And Now, The Rest of the Story…

This will be my final post about my personal odyssey with the fine folks at Anthem. It will be brief, just to update those of you who’ve been so kind with your suggestions and good wishes.

You will be happy to know that Anthem has made medical school unnecessary.

Yep–when they finally returned the multiple calls from the hospital doctors, and those doctors had once again gone through the charts, the X rays, the reports from in-hospital PT, etc., they were told that according to Anthem’s algorithm, I am not a candidate for rehab.

Their algorithm, you see, knows more about my condition and needs than the medical personnel who actually examined and treated me.

As one doctor said, “why did I waste all that time in medical school?”

I’m going home. My younger grandchildren will come over to help my husband with my care, at least for a couple of days, and we’ll figure it all out. (As those of you who know me know, I’m a tough old bird.) But everyone in this situation–as you  can see from the multitude of comments here on the blog and on Facebook–isn’t as fortunate as I am, doesn’t have a support network that can step in. And according to the doctors and caseworker, I am far, far from the only person facing this bureaucratic malpractice. And I will follow up on several of your recommendations for filing complaints, etc., in hopes that I can keep at least some others from going through a similar fiasco.

The United States is the only developed country in the world that has chosen to socialize its medical care through the insurance industry.

I asked one of the doctors if they have these same problems with Medicare. They don’t.

For now, this blog will return to its originally-scheduled programming.

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Sticking to Principle

It’s a complaint we hear constantly from both ends of the political spectrum: we want to elect people who will “stick to their principles.” We’re tired of the DINOs and RINOs willing to negotiate with the political “enemy,” look for areas of agreement and–most scandalous of all–settle for results that are less than 100% of what “our” side demands.

Look, I get wanting principal. No one wants an elected official without a spine, or worse, a lawmaker willing to “sell out” her true beliefs to placate a big donor, avoid a primary challenge or cave to pressure from a bigoted segment of the party base.

The problem is, not every compromise is a deviation from principle.

There’s a big difference between ideological rigidity and acting in accordance with principle. It’s a difference that’s invisible to the zealots who see every issue as black and white, every encounter with reality and its inevitable complexities, and every effort to find workable accommodations, a betrayal.

Americans used to understand that it’s better to get half of what you want than none at all. We used to understand that legislation is complicated, and not every description of a bill provided in hysterical internet “alerts” by advocacy groups tells the whole story. We used to recognize that legislation goes through a lengthy process, and that what might have begun  as a step in the right direction might no longer be supportable, even by those who agree with the original intent.

Americans used to understand that issues are complicated, and that we are not well-served by people who refuse to admit or understand that.

And we used to understand that a willingness to blow up Congress and shut down the government in order to get what you want (yes, Ted Cruz, I’m looking at you), or a willingness to cause continuing harm to thousands of people by holding up water system repairs in Flint, Michigan because you don’t believe the federal government should be in the business of providing aid to states (yes, Mike Lee, I’m looking at you) is evidence of grandiosity and disregard for the consequences, not principle.

Effective governance and strategic negotiation aren’t as exciting as grandstanding and moralizing, but we used to understand that we are better served by the former than the latter.

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Confirming All Your Comments: Update on Anthem

Just a brief update for those who’ve asked: the doctors at Methodist have called Anthem several times, to appeal the denial of my move to rehab.

Anthem’s personnel have not deigned to respond. They have simply not returned any of the calls.

Think about that. I am a patient whose care is in dispute: Doctors and therapists who have actually treated me are advising a certain course of treatment. Functionaries with unknown credentials–none of whom has ever seen me–decline to accept their medical judgment.

And then they blithely ignore requests to even talk about their reasons. The calculus seems obvious: if we don’t call back, these people will eventually tire of their appeal effort and go away. We win!

The doctors, nurses and caseworker are apologetic, but this impasse isn’t their fault. They are frustrated and angry; my situation is just one of many they encounter on a daily basis. They are convinced–as I have become convinced–that Anthem and other insurers care nothing about the health of their policyholders. (A caseworker told me she met an Anthem claims adjuster who cheerfully admitted that denials are rewarded with bonuses.)

We talk a lot about transparency in government. It’s long past time to talk about transparency in health insurance.  Indiana’s Insurance regulators need to investigate these practices; to the extent we still have that quaint occupation called journalism, reporters need to investigate and report on them.

If my experience is remotely typical, they’ll find plenty of health providers and patients who are ready and eager to talk.

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Theocrats or Panderers? It Doesn’t Really Matter…

Politicians at all levels keep giving God a bad name. God doesn’t want LGBT folks to have equal rights, and certainly doesn’t want them to get married, at least to each other. God doesn’t want women controlling our own reproduction. God doesn’t like immigrants, or refugees, or Muslims (wrong God). In Indiana, just ask Mike Pence. Or Marlin Stutzman.

As a recurring Facebook meme puts it, “Isn’t it nice that God hates all the same people you do?”

The Republican presidential contenders are, if anything, worse. Herb Silverman has a great commentary up at Huffington Post.

Recently I wrote about presidential candidate Marco Rubio’s comment that “all the answers are in the Bible” and his remarks to an atheist that our rights could only come from a creator. A number of readers agreed that Rubio’s view made no sense, but they also mentioned that religious views of other candidates are just as bad, or worse. I agree. Rubio has never claimed that God told him to run for president. That alone distinguishes him from current candidates Ted Cruz and John Kasich, and dropout candidates Ben Carson, Mike Huckabee, Bobby Jindal, Rick Perry, Rick Santorum, and Scott Walker.

Of those who dropped out, despite God’s support, Ben Carson remains the most active politically. He is the new national chairman of My Faith Votes, an organization that wants Christians to decide who will be the next president and all national and local leaders.

What’s so ironic about these posturing theocrats is that they also go to great lengths to present themselves as constitutional “originalists” and “strict constructionists,” a facade that requires them to ignore pretty much everything the Founders said and wrote about religion and the meaning of the First Amendment’s Establishment Clause.

Ted Cruz is by far the smartest–and creepiest–of the GOP field. A graduate of Harvard Law, he should know both the history and operation of the First Amendment, but either he missed those classes or he chooses to ignore both the Founders’ own words and 200+ years of constitutional jurisprudence. As Silverman writes,

Fittingly, Cruz launched his campaign at Liberty University, founded by Jerry Falwell. At a National Religious Liberties Conference, Cruz said, “Any president who doesn’t begin every day on his knees isn’t fit to be commander in chief.” In addition to eliminating atheists from presidential consideration, Cruz apparently would also like a prayer test for all candidates. His Religious Liberty Council seems to equate religious liberty with a God-given right to discriminate against gays. Pastor Rafael Cruz, Ted’s father, has served as a surrogate for Ted’s campaign. Pastor Cruz says that there is no such thing as separation of church and state, America is a Christian nation, and the Ten Commandments are the foundation of the Constitution and Declaration of Independence.

No wonder America is seeing the “rise of the nones.” Who in her right mind would believe in or worship the sanctimonious, repellent and vindictive God who motivates these people?

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Inexplicable, Costly and Wrong; An “Extra” Blog

Okay, I defy anyone to explain this to me.

As regular readers know, I’m in the hospital recuperating from a nasty fall. I broke my pelvis and my clavicle. I’ve been here 8 days, although the doctors wanted to send me to acute rehab three days ago. (Acute rehab is apparently more intensive, appropriate for people who have been active and can be expected to respond to longer sessions of physical therapy–and thus leave for home more quickly.)

This morning, I was finally supposed to be transferred. But then, Anthem, my “insurance” company (note the quotes) rejected the doctors’ advice and denied the move. According to the caseworker, since the first of the year, insurers have been denying approximately 50% of requested moves to acute rehab. Without seeing the patients, without consulting with their doctors. The hospital can and does appeal, and about half of those “peer to peer” appeals are granted–we’ll see what happens with mine–but even the appeal process evidently becomes a game; calls are routinely returned after hours, for example, when the insurance company knows the physician won’t be available, prolonging the process.

But here’s what is insane: keeping me in the hospital costs more than sending me to rehab.

Why would a company that should want to keep costs down opt for a placement that (1) is medically inappropriate; and (2) costs more? Why did the approval process suddenly become more arduous at the beginning of the year? What is the larger game being played in which I find myself a pawn? And what therapy will Anthem pay for? Anything? Or is my 83-year-old husband supposed to drag me up the stairs at our home and help me in and out of bed when nature calls?

Tell me again how horrible single-payer systems are…

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