Survivor’s Guilt

September 30, 2009

So I am up late watching TV because I can’t sleep the other night, and I find “Bright Lights, Big City” on one of the cable channels. The movie is a remake of a book that I’d read by Jay McInerny. It’s about a guy who spirals down into some dysfunctional behavior over the loss of his mother to cancer. Why I choose to watch this movie over going back to bed and trying to get some sleep, I don’t know.

Even though the main character is played by a 1980’s Michael J. Fox…the guy is not likable at all. Except there is one scene – that is particularly engaging. It’s when Michael J. Fox spends a night sitting next to his mother, sharing his life with her as they both absorb the importance of what may be one of their final memories together.

Although I spent many hours with my mother in the weeks before she died, we never had the long talks at her bedside like you see in the movies. Before the disease started to take away her speech, it was very rare that either my mom or I would talk about death. For me, at least, the topic was off limits – it was defeatist.

When some people find out that their time may be cut short, they take off on Hemingway-style adventures. Mom’s preference was to dedicate herself to her work and to spend as much time as she could with her family. It was as if all she wanted for the rest of her life was for things to stay the same. And that’s how it would be.

So now that all I have left is time to stay up late watching bad TV, it’s hard not to think about all of the things that are going on in my life, in all of our lives, without her.

On one of the rare occasions that mom showed me any of her tears, I could only try to comfort her and say “don’t worry, the therapy will work – it’s always worked”. Perhaps that had been my moment to have a different kind of conversation with her. It didn’t happen, and I can’t remember her ever crying in front of me again.

She’s been gone for a while now, and I am learning how to pass by a display of fresh calla lilies without feeling like someone just punched me in the stomach. But I am wondering what her final wish may have been. What it would have been…if we’d had that conversation.

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Greetings from Dallas

September 23, 2009

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The time for medical insurance reform is long past over due.  I write as an insurance agent for the past 28 years and as a consumer.  If you are lucky enough to have insurance, how confident are you that the coverage will be there for you when you need or want it?

In my experience, with clients under age 65 seeking insurance coverage, companies providing individual and family medical coverage turn down about one third of applicants as uninsurable.  They accept one third of applicants and the other third simply cannot afford the coverage.  This is insurance roulette and the insurance companies currently have complete control of the roulette wheel. 

You do not need to have a very serious medical condition to be denied coverage these days.  Clients with controlled hypertension and slightly elevated cholesterol levels will be denied coverage.  Folks with asthma or allergies who need prescriptions to control symptoms will be turned down for insurance coverage.  Living here in the San Joaquin Valley it is hard to find families where at least one member does not have some treatable medical condition that would on the surface seem not to propose undue risk to the insurance company.  Families somewhat understandably walk away from coverage when one family member is denied coverage contributing to the 47 million uninsured. 

While the art of “cherry picking” only the healthiest of applicants has been nearly perfected by the insurance industry, there are of course folks who eventually have a serious disabling accident or develop a major costly medical condition.  So companies have devised ways to get those folks “off the books” as well.  One technique is to continually propose “new and improved” plans.  Folks with a good claim experience will be allowed to move to the new and improved plan.  Those of course with poor claim histories are left in the expensive claim pool.  Rates are then adjusted based on a plan’s claim history.  The folks in the high risk pool are forced to accept escalating premiums or drop their medical coverage.  Both ways, the insurance company wins and the consumer loses.

It is amazing to me to see the insurance companies paying out over 1.4 million dollars a day to defeat medical insurance reform and then turn around and make public pronouncements that they are really in favor of industry reform.  If they truly supported insurance reform they would have taken the responsibility of changing and humanizing the industry before being faced with long overdue government imposed reform. They want reform on their terms and reform that will keep their current monopolistic advantages in place in the under-age and group markets.  I have seen companies fight even the most minor reform bills proposed in our State Legislature and engage their army of insurance agents to help them maintain the status quo.

If you think insurance companies are consumer oriented, take a good look at their practices of denying coverage, rating policy premiums, eliminating coverage for pre-existing conditions, providing substantial waiting periods before coverage is effective and cancelling coverage when hit by a significant claim within the first 2 years of holding a policy.  In the past year, 3 of the largest individual and family medical insurance carriers in California have been hit with millions of dollars in fines for cancelling policies due to claim filings within the first year of the policy and they were forced to reinstate those policies.

Ask most medical providers how much money and time they spend appealing denied claims for care provided to their patients.  Ask providers how often the insurance bureaucrats come between them and the care they provide to patients.  Most will tell you that insurance-company interference in their practice and the cost of insurance paperwork to appeal and justify claims is substantial.

I focus my insurance practice on two products that have very strong consumer protections.  One is a long term care product called the California Partnership for Long Term Care that is sponsored by the State of California.  The other is Medicare Supplement plans that have strong federal controls limiting plans to 7 fully standardized plans that do not allow for insurance company manipulations.  Both of these plans are provided by private insurance companies but are strongly regulated to protect the consumer.  These protections are not currently available to consumers purchasing individual or group medical plans.

As an under-age-65 consumer of medical insurance coverage, I have personally experienced the daunting issues faced by American families with regards to the medical coverage minefield.  And I meet these folks in my business daily.  It is a non-system that can leave people without their group coverage at anytime.  Consumer protections can be in the end, non existent. Any of us covered by group insurance can lose our job, our company can go bankrupt, our company can cancel our group plan or we can be forced to retire due to illness or disability.  In addition, I meet many people who want to retire but keep working only to maintain their medical insurance coverage.  The odds of getting private insurance coverage if you are between the ages of 55 and 64 are almost slim to none in my experience.  Most folks in that age range are in the eyes of the underwriters of medical insurance carriers too great a risk to provide them coverage.

 About 5 years ago my wife and I had our group insurance coverage cancelled by the company providing our insurance.  The company no longer wanted to incur the bottom line expense of providing medical insurance coverage for the employees even though their share of the premium was at the bare minimum allowed by law.  At the same time, my wife was diagnosed with an advanced stage cancer.  Since the insurance was cancelled by the employer, one protective insurance portability mechanism called COBRA was not available to us (COBRA is not available if the group plan is cancelled).  If you do qualify for COBRA it will only cover 18 months in most circumstances when it is available to you.   Because 5 years earlier I had experienced a mild cardiac event with no damage to my heart, I was still unable to qualify individually for medical insurance and of course my wife being actively treated for cancer at the time was uninsurable as well.

Our only option to get medical coverage was to apply for what is called a HIPPA plan.  The premium for this plan for the two of us was $1650 per month or over $19,000 per year.  The plan had a $2500 deductible and a $10,000 stop loss per person.  For the next four years between the premiums, deductibles and out of pocket co-pays we spent over $30,000 per year for our medical care even with insurance coverage.  For many families I meet, that is a substantial part of their annual income and would be impossible for them to maintain insurance at the cost levels we experienced.  

We did have the best medical care to be found and fortunately we were able to find the means to pay the insurance premiums.  My wife lived well beyond the 6 months that the prognosis said that she would have lived without insurance and the care it purchased.  The disturbing fact is that millions of Americans do not have the access or financial means to pay for the same care.  That must change.

In our personal situations, the only financial relief my wife and I found after almost 4 years in this financially draining situation was that we both turned age 65 and became eligible for a well-run and affordable government option called Medicare.  Our joint monthly premiums including the Medicare premium, a private insurance supplement and the Medicare part D prescription plan was $500 per month compared to $1650 per month before turning 65 years of age. Our coverage included no deductibles or co-pays except for our prescription drugs.  Our-out-of pocket expense was limited mainly to prescription drug expenses.

Before anyone out there wants to just say NO and to deny that reform and more regulation of the medical health insurance industry is not necessary, you may want to ask if you or a family member could fall into any of the situations described above. If it is possible that you may need to purchase insurance in the future, you want to support insurance reform, more regulation of the insurance industry and more options now.

Howard Jackson

The Past Three Months

September 18, 2009

The past 90 days have mentally gone slowly for me and have been marked with several events that were very special to Chole and to our family.  July 13th would have been our 41st wedding anniversary, and August 22nd would have marked Chole’s 66th birthday.  The end of August for the past 35 years was the weekend we spent with special friends who went back to Chole’s earliest days as a nurse at L.A. County General Hospital.  And September 2nd is my birthday.  Thinking about these days engenders special memories, and a sense of sadness that these days will never physically be shared with Chole again. 

My grief counsellor at the Hinds Hospice Agency said I should always allow the grief but also remember as fondly as possible the joy. And over time, she says, the joyful memories will gradually overtake and outnumber the sad ones.  Although these special days were mixed with sadness, fortunately, and with the help of family and friends, the emptiness I feared was filled with the sharing of life with many special people for which I am truly grateful.

I had anticipated each of these special days with some trepidation. They were days that had been especially full of so many wonderful times and memories over the past 41 years.  I was wondering how I would deal with these annual markers in our married life for the first time without Chole to help celebrate and share them. 

There is not a day that goes by that I do not think about and feel the absence of Chole in my life. For example, every morning when I select a coffee cup it brings thoughts of Chole because she virtually hand selected every one of them. I now try and look for joy in the moment and try to remember when and where she found the cup.  It is a strange and mixed process, this life without her trying to find the joy in the sadness.

 Some moments are just flashes of a memory or a thought, some are more reflective and others are very profoundly hard to move beyond.  I was afraid that these special markers in our life would be full of the profoundly difficult moments.  Fortunately with the loving help of family and friends, they became special times with the balance of emotion our life seems to require. 

I have found that allowing sadness can be almost cathartic.  When the deep, sad thoughts release, there is as sense of relief.  I can then think about the many things in my life for which I am thankful, such as just having the privilege of knowing Chole for almost 45 years and the blessings of children, grandchildren and the wonderful friends in my life.

During our anniversary week I was invited to dinner 3 different times and to lunch with Kiwanis friends as well.  A special thanks to Jane & Mike, Mary Allen & Steve, and my buds Danny and Chuck.   I was kept busy enough that I could not fall into the deep hole of sadness for very long.  Just too many people saying — not just with words but with loving support, we can find away through this together on these special days.

The week before Chole’s birthday I had a Kiwanis meeting in San Diego.  On the way down and back I had the wonderful pleasure of visiting with Chole’s mother Emma, her sisters and brother and many of their family members.  It was a very special and enriching time.  It was time I very much needed to spend with Chole’s family and share some special Avina moments.  We shared hugs, tears, laughs, memories, stories and as always the wonderful food. 

Chole’s birthday fell on a Saturday this year and interestingly it was quite overcast and muggy.  It is rarely overcast in Fresno in August.  Isaac, Alicia, Emma, Sophia and I had made plans to go to St Peters Cemetery to honor her birthday. 

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St Peters is a really beautiful place and Chole’s urn is in a niche in an indoor mausoleum named for St Joseph.  Interestingly that is Howard’s middle name.  I can still hear Chole say “Howard Joseph” to distinguish the two of us.   

Her urn, if you remember is really beautiful but is long and not tall like they are usually designed. 

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It took up most of the space in the double niche that we had originally arranged.  It was obvious that there was not going to be room for me (when the time comes) and we decided to upgrade the enclosure to a triple. Fortunately, a triple niche right above hers became available.  The process to open a niche is interesting and requires a permit from the county and of course several fees.

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After an emotional and ceremonial transfer of the urn into the new triple niche, we all went to an area of Fresno called the Tower District which Chole loved, and had a nice lunch.  After lunch we had to celebrate her birthday with a little shopping.  We found a wonderful used book store and all the girls found some special books to take home.  Emma and Sophia of course needed to find books they thought that their precious Abu would enjoy.

During Chole’s funeral you heard wonderful stories about our group of friends that have come together each year at the end of August for almost 35 years.  Two years ago we had planned a weekend in the wine country.  However, Chole was struggling with her cancer treatment at that time and felt unable to make the trip and so it was cancelled.  However, with encouragement from the Williams and Clarks we made that trip this summer.  We took a drive through the wine country with stops for shopping, eating and a little wine tasting at the Sterling winery which requires a tram ride up to the winery.  Once there, the view is breathtaking.  On Sunday, as Chole always reminded us, a trip to the ocean to replenish the soul is required periodically.  After a beautiful walk through Muir Woods in the morning we headed to Sausalito for lunch.  Chole’s shadow was with us the whole weekend.  It was her kind of weekend with places to absorb always with the joy of a child.  Great sites, wonderful conversation, incredible food, beautiful landscapes, the sea and most importantly loving friends kept our end-of-summer weekend full of more memories.

The last few years Chole would make my very, very favorite meal, her enchiladas, only on my birthday.   She said we needed to eat healthier as we got older so once-a-year was enough.  I would beg and pout but rarely got them more than once a year.  On occasion, when we would go out to dinner at a Mexican restaurant I would try and find that true enchilada that I really knew only Chole could make happen. But I would try only to be horribly disappointed.   Howard once told me “dad why do you do this to yourself – you just end up disappointed and ruining your dinner”.  So I stopped even ordering enchiladas in restaurants.  As my birthday approached, I thought about whether I could come close to replicating her enchiladas.  I would think about the process and even think about the smell of baking enchiladas.  However, I could never get the audacity to try and make them.

And so on my birthday I get invited to Chowchilla for dinner.  When I walk in the door there was a very familiar aroma – enchilada makings.  When I tasted them there was no disappointment.  They were Chole’s enchiladas to perfection.  Somewhere along the line, Chole’s secret enchilada recipe got in to Isaac and Alicia’s wonderful cooking hands.  I had a very special evening including beautiful and artful cards drawn by Emma and Sophia.  I wonder where they get the talent?

When I got home that evening I had an email with my birthday gift from Howard.   Howard is always so thoughtful in his gifts.  This year was no exception and interestingly it came in the form of an email and gift card.  I invite you to Google Kiva.  It is an extremely interesting site where you can make micro loans to people in the most remote regions of the world.  They are truly loans, and 99% of the time you will get repaid by the recipients.  Interestingly, most of the requests come from women struggling to survive.  They want to purchase the simplest of things to start a business.   I am now trying to select my first business partner from a deposit made to Kiva in my name.  It is an amazing site to read. It reminds me so much of Chole’s and my experiences in the Peace Corps.

I just want to thank everyone for the cards, calls, dinners, brunches (Rene and Roger) the sharing of moments in time the past 3 months that have allowed me to deal with what I often felt would be an impossible time.  You have got me through this most difficult time. Love to you all. 

Howard Lee

Stronger

September 16, 2009

After mom’s funeral and two months of spending every day surrounded by my family and friends back in California, my independent streak had been bruised up a little. Texas had never been so lonely.

But as you may have read over at the other blog, I’m a member of a gym called Crossfit Dallas Central that has helped me to get a little stronger, in every sense of the word.

My dad…and most of my non-Crossfit friends call it a cult. And in a way, it kind of is like a cult because it has changed the way that I think about how I eat, when I go to bed, how I approach any kind of challenge and how I live in general.

But most importantly, Crossfit has been my therapy over the past few months since mom passed away. We workout in groups (or packs?), and the 7PM class is like family to me now.

This doesn’t mean that I don’t get homesick…but there’s nothing like burpees, snatches, kettlebell swings and handstand-pushups to help put things back into perspective.

Here is a link that helps explain what-it’s-all-about: CROSSFIT