Some thoughts on numbers

Night before last I went to church, at the Cathedral in Chavez Ravine. Sadly the Dodgers lost.

But that wasn't what I wanted to talk about. As I was eating my Dodger dog, and drinking my Gordon Biersch hefeweizen (which has bannana notes, but there ya' go) I was looking around the stadium.

No, I was thinking of issues of scale.

The official count for the game was 52,000 people, in real terms, it was probably more like 50,000 (season tickets count, so if no one shows up, there will still be a paid attendence in the thousands).

We tend to forget that 50,000 is a lot of people.

There were lots of battles, battles which shaped the course of events (Hasting, Agincourt, Poiters, Pharsalus, Yorktown) had no more than that.

Compared to the massive battles of the US Civil War, World Wars 1, and 2, we tend to lose track of that, to see Armies as masses of faceless figures in khaki. Those who pump the war try to ignore the humanity of the soldiers; to convert them into icons.

Lots of those opposed to the war do the same thing, it's just that the ends are differnt, so the stereotypes are mirrored (the one side sees dupes; poor; or patriotic, slaves to duty, the other sees warriors lusting for glory and certain of victory. The truth is they are people, as varied as the fans at a baseball game. Some came to cheer the Dodgers, some to root for the Mets.

There are 130,000 soldiers in Iraq. 130,000 separate stories, and it's still less than three times the number of people sitting in that small space which is Dodger stadium.

They are responsible for occupying, and pacifying, an area the size of California, with a population of 30 millions.

A little bit on what we pay for.

In my guest stint at Majikthise, I spent my time on healthcare.

Because it seems to me we get a whole lot less than we pay for, and for what we pay, a whole lot of gaps are created.

Grisham's novel, "The Rainmaker" is about a crooked healthcare company. The problem, it seems, isn't really one of kind, but degree.

Take a look at this, from CNN.

(BEGIN VIDEOTAPE)

COHEN (voice-over): Karin Perry and her son Andrew have faced so much together. Andrew was born with a severe birth defect. He's had 21 surgeries. But Perry says she's now facing one of her biggest challenges yet. 13-year-old Andrew was born without adult teeth buds. He'll soon have no teeth in his lower jaw.

When Andrew loses that bottom row of teeth, how is he going to eat?

KARIN PERRY, PARENT: I'm not sure. I'm really not sure.

COHEN: Perry's a kindergarten teacher and doesn't have the $60,000 for teeth for her son. But wait. Perry has health insurance. Won't that pay for it? She says they told her no, that it's a dental expense. Her dental insurance has a $500 cap.

PERRY: It makes me want to scream. Why can't you just see that this is medically necessary?

COHEN: Karin Perry isn't alone, far from it. One out of four Americans says they've had what they consider a legitimate health insurance claim denied, according to PNC Financial Services Group. The insurance industry says that survey is wrong and that only a tiny percentage of claims are denied.

MOHIT GHOSE, AMERICA'S HEALTH INSURANCE PLANS: This industry pays billions of dollars in healthcare services, routinely covers millions of claims every month, and makes sure that people are getting the care they need.

COHEN: Perry says insurance has paid for a lot.

PERRY: All of his surgeries have been covered by insurance. For that, I'm very grateful because we're looking at, you know, probably a $1 million kid at this point.

COHEN: But she says she had to pay $10,000 for medical expenses insurance wouldn't pay for. Her friends held a fundraiser.

PERRY: I'm a school teacher, and I'm a single mom. And so $10,000 is a lot of money for me. It's a real lot of money for me.

COHEN: Mohit Ghose, who represents an insurance industry trade group, says people like Perry should appeal insurance decisions if they think they're wrong.

GHOSE: It's important to note that consumers do have options.

COHEN: Perry says she did appeal once and failed. And she's never tried again.

PERRY: I'm probably the exact kind of person they're hoping comes into the insurance appeals process, because it's exhausting. And it's time consuming. That's what they count on. They want you to give up.

COHEN: Ghose says that's not true. And they try to make the process as easy as possible. Perry says she's thankful for the insurance she has, but she wishes it were easier.

(END VIDEOTAPE)

COHEN: Now we called Ms. Perry's insurance company, HMO Blue, for comment. And they immediately called Ms. Perry to say they would pay for Andrew's new teeth. Their spokesman told me, "Typically, we don't cover dental implants. But if there's a unique clinical circumstance, that's considered in making medical coverage decisions..."

Now Karin Perry's situation ended well because of our story, but what about other people? What do they do when they get denied? A group called the Patient Advocate Foundation helps people with insurance problems. And they've agreed to specially staff their phones this morning just for our viewers. The founder and CEO of this foundation is Nancy Davenport-Ennis. And she's here with us this morning. Welcome, Nancy.

So they go into a couple of claims.

COHEN: The first one is from Debbie in Virginia, who writes, "My son was born at 32 weeks and went straight into the NICU. The hospital was in network, but none of the doctors in the NICU were. Our insurance refuses to pay the doctor's bills, and he would have died without immediate care. What can we do? We have medical bills of $150,000."

Nancy, what do you recommend for this family?

DAVENPORT-ENNIS: Elizabeth, the first thing that I would say to the family is please understand that what is happening to you may the first time for you, but many other consumers have faced a very similar denial.

I think it's very important for them to understand that, when you have a child that is born and needs to go into a neonatal intensive care unit, that the child was actually delivered in an in network hospital that was part of their health plan and an approved provider. When the child needed to be moved into the intensive care unit and required physicians with specialty care backgrounds, certainly, the parents assumed that those were approved providers.

When finding out that they were not, we advise that she immediately let the insurance company know she will be filing an appeal, and go to the hospital and collaborate with the hospital in this appeal. Because ultimately, the parents were not asked to make a decision of who was going to provide care to this child. The decision was made by the hospital.

COHEN: Nancy, do you think this family can work this out?

DAVENPORT-ENNIS: I do. And I think this is happening more and more in the United States. And what we find is that you have to engage the hospital in getting the resolution. And you may have to actually engage a caseworker from the hospital or caseworker from the health plan.

COHEN: Now we should point out this claim sounds legitimate. But to be fair, some claims aren't legitimate. Some things just aren't a part of your healthcare coverage.

DAVENPORT-ENNIS: Indeed, that is true. And so, one of the things that any parent has to do, if they're looking at a denial of a benefit for a child, is to look at the language of your health plan and see indeed what it provides for. In the case of this child, the child was born in an in-network hospital. And certainly the benefits that that child needed, needed to accrue to the child. That family was not aware that the doctors providing the care were not in-network providers. And that information had not been provided to them.

COHEN: Nancy, that's good guidance for this family.

How much is it worth to 1: not have to deal with this crap, and 2: see to it that everyone is covered?

Because there's an awful lot of money tied up in this. How many man-hours? How much paperwork? How many people required to chase down the right billing codes, examine the policies, pore over the medical records? And for what?

To deny people the coverage the paid for. We are paying for the profits. Spend a little less (each) and about the same, total, and no one goes without what they need.

Karin Perry hit it on the head. How many people have the means, time, and willpower, to fight this sort of thng to a win?

Is anyone willing to cover bets that, absent CNN getting involved, that kid would be looking at a liquid diet, and a shortened lifespan?

I'm not.