Sorcha's Scribblings

The State of Health Insurance in the US

I recently obtained a DME (that's insurance-speak for a piece of durable medical equipment, in my case a device that costs just under US$10,000). It was originally prescribed in November of last year.

My then-insurer (a Blue Cross company) required 6 weeks of conservative therapy before they would approve the DME. This is completely normal, and reasonable, since if non-mechanical treatment works, that's better for everyone (except the DME seller, I guess). I completed that in early February.

They then dithered around for months, failing to approve the DME. They also never actually officially declined it, barring my doctors and me from appealing the decision. In addition, we were informed that if they did approve it, they would most likely approve rental, not purchase, which would mean a reassessment every six months. Any delays in reassessment would mean repossession of the DME, and starting the process over again.

I was tempted to just buy myself the thing, and might have done so if it hadn't become obvious that the provider is in no way set up to sell to private individuals. Also, I pay for insurance specifically to deal with expensive medical situations like this, and I am stubborn in this sort of case.

Mind you, what the conservative treatment taught us was that in my case, the only way to control the problem without the DME is basically to become bedridden. For me, this has meant no more than a total of 2 hours out of bed in any 24-hour period. As a result, I have spent the better part of the last year losing muscle tone, being mostly housebound, and generally having a "gee this sucks" situation.

This summer, I changed insurers. The device was represcribed in mid-August, to start the process with the new insurer. The first thing they did was to accept the conservative therapy done earlier in the year as passing that requirement (this was a Good Thing, because if it's been more than six months, they can legally require that I do it again.) Already, I could sense that this might go differently this time.

In mid-September, the insurer sent a list of 12 questions to my doctor. It took the doctor a week to produce the 23 pages of documentation required to answer the inquiries. The answers were received by the insurer at the end of September, when they announced that they would have a decision within 45 days. Two days later, I got a letter approving the DME.

The manufacture, delivery, and training took another two weeks. Bottom line, United Health Care did in eight weeks what Blue Cross refused to do for eight months. I've heard tons of warnings about UHC, but frankly, they've been a pleasure to deal with in this matter. Kudos, also, to my doctor's office. I've heard horror stories from other people about it taking weeks or months to get a 23-page document from the MD to the insurer. (And as an aside, my own physician has been on medical leave for most of this year, so the heavy lifting was actually done by her practice-mates covering for her.)

Basically, everyone has been awesome: the MDs, the physical therapist, the DME rep, the UHC folks. Everyone except the people at Premera Blue Cross. And the kicker is that the UHC insurance is slightly cheaper (when you take into account thing like premiums, copays, out-of-pocket maxima, and so on) than the Blue Cross was.

I now face the challenges of getting back my muscle tone, my stamina, and learning to be mobile again. I consider those to be good problems to have.

I admit that during the whole process, I thought about what it was like to live in a place where universal health care is a given. I thought about my years in Canada a lot. It should not be the case that I only was able to get this life-changing treatment because I have good insurance. Anyone who needs it should have access to it. The US needs single-payer health care, just like any civilized country has.

Yikes! An Idea!

A couple days ago, I was doing some research for a book that I am 45000 words into writing. I'd run into this brick wall, see, and I needed some information about, well, it doesn't matter. That's not the point of this post. 

While I doing this research, I ran across a two-paragraph description of a now-discredited theory of inherited memory, a theory that was apparently popular in the last two decades of the 19th century. It's pretty obscure, and I have never heard of it, at all. I guess I thought no one before Jung had ever suggested anything remotely resembling a collective unconscious.

Mistakes in books

I've been reading a lot of ebooks over these couple years. I find them infintiely more convenient than paper (athough paper books still have their places in my life, a topic I may address in some other blog entry). As it gets harder and harder for me to climb stairs while carrying things, I am grateful that I can leave an ebook reader in the family rom and one next to the bed; it's great to be able to read the same book in both places without having to carry it around with me. 

At first, I just sampled, bought, and read books I would otherwise have bought in paper form. A time went on, and I got more comfortable with the ereading experience, I started looking at the wide range of self-published books out there. One thing I noticed (and made careful note of, in case I ever decide to self-publish a book) is that I can almost always tell the difference between a book that has been professionally copyedited and one that has not. 

On Criticism -- the two-way conversation

((I wrote this two years ago and never posted it. I've got some other blog posts burbling up in me, and I need to post this to make way for the new stuff.))

Well, this week, something happened that kicked off this entire set of posts. ((Urm. Two years and two months ago, actually. Oh, heck, let me provide some background, since the conversation I was responding to is no longer current. And this is the last of these double-parenthetical meta-comments. Note to self: do not procrastinate two years over putting up an already-written blog post. It just causes problems.))

Back two years and two months ago, there was a flurry of conversation in one corner of the popular culture criticism world where I hang out over what criticism is meant to be. I linked to some of the relevant material in the previous three posts in this series. Basically, the discussion was a reaction to complaints that critics did not provide a reasonable consumer guide to cultural content. This was generally expressed in terms of "But how am I supposed to know if I will like it if you don't tell me?" and "But how will I know if it's appropriate for my children if you don't address the things I think are relevant for making that decision?"

On Criticism -- consuming becomes conversation

I've always loved to read criticism. Much of the criticism I've read in my life (and all of what I read in the first 30 years of my life) was read at one remove. That is, it was published somewhere (in a book, a newspaper, or a magazine) and I read it.

The critic encountered something (a play, an opera, a book, a comic book), engaged it and reacted to it, and then sat down and wrote a review of that something. Whether it was a capsule movie review in the San Francisco Chronicle Pink Pages or a novella-length essay, once the writing was done, the review went out into the world, to be picked up by readers like me.

As readers, we read it, reacted to it, pursued the something that had triggered the review (or not), and moved on. Very few readers actually responded to criticism directly. Oh, there were the occasional letters to the editor of serial publications, but even then readers had to compete with those who wished to comment on the latest Congressional antics or the chances that the 49ers would ever in a million years make it to the Super Bowl.

For the most part, criticism was a one-way process. The critic pontificated and the reader read. I don't mean this in a negative way, really. It's simply that the nature of publishing in those days meant that most published material, including cultural criticism, went one way from its author to its reader.

On Criticism -- consuming what is critiqued

In among all the blog-talk about criticism lately, I was very struck by Keith Phipps' comment that "We’re not bullies and we’re not, though this sometimes gets forgotten, consumer guides. We're writers who think what we write about matters."

It is this approach that makes the best critics worth reading: the passion for film, for food, for comic books, for opera, that drives the devoted critic to stand to one side and analyze his reaction to a piece of work, the thrill or the disappointment or the odd mix of the two, and then to explain that to me, the reader. Good criticism is indeed not a consumer guide.

On Criticism -- a consumer's viewpoint

There's a lot of talk in various web locations about the nature of criticism, mostly written by people who engage in it for a living. I thought I'd take a whack at it from the point of view of someone who does a small amount of it as a hobby (see: Amazon reviews), but who most often relates to criticism as a consumer of it.

Here's a critic's take on some of the talk about criticism lately. This whole discussion has made me think about why I like to read good criticism. (Note that to my way of thinking, "good criticism" is not necessarily "criticism I agree with".) It also started me thinking about what criticism really is, and what it's not.

WoW posts: Not Here

I have some things I want to say about WoW. I thought about saying them here, but I'm afraid the WoW content would get drowned out here. Luckily, I have another "blog" that I already use to capture some (but not all) of my WoW-related fiction. I've decided to expand that other "blog" to be an actual blog, and put my WoW-thoughts there, along with the stories.

You can find it here.

Low carb products for trying times

My favorite thing in the world to eat is sandwiches. When I was India, the one thing I craved was a really good chicken salad sandwich, to the point that I think all the Stateside people I was e-corresponding with while I was there probably got tired of hearing it. (The one I had right after walking in the front door and before falling into bed to sleep off jet lag is one of my most vivid food memories. That sucker was every bit as good as I had anticipated.)

Anyway, sandwiches are more or less off the menu, at least in the quantities I liked to consume them. They are also one of the things I miss the most. I include in the category of "sandwiches" things like quesadillas and turnovers, by the way.

I have not yet found a way to replicate what is maybe my favorite food of all time (the turnover made with yeast dough, ground beef, onions, black pepper, and cheese, possibly but by no means necessarily mushrooms). However, there are two good products that make me feel a lot less deprived, at times when my brain hunger threatens to overtake my stomach hunger. Both are bread-like.

First off, Orowheat Light 100% Whole Wheat Bread. This stuff is no panacea -- a standard sandwich will set you back 22g of ECCs. However, when nothing will do but a grilled cheese sandwich or a chicken salad sandwich, this is my go-to saviour. Compared to my previous favorite (Orowheat Oatnut Bread), which clocks in at 40g of ECCs, this is a big enough win that I can justify an occasional sandwich.

More recently, I've discovered Mission Carb Balance Tortillas and Mission Carb Balance Whole Wheat Tortilla, which clock in at 11g and 4g of ECCs, respectively. The whole wheat ones are great for wraps (no soy taste like other low carb wraps I've tried), and the non-whole-wheat ones make a dandy quesadilla. What's more, I only need to use one tortilla to make a meal-sized quesadilla, where I need two slices of bread to make a sandwich.

Most of the time, being low carb is mostly a matter of getting into the habit, and stocking the pantry right, but every once in awhile, the brain hunger part of me starts screaming for BREAD! When it does, I can't hand it a beef turnover, but I can hand it a sandwich. Meeting it halfway is better for me than falling off that low carb wagon altogether.

Meatloaf: more musing than recipe

I love old fashioned meatloaf. My mother makes a great version, and I've been making variations on it since I was about 13. Unfortunately, it's untenable for a low carb diet. Her ratio is 1 cup breadcrumbs to bind 1 lb ground beef. No can do.

So I started playing around with meat loaf, and I learned some stuff. This post is about what I learned finding a pattern for making a great loaf out of meat that doesn't leave me all saggy and craving mashed potatoes an hour later.