Highly recommended reading: well worth your time, and not that long!

http://www.nationalreview.com/corner/290393/president-prophet-obama-s-unusual-encounter-eric-metaxas-mark-joseph

Provoked to Rant

Bonjour-

It is not often that I am provoked to actual ire by a piece of automatically generated "robo-mail"...but such was the case recently.  To put this in perspective I received --in the same mail delivery--another piece of robo-mail of undeniably more unsavory content...a reminder from my friendly, neighborhood gastroenterology center that, with the advent of my last birthday, I was also due for Colonoscopy #2.  I did not click my heels in glee when I read this and recalled my first experience at this "interesting" health facility.  But, these mortal tents we live in down here degrade over time, and this quite-intrusive procedure serves a purpose.

But what caused my blood pressure to shoot upward was the following missive, received from my insurance intruder...I mean, provider.

I quote:

"Dear KATHLEEN HOLLIDAY,

I have reviewed the request to cover *MEDICINE YOU NEED*.  I am pleased to inform you that I have approved your doctor's request for this medication.  This authorization is effective from 08/16/2012 through 08/16/2013.

If you have any questions regarding this request or the proper use of this drug, please contact your doctor.

If you have any questions about your pharmacy benefits coverage, please call the Customer Service number on your CIGNA ID card.

Sincerely,

*Intrusive Pharmo-Crat*, PharmD
Manager, Pharmacy Service Center"

Frankly, gentle readers, there is far too much objectionable presumption in the above content to comment upon sanely; however, I found myself so livid that I could decompress only by venting via a letter which I will mail to *Dr. -Crat* as soon as I can decide whether I should bother sending it certified mail or not.

For those interested, below I append my letter of complaint:

23 August 2012

Dear Mr. Imperato,

This afternoon I received a form letter over your signature telling me that you are “pleased to inform” me that you have approved –for one year--my physician’s request for the medication that she has prescribed for me.  The practical implication of your letter is that I will receive the medication that was prescribed for me some weeks ago, which I appreciate. 

In point of fact, when my husband and I enrolled for a CIGNA benefit program through his employer, it did not occur to us that the benefits to be provided were conditional.

I am aware of the ongoing, spiraling costs of medical care and medication that have plagued the US for several decades.  I am also aware of the sizeable contribution deducted from our salary that pays for our CIGNA coverage, including prescription benefits.  Although I do not find it convenient, I am content to use the mail-order pharmacy service mandated by CIGNA to fill maintenance medication prescriptions.

However, it is no happy realization for me that the current state of insurance-controlled health care benefit programs,  specifically CIGNA’s prescription plan, has devolved to the point that an insurance pharmacy manager apparently wields the prerogative to grant or deny a bona fide prescription request for a patient covered by an employer-sponsored benefit plan.   

Mr. Imperato, I am offended by this policy. 

No doubt, the development of this practice by CIGNA is not the sole responsibility of any one individual, but as you are the manager from whose jurisdiction this letter was sent, I am directing my feedback to you.  I am taking the time to do so because I choose to believe that there is good faith in the many assurances given by CIGNA that the health concerns of your member patients are your priority concern. 

However, my current experience has been the opposite.  Not only is it the case that various drugs are classified into “Step 1,2,and 3” categories with associated variations in accessibility; it is now apparent that, beyond processing and shipping valid prescription requests for member patients, CIGNA sees fit to encroach upon doctor-patient relationships.  Under what auspices or presumptions has this come about?

 I do not need or desire, nor do I think it appropriate, for CIGNA to do any more or less than what was contracted for when I enrolled in the benefit plan to which I refer.  My objections to CIGNA’s  quality of service include (1)the erecting of virtual obstacles to the fulfillment of promised benefits; and (2) requiring my personal physician to spend undue time and attention justifying and “pre-authorizing”  the very prescriptions which she has already ordered for me on the basis of her medical expertise, experience, and  intimate knowledge of my personal medical history. 

Beyond this, apparently CIGNA considers it within its purview to provide a “health advocate” service, the purpose of which, in my experience, is unrelated to the prompt and professional processing of prescriptions.

Just yesterday afternoon, I received a third unsolicited, automated call from CIGNA offering to enroll me in a program that would link me with a “health advocate” to help “answer any questions [I] might have” and to provide guidance in developing and pursing my personal health goals.  Ironically, when I asked the question of most importance to me, namely, whether my prescription would be filled as written, the well-meaning health advocate could not help me.  She seemed unfamiliar with the Step1,2, and 3 drug categories outlined in CIGNA patient literature and was only able to transfer me to a CIGNA pharmacist, who also could not answer my question.  I assume this is because my order was still awaiting an approval decision from you.

I do not need or desire any further interruptions or obstacles to my health care.  I am fortunate to have excellent medical professionals to evaluate and treat me. What I seem to lack is a simple, straightforward program by which to have my prescribed medications provided. 

Can you help me with this, Mr. Imperato?

Finally, it is apparent that the policies and practices referenced above potentially place CIGNA at cross-purposes with its own expressed goals of excellent patient care.  Some of the escalating costs which managed health care ostensibly was developed to control seem to be exacerbated by the policies I have experienced and detailed above. In my own physician’s office, an additional employee had to be added to process the many pre-authorizations  required by CIGNA and other insurance benefit providers.  Clearly, this does not reduce costs.

Mr. Imperato, it is my sincere hope that you will give thought and attention to the concerns I have described, particularly  those related to the ways in which health insurance policies  intrude upon and diminish doctor-patient relationships. Please consider this letter as feedback from a veteran client who is dissatisfied with the pharmacy service  you provide.

 In light of your pharmacy service's many claims to excellence and concern for client heath concerns,  I look forward to your reply at your earliest convenience.

Sincerely,

Kathleen K. Holliday

Why I Don't Live at the P.O.

[with apologies to Eudora Welty, author of “Why I Live at the P.O.”]

To begin with, I consider myself a staunch supporter of the U.S. Constitution, including all of the various and sundry responsibilities and areas of purview that it ascribes as specifically governmental concerns. 

To wit, “Article 1,Section 8, Clause 7 of the United States Constitution, known as the Postal Clause or the Postal Power, empowers Congress "To establish Post Offices and post Roads… with the implied authority to carry, deliver, and regulate the mails of the United States as a whole.”

And so it was, armed with an earnest and wholesome belief in the authority and commitment of the United States Post Office to fulfill its Constitutional duty that I set off on my most recent misadventure.

As these things tend to do, another family milestone had crept up on me recently and I found myself in need of postal services.  Our oldest daughter was to be graduated from high school, and the pertinent announcements, mailing lists, and open house invitations were arrayed before me on the dining room table.

Too late did I realize that in my zeal to complete this task, I had neglected to ensure that all necessary components would fit in the same size envelope.  Thus, I had already purchased announcements, just printed photo open house invitations, and had no envelopes that would accommodate both. Cowed at the possibility of having to pay first class postage to mail all pieces separately,I turned to my trusty personal accountant and husband for counsel.

 “Just take them to the post office and have them metered.  Then you’ll be sure you don’t have to pay any more than you have to.” 

With these syllables of wisdom resonating in my ears, I set forth with my bulging tote bags of mail and a gleam of hope in my eyes.

Patiently, I queued up in the Loves Park Post Office lobby.  After a not unreasonable interval, I was summoned to the counter.

“How can I help you today?” asked the smiling postal clerk.

“Well, I have some mail I’d like to have metered, please.”

The friendly brow contracted slightly in mystification.

“Metered?”

“Um, yes.  Metered.  You know, like how you run pieces of mail through a postage meter instead of sticking a stamp on each one?  You meter mail for people…”, I trailed off.

“Oh, no we don’t do that,” with a brief head shake and slightly bemused look.

“Seriously?”

“Nope. I mean, yes, seriously, we don’t meter mail here.”

I glanced from Friendly Eyes to the adjacent clerk, Kenny.

Now, Kenny and I are old, if not formal, acquaintances.  I’ve had a few skirmishes with Kenny over the years, but it’s always been civil, if not strictly logical.

For my edification, Kenny chimed in. “We don’t do meters here.”

“But, this is a post office, and I’m trying to mail my mail.”

“Oh, you can still do that here!”  Thanks, Kenny.

Back to Friendly Eyes.  “It’s just that we don’t meter mail HERE.  If we metered mail here, the line would go all the way out the door and into the parking lot.” Hmmm, wouldn’t want to work you guys too hard…

Kenny chimed in again.  “Nope, can’t do the meter here. But you could go somewhere else, like, say Adams Letter Service, they’d do it for ya.”  Adams Letter Service is easily 25 to 30 minutes away, and gasoline in these parts is running  $3.59/gallon on a good day.

“But then, they’d a likely tack on a service charge,” he added helpfully.

Friendly Eyes corroborated this by nodding. Nonplussed, I began my futile, and apparently fictional, protest that the Post Office was here to serve me.

“I’d say the quickest thing to do would be to get stamps for all of these,” Friendly Eyes concluded, slapping my invitations and announcements on the postal scale.  “Yup, they each qualify as single-first class.”

 “Hmm, let’s see, we have several forever stamps now…did you say this was for a party?”

Chiming Kenny added, “We have those Celebrate stamps. Would you like those, Miss? How many do you need?”

Um, about 90, I guess.

“Uh, don’t have that many…Kenny you got any of those stamps with the balloons?”

Quicker than you can shed a tear of frustration, Kenny slapped open his battered binder of current postage stamps and was retrieving “Celebrate” stamp sheets.

After reluctantly handing Friendly Eyes my credit card, I proceeded to take out small stacks of envelopes and, despite now  lacking anything close to a celebratory attitude,affix stamps to each.

“Ma’am would you mind stepping over there so others can get to the counter?” Kenny raised his turbulent eyebrows at me.

I glanced back at the completely empty mail lobby, loaded up my tote bags, stamps, purse, and seething frustration, and proceeded to the outer room.

About a quarter of an hour later, the last of the envelopes had been duly stamped, and I was trudging over to the “Stamped Mail” bin.  Mirthlessly, I eyed the adjacent bin, labeled “Metered Mail.”

But, the last laugh was theirs:  striding toward the exit, I spied this helpful US Postal Service sign:  “Helping Make Your Life Easier Is What We Do Best.”

Two Magic Words

When I was little, my parents admonished my sister and me over and over to use the magic words, “please” and “thank you.”  The lesson has stuck, and hopefully has been instilled in my own progeny…I see inconsistent evidence occasionally, and still verbally reinforce it.

But, I’d like to suggest that two other words are imbued with far greater power than these bywords of social convention and courtesy.  I suspect it is no coincidence that these words are more powerful because they are more costly to say, although certainly as simple: “I’m sorry.” 

If the first word adorable, wide-eyed tiny people learn to say is “NO!” [and it often is], close on its heels should be this acknowledgement of personal responsibility and remorse.  How many international incidents and domestic disputes could be quickly defused with this simple, surefire remedy?

I was reminded of this recently when someone near and dear to my heart began the day with an unexpected and uncalled for verbal salvo.  Its stinging shrapnel seemed to hang in the air a moment before the speaker departed, leaving his words to drift down like unseen ash.  Caught unaware and unprotected, the two of us in the target range could only look at each other.

The whole day dragged on as I tried to buffet away my hurt and consequent anger. Letting it “in one ear and out the other” has always been easier said than done for me.

Because relating to this person has been painful for so long, it was easy for me to make this incident a “tipping point.” As injured parties, we want to retaliate, and we want to have impact. My hurt feelings seethed on the back burner all day.

So it was a surprise, in the late afternoon, to see this familiar face linger a moment before emerging from his car with an apology on his lips -- direct, intentional, immediate, and unexpected.  The buttoned up, long suffering reserve I had adopted as my mode of protection seemed to melt away in my surprise.  Tipping point? What tipping point?  I had forgotten how powerful those two words could be.

One incident-specific “I’m sorry” doesn’t undo a backlog of old pain.  

But it’s a start.

Overheard in Cecilyville

"Ack!!! I can't decide if Davy is Mr. Scrooge or the Grinch!!! It's just too hard!"

Hmm, brings all my worries right into perspective!

But DNA is Innate...

Here, courtesy of National Public Radio this morning, is more evidence of just how insistent and persistent is mankind’s determination to “do what is right in their own eyes,” [Judges 21:25, NASB]; inconvenient biological facts to the contrary be damned!

http://www.npr.org/templates/story/story.php?storyId=147139093

“A small but growing number of teens and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.

“It's an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones…Switching gender roles and occasionally pretending to be the opposite sex is common in young children. But these kids are different. They feel certain they were born with the wrong bodies.

“Some are labeled with "gender identity disorder," a psychiatric diagnosis. But [Dr. Norman] Spack, [author of one of three reports published Monday and director of one of the nation's first gender identity medical clinics, at Children's Hospital Boston] is among doctors who think that's a misnomer. Emerging research suggests they may have brain differences more similar to the opposite sex.”

The broadcast report, originating in the link above, goes on to detail various aspects of the current debate about how soon to suppress the onset of biological puberty using hormone "therapy" and when to begin “reassignment” treatment to bring the child’s physical and psychic genders into alignment, [if such a concept does not strain the imagination too far.]

I have far more questions than answers on this curious but primal topic: why is this phenomenon apparently growing in numbers? how much of it is driven by what is now “possible” in terms of endocrinologic technology and/or changing mores about what constitutes gender? why is there growing acceptance of the concept that physical biology and psychological gender identity need not be linked?

Not only do I not have the answers to these questions, but I also think that as a society we are at a point where the very definition of words like “answer” and “truth” are being deconstructed to the point of meaninglessness. If you don’t like the pattern of your sweater, pull any thread until it unravels as far as you please.

However, there are two things I DO know: (1) no amount of tinkering will change the fact that every cell of a person’s body bears only one of the two possible genetic chromosome combinations: XX for female or XY for male. No other possibilities exist; and (2) tampering with the magnificent work of an infinitely superior intelligence never leads to greater fulfillment, joy, or meaning.

We can choose to be congruent or incongruent with what IS in an empirical world. But by attempting to deny or redefine what fundamentally is unalterable, we can succeed only in deforming ourselves.

Passing

Another one of my professors has died. The first time this happened, it was an unexpected "reality check". Now Dr. Garab is gone. I know this because today's mail brought the English Department Newsletter from my alma mater; it comes about four times a year.

My life now seems far away from those graduate school days of pressured study and long nights haunting the library. But that time in my life is part of who I am today-- for better, probably not for worse.

Eerily, I remember in vivid detail sitting as an apprehensive freshman in Dr. Garab's Composition and Literature class...I won't say how long ago. He was a curious little man with quick dark eyes, quirky jackets, and a pipe in the corner of his mouth which he seemed to have trouble keeping lit. He was the first, and probably only, man who I heard explain how much he enjoyed drinking tea with his wife out of a fine china cup. He also was one of the first who opened the world of literature to me, and that is a gift that doesn't expire.

I still recall my angst as I sat in my dorm room, in front of my new, chocolate brown Smith-Corona electric typewriter, praying for some insight and assistance in the face of my first essay on "The Great Gatsby". God was faithful, and the words flowed. It was one of the rare experiences of individual and unalloyed joy.

The following week I felt as if my face were a blinking red beacon as he read my essay aloud in class (fortunately without giving my name). It was an unexpected affirmation that served as a personal touchstone.

Dr. Garab was a lay pastor in the local Episcopal church, which made him an anomaly among professorial staff, and a weirdo among some students. He didn't trumpet this, but he didn't deny it, either. So, unlike the other half dozen or so former professors of mine whose obituaries I've read in recent years, Dr. Garab is one I expect to see again. I don't doubt that he is now in the presence of the One who is Truth.

Unlike so very many men and women of letters across the centuries who have been lauded for wrestling with and interpreting the great questions of human experience, he apprehended and bowed before Him about Whom Paul wrote, "He is before all things, and in Him all things hold together." [Colossians 1:17]