Dear Mistuh A.G.

For reasons too tedious to detail here, I will use this platform to compose the beginning of a draft to New York State’s activist attorney general urging him to take action.   This AG is the guy who successfully sued President Winner over his fraudulent university.   In NYS the AG also proposes and advocates for legislation, as it turns out.   I have a plan.  Relatively short, streamlined cover letter with several attachments laying out the infernal particulars.   Blah blah (see #1)  blah blah blah (#2) etc.

Dear Mr. Attorney General,

I am writing to give you an on-the-ground view of the stressful health care situation for hundreds of thousands of us in New York State.  As described more fully below, citizens of our state have no government agency that intervenes in cases where patients are mistreated by the corporations we buy health insurance from.   This is true even in cases of apparent fraud.  

I urge you to propose legislation to correct this grave oversight. The need for state regulation of health insurance is even more acute in light of the current federal administration’s determination to gut all regulation.

I’ve followed your career and admire the principled and proactive steps your office has taken against the powerful perpetrators of various frauds.  Leaving politics aside, as one must in a letter like this, it is gratifying to see someone in office holding powerful entities responsible for their bad acts.  Your office is well-suited to fix what I believe is a health care emergency affecting the lives of countless New Yorkers, particularly older citizens and those living just above the “poverty line.”

It has been difficult to put the many healthcare-related issues I’ve been forced to navigate into a streamlined letter.  I am certain that my experience as a consumer who buys health insurance on the New York State of Health Marketplace is representative of the experiences of countless others.  I have confirmed this many times over the last few years.  

As frustrating as my ordeals have been, I have the benefits of fluency in English, computer literacy, legal skills.  I cannot imagine the life-shortening stress that is inflicted on the elderly and other vulnerable New Yorkers unable to get so much as a hearing for often unappealable denials of their health care.  I’ve attempted to keep this letter short and to include the devilish details in a series of attachments.

I am therefore attaching a detailed description of the “consumer help” cul du sac that desperate NYS residents can spend a few hours in, looking in vain for help with health insurance-related troubles.  Anyone in your office can retrace the useless steps.  Creating a healthcare ombudsman position would be a good first step here.  (see # 1).  

Corporate “persons” are without conscience and motivated only by a zeal for profit.  When left unregulated, it is no surprise these “persons” act as they see fit.  In the case of health insurance companies, they are free, for example, to repeatedly refer patients to “in network” doctors who are not in network. They are also relatively unrestrained when refusing to provide services, in spite of what the Patient Protection and Affordable Care Act (“PPACA”) may have to say about it.   There is no penalty for these common business practices and they are well aware of it.  Regulations to address these things, with an enforcement arm, would be a good start.  (see #2)

Those mandated by the PPACA to purchase health insurance from the New York State of Health Marketplace may find themselves with a host of new problems during the short holiday season window for purchasing insurance.  A consumer advocate or ombudsperson would greatly aid in resolving problems and errors that presently can only be addressed by a lengthy appeals process.  See  #3

Billing irregularities, including improper bills, which are to be expected in a law as complicated as the PPACA, are probably the most common form of immediate stress most of us are regularly placed under.   The rep at your office’s consumer help desk offered help with billing problems, which I suspect are legion.   I offer a short overview of the larger problem and one recent snapshot as #4.

Thank you for your time.  I am available to amplify anything written here and to testify anywhere you may require.

Yours sincerely,

 

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Death by American Healthcare (part 2 of 22,000,000)

I won’t even mention Obama, except to say “fuck that charismatic sell-out punk and the whores he rode in on.”   I buy my health insurance through the New York State exchange under the immensely complicated compromise scheme crafted under his watch.  I suffer from a serious kidney disease.   I am unable to get an appointment with a recommended nephrologist who accepts my insurance plan, one of fifty or more sub-plans offered by the corporation that provides my health insurance.  

The insurance company has now listed three doctors, each one highly recommended, as  participating in my specific plan.   You call and eventually find out, oops, devil is in the details, they don’t actually participate.  The insurance company blames the providers for not keeping them updated.   I blame corporate medicine for fucking people to death with a tireless mechanical dick.  In fairness to them, there is no regulation of their practices, so why blame them for taking advantage?

Nothing I can write here will ease my frustration or rage one bit.  I might as well bang my face against the wall until I black out.  That is probably a better bet than anything else I can do at the moment.  

I just note for the, hahaha, record, that the theory of Obamacare is that doctors are fungible, interchangeable, any doctor is as good as any other doctor.   Relationships between doctors and patients, and trust, are irrelevant.  Better to pick a name out of a hat and see a doctor than to have no doctor at all, goes the theory.  Sometimes that goes badly, as when a doctor does not believe in sharing diagnostic information with a patient with too many questions.  “I am expert,” says the doctor, “you deal with side effects from chemo,” and that should be answer enough.  You want another doctor?  Dip your hand back into the hat, motherfucker, maybe you’ll do better this time.  

Or maybe you will run full force into a wall, over and over again, until you lose consciousness.  That is probably a better bet for you today.  Have a nice day, your business is very important to us, please continue to hold.

 

Death by American Healthcare

Richest country in the world, blah, blah, blah.  Only wealthy country that lets thousands of its citizens die every year, deaths that would have been prevented but for lack of access to affordable health care.  Only country in the world where basic medical services are a commodity, administered on a profit-based model by corporations whose sole mandate is to increase profits for shareholders.  Blah, blah, blah.    The Devil, as always, is in the details.   Death by American healthcare is not always as straight-forward as it seems.

 I vented to Sekhnet’s long-time doctor about American Corporate Medicine, and the externality that, to keep profits as handsome as they are, 50,000 Americans dying preventable deaths every year is reckoned an acceptable ‘cost of doing business.’  

“Where did you get that number?” the doctor asked.  

“The number I always hear is 45,000, but I’m hopped up because I haven’t been able to see a new nephrologist for my progressive kidney disease, so I added 5,000.”

“You can add a lot more than 5,000.  Those statistics are deaths based on documented ER visits when the disease is discovered in its final stage.   Many more Americans than that die preventable deaths every year.   You can probably multiply that 45,000 by some factor to get the actual number of Americans who die for lack of access to affordable basic health care.   How many more die without ever getting to an Emergency Room?  Those dead Americans don’t even get to be statistics,”  the doctor said.    I don’t dispute the good doctor’s point.    

As a man who has now had to change nephrologists so far three times (in less than a year), and is currently without care for my kidney disease as I look for a fourth nephrologist,  as a result of Obamacare’s immensely complicated private insurance scheme, I take Obama’s famous “if you like the doctor you have, you can keep your doctor” lie personally.  That poised, principled, hilarious, smooth-talking bitch looked me sincerely in the eye and lied to my face.  

I’d have liked to have stayed with the second nephrologist very much, instead I was forced, by income-based insurance laws, to visit one who was arrogant, defensive, insecure and argumentative.  As a result of her healthcare inexpertise, and the intricacies of the government-private insurance partnership, I am now more than two months without medical care for my progressive kidney disease, kidney disease the final nephrologist labeled an emergency case.  My kidney disease is of unknown origin, though all studies seem to agree that stress makes it worse.

“You mustn’t take these things personally,” says a random anal sphincter, passing by.  

Of course, it is absurd to think that Mr. Obama lied to me personally, offensive for me to refer to him with the gender insensitive “bitch” rather than as a dick or corporate shill.   He did his best to make positive change, President Hope and Change.   Mr. Obama was certainly a much better president than his predecessor, a limited man run by a cabal of psychopaths, and his successor, a man who needs no introduction.  

By the same math, of course, Mr. Mussolini was much better than Mr. Hitler and Mr. Stalin.   That is just hyperbole talking, a gratuitous rhetorical flourish, snapping snappishly.   Nobody is comparing any American president to these maniacs, it is a grave national insult to do so and it removes history and morality from the equation.  These were dictators, for one thing, our leader is democratically elected.   The tens of thousands, perhaps as many as a million, killed by the three most recent American presidents are not comparable to the millions killed by brutal dictators like Hitler and Stalin.  Collateral damage deaths in war zones are not the same as deliberately mass murdered civilians, even when they are the direct result of an errant smart bomb or a mistaken “signature” drone strike, or they are children who die as a result of an embargo of food and medical supplies.   A fine point to the families of the dead civilians, perhaps, but a discussion for another time.

The problem with assessing the real world effects of our presidents is that we don’t even have the language to talk about it.  Without a frame for the discussion, it is hard to understand how someone like Obama, who spoke eloquently from his heart on many matters of great public importance, at the same time steadily supported the powerful forces that run our pernicious status quo and ensured that any change proposed would be incremental, at best.  

Obama campaigned on “Hope and Change” with a slogan of “Yes We Can!”.   Campaigns and their tag-lines are pretty much PR bullshit, we all know that.   Reagan used “Make America Great Again” along with “Morning in America” and a bunch of other glittering, meaningless phrases.  Anyone who voted for Obama truly hoping for the advertised hope and change was clinging sadly to hopes inspired by a very successful marketing strategy.  Obama himself repeatedly told the people who voted for him that it was their responsibility to push him to keep his promises, though he phrased it more flatteringly to himself. 

Let’s take a glance at Obama’s presidency.  Before he was in office very long he was awarded the Nobel Peace Prize, for things he said as a candidate, presumably. When he accepted the prize he spoke eloquently about war, poverty, racism, but asked us to recognize that while he stood on Martin Luther King’s shoulders, his hands were somewhat tied.  As president, he reminded us, he would have to authorize the ongoing war on Terror, order extrajudicial killing by weaponized drones and engage in other violent policies Reverend King might not have approved of.   He humbly asked us to remember that there is only so much an American president can do about the institutional violence of militarism, racism and poverty.

“Everyone knows you don’t mess with the American war machine.   War is deadly serious bucks, man, it’s a powerful, lucrative industry with unlimited clout and, truly, if we’re completely honest about it, you cannot separate the American war machine from racism and poverty, and if I tried to, particularly as the first black president, I’d be a dead man, I promise you,” is something he didn’t need to add.

The reason my disgust for Obama exceeds my disgust for Dubya is that I expected nothing from the strikingly incurious Dubya and I expected something from Obama.  Obama might have come into office and turned the page back towards a world order based on international law, as most of the world was keeping its fingers crossed he would, for example.   This was the direction international law was headed when Mr. Bush took office in 2000, pursuant to a one-off Supreme Court decision declaring him the winner of a close and disputed election.  The Bush administration went on to flout international law, create a novel doctrine called Preemptive War, commit war crimes (with full preemptive legal immunity for the perpetrators), and serially violate the Geneva Conventions and other international treaties against torture and inhumane treatment.  

Obama took the high road, promising to look forward, not backwards, refusing to hold anyone accountable for the atrocious state policies carried out in our name.  Eventually he had the personal courage to publicly acknowledge that, in those confusing days after 9/11, and with the best of protective intentions, “we tortured some folks.”   Good speech, bro.

The term we are searching for is neoliberal.   Bill Clinton was a neoliberal. He was liberal on social issues: a woman’s right to choose, freedom from discrimination, protection of civil rights and the social safety net, proactive policies on Climate Change and environmental protection, gay rights, pubic education, access to affordable health care, freedom of speech and expression, etc.  He was neoliberal when it came to economic policies that disfavored corporate power– he took action during his presidency to ensure that large financial interests prospered.  He smiled as he reported great economic growth on his watch and claimed that a rising tide lifts all boats.  

He also signed several key pieces of right-wing legislation that did a lot of harm to the poor and swelled the bloated U.S. prison population, disproportionately with people of color.   He had the charisma to carry it off and to be remembered as a popular liberal president.    Until Obama, many called Clinton our “first black president”.   He was a neoliberal, a social liberal capable of forming alliances with the extreme right in the interest of promoting the continued growth of the “Free Market”.

President Bush didn’t have much to do, from an economic point of view, when he took over in 2001.   He cut taxes for the very rich, as anyone in his position would have, but Wall Street was humming, as it had been under Clinton.  Clinton signed off on the repeal of Glass-Steagall, which freed the biggest financial institutions to make risky, highly leveraged bets, backed by federally guaranteed money.  This led directly to the great scam that ended in the multi-gazillion dollar losses to Americans in concerted, industry-wide fraud by businesses too big to fail and the bailout of these crooked institutions by those same taxpayers.  

Obama presided over the aftermath of this, but nobody was ever prosecuted for the massive, coordinated fraud, the vast transfer of wealth to the wealthiest.   No serious policy changes were instituted to prevent a repeat, as Wall Street stabilized itself.   Obama’s financial brain trust was from Goldman-Sachs and the other top beneficiaries of the taxpayer bailouts.  Everybody who really mattered did very well under Obama, who also continued most of Cheney’s secretive policies, while giving moving speeches about the need for government transparency in a true democracy. The disgruntled masses who got a little poorer?  They are always belly-aching.

Neoliberalism, in matters of basic profit-making by corporations, the entities that are said to create all wealth in the “Free Market,” is identical to neoconservatism.    Their interests meet in their central belief that corporate freedom to thrive in a Free Market is essential to our way of life. For the market to remain free, government policy must give these corporations many protections, such as subsidies to oil companies, payments for agribusiness not to grow certain crops, no-bid emergency contracts, tax incentives, right to unlimited campaign contributions, a revolving door between industry and government to influence policy, financial bail-outs when their scams go south and so forth.  

Why is it called the “Free Market” if the government has to play such a key role in its operation?  

Because, if we told you the truth, the whole truth and nothing but the truth, it would make you want to rise up and smash our faces.  It really would.  

That’s why.

Insidious detail

Count on the New York Times to zero in on the big story, as it gives its sober, measured take on sometimes outrageous things.   Its piece detailing how the current president is doing everything in his considerable power to undermine and destroy Obamacare (and in fairness to him, Obama, a secret Muslim, was not even born in this country, SAD!) so that it can “implode,” contained this nugget:

The Department of Health and Human Services, which is in charge of administering the Affordable Care Act, has also been circulating bad news about the program.

I love that this is an aside, it reminds me of that throwaway line in the Bible about Onan’s brother: “the Lord slew him, also.”  The new administration is using taxpayer money to fund a campaign against the law passed by the previous administration.  Kudos to the Grey Skank for bringing this out!  

The rest of the short article is quite detailed in describing this quiet horror-in-progress, you can check it out here.

 

“Trying to suck his own cock”

There is the famous joke that explains much that is unexplainable in human affairs, most strikingly in the area of law.   How, for example, did an evil genius like Antonin Scalia do as much unappealable damage as he did, with no consequence to himself, outside of the eternal love of right wing extremists?  Here is the joke that explains it, an old one I’m sure you know.

“Why does a dog lick his balls?”

Because he can.

Nothing is illegal, absent a law that makes it so.  Things are evil, immoral, unethical, despicable, disgusting, infuriating, wrong, etc. but, unless there is a specific law against the hideous practice  — not illegal.   About these things judges and lawyers look at each other and say “de minimis non curat lex“, “the law does not concern itself with trifles.” 

Speaking of trifles, a frivolous lawsuit was recently brought by a blustering bully who owns a coal mining company.  This bully, named Bob, is a big Trump supporter and is almost as litigious as the man he supports for president.  He filed a lawsuit against a comedian who critically covered Bob’s shady practices and had a man dressed in a squirrel suit holding a sign that said “Eat shit, Bob”.   Here is what the ACLU filed in that case, as a friend of the court.  Scroll down to page two, the table of contents.  It will be the best hundred or so words you read all week.   The rest of the brief is a delight to read as well, Bob.

But I came here not to speak of fucking Bob Murray, CEO of a coal empire and man, from all appearances, bent out of shape from constantly trying to suck his own inconveniently located appendage.   I didn’t even come here to complain about the steep and disgusting decline in civil discourse since crude talking cock-suckers, ass-dickers and pussy-grabbers took over the West Wing, as well as the increasingly inclusive lunatic fringe of one of our two major political parties.  I am here to vent just a tad about a trifle that the law does not concern itself with.  

The law in question is the Patient Protection and Affordable Care Act, everybody’s favorite whipping boy.  It does not provide for very much regulation of the insurance industry, though the regulatory scheme for the consumers it protects is rigorous.  Uninsured consumers who qualify financially, for example, are mandated to participate, and to sign up during a single, very short annual enrollment period.   Insurance companies, on the other hand, can stop participating in the ACA program any time they fear their profits will be adversely impacted.  Like during times of increased profit uncertainty.   Like during times when the current president uses his bully pulpit to fulminate, Birther-style, against his predecessor’s signature law while cutting funding to the ad budget of the ACA and using tax payer money to run ads attacking the government program.   Like, now.  

There is no regulation, of course, of the practices of the state “marketplaces,” the exchanges where qualified people are required to buy their health insurance if their employer does not provide it.   Because the “free market” was given priority over “health care” to Americans (note the estimated 27 million of us still uninsured under the ACA), as an individual without employer subsidized health insurance you either jump through the exacting hoops of the PPACA or wind up without insurance of any kind.    Jump through all the hoops perfectly and you may still wind up screwed, with no recourse but a several months long line for an “appeal” at the marketplace that screwed you in the first place.  No need for state regulation when the marginally competent government agency itself is able to provide all the due process necessary.

My dealings with three different insurance companies, at three different income levels, and my ongoing nightmares with Donna Frescatore’s New York State of Health Go Fuck Yourself Self-serve Marketplace, have demonstrated over and over the need for state regulation.  Today I called a second replacement nephrologist on my health plan, this one recommended to me by a doctor friend (what happened with the prior one, recommended by another well-respected doctor, is yesterday’s news).  Today I learned, once more, that just because the insurance company has the doctor listed as a provider does not mean the doctor is actually a provider.  Strike two, get back in the batter’s box, motherfucker, before we call you out for delay of game…*

Mistakes are made, the passive voice used.   Humans are only humans.  Corporations have feelings too, they are called “profit” and “loss”.   Why am I so judgmental?  Why can’t we all just get along?  Why don’t I just shut the fuck up already instead of venting about this de minimis inconvenience to my hypochondriacal kidneys?   Who do I hope to influence by writing these words?   Why do I insist on seeing the glass of syphilitic piss as half full, instead of half empty?    Why am I not pouring all these incendiary details into my letter to the Attorney General?  Why so many questions?

Anyway, now it’s Friday evening, at long last.   Why is nobody pouring me a cold glass of beer as foamy, and richly golden, as a beaker of my own protein- rich urine?  It’s Miller time, is it not, Mr. Stephen Fucking Miller?  … if that is your name.

 

 

*    Sports fans will note that, under the rules of baseball (where balls and strikes come from) a batter cannot be called out for “delay of game” (in the National Football League it can result in a five yard penalty, a complete non sequitur in baseball).  The footnoted sentence is what’s charitably called a mixed metaphor.  If I told the ump to go fuck himself, that the threat to throw me out for delay of game is ridiculous, and not in the rules of baseball, the ump could call me out for “arguing balls and strikes,” a rule giving ample grounds for my ejection.  As always, de minimis non curat lex, baby.

 

Surviving the American Death Panel

When healthcare is a profit-driven, corporate industry, as it is here in the wealthiest country in the world, competitive companies and some individuals will become very rich participating in it.  Sadly, people also die under such a health care system, which tends to be as expensive as the market will bear.  Those who don’t die often face personal bankruptcy for bills incurred during life-saving medical interventions.   These are, one supposes, the price we all pay for freedom, for the exalted Free Market.   Americans should be free, under our system, to pursue unlimited wealth and damn the torpedoes.   Sick people die, poor people die, not our problem or responsibility, as individuals in the Free Market or as a society.

Part of the corporate structure is hierarchy, in which each level is accountable only to the ones above.   This produces natural caution, a reflex to self-justification and a tendency to ass-covering.  A related side of corporate life is patriarchy, for lack of a better word.  Corporations tend to dictate terms, be rigid, owe no explanation, erect obstacles to information and have procedures to ensure that their policies are inviolable and untouchable by courts of law.  They are not known for flexibility, fairness, even common decency.  They behave this way because they can, because they write the laws that govern them, finance the elections of their bought and paid for candidates.    

What does all this have to do with my own inability, so far, to see either of the two nephrologists recommended to me by a doctor I respect?   I shall tell you as briefly as I can, as I suffer silently with idiopathic kidney disease.

By chance, on the recommendation of an acquaintance of  a friend, who got the doctor’s name from a list, I saw a patriarchal nephrologist, a female patriarch by chance, who dismissed my questions about nutrition, life-style, alternative treatments, supportive therapies, recent studies of my disease I could read.  None of these things would help me, she said.   She urged me, from our first meeting, to immediately begin side-effect rich immunosuppressive therapy.  Months 1, 3 and 5 begin with three consecutive days of IV corticosteroid infusions and it takes off from there.

This immediate immunosuppressive therapy is called for, I eventually learn, only for high-risk patients, those with a high daily proteinuria count and other risk factors.   All other patients are advised to wait, and watch, as a cure without this regime is about as common as a cure with the sometimes devastating immunosuppressive treatment.   The statistics argue for waiting, and rechecking levels every couple of months absent a medical determination that you are in the high risk category.  

This nephrologist assessed me as a high risk patient without ever checking daily proteinuria levels and even though my kidney function is normal.  She did not share her diagnostic findings with me, beyond saying the disease was getting worse and urging me to start with the IV steroids.  She never mentioned a risk category or the reason for the haste.  She told me over and over that I need to start immunosuppressive therapy right away.

I was never told why I am at high risk as I was being pressured into starting the immunosuppressive therapy ASAP.  Patriarchs and corporate types do not owe such explanations.  They offer the service they deem correct.  To this end, I was manipulated into having a medically unnecessary biopsy done.  The necessity of the biopsy was that it is the last part of the protocol before immunosuppressive therapy.  I was told it would show the precise stage the disease has progressed to.  I’ve since learned it cannot really show this with any precision.  

For a long list of reasons, I lost faith in the defensive, argumentative, dismissive nephrologist.  I simply could not trust her, in spite of her strenuously extracted, and meaningless “unconditional apology”.   She was about as sincerely repentant as Trump was about being the nation’s number one Birther.  

I got a recommendation for a senior nephrologist.  As luck would have it, he was in the same practice group as the original patriarchal nephrologist.  I was told the two doctors would have to discuss the switch, as they generally did not see patients of other doctors in their group.  I was told my nephrologist needed to consent to the change and the other doctor had to agree.  

My nephrologist seemed to consent in a terse message: I have instructed my front stuff.   Her front stuff told me, each time I called, that the doctors were still deliberating.  After three weeks of calls to make an appointment I was told that they never, under any circumstances see a former patient of anyone in the group, it was an inviolable rule.   As Jane Fonda’s character in Grace and Frankie said the other night, during a vexing moment: “fuck me in the eye!”

I went to a good deal of trouble and expense to get another recommendation.   Thankfully this doctor was on my health-insurance plan.   I called the number the insurance company had listed for him, to make an appointment.  It was a wrong number.  I called the insurance company and was given two more numbers, not available on their on-line participating providers list.   They connected me to the doctor’s office.  

The doctor’s receptionist informed me that they do not participate in the plan, that Healthfirst has them listed incorrectly.  They only take insurance patients for the private dialysis center they run, but are not participating nephrologists for any other purpose.  This receptionist was knowledgable about insurance law, telling me, for example, that it is a crime to pay a doctor out of pocket if you have insurance coverage.  She referred me to an NYU nephrology group, the same one who had treated me so unethically. She was not all that sympathetic, in my opinion, and after snarling a bit, and cutting me off, hung up on me before I could tell her to fuck off.

Which was just as well, I don’t find it very satisfying or effective to tell unreasonable, nasty people that they are unreasonable or nasty.  In the case of this receptionist, there was really nothing more she could do.  That I had one final , quick question, which would have the same answer as all the others, was nothing compared to her duties to the patients waiting in her office as she was wasting time talking to a non-patient with an attitude problem.

“If you like the doctor you have, you can keep that doctor,” promised President Hope and Change, the former Compromiser-in-chief, while negotiating against himself during the passage of Obamacare.  If you don’t rate him highly on that promise, remember that he never came in America’s mouth.  Not explicitly anyway.  The people we have in there now, hoo boy, talk about death panels and forcers of unwanted touching.

My task now is to figure out how to use this ill-designed system against itself to get the treatment I need for this potentially fatal disease I am up against.  A disease that, thankfully, seems to take a long time to finish you off and that, as mysteriously as it comes, sometimes disappears by itself.  

I don’t know how interesting this has been to read, if at all, but I note that the knot in my chest I woke up with seems to have unloosened itself by a turn or two, and that is a very good thing.

 

The Shoelace

Bukowski’s great poem about the killing nature of the accumulated frustrations we are powerless against captures the accursed essence of our lives here.  It’s that constant swarm of trivialities, culminating in a shoelace that snaps with no time left, that finally breaks a man, sends him to the madhouse.  

“I will not be broken,” he said to nobody.  

Of course you won’t, nor die, either.  

Toilet doesn’t flush.  Call super.  See you between 6 and 7, he says.  At 9:30, after several chats with the lying super, his two underlings arrive.  One shows me how, by forcing the flush plunger inward toward the pipe while pushing it down, you can get the broken device to flush.  This works four or five times after they leave, then, kaput.  Meanwhile, new part ordered for your antique toilet, will take a week.   Super recommends improvising, try not to shit for a week or so, the toilet will eventually be fixed.  

New York City does not have an answer, besides take the landlord to Housing Court.  You look for on-line help.  The help number on their handy PDF on Housing Code Violations connects you to a wrong number.  

Doctor friend provides new information on best practices for treating your idiopathic (“cause unknown”) kidney disease.   The medical journal article she’s copied for me calls for watchful waiting before IV steroid therapy if daily proteinuria level (the amount of unfiltered protein your kidneys pathologically spill into your urine) is below 2 grams.  Doctors have no idea what my daily level is, that requires a 24 hour urine test to determine.   If you think the nephrologist who charged $860 for my first visit would have known to order such a test, you think wrong.  She urged me to have an unneeded, expensive, kidney biopsy instead.  

It’s been complicated hearing back from my primary care doctor on the 24 hour urine, how to get the jug that I will collect 24 hours of urine in.  Only two or three calls to his office so far.  Maybe the third or fourth call will be the charm.

You learn, too late to save the several thousands of wasted dollars, that the so-called Silver level health insurance plan you bought, hoping for better treatment than you had last year on the “Essential Plan”, the plan you are paying almost 900% more for (after the subsidy, restored only seven months after being erroneously removed), gives you coverage identical to what you had last year on pay-as-you-go Medicaid.   I must not think of the more than $4,200 flushed down the toilet– especially now that my toilet doesn’t flush.  

The best things I write these days, I have to pull teeth to get any feedback on. I write these things ’til my forearms ache, and read them aloud to Sekhnet.  She tells me some of the recent ones with the skeleton are excellent overviews of this ambitious, highly speculative project I embarked on almost twenty months ago.   I heard an interview with Aaron Copeland, late in his life, lamenting that so few people heard his new music, wondering how a composer goes on without an audience to hear his work.   I felt bad for him, even as I wondered where he got the temerity to whine about not being as famous as he used to be.

The list goes on and you begin to wonder about the futility of trying to persist.   How long a NYC landlord has to fix a broken toilet, under NYC law, should not be such a mystery.  It is.  You take a bucket and manually flush the toilet, it takes at most two or three buckets full.  The bathtub is right next to the toilet, easy to fill the bucket as many times as you like.

So, shut the fuck up and keep bailing.  You’re lucky you live in a place where there are flush toilets, bountiful running water, sanitation, a medical industry, a semi-functioning government.  You have fucking first world problems, white boy.

“Well, as I always said, Elie, you’d complain if you were hung with a new rope,” said the skeleton of my father.  “With your fertile imagination comes an ability to brood that is beyond the powers of most people.  Not that I envy you, I’m just sayin’.”   

Yeah.   Be careful when you bend over.