Friday, August 26, 2016

"The Doctor Blake Mysteries"

My Aussie friends in Melbourne and Adelaide would probably chortle at my recent obsession with the TV mystery series The Doctor Blake Mysteries, set in Ballarat, Victoria, and produced there. The Public Broadcasting System has made a smart move by importing this series (and another, Miss Fisher's Murder Mysteries) from Australia. They definitely spice up the programming schedule of my local PBS TV station.

It doesn't bother me that none of the actors are familiar names or faces. Or that the series is set in the late 1950's. I love that it's a "period" piece, set in a time long before personal computers, cell phones, and blockbuster anything. These mysteries pit a doctor, a "police surgeon," against the murderer and his or her methods, flaws, mistakes, and pain. The police help or hinder depending on who's in charge -- there's been one Chief Superintendent whose handsomeness hid a black heart -- and always provide the authority Dr. Lucien Blake requires to catch the villain. These mysteries proceed quietly, slowly, penetrating the social strata of Ballarat and the surrounding area with some of the most haunting music you will hear on television.

Dr. Blake, the son of a beloved doctor in Ballarat, returns after years spent abroad. His background story seeps through each mystery episode, revealing his flaws and his pain, as well as his character as a person. He takes up residence in his father's house and office, and asks his father's housekeeper, Mrs. Jean Beazley, to stay and work for him. He takes in a district nurse as well as a young police constable or two as boarders. His medical practice would be that of a general practitioner at the time, supplemented by his work with the police. The nature of the show, of course, means that it actually seems like his police work is his major practice.

Craig MacLachlan, as Blake, brings a real presence to the role, a thoughtfulness as well as a kind of reckless drive to solve each mystery. I love that the medical forensics are so early in their development and use -- no DNA profiling here. We learn that a suspect can have the same blood type as that found on a murder weapon or at the murder scene. Poison seems to be a preferred method of murder in Australia, however, in stark contrast to what would be preferred in America, i.e. shooting with guns. Psychology is also in use by the police and Blake, although they don't ascribe to its use. They depend on their knowledge of and experience with human behavior. And so far, the writing has been original and imaginative, giving the actors opportunities to develop their characters as well as making interesting, sometimes twisty, stories.

Two subplots have been threading their way through all the stories, at least so far. One is the politics of the police in Victoria, and how Blake's work with Ballarat's police has shone too bright a spotlight from Melbourne on them. At times, it looks as if Blake will lose his job. At other times, it looks like he could end up in prison. How this subplot plays out is just as suspenseful as each of the mysteries, as complicated, and as full of nastiness as you can imagine. It makes office politics look tame.

The second subplot involves Blake and his housekeeper, Jean Beazley. Over time, the two actors do a masterful job of showing the gradual romantic attraction growing between these two characters. It has been fascinating to watch their reservation, their restraint, the way the social norms of the time govern their behavior, and so on. They are both middle-aged with grown children, and this is especially refreshing to see. They have problems, pain in their pasts, and have each lost a spouse in war. Will they get together?

Jean and Lucien (Not what it looks like)

What's been especially fascinating to me has been seeing Australian culture and a moment in Australian history after World War Two. They were an ally of the Americans in the Pacific Theater and have their own war stories to tell. I grew up hearing mostly about the European Theater of that war despite my father's service in New Guinea which he rarely talked about and then not in detail. Australia had its own struggle with Communism and prejudices, corruption and vice. I feel like with each episode I'm experiencing this time in Australia through these characters and their stories.

I'm almost finished with the fourth season and have been excited to learn that there will be a fifth. If you're looking for something different and you love mysteries, request (demand) your local PBS station to air it (if they aren't already)!

Wednesday, August 17, 2016

Who Founded ISIS?


If there's one thing that will disgust me, it's when a "politician" spouts off about something he or she knows absolutely nothing about and is too arrogant to admit he or she knows absolutely nothing about it. Such politicians can be quite dangerous, and actually toxic to government and the general public. But how can we possibly know when a "politician" is spouting off and exposing his or her ignorance?

We rely on our Freedom of Press and the media protected by it to help us out. We need journalists to take the time to research and write/talk about what the truth is about a subject. We need journalists to persevere in pulling out of arrogant "politicians" just how much they know about a subject to reveal their ignorance. I'm not seeing that happen enough right now during the American campaign for president.

Let's take a recent example. Donald J. Trump claimed over and over and over that Barack Obama and Hillary Clinton co-founded ISIS. And not only in one day's news cycle, but over 7-10 days he repeated this claim, embellishing it at times with derogatory adjectives for Obama and Clinton. Trump insisted over and over that what he said was true. Obama and Clinton had co-founded ISIS. (He's since "clarified" his statements by saying their policies made ISIS strong.)



What is the history of ISIS?

Who really founded ISIS? Let's take a look at its history. If you'd like to read more lengthy articles about this group, try The Atlantic's "What ISIS Really Wants" or the Wikipedia entry for ISIS.

To summarize, this group was founded in 1999 under the name Jamāʻat al-Tawḥīd wa-al-Jihād by Abu Musab al-Zarqawi, who eventually led al-Qaeda in Iraq. It wasn't known as the Islamic State of Iraq (ISI) until after Zarqawi was killed in 2006. So, long before Obama became President, in fact, when first Bill Clinton, then George W. Bush were President, this group came into being. In response to Bush's invasion of Iraq in 2003, Zarqawi aligned the group with al-Qaeda and joined the insurgency.

In 2010, after the leaders of ISI were killed by US and Iraqi forces, the current leader, Abu Bakr al-Baghdadi, took over. The Syrian Civil War, begun in 2011, has served to grow this group into what it is today, i.e. the Islamic State of Iraq and the Levant (ISIL). The Syrian government's response to the Arab Spring uprisings opened the door for ISIL to capture territory. Al-Qaeda cut all ties with ISIL in 2014. ISIL operates on its own, and al-Baghdadi has developed it into an extremist Islamic war machine bent on creating a world-wide Caliphate and destroying every other religion and the people who follow them or go down in a blaze of glory.

As far as U.S. policy toward ISIL, it has had to respect the sovereignty of Iraq in developing operations against the group. As for Syria, I suspect that much more is going on behind the scenes than is available for the general public to know. Trump's ideas about nuking ISIL mean that he'd be nuking the countries of Iraq and Syria in the process. I doubt any Middle Eastern country would stand for that much less Iraq and Syria. Not to mention their allies -- Russia is one of Syria's staunchest allies.

And really, all Trump has to do is a little reading to educate himself on the history of ISIS (ISIL). The fact that he doesn't and that he fails to demonstrate that he has tried to educate himself only affirms his ignorance of how to deal with an enemy of the country.

Trump's ignorance of the Constitution

The U.S. Constitution is the foundation and organizing document of the American government. With the Bill of Rights and subsequent Amendments, it is the law of the land. When Trump states that Obama, our current President, and former Secretary of State Clinton co-founded ISIS which is an enemy of the United States, he betrays his ignorance not only of recent international history, but also ignorance of the U.S. Constitution. And this guy wants to hold the highest elected office in the country and swear to uphold a document that he clearly knows nothing about?


"So what?" you might ask. Well, if Trump is going to lead our country and head our government, he needs to know, at the very minimum, the Declaration of Independence, the Constitution, and the Bill of Rights as well as the subsequent Amendments. Trump has demonstrated only ignorance. Why?


In Article III, Section 3 of the U.S. Constitution:

Treason against the United States, shall consist only in levy-
ing War against them, or in adhering to their Enemies, giv-
ing them Aid and Comfort. No Person shall be convicted
of Treason unless on the Testimony of two Witnesses to the
same overt Act, or on Confession in open Court. 
The Congress shall have Power to declare the Punishment
of Treason, but no Attainder of Treason shall work Corrup-
tion of Blood, or Forfeiture except during the Life of the Person attainted.
Since ISIS is an enemy of the U.S. and is at war against us, saying that Obama and Clinton co-founded it is the same as accusing them of treason against the U.S. by "levying War against them (the U.S.), or in adhering to their Enemies, giving them Aid and Comfort." That is a serious charge. Trump needs to have one or more other witnesses for this co-founding and substantial evidence to prove the claim. By making this claim, Trump demonstrates just how ignorant he is of ISIS, of the U.S. Constitution, and of his own ignorance which is probably the most dangerous thing about his loose lips.

So in addition to not being familiar with the law of the land, of the documents that organize our democratic government, Trump has demonstrated an ignorance of the meaning of his own words in the context of the U.S. Constitution.


I fervently wish the Media would point these things out to Trump, call him out, make him uncomfortable, show him that he needs to do the work and not just stand at a lectern and spout lies and ignorance. I just have not seen it, and you know what? I doubt I will. Why?

First of all, educated people and people who seek out the truth (not mutually exclusive groups, by the way) already know about Trump's ignorance. Second, Trump's followers probably really don't care. They care only that Trump has the moxie and the influence to say in public what so many think. They believe he's right because Trump says he's right. They are not the kind of skeptical minds that think critically about what politicians say. And Trump believes he's the best person for the job. Sad but true.

Trump will continue to spout his ignorance, even though he's begun to try to sound statesmanlike. He will continue to alienate women, minorities, people of all religions with his ideas and policies for "making America great again." His followers will agree with him. I can only hope that come November, Clinton routs him in the election. And then perhaps our public education system can be improved to teach kids how to be skeptical, to research and educate themselves, and to think critically.

Monday, August 15, 2016

If I Were in Charge.....

What is the big deal about single payer medical insurance that makes so many people angry and upset?  Actually, I think it's the insurance industry that promotes activity against single payer medical insurance even though they have already made inroads into Medicare by offering supplemental medical insurance as well as Medicare-approved plans.  Maybe it's time to take a hard look at what Americans need vs. what they currently receive in terms of medical insurance, i.e. if I were in charge....

We need medical insurance that doesn't make us sick or make it necessary to hire someone to deal with it for us (Patient Advocates).

Here's an example of this: last spring I received a letter from a company I'd never heard of telling me that they'd assessed my medical need for a medication I was taking, and they'd approved coverage for that medication by my insurance through October. My first reaction was "Oh, no! Who are these people? Why are they assessing my medical need for a medication? They know absolutely nothing about me!" I was in a panic that my insurance would eventually decide not to cover this medication that I need, I'd have to go off it because I couldn't afford to pay for it (unless the drug company would be able to help me), I'd become quite ill again, end up in surgery and cost the insurance company tens of thousands of dollars more than if they'd covered the medication. Not to mention the stress and the devastation of illness.

I sent my doctor's office a note asking if the prior authorization had been revoked. I thought that we'd gotten a prior authorization for a year from my insurance company. So why did I get this letter from a company I'd never heard of? They assured me that they'd gotten the prior authorization, and sometimes medical insurance companies run medical necessity assessments on a quarterly basis, especially for expensive drugs. What?  They think my necessity will change every three months? Wrong.

Of course, this incident upset me and angered my medical team. It created work for me that took me away from my livelihood. Does my medical insurance care? No. I spend so much time on issues like this with my insurance, I sometimes think it could be a full time job. I'm in relative good health right now (thanks to that medication) but I don't know how someone who's very ill can cope with this work. I have learned that there are people you can hire to do it for you if you don't have a family member adept at maneuvering through the insurance mazes. My insurance company even hires an outside company to do their medical necessity assessments.

Doctors decide medical necessity, i.e. the patient's doctors not doctors who have never even met or seen the patient that work for a company that works for the patient's medical insurance. Wouldn't life be a lot simpler if that were truly the case? It used to be the case years ago.


We need medical insurance that's easy to understand.

When I began dealing with medical insurance after my chronic illness diagnosis 15 years ago, I struggled to read through my policy. I still need help with understanding how the medical insurance industry works. Does anyone else get the feeling that they make their policies and procedures difficult to fathom in order to catch patients or to protect themselves from paying out too much on claims? Policies and procedures need to be written in plain English that anyone can understand, and need to be simple to do, fast, and supported by the company.

For example, I have a prescription for injectable B12 that I must do every 3 weeks. In my insurance policy, it says that coverage is for a one month supply of a medication. OK. Sometimes, because of the every-3-week schedule, I need to inject the B12 twice in one month. I thought that getting 2 vials per month rather than 1 would solve the problem. So, I talked with my doctor. She called the pharmacy with her approval, but would not write a new prescription because my dosage was once every 3 weeks. But the pharmacy couldn't do the 2 vials per month because of the terms of my insurance. I finally asked the pharmacist how I was supposed to follow my doctor's dosage instructions. She told me that I could get my prescription refilled every 3 weeks and my insurance would cover it because of the doctor's prescription.  Who knew that the one month supply restriction stated so clearly in my policy would not apply to my B12 prescription?

Supporting bureaucratic language and procedures wastes time and money for everyone. Patients don't have the time or resources to be constantly checking on the rules medical insurance companies do not publish in their policies.



We need medical insurance that isn't more expensive than the medical expenses that we have.

If the insurance coverage pool consisted of every American, i.e. approximately 400 million people, that would be the biggest risk pool any insurance company could ever wish for. That in and of itself could bring down costs for both insurers and the insured. I don't buy that insurance companies are non-profits, that they use their surplus each year to cover shortfalls.  There was a gigantic insurance company in the last year who tried to claim a loss in my state when they had a surplus pool many times the amount of their alleged loss, and they were supposed to use that surplus to cover that loss.  The reason they were trying to claim a loss was to charge people more for their premiums and coverage.


Insurance companies are in the business of making money, pure and simple. In that respect, they are for-profit entities. We need to take out the whole notion of making money from medical insurance.

We need medical insurance that applies to everyone, without any kind of discrimination, no matter what age or health status.

We now have the situation in the U.S. that several big medical insurance companies have pulled out of participating in the ACA (because they are allegedly losing money), and therefore, their policies are no longer eligible for the tax credit subsidy offered under the ACA for people who have problems affording sky high premiums. This move by these companies has shrunken the number of policies available to patients and the amount of coverage.

I think that it should not be a choice for insurance companies, but a requirement on the state and federal level that they participate in the ACA. When they don't participate, that means that they can return to their practices that led to the ACA years ago, like discriminating against people with chronic illnesses, for example, and older adults.  And charging so much in premiums and out-of-pocket expenses that people cannot afford to buy coverage. We are already seeing this happening.

We need medical insurance that will cover everyone equally, that is reasonably priced, that has streamlined procedures for administration. Some have suggested Medicare for all as a solution, but Medicare needs cleaning up itself.  However, Medicare is single-payer medical insurance -- yes, the U.S. already has single-payer medical insurance for everyone 65+ years old. Why not channel all the energy being spent on insurance companies and the ACA into cleaning up Medicare, making it more efficient and less prone to fraud, and phasing it in over the next 10 years as a single-payer medical insurance for every person no matter what age he or she is in the U.S.?

And we need to make the insurance industry want single payer medical insurance.  

Guess who screams the loudest against a single-payer medical insurance system available to all? Of course. The medical insurance companies. They haven't the imagination to figure out that they could still play a role, and therefore not lose their business, in a single-payer system. But no one who has supported a change to single-payer insurance has ever explained how it would be in the best interests of the insurance industry to make that change.

First, most medical insurance companies already offer Medicare-approved plans for seniors. Second, those plans can be the foundation for phasing in Medicare for all, and the insurance companies can contract (as they already do) with Medicare to be regional centers for processing Medicare claims. What then happens is that as Medicare phases in for all ages, the insurance companies become independent contractors working for Medicare, i.e. the government. They can be a part of streamlining Medicare's business processes so that everyone saves money and time. And Medicare will then have the clout to negotiate with drug companies and pharmacies for lower drug prices for patients, and will be able to continue to establish pricing for hospitals, clinics and private practice physicians.



And so.....
I often tell people that medical insurance companies are not our friends. They really don't care if we live or die. All they care about is whether or not they must pay out on claims. They don't want to pay out. Instead, they want to accumulate as much money as possible, ostensibly to pay out on claims, but I wonder just how much of that money goes to executive pay, perks, and non-business expenses. The insurance industry, like the pharmaceutical industry, could benefit in the long term from financial transparency and being more responsive to the market. And from transforming into a single-payer system under Medicare.

Tuesday, August 2, 2016

Mathematics

The bane of my existence: mathematics. It is a demon to me, an incomprehensible thing. And yet, I feel satisfaction when I use math to solve a problem or to complete an order at work.

We need math in our world today, whether it's to balance a checkbook or be able to count out change in a retail transaction. I've managed to survive with basic math skills -- addition, subtraction, division, multiplication, figuring percentages, ratios, etc. But I put off doing my tax returns every year because they require math. I don't enjoy math.

This year, the IRS sent me a letter in June requesting...something. The language was far from clear and it took me four careful readings to figure out what they needed from me. They wanted me to re-work and re-submit the form for ACA tax credit premium subsidy thing. Ugh. Form 8962.





The first time I filled out Form 8962, I thought that the IRS had really made this reporting far more complicated than it needed to be, and therefore, more difficult for people like me who have no head for math. I followed the instructions as closely as I could. When I'd finished, I thought it was fine. The IRS disagreed, and reworked it for me.


This year, I realized my life in 2015 had been more complicated than in 2014, and it took me longer to work through the math of Form 8962. Once again, I thought I'd completed the form correctly and submitted it. Once again, the IRS disagreed. This time, as I mentioned above, they sent me a letter requesting that I re-work it and submit documentation in support of that re-working.

OK.

I began by pulling out my 2015 tax file and going through the documents I'd used to do Form 8962 the first time. As I read through them again, I realized that I'd had a change (even though I requested no change) in my premium tax credit because MNSure had finally finished making a change in my application that I'd requested -- so the premium tax credit change occurred in April.

OK.

I had not gotten the premium tax credit for the month of January because I'd kept the medical insurance I'd had in 2014 for that month until I'd finished my MNSure application and submitted it (I've written about the craziness that occurred in October through December 2014 with MNSure before). That medical insurance for January wasn't eligible for a premium tax credit so I'd paid the full premium.

OK.

So, there was no premium tax credit subsidy in January but I had the form that showed I had had insurance that month. I'd had one level of premium tax credit for the months of February and March; then a different level in April through December. I possessed two forms for the premium tax credit received for February through December, but one was for the level in February and March applied through December, and the other was for the level in April applied from February through December. Now how confusing is that?

What I ended up doing is marking each of the premium tax credit received forms in ink with a notation about when the change occurred and what was the correct time period each form covered. Then I wrote a letter explaining the mistake I'd made and why I'd made it, and included the corrected Form 8962 and page 2 of my 1040 Form.  Whew!  They must have been satisfied because I received my tax refund yesterday. But really, I wonder if someone who loves math and is good at it would have had the same problems I did.


Mixing math and computers is another area where I have problems. For example, when I work in Excel with numbers and functions, I have to go slowly and very carefully. But I do love how Excel does everything for me once I've given the program the necessary instructions. Now if I could just find a computer program that could just do all the math for me that I encounter in my life!




Tuesday, July 19, 2016

My Two Cents

This week and next, I am not watching the political convention coverage on television. It's impossible to get away from it completely, however, and this morning I watched the morning after post mortem by CBS News of yesterday's opening activities and speeches at the Republican Convention. In addition there were clips from a Charlie Rose interview with Hillary Clinton, and from Lesley Stahl's 60 Minutes interview of Donald Trump and Mike Pence.

First, Donald Trump. Lesley Stahl commented to him that he wasn't very humble. His response was to tell her that he was "the most humble" person, that he was so humble that she couldn't understand how humble he was. Well.... Dear Mr. Trump, if someone makes the comment or observation that someone isn't humble, then it's highly likely that someone isn't humble.  In other words, a truly humble person would not attract such an observation. And then there's that "the most humble" phrase. To you, dear Mr. Trump, you are "the most" of everything, right? That's either exaggeration or grandiosity or both. That's neither modesty nor being humble. A suggestion: if you'd really wanted to deflect the comment, embrace the fact that you're not a humble man and be done with it.  Otherwise, you just come off as a complete and ignorant fool.


Second, Hillary Clinton speaking about Donald Trump. She made an interesting case for Donald Trump being the most dangerous presidential candidate in the history of this country in her interview with Charlie Rose. She pointed to a long article about his personality but failed to specify the article's title and author, at least in the clip I saw. She pointed out specific things that Trump has said, especially his apparent "casual indifference" to whether or not other countries such as Saudi Arabia acquire nuclear weapons, and said that demonstrated Trump's ignorance of history, of America's relationships with allies, and the history of keeping nuclear weapons out of the hands of nations like Saudi Arabia. She has a strong case. Unfortunately for Trump, nearly every time he opens his mouth to talk about foreign policy, he demonstrates his ignorance. He's apparently not interested in maintaining the relationships America already has with other countries or forging new ones, nor interested in insuring that America's relationship with the world is a cooperative and peaceful one. That alone makes him dangerous, indeed.

Hillary Clinton and Michelle Obama (AP Photo/Gerald Herbert from cnsnews.com)

Third, Melania Trump's speech last evening. I did not hear the entire speech, but heard one section of it over and over again this morning on the news. That section apparently steals from Michelle Obama's Democratic Convention speech in Boulder, Colorado 8 years ago. The most damning coverage was when CBS went split screen, putting Obama and Melania Trump side by side as each spoke the words in question. Then I also heard Melania's speech over Michelle's and only one or two words didn't match. Donald Trump's campaign manager pointed out that the section in dispute was only about 55 words out of a 1500 word speech or about 3.7% of the speech. I don't know what the fair use cut off is without looking it up -- 200 words? -- but it seems to me that to be on the safe side, and to prevent the controversy that has occurred, Mrs. Trump needed to cite Mrs. Obama at that point in her speech and show appreciation for their apparent agreement on the things they both addressed in the same way. Whether or not Mrs. Obama can bring an infringement suit against Mrs. Trump, the real issue is that of appearance.  I would love to be a fly on the wall listening to the Donald talking to Melania in private about her copying Michelle Obama in her speech.

My two cents.