Healthcare as a human right

The radical right is consistent, most of the time, I have to say that for them.   They latch on to something like “Right to Life” (no abortion under any circumstances) or “Right to Work” (the legal right of the employer to fire your ass at any time, with or without cause) and ride it to the end.   Their disciplined relentlessness is impressive, even if it’s not always good for democracy, people, animals, plants, children, old people, babies, the environment, health, human dignity, human survival.   The important thing is that they give their supporters a rallying cry to scream, a cry that never changes, if it works.   That these phrases may not bear much scrutiny as ideas in the marketplace of ideas is not the point.  Winning is the point, the only point.

As Republican icon Ronald Reagan said, either being pithy or already in the first throes of dementia: “the right to life ends at birth.”   “Right to Life” means that the right of a fetus to be born is absolute, more absolute than a mother’s right not to die from complications of pregnancy, far greater than the right of a fourteen year old girl not to have to go through the trauma of giving birth to her rapist’s baby.   Like every right extended, except to wealth that has perpetual life (corporate folks, persons just like you and me except they never die) it terminates at a reasonable time.   In the case of an unwanted baby, the right to life ends as soon as the poor bastard is born, breathing air and crying.   When the unwanted child is born society says “you’re on your own now, motherfucker, we protected you for nine months, your own mother wanted to kill you, but we saved you from that murderous bitch.  Now get the fuck out and get a job, asshole. And try not to stink so much… can’t you change that sagging diaper already?  No self-respect, you little shitass…”   Nothing to see here.

The way America’s wealthiest and least scrupulous organized themselves to make sure Obama was not able to get bipartisan support for anything, especially his hated plan to give access to healthcare to more Americans; priceless.  Jane Mayer reminds us that when Ted Kennedy’s death in 2009 left a vacancy in the Senate, a flood of dark money was unloosed immediately before the special election in Massachusetts.   After that election unknown Republican Scott Brown would sit in the seat occupied by a Democrat (a Kennedy, in fact, Ted took over JFK’s seat in 1962) from time immemorial.   Read all about it here.  

The Koch influence machine (the Kochtopus, as admirers dubbed it)  had secretly pulled off a stunning, history defying upset in a blue state that hadn’t had a Republican senator in generations.   Wikipedia is pretty even-handed about the invisible tentacles of the Kochtopus:

As of January 8, 2010, Martha Coakley raised over US$5.2 million in total, and had $937,383 cash on hand. Scott Brown had $367,150 cash on hand. Brown spent $450,000 on television advertisements, while Coakley spent $1.4million.[99] A week before the general election, Brown raised $1.3million from over 16,000 donors in a 24-hour fund-raising effort. Reports also indicated that Brown raised an average of $1 million per day the week prior to the election.[100]

The effect of this historic upset was that the Senate, with Brown, was now 59-41 Democratic, meaning Obama’s majority in the Senate, although impressive, was no longer filibuster-proof.   The loophole now existed for the entitled vulture class to defeat the hated president’s hated, albeit mostly conservative-think-tank-created, healthcare proposal.   The compromise that became known as the Affordable Care Act, when it was passed, had many, many faults, none of them ever fixed.  The ACA contained a few huge improvements over America’s past ruthless health insurance regime, the biggest being the abolition of the vicious “pre-existing condition” loophole that allowed health insurance companies to only insure people who were good bets not to need massively expensive healthcare.   The business of America is business, how it is fair that some fuck with cancer expects to get all those expensive treatments and drugs paid by insurance?   Pre-existing condition, totally unfair to make the insurer pay!

Some socialist types, and others, believe that included among the rights of citizenship in a wealthy society is the right to decent, affordable health care, administered through a publicly supervised health care system.   Americans pay by far the highest prices for our health care, far more than the citizens of other wealthy, industrialized nations, yet our health outcomes are no better than most places, except, arguably, at the very top end of American medical care.   Wealthy patients can always seek out and buy that top high-end healthcare, if they want to pay for it (and why not? they deserve it).  

The rest of us believe we have a right to not die of the many preventable and treatable diseases that are always stalking us.  A “right to life” if you will.   50,000 or more dead Americans every year who die because their only access to health care is an emergency room where the ER doc will say to a family member “oh shit, if only we’d seen him two years ago…”   These unfortunate American dead and their loved ones unwittingly make a sacrifice for all of us, a small price to pay for the freedom of eternal, legally created “persons” to live in perfect liberty, enjoying maximum profits protected by a friendly government, with the populist cover of a manipulated mob of confused, angry, powerless people chanting “USA!   USA!!!”.

I get my health care through the problematic Patient Protection and Affordable Care Act.  I can tell you dozens of ways the law sucks, and have written about many of them here (click the category Obamacare to read ’em).   Top of my list is the difficulty of actually finding care in this corrupt, lobbyist-written regime.   After years of rabid Republican opposition to the law, and more than fifty attempts to repeal it in its entirety (check ’em out), some elected Democrats are organizing to fight back with the hated “public option” (something that already exists and works pretty well for millions of Americans 65 and older, as well as in most other wealthy nations).   Seventy Congressional Democrats have apparently formed a caucus to discuss lowering the age of Medicare to cover even that fucking unwanted baby who selfishly insists on its right to care after the government has already zealously protected its ungrateful little ass for nine long months.

Here’s the petty detail that bugs me today, as I work on rehabbing my aching knees.  It took me about a month to find and get an appointment with a sports medicine doctor for a referral to Physical Therapy (PT).   A rep for my health-insurance company (think of how fucking asinine it is to give people health care via private, profit-driven insurance companies…) assured me that referrals are no longer required by their company for things like PT.   Every place I contacted about PT disagreed.  Obviously, they said, you have to have a doctor’s referral before we can give you PT.  Made sense.   I finally was able to see the sports medicine doctor who immediately referred me for PT.   Then it was a few weeks of searching, not getting calls back from the “in-network” PT offices where I left  messages, until I finally hobbled over to a place I could walk to that accepted my insurance and where I could have PT.    

Note this:  every week I searched, without finding service, every obstacle I had to crawl over to get to the next step in finding treatment, was money in the pocket of the insurance company.  Multiply my search by a few thousand searches, by a million, and you begin to get the idea of how lucrative it is to make this basic of medical care, finding and seeing a doctor in your “network”, so difficult.

There was one last hoop to jump through on my ailing knees, now weeks and weeks, months, in fact, after they’d become acutely painful.  I’d have do be “evaluated” for PT for my knees, by doing a half squat with my back against the wall of the PT room.  I did the half squat and was told now all I had to do was go home and wait to see how many sessions my insurance company would approve.  You see, the doctor is not the one who decides what’s medically necessary, nor is the physical therapist, it is someone at your insurance company who decides exactly what course of treatment, under the current law, you are entitled to.  Fair is fair, they’re the ones paying, you dig.

They decided I was entitled to seven sessions of PT, twice a week.  If you do the math, the approved PT would last just over three weeks.  Not much time to fix a problem that had taken a year or more to get this bad, now I just had to wait until they got the go ahead from my insurance company.  A week later I was able to start PT.  It is slow going, physical therapy.   No long-festering physical ailment can be cured in seven sessions.   After session six I asked the receptionist at the PT place what I had to do to get more sessions.  Another referral, she told me.   I contacted the office of the sports doctor I’d seen for a second time a week or so earlier.  After session seven of PT I was told that once the referral arrived I would have to be re-evaluated.

Stand against the wall in the room where you’ve completed your seven sessions of PT and squat as far down as your creaky knees will take you, then just go home, without further treatment of any kind, and wait.   In about a week, if all goes well, they would get the OK from the insurance company, if your particular insurance policy authorized more physical therapy for you.  Then, the following week you could continue your PT, with only, at most, a short one or two week gap.   You see, it’s impossible to determine if you’ll need more than seven sessions until you’ve completed seven sessions, right?  That’s just basic logic, right?   No matter what your fucking know-it-all sports medicine doctor might have to say about it (the rehab could take several months of hard work, she told me sympathetically).  No matter what.

God fucking bless America, boys and girls!

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Did the Nazis actually win World War Two? (part two)

The following series of frustrating interactions with corporations involved in my medical care got me thinking how thoroughly the world now seems to run on the principles laid out, for corporations, by the famous Nazi party that ran one of the most powerful modern industrialized nations in the world for twelve of their planned thousand year rule.  These principles extend beyond lying, advertising falsely, assuming no responsibility for anything, blaming the victims, into how individual customers are cared for.  Nazi methods, once shocking, are now the routine way masses of people with any kind of problem are treated. 

Sounds overwrought, I know, to compare the now standard corporate runarounds  to techniques perfected in the Third Reich, but bear with me and you may yet be persuaded I am not merely talking through my tin foil yarmulke.  The amount of stamina and self-possession needed to have a corporation fix it’s own error, no matter how minor, is incredible.  We are often exhausted and resigned before we actually get to speak to a human.  This too is part of Nazi-inspired design.  Think about it.

The burden for correcting corporate mistakes always falls to the consumer.  Fair enough, why would a corporation care about a mistake, as long as it’s getting paid?   Profit is the bottom line, not worrying about the gripes of malcontents here and there.  A series of hurdles are erected to limit the number of complaints the lowest paid workers of any corporation will be forced to listen to on any given shift.  

It is fairly standard to have to navigate 3-5 minutes of robotic prompts and advertising, along with requests to stay on the line for a survey about the “service we are about to provide” before being placed on hold to wait for human representatives who are all busy helping other customers.  They urge you to handle your problem via their website, which enables each problem to be dealt with in a fraction of the time (if at all) and at a tiny percentage of the cost of having humans talking to other humans on the phone.

I’m not naive.  I get it.  Hire enough representatives to help everyone you are providing poor service to, without the long waits, and you cut directly into the corporate bottom line.  A ten minute hold, with blaring, nerve jangling muzak, to talk to customer service weeds out a good proportion of the whiners waiting helplessly in line to express how pissed off they are about some trifle or another.  It is simply the way it is done today in our era of global corporatism.   Corporations do what is best for corporate profits and that’s that, ask the U.S. Supreme Court if you don’t believe us.  You got something to say?  Please continue to hold, we thank you for your patience, your business is very important to us.

I was hit with a nice triple or quadruple whammy the other day just trying to get renewals for prescription drugs I’ve been taking daily for the last few years.   After weeks of looking for a physical therapist to help me with my stiff, painful knees who accepts my insurance, I took a break from leaving voicemails that were never returned and walked up to a nearby address provided by my insurance company and next week I’ll be evaluated for PT.  

“Evaluated?” I said, “I just gave you the doctor’s referral, detailing exactly what PT services I need and why.”

“We have to examine you first and submit a report to your insurance company and wait for approval before we can provide any services, that’s the law,” the pleasant receptionist told me.   Then she said that this approval ordinarily takes no more than two weeks.   Which will only make a total of five weeks since I was referred for physical therapy by the doctor who examined me.  

I vented a bit about American medical care, making sure my satirical, semi-humorous presentation was coming through as nonthreatening and ironic.  I was rewarded with a sympathetic smile from the receptionist who told me kindly that it might be less than two weeks, sometimes it’s much faster.

When I got home I followed up again on the status of getting my prescriptions renewed, a blood pressure drug, a statin and megadose Vitamin D, after hours of wasted calls with the corporation who dispenses them.  I’d had a long discussion with a rep named Don, at CVS Caremark, on May 25th.  Don assured me that he’d contact my doctor and get the prescriptions sent over to CVS Caremark, that I’d have the pills long before my dwindling supplies ran out.  

He then asked me to hold one more time, this was 48 minutes or so into our call.  I asked if he needed more information from me.  He told me he didn’t and agreed he could call me back if there was any problem processing the order.

The only problem is, reasonable as this may sound, that is not their corporate procedure.  If the customer does not stay on hold until the very end, the call is recorded as “customer disconnected” which was the notation Don made on my call, after assuring me everything was cool.  It was all cool for Don, why the hell wouldn’t it be?  The man has a job he loves, living the dream.  

Maybe Don wasn’t as amused as the receptionist pretended to be by my witty send-ups of our sickeningly broken profit-driven American health care system.  Maybe he was politely seething under his MAGA hat, imagining this demanding and ruthless prick he was dealing with, someone who expected to just be let off the line after only 48 minutes, at least five of them spent whining at tedious, didactic length, about the corporatocracy we all take for granted as simply the way the world is.

I learned my order was not being processed only by following up ten days later, when I hadn’t received the promised email confirmations of my order.   After only ten minutes on hold, and repeating all of my identifying info again, I was told the notes the corporation had for my May 25th call stated that the customer had prematurely disconnected from call, with the predictable result that no action could be taken on this jerk’s behalf.

An hour into my follow up call I conferenced in the doctor’s office where all the details were laid out by CVS Caremark rep Liz (only authorized to wait on hold for up to two minutes, exactly, she told me as she instructed me what to find out from the doctor’s office).  I put her on the line with the doctor’s receptionist, after a mere 35 second hold for Liz,  in a conference call and continued taking detailed notes.  Everything seemed to be straightened out, at last, and not a moment too soon.

This, sadly, didn’t result in the prompt resolution of my quest to have my prescriptions refilled.  One reason I prefer dealing with my local pharmacy, before they told me a few weeks back that my business was no good there.   I got an email from CVS in error, as it turned out, informing me that only one of my three prescriptions were listed on the order, which was pending.  

I followed the prompts and logged into the CVS Caremark website where I was able to confirm that only one of the three medications my doctor’s receptionist and the CVS Caremark rep had discussed was on order.  

I wrote a note to CVS Caremark in an attempt to fix this, have them update my prescription order, only to find myself in a permanent error loop “you have failed to update your email address” (which I had done by then two or three times).  Twenty five minutes of this was enough to convince me there was a technical problem with the ineptly written code for their website.  In order to get tech support with the website you must be able to send a message, after logging in.  Seamless and fucking brilliant, actually.

I thought of my former friend Andy and his ilk, mad fucking programmers and coders, well-paid guys on the Asperger’s Spectrum with no clue about humans, except as to erring like one.  The “Contact us” link on the website, of course, required you to be logged in.  You can’t contact anyone unless you update your email address in your profile, or even if you do.  Only option is to go through the standard four minutes of robot prompts and hold to wait to talk to a low paid human, who probably can’t help you anyway.  (Turns out she can’t).

Called the doctor’s office two days later to follow up on the status of the prescriptions.  The receptionist told me she’d left me a message.   My phone showed no messages or missed calls, then, when I went to renew the voice mail list, informed me again that it was unable to synchronize my messages because I  was not connected to a data network (I was).  

An hour call with T-Mobile tech support allowed me to hear the voicemail from the doctor’s office, a forty second tour de force of confusion and obtuseness.  I had Sekhnet leave me a voice mail to test it out, make sure the glitch with the voicemail was actually fixed.  “Error.  Unable to synchronize because you are not connected to the data network”.  

Another call to T-Mobile, another hour.  This time I got a $20 credit from the Nazi fucks (T-Mobile is a German corporation, originally) and delivered a few concise, impassioned but not overwrought, analyses of the inhuman treatment we are forced to take for granted in our corporate world that actually got great praise from the Indian kid I was talking to, the guy who granted me the $20 credit for the hassle I was in the middle of.   He “escalated” my complaint and I had a long pleasant chat with Leo, at the next level of tech support expertise, who couldn’t fix the problem either but promised to re-escalate my situation and get back to me ASAP with the fix (a mere 24 hours ago).  Leo sent me a text to this effect, with his identifying information.

 I am still unable to get voice mail, or log-in to CVS “Caremark” to update my prescriptions, but I am assured that everybody is working hard on my case(s) and I’m sincerely promised that everything will work out, as long as I’m as patient as…

By the way, remaining on the line the other day to the bitter end of a long chat with Liz (not to repeat the nonconsensual phone sex I’d had with untruthful Don), I  learned from the CVS Caremark rep that my pharmacy, who she contacted while I held one last time,  was not being paid by my insurance because they hadn’t updated my insurance information on their computer.  They had my old insurance policy listed, with a non-working customer ID number, and their bills submitted under that number were therefore rejected.

I dread to make the follow up call to CVS Caremark, now weeks after my original request to have the prescriptions renewed and filled by them, to find out why only my statin now seems to be on order.  (A few days ago only my blood pressure medication was on file).

In a country that was not obsessed with eternal, existential “competition” to separate God’s chosen winners (ubermenschen) from all the faceless fucking loser parasites (untermenschen, lebensunwertes leben, the “useless eaters”), masses of people with no rights a winner is bound to respect, it would not be quite so difficult to resolve simple fuck ups by the companies we deal with every day.   But that is the kind of dreamy sentiment only someone not sufficiently impressed with the importance of the corporate bottom line would express.  The dreamy Koombaya hallucination of a fucking born loser (note: most of us losers are born that way, as is the case for most winners).

“Please continue to hold, the Obersturmbannführer will be on the line shortly to facilitate your unrequested relocation eastward.  Meantime, try to control your fucking blood pressure without drugs, loser.  And dig this five second loop, played over and over at sudden wildly increased volume for the next ten minutes, by our house band, the Ultrasadistic Nervejanglers.  We think you’ll dig it, and if you don’t, oops.  Have a nice day and, please, for the love of all that is holy, continue to hold.”

Pharmaceuticals in America

I have no intention of researching and writing a piece about the folks who sell us legally prescribed drugs.   For a small, bitter taste, you can read this short bit about the wealthy family who helped bring us the Opioid Crisis.  Pharmaceuticals is a fantastically lucrative American industry up there with fossil fuels and munitions as far as the vastness of its profits.  I have to make a few calls today to line up a new drug dealer for my irbestartan and atorvostatin, as well as the weekly megadose Vitamin D, $2.50 a pill, that I’ve been prescribed.   The first two are generic versions of two famous patent drugs, Avapro and Lipitor.   Of Lipitor my mother used to say “I luhhhhhv Lipitor!”.   It seems to be lowering my cholesterol nicely, and not giving me any noticeable side effects, though I’m not sure I have the same passion for the little pill that my mother did.

Right after Obamacare, the Patient Protection and Affordable Care Act, became the law of the land I had a long chat with my local pharmacist, a sympathetic man named Bahdri.  He was lamenting what he expected of the new law.  He predicted that within five years all small pharmacies like his would be out of business.  The turf was being handed over to huge pharmaceutical distribution companies that were set up to deliver prescription drugs to millions of Americans under the PPACA.  It was the pharmaceutical version of Amazon.  No need to walk into your local brick and mortar store to get the shit you needed, just order it and pick it out of your mailbox a couple of days later.   Bahdri was gloomy about his prospects.

I liked my little local pharmacy.   I’d been having one of the drugs delivered to my home by an outfit called CVS Caremark, it was done automatically when the new drug was prescribed.   They’d send a ninety day supply of irbesartan.  I’d save five or ten dollars over the copay at the pharmacy.  I didn’t care about the few dollars, and arranged to have the prescription filled at Bahdri’s.  I preferred helping to keep a small neighborhood store in business.  As it turned out, I needn’t have been so solicitous.

Bahdri explained recently that the thirty day supply of one of the drugs cost the pharmacy $9 and my insurance reimbursed them a mere $1.37.   This did not seem fair to me either.  My new plan, a sort of pay as you go Medicaid, has no copay for drugs under a certain price (I paid a $10 or $15 drug copay on last year’s plan), and so Bahdri’s small store was getting screwed every time I walked in.  Bahdri informed me that the large chain pharmacy across the street would also not fill my prescription, certainly not the ninety day version.  He advised me to have the prescription sent back over to CVS Caremark.  I told him I would, and I will.

Yesterday, being out of one of the drugs,  I went to Bahdri’s to get four more 50,000 unit Vitamin D pills for the weeks going forward.   I take these because, after numerous skin cancers have been removed from my nose (and one from my arm) I avoid the fucking sun as much as I can.   The sun helps the body produce its own Vitamin D, or something like that.  The sun is very good in many ways, no doubt, but I avoid it.  This is no great sacrifice for me, as I stay up late, sleep late, spend my first few waking hours writing, wait for late afternoon most days to venture out.  I take most of my exercise around sunset or after dark.

Anyway I ran into Bahdri’s yesterday early evening to get the Vitamin D and his assistant (Bahdri wasn’t there) told me they no longer accepted my insurance and that Bahdri had told me as much the last time I was in.  I begged to differ, but my begging was not the kind of humble begging one usually associates with beggars.  I told him exactly what Bahdri had said and stated, with a lawyerly flourish, that Bahdri had never told me “your business is not wanted here any more.”  I suggested there was probably a law against a pharmacy denying a customer a prescription refill without some kind of prior notice giving the patient enough time to make other arrangements  (I doubt there is, of course, Big Pharma was in on writing the law).  I was beginning to get pissed off but reined myself in.  The pharmacist did his best to counter each of these points, but he was overmatched.

I demanded to know the price of the Vitamin D.  He hemmed and hawed.  I told him a few more times to tell me the price.  He consulted his computer.  The four pills were $9.95.  I tossed a ten dollar bill on the counter.  He told me he could not take my money, it was against the law, since I have insurance.   It was, he suggested humbly, sub silentio and without judgment, the kind of insurance only a homeless leper in his home country, an untouchable, might have.   Leper was my word, actually.  He was hurt that I had thrown the ten dollar bill at him.  He couldn’t understand it, as he assured me it was nothing personal, they just do not sell drugs at a loss to contemptible paupers like me.

I appealed to basic fairness, made another idle threat about using a law that almost certainly doesn’t exist.  He hemmed a bit, and then hawed some more.  I told him to save his breath.  He did. I was done strong arming him.  One of the kids who worked there handed me the four pills, I signed for them, and left, holding up poor Bahdri and his store once again.  Banned for life, like Pete Rose, from a store I have patronized for the last fifteen years or so.  

So today, as on so many days, I have to make some long, trying calls, try to navigate the hideous compromise with decent health care for all (except for at least 27 million or so odd Americans [1]) that President Hope and Change was able to negotiate with the health care free marketeers who wrote the law, folks who graciously agreed not to string him up as long as he didn’t try to fuck with their bottom line.

 Supreme Court justice Potter Stewart once said “Fairness is what Justice basically is”.  I’m not sure of the context of his remark, but I’m pretty sure they nailed that commie motherfucker to a cross and then burned the cross.   You can’t say stupid shit  like that here, not HERE, it’s just WRONG!  SAD!  Thankfully the guy we have now doesn’t need to be told any of this, or anything, really.

 

[1] This number went up somewhat dramatically in 2018 under President Highness’s rule, as he continues his tireless campaign to make America great again. As for the number of uninsured Americans cited above, it is based on the 2016 number, here is the  source

How It Is Done Here

I spent three hours at the opthamologist’s yesterday and left without what I went there to get.   I was screened for glaucoma and every other eye disease, after a very detailed vision test with the nurse.   Unfortunately, the doctor said, he could not give me a prescription for new glasses because nobody would pay him for it.   “I used to get $20, I’d charge $40 sometimes,” the solo practitioner with the crowded waiting room told me, with only a slight complaint in his tone.   In a few months, when I get the EOB from my insurance company, I’ll learn how much he made to spend ten minutes with me yesterday, above the $25 copay I had to make in cash. I’ll bet they pay him less than $100 for all those minutes.

The doctor claimed, at 4:00, seeing me for my 1:30 appointment, that the optometrists’ lobby (who knew, but why wouldn’t they have one?) had made it virtually impossible for an opthamologist to write a prescription for glasses.  Then, twenty minutes later when the drops had fully dilated my pupils, he chided me for my reflex to close my eye when something with a bright light approached to touch my eyeball to measure it’s pressure.  

“It’s not a reflex,” he corrected me, possibly incorrectly, “you just have to control it.”   On the second or third try he was able to touch the sensor down on my right eyeball, move it around.  The left eye wasn’t as cooperative.   Three tries and I was still blinking when he tried to touch the probe to my eyeball.  He snarled at my lack of cooperation.

“I’m not trying to be a difficult patient, doctor,” I told this affable, slightly gruff eye doctor.

“But you are being a difficult patient,” he said, suddenly graduating from gruff to asshole.

Funny, I had no reflex to say “I might have been a less difficult patient after waiting, say, only 90 minutes, or a scant two hours, for this exam you already told me will not result in what I came here to get, namely an updated prescription for these fifteen year old glasses.”

Nor did it occur to me, angry, scrappy, no tolerance for assholes person I have long been, to say “nor is it a reflex to be a dick, particularly after keeping a patient waiting for almost three hours.  You can control it.   I don’t give a fuck about how much you used to be able to charge for a prescription.   Or how important you think you are, or how sincerely you believe your droppings emit no foul odor, nor any of the rest of it.   I’d be tempted to tell you to fuck yourself a little, but I’m trying to be like fucking Gandhi these days, so kiss yourself instead, my brother.”

The doctor also informed me I have something called blepharitis.   I asked him how one gets blepharitis.   “Bad eyelid hygiene,” he said conclusively, making another note in my new file next to the large printed circle that was one of my eyeballs.   He didn’t seem concerned about it, told me to buy eye wipes and gently scour the area between the hairs on my lower eyelid and the eyeball itself.   I asked how often I needed to do this.  Every day, he said, for the rest of your life.

This guy was just a hardworking American doctor running a successful neighborhood practice.  People are used to waiting as long as they need to in order to see a doctor.   This guy had a waiting room full of people the whole time I was there (though the number grew over the course of the hours I was there).   They were all fairly passive, patient, used to waiting as long as it takes to see the great man.  Every one of them using their cellphones, though the office was plastered with NO CELL PHONE use signs.  The doctor, in fact, snapped at me to turn off my cell phone as he escorted me back to his office.   Nobody but me, I suspect, had any second thoughts about why it took more than three hours to see the great wizard. 

My conversation with the nurse who did the actual vision test was a bit more interesting.  She looked at my paperwork and insisted I fill in my social security number, as requested on the form.    I resent this insistence on something that was once very private and is now required by every bloodsucking corporation one deals with.   I described to her how I’d worked for a bloated, amoral leech, a collections attorney, who had taught me the great value, to creditors and their attorney partners, of a social security number.    You can freeze all their bank accounts, for example, take whatever money they owe you by serving a restraining notice on the bank, sitting back and waiting for the panicked debtor’s call.

“People owe the hospitals millions of dollars they never pay,” she said indignantly.  “Millions!”

I, myself, have an unopened stack of bills from hospitals, and collection notices from an attorney for the most aggressive of them.   I said nothing about this, what was the point?   I told her how many corporations now obtain legally enforceable default judgements, obtained fraudulently by not informing the defendants that there is a case against them.   Since they have no notice of any court case, naturally the alleged debtor doesn’t show up, and bingo, Bird Wins!  Default Judgment.  Their unethical attorneys get bundles if judgements on default, worth many, many millions annually, by simply not serving the required legal notice on millions of suckers.  It’s called “sewer service”, create the legally necessary “proof of service” and put the required notice that your proof swears was legally delivered, directly into the shredder, or sewer, whichever is handier.  No harm, no foul, courts are too busy to inquire into cases where only the powerful side shows up.

I told her that American medical care, the most expensive in the wealthy world, also has far from the best health outcomes.   We argued this point for a moment, with her going on about how poor people in America have the best insurance in the world, then I made my next point, about medical insurance.  

A big part of the cost of expensive American health care is the army of private middlemen who take their cuts.  Why are insurance companies involved in health care, again?   It was an interesting talk, after I conceded her the last four digits of my social security number.  She gave me an excellent and thorough vision test, the results of which I, arguably, do not own.    We call this free enterprise, the free market, the right of entrepreneurs, large and small, to be rewarded as handsomely as possible for the risks they take to make a profit.

Dr. McGruff did give me a recommendation to a local glasses store where there is a young optometrist who seems pretty sharp.  I require a prism lens in my glasses, to make my eyes cooperate more smoothly with one another as they get tired from the endless tracking that is reading.  Prisms are tricky, the opthamologist told me, and I should go to a recent optometry school grad to prescribe the exact prism I need, slightly different from the ones I’ve been wearing for more than forty years.

The insurance company offered me “vision” with my health insurance plan.  It was about $10 or $20 extra a month, but did not include glasses.  It would, presumably, pay the $30 to $50 I will pay this young optometrist for the eye exam.  I figure for the $120- $240 it would cost me for the year, I will make out OK on this particular deal, just like I did with the $88,000 I was charged for Rituximab.  

God bless these United States, eh?  Will you do that, God?   Can I get a fucking “amen” here?

Reminder: Thou Shall Not Kill

I hurt my knee.  It hurts like hell in certain positions, like a scalpel being inserted point-first into the patella.   If I sit too long and try to stand, or even just straighten my leg, scalpel into patella time.   I am trying a knee brace, not bending the leg when I sit, but it’s not always possible to avoid the searing pain of trying to straighten my once sturdy leg. 

Finally went to the doctor, who sat on my foot and pushed and pulled my knee from different angles.  The only thing that hurt was the direct pressure on the patella when I tried to straighten the leg.  The doctor told me to go have an x-ray, which would then allow my insurance to pay for an MRI if the sports medicine practitioner needed to do an MRI.   

I called my current insurance company, Healthfirst.  I declined the robot’s kind offer to take their customer satisfaction survey for the “service you are about to receive” by pressing two.  It was only a few moments before Jackie was on the line, very pleasant, bright, sympathetic.    She tried to walk me through the website, which was buggy today on my end.  It displayed completely differently for her than it did for me.  The search function did not seem to be working correctly on my end.

She found me a nearby x-ray place, then a sports medicine doctor, both of whom took my specific Healthfirst insurance plan.   Then an opthamologist, so I can get a prescription for new glasses, then a gastroenterologist for my overdue colonoscopy.  We truly had a great chat while all this was going on.   At the end of ninety minutes of customer service I thanked her, we had a last laugh and parted as great friends. I began to make the calls.

The nearby x-ray place does not have an x-ray machine, it turns out.  They do several other forms of diagnostics, have a lot of sophisticated equipment, but no x-ray.   The receptionist there gave me the name of another nearby x-ray place, and the phone number.   It was a fax line, I learned when that eerie squawking began.  

I called the sports medicine doctor, figuring they might have an x-ray machine on site, save me a few steps.   The doctor, it turns out, does not accept my particular Healthfirst plan.  A first time visit would cost between $320 and $640, if insurance paid nothing.   I asked the receptionist what determined whether the visit was $320, $435, $508 or $639.99.   She had no idea.

You walk into a restaurant.  There are no prices on the menu.  When you ask the waiter how much the BLT is he tells you not to worry about it, the sandwich is delicious.  In three months you’ll get the bill in the mail.   The EOB from the third party that deals with the restaurant informs you that the BLT is billed at $640, but since you have insurance the negotiated price is only $120.  Your copay is $50.  You made out like a fucking bandit.  

We can’t tell you what it will cost until the provider sends us the bill and the billing codes.    That is the standard line and it is perfectly legal under the Patient Protection and Affordable Care Act.  You see, until the provider tells us the exact price, nobody can predict anything.   That’s clear, easy to understand.  How is anybody to possibly know that this hospital charges $44,000 for a bag of chemicals they will infuse into your body?   No possible way anybody could possibly know that, prior to the procedure, the submission of the billing codes, and the calculation of the EOB.  Jackie confirmed as much when I asked if the $44,000 bag of Rituxan that may be in my immediate future is covered under my current plan.  There is simply no way to know in advance.  

The first appointment with this sports medicine doctor who will charge between $320 and $640 is a month from now.    Your aching knee is nobody’s fucking problem but your own.  You should have made this appointment weeks ago, you’d be almost in line to see the doctor by now.

I struck out with the other doctors’ answering machines.  Call during business hours, the first one advised me, between 9 a.m. and 5 p.m.   I noted to myself, with familiar bitterness, that it was 4:30.  Same deal with the next doctor’s machine, only by then it was 4:35.   Well, it was 75 degrees out, Sekhnet reminded me.

Soon she was done trying to cheer me up.  As I laid the merciless details on she was finally struck dumb, began crying because this shit is so frustrating when it happens to somebody you love.   It is worth noting, of course, that if the law allows an insurance company to list a thousand doctors as participating, and only a handful actually are, there is no harm and no foul.  The piece of shit, er, customer, merely has to keep making calls to different offices further and further from their home.  Eventually they will find a doctor somewhere who accepts their insurance.  No fraud where the law says there’s no fraud.  Patient Protection Act and shit.  Hey Barack, Arbeit Macht Frei.

I asked Jackie about getting evidence from Healthfirst that my recent invoice had been returned to Healthfirst by my local post office as undeliverable.  I told her the story, another short chapter in the million chapter book they are constantly updating.  That book is called How We Fuck You To Death You Fucking Piece of Shit.  The main device is never allowing the true facts to interrupt the dominant narrative.  If you can’t produce irrefutable proof, and you are not incredibly dogged, we can fuck you with impunity, fuckface.

Jackie wished she could help, by giving me the evidence that the local post office is now returning rent checks to me and insurance invoices to my health insurance company.   That could only be done by Finance.  There was no way for her to directly contact Finance.  Nobody was allowed to know who Finance is or what they do, but she dutifully made a complaint to them, asked them to send me some proof that they had received the last bill sent to me back marked “undeliverable”.   She gave me the complaint number, said I can follow up in a few days if Finance doesn’t contact me.  Finance unfortunately has no direct extension, so I’d have to get lucky when I try to follow up.

“This is exactly how they kill us, Jackie, those powerfully legally created psychopaths who make all the rules to best serve themselves. You have to admire the seamless perfection of it.”  I then described my request to see a mental health professional, as I imagined it would go.   It did not go well.  Jackie found it hilarious. When I hung up the phone I noticed I was foaming at the mouth.

I was seated on my aching hind legs, head thrown back, howling as loud and plaintively as I can.  I am doing that right now, as I type.   Easier than you’d imagine, really. 

Letter to Alvin Bragg (draft one)

Alvin Bragg, we learned recently, is the New York State Executive Deputy Attorney General for Social Justice.   This is the person, I discovered, thanks to a friend who alertly picked up a news release during a press conference with the Attorney General,  to whom my October 2017 letter to the A.G.  should have been addressed.   I’ve been writing “Alvin Bragg” periodically in my notebook, going back a few months, intending to write a futile cover letter to him.  Figured I’d give it a shot here, on a slow day.  I’ll have to strike just the right tone.

Dear Mr. Executive Deputy Attorney General:

(if that is your fucking name)

Enclosed please find my correspondence with your office.   I naively sent the Attorney General a letter recommending actions the state should take to protect the rights of low income health insurance consumers.   Mr. Schneiderman never saw that letter, a letter that should have been addressed to you, I learned from the organizational tree in one of the A.G.’s press releases.

My letter details some of the systemic abuses of the private insurance health system, and the lack of any state oversight available to consumers, outside of a desk in your office, and proposes actions that your office could advocate for.  It was not a consumer complaint seeking redress of a particular grievance, though it was treated as one by your office.    

Enclosed are the two responses I had from your office’s Health Care Bureau.   Neither one is responsive to the letter I wrote, except that the second one attempts to be helpful by suggesting I’m a consumer, like many, who is unaware of the powers of the Health Care Bureau in the A.G.’s office.

My October letter, and this one, fall into the category of “in a more just world letters like this wouldn’t have to be written at all”.  My letter to the A.G. was in part a cry of anguish from somebody with a limited income stuck in a bureaucratic quagmire with limited options for getting treatment for an eventually fatal disease.   The PPACA, as anyone who is subject to it quickly learns, is a very flawed solution to the vast institutional problem of providing affordable health care to millions while preserving the profits of private insurance companies and private health care providers.    

I am well aware that people with a limited income have only so much right to be heard on even the most vexing institutional injustices: like the three to six month lag between a medical procedure and Explanation of Benefits,  with the inevitable multiple bills and collection notices that accrue in that time frame.  Or that past EOBs, even with the assistance of a diligent attorney from the Community Service Society, and all required legal documents signed, were never provided at all by the insurance company.  “The law, in its majestic equality, forbids rich and poor alike from begging, sleeping under bridges and stealing a loaf of bread.”

Ah, listen, Alvin, I don’t know what I really hope to accomplish with this note to you.  What outcome am I hoping for?  A paragraph apologizing for the poor response from your overworked consumer help desk, sympathizing with the situation I describe in my letter, assuring me that the activist A.G. of New York is doing everything in his power to address some of the institutional vexations set out in my long letter.  Strength to your arm, friend, dictating that paragraph to your secretary.

My best to you and your staff,
Eliot

Procedure Codes

I suppose one way providers can fight back while being paid 20% of their billed rate for services is by skillfully working the procedure codes.  I may be wrong, but I suspect this may be the case.   The thought never occurred to me until yesterday when I got the approval from Healthfirst for the minor surgical procedure I had two weeks ago.

I had diagnosed the tiny cancer cell on my nose myself.  I had only felt that intermittent slightly stabbing pain twice before.   Each other time it had been a basal cell on my nose.   The growth was so tiny that neither the dermatologist nor the surgeon she sent me to could actually see it.   I pointed to a spot on the bridge of my nose under which the basal cell, its visible part about the size of a pinprick (if the pin is very sharp), was slowly growing.  The surgeon told me that since we’d caught it so early there would be no need for a skin graft, just a couple of tiny stitches that would leave no scar.

The surgery was painful, due, according to the red haired surgeon, to the skin sensitivity of people with red or reddish hair (my beard, before turning white, was red).  It turns out the surgeon had made a slit the length of my nose, dug out the basal cell from underneath, and left a line of large black stitches about the size of an eyebrow, from my left tear duct to the top of my left nostril.   When I first changed the bandage I had a bit of a shock at the size of the incision to remove something smaller than the period at the end of this sentence.  Sekhnet, of course, had a theory about why the long cut was the right thing to do.

Tomorrow I go to get the stitches out.  Yesterday I received approval from Healthfirst for the procedure, which they informed me would be good between the two dates indicated (first date about four weeks ago, the second date rapidly approaching).   They approved five separate procedures:

17311  MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS

17312  MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYL)  

13152  REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM  [1.02362″ TO 2.95276″ –ED]

14060  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS  [3.93701″]  

14061   ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM  [3.93701 SQ INCHES TO 11.811 SQ INCHES– ED.]  

Could all be on the up and up, I suppose.  Until they start digging they don’t know if that tiny tumor will be less than an inch across or the size of 30% of my face.  Fair enough.  The rest of that stuff, I’m not sure about.  Maybe it explains why the incision came so close to my left tear duct, where the stitches start.   Maybe I am just so bitter about corporate medicine, and so aware of the psychopathic nature of the corporation, that I just suspect the worst from these “persons”.  As for the humans– I think about the surgeon’s failure to provide me with pain medication after a surgery she acknowledged was painful for me, as it would be for her,  But why be judgmental?

Still, you know, it makes sense, from the point of view of the provider, being squeezed and nickeled and dimed on their bills by powerful insurance companies, to bill for every possible procedure.  The eyelid adjacent stuff may be very lucrative, for all I know.  Who am I, who has never run a successful business, never been an entrepreneur, never had to answer to a room full of very wealthy, pissed off shareholders, to opine about anyone’s business practices?  

Hopefully there will be little pain tomorrow when I get the stitches out, that I won’t find it necessary to ask the surgeon any pointed questions, and that, true to her word, the long line of stitches will leave no scar.   Otherwise I’ll get me an eyepatch, and a parrot, and limp down the street cursing their salty, scurvy wives and unwashed ill-reputed mothers.   Arrrgh.