Saturday, January 06, 2007

The Evolution Of Insurance Claims – How UHC Changed The Way It Listens

OK, right from the start I admit that this one is going to attract very few people for its excitement value, but it’s a very big deal if you can grasp the significance of these changes. For full disclosure, I state here that my health insurance carrier is United Healthcare, and that they will be providing coverage for my cancer treatment. This situation should be considered in weighing possible bias on my part regarding United Healthcare.

As you all know by now, I have cancer. PMP for short, Pseudomyxoma Peritonei if you’re into the long version. Cutting to the chase, dealing with this cancer has already meant a string of doctor visits and tests, and will involve at least one major surgery and a bunch of chemotherapy. There are all sorts of factors to consider in this sort of thing, but one of the big worries is what it costs, financially, to survive cancer. And a big part of that worry is the cost of medical care. One of my fellow patients with PMP revealed that her hospital stay produced a bill in the amount of roughly $280,000. You know, that’s a big number in anyone’s book, and enough to send the average household right into bankruptcy.

Now, as it happens I have health insurance, through United Healthcare. The policy in general says they will cover 80% of accepted charges after the annual deductible is paid. That’s fine when we are talking about paying for a short stay of a well-known condition, but PMP is not well-known, and everyone I have talked to says that the hospital stay will be for several weeks, followed by several months of recovery. And even if UHC agreed to cover the hospital stay, the projected bill could easily result in me being responsible for $57,000. I do not have that kind of money, and I could not realistically pay that kind of cost out even if someone gave me years to do it.

OK, roll back to the mid-1980s. One big and common complaint about major insurance companies, was how hard people had to fight to get claims covered. From 1994 to 2000, I worked for a third-party claims administrator and I can tell you that there was a lot of difficulty. Sometimes it was fraud, but as often by the provider or the patient as it was from an insurer, but a lot more often there was something missing or misunderstood in the information and communication. This happened the most often when a claim was very large, or the diagnosis was controversial or complex. Things only got worse during the Clinton Administration, because in its zeal to protect the patient, the administration often made insurance companies out to be the villain. Imagine you run a business, but you are not allowed to control your costs. This was how many insurers saw the trend in government management of Healthcare. At that same time, the strong rise in medical malpractice suits and the subsequent jump in premiums made providers feel that they were being pinched; they were being forced to accept standardized reimbursement for medical services, but which did not rise in proportion to their operating costs or sense of risk. And patients continued to complain that valid needs were unmet, and legitimate claims denied purely for financial reasons. As recently as 1998, the matter seemed impossible to resolve.

I cannot speak for every insurer, but United Healthcare examined the issue, considered its options, and made changes. So far, that sounds like something any company would do, but in the case of UHC, the first changes were not towards patients or providers, but in the quality of information UHC had to use to make decisions. Speaking at the 11th Conference of the National Comprehensive Cancer Network (NCCN), Dr. Lee Newcomer, the Business Leader of Oncology Services for UHC explained that “it can be difficult to separate human error from system error”, meaning that the data sources had to be evaluated, and for that, UHC needed to hear – directly – from providers and patients. Participation in medical conferences like the NCCN Roundtable was one way to find out information, but UHC also opened queries to doctors and clients about their satisfaction with UHC. UHC also conducts clinical research in cooperation with laboratories and doctors, especially on those conditions with little established data. UHC also began to release Clinical Profiles, a program to coordinate doctors’ practices with other programs and to establish national benchmarks for medical care. In 1999, UHC followed this with the start of a Care Coordination program, which connected the different services, medicines, and treatments that patients needed for extended and serious conditions. And somewhere along the way UHC examined the numbers and determined an Out-of-Pocket Ceiling that any client would be expected to pay in any year, and UHC eliminated lifetime limits to medical care for most clients. In my case, this means that while my surgery and the associated costs will be expensive, they will be within predictable limits and in general the level of worry I will have from my insurance claims has been greatly reduced.

It remains to be seen how the promise will meet up with the reality, but I have read accounts from other PMP patients with UHC insurance, and the response has been very favorable. True, a lot of this depends on doctors and their staffs following through with the insurance company and all the paperwork, but it should be noted that at least some of the insurance companies have remembered that the patients are real persons, and they respect us in accordance with that truth.

Friday, January 05, 2007

Friday Hitch-Hike With The Anchoress

The gerbil in charge of my brain on Fridays has decided not to go long on Imagination today, so I am following the thoughts of The Anchoress, adding my own impressions and inviting our readers to do the same. The Anchoress’ fine article is here, and basically it addresses how things have changed since 1977. The Anchoress is herself building on a piece at CBS by Dick Meyer, but I see no reason to advertise for a Communist agent if I can avoid it, so that’s all I will say here about CBS. Basically both Meyer and The Anchoress are discussing what they call Civic Immaturity, and frankly I chuckle at the notion that this is something new; I’ve certainly seen this before, but never mind, the topic is worth discussing.

People have been nasty about politics for as long as the word has existed. I remember reading quite a bit about what the media of their day had to say about President Lincoln, about President Truman, about President Adams. It has been quite common, even within their own political party, for accusations of incompetence, malfeasance, even treason, to be leveled against one person by another person or group. It seems to me that to some extent we are fooling ourselves to believe that people have changed to such a degree that anyone may expect to be treated with respect and decorum. What seems to have changed, however, is how the mainstream disrespect manifests itself, and for that, I think I have a different answer than Mr. Meyer or The Anchoress. Simply put, look at what has changed, most significantly, in the United States since 1977; It is no longer unreasonable or impractical to serve the public with a Conservative worldview. The reaction to this sea change has been hostile and bitter, in the extreme, and this can best be seen in the treatment and expectations of the President.

In 1964, life was good for a Democrat and for liberal policy advocates everywhere in America. The Democrats controlled Congress, held the courts in ideological orbit, and Democrats had won 7 of the last 9 Presidential elections (4 by FDR, then Truman, Kennedy and LBJ one apiece, against only Eisenhower’s two wins). In addition, Johnson’s last victory was a landslide by any measure, and so it appeared that nothing would happen to change that condition, least of all that the hated Richard Nixon would show his face on the national level again. By 1977, a few bumps had occurred, so that Republicans could now claim 4 wins in the last 11 elections, but with Nixon having been forced to resign, control by the Left appeared even more sure than ever. Then it all came tumbling down.

In 1980 President Carter became the first sitting President running for re-election in a general election to lose since Hoover. In 1984 Reagan won an even bigger landslide, slamming home the fact that America could get behind a Conservative leader. When Reagan’s Vice-President, George H.W. Bush, won in 1988 in an electorally-impressive fashion, the GOP could claim 5 wins in the last 6 elections, and 7 of the last 10. The Republicans effectively owned the rights to the White House. This was one reason for the emergence of the ‘Must Hate Bush’ pandemic; the destruction of the Liberal Dominance Myth.

A campaign of smear tactics, media misinformation to attack the President, and a false face for the public allowed Bill Clinton to claim the White House in 1992, in a fashion not unlike the way Nixon took it in 1968. While Clinton was able to win two terms, he never managed a popular majority of the vote, and never established a commanding sense that he was in control of the issues or the policies. Bill Clinton sort of rode the flow and played for the public, like a stand-up comedian hoping not to get booed off the stage. So a great deal depended on the 2000 election, whether another Democrat would get a shot to actually do more than sit in the office, or else whether the public would put the Republicans again in the White House. The election was controversial, but in historical terms the focus was decided by the events of 9/11. Essentially, one either understood the significance of 9/11 and supported President Bush, or else one went into prolonged denial and gradually (some not so gradually) lost sense of reality. Such dementia is evident by the repeated denial that the election counted, demands for impeachment on the grounds of Presidential actions directly authorized by Congress, or fantasy films which misportrayed historical events or fantasized about assassination.

When President Bush was re-elected in 2004 by several million votes, the effect on the political sphere of existence was to amplify and polarize existing fights and bias. The dementia I noted earlier has reached such a detachment from reality, that President Bush is now being blamed for events and effects which he could not possibly control or affect, and he remains the object of intense personal hatred, the fact that he will never run for any public office again having completely missed the comprehension of the haters.

Moving forward, it is difficult to know what sort of results in the 2008 Presidential election would serve to relieve this condition. Democrats are expecting a great deal, as if the wins in the House and Senate in 2006 will guarantee a White House win in 2008. Certainly there is something to the so-called ‘political party fatigue’, yet it should also be understood that the 2008 election will be held in the context of the Democrats’ actions in control of Congress for two years. The public will like, dislike, or be apathetic to the actions of the Democrats’ Congress, but if fatigue plays a role, it could well hurt the Democrats more than the Republicans. Also, there is a reason why the GOP has won seven of the last ten Presidential elections, and some of that reason – frankly – is that few of the Democrats’ offerings for the race have struck Americans as a good leader. While the Republicans have shown a similar failing at times, at the Executive level only the Democrats can consistently blow their opportunities so often. But in any case, it is difficult to imagine that a Democrat President aligned with a Democrat Congress would care to even make the slightest attempt at respecting his colleagues on the other side of the aisle. And if the Republicans continue to hold the Oval Office, the feuding and bitterness is bound to continue, especially if the GOP begins reclaiming Congressional and Senate seats.

It’s ugly, and it’s going to stay ugly, is how I see it.

Thursday, January 04, 2007

School and Cancer Update

Some time ago, I promised to keep anyone who was interested, updated on my journey towards my MBA degree. Unfortunately, while that effort will continue it must be postponed for a semester, as my cancer has spread and the surgery I thought might wait for summer must be done much sooner.

To be honest, I was almost a great fool on that score. I had thought that because I felt well physically, without much pain or difficulty in motion and digestion, that I might be able to set my work and personal affairs in order, even taking on the spring courseload at UH-Victoria and putting my surgery off until mid-May at the earliest. The good people at the MD Anderson Cancer Center corrected me of that presumption rather quickly. The staff reminded me that cancer does not obligingly hold off its attack on the body, but must generally be attacked as soon as possible, or else significant damage and danger will result. As if to underscore that lesson, my bowels have been especially painful these past few days, almost as if I had swallowed a handful of quarters and half-dollars which I was now trying to pass. Not a good feeling, at all. So I accepted reality and cancelled my spring semester. I also am hurrying up collection of critical information I need for the Gastro-Intestinal department at MDA, such as my CT Scan and pathology data, reports from the last three doctors I have seen, and the necessary support for the insurance company’s files.

Wednesday, January 03, 2007

A New Adventure

"I don't know if the pants still fit, but I know the hat will."

- Harrison Ford, on the making of a new ‘Indiana Jones’ movie

The Meaning of Iraq 2007

2007 will be the Year of the Jackal, or so it seems. Even as they insist that they 'support the troops', leading Democrats are demanding that our military abandon everything they have accomplished and are pursuing in Iraq. One may not question the patriotism of those on the Left, although if one looks for evidence of said patriotism, there is much greater support for the flag of Syria than the flag of America, more support for the plans and goals of President Ahmadinejad of Iran than for the twice-elected President of the United States, or even for the war which Democrats overwhelmingly supported in 2003. But fashions change we are told, and even some who would claim the name Republican have deserted the effort to bring a Democratic Republic to Iraq, or to stabilize the region so the next generation might be able to escape the sort of madness which has plagued the civilized world this past half century. To that end, many liars and idiots have assigned Iraq to the same condition as Vietnam. That is a false claim, often repeated but never true to any sense of reality.

The first dispute must begin with the fact that in Vietnam, the United States entered by condition of a treaty with France, exactly the sort of multi-lateral approach which Leftists and morons of many stripes demand America revert to now. In the case of Iraq, the United States weighed the threat of Saddam's support of Terrorism, the threat his aggressive behavior meant to the region's stability, and the utter failure of Saddam's regime to abide, in letter or spirit, with the terms of the 1991 Cease-fire from the first Gulf War, and determined that the removal of Saddam from power should not only be United States policy, as it had been since President Clinton signed such a law into effect in 1998, but the active campaign of the United States military. Unlike Vietnam, where the United States was alone except for indigenous allies, the change in Iraq was and is the work of an International Coalition, led by the United States but each member state free to act according to its moral and political necessities; the decision by Spain to quit the fight, therefore, is proof of the voluntary nature of the Coalition, a fact long ignored by the media because it controverts their campaign of disinformation. As for that, it must also be noted that the media has shamefully ignored and distorted the sacrifice and commitment of the armed forces engaged in the enterprise to bring a Democratic Republic to Iraq.

It must also be noted that the United States utterly failed to create a representative government in South Vietnam, which created the intense distrust of American intentions. In Iraq, the very instability of the government comes from the fact that the United States allowed the infant democratic system to work; even the Sunnis who now so vigorously protest that government, in relatively large numbers participated in the elections to elect that government, because they understood that the future of Iraq rests on the shoulders of such men.

I must also stop at this point and observe that the effort in Vietnam was initially supported by both major political parties, and the media initially reported the conflict in relatively fair standards. In Iraq, the Democrats abandoned the war almost immediately after they realized the President would do exactly as he said he would, and the media became the enemy of the U.S. military even before the conflict began; the decision by CNN to cover-up atrocities by Saddam's government demonstrate their intent to oppose American interests, and the systematic betrayal of American secrets and the non-stop slander of U.S. troops by the New York Times and other newspapers are poisonous proof of perfidy which even the narcissistic media of the 1970s would have found beyond the pale.

Another significant difference between Vietnam and Iraq are the stakes. In Vietnam, the United States initially failed to understand that where North Korea had been as much a Chinese client state as a Soviet client state, in Vietnam there was animosity between Hanoi and Beijing; so long as the United States made no move indicating an action against China, offensive actions against North Vietnam would likely have been allowed by China, because it would improve their regional position relative to the USSR. Evidence of that can be seen by Chinese restraint in response to U.S. actions against North Vietnam through Cambodia and Thailand. The Beijing government found it useful for the Americans to sap the strength of their Soviet rivals in the region. In Iraq, the United States understood as a strategic goal the need to break the network of a number of terrorist organizations, especially those which were technically non-governmental organizations (NGOs), but who received support from anti-Western states. The United States also pursued the course, vindicated by the resulting events, or attacking terrorist interests in the Middle East in order to pre-empt attacks by Middle Eastern terrorists in Western cities, especially the United States. A simple examination of the number, type, and casualty numbers of terrorist attacks since 2001 proves the success of that strategy. I should also note that removing Saddam and the Baathists from power in Iraq led directly to Libya abandoning its own WMD programs, encouraged Lebanon to demand independence from Syria, and served notice to the region's aggressors, who scaled back their plans for aggression until the Democrats resumed running interference for them. If the United States had remained united in this effort, the extant dictatorships and family-based oligarchies would have been slowly but inexorably replaced by democratic republics, which would have stabilized the region, checked Islamofascism, and created an economic power to balance hegemonist ambitions in Asia.

Granted, things have changed in Iraq. Emboldened by the Democrats' refusal to address the threat from Islamofascism and their pathological hatred of President Bush, the enemies of Democracy march ahead towards objectives long planned; the acquisition of nuclear weapons, the drive to push the West out of the region, the abolition of personal rights and liberty, and the inevitable next war against Israel. The new fascists of Islam can not only count on the Left getting out of their way in these ambitions, but when they are done the Left will not hesitate to blame their personal political opponents, rather than address the threat in reality. The party which blames the police for crime, the churches for immorality, and successful businesses for economic concerns, can be counted on to attack anyone who dares to address the problem or meet the threat with any sort of effective plan of action.

But again, things are different this time around. In 1974, the Democrats chased out Richard Nixon on the grounds of his actual actions against the law, assisted by outraged Republicans. This time the Democrats have built a case on lies and false accusations, perpetuated by rabid fanaticism and no more. In 1974, the Democrats could and did vilify the brave servicemen who fought in Vietnam, but this time around even those cowards who care nothing for the fate of millions of honest Iraqis who desperately want to live in the same freedom we enjoy, do not dare say in words their true contempt for our troops. Instead, they promise they "support the troops", though in actual fact there is never much evidence of it. They run a decorated veteran as their champion, never addressing the serious questions about how he allegedly earned his medals, and to say nothing of his despicable conduct against his fellow servicemen when he thought he could spit on them with impunity. But there was no mistake in their selection; a backbiter who lied to get his medals, is just what the Democrats thought would make a winner. I think a lot of folks forgot that fact when the 2006 elections rolled around.

Of course, it must be admitted that the Democrats grabbed both chambers of Congress in the last election. Doubtless this condition does not bode well, either for Iraqis who want their government to be a bit more like ours, nor for the Marines and the other services who have given so much for Iraq to have that chance. But there are still a number of surprises the Left does not see coming. And top on that list is the fact that Iraq has irrevocably changed. No matter what the Democrats want to try, the Hussein family regime has been wiped from Iraq.

Also, while it is possible that the Democrats will succeed in their desire to abandon Iraq, even they understand that they cannot do so in a way which undeniably demonstrates their hostility to freedom for Iraq and the commitments made by the United States. Also, while despots may hope for a less resolute America, the events of the last several years have quite proven bin Laden's "paper tiger" claim to be very much in error. If it remains an annoying possibility that Osama bin Laden is still drawing breath, it remains nonetheless a fact that Osama may only do so in caves and temporary residences; no one wants to be around a man who is so eagerly hunted, and who is so obviously impotent in true capability these days.

Zarqawi is dead, along with countless thousands of soulless men who chose to follow his method. Those particular monsters will not be coming back.

It should also be understood that Iraq marks, for the whole world to see, the difference between a Democratic Party government and a Republican Party government. Democrats may back down from challenges, and test the wind with a wet finger before announcing their course, but Republicans will not forget their commitments so easily, nor desert their allies because the trendy people want to change their mind halfway across the river. The next time that an election returns the Republicans to control of the American government, an air of soiled trousers will again emanate from Damascus and Teheran, because those regimes will understand and fear the resolve of the United States once again.

Sunday, December 31, 2006

What American Doctrine SHOULD Be

Dean Barnett lays it out bluntly and with sharp-edged truth:

“I think the main reason we haven’t had a repeat of 9/11 or something worse in over five years is because George W. Bush scares the s**t out of his enemies. When domestic liberal whine, “He scaaaares me,” they really mean it. The world’s bad people feel the same way. The American reprisals to a terror attack that took place under George W. Bush’s watch would likely be swift, brutal and disproportionate.

Our enemies may be crazy, but they’re not stupid. I bet the next 9/11, which will probably be magnitudes worse than the previous 9/11, will wait until George W. Bush is gone from office.”

I think he’s right. And that absolutely, positively means we need to think and pray hard for someone with similar courage, nerve, and vision to run for President.

The next President of the United States should be as much George Dubya Bush as possible, with a bit of Michael Corleone thrown into the mix. God save us from the current list of “leaders” who want the job, please.