My Log 698 Feb 10 2019: Chronicles from my Tenth Decade: 132; My latest post on Facebook by Ben Richardson; a Canadian take on US healthcare.

My eldest son Ben, who lives in Austin, Texas, has recently described his experiences when searching for adequate health care, which has always come at an extravagant price, and has compared it with the single payer system in Canada.  This is a  detailed ailment-by-ailment account that should convince the most sceptical reader. I am happy to open up my Chronicles to allow for such an eloquent piece on the superiority of socialized medicine to one dominated by private profit.

I am getting really sick of people telling me that single payer healthcare is a pipe dream.  It has worked so well for so many countries.  The people who are against it really want to maintain the status quo.  I’m not shitting on Obamacare because it is so much better than what came before it, but it is basically flawed without the single payer option.
        After ten years of living in the US as a non resident alien on assorted work visas, I met my wife Natalie in 2012 and we were married in 2014.  Natalie, while generally healthy has a lot of stomach problems and some other ailments.  

I got my Permanent Resident status in 2015 in time to sign up for Obamacare.  As I am a self employed musician/touring soundman and she is in the service industry we average around between $20000 to $45000 a year taxable income (depending on how much work I can drum up).  So when we signed up, we picked a Silver Plan from Humana, which seemed like a good deal.  $6900 a year was the cost of the plan, but with the subsidy we only had to pay $1440 a year.  For this we got Primary Care doctor and urgent care visits for a $35 copay, Specialists were $50 copay.  Anything extra we had to pay 100% till we reached a $1400 deductible and once we reached that limit, we had to pay a coinsurance of 20%.  Once we reached $4500 in additional spending the insurance would cover 100% from then on.  Drugs were also cheaper through the plan

It worked fairly well for the first few months until I got an unanticipated job for quite a bit more money.  Once I had corrected my projected income through the Obamacare website our subsidy dropped and our yearly payment rose to a total of $3840.

The coverage was good. Humana had lots of urgent care clinics in their network.  While we never got around to using the policy to it’s full potential (finding a primary care doctor, having a physical etc..), whenever Natalie had a problem, we would go to the appropriate provider and for $35 she could see a doctor.  A couple of times, I got small bills in the mail for tests and such for around $100-$150 which I paid with no problem.  

This year when I went to renew, I found that the Humana plan we were on had raised it’s rates by about $150 extra a month.  So I went on the healthcare.gov website and tried to find a similar Silver Plan.  I found one from Ambetter that was about the same cost as the Humana plan had been in 2015.  It seemed similar, although i had to admit the whole process is quite confusing and not set up well for comparisons between plans.

Well a few days after that Natalie got sick at work, and the next day I went on the Ambetter website to find a doctor to take her to.  The first couple of clinics that came up were both less than a mile away from our house.  That seemed like a good sign, but was not to be.  The first clinic turned out to be the clinic inside the Del Valle Jail.  The second clinic on the list turned out to be the children's clinic inside the Delle Valle Primary School.  The next two places I called, only took appointments and didn’t have anything available till next week.  the next place I called, the woman registered us, then had a consultation over the phone with Natalie.  After spending a good thirty minutes on the phone, she told us that no one was available and to go to the emergency room.  She was extremely insistent that she should go right away.  I asked her if she could recommend any urgent care clinics and she kept insisting that we go to emergency.  I finally searched urgent care on the Ambetter website and was directed to the only one in Austin. It turned out to be inside a CVS drugstore.  When we got there, the nurse said that they didn’t have any doctors there and that Natalie should go to emergency.  I finally got a guy from Ambetter on the phone and as it was getting late, he said that he would find us a doctor early the next morning.

The next morning he called back and gave me the telephone numbers to both the primary school and the prison, at which point I lost my cool and asked him pointedly and sarcastically if the $6900 that this Plan cost, really entitled us to a doctor.  I then posted my story on the Ambetter Facebook page, telling them that they sucked.  I soon received a call from a lady from Ambetter who, after I took her to task on the lack of walk in clinics in their network, promised me that she would get me an appointment in the next hour.  She called back and gave me the number of a doctor who could fit us in at 2:30PM.  Talk to Betty, she said.  So I called Betty right away, only to be told in a most unpleasant manner that the doctor had NO openings that day.  By this time, Natalie was starting to feel a little better and we both basically gave up exhausted and frustrated.  

The only silver lining in this whole mess, is that a couple of weeks before the end of the enrollment period, one of the fine folks at the Health Alliance for Austin Musicians had called me to tell me about a Silver Plan that they were pushing that turned out to be a bit cheaper, so they signed me up with The Sendero Silver Plan.  Looking on their website, they had a lot more urgent care and walk in clinics in their network and turned out to be much better.

“So why didn’t you just take her to the emergency” I hear someone asking.  Well I am pretty suspicious of hospital emergency rooms in the US.  That was what Natalie did for healthcare before she met me.  
I was on travel insurance for the first ten years here, when I went to the hospital one night with a sore abdomen.  Four hours later I walked out with a diagnosis of a strained abdomen.  They presented me with a bill for over $12000, and tried to get me to pay for it and get reimbursed by the insurance company even though the insurance rep had told me that that hospital could direct bill them.  Needless to say I didn’t pay them.  When I later followed up with the insurance company to make sure that the bill had been paid, they told me that they had asked the hospital for a detailed accounting of all charges.  The hospital had responded by sending another bill for $900 which the insurance paid and that was the end of it.  Can you believe they tried to rip me off for $11100?

One time, on the road, Natalie had terrible stomach pains and I took her to the hospital for a three hour visit.  I later received a bill for over $4000.  

Another time after she was rear ended by another driver and had to go to the hospital that night, and return the next day feeling worse for a total of two visits.  I had decent car insurance, the other driver had none. My Insurance company covered the repairs to the car, and assured me that they had taken care of all the medical bills to the tune of almost $3000 (the maximum they were legally obligated to pay).  Imagine my shock six months later to get a bill for over $14000 for the second hospital visit from a collection agency.  

I think this is because the doctors just cavalierly order the tests and not once in my experience have they ever mentioned that these tests are costing you thousands of dollars.  Even when I would question the need for so many tests, the nurses would just cheerily brush off your concerns by saying “the doctor has ordered them”.

Once we had signed up for coverage, we were coming home from a Caribbean holiday and feared that she had caught some kind of biting insect.  We were driving from Dallas Airport back to Austin late in the evening and she called a hospital in Waco and asked them if they took our Humana Insurance, which they assured us that they did.  We were there for two hours when upon examination they gave her a clean bill of health.  I specifically asked them if there were any charges as we left, and they said no the insurance has got it.  A month later I received two bills, one from the hospital and one from the doctor totaling over $900.  The Humana contribution was $96.  But nobody tells you any of that.  They usually tell you as little as possible till they’ve done every possible test they can think of, and then present you with a massive bill.   To add insult to injury, in not one of these cases I’ve talked about was there anything seriously wrong with us.  Stomach pains were stomach pains, my abdominal pain was a strained abdomen, and the insect infestation we feared turned out to be a figment of our imagination.  Nothing that should cost $12000, or $14000, or $4000, or $900.  This is highway robbery by the whole medical insurance industry.  

So this is Obamacare.  Much much better than the previous system where the insurance companies could deny coverage at anytime and if you had a preexisting condition you either didn’t get insurance or had to pay a small fortune for it.  The only reason that I became a permanent resident was because it looked like Obamacare would cover us for not too much money.  But the whole system is so skewed towards making a profit that it really is obscene to a Canadian like me.  

The whole day I was looking for a doctor for Natalie, it didn’t seem like one of the people I talked to was really concerned about her welfare.  All they cared about was whether they took our insurance.

I lived in Canada from the age of 7, till I left for Austin at the age of 43.  I confess for that whole period I never gave a single thought to healthcare because it was just there.

The system is administered by the provinces, so each province has a little bit of a different way of doing things, but the bottom line is that all essential healthcare is covered.  

The province (in my case Ontario) issues you a health card, and you just give the doctor or hospital your health card and almost all the charges are covered by the government.  No copays and no deductibles and almost no paperwork.

When I was 20 years old, I grew a cyst the size of a tennis ball on my forehead, and had to spend a week in the hospital as they drained it to make sure the infection didn’t spread to my brain.  The cost to me… $0.  When I was 24, my lung collapsed.  That was another week in the hospital.  Then it collapsed again.  One more week in hospital.  Then I had to go in for chest surgery to fix it.  That was a MONTH in the hospital.  Again… the cost to me.. $0.

Five years ago, my Dad almost lost his left eye.  Only a specialist in optic surgery was able to save it.  Cost to him… $0

In 2007 my mother died after two years of daily at home nursing and doctor visits plus on and off, a good month in the hospital.  Her care was uniformly excellent.  Again.. cost to my Dad… $0.

“Oh but you’re paying way more in taxes” I hear someone saying.  Well as someone who has paid taxes in both the US and Canada, I think I can say with authority, that I wasn’t paying any more in income taxes in Canada than I was in the US.  Alcohol, cigarettes and gas are definitely more expensive, and the cost of living can be higher, but that is really because Canada and most other first world countries have higher standards of living, and access to excellent healthcare.  And I have spent roughly the same amount of time waiting in emergency rooms in both the US and Canada.  

The US spends twice (that is double) what most other countries pay for healthcare per capita, and I can see why.  So much time, energy and money is spent trying to eke a profit out of the consumer that it’s no wonder Americans are so unhealthy.

There’s certain dignity that comes with being confident that when you get sick, you will be taken care of.  That dignity is sorely lacking here in the US and that is why the citizens need to elect someone like Bernie Sanders to put the idea of single payer healthcare squarely on the table.

It will save us a ton of money and lower costs in the process.  The other aspect that no one seems to be talking about is that it will be amazing for business.  I saw somewhere that the average cost to the employer for healthcare is now in the neighborhood of $12000 per employee.  So even if the taxes were $3000 per person for the government to pay all the costs, businesses would still be saving a ton.  Hell if I had to pay $3000 in extra taxes I would still come out ahead of Obamacare.

I wasn’t able to vote in the last election, but by the time the next one rolls around I will be a US citizen and I’ll be voting for the candidate who is the closest to promising a single payer option.

My Log 697 Feb 8 2019: Chronicles from my Tenth Decade: 131; I remember the young Albert Finney from the 1960s; recall something I wrote about him five years ago; and pay him honour for his great achievements

 I cannot allow the death of the brilliant English actor Albert Finney to pass without comment. Throughout the 1960s when I was a correspondent for The Montreal Star in London, I wrote a weekly column about happenings in the London theatre, which at that time was at its peak, delivering week after week memorable and sometimes unforgettable productions.

I saw many wonderful acting performances by men and women whom I considered to be the world’s best actors, but none were greater than that of Albert Finney, at the time a veritable tyro of 29, who played the lead in John Arden’s amazing play, Armstrong’s Last Goodnight. Arden wrote the play at a time when the tribal problems of the Belgian Congo were in the news, and in it he portrayed a period of British history of the early sixteenth century, when raids across the Scottish border into England by tribal chieftains were commonplace events. The play focuses on  a character called John Armstrong of Gilnockie, described in the Oxford Index as “an anarchic and immoral rogue”, who repeatedly made cattle raids across the border, in defiance of the attempts by the English to impose their suzerainty over him.

“In this well-constructed piece, Arden explores the relationship between honourable dealing and political expediency,” remarks the Oxford Index. This was a mark of Arden’s plays: though set in the past, they always had relevance to some contemporary event. Anyway, to play the role of this tribal chief, Finney had to be able to show he was a man capable of commanding a disputed borderland.  And he had to do it in Scots dialect, which did not come naturally to a Lancashire boy like Finney. Furthermore he had to impose himself despite the fact that his hero suffered from a devastating stutter, which demanded that he have a sort of aural amanuensis standing at his shoulder throughout to finish the sentences he himself could never reach the end of.  To say it was an outstanding piece of acting is to say only half of it: I never saw anything more convincing on any stage anywhere.

Finney was a lad who passed through the normal State schools until he enrolled in RADA (the Royal Academy of Dramatic Art), from which he went right into the Royal Shakespeare Company, and thus into the National Theatre. He became world-famous for his performances in multiple films, from Tom Jones in 1963 on, but he was always a stage actor first, playing everybody from Shakespeare to Beckett and many of the leading playwright in between  --- Chekhov, Strindberg, Marlowe, John Osborne, you name it --- even including a live performance in Berlin of Pink Floyd’s The Wall.

I can hardly do better, I think, than reprint here something I wrote about him on my blog on May 12, 2014, in relation to his extraordinary performance of Churchill  in The Gathering Storm. I had caught just the last few minutes of the film on this occasion, and remarked:   

I have seen it twice before and it reminded me of what an extraordinarily brilliant actor Finney is, just those last few minutes of the film. As Churchill he arrives outside the Navy Department in London in a cab with his wife, played by the peerless Vanessa Redgrave.

He makes a pretty little speech to her, thanking her for, he says, “loving me as I never expected to be loved,” such a speech as would melt the heart of the toughest among us. Then he entered the department, strode in, muttered to the attendant as he passed, “I am the new First Lord.” 

“Yes, I know, sir.”

Winston stops, inquires, “How do you know?”

Because, says the functionary, they received a notice of the appointment.

“And what did the notice say?” Winston asks.

“Winston is back, sir,” said the attendant.

Finney stops at the head of the steps, turns around, takes a puff of the cigar he had carefully lit while sitting in the cab, especially to prepare for his entrance.

“Winston is back,” he said, and then, pumping both fists in the air and shouting,  “Yes, and so he bloody well is!”

What an ending for any film!

I remember seeing a play starring the young Richard Burton, with his marvellous Welsh voice,  in the late 1950s in a small theatre called the Lyric Hammersmith, and I recall the experienced critic for the New Statesman writing that the time had come for this young actor to decide whether he wanted to become one in the line of great British actors, or whether he would rather rely on his personality. We know what decision he made, a decision that could almost be said to have killed him, for he ended his life alone and in despair.

Albert Finney, faced with the same choice a few years later, chose the opposite route through life, and was so free of the egotism endemic among the great in his profession that he turned down a CBE (Commander of the British Empire) decoration offered to him when he was 44, and twenty years later refused to accept a knighthood.  Enough to be known as a great actor, and that he certainly was.

My Log 696 Feb 7 2019: Chronicles from my Tenth Decade: 130 ; Life confessions of a chronic non-joiner; no politics for me, but then later on no rugby, cricket or running either; everything for the job in short bursts

Many years ago I was asked by someone in the NDP to stand for Parliament in Westmount. I had no hesitation in saying thanks, but no thanks, not only because any democratic socialist would be a sure loser in Westmount, but because by temperament I am not given to anything resembling the political life.

The reason is, I am a chronic non-joiner. In my late teens I briefly joined athletic, cricket and rugby clubs. I joined the Journalists’ Union, because at the time, place and era in which I grew up, when you got a job you were automatically required to join a union. I had to give up all the high school running and jumping when I started to work, because on Saturdays I was required to collect all the results of those very sporting   contests in which I had previously taken part for the newspaper.

I can’t be sure whether this disinclination to join anything was inborn or acquired, but I can say that it was probably encouraged by working as a journalist. In that particular job, as I practised it for more than 25 years, one went off with a notebook and pen to find the subjects one was assigned to write about, and that was that. One returned to the office wrote up the result, and then it was handed off to people who, I suppose, could be considered part of the team, but first you had to have the team concept, and I was notably lacking it.

Of course, my perceptions may be somewhat out of date. Maybe nowadays when the various workers are more tightly woven together by electronic gadgetry, it is somewhat different.  But when I was a youngster learning the trade I usually felt my major responsibility was to myself, to do as good a job as I possibly could. I am afraid I never felt the necessary emotions of loyalty, or still less of admiration, for the newspapers that employed me,  and so,  it never occurred to me to  consider myself part of their team.

I took into my working life a strong distaste for employers in general. And although I was reasonably well treated by my employers, I tend to attribute that to the fact that I was a reasonably efficient employee. Come to think of it, of course, even many employees who could never be considered efficient tended to stay on for years, performing their same dull functions in the same dull way with never a word of complaint from their long-suffering employers. I don’t really know if this is peculiar  to newspapers or of general application, but make no mistake: I believe one of the main targets of a sound social policy should be to attempt to ease the passage through life of this great majority to the maximum extent possible. Most of them, given  limitations of education, training, social circumstances and whatever (including lack of talent),  are doing the very best they can, and deserve support from the organized community.

I have read from time to time --- I confess, my thinking on all of this was formed half a century ago ---  that people who examine workforces for a living have concluded that three per cent of employees do the creative thinking. These are people who, as far as the employer is concerned, could play golf or tennis all day, or just goof-off, as long as they are available to be consulted when things are going wrong, and their advice is really needed.  Again, I don’t know if these classifications are widely accepted in business. In my limited experience the advice of this three per cent appears to have been supplanted by the phenomenon of the management consultant team, brought in to do a thorough investigation of working methods, and bring in recommendations. One newspaper I worked for initiated such a study, and the best I can say for it was, it was a monstrous waste of money. But then, money was, and is never in short supply for the employers.

Anyone who has read Volume 5 of Mao Tse Tung’s collected works will be familiar with his thinking on this subject of the layers of vitality, intelligence and energy in the population. Just as workforce studies of capitalism discovered that ten per cent of the workers can be expected to carry out most of the useful work, so Mao, writing in the 1950s when he was wondering what to do next, came to the conclusion that the Communist party in defending its central role as the country’s major force, would have to execute three per cent of the people who would be irreconcilable, and would have to take some, lesser but still severe, measures against the next ten percent. In 1957 he put this thinking into action. He encouraged the population to express their opinions of what his party had done up to that stage, calling on them to respond to the so-called “hundred flowers” campaign --- the idea being that everyone should speak honestly, as the slogan said, to “let a hundred flowers bloom, and a hundred schools of thought contend,” as to the next stage.   This lasted for less that three  months, during which millions of letters expressing criticism of the regime poured into headquarters, but it was ended with a brutal ban on free expression, and the arrest of hundreds of thousands of people who had given off their hundred flowers of opinion. Those who were not imprisoned, were banished to the nether regions where they were forced to take up hoes and picks as they worked alongside the peasantry.  I remember meeting an elderly writer, Ding Ling, who toured Canada from China after her rehabilitation, following 25 years of such banishment. (I was amazed by her apparent lack of bitterness). All this preceded the Cultural Revolution, in which  gangs of children and youths roamed the countryside holding struggle sessions against anyone with an intellectual background, or any slight contact with any foreigner, or who came from slightly elevated social roots--- such as  lower-middle class peasantry or minor landlords.  I met one of the victims of that purge when on a 1983 trip to China to do the research for a film on child services in China, that was being made for UNICEF.  This was a man who had been the director of the Children’s Theatre, an institution founded by Soong Ching Ling, one of the three famous Soong sisters. .(One of the others was  Mme Chiang Kai Shek).  Unlike her sister, Soong Ching Ling made her peace with the Communist authorities in the 1950s, and performed many good works especially for children. She had died before I made my visit, but  a foundation in her name had been established and was working out of the beautiful house she had occupied in Beijing.  

In Shanghai we were taken to visit the Children’s Theatre she had founded, and there, in the saddle again after 10 years of being demoted to the role of street sweeper outside the school’s premises, was the original director reinstated in his position. It is interesting that in Mao’s formulation of the forces of society, the vast majority, more than eighty per cent, were classified as  probably having no solid opinion  one way or the other. Just as I seem to remember some workforce consultants in our capitalist world concluded much the same thing about the  capitalist workforce.

Well, to return to where I took off from: from my personal history of changing jobs every three years, I began to advise my children, when I had some, that they should always remember that they could always quit, if they were unhappy in their employment.  It was a stricture I had lived by myself (with only one interregnum of eight years, when I had a job in London, England,  working for a boss 3,000 miles away,  that was almost like working for myself, so little interference did I suffer from the home office), and I had no hesitation in handing on.  Only recently has one of my children questioned it: “what kind of advice is that to give a kid. You can always quit!”  He has said, in somewhat indignant tones. It did make me stop and think: but having done so, I am not sure I was wrong. I worked for many years as a daily, wage-earning employee, and I didn’t want my kids to be automatically slotted into that niche in life.

Today as far as I can tell they are all more or less engaged in the kind of work that is of interest to them. So although I have been led to question my efficacy as a parent in other ways, on this specific advice, I have a feeling  --- note the uncertain tone --- I more or less, with only slight hesitation, taking everything into consideration, and taking account of our peripatetic, ever-changing lifestyle, I think I can maybe give myself a pass.

A maybe 60 per cent pass?

Oh, well, wot the hell!