Here’s What’s Wrong with American Health Care, or a wee example of it…

…or how $620.00 became $3,479.00.

I have psoriasis. This immune-mediated disease doesn’t kill or maim, but–to varying degrees (I’m at 5% of total skin surface)–spots one’s body with red scaly patches. No one knows for sure why this disease erupts, but it is known, for whatever reason, that the body’s immune system causes hyper-growth of skin cells–the spots–that are chronic and irritating. An additional treat for those who suffer this condition is a denudement of self-esteem. Most sufferers avoid swimsuits, or other clothing that doesn’t cover the delightful evidence that they are affected with the disease. Indeed, the sufferer is usually aware that if the telltale signs of the disease are seen by, oh, mothers of small children, those mothers might gather up their wards quickly for fear whatever malady that affects the sufferer is contagious.

Treatment for psoriasis usually consists of applying topical steroids to the spots, UV light treatments, or a pill that may control the symptoms but isn’t particularly friendly to one’s liver.

I have, over the past thirty years, used copious amounts of topical steroids and, off and on, undergone light treatments. Most recently, I completed a series of  UVB light treatments at Kaiser. The protocol is to stand in the UVB machine, much like a tanning bed, and through a series of visits the length of time within the machine is increased to a pre-determined maximum level. At the end of the protocol, the psoriasis patches are barely visible, but not gone. When the patches begin to appear again, it is time to restart the protocol.

Suffice it to say, the light treatments at Kaiser worked. The dermatology staff was great. And, the cost was, well, expensive: $30 copay for each visit.

Knowing that I will never be fully rid of psoriasis, I inquired about UVB devices for home use…something that I have been aware of for quite some time. With the cost of the in-office visits, I decided I could probably just zap myself at home rather than spend the time and money to go to Kaiser.

I inquired of my dermatologist which UVB devices Kaiser recommends, and I was given a stack of literature for the Daavlin Company. My dermatologist emphasized that Kaiser does not endorse the Daavlin products, and that there were other manufacturers out there that would work, as well. Given the relatively small skin surface, 5%, where my psoriasis persisted, I studied the Daavlin material, went to their web site and found the DermaPal device that I thought would be just perfect for my needs.

Through a series of text messages (the Daavlin site provided online “chat”) I inquired about the DermaPal, and how I could initiate a purchase. I also asked about the cost of the unit and was told it sold for $620.00. I knew my Kaiser policy required a 20% copay, and I could certainly handle that. So, I faxed off my insurance data, a prescription letter from my doctor, and the ball began to roll for the purchase.

I was soon told that unfortunately a contract between Kaiser and Daavlin had not yet been finalized, but that Apria Healthcare did have a contract with Kaiser, and I could purchase the DermaPal through Apria with the understanding I would still have the 20% copay. I asked the Daavlin representative what the markup by Apria would be, and she said she didn’t know. I was given the alternative of waiting a while until Daavlin and Kaiser finalized their contract. But, as I told the Daavlin representative, psoriasis does have a habit of blooming if not treated, and mine was already starting to reappear with a vengeance. So, I decided to go ahead with a purchase through Apria.

As an aside, the folks at Daavlin were wonderful, very helpful and genuinely concerned with my issues. Their product, the DermPal, is great and I would recommend this company to anyone who is trying to control their psoriasis at home.

It wasn’t a week after I and Apria formalized my purchase, that a nice man knocked on my door, my DermaPal in hand. I singed the paperwork he produced, thanked him, and took my box inside and opened it up. And there it was–my new DermaPal. I then looked at the paperwork I’d been given and Whoa! the cost had risen to $942.00, with tax. I quickly did the 20% calculation, and knew that was doable. I did, however, shake my head a bit with the realization that the cost of the device had increased by $322.00. “Middlemen,” I said, knowing that the third-party (Apria) involvement in the transaction had come at a significant cost. But, hey: That’s the American way! Right?

I used my DermaPal for several weeks and it worked fine, albeit not as efficiently as the great big machine at Kaiser, which is understanble. But, what the hell, I do it at home, there’s no travel time, there’s no $30 copay every time I got to Kaiser. So, I was–as they say–fat and happy, with just an occasional thought given to the fact that I had yet to receive Kaiser’s billing for my 20% copay.

I got the statement from Kaiser yesterday. Apria billed Kaiser: $3,479.00. Kaiser paid: $1,635.13. My copay: $327.03.

The percentage of difference between the original quoted price from Daavlin ($620), and what Apria billed Kaiser ($3,479) is 461%.

If my math is correct, the percentage of difference between the original quoted price of the unit ($620) from Daavlin, compared to what Apria’s invoice to me showed ($914) is 52%.

The percentage of difference between the original quoted price from Daavlin ($620), and what Kaiser paid to Apria ($1635) is 164%

The percentage of difference between what my copay would have been on the original quote ($124), compared to what it is now ($327) is 164%.

The most starkly disturbing thing about this is, I suppose, the impact this sleight-of-hand manipulation of our healthcare system has on you and me. The cost of healthcare in this country is abominable, and it’s things like what I’ve described above that grate as fingernails across a blackboard. What the hell is going on? Why does it persist? Healthcare insurers have got to know about this travesty. Don’t they? Or, is every entity involved in providing healthcare services in this country in on the deal–smiling slyly at one another with the knowledge that ultimately the consumer will pay, whatever the cost? And with what I’ve chronicled, the consumer–me–gets hit twice: premiums keep rising, and copays increase by, yes, 164% simply because a middleman stepped into the picture.

Something isn’t right about this, buckaroos. In fact, it stinks.

Posted in American Healthcare, healthcare | Tagged , , , , , , | 2 Comments

Denver Bond Promises Not Kept – Mayor Hancock and City Council Are Betting Your Memory is Short… The Latest Flimflam

Boettcher_2Since I no longer read the Denver Post, when I found just the other day Ray Mark Rinaldi’s item of October 16, 2012, “Mayor’s plan: 9 Denver institutions to share $57 million bond windfall,” I put my fingertips to my head, scratched, muttered something foul, and knew without even reading the piece that the city’s mamma’s and papa’s, the mayor and the city council, had once again duped us all. The flimflam has never been so celebrated, buckeroos, as what has gone down at city hall, apparently beginning with another bright idea from Mayor Hancock last year, and now codified this past Monday night, via ordinance approval by council.

Background: In the summer of 2007, then Mayor Hickenlooper proposed a $550 million general obligation bond package that would appear on the November ballot that year. The bond package was divided into nine segments, 1A – 1I, all of which were eventually passed by voters, with 1H receiving the fewest votes of the nine. (For an owner of a $255,000 home, passage of the bonds raised your property taxes by $64 annually.) 1H was referred to as “New Construction of Cultural Facilities,” and, if passed, would  provide $70 million to finance NEW CONSTRUCTION of Cultural Facilities, including, but not limited to: Classrooms, labs, a teacher education center and other facilities for the Denver Museum of Nature and Science and, the Reconstruction and expansion of Boettcher Concert Hall.

For the record I was adamantly opposed to 1H, witness what I wrote at the time.

(To put this in a little perspective, you might want to view the shameless, happy-crappy, feel-good hype the Hickenlooper administration engaged in before the November ballot in 2007. It’s here. As you watch, you might want to have a stranger next to you with whom you can share hugs.)

We need to focus our attention on that portion of 1H that specifically encompassed new construction for Boettcher Concert Hall, at a cost of $40 million, which is where this ignoble bait and switch story begins and ends.

Boettcher_11H was touted far and wide as being a helluva great deal, not only because it would “cure” the lousy acoustics in Boettcher Concert Hall, but public bond funding would be matched by private/donated funding from the Colorado Symphony Association to the tune of $30 million or more. (The new construction at Boettcher was contingent upon those private/donated funds.) Good stuff, huh? Well, yeah, if it would have happened. What did happen is what city folks are now calling every chance they get, in capital letters, “THE GREAT RECESSION,” of 2008, and, yes, even the fat cats who might have given a second thought about donating a few bucks to the Boettcher cause didn’t, and apparently no one else did either. So, as a consequence, the grand plan for new construction at Boettcher necessarily wobbled, tilted and fell through the proverbial floor with a great big schplatt.

What to do?

Well, time goes by and the mayor and city council start wondering how they can leverage the forty-mil just sitting there, issue the bonds that were meant for new construction at Boettcher, and start sharpening their pencils and asking the kinds of questions most politicians are apt to ask: How can we spend that money? An answer to one question asked at a meeting of City Council’s Bond Implementation Committee on May 24, 2010, came from Jack Finlaw, then the Director of Theaters and Arenas, who, in discussing the sorry state of fundraising by the CSA, noted that Mayor Hickenlooper told him, “…that if the CSO [Colorado Symphony Orchestra] is not able to make use of the $40 million on Boettcher, we should not issue the bonds at all.”

As critical as I’ve been of the Hick over the years, I do appreciate his better angels for knowing what was the right and ethical thing to do under the circumstances: Don’t issue the Boettcher new construction bonds. Why? Because, and I quote from the ballot itself, the voters approved the following: “THE ISSUANCE OF GENERAL OBLIGATION BONDS FOR THE PURPOSE OF FINANCING THE COST OF NEW CONSTRUCTION OF CULTURAL SYSTEM FACILITIES INCLUDING, BUT NOT LIMITED TO:…THE RECONSTRUCTION AND EXPANSION OF BOETTCHER CONCERT HALL, AND ALL NECESSARY, INCIDENTAL OR APPURTENANT PROPERTIES, FACILITIES, EQUIPMENT AND COSTS...” And, as Hickenlooper concluded, if the specific intent of the ballot question to which the voters gave the nod became impossible to achieve, then that’s that, don’t issue the bonds.  

Okay. The ballot language is clear in its intent. But, let me use my own words to take this a step further. What that ballot language says, with focus on the language, “…all necessary, incidental or appurtenant properties, facilities, equipment and costs…,”  is that we’ll fix up Boettcher Concert Hall and, naturally in the course of doing this large project, if some contingency pops up, if some ancillary project directly related to completion of the larger project arises, then, sure bond funds can be used for that, too. Makes sense. Large construction and reconstruction projects like this will invariably, inevitably involve a wee detour here and there, but only to the extent of fulfilling the larger purpose–the specific charge of the voters to “fix” Boettcher Concert Hall. Seems pretty simple, huh?

Oh, you may have noticed the blue words, above: INCLUDING, BUT NOT LIMITED TO.

Councilperson Jeanne Faatz honed in on those five words during the February 11th, Denver City Council meeting, calling them “weasel words,” as they have lately been singled out by the mayor, the rest of city council, and the city attorney’s office to mean something, firstly, not intended by the 1H ballot language, and, secondly, as the justification for the slickly executed bait and switch perpetrated on the people of Denver. (Faatz’s comments on this issue begin at about minute 37, in this video record of said council meeting.)

Those weasel words have been embraced by the city’s mamma’s and papa’s, including the mayor, the city council (with the notable exception of Councilperson Faatz), and the city attorney’s office to work the flimflam, the bait and switch on the people of Denver to the extent that the original intent of 1H has been gutted, prostituted for purposing the following:

Purpose 8 New Construction of Cultural System Facilities

o Boettcher Concert Hall – reduce funding from $40,000,000 to $13,881,000
o Add new project for DPAC Champa Street Bridge in the amount of $2,500,000
o Add new project for Denver Art Museum – Ponti Building in the amount of $3,000,000
o Add new project for Denver Botanic Gardens – Café, Restroom and Science Pyramid in the amount of $6,619,000
o Add new project for Denver Museum of Nature and Science and Denver Zoo – shared parking in the amount of $4,400,000
o Add new project for Levitt Pavillion Amphitheater at Ruby Hill in the amount of $2,000,000
o Add new project for McNichols Building Improvements in the amount of $4,800,000
o Add new project for Red Rocks Amphitheater in the amount of $2,800,000

The above re-purposing of bond funds–a nice euphemism for flimflam–was the product of a steering committee, formed in the fall of 2012 at the mayor’s behest, the purpose of which was eventually to let to an RFP (request for proposals) that enabled qualified Denver cultural facilities to, presumably, foam at mouth with the prospect of getting a piece of the now defunct Boettcher pie–$40 million. And the “re-purposing” of those funds, as above, was the final result; the “windfall” Ray Mark Rinaldi identified in his October 16, 2012, Denver Post story.

From the mayor to the steering committee, to each and every council member, save one, to the city staff involved in the process, to jackleg reporters; the lofty language used to enhance the particular subterfuge they were all involved in–the bait and switch–included the feel-good phrase, and iterations similar, that the re-purposing of 1H bond funds must be “Consistent with [the] context and purpose of the original ballot measure(s).”

Dare I ask what improvements to the McNichols building; the Denver Art Museum’s Ponti Building; the Botanic Gardens cafe, restroom and science pyramid; the Levitt Pavillion Amphitheater at Ruby Hill; the Red Rocks Amphitheater, and others, have to do with new construction at Boettcher that was the “context and purpose of the original ballot measure?” If you’re pausing here, just for a moment, then I believe I can suggest you may have concluded the same thing I have. These “new” projects have absolutely nothing to do with, again, the “context and purpose of the original ballot measure.” They’re all kind of cultural things, you might say. Yes, some of them are. But, so what? They’re not Bottecher. They’re not the projects the people of Denver approved in November, 2007. The people didn’t say, “Oh, by the way, if something happens that precludes the expenditure of our bond dollars on what we said you could be spend them on, just throw those dollars at something else. Hell, if it’s vaguely culturally related, go ahead, spend away. It’s only money, for Christ’s sake.”

I’m reminded of one of my all-time favorite cinematic moments from The Best Little Whorehouse in Texas, where the now-deceased Charles Durning plays the role of the Governor of Texas. Master of the flimflam, the Governor performs a charming little sidestep, while singing: (video here)

Ooh I love to dance a little sidestep, now they see me now they don’t-
I’ve come and gone and, ooh I love to sweep around the wide step,
cut a little swathe and lead the people on.

Lead the people on. Yup. Here’s what Mayor Hancock had to say with regard to re-purposing bond funds: “Denver is consistently recognized for our high-quality cultural facilities that help uphold the spirit of our smart city. As the voters intended in 2007, these funds will help maintain and improve these cherished facilities,” Hancock said in releasing the list. “We have focused the last remaining funds on advancing our facilities while staying true to the authorized intent of these critical investments.”

Okay. Enough said, I guess. Nothing to do about it now except for, yes, except

For God’s sake, let us sit upon the ground
And tell sad stories of the death of promises;
How some have been denuded; some plainly forgotten,
Some haunted by the politician’s avarice;
Some poison’d by mendacity: the trust of the people kill’d;
The people’s faith murder’d…

sstbMayorMHancock_profile96964And, with thanks to The Bard, adieu. The next flimflam, I’m absolutely certain, is occurring at this very moment, as the mamma’s and the papa’s perpetrating it know full-well that our memories are short, and our interest in their  slimy machinations incidental.councilgroup

“Democracy is a device that insures we shall be governed no better than we deserve.”

George Bernard Shaw


Posted in City and County of Denver, Politics | Tagged , , , , , , , , , | Leave a comment

ImageAnother dive into Amazon self-publishing, is Vignettes of the Office – Darkly Told. These five short stories are new, with the caveat I’ve been working on them for a while. These stories are wee visits to the dark side of anyone’s office environment or experience. Ever wonder what’s in those burritos Benita Mae makes for you all? Ever wonder what goes through the mind of the old guy, the one with the most seniority, but not yet promoted to the corner office by the window? And what about the oddball of the crew? What’s his out-of-office life all about?

I’ve written a few horror shorts over the years. When I’m writing them I do enjoy it and am somewhat surprised by the dark turn my mind takes in the process. Later, after reading them again, I’m equally surprised that such came from me. Where did I get that stuff?

Here’s the Amazon link. And here’s a sample:

Henry hunkered in his cubby. Gave up the cup of Clorox in his bath. Popped Viargra the moment he arrived at work—the resulting rise the penultimate affirmation of his manhood. Peeked into his briefcase at ten, noon, and two, and gave a wink to the silent presence and determined promise of the .44 caliber magnum he now carried to-and-fro his and Shirley’s snug condo.  He still smiled at his workmates, but without a “Hi.” Avoided the break room. Ate his lunch at his desk. Ceased dispensing his wisdom to workmates, who’d yet to be born when he first occupied his cubby; a time when he first began to nurture the certainty of his destiny, his passion to be the honcho, el jefeel supremo, the boss.
Days of Henry’s funk turned to weeks, months. Workmates passed his cubby, smelled something feral, something dangerous. Those who turned their heads to view Henry’s slump within his ergonomically designed chair, saw the newly exaggerated hump of his shoulders as he leaned forward, his elbows on his desk, his phone to his ear, his former high-pitched screech now only a bare raspy whisper. Others noticed—their glances quick, unobtrusive—what appeared to be peaches lined across his desk. Still others saw Henry’s ear holes untended, the wiry black hairs remarkably prolific, long enough to braid.

On a Wednesday, hump day, Henry ate seven peaches at his desk, left the seeds neatly spread, one after another, across his now juiced work surface, his tie and shirt, too, had received a squirt or two. At noon—High Noon, he thought, feeling the jut of his Viagra-induced hard-on against the cotton of his boxers stubbed up against his tan polyester pants—he turned his back to the entrance to his cubby, and opened his briefcase. He gently lifted the chrome-plated pistol from its lair, pulled his handkerchief from his back pocket, and polished the heavy weapon until it gleamed. He smiled.

Aside | Posted on by | Tagged , , , , | 2 Comments