Homer Simpson on Health Insurance
Andrew Malekoff© June 2010
We are all familiar with stories about the ineptitude of government officials and regulators in protecting the public. At the SEC, they fell asleep at the wheel as Bernie Madoff made off with billions. In its eagerness to put more low-income families into its own homes, HUD failed to rein in Freddie Mac and Fanny Mae from saddling borrowers with mortgages they could not afford. So, it comes as no surprise to me that I cannot get a straight answer about who regulates the commercial insurance industry in New York State.
New York State is on the verge of implementing a plan for restructuring the financing of community-based mental health clinics. The plan discriminates against the underinsured middle class and working poor and is scheduled to commence on October 1. It represents a dramatic shift away from universal mental health care and towards care for families with Medicaid insurance only.
Those who have Medicaid are able to easily access community-based mental health services. Otherwise, you will soon be out of luck. When a family cannot get essential community-based mental health services that is what is known, in insurance industry parlance, as an inadequate network of care. Network adequacy has to be monitored and enforced.
In an attempt to get some straight answers, I contacted nuclear power plant safety inspector Homer Simpson, who was recently quoted as saying, “America's health care system is second only to Japan, Canada, Sweden, Great Britain; well, all of Europe. But you can thank your lucky stars we don't live in Paraguay!”
Andrew Malekoff: It is great to see you Mr. Simpson. You are looking dapper as ever.
Homer Simpson: D’OH!
AM: I know, I know, enough small talk. So, let’s get down to business. As someone with quality assurance experience, do you have any insights into who is overseeing the commercial insurance industry in New York State?
HS: D’OH!
AM: Are you expressing astonishment at my question, or are your referring to the D.O.H. - the New York State Department of Health?
HS: D’OH!
AM: A state official told me that this was the State Insurance Department’s (SID) jurisdiction.
HS: D’OH!
AM: Okay, okay, take it easy. I contacted a senior examiner at SID and she told me that they (SID) had regulatory authority over all licensed insurance companies and that they did enforce the insurance laws and all policy provisions but, she was quick to add, “We do not get involved in the network adequacy issue.” She said that that was the Department of Health’s job. I take it that you concur?
HS: D’OH!
AM: As I am sure you know, the commercial insurance industry uses managed-care companies to hold down costs. They decide, usually from hundreds of miles away, who gets what kind of mental health care, for how long and at what rate of reimbursement. In other words, they don’t really manage care, they manage cost and sometimes they even mangle care - at a nice profit.
HS: D’OH!
AM: According to Patrick Gauthier from Advocates for Human Potential Healthcare Solutions, “Despite the deepest and most enduring recession in 70 years…the five largest health-insurance companies in the nation disclosed combined profits of $12.2 billion last year — a 56 percent increase over the previous recessionary year. They managed this feat even though they experienced a combined loss of nearly two-million members to unemployment.”
HS: D’OH!
AM: My sentiments exactly! I am not sure that families know what to do if they cannot find a provider in the advertised network of care available to them via their health plan. May I ask you one final question, Mr. Simpson?
HS: D’OH!
AM: It will be quick. I promise. I raised the issue of network adequacy with the network manager for a well-known insurance company. She said to me, “We have a large volume of therapists within a five-mile radius of your agency that see young children which supports that our network needs are being met. What brings clients to your agency rather than an individual clinician's office?” How do you think I should answer her?
HS: First of all, Marge and I want to thank the Guidance Center for helping our family. Here is what I recommend you say in response to the network manager’s question: “The kind of comprehensive service that a community-based provider offers cannot be duplicated by any private practitioner in your network. For example, at North Shore Child and Family Guidance Center, the wrap-around services, for which they are not reimbursed by you or any commercial insurer, are by no means unnecessary frills or perks. They are essential services for working with a growing population of families in emergent crisis and in need of a community-based agency approach that is designed for this population, versus an individual private practitioner with limited availability, time and resources.” That should set her straight. Now I have to leave before happy-hour is over at Moe’s.
AM: D’OH!
To learn more about your rights as a health care consumer go to the following website: http://www.ins.state.ny.us/hrights.htm.
Published in the Anton chain of 18 newspapers, Long Island, New York in June 2010
Saturday, May 29, 2010
Sunday, May 9, 2010
MAKING ROUNDS
MAKING ROUNDS
by Andrew Malekoff © 2010
I have been writing this column since February 2007. Although I try to make points to be helpful to parents and other community members that care about kids, sometimes I think what I make are “rounds” that are less hard-edged and softer than points.
My reflections in this month’s column don’t unfold in a straight line, rather in a circular and pattern. I do not think that my memories are remarkable. They are made up of a combination of milestones, transitions and random, mundane associations. I am not sure if they will have universal appeal. I will leave that for you to decide.
I was born in Newark, New Jersey on May 14, 1951. In my early years I grew up in a second floor flat in the same neighborhood where author Philip Roth once lived. The best thing about where I lived was that there were stores around the corner. Among my favorites were a bakery, candy store, luncheonette and a burger joint with a pinball machine.
My grandfather Joe was a carpenter who emigrated from Russia. He lived with us for a few months. He lost an eye in an on-the-job accident. It was replaced with a glass eye that he removed from time to time to show to me. He once mistook a box of Spic ‘n Span, a cleaning product, for a box of Wheatena oatmeal. The boxes were similar in size, rectangular shape and orange color. As a result of the mix-up, a pot of boiling water and cleaning powder overflowed and flooded the kitchen with soap suds.
My other grandfather Harry was a tavern owner who came to the U.S. from Poland. He had diabetes and two prosthetic legs that I once saw him take off and put on. I often wondered what fake parts I would have when I got older.
My aunt Rose, my dad’s younger sister, told me a story about when my mom and dad first met. The two families planned a get together at my mom’s house. I found out that my dad’s family was worried because Grandpa Joe slurped his soup. Aunt Rose told me that, although they were poor, they did not want to appear to be low class. When the soup was served they held their breath waiting for Grandpa Harry to start. He slurped too. Everyone was relieved and, well, the rest is history.
We moved to a suburb of Newark called Maplewood when I was 10-years-old. It happened fast and without any warning. There was a moving truck one day and the next day my younger brother and I were sleeping in a new bedroom where we heard crickets outside the window. No one consulted me about moving. I left all of my friends behind and had to make new friends.
In the suburbs I rode my bike everywhere since there were no stores around the corner. My father, Izzy, took over the tavern after Grandpa Harry died. The tavern was called the P.O.N. which stands for the Pride of Newark. One day someone set the P.O.N. on fire. Some years later there were race riots in Newark. I did not see my dad that much in those days.
My mother, Evelyn, started her own business when I was in junior high school. I didn’t understand. I later learned that it was to help pay the bills. She was an antiques dealer. In time she opened her own store. The sign on the store read: Antique Evelyn. That is what she was known by for the rest of her years.
My parents died in the 1990’s after at least a decade of serious health problems.
My father had multiple myeloma and my mother had heart disease. During my earlier childhood years my parents each smoked three packs of Camels every day. Sometimes they sent me to the store to buy them for twenty-five-cents a pack.
One day in the early 1990’s, when her health was failing and she was living alone, my mother fell. She called me from a hospital in Newark. The call came at two-in-the-morning. She sounded groggy when she asked me to bring her a box of tooth powder. By this time I was living on Long Island. I drove to the hospital. Her face was bruised and swollen from the fall. She wanted the tooth powder to hold her dentures in place so that she would look good. I stayed with her for a little while and then drove home and went to work.
My father died in the same hospital where I was born. I slept in my dad’s hospital room for several days before I watched him take his last breath on a late Sunday afternoon in May. And, then I drove back to Long Island, to a neighborhood where there are stores that I can walk to, just around the corner from where I live.
Published in the Long Island based Anton Newspapers in April / May 2010.
by Andrew Malekoff © 2010
I have been writing this column since February 2007. Although I try to make points to be helpful to parents and other community members that care about kids, sometimes I think what I make are “rounds” that are less hard-edged and softer than points.
My reflections in this month’s column don’t unfold in a straight line, rather in a circular and pattern. I do not think that my memories are remarkable. They are made up of a combination of milestones, transitions and random, mundane associations. I am not sure if they will have universal appeal. I will leave that for you to decide.
I was born in Newark, New Jersey on May 14, 1951. In my early years I grew up in a second floor flat in the same neighborhood where author Philip Roth once lived. The best thing about where I lived was that there were stores around the corner. Among my favorites were a bakery, candy store, luncheonette and a burger joint with a pinball machine.
My grandfather Joe was a carpenter who emigrated from Russia. He lived with us for a few months. He lost an eye in an on-the-job accident. It was replaced with a glass eye that he removed from time to time to show to me. He once mistook a box of Spic ‘n Span, a cleaning product, for a box of Wheatena oatmeal. The boxes were similar in size, rectangular shape and orange color. As a result of the mix-up, a pot of boiling water and cleaning powder overflowed and flooded the kitchen with soap suds.
My other grandfather Harry was a tavern owner who came to the U.S. from Poland. He had diabetes and two prosthetic legs that I once saw him take off and put on. I often wondered what fake parts I would have when I got older.
My aunt Rose, my dad’s younger sister, told me a story about when my mom and dad first met. The two families planned a get together at my mom’s house. I found out that my dad’s family was worried because Grandpa Joe slurped his soup. Aunt Rose told me that, although they were poor, they did not want to appear to be low class. When the soup was served they held their breath waiting for Grandpa Harry to start. He slurped too. Everyone was relieved and, well, the rest is history.
We moved to a suburb of Newark called Maplewood when I was 10-years-old. It happened fast and without any warning. There was a moving truck one day and the next day my younger brother and I were sleeping in a new bedroom where we heard crickets outside the window. No one consulted me about moving. I left all of my friends behind and had to make new friends.
In the suburbs I rode my bike everywhere since there were no stores around the corner. My father, Izzy, took over the tavern after Grandpa Harry died. The tavern was called the P.O.N. which stands for the Pride of Newark. One day someone set the P.O.N. on fire. Some years later there were race riots in Newark. I did not see my dad that much in those days.
My mother, Evelyn, started her own business when I was in junior high school. I didn’t understand. I later learned that it was to help pay the bills. She was an antiques dealer. In time she opened her own store. The sign on the store read: Antique Evelyn. That is what she was known by for the rest of her years.
My parents died in the 1990’s after at least a decade of serious health problems.
My father had multiple myeloma and my mother had heart disease. During my earlier childhood years my parents each smoked three packs of Camels every day. Sometimes they sent me to the store to buy them for twenty-five-cents a pack.
One day in the early 1990’s, when her health was failing and she was living alone, my mother fell. She called me from a hospital in Newark. The call came at two-in-the-morning. She sounded groggy when she asked me to bring her a box of tooth powder. By this time I was living on Long Island. I drove to the hospital. Her face was bruised and swollen from the fall. She wanted the tooth powder to hold her dentures in place so that she would look good. I stayed with her for a little while and then drove home and went to work.
My father died in the same hospital where I was born. I slept in my dad’s hospital room for several days before I watched him take his last breath on a late Sunday afternoon in May. And, then I drove back to Long Island, to a neighborhood where there are stores that I can walk to, just around the corner from where I live.
Published in the Long Island based Anton Newspapers in April / May 2010.
“Will all parenting experts please leave the room!”
“Will all parenting experts please leave the room!”
By Andrew Malekoff © 2010
“We have a new word in our lexicon – parenting. The word refers to what I call the technology of being a parent. The increased usage of the term is most unfortunate, and I avoid it wherever possible.” So says La Jolla, California psychologist Richard Farson in his new book, “Will all Parenting Experts Please Leave the Room!” (Western Behavioral Sciences Institute: http://www.wbsi.org/farson/books.htm).
In my unvarnished view of parenthood, it is less a well-posed, still-life portrait and more a roller-coaster ride; harrowing yet fun, with unexpected twists and turns, ascents and descents. You experience anxious anticipation and vertigo-inducing surround-sound. Sometimes, however, it is not so exciting - more like a crawling commute in rush- hour traffic, enervating, meandering, puzzling and endless.
As many of us know, parenthood can bring confusion, misunderstanding and doubt. This is an inescapable reality for most parents. Parenthood is rarely neat. It is more abstract than still life, more jazz than classical. Yet, according to Richard Farson, there is a myth that one can learn parenting techniques and all will be good.
Many times parents feel helpless because their kids make noise and move about, laugh and have fun at what feel like the most inopportune times. Raw parenthood looks like it just crawled out of bed; it is a half-eaten slice of pizza, a shirt hanging out, a chair leaning back, a runny nose, mismatched socks and a dripping ice cream cone. And there are moments when it can also be compared to a sunset. Parenthood is an adventure.
At times, parents feel ashamed and apologetic; and yet, the unspoken message from the “experts,” according to Farson, is that “somewhere there exists a person, an expert, who has it all figured out and knows how [be a perfect parent]. No wonder parents feel vaguely incompetent at the very time they think they are acquiring helpful information.” Farson offers readers a fresh, if controversial, view on the absurdities and paradoxes of parenthood, in the face of a consistent downpour of advice on what has come to be known as “parenting.” For example, he says, “Most parents love their children. Most would die for them. Paradoxically, however, as a society we do not honor or respect or even like our children. We indoctrinate, patronize, ignore, mistreat, segregate, dominate, prohibit, compel and incarcerate them.”
Among his riffs is one on the myth of quality time and the belief that how much time we spend with our children is less important than how the time is spent.
Farson reasons that genuine quality time should not be measured in discrete bursts of undivided attention. Quite the contrary he says, “It is the time when you don’t have to do anything with your child, when the child simply knows that you are around and available. It is taking comfort in the simple awareness of each other’s presence. It is allowing yourself to be angry with your child, in the knowledge that there will be time to get over it and make up.”
His advice about the myriad of books on how to have quality time with your children is to ignore them. My advice: don’t ignore Farson’s book. It will make you scratch your head. It may even make your head hurt and make you feel angry. At just 107 pages, and, with such chapter headings as “Parenting is Impossible” and “Don’t Pity the Latchkey Children,” this anti-parenting parenthood book is a must read.
And, if you are really looking for a headache, you can then read Farson's “Will All Marriage Experts Please Leave the Room!”
To be published in the Long Island based Anton Newspapers in May 2010.
By Andrew Malekoff © 2010
“We have a new word in our lexicon – parenting. The word refers to what I call the technology of being a parent. The increased usage of the term is most unfortunate, and I avoid it wherever possible.” So says La Jolla, California psychologist Richard Farson in his new book, “Will all Parenting Experts Please Leave the Room!” (Western Behavioral Sciences Institute: http://www.wbsi.org/farson/books.htm).
In my unvarnished view of parenthood, it is less a well-posed, still-life portrait and more a roller-coaster ride; harrowing yet fun, with unexpected twists and turns, ascents and descents. You experience anxious anticipation and vertigo-inducing surround-sound. Sometimes, however, it is not so exciting - more like a crawling commute in rush- hour traffic, enervating, meandering, puzzling and endless.
As many of us know, parenthood can bring confusion, misunderstanding and doubt. This is an inescapable reality for most parents. Parenthood is rarely neat. It is more abstract than still life, more jazz than classical. Yet, according to Richard Farson, there is a myth that one can learn parenting techniques and all will be good.
Many times parents feel helpless because their kids make noise and move about, laugh and have fun at what feel like the most inopportune times. Raw parenthood looks like it just crawled out of bed; it is a half-eaten slice of pizza, a shirt hanging out, a chair leaning back, a runny nose, mismatched socks and a dripping ice cream cone. And there are moments when it can also be compared to a sunset. Parenthood is an adventure.
At times, parents feel ashamed and apologetic; and yet, the unspoken message from the “experts,” according to Farson, is that “somewhere there exists a person, an expert, who has it all figured out and knows how [be a perfect parent]. No wonder parents feel vaguely incompetent at the very time they think they are acquiring helpful information.” Farson offers readers a fresh, if controversial, view on the absurdities and paradoxes of parenthood, in the face of a consistent downpour of advice on what has come to be known as “parenting.” For example, he says, “Most parents love their children. Most would die for them. Paradoxically, however, as a society we do not honor or respect or even like our children. We indoctrinate, patronize, ignore, mistreat, segregate, dominate, prohibit, compel and incarcerate them.”
Among his riffs is one on the myth of quality time and the belief that how much time we spend with our children is less important than how the time is spent.
Farson reasons that genuine quality time should not be measured in discrete bursts of undivided attention. Quite the contrary he says, “It is the time when you don’t have to do anything with your child, when the child simply knows that you are around and available. It is taking comfort in the simple awareness of each other’s presence. It is allowing yourself to be angry with your child, in the knowledge that there will be time to get over it and make up.”
His advice about the myriad of books on how to have quality time with your children is to ignore them. My advice: don’t ignore Farson’s book. It will make you scratch your head. It may even make your head hurt and make you feel angry. At just 107 pages, and, with such chapter headings as “Parenting is Impossible” and “Don’t Pity the Latchkey Children,” this anti-parenting parenthood book is a must read.
And, if you are really looking for a headache, you can then read Farson's “Will All Marriage Experts Please Leave the Room!”
To be published in the Long Island based Anton Newspapers in May 2010.
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