Sunday, November 11, 2007

A health care lesson

Recently, Bones asked what makes me pig-biting mad?

I have a wonderful nurse practitioner who has been my primary care physician for a few years now.

Correction: I had a wonderful nurse practitioner. Last week, she left private practice in order to work in public health. She's thrilled to be going back to her original focus - research & education - but here's the part that surprised even me (I'd considered myself well-informed about many of the health care issues in this country): working in public health instead of private practice, she will be making more money, getting better benefits, and working better hours.

"Really?" I said, astutely.

She went on to tell me how she was lucky to get the bare-bones benefits she had at the practice she was leaving. Many private practices, she said, don't offer benefits at all.

That five- or ten-dollar co-pay you make for your office visit? The practice depends on that to make payroll.

It's our beloved insurance companies who are making the money. Not the people who make us well when we're sick.

One thing I loved about seeing her was that she always seemed to have an appointment open when I was sick, and she always spent a generous amount of time with me. She listened to me, and she took the time to communicate clearly.

Apparently, she routinely got in trouble with the insurance company for vile, subversive behavior like this. In order to keep appointments available for people who were sick, she inevitably would have time slots that weren't filled. And this was a cardinal sin. The insurance company comes down hard on any practitioner who doesn't have every single time slot filled.

Good luck, then, getting an appointment when you're sick.

My wonderful nurse practitioner isn't an exception, either. More and more, brilliant and talented practitioners are leaving private practice in order to get out from under the thumb of insurance companies. They're leaving private practice, too, according to the dictates of the "free market": because they can make more money and get better benefits in public health than they can in private practice.

Allow me to repeat this: practitioners are leaving the private sector to work for the government so that they can earn more and have less interference from above.

Pig-spitting mad? That doesn't even begin to cover it.

Wednesday, November 07, 2007


Time for some scratch fiction. Consider this a topic tag, too. If anyone wants to write on ESL - go! Let me know in the comments and I'll link to your story.

"Oh, my. Yes, it really looked so, um...he looked...what's the word..."

Eleanor tried to describe what she saw in her head with her hands, circling them around her head. Doug's boss nodded, smiling, a tiny clump of lipstick clinging to her front tooth. Doug's boss turned to answer somebody else's question and Doug squeezed Eleanor's knee under the table.

Eleanor was to be her best tonight. Charming. Brilliant. Dazzling. Doug's first dinner with the new company and she was on display.

But it chewed at her brain, while she sipped her wine. What was the word? She could see it, the man she was describing, backpack and coffe cup in one hand, books in another, reaching for his ringing cell phone. She saw it, but she couldn't think of the word to sum it up. Not silly. Not ridiculous. For some reason her brain threw up the plays of Samuel Becket, Ionesco. Waiting for Godot. Rhinoceros. What was it what was it?

Eleanor worked with words for a living. She didn't like to see one escape, a raw-muscled fish wriggling from her grasp.

"That's a lovely necklace," Doug's boss was talking to her again, "where did it come from?"

Eleanor touched her throat. "Thank you, it was a..." oh good lord you know this word, opening the wrapping, tied up in a ribbon..."um...from my mother." say something nice back, "your..." shit. Thing, the thing you wear to a formal dinner, Eleanor lightly touched Doug's boss' collar - was that strange? "...beautiful."

Doug's boss beamed. She touched her own collar, and started talking, and the words came from her mouth but seemed to drift somehow before they reached Eleanor's ears. What language was she speaking?

Doug spoke from Eleanor's side, the words colliding and cascading in front of Eleanor's eyes. It's like I'm forgetting my language, thought Eleanor, seeing foreign people sitting in a classroom, practicing words, what is it, what is my language called?

Eleanor smiled and nodded, watching the words pop out of Doug's boss' mouth like fat grapes, like shining ornaments, like puffs of flame, they lit up the room. Eleanor smiled at Doug, seeing images of him at his desk, Doug knocking on his boss' door, his eyes on his boss, his boss reaching across her desk to touch his arm once, twice, more, but she doesn't think "boss" "desk" "arm," she sees him, she sees her, she sees more than she's ever seen, more than she could wish.

Doug's boss turns to Eleanor and pushes out words that make a question, looking at Eleanor, but her breasts are looking at Doug and Eleanor opens her mouth, then closes it and smiles.

"Your wife is such a good listener," says Doug's boss, but Eleanor only sees the bright baubles falling from Doug's boss' mouth, her breasts looking at Doug and her thighs open and Doug and his cock nodding, nodding to his boss.