This is a complicated story, and even some of it sounds fairly dramatic, I’m including those elements not to be dramatic, but to explain the situation fully.

I will start a small amount of history.  I had been purchasing insurance through my domestic partner for a couple years, paying a fairly significant sum.  When her office changed insurance providers and the price went up, I realized I could do better buying my own directly as a sole proprietor.  So I found a plan which costs a little under $5,300/year.  

At that point, I was working as a consulting with the state of Vermont, providing training and technical support.  It was a lucrative contract that got killed when we had a budget shortfall.  Therefore, in May I was informed that my contract was not going to be renewed.

Fortunately, I had seen this coming and was prescient enough to have started saving money.  When my contract ended at the end of June, I had enough money in my savings to pay both my health insurance and rent through the end of the year.

This is a very good thing, because my health took a fairly bad turn this Fall and I had to curtail my work search significantly.  This story isn’t about the loss of employment, but I include it to provide a full perspective on what’s going on.

Health insurance is something I was willing to pay for, and pay significantly for, for one primary reason: even though I am mostly healthy, I do happen to be diabetic.  This means that I am on several medications (one of which is quite expensive) but with my insurance, I rarely have to pay more than $30 for a prescription.   This insurance also covers doctor’s visits with a $20 copay for visits to my primary care physician and a $30 copay for all other providers.  

But if I, as a small business owner, had to hire anyone else, I never would have been able to cover the cost of it.  It’s just ridiculously expensive.  Furthermore, the rules of the plan require that I be hiring someone at 30+ hours/week in order to cover them (this includes me, and we’ll get to that part of the story later).  

So even if I wanted to cover an employee who only worked 15 hours/week, I would not have been allowed to do so.  You heard me right.  Under this model, I can buy insurance as a business owner, but I can only cover some of my employees, even if I’m willing to foot the bill myself.

This is all a small part of the story, and just about the economics and the ridiculousness of the nature of those economics.

This fall, three things were going on at once:

• I got very sick;


• I had to apply to get into Vermont’s Catamount Care program because I couldn’t afford to buy insurance any longer;


• I had to find work to support myself while the other two things were going on

I’m going to start with the Catamount story just to emphasize the absurdity of it.  I will note that I still work part-time as a teacher, which places my income at the level where I don’t qualify for Vermont Medicaid, which is the state-sponsored medical available to anyone who qualifies in terms of their income, but still at the point where I can’t afford to purchase my own insurance.

Catamount Care is Vermont’s private health care plan system with state support.  If you qualify for the plan, you can either pay the full monthly fee or, if you qualify for assistance, you can pay part of it (that’s means-tested based on income).  

The Catamount story starts with me trying to figure out (a) whether or not I qualify and (b) whether or not my pre-existing conditions are covered.  

I do qualify, but the process of understanding how and why I qualify was maddening.  I had to talk to five different people before I got a good answer.  One person I talked to clearly didn’t understand the program and was actively rude about it.  Another understood the program quite well, but didn’t understand my situation well enough (that was partially my fault, because I didn’t understand some of the specifics).  

But what I had to do was figure out how to make sure they had all the information I needed and present things so that it was clear that I qualified.  

It turns out the difference between being qualified or not hinged entirely on that factor I referenced earlier of how many hours I worked.  When I had a lucrative contract with the state and was working 30+ hours on my own business, I qualified to purchase my own medical insurance through a group plan.  When that contract dried up and I no longer had it, I wasn’t qualified to renew my plan.  

That was the sole reason I qualified for Catamount.  If I had merely been unable to keep up with the payments for the group plan, I would not have qualified.  It was because my insurance company was going to drop me that I qualified, which only was the case because I reduced my hours.  

Just so we’re clear: if I had continued to do 30 hours of work/week for my own business, even though I wouldn’t have been getting paid for it, I would not have been able to apply for Catamount.

Now: I am a very well educated person.  I have a master’s degree.  I am not, as they say, a moron.  And yet, I had a lot of trouble figuring all this out.

I have trouble imagining that everyone applying for health care in Vermont can follow this bizarre logical process and I strongly suspect that some people who qualify don’t bother applying because they think they don’t.  In fact, I can verify that this is the case because it turns out I would have qualified last year.  That’s right: if I had understood the program better, I could have gotten into it a year ago, and not had to pay the full cost of my insurance plan this entire year.  It would have saved me thousands of dollars to have enrolled in Catamount a year ago, and even though I very much had looked into it, I didn’t apply because I didn’t see in the documentation how I qualified.  But, so it goes.

So I applied in early November.  I got a call from them fairly soon, asking for more info about my current insurance plan.  They needed to know which plan I was on and my group number, etc. so they could verify that the plan was coming to an end, but I was told that once they had that, I’d qualify.

Except that wasn’t the end of it.  I didn’t hear anything until two weeks later, but the day before Thanksgiving I got notice that I had to prove myself to be a citizen.  Thank you so much, anti-immigration nutcases: it turns out that in order to receive any services that include any federal funding, I have to provide a copy of my passport (I don’t have a passport) or my birth certificate.  The note explained that I had four days to do this or my application would be canceled.

So, not having a birth certificate, and having legally changed my name in the meantime, produced a bit of a problem.  I called them in a panic, and was able to get an extension, but once again: more stress than I needed an an extra complication.  So I finally got in touch with probate court and in touch with the department of vital records from the town I was born in, and found out I could get everything taken care of relatively easily and quickly, but it did cost me about $40 all said and done to get things done fast.  So, okay, I now have proof of who I am and I can bring it into one of their offices so they can verify who I am and that I was, in fact, born in this country.

In the meantime, they send me a note saying I qualify for the program which helps employees pay for their own insurance when the employer doesn’t cover it all.  This, of course, is not what I applied for.  So I called them again and asked what to do, and it turns out because I’m employed part time by the college, I have to get them a copy of a form and get it sent back to the state.  This form basically tells the state “we don’t offer insurance to our faculty, so she doesn’t qualify.”  I dropped the payroll office an e-mail about it, never heard back and then on a Friday called and got the info for the one person who handles this sort of thing who was gone for the week.

Fortunately, when she did come in on Monday, she was great.  I’m qualified and everything, have a decent deductible to pay in the meantime, but after all this… I’m thinking… wow.  That was a lot of work to do and it took much longer than necessary.

The employee form that I just referenced, for example: if they’d told me it was a possibility that I’d need to have that done, I could have done it a month ago.  

The birth certificate?  If they’d just said up front “these are the things we may ask you for in the process of your application…” well, I would have had that all resolved in early November, rather than dealing with them during the weeks that covered preparation for and recovery from surgery.

But I’m also just really lucky that I was able to get this all taken care of, because while I was doing this, I was a mess.

And that is the second part of my story:

The medical issue is fairly straightforward: I got really sick in early September.  I mean, sick to the point of barely eating and having significant gastric distress.  This included days where I could not keep anything down (and one day where I couldn’t even keep liquids down).  Out of the next six weeks, I had maybe seven days where I was fully functional on my own.  During a large chunk of this, I could not sleep for more than 45 minutes in a row, and during those six weeks, I never slept for more than 2 hours in a row.  

I had five visits during that time to my primary care physician, who was convinced that it was a problem with the intestines.  Those visits would have cost me over $700 without insurance.  My current bill for them stands at $100.  The lab work that was done there would have cost me another grand or so, but there is no fee for those tests at all.

After those weeks of visits, in late October they finally decided they needed to do some actual tests that looked inside my abdomen to see what was going on.  They scheduled a scan of my intestine which would have cost over $500 if I hadn’t had insurance, but didn’t cost me a dime.

Turns out the problem wasn’t gastric.  It was kidney related.

I got called my my primary physician’s office within a few minutes after the scan was completed and they’d arranged a visit with a urologist who specializes in this sort of thing.  Mind you, I was still in fairly constant pain at this point, and had been for weeks, but I trekked over to the urologist’s office across the street from the hospital and he explained the whole situation to me in great detail:

The scan had immediately showed the problem: a kidney stone on my left side which had actually created a complete blockage.  This created a large fluid sack around my kidney which had had two dangerous effects: it had (a) ended my left kidney function entirely and (b) served to block my intestines from functioning fully, therefore explaining the gastric problems.

This was serious enough that he wanted to schedule surgery as quickly as possible.  The scan was done on a Monday.  The surgery was scheduled for Thursday.

This, of course, was terrifying.  

My insurance plan covers surgery, but with a large co-pay: up to $1,000 for outpatient surgery and $2,000 for inpatient.  So I was basically crossing my fingers hoping that I wouldn’t have to stay overnight and cost myself an extra grand.  

This, by the way, wasn’t surgery to remove the stone.  This was surgery to insert a stent which would divert the fluid from the one kidney to the other, and serve as a temporary bypass in order to release the pressure on the left kidney and give it time to heal.  The stone removal was to come later.

The surgery went extremely well.  I didn’t need painkillers, but I did have to pick them up just in case, which placed me as part of the State of Vermont’s tracking system for anyone who gets any schedule C narcotic via prescription, which is just oh so peachy.

The difference was immediate: no further pressure on the kidney, but with some minor unpleasantries that lasted the next week or so but I was able to sleep better and after that first week, I was able to sleep through the night.  This brought us to early November.

The total cost of that surgery, I found out, was $4,935.58.  My portion of that bill was $929.34.  

My insurance had almost paid for itself entirely with that one surgery, and I still had a 2nd one ahead of me.

The 2nd surgery was ten days ago: it also went extremely well, though it was a longer surgery and I had a harder recovery time.  I got motion sickness heading home that day, and (I never have motion sickness), but after a day or two of recovery, I was doing okay, still not needing the painkillers.

I haven’t been billed for that surgery yet, and if I am, it won’t be for more than $71.66, which I’m good with.  

So I’m good now: the second surgery removed the kidney stone and left me in a lot of short-term pain, but I’m beyond all that now and doing well.  In the meantime, the function has started to return to the left kidney, but I won’t know until next month whether it returns to full function or whether it sort of lingers permanently at the half-function level it was at a couple weeks ago.

I’ve got a long recovery ahead of me: I have to get used to exercising again, and I have to get back in the hang of, well, everything.  This took a small chunk of my life from me for a time, and put me in the position of having been forced to place my life in the hands of strangers.

Don’t get me wrong: once diagnosed, I was treated with the utmost respect and dignity, but this was a horrible experience.  I’m not out of the woods yet; we don’t know how or why the stone developed, or whether or not I’ll develop any more in the future, which means that having health care is a fairly big deal for me in the future as well.

And even with health care, I was misdiagnosed by my primary care physician, and misdiagnosed to the point where things got really bad before they started to get better.  

But I’m writing this because we talk about health care and we talk about the need for it, but we don’t spend enough time saying exactly how important this is.  This isn’t an extreme case.  This is something that happens to lots of people all the time, and some of us have health care and some of us don’t.

I took a look at my records from my insurance.  They break everything down by what the provider charged, how much the insurance paid, and how much I’m expected to pay.

I summarized this for the year (this does not include the prescription plan), and found the following:

My health care providers charged $23,820.97 for care I’ve receiver this year.

My insurance company, which places limits on payment charges for certain procedures, paid out $10,052.62 of that.

I’m expected to cover an additional $1,699.34 on my own.

If I hadn’t had insurance, I’d have been royally screwed.  Even as things stand, I’m not sure how I can afford the surgery, but I’ll find some way to cover it.

But through this whole process, I was thinking about something that happened to me about 15 years ago, when I didn’t have insurance: I developed an ear infection one winter.

I never treated it.  I never went to a hospital.  I never went to a doctor.  I just hoped it would go away.  

After a month, it did.

I got lucky.

Ear infections can do really bad things to you.  They can even lead to brain damage.

I was lucky.

Can I imagine someone in kidney distress doing the same thing because they think it’s a virus or an illness that just needs to pass?

Yeah, because that’s what my own doctor thought: take some antibiotics, let the problem heal on its own, and everything should be okay.  I had to push to get approved for the abdominal scan.  And I have insurance.  How much motivation will there be for people to push when they know they can’t afford the cost of it?

I also think about something that happened back in 1992: I had a bicycle accident.  I lost my breaks going down a steep hill and had a choice between ramming into some bushes or heading into traffic.

I chose the bushes, not realizing there was a hard metal fence hidden inside them.  I rolled over onto a spike on top of the fence and it impaled my neck, leaving a hole the size of a quarter, but I was lucky enough that it missed all the major stuff.

When I went to the emergency room, however, they told me they were going to do surgery right away.

Then they found out I had no insurance.

They they had a little huddle where I couldn’t hear them.

Then they came back and told me that they thought surgery would be unnecessary.

The minute they found out I didn’t have insurance, I fell to the bottom of the queue.  I was ignored, left to sit for hours at a time.  My hands were all scraped up from the accident and it took seven hours before I could clean them.  I kept asking for something to use to clean my hands, and finally the doctor showed up and threw me a washcloth and a bottle of bacitracin and told me that they were for my hands and left.

Having insurance matters.  Having insurance can be the difference between being treated like a person and being treated like a burden.  Having insurance can be the difference between health and disability, between survival and death.

This is why it’s necessary.  This is why it’s relevant.

I just didn’t realize until recently just how necessary and relevant it was.

Now that that’s all done, I think I need to go find a job.

Has anyone else noticed the excessive shock and disgust with which our talking news heads have reported Illinois Governor Rod Blagojevich’s liberal use of the F-word? In the first couple days of the scandal, Blagojevich’s (and his wife’s) potty mouths received more attention than their actual deeds.

Senate seat, a children’s hospital, editorial writers: Everything is for sale. The Blagojevichs are the Baltimore Ravens of the pay for play world. (Should someone check on their kids?) So why the media preoccupation with style over substance? Are Chris Matthews, Lou Dobbs, and Sean Hannity (to name a few) as truly offended as much as they claim? Or could it be they’re just trying to keep the “pure” in puritanical?  

I love words. I’m attracted to their etymology, to the complexity and simplicity–and to their inevitable malleability. Of course, I have my limits. I will never accept impact as a verb or aggravate as a synonym for irritate. I literally hiss when I hear the wince inducing “revert back.” But the F-bomb, used in art, literature, or private conversation does not offend me. In fact, it can, in the right circumstances, be quite effective. Powerful.

Let me just stop here and say that I would not use the F-word in front of your mother–or even mine, most of the time–at a formal professional function, or in my classroom. More than once, though, I have wished that I could create a lesson around the word fuck. Fuck can be quite illustrative in discussing parts of speech.  

Fuck as noun

Examples: Fat Fuck, Lazy Fuck, Stupid Fuck. Sure, one could substitute Ass in each of those instances. But it loses power. One exception is Dumb Ass.  That just works.  

Fuck as adjective

Examples: Fucking ridiculous, fucking great, or, most popular, fucking bullshit. Once again, substitutes dilute meaning and emotional impact.

Fuck as exclamation

Examples: Fuck! Fuckin’ a! Do I really have to explain this?

Fuck as verb

Examples: OK, I don’t want this to be awkward. But we’re all adults here, right? We can probably agree that a throatily whispered,” Make love to me” has its time and place. But if I’m in the throes of the act I am much more likely to scream something else that I want you to do to me.

Our culture has accepted the transformation of other words; spam, gay, and the previously mention verb impact come to mind. Why not fuck?  There are times when it is actually less offensive than the term it is supplanting. Isn’t “fucktard” more sensitive than that word that so many teens use? And how about borrowing from across the ocean and using “For fuck’s sake,” instead of taking the Lord’s name in vain, which greatly bothers some of my Christian friends.

The millenials seem to get it. But then, they also seem to use the C-word with some regularity. So I guess I’ll have to ponder that.

As for Rod Blagojevich? What a Dumb Fuck.  

Crossposted @ www.vermontbloggernaut.blogspot.com

This started out as a comment, but I decided it was worth expanding and building upon.

I was embarrassed this week to see Jim Douglas, governor of Vermont giving testimony in Washington. It seemingly amounted to nothing more than a beggar looking for handouts. Maybe if he surrounded himself with able, qualified, intelligent, outside-of-the-box thinking people in his administration instead of this cronies, Vermont might have more options. His appearance did not make me proud to be a Vermonter, we take care of our own, and are in much better of a position to do so than the Federal government at this point.

Hopefully this will get a few others to chime in with their thoughts. If you don’t learn history, you are doomed to repeat it. We’ve been through hard economic times before, and we need to do what we know works. It’s time for the 2009 New Deal For Vermont, there is no better time to invest in Vermont and Vermonters.

Vermont has one of the best bond ratings of all the states in the union. It’s time we take advantage of that to secure funds to rebuild our crumbling infrastructure. Put Vermonters to work rebuilding, and preparing our state for the next 100 years. We INCREASE state goverment, the biggest employer in the state of Vermont IS already the state of Vermont.

Run with this for the short term, and turn the whole state into a massive public works project to put people to work and prepare us for the future. Put forth a massive concerted effort to rebuild our bridges, roads, and telecommunications. Also of priority would be environmental conservation projects aimed at waste and pollution reduction, recycling and reuse, controlling/eradicating invasive species, and assisting Vermont communities with growth center and economic development. From working on the facilities at state parks, to turning wastes into resources, or building new businesses, there is very little we can’t do.

Today’s Freeps ran with an article that 2,ooo more Vermonters just signed up for unemployment benefits last week, bringing the total to more than eleven thousand receiving benefits. They may have to up the unemployment costs to businesses because here’s more money going out than coming in, ad that’s not going to help businesses already struggling with payrolls. We’re gonna be spending the money whether we get some bang for our buck or not. Let’s get these people some work to do! Vermonters are a hardy lot, and would rather do something than nothing.

This is not nearly a complete picture or plan, but it’s a start. Dialogue and Yankee ingenuity can and will get us through these hard times. We all need to sit back, look at the big picture, and say what can I do to help Vermont get through this, we’re in it together. Right now Vermont’s future is being decided for us, let’s take a stand, invest in Vermont and Vermonters!  

That's what we keep hearing, right? That the UAW has pushed wages and benefits up so high that the American manufacturers can't make a profit on the cars they sell. We hear that the labor costs for Ford are $71 and hour, whereas the Japanese companies, even for plants here in the United States, are only paying $49 an hour. And that's supposed to be outragous, right? After all, how many of the people who hear these statements are getting paid $71 an hour? Therefore, the problem must be the UAW.

Yeah, but no.

When you look at the figures, you see a totally different story. It's true, the all-in labor cost of Ford (or “Ford's”, if you work in production) is about $71 an hour, $22 an hour more than what the Japanese companies are paying. That's a big gap, and would seem to support the claim that the American companies are overpaying their workers. The components of that difference, though, are significant. Ford pays a little more in hourly wages, benefits, and health care. The big difference is the “legacy costs”, benefits, especially health benefits, paid to retired workers.

Why such a difference? Three reasons. First, the retired UAW workers have a union bargaining on their behalf, so they get benefits the Japanese companies aren't paying. Second, the Japanese companies don't have the same number of retired workers in the United States. They haven't been here that long, so if you look at the total number of workers the company has ever employed, the American companies have hundreds of thousands of retired workers, while with the Japanese companies with plants in the United States, almost all the workers they've ever employed are still working for them. The Japanese companies do have retired workers, of course; they're living in Japan.

The big difference is that the retired auto workers living in Japan, like the current auto workers living in Japan, are covered by national health. They aren't imposing a financial burden on their auto companies because they are covered by a public system. That component of the cost is just taken right out of the cost of a Japanese car, wherever it was made. In other words, what we learn from this is that decades of our refusal to consider national health are causing a major drag on American industry.

This isn't the whole story, of course. Primarily, this doesn't address the question of how the American companies will get to the point of building cars Americans want to buy, and that is a crucial point. Still, if we take out the legacy costs and focus on the questions of design and marketing, we can see that it's not the UAW that's causing the problem, but management. Therefore, we can't fix the problem by following the Republican prescription of beating up on the unions.