Opinion: A Health Insurance Detective Story

I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?

After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?

The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.

Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.

But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?

A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.

Here’s a snapshot of my surreal experience:

NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.

Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”

I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.

NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.

NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.

My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.

NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.

Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.

But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.

NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.

CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.

NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.

Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.

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Media Decoder Blog: Robert Thomson to Be Chief of News Corporation's New Publishing Company

2:53 p.m. | Updated

Robert Thomson, the top editor at The Wall Street Journal and Dow Jones and a confidante of News Corporation’s chairman and chief executive, Rupert Murdoch, is expected to be named chief executive of the media conglomerate’s newly spun-off publishing company.

Mr. Thomson will run the separate, publicly traded company, which will include The Journal, The New York Post, HarperCollins and a suite of lucrative television assets in Australia. The announcement is expected as early as Monday, according to a person briefed on the company’s decision-making.

Mr. Thomson took over at The Journal in 2008, soon after News Corporation completed its $5.6 billion acquisition of Dow Jones. He serves as managing editor of The Journal and editor in chief of Dow Jones, which also publishes Barron’s and the Dow Jones Newswires.

Gerard Baker, a deputy managing editor at the Journal, will take over for Mr. Thomson at The Journal, said the person briefed on the decisions, who could not discuss private conversations publicly.

At The Journal, Mr. Baker has overseen Washington and political coverage, among other topics. He previously wrote a neoconservative column for The Times of London, also owned by News Corporation, and served as Washington bureau chief at The Financial Times, where Mr. Thomson was the top editor of the United States edition.

Mr. Thomson began his career at News Corporation in 1979 as a reporter at The Herald in Melbourne, Australia. He and Mr. Murdoch are both Australian, and have taken family vacations together. Mr. Murdoch is often seen in Mr. Thomson’s office in the Journal newsroom.

In his tenure at The Journal, Mr. Thomson increased circulation by broadening the newspaper’s focus beyond business to include more general-interest and lifestyle news. He oversaw an expansion of the newsroom budget, added photographs to go along with the paper’s signature dot drawings and introduced a local New York section.

Mr. Murdoch will serve as chairman of the publishing company and remain chief executive of the entertainment company, which will include News Corporation’s movie studio, Fox Broadcasting and cable channels like FX and Fox News.

News Corporation plans to complete its split, which was announced in June, in mid-2013. Additional announcements about the publishing company’s board and cash structure are expected before the end of the year.

A News Corporation spokeswoman declined to comment. Reuters was the first to report on the expected appointments.

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Israel Moves to Expand Settlements in East Jerusalem

Rina Castelnuovo for The New York Times

From his home in East Jerusalem last year, Haj Ibrahim Ahmad Hawa looked at the separation barrier surrounding Jerusalem with the Israeli settlement of Maale Adumim in the background. More Photos »

JERUSALEM — Israel is moving forward with development of Jewish settlements in a contentious area east of Jerusalem, defying the United States by advancing a project that has long been condemned by international leaders as effectively dooming any prospect of a two-state solution to the Israeli-Palestinian conflict.

One day after the United Nations General Assembly voted overwhelmingly to upgrade the Palestinians’ status, a senior Israeli official, speaking on the condition of anonymity, said the government would pursue “preliminary zoning and planning preparations” for a development that would separate the West Bank cities of Ramallah and Bethlehem from Jerusalem — preventing the possibility of a viable, contiguous Palestinian state.

The development, in an open area known as E1, would connect the large settlement town of Maale Adumim to Jerusalem. Israel also authorized the construction of 3,000 new housing units in parts of East Jerusalem and the West Bank.

The timing of the twin actions seemed aimed at punishing the Palestinians for their United Nations bid, and appeared to demonstrate that hard-liners in the government had prevailed after days of debate over how to respond. They marked a surprising turnaround after a growing sense in recent days that Israeli leaders had acceded to pressure from Washington not to react quickly or harshly.

“This is a new act of defiance from the Israeli government,” Saab Erekat, the Palestinians’ chief negotiator, said in a statement. “At a moment where the Palestinian leadership is doing every single effort to save the two-state solution, the Israeli government does everything possible to destroy it.”

Much of the world considers settlements in East Jerusalem and the West Bank to be illegal under international law, and the United States has vigorously opposed development of E1 for nearly two decades. On Friday, Tommy Vietor, a White House spokesman, condemned the move, citing Washington’s “longstanding opposition to settlements and East Jerusalem construction and announcements.”

“We believe these actions are counterproductive and make it harder to resume direct negotiations or achieve a two-state solution,” Mr. Vietor said. “Direct negotiations remain our goal, and we encourage all parties to take steps to make that easier to achieve.”

The office of Prime Minister Benjamin Netanyahu refused to comment on the zoning and construction decisions, which were made Thursday night around the time of the General Assembly vote. But Israel has long maintained its right to develop neighborhoods throughout East Jerusalem and the West Bank — more than 500,000 Jews already live there — and Mr. Netanyahu, responding to the United Nations speech by President Mahmoud Abbas of the Palestinian Authority, said, “Someone who wants peace does not talk in such a manner.”

While Israel has frequently announced settlement expansions at delicate political moments, often to its detriment, the E1 move came as a shock, after a week in which both Israelis and Palestinians toned down their rhetoric about day-after responses to the United Nations bid. Avigdor Lieberman, the ultranationalist foreign minister who for months denounced the Palestinian initiative as “diplomatic terrorism” and said Israel should consider severe sanctions against the Palestinian Authority, told reporters in recent days that there would be “no automatic response.”

Mr. Erekat’s spokesman declined to discuss whether the Palestinians would use their upgraded status, as a nonmember observer state with access to United Nations institutions, to pursue a case in International Criminal Court regarding E1 or the other settlement expansion. Less contentious moves were already in progress: the Palestinian Authority has begun changing its name to “Palestine” on official documents, contracts and Web sites, and several nations are considering raising the level of diplomatic relations, giving Palestinian envoys the title of ambassador.

All but one European country voted with the Palestinians or abstained in Thursday’s United Nations vote, many of them citing concerns about settlements in West Bank and East Jerusalem territories Israel captured in the 1967 war. The settlement of E1, a 4.6-square-mile expanse of hilly parkland where some Bedouins have camps and a police station was opened in 2008, could further increase Israel’s international isolation.

Peter Baker contributed reporting from Hatfield, Pa.

This article has been revised to reflect the following correction:

Correction: November 30, 2012

An earlier version of this article misspelled the given name and surname of the leader of the Israeli Labor Party. She is Shelly Yacimovich, not Shelley Yachnimovich.

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NBA fines Spurs $250,000 for sending starters home

The NBA fined the San Antonio Spurs $250,000 on Friday for sending four players home Thursday before their game Thursday night in Miami.

Commissioner David Stern said in a statement that the Spurs "did a disservice to the league and our fans" when they didn't bring Tim Duncan, Tony Parker, Manu Ginobili or Danny Green to Miami for the final game of their six-game road trip.

"The result here is dictated by the totality of the facts in this case," Stern said. "The Spurs decided to make four of their top players unavailable for an early-season game that was the team's only regular-season visit to Miami. The team also did this without informing the Heat, the media, or the league office in a timely way."

Teams are required to report as soon as they know a player will not travel because of injury.

The league's statement said the Spurs were in violation of league policy reviewed with the board of governors in April 2010 against resting players in a manner "contrary to the best interests of the NBA."

After that meeting, Stern said owners had discussed the issue of sitting healthy players but that there was "no conclusion reached, other than a number of teams thought it should be at the sole discretion of the team, the coach, the general manager, and I think it's fair to say I agree with that, unless that discretion is abused."

The Heat rallied late to beat the Spurs 105-100.

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Hockey Coaches Defy Doctors on Concussions, Study Finds

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which was published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The teams were not named in the study, in which an independent specialist physician was present at each game and was empowered to pull any player off the ice for examination if a potential concussion was observed.

The men’s team, with 25 players and an average age of 22, played a 28-game regular season and a 3-game postseason. The women’s team, with 20 players and an average age of 20, played 24 regular-season games and no playoff games. Over the course of the season, there were five observed or self-reported concussions on the men’s team and six on the women’s team.

Researchers noted several instances of coaches, trainers and players avoiding examinations, ignoring medical advice or otherwise obstructing the study, even though the players had signed consent forms to participate and university ethics officials had given institutional consent.

“Unless something is broken, I want them out playing,” one coach said, according to the study.

In one incident, a neurologist observing the men’s team pulled a defenseman during the first period of a game after the player took two hits and was skating slowly. During the intermission the player reported dizziness and was advised to sit out, but the coach suggested he play the second period and “skate it off.” The defenseman stumbled through the rest of the game.

“At the end of the third period, I spoke with the player and the trainer and said that he should not play until he was formally evaluated and underwent the formal return-to-play protocol,” the neurologist said, as reported in the study. “I was dismayed to see that he played the next evening.”

After the team returned from its trip, the neurologist questioned the trainer about overruling his advice and placing the defenseman at risk.

“The trainer responded that he and the player did not understand the decision and that most of the team did not trust the neurologist,” according to the study. “He requested that the physician no longer be used to cover any more games.”

In another episode, a physician observer assessed a minor concussion in a female player and recommended that she miss the next night’s game. Even though the coach’s own playing career had ended because of concussions, she overrode the medical advice and inserted the player the next evening.

According to the report, the coach refused to speak to another physician observer on the second evening. The trainer was reluctant to press the issue with the coach because, the trainer said, the coach did not want the study to interfere with the team.

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Wealth Matters: Defined-Benefit Plans Allow Fast Retirement Saving, but With Risks

Kevin Moloney for The New York Times

John Rogers, a Denver businessman, used a defined-benefit contribution to catch up on his retirement savings late in his career.

WITH the prospect of significant changes in tax rates and deduction limits, taxpayers have been coming up with all sorts of strategies to save on their taxes, some riskier than others.

So I couldn’t help but be skeptical when I was told about a plan aimed at small-business owners in their 50s who have saved little for retirement but can now afford to put aside a lot of money each year. They can then deduct that money as a business expense, resulting in a significant tax savings.

But I checked with the Internal Revenue Service, and the plan is indeed legitimate.

It is a defined-benefit plan, much like the one large employers once regularly offered their workers, that guarantees a set monthly payment in retirement. In this case, though, the plan works best for really small businesses — those that employ just one or two people.

The I.R.S. allows a maximum annual contribution to the plan of about $255,000 for people in their 50s. (For younger workers, the contribution limit is lower, because the calculation is based on the number of years until retirement. In some cases, the limit is so low that other retirement savings options might be better.) Total holdings in the plan are limited to $2.3 million to $2.4 million, enough to cover the maximum allowed payment in retirement of $200,000 a year.

Advisers said the plans were less effective in companies with more employees, particularly older ones, because the owner would be required to make contributions for all of them, and at a high level, since older employees are typically better paid and closer to retirement. (If the additional employees were young and low-paid, the cost of offering the plan to them might be low enough for it to make sense.)

“It’s not too good to be true,” said Lisa C. Germano, president and general counsel at Actuarial Benefits and Design Company in Midlothian, Va. “But you need to be able to fund the plan and fund it for an indefinite period. It’s a commitment. That’s one of the reasons you get the reward.”

Some advisers like Ms. Germano were worried that, like other generous deductions, this one could be threatened in the current tax and budget negotiations. But regardless of how the talks in Washington turn out, this is still the time of year when many small-business owners need to decide whether to set up a defined-benefit plan or stick with more traditional forms of retirement savings, like SEP I.R.A.’s for the self-employed or a profit-sharing plan.

Here is some of what I learned.

UPSIDE Defined-benefit plans are mainly a way for small-business owners who neglected to save for retirement to catch up. The ideal candidates can put away $100,000 to $150,000 a year for at least 10 years, said Leigh Goldblatt, vice president and chief compliance officer at Glazer Financial Network.

This was the case with John Rogers, a Denver businessman. “I was in my late 50s and I didn’t have a penny saved for retirement,” he said.

He lost his life savings in his 40s, he said, in a recycling company he started with friends. He also raised six children, four of whom he said he put through college.

But by 2006, he was six years into being an independent contractor for Univera, a company that makes nutritional supplements. (The company’s sales model is similar to Amway’s, where people like Mr. Rogers sell to individuals or find other people to sell for them.)

With his business providing steady, predictable income — he and his wife are ranked as top sellers for the company — he wanted to start saving. He said a defined-benefit plan was attractive for both deferring taxes and for saving for retirement.

“Our adviser tells us at the beginning of the year what we have to contribute,” said Mr. Rogers, 63. “We’re very disciplined. We pay our defined-benefit plan first and then our business expenses.”

But even though the I.R.S. assumes the plan will make monthly payments in retirement, which is why it allows people to save so much over a short period of time, owners shut down most of these plans and roll the money in them to a regular retirement account, said Mr. Goldblatt, whose firm advised Mr. Rogers. This reduces expenses and gives the owner control over how to withdraw the money.

DOWNSIDES Such a chance for a retirement savings do-over, as it were, does not come without catches. And skeptics say these plans lure people with the prospect of quick and large retirement savings without discussing the risks.

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General Assembly Grants Palestine Upgraded Status in U.N.

Chang W. Lee/The New York Times

President Mahmoud Abbas of the Palestinian Authority spoke at the United Nations before the General Assembly voted on Palestine's status as a “nonmember observer state” on Thursday.

UNITED NATIONS — More than 130 countries voted on Thursday to grant Palestine the upgraded status of nonmember observer state in the United Nations, a stinging defeat for Israel and the United States and a boost for President Mahmoud Abbas of the Palestinian Authority, who was weakened by the recent eight days of fighting in Gaza.

The new ranking could make it easier for the Palestinians to pursue Israel in international legal forums, but it remained unclear what effect it would have on attaining what both sides say they want — a two-state solution.

Still, the vote offered a showcase for an extraordinary international lineup of support for the Palestinians and constituted a deeply symbolic achievement for their cause, made even weightier by arriving on the 65th anniversary of the General Assembly vote that divided the former British Mandate of Palestine into two states, one Jewish and the other Arab — a vote that Israel considers the international seal of approval for its birth.

In the West Bank city of Ramallah, about 2,000 Palestinians gathered to celebrate in a central square named after the late Palestinian leader Yasser Arafat. Security forces fired into the air and people applauded, danced in the streets and honked car horns when the results were broadcast to the crowd.

“We are witnessing exceptional moments after 65 years of injustice, suffering and pain,” said Jibril Rajoub, the member of Fatah Central Committee. “We are going to witness an Israeli American efforts to keep this resolution ink on paper.”

The tally, in which 138 members voted yes, 9 voted no and 41 abstained, took place after a speech by Mr. Abbas to the General Assembly, in which he called the moment a “last chance” to save the two-state solution amid a narrowing window of opportunity.

“The General Assembly is called upon today to issue a birth certificate of the reality of the state of Palestine,” he said before the vote.

But in the run-up to the vote, he and Ron Prosor, the Israeli ambassador to the United Nations, blamed the other side for not doing enough to pursue peace.

”We have not heard one word from any Israeli official expressing any sincere concern to save the peace process,” Mr. Abbas said.

“On the contrary, our people have witnessed, and continue to witness, an unprecedented intensification of military assaults, the blockade, settlement activities and ethnic cleansing, particularly in occupied East Jerusalem, and mass arrests, attacks by settlers and other practices by which this Israeli occupation is becoming synonymous with an apartheid system of colonial occupation, which institutionalizes the plague of racism and entrenches hatred and incitement.”

“The moment has arrived for the world to say clearly: enough of aggression, settlements and occupation,” he said.

Mr. Prosor, speaking after Mr. Abbas but before the vote was taken, said the United Nations resolution would do nothing to advance the process.

“Today the Palestinians are turning their back on peace,” he said. “Don’t let history record that today the U.N. helped them along on their march of folly.”

As expected, the vote won backing from a number of European countries, and was a rebuff to intense American and Israeli diplomacy. In an indication of the bitterness of the blow to the Israelis, the office of Prime Minister Benjamin Netanyahu released a statement calling Mr. Abbas’s speech “defamatory and venomous” that was “full of mendacious propaganda against the IDF and the citizens of Israel.”

“Someone who wants peace does not talk in such a manner," the statement continued.

Among the countries that had forecast their yes votes were France, Spain and Switzerland. Germany and the United Kingdom were among the countries that abstained, and a few countries joined Israel and the United States in voting no.

After the vote, Susan E. Rice, the American ambassador to the United Nations, explained the American vote as a reaction to an “unfortunate and counterproductive” resolution that placed “further obstacles in the path to peace.”

Reporting was contributed by Michael R. Gordon and Mark Landler from Washington, Isabel Kershner from Jerusalem, Khaled Abu Aker from Ramallah, and Nicholas Kulish from Berlin.

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Zynga slides after updated agreement with Facebook

NEW YORK (AP) — Zynga shares tumbled nearly 12 percent in after-hours trading Thursday after the online game company and Facebook disclosed that they changed their relationship status to become less attached to each other.

Zynga Inc. said in a regulatory filing Thursday that it will no longer have to display Facebook ads or use Facebook payments on its own properties — such as Zynga.com. In addition Zynga will no longer be required to use Facebook as the exclusive social site for its games, or to grant Facebook exclusive games.

Facebook Inc., which filed a similar disclosure, will also be able to develop its own games after the end of March. Its deal with Zynga previously prohibited that.

The amendments change the companies’ 2010 contract that gave Zynga special status among Facebook game developers. San Francisco-based Zynga relies on Facebook for most of the revenue it generates, but the company has been working to establish its independence — while also maintaining ties with Facebook.

Zynga’s titles range from “FarmVille” to “CityVille” to “Words With Friends,” the Scrabble-like game made popular on mobile devices.

Zynga shares fell 31 cents, or 11.8 percent, to $ 2.31 in after-hours trading. The stock closed up 11 cents, or 4.4 percent, at $ 2.62 in the regular session.

Social Media News Headlines – Yahoo! News

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Steelers QB Roethlisberger testing hurt shoulder

PITTSBURGH (AP) — Ben Roethlisberger can hold his newborn son Ben Jr. in his injured right arm just fine, thanks.

When the Pittsburgh Steelers quarterback will be able to say the same about a football, even he's not sure.

Roethlisberger practiced in a limited role Thursday and appears a long shot to return for Sunday's game in Baltimore.

"There's always a chance," Roethlisberger offered somewhat hopefully.

The lengthy list of issues still plaguing Roethlisberger more than two weeks after he sprained his right shoulder and suffered a dislocated rib in a 16-13 overtime win against Kansas City, however, suggests he's still a week away from giving it a go.

Though the pain isn't quite as intense as it was in the days after Kansas City linebacker Tamba Hali drilled Roethlisberger into the soggy Heinz Field turf, the two-time Super Bowl winner can still only sleep in certain positions at night. And while he's tested the shoulder this week, he's uncertain if he can make all the throws necessary to attack Baltimore's secondary.

"Can I put a lot of zip on the ball, throw it really hard before people like Ed Reed and defenders can get to the ball?" Roethlisberger said. "If I can't I'm not putting us in the best situation to win the game."

The Steelers (6-5) have struggled in Roethlisberger's absence, needing overtime to beat the woeful Chiefs before looking listless at times and sloppy at others in losses to Baltimore and Cleveland. A season that looked promising after a 24-20 win over the defending Super Bowl-champion Giants in New Jersey on Nov. 4 is suddenly on very shaky ground.

Still, don't expect Roethlisberger to push too quickly. It's something he's done in the past, with less than desired results. He played on a battered right ankle in San Francisco last year, limping around in a 20-3 loss. He ended up sitting out the next week and wasn't the same when he returned.

"We've had people talk about last year in San Francisco, if I would have rested maybe I would have been better off the next couple games but to me, I live for the here and now," he said. "I'm going to do everything I can to be out there and if it doesn't work then I'll do what I can about the next week."

Offensive coordinator Todd Haley said Roethlisberger threw "a little bit" on Thursday but the team continues to prepare as if Charlie Batch will make his second straight start. Batch completed 20 of 34 passes for 199 yards and three costly interceptions against the Browns, mistakes Haley attributed to rusty timing more than physical ability.

"I don't think there's any limitations to what Chuck can do," Haley said, "or needs to do with the guys we have."

Roethlisberger remains optimistic Batch can muster some of the magic that helped him lead the Steelers to three victories since 2010 while filling in for his good friend.

"I firmly believe that," Roethlisberger said. "They know what he's capable of. He's been doing it a long time. They respect him. I think he's ready to rise to the occasion."

Something the Steelers need to do if they want to build any momentum going into the final quarter of the season. A loss in a place they struggle to play well in — no matter who is behind the center — would leave them with no wiggle room whenever Roethlisberger gets back to work.

The game's importance is not lost on Roethlisberger, who will wear "juiced up" pads to protect his shoulder, though doctors have told him the dislocated rib no longer poses a threat to his aorta.

That's welcome news for a guy in the first days of fatherhood. Roethlisberger called being a dad "pretty cool" and while he's enjoyed the time at home, he's also eager to go back to his job. If he doesn't play on Sunday he'll do what he's done the last two weeks and stand on the sideline — earbuds in place — and provide the kind of insight Batch has imparted on him so many times though the years.

"It's hard for me," Roethlisberger said. "You watched me during these games. I've been on the field more than most of the coaches because I'm just antsy to get out there."

That anxiousness, however, figures to be around for at least another week.

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NOTES: While Roethlisberger is doubtful, S Troy Polamalu appears ready to play for the first time since Oct. 7. Polamalu practiced for the second straight day and barring a setback should be on the field in Baltimore. Polamalu has been limited to just five quarters all season due to a strained right calf ... Rookie G David DeCastro continued to make progress in his first week on the active roster after recovering from right knee surgery in August. Haley said he expects DeCastro to make an impact on the field before the end of the season.

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Follow Will Graves at www.twitter.com/WillGravesAP

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Clearing the Fog Around Personality Disorders

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.

But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.

The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”

The entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?

Habits of Thought

It wasn’t supposed to be this difficult.

Personality problems aren’t exactly new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its rogues’ gallery of vainglorious, murderous dictators.

Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.

Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of “confounded identities” that are now considered personality disorders.

Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling — in who they were.

“These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired,” said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. “They had problems that were neither psychotic nor neurotic. They represented something else altogether.”

Several prototypes soon began to emerge. “A pedantic sense of order is typical of the compulsive character,” wrote the Freudian analyst Wilhelm Reich in his 1933 book, “Character Analysis,” a groundbreaking text. “In both big and small things, he lives his life according to a preconceived, irrevocable pattern.”

Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention.

In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.

These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.

Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.

This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a catchall label meaning little more than “this person has problems” became the most common of the diagnoses.

It’s a murky area, and in recent years many therapists didn’t have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.

Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.

“The diagnoses simply weren’t being used very much, and there was a real need to make the whole system much more accessible,” Dr. Lenzenweger said.

Resisting Simplification 

It was easier said than done.

The most central, memorable, and knowable element of any person — personality — still defies any consensus.

A team of experts appointed by the psychiatric association has worked for more than five years to find some unifying system of diagnosis for personality problems.

The panel proposed a system based in part on a failure to “develop a coherent sense of self or identity.” Not good enough, some psychiatric theorists said.

Later, the experts tied elements of the disorders to distortions in basic traits.

This article has been revised to reflect the following correction:

Correction: November 29, 2012

An earlier version of this article misstated the number of traits included in the proposed criteria for narcissistic personality disorder.   The final proposal relies on two personality traits, not four.

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