I'm Tired Of These Ungrateful Hurricane Victims

[Bill Sornson]

And in alt.toys.gi-joe? - somebody please quit crossposting! (LOL,
realizing that I am now crossposting as well!)

That's OK. You made up for by leaving all the stuff (now snipped) below
your vital input.

:-D

 

[tr2267]

We are not Canadians. Tell an American with a sore knee he has to wait a
month for an MRI, and he will go ballistic, and he will fire the
congresscritter that helped make him wait that long.

That would be the same American who meekly accepts his crummy HMO making
him wait 2-3 times longer than Canadians and paying twice as much for the
same procedures? The same American who meekly accepts sharp restrictions
on their choice of doctors while the guy in Canada picks anybody they
want? The actual facts are that Americans consistenly support universal
health care every single time a poll asks them the question. Personally
I would love to have the same health care plan as my congressmen. 45 million
Americans would love to have any health insurance at all.

You are only thinking this way because you are insulated from the actual
cost of health insurance.

And Canadians and Australians are far more "insulated from the actual
cost of health insurance" at the same time they pay barely half of what
we pay and enjoy superior health than Americans.

I pay a bit over $8000 a year for health
insurance.

You pay $8000 for nearly worthless individual insurance. And anyone
with chronic conditions can pay 2-4 times that much.

A typical uncovered, cash only doctor visit bill is $300 or
so, plus any extra tests. If you want to see a doctor off the list,
no one is stopping you, its a negligible additional expense.

This is just laughable. Nobody in their right mind would pay $900 for 3 doctor
visits when using their insurance co-payments would only cost them $75 for
the three visits.

Secondly,
almost everyone is offered a choice of plans, you can go cheap or you can
go more expensive.

Almost _nobody_ is offered a choice of plans. You're stuck with whatever
shitty PPO or HMO your employer picks out for you, and that's if you're lucky.

I pay more, not for a lower deductible, but for access
to a vast list of approved doctors, and the ability to have the insurance
company pay 75% of the bill for doctors not on my list. You've made an
economic choice; enjoy the benefits and tolerate the disadvantages. If I
feel the need to go see a specialist, I just call and make an appointment;
I don't ask anyone's permission.

Few Americans can make that choice but almost all Canadians can. They
can purchase supplemental insurance if they choose to. The differences
are (1) everybody has a decent level of care, and (2) their system is
so much more effiecient they pay barely half of what we pay.

Of course we pay more for bureaucrats. It is our nature. We love paper,

It is our nature to be stupidier than the populations of every other First
World country and pay twice as much for inferior health results? Is there
some sort of genetic reason for our stupidity or is it because we have a
shitty fucked up health care system due to an historical accident?

every act of congress is designed to create more paper, and more paper
requires more unionized bureacrats to process. Even the tiniest of
medical excercises generates two or more pieces of mail. It is
unreasonable to expect that will stop simply because Uncle Sam is
collecting the checks.

Is it also unreasonable for me to expect you to understand simple economics?
We pay more for bureaucrats for the simple reason that we have more health
care plans and most of them are trying to shift costs to the government.

1 plan * 100 bureaucrats = 100 bureaucrats
500 plans * 100 bureacrats = 50,000 bureaucrats

If the company you are annoyed at is trying to avoid paying, then maybe
that should tell you something about what they charge. You bought cheap,
and you got cheap.

I didn't buy. Like everyone else with real (i.e. group) insurance, somebody
else decided for me what I have. Nor am I annoyed at any one specific
company. I could change employers but it is very likely that my next
insurance would be just bit as shitty as my current PPO. And there is
an enormous inefficiency inherit in any economic system where people make
decisions to stay or leave jobs because of health care.

If you think a physician in England pays the same (within 1%) for medical
malpractice and general liability as a physician in Houston, you are just
absolutely off the....


Much of the First World has looser pays, and much lower payout amounts for
the typical bad medical outcome.

The actual reality is that they typically enjoy _better_ medical outcomes
and longer life spans than Americans do.

http://www.oecd.org/dataoecd/7/42/35530071.xls

When your basic assumptions have been proven incorrect (that our health
outcomes are better than countries with universal care) an intelligent person
would start rethinking their position.

Lets can the lawyers and the bureacrats,

That's what I've been saying all along.


then we can have our system, and

a reasonable financing system. But you gotta get both.


As long as the lawyers are taking their cut, and vast governmental,
unionized workforces are involved, it doesn't really matter whether Uncle
Sam or Aetna is collecting the dollars.

Umm, no. There is overwhelming evidence around the world that having
one organization collecting money is vastly cheaper than having 50
organizations collecting the money because the latter system has 50 times
as many bureaucrats.

 

[tr2267]

So move to Canada already, you whiny bitch!

That wouldn't help any of the 80 million Americans who don't have group
health insurance like I do, shit-for-brains. I am interested in improving the
hopelessly fucked up health system in my own country and saving the lives of my
fellow American citizens. It is pathetic that archconservatives are such
degenerate freaks that anybody not having purely selfish motivations are beyond
their comprehension.

 

[Tim May]

That wouldn't help any of the 80 million Americans who don't have group
health insurance like I do, shit-for-brains. I am interested in improving the
hopelessly fucked up health system in my own country and saving the lives of
my
fellow American citizens. It is pathetic that archconservatives are such
degenerate freaks that anybody not having purely selfish motivations are
beyond
their comprehension.

Don't steal my money and you'll be fine.

Steal my money and I'll see your kind sent up the chimneys, with no
G.I.s to stop what the Germans tried to get done.

**** your kind dead. **** your children dead.


--Tim May

 

[tr2267]

Thanks for reminding everyone that conservatives == racists

 

[tr2267]

Don't steal my money and you'll be fine.

I've never stolen anything in my life, dickhead.

Steal my money and I'll see your kind sent up the chimneys, with no
G.I.s to stop what the Germans tried to get done.

**** your kind dead. **** your children dead.

--Tim May

My kind? You think I'm Jewish and you fantasize about yourself playing
a Nazi and killing and raping people? What a freaking loser you must
be. LOL!!!!!!!!!!!!!

 

[Vic Vega]

Thanks for coming out as a rad-lib fucktard.

Thanks for reminding everyone that conservatives == racists

 

[rwwff]

You pay $8000 for nearly worthless individual insurance. And anyone
with chronic conditions can pay 2-4 times that much.

We do have chronic conditions involved; and how can it be worthless when
we are near the break-even point on what we've paid in premiums, vs what
the insurance has paid in benefits? It smooths out the expense from year
to year. Sometimes we only use $3000 in benefits, sometimes we have used
$25,000 in benefits. No one up there has been interested in cancelling
our policy, and we've been customers on essentially the same plan for
seven years.

This is just laughable. Nobody in their right mind would pay $900 for 3 doctor
visits when using their insurance co-payments would only cost them $75 for
the three visits.

Lets say you decide to take a high deductible HMO and pay 4k, instead of
my plan at 8k. You can take those three out of coverage visits and still
be well below the other option, cost wise.

Almost _nobody_ is offered a choice of plans. You're stuck with whatever
shitty PPO or HMO your employer picks out for you, and that's if you're lucky.

Sure you are, most employers that offer these kinds of plans usually have
three or more options you can pick, allowing you some flex in your
deductibles, premiums, or doctor group.

Few Americans can make that choice but almost all Canadians can. They
can purchase supplemental insurance if they choose to. The differences
are (1) everybody has a decent level of care, and (2) their system is
so much more effiecient they pay barely half of what we pay.

Believeing that our blood sucking beuraucrats would ever be as efficient
as the more altruistically minded bureacrats in other countries is
dreaming large.

It is our nature to be stupidier than the populations of every other First
World country and pay twice as much for inferior health results? Is there
some sort of genetic reason for our stupidity or is it because we have a
shitty fucked up health care system due to an historical accident?

Not genetic. Cultural.

Is it also unreasonable for me to expect you to understand simple economics?
We pay more for bureaucrats for the simple reason that we have more health
care plans and most of them are trying to shift costs to the government.

1 plan * 100 bureaucrats = 100 bureaucrats
500 plans * 100 bureacrats = 50,000 bureaucrats

And you are dreaming if you think the government would create just one
plan, thereby fireing thousands upon thousands of dues paying union
members.

I didn't buy. Like everyone else with real (i.e. group) insurance, somebody
else decided for me what I have. Nor am I annoyed at any one specific
company. I could change employers but it is very likely that my next
insurance would be just bit as shitty as my current PPO. And there is
an enormous inefficiency inherit in any economic system where people make
decisions to stay or leave jobs because of health care.

Let me see, you call yours "real" and "shitty" at the same time, while
deriding my type of insurance as fake, yet we as moderately heavy users of
that insurance have been quite pleased with the service and support we
have gotten.

The actual reality is that they typically enjoy _better_ medical outcomes
and longer life spans than Americans do.

I didn't say that we had better outcomes, rather, I only suggest that when
bad outcomes occur as they do both here and over there, that the average
payout is much lower over there than it is here.

When your basic assumptions have been proven incorrect (that our health
outcomes are better than countries with universal care) an intelligent person
would start rethinking their position.

I've never made any such assumption. A combination of health choices
makes it impossible that our outcomes would be better than other
industrial countries. We eat more, we smoke more, we shoot each other
more often, even with the best imagineable system, our outcomes would
still be worse.

That's what I've been saying all along.

Nope, you've scrupulously left the lawyers out of your sights, like a
typical democrat hack would.

Umm, no. There is overwhelming evidence around the world that having
one organization collecting money is vastly cheaper than having 50
organizations collecting the money because the latter system has 50 times
as many bureaucrats.

If you think the government won't hire all those bureaucrats at the point
of a change over, you are again dreaming large.

 

[Bill Sornson]

Thanks for reminding everyone that conservatives == racists

Can't argue with THAT logic. (Guess all "liberals" are Farrakhanesque, eh?
Miss the mother ship much?)

Mike Vandeman must be proud of you...

 

[Jim Sanchez]

I have group health insurance, idiot. But 80 million Americans do not have
group insurance, and they're screwed by a shitty health care system that
is fundamentally flawed. Thanks for providing evidence that archconservative
nutjobs are so self-centered and selfish freaks that someone caring about their
fellow citizens is completely beyond their comprehension.

It is outrageous that Americans are still stuck with a health care system that
is a piece of shit while every other industrialized country has a far more
efficient universal system and usually have better health statistics and longer
life spans. Polls consistently show that Americans would prefer to have a
universal health care system. And since the current US system gets worse and
worse every year, it is only a matter of time before the US catches up to the
rest of the industrialized world.


*Health Economics 101*
By Paul Krugman
The New York Times

Monday 14 November 2005

Several readers have asked me a good question: we rely on free
markets to deliver most goods and services, so why shouldn't we do
the same thing for health care? Some correspondents were
belligerent, others honestly curious. Either way, they deserve an
answer.

It comes down to three things: risk, selection and social justice.

I don't know where you get the $3000/mo number but I'm 59 and get health
insurance for me and my wife for $400/mo (with $3000 deductable via
health savings account). I don't think that is all THAT bad and
certainly affordable for most folks.
Jim

 

[tr2267]

We do have chronic conditions involved; and how can it be worthless when
we are near the break-even point on what we've paid in premiums, vs what
the insurance has paid in benefits? It smooths out the expense from year
to year. Sometimes we only use $3000 in benefits, sometimes we have used
$25,000 in benefits. No one up there has been interested in cancelling
our policy, and we've been customers on essentially the same plan for
seven years.

Is that $8000 per person? Would you care to say which chronic conditions?
There are some chronic conditions that are much more expensive than others.
Furthermore, when you have a chronic condition insurers will tend to assume
that you will have more claims for even non-related things. There are some
conditions that are pretty expensive, and if you're costing your insurance
company much more than you pay year after year I still think they will
figure out some way in the fine print to make you pay. However, it does
sound like Virginia has much better private insurance than other states,
but only due to heavy state government regulation of the free market. A
very high level of federal government regulation is also the reason that
group insurance is much better than individual insurance. But you yourself
said that you are paying twice as much for individual insurance as what you
would pay for group insurance, and plus you're screwed out of the tax subsidies
that pay for group insurance. Meanwhile a Canadian could purchase a very
nice supplemental insurance policy for a lot less than $8000USD.

Lets say you decide to take a high deductible HMO and pay 4k, instead of
my plan at 8k. You can take those three out of coverage visits and still
be well below the other option, cost wise.

If healthy Americans have to pay 4k merely for a high deductible HMO, that's a
pretty terrible deal IMO. You get almost nothing for your money unless you
have huge expenses that year and many families can't afford that much anyway.
4K would pay for decent group insurance, and about 2-2.5K of taxes would pay
for Canadian insurance.

Sure you are, most employers that offer these kinds of plans usually have
three or more options you can pick, allowing you some flex in your
deductibles, premiums, or doctor group.

Not any more. It's been a long time since I've seen that kind of choice
offered to me. Most employers do _not_ offer that choice, although some
still do.

Believeing that our blood sucking beuraucrats would ever be as efficient
as the more altruistically minded bureacrats in other countries is
dreaming large.

You have a very low opinion of American workers compared with Canada, Europe,
Australia, etc. Here is the real difference: Most of our health care
bureaucrats are _private_ sector instead of public sector, so it should
be no surprise at all that our private sector bureaucrats are not
"altruistically minded". If we desire to have "altruistically minded"
bureaucrats than having them come from the private sector is obviously
the worst possible mistake.

Not genetic. Cultural.

I agree with you that our culture is stupid because we pay twice as much for
health care for inferior results and we have so far failed to achieve a
universal system that every other First World country in the world has
already done.

And you are dreaming if you think the government would create just one
plan, thereby fireing thousands upon thousands of dues paying union
members.

There's no need to dream. If you got rid of the private plans (except for
supplemental insurance) there would be no reason at all for the government to
maintain 3 different plans (federal workers, medicare, veterans). But
even if it did you would still be rid of 99% of the plans and bureaucrats
maintaining them.

Let me see, you call yours "real" and "shitty" at the same time, while
deriding my type of insurance as fake, yet we as moderately heavy users of
that insurance have been quite pleased with the service and support we
have gotten.

Just as Canadians are generally pleased with the support they have gotten,
while paying about 1/4 to 1/3 of what you pay. If I was given the choice
to pay about $2500USD for the Canadian plan or $8000 for your individual
plan (which is not even available in most US states) I would pick the
$2500 Canadian plan and so would most Americans.

I didn't say that we had better outcomes, rather, I only suggest that when
bad outcomes occur as they do both here and over there, that the average
payout is much lower over there than it is here.

Partly because of trial lawyers. Why don't you make up your mind whether
you think high medical payouts are good or bad. First you say its a bad
thing and then totally reverse yourself and say high payouts are a good
thing.

I've never made any such assumption. A combination of health choices
makes it impossible that our outcomes would be better than other
industrial countries. We eat more, we smoke more, we shoot each other
more often,

Plus we let our fellow Americans die early because they don't have health
insurance. In fact American citizens were 60 times more likely to die in the
last ten years from lack of health insurance (183,000+ deaths) than from
terrorism (3000 deaths). So how come we spent $800 billion fighting
terrorism when Americans were 60 times more likely to die from losing their
health insurance than from terrorism, and a small fraction of the $800 billion
could have easily saved 183,000+ American lives?

If you think the government won't hire all those bureaucrats at the point
of a change over, you are again dreaming large.

Why the hell would government hire all of the private sector bureaucrats
layed off when it already has 3 times as many public bureaucrats that would be
needed in a single payer system. The whole idea is laughable. All of the
bureaucratic parasites in private health insurance companies would finally
have the chance to do something productive with their lives and the money
that is currently thrown down the drain would be steered towards more
productive areas of the economy.

 

[tr2267]

I'm not the one who just posted a racist poem to the whole world. Now that
you've openly exposed yourself as a racist there's not much more that needs to
be said.

 

[rwwff]

Is that $8000 per person? Would you care to say which chronic conditions?

8k for the family. 2+1 kid. I think describing medical conditions is a
bit to personal though... They aren't of the "self-diagnosed" variety
that sends insurers through the roof though. Simple blood tests prove
the conditions, and well defined drugs are used to manage them.

group insurance is much better than individual insurance. But you yourself
said that you are paying twice as much for individual insurance as what you
would pay for group insurance, and plus you're screwed out of the tax subsidies
that pay for group insurance. Meanwhile a Canadian could purchase a very
nice supplemental insurance policy for a lot less than $8000USD.

But that Canadian's income tax would be much higher. Net the two
together, and I'm not convinced the cost would be all that much better.

Not that I'm particularly against the Canadian system, if we let Canada
run it. Get US workers, lawyers, and legislators in on the deal and we'll
be screwed worse than I think you can even imagine.

You have a very low opinion of American workers compared with Canada, Europe,
Australia, etc. Here is the real difference: Most of our health care
bureaucrats are _private_ sector instead of public sector, so it should
be no surprise at all that our private sector bureaucrats are not
"altruistically minded". If we desire to have "altruistically minded"
bureaucrats than having them come from the private sector is obviously
the worst possible mistake.

I do indeed have a very low opinion of American paper pushers, and the
unions that make them powerful.

There's no need to dream. If you got rid of the private plans (except for
supplemental insurance) there would be no reason at all for the government to
maintain 3 different plans (federal workers, medicare, veterans). But
even if it did you would still be rid of 99% of the plans and bureaucrats
maintaining them.

Maintain three?? You are absolutely out of it. They'll find a
way to maintain every last one of them, and then add some so they can hire
even more bureaucrats and feed even more lawyers.

Just as Canadians are generally pleased with the support they have gotten,
while paying about 1/4 to 1/3 of what you pay. If I was given the choice
to pay about $2500USD for the Canadian plan or $8000 for your individual
plan (which is not even available in most US states) I would pick the
$2500 Canadian plan and so would most Americans.

You're telling me that in most states a family of three can't get by a
high quality PPO plan with reasonable out of network benefits. Texas
ain't small, and it is definately available.

Partly because of trial lawyers. Why don't you make up your mind whether
you think high medical payouts are good or bad. First you say its a bad
thing and then totally reverse yourself and say high payouts are a good
thing.

I never have said "high payouts to lawyers" is a good thing. It is
intrinsically bad.

Plus we let our fellow Americans die early because they don't have health
insurance. In fact American citizens were 60 times more likely to die in the
last ten years from lack of health insurance (183,000+ deaths) than from
terrorism (3000 deaths). So how come we spent $800 billion fighting
terrorism when Americans were 60 times more likely to die from losing their
health insurance than from terrorism, and a small fraction of the $800 billion
could have easily saved 183,000+ American lives?

Sorry, but one of the few things the federal government is designed to do
is raise armies, build ships, and go blow up those who annoy us. The
constitution specifically authorizes that function for the feds; it
doesn't specifically authorize health insurance to the feds. So blowing
stuff up takes a higher precedence than national health insurance.

You want it to be different, pass a constitutional amendment. Or go down
in flames finding out that Americans currently don't support that
objective in high enough numbers.

Why the hell would government hire all of the private sector bureaucrats
layed off when it already has 3 times as many public bureaucrats that would be
needed in a single payer system. The whole idea is laughable.

It would be laughable if it weren't true. They'll hire them so they
won't be unemployed. The unions representing them will demand it. Those
few democrats who buck the unions will be stripped of funds, pilloried,
and replaced at the next election.

 

[Vic Vega]

What's racist about it? its writen in the language of Fifty Cent and other
black icons.

 

[The Wogster]

What's racist about it? its writen in the language of Fifty Cent and other
black icons.

I'm tired of this thread, other then possibly neworleans.general it's
totally off topic for every list it's on.

W

 

[Tim May]

What's racist about it? its writen in the language of Fifty Cent and other
black icons.

His name is "Fitty Cent," and his kind call themselves "niggaz," not
"blacks."

It is time to exterminate the negroes who will not voluntarily return
to their Dark Continent.


--Tim May

 

[Geno Rasta]

It is time to exterminate the negroes who will not voluntarily return
to their Dark Continent.

Indigenous Americans said the same about whites and their
White Continent.

GR
--

 

[bigjim]

The injuns had no concept of land ownership and were underutilizing the
North American continent

 

[tr2267]

But that Canadian's income tax would be much higher.

Their tax includes paying for health insurance and they are paying a
lot less than you when you add your $8000/yr American health insurance cost
to your taxes. Plus, they have the peace of mind of knowing they will
never lose their insurance no matter what happens. It is very common
for Americans to lose their insurance at the very time whenever they need
it most, such as being diagnosed with cancer. [1]

Net the two
together, and I'm not convinced the cost would be all that much better.

You're paying about 30% of your money on useless bureaucrats, Canadians are
only paying about 10% of their money on bureaucrats.

Not that I'm particularly against the Canadian system, if we let Canada
run it. Get US workers, lawyers, and legislators in on the deal and we'll
be screwed worse than I think you can even imagine.

You're saying that Canadian legislators and workers are good and American
legislators and workers are bad. The main difference in bad US and good
Canadian legislators is that their conservatives are more liberal than our
liberals. The main difference in US and Canadian workers are that ours are
more ethnically diverse. You seem to think that is a bad thing while
the Heritage Institute political propoganda paints that as a good thing.
In reality having a multi-ethnic work force (if they are legal US citizens), is
neither bad nor good. If Americans can put a man on the moon and invade a
country on the other side of the world why can't Americans accomplish a simple
thing that Canada and every other industrialized country has? Obviously we
can accomplish it.

I do indeed have a very low opinion of American paper pushers, and the
unions that make them powerful.

In that case you'll want to get rid of useless bureaucrats just like
I do and the Canadian health care system automatically cuts bureaucratic
costs from 30 percent to 10 percent.

Maintain three?? You are absolutely out of it. They'll find a
way to maintain every last one of them, and then add some so they can hire
even more bureaucrats and feed even more lawyers.

"Every last one of them" government plans amounts to THREE different plans.
The hordes of bureaucrats come from the dozens of PRIVATE health insurance
plans. Why the hell would the government hire all the hords of people now
working for private health insurance companies?? YOU are absolutely out
of it because their is not the slightest chance whatsover of that happening.

You're telling me that in most states a family of three can't get by a
high quality PPO plan with reasonable out of network benefits. Texas
ain't small, and it is definately available.

In Texas like most US states private health insurance is only slightly
better than useless. Because if you develop a significant chronic condition
within 6 months or so your insurance will be either canceled outright or
the rates will be jacked up so high you'll never be able to afford it.
Your state happens to be one of the few that tries to protect people from
this, but it is NOT the norm. Texas is so fucked up that one out of every
four people don't have health insurance.

Sorry, but one of the few things the federal government is designed to do
is raise armies, build ships, and go blow up those who annoy us. The
constitution specifically authorizes that function for the feds; it
doesn't specifically authorize health insurance to the feds. So blowing
stuff up takes a higher precedence than national health insurance.

Bullshit. "Providing for the common DEFENSE" does not equal "blow up those
who annoy us". Iraq didn't do anying to America (except try to assasinate
Bush's father which triggered the attack). The attack on Iraq was obviously
OFFENSIVE rather than defensive which is NOT specifically authorized by
the Consitution. Of course only an idiot thinks that the Constitution has
to specifically authorize something. On the other hand "promoting the general
welfare" obviously authorizes the government to do something it is far more
efficient at (http://www.oecd.org/statistics/) than the private sector and
provide health insurance like every other industrialized country, thereby
protecting our citizens from a danger 60-1 more likely to kill Americans
than terrorism is.

You want it to be different, pass a constitutional amendment. Or go down
in flames finding out that Americans currently don't support that
objective in high enough numbers.


It would be laughable if it weren't true. They'll hire them so they
won't be unemployed.

The GOP has already proven that they doesn't care the slighest bit about
the unemployed. Your theory that the federal government would hire all
these private sector workers is damn idiotic.

The unions representing them will demand it.

Who the hell cares? The union is going to go on strike in order to save
their company? LOL!!!! First of all few of these people (or any workers)
belong to unions and second when a corporation goes away a union does too.


------------------------------------------------------------------------
[1] The New York Times <http://www.nytimes.com/>
December 17, 2005

Being a Patient
Sick and Vulnerable, Workers Fear for Health and Their Jobs

By LISA BELKIN

When Marty Domitrovich was first told that he had cancer
he was a 51-year-old sales executive, so successful that he had two
goals: to reach $1 million in commissions and bonuses and to become
chief executive of his company, where he had worked since his summers in
college.

Before long, however, he could no longer travel, and on the bad days he
did his work at home, lying on the couch and talking on the telephone.

When Shannon Abert was first told she had scleroderma, she was 35, and
loved her job teaching high school algebra. Until her illness was
diagnosed, she was healthy and active, never taking a sick day from
work, not even bothering to find a doctor who accepted her school
district's insurance plan. Her disease progressed quickly, though, and
soon she could not write on the blackboard, pull students' files or turn
the classroom doorknob.

Work takes on many meanings when illness strikes: a cause of added
stress; a place to escape from that stress; a source of income,
insurance, identity and normalcy; and a fear of losing all those and more.

Both Mr. Domitrovich, now 58, and Ms. Abert, now 38, wanted to keep
working after their conditions were diagnosed, and both asked their
employers for help. One was told, "We'll give you whatever you need."
The other recalls facing much more ambivalence, with one administrator
telling her, "We all have problems, just do the job."

In this way, their stories reflect the realities of being ill in today's
workplace, at a time when sick workers have more legal safeguards than
ever before, and yet also face gaps, inconsistencies and question marks
in those laws. Yes, how an employee is treated after crossing the stark
line from worker to patient is broadly defined by legislation. But it is
more specifically determined by things like the culture of a workplace
and the sensitivity of a boss.

"We've come a million miles from the bad old days," said Robin Bond, who
runs an employment law firm in Wayne, Pa., and represents individuals
with claims against employers. "But no law changes the basic fact that
employers want to do what's good for business. Their job is not
necessarily to do what is good for you."

At a time when a worker is most physically and emotionally vulnerable,
the person must also adroitly navigate to protect himself or herself.

"I didn't want to worry about work, but work was all I worried about,"
Ms. Abert said of the months after her illness was diagnosed in 2003. "I
had to keep my insurance. I had to pay my rent.

"When you're sick," she said, "trying to get out of bed every day,
that's the worst time to have to worry about your job, but you have no
choice."

*Double Jeopardy: Health and Job*

Whether an employee enters a job with a diagnosed disability or becomes
impaired after being hired, the worker faces the decision of whether and
when to tell the employer. It is a choice loaded with emotion, and also
with ramifications under the law.

"The diagnosis is a crisis in itself," said Carolyn Messner, an oncology
social worker and director of education and training for cancer care in
Manhattan. "The next crisis is telling people."

Mr. Domitrovich announced his devastating news almost immediately after
he received it on Jan. 1, 2000. As vice president of sales and a
regional manager for Cutco/Vector, which sells and manufactures cutlery,
he was based in Chicago but traveled constantly.

When he began experiencing gastrointestinal symptoms in 1999, it was
impossible to keep his team from noticing that something was wrong. He
said he did try not to let word spread beyond that small group, however,
because "as a leader you don't want to show too many of your weaknesses."

Soon the symptoms became more severe, and tests found an neuroendocrine
islet cell tumor in the pancreas. The cancer had already spread to his liver.

Mr. Domitrovich told his wife and grown children first; then, within
days, he informed the chief executive of the company and his close
staff. The company's yearly banquet for the regional sales team was held
two weeks later, and he shared the news in a brief speech to the 700
people who attended.

Ms. Abert, in contrast, kept her misery to herself. Her first symptoms
appeared in the fall of 2002, when her fingers began turning purple, as
if she had frostbite, but she knew that was unlikely in Clear Lake,
Tex., near Houston.

An internist theorized that she had developed carpal tunnel syndrome
from writing math equations on the board, and gave her wrist splints,
which only made the problem worse. The pain spread to her legs and toes,
but she did not tell her principal because she did not want to be seen
as a weak link. It was stress, she reassured herself. It would go away.

It did not, and eventually, in January 2003, at the end of her school's
winter vacation, a rheumatologist confirmed that Ms. Abert had
scleroderma, a chronic connective tissue disease in which the body
attacks itself, leading most noticeably to hardening of the skin. Now it
was not pride, but fear and a need for privacy, that kept her quiet.

On the one hand, she was still absorbing all that was happening to her
and she was not ready to share that exquisitely personal process with
the world. At the same time, she did not know whether her job was in
jeopardy and she was too afraid of the answer to ask the question.
Besides, if her supervisors and colleagues knew, she was certain her
students would find out as well, meaning she would lose the authority a
teacher must have to command a classroom.

"I can't look at them and say, 'Y'all, I'm not feeling well,' " Ms.
Abert said. "They will wreak havoc."

This instinct for privacy is common, said dozens of employees,
employers, lawyers, health care providers and patient advocates
interviewed for this article.

"I don't want to be labeled as the sick person, where all people see is
the disease," says Tecela Harris, 38, who told only a version of the
truth at a job interview for State Farm Insurance more than a decade
ago, not mentioning that she had rheumatoid arthritis
which made her joints swell horribly and caused constant pain.

"They told me the job was for claims adjuster and it included climbing
up on roofs," Ms. Harris recalled. "When they asked, 'Are you going to
be able to do that?' I said I could do it."

The result was years of agony until, needing to take 70 days off to
recuperate from foot surgery to correct damage from the disease, she
finally revealed her illness to her boss in 2000.

"I was almost in tears," during that conversation, said Ms. Harris, who
is now on a recently approved medication that leaves her free of pain.
"My illness was not something I was proud of, so I didn't really want to
share that."

And yet, while patients might prefer to keep silent, the law favors
disclosure.

Two pillars of legislation have come to define the rights of ill workers
in recent years: the Americans With Disabilities Act, passed in 1990,
requiring employers to make "reasonable" accommodations for disabled or
seriously ill workers, as long as they can perform the "essential"
functions of the job; and the Family and Medical Leave Act, passed in
1993, allowing workers to take up to three months off from work without
losing their health insurance or job.

Under each, employers are only obligated to help employees whose
conditions are known to them. A worker who regularly misses work for
chemotherapy treatments, but does not explain why, can be dismissed for
absenteeism and cannot then appeal on grounds of disability.

That creates a dilemma that is equal parts emotional and tactical.

"I advise workers not to tell their employer, unless they want to ask
for accommodation because of a disability," said Sharona Hoffman, a
professor at Case Western Reserve University School of Law and an expert
on the legislation. "If you want to invoke the protection of the law,
then you have to tell."

*A Plan to Stay Alive*

Mr. Domitrovich armed himself for his early conversations with a
business plan. He would never tackle a new business challenge without a
plan, he said, and this was a new business challenge. Among his goals
were to "stay alive long enough to find a cure" and to "see
granddaughter go to grade school."

He told his bosses that he was certain he could keep working through his
treatment, meeting sales projections. "I believe my team can produce,
even though I'm not there every day," he remembers saying.

Sales positions at Cutco/Vector are paid solely on the basis of
commissions and incentive bonuses, so his own income along with that of
his staff was on the line.

For six months, Mr. Domitrovich was able to work with little trouble.
The medication he was taking had few side effects and succeeded in
restricting the growth of his tumor.

But eventually the mass began to press on his biliary duct, requiring
surgery to insert a stent to relieve the pressure. Then the cancer began
growing faster. He entered a clinical trial, which slowed the growth,
but by then years of toxic medication had damaged his gallbladder, which
had to be removed.

Through all this, he did meet his sales goals. His team's revenues
increased 25 percent in 2001 and another 38 percent in 2002, which is
the year he reached his $1 million income goal. (He also saw his
granddaughter start kindergarten last year.)

But the toll of work and treatment was heavy, and he decided that he
could not keep up the pace.

Before Mr. Domitrovich could tell his bosses of that decision, though,
they made one of their own. They announced a restructuring, increasing
four sales regions to six, and effectively eliminating his job. They
suggested another role that he might play: running the Fair and Show
program, which coordinated cutlery sales at places like local fairs and
conventions. It was an important part of the business, but it would
require travel, which he knew he could not do.

When his disease was first diagnosed, Mr. Domitrovich joined a support
group of cancer patients, and over the months, he said, he heard "the
horror stories." The man with cancer of the jaw who had to take out a
second and third mortgage on his home when he lost his job after his
family medical leave time ran out. The man with stomach cancer who was
told that his company would "stand behind you 100 percent," then let him
go within six months.

So Mr. Domitrovich did not turn down the new job right away. Instead he
asked for some time to think about what work he would like to do next.

*'I Am So Sick, I Can't Make It'*

Scleroderma patients have a particularly hard time getting out of bed in
the morning, possibly because muscles stiffen and weaken overnight. Ms.
Abert lived alone in the months after she became ill, and she had no one
to help her with morning buttons and zippers. Each night she would take
a sedative so she could sleep in spite of the pain, and even though she
went to bed at 8 p.m., she was often late for the start of class at 7:30
a.m.

Her students noticed, she said, just as they noticed the ulcers
<http://topics.nytimes.com/top/news/...pics/ulcers/index.html?inline=nyt-classifier>
on her fingers and the steady weakening of her hands. She could not get
the caps off the markers for the dry erase board. Even screwing the top
off a bottle of water meant asking a student for help.

But still Ms. Abert maintained the facade of health, until the fall of
2003, when the weather turned colder and she finally hit bottom.

It was the time of year when the forms arrived for her to choose her
benefit options for the next 12 months. She read carefully, but when she
found nothing about long-term disability, she assumed she did not have
that option.

A search of the Internet found information about the Family Medical
Leave Act, including the fact that the three months of leave were
unpaid, and then neither her job nor her health insurance were protected.

She could not imagine how she would cope under those circumstances.
Still, she thought, maybe a few months off would help her regain some
energy. So she dragged herself to the human resources department, where
she recalls telling a counselor, "I don't think I can do this anymore. I
am so sick, I can't make it day to day."

His initial answer, she says, was: "You don't look sick. We're all
tired. Hang in there."

"He kept saying 'It has to be measurable, you need documentation, it has
to be something that can be measured,' " Ms. Abert said of Steven
Austin, the director of employment benefits and risk management for the
school district.

While Mr. Austin agreed that he probably did explain the need for
documentation ("You have to provide certification for medical leave," he
said in an interview), he said he did not believe that he said anything
harsher than that. He concedes, however, that others in the district may
well have said such things to Ms. Abert.

"There wasn't a lot of support for her" from her superiors, Mr. Austin
said, adding that he wondered whether her memory had put someone else's
words in his mouth.

*Most in Need, Most at Risk*

The Catch-22 of the American health care system is that while many
people work "for the insurance," when they become too sick to work and
are most in need of that insurance, they are most at risk of losing it.

This is particularly true of workers at small companies, which are not
covered by existing law. (The Family and Medical Leave Act, for
instance, only applies to workplaces with 50 or more employees.)

One employee at such a company, who asked that her name not be used
because she feared retribution from her former boss, learned the
significance of this distinction the hard way when she had a brain tumor
removed five years ago. Her employer, she said, "told me that my tumor
came at a really bad time for the company."

The woman had recently received a significant raise, $20,000. Her
workplace was small - about a half-dozen employees - and a few months
after her illness was diagnosed, the group's insurance premiums jumped.
"My raise was rescinded, to cover the increase," she said.

Experts fear that as insurance rates increase, even companies large
enough to be constrained by law will make personnel decisions based on
the cost of health care. Those costs, which were stable during most of
the 1990's, have increased at double-digit rates for the past three
years, said Glenn Melnick, a professor of health economics at the
University of Southern California.

Dr. Melnick thinks it is not coincidence that this environment led
Wal-Mart, whose health costs increased 15 percent last year, to suggest
what a confidential internal memorandum to the board of directors called
"bold steps." If the company took action to "dissuade unhealthy people
from coming to work at Wal-Mart," the widely leaked memorandum said, the
potential savings would be $220 million to $670 million by 2011.

The proposed method of dissuasion, as explained in the memorandum, was
to define every job so that it included some form of physical activity
("e.g., all cashiers do some cart gathering"). Unfit people would be
less likely to apply and if they did apply, the company could legally
refuse them because they could not do the job as described.

There is similar "wiggle room" in laws requiring employers to provide
"reasonable accommodations" for employees, and here, too, experts are
concerned. "The key word when talking about accommodations is
'reasonable,' " said Ms. Bond, the employment lawyer. "And the employer
gets to define that word."

If employers remain overwhelmed by health care costs, they may see this
as an incentive to play hard ball, Ms. Bond and others fear, hoping that
employees with health problems will just give up and go away, taking
their expensive illnesses with them.

*Navigating the Obstacle Course*

Mr. Domitrovich suggested to his bosses that it was time that he left
sales, stopped traveling and became a mentor. The result was
"Cutco/Vector University," a management training program run by Mr.
Domitrovich. His salary is only a fraction of his former commissions,
but he maintains his insurance.

"We wanted to do whatever we could for Marty," said Bruce Goodman, chief
executive for Vector sales and president of Vector West. "Marty is the
conscience of our company."

Cutco/Vector might not be able to make similar arrangements for every
ill employee, Mr. Goodman said, "but in Marty's case there truly was
never any consideration of should we fire him, should we put him out to
pasture."

Ms. Abert, in turn, tried to stay at work. She became vocal about her
condition after her meeting with human resources, and she asked the
maintenance staff to change the doorknobs on the teachers lounge and on
her classroom so that she could open them more easily.

In the spring of last year, Ms. Abert's hands became seriously infected
and she was hospitalized for much of the spring. Since then, she has
been on long-term disability, which is a benefit available to every
district employee, even though it was not in her packet of paperwork.

She will receive 80 percent of her income until she is 65, but she will
not receive insurance indefinitely. Her district policy has already
lapsed, and she will pay $498 a month under COBRA until that too
expires, next September.

Her unexpected ally in navigating the system was the same human
resources counselor who seemed so brusque at their first meeting. "Once
he saw I was really sick, he did everything he could to help," she said
of Mr. Austin, to whom she now turns for advice.

Most recently, he told her not to return to teaching part time. If she
did, the pay would be less than what she now receives on disability,
though it would include insurance, making the equation temporarily worth
it. But, he said, were she to require disability again, she would only
be eligible for 80 percent of her part-time pay.

Ms. Abert has considered trying to return full time, but she cannot
figure out a way to fit her regimen of doctor's appointments into a
teaching schedule.

"I can't close the classroom door and say 'I will be back in an hour,' "
she said. "It's difficult being sick as a teacher. I guess it's
difficult being sick in any job."

 

[Vic Vega]

<snip>

So get your ass to Canada already.