boss had promised weren’t moving after all, he demanded the one where the abused woman had lived. I told the interpreter that young children lived in that building and he’d already been too noisy for a family building. When she asked how noisy, I mentioned the police.
The ice cream man came in the next day to pay the rent in another man’s name. I rather suspect the interpreter represented the man he’s to whom he promised to rent the second bedroom and the mention of the police was a surprise.
My problems aren’t over. When the bouncer came in with his rent, he said his 12-year-old son had just moved in with him. Maggie’s daughter’s the same age
Sunday, December 13, 2009
Medicare Part D
Medicare Part D, the program that covers prescription drugs, is a world of Potemkin web sites.
Everyone explains the program has three phases. No coverage for the first $310 and no coverage after $2,830. Another part of medicare takes over after you spend $4,550. The $1,720 between is the infamous doughnut hole where the patient pays everything. Insurance, of course, is available to cover those extra costs.
After that simple information, everything is hidden. The deductible and the doughnut hole running balance counts everything you and the insurance company pay, except the premium.
You know what you pay, without the help of fancy websites. You cannot find out what the insurance company says it pays or, for that matter, if that list price is in fact what it does pay. The excuse is prices change weekly. The real reason may be more nefarious.
I began with the government’s medicare site which ranks plans by zip code. All the rest of the cost information is useless, since it only calculates premiums and co-pays. I discovered there were 47 available plans, of which six had ratings of four stars or more out of five. Those six are offered by four companies. Three charge standard co-pays, and one charges 25% of the unknown drug costs.
I called all four, and asked them to mail information. The one that charges by percent still has sent me nothing, despite two requests. I should note I live in a primarily rural county with high rates of diabetes, alcohol caused accidents and heroine use. While Medicare allows insurance companies to offer rates based on an individual’s health and age, most choose the location option which places me a high risk group. No doubt the one that won’t send information is willing to offer something in other parts of the state, but tries not to offer anything here.
Next, I made a list of the drugs I took in the past year, figured what I paid currently, and what I thought the actual insurance company cost was, based on one of those websites that list costs for Canadian and American sources. I used the numbers it listed for CVS drugstores.
Every month I need a bone density drug that’s listed as tier 2. I currently pay $30 a month, and the drug website listed it as$104, or roughly 29%.
Almost every month I need a hormone replacement that’s listed as tier 2. Again, I currently pay $30 a month and it was listed as $104.71, and again I now pay roughly 29%.
Those two drugs alone would cost $2,520 for a year, just $310 less than the coverage cut-off. Any other drug requirement would take me into the area where I paid everything again, unless I paid a much high monthly premium.
Because of serious muscle problems this past year, I took Celebrex and expect to need to buy it maybe six times in the coming year. My insurance company only grudgingly authorizes the use of the anti-inflammatory after the doctor writes a letter showing any alternative would cause serious stomach problems.
My co-pay was $55, and my local drug store couldn’t tell me in fact what it would cost me if I didn’t have insurance. The listed price for the tier 3 drug ranges from $50 a month in Canada to $122 for the American company I’ve been using as a standard. However, I suspect the number is much higher.
One medicare part D plan charges $42 for Tier 2 and $90 for Tier 3, with a monthly premium of $34. The total cost per month is close to $208, with no deductible.
The second provider charges $38 for Tier 2, $73 for Tier 3, and a monthly premium of $33, for a rounded monthly total of $183. If I allocate its $180 minimum deductible for the year, the monthly rate rises to $198.
The third charges $33 for Tier 2, $90 for Tier 3, and $47 a month, for a total of $202, with no deductible.
If price alone could be calculated, the choice would seem simple. However, I’ve never heard of the people who provide the second plan and only know they’re in Texas, while the others come from people with reputations, AARP and a national drug chain.
Since losing coverage when one reaches the doughnut hole depends on what the companies say they pay for the drug, everything ultimately depends of their veracity. One, AARP, has a plan that will cover the gap between Medicare and catastrophic coverage, and the premium difference is $556 year. It’s only worth it if the cost of drugs is greater than that. Since I can get no reliable information on Celebrex, I have no idea how much I would spend.
Once I go through a year on Medicare, and get the periodic statements that indicate exactly what the drugs cost, I can make a more informed decision the following year. However, the first year is an absolute blind pig shoot.
Everyone explains the program has three phases. No coverage for the first $310 and no coverage after $2,830. Another part of medicare takes over after you spend $4,550. The $1,720 between is the infamous doughnut hole where the patient pays everything. Insurance, of course, is available to cover those extra costs.
After that simple information, everything is hidden. The deductible and the doughnut hole running balance counts everything you and the insurance company pay, except the premium.
You know what you pay, without the help of fancy websites. You cannot find out what the insurance company says it pays or, for that matter, if that list price is in fact what it does pay. The excuse is prices change weekly. The real reason may be more nefarious.
I began with the government’s medicare site which ranks plans by zip code. All the rest of the cost information is useless, since it only calculates premiums and co-pays. I discovered there were 47 available plans, of which six had ratings of four stars or more out of five. Those six are offered by four companies. Three charge standard co-pays, and one charges 25% of the unknown drug costs.
I called all four, and asked them to mail information. The one that charges by percent still has sent me nothing, despite two requests. I should note I live in a primarily rural county with high rates of diabetes, alcohol caused accidents and heroine use. While Medicare allows insurance companies to offer rates based on an individual’s health and age, most choose the location option which places me a high risk group. No doubt the one that won’t send information is willing to offer something in other parts of the state, but tries not to offer anything here.
Next, I made a list of the drugs I took in the past year, figured what I paid currently, and what I thought the actual insurance company cost was, based on one of those websites that list costs for Canadian and American sources. I used the numbers it listed for CVS drugstores.
Every month I need a bone density drug that’s listed as tier 2. I currently pay $30 a month, and the drug website listed it as$104, or roughly 29%.
Almost every month I need a hormone replacement that’s listed as tier 2. Again, I currently pay $30 a month and it was listed as $104.71, and again I now pay roughly 29%.
Those two drugs alone would cost $2,520 for a year, just $310 less than the coverage cut-off. Any other drug requirement would take me into the area where I paid everything again, unless I paid a much high monthly premium.
Because of serious muscle problems this past year, I took Celebrex and expect to need to buy it maybe six times in the coming year. My insurance company only grudgingly authorizes the use of the anti-inflammatory after the doctor writes a letter showing any alternative would cause serious stomach problems.
My co-pay was $55, and my local drug store couldn’t tell me in fact what it would cost me if I didn’t have insurance. The listed price for the tier 3 drug ranges from $50 a month in Canada to $122 for the American company I’ve been using as a standard. However, I suspect the number is much higher.
One medicare part D plan charges $42 for Tier 2 and $90 for Tier 3, with a monthly premium of $34. The total cost per month is close to $208, with no deductible.
The second provider charges $38 for Tier 2, $73 for Tier 3, and a monthly premium of $33, for a rounded monthly total of $183. If I allocate its $180 minimum deductible for the year, the monthly rate rises to $198.
The third charges $33 for Tier 2, $90 for Tier 3, and $47 a month, for a total of $202, with no deductible.
If price alone could be calculated, the choice would seem simple. However, I’ve never heard of the people who provide the second plan and only know they’re in Texas, while the others come from people with reputations, AARP and a national drug chain.
Since losing coverage when one reaches the doughnut hole depends on what the companies say they pay for the drug, everything ultimately depends of their veracity. One, AARP, has a plan that will cover the gap between Medicare and catastrophic coverage, and the premium difference is $556 year. It’s only worth it if the cost of drugs is greater than that. Since I can get no reliable information on Celebrex, I have no idea how much I would spend.
Once I go through a year on Medicare, and get the periodic statements that indicate exactly what the drugs cost, I can make a more informed decision the following year. However, the first year is an absolute blind pig shoot.
Friday, December 11, 2009
Tales of Eviction 1
Renting apartments for my boss makes me feel like a pastor doing marriage counseling, without the authority to recommend caution. Couples come to me, full of hopes for their relationship, only to be evicted a few months later because dreams aren’t enough.
Our most recent pair was an aunt and her niece who had returned from California with a young baby to start over together. The older woman had been laid off as a therapist for the elderly when the recession meant fewer people could afford to have an outsider help them with their parents, and the charitable organization that employed her had laid off five of its six caregivers. The women thought her unemployment and the girl’s earnings as a pharmacy tech would be enough.
Before they made the last installment on their move in rent, I got a call from one of the neighbors in the building explaining why he’d called 911. He’d seen the young baby and when he heard someone screaming “my baby’s dead” over and over, he acted.
The older woman came in the next day with the rest of the rent money. She was dressed badly and couldn’t stop crying. The baby in question was her son, the same age as the niece, who had died in a treatment facility. Apparently, they notified her when she was alone, and she went mad, banging the walls and screaming. The police got someone to sedate her.
I’ve learned nothing about the mother-son relationship, if he was a young man led astray by bad friends, or if the family was dysfunctional and the woman or the boy’s father had been an alcoholic or drug user.
All I know is the woman had no intention of getting over his death. If I even hinted she looked a little better, she took umbrage. She attacked her daughter when she wasn’t grief stricken enough, then kept the boy’s ashes in her bedroom to console at night.
The woman had no medical insurance, and broke an arm and several teeth when she fell down the back step, if that’s what she did. One of her comments made it sound like she had run out the back door and smashed into the concrete block yard wall some 25' away. Soon after she was taking oxycontin and drinking.
The niece finally called her cousin and told her her mother needed serious care and put the woman and the ashes on a bus headed for Denver.
Meantime, her life had also fallen apart. When they missed paying the second month’s rent, the two women came in to say the girl’s boyfriend had come out for the funeral and not left. They’d called the police the day before and filed a restraining order when he beat her and stole the rent money.
When I talked to them, I discovered the young woman had three more children she’d left in California with their father’s family, a different man than the baby’s father.
When the older woman came in a few days later with some of the rent money, she said how funny it was people were willing to help them now, but weren’t when the boyfriend was around.
A few days after the young woman came in with some more rent money and told me she had sent the aunt to her daughter’s, I took the exterminator to the apartment and found the man was back. I knew then we’d never get our rent when it was due, and it was a matter of time before the problems got worse.
Next, another of her neighbors called to say he had heard her screaming “don’t hit me” over the weekend, and the next time he heard any violent sound he was calling child support services. I told him to definitely make the call if he thought anyone was going to be hurt.
We put an eviction notice on the door the next day, citing the failure to never pay rent on time. It was now the third month and we still had only half the month’s rent.
The second neighbor called again to report the police had been there the night before, stopping first at the apartment, then searching the yard. He admitted that during the raid he’d kept an eye on his car to make sure his property stayed safe.
When I talked to him Friday, when he came in to pay the rent, he said she had moved out with the help of people who might have been her parents. Since she made it sound like she had been raised by her grandmother, they may have been another of her aunt’s siblings.
The first neighbor said he was glad they, not she, had gone. She’d called him to walk her to her car, and he’d had no desire to get caught in a domestic violence situation. He’d already chased some strangers away from his apartment and had begun to worry about the safety of his grade-school-aged daughter.
If she’s living with people who can keep her boyfriend away from their home, she and the baby may have a chance. When she talked about trying to help her aunt with her oxycontin prescription, she sounded like a capable pharmacy tech who could make a tolerable living as a single mom.
If the people who helped her move don’t help her deal with the psychological problems of domestic violence, then she may actually have been better off in a shelter for homeless woman if it were run by people who could help her and the child.
The two times I saw the infant it was being held, either by the sobbing aunt or the boyfriend, and expected to watch television and keep quiet. I hope the experience of the last three months isn’t part of a permanent pattern. Otherwise, I know family problems have just been passed on to at least the third generation.
I also know her aunt was right. Everyone is willing to help a deserving young woman, but no one, not even the police, are willing to risk their personal safety to intervene when an exploitive, violent man is present.
Our most recent pair was an aunt and her niece who had returned from California with a young baby to start over together. The older woman had been laid off as a therapist for the elderly when the recession meant fewer people could afford to have an outsider help them with their parents, and the charitable organization that employed her had laid off five of its six caregivers. The women thought her unemployment and the girl’s earnings as a pharmacy tech would be enough.
Before they made the last installment on their move in rent, I got a call from one of the neighbors in the building explaining why he’d called 911. He’d seen the young baby and when he heard someone screaming “my baby’s dead” over and over, he acted.
The older woman came in the next day with the rest of the rent money. She was dressed badly and couldn’t stop crying. The baby in question was her son, the same age as the niece, who had died in a treatment facility. Apparently, they notified her when she was alone, and she went mad, banging the walls and screaming. The police got someone to sedate her.
I’ve learned nothing about the mother-son relationship, if he was a young man led astray by bad friends, or if the family was dysfunctional and the woman or the boy’s father had been an alcoholic or drug user.
All I know is the woman had no intention of getting over his death. If I even hinted she looked a little better, she took umbrage. She attacked her daughter when she wasn’t grief stricken enough, then kept the boy’s ashes in her bedroom to console at night.
The woman had no medical insurance, and broke an arm and several teeth when she fell down the back step, if that’s what she did. One of her comments made it sound like she had run out the back door and smashed into the concrete block yard wall some 25' away. Soon after she was taking oxycontin and drinking.
The niece finally called her cousin and told her her mother needed serious care and put the woman and the ashes on a bus headed for Denver.
Meantime, her life had also fallen apart. When they missed paying the second month’s rent, the two women came in to say the girl’s boyfriend had come out for the funeral and not left. They’d called the police the day before and filed a restraining order when he beat her and stole the rent money.
When I talked to them, I discovered the young woman had three more children she’d left in California with their father’s family, a different man than the baby’s father.
When the older woman came in a few days later with some of the rent money, she said how funny it was people were willing to help them now, but weren’t when the boyfriend was around.
A few days after the young woman came in with some more rent money and told me she had sent the aunt to her daughter’s, I took the exterminator to the apartment and found the man was back. I knew then we’d never get our rent when it was due, and it was a matter of time before the problems got worse.
Next, another of her neighbors called to say he had heard her screaming “don’t hit me” over the weekend, and the next time he heard any violent sound he was calling child support services. I told him to definitely make the call if he thought anyone was going to be hurt.
We put an eviction notice on the door the next day, citing the failure to never pay rent on time. It was now the third month and we still had only half the month’s rent.
The second neighbor called again to report the police had been there the night before, stopping first at the apartment, then searching the yard. He admitted that during the raid he’d kept an eye on his car to make sure his property stayed safe.
When I talked to him Friday, when he came in to pay the rent, he said she had moved out with the help of people who might have been her parents. Since she made it sound like she had been raised by her grandmother, they may have been another of her aunt’s siblings.
The first neighbor said he was glad they, not she, had gone. She’d called him to walk her to her car, and he’d had no desire to get caught in a domestic violence situation. He’d already chased some strangers away from his apartment and had begun to worry about the safety of his grade-school-aged daughter.
If she’s living with people who can keep her boyfriend away from their home, she and the baby may have a chance. When she talked about trying to help her aunt with her oxycontin prescription, she sounded like a capable pharmacy tech who could make a tolerable living as a single mom.
If the people who helped her move don’t help her deal with the psychological problems of domestic violence, then she may actually have been better off in a shelter for homeless woman if it were run by people who could help her and the child.
The two times I saw the infant it was being held, either by the sobbing aunt or the boyfriend, and expected to watch television and keep quiet. I hope the experience of the last three months isn’t part of a permanent pattern. Otherwise, I know family problems have just been passed on to at least the third generation.
I also know her aunt was right. Everyone is willing to help a deserving young woman, but no one, not even the police, are willing to risk their personal safety to intervene when an exploitive, violent man is present.
Sunday, December 06, 2009
Medigap
I’ve always had an ambivalent attitude towards AARP. I always thought joining would be a bit like becoming a teamster: I would pay my dues, knowing I was contributing to activities that improved my life, even though I suspected I didn’t approve of everything the organization did. Now that the radical conservatives are considering targeting it as a way to destroy health reform, I might actually be willing to make a contribution beyond my dues.
The market for supplemental medicare policies grew from the fact that while the government sets the price for services, it tends to only pay 80% of that price. The rest is left to the patient.
My father had some kind of policy when he died from lung cancer in the 1980's that seemed to have covered everything. However, by the time Congress was considering the medicare drug proposal, anarchy (or genuine market competition) had taken over the supplemental medicare insurance industry.
Congress defined several levels of coverage, and that’s all any company can offer. The competition, if any, lies in prices and reliability of services. Most cover the medicare deductibles, but only plans F and J cover the 20% gap. The only difference between the two, is one offers $120 for "preventive care not covered by medicare"and $1,600 for "at home recovery."
Getting a definition of "preventive care not covered" is impossible. One reason I have bone density problems is my body doesn’t absorb vitamin D. Each year, as part of my physical, my doctor orders blood work to check my vitamin D levels. I can’t find out if that test would be covered by medicare or, if not, if it costs more than $120 and would be covered by plan J. I do know this year my insurance company set the amount that could be reimbursed at $75 of the $315 the lab billed.
Once I had some idea which medigap policy I needed, I found getting information on what was available where I lived nearly impossible. Every website tells you to check your state’s insurance regulator’s website to find what’s available. It took the better part of two days to find that site, and then all it provided was a list with 800 numbers that did not include AARP’s provider, UnitedHealthcare.
Of the 31 companies the state listed, 30 offered plan F and two offered plan J. So much for finding competitors with AARP.
If I go with UnitedHealthcare, it’s because I know the AARP card will be recognized anywhere (except possibly the state of South Carolina) and that it has a large enough pool that it can offer lower rates, if it’s so inclined. More important, even if AARP has put itself into the unfortunate position of both consumer advocate and company shill, it’s continued success depends on satisfying the former group of notoriously cranky people and that may exert some pressure on the quality of service and price.
The market for supplemental medicare policies grew from the fact that while the government sets the price for services, it tends to only pay 80% of that price. The rest is left to the patient.
My father had some kind of policy when he died from lung cancer in the 1980's that seemed to have covered everything. However, by the time Congress was considering the medicare drug proposal, anarchy (or genuine market competition) had taken over the supplemental medicare insurance industry.
Congress defined several levels of coverage, and that’s all any company can offer. The competition, if any, lies in prices and reliability of services. Most cover the medicare deductibles, but only plans F and J cover the 20% gap. The only difference between the two, is one offers $120 for "preventive care not covered by medicare"and $1,600 for "at home recovery."
Getting a definition of "preventive care not covered" is impossible. One reason I have bone density problems is my body doesn’t absorb vitamin D. Each year, as part of my physical, my doctor orders blood work to check my vitamin D levels. I can’t find out if that test would be covered by medicare or, if not, if it costs more than $120 and would be covered by plan J. I do know this year my insurance company set the amount that could be reimbursed at $75 of the $315 the lab billed.
Once I had some idea which medigap policy I needed, I found getting information on what was available where I lived nearly impossible. Every website tells you to check your state’s insurance regulator’s website to find what’s available. It took the better part of two days to find that site, and then all it provided was a list with 800 numbers that did not include AARP’s provider, UnitedHealthcare.
Of the 31 companies the state listed, 30 offered plan F and two offered plan J. So much for finding competitors with AARP.
If I go with UnitedHealthcare, it’s because I know the AARP card will be recognized anywhere (except possibly the state of South Carolina) and that it has a large enough pool that it can offer lower rates, if it’s so inclined. More important, even if AARP has put itself into the unfortunate position of both consumer advocate and company shill, it’s continued success depends on satisfying the former group of notoriously cranky people and that may exert some pressure on the quality of service and price.
Subscribe to:
Posts (Atom)