Simplifying the System

Simplify the System

Unlike most twenty-three-year-old sorority alumnae, I receive my monthly subscription of Cosmo with a side of insurance rejections: such is the life of a coed who lost the genetic lottery. Thankfully, I earned an undergraduate degree in Health Administration and specialize in reminding health care organizations of their contractual obligations. Unfortunately, the majority of Americans have not had this training while the red tape surrounding the insurance system is dense and misleading (1). But that’s to be expected; even the laws put in place to protect patient rights are incomprehensible. A Journal of General Internal Medicine report found that legislation set to protect patient rights is comprehendible to people with a reading level equivalent to that of an Associate Degree (2). To put this in perspective, approximately 70% of the United States population over the age of 25 can’t understand the laws which protect their health care rights (3). This ambiguity has created a market of confused individuals who are easily melded into padding the bottom line for both insurance companies and for-profit health care advocates.

According to the California Nurses Association, 1 in 5 claims are rejected by private insurance companies each year (4). These rejections can occur before or after care is received and come in two classes: quantitative and subjective. The first genre consists of clerical errors and miscoding issues, both of which are easily corrected to the subscribers benefit (so long as the subscriber catches the error, knows their benefits, and appeals the rejection in a timely manner).  The second groups of denials are difficult to negotiate as they result the insurance companies definition of preexisting conditions, medical necessity and experimental procedures (5).

Comedian Stephen Colbert illustrated the satirical nature of this licensure in his October 29, 2009 introduction in which he asked “What qualifies as a preexisting condition? … If you have to ask, you probably have one! (6)” Take for example Stephanie, a 24 year old from Oakland, California, who opted into a single-payer insurance policy while she was studying for her MCATs. She went to the doctor for an annual exam and was diagnosed with bronchitis. This diagnosis led her insurance company to do a five-year review of her medical records in which they found evidence of a past chest infection, providing them with grounds to refuse payment for her care. She never thought that her former chest cold could be a preexisting condition, yet due to her insurance company’s interpretation, she was forced to pay out of pocket (7). Obviously the insurance industry has to stack the deck in their favor; they are for-profit companies and deserve to be compensated for their sizeable gamble on individuals, but the high profits which result from rising premiums and unclear coverage denials is unethical (8).

This no-man’s land between insurers and individuals has led to a job market in patient advocacy. Many advocacy groups are either non-profit or governmental agencies; indeed, most states have patient advocacy bureaus to help their residents navigate the difficult legislature governing their care (9). Unfortunately these bureaus, like most social service sectors, are overworked and underpaid, forcing states to mandate who qualifies for advocacy (10). This urges patients with financial means to employ private, for-profit advocacy agencies to help them navigate the intricacies of the health care system, adding additional cost to their health care. Furthermore, the for-profit nature of these companies caters to healthy individuals, and some refuse to work for people with preexisting conditions, leaving those who desperately need support without recourse (11).

Einstein once said “make everything as simple as it has to be, but no simpler.” If this principle governed the success of Time’s “Person of the Century,” perhaps we should consider applying his wisdom to our current health care crisis (13). Simplicity is indeed the key to our success. Currently, health care reform bills have provisions to subsidize and reward the utilization of electronic medical records. Unfortunately, these electronic medical records are not currently at a developmental level which would supply security or uniformity. Yet these systems have great promise, indeed, if they are streamlined, continuity and accuracy of care would be vastly improved (14). A standardized record system would incite uniform regulations across insurers, helping to hold the insurance system accountable in a laissez-faire manner which increases its political viability. Furthermore, the clarity this system provides would help subscribers to understand the reasoning behind decisions which were formerly illogical. Unfortunately this goal is several years in the offing and we cannot wait to provide culturally relevant data to patients.

I recently attended a Comparative Effectiveness Research seminar in which Dr. Robert Epstein was panel member; I recognized his name, but couldn’t immediately place him (12). Halfway through the panel, it hit me, Epstein’s signature is affixed to letters I receive from Medco Health Solutions when my prescription drug coverage changes. In my world, Epstein is the prescription-drug-coverage-devil. But as I sat listening to his speech on personalized medicine, his congenial nature and “carpe diem” philosophy made me realize that the man behind the signature is human and truly cares for his subscriber’s futures.

Insurance companies are made up of educated people who, like Epstein, want what’s best for their subscribers. Admittedly, the more effective treatments are, the less they have to pay in the future. Yet these companies are woefully unsuccessful and demonized by the lay public in their attempts at efficiency. Likewise, the current push for health care reform is misunderstood and chaos abounds. If you want proof that a number of Americans do not understand the goals of health reform, look no further than “end of life counseling” being touted as “death panels.” Something has been lost in translation. If our goal is efficient, culturally competent care, the information delivery system must be clarified and translated via an appropriate advocate.

Works Cited:

1. Kaiser Family Foundation. Confusing Insurance Jargon Prompts Call For Reform. Kaiser Health News. [Online] September 21, 2009. [Cited: October 31, 2009.] http://www.kaiserhealthnews.org/Daily-Reports/2009/September/21/2khnstory.aspx?referrer=search.

2. Gardner, Amanda. Patient’s Bill of Rights Too Tough to Read. U.S. News & World Report. [Online] March 27, 2009. [Cited: October 31, 2009.] http://health.usnews.com/articles/health/healthday/2009/03/27/patients-bill-of-rights-too-tough-to-read.html.

3. United States Census Bureau. Educational Attainment: 2000. census.gov. [Online] August 2003. [Cited: October 2009, 30.] http://www.census.gov/prod/2003pubs/c2kbr-24.pdf.

4. California Nurses Association. California’s Real Death Panels: Insurers Deny 21% of Claims. National Nurses Organizing Committee. [Online] September 2, 2009. [Cited: October 30, 2009.] http://www.calnurses.org/media-center/press-releases/2009/september/california-s-real-death-panels-insurers-deny-21-of-claims.html.

5. Vogin, Gary. Dealing With Rejection. MedicineNet.com. [Online] WebMD, March 22, 2002. [Cited: October 30, 2009.] http://www.medicinenet.com/script/main/art.asp?articlekey=51313.

6. Wednesday, October 28, 2009. Comedy Central, New York : Stephen Colbert, October 28, 2009.

7. X., Stephanie. Personal Interview. October 2009, 28.

8. FactCheck.org. Insurance Co. Profits: Good, But Not Breaking Records. FactCheck.org. [Online] August 5, 2009. [Cited: October 31, 2009.] http://www.factcheck.org/2009/08/insurance-co-profits-good-but-not-breaking-records/.

9. Patient Advocate Foundation. The National Financial Resources Guidebook for Patients. Patient Advocate Foundation. [Online] [Cited: October 30, 2009.] http://www.patientadvocate.org/report.php.

10. R, S. Personal Interview. June 2009. Mr. R is a CNA employed by Tenderloin Health in their case management and health advocacy departments.

11. HealthCare Advocates, Inc. The Consumer Price Plan. HealthCare Advocates, Inc. [Online] 2009. [Cited: October 31, 2009.] http://www.healthcareadvocates.com/priceplan.html.

12. Personalized Medicine Coalition/National Pharmaceutical Council. Comparative Effectiveness Research and Personalized Medicine: Policy, Science, and Business. Arlington, VA : Personalized Medicine Coalition/National Pharmaceutical Council, October 28, 2009.

13. Golden, Frederic. Person of the Century: Albert Einstein. Time. [Online] Time, Inc. , January 3, 2000. [Cited: October 31, 2009.] http://www.time.com/time/time100/poc/magazine/albert_einstein5a.html.

14. Huslin, Anita. Online Health Data in Remission. The Washington Post. [Online] February 16, 2009. [Cited: October 30, 2009.] http://www.washingtonpost.com/wp-dyn/content/article/2009/02/15/AR2009021501284.html.

Hearts, Homelessness, and Hope

[[ No, it won't always go the way it should, but I know the heart of life is good -- JM ]]

Some amazing things have been happening. No, I didn’t get into grad school (one can hope….), but I did get my own research study. Yes ladies and gentlemen, I am the new director of epidemiology at TLH. I get to decide what holes are missing in the statistical correlations between HIV/AIDS and STD’s and create supplemental questionnaires about behaviors which might effect the results. I have carte blanche on the sociological, economic, and psychological behaviors/situations that are germane to the interrogation. Once I have a good research model and questionnaire written, my little minions will get the information and do the data entry. All I have to do is analyze it and write briefs (can you say published articles) on it. I’m so excited.

[[ Thank you for making me struggle, -- Tell me the world ain't mine -- I'm a miracle baby -- I refuse to lose -- Tell me what do you see when you look at me -- On a mission to be what I'm destined to be – M/TI ]]

Secondly, I became a site administrator for sfhomeless.net. It’s still a pretty hokey website, but give me a week or two and I’ll get on cleaning it up. Well… maybe… First I have to take the GRE (crazy stressed—I’ve forgotten how to write a five paragraph essay), get my research study going, and write that ethical analysis for NYU on a book I haven’t finished. Ok, so it might be a few weeks before I get to the website. BUT- it has tremendous potential to be an even more amazing resource.

[[ Give me your eyes for just one second -- Give me your eyes so I can see -- Everything that I keep missing -- Give me your love for humanity -- Give me your arms for the broken hearted -- Ones that are far beyond my reach -- Give me your heart for the ones forgotten -- Give me your eyes so I can see -- BH ]]

Ok and finally… I Ran. On the verge of becoming trite, “I can’t believe it.” I ran an 11.5 minute mile today. I haven’t run a mile since, well, yesterday (15 mins), but before that I haven’t run in probably a year. I couldn’t believe I didn’t pass out! I finally feel like I’m getting control of my life. This week I grew up. No, really. For the first time in my life, I knew, on my own, when I couldn’t handle that whole fainting thing and I actually asked for help from a qualified medical professionals (ie the emergency room). Not only that, when they brushed me off, I went back and got hyphy with them. And it got results. It was completely unprecedented by my previous actions and for that I am amazed with myself. I wasn’t independent and at the same time I was my own advocate. Seriously people, be amazed.

[[ No more stress, now I'm straight -- Now I get it now I take -- Time to think, Before I make mistakes -- That part of me left yesterday -- The heart of me is strong today -- No regrets I'm blessed to say -- The old me dead and gone away -- TI/JT ]]

So now, hope that my luck continues into tomorrow afternoon because after that, my genius shall be measured and hopes gained or lost. So say a little prayer for me. And all of my causes.

[[ I turn my head to the east, I don't see nobody by my side. -- I turn my head to the west, still nobody in sight. -- So I turn my head to the north, swallow this thing called pride. -- The old me's dead and gone but the new me will be alright -- TI/JT ]]

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Apposite Bondage, Adverse Laws

Here’s an op-ed I wrote for my public policy class– enjoy!

Apposite Bondage, Adverse Laws

It’s a benign flag—white, black, and blue stripes, topped with a seemingly-happy heart. Though practitioners say otherwise, all I see are the literal colors—black and blue bruises, blood, and bandages. BDSM—Bondage, Domination, and Sado-Masochism. Here in San Francisco, the flag is flown high as thousands of BDSM practitioners in full (or lack thereof) regalia flock into Dore Alley to share their passions each year.

I was there this year. Only I was fully clothed, an outfit completed by my security headset and orange vest, and, for once, not a member of the majority population. My duties required standing on the corner of Folsom and 10th, keeping the police out and those with ass-less chaps in; I watched as leather-clad folk enjoyed themselves, in, umhum, public ways.

Getting over the obvious breeches in normative behavior, I was struck by the ease the BDSM community shed their secrecy (with their clothes) and uniformly practiced bondage in both homo- and hetero-erotic ways. In a 2000 survey of self-professed BDSM practitioners, 68% expressed that they were heterosexual. This figure is surprising, as BDSM in its public form originated as a gay subculture. While the images of leather-daddies leading young men in nipple clamps are still salient, this shift from homo to hetero is intriguing.

Here in San Francisco, you can see this depolarization of the homo-underground. But then again, this is the unofficial gay Mecca and there are plenty of men to spare. But this makes me wonder—why is it that San Francisco is the unofficial Mecca of homosexuality? There’s the usual reasons including dishonorably discharged sailors, the AIDS crisis, or Harvey Milk’s election and subsequent martyrdom in 1978- But why does it continue to be the epicenter for the flamboyant, the irreverent, and the just plain odd? How did it get to the point where underground factions would exist and separate within the community—BDSM, Circuit Boys, Club Kids, Druggies, Drag Queens, etc?

San Francisco attracts outsiders people because like attracts like, and in this case, like also attracts acceptance. But what of the people who are not so out of the mainstream? What if San Francisco’s stand is debunked by Proposition 8 this November? While I know the veiled Sisters of Perpetual Indulgence will be ok because they’ve been built against prejudice (and being nuns, they don’t need sex), but what will happen to the homosexual population that simply wants to create a (modified)-nuclear family? What about those who do not want an underground life but who want to stand proudly and feel normal amongst their peers? There are many.

Many people have seen the popular photograph of Del Martin and Phyllis Lyon, a lesbian couple of fifty-five years before they were married by Mayor “Gay”-vin Newsom on June 16, 2008. Had their 2004 marriage not been annulled, Martin and Lyon would have had four more years of wedded bliss before suffering the tragic death of Del Martin last month.

The public and mostly heterosexual BDSM community certainly defies more conventional archetypes than this couple, does it not? Even my Christian side says yes. Not to say that we have all changed our views or proudly accept Bondage and Discipline, Dominance and Submission, Sadism and Masochism, but if heterosexual people can beat each other publically in the streets I can’t help but feel that we can change our strict laws on something as convivial as marriage. Proposition 8 threatens to defeat fairness in San Francisco and all over California.

And even though I may not practice BDSM and I may not be a lesbian, that doesn’t mean I shouldn’t put my agenda aside for a few hours to help protect those ascribing to an alternate lifestyle. In the city with the golden gate bridge, I would hope we can uphold the golden rule. It’s time for marriage to go homo—uniformly given to all people. Until my peers remember that, I’ll be here warming up for next month’s Folsom Street fair, the largest leather fest in the world. Oh Daddy….

Bringing Classy Back…

It all starts with a definition…

What do you think of when you think of classy? Personally my mind goes to the starlets of the 1940′s black-and-white cinema. I think of women dressed to the nines wearing nylons and pearls. I think of dainty tea parties, beautiful homes, and meticulous grammar. I think of a bygone age of seeming perfection.

Yet when I look at my impression I see something that I can never be. I’ll never have a huge home with a koi pond and I’m not about to wear high-heels (they make my feet hurt!). Yet is that all being classy is about? Can’t I be classy without the nylons and living in this colorific world?

This desire for elegance led me to look up the definition of ‘classy’ in Webster’s. There I found that the art of being classy is defined as “having or showing class”: a: elegant or stylish b: having or reflecting high standards of personal behavior c: admirably skillful and graceful.”

Looking at that definition I think it’s possible to be classy (even without the butler). I just have to fulfill a couple of definitionalistic criterion…

Does it matter what I look like?

Learn to appreciate and give dignity to your body, not abusing it, as is so common among those who know nothing of God. … God hasn’t invited us into a disorderly, unkempt life but into something holy and beautiful—as beautiful on the inside as the outside. (I Thessalonians 4:4-5 & 7, MSG).

Classy: a. elegant or stylish.

I know what you’re thinking. Elegant? Stylish? Me? We are constantly bombarded with the world’s image of what it means to be elegant and stylish. Everyone does it- we all wonder if we can wear that size, have that boy, drink that drink, or have that device, live that popular life. Let me tell you- these worldly images are NOT what it’s all about! It’s not that these things are inherently wrong, it’s just that they easily can lead you into temptation and make you forget the value God has placed upon your life, and anything that leads you astray is wrong.

Paul charges you to change your life in Romans 12:1& 2- “take your everyday, ordinary life—your sleeping, eating, going-to-work, and walking-around life—and place it before God as an offering. Embracing what God does for you is the best thing you can do for him. Don’t become so well-adjusted to your culture that you fit into it without even thinking. Instead, fix your attention on God. You’ll be changed from the inside out. Readily recognize what he wants from you, and quickly respond to it. Unlike the culture around you, always dragging you down to its level of immaturity, God brings the best out of you, develops well-formed maturity in you (MSG).” God has called us to be living sacrifices to him, he is a jealous God. He doesn’t want a portion of you, he wants all of you without reservation (James 4:4-5). And if you give it to him, you’ll be blessed (Isaiah 64:4).

Being set apart and listening to what God wants for your life may not be popular, but “what good will it do for people to win the whole world and lose their lives? (Matthew 16:26, GWT).” As Christian women we should aspire to an intimate relationship with God, not with the world. His definition of what is stylish and elegant is different from what the world thinks it is, afterall “the Lord does not see as man sees; for man looks at the outward appearance, but the Lord looks at the heart.(1 Samuel 16:7, NKJ)” — God would rather have a woman with a heart for him than a girl in Prada any day!

It all comes back to Integrity

He who walks with integrity walks securely, but he who perverts his ways will become known. (Proverbs 10:9, NKJ)

Classy: b. having or reflecting high standards of personal behavior

David, for all his iniquitious wrath, adultery, and murder, was a man after God’s own heart because he called on the Lord to ask God to judge him according to His standards of righteousness and integrity (Psalm 7:8, NIV). Just before he died he said “I know, my God, that you test the heart and are pleased with integrity (1 Chronicles 29:17, NIV).” David was confident that he was going to pass the test of integrity because he had asked God to examine his heart and changed his ways. Like David we need to invite God to examine our hearts. But asking him to examine our hearts isn’t enough; we must heed his correction and change our lives to be more like His. After all, “healthy correction is good, and if you accept it, you will be wise (Proverbs 15:31, CEV).”

Reverand Henry Beecher once said “Hold yourself responsible for a higher standard than anybody expects of you. Never excuse yourself.” This higher standard is to say that we uphold the high standards of God, and not of men. Romans 1:20 agrees with this statement– “since the creation of the world God’s invisible qualities—his eternal power and divine nature—have been clearly seen, being understood from what has been made, so that men are without excuse (NIV).” We know what is wrong (if you don’t know, check out 2 Timothy 3:1-5), hence we have no excuse to live life deviant to God’s moral standards. He knows what’s best for us and his correction, and by living in him, he promises immeasurable joy (John 15:10-11).

What are my Skills?

He handed out gifts of apostle, prophet, evangelist, and pastor-teacher to train Christ’s followers in skilled servant work, working within Christ’s body, the church, until we’re all moving rhythmically and easily with each other, efficient and graceful in response to God’s Son, fully mature adults, fully developed within and without, fully alive like Christ. (Ephesians 4:12-13, MSG)

Classy: c. admirably skillful and graceful

Sometimes I wish I were skilled at playing the piano or was graceful like a ballerina. My parents gave me lessons, buying a piano and pointe shoes- giving me the tools I needed to learn, but I refused to practice. The old adage, practice makes perfect is all too true. You can’t become skillful or graceful without practice and constant refinement. While these examples are of the world’s standards of skill and grace, the principle that refinement transforms an ordinary spiritual life into an extraordinary one rings true.

Refinement hurts. It requires patience and trust. But it’s worth it.

Sometimes we have hard times in where we want to blame God and have a bad attitude. When this happens look at what James 1:2-4: “Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything (NIV).” Hard times are just tests, they measure how you are going to react to trials and indicate what you can be trusted with. God wants to know: Will you praise and trust Him no matter what? (check out Job 42:1-6).

We were not meant for an ordinary call, we were meant to be extraordinary women of God who further his kingdom, joint heirs with Christ (Romans 8:30), and as such we have been given much. Yet “from everyone who has been given much, much will be demanded; from one who has been entrusted with much, much more will be asked.(Luke 12:48, MSG).”God is calling us to be refined, mature, individuals called fulfilling his purpose (Romans 8:28). If you don’t know what your purpose is- pray about it, look at your strengths and see how they can be used for God’s purposes. Remember, His purpose may not be your purpose, but His purpose is better than anything you’ve ever even imagined (Joshua 29:11).

Is it possible?

The metaphorical Proverbs 31 woman, trite though she may be, is the perfect example of a gracious, skilled, honest, beautiful, classy woman. She knows to focus on things not as the world sees them, but as God sees them. Instead of clothing herself in the world’s clothing and culture, she clothes herself with “strength and honor.” She’s skillful in her work, she’s gracious to those less fortunate, she’s beautiful because of her fear in God (Job 28:28). She trusts God in all of her works and has hope for the future (Proverbs 31:25).

I don’t know about you, but that’s what I want in my life. I may not ever live up to this epitome of womanly perfection, but I can try, and with God’s help, I can succeed.

Let it be said “I have walked in my integrity, and I have trusted in the Lord without wavering (Psalm 26:1, NAS).” Let it be said that I walked in His ways instead of those of my culture. Let it be said that strived for wisdom and heeded his correction. Let it be said that I finished the race graciously (2 Timothy 4:7, Colossians 4:5-6). Let it be said that I was a truly classy woman.

“Many women have done wonderful things,
but you’ve outclassed them all!”

Proverbs 31:29, MSG

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My Run in with an Enchanted Tree

As previously stated, holidays with me are never dull. New Years was no exception. It started off quietly enough- a lil church, a lil skiing, but all hell broke loose eleven hours and twenty three minutes into the new year. I was skiing along nicely when suddenly a punk ass snowboarder hit me. I tried to carve to the right but to no avail- I ran smack dab into the middle of a HUGE tree.

The Tree.

The Kid. His name is Sam, how ironic.

If I hadn’t been wearing my helmet I’d be dead, as my eye attests to, and as it turns out I comminuted my femur- that means it’s broken in so many places they stop counting.

After the ski-patrol guy determined that I wasn’t faking the pain and couldn’t ski to the bottom of the hill as he had suggested, he put me in a ‘scoop’ backboard which means that they assembled it around me in a snow bank since they couldn’t move my leg from its bent position. They had to pick me up three times, and let me tell you I screamed bloody murder each time. I finally got to the bottom of the hill where they cut off my five-day-old-686-snowboard ing pants, gave me some morphine and straightened out my bent leg. Let me tell you, it is exactly like the movies-bone popping, screaming, and really hot ski patrollers

My eye. Before it turned black.

Inside the snow-mo.

After enduring a hour ride to the nearest hospital, ten hours in ER, two catheters, ruination of my supergirl stuff, breakage of my camera, and really unresponsive nurses- they finally operated. 4 am and I had a brand-new-titanium-filled- femur.

A lil break…

Rod and screws

My Butt. Well Thigh. But really close to my butt.

My Knee.

But my story isn’t over yet. According to my doctor breaking your femur is the most painful thing you can possibly do. Additionally, as each femur is responsible for 20% of the hemoglobin in your blood, I was in trouble. At least all those donations paid off. What didn’t pay off was the poor nursing staff in a small Podunk town- the nurse who gave me my transfusion had a MPH but didn’t wash his hands after touching blood and checked my pulse with his thumb. I thought he was going to kill me- which his counterparts had almost done by not reading my allergy bracelet making me swell up to Pumpkin Size

Looks like cool-aid!

A-. Thank you very much.

Thankfully he didn’t kill me, and I finally got my fever down under 100 on Friday and got to go home. The only thing left is to finish up the anti-blood-clotting shots I have to give myself

A shot.

Ouch!

Oh, and if you ever end up in the hospital don’t eat the food- it’ll kill you.

The Food, Sam, Me, and a Black-Eye