Leader of the Pack

I got the final bill from the hospital for Shannon's 2 weeks in the ICU: $204,000, of which Medicare is paying $175,000. For the $29,000 discrepancy, they want $1,100 immediately. I've also gotten bills from several contractors that provided services like imaging and respiratory therapy for additional amounts. This total cost will come in somewhere between $205,000 and $210,000.

All that with little to no detail about what the charges are for.

If anyone doubts that our health care system is broken, those should be some sobering numbers. What's most shocking to me is that there is a two-tiered price system: one for people with insurance and a more expensive one for those that lack it. If my insurance company or Medicare is paying for something, providers discount the service. People without insurance pay more.

Health insurance is more expensive that some realize, but since I pay the bills at work, I know just how much it costs. I couldn't afford it if my employer didn't cover 75% of the cost. It's well over $600 a month just to cover me. I pay 1/4 of that.

For those without access to affordable health insurance, not only do the bills add up quickly, but they'll be charged more than I would in the same exact circumstances.

It spotlights the fundamental inequity in our health care system: because I'm lucky enough to have coverage, I'm charged less. I suppose I pay for it when premiums go up. But those increases don't mean a provider will be reimbursed on a higher level. That only mean the insurance company's profits will once again set records.

Any health care-delivery system that by its nature serves largely to provide profits to insurance companies won't be very good. That should be self-evident. Health care systems should exist to provide health care.

I have no doubt that individual practitioners never think about what something costs when they order it. I doubt that they even know or care. As it should be. They're treating a patient and doing what needs to be done to provide a standard of care that they find acceptable.

But the system, as it exists, drives costs up. People who can't afford health insurance certainly can't afford a $205,000 bill. Had Shannon not had Medicare, the entire bill would have be absorbed by other consumers, as opposed to the $29,000 that will be passed on because of Medicare's reimbursement rate. While that might still seem a high number, my private health insurance never reimburses at the rate medical providers would bill someone without insurance. Aetna would probably reimburse at a similar rate.

Therein lies the irony of our current system: the people who can afford it least are charged the most for health care, almost regardless of who is billing them. If my primary care physician normally charges $50 for an office visit, I give them $10 and Aetna sends them about $25. If I didn't have insurance, I'd have to pay $50 before I could see a doctor.

While my doctor makes less because I have insurance, the AMA has been a strong supporter of reform. They recognize that universal health care would, over time, lower its cost because most people would see a doctor if they could before they were so sick that they have to get emergency treatment . Very expensive emergency treatment that often leads to hospital admission. Then, the costs go higher, and the outcomes aren't as good as for people with insurance.

Health insurance encourages early care before illnesses begin to compound on themselves. It's one thing to go to a doctor who will charge $50 for 15 minutes and another when the visit will cost $10.

Universal care will ultimately lower health care costs because earlier medical intervention will forestall expensive emergency room visits and hospital stays by making earlier treatment available. It's much easier to treat someone with pneumonia during the first week they have it is than to treat someone in an ICU because their condition has deteriorated to the point that it's the last, best option.

Without reform, costs will continue to spiral out of control. It will eat up even more of the GDP that it does now. While some argue that universal care will bankrupt the country, I think the opposite is true. Not doing anything paints a far bleaker picture. Costs will continue to increase, and more employers will stop offering coverage. For the ones that continue offer it, employees' rising costs would force many out of the system.

The most powerful country in the world has about the worst health care system of all industrialized countries as far as access to quality care goes.. We lead the pack on many issues, but not this one.

Telling Lies

People ask me all the time how I'm doing. My guess is that they don't want to know the real truth. They ask so as to be polite. But they don't really want to know. So I tell them that I'm okay, when nothing could be farther from the truth.

And the truth is that I'm doing awful. Shannon's been gone for about 6 weeks now, and he was in the hospital for two weeks before that. It's been two months since he's been here where he belongs.

I miss him almost every minute I'm awake. And he invades my dreams, so i don't get a lot of sleep. I usually wake up when I start dreaming about him.

And then, the realization sinks in, yet again: he's gone. My bed is empty except for me.

I used to be able to sleep, even though he was snoring. It let me know he was there, so I'd curl up around him and let him lull me to sleep.

No one who asks me how I'm doing wants to really know much of that. Except maybe my mother. We both have dead husbands, so we have a lot to talk about. She knows what it's like.

Only the people who have a dead spouse or partner understand or care to any great degree.

They don't understand how hard it is to move forward, pick up the pieces and try to start over.

I don't fault them. Many people don't know how to even address the topic. It's too scary a place for them to go. They're so afraid of death that they don't want to admit that it really happens. But it does.

I will die one day. As will all the people that I care about. I know that. I'm painfully aware of that simple fact of life: it will end some day.

I'll go on until it's my time to check out and finally get a good night's sleep.

I could use one these days.

I, Too

I, too, sing America.

I am the darker brother.
They send me to eat in the kitchen
When company comes,
But I laugh,
And eat well,
And grow strong.

Tomorrow,
I'll be at the table
When company comes.
Nobody'll dare
Say to me,
"Eat in the kitchen,"
Then.

Besides,
They'll see how beautiful I am
And be ashamed--

I, too, am America.

--Langston Hughes

I share Ft. Worth City Councilman Joel Burns’ experience of being harassed as an early teenager because I was perceived as being gay. I was, but I barely knew what sex was, and suddenly it seemed to be every one else’s business. The bullying was too humiliating to tell anyone about. So I didn’t.

Instead, I lived inside a shell pretending to be straight until I was 25. I had girlfriends to keep up the appearance of heterosexuality, but was never sexually attracted to any of them. I made it through high school and college by using girls and then women as beards. I lied to them, to the world and to myself.

That fundamental dishonesty was probably as bad for me as being harassed: I was harassing myself.

I felt like I was broken, that I possessed some basic defect that would make me miserable for the rest of my life. That my life would be lonely, depressing and not worth living. That I would be a freak, shunned by the world, for the rest of my life.

So I lived in my shell, desperately alone.

In grad school, I accidentally outed myself to a close friend while, ironically, we were watching “professional” wrestling late one night. We’d both had a few beers, and I told him that wrestling reminded me of a drag show. Then I had to explain why I knew so much about drag shows.

He was a little shocked, but didn’t care. He was a friend. A good one.

I systematically told my closest friends over the next few weeks, and it was a truly liberating experience. I finally felt free and normal. It had taken me over a decade to do it, but with every confession, the weight on my psyche lightened.

The worst was my last girl friend. We hadn’t been together for a while, but she lived right upstairs. I told her, then didn’t answer the door for three days. I was getting stronger, but I wasn’t ready to deal with her pain over my deception just yet.

I’m older now and have two dead husbands that I loved dearly. I’m not happy about the “dead” part, but I had many happy years with them. That’s something I couldn’t even have dreamed of when I was 13. Or even 23.

I contemplated suicide for a while when I was an undergraduate, and even as a grad student. I remember one cold winter night in my old bedroom at my parents’ house on a school break. I curled up against the wall and listened to the wind howling outside. I was so alone and isolated. I couldn’t be honest with anyone, not even myself, about anything. I didn’t see how my life could ever be any better than the miserable one that it was.

Things got better. I learned how to be a man. The gay part became secondary. It hasn’t defined who I am like I thought it might have way back then. I’ve grown to become a man who happens to be gay. It’s one of the least important things about me.

I wish I’d known that a couple of decades before I did. I lost so many years to the dark place of guilt and despair that I've treasured the happy ones more that I might have otherwise.

Maybe I should be happy that those dark years made me stronger and more aware of what matters and what doesn't. But I came very close to not making it.

If anyone had told me when I was 23 that I would be 45, still alive and at peace on a fundamental level, I'd have laughed. I had no point of reference to understand that life as a gay man could be happy, fulfilling and normal.

Even with two dead husbands, I'm happier than I was then.