Are You Insured... Enough?

Insurance is a means of protection from financial loss. It is a form of risk management primarily used to ‘hedge against the risk’ of a contingent, uncertain loss.

An insurer, insurance company, or insurance carrier provides the insurance. A person who buys insurance is known as an insured or policyholder. The insurance transaction involves the insured ‘assuming a guaranteed’ and known relatively small loss in the form of payment to the insurer in exchange for the insurer’s ‘promise to compensate’ the insured in the event of a covered loss. The loss may or may not be financial, but it must be reducible to financial terms, and must involve something in which the insured has an insurable interest established by ownership, possession, or preexisting relationship.

The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insured will be financially compensated. The amount of money charged by the insurer to the insured for the coverage set forth in the insurance policy is called the ‘premium’. If the insured experiences a loss that is potentially covered by the insurance policy, the insured submits a claim to the insurer for processing by a ‘claims adjuster’.

There are all types of insurance:

• Auto insurance • Gap insurance • Health insurance • Income protection insurance • Casualty insurance • Life insurance • Burial insurance • Property insurance • Liability insurance • Credit insurance

You can insure just about anything. You can insure your pet. You can insure your hairdo. You can insure your shoes. You can’t insure your faith?

Health insurance policies cover the cost of medical treatments. Dental insurance, like medical insurance, protects policyholders for dental costs. In most developed countries, all citizens receive some health coverage from their governments, paid for by taxation. In most countries, health insurance is often part of an employer's benefits.

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly ‘premium or payroll tax’, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private (for-profit) business, or not-for-profit entity. Health insurance includes claims for injury, sickness, accident, medical expense, disability, or accidental death and dismemberment.

Health maintenance organizations (HMO) tended to use the term “health plan”, while commercial insurance companies used the term “health insurance”. A “health plan” can also refer to a subscription-based medical care arrangement offered through HMOs, preferred provider organizations, or point-of-service plans. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans.

Pre-paid health plans typically pay for a ‘fixed number of services’ (for example: $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.). The services offered are usually ‘at the discretion’ of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review).

There are different options available to both employers and employees. There are different types of plans, including health savings accounts and plans with a high or low deductible. The plans that have the high deductibles typically cost the employee less for the monthly premiums, but the part they pay for each time they use their insurance, as well as the overall deductible before the insurance covers anything is much higher. These types of plans are good for the people who rarely go to the doctor and need little health care. The lower deductible plans are typically more expensive, however, they save the employee from having to spend a lot of money out-of-pocket for services and treatment.

The recent trend for employers is to offer the high deductible plans, called ‘consumer-driven healthcare’ plans, because it costs them less overall for the care their employees need, but it is a lower monthly premium for the employees.

‘Comprehensive’ health insurance pays a percentage of the cost of hospital and physician charges after a deductible or co-pay is met by the insured. These plans are generally expensive because of the high potential benefit payout — $1,000,000 to $5,000,000 is common — and because of the vast array of covered benefits.

‘Scheduled’ health insurance plans are not meant to replace a traditional comprehensive health insurance plans and are more of a basic policy providing access to day-to-day health care such as going to the doctor or getting a prescription drug. These plans have taken the name “mini-med plans” or “association” plans. The term “association” is because they require ‘membership in an association’ (like AARP or Health Care Credit Union Association) that must exist for some other purpose than to sell insurance.  These plans may provide benefits for hospitalization and surgical, but these benefits will be limited. Scheduled plans are not meant to be effective for catastrophic events. These plans cost much less than comprehensive health insurance. They generally pay limited benefits amounts directly to the service provider, and payments are based upon the plan’s “schedule of benefits”.

Getting confused yet?

‘Health care’ or ‘healthcare’ is the maintenance or improvement of health via the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. ‘Health care’ is delivered the insured by allied health professions, chiropractic, physicians, physician associates, dentistry, midwifery, nursing, medicine, optometry, pharmacy, psychology, and other health professions. It includes the work done in providing primary care, secondary care, and tertiary care, as well as in public health.

According to the World Health Organization (WHO), a well-functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained health facilities and logistics to deliver quality medicines and technologies.

Got it so far?

You choose a provider of health insurance and choose the options that fit your needs and your budget. You pay your monthly premiums and hope you don’t get sick or hurt.

If you do get sick or hurt, you turn to your health insurance provider to assist you in paying the cost from your previous premium payments and agreed upon co-pay.

Sound good so far?

Then your doctor or physician or whatever kind of medical practitioner suggest a procedure not covered under your health insurance contract. Out of pocket expense that was not expected.

Is it a toss of a coin in a life or death experiment to survive?

The government now wants to step in and save you from the fear of pain without any medical assistance and as we have done since the civil war we expect to be taken care of, but remember our medical providers are a market based industry based on making a profit whether you feel better or not.

Socialism is a range of economic and social systems characterized by social ownership and democratic control of the means of production; as well as the political ideologies, theories, and movements that aim to establish them. Social ownership may refer to forms of public, collective, or cooperative ownership; to citizen ownership of equity; or to any combination of these.

Democracy is a system of government in which the citizens exercise power directly or elect representatives from among themselves to form a governing body, such as a parliament. Democracy is sometimes referred to as “rule of the majority”. Democracy contrasts with forms of government where an individual, as in an absolute monarchy, either holds power or where power is held by a small number of individuals, as in an oligarchy.

A Republic is a form of government in which the country is considered a “public matter” – not the private concern or property of the rulers – and where offices of state are elected or appointed, rather than inherited. It is a government where the head of state is not a monarch and government leaders exercise power according to the rule of law.

Republics became more common in the Western world starting in the late 18th century, eventually displacing absolute monarchy as the most common form of government in Europe. In modern republics, the executive is legitimized both by a constitution and by popular suffrage. Most often a republic is a single sovereign state, but there are also sub-sovereign state entities that are referred to as republics, or that have governments that are described as ‘republican’ in nature. For instance, Article IV of the United States Constitution “guarantee[s] to every State in this Union a Republican form of Government”.

Enough of political science, you have a representative telling you that this is the kind of health insurance that is approved by your government. A variety of providers are more than happy to take your money with promises of happiness and no worries until….

Old Doc Page used to come around to the house when I was blowing chunks into a trashcan and my mom and dad didn’t know what to do but put a cool wet washcloth on my forehead and give me ginger ale. Old Doc Page would read the thermometer and say, “Take two aspirin and call me in the morning.” There were no scheduled visits to his office to check for preventative signs of unhealthy habits.

Before Old Doc Page it was just grandma and aunts and uncles and the church elders who stepped in when your parents were overwhelmed with illness in the family. These were the same folks who dug the hole to place the body in.

You make your decision and fret on if you have enough insurance. There are lots of options and they are changing everyday. Alone the pharmaceutical industry is coming out with plethoric amounts of variables to purchase and place in your body to see if they make any difference.

Unfortunately things happen to us whether willingly or by fate and suddenly we must deal with sickness or injury. The old idea of ‘shake it off and rub some dirt in it’ has transformed to ‘who is going to take care of me?’

If instead of using your local doc-in-a-box for visits to check all the internal and external problems, the Emergency Room is your physician of choice. Unless you are rolled in on a gurney with trauma (you know that icky stuff) you sign in and wait for the next number to be called. No matter which insurance policy you have or how much you get frustrated you have to wait your turn.

Everyday we come up with a new description for all our maladies and the health care professionals must find a way to sooth us. They may not be able to cure us but they can dope us up and poke us and pump us and charge us to increase their knowledge using us as genie pigs.

I pity those poor folks who really need the care and appreciate those marvelous folks who run to help in disasters without asking for their identification or insurance policy. I also wonder about all the government’s warnings about how we eat and what we eat and how we sleep and our lack of exercise goes unnoticed like the speed limit and picking up after your dog poops.

I have gone for years without the safety net of health insurance. It is a crapshoot. Did I follow the healthy regiment of three meals a day, exercise and plenty of sleep? Was it a sane decision or a necessary?

Until the government or whatever powerful being declares that everyone can go to any medical provider and get the best care without restrictions, then I’ll be comfortable. In the meantime, I’ll try and eat more greens than ice cream, sleep before 2AM and wake before noon, take a daily ride and stay hydrated. I’m insured.

It may not be what Old Doc Page would have prescribed but so far it has work for me. So far?

What ‘cha Gonna Do About It?

Like most of our problems that make us uncomfortable and distract us from our inane hedonism, we pick up our self-made refuge in plastic bags and put them in large plastic bins and roll them to the curb and wait for the city or county or someone else who takes our money to remove this every growing amount of waste and place it somewhere else. Somewhere we cannot see it or smell it or contemplate the consequences of the amount of waste we make by ourselves.

Yet this trash doesn’t go away. We can hide it underground like nuclear waste or pretend to recycle some of it, but it just keeps piling up. So what ‘cha gonna do about it?

With the manufacturing of easy and cheap products like plastic that does not quickly biodegrade and the acceptance of our cultures for these inexpensive containers our trashcans overflow. 

What started with the occasional cigarette butt or beer can on the side of the road have now become dumping grounds. All the trash we have thrown into our water ecosystem after spoiling our drinking filtration flow down to then pollute the oceans only to have it wash back on shore.

The next summer vacation might not be as pleasant with spoiled beaches?

What happens if the truck doesn’t come around next Monday? What happens with the piles of continuous bags and boxes and bottles that we just want to go away? What ‘cha gonna do?

Would we do as our forefathers have done? Bury it and wait for the future archeologist to dig up and try to figure who we were and what we did and what we ate by our trash.

Maybe our trash is our history?

Do You Like That?

We do nice things for others and ask, “Do you like that?”

It maybe cleaning out the garage or arranging the bookshelves or making an exquisite meal or some new flexibility endeavor during a moment of intimacy.

Why do we ask this question? Are we so emotionally shallow we need constant self-validation?

The simple answer is “Yes”.

We create ceremonies like Christmas, Valentine’s Day and even birthday parties to affirm our beliefs that others like us.

But if you don’t get any presents? If there are no valentine request, then what? No cake and candles and funny hats may shatter your emotional worth and just become another day on the calendar.

“Do you love me?” is another good question. It is in all the songs and books and is repeated more than “Did you find your keys” or “What is that smell?”

The best of us will be pro-active and bring home flowers without advance notice. A surprise vacation, even if it is just an overnight stay at a B&B reaffirms promises made and reestablishes emotional ties.

The next times you get the question “Do you like that?” remember what the other person is asking.

Are You Under Investigation?

It seems now a days that everything is under investigation.

That shooting is under investigation. The cause of the fire is under investigation. The sale of that house is under investigation. That mysterious email from Russia is under investigation.

Where do all these sleuths come from?

The act of investigating something or someone; formal or systematic examination or research is to examine, inquire, study, inspect, explore, consider, analysis, appraise, research, scrutinize, peruse, probe, review, check and survey.

When we cannot make a decision we can make an investigation. Is this food healthy? Set up a nutriment investigation. Is this a good investment offer? Give your private monetary standings to a financial advisor and there is another investigation. Is your significant other wandering? Get a private investigator.

If you become paranoid of the results of the first investigation you can request a new investigation on the previous investigation. Examples of court cases where new evidence missed by the first investigation appears to overturn the verdict prove you can never find out all the facts.

Our topical fanatical vetting process panic is just another investigation. After the basic paperwork the investigator has to determine if it is remotely possible that you could be a ‘bad person’. Suppose you went through this vetting before you got married?

Investigations are a good way to avoid an answer. The prognosis is somewhat questionable so there will be further investigations in this matter. 

Clouds

Did you ever wonder where clouds come from?

Sure there are those meteorologist and scientist and whatever-other-kind-of-ist that have all these charts and graphs and formulations of how the atmosphere forms winds and currents and updrafts and yadda-yadda-yadda.

Yet new studies done by those folks who think about this stuff have found that clouds come from heaven.

Yes, all those who have gone before produce those puffy white cotton balls that float through the skies.

It seems, as it were, that we do carry one sin with us going through the pearly gates. While we get our wings and robes and harps and halos to exist in eternal ecstasy, we still fart.

Flatulence and all of its history from birth to death will come along with us for a ride in the heavenly kingdom. Why do you think St. Peter is there? He is kind of like the TSA of heaven. He makes sure you got all your affairs in order and then explains the rules of heaven.

He tells you where you can fly and at what hours meals are served. He also informs you that farting in heaven is a good.

It seems that expelling gas from our worldly and spiritual bodies cleanses us from massive buildups and exploding. Like belching, farting in heaven does carry some restrictions.

Farts in heaven do not smell bad. Everything is heaven smell like a disinfected bathroom. Farts have no sound in heaven. You can do a quick cheek lift or bend over and blast away, but all you will hear is harps and birds singing. If you get inclined to burn one of your gastrological outbursts, there is a one-way ticket downstairs where you can have all the fire you want.

So while you are lying on your back in a field of grass and tick this summer looking up at the sky enjoy the clouds. “That one that looks like a bunny probably came from Nana.” “That one that looks like a boat was probably from Captain Jack.” “Those little ones must be from Aunt Sally. She always was a tooter.”

What about those dark foreboding clouds with all the rumble and wind? It was Chili Night in heaven.

My apologies to Joni. 

The Mystery For Today

Started out as an ordinary day. You know, one day at eighty degrees and today snowing kind of day.

Following the usual routine, updating the new (real or fake?) and on time to mount up and ride the route, I see nothing unusual. Well except that it is snowing. 

Not many people out except guys in yellow vest and hardhats tearing up the sidewalks with their noisy machines and the laundry trucks darting through the streets picking up stinky underwear and leaving behind pressed shirts wrapped in plastic. No one is walking their dogs or pushing baby strollers on this day’s wintery mix.

I ride in the morning to get my functions going and up to speed. Taking deep breaths and stretching to get the old thumper pump going and the crimson juice circulating my habit is mostly uninterrupted and I can concentrate of the day ahead.

Wind in the face my senses become alert to sound and movement. Mostly trying to avoid drivers talking on the phone and the potholes, I can pretty much follow the line from yesterday.

I see this woman exit an apartment through the white flurries. I don’t normally listen to people as I whiz by but today there was something different.

“Hi Cliff” she calls out.

Not knowing anyone in this neighborhood and not recognizing her from afar and concentrating on my pathway, I turned my head and said “Hi”.

She laughed, as I didn’t stop for I was already in rhythm and stopping at that pace would have probably thrown me over the handlebars and done some damage to my noggin.

I finished my route and chores and returned home on a different route but the brief incident kept me wondering. “Who was that?”

I didn’t recognize the voice. I did notice nice legs. A brunette in a long black bubble wrap coat like you wear in the dead of winter had called me out. Well it was snowing.

And she called my name. Normally if mistaken identity it would be a “Bob” or “Tom” or “Igor” but my name usually isn’t on the first page of the list. Maybe she was on the phone with a doppelganger that was impersonating me?

Maybe there are posters around the neighborhood with my picture and name on them telling parents to keep their daughters away from this old white haired guy on a bike? He is not Santa Claus. I only thought Fred had those on his ice-cream truck.

Either way it did get my attention. These events are what make life interesting.

Tomorrow I will travel the same route at about the same time and whoever she was won’t be there.

So if you happen to read this, forgive me for being rude and riding off. I did acknowledge hearing you but couldn’t immediately place the voice or face. Leave a comment if you read this but do sign it ‘anonymous’. Keep the mystery going.

Life Is About Dealing With Crisis

It’s true. From the struggle for the first breathe to dealing with the end, life is just a bunch of speed bumps to happiness.

Johnny skinned his knee, Sally lost her favorite doll, Tommy failed kindergarten, Amy was left on the bus, Billy lost his bowel control in school, Little Jamie’s turtle died, Mike threw up all over grandmother’s cat, Mary has to get glasses, Don was helping dad when he fell off the roof….

The list goes on and on when you are a kid. It doesn’t end when you have your own kids. It doesn’t end when your kids have kids. Every moment is a crisis.

Remember you were a kid too. Not growing as tall as everyone else, pimples, voice changes in the choir, not being selected to the sports team, that run in your stocking at the prom, a zipper break, bad haircuts, that phone call that never came, whatever that stuff is between your toes, hair coming out of your body, what is that smell, stepping on your dates foot, bad kiss, family chores, report cards, the first time….

Yes, the list goes on and on. There is no way to avoid it.

That affair, a long night out with the guys and then you wake up, the raise that didn’t come, spilling mustard on your tie, flat tires, broken washing machines, leaking pipes, backed up toilets, late for meetings, copier broken, late bills, a robbery, the boss is mad at your lack of productivity, your partner leaves, the vacation is a disaster, the parents are dying, the dog dies, your phone breaks, customer service calls, noisy neighbors, loss of hair, lost, pain, addiction, shame, depression, suicide….

While we all seek rainbows and butterflies and unicorns, this life thing is rough. There is no book of instructions to guide you through it so you are on your own. There are options. Religions of alternating varieties, alternative healings with candles and meditations, physical release of stress and temptation, chemical and herbal potions and concoctions are offered to ease the strain of just waking up in the morning and facing another day.

It doesn’t go away. Long lines at the grocery store, traffic jams, bad reception, mother-in-law moving in, flight delays, late delivery with the wrong item, remote dies, corns, snoring, late night meetings and lost dinners, early check-outs, lost luggage, bad breath, doctor’s diagnosis, an itch, cold feet, sweat, kitchen fire, parking ticket, jury duty, fat, yoga, doughnuts, farts, exercise, loss of eyesight.

You thought it would stop? Pain, higher prices, power failure, snow, insomnia, sink replacement at Christmas, holidays, birthdays, emergency rooms, does this dress make me look fat, flirting, diarrhea, yards, retirement, coffins, baptism, socks, toe nails, leaking roofs, test, love, tossing your cookies, death….

The ultimate crisis is we know, logically that there is a beginning and an end. There have been enough of us to go before us to prove the theory that we all are going to die.

Have you ever noticed the wild kingdom that surrounds you? They have the same crisis of fear and hunger and shelter but know not of death. When one dies, the others will recognize the loss and then move on. For the remains will be devoured by the carnivores or simply disincarnate as we all will.