Namo amitabha Buddhaya, y'all.
This here's a religious establishment. Act respectable.

Wednesday, February 19, 2014

The ACAs of Obamacare

During the whole national hoo ha about whether or not poor people, sick people, young people and unemployed people should be able to buy health insurance, I was firmly on the side of the poor, sick, young and unemployed, but in an abstract kind of way. It didn't really apply to me. ( It didn't apply to President Obama, either, as he has a doctor following him around 24/7.)  I got insurance from my employer, had for a long time, couldn't imagine getting it any other way and certainly couldn't imagine buying it on the open market, a concept more foreign than e-bay.

Well, guess what. I'm buying insurance on the open market.  I went to the library yesterday, where a trained facilitator walked me through the Web site, (Dallas Public Library, every Tuesday, 1-5.)  There are a dizzying array of options, but we found one that's very similar to what I have now.  It's a "silver" plan with a $3500 deductible, which is more than I'd like. But, if you're me, it's pay now or pay later.  I can see my Regular Doc for $20, my specialist for $55 (which is going to suck if I go through another crisis like I did six months ago, but let's just assume that's not going to happen) and generic prescription drugs, which are by far the biggest expense component of my whole health care mess, are only $4. Or maybe free.  I can't recall.  I have to go back to the Web site and stare at it some more.

Should you be one of those about to make the leap into buying insurance on the open market, please be aware that they HAVE TO SELL IT TO YOU.  They can't not let you buy it.  This is important; in the not so distant past, you had to be young, healthy, not pregnant, not afflicted with a chronic condition of any kind, and in other words not likely to cost the insurance company any money whatsoever before they would cover you.  This is no longer true.  So anybody can get on the Web site and look for insurance coverage.  Please note that it's really not as easy as that; you have to sign up for an account first, and have your identity verified (which was a bit creepy; how did you guys know I worked for the County of San Diego in the 1990s?) That took about 15 minutes.  Please also note that your state may have its own Web site that's different than the Federal web site mentioned above.  But if it doesn't, you're in good company.  About 34 states, including Texas, are referring people to the Federal site.

Some other stuff you might want to know: It helps to know what you made last year, and it really helps if you've already filed your taxes because they'll just go get that information when calculating your eligibility for subsidies.  If you're buying coverage for more than one person, have the other person's Social Security number handy.  But you don't need a whole lot more information. You don't need to have your health history handy, or your doctors' names, or a list of medications you've taken.  This Web site isn't as easy as buying something on e-bay, but it's nowhere near as complicated as, say, filing your taxes online.  In about 25 minutes, we found a plan I was comfortable with. There were other, cheaper plans, but I wanted to stay with Blue Cross if possible and I wanted a PPO, not an HMO, so as to be able to keep the doctors I currently have.  That was not a problem. Blue Cross had a number of available plans.  Some of them in the "gold" range were really nice, but again, pay now or pay later.  Am trying to balance that out as much as possible.

I should add, this is all new to me.  I have left jobs before, and I always went straight onto COBRA to continue my health insurance.  Well, this coverage beats COBRA by about $100 a month, which is not surprising actually; COBRA costs more to the consumer than it does to the company that was paying for it in the first place. (I did not know that until yesterday.)  Still, three times now I've gone onto COBRA.  Leave job, go on COBRA. Leave job, go on COBRA. So not going on COBRA - signing that piece of paper rejecting COBRA and putting it in the mail--felt like walking off a cliff.

Still, we live in a brave new world.  Something I wrote about and argued in favor of and got in people's faces about is now available to, of all persons, me.  God helps those who helps themselves, or something like that.  So, back to finding a job.  If you know anybody who needs a good paralegal, tell them I'm available.

Monday, February 10, 2014

"Distressed Babies," Idiot CEOs and Your Dwindling 401k

By now you've probably heard the story of the Mensa member CEO of AOL, Tim Armstrong, and his clunky attempt to blame 401k benefit cuts on a couple of premature babies.  In case you haven't, though, here's the link. Oh, of course he's apologized - publicly, as well as personally to the families of the "distressed babies" involved.  And I'm sure he was sincere (it's amazing how sincere people get when they've just recently made themselves look like a horse's ass in public).  As the mom of one of the "distressed babies" pointed out, the whole point of having health insurance is to be able to use it to get health care.

Born three months premature, the baby in question needed all kinds of health care.  She couldn't breathe on her own and because her skin wasn't fully formed yet, no one could hold her.  On her third day of life she suffered a stroke and almost died.  The hospital gave her a one in three chance of surviving and going home.
Luckily, the little girl made it and is doing all right now, though not without problems (and the ongoing need for health care).  And the resulting social-media outcry that made the CEO apologize also got the AOL benefits package restored to its former glory, whatever that was (I'm a little fuzzy on that).  But can you imagine what would have happened if the parents had decided not to treat their daughter?  If they had just said, "Well, obviously she's not meant to live, and since it's going to cost our health insurance too much money, let's just pull the plug on the ventilator"? The social-media outcry over the CEO's remarks would have been minor in comparison to the hoo ha that would follow that revelation.  

Besides, just saying no to trying to save a premature infant isn't only controversial, it might be against the law.  In 1984, an amendment to the Rehabilitation Act, called the "Baby Doe amendment", added "medical neglect" to the definition of child abuse for the purposes of receiving federal funds.  The law followed several highly publicized cases of parents deciding not to treat seriously ill infants--ie, just letting nature take its course.  Among other things, the law required hospitals to install hotlines so that any staff member who felt that a child was being "discriminated against" because the parents were refusing surgery or some other procedure could call in the Feds. I am not making this up. If your kid was born with half a heart, missing limbs, unformed genitalia and an intestinal blockage--meaning he couldn't eat, so he might die if one of the other malformations didn't kill him first--you could go to federal prison if you didn't authorize the surgery to unblock the baby's intestines. (And probably to "fix" the genitalia, a controversial issue in itself, and to repair the heart, just arguing that's possible.) In 1986, the appeals court threw out the regulations, but they are still on the books.  Federal courts may not enforce them anymore, but they can still be used by state child welfare departments as part of their justification to seize custody of a newborn that's not being "properly" treated.

And the hospital hotlines? Gone, but not before Federal agents had to crash about a dozen nurseries and demand medical records from maternity nurses who, I'm just thinking, had better things to do at the time.

So you shouldn't treat your extremely premature infant because it might cost too much in health insurance, but if you don't treat your premature infant, you might run afoul of Federal law, not to mention state child welfare departments (a whole different kind of nightmare) and the howls of outrage from Twitter, Facebook and, oh, maybe AOL.  Does anybody else have a problem with letting the people who are closest to the situation--ie, the parents--make the decisions here?  Yeah, I thought some of you might.  Probably the same bunch of you that thought Terri Schiavo's parents should have been allowed to keep her alive forever, even though that wasn't what she wanted and the person closest to her--her husband; says so right there in the Florida state code, not to mention the Bible--made the same decision on her behalf.  The four candidates running for Texas lieutenant governor--the only race that's generating any interest, really--all had conniptions and foamed at the mouth during the first debate when they were asked what they thought of unplugging "life" support to pregnant dead person Marlise Munoz. Obviously, their first actions upon becoming lieutenant governor will be to make sure the law says that dead pregnant women must become zombie mothers and stay on ventilators forever, or at least until their fetuses are "viable." (You know, three months premature.  Like the "distressed baby" that the AOL CEO had such a problem with.)

Billions of dollars in medical bills later, what do we have?  We have two points of view as to how these decisions, and end of life decisions generally, should be made.  I, and a lot of other relatively sane persons, believe that the family members ought to be making the decisions, following the instructions of the person involved, turning to courts and laws for help only if there's some kind of major disagreement between the decision makers.  And then you have the other crowd, the right-to-life conservative generally Republican gang of idiots, who advocate for "small government" and no Federal interference in personal lives, yet who seem to have no problem reaching the long arm of the law all the way into a woman's womb and telling her how to live her life, raise her children and provide them with education and medical care (unless we're talking about state-subsidized health care coverage, and we can't have that).

And I say that as a pro-life Buddhist.  Which should worry you.

Let me just add, in closing, that any woman, non-white person, poor person or basically anybody that's not a rich white guy, who votes Republican, might as well punch himself or herself repeatedly in the face. The last time the Republicans cared about you, you were a fetus.  And yes, I did steal that from a bumper sticker.

Wednesday, February 5, 2014

Mini-Post: Random Pieces Of Advice

My friend Bob, the lawyer, was not talking about me when he said, "Jobs like that don't last. Something happens, you change, the job changes, something.  You don't retire from a job like that." He wasn't talking about me, but he might as well have been. It was a little spooky that he said it because I lost my job on Friday. I'd have told him that if I could get a word in edgewise. I like Bob, but boy is he a talker.

So I wasn't able to tell him I lost my job Friday, but it seems like a perfectly relevant piece of advice anyway.  If you haven't read Dirk Gently's Holistic Detective Agency by Douglas Adams (and if you haven't, you poor benighted soul; go get yourself a copy immediately), one of the basic points of holistic detecting is that everyone, including whoever you're about to talk to next, has some piece of advice on the problem you're currently trying to solve.  So listen to what everyone says, ponder it and apply it to the problem and sooner or later you'll have a solution.  So, everybody, I lost my job on Friday.  My resume is here:  Please send the link to every attorney you know in the greater Dallas area.  And please also provide random pieces of advice.