Graveyard or Dumping Ground — You Decide

Most of the time, I write for money. Occasionally, however, I write for fun, or because I need to get something off my chest. Since I’m rarely able to publish these things, I’ve decided to share them here. I hope you enjoy these miscellaneous pieces, and I’d love to hear what you think of them.

State of Pain

There’s been a lot of fearmongering in the current debate over health care reform, and much of it makes me want to laugh and cry all at once.

Take the bit about rationing. Critics maintain that the Obama administration wants to ration our access to medical care, limiting the services we receive. This, we are told, would represent a gross infringement of our rights as healthcare consumers, and would prevent doctors from treating us as they see fit.

Really? So how would you describe a system in which health care is rationed based on income alone, rather than need or efficacy? Because that’s what we’ve got right now. And it has some pretty stark consequences, ranging from people who can’t afford any health insurance to those whose insurance doesn’t provide them with the care they need.

I fall into the latter category. I’m a freelance writer. My wife is a freelance musician. We have two small children. And we pay for our own health insurance.

We’re fortunate to live in New York, where the state works with insurers to help cover people whose incomes fall within certain limits. Simply put, we qualify for subsidized health insurance because we earn too much money to qualify for Medicare, but not enough to buy private insurance at market rates. This might sound like a sweet socialist deal, and we’re indeed grateful for the coverage we have; God knows we’re far better off than many of our freelance friends, most of whom have no insurance at all. But health care costs in this country are so insanely high that our subsidized premiums still eat up more than twenty percent of our income. And they go up every year, sometimes by as much as ten or fifteen percent. In the long run, that’s unsustainable. Yet despite its still-hefty cost, our coverage remains severely constrained.

I’ve been limping along, both figuratively and literally, with a variety of problems for the past several years, including recurring muscle and nerve problems in various extremities. My doctors would love to stuff me into an MRI machine to get a better look at what’s going on. They’d also like to get me into physical therapy and onto some potentially helpful drugs. Unfortunately, none of that’s going to happen. And the reason is simple: my coverage won’t allow it.

My health plan doesn’t cover physical therapy unless I have had surgery. And in a twist that Joseph Heller would appreciate, my insurer has repeatedly refused to authorize an MRI until I’ve completed a course of physical therapy. Meanwhile, we don’t have prescription coverage because… well, because we can’t afford it. We pay for whatever medicines we cannot go without — antibiotics, mostly — and skip the rest, hoping we’ll get better on our own.

So here I am, left to cope with chronic pain that makes it difficult for me to play with my children or to earn the middling income that got me into this mess in the first place. This is what people mean when they say that we already have healthcare rationing in this country: rationing based on income. There are treatments that might help me, but I don’t have access to them because (a) my insurance won’t pay for them, (b) I can’t afford the kind of coverage that would, and (c) I don’t have the money to pay for them out of pocket and feed my kids at the same time.

To all those who would argue that this is simply how things work in a free-market economy, I say: precisely. As in, this is precisely why healthcare cannot be left entirely to the tender mercies of the market.

My own problems are relatively minor. Many people who carry inadequate health insurance, let alone those without any insurance whatsoever, are looking at much worse scenarios. Someone who can’t afford to take care of her diabetes could lose a leg. Someone who can’t afford treatment for cancer or high blood pressure could lose a lot more.

Some kind of healthcare rationing is inevitable. A system in which everyone received every treatment they wanted without any controls or limitations would rapidly collapse under its own weight. But I’d much rather that rationing be more rational, and more humane; that it be determined not by the depth of a person’s pockets but by the extremity of their need, the efficacy of their recommended treatment, and the expert opinion of their doctors.

And I say this as someone who can’t afford to be sick, but can’t quite afford to get healthy, either.

Steal a Piece of the Rock

A couple of weeks ago, I was playing with my little boy while my wife was taking her life insurance physical at the dining room table. The visiting nurse was asking questions, and Ingrid was breast-feeding our baby as she answered.

“Well, my mother nearly had a stroke a few years ago, and her doctor put her on steroids, and now she has polymyalgia,” Ingrid said.

“Poly… myalgia,” I heard the nurse mutter.

“Oh yeah, and my doctor said that my fainting spells might have been caused by low blood pressure.”

“That would do it,” said the nurse.

By this time, I was on my feet and heading towards the laptop in our bedroom-cum-home office. Ingrid had her own laptop open in front of her in the other room, and I sent her a frantic e-mail, hoping she would get it before the nurse stamped the word “REJECTED” on her file.

“Subject: STOP OVERSHARING,” I hammered out “Everything is fine. You’ve never been sick, and neither has anyone else in the family. Ever.”

I could no longer hear the conversation, but I feared the worst. “Well, all in all, I’m pretty healthy,” I pictured Ingrid saying as she twisted a lock of hair around her finger. “Once a month — every few weeks, tops — I wake up and I’m blind, but it usually goes away by lunchtime. And sometimes I get these prickly sensations in my legs; you know, like pins and needles? But I shouldn’t complain. Most of the time, I can’t feel them at all.”

A few hours later, a small group of actuaries back at the home office would be adding a bunch of zeros to her premium. “What a shame — just years to live. And she’s a mom, too,” one of them would say, as he pasted tiny red flags all over her application.

Ingrid and I have long scrambled to maintain health insurance, first for ourselves, and now for our kids. As self-employed people whose bosses don’t pay much, buying into a regular plan has never been an option. Here in New York City, our premiums would run higher than our monthly housing costs — and around these parts, that’s saying something.

Our low earning power has had one benefit, however. As certifiably near-destitute individuals, we qualify for a couple of subsidized health insurance programs that New York State provides to people who are too poor to buy their own coverage but too flush for Medicare. So while we can’t afford to replace the cracked bumper on our 2000 Honda minivan, we can still have our blood tested and our children vaccinated.

When I say “qualify,” I mean that we have figured out what to tell the people who administer these programs so that they will keep us on their rolls. Mostly, this involves sussing out the secret formulae that the insurance companies and the state government use to determine eligibilty, while desperately trying not to say anything that might get us kicked off the island.

ME: “So, bearing in mind that this entire conversation is totally hypothetical and that I have never given you my name, how much would we have to pay each month if we earned more than, let’s say, $40,000 a year?”

HEALTH INSURANCE COMPANY FACILITATOR: “$2000.”

ME: “And how much would we pay in an imaginary universe where we earned less than $40,000 a year?”

HEALTH INSURANCE COMPANY FACILITATOR: “$200.”

ME: “So here’s the deal. We make $39,999. Do you need to have that notarized?”

We’ve never exactly lied about our financial situation, but we have learned to present ourselves in the most eligible light possible. Even so, we’ve had a couple of close calls, and the entire process makes us incredibly anxious. As a result, I’ve come to think that it’s best simply to say whatever it takes to keep us and our kids covered and out of the poorhouse – or the morgue. So when my finely tuned insurance-seeking antennae detected a potential eligibility implosion in progress, I leapt into action.

Of course, Ingrid didn’t get my e-mail until hours later, at which point it made no sense whatsoever. When I explained what I had been thinking, she rolled her eyes.

“She wasn’t writing any of that down,” she said of the nurse, with whom she had bonded long before I began eavesdropping on their conversation. (Kim is a grandmother with a bad hip, and her husband runs a pizzeria near the beach in Far Rockaway, Queens. Apparently, we’re all going there for a swim and a slice next summer.)

Still, better safe than sorry. Anyhow, I’m just proud that my wife –- and our kids -– are so incredibly healthy.

Preferred-rate healthy, if you know what I mean.

I Was Madoffed

I’m not exactly what you would call a high roller. I treat my wife to the occasional dinner out using the money I make selling used CDs on half.com, and every stitch of clothing our two kids wear was either gifted by grandparents or handed down from older cousins. So it surprises me no end to find that I’ve been Madoffed.

A few months before Bernard Madoff admitted to having bilked thousands of people out of $65 billion in the world’s biggest and longest-running Ponzi scheme — and long before we learned that he had a penchant for screwing at least some of his investors both literally and figuratively — I applied for a grant administered by an arts organization in my home borough of Queens. The Roger Madoff Literary Fellowship promised $10,000, a year-long residency at the Writer’s Room in Manhattan, and regular meetings with a mentor to help an “emerging writer” craft a “substantial” new piece of work.

I’m a little too old to count as an emerging anything, or to have much interest in acquiring a mentor; and as a work-from-home dad with hermit-like tendencies, I lack both the opportunity and the desire to haul my ass across the East River just to sit around drinking coffee with a bunch of other non-emerging writers. But that $10,000 sounded mighty appealing. I hoped to use it to write a memoir of the time I spent living in Ghana, West Africa; or, more precisely, I hoped to use it to buy diapers for my nine-month-old and graham crackers for my four-year-old while I wrote a memoir of the time I spent living in Ghana, West Africa.

So I filled out the lengthy application form — I have never before had to write an artist’s statement, and I hope never to do so again — cadged letters of recommendation from the two editors whom I thought were least likely to secretly hate me, and promptly forgot about the whole thing.

When news first began to leak out about Bernard Madoff’s financial hijinks, my first thought was: that name seems awfully familiar. When I finally figured out why, I wondered if my Madoff and that Madoff could possibly be related. And when charitable organizations began to report that their endowments had suddenly ceased to exist thanks to the collapse of that Madoff’s little caper, I began to wonder if I was about to get pantsed — financially speaking, of course.

So I wasn’t entirely surprised when I woke up one morning to find that I had received a Dear John e-mail from the poor chump who was administering the fellowship competition: “I regret to inform you that the Roger Madoff Literary Fellowship has been suspended indefinitely because of unforeseen developments regarding the funding of the fellowship. Applications for the 2009 fellowship will be kept on file for consideration if and when the program resumes.”

Turns out that Roger Madoff was not just a journalist whose life was cut tragically short by leukemia at the age of 32, and whose family decided to honor his memory by giving other writers a helping hand. He was also the son of Peter Madoff, Bernard’s brother. Given the way things have turned out for Uncle Bernie, I think it’s fair to say that both the “if” and “when” in that e-mail were wildly optimistic. My dreams of avarice had been dashed. Bernie had stolen my mojo, just as he had stolen that of so many others.

Now I’m not saying that I have as much cause for grief as those poor bastards who lined up at the courthouse to hear Bernie’s fake apology. (“I am deeply sorry and ashamed?” Please. If you felt that bad about the whole thing, you wouldn’t have mailed over $1 million worth of gold Rolexes to your family and friends after the criminal investigation had begun.) And I’m certainly not going to compare myself to Elie Wiesel, who lost everything — from his foundation’s funds to his personal fortune — in the Madoff whirlwind. Though I will say that, if there is a God, He must have a very strange sense of humor. What kind of sadist lets a Nobel Peace Prize-winning Holocaust survivor get taken for $37 million?

I can’t even claim, like Eric Roth, the guy who wrote the screenplay for Forrest Gump, to have been “the biggest sucker who ever walked the face of the earth.” (I guess life really is like a box of chocolates – if, rather than containing a luscious liquid center, each one of those chocolates is instead filled with a tiny nugget of poop. “Poop” being a word that I hear a lot of these days, thanks to all of the extra quality time I get to spend with my four-year-old now that I can no longer claim to be working on something new and substantial.) After all, I never actually invested a cent with Bernie.

But that’s the point. You don’t have to be a financier or a millionaire — hell, you don’t even have to own an IRA or a decent pair of shoes — to have been affected by the current round of financial frauds and panics. You just have to have a pulse.

We’re all suffering, to one degree or another. Bernie liked to tout the exclusivity of his investor’s club, but as we now know, that was just another lie: he roped in thousands of suckers. Big fish, little fish, Bernie feasted on them all — just like the banks that sold loans to anyone who could sign their name, and the insurers that wrote credit default swaps for anyone who asked.

Fortunately, I have found many ways to occupy the time that I would otherwise have devoted to that memoir. For example, I’ve spent way more time than usual babysitting for my kids while my wife has gone out to hustle additional work as a freelance musician. I have spent long hours online, obsessively researching several pieces of consumer electronics that I can no longer afford to buy. (Hey, that handheld digital recorder would be deductible, baby.) And I have written this essay, which, if sold to an actual publication, might even help me recoup a percentage of my loss equivalent to that which we can all expect to get back from AIG, Citibank, and whoever else Congress next decides to toss a few billion.

So I was Madoffed. Who wasn’t?