Archive for March, 2009

For Judy

Tuesday, March 31st, 2009

My wife died ten weeks ago today.  I promised myself that I would wait this long before I tried to put my thoughts onto paper about what happened to us over the last three years.   It may take ten more weeks to say everything I feel.


Judy had cancer.  It started as a single mass in her breast (which our first doctor passed off as inconsequential), and it eventually spread to her brain.  “Welcome to your new full-time job,” the second doctor said when the correct diagnosis was finally made.  And so it was.  We spent the last three years of Judy’s life driving up and down the I-5 corridor, going to this examination or that, this chemo session or that radiation treatment regime.  It was long…it was difficult…and it was stunningly expensive.  In the end, my beloved wife died in my arms in the waning hours of Christmas day.


Those of you who have followed my blogs know that my statements have all been linked in one way or another to solar energy, and to the climate crisis generally.  How, then, does the passing of my wife find its way into the Deathstroke Blogs?  It is because I have just experienced firsthand how our medical system is driving our nation to its knees, and which, if left unchecked, will likely doom any hope this country has of being financially capable of undertaking a global transition to alternate energy.


I knew a little about cancer before Judy was diagnosed.  I had a very treatable kind of cancer the previous year (my diagnosis came one year to the day before Judy’s).  A quick surgery removed the offending tumor, and a series of follow-up MRI’s showed that there was no recurrence.  There was no chemo, no radiation, just a stack of unpaid medical bills that slipped by unnoticed until my time limit to appeal the insurance company’s rejection of the claims had passed.  More of that later.


Judy’s cancer was nothing like mine.  “Inflammatory Breast Disease”, the doctor said in that first meeting, “Stage 4”.  We didn’t know it then (or for years to come), but those words were in essence a death sentence on day one. 


I could say much about those first hours…that first week.  Those heavy hours became the foundation of a new and powerful bond between Judy and I, and our relationship with God.  It’s a highly personal aspect of the journey I have just finished, and, if you don’t mind, I will keep it in the realm of privacy.  It is the all-too-real world of money, and the cost of fighting a disease like cancer that this post is directed to.


Within a day, our “new, full-time job” found us sitting in recliner chairs in the chemo ward of Seattle’s Swedish Cancer Center.  There, dozens of patients sat quietly while opaque IV tubes led downward from bags of liquid suspended from stainless hangers behind them.  I remember well that first day, and the routine that was to become so common for us — -“What is your name?  What is your birth date?” a pair of nurses would ask as they double-verified which treatment regime had been designed especially for Judy.  But what struck me most that afternoon, was the obsessive care with which one of the nurses was treating a hypodermic needle as she prepared to give Judy her first injection.  “Must be a new nurse,” I thought.  But then she let slip a statement that was to be a harbinger of a new reality about to fold in upon us — -“If I drop this needle, it’d be half a year’s salary!”


Welcome to the big league world of do-or-die medicine.


The bill for just three different containers of liquid given to Judy that day was a staggering $25,000 — -$10,000 for the chemo drug, $10,000 for a single hypodermic needle of something that was to do something for her blood, and $5,000 for a needle-full of something else that was supposed to do something else for her blood.  And this was just day one!


I asked the nurse why the drugs were so expensive, and her reply was a matter-of-fact, “Because they are the only companies allowed to make those particular drugs.”


“That’s an answer?”


Enter one of the ugly realities of American medicine.  Think back to January 24, 1848…Sutter’s Creek, California.  A millwright named James Marshall discovered a handful of gold nuggets lying in the bed of the creek and in doing so, fired off the starting pistol in the second largest gold rush in human history.  I say “second”, because at the present rate, the pharmaceutical gold rush of the 21st Century promises to dwarf all of the bullion ever dug up by an army of ‘49er’s plying the California hills.  The concepts are not far removed:  a bedraggled would-be miner would stake out his claim, while a modern pharmaceutical miner files a patent.  If the miner hits the “The Mother Lode”, it’s all his.  If ABC Pharma hits on a cure, it’s all theirs.  But there, the analogy breaks down.  When the 49er pulls an ounce of gold out of the ground, it can only be sold at the market price.  When ABC pours an ounce of cancer drug into a plastic baggy, it can charge whatever it wants for it — -whatever the market will bear.  In Judy and my experience, that price was unbearable.  If one thing came clear to us, it was that every ounce of the liquid they were pumping into her body was worth far more than an equivalent ounce of gold…ten times more.


There is no question but that there is a “gold rush” taking place today in the pharmaceutical hills of the United States.   The goal is the same as it was 150 years ago — -stake a claim to a Mother Lode. 


I ask a simple question: “Is this right?”


Or perhaps, it should be stated like this: “Is it appropriate to destroy a nation financially in order to save or prolong the lives of a portion of its population?”


I happen to believe that it is entirely possible to save or prolong those lives without destroying our nation.  We simply need to go about the whole thing differently.   I have come to believe that the swamp we now find ourselves in has a name: Profit.


Did anybody ever stop to ask whether it is morally defensible that a society should organize itself so that there are massive profits to be made off of the sickness, suffering and death of its members?  It seems to me that that very same society could organize itself to treat those same illnesses without having to devote an extraordinary share of its capital to the profit of those involved in the undertaking.


Consider how much of our health care dollars are not going to health care.  Before Judy died, I was spending over $800/month on health insurance.  Where did those dollars go?  Let’s examine the dollars that did not go to health care:


1)      Advertising:  Because my insurance company is in business to make a profit, it advertises to attract more customers.  So it spends part of my $800/month on advertising.  That means:

          a)      That it pays some of my money to an advertising firm to create ads for both print and radio/TV commercials;

          b)      That it pays for space in newspapers and magazines to show their ads;

          c)       That it pays for air time on both radio and television to air their ads.

          d)      Profit:  Each of these entities (the ad agency, the newspapers and magazines, the radio and television stations and networks) is in business to make profit.  So a sizeable chunk of my $800/month goes to pay for things that have absolutely nothing to do with health care. 


2)      Profit for the Insurance Company:  My health care insurance company makes money for its investors.  So, like every business, a very big chunk of my $800/month goes to pay for “executive compensation” (the more profit that can be squeezed out of the system, the bigger the compensation).  It also goes to meet the demands for return on investment of the stockholders.  Not one of these dollars goes to buy a drop of chemo drug or even a bandage. 


But more ominous than this, is what it causes an insurance company to do in order to maximize its profits.  It has two options:  1) it can increase premiums, and/or it can 2) reduce what it pays out for claims.  I have had the unhappy experience of being on the receiving end of 2) for the past three years. 


My Experience:  When you are confronted with a catastrophic illness like cancer, your “full time job” becomes immersed in treating the disease.  What is not well known is that your other “full time job” becomes plowing through a mountain of paper in order to find out if your insurance company is actually paying your bills. 


I had an MRI to screen for the recurrence of my cancer.  It was the normal course of treatment for my type of cancer.  The MRI was done in January.  I received an “E.O.B” (Explanation of Benefits) form from my insurance company which listed the MRI.  I thought it meant that the bill had been paid (after all, it came on a document called “explanation of benefits”).  But in reality, there was a code on the form that, had I understood it, would have informed me that my insurance company was denying the claim (because the MRI wasn’t performed on the same day as my doctor’s appointment — -one of the many fine print exclusions under my policy).  The problem is that my insurance company didn’t inform the MRI company that it was denying the claim until the end of May.  The MRI people didn’t get back to me until late July.  By then, my 6 month period for appealing the denial had passed.  I went ahead and appealed anyway.  A year later, after two rounds of appeal, the insurance company acknowledged that they should have paid the bill, but said that since my appeal was not timely filed, they would not pay it.  And to rub salt in the wound, I had to pay the bill at the full rate, whereas, if my insurance company had paid it, the MRI company would have accepted 50% of the full price.


That was just one bill.  For Judy’s three year ordeal, the denials came fast and furious.  One example was particularly infuriating.  When Judy developed headaches (a sign that the breast cancer had spread to her brain), her doctor ordered an immediate brain MRI.  Because the hospital MRI was not available, they sent her to another MRI facility across the street from the hospital.  My insurance company denied the claim because the MRI was not performed in the hospital.  That one took a year and a half to resolve with the insurance company.  Eventually, after three rounds of appeal, the company agreed to pay the bill under duress.  They sent me a letter stating that they would pay the bill but admonished me not to allow it to happen again (as though I were some sort of a criminal policy holder).


My point is this:  As a society, we have turned our medical care over to a system that is based on profit.  I have come to see quite clearly that this produces a system that seeks to actively reduce its payments for treatment by 1) putting a mine field of fine print exclusions in the policy language, and then 2) refusing to pay claims and then hide that refusal behind outright deception and a wall of appeals that will exhaust even the heartiest of policy holders.  All of this takes place because PROFIT encourages it.  Indeed, PROFIT DEMANDS IT.  Without profit, there would be no incentive to cheat the policy holder or deny the payment of his or her just medical bills.


President Obama said that his grandmother spent the final months of her life locked in a battle with her health care company over bills that they would not pay.  Having just spent the last three years locked in the same battle, I wonder why our lawmakers are seeking to address the health care crisis by making sure that every American can afford insurance!  I believe that this is the wrong solution.  You can’t solve a crisis by pouring more gasoline on the fire.  Unless and until we come to grips with the real source of the problem — -that a health care system that is based on profit will devour the country that employs it — -we will never find our way out of this swamp.


Much of this has been directed to insurance companies.  But other profit centers are found in the pharmaceutical board rooms of this nation.  I sat week after week watching the nursing staff pour $25,000 worth of liquid into my wife.  As I looked around, I could see dozens of other patients receiving the same or similar treatment regimes, while dozens of others waited in the lobby.  And this was just one chemo room in one hospital.  I know the same scenario was being played out over at Fred Hutchison Cancer Center across town, and at the University Hospital…and In Tacoma, and Olympia, and Yakima and Spokane.  $25,000 for a few ounces of liquid!  Isn’t anybody ashamed of this?  It is not just profit gone wild — -it is profit gone insane!  We are all outraged at what is taking place on Wall Street.  Well, I’m here to tell you that a similar outrage is taking place in every cancer center in the United States.  And the source of the disease is the same in both places: Profit.


A SUGGESTION:  It seems to me that the only way out of the swamp is to nationalize our health care system like almost every other nation in the western world has done.  But I realize that this is virtually impossible given the power of the health care industry in Washington (yep, a big chunk of your health care dollars is spent in that city making sure that the system is never changed).   But we face a true looming disaster:  the baby boomers are coming!  My generation (I was born in 1945) is going to inundate the health care system and the social security system with it.


I suggest that we train doctors in geriatric medicine.  Every year, 9 out of 10 applicants are turned away from medical school.  Why don’t we scoop up a slew of those very qualified would-be doctors and train them at taxpayer expense.  In return, they will go to work for us by treating the elderly at a very substantial reduction in cost.  It would be a first step — -a toe in the water of “socialized medicine”.  Maybe we would find that we could put our entire foot in over time.


We need to drain the swamp before we drown in it.



We Are All Guilty

Wednesday, March 25th, 2009


A few weeks ago, Rick Santelli, CNBC’s commentator from the floor of the Chicago Board of Trade, went on a tirade against government assistance to people who find themselves facing mortgage foreclosure in these troubled times.  Like a high school cheerleader, he lead a chorus of Board traders in a rousing chant against those whom he claimed had bought houses they couldn’t afford, or failed to read the mortgages that paid for those houses.  Why, he asked, should responsible people like himself (who pay their mortgages on time) be asked to bail out these over-extended, ignorant ne’er-do-wells.  To a thunderous applause, he turned and faced the camera and exclaimed, “Are you listening Mr. President?”


His ranting tirade got me thinking.  Two summers ago, I sold a house I owned at considerable profit to myself.  Looking back on it, I now realize that the handsome price I got for it was due to “housing bubble money”.   Be that as it may, I used part of the profit to build a stunning brick wall around my home.  The contractor who built the wall took his share of my bubble profits and went out and bought a shinny new truck, made I’m sure of steel, and copper wire, and big fat rubber tires. 


My point is this:  my bricks and cement, and my contractor’s steel and copper and rubber quite likely all passed through Mr. Santelli’s Board of Trade in one form or another.  Mr. Santelli bought and sold those items, and countless millions of tons of other commodities that flourished on bubble money, from which he derived the paychecks that allowed him to pay his mortgage on time.  It seems to me that we are all guilty of this mess, and that it is disingenuous for Mr. Santelli, or any of us, to point an accusing finger and self-righteously claim that it is all the other guy’s fault.


Are you listening, Mr. Santelli?




PS.  And as for not having read the fine print of the mortgages that now ensnarl millions of our fellow Americans, I have to say that after buying and selling countless homes and rental properties, I, an attorney, admit that I never read a single page of any of those mortgages.  And in all of this, I am comforted in the knowledge that apparently not a single congressman or senator ever read a single page of the stimulus bill that committed all of us to nearly a trillion dollars in future tax obligations.


I say again, “We are all guilty”.


Friday, March 13th, 2009

When I was growing up, we gassed up at “service stations”.  I can still remember Mr. Anderson at the Chevron across from my school wearing a uniform with a little white hat.  Whenever a car would pull up for gas, he’d come at a quick pace, ask you what you needed, and start the gas pouring into your tank.  While he waited for the gas to finish, he’d check your water and oil, clean your windshield and, if there was time, check and fill your tires (there used to be little air and water hoses sticking out of the end of the gas islands in those days). 



I don’t know whatever happened to Mr. Anderson, but wherever he went, the “service” went with him.  Now, we all fill up our own tanks, clean our own windows (if we’re up for it), and pay with a swipe of a plastic card.  I seldom if ever check my oil, or my water.  I almost never check my tire pressure because I don’t carry around one of those gauges, and even if I did, an air pump is kind of hard to find these days.  As a consequence, I simply go on the belief (more hope, actually) that my water and oil are O.K., and all too often, my washer fluid runs out.  Worst of all, I drive around on sloggy tires.


Now sloggy tires are not a good thing.  First off, they wear out more quickly which means that we spend more energy making new ones, and the land fills fill up more quickly.  More importantly, sloggy tires reduce a car’s mileage per gallon of gas.  I’ll bet that more than one super tanker a year crosses the Atlantic Ocean just to make up for what sloggy tires siphon off the top of our national energy needs.


So here’s my suggestion.  Pay people a nickel a gallon to pump gas.  Let’s bring back Mr. Anderson.


Here’s what we get for our nickels:

1)      There are a lot of people out there who are really hurting right now — -good, decent people who could use a job in these tough times.  I think this would really be a life-saver for maybe a million or so people for whom it could make a real difference on whether or not they can make ends meet.  And what would it cost you and me?  Just a buck for every 20 gallons of gas.

2)      We’d all drive around with clean windshields.  I’ll bet you anything that it would end up preventing an accident or two in the process.

3)      Some of us would have our engines saved by finding out that we’re running 4 quarts low and the indicator light wasn’t working.

4)      A super tanker or two (or three) would have to drop anchor off Galveston and wait for a real demand for the oil in their bellies.

5)      It doesn’t require the government to spend any money putting those people to work.  In fact, they’d end up paying taxes on their new jobs.

6)      By raising the price of gas, it would add incentive to people to think about getting more economical cars, eventually causing even more tankers to drop anchor off Galveston.


I know this can all work.  I have a home in Mexico.  Down there, your gas is pumped by an army of waiting attendants who will also check your oil, water and air.  I also know that Oregon had just such a law for years that mandated this exact thing (I don’t know if it is still required there).  


It’s another one of those win/win things.  So let’s make it happen!




OK, I know that there aren’t as many air pumps out there as when Mr. Anderson was doing it.  But at least our new service attendant can still check out tires and tell us if we needed air.  We could all feel suitably guilty about it until we made the effort to seek out a pump and fill our own tires.  (Hint: there’s one beside the Mercantile on Boston Harbor Road).