2009 Graduate Scholar (Second Runner Up)

Unlike most twenty-three-year-old sorority alumnae, I receive my monthly subscription of Cosmo with a side of insurance rejections: such is the life of a coed who lost the genetic lottery. Thankfully, I earned an undergraduate degree in Health Administration and specialize in reminding health care organizations of their contractual obligations. Unfortunately the majority of Americans have not had this training while the red tape surrounding the insurance system is dense and misleading (1). But that’s to be expected; even the laws put in place to protect patient rights are incomprehensible. A Journal of General Internal Medicine report found that legislation set to protect patient rights is comprehensible to people with a reading level equivalent to that of an Associate Degree (2). To put this in perspective, approximately 70% of the United States population over the age of 25 can’t understand the laws which protect their health care rights (3). This ambiguity has created a market of confused individuals who are easily melded into padding the bottom line for both insurance companies and for-profit health care advocates.

According to the California Nurses Association, 1 in 5 claims are rejected by private insurance companies each year (4). These rejections can occur before or after care is received and come in two classes: quantitative and subjective. The first genre consists of clerical errors and miscoding issues, both of which are easily corrected to the subscribers benefit (so long as the subscriber catches the error, knows their benefits, and appeals the rejection in a timely manner).  The second groups of denials are difficult to negotiate as they result the insurance companies definition of preexisting conditions, medical necessity and experimental procedures (5).

Comedian Stephen Colbert illustrated the satirical nature of this licensure in his October 29, 2009 introduction in which he asked “What qualifies as a preexisting condition? … If you have to ask, you probably have one! (6)” Take for example Stephanie, a 24 year old from Oakland, California, who opted into a single-payer insurance policy while she was studying for her MCATs. She went to the doctor for an annual exam and was diagnosed with bronchitis. This diagnosis led her insurance company to do a five-year review of her medical records in which they found evidence of a past chest infection, providing them with grounds to refuse payment for her care. She never thought that her former chest cold could be a preexisting condition, yet due to her insurance company’s interpretation, she was forced to pay out of pocket (7). Obviously the insurance industry has to stack the deck in their favor; they are for-profit companies and deserve to be compensated for their sizeable gamble on individuals, but the high profits which result from rising premiums and unclear coverage denials is unethical (8).

This no-man’s land between insurers and individuals has led to a job market in patient advocacy. Many advocacy groups are either non-profit or governmental agencies; indeed, most states have patient advocacy bureaus to help their residents navigate the difficult legislature governing their care (9). Unfortunately these bureaus, like most social service sectors, are overworked and underpaid, forcing states to mandate who qualifies for advocacy (10). This urges patients with financial means to employ private, for-profit advocacy agencies to help them navigate the intricacies of the health care system, adding additional cost to their health care. Furthermore, the for-profit nature of these companies caters to healthy individuals, and some refuse to work for people with preexisting conditions, leaving those who desperately need support without recourse (11).

Einstein once said “make everything as simple as it has to be, but no simpler.” If this principle governed the success of Time’s “Person of the Century,” perhaps we should consider applying his wisdom to our current health care crisis (13). Simplicity is indeed the key to our success. Currently, health care reform bills have provisions to subsidize and reward the utilization of electronic medical records. Unfortunately, these electronic medical records are not currently at a developmental level which would supply security or uniformity. Yet these systems have great promise, indeed, if they are streamlined, continuity and accuracy of care would be vastly improved (14). A standardized record system would incite uniform regulations across insurers, helping to hold the insurance system accountable in a laissez-faire manner which increases its political viability. Furthermore, the clarity this system provides would help subscribers to understand the reasoning behind decisions which were formerly illogical. Unfortunately this goal is several years in the offing and we cannot wait to provide culturally relevant data to patients.

I recently attended a Comparative Effectiveness Research seminar in which Dr. Robert Epstein was panel member; I recognized his name, but couldn’t immediately place him (12). Halfway through the panel, it hit me - Epstein’s signature is affixed to letters I receive from Medco Health Solutions when my prescription drug coverage changes. In my world, Epstein is the prescription-drug-coverage-devil. But as I sat listening to his speech on personalized medicine, his congenial nature and “carpe diem” philosophy made me realize that the man behind the signature is human and truly cares for his subscriber’s futures.

Insurance companies are made up of educated people who, like Epstein, want what’s best for their subscribers. Admittedly, the more effective treatments are, the less they have to pay in the future. Yet these companies are woefully unsuccessful and demonized by the lay public in their attempts at efficiency. Likewise, the current push for health care reform is misunderstood and chaos abounds. If you want proof that a number of Americans do not understand the goals of health reform, look no further than “end of life counseling” being touted as “death panels.” Something has been lost in translation. If our goal is efficient, culturally competent care, the information delivery system must be clarified and translated via an appropriate advocate.

Note: For this piece I was recognized in NCHE's Annual Scholarship competition.

NCHE Year One

Works Cited:

1. Kaiser Family Foundation. Confusing Insurance Jargon Prompts Call For Reform. Kaiser Health News. [Online] September 21, 2009. [Cited: October 31, 2009.] http://www.kaiserhealthnews.org/Daily-Reports/2009/September/21/2khnstory.aspx?referrer=search.

2. Gardner, Amanda. Patient's Bill of Rights Too Tough to Read. U.S. News & World Report. [Online] March 27, 2009. [Cited: October 31, 2009.] http://health.usnews.com/articles/health/healthday/2009/03/27/patients-bill-of-rights-too-tough-to-read.html.

3. United States Census Bureau. Educational Attainment: 2000. census.gov. [Online] August 2003. [Cited: October 2009, 30.] http://www.census.gov/prod/2003pubs/c2kbr-24.pdf.

4. California Nurses Association. California's Real Death Panels: Insurers Deny 21% of Claims. National Nurses Organizing Committee. [Online] September 2, 2009. [Cited: October 30, 2009.] http://www.calnurses.org/media-center/press-releases/2009/september/california-s-real-death-panels-insurers-deny-21-of-claims.html.

5. Vogin, Gary. Dealing With Rejection. MedicineNet.com. [Online] WebMD, March 22, 2002. [Cited: October 30, 2009.] http://www.medicinenet.com/script/main/art.asp?articlekey=51313.

6. Wednesday, October 28, 2009. Comedy Central, New York : Stephen Colbert, October 28, 2009.

7. X., Stephanie. Personal Interview. October 2009, 28.

8. FactCheck.org. Insurance Co. Profits: Good, But Not Breaking Records. FactCheck.org. [Online] August 5, 2009. [Cited: October 31, 2009.] http://www.factcheck.org/2009/08/insurance-co-profits-good-but-not-breaking-records/.

9. Patient Advocate Foundation. The National Financial Resources Guidebook for Patients. Patient Advocate Foundation. [Online] [Cited: October 30, 2009.] http://www.patientadvocate.org/report.php.

10. R, S. Personal Interview. June 2009. Mr. R is a CNA employed by Tenderloin Health in their case management and health advocacy departments.

11. HealthCare Advocates, Inc. The Consumer Price Plan. HealthCare Advocates, Inc. [Online] 2009. [Cited: October 31, 2009.] http://www.healthcareadvocates.com/priceplan.html.

12. Personalized Medicine Coalition/National Pharmaceutical Council. Comparative Effectiveness Research and Personalized Medicine: Policy, Science, and Business. Arlington, VA : Personalized Medicine Coalition/National Pharmaceutical Council, October 28, 2009.

13. Golden, Frederic. Person of the Century: Albert Einstein. Time. [Online] Time, Inc. , January 3, 2000. [Cited: October 31, 2009.] http://www.time.com/time/time100/poc/magazine/albert_einstein5a.html.

14. Huslin, Anita. Online Health Data in Remission. The Washington Post. [Online] February 16, 2009. [Cited: October 30, 2009.] http://www.washingtonpost.com/wp-dyn/content/article/2009/02/15/AR2009021501284.html.

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[[ No, it won't always go the way it should, but I know the heart of life is good -- JM ]]

Some amazing things have been happening. No, I didn’t get into grad school (one can hope….), but I did get a huge opportunity to create a public health reporting system for TLH. I get figure out what holes are missing in the statistical correlations between HIV/AIDS and STD's and create supplemental questionnaires about behaviors which might effect the results. I’m so excited.

[[ Thank you for making me struggle, Tell me the world ain't mine -- I'm a miracle baby -- I refuse to lose -- Tell me what do you see when you look at me -- On a mission to be what I'm destined to be – M/TI ]]

Secondly, I became a site administrator for sfhomeless.net, a totally awesome wiki targeted at players in the homeless community

[[ Give me your eyes for just one second -- Give me your eyes so I can see -- Everything that I keep missing -- Give me your love for humanity -- Give me your arms for the broken hearted -- Ones that are far beyond my reach -- Give me your heart for the ones forgotten -- Give me your eyes so I can see -- BH ]]

Ok and finally… I Ran. On the verge of becoming trite, "I can’t believe it." I ran an 11.5 minute mile today. I haven’t run a mile since, well, yesterday (15 mins), but before that I haven’t run in probably a year. I couldn’t believe I didn’t pass out! I finally feel like I’m getting control of my life. This week I grew up. No, really. For the first time in my life, I knew, on my own, when I couldn’t handle that whole fainting thing and I actually asked for help from a qualified medical professionals (ie the emergency room). Not only that, when they brushed me off, I went back and got hyphy with them. And it got results. It was completely unprecedented by my previous actions and for that I am amazed with myself. I wasn’t independent and at the same time I was my own advocate. Seriously people, be amazed.

[[ No more stress, now I'm straight -- Now I get it now I take -- Time to think, Before I make mistakes -- That part of me left yesterday -- The heart of me is strong today -- No regrets I'm blessed to say -- The old me dead and gone away -- TI/JT ]]

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Here's an op-ed I wrote for my public policy class-- enjoy!

Apposite Bondage, Adverse Laws

It's a benign flag—white, black, and blue stripes, topped with a seemingly-happy heart. Though practitioners say otherwise, all I see are the literal colors—black and blue bruises, blood, and bandages. BDSM—Bondage, Domination, and Sado-Masochism. Here in San Francisco, the flag is flown high as thousands of BDSM practitioners in full (or lack thereof) regalia flock into Dore Alley to share their passions each year.

I was there this year. Only I was fully clothed, an outfit completed by my security headset and orange vest, and, for once, not a member of the majority population. My duties required standing on the corner of Folsom and 10th, keeping the police out and those with ass-less chaps in; I watched as leather-clad folk enjoyed themselves, in, umhum, public ways.

Getting over the obvious breeches in normative behavior, I was struck by the ease the BDSM community shed their secrecy (with their clothes) and uniformly practiced bondage in both homo- and hetero-erotic ways. In a 2000 survey of self-professed BDSM practitioners, 68% expressed that they were heterosexual. This figure is surprising, as BDSM in its public form originated as a gay subculture. While the images of leather-daddies leading young men in nipple clamps are still salient, this shift from homo to hetero is intriguing.

Here in San Francisco, you can see this depolarization of the homo-underground. But then again, this is the unofficial gay Mecca and there are plenty of men to spare. But this makes me wonder—why is it that San Francisco is the unofficial Mecca of homosexuality? There’s the usual reasons including dishonorably discharged sailors, the AIDS crisis, or Harvey Milk’s election and subsequent martyrdom in 1978- But why does it continue to be the epicenter for the flamboyant, the irreverent, and the just plain odd? How did it get to the point where underground factions would exist and separate within the community—BDSM, Circuit Boys, Club Kids, Druggies, Drag Queens, etc?

San Francisco attracts outsiders people because like attracts like, and in this case, like also attracts acceptance. But what of the people who are not so out of the mainstream? What if San Francisco’s stand is debunked by Proposition 8 this November? While I know the veiled Sisters of Perpetual Indulgence will be ok because they’ve been built against prejudice (and being nuns, they don’t need sex), but what will happen to the homosexual population that simply wants to create a (modified)-nuclear family? What about those who do not want an underground life but who want to stand proudly and feel normal amongst their peers? There are many.

Many people have seen the popular photograph of Del Martin and Phyllis Lyon, a lesbian couple of fifty-five years before they were married by Mayor “Gay”-vin Newsom on June 16, 2008. Had their 2004 marriage not been annulled, Martin and Lyon would have had four more years of wedded bliss before suffering the tragic death of Del Martin last month.

The public and mostly heterosexual BDSM community certainly defies more conventional archetypes than this couple, does it not? Even my Christian side says yes. Not to say that we have all changed our views or proudly accept Bondage and Discipline, Dominance and Submission, Sadism and Masochism, but if heterosexual people can beat each other publically in the streets I can’t help but feel that we can change our strict laws on something as convivial as marriage. Proposition 8 threatens to defeat fairness in San Francisco and all over California.

And even though I may not practice BDSM and I may not be a lesbian, that doesn’t mean I shouldn’t put my agenda aside for a few hours to help protect those ascribing to an alternate lifestyle. In the city with the golden gate bridge, I would hope we can uphold the golden rule. It’s time for marriage to go homo—uniformly given to all people. Until my peers remember that, I’ll be here warming up for next month’s Folsom Street fair, the largest leather fest in the world. Oh Daddy….