friendly advice.

Text message conversation:

"How are you doing?"

"I've got some serious heartburn."

"Ah! That acid reflux! They need to find a cure!"

"Or I can be more careful about what I consume."

"HEALTHY LIVING IS NOT A CURE!"

Personal health care timeline.

December: I visit the doctor and tell him I have acid reflux and have had it since I was a teenager. I tell him I've learned to live with it and have improved my situation by maintaining a healthy diet, staying active, and taking Omeprazole. He says that's all well enough, but fifteen years is a long time to be suffering from the same heartburn. I can't disagree with that, and I'd really prefer to not have to take medication every day, so we schedule an appointment with a GI specialist.

January: The GI specialist tells me I should have an upper endoscopy done. United Healthcare tells me that will cost me $300 ($200 deductible plus $100 copay). I ask the specialist how necessary this procedure is. He says it's imperative that we get my quirky digestive tract figured out once and for all. Again, there's no way I can disagree, so we schedule the thing. Every step of the way I'm asking someone else, "So this isn't going to cost more than $300, right?" All answer affirmatively. At Hoag Memorial, I pay the $300 up front before they anesthetize me and shove a tube down my throat. A week later, the specialist calls me back to tell me my results. I have acid reflux, he says. I should continue my current dietary practices and keep taking Omeprazole. For a split second I consider channeling John Goodman's character in Barton Fink and exclaiming, "I said that already, you should pay me $300!" But I don't. I've learned to see doctors and hospital billing departments as co-conspirators in one big swindle, and largely consider my own interaction with them as a gamble. I treat it like blackjack in Vegas: I only took $300 to the table because that's what I was prepared to lose. At least I know I won't lose anymore.

March: I receive a letter from Pacificare telling me that they're denying payment of my January claim. Upon calling, I find out that the whole thing was somehow billed to a no-longer valid Pacificare account I had when I worked at a bank many years ago. I give them the correct account number and they tell me not to worry about it.

April: I get two new bills: one for the facility and one for the IV drip. The former is for $640, the latter for $212.10. I call on both in a panic, and the representatives tell me that--though they're now at least working with the right insurance company--they still have my account numbers wrong. I give them the correct account numbers and, again, they say it's all taken care of.

June: I get the same two bills. I call on the $640 and magically upon the customer service rep hearing my voice it gets reduced to $38. I don't understand how I owe $38, but at least it's not $640, so I just pay it. The $212.10 is more complicated. United Healthcare says they never received that bill, despite it saying in bold type "INSURANCE DENIES CLAIM." I call Newport Pathology, and am told that they did bill United, but that my account was canceled in 2002. That's impossible, I say, since I didn't even get this account until I started grad school in 2007. They ask for my account number. I give it to them. They say it's not valid. Yes it is, I say, and every other office has taken it except yours. Am I reading it off the card, they ask. Yup. Is that the policy number? No, it's my subscriber number--policy number is... Oh, well, that's the number we submitted before that got rejected. Makes sense, I say, since you're the only ones who ask for that number. They say I need to tell United that they actually did get the bill but that it was rejected mistakenly. So I call United again (each of these calls involves at least a ten minute wait) and they repeat that they never received the bill, adding that Newport Pathology probably doesn't know how to bill student insurance accounts, which have a different number of digits than regular ones. I get a fax number to give to Newport Pathology and call them again. I explain the whole thing, insist that the person on the line take down all the numbers on my card despite her insistence that I'm reading my card wrong and that there must be a nine-digit subscription ID or policy number somewhere (seriously?), and give her the fax number to contact United. She tells me I can call back in two weeks to find out the status of the claim. I tell her I'll be out of the country by that time, that the whole point of getting the fax was supposed to be that it would be taken care of immediately. That's the best she can do, I'm told. I grumble a halfhearted thank you and hang up.

Here's what really gets me: despite a persistent condition that requires minimal attention, I'm healthy. I don't think it would be right to whine that a visit to the doctor confirmed that I'm in good health, which is why I didn't complain about the initial $300. But I would not have agreed to the procedure if it had cost $1100, or even $500. Furthermore, this isn't the first time I've had to deal with this sort of thing. In fact, it happens more often than not with my insurance. This is an insurance plan, by the way, that doesn't cover physicals and whose doctors appear to have no interest in preventive care. Why does this bother me so much? Because cancer is extremely common among men in my family. As I approach my thirties, I would like to be able to get myself checked in the necessary ways before turning up with lumps and weight loss and lethargy. But in addition to not being insured for that sort of thing, I don't trust these glorified drug dealers, and I have neither the money nor the time to do this dance every time I have a question or concern. So I just don't go to the doctor, and though I know it will eventually bite me in the ass, I don't know what else to do.


image: Marriage à-la-mode III: The Inspection, by William Hogarth (1743)

Methuselah killed Social Security.

There's a lot going on in this article, much of which is unsettling despite its ultimate optimism: people are living longer and eating up resources without contributing to society; part of the proposed solution is to delay retirement age to account for increased life expectancy and combat ageism that keeps the old out of the workplace. Right enough, I think, except that one of the current issues making it difficult for young people to get work is that retirement-aged folks are staying in or returning to the workforce. But these are issues for people with more capacious brains than mine. What really got me was this:

"Of all the people in human history who ever reached the age of 65, half are alive now."

Shit.

Playing doctor.

My inner right ear hurts. It radiates down the right side of my throat and the whole right side of my head is sensitive, like when you have the flu, but only in that small area. I tell this to the doctor. She asks if I have a history of chronic ear infections. When I was child I got quite a few, but not as an adult. She asks if I've had a fever recently. No. Have I been swimming? No. Sore throat? Nope. Any rashes? Negative.

She checks my ear and says I have tiny ear canals. That's not symptomatic of anything, she's just letting me know. She checks my throat and asks if I've had my tonsils removed. I answer no and she checks again. This time she sees my tonsils and says that they too are smaller than the average. That's two remarks about the diminutiveness of body parts to which I've never given much consideration. I'm a little hurt.

Finally she says there's nothing wrong with me. But there is, I say: my ear and one whole side of my head hurt. She says that I might have shingles. She doesn't actually get this from a new look at anything on my person, it just seems to occur to her mid-conversation. A flash of inspiration. Shingles, out of nowhere. Am I sure I haven't had any rashes? Positive. But there's a red line across my forehead. I hold up the hat that I wore in. She gives a slightly abashed smile, but only retreats from the shingles speculation enough to open the field to viruses in general.

I might have some kind of virus, and it might show itself over the next few days. But it might not. Not that we have any idea what to look for besides symptoms of shingles, because we're not sure what it is. We're not even sure if there's anything. It could be (her words) transient ear pain. Just passing through.

This conversation is quickly becoming a contender for the single least informative exchange I've ever had in my life.

I think a shrug should be part of the doctor's repertoire. I realize that I shouldn't be annoyed by her inability to decipher the secrets of my aching scalp by looking into my tiny ear canals, but it's really hard when what I get is a litany of vaguely defined, barely explained possible diagnoses that amount to one big who-the-fuck-knows. She should just be allowed to shrug. And I should be prepared to take that as an answer.

But I suppose she's not allowed to do that, and I probably wouldn't be satisfied with it as an answer. So we drag this out for fifteen minutes and in the end I have no answers. My ear still hurts. I pay my $15 copay (a dollar a minute!) and go home. My roommate asks me what's wrong with my ear. I shrug.

image: Self-Portrait with Bandaged Ear, Vincent van Gogh, 1889

Beyond the laundry.

Just when I thought the church would stop and leave me to practice passive heresy in peace, the pope goes and opens his mouth. Condoms contribute to the spread of AIDS now. I, as a white middle class American male, never felt the urgency of the church's disdain for prophylactics. I knew it was frowned upon (having never been married and all), but we were never talked at about birth control, and especially not about condoms. Abortion, yes, but condoms and birth control pills were simply an accessory to sex. That is, sex is wrong, but if you're ok with that you should probably use a condom.

Now, I think it's safe to surmise that the pope doesn't actually oppose the policy I just stated: if you're not worried about eternal damnation he probably prefers that you at least have some consideration for others and try not to spread sexually transmitted diseases. The problem, of course, is that he did not say this. He said that the distribution of condoms actually hurts attempts to fight the spread of AIDS. Meanwhile the Vatican's talking heads gushed about recent increases in membership.

Hooray for increases in membership! It's like the old days, but without the galleons and heavy artillery.

illustration by AD McCormick, in The Land of the Golden Trade, by John Lang

"It's gonna be a bright (bright), bright (bright) sunshiny day."

Walking home from the optometrist today I changed course and hung a quick left at Pereira to head for Albertson's. Just because I could see. It felt a bit silly to be so awestruck by contact lenses--not exactly a new technology--but I've never had them, so it was a big deal. I could see, and there was no sliding a frame back up my nose, no sweating on and then wiping off the lens. Just walking to the supermarket, seeing things, stupidly amazed.

It occurred to me at some point that I've become more timid as my vision has worsened. This is actually good news, as lately I've found myself worrying that graduate school is ruining my personality. As it turns out, it's only ruining my vision.