Link to Anderson Valley Advertiser:  www.theava.com

  As of last week more than 3.3 million Americans have signed up for private health insurance through online marketplaces under the auspices of the Affordable Care Act (Obamacare). California leads the nation with nearly 730,000 enrollees under its Covered California program. At the end of January Anthem Blue Cross led all other health insurers in the number of new Covered California enrollees, with Blue Shield of California only a percentage point behind.
     In November I reported on the relatively prompt service a local health care customer received when using the Covered California system. With telephone assistance from a Covered California representative, the consumer navigated the online application process with relative ease (in half the time that the site warned about). The Covered California system proved even more of a positive in the matter of cost. Through subsidies, based on income (not possessions or property owned), the consumer's monthly health insurance premiums were cut more than in half. With the same company and a slightly better plan, the consumer's premiums for the first three months of 2014 were $115 less than the premiums for the last two months of 2013 under the old non-ACA, non-Covered California health insurance.
     Now let's take a similar consumer fom Mendocino County, whom we will call The Patient. The Patient has also had a reduction in rates under Covered California and the Affordable Care Act. A month or so before signing up for the new insurance, The Patient went in to a local doctor's office for an annual physical.  A trace amount of blood came back in a urine test. A follow up PSA test, however, showed no prostate problems. An ultrasound more than a decade ago had disclosed a small to medium kidney stone, but The Patient had experienced no symptoms of passing a stone (Anyone who has had one or viewed Tom Hanks' character's excruciation in the opening minutes of The Green Mile can attest to the obvious nature of a kidney stone passing).
     The Patient's doctor recommended a visit to a Santa Rosa urologist. The Patient, feeling no obvious discomfort or pain, procrastinated through the holiday season and on into the new year of 2014. Finally, The Patient caved and called the urologist's office. The urologist's receptionist asked for The Patient's insurance info. The Patient responded with an ID number for his brand spankin' new Anthem Blue Cross plan. The receptionist added another question, "Is this a Covered California plan?"
     "Yes, part of it is subsidized through Covered California."
     "We're not accepting Covered California plans."
     Stunned silence, according to The Patient. The receptionist must have picked up on this, for she told The Patient that she would double check and get back to him. As of this writing, The Patient reports no "getting back."
     Next, The Patient called his local doctor's office to report the problem with the urologist's office. Guess who else isn't continuing to see Anthem Blue Cross insurees who have used Covered California? That's right, our Patient's local doctor. The same office that willingly saw The Patient last autumn, billed through Anthem Blue Cross, and received payment through the same company. The Patient asked the local doctor's receptionist what he should do? Where could he go under his Anthem, Covered California plan? The receptionist reportedly hesitated for several moments before reciting the name of a nearby clinic.
      On behalf of The Patient your intrepid writer checked with a Covered California agent, who stated that so many doctors are switching contracts with Anthem, Blue Shield, Health Net, and what not that Covered California has had to take down an internet page that identified which doctors (providers) were in which networks.
      Confusing? Imagine a truly incapacitated patient having to deal with all these switches. Eventually, The Patient decided it would be easier for him to switch to a Blue Shield health plan in order to stay with his local doctor. That plan, identical in detail to an Anthem Blue Cross plan costs roughly 15% more per month. This writer asked two different Covered California representatives why identical plans would differ in price. One could almost see them shaking their heads on the other end of the phone line. The first rep said that the price could vary geographically. Another said, "Let's hope this is all sorted out by next year."
     Mendocino County residents who have used the Covered California system would be well advised to double check on whether or not their local provider (doctor/nurse practioner/physician's asssistant) is still affiliated with the same insurance plan.
     And let's hope that 15% increase isn't a "kick back" incentive to physicians for contracting with Blue Shield over Anthem Blue Cross. Worse yet, let's hope it's not just another case of a big corporation skimming 15% of the profits right off the top of every health care bill.

                                                                                                         Link to Anderson Valley Advertiser:  www.theava.com

“This ain’t no place for the weary kind. This ain’t no place to lose your mind.” Those lines from the Crazy Heart theme aptly describe Mendocino County when it comes to its mental health system.

“There is no mental health in Mendocino County.” That’s what some professionals from local agencies that regularly interact with Mendocino County’s privatized mental health providers say when they meet with colleagues from around the state.

And yet in a late January press release Mendocino County’s Health and Human Services Agency (HHSA) had the unmitigated gall to state, “Six months after assuming the lead in reorganizing adult mental health services for Mendocino County, the Ortner Management Group is assessing the on-going transition with a sense of strong optimism."

Woe be unto the weary minded who live on the Mendocino Coast and need mental health care help. When Ortner took over adult mental health services last summer and made it be known that its coastal subcontract would go to those who run Hospitailty House in Fort Bragg, one mental health client who had encountered the leadership at Hospitaty House while homeless, immediately threatened to jump off the Noyo Bridge if sent there. Crisis care for such a person? More than six months into the privatization experiment and there is only one fully trained, full time crisis worker on the Mendocino Coast. Inside and out of the system, professionals will tell you that there must be at least two more full time, thoroughly trained crisis workers in Fort Bragg.

Tom Ortner himself, the CEO of Ortner Management Group (OMG) deigned to comment for the January press release. When asked about Ortner’s accomplishments during their first six months on the job, he said, “I would say that we have made some real progress in improving crisis services in the county. We now have Access Center locations situated in both Ukiah and Fort Bragg.”

What if you are somewhere between just needing help and crisis. With that in mind, last Thursday afternoon at 2 p.m. sharp I called the 964-4747 number listed inside the 2014 Fort Bragg/Mendocino phone directory. I found the number under “Mental Health Services” with subheadings for “Crisis-Suicide Prevention” and “Outpatient Services.” The woman who answered said, “Are you in crisis?”

I said, “No. I’m looking for the hours to the Access Center in Fort Bragg.”

Her first response sounded like, “Oof.” After a few moments hesitation she added, “I don’t know.”

When I said that the Access Center might be connected to Hospitality Center the woman gave me a 961-____ number that when dialed turned out to be the Hospitality House, the location that provides assistance for the homeless. A man answering the phone there gave me the number 961-0172. That did turn out to be the number for the Hospitality Center’s (I can’t be the only one confused by the similarity between Hospitality House and Hospitality Center) Access Center. Unfortunately, the Hospitality Center was closed. Apparently it is only hospitable for someone to walk into between 9 a.m. and 1:30 p.m.

So, I called the 800 number that is also listed in the phone book for Mental Health Services. I got the same woman who answered my original call. She is located in Ukiah. Again, her first words were, “Are you in crisis?”

I responded, “No,” and asked her how a person on the coast could access the mental health system since the Fort Bragg Access Center had closed at 1:30.

She replied that most trained staff seemed to be constantly “enroute” to somewhere, but gave me a number and a name, which turned out to be that single, solitary fully trained crisis worker. I asked further, what should be done with someone who does go into a mental health crisis situation.

“Take ‘em to the ER.”

That’s where we were last summer when Ortner took over. Law enforcement and hospital ER staff are still the first responders, the first crisis workers beyond friends or family or passerby, for most mental health clients in this county, especially anywhere outside of Ukiah.

Last summer I began writing about “Carole,” a fifty something Mendocino Coast woman. Her son, “William,” is in his thirties and often in mental health crisis. AVA articles chronicled William’s suicide threats, run-ins with law enforcement, and shuffling around the Ortner system from Yuba City to a short-lived placement in Willits in a locale that also houses elderly rest home folks, a walkabout back to the coast, more incarceration in the county jail, then a seemingly hopeful temporary conservatorship. The last meaning that he got some 24/7 mental health treatment – temporarily. A January 29, 2014 letter from Carole shows the circle game William is still caught up in. Carole wrote: “Our family was shocked to learn yesterday that a Judge ordered [my son] no longer be conserved – AGAINST, we’re told, recommendations from two physicians, the Public Guardian, as well as his family. He is to be released to a homeless shelter tomorrow. He needs to be released to a Residential Treatment Program with 24/7 care or he will once again become part of Mendocino County’s jail and hospital revolving door. In a Residential Treatment Program, he has the potential to break out of that cycle. PLEASE take William to a Residential Treatment Program instead of a homeless shelter, so he can have a chance to have a life he would want to live.”

Among others Carole’s letter was addressed to the Clinical Director of Ortner Management Group (OMG). More than a week later, Carole’s plea has gone unfulfilled. William has avoided a homeless shelter. As of last notice, he was living day-to-day in his mother’s basement.

                                                                                                      Link to Anderson Valley Advertiser:  www.theava.com

Baseball’s Hall of Fame in Cooperstown, New York celebrates its 75th anniversary this year, but January 29th marks the date in 1936 when the Baseball Writers Association of America (BBWAA) released the results of its first vote, enshrining Ty Cobb, Walter Johnson, Christy Mathewson, Babe Ruth, and Honus Wagner. The building that holds the plaques and memorabilia of the greats of our national pastime opened its doors three years later. By then twenty-one other names had been added to the honor roll, including Lou Gehrig, who had just been diagnosed with Amyotrophic lateral sclerosis (a fatal illness that many now call Lou Gehrig’s disease).

Just as there are quibbles about who was left out of the most recent balloting there were slights back at the beginning. Rogers (his first name was his mother’s maiden name) Hornsby, who still possesses the second highest lifetime batting average behind Cobb, was overlooked for six years before gaining entrance to Cooperstown. Hornsby provides quite a contrast to many overpaid professional athletes of the 21st Century. His mother was widowed when Rogers was only two. The single parent family moved from Winters, Texas to Fort Worth so Hornsby’s older brothers could get meat packing jobs with Swift and Company. At ten, Rogers went to work part time at Swift as a messenger and utility infielder on the company baseball team. He dropped out of school in the tenth grade to labor at Swift and continue to play semi-pro baseball in the evenings and weekends. Hornsby signed a minor league contract at eighteen. He made it to the majors at nineteen and by the time he reached the age of twenty-five he was an established star with the St. Louis Cardinals. After the 1921 season, in which he batted .397, placed second in the league in home runs, and led the National League in doubles, triples, runs scored, runs batted in, slugging percentage and on-base percentage, Hornsby earned the highest salary in all of major league baseball: $18, 500. Adjusted for modern inflation that would be slightly more than a quarter million dollars per year. Throughout his life Hornsby neither drank nor smoked. He did not go to what he termed “movin’ picture shows” and he refused to play cards. However, he was an inveterate gambler on horse races, losing much of his salary as a player and later, manager. He remained so constantly indebted that he was still playing for and managing a Mexican League team during World War II.

There are no equals of Hornsby at the plate in today’s major league baseball, but salaries have skyrocketed in the three and a half decades since players were allowed to become free agents. Earlier this month Los Angeles Dodger pitcher Clayton Kershaw signed a deal that will pay him approximately $30 million per year for seven seasons.

Before anyone starts to complain about Kershaw’s salary, consider that even if he made the entirety of his contract, $215 million, in a single year, Kershaw would not even be a blip on the radar of the world’s richest people. And, by the way, Oxfam recently noted that a mere 85 individuals possess as much wealth as the poorest half of the world’s population!

Why do we, the masses, tolerate this? Probably for the same sort of reason that more people can name the members of the Baseball Hall of Fame or the Rock ‘n’ Roll Hall of Fame than any living rich person beyond Bill Gates, Warren Buffet, and a Koch brother. We spend too much of our lives diverted: either working too hard to have time for even the most worthy of diversions like a game of catch or a fine piece of music or we are stupefied by what passes for mind numbing entertainment that big business tries to drown us in. Need I mention the Kardashians, Honey Boo-Boo or pay per view “Ultimate Fighting Championships”?

While you’re searching for the nearest guillotine, the list of those 85 nabobs will be forthcoming. Before sharpening the blade, perhaps we should take a closer look at those who are sitting on enough wealth to feed, clothe and properly house most, if not all, of China, India, and Africa. There are some incredibly wealthy souls like Bill Gates, Warren Buffet and Mark Zuckerberg who have signed a pledge to donate at least half their fortunes to charities. Readers will have to do their own research and form their own judgments on the other wealthy folk listed below. Without further ado here’s your Hall of Shame, with their current net worth (estimated as of December, 2013 by Forbes magazine):

1. Carlos Slim Helu $73 billion 44. Len Blavatnik $16 billion
   
   
2. Bill Gates $67 billion 45. Cheng Yu-tung $16 billion
   
   
3. Amancio Ortega $57 billion 46. Joseph Safra $15.9 billion
   
   
4. Warren Buffet $53.5 billion 47. Rinat Akhmetov $15.4 billion
   
   
5. Larry Ellison $43 billion 48. Leonid Mikhelson $15.4 billion
   
   
6. Charles Koch $34 billion 49. Leonardo Del Vecchio $15.3 billion
   
   
7. David Koch $34 billion 50. Michael Dell $15.3 billion
   
   
8. Li Ka-shing $31 billion 51. Steve Ballmer $15.2 billion
   
   
9. Liliane Bettencourt $30 billion 52. Viktor Vekselberg $15.1 billion
   
   
10. Bernard Arnault $29 billion 53. Paul Allen $15 billion
    
    
11. Christy Walton $28.2 billion 54. Francois Pinault $15 billion
    
    
12. Stefan Persson $28 billion 55. Vagit Alekperov $14.8 billion
    
    
13. Michael Bloomberg $27 billion 56. Phil Knight $14.4 billion
    
    
14. Jim Walton $26.7 billion 57. Audrey Melnichenko $14.4 billion
    
    
15. Sheldon Adelson $26.5 billion 58. Dhanin Chearavanont $14.3 billion
    
    
16. Alice Walton $26.3 billion 59. Susanne Klatten $14.3 billion
    
    

17. S. Robson Walton $26.1 billion 60. Vladimir Potanin $14.3 billion

1. Karl Albrecht $26 billion 61. Michael Otto $14.2 billion
   
   
2. Jeff Bezos $25.2 billion 62. Vladimir Lisin $14.1 billion
   
   
3. Larry Page $23 billion 63. Gennady Timchenko $14.1 billion
   
   
4. Sergey Brin $22.8 billion 64. Luis Carlos Sarmiento $13.9 billion
   
   
5. Mukesh Ambani $21.5 billion 65. Mohammed Al Amoudi $13.5 billion
   
   
6. Michele Ferrero $20.4 billion 66. Tadashi Yanai $13.3 billion
   
   
7. Lee Shau Kee $20.3 billion 67. Mark Zuckerberg $13.3 billion
   
   
8. David Thomson $20.3 billion 68. Henry Sy $13.2 billion
   
   
9. Prince Alaweed 69. Donald Bren $13 billion
   
   

Bin Talal Alsaud $20 billion 70. Serge Dassault $13 billion

1. Carl Icahn $20 billion 71. Lee Kun-Hee $13 billion
   
   
2. Thomas & 72. Mikhail Prokhorov $13 billion
   
   

Raymond Kwok $20 billion 73. Alexey Mordashov $12.8 billion

1. Dieter Schwarz $19.5 billion 74. Antonio Ermio
   
   
2. George Soros $19.2 billion de Moraes $12.7 billion
   
   
3. Theo Albrecht Jr. $18.9 billion 75. Abigail Johnson $12.7 billion
   
   
4. Alberto Bailleres 76. Ray Dalio $12.5 billion
   
   

Gonzalez $18.2 billion 77. Robert Kuok $12.5 billion

1. Jorge Paulo 78. Miuccia Prada $12.4 billion
   
   

Lemann $17.8 billion 79. Ronald Perelman $12.2 billion

1. Alisher Umanov $17.6 billion 80. Anne Cox Chambers $12 billion
   
   
2. Iris Fontbona $17.4 billion 81. Stefan Quandt $11.9 billion
   
   
3. Forrest Mars Jr. $17 billion 82. Ananda Krishnan $11.7 billion
   
   
4. Jacqueline Mars $17 billion 83. Alejandro Santo
   
   
5. John Mars $17 billion Domingo Davila $11.7 billion
   
   
6. Georgina Rinehart $17 billion 84. James Simons $11.7 billion
   
   
7. German Larrea 85. Charoen
   
   

Mota Velasco $16.7 billion Sirivadhanabhakdi $11.7 billion

1. Mikhail Fridman $16.5 billion
   
   
2. Lakshmi Mittal $16.5 billion
   
   
3. Aliko Dangote $16.1 billion
   
   

                                                                                                         Link to Anderson Valley Advertiser:  www.theava.com

Two weeks ago I wrote about my experiences with the Mendocino Coast District Hospital (MCDH) billing department after having had a colonoscopy at that institution on November 25th of last year. Here’s the background for those who might have missed the January 8th edition of the AVA (Heaven forfend!): In 2008, having reached an age at which one is supposed to undergo a colonoscopy (though there is no history of colon cancer on either side of my family tree), I did so at Mendocino Coast District Hospital. Dr. Daniel Conlin, who travels from San Francisco to Fort Bragg regularly to do several of these in a day, performed the procedure. He removed two benign polyps and advised returning for another colonoscopy in five years.

Forward to 2013 when I made sure at the beginning of the year that my Anthem Blue Cross health insurance policy was one that fully covered colonoscopies. I did so by phone with an Anthem representative and also had in hand the personalized health care checklist the company had printed out for me. Underneath the colon cancer screening part of the checklist were the words, “No cost to you. Covered at 100%.”

Dr. Conlin performed the colonoscopy three days before Thanksgiving, finding no polyps this time. All looked rosy until a week before Christmas when I picked up the mail at the post office and found a bill from Mendocino Coast District Hospital for $2,635.47.

As soon as I got home I called the hospital’s billing department. I spoke at length to two women who work there, the second has the title of “Director, Quality & Risk Management.” Both women claimed that the colonoscopy was billed as a surgery, not as part of a system of preventative care. The most I got from the Director of Quality & Risk Management was a grudging, “I’ll look into it.” As of the January 8, 2014 AVA story I had not heard back from her or anyone at Mendocino Coast District Hospital.

That same day, a week before Christmas, I placed a call to Anthem Blue Cross. Without prompting, the representative I spoke with noted that the November 25th colonoscopy should be fully covered, that the problem lay with either the doctor or the hospital incorrectly marking it as billable to the patient. In the January 8th article I clearly implied that the hospital made the error. Turns out it was the doctor or someone at his office, but that is the only part of this tale where our coastal hospital would prove innocent.

While I had given my phone number to MCDH’s Director of Quality & Risk Management, I never heard back from her. However, I was not sitting idly by. I continued to track the case, calling back to Anthem Blue Cross on New Year’s Eve. Getting through to a human being at Anthem while they sort out the kinks of implementing the Affordable Care Act (ACA – aka: Obamacare) ain’t easy. It usually involves being on hold for an hour or two or more. Persistence is the virtue here. I waited on hold through those hours on New Year’s Eve, January 13th and again January 16th. On New Year’s Eve the Anthem representative stated that they had left several voicemails with the MCDH billing department, but that the situation wasn’t expected to be cleared up until January 7, 2014.

I actually attempted to place calls to Anthem twice between January 7th and the 13th, but their call volume was so heavy they would or could not accept further calls those days. I called on January 13th and waited on hold for more than two hours because that day I had received, in my P.O. Box, another copy of the Mendocino Coast Hospital bill for $2,635.47, this bill stating that payment was now overdue.

On the phone with Anthem on Jan. 13th, I waded through one representative who was nearly as grudging as the women at MCDH billing (in other words the Anthem rep was ready to rubber stamp the hospital’s take on things and leave me hanging with the bill). Finally, I spoke to a supervisor (presumably Anthem’s equivalent of a Quality & Risk Manager). She had the notes on the case dating back to my initial call on December 18, 2013. I waited while she read through the notes then told me about the error being in the doctor’s office, but that it had been corrected and, most importantly, I did not owe any money, Anthem was sending a check to MCDH for $2.635.47.

Much relieved, I went about my business, which on January 15th included attending a Pitchess Motion hearing in Ten Mile Court in Fort Bragg then driving over the hill to Ukiah to catch the second half of the County Mental Health Board meeting, back to Fort Bragg to drop off my laptop for some cleanup work, finally to Mendocino for the monthly meeting of the Writers of the Mendocino Coast. On the way home I stopped to get the mail, hoping for a late arrival of the New Yorker (which at times can be as tardy as the AVA is for some of the farther flung subscribers).

There was a New Yorker, but there was also a letter from the “Director, Quality & Risk Management” at Mendocino Coast District Hospital. Because it was at first glance obviously not printed in the traditional billing form I naively thought for a moment or two it might be some sort of communication detailing how MCDH had cleared things up with the doctor’s office and Anthem Blue Cross; that all was well and good here on the Mendocino Coast.

I should have suspected something was amiss when my last name was spelled two different ways within the first half dozen lines of print on the page. Below the garbled surname (and almost nothing ticks off a Highland Scot descendant more than the misspelling of their name!!) lay the following, reproduced for you here, word for word:

“Your chart and charges were reviewed concerning your outpatient colonoscopy visit on November 25, 2013 and it was determined the charges were appropriate for the procedure provided. As you may have discovered in connecting with your insurance company, a screening colonoscopy is covered 100%. A diagnostic or surveillance colonoscopy falls under insurance deductible requirements, which are impacted by a patient’s specific insurance policy.

The physician is responsible for coding the procedure performed and determines whether it is a screening or diagnostic/surveillance colonoscopy. Dr. Conlin performed your colonoscopy and he coded your procedure as a “Personal history of colonic polyps” which would indicate a diagnostic or surveillance colonoscopy.

I am sorry that this expense has occurred and can certainly understand your frustration. I am glad that you contacted us about this issue. I can assure you that we take your concerns seriously as this gives us a chance to review the care delivered and make sure our charges are accurate. We always want to provide quality care and make improvements as necessary.

I recommend you follow up with your insurance carrier to provide further information regarding this issue. There will not be any adjustments on this account. You can contact _____ ________ (name withheld) in our Billing office to set up a payment plan for any amounts not covered by your insurance.

Again, thank you for bringing your concerns to us. I hope you are doing well.”

The consternation caused by this sent me back to Anthem Blue Cross the following morning for another hour on hold, then a reassuring agent who forwarded to me an email version of the corrected billing, showing that I did not owe MCDH a penny. Why MCDH so quickly chose to send out the letter I received on Jan. 15th is beyond me.

Apparently, we’ve moved from the “audacity of hope” to the audacity of b.s! One of the disturbing aspects in this whole rigmarole is that it was representatives of a huge healthcare insurance company, Anthem Blue Cross, who proved to be far, far better patient’s rights advocates than the Quality & Risk Management Director at Mendocino Coast District Hospital. The person who holds that position at MCDH and the signer of the letter quoted above is a registered nurse. The code of ethics for nurses in this country states, “The nurse's primary commitment is to the recipient of nursing and health care services --the patient--whether the recipient is an individual, a family, a group, or a community.”

That same code of ethics also says: “When the patient's wishes are in conflict with others, the nurse seeks to help resolve the conflict. Where conflict persists the nurse’s commitment remains to the identified patient.”

There is nothing on the record to suggest to me that the RN who works as the Director of Quality & Risk Management at Mendocino Coast District Hospital persisted in advocating for the patient, Malcolm Macdonald. The letter reprinted above serves to show us that the Director of Quality& Risk Management’s bottom line is billing, not patient advocacy. Placing an RN in a supervisorial role in the billing department could be beneficial to patients – if that RN was truly free to advocate for them. If in my case there was any advocacy done that I am not privy to, it clearly was superseded by a capitulation to a monetary bottom line rather than an ethical one.

If there are those higher up the food chain at MCDH who have placed an RN in the billing department then undercut that RN’s ability to advocate for patients, then SHAME on them.

Of course, the problem is the national health care system. Obamacare has taken baby steps toward getting far more people insured, and many at more affordable rates. Nevertheless, Obamacare is just replacing one expensive bandage for another. Anyone who has read Steven Brill’s in depth piece in Time magazine will remember the case of the man who bankrupted himself and other family members for an initial cancer treatment that cost him nearly $100,000 out-of-pocket in advance. His first drug transfusion cost more than $13,000. It cost the drug company approximately $300 to produce the drug. The company’s chief executive took home about $11,000,000 that year. Under the Affordable Care Act (Obamacare) that bill might very well shift from the individual to… wait for it… the taxpayers. That money is still going back to the drug company at the same $13,000 price. The drug company’s exec is still making millions and millions per year.

Brill’s study, from less than a year ago, also took a look at actual hospital bills patients were asked to pay, which (no surprise) includes incredibly inflated prices for everything, even simple items like gauze pads (around fifty cents through Amazon, $18 apiece at some “not-for-profit” hospitals). Readers who want to know more about the complex machinations of how a hospital goes about its billing business should type the term “chargemaster” into your computer’s search engine.

In case you are cursing the government because of Obamacare, think twice. The one thing that does work to curb extravagant billing is Medicare. Good old LBJ’s Medicare is helping to keep prices down. One quick example: A hospital attempted to charge over $300 for a patient’s X-ray, Medicare said no, you (the hospital) can have $24. There are hundreds of further examples, just do the research. Does anybody not know that the dreaded, cursed, socialistic concept of “Universal Health Care” or the so-called “Single Payer Plan” are nothing more than politicized terminology for Medicare for all ages? If you didn’t know, if you were lost somewhere behind a John Birch Society billboard or at your friendly neighborhood Confederate States of America Army re-enactment, let me repeat it: giving health care to all Americans would mean nothing more than expanding Medicare to include everyone in this country.

Since that doesn’t seem to be in the wind for the foreseeable future, readers must advocate for themselves when it comes to your health care costs. Read everything you can. Hold on to those pages from your insurance company that tell you which procedures are fully covered. Schedule your day so you can stay on hold for as long as possible. Get hold of Steven Brill’s “Bitter Pill” piece. Hold those who would overbill you at hospitals and insurance companies responsible, from the correct spelling of your name to the true cost of every last cotton swab.

                                                                                                         Link to Anderson Valley Advertiser:  www.theava.com

  The smattering of recent rain hasn't rid the Albion River of its gray and orange hued appearance. On the other hand the 200 foot deep  well that serves this house continues to regularly pump water into a tank that holds thousands of gallons.
      I was in the Savings Bank of Mendocino County branch in the town of the same name last week and inquired of one of the long time employees about their water situation. "We've been buying it since June," she replied. "Last year [2012] was just about the same. We started buying water in June or July."
     Across Ukiah Street and a bit east the good folks at Frankie's (purveyor's of delicious ice cream, pizza and more) have been buying water since October. Recently, they've shut down the restroom and rented a port-a-potty.
      At a more than one hundred year old  residence near the Mendocino Art Center, the forty foot well isn't completely dry, but the owner is planning to pay for water delivery starting sometime this week. As the Board of Supervisors recently recognized on an official level, this is a drought. Drive by Lake Mendocino if you still have any doubts.
     While California and much of the West remain painfully dry the Midwest has just suffered through intense cold, unsuitable for a polar bear. Anyone who doesn't believe that we humans are impacting climate change need only take a long hard look at time lapse photography of what once were polar regions covered in ice and snow for millienia and now thoroughly melted in less than an average human lifetime.
     That doesn't mean that there haven't been instances of whiplash weather before. The heat and high winds that caused the Great Comptche Fire of September, 1931 (burning many miles wide from the east end of Big River southward to the Navarro River) was followed two and a half months later by an extended December cold snap so severe the Albion River froze over in tidewater. In its freshwater the Albion froze so solidly about a half mile east of here that cattle walked over the river without so much as a crack in the ice.
     Seven years before, in 1924, California was in its third straight year of drought, the worst to date here at the Macdonald Ranch. My then teenaged father and his younger brother, Forrest, dug deep holes in the bottomland adjacent to the river in order to find enough pools of water for their grazing milk cows to survive on.
      That 1920s drought covered the entire state and brought into play one of the most unusual figures in California history. In late May, 1924 a Modoc County newspaper, the Surprise Valley Record, noted an item that had just run in the Lakeview Examiner of southern Oregon. The Record's piece said, "There is some talk of getting Charles Hatfield, the rainmaker, up there in order to have him punch up old Jupiter Pluvius and have him get on to his job of giving mother earth [a] bath. His services would be mighty acceptable down this way, also. A great deal of fun is being poked at the rainmaker. At any rate, he pulled down eight thousand dollars for making it rain in the lower country. A good rain here now would do an immense amount of good just now for the ground is getting very dry, and unless rain comes soon, the crops here will be very short."
     Charles Mallory Hatfield was certainly the most successful person to practice the art of pluviculture, or artificial rainmaking. Born in Kansas but raised in southern California, Hatfield first gained broad public acclaim when, in 1904, he climbed to the top of Mt. Lowe and released a secret mixture of chemicals into the air. The rain storm that followed proved so successful that the local farmers who had promised a $50 payment for precipitation doubled the amount. Hatfield followed up by making it rain buckets near Rubio Canyon, with a reward in the neighnorhood of $1,000.  
     In 1914, the City of San Diego purchased the recently completed reservoir at Morena Dam. A year later it was far from full, so late in 1915 the city council hired Hatfield for a $10,000 fee. Hatfield and his brother, Paul, built a twenty foot tower alongside the dam, where early in the new year of 1916 Hatfield released his secret cloud-seeding chemicals. On January 5th heavy rains began to fall, and continued to fall, day after day, until nearby rivers topped their banks. The rains continued more or less unabated for over two weeks. Two neighboring dams (Sweetwater and Lower Otay Lake) overflowed. The flooding engulfed homes and farms, knocked down power poles and bridges, cut off road and rail travel throughout the region. The rains ceased for two days then started up again, pouring down for another week. By the time the flooding stopped at least twenty people had been killed.
     Hatfield certainly fulfilled his end of the bargain, but the City of San Diego refused to pony up his fee unless he paid for all the damages. Lawsuits between Hatfield and the city went on until the late 1930s, when a court finally absolved him of blame, ruling the deaths and damages an "Act of God." The lesson of the story, perhaps to this day, is to be careful what you wish for, even if it's just rain; might turn out to be too much of a good thing.
  *  Followup to the recent denial by the Fort Bragg Planning Commission of  Robert Affinito's request for permits to bring a Dollar Store to South Franklin Street: On Monday, January 24th, at 6 p.m. in Town Hall, the Fort Bragg City Council will hear an appeal of the Planning Commission's denial of said permits.

    

_                                                                                                        Link to Anderson Valley Advertiser:  www.theava.com

  Back in the early 1920s my great uncle, Leonard Ward, had the good fortune to meet and wed Mary Hittson. Leonard was a rodeo cowboy. Mary possessed a home movie camera. She filmed all his rides and roping events along with  those of the highest caliber competition. She sat Leonard down and ran the footage of each and every event. Then she'd run the film again, and again, until Leonard or she spotted something that could improve his riding and roping technique. Whenever Leonard slid into the chute to mount the likes of Old Midnight, Tipperary, or Five Minutes to Midnight he was doing so with more foreknowledge than any other cowpoke of his age, culminating with an All-Round Championship of 1934 and a place in the Rodeo Cowboy Hall of Fame.
     After meeting Mary Hittson and her movie camera, the phrase, "This ain't my first rodeo,"  applied most aptly to Leonard Ward.  In those days of the Roaring Twenties and the Great Depression most rodeo injuries, short of a major fracture, were literally spat upon. You sucked it up, dusted off, and climbed back in the saddle. Care for broken bones was paid for out-of- pocket. If you broke too many bones you moved on to another profession.
     Uncle Leonard was lucky (He was inordinately fortunate throughout his long life, surviving four years in Japanese prisoner of war camps during World War II being just one example of his good luck); Medicare arrived on the scene just when he reached the age to receive it.
     Leonard didn't require much of any medical care until his late eighties when he developed melanoma. This could have come on through years of outdoor sun exposure or it may have been a delayed reaction to having stood within shouting distance of the atomic explosion that destroyed Nagasaki on Augst 9, 1945.
     Leonard's ten brothers and sisters lived into their eighties and nineties and beyond with the exception of two who were killed as a result of automobile accidents.  My mother, an only child, lived into her late eighties despite being born two and a half months premature in the most rural of settings. My father's mother lived into her nineties while working a hard ranch and farm life from childhood on. My father survived into his late eighties as well, working in the woods as a timber faller much of his adult life.
     The major point of all this is that there isn't a lot of debilitating illness in my family tree. These were rugged people who toughed it out. Nevertheless, these hardworking folks welcomed Social Security, Medicare, and health insurance. One of those auto accidents, referenced earlier, took the life of a maternal great grandfather and Leonard Ward's eldest brother. The horses pulling their wagon in 1919 on a Nebraska sandhill road were spooked by the noisy horn of a passing automobile. The injuries they sustained did not kill them. In fact, they lingered for more than a year. The medical expenses incurred during that time essentially cost the family their farm/ranch.
     So, though I stem from this hardy breed I, too, have been a consumer of mainstream health insurance and have maintained a fairly steady habit of checkups and preventative care. In the spring of 2008, having reached an age at which one is supposed to undergo a colonoscopy, I did so locally at the Mendocino Coast District Hospital. In 2008 colonoscopies were not yet fully covered by health insurance policies. The hospital required a check for several thousands of dollars well in advance of the procedure.
       Two polyps removed, let's move on to 2013. At the beginning of that year I made sure that my new Anthem Blue Cross health insurance policy was one that fully covered colonoscopies. I even kept the personalized checklist Anthem produced for me, which listed two things: an annual physical and a colonoscopy. Underneath the colon cancer screening part of the checklist are the words "No cost to you. Covered at 100%."
     I didn't get around to the colonoscopy until three days before Thanksgiving. It not being my first colonoscopy rodeo, the whole procedure went painlessly, even the preparation period that voids your body of all things foodlike. No polyps, good to go.
     Not so fast, spaketh Mendocino Coast District Hospital.   Exactly one week before Christmas I received a bill in the mail from the aforesaid hospital for $2,635.47. Immediately after arriving home from the post office, I called the hospital's billing department. I spoke at some length to two women who worked there. They both claimed that the colonoscopy was billed as a surgery, not as part of some sort of system of preventative care. Neither was willing to concede the concept that charging people for follow up colonoscopies might prove quite a deterrent in getting any patients to come back for further colonoscopies. The most I got out of the woman with a seemingly higher position in MCDH's billing office was a very grudging, "I'll look into it." I gave her my phone number and have yet to hear back from her or anyone at Mendocino Coast District Hospital.
     Readers might guess that the nsurance company, Anthem Blue Cross, would be the outright villian in this situation. No sooner had I gotten off the phone with the unwilling-to- help women at MCDH's billing department than I gathered all my Anthem Blue Cross paperwork and called Anthem's 800 number for customer service. Lo and behold the phone answerer turned out to be understanding. Without any prompting she noted that the colonoscopy should be fully covered, that the problem lay with either the doctor or the hospital marking it down as some sort of billable (to the patient) surgery. When pressed as to which was more likely to have made the mistake, she said, "The hospital," because they are the ones sending out the bill.
     As of New Year's Day, when Anthem Blue Cross workers were answering the phones in contrast to Mendocino Coast District Hospital, Anthem had left several voicemails with the MCDH billing department, but the situation wasn't expected to be cleared up until January 7th of the new year.
      Lest readers think giant health insurers like Anthem Blue Cross have turned over a completely new leaf: Right after my colonoscopy in late November I, like many Californians, went through the process of switching to a new health insurance policy, since Anthem had eliminated the old one. Using the Covered California web site and some assistance from a Covered California agent on the phone, I navigated the system successfully enough that by mid December I had received approval through Covered California and a bill from Anthem for my new health insurance at a reduced rate from the previous policy. However, on December 31st, I got a bill in the mail from Anthem Blue Cross for a completely separate health insurance policy. A bill that was nearly double the amount of my old 2013 premium, and the due date for payment was the next day, January 1, 2014!! Presumably, this is simply a result of the health insurance companies being overwhelmed by vast nummbers of new and changed policies under the Afforable Care Act.
      The whole debacle, from the unthinking, inhumane creatures at Mendocino Coast District Hospital's billing department to the crossed wires at the huge health insurance company reminds me of my forebearers best medical and insurance advice, "Don't get sick."