California’s Real Death Panels

grim_reaperA new report from the California Nurses Association, “California’s Real Death Panels: Insurers Deny 21% of Claims,” shows a shocking — but not surprising — rate of denial of claims among California health insurers:

More than one of every five requests for medical claims for insured patients, even when recommended by a patient’s physician, are rejected by California’s largest private insurers, amounting to very real death panels in practice daily in the nation’s biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care — 22 percent of all claims.

Claims denial rates by leading California insurers, first six months of 2009:

  • PacifiCare — 39.6 percent
  • Cigna — 32.7 percent
  • HealthNet — 30 percent
  • Kaiser Permanente — 28.3 percent
  • Blue Cross — 27.9 percent
  • Aetna — 6.4 percent

“Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences,” said Burger.

PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.

No one should be surprised by these numbers. The practice of denial — the key to insurance company profits — is exactly what Wendell Potter, former executive with Cigna, has been shouting from the rooftops so relentlessly for the last several months.

If health care reform legislation does not include some method — such as the so-called public option — for curbing obscene insurance company profits, then it will not be true reform.

Better yet would be a single-payer system, such as Medicare, which could destroy the monopoly power of insurance companies.

Book Review — The End of the Long Summer

book_long_summerDianne Dumanoski, in her book, “The End of the Long Summer: Why We Must Remake Our Civilization to Survive on a Volatile Earth,” writes with great breadth and depth about what she calls the planetary era. Since the beginning of this era, in the middle of the twentieth century, it has become clear that man-made global climate change — and she doesn’t waste time trying to convince the deniers — is part of a deeper problem, the impact of human civilization on a whole set of planetary systems (species diversity; species abundance; nitrogen, phosphorous and sulfur cycles; fresh water systems, etc).

In its final days [the final days of Apollo 11], I watched Neil Armstrong step onto the moon again and again while I waited in vain to read or hear even a passing mention of the Antarctic ozone hole or recognition of the profound watershed in the human journey it symbolized — the arrival of a new and ominous epoch when human activity began to disrupt the essential but invisible planetary systems that sustain a dynamic, living Earth …

… In the second half of the twentieth century, modern civilization emerged as a global-scale force capable of redirecting Earth’s history. This fateful step marks a fundamental turning point in the relationship between humans and the Earth, arguably the biggest step since the human mastery of fire, which hepled launch the human career of dominion. The consequences are not limited to global warming,  nor are weather extremes the first evidence of our new status. Accelerating climate change signals a far deeper problem — the growing human burden on all of the fundamental planetary processes that together make up a single, self-regulating Earth. When future historians look back on the twentieth century, this quick visit to the moon will surely seem like a minor event compared to the giant leap humanity had taken here on Earth.

She cites the appearance of the Antarctic ozone hole as the beginning of this planetary era, and explains how that event might easily have been much more disastrous:

The human enterprise survived this first encounter with planetary systems thanks only to dumb luck, argues Paul Crutzen, who shared the Nobel chemistry prize with Rowland and Molina in 1995 for his pioneering work showing that nitrogen oxides from fertilizers and supersonic aircraft could damage the ozone layer. Had the problematic refrigerants been engineered not with chlorine but with bromine, a similar chemical and possible alternative, the world would have faced catastrophic destruction of ozone everywhere in all seasons and significant harm to land-based forms of life. In his 1995 Nobel acceptance speech, Crutzen explained that, atom for atom, bromine is one hundred times more destructive to ozone because it does not require unusual conditions for its activation. The rapid ozone destruction caused by CFCs over Antarctica, by contrast, depends on heterogeneous chemical reactions on the solid or supercooled liquid particles found in rare polar stratospheric clouds, such as those found over the South Pole in the total darkness of winter. “I can only conclude that mankind has been extremely lucky,” Crutzen concluded. “It was a close call.”

Dumanoski’s “Long Summer” is a work full of big ideas, and I must admit to a guilty pleasure: an infatuation with big ideas, no matter how (as in this case) dire.

In the end she achieves a tough hope, a hope earned through the difficult process of facing frightening truths, and seeing beyond them to some possible viable human futures.

Big Idea: “The Return of Nature”

Modern civilization has been built on mistaken assumptions, chief among them that in the past, climate has generally changed gradually.

“Abrupt climate change” Dumanoski says, ” … is not some theoretical possiblity. It has happened before, and happened repeatedly … The most mind-boggling insight from the ice cores is that rapid climate change is normal; it is the rule. When the Earth system changes, this is how it behaves.”

She explains the “long summer” in which we’ve been living, and what a freakishly unusual and mild period it’s been in Earth’s history:

The ice cores drilled from Greenland and Antarctica also tell us that we live at a truly extraordinary time within this long, volatile climate history, a rare period blessed with a warm and stable climate that has now lasted almost twelve thousand years. During a visit to the National Ice Core Laboratory in Denver, I sat for a long time contemplating a graph with a red line tracking temperatures in Greenland through the most recent ice age and the interglacial period we now live in — a period of roughly 110,000 years. This line surges like a roller coaster through great peaks and valleys of coldness for over a hundred millenia and then soars upward in fits and starts and reversals and renewed ascent to our own time, the long summer since the last ice age, known to scientists as the Holocene. Then the sweeping temperature excursions simply stop, and the red line settles into a dense scribble stuttering within an extremely narrow range of climatic possibility. The difference in this climate record between most of the time in recent Earth history and our time is positively stunning. It looks as if this immensely dynamic climate system had suddenly fallen asleep for the duration of the long summer.

“It is already too late to prevent global warming,” she says. But it’s not too late to do anything at all. And as a basis for hope, she points to the fact that the planet’s “fitful variability has helped make us who we are.”

Big Idea: “A Stormworthy Lineage”

Humans evolved in conditions of wild climatic variability and instability. “What has emerged from this instability is a versatile human species for all seasons and climes.”

She quotes Rick Potts, a Smithsonian researcher in human origins, as saying that our evolutionary pattern represents “the survival of the generalist” (not adapted too restrictively to any particular landscape niche, such as the Neanderthals were to narrow transition zones between grasslands and woodlands).

Humans are just one of perhaps as many as twenty upright-walking hominin species that evolved in the face of climatic oscillation and shifting landscapes. Our 5-million-year family history is in large part a story of extinction. Today humans are the sole survivors, the only member of this diverse family — which scientists long ago called hominids but have recently renamed hominins based on new genetic evidence of relatedness — to emerge from a brutal gauntlet of intensifying climatic extremes …

… The rising instability, particularly over the past 700,000 years, forged the very human talents that have allowed us to become a planetary force and an agent of crisis and instability. At the same time, however, this evolutionary legacy also gives me good reason to believe that humans can — with wisdom and luck — make it through the dangerous passage ahead.

Other big ideas I’ll leave it to you to explore:

  • Progressive externalization” of the brain’s developmental program (” a collaboration between biology and culture”).
  • Human culture as a nurturer of man’s survival, and also as “a manufacturer of crisis.”
  • Geo-engneering, the “temptations [and pitfalls] of technofix.”
  • Civilization’s growing complexity and increasing vulnerability.
  • Modern civilization at risk because of its dependence on stable climate, cheap energy and growth.
  • Globalization is contrary to traditional human evolutionary survival strategy, which depends on modularity and redundancy (a survivability strategy is often not the most efficient strategy).

The hope that Dumanoski speaks of at the end of the book is hard-headed, and does not ignore the possible desperate future we may be facing.

But she never doubts the survival of the Earth.

What’s clearly uncertain is the fate of the civilization man has built so profligately upon it.

Change We Can Laugh At?

Here’s my letter to President Obama today, via (modified slightly to include some useful links):

Dear Mr. President:

Robert Pear’s article — “Obama Aides Aim to Simplify and Scale Back Health Bills” — in the 09/02/09 New York Times, contains this paragraph:

“It’s so important to get a deal,” a White House official said, speaking on the condition of anonymity in order to be candid about strategy. “He will do almost anything it takes to get one.”

Please, Mr. President, understand that it’s more important to get real reform — reform that reduces the cost of health care — than it is to get just any deal.

The suspicion is widespread that the subplot in the whole health care debate has to do with preserving the source of financing (Pharma, health insurers) for the next election.

If that’s true, it would be tragic for all of us.

It would be better to suffer a defeat fighting for real reform than to achieve nominal success with a bill than makes a mockery of the word, “reform,” not to mention the phrase, “change we can believe in.”

Please, don’t give us change we can laugh at.

Roll With It (Group 3)

smooth_jazz Turn your audio up loud, then tell me this isn’t hot!

(Note: You can listen to this — the full track! — only a few times, because — I’m glad to say — they’re protecting the artists’ business here. Then you’ll get prompted to buy a subscription or a download, etc).

What Radical Left?

radical_leftI like Jeff Ackerman’s Op-Ed today in The Union, “Radical left and right are squeezing out the middle.”

Why do I like it? Not because I agree with all of it, or even most of it, but because it seems to be an honest list of what he believes, what he’s for and what he’s against, and that’s a subject of interest to a lot of people in our community who are often perplexed about the connection between what he believes and what appears in The Union. Of course, he continues to insist that there’s little connection between what he or anyone else at The Union believes — say, politically — and what appears in its pages.

I’ll leave it to others who are more skilled and who pay more attention to The Union than I do to assess that sunny claim. (Update: See Jeff Pelline on this very subject, here).

But I will say this, based on my modest experience: whether or not the editor’s beliefs govern the content of The Union, it’s clear they have a profound effect on the style with which that content is presented. Think of the now infamous mine vandalism story that appeared above the fold on the front page, as if it were today’s news … some five years or so after it actually occurred.

Who made that decision? And why?

Still, reading today’s Op-Ed, I felt some sympathy. I don’t like the whacko screamers either. I think they are a threat to what’s left of our democracy. I also feel myself — though a liberal/progressive — to be in the middle (because — while more people self-identify as conservatives than as liberals — polling clearly shows that most people agree with the positions that are traditionally considered liberal: universal health care, withdrawal from Iraq, taxing the rich, etc.).

Chew on that confusion!

I could argue in detail with many of Jeff Ackerman’s beliefs: I oppose the death penalty as public policy, but not as my rightful response to mortal threat. I’d go even further. My objection to the death penalty is not based on some sentimental bleeding heart fantasy that everyone is ultimately reformable. No, sorry folks, there are evil people out there whose immediate demise would be a tremendous boon to all of us.

The problem is that many supporters of the death penalty — like Jeff Ackerman — are also forever whining about how government can’t do anything right.

It’s deeply ironic that I — on the other hand — feel that government (the embodiment of We The People) often does many things right, but when it comes to the death penalty, it must do it perfectly, or else I won’t suport it. In my frame of values, the entire system of the death penalty is not worth the wrongful death of even one innocent person. Think of someone you love.

I have to admit, finally, that I only read Jeff Ackerman’s Op-Ed today because of the title (so, good choice of title!), in particular, the reference to the “radical left.” I thought, “Who the hell is the radical left?”

Maybe this reflects my age but as far as I know, the radical left — Trotsky, Lenin, Stalin, Groucho Marx, Che Gueverra — were all completely discredited sometime around the middle of the twentieth century.

Well, and to show you how confusing that get’s, the thumbnail I found of Che Gueverra to accompany this blog post, now that I look at it more carefully, could well be Benicio Del Toro!

Is Benicio “far left?” Give me a break!

Seriously, there is no viable far left in American politics any longer (you have to go to evil Europe to find that).

It’s only because we’re still living in the fading afterglow — like some sickening nuclear radiation that has rotted our brains — of the most radical far right administration in American history, that we allow our conservative commentators to get away with referring to someone as centrist as Obama as “far left.” I heard Monica Crowley say exactly that recently about Obama … Obama, who has gathered around him a stable of conventionally corporate types such as Geithner, Summers and Bernanke.

Most of the screaming and violence lately has come from the far right, which is still well and thriving in our political culture.

For conservatives to locate themselves in the mythical “middle,” it’s necessary for them to posit a “far left.”

That’s what Ackerman does in this Op-Ed, and that’s its chief weakness.

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