The Baltimore Sun has a writer who publishes "Jay Hancock's Blog," and Mr. Hancock's entry for November 6, 2009, is entitled, "Profiles in wimpiness," briefly citing several leading voices calling for approval of pending health care reform legislation.

Mr. Hancock first quotes Paul Krugman, a fellow whom I have harshly criticized, both in writing and on my Internet talk radio show. Even the most meritorious of ideas will have its share of oafs littering the parade route, and Dr. Krugman's unconscionable intellectual prostitution for countries that massively undervalue their currencies against the U.S. dollar qualifies for the blue ribbon parade award for the Float That Should Be Shot, notwithstanding his Nobel Prize in economics this year (a prize previously granted to the very epitome of oafishness on the speaking tour parade, the late Right-wing extremist and howlingly lackluster "intellectual," Milton Friedman).

One comment, written by someone using the pseudonym "MrRational," on Mr. Hancock's article struck me:

I still remain opposed to the entire scheme.

Corporate and Government are two sides of the same nannyism coin. Neither can be expected to solve anything for us.

But to the degree that either is allowed a brief or responsibility...
make it a narrowly focused one.

there are three basic levels/categories of care:
1) the 80% that constitutes everyone's day to day uses which should be paid for out of pocket (by most of us) on a fee for service basis to the provider we choose. (and yes, people with some conditions can expect to pay more for that basic care than people who don't have those conditions.)

2) the 10 % that will occasionally crop up beyond those routine year to year expenses that we can mitigate the budget impact of by having some back stop insurance (or an HSA) which we also pay for on our own and most will use very similarly to how we use our homeowner or auto insurance.

3) The 10% that NO ONE can reasonably expect to afford or in most instance to even insure against privately. These catastrophic and traumatic bankrupting expenses are the perfect category for and reasonable limit to a government plan with a tax supported 100% actuarial base.

If we are willing to be truly honest we can add a fourth category:
4) Stop pretending that anyone gets out alive by refusing to flog and abuse our elderly loved ones and call it medicine.

We can make it more complicated but there is no reason to.

I have not had much success in recent years with getting my comments I write published at reputable Websites. The Leftist site truthout.org — persistently begging for donations while doing little more than republishing other sites' content — will not post any comment I write, The Huffington Post only rarely lets one of my comments through, and the same goes for CNN.com; hence, I no longer bother visiting these sites much. Long-time readers here at The Dark Wraith Forums know very well that my style of writing does not include the use of profanity or unrealistically hyperbolic literary imagery unless in the service of occasional satire.

Okay, I did use an obscenity, a profanity, and several vulgarities in writing about Paris Hilton's early release from incarceration; in my own weak defense, however, once in a blue moon, the mockery of uniform rule of law that is the American justice system bunches my boxers. As a broad principle, however, I write what could be published just about anywhere children would not be a target audience.

Still, I get censored. My short-lived gig writing for OpEdNews is over: one of the sneering, Leftist editors there got appallingly nasty in rejecting an article I subsequently published here to the usual, decent number of hits. The Institutional Liberal Manual of Style seems to be widely available to dwarfs at places like truthout.org and other caves on the Left Bank of the American river of ideological polarization. (As an aside, in a few days I shall republish excerpts from that article because those sentiments I expressed there are every bit as timely now as they were in the late Winter when I first wrote them.)

With all of the above as admittedly somewhat unshaped background, I nevertheless offered a follow-on comment at Jay Hancock's Blog. To my surprise, it was published this morning in unedited form.

I am herewith offering it to my own readers here at my online properties of Dark Wraith Publishing to the purpose of providing one more means by which I may speak to the debate over health care reform.

The comment by "MrRational" is worthwhile, although I have no particular use for the idea that we cannot take care of the poor, especially the children in this condition, who need basic medical services but who cannot afford to have them on a readily available basis. As a quite affluent society, we can surely afford to take care of people whose earnings make keeping body and soul together a challenge, and those people will number in the many millions, even in an industrialized society such as ours so long as we choose a form of economic organization where there are winners and losers, as well as stark differences in the long-term, even inter-generational fortunes of those two groups.

It is most unfortunate that a "progressively conservative" approach to reform was never in the cards for the debate in Washington; however, as a purely academic exercise, I note three major points that are missing in Mr. Rational's comment.

First and foremost is the matter of price transparency. Doctors, medical centers, and hospitals all hide their prices, which thwarts the very foundation of competition that would cabin those prices within an envelope formed by profitability and affordability. As a professor, I make a big issue of this. Price transparency is crucial if the demand and supply sides are to discover prices that clear markets efficiently; but no serious federal or state proposals have been fielded to mandate publicly available price disclosures for a standard list of medical services and treatments.

Second — and this point goes far, far beyond the health care industry — we are using antitrust laws written in the first half of the 20th Century to deal with markets of the 21st Century and the market power of concentrated industries in an age where "deregulation" has allowed the argument for scale economies to sway regulatory oversight despite overwhelmingly larger, social and economic interests that are harmed by compacted industries. The Federal Trade Commission frets about "unfair and deceptive" advertising, it uses antiquated metrics like the HHI to measure market concentration, and it chases market concentrators after they've become too large to bust (as in the case of Microsoft, and as in the case now of Google).

Third, and finally, the rampant lack of education in basics of economics and business allows far too many people to get by with no understanding of such concepts as "moral hazard" and "adverse selection." This ensures a debate where only Right-wing conservatives bring up these ideas, and usually in offensive ways, making the underlying concepts as loathsome as everything else Right-wing conservatives talk about. If we are to have a truly informed debate, it would be so much better if the dancing, naked clowns of the Right (as I've called them in my writings) would shut up so the legitimate points they are mimicking could be brought up by people who aren't dancing, naked clowns.

Unfortunately, as it now stands, the only health care "reform" being discussed is really just health care repair, and it's sloppy repair done by self-serving politicians. Some things never change.

That's politics.

For the record, I am opposed to the health care reform bill in the form that the U.S. House of Representatives has just passed. I will sharpen my attack as time goes on, but I can assure readers here that those Right-wing clowns in the entertainment industry, along with their Republican sidekicks in Congress, will never be outside the scope of my criticism, either. Nothing irritates me more than intellectual fools and entertainment industry charlatans. They make legitimate debate next to impossible, so I hold them in particular contempt, even as I do the same for the Democrats in Congress who don't have the guts to write a genuine health care reform bill, much less a real, comprehensive overhaul of this country's miserably failed antitrust, financial services, and privacy laws.

I shall write what is on my mind and leave to the Democrats such ideals as compromise and accommodation, which those same Democrats over the past decade have turned into rank, disgraceful appeasement by another name.


The Dark Wraith is officially on yet another roll.

On August 9, 2009, Dr. Andrew Weil, the Founder and Director of the Arizona Center for Integrative Medicine, published an article entitled, "The Wrong Diagnosis."

Long-time readers of my own articles know that I am not one to write an article that is just another writer's work; while extended quotes from other sources, where allowed, are just fine for spreading good information — especially when a useful, integrated compilation is the resulting post — making a blog of nothing but aggregated articles strikes me as too parental for my own style. Moreover, given that Dr. Weil published his article at The Huffington Post, I am doubly reticent to use Websites of my publishing company for an extended quote from the author, given my open disdain for Arianna Huffington as a journalist and as a user of other people's talent to asymmetrically enrich herself.

However, what Dr. Weil has to say is far too important to allow myself to pass unrepeated and unpraised. It is a predicate to some of my gravest concerns about health care "reform" as it is now being cast by the Democrats who have crafted the House and Senate versions of responsive legislation.

Suffer me this relatively short, elided passage from Dr. Weil's article, after which I shall close this opening essay about health care reform with harsh words and then an altogether reasonable, if unusable, path to progress.

From Dr. Weil:

I'm worried -- and if I'm worried, you should be, too.

The reason I'm worried is that the wrong diagnosis is being made.

As any doctor can tell you, the most crucial step toward healing is having the right diagnosis. If the disease is precisely identified, a good resolution is far more likely. Conversely, a bad diagnosis usually means a bad outcome, no matter how skilled the physician...

But what's missing [from current reform legislation], tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly.

It's impossible to make our drug-intensive, technology-centric, and corrupt system affordable...

[Read the entire article at The Huffington Post]

Most unfortunately, the hysteria-whipped mobs now showing up at town meetings where health care reform legislation is supposed to be discussed have made any reasoned, rational attack on the reform efforts virtually impossible. This same problem faces any critic of Obama's policies and actions in other spheres, too. In my article, "A Paleo-Conservative Message to Republicans," I tore into the current breed of Republican conservatives for what they are doing to constructive debate:

My worst problem now is you Republicans: you swirling gaggle of disgraced, naked clowns still dancing on the stage while adults try to speak; you crowing blast of hot air gusts still trying to fan the flames of hate you once used to scorch the land of tolerance; you craven, culled pack of eviscerated hyenae nipping at heels of people far larger than you can ever again be.

I am maddened to find that opposing certain of President Obama's policies and personnel appointments, opposing the prevailing current in health care reform, opposing the already-established directions that financial services industry reform are taking put me in apparent, superficial league with vicious demagogues and their blind, uninformed masses.

It is like trying to give a lecture on exobiology while surrounded by Star Trek fans in full Federation and Klingon regalia.

It is like trying to explain the catastrophic failure of the Federal Reserve of the past eight to ten years while sharing the stage with Ron Paul's neo-Nazi followers slapping me on the back and saying, "You tell 'em, Boss! The Fed must DIE!"

(And in the interest of full and honest disclosure, that last one is way too close to my actual experience for comfort.)

Nevertheless — and may God help me in this trial — I shall have my say. I shall expect no increase in my popularity as an analyst: calling the Right-wingers and some conservatives "imbeciles" and calling some Leftists and liberals "air heads" is not the way to make friends and influence people, but if it is of any comfort to those on both sides of the political debate, I will have some kind words for what underlies your rhetoric. Setting aside self-serving, craven politicians and talk-show entertainers who care about nothing other than the power and wealth they garner, the rank-and-file of both the Right and the Left are not really stupid, and they generally, at least in their quieter moments of reflection, speak from their own hearts, even though their own hearts can be used by those who really care about no one but themselves.

I have much to write in opposition to what both sides are doing; and it is not that I am a contrarian that I take such a dim view of what is going on.

In fact, although beside the point right now, I am a contrarian. For example, Nobel Prize-winning economist Paul Krugman says that current Federal Reserve Chairman, Ben Bernanke, should be appointed to a second term. I condemn this: Ben Bernanke is a failure, and Paul Krugman is a self-serving, lousy tool of an economist. Note that I provided a link for each of those harsh statements: read for yourselves that I provide sound reasons for my otherwise seemingly cruel assessments. When I can speak from facts, sound theory, and strong personal experience, I waste little breath speaking of my "feelings"; those come at the end of the day and speak for themselves through the subtext of my expositions and narratives.

At the beginning of this article, I quoted from an article by Dr. Andrew Weil and wrote favorably of what he had to say. Promoting fools, uneducated (and educated) imbeciles, and political opportunists is not my style. When I quote someone, especially at length, I confer an assessment I rarely give even to a President I might — to some minimal extent, anyway — actually like.

In at least one following article, few will be my opportunities to have good things to say about either side in the current debate about health care reform. An ignorant, hateful opportunist like Sarah Palin is a good place to start in condemning the Right for opposing reform. Any Congressman who thinks forcing uninsured people to buy "public option" health insurance under penalty of law for non-compliance the way Massachusetts does is a good place to start on the Left.

And anyone on either side who thinks shutting down a vigorous conversation with a "my-way-or-the-highway" mentality merits nothing other than scorn, and I will be more than glad to mete it out.

I wish I could offer an olive branch to everyone passionately involved in this acrimonious debate. Those opposed to health care reform are difficult for me to reach at this moment. They have built a fortress of certainty around their sentiments. It will be hard to overcome the sound-deadening ramparts that insulate them from alternatives to the extremes to which they believe they are justified in going; but that is precisely why I shall, instead, offer some words to my more progressive friends, should they be interested in a non-aligned, alternate idea for overcoming not just the barriers stopping reform, but also the despair of trying to talk with people who are not listening.

I need not tell you that this is a difficult and wholly new area of social progress you are seeking in health care reform. The United States of America is not Europe, and it is not Canada; it is not even the United States of the 1930s, when sweeping changes brought the federal government into the lives and business activities of the people more than had occurred since the War between the States.

Yes, our health care system is in desperate need of reform, but its need is part of a much larger, much more complex need for reforms of our antitrust laws, our regulatory structures, our courts, and even our law enforcement model. Underlying — and, oddly, beyond — all of these, though, is our need for renewal of ourselves and our civil society. As Dr. Weil implied in his article, we cannot cure a disease by addressing symptoms alone. We can, of course, offer comfort while the illness, itself, is being addressed, and that is what health care reform at this time should be about.

The last attempt to reform our system of health care in this country met with complete failure, but this was not, as many progressives believe, because of the conspiracy of business interests and their feckless minions in politics; instead, it failed because it was crafted beyond the view, input, and dialectical process of the people — the people — who would be its beneficiaries. That early-1990s reform proposal came to the citizenry fully developed, complete and integrated, with virtually no room for deep change based upon the input of real people with honest-to-goodness, real ideas, concerns, fears, and questions.

In a democracy, we the educated — the elite, the informed, the knowing — simply cannot presume that we know better than those we govern, those we educate, those we pose to lead. As frustrating as it might be, we are no better than they when it comes to either the ballot box or the grocery store. Simply handing the electorate the products of our ideas and saying something to the effect, "Now, ask us how this works," is a prescription for disaster.

The considerable and legitimate fear of a neo-fascist movement in this country is not addressed by labeling it, demanding action against it, and decrying its beliefs. Beneath that extremism is a penetrating, unspoken, sometimes unconscious fear among far too many of our brother and sister citizens that their lives — all of our lives — are now beyond our control, in the hands of faceless technocrats, academics, shadowy forces, and law enforcement personnel who are without mercy, without control, and beyond redemption.

Ignore the fears of these people as you will, but I can draw straight lines for you across the years and decades from the here and now clear back to 9/11, on back for some of those "Right-wing crazies" to Ruby Ridge and Waco, and on back from there.

Symbolic representations are not just for dreams. We lose control of our children to entertainment media and its unwashed trash, to technological innovations, and to education theoreticians, so why is it surprising that this billows forth as out-sized fear of everything from evolution education to child predators around every corner?

We lose absolute sovereignty in our own homes and in our cars, so why is it surprising that this comes out in skyrocketing sales of personal firearms and cries for more of the very police who will treat us all like we're criminals waiting to get caught?

We lose control of the right to work, to earn a living without being fired for no reason, so why is it surprising that people blame everything from unions to immigrants?

We lose control of our bodies to media-flogged fears of cancer around every corner, diseases of which no one even heard (including doctors) a generation ago, so why is it surprising that a non-existent status quo is far preferable to a situation where bureaucrats take control of the health of people who have no control over it, as it is?

Stop. Think. Most importantly, shut up and listen. Do what President Obama did with Gates and Crowley.

In fact, President Obama, to whom I gave high praise for sitting down with the professor and the policeman, should do the same right now, except that he should let the progressives stay at home. He needs to peel off common citizens protesting against the health care reform effort, bring them to the White House, and talk with them. Get them away from their mean, opportunistic, talking-points cheerleaders, and let them speak for themselves to him; and once an honest dialogue has been fully engaged and exhausted, let Mr. Obama take what he has heard to the Congress with the full intent of making its Senators and Representatives listen, that they may have yet another chance to reform themselves before they seek to reform that which is outside their chambers and their own interests.

I remind you of what Mr. Obama said during his acceptance speech in Chicago, Illinois, on the night of Tuesday, November 4, 2008:

I will listen to you, especially when we disagree.

It is not enough to decry "the mob," the obstinate congressional representatives, the profit-hardened pharmaceutical companies, the intransigent GOP, the hateful grandstanders of the Right, and some ill-defined "capitalist system." Break the back of these destructive forces by taking their very instruments — the people who have real, honest, and genuine concerns — and bringing them into a truthful, productive, nation-changing dialogue.

If you think that cannot be done, you don't believe in your own President. Worse yet, you don't believe what you have seen and heard in his own words and ways when he is at his very greatest.

"Change you can believe in"?

That begins in your own house.

The Centers for Disease Control reports that the infant mortality rate in the United States stood at 6.89 deaths per thousand live births in 2004, the latest year for which comprehensive figures are available; as such, the U.S. slipped from a rank of 24th in infant mortality rate for the year 2000 to 29th among countries the CDC tracks. The report also shows that the mortality rate for infants born to non-Hispanic Black women was almost two-and-a-half times as high as it was for babies born to non-Hispanic White women. Other groups with high infant mortality rates included Native Americans and Puerto Ricans.

A significant factor contributing to the high infant mortality rate in the United States appears to be premature births, which account for 12 percent of all live deliveries in the country. A birth is considered preterm if it happens before the 37th week of gestation. Premature births are on the rise in many countries, and in the U.S., the incidence has increased by 30 percent over the past 25 years, although a certain percentage of preterm deliveries from 35 to 37 weeks may be the result of unnecessary Cesarean sections being performed. This is probably not, however, an adequate explanation for the high rates of infant mortality among certain minority groups in America because women of color would be less likely to have access to the kind of prenatal care and counseling, misguided as it might be, where doctor recommendations for C-sections would be made. In fact, the preterm birth phenomenon in general has more complex, unknown causes than could be completely explained away by a high incidence of Cesarean sections and other birth-inducing procedures being performed.

The infant mortality rate in the U.S. dropped throughout the 20th Century, but the 21st Century has been different: from 2000 to 2005, the infant mortality rate held steady; it did, however, decline from 6.86 infant deaths per thousand live births in 2005 to 6.71 deaths per thousand live births in 2006, still far above the stated goal of U.S. policy, which is to reach an infant mortality rate of 4.5 deaths of babies for every thousand born alive.

For decades, the U.S. has been losing ground in its ranking among countries with respect to infant mortality rates: from a rank of 12th in 1960, the United States had fallen to 23rd in 1990 and then to 24th in 2000. The new data released by the Centers for Disease Control indicates that this trend has continued, with the United States, as of 2004, behind virtually every First World, industrialized country and even some Second World nations. The graphic below vividly illustrates the relative position of the U.S. and rightly calls into question what is often touted as the superiority of American health care.



Data from 1960 to 2004 can be viewed in the graphical table below:



Rankings for 2004 show that the United States shares 29th place in infant mortality rate with Slovakia and Poland. Virtually every developed, industrialized country in Europe and Asia had a lower infant mortality rate for the year, and so did Cuba, a country often harshly criticized by conservative American politicians.

The challenge to the United States in caring for its youngest, most vulnerable citizens is clear: considering the lower infant mortality rates that so many other nations are achieving, far too many American babies are dying. High on the list of priorities for the next Administration taking office in January 2009 must be the rectification of this outrageous national disgrace. An industrialized country with the resources to rescue a reckless financial services industry with a $750 billion dollar bailout for Wall Street welfare queens must surely be able to find sufficient money somewhere to save the lives of infants, even though they cannot speak for themselves, much less pour campaign contributions into the pockets of legislators.


The Dark Wraith encourages others to publish the graphics above and raise Holy Hell about what priorities this nation should have as opposed to those it has thus far demonstrated.

The problem with my teeth has been with me for years. Truth be told, one of my baby molars had not come out when it was supposed to, so a dentist had to pull it when I was about 11. The thing had a root that hadn't dissolved. The molar that replaced it would start bothering me again in the late 1990s. I did what I could for it. Several times, the left side of my face swelled up with a knot the size of a softball. I'd brush the infected area, and I'd even hack at it with a sterilized knife. I would get people to give or sell me pain killers and antibiotics, and eventually, the infection would retreat. Once, when I was making decent money, I went to a dentist. I wasn't making enough to pay for him to pull the tooth, but I got him to believe that this was my intention. He gave me a prescription for penicillin, which was what I really needed, and I made an appointment to come back in two weeks to get the tooth pulled out.

I never went back, of course. Even in the late-'90s, the cost of the extraction would have been more than I made in a week. I'm a low-level college teacher. I usually don't make more than about eighteen to twenty-two grand a year. After deductions, including either Social Security or some state teachers retirement deal, I don't make enough to pay all my bills and eat. That's my choice, though. I'm a hack. I play a hard-core, individualist card: I don't want tenure because it's a system that corrupts the very essence of those who grovel for it; I don't want a corporate gig because it's an even more corrupting system; and I don't want fancy titles, awards, chairs, grants, giveaways, or oodles of benefits. I just want to be paid a living wage for what I do. If the education system can't do that, I'll still teach anyway. It's something at which I am reasonably good, and it makes me strong of mind and resolute of spirit. The times in my life when I did other things, things that made me more money, I became pale in principles and weak of valence. To be perfectly and brutally honest, though, it's pretty easy for me to say I don't want things when I know very well I'm not going to have them offered to me. Still, it makes me feel pretty butch to talk about how fiercely independent I am. I had a few chances to live a better-financed life: several, I blew; a couple, I walked away from; and a few more, I couldn't manage to hold onto.

Fate can bite me. So can I.

I teach economics, among other things. Early in the first principles course, I explain to students that one can be magnificent at what one chooses to do, but that means nothing in terms of monetary reward. The very best hamburger cooker will be very unlikely to make any more than a hamburger cooker who is no better than competent. Fabulous artists and writers get nothing because fabulous artists and writers are worth nothing; wealth and fame accruing to a few is the illusion of esteem Western civilization provides as a veneer to a handful of randomly chosen hacks among the legion of the talented. That's just how the world works. Get lucky, and our society might make you the proof of how high-minded we are as a people; but have no illusion: it's just a show, and if you attain fame and fortune, it's because society needed another cute pet.

I'm a good writer, by the way; in fact, I'm better than most. I make not a single damned dime writing, and believe me, I've tried. At least I used to, until my own economics lessons soaked into my thick skull.

Choose your destiny and spare the world your lamentations about its unfairness; otherwise, lead a rebellion to some workers' paradise where you'll still be nothing more than you are now. Freedom isn't an illusion; it's a bitch.

Eventually, I got that horrendously painful molar of mine extracted. It had almost killed me before I got the wherewithal to face the problem and take care of it. Pain is magnificent in the way it focuses and prioritizes human action. I had always wondered why pain persists after it has made a problem known to a sufferer, but I finally came to understand that I, like most people, will set aside any problem that does not nag me to the point of distraction. So it is with toothaches: they don't quit unless something effective is done to remedy the source of the pain.

After getting rid of that pesky molar, I realized right away that the tooth in front of it—a bicuspid—had some infection underneath it. I was sort of hoping that, with the totally messed up tooth behind it gone, the breathing room would allow the bicuspid to heal up nicely; and so it did, at least for a while. A few months ago, my hope of permanent salvation for that tooth began to fade. At first, it was the usual, minor aching that would last a few hours, then go away: nothing that a good dousing with generic Listerine and a fierce brushing wouldn't solve. A couple weeks ago, though, things got really bad.

It used to be that I could easily score on some antibiotics. People were always wanting to be helpful. Even a friend who knew a dentist could get me some. That all changed, ostensibly because of the hype about "overuse" of antibiotics. That's nothing but a ruse. Dentists hand the stuff out like candy to patients who have "heart murmur" issues, whether or not the patients really do. The connection between a heart murmur and prophylactic antibiotic therapy is beyond me. Then again, I'm not a doctor; I just play one when it comes to my own body and health. I certainly can't be trusted to know when I've developed an infection that might kill me without a simple medication no doctor or dentist will prescribe unless I pop the fifty to one hundred bucks for him to first have a five-minute look and then say, "Oh, you need an antibiotic."

Whatever. The bicuspid infection had gotten out of hand by last weekend. The pain was still not persistent, but it was getting more so, and it was getting more mind-bending with every session. Monday was the last straw. The pain wouldn't go away, and the analgesics weren't doing anything. Worse, I had no clue as to how the root was seated, so pulling it out by myself was risky. If the root was not straight—a possibility, I thought, given how that old molar had been making a crowded mess back there—I could end up breaking the upper portion of the tooth clean off, leaving an infected root in place about which I could do nothing but head to a dentist, anyway.

For about six months, I'd been getting ads in the mail from some new dentist in town. The ads were nice, and I'm always a sucker for an entrepreneurial approach others in a business won't try. I'd never had a dentist actually solicit my business. There was a phone number I could call to schedule an appointment and ask any questions, so I decided I'd see how much it would cost me to have a simple tooth extraction done. I knew I couldn't afford hardly anything. The way pay schedules work at my college, I'd just gone five weeks without any paycheck (two weeks between semesters, then three weeks into the new semester). On a good payday, after bills, I'd have maybe a hundred and fifty dollars left over to last two weeks to the next payday; but last Friday hadn't been a good payday since I was having to catch up on bills I hadn't paid because of the five-week dry spell.

Twenty-five bucks was all I had, but if I knew how much a dentist wanted, I could hock some stuff. Maybe I could put together two hundred pawning my video camera I use for recording lectures, my pay-as-you-go cell phone, and a digital camera. The pain was getting wild enough that I was prepared to hock my computer and printer if need be.

I called the dental clinic on Tuesday morning. The lady with whom I spoke there was so nice. She started off with something like, "I promise, we'll make your pain go away." She said the doctor could get me in on Wednesday, and I would leave feeling wonderful compared to how I felt going in. Considering that, by Tuesday night, I was going positively bananas with pain, those were comforting words. I still can't believe I'd taught classes in that condition; but, then again, sometimes I can be at my best when I have the motivation of brain-crushing pain. Funny how that is.

Anyway, I got straight to the issue with that lady at the dentist's office: How much was this going to cost? She hemmed and hawed. Lack of pricing transparency is the spearpoint of how competition is consistently frustrated in healthcare. There's always an excuse for why doctors and dentists are simply too special to be forced to publicly display or otherwise reveal prices. It's the same whine other retailers have made when faced with legislation requiring price disclosures: it just can't be done; there are too many complicating factors; it's another regulatory burden; etc. Medical professionals treat humans like so many assembly line machines, yet they, themselves, want to be treated as something other than car mechanics, who are required to give estimates.

I explained to the woman with whom I was speaking that I was of insubstantial means. I just had to know if I could afford to even so much as walk in the door. After a few more excuses, she lowered her voice and said that it usually comes out between $150 and $200 for a simple tooth extraction. I was relieved: between what was in my account and what I could take to the pawn shop, I could have that much on me, so I asked her to make me an appointment. She scheduled me for Wednesday morning at 9:00 a.m., which was great since Wednesdays are when I don't have classes until the afternoon. I'd be able to get the tooth pulled, and I'd have a few hours afterward to get my head back together.

Wednesday morning came, and I was just a mess of pain and nausea. I was shaking all over, and I had a fever of almost 103°. I showered; made hot, brutally strong coffee; and headed out. I should have known this wasn't a good idea as soon as I realized how far I was having to drive to get to this clinic. It was clear on the other side of town, the part where all manner of housing divisions comprising McMansions and Medium-McMansions had sprung up by the thousands. It was way away from the bad side of town I live on.

The clinic was nice inside, and the lady with whom I had spoken the day before greeted me from her reception station. She was still being very nice. She asked me to fill out some forms, and I explained to her that I was in very bad shape, so I might need her assistance. She told me not to worry; they'd get me into a room and get me feeling all better right away.

I filled out the forms as best I could, and a dental hygienist came up to get me. She looked vaguely familiar; as it turned out, she'd been a student at the college where I teach, and she recognized me right away. That was somewhat embarrassing to me: I'm not of a mind to have students see me when I'm in such bad shape that I can barely walk.

I was put in one of those dental patient chairs, and the hygienist started to work. She had a very cool, tiny little fiber-optic device she put in my mouth so she could take pictures. She panned around, and I saw all of the years of damage, from one side of my mouth to the other. I even got a good look at the cancerous lesion that had been growing for quite a few years on the inside of my lower lip, something I really didn't need to see in such detail, given that I know very well that thing is going to be what kills me someday. It almost makes getting tooth extractions entirely moot. Fortunately, she took my word for it when I told her I was well aware of that awful thing, and I wanted to hear no more about it. She didn't fuss about all the other broken teeth, missing fillings, and periodontal disease, either. She went to the infected tooth and took some pictures.

I was at once impressed and rather appalled. The bicuspid was black and disgusting in the middle; there was nothing left of white on the side facing where the molar had been, although there was otherwise a fairly thick ring of white enamel still intact. I told her I would be glad to have that gross mess out, but she informed me that the dentist was in the business of saving teeth, not extracting them.

"O God," I thought to myself. "This dentist is going to try a root canal on that thing." Like, to begin with, I could afford a root canal; and like a root canal is even indicated when there's that much necrosis.

She took an X-ray and then turned on a video for me to watch. Sure enough, it was a video about how a root canal is done.

Just great. I hate watching television—no, no; I loathe watching enforced electronic narratives—and there I was having to watch some pedantic, animated infomercial about how easy and fun root canals are, what with o-so-modern, "painless" dentistry, and all.

When she came back in, she shut off the video. "Doctor says we'll have to extract that tooth. There's too much damage to save it."

"Ah, good," I said.

The dentist came breezing in shortly thereafter. He was an affable man, muscular, fairly handsome in a balding sort of way. He wanted to be folksy and friendly. He asked me what I did for a living; then he asked me some other trivial stuff. I got him to start talking about himself, instead. After a few minutes, he explained to me what he was going to do. He said I had come not a moment too soon. He pointed to the picture of my tooth and said, "That used to kill people."

Indeed. It was about to do it to me. He then showed me the X-ray of the tooth. The infection was all clear down at the bottom, right under the point of the root, at the base of the nerve and going straight up the nerve, itself. That explained why I couldn't hack the gum line and get the pus out: it was way too deep, and it was in the core of the tooth.

By this time, I was very excited about getting the tooth out of my face as quickly as possible. They were obliging dentistry-type people in that regard: the dental hygienist had already prepared the Novocaine shots and the benzocaine pretreatment. Lord! but that stuff hurt. Within a matter of a minute, though, all the pain was gone. It was like Heaven. I swear, the relief was about as wonderful as anything I'd ever felt in my life; and I knew that the misery wasn't going to return because, by the time the anesthetics had worn off, the tooth would be gone, the infection would be cleaned out, and I'd be like a new man.

And that's where I was all wrong.

It didn't strike me as odd right away that both the dentist and the dental hygienist left the room. I sat there alone for about a minute, enjoying the numbness wafting across the left side of my face, and then this nice, older lady came in with a clipboard. On it were some papers. She introduced herself as the billing person, and told me that she had some paperwork for me to sign before the surgery. There was the bill: $408. She told me that, if I had dental insurance, she'd submit the claim so I could get reimbursed (which is common these days; the clinics don't want to have to fight for their money with the insurance companies). She told me that she had given me a $50 first-time patient discount. She asked me to sign the bill and let her have my credit card so she could ring it up.

I was in a good place: no pain; but my mind was somewhat fuzzy. I took out my debit card—it's one of those pre-pay deals I get at a truck stop. I told her there was nowhere near $408 on it. To my surprise, she said that was okay; she'd run it anyway, and if it didn't clear, she'd bring back a little form for me to sign to make monthly payments. I was so relieved. She left with my card and the signed bill.

A few minutes later, she came back and told me I was right; there wasn't enough on the card for a charge of $408, so she had the payment agreement for me to sign. Unfortunately, it wasn't some contract with the dental clinic; it was a loan agreement with a lender called One Care. I knew exactly how that loan application was going to turn out, but I acted like everything was okay, and I signed the short little form so she could take it back to her office and get it approved by the lender.

She left, and I immediately got out of the chair. I took off the silly bib they'd put on me, and I shook my head as hard as I could to clear the fog. I straightened myself up and grabbed some tissue paper to wipe the drool off my face. She came back in, trying as best she could to still be happy. She explained that One Care had declined my loan application. I told her I knew they were going to do that, and I told her it was okay. She explained that as soon as I could get the money together, I could come back and get the tooth pulled. She also said she'd billed my debit card only for the initial visit and the X-ray; the Novocaine shots were on the house. I thanked her sincerely for the slack.

The dental hygienist came back in with two sheets of paper: photocopies of prescriptions, one for a painkiller, the other for an antibiotic. She said I should get the antibiotic prescription filled right away to stop the infection from getting any worse, and she told me I should come back in as soon as I possibly could.

I departed quickly. The situation was quite uncomfortable all the way around. I thanked the billing lady and the dental hygienist for everything they'd done. The billing lady handed me another piece of paper to sign, a bill for only the services actually rendered: $61. Below it, she'd hand-written another number: $284. She told me that's all she'd charge me when I came back. I signed the bill and said, "I can't tell you how grateful I am."

As I left, the woman with whom I had originally spoken at the front desk cheerfully said good-bye to me and asked, "Are you feeling better, now?"

Of course, with all that Novocaine in me, I was feeling absolutely excellent, and I told her so. She said, "See, I told you we'd make you all better!"

I swiftly exited the nice building and the weird irony.

Walmart was right on the way to the college, so I stopped there to get the prescriptions filled. Amoxicillin, $14.99; generic Vicodin, $5.99. The prescriptions took almost 40 minutes to fill, which meant I wasn't going to have enough time to drive clear back to my flat, where I could have pulled the tooth out myself while the Novocaine was still in full force. I'm still kicking myself about that missed opportunity. The X-ray and picture I'd seen showed me exactly what the situation looked like back there in my mouth: there was a lot of solid enamel to grip, and the root was straight as an arrow. It would have been a clean pull, and I could have done it if I'd had enough time. As it was, though, I had to get to campus.

I taught like an animal. No pain, and even the fever wasn't bothering me. I roared and raged, knowing as I did that the amoxicillin would start killing off the infection very soon; and when the anesthetic had worn off, that Vicodin—something I'd never had before—would surely be good enough to hold the pain down until the pressure was off that tooth nerve.

The next day, Thursday, I wasn't feeling any better. In fact, I was feeling worse; but I finally realized it was that stupid Vicodin, yet another modern drug that might very well have some efficacy, but at a ridiculous price in terms of side effects. I was dizzy, lethargic, nauseous, and altogether confused. Literally, between when my one class ended at 11:50 a.m. and when my next class began at 1:00 p.m., I sat in a quiet place on campus and went into something like a semi-coma. I roused myself just in time for class, and on the way, I threw that bottle of Vicodin in the trash. Aspirin is just fine for me. Taken in rotation with acetaminophen, I can manage pain as much as necessary without turning myself into walking broccoli.

Strange thing was, though, that the pain and the fever weren't abating by Thursday night. Usually, at least back in the old days when I'd used amoxicillin to deal with tooth infections, it would take about 24 hours for the infection to get beaten down to where the pain and fever would let up; but that wasn't happening this time. I began to worry that Walmart had given me bogus medicine or that something else was keeping the drug from getting its job done. I was relieved when I awoke Friday morning without as much pain and a fever that had dropped to less than 100°. I figured everything was going to be fine. Then something strange happened.

By the time I'd finished teaching Friday afternoon, I was simply exhausted, tired in that bone-weary sort of way. The fever was back up, but the tooth pain was still not too bad, nothing that a good hammering with a couple of aspirin couldn't put down to tolerable level.

I went back to my flat and lay down on the couch. I awoke about 45 minutes later with raging fever and pain that was driving me out of my mind. I cursed myself for throwing away that Vicodin stuff.

All I could postulate was that lying down on my back must have allowed the pus sac at the base of the root to move in such a way that it was putting some kind of new pressure on the root nerve. Still, why the amoxicillin hadn't gotten things under control was a mystery. I tried about everything I could: benzocaine (generic Ora-jel), generic Listerine, a sterile knife, heating pad. Nothing was working. I figured I had to pull the tooth, minus the anesthetics, minus anyone around to call an ambulance if something went really wrong.

Then, something occurred to me: I have a dentist, now! Sure, things hadn't quite worked out with the Wednesday visit, but I paid my bill, and I promised to reschedule to get the tooth pulled. Dentists have emergency numbers where their patients can reach them after hours, so I could call the clinic to get information about how to contact him.

It was a little after 8:00 p.m. The answering machine at the dentist's office picked up. It was that nice receptionist's voice, first providing office hours and all that, and finally, the number to call for an after-hours emergency. I almost felt better as I was simply dialing the dentist's emergency voicemail. The recording indicated that I should leave my name, phone number, and the nature of the emergency. I tried my best to be calm, although I'm sure I came off sounding pretty desperate. I asked him to contact me and let me know what I should do. I gave him the number of the Walmart pharmacy so he could call in a prescription, hoping as I did that he would prescribe something like Tylenol 3 to beat back the pain until whatever had caused the problem could pass of its own course. I thanked him and said he could call at any hour, given that I wasn't going to be able to sleep until the pain had gone away.

He never called.

I honestly understand. He's not going to stay in business dealing in charity work. I didn't have the money to pay for what he had to offer on Wednesday, and he wasted his time and the resources of his clinic on what turned out to be a failed business transaction that collapsed because of my financial situation. He's under no moral obligation to go out of business spending time with patients on whom he cannot make a living and pay his office expenses.

As for me, at about three in the morning, I got on my couch with the front half my body hanging over the edge, suspended nearly straight down. Maybe half an hour later, I fell asleep. At 4:30 in the morning, I awoke, and the pain was much less. It seems I had been right: the pus had slid into a place where it was causing all kinds of trouble; and by getting myself into a position nearly opposite to that which had started the trouble, I had managed to move it out from where it was inducing so much pain. I slid onto the couch and lay on my stomach, and I fell back asleep. I awoke again a little after 8:00 a.m. My cat was sleeping right beside me.

I felt like a new man. Although the pain wasn't gone, it was trivial compared to what it had been. I felt so rested.

The remainder of the day was an ebb and flow of pain, although none of it was as severe as it had been Friday night.

About three hours ago, I broke out in a profuse tirade of perspiration. I got in the shower and found myself actually singing. There's still a lot of pain, but only when the aspirin is wearing off.

I sat down and built the graphic at the beginning of this article; then I wrote this narrative of my most recent intersection with the country's healthcare system. It really is the very finest in the world, and I mean that in all sincerity: were it not for that amoxicillin, I'd be dead tonight. Instead, I am alive, and I shall stay that way long enough to write a few more articles. Maybe among them will be some wherein I address all the conservative politicians who praise the "free market" approach to solving the healthcare crisis in this country. To them, I shall say, "You and your mythical 'free markets' can go to Hell; you wouldn't know a free market if it bit you in your sneering, rich asses."

Of course, if I am to do that, I must also take the opportunity to say to the liberal politicians who "understand" the suffering of the poor, "You, too, can go straight to Hell; you wouldn't know the suffering of the poor if it bit you in your phony, rich asses."


The Dark Wraith is definitely feeling better.

Publisher's Note: A long-time regular reader, albeit rare commenter, here at The Dark Wraith Forums contacted me by e-mail awhile back asking if I would be interested in a relatively minor healthcare story that has some good economics lessons in it, yet ends relatively happily in that no one goes bankrupt or dies. "Ellen," as she will be called to protect her real identity in this story, is right: this is a good story to highlight some of the utterly maddening economics of the American healthcare system, where interests far too powerful for the health of the nation bray about "free markets" and "capitalism," having no intention whatsoever of facing some of the most important economic forces and principles that would otherwise lay them low on a truly competitive economic battlefield. At the same time, small stories like this one illustrate the long-term institutional failure of federal and state legislatures to enact even the very simplest of laws that would dramatically circumscribe healthcare providers' historical reliance on anti-competitive price-gouging practices. However, the story also delivers an equally strong indictment of "solutions" that involve over-reliance on traditional insurance—even if provided by a single payer—to solve the economic dimensions of the healthcare crisis without addressing the relatively simple underlying dynamics of incentives both for consumers and for healthcare providers.

On the consumers' side, detaching the user of a service from the full force of the price of that service is, always has been, and always will be a guarantee that the most effective force of free markets—prices, themselves—will be blunted. In the terminology of insurance and economics, this is called "moral hazard"—or, more technically accurately, morale hazard, since it is not a willful act from incentives that causes an outcome adverse to others.

On the healthcare providers' side, hiding prices and falsely, disingenuously claiming it would be impossible to clearly show them openly, categorically, and in advance to both consumers and insurers is the most effective way to systematically and persistently protect price-gouging activities. Again, in the terminology of insurance and economics, this is genuine, moral hazard, since the incentive to greater gain is engaged willfully and to an end that adversely affects others. The moral hazard is expressed in price-veiling behavior that walks on veritable stilts; and the only way—the only way—to prevent moral hazard from become action is a statutory and associated regulatory framework that not only proscribes the behaviors deriving from the incentives, but establishes uniform, systematic, countervailing disincentives severe enough to alter the calculus of action for those who face the moral hazard compelling them to act adversely to the interests of others. In plain English, that means the only way to keep healthcare providers from acting on their price-veiling incentives, which allow them to avoid facing price competition, is to make the risk and cost of the behavior (along with the risk and cost of collusion in an open price display environment) so high that it is more profitable to compete than it is to cheat.

To avoid any further lecture about markets, incentives, and what can be done to use "free markets" against the healthcare system that so disingenuously hides from brutalities like real competition, this story will focus on Ellen, the person, who just happens to be one of the several hundred million healthcare consumers in America, and who just happens to be one of the hundreds of millions of those consumers who has received a rather appalling bill. The economics lessons about incentives, pricing, and "morale" and "moral" hazards are on lovely display in the simplicity of the narrative, itself. Subsequent articles here at The Dark Wraith Forums will focus on the dry economics of the mess that is the American healthcare system; but offering anecdotal evidence from the human interest side of the whole story is a fine opus.

Ellen is a middle-aged, well-educated woman. She has two Bachelor's degrees and a Master's degree, all in the hard sciences. Those degrees haven't ever done her much good, though. Like many science-oriented, very bright people, she's never really found much need for her education-based knowledge and skills. For most of her life, she's had to work hard: grueling part-time/full-time work as a banquet waitress and full-time work doing something else. For a few years, she had a sweet, full-time job as an EDI jockey at a billing services company, but she let a young man with whom she was involved talk her into his grand, self-fulfilling dream of moving to another city, where he did well for a while as she found next to nothing in terms of work. Lesson learned: she dumped the delusional loser and moved back to the Midwestern city where she could at least get back into the grind of solid hours as a banquet waitress while scouring the employment landscape for a full-time job to get healthcare benefits.

Although not in bad health by any means—being rigidly disciplined in her healthful eating habits and exercise regimens—Ellen had faced her share of scares and long-term trials: ravaging endometriosis, then fibroid tumors, endured for years before she finally got a hysterectomy gave her quite a bit of reason to stay focused on ensuring continuity of medical insurance coverage.

After a few temporary gigs back in town, Ellen finally landed a position in one of those low-end lab/factory types of places where the lenses for glasses are coated, packed, and shipped off to the pretty, nice-smelling, clean optical retail shops.

Ellen works like a machine: efficient; nearly obsessed with detail and quality; loyal to her work, even when she doesn't like it. She'd like to get out of this place sooner rather than later, but there's not much out there. Who needs a middle-aged, never-married woman with a handful of degrees in the biological sciences and in geology? (She does take courses in computer software skills at a regional community college; but, then again, so do tens of thousands of other people fruitlessly hoping such skills will land them a full-time job paying more than ten bucks an hour.)

The place where she works is on the south side of town. She works the night shifts; the hourly pay's a little better. The south side is where the trash that doesn't live closer to the center of the city, on the north and east sides, lives.

Ellen's co-workers are mostly poorly educated: younger women with bad soap operas for lives, a cluster of younger, Right-wing, FOX News-watching men, and a few other types, mostly really hard-working, somewhat older women who, with Ellen, pretty much get the work done while getting trashed, written up, and otherwise treated with varying degrees of disdain by the men.

Scumbags living in the surrounding communities (if that's what those gutted towns could be called, given the long-term economic depression on the south side of the gleaming city) routinely prowl the parking lot looking for cars to break into during the evening and night shifts. The women in the lab used to keep their purses in their cars, hidden under the seat, so they wouldn't get money stolen by the other workers in the lab; unfortunately, that meant the dope addicts, homeboyz, whores, and assorted other vermin cruising the lots had reason to just go around smashing car windows on the chance that a jackpot would be waiting. That happened to Ellen once, so she stopped hiding her purse (once she got a new one) in her car. The dope addicts and other desperates who hit the parking lot might still smash the windows of her car, but they aren't going to get her money once they get in.

Last Spring, on a visit back home to her parents' place in the northern part of the state, Ellen's mother gave her a small, somewhat ugly end table. Having little room for much of anything else in her small apartment, Ellen had kept it in the back of her car, politely ignoring it.

Sure enough, that was more than enough excuse for some loser to break into her car at work. The end table was stolen, the rear passenger side window of the car was totally shattered, and Ellen had absolutely no incentive to even so much as hint to her auto insurance company that something had happened, given that she was afraid that would be more than enough reason for her insurer to jack up her rates.

Auto glass isn't like normal, everyday, window glass. When it gets shattered, it goes into a million pieces, almost all of them tiny. It's all those countless, barely visible shards that are really hard to vacuum up because they catch in the floor carpets, in the seats, and underneath things; and it's those minuscule pieces that are like finely-honed razor blades: just barely touching one can cause blood to flow from a finger; and may Heaven help the hapless fool who sits in a seat that hasn't been thoroughly, repeatedly vacuumed after shattered auto glass has landed on it. Ellen got the window fixed, and the auto glass shop did a nice job of cleaning up the awful mess of glass all over the floors and seats.

At the end of June, Ellen decided it was time to get rid of some of the accumulation of junk in her car. As meticulous and detail-oriented as she is in her professional life, she is quite inattentive to the state of her apartment and her car. In her defense, given that many days she works anywhere from 12 to 18 hours at her full-time job on the south side of town and at her banquet gigs at several big hotels downtown, it's amazing she has time even to put her clothes away properly after she's washed them at the laundromat. When things pile up, though, she eventually gets religion and goes on a cleaning spree; and so it was that her car was going to be the beneficiary of a thorough cleaning out. It was pretty messy in there. After she'd gotten the car window fixed from the robbery in the Spring, she'd let things pile up in the back seat: books, clothes, odds and ends, some trash, even coins that had fallen out of her pockets and purse and rolled to the back.

So there she was: pawing around in the dark after she'd gotten home from her night shift, gathering trash, reaching around here and there on the floor of the rear passenger area. All of a sudden, she felt a sharp pain in her finger. Pulling her hand out and holding it up, at first she couldn't see what was causing it to hurt like Hell. Finally, she did. There it was: straight through the meaty part of the end of her index finger and on out through the fingernail on the other side, a sparkling shard of glass, about an inch-and-a-half long, and so thin it was barely visible.

Now, odd as it might seem given her rigorous training in biology, Ellen is not big on blood. A fair-skin, natural redhead who has repeatedly had problems with anemia, she's the kind of person who can start rolling her eyes to the back of her head even so much as hearing about a blood draw; so what she was seeing in front of her own eyes there in her own finger was unwelcome in a big way. Fortunately, her background in science actually kept her from passing out: this was an observational curiosity, and it was also a matter that required a step-by-step, rational solution. Having grown up on a farm, Ellen is no stranger to the occasional cuts and bruises; but having learned her biology lessons well, and having worked as a graduate research assistant in a biology laboratory, she has a healthy respect for, and fear of, bacterial and viral pathogens. Yes, pulling the shard out might be a good idea, but something occurred to Ellen: she hadn't had a tetanus shot in well more than a decade. In fact, it had been so long ago she couldn't put an exact year on when she'd gotten her last booster.

Late at night, and without any doctor she could call her own, anyway, Ellen got behind the wheel of her car and headed to the nearest emergency room, which happened to be the one associated with the gigantic state university near which she lives. At the emergency room, and after something of a wait, she got her finger fixed, and she got her tetanus shot. Subsequently, she got her copy of the bill, which was also sent to her medical insurance provider.

The bill prompted her to contact me, and I told her that I would want to see how the insurance company handled the nonsense there on display. Amazingly, the insurance company didn't knock down the bill and pay its part of what it decided was reasonable, which is what a lot of insurance providers do these days: they get the medical bills, then they simply say, "No, we're going to say it's this lesser amount, and we'll pay our percentage, and then you can bill the patient for the remainder." Not this time, though; the insurance company didn't even so much as bat an eye at the bill, much less ask Ellen any questions about what had happened and what she actually got as far as healthcare services were concerned at the emergency room.

Below is the main portion of the final statement of payment from Ellen's insurance company. (Click on the image to see the entire "Explanation of Benefits" document she received and subsequently faxed to me.)


In words and numbers, the Explanation of Benefits presented above lays out what happened: walking into the emergency room cost $658.00; the drugs that were administered cost $105.00; and the tetanus booster cost $44.00. All told, that visit to the emergency room cost $807.00.

That's right: $807.00 for an inch-and-a-half shard of glass through the top of her finger. Ellen's insurance provider paid $657.00 of the bill, and Ellen paid the $150.00 balance.

Oh, but the story is even better. What follows is part of my telephone interview with Ellen for this story.

Dark Wraith: So, you were charged $658.00 just to check in at the emergency room?

Ellen: Uh-huh.

Dark Wraith: Did you have any idea at all that it was going to cost this much?

Ellen: Uh, no... it's not like they have weekly ads in the paper or a big sign outside like a gas station.

Dark Wraith: So, you had no idea what one emergency room charges versus another, right?

Ellen: Right.

Dark Wraith: Okay, let's get past the initial sticker shock and find out about the quality of care you received. I mean, for that much money, you were probably treated pretty well.

Ellen: You know what happened? I sat there for a while... I don't know how long, really... and then I was called back to this sort of open area where the nurse sat me in a chair beside a little cabinet. She washed my finger with warm, soapy water; then she gave me my shot and said I was all done.

Dark Wraith: Wait... wait a minute. I... let me... they did pull out the glass, right?

Ellen: No, I'd already pulled that out myself while I was waiting.

Dark Wraith: So they didn't put in a stitch or two?

Ellen: I don't know whether they should have or not, but it wasn't bleeding anymore, and they didn't.

Dark Wraith: ...didn't put in any stitches.

Ellen: That's right.

Dark Wraith: Well, what about the "Drugs" on the bill? Was that... were those painkillers?

Ellen: They didn't give me any drugs.

Dark Wraith: They didn't?! Not even any Tylenol? It says right here on this bill... this insurance statement that they did: a hundred and five dollars worth.

Ellen: No.

Dark Wraith: Nothing. No drugs of any kind.

Ellen: None.

Dark Wraith: So the line item "Drugs" would be referring to that 'warm, soapy water' you mentioned.

Ellen: I guess.

Dark Wraith: Was it tap or bottled?

Ellen (laughing): Right out of the sink.

Dark Wraith: Did you tell this to your insurance company?

Ellen: They didn't ask... I never talked to them. I just got the thing from them I faxed to you.

Dark Wraith: Forgive me for being a little aggressive here, and I mean... I don't want you to think I'm blaming you for anything about this, but why didn't you take the initiative and say something?

Ellen: I don't like to rock the boat. I didn't want to get into a fight like that. Besides, I'm not really sure who I should call. It's not like I wanted to argue about what part of the bill they paid... it seemed pretty generous what they covered.

Dark Wraith: Yes, I understand.

Ellen: You think I should have said something.

Dark Wraith: No, no. I really do understand. I mean, it's like, you call some one-eight-hundred number at the insurance company, and then you get some brainless recording going, "Press one for this, press two for that," and on and on.

Ellen: Exactly. And besides, I figure I'm out a hundred and fifty dollars. I'm glad it's over with... and I learned my lesson.

Dark Wraith: You'll try to find out what different emergency rooms around town charge before you have to go to one again.

Ellen: Well, yeah, maybe... but I meant I won't clean out my car ever again without wearing those heavy gloves you get at the hardware store.

Dark Wraith: Ah. Lesson learned... Thank you for letting me write an article about this.

Although Ellen has communicated with me on several occasions since that interview, not once has she mentioned the visit to the emergency room or the bill. She paid the $150, and she moved on with her life.

And, of course, that well-respected emergency room has moved on, too, no doubt continuing its price-gouging practices, supported by insurance companies that pay the medical bills without even so much as fussing because, after all, the outrageous costs can always be passed on in continually rising insurance premiums paid by consumers and their employers. The only losers in a symbiotic system like that are those who don't have medical insurance, a lot of them in that situation because they can't find an employer stupid enough to offer healthcare coverage under a system that's really win-win only for the healthcare providers and insurers.


The Dark Wraith will, most definitely and at length, write further on the economics of healthcare.

You read that headline correctly, and it's the conclusion of a study by researchers at Queen Mary Hospital in Hong Kong: cognition-induced epileptic seizures were documented in 23 cases studied, with all but two of the victims being male. The average age of observed patients was 54 years. Most of the individuals had never had a seizure before the game-induced episodes.

Although they could not pinpoint the precise aspect of the game that triggered the onset of runaway electrical impulses in the brain that are characteristic of epileptic events, the doctors speculate that patterns in the tiles or their sounds against each other are potentially causative factors.

The study also found clear, positive correlation between frequency of game play and frequency of seizures, although the time from game play to seizure onset varied from just an hour to as many as eleven.

Epilepsy came to national attention again recently when Right-wing U.S. Supreme Court Chief Justice John Roberts last month suffered what at the time his doctors described as a "benign idiopathic seizure," his second, following one in 1993. Although now having had only two–and 14 years apart, at that–he meets the criterion for having mild epilepsy, although the "mild" qualifier would be less likely to apply were he to have had others that were unacknowledged publicly.

Readers seeking a good computer version of the ancient classic Chinese game mahjongg should consider Moraff's MahJongg 1.1, which is still available in a fully functional freeware version complete with attractive tile sets and realistic audio.