Gil Ahrens knows health insurance. One terrible accident. Years of life turned upside down. Denials of payment. Claims argued. Liens placed on property. Throughout a long and arduous struggle to get life back on track, obstacles created by insurance issues stood in the way of what should have been everyone’s focus: care. It is a story familiar, in one variation or another, to millions of Americans.
Author of the recently released Shattered, Shaken and Stirred, Ahrens began his eye-opening journey through the catacombs of our health insurance system almost simultaneously with a devastating automobile accident. He escaped with a badly mangled foot and other injuries, his wife was left paralyzed. Their three-week-old daughter survived intact — but that was about the only good news the Ahrens family would have for a very long time. For the successful California businessman/entrepreneur and his family, life was forever changed; the book tells the years-long challenge of that change.
In recent appearances and radio talks, Ahrens has spoken out against what he describes as a health system “in shambles. In its current state, health care is a bigger threat than terrorism. And needless to say, we are paying through the nose.”
Shattered, Shaken and Stirred, written in the form of a letter to his now-school-age daughter, is part description of unbearable tragedy and misfortune, and part how-to guide for rebuilding one’s spirit. But underlying it all is an unvarnished message to America from one person who has been entrapped in the system: insurance is the #1 evil of American health care.
Elsewhere around the globe are examples of how to do health care right. The world’s top ten livable cities, Ahrens points out, share one characteristic: their citizens have health care. Not health insurance, health care.
“Americans do not want coverage,” Ahrens says; “they want care.”
American health care, with or without the reform so desperately needed, seems headed in the direction of comprehensive care. For us patients — those of us fortunate enough to have coverage allowing us to be patients — part of this is having one doctor who really knows and follows your general condition. A century ago, before costs went through the roof and access to care went out the window, American health care worked that way.
At the California Wellness Foundation‘s Healthy Aging Conference in Los Angeles earlier this week the talk was all about “medical home“. Unwilling to risk a blatant display of ignorance I spent much of the morning frantically searching the speaker’s handouts for a clue about what a medical home might be. The speaker, it being early on in the event when my bewilderment arose, was keynoter John Rother, Executive Vice President of Policy and Strategy for AARP.
Though it was not in the handouts — the audience consisted largely of health professionals who presumably knew all this — I will clarify the medical home business here. With a little help from Wikipedia: “an approach to providing comprehensive primary care… that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.”
Rother’s power-point presentation, billed as “Moving Past Talk: the Challenge of Wellness” reviewed the state of U.S. health, health care and endangered health reform before getting to the medical home issue. When he did, he characterized the medical home as “more personalized delivery of services,” adding that the concept envisions that “someone’s in charge.” It enables hospitals and doctors to work more closely together, Rother said, and provides extra payments for primary care doctors.
Kaiser has this. Many of us enjoy this. Could we please find a way for the healthcare homeless of America also to find a medical home?
Virginia Governor McDonnell, who proclaimed in his rebuttal to President Obama’s State of the Union address that we have “the best medical system in the world” has my qualified agreement on one point. My personal medical system is the best in the world. As a member of Kaiser Permanente, I consider my physicians among the best in the world and my care right up there. I can e-mail any of my physicians with any question; most of them reply in 24 hours or less. I can schedule appointments with specialists with ease; usually I see anyone I want within a few weeks. Medicare helps me pay for all this.
Problem is, not everyone in America enjoys such care at such cost. Millions of my fellow Americans – who might not agree with Governor McDonnell – would be happy for any kind of medical care at any remotely affordable cost. Millions of Americans are suffering and dying for lack of care. Maybe, to correct this, I’ll have to settle for just moderately excellent care rather than the best. So be it. Maybe my costs would go up. So be it. It is morally wrong for people in this country to be without health care.
(In a recent comment on this page written very late at night I attributed Governor McDonnell’s interesting phrase to former Virginia Governor Tim Kaine. Even before my astute True/Slant editors had caught the gaffe an astute reader had brought my attention to it. After I thanked him, Astute Reader replied, “Virginia might be better off if you did give it back to Tim Kaine.” We’ll see.)
But back to health care. Although it has faded slightly into the background, word is that House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are still hoping to salvage the sprawling bill. It could be done, if the Senate bill’s sprawl. As Noam Levey reported in Sunday’s Los Angeles Times,
(I)n the coming weeks, Pelosi and Reid hope to rally House Democrats behind the healthcare bill passed by the Senate while simultaneously trying persuade Senate Democrats to approve a series of changes to the legislation using budget procedures that bar filibusters.
At the same time, leading consumer groups, doctors and labor unions that have backed the healthcare legislative effort for more than a year are stepping up attempts to stiffen lawmakers’ resolve.
These included scaling back the Cadillac tax, boosting aid to help low- and moderate-income Americans buy insurance, closing the “doughnut hole” in the Medicare prescription drug plan, and giving all states the assistance that Nebraska secured to expand Medicaid.
But many House Democrats do not want to vote on the Senate bill until the Senate passes the fixes they want. And it is unclear whether the Senate could approve a package of changes to its bill before the House approves the underlying legislation, according to senior Democratic aides. Democratic leaders hope to agree on a procedural path forward by the end of this week.
Despite the hurdles, there is a growing consensus that a modified Senate bill may offer the best hope for enacting a healthcare overhaul.
“The more they think about it, the more they can appreciate that it may be a viable . . . vehicle for getting healthcare reform done,” said Rep. Gerald E. Connolly (D-Va.), president of the Democratic freshman class in the House.
Sen. Tom Harkin (D-Iowa), who chairs the Senate health committee, noted that even before the Massachusetts election, senior Democrats had substantially agreed on a series of compromises that addressed differences between the House and Senate healthcare bills.
This space still hopes that “the best medical system in the world” can be made available to a few of the millions in America who still so desperately need it.
The photo on the front page of the Sunday New York Times tells the ultimate underside to holiday joy: a young woman, Sarah Walton, with her arms around the tombstone of her husband. The scene is in Arlington cemetery; the simple stone reads LTC James J. Walton and lists the parameters of his brief life, 1967-2008.
In households and hotel rooms everywhere, sadness and loss color the holidays gray. Most of the sadness is of a far lesser sort than that of the grieving widow, but just as real: relationships gone sour, bills that can’t be paid, health that can’t be restored — or the old, familiar pains of too many demands and too little time.
At my San Francisco church, a ‘Blue Christmas’ service was started four years ago by Associate Pastor Catherine Oliver, designed for those who struggle under the weight of everyone else’s festive spirits. Some of the faces she sees are familiar, but many belong to strangers seeking comfort or relief. This year, Oliver reports, attendance was not notably higher — “but there were more men.”
Acknowledging the stress and depression that so often accompany the Thanksgiving-to-New Year’s Day season, the Mayo Clinic recently posted a few tips to help bring a little peace and joy into the season. They are summarized here, in categories found to be common.
First, Mayo Clinic recommends, recognize holiday triggers so you can disarm them before meltdown occurs. Most common among these are:
Relationships. Relationships can cause turmoil, conflict or stress at any time, but tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you’re thrust together for several days. On the other hand, facing the holidays without a loved one can be tough and leave you feeling lonely and sad.
Finances. With the added expenses of gifts, travel, food and entertainment, the holidays can put a strain on your budget — and your peace of mind. Not to mention that overspending now can mean financial worries for months to come.
Physical demands. Even die-hard holiday enthusiasts may find that the extra shopping and socializing can leave them wiped out. Being exhausted increases your stress, creating a vicious cycle. Exercise and sleep — good antidotes for stress and fatigue — may take a back seat to chores and errands. To top it off, burning the wick at both ends makes you more susceptible to colds and other unwelcome guests.
The good news is that even with the worst of causes, holiday blues can be lessened. Most effectively by following a few good recommendations such as these:
Acknowledge your feelings. If someone close to you has recently died or you can’t be with loved ones, realize that it’s normal to feel sadness and grief. It’s OK to take time to cry or express your feelings. You can’t force yourself to be happy just because it’s the holiday season.
Reach out. If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.
Be realistic. The holidays don’t have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can’t come to your house, find new ways to celebrate together, such as sharing pictures, emails or videotapes.
Set aside differences. Try to accept family members and friends as they are, even if they don’t live up to all your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they’re feeling the effects of holiday stress and depression too.
Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don’t try to buy happiness with an avalanche of gifts. Try these alternatives: Donate to a charity in someone’s name, give homemade gifts or start a family gift exchange.
Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That’ll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.
Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can’t participate in every project or activity. If it’s not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.
Don’t abandon healthy habits. Don’t let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt. Have a healthy snack before holiday parties so that you don’t go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity.
Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Take a walk at night and stargaze. Listen to soothing music. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.
None of the above can bring back a loved one, or make a new job appear. But perhaps they can help you through to a better and brighter New Year.
What about moms and dads who really don’t want to move?
The problem of where to go and what to do about housing in the sometimes not-so-golden years has an assortment of solutions for those who prefer (and can afford) the retirement community or any of the multitude of assisted living communities around. But for those who are bound and determined to stay put in the old house or the long-familiar apartment? A collection of obstacles begins to accumulate.
Enter the village.
Swiftly catching on around the country, aging-in-place “villages” are designed to help members overcome those obstacles by providing a variety of programs and services – while the members stay put. The prototype was Boston’s Beacon Hill Village, founded in 2001, which offers “groceries to Tai Chi to cultural and social activities to home care.” Others have popped up in states ranging from Colorado to New York, Florida to Nebraska, Massachussetts to Hawaii.
San Francisco Village was the second, after Avenidas in Palo Alto, to get off the drawing boards and into action in California. Although each Village differs from others, SFV illustrates many of the attractions that are drawing in the stay-put crowd. The organization began with some local grants and individual donations, and is sustained now by annual membership fees.
Sarah Goldman agreed, after a good bit of arm-twisting, to be a poster girl for SFV in upcoming stories for the neighborhood’s New Fillmore newspaper. Sarah was among the first to join the organization, and in many ways typifies the village member-enthusiast: fit, active and fiercely independent at 80, she plans to stay that way as long as humanly possible. Her first move, as a Village member, was in support of someone older still and desperately in need of help: her landlady. Goldman could see that the landlady, who also lived alone, was becoming forgetful and increasingly unkempt – the distress signals that often propel seniors into care facilities. So she began by talking the landlady into joining also. This paved the way for calling in, with the landlady’s approval, a wide-ranging group of service providers: house cleaners, organizers, financial assistance people, personal care helpers. All had been vetted by SFV. Their help has now enabled both landlady and tenant to keep right on aging in place.
Goldman also quickly started a program patterned after one she had organized when working with an assisted living community. SFV’s play-reading group was an immediate hit among those seeking socialization and intellectual stimulation. Three necessities of life — social, physical and mental fitness — added to issues such as those dealt with by the landlady, add up to the heart of the Village. Members hope that by accessing things like this while staying on familiar turf their golden years may indeed stay shiny.
This one hopes that SFV membership will help keep the contributions of this space emanating from this laptop on this Sacramento Street kitchen counter for a very long time to come.
These paragraphs are a segue from talk of holiday festivities, over the past several days, into the very un-festive subject of Alzheimer’s disease.
Part of the conversation at the very festive Thanksgiving dinner I was lucky to enjoy (without having cooked a single dish!) centered around food for the brain. One argument was that the good stuff for one’s neurotransmitters — egg yolks, broccoli, soy, starches — should be meticulously watched. I heard my mother’s voice in my head in response. “If you have three meals a day that look pretty on the plate,” she liked to advise, “you’re getting the proper diet.” When pressed she would explain that “pretty” equates to “color-coordinated,” i.e.: toast/bacon/scrambled eggs with parsley; or broccoli/carrots/potatoes/hamburger. I can’t remember whether our plates were 9-inch or otherwise.
Then there is the larger issue of exercise. Fitness, and occasionally brain exercise, have been contemplated several times in this space over the past few months (10/5: How’s your brain fitness today?; 9/7: The new best thing.) These theories hold that it is possible to strengthen, possibly even build anew, those neurotransmitters.
The definitive word on all this has not been written, and answers surely won’t originate with someone who barely passed Science I-II for the math/science requirement of her BA in Art. But some fascinating studies are being done, and new American Recovery and Reinvestment Funds will be going to projects that will be the focus of this space tomorrow.
Meanwhile, Alzheimer’s and various forms of dementia remain the ultimate tragedy in millions of lives, diet and brain exercise and clean living in general notwithstanding.
One of the most poignant insights into this disease you’ll be likely ever to see is currently offered by the PBS series Life (Part 2.) It follows a beautiful, articulate woman named Mary Ann Becklenberg as she confronts her own decline with incredible courage. What science may find answers for in the next few years, Mary Ann Becklenberg is exploring in real time. Schedules and clips are on the Life (Part 2) website.
Chances are, whether you’re over 50 or not, your life will be impacted by dementia. I, for one, am grateful for science and for Mary Ann Becklenberg.
The only thing worse than toothache/jaw pain, to be cruelly specific, is toothache/jaw pain without insurance. Most of us are without such insurance. It has not even been on the radar of health reform advocates, which is just as well — if you add dental terrorism to abortion and public options we won’t see reform for another few decades.
Nevertheless, tooth reform, euphemistically referred to as full mouth restoration in some circles, is ahead for increasing numbers of Americans sooner or later. It comes down roughly to a choice between fixing the mouth or buying a yacht, but if your jaw aches, you forgo the yacht.
New York Times health writer Jane Brody traced the new path of dental repair journeys in a thoughtful article yesterday, explaining her own costly route from tooth decay to bridges to implants, and throwing out an estimate of approximately $3,500 to $4,000 per tooth for the now-preferred latter. Multiply this by at least three or four times if you have other issues, which most of us do once things start going south in the mouth, needing attention. That would be gum problems, repair to surrounding teeth or necessary attention to bone.
I write with authority. Some years ago, facing all of the above, I visited an assortment of dentists with an assortment of solutions that frequently had me in tears when contemplating the time, details (one would have had screws in my jawbone which I would tighten every few days for months as it rebuilt itself) and costs. Like Brody, I grew up before the days of fluoridated water and have had more repair work since childhood than the Bay Bridge. It was a mess in there.
Finally my husband, whose best wives have been born in 1933 but with bad teeth, said, “Just do it all. Don’t be going patch-patch-patch; do it all.” I proceeded to choose the most sympathetic and understandable (most of them were, except for the screws-in-the-jaw guy) dental professionals, assembled a team and went to work. Or rather, I scrinched my eyes shut while they went to work. Some 18 months and $40,000 later we were free at last.
(Out of this experience, during which I was doing a great deal of entertaining just to keep us happy and sane, came one of my finer unpublished books, Cooking for the Dentally Impaired: Recipes and Menu Suggestions for the Impaired and Unimpaired in Difficult Times. I think it’s a book whose time has come; my agent disagrees.)
Brody’s article is a must-read for anyone stewing over this issue. The following are abbreviated tips for anyone with teeth and plans to keep them:
1 – Consider early-decision. The sooner things like gum surgery, crowns, implants-v-bridges or bone issues are dealt with, the likelier all can be made well and kept that way.
2 – Get second opinions. You may even choose the screw-in-the-jaw route, but there are many different procedures and it is good to find one suited to your temperament and bank account.
3 – Ask questions. I asked so many that I was fired by one team; a polite letter said they did not believe they should take my case. It’s just as well. Those I wound up with answered my questions and seemed happy to do so.
4 – Ask for references. Brody suggests this, and I agree. Because I already knew several people who had been patients of the dentists with whom I eventually invested all that time and money, talking with them about their experiences helped keep me from any surprises.
5 – Talk finances. Several friends of mine have had major dental expenses that were far outside their budget, but worked out payment schedules with their dentists so that necessary work could be done sooner rather than later.
All those mammograms, self-exams and dutiful attention to catching breast cancer at the very first sign? Forget it. Might even do more harm than good.
As summarized by Associated Press writers Stephanie Nano and Marilynn Machione late Monday,
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task forcesaid Monday. It’s a major reversal that conflicts with the American Cancer Society‘s long-standing position.
Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.
For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.
But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.
“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.
The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.
But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.
Maybe, just maybe, a clearer look at breast cancer screening could be accompanied by a good look at a little of the other possibly unnecessary and extraordinarily pricey “defensive medicine” going on around the country. What a fine way that would be to hold down costs and save a lot of time and angst. In another recent article (November 5) published in the San Francisco Chronicle, Associated Press reporter Steve LeBlanc wrote of how the costs of “defensive medicine,” along with malpractice insurance and lawsuit awards, are adding significantly to the soaring costs of health care.
LeBlanc illustrates the issue with a story that rings sadly true:
Dr. James Wang says he tries to tell his patients when medical procedures aren’t necessary. If they insist, though, he will do it – not so much to protect their health as his own practice.
After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.
“You are thinking about what can I do to prevent this from happening again,” he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.
We have, LeBlanc explains, doctors battling malpractice premiums and lawyers saying malpractice suits discourage bad medicine — meanwhile, the costs of it all add up to some ten percent of health care expenditures.
We the public, healthy and sickly alike, are caught in the middle. Could we not somehow declare a truce? We’ll quit rushing to sue, lawyers back off from chasing ambulances, doctors go about the business of practicing medicine according to patient need rather than fear of consequences. Seems like a good idea to me, but I’m not holding my breath.
I’m also not having any more mammograms any time soon.
