This is not a feel-good post. My apologies.

PG&E has gone to the California Public Utilities Commission, pleading that their liability insurance costs are 4x after the big wildfires last year: those fires that were sparked by unmaintained PG&E utility lines brushing trees in their right-of-way, which should have been trimmed by them and were not, causing arcing. They specifically want their ratepayers to reimburse them for fires caused by their lack of maintenance on their lines.

The San Bruno gas pipe that exploded had had a sewer line criss-crossing it that was replaced two years ago by explosives bursting it outward as a new sewer pipe went in.

This was a few feet from the high-pressure 30″ gas line.

Which PG&E said it inspected afterwards. According to the local newspapers, when pressed hard this week, they admitted no, not internally they didn’t, not that stretch of it, and no the type of pipe was not now up to code, no it shouldn’t have had that seam, that’s not standard, no, we didn’t know it was corroded. Because we didn’t look inside that particular section after the sewer work.

There was a homeowner whose walls cracked after the same sewer company used that same method near his home in Millbrae. (He sued, they settled.)

PG&E just spent nearly $50 million in ratepayers’ dollars trying to push a fraudulently-presented election measure that would have given them monopoly status and shut down many cities’ efforts to go green. When Prop 16 failed, they tried within days to get regulators to let them raise rates to cover the amount they’d spent on that campaign.

Think how far that money could have gone towards trimming trees that make the power lines arc. Towards replacing old and substandard pipes.

PG&E is trying to look magnanimous towards the homeowners whose friends and neighborhood they just blew up by offering them money they want their customers to then have to provide. Again, they want their shareholders to have a direct disincentive for holding them responsible for maintenance and public safety. As a friend put it, only the profits are privatized.

One of those who burned to death, Jacqueline Grieg, was a CPUC regulator of their lines.

Now they want her co-workers to make her heirs have to help pay for killing her.

Utter, bitter, classic chutzpah.

One might think the CEO who’s running the corporate culture of Pacific Gas And–the word that unfortunately leaps to mind is–Evil would have the sense to wear a little financial sackcloth of upgrading equipment and getting the actual work done that the public pays for while so many of San Bruno Mountain’s families, the ones still alive, stand among only ashes.

Fire the guy. And CPUC, please, do right by us all. In Grieg’s memory.

So this guy  calls himself a pastor.  He’s broke and on the verge of losing his property.  So he comes up with a way to scare up major notoriety and grab attention from all over the world and to get his hands in the pockets of people who are creeps like himself.

He’s not quite Westboro yet, but he’s definitely working on it.

I have this deeply-felt wish: that the good people of Florida go to where Jones plans to hold his Koran burning on 9/11.  That they race to protect those Korans from the flames unharmed as we want to be able to practice our own religions–or lack thereof–unharmed.  That they manifest the honor of our country, our cherished belief in religious freedom, and our goodwill towards our fellow men. Everywhere.

(Ed. to add: Half an hour after I posted this, the Washington Post published a report that Jones has agreed to cancel his bookburning.  He is now painting himself as a good person urging others not to burn Korans.  I think we have a new definition of chutzpah.)

I wrote a post. I’m still thinking about it.  (Moral of the story: never, ever comment on a politician’s FB page; there, it is not a family discussion.)

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.)

I know not everyone agrees with me. But oh thank goodness. At last!

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.

Having visited my House representative’s website on occasion, being a good little constituent keeping tabs on things (did I mention I was born in Washington DC?  It’s in my blood) I got an email a day or two ago:  it was a series of questions. The first was, what did I think was the most pressing issue before Congress, offering me several answers to choose from that surprised me on the one item it did not offer.

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?)

So the hubby comes home tonight and opens his mail.

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?

My own grandmother, ratting someone out! Not that I want to give anyone ideas.

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.

(Typing fast, I’ve only got two minutes…)

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.)

A stunning item in the Newsweek issue that arrived today:

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.

The Rooster is rocking on. Slowly but surely, despite a day of a thousand distractions and things needing doing. And by the way, Mr. Stewart? Nice catch.  (Re that link: 1. Fox is unembarrassable. 2. Our President honoring our veterans. 3. The Muppets singing “Ode to Joy” in meep meeps, and a school in Massachusetts that has banned the nefarious word “meep.” Sometimes you can’t make this stuff up.)

I’ve been trying to be an informed voter and have been spending a fair amount of time trying to learn more about our current health-care system.  All facts and figures here via Google.

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.

Pardon another rant. I do try to keep them to a minimum. Ooh, looky, the baby alpaca stole is done! (Did that help?) Bluejay shawl pattern, three repeats plus an extra stitch each side, cast on 36.

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.

I’ve been debating writing this all day.  It would be far more fun to talk about how cool Karin’s yarn is starting to look in my new project. And I do try not to go on and on on such things.

But I think this is compelling, and I think it’s terribly important. I read this article today, thanks to Lene: about the executives at the nation’s major health insurers admitting Tuesday before incredulous members of Congress of both parties that yes, it is true: there is a list of about 1,000 expensive medical conditions which, if you have, and if you have private coverage (ie, you’re not protected by the laws governing HMOs about pre-existing conditions) they will scour your medical records as far back as 20 years looking for a reason to drop you. Something, anything, you didn’t disclose on your application.  And they will find one.  Some have whole departments set up for this and give bonuses and positive performance reviews to their employees who drop expensive patients.

One person’s doctor had once noted that he had gallstones but didn’t mention it to his patient. When the guy later found out he had cancer, his insurer canceled him for fraud for not disclosing what he didn’t know.

This was not an isolated case; this is simply how they conduct their business and they freely said so. They told the congressmen that it had saved them $300 million over five years.

I recommend that these lovely individuals put a Bob Marley cd on and go read Charles Dickens: “Business? Business! MANKIND was my business!”

Note that in California the insurance commissioner proposed fining one of the Blue Cross companies $12.6 million. And then did not do so.

There is a case underway, finally, in which the insurance company did not notify a couple they were considering them for rescission during the period during which the wife could have switched their insurance to her employer’s; then, after her husband was in a car accident, which, as I read the article, the company apparently knew about, they continued to collect premiums from them.

Until the husband submitted medical bills that were more than that monthly payment.  And then they dropped the couple and refused to pay a dime.

All three executives said they would continue their policy of rescission regardless of whether the insured had knowingly lied in filling out the application or not. They said it keeps their costs down.

You got a problem with that?

With apologies to Paul Simon (and an extra verse added by special request of the peregrine group)…

The problem is all inside your wings, Clara said to Kya
The answer is easy if you practice, and eventually…
I’d like to help you in your struggle to fly free
There must be fifty ways to leave your louver.
Fifty ways to leave your louver.

Dive out of the way, Jose. Set a flight plan, Esteban. Watch your Clara, Tierra. And set yourself free.  Look and fly clear, Veer. Try it today, Ilahay! Just hop off the ledge. Fledge. And set yourself free.

The watchers said it grieves us so that Carlos went astray
We wish there were something we could do, to make him show again
But Esteban is here. A peregrine papa too, now, teaching,
Fifty ways to leave your louver.  Fifty ways to leave your louver.

Dive out of the way, Jose. Set a flight plan, Esteban. Watch your Clara,
Tierra. And set yourself free. Look and fly clear, Veer. Try it today,
Ilahay! Just hop off the ledge. Fledge. And set yourself free.

Glenn said it’s really not my habit to intrude
But the more I see you’re grounded and your directions misconstrued–
Don’t want to box you in. But at the risk of being rude
There must be, better ways to leave your louver. Better ways to leave your louver.

Dive out of the way, Jose. Set a flight plan, Esteban. Watch our Clara, Tierra. And set yourself free.  Look and fly clear, Veer. Try it today, Ilahay! Just hop off the ledge. Fledge. And set yourself free.

Tierra said why don’t we all just sleep on it tonight
And I believe in the morning, we’ll begin to see some flight
And then Veer kicked her. And she realized, they probably were right
There must be, fifty ways to leave your louver.
Fifty ways to leave your louver.

Dive out of the way, Jose. Set a flight plan, Esteban. Watch our Clara, Tierra. And set yourself free.  Look and fly clear, Veer. Try it today, Ilahay! Just hop off the ledge. Fledge. And set yourself free.

———–

A side note. My son John got T-boned by someone speeding fast, totaling both cars. He lucked out in that his passenger wasn’t hurt and only John’s shoulder got reinjured: it was operated on after a high-school wrestling team injury a few years ago.  He hurts, but oh goodness.  Thank you dear God for saving the life of my child and the others.

And of course, since he’s not currently a full-time student while on a mission for the Mormon Church, our insurance won’t cover him even though we pay the same premium as before he left. But that’s just noise at the moment compared to what matters.

Remember when the employee of Caremark, the prescription distributor my insurance company contracts with, told me they weren’t sure they wanted the liability of selling me my prescribed Humira?  At a time it looked like nothing else would keep me alive?  I wanted to say to them, all drugs have side effects and if you can’t handle that simple fact of life, what on earth are you doing in this business?  And why do you have any say whatsoever?  You’re just a supplier. My insurance has (FINALLY!) approved that Humira.  It is approved by the FDA for the disease I have.  Send me the flippin’ med, fer cryin’ out loud, since it’s one I cannot pick up at a drugstore and cannot do anything about on my own.

And we all know how that one went. Nada, despite frantic phone calls from us, from my doctor, even from that Caremark employee’s secretary responding to me by walking around the floor trying to find where that woman went so she would finally take my call again and do the right thing.

And then my readers saved the day by bombarding them with messages till they not only caved when the weekend was over, but they actually grovelled.  Which was a little too satisfying for my own good.

So. On the Sunday of Memorial Day weekend, as I’ve written here, I was in Urgent Care again in great pain with a new flare, and one of the things the doctor I saw did was to prescribe me Zofran.

When my Crohn’s flares, I barf.  I never did once during all my pregnancies and I used to pride myself on having an iron stomach. Shows you what I knew.  So.  It is somewhat unusual for Crohn’s to cause barfing, and I can assure anybody that thank you, I’d prefer to be normal on that one.  But all the iron-stomach thinking and determination I’ve tried gets me nowhere these days: in the hospital, they had to keep me on two different high-powered IV anti-nausea meds at a time pretty constantly.

I could draw you graphic pictures of what I do on Phenargan, the entry-level med. Let’s not.

Based on all that, the Urgent Care doctor prescribed me Zofran instead, and rightfully so.

Which the insurance company denied. And not only denied, but since it was a holiday weekend, they had nobody on staff to even begin to appeal it to to get me through the long weekend. The doctor filling in for my Dr. R. reiterated to them a few days later my need for that med; with my very low blood pressure, barfing is an emergency and I need to have access to it.

I got a letter Saturday. Not from Blue Cross, my insurer, but from Caremark, who, like I say, they contract with, and who my local pharmacy had to get the okay from.  And I quote:

“The request was denied for the following reason:

The patient is not receiving moderate to severely emetogenic chemotherapy, total body irradiation or fractionated abdominal irradiation. The patient is not less than 18 years of age with a diagnosis of gastroenteritis and dehydration.”

I don’t have cancer so go ahead and barf. Nice.

And we wonder why the insurance companies don’t want the accountability that would be a natural part of the competition of having people having a choice of a government plan vs. them?  Right now, their only accountability is done legislative piece by piece, state by state, as outraged people get the one part of medical neglect they’ve been subjected to fixed by the demand of the law, while other parts wait for someone to suffer loudly enough.

My friend and hero Marnie took on a quarter million dollars in medical debt to adopt her kids, because at the time insurance companies were allowed to deny coverage to babies till they’d proven they were healthy their first month and forever if they weren’t.  That loophole was so egregious as to spark a Federal law outlawing it, too late for her.

We need a better system.  We need the will to do it. I’m not one demanding a single payer, but I do say, and loudly, that the insurance companies MUST be held accountable.  And the only way to do that, short of lawsuits that drive up healthcare costs and enrich the lawyers, is if they have true competition, which they do not now.  You know why they’re fighting so hard against the government providing an optional plan.  They’d have to change.