My irregular musings on city life, politics, baseball, roller derby, and whatever happens to be getting my goat today.

Tuesday, September 22, 2009

Well that didn't work

Apparently today was world car free day. In practice, traffic was awful, the worst it's been since the traffic jams returned after Labor Day. So bad I abandoned my first route to work in favor of a second route that ended up being worse and resulted in my being late to work on a day I was sure I'd be early. The bitch of it is, Chicago's transportation infrastructure really is more or less adequate for the core task of getting people to work in the morning and home in the evening. That's why traffic really isn't that bad over the summer, when most rush hour drivers are actually on their way to work, and a large share of workbound commuters are using public transportation (my office, unfortunately for me, is not located in the central business district, but in another neighborhood, much like the one where I live except less affordable - and being neither downtown nor suburban, it features neither easy transit access from home nor parking). But every year once Labor Day weekend is over, the horrible traffic meltdown returns. The reason? Public school is back in session.

I haven't heard this discussed enough when people talk about planning, or at all really. But the largest cause of Chicago's horrible traffic jams is people driving their kids to school, not people driving to work. For one thing, if you work in the central business district you can probably find another way to work other than driving yourself alone in your personal automobile. The infrastructure, as I said above, is designed to help you achieve this. But faced with abysmal test scores and the resulting environment of selective enrollment and charter schools, few middle class parents are actually allowing their kids to be (mis)educated at their local public school, which is typically right down the street from their houses. Instead, they have picked the public or private school they feel best fits their children's needs and yet will allow them to attend, regardless of where it's located, and then resigned themselves to driving them to school every day and then driving to work. Part of the reason is the relative rarity of yellow school buses in Chicago - but then, how do you design a bus route that transports kids from neigborhoods all over the city to your school? And the existing public transit system, while adequate for transporting workers from many neighborhoods to work, do not allow for crosstown transportation of school children in less than two hours if neither the child's home nor school are centrally located. Such a route would typically involve several bus transfers as well, potentially leaving school age children standing by a busy street in a crime ridden neighorhood for up to 20 minutes several times a day - not an ideal situation.

So our substandard education system is directly negatively impacting the environment and our quality of life in a way most of us don't seem to recognize or understand. There's probably some deeper insightful point to make here about modern society or something, but I'm tired and I just don't have it in me.

Thursday, September 10, 2009

Sprain - Part 2

Right on cue, the big evil corporation that "provides" me with health insurance has decided to screw me over. It's as if someone out there (probably an evil web-based insurance company AI) heard me typing
And anyway, while it will be great to have a public insurance option to cover the uninsured, I have no intention of ever using it for myself while I can get employer-subsidized private health care.
and thought to themselves, "hey, it sounds like we're not doing enough to make this guy suffer." So within 24 hours I get a call from the physical therapist's office.

Tuesday morning I had my initial PT session with a friendly therapist named Jamie. Basically, she repeated the stress tests the Sports Medicine Genie performed last week (Does this hurt? How about this? Okay, how about this?), then attempted to yank my arm all the way out of its socket. Oddly enough, that part felt pretty good once I got used to it, since it apparently took the pressure off my bursitis for a moment. Seriously, as in "my bursitis is acting up." When did i get so old?Afterwards, she gave me some odd activities to do at home, including dangling a can of soup from my limp arm and making circles in the air with it, and pulling on a giant rubber band, and scheduled me for several more weeks worth of appointments.

Today they called and said my insurance company had told them that I didn't have a primary care physician on file, and that therefore my referral from my primary care physician was not on file. Since this made no damn sense at all, I called my insurance company. After spending ten minutes or so in voice mail hell, I reached a fairly rude woman in Plano, Texas who told me that my primary care physician was in their other HMO network, but not in my HMO network. I asked why they were mentioning this now, since I've been on this plan for nearly two years and have gone to the doctor several times within that span. She said - seriously - that they have a computer program which randomly selects claims for . . . I wasn't taking notes, but I think the term she used was adjudication. She said that most claims were paid automatically, but a certain number were randomly selected to be scrutinized and my number came up. Now that they've actually looked at the file, they have noticed for the first time that my primary care physician is not someone in their network, and now I have to pick a new one. Since my doctor is not my doctor according to the insurance company, her referral to the physical therapist is not valid. In fact, she said none of the claims should have been paid in the past, but we would just "start over going forward."

This is, on top of everything else, clearly a lie. I mean, they way my doctor got to be assigned as my primary physician was, I picked this plan out of three offered by my employer, I looked up my doctor on the insurance company's Web site, then called the insurance company's registration number and dialed in the ID number I found next to my doctor's name on the insurance company's Web site. So clearly, at one point my doctor was part of my network and subsequently she has been dropped. But according to Texas lady we have always been at war with Eastasia. . .

What I suspect happened is that the insurance company was happy to ignore me as long as my premiums kept getting paid and I didn't need any particularly expensive care. Once I was injured, they went through my records looking for a reason to delay or deny care, hoping if they caused me enough trouble I would go away.

So Annoying Texas Woman told me to get a new doctor and ask them to give me a new referral to the physical therapist. This, of course, is never going to happen. None of the doctors offices I spoke to today refer to the clinic I went to on Tuesday, they all refer only to specialist within their own hospital networks. Evidently some kind of elaborate kickback scheme is in place where by specialists bribe medical practices to refer to them, possibly the doctors are part owners of the firms etc. Anyway I will have to go to an appointment with a new primary physician next week, who will probably refer me to a new Sports Medicine specialist within his own network, who will then repeat the same examination again (Does this hurt? How about this? Okay, how about this?), and then, a couple weeks later I will start physical therapy again at a new, less conveniently located clinic. So several people will get paid unnecessarily, and the insurance company won't end up saving any money by harassing me.

Of course, my shoulder will continue to hurt like a bitch in the meantime, but nobody in the medical industrial complex seems too concerned about that. Some "centrist" politicians have raised concerns that if health care reform passes with a public insurance plan attached, this will be "unfair" competition that may drive private health insurers out of business. To me, that seems like a feature, not a bug. I mean, do people seriously think adding Annoying Texas Woman to the unemployment rolls is a reason not to do reform? Again I will direct your attention to this:
In Japan, waiting times are so short that most patients don't bother to make an
appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic
clinic at Keio University Hospital to schedule a consultation about my aching
shoulder. "Why don't you just drop by?" the receptionist said. That same
afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an
operation. "When could we do it?" I asked. The doctor checked his computer and
said, "Tomorrow would be pretty difficult. Perhaps some day next week?"
America has "the best health care system in the world?" Whoever told you that is your enemy.

Wednesday, September 09, 2009



So I hear the President made a speech tonight.

Full disclosure - 0ne thing I regret about taking a couple years off from blogging is that I didn't really write down anything about the whole campaign thing. It's sort of a damn shame because I started this blog to write about the election we lost and everything it dredged up about America, culture, values, religion etc. Then obviously I kinda got sidetracked. But I think the 2008 election cycle, while it certainly dredged up a lot of garbage as these things do, also revealed a lot of promising things. For my part a knocked on a lot of doors - Iowa, this time, Dubuque and Waterloo, places I discovered I really like. I wish I had pictures to post. The energy and tone of the campaign, as well as the stated political goals, were a profound mix of inspiration and practicality, the right message and messengers at the right time. I say this to let you know that I'm a sort of a diehard supporter, to give you context for what may well be a solid week of critical posts.

Because right now I'm frustrated with the guy. Not really with the policies - outside of the refusal to investigate torture, which I do believe is wrong and sets a dangerous precedent. But honestly I haven't given much thought to foreign policy and security issues in the last few months. On domestic policy, I'm actually lined up pretty closely with the Administration. For example, unlike lots of vocal lefties, I'm glad the Administration is not pushing for "single payer" health insurance. I don't want "single payer." The country I'm vaguely familiar with using this approach is Canada. And while Canada's health care system is probably better that the US, that's only because our health care system is really lame. Canada has the second most expensive system per capita to the United States, and in other ways seems like it's better that the US but worse than every other industrialized democracy that is not the US. And in this country, if there's only one insurance provider in the country, you just know they're not going to pay for abortion services or indeed much reproductive health care at all. It's just too politically explosive here for a plan to ever pass which actually paid for that stuff. And that won't be the only health issue that gets to be used as a political football. Remember Terry Schiavo? And anyway, while it will be great to have a public insurance option to cover the uninsured, I have no intention of ever using it for myself while I can get employer-subsidized private health care. I hate the bureaucracy (yes, Virginia, there would be less bureaucracy with a government plan, look in your heart you know it's true if you've ever tangled with an HMO or PPO over what they will deign to pay for) but like having choices.

No, what actually is pissing me off about the Administation is how incompetent these people appear to be. Which is frustrating because while I had tons of policy differences with them as well, the rank incompetence was really what drove me batty about the Bush Administration as well. I'll be bitching a bit about implementation tomorrow if I get the chance, but today what sticks in my craw has been the shocking political incompetence, a complete misreading of the political currents in which policy proposals need to swim, and from a team that really seemed to understand these things just a short year ago.

Here are some facts that everyone who pays attention to politics should be aware of:

  1. Ever since Clinton the American right has thrived by using cultural identity politics to convince a solid majority of white people that liberals are dangerous "other," alien, subversive, "anti-American," possible traitorous. The Bush "Administration" used this as a key element of its governing strategy. There was no reason to believe Republicans would stop this behavior in the minority. It's all they've got right now, frankly.
  2. Decent health care reform that gave everyone guaranteed coverage and ensured that no one would go bankrupt because of illness, lose their coverage because they lost their jobs, or be denied coverage because of an existing health condition would be extremely popular. It would change the nature of the relationship that Americans would have with their government in ways that would not benefit Republicans or the Conservative Movement. They know this, people. To answer the perennial political question, they are evil, not stupid. Had the Obama Administration been able to pass comprehensive health care reform quickly during the "honeymoon" period Democrats would have stood to pick up even larger majorities around the country in 2010, and go into post-census legislative redistricting from a position of great strength. In other words, they'd be in political power for a generation. No sane Republican politician would allow this to happen if they had anything to say about it.
  3. Following on from the point above, a bipartisan health care bill is impossible. Hell, the GOP wasn't even willing to go along with a bipartisan economic stimulus package. It had to be substantially weakened and made much less effective (by reducing the amount of aid to states, thus forcing pro-cyclical cuts to state budgets to offset new Federal spending) to get the tiny sliver of Republican support it needed to escape the Senate - and one of the Republicans who voted for it had to switch parties afterwards to avoid losing his primary. It's just not in the self interest of any Republican politician to support a Democratic health care reform bill.
  4. Republicans are therefore going to try to kill any proposal, attack it as Socialistic or Death Care or whatever. This is what they do. Making concessions to make the bill more palatable is just not going to work, they are going to make the same attacks whether they are true or not. Whatever it is, they are going to call it evil, immoral and Communist. Center-left Third Way proposals are going to be attacked with the same vitriol as more robustly liberal proposals. It's not about the policy, it's about holding together and expanding their coalition based on cultural identity politics.
  5. The right lost the last election and lost pretty badly. So while there are not many possible legislative parters on the right, the right is somewhat marginalized in Congress, with both houses dominated by a Democratic coalition of the center and the left. The only compromises that need to be made are among Democrats. Attempts by the Administration and even more so by Senate "moderates" to build a coalition including some Republicans have been foolish, not only because the GOP has not incentive to play along, but because these attempts have alienated many Democrats, angry about being cut out of some theoretical center-right legislative alliance. The real goal of Senate "bipartisanship" has been to falsely cast the position of these "moderates" as the conciliatory center of the debate, when in fact they represent its right flank. The real compromise needs to be worked out between Ben Nelson and Evan Bayh on the right and Bernie Sanders and the Progressive Caucus on the left. The President's original blueprint for health reform occupied such a spot in the center, not the center of the national "debate" but the center of the Democratic party. Attempts to "compromise" with the GOP are really attempts by the most conservative Democrats to bring the plan closer to their own position. And the Administration got played by these guys and lost control of the agenda.

So I hope the President gave a good speech tonight. I don't know, because I forgot about the time zone thing and tuned in at 8 pm, right as he was finishing. But whether or not he did, he needs to figure out, and quickly, that it's the Democrats' right flank he needs to be putting pressure on to make concessions, not the left flank. And if they won't get 0n board, then screw 'em. Who cares if we lose those seats. If they won't vote for the President's agenda, then "we" don't have those seats anyway. And we don't need them. Bush's Medicare expansion passed the Senate with something like 54 votes. It's not true that 60 votes are needed. And in a year nobody will care how a bill was passed, only if it's a good bill that helps Americans get their health care needs filled. Because it's not how popular a law is on the day it passes that matters, it's how popular the law is on election day. And on core practical issues like the economy and health insurance, the public knows more about what's working than the isolated media elite do. To win on this turf, you need effective policies. Winning the news cycle on a Thursday fourteen months before the next national election isn't actually worth very much. But policies that work matter. And if my side is incapable of delivering policies that work, then they will deserve to lose.

Tuesday, September 08, 2009

Get Off My Lawn!

Drove this morning through all the back to school traffic. This system of roads is such a socialist crock. I mean why do we need the government building all these roads? They're obviously not building them in the right places, am I right or am I right? Or what's all this traffic about? Look, individual citizens are perfectly capable of paving their own driveways, and maintaining the sidewalks on their stretch of street, right? I mean except for that guy who lives at the corner of North Shore and Bosworth . . . So there's no reason to think they can't build their own damn expressways if they like them so much.

So that's my plan - Just let people build their own damn roads. With the government involved, because you want to go visit your grandma in Cleveland, I have to pay part of the bill! And that's socialism! Socialism is bad, people! Socialism kills! If you want to drive to Cleveland, build your own damn road! I don't want to pay for it anymore! I'm never going to drive to Cleveland! I don't like Cleveland! It's too damn cold.

/sarcasm - I think.

Tuesday, September 01, 2009


Yesterday I went to the doctor to have my shoulder looked at. This is very unusual behavior for me. Normally I avoid doctors the way a pickpocket avoids the police. I don't think they're going to do anything really bad do me, but there's no reason to go looking for trouble. So evidently (and I'm really not "in touch with" my body, so I don't have much more to go on then you do) I was in a great deal of pain on Thursday when I actually called the doctor and asked for an appointment. My regular physician directed me to call a sports medicine guy directly and make an appointment, and foolishly I believed this meant I should call the sports medicine guy directly and make an appointment. So I did.

ntense nausea inducing pain aside, there was no way they could see me before Monday, so Monday it was. By Monday the pain had subsided quite a bit, but I'd already asked for part of the day off and couldn't bear the thought of actually working instead (it's been an intense month at the office) so I went anyway. At first i did a double take when I was given the address, since it was the street address of my son's pediatrician and I had never seen any trace of a sports medicine specialist loitering around the waiting room amongst the snot-nosed toddlers and desperate looking couples huddled with their tiny baby-in-Graco-pods. But I went there somewhat secure in the belief that my doctor would not send me on a complete wild goose chase.

Sure enough, when I walked through the front door, I noticed that the small "airlock" anteroom between the automated glass doors to the outside and the automated glass doors to the waiting room, there was an elevator door. This struck me as odd, because before yesterday I would have sworn up and down that the doctor's office was in an ugly modern one story brick medical building. But I pressed "up" which was my only choice, and rode the old creaky elevator up to another floor. It deposited me in a hallway with no markings. I walked down to the end of the hall and found a medical practice, but not the one I was looking for. Walking back to the elevator, I noticed a black sign with tiny white writing on it next to the elevator door. My sports medicine guy's name was one of those listed, and the number 202. I looked back down the hallway, the place I'd found was marked 210. About a third of the way down the hall was the only other door, which was so nondescript I'd assumed it was a supply closet. But when I peered in, I saw a small waiting room with a receptionist sitting behind a glass window. On the window was a small sign that read simply "202." Next to the window was a door that led to another hallway and more offices and examining rooms than could possibly fit in a supply closet on the roof of of the pediatrician's office. This had to be the place.

I thought I was doing well, arriving ten minutes early and having already downloaded the requisite paperwork from the Web and filled it out in advance. But I was greeted by an attractive and exceptionally tall woman of indeterminate Central Asian ancestry who informed me that while I had been referred here by my doctor, she hadn't given me a referral, which meant that I was missing a specific piece of paper in my file. She told me if I didn't have that specific piece of paper in my file before the doctor saw me then my insurance company would refuse to pay the bill. Since out here in the real world the only reason I came to the magic sports medicine closet was because I'd been told to by my doctor, I had to assume that the only purpose for this specific piece of paper to exist was to create a frivolous pretext for the insurance company to deny a certain number of claims. I ended up sitting in the waiting room for about an hour while the two doctors' offices called back and forth and debated exactly which piece of paper would convince the insurance company to reluctantly pay its bills.

Before I found out about the paper scam, I had believed that the mysterious elevator and magic sports medicine supply closet were only visible to patients with a referral due to a spell cast by demonic insurance company lawyers. But that was clearly delusional thinking on my part. I mean, seriously, why would the insurance company do that? It would go against their entire business model. They want you to see the guy without a referral, precisely so they can deny your claim! No, it's clear to me now that the Sports Medicine Genie has cast a spell on his own magic supply closet to conceal himself from potential patients whose insurance companies won't pay him. An elaborate scheme to be sure, but easier that trying to collect on medical bills from public employees whose insurance plans have denied their claims.

Speaking of the Sports Medicine Genie, he was a shorter, friendly, shaven headed man also of indeterminate origin, but probably not the same indeterminate origin as his lovely assistant, who interviewed me first. After I told her the story of my injury (which amounts to "my shoulder hurts, I have no idea why or for how long"), she left for a whild and then brough in the Genie and repeated my story to him, verbatim, as if I were not there. After which he poked and prodded me for a while and made me perform what amounted to Stupid Human Tricks for a few minutes, some of which I'm convinced he was just doing to make me look ridiculous so the two of them could have a laugh at my expense after work when the walked down the street to have a beer at the Old Town Ale House. In the end, he told me I have a rotator cuff sprain, an injury I associate with pitchers who have just been signed to multi-year deals with no-trade clauses, not with thirtysomething men who pull their flailing two year olds out of the carseat the wrong way. I need physical therapy to make the ball of my shoulder joint stay in the socket the right way, or so I'm told. That sounds painful, but if it makes my shoulder thing go away I suppose i'll do it.

He wrote a prescription that's only good at one particular clinic, at which his assistant is also employed. Now tell me how that works - doesn't it sound to you like he's referring to a business he also has a stake in? I'm not saying he's not right about my particular case, or that he personally is doing anything corrupt. I would never imply such a thing about a powerful genie who has an office in a magic supply closet. Who knows what other supernatural deeds he's capable of if aroused? But this kind of situation seems rife with potential conflict of interest, and incentives that perversely reward prescribing unnecessary treatment. No wonder the insurance gnomes are reluctant to pay. . .

I told you that story to tell you this one, as Bill Cosby used to say. (Still does, for all I know.)

Today I was reading blogs online (apparently I felt my blood pressure was getting too low) and I came across an excellent piece on health care in the Washington Post. And it ain't often you come across an excellent piece in the WaPo these days, not since they fired most of their reporters and replaced them with Random Non-Sequiter Conservative Opinion Piece Generator Software (sometimes referred to as "George Will") designed by the American Enterprise Institute. The piece is called 5 Myths About Health Care Around the World and you should read it, because there's a lot of babble and blather floating around the mediaverse about health insurance and health care reform, and you probably don't actually know as much about different systems of health care provision as you think you do. I didn't.

At the beginning of Page 2 I came across this gem:
In Japan, waiting times are so short that most patients don't bother to make an
appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic
clinic at Keio University Hospital to schedule a consultation about my aching
shoulder. "Why don't you just drop by?" the receptionist said. That same
afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an
operation. "When could we do it?" I asked. The doctor checked his computer and
said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

What huh? I try to imagine any American health insurance company allowing that. The mind boggles. And yet:
In France and Japan, you don't get a choice of insurance provider; you have to
use the one designated for your company or your industry. But patients can go to
any doctor, any hospital, any traditional healer. There are no U.S.-style limits
such as "in-network" lists of doctors or "pre-authorization" for surgery. You
pick any doctor, you get treatment -- and insurance has to pay.

Yet this system is cheaper than what we have in the United States, and results in a longer life expectancy and lower infant mortality. Like just about every developed country. But isn't the Japanese system, you know, all Socialist and un-American? Actually,
many wealthy countries -- including Germany, the Netherlands, Japan and
Switzerland -- provide universal coverage using private doctors, private
hospitals and private insurance plans.

Bet you didn't know that either. I happen to favor a "public option" as part of a health care reform bill, primarily because I think it will achieve the same result as subsidizing private insurance coverage, only cheaper. After all, insurance companies are going to find a way to turn some share of a public subsidy into pure profit by raising prices to match the subsidies, which will make publicly funded private insurance more expensive than it needs to be. But a fancy new plan with a fancy new name like AmeriCare isn't the point of health reform. It's just a means. The goals are:
  • Guaranteed Issue: this means insurance plans would have to let you buy in, and would have to cover "pre-existing conditions," which is a good thing gramatically as well as health policy wise. I mean, what purpose is that "pre-" actually serving there? Why not just call them "existing" conditions? And that's just one example of the kind of waste that's built into our current system that could easily be eliminated.
  • Community Rating: that means that plans would not only have to give you insurance even though you're sick, they wouldn't be able to charge you rates much higher than everyone else. But wouldn't they lose money on you if they had to do that? you ask. It's called risk pooling, people. Another word sometimes used for this concept is insurance.
  • National Minimum Benefits: Right now there is a patchwork of state regulations governing what kind of minimum benefits have to be included in basic plans. This results in a near monopoly in some states, but if you allowed for insurance plans to compete nationally without minimum standards on the national level, all the plans would just move to the states with the wimpiest regulations, like the credit card companies do. This would prevent situations like the one we had after my son was born, where we had a health care plan which had an annual budget for well baby care which was so small it was used up by the first round of immunizations. (We were able to delay the third round until after the new year when we could switch to a new plan. But I'm still pissed we had a year where we paid for a health care plan that refused to pay for any actual health care. I'm looking at you, Blue Cross PPO.)

These are the actual issues that the media should be talking about. Instead, they continue with horse race coverage like they did during the election. Who's up? Who's down? Who's cheating on his wife this week? Is it bias? Or is it just the result of cost cutting moves in which media outlets fired all their investigative reporters and replaced them with cheaper, easier to maintain evil robots. Or with bloviating center-right talking heads. So hard to tell the difference these days.