new friend for mom

Girlfriends

Tammy Durham, clay artist

My tween daughters started junior high this year. Lots of new faces. Recently, one of them spent the day with a new friend.

When she got home, she volunteered, "I think you would like Stacie's mom."

"Oh really?"

"Yeah. You're both a lot alike."

I took the bait.

"How are we alike?"

"You both get mad easy."

Ah. I'll be sure to hook up with her, then.

Bluebirds

Tammy Durham, clay artist

health reform from a provider's perspective

Here's what I'm seeing in my practice. I've been doing this for ten years now. Long enough to declare a trend.

And no, stodgy research types, I don't need to conduct a double blind placebo trial in order to render opinions of substance. This is my peer reviewed blog.

Copays are going up. When I first started, the $15 copay was routine. Maybe the copay of highest frequency. I even saw a few $10 copays. Copays of $20 and $25 were the next most routine. But now? The most frequent copay has inched up (and by that I mean, nearly doubled) to $30 and $35. I have a few people who pay $50 per visit. And yes, that's a copay. And I haven't seen a $10 copay in years.

Deductables are higher. And I'm seeing them more often, too. When someone comes in for psychotherapy, especially for the first time, they mistakenly believe their mental health copays and deductables will be the same as a visit to the medical doctor. But the reality is that most of the time? As in, 90% of the time? The mental health benefit requires more cha-ching. (90% was derived from my unscientific, morning cup of coffee to jostle the memory, study).

Usually the most jarring shock is delivered in the form of the mental health deductable. It is not unusual, these days, for me to see $1500 and $2500 before their copay kicks in. Of course, for most, this is a no-getter. No getter therapy. No getter better.

Score one for the insurance industry. They got their premiums. Now you don't get your therapy.

Number of sessions authorized? Going down. It isn't at all unusual, these days, to see "20 visits per year" maximum. Or, lifetime maximum, 60 visits. That's lifetime, people. Which means, if you are diagnosed bipolar you can count on 20 visits per year for three years. Or it might be a dollar amount maximum. $3000 lifetime max. That doesn't cover very much therapy over the adult lifespan, which could be 60 years, easy.

Fees paid to providers? Not going up. Much. Or at all.

A couple days ago my daughter, TwinB, who is at a new school and meeting lots of new friends, approached me, wide eyed. That day she had told a new friend that her mom (me) is a psychologist. "Wow." The girl replied. "You must be rich." TwinB tilted her head at me, as if to say, "What the heck?!?"

This is the same daughter I took to the thrift store earlier in the week to shop for "new" jeans. She looked at me that way because she sees nothing of the rich lifestyle at our house.

We therapy shrinks, the ones paid by health insurance companies, are not making money hand over fist (what does that saying even mean?). Therapy shrinks as opposed to medical shrinks, that is. You know, those real doctors.

But, last I checked the business page, the insurance companies are making it hand over fist. How do we think they have become one of the most powerful lobbies in Washington? Their good looks?

One example. For ten years a certain health insurance company, whose name rhymes with poo-knighted wealth bear, has not increased my fee. Ten years. This lack of regard for inflation means many providers drop off the network. When a poo-knighted client of mine requires psychiatric care, I wince. Good luck finding a quality psychiatry doc who can see you before the next Perseid meteor shower arrives.

Which brings me my next point:

Provider networks are shrinking. No pun intended. I recall when my family doctor posted a sign that they no longer accepted, guess which one? Poo-knighted wealth bear. I knew why. But I asked anyway. The doc, looking none too comfortable discussing his bid-ness with a patient, said he was "having trouble getting payments." I wanted to ask, "Trouble getting a raise, you mean?" But didn't. I had a sick child before him. And I understood his decision. And endorse it even, from the hope that if enough doctors drop off the networks, people will see that insurance companies are dropping the ball.

It's common knowledge that when psychiatrists get a big enough clientele, or patientele, they drop off insurance networks. Private pay only. Those are some pretty discouraging words to hear when you're suffering from major depression because your husband has left you for a younger woman and you have no job because you've been raising his kids for the past twelve years and all you've really got left of your marriage is the fact that he still claims you as his dependent on his health insurance and that will only last until the divorce goes through so you need help now.

And there's more. There's HMO forms and authorization requests and stalled payments and denied payments and being on hold for fricking forever when you call the claims department. But that's about all I have time to go into right now because it's time to head into the office, and you know, be the provider.

But here's my end of the rant summation: The health insurance system, from my view, has tilted into the direction of the wealthy get healthy but the middle class get screwed. And dropped coverage. And depressed. And in need of mental health services but can't afford it.

Ok, after all of that, I'm depressed. I need to make an appointment with a shrink. Oh, but wait. That's right. I can't. I'm self-employed. I don't have mental health coverage. Can't afford it.

So I guess we providers on the networks are shrinking in more ways than one. Or we want to. But we can't afford the coverage.

when shoes matter

I have a long history of shoes mattering.

When the 8th grade Basketball Boy wore these

I wasn't interested. This was the mid-70's. Chuck Taylor's were not high fashion. They were just what boys wore. On the right shaped feet these shoes looked okay. Wide feet, high instep. Basketball Boy's feet were long and skinny. Made his toes curl up in front, like elf shoes.

But the next year, when Basketball Boy wore these

I was all over that. It was heartthrob city for five years.

After Basketball Boy came Bartender Man. I don't think I ever saw bartender man in a bad pair of shoes. Bartender man lasted five years. We did not end because of his shoes. We ended because he took off his shoes under the wrong bed.

After Bartender Man, came Mechanical Engineer Man. ME Man had decent enough shoes when I met him. But one evening he picked me up for a date wearing shoes such as these

For the record, this is not the exact shoe. This is a brand name shoe. ME Man's shoes were generic. The type of shoe the boys in high school wore who hung out in the smoking corral. Rust brown suede. Dark brown laces. Gum rubber sole. And Members Only jackets. The exact shoes I'm thinking of are not for sale on the internet. And I'll tell you why: Men who bought these shoes did not reproduce in great numbers.

But I continued to go out with ME Man. I was not going to reject him based on his shoes alone. I was better than that. Besides, we were in graduate school. Money did not flow freely.

At least that's what I thought initially. Soon I learned that money did flow freely in his world. He pulled up the carpet in his spare bedroom closet to reveal this

I knew he liked to partake of the ganja. I now knew he was putting himself through school with it. This was even less cool than his brown suede shoes. But at least there was hope. For better shoes.

Graduation day came. His masters degree. His mother and stepfather came to see him cross the stage. We met for lunch afterwards. I liked his parents. A lot. Nice looking, friendly, smart, well mannered, well dressed people. Everything was coming together. Maybe this guy could be the guy. And then I glanced down at his feet under the table. He was wearing these

Bedroom slippers. Vinyl bedroom Romeos. ME Man walked the stage of a major university with vinyl Romeos on his feet.

No, this would not be the guy. He would no longer be A guy.

After ME Man I moved up to doctoral-candidate-Chemistry Man. When we started hanging out, it was summer time. Everyday attire was shorts and flip flops. You can't really judge a guy's footwear by his flip flops.

As the fall came into full swing, I noticed Chem Man didn't have any tennis shoes. You know, the white leather sneaker standbys that nearly all guys wore in the 80's. But in Texas you don't say sneakers. You say tennis shoes.

Eventually I asked Chem Man about his lack of tennis shoes. He didn't own any, he said. Why? I asked. Because everybody wears them, he said.

He also did not own a pair of jeans. That's right. Because everybody wears them.

Now, if there's one thing I absolutely love on a guy, it's blue jeans. Preferably Levi's. I lurrve me some nice man ass in a pair Levi's.

That was for the ladies.

And the guys who are also into man ass.

But back to Chem Man. We were both in the poor-graduate-student boat. Chem Man lived on a teaching assistant stipend. No cash stash in his spare closet. I wasn't going to fire a guy because he didn't have the right shoes. Or pants.

But then he showed up at my job. Wearing something that resembled these

Only instead of green stripes, his tennis shoes had a light blue knock off Puma swoosh that looked like a dolphin silhouette.

I couldn't resist asking him why he bought the dolphin shoes, why the sudden change of heart.

I didn't buy them, he said. I found them.

Found them?

Found them on the beach in Galveston. Abandoned. Not a soul around for miles. So I took them.

Oh so, shoes that everybody wears are okay as long as they are found and not bought.

Chem Man told me about his found shoes while sitting across from my desk. I was working at a private psychiatric hospital. The admissions clinician. Chem Man sat in the very spot where severely disturbed individuals signed their psychiatric admission paperwork. Psychotics. Paranoids. Schizo-affectives. Chem Man with his abandoned dolphin shoes and twisted fashion philosophy.

The irony did not escape me. Chem Man was soon history.

So what of the shoes of the man I married? What manly footwear captured my matrimonial M.O.?

To be continued.

time flies

at no faster rate than when I'm reading blogs.

It's Jen @ you know that blog's

rescuing me from my usual mid-week blog infarction.

Jen's theme today is "Time."

Ah, time. That fickle mistress. She slows down when I want her to fast forward past the bad stuff, the tedious waiting, the checkout lines, the lady who doesn't get out her checkbook until the checker gives her the final amount, the long days at the office when I'm counting the number of sessions, hours, until I can pack up and head home.

But when I want her to s...l...o...w down, when I'm hurrying to get myself ready for work, when the ticking of the clock whispers, look at me, please, pay attention to me..., time is not my faithful friend. Oh no. She abandons me.

minutes fly, reading

blogs and comments and pictures

late for work, again

Be sure to check out Jen's haiku. A different, deeper level of how time flies.

the big O's

The Obamas, The Olympics, and The Oprah. Exciting.

I don't know about any of y'all, but I'm actually relieved to learn that Chicago wasn't chosen as the host city for the 2016 summer Olympics.

It settles something I've been worried about for more than a year, now:

Obama is not the anti-Christ.

Whew.

Ok, so can we all switch back to the important mission of health care reform? And that means you, too, Mr. President. Ahem. The ball does appear to be dropping.

And not in a swoosh-nothing-but-net kinda way.

Rather, in a $13K-annual-premiums-plus-$4500-deductable kinda way. As in, I'd like to help stimulate this economy back to good health but I can't because I'm drowning in health care expenses.

So pardon me if I'm not altogether blown away with excitement that a South American country, for the first time in history, will be hosting the Olympics. Or blown away with disappointment that Chicago won't be hosting.

But I will be blown away if this great country of ours can't figure out how to legislate a public option.

As always, it's about choice. And I am all about choice. All ways.

dude, perfect throw

And you thought Texas Aggies did nothing but eat, sleep and breathe engineering.

(19 second clip)

After the clip finishes, you can click on the right hand side to see the view from under the net.

One last thing, these guys donate proceeds from their website to feeding and educating children in third world countries. Compassion.com.

Dude, perfect.

protozoa in your piehole

I read this in my local paper a few days ago: Study finds dangerous bacteria lurks in shower heads. Warns: Do not stand directly under shower spray when first turned on.

Wait. Do people really have to be instructed to stand away from the shower head when they turn on the jets? Isn't the blast of icy cold on warm body deterrent enough?

But to my point. As if we don't have enough to worry about with drug cartels across our borders, economic forecasts dependent on Asia, and nuclear threat in the Middle East, do we really need news outlets publishing one unreplicated study story after another that warn us of the dangers lurking right in our own homes? Cancer from barbeque, radiation from cell phones, hormone additives in our dairy, BPA in the baby bottles, pesticides on our produce, salmonella in the salad. Is there no safe harbor from unseen domestic dangers?

Yet, last I heard, people are living longer than ever. Nursing homes are crowded. No room at the Sunset Inn for grandma. How can this be?

And if is there a better example of toxicological irony, please share in the comments: After everyone but me traded in their BPA laced Nalgene bottles for SIGG containers, SIGG

revealed that their proprietary ‘water-based epoxy liner’ which coated the inside of every SIGG reusable bottle made before August 2008, contained trace amounts of BPA.

So given all of this fear driven news, I sincerely expect to see an article that reads,

Scientists Warn: Kissing is Dangerous

Research microbiologists report findings from a study indicating hundreds of millions of bacteria are found in human saliva. Six hundred different microbial species of bacteria are waiting to spring from that red and white cavity behind your lips.

Stand back, study warns. There's fungi on your face. Cooties on your kisser. Protozoa in your piehole.

What can we do to protect ourselves from this bacterial quagmire?

Dr. Hal I.Tosis of U of OCD recommends donning protective head gear:

music monday with a bit of heaven

It's one of radio listening's greatest moments. Driving down the road, rushing to my office, when I hear a new song, a new voice, a sound that says "gotta hear more." It's what I call a driveway moment after the NPR segment. Idling in my car, I hope the announcer does her job and tells me the name of the artist I just heard.

This latest driveway moment belongs to a young artist from Northern California, Brett Dennen. He's a fiery redhead with a soft, soulful voice. Something in his tone reminds me of Amy Winehouse. Winehouse without the drug drama and smeared eye liner.

"Heaven" is the song I heard. It features Natalie Merchant. I had a driveway moment with her many years ago when she sang "Like the Weather" with 10,000 Maniacs. I had to run out right then and there and buy the album. So it's only a bit of symmetry that I loved this young artist with whom she chose to collaborate.

I can't decide what I like better, Dennen's folky sound or his lyrics. What do you think?


Beyond the rules of religion

The cloth of conviction

Above all the competition

Where fact and fiction meet


There`s no color lines casts or classes

There is no fooling the masses

Whatever faith you practice

Whatever you believe


Heaven?

Heaven?

What the hell is heaven?

Is there a home for the homeless?

Is there hope for the hopeless?


Throw away your misconceptions

There ain't no walls around heaven

There are no codes you gotta know to get in

No minutemen no border patrol


You must lose your earthly possession

Leave behind your weapons

You cannot buy your salvation

There is no pot of gold


Heaven ain`t got no prisons

No government no business

No banks or politicians

No armies and no police


Castles and cathedrals crumble

Pyramids and pipelines tumble

The failure keeps you humble

Leads us closer to peace

now haiku yo selves off to school

Saved by the bell.

Jenn's haiku bell @ you know ... that blog ?

See, I'm due for a post and feeling, uhh, uninspired. Tapped out. In a funk. Wondering who out there in the internets really gives a crap hoot what I have to say because I'm pretty sure I don't give a crap hoot what I have to say.

But then? An invite from Jenn to ring her bell with an education theme on ...

rise up, kids, school's on
morning coffee awaits mom
and sounds of silence

Ahhhhhhhhhh.

A big thanks to all the teachers out there who show up every morning to inspire my kids. I am in awe of you. And I appreciate you.

young people, look away

Bad Mom posted a funky haikulicious poem the other day a while ago with a 70's theme in honor of You Know...That Blog's Haiku Wednesday.

It made me think of something that freaks me out on a regular basis. Or whenever I allow myself to "go there." Which I don't do very often because it gags me with a spoon.

I was in high school in the late 70's. Back then, it was a big fad to dress up in 50's attire: poodle skirts, bobby socks and saddle shoes. We had a sock hop dance and various other school functions with the 50's theme.

My mom was a high schooler in the 50's. She used to reminisce with us. Especially with the music. Those great 50's songs: That'll Be the Day by Buddy Holly; Earth Angel by the Penguins; Why Do Fools Fall In Love - Frankie Lymon & the Teenagers. Loved those.



But to get to my point. I distinctly remember thinking how ancient it all was way way WAY back in the 50's. A whole two decades ago. Dried up and crusted over ancient.



And now? It's the rad thing to have parties with a 70's theme. My decade. Three decades ago.

So today's high schoolers are looking at me with even more "you're so ancient" disdain than I judged my mom and her chronies?

Is that bogue, or what?



Does anybody out there copy?

he who hesitates is los loserface

And his wife, los loserest loserface of all.

It was summer 1990. Late July, I think it was. Sam and I were still dating at the time. In a few weeks I would be moving away for a year. Far away and out of state. When you live in central Texas, anywhere out of state is far away, but I was moving many states away. At the time I didn't know if I would be returning to Texas.

Sam was a big fan of Austin music legend Stevie Ray Vaughn. Had been since Stevie was an unknown playing Miranda's at Northgate in Aggieland College Station. And later, when Sam would drive to Austin on weekends to catch him at the Soap Creek Saloon.

During 1990, Sam and I spent a lot of evenings listening to his albums. I didn't think I liked blues before then. Sam helped cultivate my taste for it. I had never been one for loud lead guitar riffs, but I did favor rhythm and blues, so Sam took the time to find SRV songs I would like. By summertime, I was a fan.

So on this particular Wednesday in July I heard that SRV was playing that night about 45 minutes away. Now was my chance to see this guitar wizard on stage.

"But it's a work night," complained Sam, sucking the wind out of my spontaneous sails. But then, he was the only person in the room with a 7am wake up call. "We can hear him in Austin anytime. We'll catch him during one of your weekend trips back."

So I went by myself plopped down on the couch and pouted kept the 8-to-5 working man company.

A few weeks later, I heard the sad news.

Stevie Ray was killed in a helicopter crash August 27, 1990.

I can't hear his music without feeling incredibly sad. And gypped.

So this is for you, Stevie. The sky is still crying and the telephone lines are still down.

Looks like I'll have to catch a performance on the other side. Until then, it'll be Sam's albums and youtube. Like these two, below, my favorite SRV tunes.

the lion sleeps tonight

Sen. Edward M. Kennedy

1932-2009

Health Care Stories, Austin, Texas

This month Tome of the Unknown Writer is featuring a Health Care Stories Project "focusing on health care stories and opinions from the US and countries with universal health care all this month." Here is my story, fresh in my mind, as my young daughter required emergency surgery a few weeks ago.

The physician's assistant (PA) at the urgent care center diagnosed her with a kidney stone. She ordered a CT scan for later that afternoon, explaining that 90% of all stones are small enough to pass but a scan would alert us if the stone was too large to pass.

As the morning passed into the afternoon and the time of the scan approached, my daughter's pain moved from her back to the lower front of her abdomen and seemed more tolerable. We deduced she was passing the stone.

But let me back up so I can explain our health insurance situation. Husband and I are both self-employed. I'm a psychologist. He's a home builder. Husband is covered under a separate policy from the kids and me. Why? Because no individual underwriter will cover his chronic disease, AKA his pre-existing condition (diagnosed at 18 years old). He has special coverage under the Texas "high risk pool" (subsidized by the state). As a result, we pay two high premiums for two separate plans. We have high deductables ($4500 and $2500) and high copays ($45) so that we can keep our premiums to $1000/month. That makes for a combined total of $12,000 per year, math majors. And with copays that high, we see the doctor almost never only if we think it's absolutely necessary.

Given the high deductable, we knew the cost of the urgent care and the CT scan would be coming straight out of our pockets. Because we believed she was passing the stone, her dad and I considered skipping the CT scan because of the cost. I called the PA and ran it by her. She urged us to go, this time saying she wanted to rule out a few other conditions. We decided to play it safe and take her. But we still wondered if we weren't "wasting" a huge chunk of money.

The CT scan revealed that the source of her pain was not a kidney stone but, rather, a large cyst. At 4:45pm we were told to get her to a hospital emergency room (ER) immediately, that the cyst required removal.

Since then, my husband and I keep thinking, "What if we hadn't gotten that scan?" All because we can't afford a low deductable.

One last note on affordability. We're grateful we're able to maintain our current coverage. The recession has hit our family pretty hard. My biggest fear is that a harder hit will force us to join the nearly 50 million uninsured Americans. I don't even want to think about where we'd be, where my daughter would be, if we weren't able to flash that BCBS card at the medical centers.

But for now we're scraping by and paying our insurance premiums. To say I feel uneasy is a gross understatement. I think its unfair that small business owners have to pay so much more compared to someone working for a large corporation. Supposedly this country is all about supporting small businesses. Not where health insurance is concerned.

So I strongly support health care reform with a public option. Have been holding my breath for it, in fact, since we dropped husband's long held individual policy in hopes of the Clintons promised reform in the early 1990's. But the strong insurance lobby pushed back. And now here we are, more than fifteen years later, trying again.

To all of those congresspersons against reform legislation? Here's a challenge: Surrender your federally funded health insurance and join we hard working Americans who pay out the nose for our supposedly "best health care system in the world." I bet know if you were out here in our world you would pass something quick.

hammer toes

Today it was announced that former House Majority Leader, Tom Delay, will be Dancing with the Stars this season.

What's that going to be like, I wonder?

Will we be treated to the smiling mug of twinkle-toes-Tom, whipping the majority of the audience into a frenzy, exterminating the competition?

Or, more likely, will we see hammer-toes-Tom, leading his partner with a powerful hand down K Street, stomping on her pretty liberal feet whenever she doesn't follow his conservative moves?

Typically I'm not a huge fan of the show, but you can bet I'll be casting my vote this season to send him back to Sugarland.

now hurry up and relax

Today is National Relaxation Day.

My favorite way to relax on a hot August day is to be fully submerged in a spring fed river, feet floating in front of me, collecting smooth, flat, round river stones with which to balance tiny rock pyramids while drinking snorkely-slinky.* It sounds easy, but after a few snorkely-slinkies? Perilous.

Reader, how do you like to relax?

*The drinking alcohol part is optional. Unless it's a typical day at home when a spring fed river is not readily available, in which case, the drinking alcohol is mandatory.

*Oh, but wait. You're probably following the (*) to find out what a snorkely-slinky is. It's my personal favorite mixed cocktail of Svedka, club soda and cranberry. Or better, when I'm uber organized, prickly pear juice, in which case, I should be calling it, snorkely-prickly.

pass that wand to me, please

Blognut at More Mindless Rambling wishes she knew magic whenever her kids ask her to find their lost items.

Well I say to Blognut, if you find that elusive magic wand, pass it to me, please. And I will then immediately pass that wand right over to my kids. Leave me out of the equation altogether, thank you so much.

I don't want to know that the goggles have grown fins and swam away for the thousandth millionth time this summer.

I don't want to be distracted by the search for a matching pair of socks because noone bothers to go through the unmatched sock bucket sitting right on top of the dresser.

That goes double for the husband looking for his mango pomegranite yogurt in the fridge but refuses to kneel down before the altar of the bottom shelf and move the tupperware containers blocking the view. No, he wants me to kneel down. He always wants me to kneel down. What is up with that? Zheesh.

everybody go, pet scan, cat scan, hospital inn

say if your girl

starts actin up,

then you take

her friend.

Or make that, then you take her to the children's hospital.

What a shocker of a weekend.

One minute I was on my way out to play tennis, keys in hand, the next I'm rushing my daughter to an urgent care center with severe abdominal pain and vomiting.

A few hours and a myriad of uncertain diagnoses later, we're at a radiological center for a CAT scan of her abdomen.

By the end of the day we were told to rush her to the children's hospital for emergency surgery. As much as one can rush while crossing town during Friday rush hour.

By evening she was recovering in her hospital room, two small incisions and a heart shaped bandaid on her belly button, quietly but happily in control of the remote, eating graham crackers and apple juice.

By bedtime, chocolate pudding. (That's my girl!)

By lunchtime the following day, discharged. The family in the car, taking her home.

Finally, a stop off at Sandy's for an ice cream cone.

I said a hip hop the hippie to the hippie

the hip hop, a you don't stop the rock it

to the bang bang boogie say up jumped the boogie

to the rhythm of the boogie, the beat

skiddlee beebob a we rock

a scoobie doo

and guess what america we love you

Especially when you provide surgeons and hospitals who return my daughter to good health.

And that's this Rapper's Delight: