what is wrong with america's health care system?

ok, i am officially p*ssed off at the american health care system, and here's why: you get penalized for being proactive. let's face it: in america, you have to literally be *dying* for certain kinds of tests or screening to be authorized and paid for by the insurance companies. you can't just waltz into the doctor's office and say that you want a blood test or an mri just to make sure everything is ok with you. you have to have a "medical" reason for it, otherwise, you have to pay out of pocket for the tests.

the u.s. is one of (if not the) only industrialized nation that does not provide universal health care to its citizens. i mean, even cuba, which is neither industrialized nor even democratic, provides subsidized universal health care to its citizens. why we in america can't have the same benefits afforded to our citizens beats me. even if you are one of the lucky few to be privately insured, there is no guarantee that the insurance companies will pay for your medical expenses, it all depends on how the medical provider "codes" your visit.

an example: my friend pili felt ill on christmas eve last year, so she went to the emergency room. after an examination, the emergency room doctors determined that she'd just had what they deemed a "mild" heart attack (gasp!). it turns out pili had coronary artery disease, with three arteries blocked at 99%, 95% and 85% respectively, and another blocked at 40%. she was scheduled for surgery to place heart stints in her three most clogged arteries, and when she inquired about the fourth, she was told that it was not sufficiently blocked and that she had to wait until it was blocked at least 80% so that they could operate on her. when she pressed on for further information, asking what would happen if she wanted all four of them to be stinted so she didn't have to go through surgery again in the future, they said that it would not be covered by insurance if it was not medically necessary..."not medically necessary"?!?! pili had just had a heart attack for pete's sake!! so now, not only is she worried sick that her artery may get worse, but is now under heavy medication precisely to prevent that, which keeps engrossing the arcs of big pharmaceuticals and the insurance companies, while diminishing her quality of life.

another beauty: i called my insurance company a few days ago to ask about my annual well woman visit as my doctor had advised that, in their experience, only one visit was allowed every 365 calendar days. i was put on hold for what seemed like hours and when the customer service rep finally got back on she said that it was ok to go sooner than 365 days as my insurance company would pay for two "routine" visits per calendar year...screeeech...two routine visits? i asked. what do you mean by "routine" visits? she said that routine visits were basically "preventive" care visits that you make to a general practitioner or family doctor when you do not have a "medical reason" for going (translation: when nothing's hurting).

obviously this explanation didn't sit very well with me and, as a good auditor, i continued to inquire:

me: what happens if you want to have a third "routine" visit?
insurance rep: you have to pay out of pocket for it.
me: so you are telling me that i am penalized for being proactive and wanting to get a checkup even if nothing is essentially wrong with me?
rep: yes, basically.
me: what happens if there is, say, family history of cancer or other hereditary diseases and i want to get tests performed more often or at an earlier age than the "medically recommended" age?
rep: unless you can prove that you have a first degree relative that had the disease, it will not be covered by insurance .
me: what happens if i go to the doctor and say that something is hurting just to get a particular kind of test, will insurance cover that?
rep: well, depends on how the doctor codes your visit, if they code it as a medical reason, then yes, it will be covered.

i later googled "medical billing codes" and found out that these codes are what insurance companies use to determine whether they will cover whatever procedure you are having done. obviously "being proactive" is not one of the codes that is covered...

good bye croatia, hello turkey!

my heart is about to pop out of my chest! i am typing this just as i watch turkey’s dramatic victory over croatia via penalty kicks, which has earned this incredibly resilient team a well-deserved spot in the semi-final of the euro 2008 football cup.

turkey has managed to pull what no other team has done in the history of the tourney: not just one, but three “come from behind”, back to back wins – and not just any wins, turkey’s victories against switzerland, czech republic and now croatia have been some of the most dramatic, astonishing, edge-of-your-seat triumphs i have seen in international competition in recent decades. with their performance in this cup, turkey has become the underdog that everyone wants to root for.

on the flip side, what a heart-breaker for croatia to have allowed turkey to equalize on the 120th minute of second overtime play and then move on to miss three penalty kicks – including a spectacular save by turkey’s redeemer, goalkeeper rustu.

another one of my favorite teams of this cup, portugal, was likewise eliminated by a very effective germany, despite some minor controversy.

croatia and portugal’s elimination prove once again that in soccer, there are no “almosts”.

my "extreme" love of football

joy, oh joy!! football season is upon us. and i don’t mean american football…what i—and the rest of the world outside of the usa—refer to as (the real) football is known within the borders of america as “soccer”. but i digress. football season is upon us and i can’t hardly contain my excitement at the thought of watching two—and sometimes up to four—games a day. between world cup qualifiers, euro cup matches, the marseille fifa beach soccer world cup, local major league soccer (mls) games, and an assortment of friendlies and non-competition matches, not to mention the upcoming beijing 2008 olympics, i have the next couple of months mapped out in football matches.

with international superstars like ronaldinho and messi in the lineup, as well as newcomers like pepe (or pretty much any of the poland national team players) that hope to make it big after their first international appearance, the summer promises to be one of non-stop excitement.

well, as with everything, there is a perfectly good explanation for what has recently been dubbed by a friend of mine as my “extreme” interest in football (at least for a girl). in the year of our lord, nineteen hundred and ninety (1990), the italy fifa world cup changed my life. it was the first time in many decades that my home country of colombia had qualified for a world cup and football fever was in the air. i was all of 12 years old and had never really paid any attention to football, despite the fact that i had been born and raised in a football-loving nation. no one else in my household liked football, not even my father who was from spain—and like most spaniards and europeans (and most men for that matter!), should have been in absolute l.o.v.e and awe of the sport, therefore i was left to watch most matches by myself, which allowed me to have a pure and unadulterated experience of man (or girl) vs. television. i was by myself when i heard on the radio the goal scored by colombia's forward freddy rincon in between the legs of germany goalkeeper khan, which allowed my team to tie the undefeated (and later champion of the world) germany and thus advance to second round, and i was also by myself when, in a turn of fate, colombia was eliminated from the competition on the second round at the hands of 42 year old cameroon forward roger milla, aided by a huge mistake from colombia’s colorful goalie, rené “el loco” higuita who came out of the area to kick the ball and was dispossessed by milla, who then scored.

after that, i watched faithfully the remainder of the cup, as germany was crowned new champion of the world, and all international competitions that i could get my hands (or eyes) on after that: copa libertadores, copa america, confederations cup, euro cup, etc. when the next world cup rolled around in usa 1994, my heart was broken by colombia’s defeat in the first round at the hands of the host team itself, due in part to an even bigger mistake than that from 1990: colombia’s defense andres escobar scored an own-goal. escobar was later shot to death outside a nightclub in medellin, colombia, in an incident that some still claim was not related to the football match, but which will forever remain etched in the minds of football fans all around the world. in 1995, i relocated to the usa.

in america, football is not as wildly popular as it is in the rest of the world, and it was even less popular when i first arrived in the country. there was no national league to speak of, and activity was reduced to local amateur and varsity leagues (high school/university). i did not like any of the sports that were—and still are—popular in america: baseball, american football (oh god!), basketball (which i can tolerate to a certain extent), hockey, golf, racing, etc. so i fell back on football. i tried to catch whatever match of competition i could on t.v., but there weren’t very many channels that would show international games, and most of them were “pay-per-view” so whenever there was an important match or tourney, i would watch the game at bars with friends, or someone would purchase the pay per view event at their home and we would all pitch in to cover the cost. great times.

in 1996, major league soccer (mls), the national usa football league, made its debut with all necessary pomp and circumstance. however, as much as mls has made great strides in trying to appeal to an ever growing number of fans (many of whom are of foreign descent), it still does not measure up (at least, in my humble opinion) to clubs of international stature, but it is, alas, the closest that we are at the moment to football, and bargain-basement entertainment for approx. usd $15 a match—especially considering that (american) national football league (nfl) games go for upwards of usd $80 per regular season game!

we “real” football fans can find solace in the fact that we can watch former international stars like david beckham and cuauhtémoc blanco battle it out in a mere few yards from our seats. as i type this, i have just watched my new home team, the two time back-to-back mls champion houston dynamo, beat toronto fc 3-1 in a home game. go dynamo!

so my “extreme” love of football, as my friend recently put it, is rooted in tradition, but mainly in a lack of any other sports that have appealed to me during the majority of my adult life. i just hope that i can continue to entertain my fancy for many years to come, and that my dream of making it to a world cup comes to life in the (very near) future. south africa 2010, here i come!!

(photo caption: celebrating argentina's victory over mexico in the 2006 fifa world cup at buenos aires' "obelisco")

where is the hot water?!?!

i recently came back from a business trip to russia. one word: w.o.w.

lovely country, amazing history, fun people, superb vodka. i was incredibly lucky to witness while in moscow the celebration of the 63rd anniversary of the defeat of nazi germany, celebrated as "victory day" with an impressive military parade and air show to rival those seen in soviet times.

moscow is an impressive city, full of history and contrasts, where you can see couples on their wedding day parading around the city centre, alongside skateboarders, military personnel and the ubiquitous hordes of gorgeous women in impossibly high heels. with an economy growing at the speed of bullet trains, and an increasingly upwardly mobile and educated population, moscow is also the most expensive city in the world.

when we left moscow for siberia, however, things reverted to another era. tyumen was not as cold as i expected it to be and, alas, i was ill-prepared for facing the constraints encountered, as our accommodations fell short of my expectations for a business hotel. for starters, for an eight storey hotel, the lift (elevator) started on the third floor…not sure why, i am convinced that it was a makeshift lift fashioned out of a broom closet with little elves tugging on the pulleys, which would collapse any minute. so we were forced to lug our suitcases and very heavy computer bags up three flights of stairs before we could get to the lift. lesson learned: pack light, like our russian friends, who brought small duffle bags and slim computer cases, and one of them, amusingly, only brought whatever could fit in a medium sized plastic bag! my hero!

next, with a temperature of 20°c+ there was no air conditioning in our rooms. this may not seem like a big deal to some, but if you have lived in the usa for the last 13 years of your life—particularly in texas—you get used to having a/c at all times of the day and night, all year round (yes, even in winter!). then, there was no hot water in the shower. again, this may seem to some like a contradiction, seeing as being hot would perhaps be alleviated by a cold shower, but try showering with cold water first thing in the morning. apparently, in every city in the russian federation, the government provides the hot water to city residents, but every year in the late spring or early summer for about 20 days, they cut off the hot water so that the pipes can be maintained. lovely system, except the cut-off happened while we were there...oh joy. i had to exercise my creative side by using a tea kettle that i managed to obtain from the only english-speaking front desk clerk in the entire place, with which i boiled some water and made a bath in the sink, resulting in water being splashed all over the bathroom (see prior post).

by far the most peculiar anecdote was the laundry. we were told by our russian students that, to get our clothes washed, all we had to do was put them in a plastic bag (which we were expected to provide) and hand them to the floor housekeeper. we found bags and put our clothes in, but we could never find the floor housekeeper, so we took the clothes to the front desk and told the clerk via hand signals (the english-speaking clerk was not working that day) that we needed our clothes washed. she nodded and smiled (a rarity) which we assumed meant she understood us. when we arrived back at the hotel that evening, my bag of clothes was sitting in the exact same spot where the lady in the morning had put it, with a note on it stating (in russian) my name and room number. i was extremely aggravated initially, as i had no clean clothes left whatsoever, until i remembered that i was lucky to have even found my clothes, as they could’ve very well ended up enlarging the inventory of a street vendor at the local flea market. eventually we figured out where the floor housekeeper resided and took the clothes to her, and got them back the next day in perfectly good order, but the entire experience was, as much of the rest of the trip, very unusual.

but despite all of the “character building” experiences, and the harassment of a local drunken woman who kept trying to kick us (mostly me, really) out of the local square for being a (loud) english-speaking foreigner, the best of times were spend hanging out with our russian friends, with a beer in hand and just talking, telling silly jokes and stories, and at times even singing. these were some of the best times we had and i can’t wait to go back to repeat them :)

(photo caption: st. basil's cathedral in red square, moscow, russia)

absence

ok, so i have been absent for a while...i know. there's been loads of things going on, trips, work stuff, etc. but i'm back and have a few articles in the pipeline, so i will attempt to publish them in the next few days. here are the first few :)

thank goodness for "western" toilets

i have always considered myself to be fairly conscious of my surroundings and, not having grown up in the usa, i've always been grateful for the comforts of living in an modern and highly industrialized nation – after all, as eloquently put by my spanish uncle, where else in the world can you do your banking, get your food, and even get married, without having to get out your car? however, nothing could’ve prepared me for what i will call the “toilet situation” in a recent trip to southeast asia.

first, as i very quickly discovered, toilet paper is a luxury. predominantly muslim cultures do not use toilet paper for...er…personal cleansing. they use a water hose conveniently affixed to the toilet cubicle wall instead. in rural areas, a bucket of water and scoop is provided. so i quickly learned to bring my own t.p. on all trips to the toilet, lest i be forced to use the hose!

second, you're lucky if you find a western-style "sitting" toilet ; more often than not, you will find a "squat toilet" (basically, a hole in the ground), which turns the simple act of using the toilet into an excercise of your lower half--maybe that's explains why the "pear" body shape does not occur as often in eastern countries...but i digress.

third, there is water e.v.e.r.y.w.h.e.r.e.! due to hose usage, water gets splashed on every possible surface in the toilet cubicle: walls, floor, toilet seat, tank (if there is a sitting toilet), i even went into a stall that had water splashed on the ceiling (don’t ask me how that happened…). as water ponds on the floor, it is necessary to roll up one’s pant legs before entering the restroom, and if wearing flip-flops or sandals, well, it may be best to just hold it. as a direct result, the toilet seat (again, only if there is a sitting toilet) is often entirely covered in water and as there is no toilet paper with which to wipe it or line it, one is highly advised not to sit.

finally, if you’ve managed to survive the above, most restrooms have water to rinse your hands but few have soap and even fewer have paper towels or a hand dryer. so after having touched all those wet surfaces and knowing how they got wet, hand sanitizing gel is highly advisable. needless to say, every trip to the restroom was an adventure, and by the end of 3 + weeks i was ready for a regular toilet experience.

i didn’t realize how much of an impact this whole situation had made on me until i came back home and the first day back in office, i went to the ladies room to find a full roll of toilet paper and a dispenser of toilet seat liners, so common in american ladies’ rooms. i couldn’t help but smile and reflect back upon the most basic commodities that we so often take for granted but that elsewhere in the world are considered luxuries, and felt instantly enlightened :)

(photo caption: looking up at the petronas towers, kuala lumpur, malaysia)