Recently in health etc Category

Everyone who is not either ignorant or cynical recognizes that private health insurance must go, and be replaced by a publicly financed single-payer system such as those that exist in virtually every civilized democracy on the planet. Once again I picked up my quill and penned another missive to my Congressman and I urge you to do the same without delay.

Dear Congressman:

I write to urge you to co-sponsor and support HR 676, the Expanded and Improved Medicare for All bill re-introduced by John Conyers.

Everyone knows Obama's healthcare "reform" is coming unravelled, as was to be expected. Based on the thoroughly dysfunctional private insurance system we now have, it was doomed to fail from the start. Many people -- not only the right -- rightly detest the individual mandate because it compels the purchase of a defective product. It is truly a dreadful idea, and yet the Obama legislation can never be even minimally effective without it.

Meanwhile we have the likes of Scott Walker and Chris Christie doing their best to destroy the public sector, as if firefighters and librarians were to blame for the budget crises many states are suffering. One of the recurring themes in these confrontations is the cost of healthcare. How can we take this contentious healthcare issue off the table and save our society billions of dollars, while achieving superior public health outcomes at the same time?

The solution could hardly be more obvious. We have been needing a single-payer, national health insurance plan for decades, but the need has never been more desperate than it is today. Single payer has been proven to work in other countries and it will work here. The time has come to discard Obama's ill-conceived, private-insurance-based debacle and start over. Healthcare is a human right, not a commodity. The struggle will not be easy, but that is no excuse not to do the only morally and economically sound thing: single payer, Medicare for All. One publicly financed national health insurance plan for everybody.

I look forward to hearing your thoughts on this matter.

I wrenched the holy fuck out of my lower back while getting into the car to drive my daughter to school last Friday morning. That simple act seems to have triggered it, but an accumulation of insults must have contributed. I had never had a back experience quite so bad in my 50-plus years. I could barely walk, and had to miss a couple days of work. I could not dress myself without assistance, and was only just able to maintain that essential, minimal autonomy and independence: lower myself onto the toilet to take a shit, and wipe my own ass.

The back is hard to ignore, being right in the center of the body, the hub of everything: arms, legs, head. For the first day or two or three, I tried to be tough. Pain? Fuck pain, I can deal with it. But after about four or five days of it, when you are stiffly shuffling around in your bathrobe, staring out the window at the rain falling from the quiet gray sky... then you understand how a person could get depressed.

I had planned to run a local 5K race Saturday morning, even indulging fantasies of winning my age group. Indeed, the guy who did win it is an acquaintance, and his pace was 2 seconds per mile slower than my last 5K, on August 14. There would have been a dramatic battle to the finish line! (I could have this, I would have that --- yeah, so go into a bar and brag about "could have" and see how many people you impress.) Instead, as runners were milling about the starting area, I was struggling just to get from bed to toilet, taking tiny baby steps, gasping and holding the walls for support.

Debilitating injury and pain get to us for any number of compelling reasons, but foremost among them is that such episodes are prefigurations of our eventual, inevitable death. Yeah you heard me: one of these days you are gonna go down and stay down, and your life will end. We should regard these illnesses and pains of our decaying bodies as opportunities to reflect on impermanence.

And yet there is a hilariously comical element mixed into this mess. A couple of times I burst out laughing at my predicament, stuck somewhere in the middle of a room, unable to stand still, unable to move forward. The vibrations from the laughter made my back hurt worse, of course, so I laughed all the harder -- erasing from my wife's mind any lingering doubt that I am crazy.

The short answer is The Omnivore's Dilemma by Michael Pollan. I was already generally aware of the atrocious ways of meat production in the United States: extreme cruelty to animals; adverse impacts on human health and on the environment. But the gory details were sufficient to compell me to decide not to participate any longer. There is no excuse for treating chickens, pigs, and cattle the way large industrial producers do, and I refuse to be complicit in a system of which I so strongly disapprove. Indeed, it would be hypocritical of me to do otherwise.

That doesn't mean I am a full-blown vegetarian. Homo sapiens is one of those animals that eat other animals in order to survive, and I have no problem with that in principle. If you can serve me a piece of pork that was once a pig who was raised and killed in as humane and environmentally sustainable a way as is reasonably possible, I will happily eat it, mindful of the pig's sacrifice. A roasted rabbit, who led a natural bunny life hopping around and eating and fucking until dispatched so skillfully that Mr/Ms Bunny never knew what hit her or him? Bring it! But getting that kind of meat requires substantially more expense and effort than does the supermarket kind, and as of yet I haven't made the effort, so I have gone without eating the flesh of cattle, chickens, pigs, turkeys, and so forth.

Fish is another matter. Figuring out which kinds are harvested in an environmentally responsible fashion also takes some homework, and they have faces, and they probably don't like suffocating any more than you or I would. But I am content to rationalize that a sardine does not have the cognitive functioning to realize how bad it's getting fucked before it ends up in a can. Maybe I will eventually change my position. For now, I need protein and don't want to depend solely on nuts and tofu. So I eat fish with some qualification.

One might say, let's see you kill and butcher that animal yourself, and then see how you feel -- as Michael Pollan did. I would certainly be willing to give it a try some day -- killing my own food sounds kind of cool, in fact. But for now I am a creature who lives in the suburbs, works in a city, and going hunting with my crossbow is not really a practical alternative. The idea is certainly not forever foreclosed, but for now I am content to allow someone else to kill my food animals for me.

Opting out of industrial meat has not required any difficult adjustments in my diet, because I was already eating a lot of vegetarian meals, rarely consuming red meat, and increasingly eating fresh and local food. I have had to renounce that Cambodian style noodle soup from a Cantonese place near my office, a delicious concoction made with sliced and ground pork as well as shrimp and egg noodles in broth probably made from ducks who undoubtedly fare no better than the pigs.

As for eggs, we generally buy the most environmentally correct ones available, and willingly pay a premium over the industrial kind (think of it as insurance against salmonella poisoning courtesy of a mass producer in Iowa who churns out millions of eggs a week -- you don't need to be a Slow Food connoisseur to see the problem inherent in production on that scale). But that's also a tricky game, since what you read on the carton -- "cage free," for example -- may be bullshit. But I eat salads from a deli near my workplace, sometimes containing a hard-boiled egg about whose origins I know nothing. I am not a purist; I compromise. When I eat my kids' left-over pepperoni pizza, I peel off the pepperoni and eat it, unconcerned about the pizza being tainted with pepperoni residue. And maybe -- maybe -- when Thanksgiving rolls around I will decide to go along with the program and partake of the turkey. We'll see.

The result of this modest dietary change is that I feel fine both ethically and physically. I like to burn a lot of calories running, and have kept on setting personal record times since quitting the meat. Over time, I suspect our family will be eating still more local and fresh, and adjusting our diet according to the seasons in New Jersey. The rest of the family might even phase out the industrial flesh consumption. For now, this is working well for me.

As someone who struggled intermittently with sleep problems for decades and ultimately beat them, I am pleased to share what I consider the secrets of my success. None of this can be proven objectively; none of this is science; all of this is subjective and anecdotal. But it's consistent with both science and common sense.
I assume you're already familiar with the conventional wisdom: take it easy on the caffeine; don't eat heavily too soon before going to bed; don't work out hard too soon before going to bed; and so on. All that is fine. But here's what seems to be working brilliantly for me.

Step one: clean house. Everything else can almost be considered a subset of this overarching principle. By house-cleaning, I refer metaphorically to getting one's personal shit in order. This may seem self-evident at first glance. But this sort of mental-personal hygiene is forever a work in progress, and many of us are wandering around in various degrees of denial and delusion, so it bears a closer look. Hate your job? Deal with it. Hate your spouse? Deal with it. Need a shrink? Get one. Need to change shrinks? Do it.

Next, be very careful with alcohol. Even though I've always been high-functioning, I used to drink abusively most weekends of my life, thinking of it as a form of recreation. A few years ago I realized I had had enough, and abruptly quit binge-drinking. Few things disrupt sleep as cruelly as alcohol, and it gets worse as you get older. Moreover, the effects of boozing are more subtle, pernicious and persistent than we might think. You might be smashed on Saturday night and think that sin should be in the past on Wednesday, when you can't sleep. Not so. Moreover, a penchant for getting hammered usually points to some underlying issue that has to be addressed: see step one above. I am still in the process of examining my own story, but getting to sleep is no longer an issue.

Next: exercise. Seriously burn some major calories doing hard cardiovascular exercise several times a week. The benefits are amply documented, and getting more so all the time. Don't make excuses. Do it, and learn to love it. It's good to lie down at night with a body that is really, legitimately tired, not just an exhausted body and a mind buzzing with all of life's bullshit.

Next: sit. That's the simple, unpretentious term many meditators like to use for what they practice. We call it sitting because it really is just sitting. There are many different meditation techniques, but the form I favor is arguably not meditation at all because there is no external object of concentration, no mantra, no effort to stop thinking and attain some pure state of single-pointed concentration. Sit up straight -- on a cushion, or a kneeling bench, or even a chair -- eyes open, looking down at about a 45 degree angle, and inhale and exhale. It's good to set a timer so you don't have to worry about the clock. Pay attention to what you're doing: breathing in and out, receiving sensory input, thinking thoughts. Keep returning your attention to the experience of right now. The attention will wander -- will crawl away like a turtle, or fly off like a bird. No problem, just keep coming back, time and again. Don't worry about goals and objectives. Just sit. As Matthieu Ricard puts it with elegant understatement in one of his books, the benefits of meditating for 15 minutes a day far outweigh the scheduling difficulties. And by the way, the state of pure concentration -- moments of astonishing clarity and calm -- will eventually begin to happen from time to time. But not as a result of chasing after it.

Next: when it's time for sleep, do not try. I can't emphasize this enough. Stop trying to go to sleep. What could be more ridiculous, and self-defeating? There is no hurry. I have found it far more effective to just lie there doing nothing than to worry about the clock. Just lie down and let it happen.

Or not. The final point here is that you may do all this stuff with great diligence, and still have occasional difficulties getting to sleep and/or staying there. Maybe a bit too much coffee, or anxiety, or food, or some combination of these -- whatever. When this happens, it happens. Do not worry about it. After all, what good does it do?

On October 15, 2009, I participated in a nationwide campaign of nonviolent civil disobedience to demand Single Payer health care and an end to the profit-driven private health insurance system. Supported by some 50 legal protesters in the street, 14 protesters entered the lobby of One Penn Plaza in midtown Manhattan, a building that houses offices of the insurance giant UnitedHealth Group, and sat down on the floor. When we refused to leave, police arrested us and loaded us into paddy wagons.

Our group consisted six women and eight men. Of the men, two were in their mid-seventies; one of these was a retired Episcopalian priest, whose bearing and clerical color gave our group an air of respectability and gravitas; the other happened to be a Quaker.

Most people who do civil disobedience hope to get what is known as a Desk Appearance Ticket (DAT), where the police take you to the precinct, check your fingerprints for warrants, and if they find none, hand you a piece of paper like a traffic ticket and send you on your way. The whole process takes typically four to eight hours, and is perhaps only slightly more (or maybe less!) unpleasant than typical airline travel, where you are in a sense imprisoned, and your patience is tested. But we were not so fortunate. It was determined -- I don't know how or by whom -- that we were to go through "the system" with the rest of humanity in all its wretchedness. Some of us speculated that this determination may have been political, i.e., someone powerful made a phone call and said that protesters should be discouraged and not given any breaks.

First we were taken to the 9th Precinct, in the East Village, where we were divided by gender and kept in two cells for over 10 hours. For the first five or six hours, morale was high. We had lively and stimulating conversation, got to know one another, sang songs, had some good laughs. After seven or eight hours had elapsed and we still had not been provided water, much less food, we began to complain. Ironically enough, the priest had headed a commission some years ago that promulgated a set of reforms for the New York law enforcement and penal system. Among these was a regulation that any prisoner detained for over five hours between midnight and 7:00 a.m. had to be provided food and water. When the priest pointed this out to one of the officers, she argued that the rule applied only to Corrections and not the NYPD. The priest insisted that it wasn't so, and encouraged her to consult her supervisor. Eventually, she offered to take a few dollars from us, go to a vending machine in the building and bring some bottled water. I don't think it took much effort. Shortly thereafter one of the support team was allowed to send in a bag with refreshments: more water, some fruit and energy bars.

In the meantime, the police went through an arduous process of fingerprinting us one by one with a scanner that kept failing to recognize our fingerprints. Whether it was software or hardware that was defective, or both, the machine balked if your fingers were too oily, or not oily enough, or if you were simply too old and your prints were too faint. The cops muddled through with commendable patience for the several hours that it took to fingerprint all 14 of us.

It was approaching 10:00 pm when we were transported downtown to a place known as the Tombs, in the basement of the courthouse at 100 Center Street, too late to appear in night court and be released. The place was packed, and we all stood handcuffed in a slow-moving line for over an hour to be photographed one by one, and finally, around midnight, admitted as a group to one of several large holding cells.

Some of us were still wearing white T-shirts with black lettering that said "Victim of Private Health Insurance" on one side, and "Medicare For All" on the other. We were repeatedly asked by both police and prisoners why we were protesting, and we seized every such opportunity. People were overwhelmingly receptive. (Only the intake photographer at the Tombs was hostile, but then again, from what I was able to observe, he seemed to have hostile attitude towards everyone.) Thus the system handed us an opportunity to promote our cause and continue the very sort of work for which we were arrested.

The Tombs was not particularly pleasant. I was grateful not to have known in advance what it would be like, because if I had, I might have hesitated to get arrested. We were in a windowless rectangle with a built-in stainless steel bench along three walls (the fourth being the bars). There were a lot of miscellaneous arrestees, people sleeping on the floor or on the benches, overwhelmingly black. A group of kids, whom I found vaguely menacing, had apparently been arrested together for drugs; they monopolized one of the two phones. Shortly after we arrived, the guard announced a feeding and let us all out into the hall to collect little boxes of corn flakes and milk. When we returned to the cell there was a confrontation, basically about territorial boundaries. Another prisoner struck one of our group in the face, breaking his glasses and giving him a black eye. Another of our group yelled for the guards, who came promptly and removed both victim and assailant to different cells. This was how our evening at the Tombs began. (Note to those considering doing CD who have an aversion to violence: this incident could surely have been avoided had we exercised a bit more caution.)

A guard came to the bars to ask witnesses about the incident. A couple of us went over and provided a narrative. Then there was some grumbling in the cell about snitches, and I had some fears of getting my white ass beaten. But the whole affair seemed to blow over, and the hours dragged on.

And on. After so many hours under flourescent lights with no windows and little sleep, the time of day reported by my watch became a meaningless abstraction; there was no discernible difference between 4:30 a.m. or p.m. There was a water fountain in the cell, but I distrusted the foul-tasting water and drank sparingly. As for food, it's too painful to remember and I'd rather not talk about it. Seriously, though, the nourishment provided was evidently designed to keep us from starving and no more. For a good meal you should look elsewhere.

At some point, a handsome, well-dressed, articulate black man was brought into the cell. He and a like-minded friend began to lecture the assemblage about God, and His purpose for us all, and what we had to do to attain true manhood. "Gentlemen," he said, "there are four attributes that you do not find in a real man. A real man is not a gangsta, a pimp, a thug, or a playa." This seemed to be directed at the vaguely menacing kids. Eventually, there was a genuine conversation to which everyone who was not asleep appeared to pay attention, many of them participating. We discussed spiritual and philosophic issues and basic personal values. Where we could find common ground, we did so. When our well-dressed friend argued the inferiority of women, we called him on it. It was a remarkably fruitful exchange of ideas. But the preachers outlasted us, and the dialogue degenerated back into a one-sided lecture that became oppressive.

Our Episcopalian priest had been placed in a separate, more private cell -- presumably because of his age and status. Towards morning, they put him back in with the rest of us. His appearance apparently humbled the two lay preachers, as they finally quieted down as soon as this real clergyman arrived.

The morning wore on and became afternoon, according to my watch. At last the guards started pulling small subsets of us out to go to court, where a judge released us on our own recognizance. Mine was one of the last three bodies -- as we call humans in the judicial/corrections trade -- to be summoned. Our lawyer, a volunteer who enjoys representing protesters, stood up for us in court without having had a chance to talk to us beforehand. The prosecutor offered Defendant Yours Truly a plea to Trespass Violation, the lightweight version of the misdemeanor Criminal Trespass, and one day of community service. Community service? Excuse me, I have been serving the community big-time for the last 32 hours. For our septuagenarian Quaker, who has more of a track record than most of us, the offer was seven days in jail. Apparently he is deemed a danger to society and in need of some deterrence. Fuck that. The UnitedHealth 14 will be holding out for much more favorable dispositions.

My brief encounter with the system was sufficient to underscore what I already knew: we live in a profoundly racist society. There can be no justification for the extreme overrepresentation of minorities and the poor in the jail population. If patterns of law enforcement have a disproprortionate impact on non-whites, which they undoubtedly do, that is inexcusable; and if dark-skinned people in fact commit crimes at a greater rate than light-skinned people do, then they must be disproportionately affected by inequality and social problems that make it so, and which must be addressed. Most people would rather make a living wage than spend the night in the Tombs for shoplifting cosmetics from Walgreens.

The experience also reinforced my feelings of gratitude. I knew I was lucky to enjoy a bourgeois life, but after being released from the can, sleeping in a comfortable bed next to my warm and yummy wife, with the cat Master Lin-chi curled up purring next to my legs in all his astounding furriness -- this was delicious beyond description. I slept like a god.

When I awoke, the first thought in my head was this: Patients, not profits. Medicare for all. I realized my determination was now all the stronger.

* * *

Since you've been good enough to read all these words, you can now be rewarded with pictures and video. An excellent YouTube piece is at http://www.youtube.com/watch?v=3Vx_Cnw2Wxk, and there are still photos at http://www.antiauthoritarian.net/NLN/photo-gallery/2009_10_14_health/ -- scroll down past the silly HCAN stuff about the meaningless public option to see some great shots of the UnitedHealth action.

And yes, there is something you can do: http://healthcare-now.org/ The struggle is far from over and we have no intention of giving up.

My right honourable friend David Mintz shares with us this missive that he composed for Senator Robert Menéndez, gentleman from New Jersey, in regard to health care reform legislation. Though it's substantiallly redundant with your humble servant's letter published here just a few days earlier, we think the message herein bears repeating.

Dear Senator Menéndez:

I write in response to your invitation to your constituents to their submit ideas regarding health care reform. Note that this is not a canned text or a copy-and-paste job, but my own words.

The public option may sound like a good idea, but it's clear that the likely outcome of HR 3200 is more of the same. Any solution built on top of the existing private-insurance-based scheme is a loser, as a public option plan will only be able to compete with the private sector by emulating the latter's worst characteristics, shifting costs onto consumers and delaying or denying benefits. Indeed, from what I read of HR 3200, it contains a provision that the public option offer three or four distinct tiers of coverage with names like "Basic," "Standard," and "Premium" -- meaning if you have enough money, you can buy relatively good coverage (emphasisi on relatively), whereas if you can't afford the higher premiums, you can gamble with your health; and if you lose, go down the toilet both financially and medically. This sounds all too familiar.

It's abundantly clear that the only rational and humane solution is a single payer system, and I therefore urge you to forget HR 3200 and support HR 676 and Senate 703. As a society, we are already spending enough to cover everyone, but 30 cents on every health care dollar is sucked up by insurance companies' overhead and profits, while millions continue to go uninsured or underinsured. This is as immoral as it is wasteful. For-profit healthcare is an oxymoron, because health care is a human right, not a commodity.

When politicians say single payer sounds good but it isn't politically feasible, I don't buy it, for if every politician voted for single payer, you would have the votes. At worst, "not politically feasible" is a cynical expression whose true meaning is "I am up to my ears in private insurance and pharmaceutical money, and dare not betray my corporate masters."

The economic disruption to the health care industry can be managed. Consider, as a reasonable compromise, phasing in single payer by lowering the eligibility age for Medicare by ten years every two until everyone is in from cradle to grave. (And, as a real "public option," provide that others who are below the eligibilty age can opt to buy in at an earlier age via payroll deduction.) Further, HR 676 provides that displaced health insurance workers receive top priority for re-training and employment in the public, national health insurance program.

Of course, the right-wing fear-mongering about socialized medicine is to be expected, and should be ignored. HR 676 ought to be a true conservative's dream, because it provides for an efficient, publicly financed, privately delivered health care system and eliminates vast amounts of waste. Even if we accept the language of the right and call it socialized medicine, I am telling you as a voter and citizen of these United States that I want socialized medicine.

How many of your constituents are satisfied with their private coverage, with its premiums, co-pays, co-insurance, exclusions, denials, delays, voicemail mazes, unintelligible form letters ironcially entitled Explanation of Benefits, and bureacrats incentivizing care providers to withhold care from them? I, for one, am among the fortunate: a healthy 51-year-old male with no chronic problems and relatively good insurance under BlueCross BlueShield Federal Employee Program "Standard Option." Even so, I spend way too many hours doing battle with BCBS and providers over billing and reimbursements, and I have had quite enough.

I sincerely hope you will lend your support to genuine health care reform: Senate 703 and HR 676. As a bare minimum alternative, please support the Kucinich Amendment to 3200, which would make it easier for the states to implement single payer. If there is anything I can do to be of assistance in this regard, please feel free to call on me.

Just now I emailed the following to my Congressperson, Bill Pascrell, who represents the 8th District of New Jersey.

Dear Congressman:

It's time to eliminate the private health insurance industry and cover everyone with Universal Single-Payer National Health Insurance (NHI).

Under a comprehensive National "Single-Payer" Health Insurance Program, every American would be covered for all necessary medical care. All citizens would receive a National Insurance Card entitling them to care at any hospital, doctor's office or clinic, as well as coverage for prescription drugs and supplies. The United States National Health Insurance Act, HR 676, embodies these principles and I urge you to support it.

Under NHI, a single, public insurance plan would replace the current patchwork of thousands of private plans. Eliminating the existing complex and redundant insurance bureaucracy and the paperwork burden it inflicts on doctors, nurses and hospitals would generate massive administrative savings. Overall, NHI would save about $350 billion annually on bureaucracy and profits, more than enough to pay for covering the uninsured and improving coverage for the tens of millions who are currently under-insured. (But if you aren't convinced, I would urge you to ask the CBO to do an analysis of HR 676).

Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. The NHI would pay for care in private doctors' offices, as well as in group practices and clinics.

A National Health Insurance Program is the only affordable option for universal, comprehensive coverage. Lesser reforms that retain the private insurance industry cannot streamline bureaucracy; as a result, expanding coverage inevitably means increasing costs, and reducing costs inevitably means limiting coverage. But NHI could both expand coverage and reduce costs. It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine and nursing. For patients, NHI would assure comprehensive coverage and a free choice of doctors and hospitals. For physicians and nurses, NHI would minimize bureaucratic hassles and costs, and nurture the best traditions of these honored professions.

The so-called public option, so dreaded by the right wing and the insurance lobby, would most likely not be able to compete with the private sector except by emulating its worst characteristics: denying care and shifting costs onto consumers. We don't need any more of that. And such a scheme has no realistic chance of "bending the cost curve."

Medicare, on the other hand, already is a successful and efficient single-payer program that operates with 4% overhead (some sources say 3%) -- unlike the private insurance industry, which consumes 30 cents on every dollar in overhead and profits while contributing nothing to the actual delivery of health care.

I am a 51-year-old healthy male with an exemplary lifestyle and relatively good insurance: Blue Cross Blue Shield federal program, "Standard Option." Still, I spend far too many hours dealing with BCBS bureaucrats who feed me an endless stream of lies and obfuscation as they try to maximize profits by delaying or withholding benefits. And I am among the lucky ones fortunate enough to have coverage. I have had enough of this.

I do not buy the argument that Single Payer is not politically feasible. The majority of the public wants real health insurance and despises the status quo. "Not politically feasible" is at best a self-defeating, self-fulfilling prophecy �?? for if enough politicians voted for it, you'd have the votes -- and at worst, a cynical subterfuge meaning "I am up to my ears in pharmaceutical and health insurance industry money."

Single Payer is the only rational and humane solution to the crisis afflicting our country. Please do the right thing: support HR 676.

Thank you.

Postscript: some of the above text is borrowed from http://www.gopetition.com/petitions/petition-congress-to-pass-single-payer-hr-676-national-health-insurance.html

When you go to some sort of health care provider for the first time, you are invariably presented with some forms to fill out. One of these usually contains language that says you agree to be responsible for any and all charges not covered by your insurance. Cross it out, put your initials next to the stricken text, then sign the form.

This has been my practice for at least the past ten years. Why on earth would any person of sound judgement agree to pay for anything without first knowing how much it is going to cost? I still get a little anxious when I walk up to the little window and hand in my completed forms, fearing they will give me some shit about refusing to bend over. I think I've gotten shit about two times out of... 50? In other words about 95% of the time no one will argue with you. Sometimes they don't bother to look at what you've written, at least not right away. Sometimes they do, but you know what? The grunts in the front lines are, for the most part, weary and do not want to fight.

You will thank yourself for adhering to this sensible practice. I got a bill for something like $9000 for an upper endoscopy from a place that styles itself The Ambulatory Center for Endoscopy. I had crossed out the offending language on my forms. I sent them a letter that said, show me when and where I ever agreed to pay you whatever amount that you unilaterally determined to charge me after the fact, without my prior knowledge and consent, and I will reconsider. Until then, you will accept whatever you get from the insurance company and that's that. They backed down.

A couple years later I had the pleasure of doing business with these people again. They billed me some two thousand dollars. I sent them a letter that said, gee, this sounds familiar, and the outcome will be the same as last time. You get what you get, and fuck off. They sent me another statement for the same amount. I sent them another letter saying, what was it in my previous letter that you didn't understand? That was some months ago and I haven't heard from them since.

You can just guess what would have happened if I had been too timid or ignorant to resist. They'd have taken the money from me and put it in their pockets. Fuck that.

By the way, if you think striking out the objectionable language is irrelevant as a matter of law -- either the contract is enforceable or it isn't -- you may or may not be right, depending. I just found this jewel in the Blue Cross/Blue Shield 2009 Service Benefit Plan, a PDF weighing in at 136 pages:

"In some instances, a Preferred, Participating, or Member provider may ask you to sign a 'waiver' prior to receiving care. This waiver may state that you accept responsibility for the total charge for any care that is not covered by your health plan. If you sign such a waiver, whether you are responsible for the total charge depends on the contracts that the Local Plan has with its providers. If you are asked to sign this type of waiver, please be aware that, if benefits are denied for the services, you could be legally liable for the related expenses. If you would like more information about waivers, please contact us at the customer service number on the back of your ID card."

Interesting, isn't it? Note that they don't tell you not to sign. Heaven forfend they should alienate their Providers. Their attitude towards you the patient is, you're on your own, good luck. They could use a little help with their punctuation, too.

But the important point of the above excerpt is that following my advice may well save you a bundle. Remember these two simple words: fuck that.

All of the preceding discussion assumes you actually have the good fortune to enjoy health insurance. Any fool knows this system is broken and Single Payer is the way. Of course that will only happen over the insurance companies' dead bodies -- which is fine with me.

Whenever I see a commercial for one of those "lifestyle" drugs like Viagra, the greedy entreprenuerial instinct in me laments the fact that there is no way for me to package and sell my surplus virility to those poor fools who are overpaying for Viagra. I would be more than happy NOT to be awoken at 4:00 a.m. with a throbbing erection, especially if I could sell that hard-on to someone who needs it. My imaginary product would be cheaper than Viagra and come without the risk of ghastly side-effects like priapism. It would be a win for everybody: more peaceful sleep for me, more fun for my customers and whomever they in turn are entertaining. Damn.

The New York Times reports that "after analyzing data from clinical trials, GlaxoSmithKline has sent letters to doctors warning that its antidepressant drug Paxil appears to increase the risk of suicide attempts in some young adults." Why is that a problem? Doesn't suicide cure depression?

I sneer with characteristic arrogance and self-righteousness when I hear people speak of going on a diet. That's crap, my friends, it's a fundamental mistake. You want to get in shape? I can't hear you. I said, do you want to get in shape and stay that way? OK good. Now understand this first: you don't "go on a diet," because go on implies go off. You adopt sane eating habits. (Note the period at the end of the preceding sentence.) That's step one.

Next, work out. If you claim you don't have time, then sorry, you're out of luck. Don't complain to me when your clothes strain to contain your fat. If your problem is that you don't like perspiration and exertion and raising your heart rate -- that is, if you try to excuse yourself on the grounds that you're too lazy -- then you need a thorough brainwashing. You need to learn to love it, as Winston what's-its learns to love Big Brother at the end of 1984. I guarantee you that once you win this Orwellian victory over yourself, it will literally be harder not to work out than to work out. Your brain starts to demand it and next thing you know you are strapping up and hitting the street to go running -- or walking, that'll work too.

Oh by the way. My program -- which, modesty aside, is marvelously effective -- costs me the price of a pair of shoes every nine months or so. I don't pay for gyms, personal trainers, or any of that shit. For cardiovascular I put on my shoes, go out my front door and run. For strength training I do body-weight stuff on my lunch break with the playground equipment in a park near where I work, and I do it close to five times per week, even through the winter (those mild global warming New York City winters are a boon).

This is what we call a lifestyle, to use a term that makes me want to puke, but it has its uses. It's a question of permanent, consistent behavior, not something you do for a while until you reach a goal and then stop.

It seems that several times a month my so-called Health Maintenance Organization Blue Cross/Blue Shield finds a reason to send me a document they call an Explanation of Benefits.

I don't think I am a total and complete moron. I can read and write; I have two Masters Degrees; I have to my credit one or two other intellectual accomplishments that require a certain level of cognitive functioning. But I cannot for the life of me decipher the Explanation of Benefits, and not for want of good faith effort. You see, many "providers" and all insurers will fuck you at every turn if you let them -- that's my philosophy -- so I really want to know what they are trying to tell me, and I can't figure it out. Perhaps the oddest thing they do is tell you that you both do and do not owe the provider $228.73. Which is it?

Sure, you can call Blue Cross/Blue Shield during regular business hours and navigate the voice mail tree, eventually coming to a recorded disclaimer that tells you -- with breathtaking chutzpah -- that whatever the human "customer service" drone is about to tell you may be a lie. That pretty much goes without saying these days, doesn't it?

Finally you start to question your assumptions. They call it an Explanation but you can't understand it despite your best efforts. Perhaps it's not really intended as an explanation at all! And the typical purpose of this non-bill is to tell you how much they will not pay -- quite the opposite of Benefits. The very name of this document, Explanation of Benefits, is a lie. The only honest part is the preposition "of." Let's strike Explanation in favor of Obfuscation, and... let's see, what's the opposite of benefit? Harm, calamity, misfortune, infliction, detriment... I think I will call it an Obfuscation of Detriments until I come up with something better.