Scarlet Letters

The not-so-private thoughts and rants of Elizabeth Donald, journalist/author and founder of the Literary Underworld.

Friday, December 16, 2011

Wal-mart at Christmastime

Generally, there's no deeper pit of hell than Wal-mart. The awful fluorescent lighting, the cart that undoubtedly has one bad wheel, the inability to find what you're looking for ever since they changed things, the sure knowledge that you have sold your soul to Sam Walton because there's simply no way to meet the monthly budget without him. Not while the boy drinks three gallons of milk a week.

That said, when I see people laughing at "People of Wal-mart" or the current meme of "Wal-mart Bingo," I start to wonder what we find so amusing. Sure enough, the photos of "People of Wal-mart" are pretty awful. They're generally photos catching unattractive people unawares - oh my, this lady's buttcrack is showing? That guy's wearing shorts with a long-sleeved shirt! That woman is too fat for her outfit! This guy's got a really long beard!

The Wal-mart Bingo is so much worse. Among the mocked are "someone with an eyepatch," "obese person using a scooter," "someone using a voice box," "pregnant woman with visible tramp-stamp tattoo," "white girl with three multi-racial children," "someone using an oxygen tank"... need I go on?

There's some serious mean-spiritedness going on there, on the level with the asshole in junior high who pointed and laughed at the girl with glasses or the boy with curly hair. Whatever their fashion sense, these are real people we're mocking... because we don't think they're attractive? Because they're sick? I presume it takes a second card to mock, say, a cancer patient with a head scarf, an amputee fresh back from the war or a woman with a black eye? It's a cross-section of America, folks: not so pretty and perfect as you'll see in a commercial, but real nonetheless.

This came to mind today because I ventured into Wal-mart. It was stocking-stuffer time, plus we needed milk, eggs, sugar and assorted cleaning products. As I wandered the aisles, fruitlessly steering my defective cart (I always get THAT one), it occurred to me that I was in sweatpants and a T-shirt, no makeup, and my hair was, shall we say, uncooperative today.

Hardly the fashion plate of my author photos, to be sure. I am not the most svelte of women, either. If someone had snapped my photo today, I'm sure they could have found something to mock on "People of Wal-mart."

I didn't see anything that horrified me about the state of our culture today.

What I did see was a young woman offering to get a container of mustard potato salad off a high shelf for a petite older woman who was unable to reach it.

I saw two people nearly ram into each other with their carts... and back up, apologize and laugh about how crowded the store was.

I saw someone put his pocket change in the pail for the bell-ringing Santa out front.

I saw two parents looking at the same toy in one aisle, and each offer the other the chance to take the last box.

I met a worker in an aisle who was loading Christmas candy, and upon seeing me try to decide which of two bags to get, she discreetly pointed out a third option that would satisfy both the menfolk while costing less. She gets no kickback for doing this. Just another good deed.

Time and again, the narrow aisles meant a do-si-do of carts twirling around each other... and yet no one was angry, annoyed or swearing. Just laughing at our own silliness.

When I reached the cashier, I got the familiar sideways glance I get whenever I wear my Browncoats T-shirt: trying to read the fine print and figure out what the heck that shirt means. Only then her face cleared and she declared, "Browncoat! You're a Firefly fan!" Yes, Wal-mart employees can be Browncoats too. And we commiserated at the sad fact that there are too few of us.

I am not declaring Wal-mart the bastion of good tidings this holiday season - if I were, you should check to see what I'm drinking and help yourself to a cupful. Wal-mart is still a necessary evil. But it occurs to me that when we laugh at the people we see there, we are laughing at things we know little about. The man with the eyepatch may have lost it in any number of ways, including combat. The woman in the scooter may be suffering from an injury or illness you could never bear. The mother with three biracial children? That is something to celebrate, you assholes.

For all that the headlines are filled with sadness, despair and a headdesking sense of our entire way of life slipping away from us, it seems to me we need to remember that there are good things happening as well. Sometimes it's a man who shows up at a local homeless shelter and buys groceries and presents for an HIV-positive single mother. Sometimes it's a person who randomly pays off the layaway accounts of strangers at Kmart. Sometimes it's a cashier who wishes you a Merry Christmas because you both like the same TV show and she can tell from the pile of Christmas-themed wrapping paper that you won't be offended.

Maybe it's just a young woman offering to get that potato salad down for you, ma'am. And have a happy holiday.

Friday, December 09, 2011

Geek Points

Setting: The Daily Show is on. Boy flops onto the couch.

ME: It's bedtime.
BOY: Just a few minutes? I love Daily Show.
ME: Hmmm. Look, you're still here and not in bed.
BOY: I'm not here.
ME: I see you. You are here.
BOY: *handwave* These are not the droids you're looking for.
ME: *bwahahaha* You get to stay up a few minutes more just for the geek points.

Thursday, December 08, 2011

Communing With the Cosmos: A Conversation with Neil deGrasse Tyson

I had the good fortune to meet Dr. Neil deGrasse Tyson yesterday at a ribbon-cutting for the new observatory in Edwardsville. In addition to the story I wrote for the News-Democrat, I had him cornered at the top of the stairwell next to the telescope, so I asked him a few more questions. Here is the long version of our interview, for those who are interested in such wonderfully nerdy things as planetary biota, the physics of interstellar space travel and the devolution of Pluto.

In case you're wondering, Dr. Tyson is just as emphatic, enthusiastic and personable in real life as he is jousting with Jon Stewart over the planethood - or not - of Pluto. It's easy to see how he has become the Elvis of astrophysicists. I was tempted to tell him that on this year's book tour, the button we sold out of most quickly and literally could not keep in stock was the one that read, "Pluto is still a planet, I don't care what you say."

Q: What do you think about the Christmas Planet? It sounds like something out of Doctor Who.

TYSON: I don’t know if the Muslims or the Jews are calling it the Christmas Planet, so maybe it’s the December Planet. (laughs) It was just announced a few days ago. It’s an Earthlike planet, we’re pretty sure it’s rather rocky. There’s still measurements that have to be made to confirm that…

It’s about two and a half times bigger than Earth. That sounds like “much bigger.” No, no, “much bigger” would be, like, Jupiter. That’s much bigger. There’s a range of planet sizes where they’re all going to be rocky… So it’s an Earth-like planet, orbiting a sun-like star, in the Goldilocks zone. That’s everything, there you go. We’ve found Jupiter-size planets orbiting at different distances from odd stars, we’ve found Earthlike planets but not orbiting in a habitable zone…

This Goldilocks zone, if you’re too close to the sun your water evaporates, if you’re too far away it freezes. So, we have a bias, understandably. We’re looking for life as we know it, so we’re looking for planets where the temperature is just right, in the Goldilocks zone. It was an exciting announcement…

Q: It’s 600 light-years away, right?

TYSON: Right, so people say, when are we going to go there? Hire a science fiction writer for that one. The fastest hunk of hardware we’ve ever launched is right now in motion towards Pluto. If you somehow hitched a ride on that and redirected it toward this planet… (stops to calculate)

Q: I’ll let you do the math.

A: 50 million years. (laughter) So that slightly exceeds a human life expectancy. We just don’t know how to do this yet, how to actually go there.

So the next best thing is to make follow-up measurements to see if the atmosphere has what we call biomarkers, molecules that would only exist in the atmosphere of a planet if life were thriving on its surface.

Q: Like oxygen?

TYSON: Oxygen! Oxygen is highly reactive and on Earth if you took away all the life from the surface and went away, eventually when you came back there would be no oxygen left because it’s trying to react with things. It’s the fact that life is constantly pumping it back out there against the wishes of its own chemical urges is evidence that there’s a thriving biota. I love that word, biota…

Then we can say, maybe there’s more than just microbes and photosynthesis, maybe there’s complex life, maybe there’s intelligence. So then we tell all the SETI people to take their radio transmitters to try to send a signal to them, and of course it would take 600 years to get there. We’ll all be dead before they will have heard the message. If they are there, and they have a way to communicate back, it’s another 600 years back. That’s 1200 years. What were we doing 1200 years ago? It was the Dark Ages. So it’s not clear that you can match these things up.

Q: When I was a kid, we all imagined what space travel would be like when we grew up. For my father’s generation it was the same, and his father’s generation. For kids growing up now, though, I imagine it would be somewhat disheartening, since we’re no longer sending out manned missions in the near future. What can we tell them?

TYSON: I think it’s disheartening for adults too, especially since adults are responsible for not keeping that as alive as I think it could have been. Adults outnumber kids and adults wield resources and funds and opportunity. All this talk about keeping kids interested in space, that’s useless unless the existing adults can embrace what that frontier represents, because they make the opportunities. Otherwise we have to wait until these kids become adults. That’s another 30 years, and I’m not that patient.

Q: You were very involved with the Pluto thing, as I recall.

TYSON: That was because I run exhibits at a museum and we were re-doing the exhibits of the solar system and it was time to put Pluto where it belonged.

Q: As the man who famously said, “Pluto had it coming”…

TYSON: You’re right, it had it coming! I was just the messenger from the people who actually discovered the damning evidence that sunk America’s favorite planet. The book that I wrote on that, The Pluto Files, is not my research on Pluto as a cosmic object. It’s what happened to me after we reassigned Pluto to another part of the solar system. The book is really about the intersection of science and culture.

Q: Has it changed at all in the years since?

TYSON: Nope! I know you’re praying for that, but nope!

Q: They’re still writing letters?

TYSON: Actually, the letter-writing has died down, because we first made this assertion 11 years ago. When do you first learn about planets? It’s like in third grade. So all my hate mail was from third- and fourth-graders. Today, they’re all freshmen in college. They’re not thinking about Pluto anymore, they have other hormonal considerations than the status of a body in the outer solar system.

Q: What do you think about the (Edwardsville observatory telescope)?

TYSON: The exciting thing about it, and (Professor Sabby) should have been jumping up and down about it – I know he was inside – is that you can do this from your kitchen table. That’s the best part of it all. In the warmth of some place other than where you’re freezing your buns off.

It happens that some of the crispest, lowest-humidity days happen in the winter, so some of the best night-sky observing is in the coldest, deepest winter nights. And winter nights are longer than summer nights. So just when the sky is at its best, is when you would most freeze at the telescope.

So the remote-control telescope is not simply a lazy idea, it’s actually an extraordinarily useful idea. It allows you to exploit all of the great observing conditions that are good for the telescope that would be uncomfortable for you the observer.

Q: Is it the same experience, though? At the kitchen table?

TYSON: I used to lament the fact that there was no longer the pilgrimage to the mountaintop. Some of the great observatories in the world are in the most remote places. You take planes and trains and there’s a day when you go by pack mule, not anymore, but that’s what it feels like – the things you have to do to get to the top of these mountains.

Then you’d commune with the cosmos from the mountaintop.

So I missed that, for about five years. Then I came to realize how much time I was spending just gaining access to the telescope. At the end of the day, it’s the productivity that any active scientist is trying to accomplish. The rest, there’s a romance to it, but now there’s a romance to other things.

There’s how rapidly you can observe the night sky, just by touching a button. You used to have to grab the telescope and move it by hand and wonder if you were there, take a picture and develop it in chemicals and you didn’t even know if you had the right image. Now it’s there, it’s instant, so there’s a certain access... and the detectors are a hundred times more sensitive than the detectors that were once used…

It was very easy for a clever person to say, “I don’t have to be at the telescope, I don’t have to be in an adjacent room, I’ll just use a cord that’s a little longer and I’ll go home.” Now with the internet, I can be on another continent and use the same telescope.

So for a few years I missed the romance of the ascent to the mountain, but nowadays I no longer miss it, because of the totality of what remote observing provides you.

Q: They told me that most discoveries in astronomy now are being made by amateurs.

TYSON: I would not say most, but many, and many more than ever before, because technology such as this used to be prohibitively expensive. Now they’re within the budget of avid amateurs and other sizes within the budget of schools, whereas there was a day when that was completely out of reach.

Monday, December 05, 2011

A $16,000 Cup

We're in the middle of a battle right now. Not my partner against his illness - no, that battle is fought and nearly won. The real battle is Us vs. the Insurance Company.

A union man, J has never had to battle his insurance. I know a few other people who must have mega-insurance, because when I tell them about the incessant fights I've had on behalf of my son and (occasionally) myself, they said, "I've never had to do that." I envy them. I envy people who can go get an MRI when the doctor says they need one. Mine would have cost $930 - after insurance. So I didn't get it. Programs? Yes, there's programs. You can apply... after you get the bill. Don't qualify? Out of luck.

As most of my friends know, J was rushed to the hospital two months ago with symptoms of a heart attack. Fortunately there was no lasting damage to his heart - just a warning flare, they said. But while they were poking around in there, they discovered he has nine ulcers in his stomach.

Nine. It's a wonder that he didn't have soda squirting out on his chest every time he took a sip.

While he was in the hospital, J stressed about the money. Sure, he has insurance. And just like me and everyone else I know, he's stuck with the insurance his employer picked at the lowest bidder, because no human can afford insurance without your employer's help - at least, no one anywhere near my tax bracket. (Just for laughs? I tried to get insurance on my own when I graduated college. I was 23 years old and they wanted me to pay $900 a month on a salary of barely over $1100. And that was nearly fifteen years ago.)

I told J not to worry. Get healthy, then we figure out the rest. I knew we were signing up for war. And here we are. He spent one night in the hospital, plus a couple of doctor's visits, two procedures and a battery of tests. And it's the perfect example as to how this system makes absolutely no sense.

To date, the medical bills total nearly $16,000. I'll let that number sink in for a minute, because I have to go breathe into a paper bag when I think about it and how damn lucky we are it wasn't something like a car crash or a full-fledged heart attack. My father's attack a year ago totaled more than $100,000, but fortunately he has the Godzilla of insurance. If that had been me, with my insurance, you'd have to just let me die. Like I have $30,000 sitting around doing nothing.

They gave J a water jug at the hospital, so we could track how much water he was drinking. He brought it home and drinks from it at work so he's not tempted to drink the soda and coffee that worsens the ulcers. Also, it has the name of the hospital - which really did give him excellent care - on the side. We joke that it's his $16,000 cup. The most expensive cup we'll ever own.

Fortunately, J's insurance has processed... well, some of the claims. Enough to bring it down to a less-horrific $3,000 or so. This, however, is still beyond the capabilities of a couple with the combined take-home salary of the slaves that built the pyramids, particularly given the Boy's increasing appetite (does it ever STOP? Don't answer that.) Most are small bills that we will have to pay off one paycheck at a time... if we can get them to wait in line. It's a fight at every step.

But it's the ones they've denied that really hack me off. First of all: why is it that every separate person who gets near you in a hospital gets to send you a different bill? At this point I'm waiting for the janitor to send us his personal invoice. If any hospital declared, "You'll get one bill, and it covers everything," I'd list it as my personal preference.

We have a spreadsheet of bills and insurance payments and the copays we've made so far - keep in mind, this is for a 48-hour emergency that thankfully was far less serious than it could have been. We have nineteen separate bills at last count, including the hospital, the hospital's urgent care center, the hospital's cardio-cath lab, the hospital's outpatient wing (seriously? They couldn't just send one bill?), the ambulance that the urgent care center called after they saw his EKG, the pathologist, the cardiologist, the gastroenterologist, the emergency room doctor, the floor physician who oversaw his care and a partridge in a pear tree. (It's in there somewhere.)

They've denied coverage for an X-ray and all of his blood work, citing "out of network." Wait, the hospital is in-network. But the person who took his blood wasn't? And the person we never saw who ran the tests on his blood? What were we supposed to do, screen every human who came near him with a needle? "Excuse me, ma'am, I realize that he may be crashing with a myocardial infarction, but are you in the Insurance From Hell network? No? Sorry, then, he needs to sit here and DIE." It was an emergency room, for the love of Clara Barton! We're just lucky the nearest hospital to the factory where he works was actually in his network.

We're filing appeals on the denied claims. It'll take months. In the meantime, we've already gotten a collection call from the X-ray people. That conversation was fun.

ME: This claim was improperly denied and we've filed an appeal with his insurance company.
IT: Yes, but it's been two months.
ME: It's been two months since he was hospitalized, but it took more than a month for the claim to process in the first place. I have no idea how long the appeal will take.
IT: I'm sorry, there's no way to stop this from going to a collection agency unless you pay it in full.
ME: If we pay it, they'll never reimburse us.
IT: We could take a partial payment, but the rest would still go to a collection agency.
ME: We'd like to avoid that, as it'll hurt his credit rating. We are appealing the claim denial.
IT: I'm sorry, there's nothing we can do.
ME: Do you have a supervisor I could speak to?
IT: No, I'm afraid not.

So, no matter how that fight turns out, J gets a hit on his credit rating. That might matter more if we had any credit. We'll call that one a draw. At least until tomorrow, when I call back and ask someone else for a supervisor.

There's also the passingly important part of getting J healthy. His doctor put him on a stomach medicine, we'll call it O. He takes 80 mg a day. It's been doing a good job, he feels better and he's starting to heal. He's filled it twice and went to order another refill - this time a three-month supply, following his insurance company's guidelines for ordering maintenance prescriptions via their mail-order service.

Denied. Why? "This medication requires preauthorization."

Step up, it's time to fight. We strap on the boxing gloves. This medicine didn't require preauthorization the first two times we filled it. Why now? They tell us he doesn't have a medical condition requiring it.

a) I love it when insurance companies decide they know better than the treating physician what is or is not required for treatment.
b) Did you morons miss the $16,000 in bills you've processed in the last two months for his nine ulcers?

Our Doc rolls his eyes and files the preauthorization form.

Denied. Why? "We want you to take R instead. It's cheaper."

See (a) above.

Keep in mind, the insurance company isn't talking to the doctor. The insurance company talks to us, we talk to the doctor, the doctor talks to us, we talk to the insurance company. It's a game of Telephone designed by the Marquis de Sade.

We go back to Doc and he says that J can't take R (pardon the shorthand), it won't do anything for his ulcers. So he gets out the "Yes I Really Meant It" form and sends that to the insurance company. If I were a doctor, I'd find it really insulting that that form even exists. "Well, I prescribed that medication but I was just kidding. Now that I know it's expensive, he can have M&Ms instead."

Denied. Why? "There's an over-the-counter equivalent."

Why, yes. Yes, there is. At one-quarter the dose. We do a little investigating and find out that in order to get 80 mg a day of O, he will have to take four pills of the over-the-counter equivalent - twice as much as recommended, therefore off-label.

Then let's talk money! The generic Wal-mart version costs $18 a box. At four pills a day, he'd need a new box every ten and a half days. So instead of $10 for a three-month supply (which is admittedly an awesome deal), we'd be paying $162, which is way out of our budget. Plus, we can no longer use FSA money for a prescription.

Screw all this! we declare. Screw the Insurance From Hell, we'll just buy the damn prescription outright. How much could that cost?

$300 a month. Generic.

No wonder Insurance From Hell is throwing such a fit. I had a little choking spasm when I heard J repeat that number incredulously on the phone.

Doc has a helpful suggestion: cut it back by half. Take two pills a day on-label, 40 mg. See how that goes. Maybe the ulcers have healed enough that he doesn't need that much. This still means $54 a month, but we'll pretend that doesn't matter as we sing and dance our way to the poorhouse.

J lasted a day on the lower dose. Pain. Heartburn and nausea, of course, but actual pain as well. The language I have for the people who think his pain is an acceptable cost of doing business cannot be repeated in polite company. It was the weekend, so he doubled back up to four pills and made it through until we could call Doc again.

It's an ulcer. (Well, nine of them.) It's not life-threatening - unless you ignore it or fail to treat it properly. You want one that's worse? A friend of mine is going through a similar battle of stupidity, nine rounds with an Insurance From Hell, only the treatment she's fighting over is her mother's goddamn chemotherapy and while they wait endlessly on the appeals, the treatments have stopped and her mother has lost whatever ground she was making against her cancer.

And when it's cancer on the other side of the ring, people, you need all the help you can get.

Today, J told Doc that the experiment was a catastrophic failure. Doc swung into gear - I think he had to file yet another "Yes I REALLY FUCKING MEANT IT" form with the Insurance From Hell.

And that is how, on Round Six of this particular bout, we won. Insurance From Hell opted to pay for the damn scrip and he'll get his meds. And then I'll start taking that over-the-counter stuff, because I think all this fighting is brewing an ulcer for ME. Did I mention that we have nineteen of these bills?

The lesson in all this is that in order to get the coverage for which you are paying an ever-rising premium each paycheck, you have to fight. You have to appeal and appeal and appeal, ask to speak to supervisors, read the fine print and don't take no for an answer. J said until this, he never knew that you could fight an insurance company and win. And I wondered how many people didn't know you could fight at all, that "claim denied" does not have to be the end of the conversation or a one-way ticket to bankruptcy - or, in the case of my friend's mother, death. 

Sure, not every claim is supposed to be paid. But to ask a patient lying in an emergency room to refuse treatment because the person holding the needle might work for a hospital subcontractor that isn't a participating provider on your insurance plan is the height of venality. If my car insurance company or renters' insurance company provided this kind of service when I had to file a claim, I would immediately seek another insurance provider. That's why my car insurance company treats me better than this - they know I have a choice. I can fire them.

What happens if I fire my health insurance?

A $16,000 cup.