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)

Live, from America's anus.

I complained about this recently and then rejoiced over the governor's rather unsatisfactorily reasoned but still welcome veto. Well, the steaming turds that comprise Oklahoma's legislature have voted to override the veto to pass a law which states that, if a woman wants to undergo a perfectly legal procedure, she must publish private information to a government database, subject herself to medical advice with a clear political agenda, and consent to an invasive, medically unnecessary procedure. The law also protects doctors from malpractice lawsuits that might be brought against them for failing to inform pregnant women of fetal birth defects, with the intent of protecting doctors whose purpose for lying is to lessen the likelihood of choosing abortion.

image: detail from Examination of a Witch by TH Matteson (1853)

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

"It is later than you think!"

It turns out that my new favorite Congressman and countryman once removed is remarkably quotable. He also said that the health care bill is the Democrats' way to "lay the cornerstone of their socialist utopia," to which I say...wait, wait, I can't...stop...laughing.

My personal favorite response to Nunes's tribute to Cold War genre fiction has been the evil socialist role-playing that erupted on this message board.

As one commenter said, I'm not terribly thrilled about the bill's contents (it's not socialist-utopian enough!), but given the hysteria against it I can't help gloating. I just really can't wait until campaigning Republicans are forced to explain which parts of the health care bill's most instant measures they actually want to repeal. There won't be federal funding for abortion, and mandatory health insurance won't take effect until 2015. That leaves the Republicans to take shots at such totalitarian measures as regulations that prevent rejecting people with preexisting conditions, prescription aid for seniors, and a provision that allows college students to stay on their parents' insurance for a few more years.

Even some conservative strategists acknowledge that they've gotten themselves into an impossible political bind. (Best part of Frum's column: the first sentence, where he says that this bill's passage represents conservatives' "most crushing legislative defeat since the 1960s." Unless he's talking about the Civil Rights Act, Frum's got to be referring to the Social Security Act of 1965, which established Medicare, the protection of which has been one of the more confusing talking points for health care reform opponents for the past year. I mean, it's just too delicious. I can't help thinking the Democrats are going to screw this up somehow, but for now it's a lot of fun to watch)

So get ready for the crazy, because someone's going to start flinging shit. If I were a Democrat, this would be my campaign poster:

Rant.

Jindal channeled Mr. Rogers at the start, and it was downhill from there. Evoking Katrina, bringing up debunked myths on high speed rails, ranting about a volcano safety program. This was not an accident. He was sacrificed by his own party.

But why?

Neoconservatism and neoliberalism have both learned to capitalize on the trend to failure. Why train for the high jump when you can get away with lowering the bar? The Republicans have made nothing but stupid moves since Obama got elected. Rush Limbaugh is now considered a party leader, and was one of the few commentators to defend Jindal's speech.

Why?

They want expectations lowered. Or they're stupid, but for the sake of conversation let's assume that this is a very sophisticated ruse.

The president commits to healthcare and the very next day Democrats turn up on TV remarking that, while universal healthcare is of course the ideal, it's not very likely to happen and, well, we'll take what we can get. The president vows to close Gitmo and end torture, then waits a few weeks before vowing to carry on the War on Terror in a manner disturbingly similar to what we've grown used to (including renewed bombings in Pakistan). This is accompanied by reports of possible court challenges to the closing of Gitmo and even a Democrat now arguing that if we can keep it well-run and respectable, maybe closing Gitmo isn't such a good idea.

Extinguish the light at the end of the tunnel and people will just be happy just to set foot on solid ground.

This is politics. Lowering expectations in these circumstances may not be such a bad idea, but this is more than a plea for level-headedness, it's cynical propaganda, and it works with Jindal's absurd history lesson: America's work is done. Racism's over. Now don't expect too much.