A Tragic Story

As it is my 500th post I have elected to tell a story from T. R. Reid’s Healing of America. This story of Ms. White eloquently captures the problems of the American healthcare system. Functionally, America does not have a healthcare system, it has a healthcare marketplace that is driven to produce as large a profit as possible.

According to studies arising from Harvard, one of the conservative bastions of capitalism, each year 40,000 to 44,000 Americans die every year with a medical condition that could have been readily addressed if the person received adequate medical attention but died because they lacked adequate medical insurance. The Harvard figures do not include the number that do not die but who become prematurely disabled or miss work at a high rate due to untreated medical ailments. While horror stories can be told about any system in the world, Ms. White’s story is more common than Americans wish to admit, and some will heatedly claim the Harvard figures and Ms. White’s story are lies.

In blue print is Ms. White’s story as found in two sections of the Reid's book. It is rather long for a blog but deleting sections would do the story a disservice.


RESIDENT OF ANY OTHER rich country, she would be alive today. Around the time she graduated from college, Monique A. “Nikki” White contracted systemic lupus erythematosus; that’s a serious disease, but one that modern medicine knows how to manage. If this bright, feisty, dazzling young woman had lived in, say, Japan—the world’s second-richest nation—or Germany (third richest), or Britain, France, Italy, Spain, Canada, Sweden, etc., the health care systems there would have given her the standard treatment for lupus, and she could have lived a normal life span. But Nikki White was a citizen of the world’s richest country, the United States of America.

Once she was sick, she couldn’t get health insurance. Like tens of millions of her fellow Americans, she had too much money to qualify for health care under welfare, but too little money to pay for the drugs and doctors she needed to stay alive. She spent the last months of her life frantically writing letters and filling out forms, pleading for help.

When she died, Nikki White was thirty-two years old. “Nikki didn’t die from lupus,” Dr. Amylyn Crawford told me.“Nikki died from complications of the failing American health care system. It was a lack of access to health care that killed Nikki White.” Dr. Crawford is a family physician at a no-frills community health center in an old strip mall in a downscale section of Kingsport, Tennessee.


Who was Nikki and what is behind her story? T.R. Reid goes at the end of his book returns to her.


The late Monique “Nikki” White, the bright, vivacious young woman…Tall, slender, athletic, she grew up in a middle-class family in Bristol,Tennessee; her parents were both middle managers in corporate America, and she was covered by a family health insurance plan until she finished college in 1999.

She earned a degree in psychology at the University of Texas and went to work after college for a bookstore near the campus in Austin. It was a perfect job for her. But Nikki, beginning to feel ill, felt obliged to look for a job with health benefits—the bookstore didn’t provide them, and her parents’ plan wouldn’t cover her after she finished school. She found work at a hospital in Austin, where she was eligible for the employee health insurance plan. Some days, Nikki was too sick to go to work; she developed severe stomach pains, extreme fatigue, and skin lesions on various parts of her body.

A doctor confirmed that Nikki had contracted systemic lupus erythematosus, a chronic inflammatory disease that mainly strikes women. This was not good news, but it was hardly a death sentence; about 80 percent of Americans with lupus live a normal life span. “For the vast majority of people with lupus,” says the Lupus Foundation of America, “effective treatment can minimize symptoms, reduce inflammation, and maintain normal bodily functions.” But effective treatment requires health insurance.

In 2001, Nikki was so ill that she had to leave work. That’s when the long, frustrating, and eventually fatal struggle with America’s health care system began for Nikki White. Like most working Americans, she lost her health insurance when she lost her job. “The timing was just tragic,” said her family physician, Dr. Amylyn Crawford. “The insurance system dropped her at the point when she needed it most.”

With grim determination, Nikki applied to every individual insurance plan she could find—in vain. No for-profit insurance company in the United States was willing to cover a person who had chronic lupus. Unemployed and uninsured, she moved home and set up an apartment over her mother’s garage in the green, rolling Appalachian country where Tennessee, North Carolina, and Virginia meet. This not only provided free housing, but the return to Tennessee also meant she could enroll in TennCare, the local version of Medicaid, the government program that provides health insurance for the poorest Americans.

Nikki had trouble finding a specialist who would treat her condition at Medicaid’s payment rates—Medicaid pays doctors less than Medicare, the U.S. government program for the elderly—but eventually she found a rheumatologist who agreed to take her on. The doctor prescribed azathiopine, a drug that would control the inflammation that was causing painful lesions on Nikki’s chest and hands. He warned her clearly that this powerful medication could have dangerous side effects. To avoid them, she needed regular blood tests, CT scans, and office checkups. Neither Nikki nor her mother could pay for such expensive care.

Fortunately, they had TennCare to help. In the summer of 2005, though, Tennessee cut back sharply on its TennCare insurance program. Under the new rules, Nikki White had too much money to qualify for Medicaid. Once again, she was uninsured. She kept trying to get health coverage, but all her appeals were denied. By now, her hands were so painful from the lesions that she had to wear thick gloves just to fill out an application. “She fought and she fought and she fought,”

Dr. Crawford recalled later. For months at a time, as Nikki dealt with a bewildering onslaught of cold bureaucratic form letters, it was unclear whether she was insured or not. “If your TennCare has ended, you should not have gotten this letter,” one missive said. That was followed by another, equally mysterious: “If this box is checked, the person listed in line 3 has at least 18 months creditable coverage. IMPORTANT! This does not mean you have coverage now.” The state Department of Human Services sent TennCare Form Letter 207.5, explaining the extent of her legal right to get insurance: “You can still apply for individual health insurance coverage. Some companies may let you buy a different kind of insurance (not a HIPAA plan). But, they don’t have to. AND, they don’t have to cover preexisting conditions.”

Nikki White was a college graduate and had worked in medical care. She knew how to research health insurance regulations. Eventually, she figured out that Medicaid would have to give her coverage if she was legally determined to be “disabled.” She began filing applications with yet another government department, the Social Security Administration, the agency that determines whether or not an American is disabled. Denied.

By the summer of 2005, Nikki White began to fear that she would never get the medical care she needed. “I don’t want to die,” she said on her thirty-second birthday. “Please don’t let me die.”

In her last weeks of life, Nikki began to receive medical care. In November of 2005, she suffered a seizure—due to kidney failure and perforated intestine—and was admitted to the emergency ward at Bristol Regional Medical Center. From that point on, her insurance problems didn’t matter; under federal law, the hospital had to treat her until her condition was “stable.”

Over ten weeks, she had more than twenty-five operations, all provided gratis. By then, though, the patient was too sick for any hospital to save. In the spring of 2006, at the age of thirty-two, Nikki White died.

Officially, the cause of death was listed as “complications of lupus.” In fact, as her doctor said, the proximate cause of death was a health care system that failed to provide the treatment that would have saved her life. Monique White was an American citizen, guaranteed equal access, along with every other American, to certain basic rights. But she didn’t have equal access to health care. If Nikki had received the standard treatment regimen for lupus readily available to any American with health insurance, she could have lived a normal life span. If she had been a resident of any other developed nation, she could have lived a normal life span. No other rich country would have tolerated the inequality that left Nikki White dead.

Sheep Herding At Its Finest

This clip of sheep herding is a hoot. Check it out.

http://video.telegraph.co.uk/services/player/bcpid1137883380?bctid=17075685001

LSU Football Facility

American college sports is a serious matter, particularly football and basketball at major colleges. Following is a Youtube clip of a tour of LSU’s football facility.

Going For the Close-up

At Ohio State one of the traditions is for the band to spell out Ohio in the pre-game. It is a great honor to be the sousaphone chosen to dot the “i” with flare and finishing with a bow. Watch what happened this past weekend when the cameraman got a little too close.

Thanks Josh for drawing this to my attention.

Equal But Not Really Equal

The Constitution of the United States states that all men (male and female) are created equal. These noble words are taught to the young, and held close to the hearts of each adult citizen. Entrenching them in the Constitution does not make them a reality in everyday life.

Equality in America is must be understood within a narrow context as clearly not all are created or are equal in America. Equality means that there are no first or second citizens, each citizen of age having a right to vote, having the opportunity to express their opinion to the community and elected representatives, to run for public office, to travel freely, to live anywhere within their means and as zoning allows, to free public elementary and secondary education, to have their day in court if grieved or if charged with a crime and to walk the streets without fear of arrest.

While each has the right to vote, and all votes within the ballet box are equal, not all votes are equal outside the ballet box. While all are free to express their opinions, not all voices have equal weight. Due to wealth and financial support some individuals and groups have far greater access to their representatives and to influencing the outcome of legislation. While all have available to free public education, not all schools are equally funded or equipped with equally skilled teachers. This inequity means that students from a community and family of less means are far less likely to succeed than their neighbors in other communities. Such students do not lack the capacity of their neighbors that live in wealthier communities, what they lack is equal opportunity.

While justice may be blind, access and the veracity of an argument are influenced more by the dollars of the one before the court than we wish to admit. Those with true and legitimate grievances who have the means have a far greater capacity to pursue their claim than those who are the working poor. Courts history is replete with cases victorious and questionable cases being successfully pressed by those with means over those who lack.

While in theory all have access to medical care, it is all theoretical to the 45 million Americans who lack insurance. This result is that 24,000 uninsured people under the age of 65 yrs. die a year from treatable and recoverable illnesses a year that those with adequate health care coverage. While that 9-11 attacks are considered a national tragedy the deaths annual of a number eleven times than those who died at the Pentagon and Twin Towers is not considered a tragedy. Eight years ago we saw the vivid images but the 24,000 dying one at a time hidden from sight does not move the heart of nation. Instead of being enraged it into moral action far too many of us shrug our shoulders and dismiss their deaths as being of little consequence…that is until one of our loves ones or a very close friend becomes part of that statistic one year, and will happen for at least half the families at least once in 50 years, then we will howl but our neighbors will shrug their shoulders and remain unmoved.

In America, all are equal, but some are just more equal than others…that’s just the reality of life. While all should not be equal, the nation does not view health care as something to which all should have equal access which will continue to remain in contrast to other developed industrializated nations that have said yes, all should be equal when ill or need of a health care professional. In America it is not a moral imperative as it is within its world peers.

LSU Band Goes Into Hall of Fame Saturday Night

Last night Josh told us last evening of the “LSU Golden Band from Tigerland” being inducted into the Louisiana music Hall of Fame. I got this google alert on the news coverage. If you watch carefully you will see Josh in the background several times (2:08-2:12, 2:31-2:32). He is in a gold T-shirt and red shorts. At the 2:31 mark he is front left on the screen whereas in the earlier section he is well in the background.



Congratulations to the band on their recognition.

Representative Joe Wilson's Shout-out

Joe Wilson’s shout out during President Obama’s address to Congress shocked many of his colleagues and friends. It also raised a storm of criticism from a host of Democrats.

His defenders explain it away as Wilson being loosing it on a subject over which he is passionate. Let’s hold that explanation in reserve and measure it by what is evident for any observer to put together.

1. Wilson is a lawyer by profession. Lawyers are trained to control their emotions and to remain cool, deliberate and thoughtful when others panic. As a practicing lawyer for over twenty years he has honed the lawyerly skill of anticipating an argument and then honing a phrase or statement so that its impact will have maximum affect.

2. Wilson practices his skills in the military for 31 years and retired as a colonel. Military personnel are well drilled in remaining calm, cool and collected in the heat of battle. A military officer who is prone to losing their emotions will soon be out of the military. Officers are models of decorum. To rise to be a colonel speaks volumes as to the level of control he is able to maintain.

3. Though Wilson represents a district in South Carolina that has never elected a Democrat since 1965, in the last election Wilson was nearly defeated by Rob Miller who is running against Wilson again in 2010.

4. Increasingly Wilson is working at stirring and shoring up his Republican base while also attracting the independents who are angry about the level of illegal immigration as well as those who are concerned about deficit spending.

5. The outburst has been well received within his district.


While I do not know Wilson, and will not judge his heart, I the explanation of his defenders about losing his calm on a matter close to his heart does not match Wilson’s background and context. Notwithstanding the quick call to apologize to the President, I would not be at all shocked to learn in the weeks or distant years that the cry was the honed lawyerly courtroom skill at work and that the outburst will be leveraged by his campaign during the next election.

Why Health Insurance Firms Fight the Public Option

Whether measured by GDP or on a per capita basis, Americans spend more money on healthcare than any other industrialized nation. It would stand to reason that Americans would therefore have the best system for the average citizen. Yet measure after measure, it is in the bottom rather third. Here are just some of the measures, life expectancy, infant mortality before the age of one, life expediency at age of sixty, recoverability from treatable medical conditions, etc.

In America 20% of medical premiums is insurance company overhead and profit. This figure does not include the medical billing costs and overhead experienced by provider. Nor does it factor in the amount of time a patient and the patient’s family spends pouring over medical bills to ensure accuracy. For Canada’s single payer system, the overhead is 3%, the same as it is for Medicare and the Veteran Affair’s program for Vets.

When an insurance company pays a bill, they call it a “medical loss”. The companies seek to have a “medical loss” no worse than 80%, and some aim to push it toward the 76% market. To achieve this end, they deny coverage to people they consider to be too risky. Another vehicle is to put great efforts into avoid and delaying payment on medical claims. About 30% of claims are “denied”, the most of which are paid upon appeal by the recipient of the treatment.

Some excuses for denial are dubious, such as a signature not in the right place. One person’s claim was denied because the services were given to this businessman while he was in Japan. The insurance company denied the claim for two reasons, the bill was in yen and they could not verify treatment. The company says that the provide insurance for out of country treatments but policy holders only learn later that the statement must be in US dollars and is paid in US dollars. Second, and the more daunting is that treatment must be verified by the insurance company personnel which creates two problems, a) the company’s phone system does not allow for out of country calls to verify treatment and payment information, and b) having to find someone who speaks English well enough on the other end to answer satisfactorily the range of questions being asked by the company. Hence, the insurance company puts up walls that the insured must find a way to overcome in order to have the out of country treatment paid by the plan.

A host of minor treatments provided within the US are routinely denied with the hope that the insured will cover the items out of their own pocket (one out of two will not appeal) even though the company knows they will pay the bill if the insured appeals the decision. A majority of the 30% denied claims fall into this category. For profit companies have teams of people who examine bills to find reasons to deny them so as to maintain the targeted profit margin.

Medicare on the other hand which does not have to pay out high seven figure and eight figure salaries to executives or pay out dividends to shareholders, or have teams of people whose primary purpose is to deny claims, which is why it has a 3% administrative overhead versus from profit companies 20%. Insurance companies are right when they say that they will not be able to compete with a public option as either the government will be able to offer the same coverage for about 15 to 17% less or for the same premiums offer greater coverage. Regardless of what other reasons the health care insurance firms will give, the 17% difference will kill them.

An Effective Ad - Not! - But One That Would Be

Following is an advertisement from 1919. Whoever designed this item was out of touch with reality. If you were a guy and drank would their promise persuade you?
























I can hear young men sitting seeing this ad and saying, "I'll start drinking if it will keep these ladies from kissing me."

Now something more along the lines of the following would have made a more persuasive impact.

An Irresponsible Statement From the Pastoral Office

On August 16, Reverend Steven Anderson, the pastor of Faithful Word Baptist Church, an “old-fashioned, independent, fundamental, King James only, separated Baptist church” in Tempe Arizona informed his congregation that he is praying for the death of President Barack Obama. Anderson stated the he prays that Obama “dies and goes to hell.” He went on to say, “If you want to know how I’d like to see Obama die, I’d like him to die of natural causes. I don’t want him to be a martyr, we don’t need another holiday. I’d like to see him die, like Ted Kennedy, of brain cancer.” He not only mentioned it in his sermon, but has posted that sermon on his web site.

I do not know Anderson, but his statements alarm me on several levels. While I will not judge his spiritual standing, I do judge such statements as lunacy, irresponsible and most unbecoming of a man in his position. While we could be tempted to dismiss Anderson as a very rare case, he is not. Over the course of the last twenty years a good number of fundamentalist and evangelicals leaders, ministers and laity who have and continue to demonize those who do not think like them.

The roots of such thinking stem back to the early 1980s to Jerry Falwell’s defunct and failed “Moral Majority”. Falwell rightly encouraged the faith community to be engaged in the political sphere and to make decisions on voting not by party but by faith measures. It is the latter where the failed legacy of the Moral Majority’s continues to linger. Instead of encouraging people to make decisions in a balanced way on a wide host of issues and values they made at the time four issues exclusive measures, a) reversal of Rowe v. Wade, b) fighting the passage of the ERA – legislation that recognized the equality of women both in the home, law courts and work-place, c) fighting passage civil-rights laws, and d) standing firm against any laws that recognize gays as having and civil protection in the work-place or from prosecution. Since, the religious right has kept to a very narrow agenda and has increasingly become an extension of the right wing of the Republican party.

As for Anderson, let me deal with the cancer statement first. Anderson has implied that brain cancer is a divine judgment and rightly fitting those who are destined to hell. No doubt about it cancer is a curse but it is a curse that falls upon the just and the unjust. To imply that those who have cancer are under some sort of divine judgment is preaching a gospel that is not found in the Bible and but is a false man-made gospel.

Rather than starting with the Word and allowing it to speak and shape his mind, it is clear from these few statements that like all too many other’s on the far right that Anderson starts with a political position and belief system and then uses carefully selected Bible passages to justify his preconceived bias while dismissing others that would not support such a view. In other words he is an extreme Republican who happens to be a Christian and uses the church and the Bible to support his political views.

What is most alarming is not his views, but the context and venue in which they are uttered. As a citizen of the United States he is free to hold any view he so desires whether they are grounded in truth or not. Also he is free to express them freely to the cheers or jeers of the listener.

I take issue with Anderson as these comments are spoken from the office of pastor and in the venue of worship. Credible seminaries carefully remind their students that what one says from the pulpit and in the context of the pastoral office must done thoughtfully. They remind their students that the listener views their words as a divine message more than merely the opinion of a man or woman. Such views are taken seriously by their congregants and some will accept them uncritically. A thoughtless personal opinion the pastor sees as “just my opinion” is viewed as a divine opinion by the listener. The pastor therefore must be guarded in his opinion and is advised to be cautious in uttering them within the contexts of a sermon, prayer, worship, pastoral counseling, or pastoral pronouncements. Anderson either was never taught this wise instruction or he has ignored this fundamental pastoral teaching.

As mentioned, as a citizen he has a right to speak these things. If he said them apart from the pastoral role and worship I would have no issue as such other than to say that I would disagree. But to state these things as part of worship or in the formal context of fulfillign the pastoral role is another issue.

That said, many other evangelical and fundamentalist leaders likewise ignore the wisdom of their thoughtful teachers. Too many start with a political agenda, speak on that agenda while using faith statements to justify their position, without most in their congregations realizing that they minister has misused his office and Scripture to push a political agenda. What is also disturbing is that many pastors do not realize that they are starting with an external manmade agenda and labeling it as God’s agenda.

The response from the religious community at large when a religious leader utters such statements is disappointing. Instead of their supervisors and peers speaking out in various ways against such thinking, they remain silent, and thereby tacitly indicate that such an utterance is acceptable. Since Anderson is an independent fundamentalist separate Baptist, he has no supervisors or peer system to hold him accountable. It is up to the church and individuals at large to speak out against such statements, statements that harm civil discourse as well as the church body as a whole in the eyes of the world at large.

The Crucible of War - A Worthwhile Read

I recently finished The Crucible of War: The Seven Years War by Fred Anderson. This history textbook is not a quick read, but moving through it at a steady pace is well worth the effort. Anderson draws out the social and political dynamics of the age that triggered the first global war as England and France fought it out for world dominance.

The book fleshes out what transpired in the pre-revolutionary war period in the colonies, the stirring of unresolved issues, the self-centered actions of a host of people who were seeking more money for themselves and the stumbling of cultural misunderstandings that sowed the seeds for the American Revolution. The book helps the reader to understand that the colonists did seek to revolt but progressively did so because they could not resolve how they viewed themselves and their social standing within British Empire. Anderson nicely shows that the colonists sought to be left alone but the moment they ran into trouble, quickly sought the help of the Crown but were reluctant to pay that help.

One little tidbit I found of interest is that young George Washington and a force of men he lead against the French and Indians in Ohio triggered the war the consumed the two empires and the ultimate defeat of France.

The book not only is of interest in helping the reader to understand the nature and characters that make up modern America but it also shows how America has not learned from its own national experience. Throughout the book I could not help see similarities between the dynamics at play in Afghanistan and Iraq. All too often one is seeing in contemporary American policy and national attitudes the viewpoints of the Crown and the British nobility of the 18th Century. Further all too often the viewpoints and attitudes Americans are seeing in the Afghani and Iraqi leadership and populous today are similar to the attitudes, language and actions held by the colonists in the ten to fifteen years before the American Revolution. In other words, America today is acting in a very similar fashion that Britain did in the 1750-1776.

Storm and Waves

For the last two nights, and throughout yesterday, we have been experiencing rainstorms. A high volume of rain has fallen due to low pressure system that developed just east of the Outer Banks. Following are some pictures from this morning of the waves along the beach by the campground.

Once it stopped raining, people started to move out and about the campground and beach. Notice the large amount of sea foam that the waves are creating.

Ferry Trip and the Gulls

Yesterday we traveled to Hatteras Island on the Outer Banks via two ferries. The first ferry took us from Swan Quarter to Ocracoke Island. We drove from 12 miles north from the south end of the island where Ocracoke Village is located to the north end to catch the ferry to the south end of Hatteras Island and the town of Hatteras. There was a fee for the ferry from Swan Quarter ($30 for us as we are oversized) but no fee from Ocracoke to Hatteras.

I spend some time watching the gulls and managed to get a few shots along the way.

The first picture is not a gall but a pelican of some sort. I got lucking in the second with the bird zeroing in on a bug (note his beak is just starting to open).

Baltimore

This is a picture of Baltimore's Inner Harbor. It is on my list of places to visit this year with my wife.

Last of Pictures From Charleston SC

On the eve of heading out for a week's vacation on the Outer Banks I am posting the last pictures from Charleston SC. The following are from the Battery, an area with large homes for those of significant means.