Why Are Insurers Blocking H1N1 Treatment Prescriptions?

I got swine flu. Five days later, I was at death’s door—because my evil insurance company wouldn’t honor my doctor’s prescription. Memo to future revolutionaries: if you require a firing squad for the executives of the Health Insurance Plan (HIP) of New York, I’m handy with a rifle.

I wasn’t worried at first. A little sneezing, slightly achy joints. I figured it was my usual bout of fall allergies. There’s usually nothing to do but suffer. But I felt worse each day: achier, more congested, stiffer, headache, fevers. The third night was bad. I went to bed under a pile of comforters, chattering uncontrollably. Then nightsweats. I checked my temperature: 103.7. When your temperature looks like a classic rock station, it’s time to see the doctor.

I’ve known my general practitioner for decades. So I pay out-of-pocket to see him even though he’s not on HIP’s list of plan-approved doctors. Hey, what do you expect for $749.01 a month?

My ordeal with the insurance company began when I went to fill my prescription for Tamiflu, an antiviral medication that is widely considered the standard treatment for swine (and other types of) flu.

“Your insurance isn’t going to cover this,” the pharmacist said. “You would need a pre-approval from your doctor.”

“But that’s a prescription,” I said, motioning to the white slip of paper in her hand. For younger readers, I come from a generation when a doctor’s prescription was all you needed to get a medication.

“It’s not going to work,” she said, slowing her speech for emphasis. “This drug is for people who have the flu.”

“Um…I have the flu.”

“You have the flu?” She looked shocked.

Because Tamiflu or another drug called Relenza can significantly reduce flu symptoms if taken less than 48 hours after the onset of symptoms, people have been hoarding and taking anti-viral drugs prophylactically—especially in New York City. Given what was about to happen to me, I admire the hoarders. Smart.

I called my doctor. No answer; left a message. Waited. I called back. Got his assistant, who patched me through. I explained the situation. “Put her on,” my doctor said.

I offered my cellphone to the pharmacist. She recoiled in horror. “You have the flu! I’m not using your phone!” She believed I had the flu enough to shriek like a wee girl. So why did she need to confirm it with my doctor?

I asked my doctor to call the pharmacy. “Right away,” he promised.

Wait. Wait. Wait more.

I called back. “Wait. Are you already at the pharmacy?” he asked. “You want me to call where?”

At this point I began to lose my mind.

An hour passed after my doctor and pharmacist exchanged the required bureaucratic pleasantries. She returned to the counter. “I’m sorry, Mr. Rall,” she said, “but your doctor is going to have to call HIP to get their advance approval. It will take him quite a bit of time…it’s complicated, especially for doctors.”

Especially for doctors?

Remember, this isn’t heroin. It’s Tamiflu. The street value of this stuff isn’t that great, and it’s a really, really bum trip. My brain may be baked from a week of triple-digit fevers, but I want to know:

Why the hell would an insurer make it more difficult to get the main drug prescribed to treat the number-one most-talked-about disease in America, one that’s a probable pandemic?

Shouldn’t HIP and other insurers be shoveling these yellow and white capsules out the door, trying to keep their own costs down by getting as many flu victims to recover as quickly as possible?

What the hell is a “pre-approval”? If a doctor prescribes a drug, why isn’t that good enough for the health insurance company?

Oh, and why doesn’t the federal government make Tamiflu available free? Hey, President Obama: What part of “pandemic” do you not understand?

Another hour went by. My pharmacist’s phone rang. She winked at me. “Everything should be fine now,” she said.

Everything was not fine.

I was getting sicker and sicker, just sitting there. My head reeled; an invisible C-clamp tightened behind each ear. I could barely breathe. It felt as though there were shards of glass stuck in my lungs. Every breath hurt. I barely had enough energy to stand up and take a step. My fingers were bluish-gray (an early sign that breakdown of the cardio-pulmonary system is imminent.) I coughed and caught a ball of phlegm in a napkin. It was soaked in blood.

Four hours and 12 phone calls after I arrived at the pharmacy, I went home empty-handed. HIP’s approval still hadn’t appeared in the pharmacy’s computer system.

When swine flu appeared in the U.S. this spring, the government prompted hysteria, predicted the deaths of as many as 90,000 Americans. Now they’re going to the opposite extreme, downplaying a genuine threat by trying to ignore it. They’re no longer even tracking new cases. And Obama Administration health officials are now selling an official line—for most people, swine flu symptoms are no worse than those of any other random flu—that isn’t quite accurate.

For example, while it’s true that children and the elderly are in high-risk categories for swine flu, “40-year-olds are the group most at risk of developing life-threatening complications from H1N1,” according to Canadian researchers cited by the Montreal Gazette. (Centralized data collection is a big advantage of a national healthcare system.)

Another difference is that swine flu is much more likely to cause viral pneumonia, the most common life-threatening complication of flu. It is not just another flu.

Lord knows, it’s not like any other flu I’ve had. I spent that night coughing up blood and downing aspirins to try to keep the fever down. By way of comparison, I’ve been thrown down two flights of stairs—and swine flu is worse. I had pneumonia last year; it sucked hard, but it was a joke next to this.

I went back to the pharmacy in the morning. Still nothing. I called HIP. Unsurprisingly, their voice recognition voicemail tree had some trouble understanding my voice by this time. God forbid they should hire someone in India to actually answer the phone. Finally—success. Sort of.

“The pharmacy needs to enter the approval code,” the HIP lady explained. She read me a long number. I gave it to the pharmacist. She typed it into her computer. “No. Still nothing,” she said.

She didn’t look surprised.

“Would you like me to call HIP?” the pharmacist asked.

“I thought you’d never ask,” I replied.

Half an hour, an overnight and about two pints of phlegmy blood later, I had my Tamiflu in hand. “$87.12,” demanded the pharmacist.

I asked her how much it would have been out-of-pocket, without insurance.

“$112,” she said.

Losing that night has diminished the effectiveness of the drug. It took three days more of feeling like death just to advance to the stage of feeling like crap. Now I’m settling into a nice, comfortable state of wretched.

I just read that a recent ABC News poll says that 32 percent of Americans think the current healthcare system is just peachy. Let’s hope they don’t catch swine flu this winter.

(Ted Rall, President of the Association of American Editorial Cartoonists, is author of the books “To Afghanistan and Back” and “Silk Road to Ruin.”)

COPYRIGHT 2009 TED RALL

How Many More Must Die for Karzai?

“For five years Mr. Karzai was my president,” Ashraf Ghani, an opposition candidate, bemoaned after widespread reports that incumbent Hamid Karzai had used fraud on a massive scale to steal the election. “Now how many Afghans will consider him their president?”

Not many. In a country where civil war is the national pastime and five-year-old boys learn how to fire an AK-47, this is not good. But Ghani is asking the wrong question. The real question is, how many Americans will continue to see Karzai as viable–and be willing to continue to pay the price of propping him up?

California Senator Diane Feinstein used to support Karzai. “Afghanistan is our beachhead on our war on terror. We cannot lose it, or we lose our war on terror,” she said in 2002. What a difference seven years makes! “I do not believe we can build a democratic state in Afghanistan,” she finally admitted last week.

Americans are finally waking up. Afghanistan, most people finally understand, is not “the good war” but the stupid one. We can’t win. Even worse, there’s nothing to win. The historical parallels aren’t perfect–they never are–but it’s hard not to think of the cost of propping up the corrupt Diem regime and its successors in South Vietnam when you see Hamid Karzai prancing around in Kabul, never an arm’s length away from U.S. Special Forces commandos. You see, Karzai’s own troops can’t be trusted not to kill him.

A July headline in The Christian Science Monitor asked an intentionally hilarious question: “Afghan Election: Can Karzai’s Rivals Close the Gap?” Not with the way Karzai stuffs ballot boxes!

There were at least 800 fake polling sites on Afghanistan’s election day–places that “existed only on paper,” reported The New York Times. “We think that about 15 percent of the polling sites never opened on Election Day,” the paper quoted a “senior Western diplomat.” “But they still managed to report thousands of ballots for Karzai.”

Also, “Mr. Karzai’s supporters also took over approximately 800 [additional] legitimate polling centers and used them to fraudulently report tens of thousands of additional ballots for Mr. Karzai.”

Actually, make that hundreds of thousands. In “Kandahar…preliminary results indicate that more than 350,000 ballots have been turned in to be counted. But Western officials estimated that only about 25,000 people actually voted there.”

Overall “pro-Karzai ballots,” reports the Times, “may exceed the people who actually voted by a factor of 10.”

The truth is, there’s nothing new here. Ashraf Ghani may have been the only Afghan to have ever considered Karzai legitimate. To most Afghans, Karzai has always been a curious “impotent dictator,” propped up by U.S. military force but with insufficient funding to exert his power outside the capital Kabul. In the provinces, tribal warlords fight the Taliban for control.

Looking at Karzai’s resume, it’s hard to imagine what George W. Bush and his “pet Afghan” Zalmay Khalilzad were thinking when they appointed Karzai as the U.S. puppet “interim president” of occupied Afghanistan in late 2001. Granted, all three were oilmen–Karzai and Khalilzad had both worked as consultants for the energy corporation Unocal, which tried to build an oil-gas pipeline across Afghanistan in the mid-1990s.

But Karzai lacked both integrity–as a Taliban official in 1997, Karzai was caught embezzling government funds and forced to flee the country–and support. He was a Pashtun, and the new Northern Alliance government was predominantly Tajik. Always essential in a nation permanently at war, Karzai had no military bona fides, having rarely seen a shot fired in anger.

Karzai’s drive to consolidate power since 2001 has been marked by trickery, intimidation, ballot stuffing and systemic corruption. One “election” has followed another. But none have been conducted legitimately.

Perhaps democracy was too much to hope for in a nation whose infrastructure had been degraded to the 14th century. There was no census, no house addresses, no mail service. How could a fair election be held?

Karzai didn’t even try.

At a June 2002 loya jirga (grand assembly) to choose the new head of state, Karzai got his U.S. masters to lean on his main rival, former king, Mohammed Zahir Shah. Zahir Shah withdrew, as did 70 of his delegates. They did the same to ex-President Burhanuddin Rabbani, guaranteeing Karzai a phony mandate.

“Voting for the loya jirga has been plagued by violence and vote-buying,” said UN envoy to Afghanistan Lakhdar Brahimi at the time. “There were attempts at manipulation, violence, unfortunately. Money was used, threats were used.”

“This is not a democracy, it is a rubber stamp. Everything has already been decided by the powerful ones,” added the Women’s Affairs minister.

On October 9, 2004, Karzai “won” his first “democratic election.” As before, Karzai’s goons stacked the deck. Unsympathetic elections officials were kidnapped. The UN concluded that “that fraud had occurred, particularly ballot-box stuffing” in the 2004 election. The UN “noted that some estimates have said that 10 percent to 15 percent of the 11.5 million registered voters, in Afghanistan and among Afghan refugees abroad, may be registered more than once,” reported The New York Times at the time. The three-member committee that counted the ballots were all appointed by Karzai.

Those who can’t win, cheat. Without the U.S., Karzai would never have won power in Afghanistan. He certainly wouldn’t have kept it.

Meanwhile, the New York Times reported May 18, 2009 that Zalmay Khalilzad “could assume a powerful, unelected position inside the Afghan government under a plan he is discussing with Hamid Karzai, the Afghan president, according to senior American and Afghan officials.”

Bush’s corrupt oilmen are still having fun looting Afghanistan. The question for us Americans is: why should anyone die to help them?

(Ted Rall, President of the Association of American Editorial Cartoonists, is author of the books “To Afghanistan and Back” and “Silk Road to Ruin.”)

COPYRIGHT 2009 TED RALL

A poll says that 67 percent of Americans don’t understand Obama’s healthcare plan. I’m one of them.

It’s not because I don’t pay attention. I’m a news junkie. Could it be that I’m an idiot? If my insurer offered psychiatric coverage I could afford to find out.

I’m pretty sure, though, that my friends are smart. I asked my publisher, who runs the oldest publisher of graphic novels in the U.S., whether he understood what Obama’s “public option” was. He didn’t. I asked a teacher, who earned a masters from an Ivy League school. She didn’t either. I asked a bunch of political cartoonists. Neither did they.

Obama’s attempt to reform healthcare is all but dead; his polls are dropping. How did Obama turn lemonade into battery acid? Obama PR flack David Alexrod tries to explain that “to make choices is to make some unhappy.” GOP strategist Charles Black counters that the president’s popularity and “good will” doesn’t equate to support for “liberal policies.”

I think they’re both wrong. The collapse of ObamaCare is rooted in the problem described by the cognitive linguist George Lakoff: liberals do a crappy job of communicating to the public.

Speaking of which: what is/was this mysterious “public option”?

On the left, The Nation magazine says it’s “designed around not making people change their healthcare if they like what they have.” OK, so that’s what it’s not. What is it? “Instead, there will be rules that insurance companies have to follow to provide better care, and a health insurance exchange, including a public option, for people who don’t have employer-provided care.”

A public option is a public option is a public option. How helpful.

I rely on words to make a living. I’ve published 14 books. Some have even sold well. “Health insurance exchange”? WTF?

You know what I think? I think this is like that fairy tale about the emperor’s new clothes. I think The Nation doesn’t know what the “public option” is any more than the rest of us. They’re just afraid to admit it.

On the right, The National Review says it’s “a government-run insurance plan that will compete with private insurers.” Compete how?

For a guy reputed to have a way with words, Obama isn’t adding any clarity.

Huh?

Dems say the “trigger” isn’t a death panel. Instead, private insurance companies would have to make their services cheaper within a certain number of years (say, five). If costs stayed high, the U.S. government would then create a…public option. (Unless Congress, feeding at the trough of insurance company lobbyist money, was persuaded to amend the law between now and then.)

“This is the best shot we’ve got for getting a public option,” a House Democratic adviser told UPI. “It’s better than nothing.”

Actually, it’s exactly the same as nothing. Except that nothing sounds better.

I understand “nothing.”

Nazis. Americans are Nazis. We are Nazis.

Godwin’s Law be damned–it’s impossible to read the newly-released CIA report on the torture of Muslim prisoners without thinking of the Third Reich.

Sadism exists in every culture. A century ago, for example, Western adventurers who visited Tibet reported that the authorities in Lhasa, that supposed capital of pacifism, publicly gouged out criminals’ eyes and yanked out their tongues. But Nazi atrocities were stylistically distinct from, say, the Turkish genocide of the Armenians or the Rwandan massacres of the early 1990s. German war crimes were characterized by methodical precision, the application of “rational” technology to increase efficiency, the veneer of legality and the perversion of medical science.

Nazi crimes were also marked by public indifference, which amounted to tacit support. Here and now, only 25 percent of Americans told the latest Pew Research poll that they believe torture is always wrong.

“The CIA’s secret interrogation program operated under strict rules, and the rules were dictated from Washington with the painstaking, eye-glazing detail beloved by any bureaucracy,” observed The New York Times. We have much in common with the Germans.

“In July 2002,” the declassified report reveals, a CIA officer “reportedly used a ‘pressure point’ technique: with both of his hands on the detainee’s neck, [he] manipulated his fingers to restrict the detainee’s carotid artery.” Another agent “watched his eyes to the point that the detainee would nod and start to pass out; then…shook the detainee to wake him. This process was repeated for a total of three applications on the detainee.”

The CIA’s rinse-lather-repeat approach to torture is reminiscent of Dr. Sigmund Rascher’s experiments at Dachau and a parallel project conducted by the Japanese Imperial Army’s infamous Unit 731 in occupied Manchuria in 1942-43. Rascher, who was tried for war crimes after World War II, froze or lashed detainees nearly to death, then revived them over and over. German and Japanese doctors developed detailed protocols governing the severity of exposure to which inmates could be subjected–protocols seized by U.S. occupation forces and turned over to the OSS, predecessor of the CIA.

(Or, to be more accurate, so it is. Bush publicly banned torture in 2006, but we know it was still going on as of 2007. Obama supposedly banned it again earlier this year, but then his CIA director Leon Panetta told Congress the agency reserves the right to keep doing it. Until the entire secret prison network is dismantled and every single prisoner released, it would be absurd to assume that torture is not continuing.)

Among the verbal treasures in the CIA papers is the “Water Dousing” section of the “Guidelines on Medical and Psychological Support to Detainee Rendition, Interrogation and Detention,” which “allow for water to be applied using either a hose connected to tap water, or a bottle or similar container as the water source.” Ah, the glorious war on terror. Detainees may be soaked in water as cold as 41 degrees Fahrenheit for as long as 20 minutes–no longer, no colder.

For the record, the CIA’s medical expertise is about as reliable as its legal and moral sense. Forty-one degrees is bracingly cold; 41 was the temperature of the Hudson River was when US Airways Flight 1549 crashed into it earlier this year. (Remember the ice floes?) “Generally, a person can survive in 41-degree water for 10, 15 or 20 minutes,” Dr. Christopher McStay, an emergency room physician at New York City’s Bellevue Hospital told Scientific American magazine.

Like its Gestapo and SS antecedents, the CIA is highly bureaucratic. CIA employees were informed that “Advance Headquarters approval is required to use any physical pressures [against prisoners].” And those permissions came from the very top of the chain of command: the White House, which ordered the Office of Legal Counsel and other legal branches of the federal government to draft “CYA” memoranda. The memos, wrote Joshua L. Dratel in his introduction to “The Torture Papers: The Road to Abu Ghraib,” a compilation of memos authorizing torture of Muslim detainees reflect “a wholly result-oriented system in which policy makers start with an objective and work backward.”

Also reminiscent of Nazism is the utter absence of firewalls that has come to characterize the behavior of top government officials. Totalitarian regimes like Nazi Germany corrupt the judiciary by using the courts to carry out political policy. Beginning under Bush and now under Obama, judicial independence has been eradicated.

On August 28th The New York Times reported: “In July, Leon E. Panetta, the CIA director, tried to head off the investigation [of the CIA’s torture program], administration officials said. He sent the CIA’s top lawyer, Stephen W. Preston, to [the Department of] Justice to persuade aides to Attorney General Eric H. Holder Jr. to abandon any plans for an inquiry.” There’s a term for this: Obstruction of Justice. You’re not supposed to try to influence the outcome of an investigation. It was count six of the impeachment proceedings against President Nixon.

To Holder’s credit, he has appointed a special prosecutor. To his discredit, the focus of the investigation is narrow: he will only go after officials who went beyond the Bush Administration’s over-the-top torture directives (which allow, as seen above, freezing people to death). He does not plan to go after the worst criminals, who are the Bush Administration lawyers and officials, including Bush and Cheney themselves, who ordered the war crimes–much less those like Obama who are currently covering them up.

He should change his mind. While he’s at it, he should throw Leon Panetta in jail.

Holder’s brief currently involves just 20 cases, which include detainees who were murdered by the CIA. But even those will be tough to prosecute, reports The New York Times: “Evidence, witnesses and even the bodies of the victims of alleged abuses have not been found in all cases.”

Because, you see, the bodies were burned and dumped.

They–the CIA–are Nazis for committing the crimes.

And we are Nazis for not giving a damn. Only a third of Americans told the April 27th CBS News/New York Times poll that there ought to be an investigation of Bush-era war crimes–and they don’t care enough to march in the streets, much less break a few windows. So few of my columns on torture have been reprinted by American newspapers or websites that I seriously contemplated not bothering to write this one.

We have met the Nazis, and they are us.

(Ted Rall, President of the Association of American Editorial Cartoonists, is author of the books “To Afghanistan and Back” and “Silk Road to Ruin.”)

No wonder President Obama won’t stand up for us. He won’t even defend his personal safety!

Two weeks ago, a right-wing man protested outside the president’s healthcare meeting in New Hampshire wearing a gun strapped to his leg. Lest we miss his point, he carried a sign that called for the shedding of blood in a new revolution.

A week later, a dozen men appeared outside Obama’s appearance in Phoenix brandishing loaded guns. “We will forcefully resist people imposing their will on us through the strength of the majority with a vote,” said one, who carried an AR-15 military-style automatic rifle. You read that right–they threatened to use guns to annul the results of the last election.

Cops stood by and watched. The Secret Service did nothing. Strictly speaking, these mooks are allowed to openly carry guns. Which is fine with me. I’m a big fan of the Second Amendment.

It is, however, horrifying to watch goons threaten to assassinate the President of the United States and get away with it. Make no mistake: guns don’t have anything to do with healthcare. This is a revival of Klannism. A black man is president, and the good ol’ boys don’t like it. That’s what this is about: putting him in his place. Which, if they or someone they inspire has their way, will be six feet under.

God. The smirks those turds wear! Run a Google Image search on “Klansmen” or “lynching.” Same ones.

(Doubt this is about race? Bill Clinton’s 1993 healthcare proposal would have gone farther than Obama’s. And he wasn’t nearly as popular. Yet he didn’t face gun-toting loons at his public appearances.)

John Lott of Fox News says the liberal media is making a big deal out of nothing. “A story about an American with a gun who behaved properly is twisted into something else: a narrative about crazy conservatives who want to threaten the president,” he argues, too clever by half. But the right-wing media doesn’t even try to explain what place guns have in the healthcare debate. These are crazy conservatives who want to threaten the president.

Federal laws do change. Kody Ray Brittingham, who faces five years in prison and a fine of up to $250,000 under Title 18, Section 871 of the United States Code for threatening Obama–thinks a lot about that fact nowadays. “We take all threats against the President and other high officials of the United States very seriously,” said the U.S. attorney prosecuting the case against the 20-year-old soldier, who said he planned to shoot Obama–but never made any move to do so. “The threat itself represents a disruption of the United States Government, even if no actual attempt is made to carry out the threat.”

That was just six months ago.

Why doesn’t the Obama Administration want the gunmen taken in for questioning and investigated? He wouldn’t even have to file charges. Habeas corpus is gone, eliminated by Bush. Obama’s “indefinite detention” continues Bush’s policy. These town hall terrorists could be declared enemy combatants and bundled off to Bagram with the stroke of a pen. If ever there were a reason for suspending civil rights, this is it.

Perhaps Obama’s team doesn’t think gunmen a block or two away from a Secret Service perimeter is a big deal. Maybe the White House has made a political call: better to gamble the life of the president than to risk antagonizing the gun lobby.

They should rethink.

Arthur Schlesinger’s classic book “A Thousand Days: John F. Kennedy in the White House” describes how an atmosphere of violence can contribute to the death of a president:

In late October 1963, former vice presidential candidate and then U.S. ambassador to the U.N. Adlai Stevenson “had gone to Dallas for a meeting…The next day handbills with photographs of the President of the United States–full-face an profile–were scattered around Dallas: ‘WANTED FOR TREASON. THIS MAN is wanted for treasonous activities against the United States,’ followed by a scurrilous bill of particulars.”

What follows reads like last week’s news reports about town hall meetings on healthcare: “That evening…While Adlai spoke, there was hooting and heckling, placards and flags were waved, and noisemakers set off. When the police removed one of the agitators from the hall, Stevenson, with customary poise, said, ‘For my part, I believe in the forgiveness of sin and the redemption of ignorance.’ At the close he walked through a jostling crowd of pickets to his car. A woman screamed at him, and he stopped for a moment to calm her down. The mob closed in on him. Another woman crashed a sign down on his head. A man spat at him.”

Schlesinger didn’t claim that JFK was killed by a right-wing anti-U.N. protester. Instead, he wrote, “The fundamentalist religious background of many of its inhabitants had instilled a self-righteous absolutism of thought…[Dallas] was a city of violence and hysteria, and its atmosphere was bound to affect people who were already weak, suggestible, and themselves filled with chaos and hate.”

Four weeks later, a weak-minded, eminently suggestible man shot President Kennedy to death.

“Supporters of the Second Amendment ought to find another way to send their message,” editorialized The Washington Post. It was a typical, reasoned, pointless stance. But it’s too late now to call for common sense and self-control. Now that extreme right racists have made a splash, they’re only going to double down.

Obama’s approach may be a brave one, but it’s not his to take. As a recent headline put it, the presidency belongs to all of us. Like JFK, Obama’s assassination would lead to a host of tragic consequences, not least in the area of race relations. And what about the more likely danger, a repeat of the Greensboro massacre, when right-wing thugs shot leftists at a rally?

Existing gun laws weren’t written with death threats to public officials in mind. Anyone who shows up armed at a forum where a public official or political candidate is due to appear ought to be detained–and possibly prosecuted.