Archive for June, 2009

Folks on my Twitter feed were pretty excited yesterday about Bernie Madoff getting sentenced to 150 years in jail.

I wasn’t one of them.

Jail means Madoff gets to always know where his next meal is coming from. His cable bills and continuing education are paid for until he dies. So, for that matter, are his mortgage, heat and light bills. All he has to worry about are that he may not like the food and he may not care for the company.

This does not suit me.

I think Madoff ought to be sentenced to wearing a Lojack ankle bracelet. He should then be given a job as a janitor in a nursing home, hospital or elementary school. And he should be sentenced to live solely on the pay from that job–and any part time work he wants to get as a greeter at Walmart or a stockboy at Kroger.

In short, he ought to face what other aging Americans whose investments were robbed from them are facing.

He should have to constantly figure out where the next rent payment is coming from. Whether to spend his leftover income on the light bill or some Spam to go with his 25cent mac and cheese.

That would be a fitting way for him to serve the community he helped destroy with his cunning, greed and guile.

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Health Care is the big topic of debate right now–when we aren’t distracted by those who no longer need any health care at all–and I am leery of alienating anyone by taking sides.

But there is one thing that is very important. Something that we can–and should–agree on regardless of where we stand on Goverment-Subsidised Health Care.

In 1995 the Association of American Physicians And Surgeons adopted The Patients’ Bill Of Rights.

All patients should be guaranteed the following freedoms:
To seek consultation with the physician(s) of their choice;

Any change in U.S. health care that robs you of your right to pick your own doctor flies in the face of the basic principles of the Constitution. How can you have liberty or the pursuit of happiness if you’re stuck in an unhappy situation by fiat?

To contract with their physician(s) on mutually agreeable terms;

Your doctor wants to be paid, and you want to be able to pay her what you can without having to trade in a couple of your offspring.

To be treated confidentially, with access to their records limited to those involved in their care or designated by the patient;

The records which say you’re complaining about painful intercourse, burning when you pee, cockroaches laying eggs in your belly button or any other private thing are between you and the folks who are trying to help you. Any change to the current system where those records become part of a third party database designed to “assess risk management positions” or “ferrett out patterns of drug abuse” may sound well-meaning but are a direct violation of your expectation of privacy. In the long run they can harm patients by making people less forthcoming with their doctors and therefore not telling the whole story to the treating physicians. Without the necessary information, many avenues of treatment go unexplored and make problems worse. Privacy is essential to optimum patient care.

To use their own resources to purchase the care of their choice;

If you want to use your Christmas bonus to get a boob job, that’s your business.

To refuse medical treatment even if it is recommended by their physician(s);

If you are a woman and your doctor says “get a hysterectomy” but you’d like to keep your own uterus and ovaries for as long as posssible, that is your choice. If you’re a man and you’d like to not have chemo but would rather spend the last few months of your life saying goodbye to your kids and grandkids, that’s your business. No court or hospital or group of doctors should exert control over your most fundamental rights to your own body.

To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;

Let’s say there are three ways to treat your problem. You want to know all three. You don’t want to be told only of the option that is least expensive to your insurer–whether that insurer is Blue Cross or Blue State.

To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians;

You should be able to tell the insurance company to stuff it. If you want to refill your pain meds sooner than they say, and you don’t mind paying the extra $50, that’s your business. If you want to tell the government you’d just as soon stick with Blue Cross, that’s your business.

To receive full disclosure of their insurance plan in plain language, including:
CONTRACTS: A copy of the contract between the physician and health care plan, and between the patient or employer and the plan;
INCENTIVES: Whether participating physicians are offered financial incentives to reduce treatment or ration care;
COST: The full cost of the plan, including copayments, coinsurance, and deductibles;
COVERAGE: Benefits covered and excluded, including availability and location of 24-hour emergency care;
QUALIFICATIONS: A roster and qualifications of participating physicians;
APPROVAL PROCEDURES: Authorization procedures for services, whether doctors need approval of a committee or any other individual, and who decides what is medically necessary;
REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
APPEALS: Grievance procedures for claim or treatment denials;
GAG RULE: Whether physicians are subject to a gag rule, preventing criticism of the plan.

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About two years ago I switched doctors on the advice of several people. The physician I was seeing kept ascribing my various aches and pains to the extra pounds I carried and seemed profoundly disinterested in any other cause for my pain. I loved the new doctor. She took me seriously and immediately sent me to various specialists looking for a cause beyond Fatty Boombaism. Sure enough I is one sick puppy, and now am at last getting it under control.

I like that doctor very much, but the practice in which she works is one of the most hideous places in Nashville. Judging from the location of the office and the signs posted on the wall and the clientele in the waiting room, this practice is one which caters almost exclusively to the lower middle class. Signs scream to the newcomers about Workman’s Comp and Doctor’s Excuses. The reception desk is helmed by workers who ignore patients in favour of conversations about guys who don’t call and annoying other patients who just left. Private details about a person’s medical history, issue of concern, insurance and payment arrangement are dealt with at full volume–often yelled across the waiting room.

“Hey, Your Credit Card didn’t Go Through!!!” Even with the name on the credit card, on the computer screen and the sign in sheet, patients are referred to as “Hey!”

It’s a hideous place with a reputation so bad that every other doctor’s office I spoke to last week (three others) remarked on it. Two of the other offices even said as much as to admit that this practice has a reputation in my area of being ‘hateful’.

I’ve thought about this alot. I know that when it comes to doctors, money can get you a good place in line for a liver. It can get you more comprehensive testing, better medicine for chronic ailments and more prompt patient care.

But it shouldn’t cost any extra to be treated kindly and with respect. It shouldn’t cost extra to have someone speak to you as though you are a human being and not just an annoyance to get past before Beer O’Clock. Frankly, I’m scared about where healthcare is headed in this country. I’m scared mostly because I’m afraid I won’t be able to fire a doctor who doesn’t work for me. I’m scared that I’ll be stuck forever in Hateful Medical Practice, Inc.

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The only celebrity whose death–or impending death–upset me was, of course, Warren Zevon. When he announced that he had a terminal illness my world was rocked. His music is on every day in my life and I sort of consider him the poet laureate of my adulthood. I didn’t cry on that September day, though and I didn’t cry on the September day a year later when he actually died. The only time I cried was when one of his songs came up on iTunes Shuffle unexpectedly.

I didn’t cry when my grandpa died. In fact, the only death for which I’ve so far cried is that of my dog. I’m just not a cry-er, I think.

If I were to cry over every sad thing in this world I quite simply would never stop crying. Ever. War, famine, poverty, illness–there is no shortage of things to cry about on a daily basis.

For me and my belief system, death is a transitional step–no different, really, than sending a kid off to college or getting married or finding a new job. In fact I think all those transitional steps exist in life to prepare us for the Big Transition.

Michael Jackson died yesterday. I know you know this if you’re reading this on a blog in 2009, but in case I print these off and save them in a book for my neices and nephews I think I need to make clear why, on this June day, I’m defending my lack of tears.

I’m not crying for Michael Jackson. If I had decided to get it into my mind to cry for him I would have started around 1991 and never stopped. The last 18 years of his life have been a cacophony of strange, the likes of which the world has rarely seen. If I am having any reaction at all to his death it’s most likely a sigh of relief on his behalf. He was clearly not at ease with who he was on this planet. He was obviously hurting–news reports now speak of daily shots of Demerol–and as someone dealing with pain I understand all too well the sense of welcome calm that the transition of death holds.

I am sad for his life and what it became. But I’m saving my tears for the deaths that rend my soul.

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I don’t care that Steve Jobs got a new liver possibly because he’s rich. I really don’t.

I know that I should. I know that I should be yelling and screaming about how unfair it is that money can buy things.

But I’m not. I’m also not writing a blog post on how wet water is, how sweet sugar is or how hot the afternoons are in June in Tennessee.

If Steve Jobs actually bought a liver I suppose I might stop to give a thought to how unethical it is. But Steve Jobs is the reason a lot of the people I know have jobs. (Ignoring obvious joke opportunity.) Steve Jobs wealth didn’t come from cheating or stealing* or the blood of Chinese immigrants. He revolutionised the personal computer industry twice and created an industry from the ground up with the iPod. I guess I figure he’s enriched the lives of millions of people already so if he wants to find a way to make his last a little longer I’m okay with that.

He didn’t buy his liver, we are all somehow agreed on that. But we’re also agreed that he had advantages about getting properly placed to get that liver. I know that isn’t fair.

But I’ll be honest. I read about Steve Jobs’ liver the same way I read romance novels and books about people who win the lottery and biographies of the Beatles. I like a story where something good happens to someone. I like watching people fall in love and become successful and have their financial needs met. I like the bizarre sense of justification that comes from watching someone else triumph over red tape and nonsense. I figure I’ve got to put up with the run-around enough that it’s fun to go to a place where someone else can cut through the crap and get results.

*I’m refraining from dredging up the whole PARCXerox thing.

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I’m breaking my self-imposed silence on Jon & Kate Gosselin because they filed for divorce on my 18th wedding anniversary. In doing so they became the exact opposite of me.

During the brief time that I watched the show last summer it struck me at just how much Kate is like me if I were turned inside out and upside down. We both grew up in a conservative Christian background. But where she decided to sacrifice family for wealth, I decided to sacrifice wealth for family. Where she decided to fight her infertility I decided to embrace God’s path for me.

I started watching the show during an extended visit with my parents–Kate Gosselin doesn’t speak to hers anymore–and it was the source of a lot of philosophical discussions between me and my mom and sister. They both seemed to believe that if the show provided the kids with ‘advantages’ they wouldn’t otherwise have it was okay.

I said then, say now and have said always in between that marriage and family is a private thing. There is no worse sacrifice, no more personally-destructive act than to turn your marriage and family into a public spectacle. I stopped reading Dooce and many other ‘mommy bloggers’ for the same reason.

If you turn your family home into a film studio, your husband and children into cast members and your family friends into day players you brutally murder the best gift God has given us apart from salvation. The world is hard and navigating live in the world is nearly impossible. Your home and family are the safe haven from that. Home is the place you go where they have to take you in. Someone famous said that, and while it’s funny it’s very true. Home is the place where you go to unwind from the pressure of the world. It is a vainglorious hope to believe that turning your private home into public spectacle will make life easier to navigate.

My marriage–childfree as it is–is still the best place for my best friend of 20 years and me to relax, regroup and recuperate. I am unconvinced that the constant presence of cameras and film crews would allow the same nurturing environment.

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This is more-tagged because it contains a lot of my inside-baseball thoughts on book publishing. Which to most people is far more boring than baseball.

I’ve been doing a lot of thinking about the publishing industry lately. It’s a loosely kept secret that I’m in the process of finishing up my book and shopping it to literary agents. It’s an even more loosely kept secret that I’m an avid reader with a terrible habit of buying more books than I could possibly read in a day. Playing both sides of the publishing game puts me in a bit of a quandry as to what side I should take in the Kindle Pricing and DRM Wars. (more…)

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