Friday, May 23, 2008

Fighting Time

How difficult can it be to get quality health care in America? Nearly impossible. My good friend Bob describes the scene perfectly: If you make the system as difficult as possible to navigate, a certain percentage of the applicants will simply give up. Reporting from the front lines of this tragic mess, I can tell you that his perception is deadly correct, literally.

I want to share with you what I have learned from battle. First, you must have the proper tools. The most important item to own is a working fax machine with a dedicated telephone line. This is the year 2008. You might suppose that the health and legal industries would depend completely on the efficient and expedient exchange of information electronically. Think again!

I am completely convinced that paper companies underwrite these industries. Absolutely everything is based on paper records. Create a paper document of thirty pages. Print it out and fax it to your lawyer and then your health care firm. You have already eaten up 90 pages of paper. Of course, now you need to file the document into a space-devouring file cabinet. Maybe you also have to send the original to your lawyer and make a copy for your records. There goes another 30 pages of paper and another donation to the postal service of your choice. It is cumbersome, inefficient, wasteful and time-consuming.

Don’t try to fight this methodology. I tried and tried and it is simply a huge waste of time. These industries have never heard of Adobe Acrobat nor do they want to. I’m convinced few of these people have heard of a zipped file and even fewer know how to deal with them. Advancing law and health care just into the electronic second half of the 20th century would be a huge step forward alone. I find all of this infuriating for one very good reason. It wastes time.

Time can be extremely important. If you are old or very sick or both, your use of time can determine your fate. For instance, in the State of Florida, the average time between application and approval for Medicaid coverage is about eight months. Add to this a couple of months of preparation time and thousands of dollars in fees to firms who exist just to prepare your application forms and additional documentation for Medicaid’s review. You can literally die waiting.

Do the best you can but realize your limitations. The system is too complicated even for the professionals to completely understand. Nearly everyone depends on collaboration to do business. American healthcare is certainly not for the faint of heart. You are bound to make mistakes, but learn from them. I did. Try not to be discouraged by Monday morning halfbacks coaching you about every move you make. Don’t get involved emotionally. Follow your heart. Steady on!

Take fastidious records and keep a log book. I keep two kinds of records for each company or entity I deal with. Make collecting phone numbers and names an obsession. Every clue you uncover will be helpful now and in the future. When you are prepared with complete and detailed information about your case, you garner more attention and become a much more effective warrior. Knowledge and connections equal power. Also, keep a chronological record. Always know who you have talked to at what time and what they said. Quote their actions from your records. This simple tip will accelerate your progress. What you know will keep them on their toes. Carry basic information in a notebook to be carried with you at all times. You don’t want to be unprepared if a customer service representative finally calls you back on your cell phone!

Accurate filing of your information and documents is important too. Keep all your paperwork arranged in a system that works for you. Make sure you can access your files quickly. Write down when everything is received and transacted. You may consider using an inked stamp for dating your records. If you want to be quite complete, number your documents but devise a method that allows the inclusion of support documents to existing trails of paper.

You may need to compose additional documents to help you chart the history of companies that have evolved over time. This may require detailed research. I traced an unknown home equity loan to a contemporary firm in this manner. The classical case of this dilemma is the development and eventual consolidation of the old Bell System and AT&T. This exercise is required for your Master’s degree in estate management!

Another major source of anxiety is your ongoing battle with computer automated telephone receptionists especially ones with voice recognition. This problem would make great comedy material if it wasn’t so infuriating and time consuming. Consider the next paragraph as group therapy between myself and my readers. Here’s a typical scenario:

Allow 90 minutes for each call. Be ready to take notes and call up information on a moment’s notice. Begin by dialing the main customer service number of your vendor. Don’t expect to speak to a human being. Most healthcare firms now use computer generated receptionists using voice recognition technology. Your family will think you are possessed as you sit and say, in a staccato voice, No! Yes! Billing! Something else! If you are lucky, eventually a human being will appear and, hopefully, you’ll get some results. Your worst nightmare is the live person transferring your call back up to the top of the sequence and you have to start all over again.

Predetermine your choice of assisted living and nursing home facilities before you become infirm. Visit and observe their cleanliness and practice of hygiene. If possible, try to reserve accommodations at your place of choice now. Learn as much as you can about Medicare. Know what Part A and Part B are all about. When you become eligible for Medicare apply for prescription coverage immediately. There can be out-of-pocket penalties if you don’t! Also, learn about Medicaid and how it differs from Medicare coverage. Each state has an individual system for instituting Medicaid. Discover the requirements for eligibility and plan your finances to meet them.

It is so important to become fluent regarding your care and finances. Once placed in a nursing home, you may be extremely limited in your ability to move elsewhere, especially if your Medicaid coverage is pending. Arrange everything you can while you are still adept and cognizant.

One thing will probably always be true: Involvement with the healthcare industry will consume endless hours of time. Your efforts may often seem in vain. Every once in a while, take a mental health break for yourself. I’m sure you have more than earned it! Do the very best you can. You can run for months, at all costs, and still lose the race. If a place in Heaven is earned, this pursuit could very well be the price of admission.

Into The Woods

It’s Memorial Day. I can’t think of a better time, at the start of vacation season, to reminisce about summers past. As a child, summertime meant only one thing: going to North Adams, Massachusetts. Here’s what it was like…

I couldn’t sleep! Sitting on my aunt’s lap, I was finally on my way to North Adams. What had I gotten myself into? Here I was, in the front seat of a little green 1950 Chevy coupe, getting ready to greet the unknown. I heard my two older cousins talk about this place and I just had to see it for myself. It was a land of adventure and legend. What would it be like?

Nervous and apprehensive, I read every road sign aloud: ‘Speed Limit 40,’ ‘Do Not Pass,’ ‘Hoosac Tunnel – 15 miles.’ My aunt could not go to sleep. My uncle didn’t react to anything. He focused on getting the family up to the familiar cabin. Nothing was going to stop him. It was 1958 and superhighways were a futuristic dream. These were country roads, like Route 22, and progress was a lot slower than today’s zoom rides.

Starting at 93 Kellogg Street in Oyster Bay, on Long Island’s north shore, we began our journey at just about dusk knowing the ride would be about five hours long. We passed all sorts of exotic places: Purdys, Otis, Pittsfield and finally Adams, Williamstown and North Adams. North Adams was the big city, with bright lights, restaurants and motels and (wow) a Dairy Queen.

We toured the entire town following signs to Route 2 ‘The Mohawk Trail.’ According to legend, Route 2 was built along the precise path carved by the Mohawk Indians to travel east and west through the forests. ‘Look! There’s Pop’s Variety Store! There’s the Hairpin Turn! There’s Mount Whitlock!’ I didn’t have the slightest idea what this meant, but one thing was sure. We were close to where we were going. Little did I know the mystery trip had just begun!

We reached the top of the hill and then followed Route 2 east towards Greenfield. The road was desolate and dark. No lights, no signs, no markings. This was getting really interesting. Suddenly, my uncle veers off the main road onto a bumpy and wet unmarked path. I was the only passenger still awake. I looked up at the darkness and the tall trees passing by. Where, on earth, were we?

The muddy ruts and bumps made for punishing motoring. I held on tight. Their little Chevy was really made for four people, not five. With their black cocker spaniel mix dog, Sparky, squeezed in the back seat with my cousins, there was no room for me, so I rode my aunt’s knee the entire trip. The cold had forced us to close the little triangle vent windows a couple of hours before. The windows were a little foggy and the atmosphere was clammy.

Some clues were found indicating our path. A rustic wood sign said ‘Spruce Hill’ and then I saw signs for North Pond. Just as we passed North Pond we made a slow hard left turn and I saw a mailbox with ‘MOGUL’ painted on it. A couple of hundred feet more and the headlights hit a small brown cabin. We had made it! We were there!

The car doors opened and chilly air blew in. The forest was alive with crickets and peeper frogs and a million other sounds. The sky above was deep dark black loaded with more stars than I had ever seen. Holding a flashlight, my uncle jiggled the latch on the cabin and cracked the door open. My cousins knew to wait for awhile before the cabin aired out. After a few quick sweeps of a broom into a dustpan, my uncle built a quick fire in the wood stove. We got the cue: ‘OK. Come on in!’

The cabin was tiny and dark. There were two rooms. The back room had a bunk bed and two single beds. My cousins shared the bunk bed. My aunt and uncle used the single beds. Where was I sleeping? I had a cot that was folded out in the other room right by the wood stove. I didn’t realize it until morning, but I may have had the best seat in the house. Although I had no mattress, I was just an arm’s length from the crackling warm stove. The sound of the burning wood kept me company.

There was a sink but no running water. Electricity consisted of one bare light bulb mounted above the stove and one outlet. Telephones did not exist. The walls were fashioned out of dark brown large unfinished logs. Inside, it always smelled a little bit like burning wood. The scent was comforting and became familiar almost immediately.

Outside the cabin was truly amazing. The air was so clear and the sky was as blue as ocean water. I quickly learned the necessities of life. Water was procured from an old manual pump above a deep well across a short meadow. The bathroom was actually a wood framed outhouse. There was a toilet seat, a roll of toilet paper and a huge bucket of white lime with a metal cup. Instead of flushing a toilet, you sprinkled some of the white stuff over your business before you left.

Getting water was magical. Press down the lever two or three times and you would prime the pump. All the rusty brown crud, which had been sitting in the pipes forever, would spit out along with some air. Delicious and refreshing clear cold water followed. You could fill a metal bucket and bring it back to the cabin, hold a cup for a taste or dunk your head under it for afternoon refreshment on a hot day. What a great invention it was!

Our single modern appliance was a short white refrigerator. It had a large chrome locking handle that closed tight like a port seal on a large boat. Most of our food came from a small convenience store at the top of the dirt road just before you reached Route 2.

Our diet was quite basic: toast, eggs and cereal for breakfast; burgers and hot dogs for dinner. Corn on the cob was a treat. Once a week we would go out for dinner. We would pile into the car and head down into North Adams to our favorite restaurant: Howard Johnson’s. We’d slide into a booth with a wide Formica-topped table. I would always have the same thing: one “frankfort” and a glass of milk.

The best thing we ate was hand-picked. Savoy State Forest’s meadows were filled with endless amounts of blueberry bushes. We would bring as many wicker baskets as we could carry and pick berries for an hour or two. The tiny wild berries were tart, sweet and full of flavor unlike store-bought blueberries you are accustomed to today. The ones we didn’t eat from the palm of our hands went into pancakes and muffins that were not to be believed. The blueberry pancakes flipped on the skillet in our cabin were like no other. They weren’t the only treats we enjoyed!

If we had really behaved ourselves we would be treated to a visit to the Dairy Queen. Soft chocolate or vanilla ice cream in a cake cone created a delicious dessert. The menu item of legend was the enormous, chocolate-covered banana boat. I don’t think I ever had one, but I remember my cousin Bill had one once. Piled with ice cream and chocolate sauce all atop a banana slice, this was more dessert than we could ever imagine. It sure looked good on the posters taped to the store’s window!

A couple of summers later, my uncle traded in the green Chevy for a light blue Chevy station wagon. It had a fold-up seat in the back allowing kids to sit backwards. You could roll down the back window and feel the fresh air go by. My cousin Bill dreamed up a great invention. We had some left over kite string. We made little holes in some paper cups and tied the cups to the string. This creation would be tossed out the window as we held the end of the string. The cups would bop and bounce on the road behind the car and we would laugh our heads off.

The best moment came when we were driving through downtown North Adams. A policeman was directing traffic. As our station wagon passed him, the cups bounced over his shoes. The cop yelled “Hey you kids! Get those cups in the car!” We laughed until we cried. That moment became a legend for years to come.

Another source of wonderful fun could be found half way up the hill towards the cabin. A little shop, called Pop’s Variety Store, was the place we spent all the pocket change we could find. Our source of revenue was penny bottle deposits, money found here or there, or maybe a small allowance if we were lucky.

Two candies from Pop’s are remembered fondly. The store had dozens of round glass canisters filled with candy sticks with so many flavors it was hard to choose! Each and every one was distinctive and interesting. We would trade sample licks with anyone we could find. ‘You have to try this one!’ Another candy was the combination of heaven and butter. This area was known as maple country and beyond pedestrian delights, like pancake syrup, were little maple candies in the shape of toy men or stars or animals. Wrapped in little cellophane covered boxes, these treats were the most amazing things I had ever tasted.

A little farther up the hill was ‘The World Famous Hairpin Turn.’ It was a really tight 180 degree turn along Route 2 that had its own gift shop. In our eyes, the big attraction here was a big upright console music box. They had a couple of dozen disks, each with a different song, which played for about two minutes. The metal disks were about three feet across, with beautiful engraved decorations appropriate for its song, and little cut-outs that would control what notes would plink as it slowly turned round and round. Although it had the same timbre as a little music box, it had a great big sound. The lush harmonics it produced were charming and delightful. Built in the mid-1800s, it had been restored and maintained and ran for years and years.

At the very top of the hill was Whitcomb Summit, a scenic overlook for tourists and the site of an elk statue that made the location unique. The vista revealed the entire valley including a good look at Mount Greylock, the tallest mountain in Massachusetts.

Back we went to our cabin. There were two cabins actually. Both were owned and operated by Bob Mogul, a lifetime resident and a seasoned forest ranger. His place is still there, along with his signature mailbox, just past North Pond. Mr. Mogul’s property is right in the middle of Savoy State Forest located in Florida, Massachusetts. For decades, he served as one of many people who looked over this expansive undeveloped area.

One of the important duties of forest rangers was to keep constant watch for fires. Very tall towers topped by glass-enclosed huts would be manned by rangers watching out for disaster. This was often the point of first alert when a fire started. The fire towers were also the place where you could sneak a magnificent view of the mountains. Every fire tower had a long walk-up stairs. Even if a ranger was not there, you could climb nearly to the top and have a look. The views were absolutely amazing.

Sparky the dog had a nasty adventure at the fire tower one day. We were all on top of the tower stairs, looking around, and we saw Sparky take off after something in the woods. Suddenly, his barks turned into yelps. We quickly found him shaking his head like crazy. What had happened? Sparky had confronted a porcupine, who didn’t like being chased, and now had a nose and face filled with painful quills. We had to gently nurse out the quills and clean Sparky’s nose. It was a day we would never forget. What a mess!

Another great adventure was our occasional treks up to the summit of Spruce Hill. The trail began at an off-road pull-in. Many obvious signs would keep you on-track as you walked to the top. The trail was a delight. You would pass through many, many different types of woods and meadows featuring quite a variety of environments from swamps to swaying grass. Only at the very end of the path did the trail become steep. A few careful steps up some rocks would reveal, for the first time, a dramatic view all around for a hundred miles or more. You never had a clue as to how high up you really were until you reached the very end.

The hour-and-a-half walk was always worth it. We had some great picnics on top of Spruce Hill and Sparky was always around to enjoy the leftovers. The way back only took half that long. Going down hill, we would run half the way, falling a couple of times, down to the bottom. We would wait for the adults by the car. A quick dip into North Pond would cool us off for the rest of the afternoon.

There are actually three ponds in Savoy State Forest: North Pond, South Pond and Bog Pond. Bog Pond was the biggest and most rustic. The over-run from the pond went over a beaver dam and down into a little stream. Often, the pond was the residence of a large community of beaver. The signs of their presence were easy to see. Young trees would be gnawed free leaving little stubs that looked like oversized pencil points sticking out of the ground. The beavers were exceptional architects creating elaborate lodge homes and dams.

Often, my cousin Bill and uncle would bring Bill’s seven-foot dinghy up to the cabin and we would launch it into Bog Pond. No engines were allowed in the clear water, but you could row all you wanted. We discovered a nifty trick entirely by chance. After casting out the dingy, we smacked an oar against the water with unexpected results. The beavers misunderstood the sound as their signal of distress and the entire group ran off for cover!

If our summers in North Adams could be remembered for one thing, it would be rain. We often thought one of our neighbors might be named Noah. It would rain and rain and rain. Often, we simply didn’t care. We would walk down to North Pond, dodge the millions of red and green salamanders all over the roads and grass and hop in the water anyway. We were only bound by two rules: You didn’t swim when you had just eaten and you didn’t swim when it started to thunder.

How it could thunder! One storm was particularly legendary. A thunderstorm brewed late one evening after dusk. It was completely dark and it must have been 11 or 12 at night. The thunderclaps were strong and loud and we cowered in our beds as if we were being tossed in a little boat at sea. Suddenly, with a huge bang and flash, we suffered a direct hit to the power lines. The single light bulb above the stove flashed like a camera and our radio stopped playing and smelled atrocious.

When the morning finally broke, and the storm had passed, we assessed the damage. Light bulb pieces, now just little shards of black glass, were all over the floor. The radio was literally toasted. When we finally went home, my Dad removed and replaced all the blasted parts and the radio came back to life. If you saw what the radio looked like right after the lightning strike, you would understand what a miracle this was!

Radio was often our only link to the real world. There was only one local radio station: WMNB 1230 AM from North Adams. WMNB only broadcast during daylight hours. We only listened to the radio when it got dark around 10 or 11 at night. After dark, the world would drift into our AM radio. It was never the same twice!

The one station I remember listening to in the cabin was WWVA in Wheeling, West Virginia. They would always come in so strongly at night. Back in 1958, WWVA played bluegrass music all night long. We would listen to crooners sing lyrical stories about every facet of the lives of coalminers and mountain life. Nearly every song included amazing harmonies and great picking.

The main advertisers on WWVA were record companies hawking complex sets of recordings by mail. You would never hear them sell just one record. “Buy the two record set and get a third record free… and if you order now, we’ll also send you…” The music fit the location where it was being heard. We were also in the mountains, just very far away!

My most important possession was my little transistor radio. AM was the only band back then. This two transistor miracle had a little whip antenna about 6 inches long. I could just barely hear the station in North Adams. At night, it produced a weird hodge-podge of noise. My Dad cured this problem by giving me a long hank of wire, maybe 30 feet or so, which I strung up around the windows. When I attached the wire to the little whip antenna, a zillion stations came in at night. It was amazing. It was fun.

About forty years later, I visited Savoy State Forest again. This time, I brought my wife and my two daughters. Many sites were still there: Pop’s Variety Store, Hairpin Turn, Whitcomb Summit, Spruce Hill, North Pond and the Mogul’s place. I couldn’t see into the woods to see if the cabin survived. So much of it looked exactly the same.

The summers I spent in North Adams, 1958 to 1965, gave me a grand appreciation of nature and very simple living. It balanced my life at home in a small apartment in Queens. Life in the woods was so uncomplicated without all the encumbrances of city life and the responsibilities of school. Years later, I would move to the country forever. It all began in a small cabin far into the woods…

Thursday, May 22, 2008


A spectacular show has been playing in our backyard for the past two evenings. A recurrent rain shower system has been sprinkling our lawn nearly continuously. A spray of moisture hangs in the air ready for action. Just when the sun is low on the horizon displaying 'magic light,' bold and beautiful double rainbows have appeared with deep colors and full arcs across the sky. What an amazing sight to see!

Monday, May 5, 2008

Grazing in the Grass with Robin

Good conversations with different species are a hard 'get.' Recently, after endless negotiations, I was granted an interview with possibly the most famous bird around. The robin could be most recognizable flyer known to man. Spring wouldn't be the same without them! It was only a few fleeting moments, but interesting nonetheless. How those minutes flew by!

K: You don't talk to humans very much. What should we know about robins? What do you want us to be aware of?

R: We keep it simple. When we need to eat, we hunt worms, grubs and caterpillars. Fruit and berries are our dessert. We build nests. When it gets too cold, we fly south.

K: Robins always seem to be looking for worms. You stop. You listen. You move again. You pounce and dig. Don’t you ever get tired?

R: Look, we need to feed ourselves and we need to feed our chicks. We hunt with our eyes a lot more than our ears. Rainy days are a luxury because those squiggly guys come out in droves. It’s very much like free food for humans. By the way, we don’t ‘bob’ whatever the heck that means. We’ve all heard that song. We’re just doing our jobs, OK? Lay off the ‘bob, bob, bobbing along’ nonsense already!

K: While we are on stereotypes, how do you react to ‘robin red breast?’

R: This is another thing we don’t understand. First of all, our front plumage is orange, not red. Secondly, I don’t see you giving cardinals a hard time. They are red and they have those silly little crests, as well. What really annoys us is the Latin scientific identifier you handed us! Turdus migratorius? I just don’t think that’s very polite at all!

K: I’m truly sorry. I didn’t come up with it. Robins have good connotations, as well, you know. You are the state bird of Michigan, Wisconsin and Connecticut. There’s a great standard pop tune called ‘Rockin Robin.’ Robin Hood was a working class hero. And, of course, there was Batman and Robin. If you know Winnie the Pooh, you’ve heard of Christopher Robin.

R: OK. OK. I forgive you.

K: Besides hunting for food, what do you do with the rest of your day?

R: We stay out of trouble. We are not big and we look like dinner to a lot of creatures. Raptors, raccoons, fox, cats and you humans moving around in those metal boxes you get into. Do you know what it is like to fly around and suddenly have one of those things coming at you? Most of the time we get out of the way, but when we get hit, man, it hurts!

The other thing that takes a lot of effort is parenthood. First, we have to gather all the sticks and leaves and mud and build a nest. Your mate has to lay maybe even six blue eggs and incubate them for 14 days. You try sitting still for two weeks! Then, we have to feed them constantly. At the end of the month, you kick them out of the nest and start all over again. Sometimes we produce three broods in one season. It may not sound like much, but you are trying to survive all day, every day!

K: How do you tell each other apart? You all look pretty much the same to us.

R: Here you go again. You should know how we think about humans. You’re big and you thump around. Loudly. It’s really distracting. You keep chopping down trees and building your nests. You can really make a mess! You look a lot alike to us, too.

K: But you didn’t answer the question…

R: The secret’s out. We look at the plumage around the eyes and head and along the wings. Everybody’s is quite distinctive. And we look at weight, too. You can tell who’s been busy and who hasn’t!

K: If you had one message to send to the human race, what would it be?

R: Take it easy with all the stuff you like to spread over grass. It makes our worms and grubs really bitter and makes us sick. Plant more trees and let things grow out. We need to have safe places to stay. If you need to destroy our world, at least put out seed and water for us. It’s the least you can do. Just take it easy, will you? Thanks for asking.

K: And thanks for the interview!