Learned my lesson.

(The sound you just heard was my entire extended family snorting in disbelief.)

(p.s. Yeah, I went back and deleted that comment.  There is, literally, no point.)

And–calling Bart Stupak, of all people, the one who gathered his fellow Democrats in opposition to the bill earlier because of his anti-abortion stance, a baby killer?  Calling John Lewis, a civil-rights-era hero, truly, a hero, the N word?  Spitting on the opposition?  Republican congressmen inciting the crowd outside to a near riot from the House balcony and proclaiming, That’s kind of fun! Watching Boehner screaming Hell! NO! over and over–

Who on earth wants to be on the side of people like that?

And then Nancy Pelosi.  Whatever else you may think of her.  Calmly and surely, taking her turn at the podium, talking about the actual issue at hand: what was in the bill, what it meant to Americans, and why it was an important piece of legislation that after all the work done on it and the ways that it would benefit the American people, deserved to be passed.  The contrast!

Well, now, actually, Mr. Boehner, sir, the American majority has voted.

Yes.

Or a blank to fill in.  Okay, given the timing of that query and what is immediately on Congress’s plate, that was real easy.

The rest were questions about my views on the healthcare bill; surprise, surprise. Beat’em to it at question one.

Though Republicans may shout and continue to believe that Americans want the healthcare industry left alone because all is well, lalalaa fingers in their ears they’re not LISTENingggg…  It’s simply and absolutely not true.

The current system is killing people of all ages who are treatable and who could have been saved.  The very fact that a low-level clerk who was not available after hours, on weekends, or during a snowstorm was making life-and-death decisions IN AN EMERGENCY, with no recourse, about my monoclonal antibody medication a year ago only because my insurer didn’t want to pay for it is unfathomable; just who gave that clerk a medical license? And you know my case is only one of thousands at just that one company, simply because that’s how they’re set up.

This absolutely must change.  We may argue over how it is to be done; we may argue over what should fund what; but the current system is absolutely untenable, and after a year of everybody trying to hash out their differences and their beliefs and their constituencies in Washington, after a long and terrible pregnancy, we have birthed a bill. It may be on life support, but we have a bill and it is still breathing.

Like all good politics, it’s full of compromises such that nobody is completely happy with it–it doesn’t go far enough, it goes too far. He looks like your side of the family, he doesn’t look enough like my side of the family.

Yes, well; that’s what democracy produces. Mashups.

Now vote on the %#* thing and PASS it like we voted so many of you into office to do.

(I totally love that Caremark got members of Congress slapping multiple investigations on them for the sake of Federal employees; where were our congressmen when such practices were messing over the rest of us?  Where are they now?)

And now we know the details.

To all those who think employer-based healthcare plans are the pure and only true path to medicine? Given my medical history, insurance is a subject close to home here.  Are you sitting down?

My husband and I are celebrating our 30th anniversary this summer.  Thirty years ago, with both of us having grandfathers on the political scene in DC for decades, they knew everybody, they had us invite everybody to the reception, we sent out 500 invitations and 500 people actually showed up! We were standing in that receiving line for three and a half solid hours with no breaks in the flow of humanity, most of whom my new husband and I didn’t know, all these people taking the time out of their lives to come shake our hands and wish us well.

We solemnly promised our own children we would never do that to them.

I guess one could say now that we had a lot of witnesses, having no idea we might someday need them. (One thank-you note, on the other hand, was returned two months after the wedding as “recipient deceased.” That was fast. We might be in trouble here.)

My husband’s employer, a Fortune 500 company, now says we must produce our marriage certificate, and fast, or they are cutting off my medical insurance on the assumption of fraud.  They are doing this to everybody.  We claim John is our son? We’d better produce the birth certificate and prove it, and his school transcript, too.  We have to order the license or the birth certificate from the states they happened in? Oh, those states are furloughing workers and are weeks or even, in California’s case, months behind on all paperwork?  So sad too bad, you’re out.

It took California over ten weeks to process my auto registration payment, and that’s when they were in effect getting paid money by me to do so, and not just some nominal fee.  Okay, yes, we have the kid’s birth certificate, but not his transcript.  And what of all the people who don’t have a copy on hand for their kids?  Or of their marriage certificate?

I so much want to ask the CEO, whose own insurance, I am sure, is in no way imperiled: exactly what kind of corporate culture do they think they’re trying for here? Are they familiar with the term meta-message? Could you shake each employee’s hand, look them in the eye, and convince them you were wishing them and their families…well?

Note that Strom Thurmond is famous both for his record filibuster stalling the Civil Rights Act of 1957 and for how very wrong he was on that issue–he made it appear *more* wrong by what he did, by how he frustrated his country as well as his fellow senators, and he never got completely away from the image he gave himself by doing so.

Okay, now, a word on Massachusetts:  they elected a charismatic, good-looking guy who knows how to throw a zinger given a chance. Tip O’Neill of Massachusetts once famously said “All politics is local.” I would add, “and of the moment.”

So here we have that lost 60th vote–but it’s a Republican and he’s from Massachusetts, representing a whole lot of Democrats. He knows he has to keep them happy if he wants to keep that plum job.  He knows he has to work with the other party.  In today’s severely divided Congress, this is a good thing. He also happens to have been for the plan in Massachusetts that the one in Congress is trying to improve upon. (It ain’t perfect, but we gotta start somewhere.)

Back when I was in college, I was at my grandparents’ home and somehow a cousin asked Gram a question re their political life back in the day; usually, those got directed at Grampa. But he wasn’t in the room just then.

My very proper grandmother, whom I’d never heard speak an ill word towards nor about anybody in any way ever before that moment, looked suddenly like she’d kept this one to herself for far too many years. It was just too much. The truth had to be told.

The subject was that record filibuster.  Passing that Act was the right thing to do, but Thurmond was having none of it. As long as he stayed on that floor, reading the Washington DC phone book, or, famously, his grandmother’s biscuit recipe, then the floor was all his.

As long as he didn’t step away from it.

And what would limit that?

“Strom Thurmond had a catheter under his pants!” exclaimed Gram.

Wha-a-a-t! That’s not supposed to…! I just put that in there!

Context:  Blue Cross helpfully said there were no deductibles on ileostomy supplies this year. Given our $10k deductible and a no-insurance catalog price of $995/month, that was a huge relief. They don’t tell you the fine points during the November enrollment period, nor do they answer the questions they don’t want you to know to ask.

So I was going, oh good.  And then they said that oh by the way that one month supply that just shipped, same monthly amount as ever, was, as of this year, to hold me for the quarter.  Wait, *what*!  Are you out of your MINDS?!

And today, how stunningly bad an idea that was was staring hard at me.

It’s okay. My doctor’s office is on it. (But why should they have to be?)

Michelle was sitting in a cozy spot on this cold, rainy day.  First time I ever saw a bluejay shaking itself off like a dog, or a very soaked squirrel, but I don’t think either would have cared for an offer of a hairdryer. Brrr.

Wrapped up in a blanket, hot mug of cocoa on the arm of the chair, laptop propped up on the other one, safe from all ills.  It cheered me up just to look at her.

I plunked down at her feet. “Can I growl?”

She looked at me. “Okay, you got one minute of whine.”

“Stupid bag burst.”

“Oh,” wincing.  She thought about it a moment.  Then she threw her arms out from under her blanket in a magnanimous, wide-open gesture, and granted me, “For that, you may have TWO minutes of whine!”

We both burst out laughing, and that was the end of that.  Hey, Michelle–you’re a good one.  Thank you.

(Massachusetts voters:  60.  It’s all in your hands tomorrow.)

They write about the Cleveland Clinic, showing the various ways in which it has cut costs while improving patient outcomes and how it hopes to be a model for ways in which the delivery of healthcare could be reformed.

But there is one major problem they can do nothing about.  They describe the clinic’s clerks.  Picking up the phone to deal with the “thousands of different health plans from the hundreds of companies all over the country” and getting “put on hold like anyone else who calls an insurance company.”  Industry estimates, they say, are that the average cost of handling a phone call is $3 to each party. “This is the hidden cost of competition…”

So, one might wonder, reading that, how many phone calls are there per case?

What dropped my jaw was what they said next: there are 2,000 doctors at Cleveland. They have to keep 1,400 clerks to deal with those companies. And they know, their CEO says, that the insurers have just as many people working on each of those cases, doing everything they can to examine them.  And then if they can in any way they will deny or at least delay each claim for as long as possible.

Which is one big reason why the overhead for private insurers averages out, Cleveland Clinic’s CEO says, at 29% vs. Medicare’s 3%.  (As an aside, I have read that the Blue Crosses of California run at about 50%.)  That’s just on the insurers’ end in terms of the lost money that could have been spent on actual care of human beings in actual medical need.

Cleveland, it should be noted, told insurers what its average maternity cost was and offered to simply charge that average fee per baby delivered to each, freeing themselves and all those insurance plans all the costs of all that wrangling and nitpicking.  Spend that premium money on the patients instead! Please!

Not a single one took them up on it.

We need a public option. Now.

In California, Blue Cross was allowed to be changed from being a not-for-profit to being for-profit in the 90’s, with a domino effect on other states.  Blue Cross covers roughly one in seven people in California.

As an aside, from North Carolina we read this from three years ago, with more recent figures hard to find online somehow:

“Aetna CEO John Rowe had total compensation of $30.6 million and Cigna CEO H. Edward Hanway received $12.3 million. That includes millions of dollars in stock compensation. Meanwhile, the president of Cigna HealthCare of North Carolina made a total of $279,526 last year.”

You catch that?  $279, 526.  Go Cigna!  So much for the idea of needing to pay millions to attract top talent.  Larry Glasscock, BBA Cleveland State, graduate school NA, was CEO in ‘06 of Wellpoint, which owns Blue Cross in California and a dozen other states. According to this, his total compensation that year was $52.4 million.

My daughter’s premiums, had Blue Cross accepted her, would have been $133/month as a young single woman for a plan without maternity benefits. Let’s round that up to an even $1600/year.

Let’s picture, for a moment, how many people would have to pay that premium for one year while requiring absolutely zero in medical pay-out, in order to sustain just that one CEO salary.  Just for that one executive.

Three million, two hundred seventy-five thousand people.  Paying that premium faithfully, month by month, and not going to the doctor once. Not even getting so much as one flu shot in 12 months.  Over three and a quarter million people.

And the CEO’s claim their pay has no influence on the medical care of their subscribers.

As for the town hall talking points and the obscenely defaced pictures of our President that are beneath each and every one of us, the screaming and the shouting, the attempts to silence all discussion of changing any part of this system–

–Remember the Watergate line.

“Follow the money.”

‘Cause there’s a whole lot of it (that’s for lobbying in 2009, so far) that sure isn’t being spent on taking care of us.

We were sure it was coming. But still.

Remember my saying insurance companies look back through your records up to 20 years to look for something to deny you coverage over?

Our daughter aged out of ours and we’ve got her on COBRA while we can, at nearly four times the rate of private health insurance.  Same company, same coverage.

They denied her attempt to get her own policy, in part because she had a) a cataract sixteen years ago as a young child (which she fully disclosed) and because b) she had the surgery for it.

Wait–what?!

The note from the insurance agent said to try again if we keep up the COBRA the full 18 months it’s good for: by that point, the insurance might be required to take her on.

Might.  If.  If.  If healthcare reform happens. If it does, my normal, young, healthy daughter will be able to pay premiums and help support the system. If it does not, COBRA will end, we can’t cover her even with an inflated price, and she will have no coverage.  Should anything major happen to her that would keep her from working, she will have no choice but to be a burden on the taxpayers even though that’s the last thing she wants to do.

Note that our premiums didn’t go down in the slightest with three kids aged out.