I’m not sure how I feel about it, but the hospital is making tentative plans to discharge my mother. This should be good news, right? The thing is, she’s not being released to go home – she’s not well enough. Instead, they’re making arrangements for her to be placed in an assisted living facility.

If my life had a soundtrack, something foreboding would be playing right now.

You may recall (or not, she’s not your mother) it was an incident at an ALF that precipitated her extended stay at the state hospital. My fear is this fits the national trend. We run out of places for the mentally ill, so we dump them in nursing homes, or something similar – places ill suited to care for them. The end result is something like what happened to my mother already – or worse, someone gets hurt – and the cycle starts over.

I’ll be happy to have her nearby, but not at the cost of her safety.

Maybe she has improved. Maybe an ALF really is appropriate now. I understand there are ALFs with some kind of certification to treat the mentally ill. I’m a little worried though. In this case, I don’t think it’s just me.

I want to be hopeful. I haven’t seen her in months, but others say she seems a little better – in some ways. Being closer will fix one of my problems (self inflicted though it may be) – the guilt I carry for not visiting enough.


Back on the healthcare rant

I love it when folks say: “I want my doctor making treatment decisions, not the government,” as if an insurance company never set treatment terms.

I loved it even more when our insurance company said they wouldn’t cover treatment for Beth’s Aspergers. Why? “Because Florida Law only requires us to cover treatment for Aspergers if it’s diagnosed before a child turns eight.”

Translation: “We wouldn’t cover you losers at all if it weren’t for those meddling, socialist pigs in government.

If you don’t like your insurance, you can just switch, right? I mean, that’s the beauty of the free market. How many of you have a job that offers a wide selection of insurance providers? No? Well, you could just switch jobs, right? Yeah, that’s the ticket. In this economy, finding another job should be no problem. Oh crap! That’s right. There will probably be a temporary exclusion of pre-existing conditions if you switch jobs and insurance (temporary – not permanent – because of those meddling socialists again).

Regulation isn’t sexy and it’s easy to pick on. The problem is, you never know when it’s working. There are few eureka moments where you learn a regulation kept you safe, healthy, or alive. Too often you don’t know they’re there until someone finds a bad one, a business ignores one (aided and abetted by a willingly blind, often Republican administration), or one doesn’t go far enough.

But isn’t regulation the opposite of freedom? Yeah, isn’t it grand when your insurance company is free to screw you over?

I wanted to say something really crude about protesting taxation with representation today… but I’ll hold off for now. I’m angry enough about the insurance thing. I could get myself in some real trouble with a double rant.


It’s all my fault

You don’t want to read this post. Why am I writing it then?


I have a theory for why I’ve been feeling down lately, and the title to this post is a strong clue. Since it’s apparent no one else is ever at fault for things that go wrong, the logical conclusion is it must be my fault. When everything is your fault and you accept responsibility – even if it’s just a small part of your subconscience doing the accepting – it’s really easy to hate yourself.

Take one guess where this is leading. Did you guess something related to healthcare or insurance?

A month or so ago, Cheryl went to have a procedure done. It required preauthorization from our insurance company (health insurance, if haven’t been keeping score at home). Before they did the procedure, Cheryl asked them if the preauthorization came through, and was told “don’t worry, it’s done.” Cheryl had the procedure done, along with two others under similar circumstances. Then we got a bill. Make that bills.

“So, why did we get a bill? I thought you all were submitting a claim to our health insurance.”

“No, we didn’t.”

“Alright, then submit it now.”

“We can try, but insurance will reject it. They require PREauthorization for this procedure. They won’t authorize payment after the fact. The bottom line is your insurance company won’t pay, and you’re responsible for services insurance doesn’t cover.”

“So you lied to us when you said you had taken care of the preauthorization.”

“No. I said no such thing. In fact, I didn’t even know you had health insurance.”

Brain cells screaming in agony from the abuse of high blood pressure suddenly running through nearby arteries….

“WHAT THE HELL are you talking about? I’ve lopped years off my life bugging you people about which insurance you were supposed to make the claim with, and now youre going to sit their and lie to me, or worse – imply I’m a liar? Check my file and tell me you don’t have a copy of my health insurance card.”

Unappologetically…. “Ah yes, I see we do have it. But you know, it’s your responsibility to see that procedures are preauthorized when it’s required.”

“But you’re supposed to submit the initial request…! (Fists clenched) So you’re telling me it doesn’t matter what you say, we should assume you didn’t do what you told us you’ve done… that we can’t trust anything you say? We should go on the assumption that you’re incompetent, to cover our ass?”

I’m not sure Cheryl really said that last bit, but that was the gist of the conversation. I kind of wish I was on the phone. I think it would have been good for my mental health to say it myself.

But here’s the thing: I know it’s our responsibility to verify those kinds of things with insurance. So all that anger I felt before has done a 180. I’m angry with them for not doing their job, but I’m also angry with myself for being such a rube.

Then there was yesterday. I got a letter from the good people at my health insurance company, saying they were not going to pay for my last visit with my oncologist. Why? He’s not “in the network.”

To truly appretiate this letter you have to understand two things. One: I’ve been seeing this doctor for two years – two years he’s been “in the network.” Two: my last visit was before all of the trouble Cheryl had.

On my last visit I had to meet with a “financial counselor” before seeing the doctor. This was when I found out my oncologist’s practice merged with another company. As the “financial counselor” put it: “the company doesn’t have a contract with your insurance provider to accept new patients, but they’re working with us to ‘grandfather in’ existing patients.”

That was news to the office manager who took my call yesterday, after I opened my letter. She didn’t know who I spoke to (I wish I did) but they had no such agreement with my insurance.

I started to say I’d been a patient for two years without any problems, and it would have been nice to know this before my last visit so I could have planned accordingly, but the nice lady interupted me after I got out the words “two years.”

“You do know you have an HMO, right?”

It’s possible I might have thrown the phone at her if we were sitting in the same room. My what a fucking presumptuous mouth you have. I know how the game works. I know I’m at the mercy of changing provider lists. I accept this trade off.

Mind you, I had this conversation with the doctor’s office after spending ten minutes trying to convince a customer service rep my oncologist had EVER been “in network.”

What I’m having trouble accepting is this evolving trend: I can’t trust a damn thing anyone says. Frankly, I feel betrayed. I trusted my doctor. I trusted his staff. A woman told me to my face that things were taken care of – when they clearly weren’t.

These things happen to everyone. It’s not that big of a deal. But with everything else, it feels like one. Trips to the mailbox feel like they merit hazzard pay. Integers with three digits qualify for an “only.” No one you speak to knows what they’re talking about. Insurance companies find every excuse to question claims. Playing go between for attorneys, insurance companies, doctors, therapists and hospitals becomes a full time job. Being sick or injured is beginning to feel like a secondary problem. I tell myself things could be a lot worse, but I’m a bad listener.

At the end of the day it boils down to me. I should have known better. If you think I’m angry with any of them, I’m twice as angry with myself.

note: I wrote this post a few weeks ago. By the time I finished, the tone didn’t fit my mood. As therapy, it worked. Now I’m hoping posting it will have the same effect.


Stray comment

I was having a good day. Everything was fine until I heard one stray comment. Do you have days like this? Can one or two sentences ruin it for you? I wish I could say I have the self assurance to shrug off what other people think and say, but it’s not me. Not at all. It sticks with me. It burrows and churns through my mind, infecting everything that follows.

“I don’t get it. This guy supposedly can’t work because he’s got bipolar disorder? What kind of bullshit is that?”

This was an opportunity to intervene. I could have spoken up. I could have defended this person – a stranger, circumstances unknown. I could have spoken up for all those who can’t speak up for themselves: people who know the cruel reality of severe mental illness. I could have spoken up for my mother, who can’t be left alone for more than a few moments in the hospital because she may hurt herself, who can no longer communicate rationally with the world outside the confines of her own mind, let alone live independently and earn a living.

My mother has bipolar disorder. That’s no bullshit. I’ll tell you what is though: the way we simultaneously stigmatize and dismiss mental illness. Could we be more cruel?

I shouldn’t ask that. Things can always get worse. Anyone who knows our history knows we’re capable of much worse. I guess I just wish more of us aspired to something better.

We’ve all heard how mental and physical illnesses are perceived and treated differently; from the disparities in insurance coverage to the sympathies of the public. Instead, let’s think about how similar they tend to be. They have biological causes. They have ranges of severity. Some people respond to treatment, while others don’t (many fall somewhere in between). Some treatments poison other parts of the body, causing further complications. Both can lead to the death of spirit, hope, and body.

You could watch a hundred people get thousands of colds over your lifetime, and never see one person develop life threatening pneumonia. Obviously that doesn’t mean it’s not possible. Yet someone can know one or two people with mild depression and think psychiatry is a scam?

Some of it has to do with plain old ignorance. That’s why I feel like I can’t sit still when I hear evidence of it – even when it’s just a throw away comment in passing.

And yet, that’s exactly what I did. I sat still. I let the comment go.

I wish I hadn’t. I’ve rationalized it since. It probably wouldn’t have made any difference. I would have sounded like one more fanatic from the fringe. Bringing up my personal experience would only prove my inability to be impartial.

Look ma! More bullshit.

What customer?

“What about our shareholders Bob? Who’s looking out for them?”
– The Incredibles

You know me. I love insurance. I love it so much I bought a bunch of it. We’re like that ice cream place that brags about all the flavors they’ve got. It’s a good thing too, because it’s coming in handy after Cheryl’s accident.

I know what you’re thinking, or I think I do. Well, maybe it’s just a hunch. Yeah, better call it a guess. I’ve been off my game lately. I’ll bet you’re a little suspicious, waiting for the switch to go with my bait. (My, what terrible bait you have.) I’m predictable that way.

The customer relationship is a little off in the insurance business. You’re only right as long as you’re not trying to get something for your money, besides a monthly/annual statement… or… brace yourself: a renewal notice. They’re down with the statement gig. Aren’t statements grand? I love statements. I love the way they file, so smooth with delightfully heavy paper that just….

Sorry. I should really keep that to myself.

Something happens to you when you need more than reassurance from insurance. You’re not really a customer any more. The industry term often used is leech, or rube; depending on the context, or wether they’re trying to be civil.

When you have more than one policy, even if you don’t think they’re related (or overlap), you become something else again: screwed. Company A wants company B to pay, due to Y coverage. Company B says they won’t pay because you don’t have any more Y coverage. You thought all along that company A would pay something – why else would you have X coverage? So you go back to company A, explaining that you don’t have any more Y coverage. They say “prove it.” You say, “I’m already responsible for the deaths of a thousand trees proving things to you people. Don’t you ever stop?”

They laugh.

You almost feel guilty for thinking bad thoughts.


And so it goes.

Sick of me writing like I flunked junior high English? (It was a D – and only that one time.) Here’s the deal. We have two insurance companies (more than that really, but stay with me): one for auto and one for short term disability. Neither one wants to pay for short term disability, despite there being no dispute Cheryl is ‘short term disabled.’ How fracked up is that? Sure, I can see auto’s beef. They’re only gonna let us get so fat on their dime. But come on disability… you don’t cover disability? Your policies are printed on some great paper, but it’s not that good.

I know one thing. You probably knew it already, but I’m slow. You’re foolish if you think anyone but shareholders are the real customer. Everyone else is just a prop in the show, or so it seems.

It’s not easy being a prop. How did we get here? Is it something we did, or didn’t do? Are there insurance companies* out there fighting on the side of good, who aren’t trying to bring down the dreams of freedom loving people everywhere?

*Although I’m in no mood for fairness, I must admit my health insurance company was fantastic when I was sick last year. Sanity and fairness can be a real downer sometimes. It will return in 3… 2… 1…

1 Comment

Adding insult and injury to injury

image59298627.jpgMany of you know Cheryl was in a car accident a while back. A few of you know about the mess physical therapy made of her injuries. Only Cheryl and I know about our most recent adverures in the mysterious world of insurance, so I gatthered up all my frustration and this post was born.

Way to grab you readers, eh?

A month back Cheryl went for another opinion, seeking to avoid immediate surgery. This opinion not only said the first was a bit rash, but the physical therapy she’d been getting was a textbook example of what NOT to do in her condition, likely making her pain worse.

It goes without saying we didn’t go back to that first therapist. The new doctor had her assistant make an appointment with a new therapist on the spot, while Cheryl was watching. With her mother as witness (hearsay though it may be), the assistant asked “you do take AvMed, right?” (We’re rapidly approaching the limits of our auto coverage.) The answer was allegedly yes, so she made the appointment.

That’s where the really cool part of this story begins.

Two weeks later we got a bill from the first therapist, “reminding” us they didn’t take AvMed, and we’d be responsible for approximately x amount after we reached our auto insurance limit. I didn’t mention this, but Cheryl asked if they took AvMed before going there. If you’re keeping score at home, that’s one aggravated injury and one false representation.

Then Cheryl has her first appointment with the new therapist, and has a wonderfull run of sessions. Then a new therapist takes over (at the same office), and Cheryl’s back in agony. It turns out the new gal isn’t big on chart reading. THEN, Cheryl meets with the receptionist, and she tells her they don’t take AvMed, and reminds her we’re running out of auto coverage.

Score – two injury aggravations and two false representations.

I’m no attorney, but I wonder if we should offer to forget any thoughts of civil liability for her condition if they’ll forget about the bills.


F…ing insurance

Warning! My potty mouth comes out of storage for this one.

We got the official fuck-off letter from the other guy’s insurance company the other day. I can’t say I wasn’t expecting it, but it was still a bit maddening. The dude had the minimum amount of insurance required by law, which apparently dates back to when a dollar was still a lot of money… back when change wasn’t spare.

If you know me at all, you know one of the issues I care about is healthcare. If you know my liberal leanings (my heart swoons for “social” medicine), then guess how much sense it makes to me to rely on someone else’s car insurance for healthcare. Accident attorneys are free to keep their comments to themselves. Yeah, our policy provides some coverage, and everyone is required to have a minimal amount of coverage to cover their own injuries (in Florida), but why should any part of the healthcare industry involve auto insurance? Maybe it makes a lot of sense to you, but it’s a fucking mystery to me. (No, not really – but it feels good to swear every now and again.)

I have this sneaking suspicion the health coverage from auto insurance is among the worst. If that’s true (it is in my case, but my situation may not be representative), I’d really like to know what percentage of healthcare spending is attributable to car accidents. Maybe that’s why auto insurance gets thrown in the mix. How much love do you think health plan administrators or employers (those folks that pay most of your premiums) have for the money losing, unpredictable nature of car accidents?

That would work out well, eh? Take a chunk of the system – possibly some of the more expensive parts – and outsource it to the hinterlands of auto insurance, where people are more likely to be un/under-covered, thereby footing more of the bill themselves. It’s a win-win for the insurance industry! Woo-hoo! Three cheers for private fucking insurance!

Yeah, some of this is sour grapes. We could have paid more for auto coverage so our health in and out of the car was equally protected. We could have paid closer attention when our manic agent on speed was going over the policy. When we read it, we should have asked more questions. Then we would have known “stacked” referred to more than the work at my office (or the hired help at a certain kind of restaurant). But here’s the question of the hour: why the fuck should we have to? Toss out the old “you’re not entitled to healthcare” line, and so help me….

Surely this is a system that isn’t ideal for doctors either. It’s like we’ve got two different healthcare systems – one for sick people, and another for accident victims. I’ll wager that doesn’t make the paperwork any easier. And it gets better. Most of the folks caring for Cheryl are holding the bills until the insurance company knows what the whole claim will be. Who knows when that day will come? In the mean time they’re eating their costs (and I’ll bet them are some tasty costs). And when judgement day finally comes (and we find out our share) at least one of us may need more healthcare.

It’s just one more fuck-you very much from the private (for profit) healthcare system.

Already heard the ads

Newsvine / AP:

Health care is returning as a campaign issue, with special interest and advocacy groups preparing to spend at least $60 million to push politicians to embrace universal access to medical coverage.

I’d like to believe this will be an issue this fall, but I have to think it’s a distant third on most people’s list behind the economy and war. If I could choose, I’d rather have it discussed next spring (though both is o.k. too).

Have pity on your health insurance company

I mentioned a Republican representative from our state legislature the other day, the one I heard on the radio. I kind of suggested he might’ve said something that made me a little mad; “pissed off” may have been the words I used. Well, if you don’t want to read a rant on Florida politics, now is the time to bail.

The Florida Legislature is in session for two months of every year, and has been in session for a little over a month now. That means I’ve been slowly grinding my teeth down to smooth, uniform stumps… for a little over a month now. It probably wouldn’t be a bad idea to invest in a mouth guard every spring, like the ones they wear in football. It’ll save me some grief with the dentist down the line.

But I digress.

I love to digress. Have you ever noticed that?

We’re having a little health care debate in Florida, in case you haven’t heard – and I’ll bet you haven’t. Our governor (last year’s winner in the Hooters’ George Hamilton look-alike contest), along with his pals in our legislature, have been hell bent on making health insurance more affordable in Florida. I say that like it’s a bad thing. I don’t mind paying less for the same thing, something nearly as good, or even something that’s good enough. I don’t think that’s what we’re talking about though.

Back to that Republican on the radio on Friday. He was calling attention to the suffering of our health insurance providers in Florida, saddled as they are with laws which make it mandatory to cover over fifty different illnesses and procedures. It’s amazing they can make any money in Florida at all.

Pardon my french, but boo-fucking-hoo.

If I know my party talking points, I’ll wager he even said something like, “we want the citizens of Florida to be able to choose the kind of coverage they want, not some bureaucrat in Tallahassee.” Not to quibble…. No, on second thought, I really do want to quibble. If it’s a law that makes insurance companies provide certain kinds of coverage, it’s not some unelected government bureaucrat calling the shots, it’s the elected representatives of the legislature and the governor. And given the state of Florida politics the last twenty years, it was probably a Republican legislature (with A BIG majority to boot).

(Full disclosure: I’m a bureaucrat.)

So stick that up your quorum.

Of the oft-cited illnesses and procedures we force our downtrodden insurance companies to cover, they (with a capital R) often mention organ transplants, and HIV treatment… like there’s something wrong with organ transplants and HIV treatment. Well, I dove into the law this weekend (something I don’t recommend, by the way) and found a few more things our communist manifesto (aka the Florida Statutes) mandates coverage for (all of which come from Chapter 627… I didn’t have the stomach to read any more):

  • A requirement for the continuation of coverage for handicapped children who remain dependent due to their disability (after they would otherwise be old enough to support themselves).
  • A requirement that maternity coverage must also provide coverage for post-delivery care (for the mother and baby).
  • A requirement that maternity coverage may not limit hospital stays to fewer days than is deemed medically necessary (either by guidelines established by the American Academy of Pediatrics, or the physician).
  • A requirement to provide diabetes coverage.
  • A requirement to cover the diagnosis and treatment for osteoporosis for at risk patients.
  • A requirement to provide coverage for newborn care.
  • A requirement to cover adopted children (in a family plan) the same as biological children would be covered.
  • Requirements regarding breast cancer coverage (may not limit hospital stays, must provide coverage for outpatient post-surgical follow-up).
  • A requirement to cover mammograms for women over 40.
  • A requirement that any policy that covers a child under 18 must provide coverage for treatment of cleft lip and/or cleft palate.
  • Limitations on the period of exclusion for pre-existing conditions.

That’s where I gave up. Reading through the Florida Statutes was even less fun than I thought it would be, but you can clearly see from my partial list (and the aforementioned requirement to cover organ transplants and HIV treatment) the law in Florida is completely unreasonable. What are we, a bunch of sobbing, sentimental pinkos?


Here’s the next thing my fine Republican friend said (who has no idea who I am): “We’re requiring everyone to drive Cadillacs in Florida, when most people can only afford a Chevy.” (Just in case I haven’t been clear, what they mean by that Chevy analogy is coverage that doesn’t cover as much stuff.)

Just so you know, from here on out I’m going to refer to “Cadillac coverage” as “good coverage” and “Chevy coverage” as “cheap” (with out the quotes).

Boy oh boy, I don’t even know where to start on that one. First, why is it that folks still go broke paying for health care despite their Cadillac coverage? (Sorry, I couldn’t resist a primo opportunity for sarcasm.) But that’s not even my biggest concern, or my strongest argument. (I’m losing more and more humility by the minute.) Think about insurance pools and their intended purpose: risk sharing. Think about who is more likely to purchase cheap coverage, besides the people who can’t afford good coverage. I’ll tell you who: healthy people. Hell, I don’t count on ever needing a mammogram, so there’s coverage I don’t need right there. If there’s one thing that Wal-mart has taught us, it’s that a lot of us, regardless of means, will buy the cheaper alternative – regardless of quality. Presumably more people would have insurance due to the lower prices, but will that offset the money pulled out of the pool by people opting out of good coverage, in order to realize savings in their monthly bills? Why is this even a problem? We stop sharing the risk of getting sick, that’s why.

What happens to the cost for that good coverage when only sick people are buying it? If overall we’re siphoning money out of the system by rolling healthy people into cheap coverage (more on that later), how does an insurance company make money on sick people? Simple: it raises their rates. It seems to me that sick people are the ones who are least likely to be working, or working at a high level of productivity, so they’re already the ones in the pool that are most likely to be priced out of good coverage. And what happens to the folks with cheap coverage when they get sick and find their insurance doesn’t cover them? How many employers that provide costly coverage for their employees now will decide on behalf of their employees to buy cheap coverage? We talk about having choice in our “free market” system of health care, but who’s really making the most important choices?

Anyone out there know what a positive feedback loop is?

In effect we have a kind of universal health care system now… paid for by those of us who have insurance. People who don’t have coverage (or insufficient coverage) tend to wait to get treatment because they can’t afford it, and our system won’t pay for it if they can’t – until it becomes an emergency (and much more expensive). That care isn’t free, but it’s hard to collect from a dead person who’s been too sick to work. So those of us who can pay for services ultimately bear the cost… many of us with the assistance of our good coverage. But now we’ll move a bunch of folks to cheaper coverage, betting on A LOT of people signing up who didn’t participate in the system before. But what if the additional people paying into the pool doesn’t offset the money lost by the folks already in the pool being rolled into cheaper coverage (either by their own choice, or by their employer’s)?

I’ll tell you what happens. We’re in trouble.

I desperately hope there’s a hole in my logic here, because this appears to be a done deal.

By the way, I’m sorry for rambling on and on. I know I’ve been a bit repetitive, but what decent rant isn’t? (Not one that’s at all cathartic anyway.)

Why is S-CHIP an issue?

An op-ed in the NYT discusses the big argument against expanding S-CHIP: that parents will drop private coverage in favor of S-CHIP (or substitution).

An Overblown Fear About S-Chip – New York Times:

New York estimates that only about 3 percent of the children enrolled in the program came from families that dropped employer coverage to obtain S-chip. Mathematica Policy Research, in a report prepared for the federal government, looked at states across the country and pegged the typical substitution rate at less than 10 percent.

Some critics of S-chip like to cite substitution estimates that are much higher. Mathematica found that so-called “population-based studies” estimated the substitution rate at 10 percent to 56 percent, depending on the approach and assumptions used.

The problem with these studies is that they assume that all parents that dropped or decided not to go with private coverage did so because of the availability of S-chip. They ignore other very possible circumstances, such as when families lose their private coverage because a parent dies or loses a job. These studies also take no account of whether a private policy, though theoretically available, was too costly to be affordable for a low-income worker.

Bush says it would be irresponsible to expand S-CHIP beyond it’s original intent, as the legislature has proposed. Me thinks Bush is the wrong person to be lecturing anyone about being responsible.

Just off the top of my head…
In 2000 and early 2001 (just before and after he was elected), George pushed big tax cuts with the stated intent of “giving people back their money,” due to large budget surpluses. What happened when those surpluses turned into large deficits shortly afterward?

In 2002, Colin Powell went before the U.N. to explain why it was necessary to remove Sadaam Hussein from power in Iraq, citing the need to destroy his advanced WMD programs. I wonder how that worked out?

Let’s see, what’s the worst that happens in these examples of “irresponsible” excess?

In the case of tax policy, the worst that happens is we ring up big budget deficits.
– Check!

In the case of foreign policy, the worst that happens is we destroy our credibility in the world, virtually print the terrorist recruitment flyers for them (the terrorists), get a bunch of people killed, and ring up huge budget deficts.
– Woo hoo… big check baby!

In the case of providing health care for poor kids without health insurance, the worst that happens is we add a few billion dollars to the budget (congress is asking for an increase that amounts to a fraction of what is being spent in Iraq), and a few more needy kids get health care.

Now that’s going too far.

Consider that the original intent of S-CHIP was to provide health care to poor kids who didn’t have health insurance; and the intent of the expanded SCHIP is to provide health care to kids a little less poor, who also don’t have health insurance. That’s not a big leap.

I remember when George was running against Al Gore, and later John Kerry. Both were famously chided for being “flip-floppers,” based on their changing views on certain topics. The Clinton’s were also occasionally brought into the discussion, pointing out an alleged patern of indecisiveness on the part of his Democratic opponents. What I’d like to ask you is this: what trait would you prefer in a president: someone who changes their position as circumstances change, or someone who invents new justifications (as circumstances change) for the same position? I’ve had a little experience dealing with people suffering mental illness, so I’m familiar with people who shape their perception (either consciously or unconsciously – creating justifications on the fly) to match their world view.

I would suggest to Mr Bush that in the case of S-CHIP, circumstances have changed. The ranks of the uninsured are on the rise, and many of them are our most vulnerable… our children. Many of them come from families known as the “working poor.” They have income, they own property, and they still can’t afford health insurance. My family makes considerably more than 4x the poverty rate for a family of four, and I can tell you that we could not afford the $1000/month premiums that an average policy would cost. I would further point out that it’s unlikely anyone would give us a policy at the average rate, due to our long list of pre-existing conditions. Hell, just having leukemia in remission probably puts a big, bold asterisk next to my family’s name. We’d be priced right out of the market – if anyone would give us a policy at all – if our employer didn’t provide coverage.

You can probably guess which way I’m hoping the vote goes in the House tomorrow.