Sunday, June 25, 2017

Catastrophe is generally unplanned

In innocently mentioning to a friend, who is a Physical Therapist, the prognosis of a foot thing I have been dealing with, she said to me “Lesley, do you really want to know why you can’t get a diagnosis on your foot”  Well, of course I do so I said, “Yes”.  She told me it is because they have to treat all the Medicaid and Medicare patients for about $17.00 a visit. (that is the PT reimbursement I don’t know what the physician visit is)  That in order to make enough money as a provider, they have to treat more patients, often overlapping visits, and doctors and therapists don’t have the time to sit with you to determine the full diagnosis of intermittent and transient symptoms.  I said, “My visits cost me a $75 copay as well as the $200.00 the insurance company paid.”  She became adamant and said, it was because of the Medicaid patients that I had to pay so much.  We were at a party, I didn’t want to go into this any farther and quite frankly, I had to think about this and unpack both her anger and the facts. 

Cost of Reimbursement
I didn’t ask her what her solutions would be so my conjecture shouldn’t be connected to her.  Maybe she didn’t have a solution, maybe she was just frustrated with the increasing work load and changing regulations.  From what little research I did, I found the coding and regulations changed the end of the year and she is right the reimbursement is incredibly low.
I did two physical therapy visits at the previously mentioned charges ($275).  The first visit I was with the Therapist about 20 minutes and she did some strength and movement assessments, sent me some exercises by email and gave me an elastic exercise band.  The next appointment I went to the main exercise room which looked like a small gym.  I was instructed to warm up on the exercise bike for a few minutes while she finished her previous patient.  Then we went through some calf stretches, leg lifts, hip flexor machine, a foot rotating board which she asked me to do while she attended to a new patient who came in. She got him started on the bike.  When she came back to me, I was pretty frustrated because due to my “issue” I couldn’t do the foot board which she said something to the effect “oh, just do this…..”
”well, I can’t, that is why I am here…duh”.

 I left frustrated and of course, $75.00 poorer. (which they made me pay up front…smart)  None of that visit was satisfactory in any way.  I didn’t go back.  I joined a gym.  So I have digressed here somewhat. (Plus I will fully admit that I am sort of a nightmare patient… impatient and skeptical and a bit of a know-it-all)

I could see that the PT’s where having to balance several patients.  Some patients with far more serious issues were getting more attention and that was as it should have been.  I don’t know if they got reimbursed more for higher need patients but from the looks of most of the people in there…I was definitely paying the most and not a Medicare or Medicaid patient.  I don’t know why we have made the reimbursements so low, this shouldn’t be acceptable.  We, as the American public shouldn’t want that for our providers. 

I mean seriously, if you worked 8 hours and saw 16 patients you might bring in $272 for the day.  That is not enough to keep the lights on.  You definitely need me the insurance customer because you made the same on me as you did the entire caseload for the day!  Actually, I don’t know what the patient load for the PTs is, it could be even more.

I remember before the ACA a doctor said to me that we were already rationing health care by cost.  If you didn’t have the money and or insurance you were simply not getting care until it was an emergency.  I don’t think we want to get back to that because that isn’t ultimately cost effective.  But on the other hand we can’t expect doctors and therapists to work in areas with low reimbursement due to poverty when they barely can cover their costs:  building, staff, equipment, malpractice insurance and other health insurance for themselves and staff, and probably for time, college loans. 

So here is probably the “not” news;  Our insurance premiums are related to the low reimbursement of Medicare and Medicaid because those doctor fees the insurance companies are paying are necessary to offset the losses they are incurring due to the government squeeze. 

We need to cover everyone equally
I believe that my friend is compassionate and she wants people to have care if they need it.  However, not at great cost to her.
That is the $64,000 question; “What is great cost to each of us and how do we compute that?” I will just say that I do not have the ability to tease that magic needle out of the haystack.  I am just going to list some things I know.
            We need affordable healthcare coverage in what form, I am not sure
            When a person does not have reasonably regular checkups, things get missed.
Things get missed for long enough they have a tendency to become big things which are more complicated and costly to take care of.
Shit happens.  Yes, to the young and healthy as well.  Catastrophe generally means unplanned. 

Unlike buying tires, healthcare is a universal need.  You can choose to own a car but not your body.  I mean, here is a dystopian novel concept:  People who are injured in auto accidents and uninsured will simply be taken to a holding center (for sanitary reasons) until they are either picked up by a family member or die.  If there are any unresolved costs to their care, we can just begin harvesting organs….you only need one kidney, one lung, or one eye.  A slight hyperbole there for sure but what the heck!

I think there has to be some universal rate system.  I believe they do that in other countries that even have private insurers.  This is a hard problem, one that takes great care and we can’t allow our partisan division get in the way.  It is one of humanity.  Heaven help us.  

Thursday, April 20, 2017


Sometimes reflection takes me down a rabbit hole that I did not foresee.  I find myself in that position now.  I was approached as an artist to help with a program at Goodwood Museum and Gardens that was obtaining, on loan, the works of Clementine Hunter.  As I stumbled through the conversation, attempting to sound a bit enthusiastic for them, I thought “Who the heck is that”.  Sometimes people assume that because you are an artist you know about all artists throughout history.  I will admit that my knowledge in that regard is pretty slack.  I agreed to help, a bit, still not really knowing who she was.  Of course, once home I researched her. 
Clementine was a black painter born in 1886.  Her parents where slaves at one time.  They were still employed as field hands doing the hard work for the plantation in Louisiana.  In the 1940’s she and her family moved to Melrose Plantation in Natchitoches Parish, where she lived and worked as a cook and domestic.  As you know, the plantation life, with no free labor, was waning and Melrose was failing.   Carmelite Garrett Henry of Melrose brought it back to life as an artist colony where writers and authors stayed.  They encouraged Clementine to paint by giving her paints and supplies.  Thus her career began.  Her work is simple, untrained, and childlike but its simplicity tells the story of her and her people of the fields and community. 
So now you and I know who she was.  The “why” was that Goodwood wanted to present her work as a contrast to the art procured by the Arrowsmith’s of Goodwood, mostly Mrs. Arrowsmith.  This would be art of the Grand Tour. You know when all the well healed traveled Europe to play and buy things.   Well a small problem was that there is a bit of a time gap here.  The Arrowsmith’s owned Goodwood from 1886 – 1911.  They did furnish the house with lovely European art and objects. However, Clementine didn’t start painting until the 1940’s. Sadly, I don’t know that much had changed from her experience as a domestic and the 50 years prior when the Arrowsmiths owned the house.
I didn’t think too heavily about this at the time.  I just filed that away thinking that the board of Goodwood had thought this through and this was their program and it seemed like a good idea. European art contrasting with untrained art of an ex-fieldhand; you know, the haves and the have nots.  You might begin to see the problem here as I lay this out. 
Now, we know that in Tallahassee, just as now, and just as in everywhere else, there was a thriving middle class black community and there was an extremely poor community. There were those still providing domestic and field help to the large manor homes of the area…yes, they were still called plantations.  But here is one of the little itches under my collar, Goodwood doesn’t call itself a Plantation now.  They don’t like to use that word.  Granted, when you look at its long life from the 1840’s to today, it has not operated as a Plantation for most of that time.  It became a grand home, a hub of political and social activity and entertainment. Unfortunately, there is little historical data of slavery at Goodwood or conditions that the help lived in.  That isn’t really surprising because really it wouldn’t have been of much concern to write of anything distasteful.    
But here is the thing, all through this group of events, they did not address the lives of the domestics or field hands.  They did have one program that talked about the religious practice of hush arbors which was a way for slaves to quietly practice their religion as a mix of Christian and African.
 So you have to ask yourself how did we get Clementine Hunter here?  One of the co-directors knew the major collector.  That is all fine and good, her work has value as the story of her time and experience.  However, Goodwood has not addressed that at all.  That is my problem.  She was an interesting lady, no doubt, but really what does it have to do with Goodwood?  It was a stretch.  As a newspaper person once asked me. “What does this have to do with Tallahassee?”.  Not really a darn thing if you aren’t going to talk about the poverty, the back breaking labor, the community churches, the ways of life of Clementine’s time that where similar to the people here in Tallahassee working in the Plantations, farms, and homes. 

I don’t know, I just don’t see much celebration in the wide chasm between the haves and the have nots.  It is sort of like when they have the big real estate open house and the million dollar homes have the most traffic because who doesn’t like to see how the other half lives.  Goodwood is a beautiful home and has lovely tended southern gardens.  It has some interesting architectural elements but, yes, it is how the other half lived.  Maybe, they should just stick with that.  Even a large majority of their supporters come from the “have” side of things.  That is not that unusual in that that is where the money and time often is to participate.  But it all feels classist and it clashes in my mind with trying to pull some of the white privilege out in the open.  I could be overthinking this, as I said, a rabbit hole, but it is itchy.