Saturday, December 27, 2003

American Justice Part 1

They're lined up around the block." LaVerne looked out the window. The guests attending the Grand Opening of the Starzinsky Elder Lifestyle Improvement Center were dressed to the nines, despite the black puddles of slush on the sidewalk. The only flaw in this picture was the man sprawled out in a pile of wet cardboard across the street. He had been there for as long as she could remember. The crusted blood and his broken face marked him as something to avoid.

LaVerne still couldn't believe how smoothly things had gone during this year, transforming the Star Ortho-Surg Clinic into this welcoming home of an innovative program for the community. The federal auditors had taken most everything, except the lease on this prime real estate right across from the Verizon headquarters. It was LaVerne's quick thinking that had brought the Verizon Retirees Assoc. together with the community leaders to fund the project.

Dr. Tony Star took a fast look in the back seat of his classic Mercedes. "The Russians won't miss a couple of hip replacements here, a few knee repairs there." He paid them plenty for the referrals their No-Fault scam provided. He knew he'd be basking in the sun, spending the cash that was now stashed in the Mercede's boot, long before the Courier News caught wind of the Attorney General's investigation into fraud at the clinic.

Dr. Star was lost in a fantasy where an ice cold Mohita was being brought to him by a nubile young native girl. No more Russian Mule Sweat for him, after he collected on this last procedure. Lieutenant Dan had great insurance.  The seconds pins, Dr. Star used on the Lieutenant's son, wouldn't hold up for any fancy footwork, but the savings were paying for Dr. Star's Cessna. He thought he remembered something about the kid going to college next year anyway.     

Author; Caryn Isaacs

American Justice Part 2

PLEASE READ American Justice Part 1 FIRST!

He heard, more than felt the fist that broke his jaw. Dr. Star couldn't see where the blows were coming from because his eyes were rapidly filling with blood from a cracked skull. He couldn't breath through his broken nose. The cold on his crumbled teeth brought him to his knees and he scraped his face against the bumper of the gleaming classic Mercedes. He struggled to stand. He thought he could make it to his office across the street, but this was the 15th. The 15th was the one day of the month that garbage was still collected. The brakes on the city garbage trucks were also a victim of Dr. Star's hand picked Mayor's budget cuts.

Dr. Star was catapulted against the pile of cardboard boxes leaning against the Verizon headquarters.  He didn't know how long he had been sitting there. From time to time he could see someone in a uniform would come by to bring a cup of coffee or some soup. Dr. Star alternately yelled obscenities and pleaded for recognition. He was sure someone from the clinic would be looking for him soon.  

LaVerne turned from the window. " Dan, can't you get that guy to move somewhere else. I'm giving my speech in front of this window and I don't want the guests to be reminded of the rest of the city's problems."

"Sure, I'll get my son to call a few friends from the Precinct. He loves to help out here. It will be good practice for him when he is a doctor, himself.  Mike's really grateful for the The Anatoly Starzinsky scholarship. After his legs were ruined by that quack, he didn't think he'd get to go to college.    

LaVerne agreed, "If  you and your son hadn't been here, on the same day that Dr. Star disappeared, we may never have found all that money in Dr. Star's car. Your being a policeman must have scared him into leaving the car behind."

"Yea, I call that real American Justice."  

Author; Caryn Isaacs


Monday, December 1, 2003

The Perfect Partner

Here are some American health system partnership arrangements that have changed the way we receive and pay for care. 

1960     The patient and the doctor are partners in health.

You feel sick, you call the doctor's home. His wife says he'll be right over.  He leaves you some medicine and you give him a check. If you don't get well, it was just your time to go.

1970     The patient and the employer are partners in health.

You feel sick, you go down to medical. The staff gives you some medicine and tells you to go back to work and enroll in the company exercise class.  If you don't get well, you can always go on disability or collect on your pension.

1980     The patient,  the clinic and the insurance company are partners in health.

You feel sick, you stop at the clinic in the mall. They do some tests. The secretary gives you a prescription. You wait for your pills to come in the mail. It's all billed to your insurance plan. If you don't get well, you can pursue the options up to the maximum of your plan allowance. Then you can pay the bills from your pocket or claim bankruptcy.

1990     The patient, the provider and the payer are partners in health.

You feel sick, you call your primary care facility. A nurse practitioner discusses your symptoms. She says they will call in a prescription to your pharmacy plan.  If the medicine doesn't work , you can come in next week for an approval form to see a specialist. Your HMO pays the bill. If you don't get well, you can change HMO's or your heirs can sue for malpractice.

2000    The Consumer, the Supplier and the Provider are partners in health.

You feel sick, you go on the Internet to upload your symptoms to the Provider Benefit Manager's web site. You wait for EMail competitive bids for alternative treatment options from Suppliers. Enter your card number to have the amount deducted from your health savings account. Print out a receipt and bring it to any Super Store for Self-Directed Healthcare.  If you don't get well, call the consumer health partner support group.

Author; Caryn Isaacs

Sunday, November 23, 2003

The Blind Date

"Hello, I'm the prescription drug coverage you invited. May I come in?" 

"Sure, what are your plans?" 

"I'm going to cover you."

"What was your name again?"

"My short title is the Amendment to the Social Security Act. My full name is the short title plus, Medicare Prescription Drug,  Improvement and Modernization Act of 2003*. But you can call me Medicare Advantage."

"I thought you were coming alone. Who's that with you? What are they doing here?"

"That's BIPA. The Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act. We want to make sure you get all the coverage you deserve."

"Are they included in the plans?"          

"BIPA asked the Drug Manufacturers and the Benefit Management companies to handle all the details. They'll get theirs from Social Security or they'll just borrow  and your children can pay later."

" I thought this was supposed to be an all expenses paid date with Prescription Drugs?"

 "Well I am Prescription Drugs, but the only way I can cover my expenses and those I have for my other wives, Medicaid and SCHIP, is to bring them along. I also have to include the Indians, the NIH and the VA. As long as we're counting, the Pharmaceutical Assistance Transition Commission and the Quality Improvement Organizations are hungry too. I hope you've made room for the Special Provisions Grantees.  I've ordered takeout for the suppliers, I mean the doctors and hospitals. It's all under control. I'm having your fire exit removed right now so Modifications to Medicare Payment Advisory Commission's new Digital Superhighway can be installed."

"I don't like this. I want to talk to the guy who set this date up!"

"Go ahead, call this 800 number. They will give you a number for your State so you can be directed to your County agency. They will have a volunteer call you back. While we're waiting, let's watch some new medical research I'm paying for on TV. "

"I can't watch TV. Didn't you know that I am blind?"  

"Really? Maybe I can get you a hearing aid. And get your wallet. I need money for tips." 

* The placement of commas is not an error.






Saturday, November 15, 2003

Someone Like You

"How are your feeling, Ada?" Ruth, her friend and neighbor for the past ten years asked.  Ada seemed surprised to be addressed. "I'm fine, why wouldn't I be?" Sylvia, usually the diplomatic one of the group leaned across the table. "We just thought that maybe you were too tired to come tonight. After all, you leave here so early every morning and return after dark." "Well she's here now, so let's just start playing." As the host, Betty felt responsible for keeping to a schedule. After a few hands, it was obvious Ada did not have her mind on the cards. "I'm going home. I don't belong here." Betty sprung up as fast as her new hip would allow. "What do you mean? Aren't we always here for you?"  Sylvia continued her diplomacy " She'll adjust, just like I had to." Ada's face turned red "My situation is nothing like yours, Sylvia. Your husband has gone to a better place. You can treasure your memories and find new interests. Harry is not with me but he still needs me all the time." "Why don't you try writing about what you're going through?"  The thought had just popped into Ruth's head. Ada looked like she had just been slapped. "What are you talking about? I don't have time for nonsense. Who wants to hear about sitting in a room full of people staring at the wall. Should I send a story to the bill collectors?"  But Ruth could see her friend standing at the podium, giving lectures on nursing home reform, as she used to lead the community meetings. "I've seen on the Internet where people keep a journal, a kind of diary.  Other people who are dealing with the same issues can read it and offer their support. Even some prominent experts share their perspectives." Ada was still on the defensive "I don't even have a computer or money to go on the Internet." Sylvia was glad the conversation had taken on a positive direction "You can start with pencil and paper. Imagine how many others could benefit from the experience of someone like you." 

Secrets of the Ancient World

My name is Seshat. I was named after the goddess of writing and measurement. I received my training as a physician at the Sais Medical School in Alexandria. I am part of  an elite corps of women who are full physicians and not just midwives.  We are followers of Peseshat, the Lady Overseer of the Lady Physicians, who is the first female physician in the world. For many years, I studied the papyrus of recipes for diseases and symptoms gathered from the knowledge obtained by the embalmers. Previously Herodutus taught that all disease was produced by the food on which we live. Now, we know that many things contribute to our health including the climate, good hygiene and even our thoughts. Most women do not work outside the home. They are busy beating the flax into fiber that will be spun into linen for clothing and bedding. I have the opportunity to go to the homes of the craftsmen and the wealthy. I am lucky to have inherited the land that Pharaoh gave my uncle for his work on the tombs. If I do not find a husband, without my own property I would be forced to live with one of my sisters. The women are planning a pilgrimage. Tonight there will be a banquet of quails, ducks, geese, tilapia, perch, catfish, carp and eels. We will drink wine, milk and water. Wild barley is soaking into a mash that will be used to bake bread and fermented with dates into Beer. We will drink a lot of the Beer and use the rest as payment for incense, honey and sandles for our journey. We will take up a collection of gold, silver and copper rings so that we will not have to pay the interest rates on a loan from the grain bank in Alexandria.  I have commisioned the building of a bathroom. A coppersmith, who owes me for a Dead Sea Salt poultice I made for his arthritis, will craft a basin to catch waste water. Our current pipe is made of straw and clay which is very crude. We have to wash our hands and clothing with lye made of castor oil and saltpeter and wear heavy blue eye makeup to avoid disease. Before I leave, I will visit the home of our rabbi. He is old and suffers from cystitus, a recurring, very painful type of urinary tract condition. He will not wear the amulets that some do to break the spell from their enemies. After I take his pulse and examine him, I will make a tea of garlic, vinegar and coriander seeds. Garlic is known to relieve any kind of pain. 

The Way We Do It

We use words to deliver a message. Using the wrong word can distort the meaning of the message or deceive the listener. The right work will portray your intent accurately.

Resource Evaluation Leaders Inc. struggled to find the appropriate word to refer to people who because of advancing age cannot do some of the things they used to, but who still have many assets with which to build an improved lifestyle. The way we determined which word to use was by first asking for suggestions and then researching how each word was used in other contexts. Then we chose a word that would put a face on the name.

The first word that came to mind was seniors. When people turn 65, they are entitled to certain senior citizen benefits, such as Social Security, Medicare and discounts at restaurants and theaters.

The term retired persons was suggested. Many people look to change their lifestyle after retirement. In November, 1998 the American Association of Retired Persons changed their name to the acronym AARP to include anyone over 50 years old regardless of their needs.

We looked up Geriatric, Aged and Older Adults.  These phrases are gaining popularity among the Medical and Government agencies to infer services for people with limited abilities in need of social services.

Then we remembered the word Elder. Elder is from the Anglo-Saxon word meaning more experienced. It is used to translate a number of the original words of the scriptures, such as the Hebrew word (pronounced) gaw-dole, meaning greater. Elder was also a political office held by responsible individuals. The appointed elders of the Christian Church served in a more religious than political way, "let the elders who rule well be considered worthy of double honor, especially those who labor in preaching and teaching. (1 Timothy 5:17-18 RSV)

After much consideration, RELI felt that the word Elder will show our respect for those with greater experience and honor the priorities of those who can teach us. We may be mistaken, but this is the way we do it.