Wednesday, May 2, 2012

Anecdotal Evidenz: A health-insurance odyssey, amid my dealings with CPG (1993-94), Part 2 of 2

[Preface: It’s hard to believe I started this Anecdote 2 series over a month ago, in the wake of the late-March hearings on the Obamacare law at the U.S. Supreme Court. But what follows below should still be timely, because the issues discussed of employer benefits-related and other shenanigans—whether related to health insurance or not—still pop up often in newspapers lately. As you will see, this long story—I think this entry is pretty short and summary given the ground it has to cover—is something that would take anyone who’s endured what it has to relate a long time to assemble, whether for purposes of a lawsuit, publishable material, or discussion with confidants. And indeed, I have gone over this ground in the latter two ways a number of times within the past almost-20 years. In an important way, too, this story is water under the bridge, while from another angle it represents one of the most disgraceful instances of employer-produced disservice I have ever experienced. One way to measure this is this: When I was an employee at CPG, I was 31, and my two younger craft-level editorial coworkers were 23 and about 27. Yet I was treated—by several workers there, not least by the ownership partners—as if I was junior to both of the younger editors, totally in disregard for my past editorial experience that was greater, at least in terms of wordage, than that of the two of them combined. This also when the editorial director, Bob D., was, at about age 40, about the same number of years older than I was (nine years) as I was of the youngest fellow editor (about eight years). When I turned 40 in 2001, when I thought of the CPG partners’ behavior toward me (when they were about 40 in 1993), I thought I would never treat someone of age 31, who was in my position at the time, as they had me. Having recently turned 50, I find their behavior at their 1993 age to be even more disgraceful. But water goes under the bridge for me, and business practices have changed. Some of today’s high-handed business disgraces seem to come at the hands of people in their twenties and thirties, and—though it may sound a bit sour to say—they don’t have the excuse of acting on “middle-aged got-to-avoid-loser-hood” that the CPG partners seemed to be grappling with.

[At the end of Part 1, I posed the practical question: In trying to get individual insurance and being denied coverage due to preexisting condition, what remedies, tools, procedures are there in the health-care system to help us, especially when some overarching “reform” program is being enacted? As I unfold and edit the story below, I realize I don’t have any answers to this question that would suit everyone. As with so much else involving severe failures of high-minded business like health-care services and trust-related affairs like business engagements, there is so often no formula for what to do: you are in a raw troubleshooting-and-mitigating situation. I think that whatever the outcome of the Supreme Court case on Obamacare, a few things will be sure: it may not be that “There will be blood,” but there will be insurance shenanigans; there will be people falling through the cracks of the supposed overall health-care system; there will be “sad-sack” people in this situation that no one wants to help. So maybe with respect to the Supreme Court decision, I will gravitate to doing what I did in the 1990s (as an aftermath to the disservice from CPG), aiding in community approaches to health issues (which in the 1990s included involvement with a township board, and attending and reporting on meetings of a state board). Maybe the thing to do is set up an informal service to help people deal with the new disservices and “being thrown into oblivion” by the new health-care “regime.” But maybe, instead, I’ll just make everything simple for myself and move to Indonesia and, there, deal with the comparatively simple problems of earthquakes, volcanic eruptions, tsunamis, poverty, religious radicals, unfamiliar language, too-hot climate, and weird diet. (Come to think of it, a lot of this sounds like New Jersey.)]


Anecdote 2: My story of CPG

As I said in a previous blog entry (that of April 27), one important attitude to have when addressing the complex bear of the problems of the health-insurance industry is not to be naïve. A lot of workplace horror stories I have to tell involve medical-media firms (usually medical-advertising agencies). You say, Wouldn’t a firm that deals with medical matters be fair about an employee’s medical issues? I say, Any medical-media firm is a media firm first, and medical in any sense second. And being a media firm means sleazy management, more often than we would care to think. What are some examples? There are some broad types that become familiar after you’ve been in the industry a while, and in my anecdote about CPG, we’ll see some doozies.


1. Eventually trying to get individual insurance

a. CPG in the series of my early-’90s jobs

Clinicians Publishing Group was the third staff editorial job I had within my “working in-house stiff” period of 1990-94, and basically it was my last. It was my last for good reason, with what happened with me there. I started there in January 1993 and was fired in February 1994. It would almost seem like ancient history, but I think it still provides relevant lessons for a couple reasons: (1) in my experience from 1990 to today, the sleazy things that can happen at media companies have been worst among the medical-media ones, probably because of the fundamental fact of there being more money at stake (that is, more riding on the backs of employees—more money per back of each employee); and (2) the health-insurance aspect of this particular story involved early-1990s reforms in New Jersey that seem a small-scale version of what the Obamacare plan is trying to do with insurance—and thus it would seem to hold lessons for people today. I could imagine a number of stories roughly similar to mine turning up in the future with respect to insurance company disservice; the only questions are how many, and how weirdly these companies try to circumvent the law.

I have dealt with this story in a number of ways over many years. I wrestled with what to do in a legal sense in 1994-95 or so. I wrote on it at that time, in relation to the Clinton reform attempt, and I wrote on it later (in ~2001) in a book manuscript. I look at my nearly-20-year-old papers on this episode today and I think, “Not again. Do I have to try to make this story relevant again?”

When I was at All American Crafts in 1990-91, I was part-time till July 1991, then was made full-time. I was allowed to start health insurance in August 1991, a few weeks after my status changed, which was a reprieve from the usual rule there that a new employee waits four or six months (whatever it was) before insurance kicked in. And the insurance in my case did cover what minor claims I made, for relatively routine health care in later 1991. Then I lost the job in December 1991 (I was technically laid off, but it was more of a forced resignation).

AB Bookman, where I worked from February 1992 to January 1993, did not offer insurance, because, as its owner said, it was too expensive (I credit him: it was better to be honest about it than be a double-dealing snake). By the time I started at CPG in early 1993, I wanted to see if I could get health insurance independent of the employer (because I would have liked to have “portable” insurance, not a term I would have used then, when I knew such employers could be transient). I was told by the CPG treasurer that they preferred employees to be on the company’s group plan.

Well, I was “on probation” for about three months; insurance didn’t start yet. Finally, in about April 1993, in a weird self-dramatizing move, my boss, the editorial director (and one of the firm’s ownership partners) Bob D., told me there were doubts about whether I would fit in, and if I didn’t show more whatever (I also had engaged in a blast of temper within my first two months there, but I would say in retrospect it was understandable given how the place was, and how my previous editorial experience was not shown respect)….

b. The nature of CPG

Let me describe CPG a bit. It had been started in about 1991 by several men who (as I recall) had been laid off en masse from a larger publisher, Physicians World (or “PW” as it was familiarly called). Not wanting to dwell in resentment, they started their own firm, and its flagship publication, Clinician Reviews, was something of a competitor with PW’s magazine that was directed to physician assistants.

Physician assistants—which at a minimum had a certain degree and could get further certification in some regard (a regular one was a “P.A.,” but you could have one that was a “R.P.A.-C.,” “registered physician assistant, certified”)—were, roughly speaking, less than doctors and a little more than nurses. In many states in the early 1990s (if I recall rightly), they had the power (given by state licensing) to prescribe medication. A similar group was nurse practitioners (N.P.s), who could also prescribe medication. There was thus a sort of political tension between medical doctors and the informally allied P.A.s and N.P.s; the doctors felt the latters were a little pretentious; if they wanted to function like doctors, why not go all the way and obtain an M.D. degree? Meanwhile, the P.A.s and N.P.s felt they could almost be like doctors, and certainly could be licensed to prescribe medication, therefore…. This probably oversimplifies things a bit, but it shows how the audience at which CPG aimed with its flagship publication was subject to a certain amount of controversy, as if there was a certain cloud over the heads of the P.A.s and N.P.s; and of course, if you were a lowly editor at such a publisher, you could almost be seen (by an outside critic) as a party to half a fraud. (Maybe that’s a little strong.)

In any event, we editors helped prepare items for publication in Clinician Reviews (as well as other publications, some of which were aimed to M.D.s); all (or almost all) the publications were a fixed-circulation type, which means they were sent (free, I think) to everyone on some kind of professionally oriented mailing list (which might have had a paid-membership basis). If I recall, few if any of the CPG publications were subscribed to (though if any were, they were smaller ones, like little newsletters). Moreover, the Clinician Reviews magazines were qualified by P.A. and N.P. accrediting bodies as being good for one or two contact hours of continuing medical education. And as it turned out, the favorite part of CR that helped the professionals qualify for this was what was called the “abstracts” of refereed articles in professional journals, though they were not technically that but were rather originally written summaries, which were the hardest things (and in a sense the most rewarding) items to work on for us editors. (We either wrote them or edited versions that an outside freelancer wrote; and when we wrote them, we pumped out two a day on average—and they could be hard to do, at least for me; we based them on original studies in the likes of The New England Journal of Medicine, the Journal of the American Medical Association [JAMA], and the Annals of Internal Medicine. The P.A.s who were CPG’s ownership partners chose the articles to do abstracts on, and we editors [as well as occasional freelancers outside the company] wrote the abstracts. Altogether I wrote 100 of them and am proud of this work. Of course, the youngest editor also wrote or edited them; I think the 27-year-old senior editor only edited them.)

So this company was a kind of borderline or “grey areas” case, you might say—serving subsets of the medical profession that were controversial as to how much medical authority they should have, and doing it with “abstracts” and the like written by laypeople, which abstracts helped the professionals beef up their CME. Also, there were full feature articles written by medical professionals, which we editors edited. (Bob D., usually or exclusively, did the substantive editing of such pieces as this. We lower-level editors only copy edited or proofread them.)

I remember I was at an educational meeting of the Editorial Freelancers Association in 1994 or so, and a woman was giving a lecture on medical writing or the like. She was an old, I believe retired, doctor, who had chosen to write; but she didn’t write academic or professional articles (as might appear in JAMA); she wrote more along the lines of general-audience magazine articles or maybe trade books. She did not write as any sort of professional researcher, in other words. And when I told her how I’d been writing “abstracts” at CPG, including with reference to the management’s pressure to pump them out, she intoned, with what I’ve long semi-creatively recalled as a pretentious quality of voice associated with what’s been called “Larchmont lockjaw,” like some arch old biddy pilloried in a Pink Panther movie, “You know, that’s the worst way to do medical writing.” It was on the basis of this as the one main insult I received when attending educational events offered by EFA (and on the basis of something else) that I discontinued being a member of EFA later, in 2000. (If you wonder why I hadn’t responded to her tartly, something like, “Well, I didn’t design the managerial structure or work demands of that company,” I was not the type then to do that, not in that kind of Manhattan/educational lecture context. But I certainly have thought many times that that would have been a good response.)

When I was there, CPG included 13 full-time employees (who I believe were the only ones to get benefits): of these, four were ownership partners, two of whom were P.A.s (one was an R.P.A.-C.) who also were salesmen for the company, one a treasurer (who, oddly, was my main ally there after a while), and my boss, an editorial director (without any sort of medically related degree) who spoke as if he was a veteran of long experience in editorial management, but had been an executive editor or the like at PW for only five years. There was another P.A., not a partner, who was an ad-space salesman (like the two partners who were P.A.s); and there was a young man, very nice, who was also a salesman (and not a P.A.); he had the title “publisher” and was pulling in ads to back up a “tabloid” fixed-circulation publication, Neurology Reviews, that was to launch in 1993. (Typically, half of Clinician Reviews, and much of Neurology Reviews, comprised ads for Big Pharma products. The company could not survive but on such ads or the amount of space it gave to them.) 

There was also a full-time art director; a human resources manager; a young receptionist (age about 23; from an upscale community, but had not graduated from college); and within the editorial staff, there was myself; a senior editor who was a little younger than I; a young woman of 23 who had previously worked a bit for PW, had been a high school classmate of the receptionist, and was literarily oriented enough to be the only medical-editing type who actually wrote serious poetry; and a woman older than I, Diana Ver Nooy, who had years of experience in editing, and was my superior when I was the unofficially preferred copy editor for Neurology Reviews, and who I understand (from someone I know in the support-group realm) died of breast cancer by about 2000. There were also a couple part-timers—one in the art department and another who did filing and such for editorial.

One main thing to note about this constellation of workers is that, in a way, the company was top-heavy with its set of four partners (they, along with whatever other perks, got disability insurance, while as far as I’ve known, the rest of the employees didn’t); and we editors were a small group for the company to shove the amount of copy through us, some fairly technical, that we worked on. At one point the partners wondered if we couldn’t speed up the writing of abstracts more, as if two a day (from each of us editors) were just too few. In that regard, I felt they were trying to make the operation more of a boiler-room fraud than an acerbic onlooker could already call it.

(By the way, one way CPG had professional bona fides—though today reasonable people can disagree on this—was that, at least when I was there, the production and distribution company for at least the main publications—and perhaps a partial-stake owner of the company?—was Williams & Wilkins, the famous medical publisher.)

I have to add that—as people may not appreciate who are quick to criticize as “frauds” all sorts of businesses, not just publishing entities, today—despite the pressured circumstances, the petty politics, and so on at CPG—and despite we editors’ not being quite as technically schooled in medical material as we should have been at times—we still did good enough work, as often publishers of numerous types can pump out bona fide material under tawdry conditions. I am generally proud of my work there, and still use some of my writing work there as samples in seeking work today. I can’t say the same for work at numerous other places I’ve been at, both before and afterward.

(What became of CPG in later years? Not necessarily in the order these occurred: It grew, to what number of employees I don’t know; it eventually shortened its name to Clinicians Group; it eventually was partially bought up, or supported, by a company named Jobson; it moved to Bloomfield, N.J., after being in Clifton, N.J., for some years; and by about 2005, perhaps, it sold some if not all of its titles to another firm, a medical publisher in Parsippany, N.J., for which I worked briefly as a placement-agency temp in 2001. At least, this latter firm acquired Clinician Reviews and Neurology Reviews. A Web site you find if you Googled Clinicians Publishing Group has not been updated since 2004, and I think it is an “orphaned” site whose company it supported has long gone. [I need to follow up this information and flesh it out a bit--I can't do it here.])

c. CPG in terms of gritty politics

CPG was different from my previous two employers, in a way that about 17 years later I could say is very typical of medical media. In fact, my work period 1990-94 was a microcosm of what I would experience from 1990 to 2010: I did by far the most work at non-medical places, where the work could be grueling and the pay relatively low; but at the medical-media places, there was a lot more posturing and weird tension, yet the amount of editorial words on which so much of the money and ego depended was much less. Put it this way: at All American Crafts: 5+ million words of copy passed through my editing hands. AB Bookman: almost 3 million. CPG: about 600,000, but the politics and tensions there were distinctly worse.

Now recall my start of the story where I said that, in a weird self-dramatizing move, my boss, the editorial director Bob D., told me there were doubts about whether I would fit in….

Well, I “tried to fit in” (or whatever Bob D. saw me as needing to do) so that I “fit the company” better, and by about July 1993, I was finally offered full-time status. (Ironically, this employer was a good example of how, in a workplace that features a lot of big-money-based posturing and weird politics, my being as routine-oriented and colorless a worker as I might—a sort of drummer Charlie Watts amid the more self-expressive Rolling Stones—is my preferred strategy of comportment. I would use something of this style again later, notably at one or more other medical-advertising places.)

Interestingly, for about three months until July 1993, I had temporary health insurance through an insurance agent I knew in my hometown, insurance that was made for people between jobs. That worked fine for me, in terms of being able to qualify for it and pay for it. But when I was offered full-time status in July, I asked CPG, again, if I could have health insurance from outside the company. I was thinking of an insurance plan I could get that was similar to what I had just had.

The CPG partner I talked to about this (probably the treasurer) said OK. But then, when I started to try to sign up for insurance outside the company, I ran into a big problem, which I think I was alerted to either by the agent from whom I’d gotten the temporary insurance, or some financial planner he put me in touch with. The problem was that with state health-insurance reforms going into effect, I was forbidden from getting private insurance when I qualified for an employer’s group insurance plan. New Jersey’s reforms were such that they were covered in an article (as I referenced in CPG, Part 1) in the Journal of the American Medical Association (Joel A. Cantor, Sc.D., “Health Care Unreform[:] The New Jersey Approach,” JAMA 270 [December 22/29, 1993]: pp. 2968-70 [not quite AMA style, I know]).

So, not loving the prospect because it thwarted my ability to get outside insurance, I applied to get insurance through CPG’s group insurer. Ironically, this was the same company by which I had been insured by All American Crafts about two years before. Except now, they were far less cooperative with me (not that they knew me from AAC). The fun really began, and I will try to make this brief.


2. Into a Kafkaesque situation

I think I applied for group coverage in September 1993. It took roughly two months to get an answer…and early on they had me fill out a form to ask about preexisting conditions or the like, which the plan had a provision to do for those applying for coverage later than when they were initially entitled to. And then, by sometime in November 1993, I was denied coverage by the insurer, because of a preexisting condition.

Things got so snaky at CPG—and picking this up was par for the course for my “fly on the wall” approach there—that, in November I believe, I overheard the treasurer say on the phone—and I knew he was speaking to the firm’s financial planner/insurance agent—“I can’t fire him without cause.” I knew there was only one person he would talk that way about—me. (This even after I had been made full-time in July.) The reasonable inference was that the financial planner, having gotten the word from the insurer that I would not be covered, suggested that I be fired.

Why was it a problem for the company that I had a preexisting condition? The simple fact was that, of the 14 or so people on the CPG group plan—and this included coverage of at least two spouses of some of the partners, spouses who did not work for the company—there were already about four preexisting conditions (including that of my boss, Bob D.). I was one preexisting condition too many (and the problem that the insurer considered such was one for which it paid for treatment without comment in 1991 when I was at AAC).

On a more general level, one can infer that there was some weird insurer snakiness going on in relation to the New Jersey reform situation: though the New Jersey reform law, which included forbidding insurers from refusing coverage due to preexisting conditions, in some general sense went into effect in August 1993, the full set of articulated rules would not become effective until January 1994. Therefore, it seemed the insurer used this ambiguous window from August 1993 through January 1994 to deny me coverage in a way that, though not in the spirit of the reforms, was apparently allowable by the letter—or lack thereof—in that period.

One of the New Jersey reforms was a mandate that there be an array of five separate plans for people who wanted to apply for insurance as individuals: these were provided (and chosen, I suppose, as business considerations allowed) by private companies; and the state guided what types of plans there were to be, depending on whether one wanted the Cadillac of plans or not. Price, of course, was one main characteristic of each, differentiating them distinctly.

The financial planner/agent of CPG sent me a letter offering me to sign up for an individual insurance plan (of course, out of this he would get a commission): he named only the most expensive plan, which was from Blue Cross-Blue Shield. It was the easiest decision for me to make in the mess that was brewing for me and would get worse in future months, to decisively not take him up on his offer. (Probably this sort of insurance-agent move would be outlawed by the Obamacare plan.)

As I did without the greatest ease, starting I believe in December 1993, I got in touch with various entities that should have had authority over such a matter. By late winter 1994, to get ahead of myself a bit, I had gotten in touch with the state’s Division of Enforcement and Consumer Protection of the Department of Insurance. This office put me in touch with the New Jersey Individual Health Coverage Program Board, with which I ended up having several exchanges by mail in 1994.

It excites me today to see how far I went with this, partly because I know, from my standpoint of today, that I was naïve about various aspects of this situation and yet could follow my wits and deal with it capably enough. I also recall getting a letter signed by, or otherwise indicating the involvement of, Charles Wowkanech, who currently is president of the New Jersey subdivision of the AFL-CIO, and was involved at a high level with the health insurance reform in 1993-94.

To back up a bit, in a deteriorating situation for me in late 1993 at CPG—which roughly speaking was a matter of office politics, and involved some particular incidents that would require a separate, sensitive account to properly convey—my stock was running out. At one point I let on to some of the partners—when I felt it was a savvy move to do this, all things considered—that I had been in touch with one of the insurance-reform offices I’ve mentioned; I knew this could further erode my standing there, but by that point I felt this served them (CPG) right. In late February 1994 I was fired on a pretext—in a situation where I later won an appeal in the unemployment system, an appeal of an initial denial of unemployment coverage that was based on the idea that I had been fired with good cause. My winning the appeal meant I had not been fired for good cause: it was a sort of poor man’s lawsuit against CPG.

So there were two tracks of problems: the office politics, generally independent of the insurance issue, which led to my being fired; and the insidious, sad insurance situation, which is my main topic here. (I deliberately omit some office-politics tales—especially the details surrounding how I was fired—that would really make this overall story one of the most hair-raising by far that I have to tell from almost any employer in 30+ years.)


3. Something of a runaround, or a Catch-22 situation; and an insurer “not following a legal standard”

The part of the CPG story that follows most directly relates to the Obamacare debate and the pending Supreme Court decision on same—the latter entailing my musical question, “Can or should a federal law be enacted that requires that everyone get health insurance, no matter where he or she gets it from, even though rationally a motley collection of health-care insurance plans arrayed nationwide would not handle everyone equally fairly, nor is there a guarantee every last soul can get insurance from one of these plans?” However, I am not going to bore you—or intrigue you—with many details from the insurance-related odyssey that I went on in 1994-96 or so.

For one thing, there are too many details sprayed all around—in scrappy notes, manuscripts, letters—from a set of experiences that are too long ago for me to want to dig them all up (and boil the full story down helpfully) for your consideration. Nor would the full story all be relevant to today’s problems that others may face. Also, I rather don’t like trying to convey many of the details because what it comes down to is coughing up the particulars of a big hunt for help when you fall through the cracks of the system, and after the number of times I’ve been through this, I feel like it is an impertinence to have to tell such a story. The simple fact is that with so much in this country where big promises are made—“You can have state-of-the-art health care,” or “You can get help if someone screws you over in the workplace”—there is no actual system fully in place to help you with this. People fall through holes and they have to help themselves. Sometimes they don’t get a solution to their problem. They get fatigued with the mess they’re in and, not fully satisfied, move on.

That doesn’t mean you shouldn’t try to get help for yourself when you fall through the cracks. But you should know there is no formula for doing so, and you have to be self-reliant. And even if you get somewhere, you may feel, as I do, that you find it insulting or annoying to have to tell your story as if others can benefit from it. Because, in part, maybe others couldn’t get the results you did. “Past returns don’t guarantee future results,” as they say in municipal-securities-trading ads.

Anyway, some highlights…and I’m a little ponderous spelling this out, but it shows how many different ways the insurance mess I was in (in 1993-94) was wrong.

Summary. In a series of letters over months in 1994, I definitely asked a fair amount of questions, in a series of letters, of the state board about the CPG/insurer situation, with an eye to getting a legal reading. The board did seem to see a problem that I think falls under the heading of CPG and its insurer having put themselves in the area of liability for a lawsuit, but the board made clear it could not offer specific legal advice, and it usually had an interesting circumspect way of discussing this (meaning that it showed obvious sympathy with me in some ways).

The state was clear on one thing: the illegality of denying coverage based on preexisting condition. At one point, I was sent a draft of some rules written by the New Jersey Individual Health Coverage Program Board, dated November 29, 1993, which included the statement, “The Board believes that an employer’s exclusion or rejection of a person from participation in a group health benefit plan based on a medical condition or disability may violate the Americans with Disabilities Act, the Federal Pregnancy Discrimination Act, the New Jersey Small Employer Health Benefits Act, or other state or federal statute, and would not, therefore, be considered a lawful standard of participation.” [boldface mine]

But I could not get individual insurance, at least for some time, in light of how I was denied group coverage. There was one point where a March 1994 letter from the Individual Health Coverage Program Board said that, under the new reform law, I could not apply for individual coverage—as I guess I looked into at that point—if I was eligible for group coverage (as if it was realistic to expect I could get coverage at CPG, which CPG’s insurer’s law-flouting denial of coverage undercut), though there was an “open enrollment” period for signing up for individual insurance with “a January effective date.” If you look this situation over closely, and even check the letter, you are impressed with how, as much as the state tried to make reforms, it seemed to add a new element of bureaucratic clumsiness and disservice.

The state acknowledged an illegal insurer move, yet in a sense penalized you for it. Another way my Kafkaesque situation in 1994 can be defined is in some advice I got, either worded this way, or as interpreted this way (in a March 17, 1994, letter): I could sign up right away for one of the new individual-insurance “standard plans” if I had been lawfully denied coverage under a group plan, but if I had been unlawfully denied coverage (as I had by CPG’s insurer), I could not sign up for a standard plan for some time. For someone like me at the time who was sincerely trying to get insurance, this was a lonely, absurd situation. For me now as a more jaded older person, I would say this situation doesn’t surprise me so much.

Minorly missing the point. The same letter (March 17, 1994) also gave advice related to the assumption that I had a complaint about a specific carrier. Well, I could not complain about CPG’s insurer in March 1994; any business between me and them was a moot point by then. I was no longer at CPG, etc.

The old legal situation went on of acknowledging the general half of a problem without acknowledging the more-specific-to-you half. The board reps I wrote to were forthcoming in giving customized answers, but they weren’t helpful in terms of ironing out my problem, and they tended to point up “the holes in the system” without identifying them as such. As I wrote in one mid-1994 manuscript, with which I tried to publish an article (and did not succeed), the board (in a January 17, 1994, letter) “said the fact that the insurer declined me insurance after the general law went into effect but before the detailed rules took effect made the question of whether the rules were effective in my case ‘tricky.’” Tricky—but with no actionable resolution offered.

Takeaway for me. One phrase has remained in my mind ever since, and for me it became a good standard by which to judge so much of what happens in the media world, and in particular at medical-media firms: what CPG’s insurer had done with me—though there was ambiguity in whether they were allowed to deny me insurance in the window between August 1993 and January 1994—“did not follow a legal standard” (I paraphrase the original a tiny bit). “Not following a legal standard”: would this ever be a tool I would see fit to use time and time again, with respect to media-company behaviors, in the 17 or so years that followed (and usually not connected to health insurance). You might not be able to cite a particular statute—because often there may not be one—but you knew when a company acted, in some general sense, not legally—because often this entailed acting out of hand as if you had no rights, or close to it.


4. Why didn’t I get an attorney?

An attorney would have been more useful (but ultimately was not likely to be used) regarding the more or less typical office politics or abuses; but one was not relevant to the insurance issue—in ways and for reasons I’ll detail.

Quite simply, this CPG situation was the best example of why, in the 1990s, I could not get an attorney for a clearly actionable work-related situation—certainly this was true regarding the office politics that led to my firing. I knew of no attorney who would help me, and they certainly didn’t come out of the woodwork like your guardian angel and help you. In my part of New Jersey, attorneys show they simply aren’t equipped (or inclined) to deal with the kind of issues you encounter in the media world.

There was an attorney I regarded as my “personal attorney” in the 1990s, a Laura B.-B., who was a solo practitioner in a hole-in-the-wall office in Sparta, N.J. The only thing she really helped me with was making a will in late 1990-early 1991. Every time I tried to get help from her later, she was either suspicious of me, or only apt to give scraps of help on what she regarded as a trivial question, or (in a more helpful instance) inclined to point out that with issues regarding small publishers, it was hard to sue them because of evidence-getting difficulties, the inability to get much recovery, etc.

This last bit of advice, from early 1992, I’ve taken to heart for many years; and though other attorneys might have posed advice on this sort of thing differently, I think in general the solid, widely observable fact holds: with small companies where so much that is relevant to the basis of a lawsuit claim has been witnessed, personally experienced, but not rigorously documented; and remaining workers are paranoid or selfish about keeping their jobs; and small companies would rather kill your motivation with nasty litigation than pay out much in a settlement or judgment, it is wiser to move on and not try to sue those companies than to do so.

Other people I’ve encountered could have benefited from the same advice. A young woman who was hired by AB Bookman in 1992 as another proofreader (there were about four of us already) was let go after one month, simply because she was one proofreader too many. She was incensed; she spoke of suing. I told her, don’t do it; this place is too small, the expense of a suit won’t be worth it…and I don’t think she sued.

Another associate, a middle-aged stringer newspaper reporter who sued a northern New Jersey newspaper in about 2004 for a boss’s harassing behavior (he supposedly had a long history of harassing and alcohol-related problems through jobs in several states) was fought nastily by the newspaper in litigation; she eventually received a settlement, I believe, of less than $5,000, and it was slightly lower than an earlier settlement she was offered.

The attorney I “consulted” in the 1990s, Laura B.-B., was increasingly unhelpful to me as the decade went on. I don’t have a clear idea of what she did for me regarding CPG, but I think it’s safe to say she was decidedly not helpful either to the extent I consulted her or to the extent that, in fact, I prudently opted not to consult her at all on this. But let me be clear: whether I consulted her, or considered doing so, regarding the office politics/abuses side of the CPG mess, the insurance/state situation wasn’t one she could help me with. I had to deal with that on my own, because in a way the questions I was asking were more academic than practical anyway.

In any event, in situations in the 1990s where I did go through a legal process regarding an employer, I represented myself, and with success: with unemployment in 1992 (regarding All American Crafts), with unemployment in 1994 (regarding CPG, where I had to appeal, and won), and with unemployment in 1995 (regarding a long, torturous fight with a temp agency, on the important issues of which I eventually won); and when writing to the state about CPG and its insurer in 1994.

In 1998 I had a disappointing experience with Laura B.-B. regarding a matter involving my serving on the Vernon Township Environmental Commission. I stopped using her for any purposes after that. She eventually moved her practice to Livingston, N.J.

I have consulted another attorney sporadically for personal affairs since 2001, but in general I’ve been very inclined NOT to use an attorney for professional (meaning, publishing-related) issues since the 1990s. I find that attorneys simply don’t get the publishing world, and I could dilate on this matter very lucidly and with further colorful examples, but here is not the place for it. And as far as health insurance was concerned, I never had even a remote cause to consider using an attorney after 1994.


5. Sequelae

In late winter 1994, I was so crestfallen by having been fired for the first time in my life that I thought of leaving the publishing industry altogether. After sheer dogged trying for a new job, by April 1994 I started work as a temp of the old-fashioned kind—an “envelope-stuffing temp,” as I call it, and through Olsten Staffing—at a branch of MetLife in East Hanover, N.J., a job for which my time would be renewed by short periods for a total of over a year. I could not get health insurance through the temp agency, Olsten, unless I paid for it, and then I had to work a certain number of weeks starting in a certain month to qualify, or some such thing: I did not qualify in 1994 (as I recall) because of when I started, and in 1995 I did not qualify because of my time's ending midway through the year. Suffice it to say I was well encouraged not to get insurance when with Olsten.

I still looked into the “standard plans” New Jersey offered for individual insurance, but I think this was practically unworkable from later 1994 through fall 1995. I did sign up for individual disability insurance in mid-1994 (with help from a financial planner I’d consulted in 1993), which I paid for for all of two years. I ended it in mid-1996, because for the $60 or so monthly premium, the benefit if I was disabled would have been shockingly too little.

Ironically, the next in-house publishing job I worked was at a division of what was called Reed Reference Publishing, from October 1995 through March 1996. In that temporary gig, they actually provided expensive (to them) traditional insurance through Blue Cross-Blue Shield, one of the few times I actually had that kind of insurance (another time had been with the federal service program VISTA in 1986-87).

In sum, after my desultory experience with health insurance within the mid-1990s, I did not try to get insurance, either individual or group, through an employer again after the Reed job ended.

As for the state plan of subsidized insurance for low-income people, I recall this becoming irrelevant when I was at Reed, because it offered its own insurance; when I got out of Reed, I had too little income to apply for any kind of health insurance, in 1996. By 1997, I think the subsidized-insurance plan was on hold because of money shortage within the unemployment system, by which that plan was funded.

I’m sure I am oversimplifying this story a bit; I know I was very careful, and plodding, and apt to look at many angles, and feeling as if I had few choices—everything had to be painstakingly worked toward—in those trudging, patient days of about early 1993 through mid-1996. I am proud to see how I handled things then.

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CPG wasn’t a total waste; a number of important trends to my life started as a result of my experience there.

* First of all, anyone who thinks—and there have been some, in about 1992 and maybe 1994—that it may be time to move on to a different industry when my work and prestige in the publishing realm ignominiously collapse, doesn’t realize that moving on after the first or even fourth setback is not how you maintain your part in the industry. At least not within the period of my career 1990-2010. After CPG would come the following prestigious or otherwise pride-supporting work gigs: grueling, idiosyncratic editorial work on the Official Catholic Directory in 1995-96; work on the massive High School Literature project at Prentice Hall in 1997-98 (~8,000 pages including four textbooks with four corresponding teachers’ editions, involving several of us proofreaders in the art department); proofreading for three editions of The World Almanac (1999-2001); proofreading for two editions of a Catholic school book, in the Blest Are We series, published by Silver Burdett Ginn; proofreading and copy editing work (2000) on the nicknamed “African American textbook,” the second edition of Professor Molefe Kete Asante’s text published by Peoples Publishing Group; and of course, writing most of the book manuscripts that were handled by a literary agent from 1997 through 2005. So you see, my CPG collapse didn’t end my publishing-related work, but it certainly ended, for most purposes, my will to do editorial work in a permanent staff position.

* More generally, I learned not to rely on one employer for income (or benefits). From 1997 to 2007, I generally was in freelance mode, which it took slow work to get going, starting in 1995; and after it got going by 1997, it required some effort to pile up enough income per year. But I became adept at stitching together a freelance career—which not only protected me from relying on too few (and abusive) employers, but actually led to increases in income and my highest yearly income in 2006.

* Seeing what happened with the Clinton health-care plan in 1994, and with my own experience of health-insurance mishaps, I became involved with a local Democratic group from fall 1994 to early 1997. This was an enriching experience.

* Partly as a result of my involvement with the local Dems, I ended up serving on township government bodies (in a volunteer capacity), including one year on the Vernon Township Board of Health (1997).

* In the mid-1990s, I attended (as a member of the public) several meetings of the Region One Health Planning [Local] Advisory Board, a local version of several such boards that served New Jersey’s planning for adequate health-care facilities in the state. There were about 10 regions the state was divided into for purposes of this set of boards, and they operated (I believe) under the Division of Health and Social Services (whatever it was called at the time). I eventually wrote a bylined news article in a local paper on the particular board (Region One’s) whose meetings I attended. [See my earlier May 2 blog entry.]

* I was involved as a member with the Editorial Freelancers Association, most richly from 1994 through 1996, which schooled me in how to be a freelancer.

* Ironically, I became acquainted with Horizon Graphics, a placement agency for editorial workers who worked (temporarily) at large corporations and the like; I first spoke with someone there, Louise Asper, in late 1993 or early 1994, and found they were selective about whom they used; I needed three references to give them. I would not be able to give them these until 2001, and then I worked through Horizon Graphics from 2001 through 2003, without Ms. Asper there; notably, I entered the world of editing at medical-advertising agencies, which would be (in general) the financial backbone of my freelance work from 2001 to 2010. In 2000 Ms. Asper moved on (with a partner) to establish another placement agency, which I’ve elsewhere given the pseudonym The Gary Laverne Group (“GLG”); I worked for them from 2004 through 2006. GLG flourished until 2007, when it collapsed very strangely.

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In short, I became more socially involved and a freelancer in the wake of my disaster at CPG. And I would not encounter another, vaguely similar professional disaster until 2010, 17 years after CPG.

But while the media world, in general, is notoriously cheap about offering benefits and fair opportunities for same, the health insurance world of New Jersey in the mid-1990s looks as if it holds lessons for what seems a painfully familiar situation today in 2012: (1) people without insurance through no fault of their own, (2) assumptions around them making them feel as if they owe it to themselves and/or to society to jump the dark chasm to getting insurance, and (3) a system that has a way of not making a ready compact with all and sundry.

If private insurance is who we expect to be our partner to a fairer health-care world in this country, be ready for our partner to have a way of being untrustworthy at unexpected times. In general, though, the idea that some of what happened with me in 1993-94 would become a federal crime rather than a state crime (or a state-level "failure to follow a legal standard") would mean that the New Jersey media way of trying to "fly under the legal radar" when relevant laws are just state-level  would have to stop, or at least be reduced; with Uncle Sam on your side, maybe you have more of a fighting chance to work at a firm that operates in a more thoroughly legal fashion. But who the hell knows.