My Young Invincible, His Lost and Found Toe, and University Health Insurance That ‘Technically Isn’t’

IMG_1225 - Version 2Last fall I wrote about my 26-year-old son who lost his right big toe in a freakish university gym accident a day after his student health insurance officially took effect. (See my blog post Young Invincible Health Insurance Saga 10-5-13). He had aged out of my university job-based health insurance three months before and, much to my consternation, had ‘gone bare,’ unable to afford any of the health insurance plans available to him at that time. He signed up for the University of Washington’s School Health Insurance Plan (SHIP) as soon as he started in a graduate program there. As I drove him to the (University-affiliated) emergency department with his (found) toe, and then as a wonderful physician cheerfully sewed it back on, I breathed a huge sigh of relief that his SHIP would at least cover most of the cost.

Although, on second thought, as I wrote then:

“Even though he officially has health insurance to cover his expensive ED visit (X-rays, sutures, IV Vancomycin, physician quips) and ortho follow-up, I do not trust it. There are pages upon pages of exclusions to his health insurance plan, including bungee-jumping and intercollegiate sports–neither of which would seem to apply to losing a toe in ballet/karate. But I know how crafty and devious health insurance companies can be in trying to deny medical claims. I would hope that the university where I am employed and teach (and where my son is now a student) would have a decent health insurance plan option for its students. I guess I’m about to find out.”

And now, almost seven months later, I have discovered a very surprising answer: his university health insurance ‘technically isn’t health insurance.’ Silly us for assuming that something called a ‘Student Health Insurance Plan’ offered through a major U.S. public university was really health insurance!

This was explained to me today by a nice young representative who answered the phone at LifeWise, the insurance company that underwrites and administers University of Washington’s SHIP. I called to ask (nicely) how it was that they could still legally include a pre-existing condition exclusion since ACA/Obamacare requires insurance companies to cover people with pre-existing conditions (including the ‘pre-exisiting condition’ of being a woman, for which insurance companies charged more). I had done my homework on this, reading the user-friendly Healthcare.gov website to find that there was one exception to this rule: the benignly named ‘grandfathered individual health insurance plans.’ I wanted to know how SHIP could possibly qualify for this ‘grandfatherly’ exception category, and if they did, why they didn’t include that statement clearly in their information brochure as mandated by the ACA. LifeWise has hassled my son to prove that his torn off toe wasn’t a pre-existing condition and has refused to pay for some of his other healthcare claims.

The LifeWise representative’s answer was that they weren’t a grandfathered plan, but that they didn’t have to follow many of the ACA mandates because ‘technically this isn’t a health insurance plan, it is a disability plan.’ Huh? She went on to explain that the fine-print ‘Note’ clause on the front page of their consumer brochure ‘clearly states this.’ I had the brochure on the screen in front of me and sure enough, right under the large purple banner/title “University of Washington/ Seattle ‘SHIP’ Student Health Insurance Plan” it has a teeny tiny “Note:This coverage is blanket disability insurance. Coverage provided is “excess” only and does not contain a “coordination of benefits” provision.” 

That is so (not) clear and transparent for any self-respecting university-attending Young Invinsible, not to mention their University Professor parent who, oh I don’t know, perhaps has a doctorate in health policy? Now I happen to have both ‘real’ health insurance and ‘real’ disability insurance through my university job and I know the difference between them.When I asked the LifeWise representative to please explain how SHIP was really S-DIP I suppose, she replied that she really couldn’t explain it: “of the hundreds of different insurance plans I deal with, this is a unique policy.”

Unique indeed. How can a university (‘my’ university no less) offer what it clearly labels ‘student health insurance’ when it isn’t really health insurance and therefore doesn’t have to comply with current ACA mandates? What will it take for our country to get a saner health care system?

 

Red Lineage Project and Community Workshop

Red Lineage Wksp Flyer

Natasha Marin sent me information on this way-cool poetry/identity/advocacy (how I would describe it) project. They are offering a Seattle-area free workshop this coming Saturday 4-26-14 (details below).

Take a look at their project video and make sure to stick with it past the first minute or so of what I would call the opening. The different people reciting their poetry pieces are quite powerful. It reminds me of the writing prompt I use quite often: ‘Tell me the story of your name.’ It brings out a surprising amount of complex self-identity and heritage issues. If you can’t make it to their workshop you can still participate remotely by creating your own Red Lineage online. Note that in this project everyone is Red, “invoking the metaphor of bloodline and illustrating our connectedness as a whole.”

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The Red Lineage is an original poem by Cave Canem poet and fellow Hedgebrook alum, Natasha Marin, adapted to allow inclusion of multiple voices and viewpoints. Since it’s inception in 2006, hundreds have added their voices to this multimedia, multilingual, collaborative poetry project. This project is supported in part by the City of Seattle’s Office of Arts & Cultural Affairs.

See project video here.

Workshop Goals

The Red Lineage Community Workshop aims:

- To offer members of the community of various ages and backgrounds, who might not consider themselves to be poets, the opportunity to succeed and be validated as they explore their family history by creating a unique Red Lineage poem using the adaptable “frame.”

- To document, record, and otherwise capture these new metaphoric branches of the Red Lineage tree using photography, video, and audio recording equipment.

- To perform a choral recitation (group reading) of the Red Lineage poems generated during the workshop using voice and movement.

Relevant Details

Saturday, April 26, 2014
2:00 – 5:00 p.m. Red Lineage Community Workshop
Northwest African American Museum
(2300 S Massachusetts St, Seattle WA 98144)

Please bring snacks and something to write with/on.

Selfie-Healthy Health Care

IMG_1897 - Version 2What does Obamacare/ACA mean to me in terms of my personal health care now that the 2014 roll-out is officially in place?

I have the same job-based health insurance through the same health insurance company that I’ve had for the past two decades. I’m sure that they have continued to raise my deductibles and co-pays this year as they have in most years, but, truthfully, I have ceased to pay much attention to those details.

The biggest change that certainly has gotten my attention was a recent mailing I received with the following highlighted in bright orange: “Premium surcharges and a wellness incentive are coming! Take action on the four steps below.” I knew these were coming and had already taken their wellness survey back in December just for grins (see blog post My New Year’s Resolution: Avoid Wellness Programs, 12-30-13). As the blog post title implies, I had planned to ignore this Big Brother naughty or nice-style intrusion on my sense of privacy, but then I read the next highlighted item on the mailing: “What happens if I don’t respond…?” Answer: I’d start being charged a $25 per month tobacco use surcharge (even though I am a never smoker) and I’d forfeit a $125 reduction on my 2015 medical deductible. Opting out this year would cost me $425. The ACA/Obamacare allows employers to offer larger health/wellness incentives, up to 30% of the cost of coverage, so my health insurance company could hike up these ‘incentives’ (penalties?) considerably in the future.

Begrudgingly, I signed onto their website to attest to not using tobacco products. Then I chose a primary care provider (who I haven’t seen in two years because she is too popular/busy/on her way to becoming another burnout statistic). Then I had to re-take their silly, non-evidence based health assessment. It still tells me I need to stop eating a high-fat diet when I’m a vegetarian. Finally, I registered for one of their wellness program activities: doing at least 90 minutes of moderate to vigorous physical activity per week for at least 10 consecutive weeks. Walking, swimming, cycling, yelling profanities at my health insurance company and our health care system…..Great. OK. Go away you silly premium surcharge/personal wellness incentive that raised my blood pressure!

Just when I thought I was done with all of that for the year, I got an e-mail invitation from my insurance company inviting me to enter a HealthieSelfie photo contest on their Facebook page. All I have to do is ‘snap a selfie’ of my wellness goals and send it to them, to what? share with all their other selfie health care absorbed health plan enrollees? The ultimate of (flat, fit, no flab allowed) navel-gazing healthism? An example of medical sociologist Deborah Lupton’s imperative of health? A fun, harmless, effective way to use social media to promote personal health (and thereby enable the health insurance company to reap more health plan profits)? Yes to all of the above.

Having never taken a selfie before, my first attempt resulted in a photo of my thumb. I find deep symbolism in that. The photo here is my second attempt, and shows me ‘doing’ my 2014 selfie-wellness goal: Less time trying to figure out our crazy health care system and more time in my garden playing with my Corgi.

What Do You Think of Obamacare?

DSC01678Besides having a severe case of jet-lag and change-of-hemisphere-lag upon returning to Seattle from New Zealand, one of the more disorienting re-entry issues I’ve encountered this week has to do with our health care system.

While in New Zealand for three months, one of the top questions I was continually asked (right after ‘How do you like New Zealand?’ Answer: ‘I love everything about it except your crazy roads and drivers!’) was, ‘So what do you think of Obamacare?’ My answer was, and continues to be, ‘Good and bad things, but it’s at least a step in the right direction.’

New Zealanders, along with citizens of all other industrialized countries, don’t understand how we Americans tolerate our crazy health care system. Consistently, New Zealanders I spoke with told me they don’t ever really think about health care, and especially not about health insurance. They pointed out that their choice of jobs isn’t tied to health insurance coverage. They have guaranteed basic health care coverage for all citizens, or ‘universal health care,’ through their Ministry of Health. People in New Zealand have the option of purchasing additional private health insurance to help speed up access to things like hip replacement surgeries, but it’s mainly affluent older people who take that option. New Zealand has a centralized national pharmaceutical agency, Pharmac, in order to keep drug costs down. U.S.-based large pharmaceutical companies continue to try and block Pharmac. And they have a national, comprehensive, no-fault personal injury coverage system, the Accident Compensation Corporation (ACC), that covers New Zealand residents as well as visitors. ACC also covers instances of medical malpractice/liability: people in New Zealand cannot sue their health care providers or hospitals.

In terms of life expectancy, in the Health Olympics, New Zealand ranks #16, coming in just after the Netherlands. The U.S. ranks #34 right before Qatar. According to a 2011 Commonwealth Study (The US Health System in Perspective: A Comparison of Twelve Industrialized Nationsby David Squires), New Zealand spends almost one-third less per person on health care than we do in the U.S. ($2,683/person/year versus $7, 538/person/year). Obviously, New Zealand is a much smaller, less diverse country than the U.S., and no health care system is perfect, but their health care system blows ours out of the Pacific waters.

It is interesting to note that the (Republican) Harvard Business professor Michael E. Porter’s new Social Progress Index of overall livability ranks New Zealand No. 1, and the U.S. No.16 (and he ranks the U.S. No. 70 in health). See Nicholas Kristof’s NYT op-ed piece We’re Not No. 1! We’re Not No. 1! (April 2, 2012).

The photo this week is of me on a home visit in Hobbiton, New Zealand. This is a community where hobbits manage to live very long and healthy lives, despite the fact that they have high rates of smoking and drinking and eating of high-fat foods. How do they do that?

The Intima: A Journal of Narrative Medicine

Cultural Safety: A Wee Way To Go

DSC01879 - Version 2DSC01418This week I had the good fortune of meeting with Denise Wilson, RN, PhD, a Maori New Zealand nurse and Director of the Taupua Waiora Centre for Māori Health Research at AUT School of Public Health and Psychosocial Studies here in Auckland. She talked about her work with cultural safety in New Zealand.

Like many indigenous peoples across the world–including our own in North America–Maori cultural conceptions of health and well-being tend to be much more holistic and less individualistic than mainstream Western ones. As Ms. Wilson explained, for most Maori patients she has worked with (clinically and in research), spirituality and connection with their land and extended family are the most important aspects of health. The Maori word for land, Whenua, also means placenta: it is what nourishes you. The history of colonialization, and being displaced from ancestral lands, have had profound negative effects on Maori health and well-being.

The term ‘cultural safety’ came from a Maori nursing student, Iriphapeti Ramsden (1946-2003), who in the early 1980′s stood up in class one day and asked something like, “We talk about patient safety, physical safety, and ethical safety, but what about cultural safety?” She was specifically referring to the difficulties Maori patients and their families (as well as Maori nursing students such as herslef) have within the Eurocentric health care system in New Zealand. These difficulties continue to contribute to New Zealand’s large health inequities and low representation of Maori nurses and other health care providers in the healthcare system. Ramsden went on to receive her PhD, developing the concept and practice of cultural safety. I discovered that Dr. Ramsden was part of the New Zealand feminist Spiral Collective, which ‘self-published’ Maori writer Keri Hulme’s book The Bone People after it was rejected by all major publishers. The Bone People, of course, went on to win the Man Booker Prize. One of my all-time favorite books, I assigned it as our New Zealand study abroad Common Book this quarter.

According to Denise, a culturally unsafe practice is “anything that diminishes, demeans, or disempowers the cultural identity and well-being of an individual.” A culturally safe or unsafe practice is determined by the patient and the patient’s family (another form of what we term in the U.S. ‘patient-centered care.’) Denise told me that a good ‘cultural safety’ question nurses can ask patients (and their family members) is, “What are things that are really important to you that we need to consider in your care?” Cultural safety includes an emphasis on self-reflection (and action) by the nurse in terms of understanding his or her own cultural and social attitudes that affect their care of patients and communities.

Cultural safety has been taught in New Zealand nursing programs for over twenty years. Since 1992 it has been a requirement for nursing and midwifery registration examinations. What started off as a bicultural focus (Maroi and Pakeha/non-Maori), has been expanded to include things like migrant status, gender/sexual orientation, socio-economic ‘class’ status, and disability. The concept of cultural safety has been adopted by regions in Australia, Canada, and the United States. Denise acknowledged the significant advances that have been made in New Zealand in terms of cultural safety, but she concluded with: “We do have a wee way to go.”

Cultural safety seems to have much in common with my favorite U.S. ‘cultural’ concept of cultural humility, which I have written about in a previous post. Cultural humility was developed as a concept by the African-American physician-nurse duo Tervalon and Murray-Garcia in their 1998 article, “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. (Journal of the Poor and Underserved, 9(2) 117-125. Since then, the practice and concept of cultural humility have been further refined. Cultural humility emphasizes: 1) a commitment to lifelong learning and critical self-reflection, 2) recognizing and changing power imbalances, and 3) developing institutional accountability. Take a look at the excellent 30-minute video Cultural Humility: People, Principles and Practices by San Fransisco State professor Vivian Chavez.

Even closer to (my) home of Seattle, the historical roots and “remnants of our unresolved past” of racism and classism are powerfully presented in Shaun Scott’s short documentary A Really Nice Place to Live. In the film, Shaun Scott points out that Seattle is a byproduct of White Western Frontierism. He references historian Richard Drinnon’s work on the ‘Metaphysics of Indian-Hating,” where Drinnon asserts that all of American’s domestic and international race and class dynamics can be traced back to our original interactions with our ‘own’ Indigenous peoples.

We all have a wee way to go in terms of addressing and redressing the effects of racism and classism and all the other ‘isms’ of the world.

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The first photograph here is of the friendly and informative staff at the Alliance Health booth at Auckland’s annual Pasifika Festival, which I attended this past weekend. The staff members were promoting community awareness and prevention of rheumatic heart disease. New Zealand has the highest prevalence of rheumatic heart disease of all industrialized countries, and the highest rates are among Maori. It is a result of untreated ‘strep throat’ and is considered a disease of poverty. One of their community-led ‘interventions’ was the creation of Mama’s House as a culturally-appropriate way to engage the Pasifika community.  “Knowing that mothers, sisters and aunties are the first port of call about all matters relating to family health and well-being. After all, ‘Mama knows best’.” It also happened to be International Women’s Day. (And I also had just played ‘Mama-Nurse’ for some of my students who had developed penicillin- resistant strep throat, resulting in some ‘interesting’ interactions with the New Zealand healthcare system, which–like our own–has ‘a wee way to go.’)

The second photo is an interactive game show called “The Survivors,” part of the Maroi section of Wellington’s excellent Te Papa Museum exhibition Slice of Heaven: New Zealand’s Twentieth Century History. As this photo shows, one of the decisions you have to make while playing the game is whether you (as a Maori young woman in the 1970′s) went to the shorter/cheaper nurse aid program or to the longer/more expensive (and heavily Pakeha/’White European’) program to become a Registered Nurse.

Green Beyond Death

indexThis is a shout-out to the work of a former nursing student of mine, Hunter Marshall. He is now a hospice nurse, as well as an environmental and death with dignity advocate, community activist–and a  talented writer! Check out his recent article “Dying to give back to the earth” in Waging Nonviolence (3-3-14).

Hunter told me that he is actively pursuing writing as a mechanism for continuing his patient/policy advocacy: “I particularly enjoy using narratives about individuals that intersect with larger policy issues.” Another rebellious nurse (and writer) in the younger generation warms the cockles of my older nurse/writer heart!