ARTS & FARCES internet

In about a half-hour, I’ll be heading down the Grand Avenue hill to the Nasseff Heart Center for a coronary angiogram. A catheter is inserted in an artery in my groin and passed up to my heart. A contrast dye is passed through the catheter so the arteries display well on an x-ray and any coronary artery problems become apparent.

As it was explained to me by the cardiologist while I was in the hospital, “We want to make sure there’s nothing else wrong while we’ve got the hood open.”

All I’m saying is they better have excellent drugs. I’m in no mood for any bullshit. And this is awful early in the morning.

Update: Thursday, 17 February 2011 2:54PM CST: I’m back up the Grand Avenue hill and at home. The coronary angiogram was a relatively simple procedure and took less than an hour. No way did I have to get there at 6:30AM; they didn’t do anything until almost 8:30AM. I’m a notoriously tough stick for doing blood draws and starting intravenous (IV) lines, but I had a great nurse—with the same birthday as mine—who stuck the stick with no problem at all.

The coronary angiogram revealed no surprises, thankfully. I have significant calcification of my arteries as a result of kidney failure and 11 years of dialysis, but the calcification is on the outside, presenting no problems whatever.

So, the damage to my mitral valve occurred relatively quickly and is isolated. Open-heart surgery will consist of attempting to repair the damaged mitral valve—and replacing it if repair is unsuccessful—and out.

Update: Friday, 18 February 2011 3:35AM CST: The main function of dialysis is to remove toxins and fluid from the body; a function the natural kidneys are no longer capable of performing. After 11 years on dialysis it’s remarkable that I retain a little—very little—natural kidney function. The contrast dyes in procedures like a coronary angiogram are really hard on healthy kidneys, so for an individual whose kidneys have already failed, it’s not much of an issue. But if there’s any function at all—however minimal—it’s a good thing to try to do whatever necessary to keep it. The way that’s done with patients with healthy kidneys is to flow excess fluid into the body to dilute the contrast dye, knowing they’ll just pee it off later. So that’s what they did with me yesterday. The original prep nurse understood the conundrum and countermanded the order for excess fluid. The procedure nurse—meaning well—followed the order and ran the saline. As a result—because I’m unable to pee more than a tiny fraction of it off—I’m a whopping seven pounds heavier and unable to breathe lying down. My breathing problems are mostly related to the mitral valve regurgitation, but carrying seven extra pounds of fluid certainly doesn’t help. The law of unintended consequences is a bitch and—regardless of intent—it’s times like these that I think it would be a good thing for medical professionals to have to experience the process of removing that much excess fluid from one’s body.

Every time I rub up against the American healthcare system I get a little more disappointed. And then the insurance company’s explanation of benefits comes and I get logarithmically more angry.

This morning, in preparation for open-heart surgery to repair or replace a valve, I was required to have a dental checkup. So, off I go to the University of Minnesota Physicians Dental Clinic. I try to avoid going more than once a year or so because it’s like trying to do business with the Keystone Kops. Last year, the question was whether or not to pull a tooth. The answer changed depending on the dentist and, apparently, the day. “That tooth’s got to come out.” “No, it just needs a deep cleaning.” I walked away from the Kops’ ping-pong match, still have the tooth; it’s no worse this year than last, and doesn’t hurt at all.

I was told to request the dental appointment for pre-open-heart surgery and that it was urgent. You’d think that “urgent” means pretty much the same thing to everyone in the healthcare field. Today I learned that’s not at all the case.

The dental assistant took x-rays and the dental resident did an exam. But the cleaning and a peek by the endodontist would have to wait a week. Just like last year, two visits for what should have easily been done in one. Who’s on first; what’s on second, but they made me sign an acknowledgment that they expect their co-pay up front.

After a quick lunch at home it was off to the cardiologist’s office for what I was told was to be a meeting about my coronary angiogram in two days. Turns out they want to draw blood for labs. But I’m a very difficult stick and needle-phobic (even after 11 years of dialysis with 14-gauge needles) and of course, it was no go. If they had bothered to communicate with the dialysis center, extra blood could have been drawn yesterday—prior to my dialysis treatment—for the cardiologist’s office. But no, because then they couldn’t have billed for it. Then it’s off to an exam room for yet another electrocardiogram—the third in about a month and the second in less than a week. Of course, all three providers get to bill separately for the procedure.

All of that, believe it or not, is tolerable. Or at least nearly so. Here’s what’s not.

Each provider wants insurance information, medicine allergies, and current medications. And they each want it separately. I carry it around on my iPhone, but each time a medical assistant enters the data there’s possibility of error. Each provider claims this information can’t be centralized and shared because of the Health Insurance Portability and Accountability Act (HIPPA) privacy rules. Fine. So, store the information centrally, in an open format, encrypted with public key cryptography, and allow the individual patient to unlock the information for each provider. Or, in the alternative, waive your co-payment, give me secure, authenticated remote access to your system, and let me enter my information myself. Something, anything other than multiple redundant error-prone systems.

Make no mistake: I have immense respect for the healthcare practitioners that provide my care. The American healthcare system works like clockwork in the event of a crisis. It’s amazing how all the parts mesh perfectly under pressure. But when the crisis has passed and the pressure is off, the wheels fall off.

At 4AM on Thursday, 10 February I went into the emergency department at United Hospital in Saint Paul, unable to breathe adequately. My breathing difficulties have been worsening for several weeks. I had attributed this to the severe anemia associated with my kidney failure. Dozens of times in the past this has happened, and, as soon as my hemoglobin level was raised with increased doses of erythropoietin (EPO), I felt better. This time it was something else. I had a pretty severe heart murmur that no one had heard before.

I was admitted to the hospital and later in the day was diagnosed with mitral regurgitation after an echocardiogram. The mitral valve in my heart is not closing all the way, thereby allowing blood to flow backward into my heart. The valve has leaflets that open and close, controlling the flow of blood through my heart. Small muscular cords are attached to the leaflets that work the opening and closing of the leaflets.

These cords that attach the valve leaflets to the wall of my heart have somehow become torn or otherwise damaged and the leaflets no longer close properly.

As with my kidney failure, the cause of the cord damage is unknown.

As a result of the valve not being able to close properly, approximately 80 percent of the blood flows back, and my heart has to work harder, pumping the blood nearly twice. As a result, my heart has grown larger as it tries to pump more blood with each heartbeat.

The good news is that there doesn’t appear to be any damage to the rest of my heart and the muscle itself is still sound.

On Friday, 11 February, the initial diagnosis was confirmed with a transesophageal echocardiogram (TEE). A tube with an echo transducer was passed down my esophagus and positioned next to my heart. Because the heart rests on the esophagus, the ultrasound signal is stronger because it only has to pass through a few millimeters of tissue.

Law

The US House of Representatives needed a two-thirds majority vote to extend the expiring provisions of the Patriot Act. The provisions in question were roving wiretaps, seizure of “any tangible things” seen to be relevant to an investigation, and the ability to obtain wiretaps against terrorism suspects who are unconnected to any foreign government or known terrorist group. The votes weren’t there and in a 277-148 vote, the measure failed. For now. Almost immediately after the vote, the House took the necessary step of sending the bill through the House Rules Committee. The committee approved the measure in a 7-2 vote and thereby virtually assuring its passage, as it now requires only a simple majority vote.

Media

AOL has purchased the Huffington Post for US$315 million (US$300 million in cash and US$15 million in stock)—not a bad payday for the online aggregator that started with US$1 million in investment capital. Surprisingly, Arianna Huffington, Huffington Post co-founder and publisher, takes control of AOL’s editorial content and becomes president and editor in chief of AOL’s new Huffington Post Media Group. As Jeremy W. Peters and Verne G. Kopytoff, writing for the New York Times opine, “... the deal carries a risk for the Huffington Post, which has had none of AOL’s troubles and is widely viewed as a business success with its own unique voice and identity. Now that it is to become part of a large corporate entity, what becomes of that unique character is an open question.” Erick Schonfeld, writing for TechCrunch, has the internal memo sent by Tim Armstrong, AOL’s chief executive, to staffers. From the other side, Alexis Madrigal, writing for the Atlantic, has the email Arianna Huffington sent to her (mostly unpaid) staff. Tim Rutten has written a scathing op-ed piece for the Los Angeles Times, carrying the deck: “To grasp the Huffington Post‘s business model, picture a galley rowed by slaves and commanded by pirates.” Jeff Jarvis tweets that Rutten doesn’t understand abundance economics (ed. note: Link not in original). The most telling part of AOL’s acquisition of Huffington Post? Eric Hippeau, Huffington’s chief executive, bailed.

Publishing

The Washington Post, in a move that just might mark the beginning of a turnaround, has released its corrections/suggestions form. The form is linked from every staff-written article on the paper’s website, making the Post the first major US corporate news outlet to answer the challenge by the Report an Error Alliance, formed by Scott Rosenberg (MediaBugs) and Craig Silverman (Regret the Error). What’s especially interesting is that this is clearly an important issue for the Post. Scott Rosenberg, writing for Idea Lab, reports the feature was originally tied to a content management system upgrade. When the upgrade was delayed, the Post cobbled together an interim solution using a Google Docs form. I’m so taken with that solution, I’m thinking of implementing it myself. It remains to be seen whether or not the Washington Post actually corrects reported errors. But, hey, baby steps.

MinnPost.com has published an interactive Minnesota deficit calculator. While it would be much better (and more realistic) if there were sliders instead of radio buttons for the options, I was still able to run up a US$770,700,000 surplus without even touching the “cut spending” section or anything below it.

Here’s how I did it:

1. Extend sales tax to clothing (US$600 million)
2. Extend sales tax to services such as car repair, hair styling, accounting, and legal work (US$868 million)
3. Increase taxes on alcoholic beverages (US$278 million)
4. Increase tobacco tax (US$252 million)
5. Return income tax rates to 1998 levels (US$1.8 billion)
6. Adopt a corporate “throwback” rule (US$39.7 million)
7. Allow a racino or some other state-sponsored gambling (US$140 million) but don’t allow revenue to be diverted for new stadium
8. Create a new 10.95 percent tax bracket for taxable income above US$150,000 a year for married couples (US$1.9 billion)
9. Eliminate home-mortgage interest deduction (US$1.1 billion)

It really wasn’t very hard at all, taking less than 10 minutes to complete.

Here are my personal household notes:

We buy clothes from time to time (I bought a US$300 winter coat last fall) but probably not as many or as expensive as you.

Sales tax on services would extend to our business.

We drink, occasionally and sometimes even immoderately.

Neither of us smoke.

Our 1998 income taxes—like yours—were higher than they are now. Deal with it.

Corporate throwback taxes are only fair; if a business earned a profit on it—regardless of where the profit took place—it’s taxable income in the home state.

I’d reluctantly support a racino or state gambling but only if the revenue was no diverted for a new professional sports stadium. My reluctance isn’t to the gambling bit; it’s related to competing with the Indian casinos—we’ve screwed them enough for several dozen white generations.

A 10.95 percent tax bracket for married couples making more than US$150,000 is a no-brainer. Remember that only the amount over US$150,000 is subject to the new tax. There have been years that we’d be subject to this higher bracket.

For the last several years—because my health insurance was paid for by an employer and because our mortgage is relatively small—we haven’t been able to take the home-mortgage interest deduction anyway. Neither have 71 percent of you. That’ll likely change again now that I’m wholly self-employed.