Why the fuck am I keeping this on-line journal?

Good question, even as I have to jet out of here in a moment.  I write here, as often as I can, mainly for the feeling of being in control of things we humans have little or no control over.  It makes me feel good to write.   I write here to make sense of things as they happen, to the extent I can.  I find it helpful and hope that what I write is sometimes also helpful to someone reading it.    

I also like to keep the old writing pencil sharp, because I love the craft of writing.  It is very satisfying to see words lined up to bring something into focus.  I also hope, one day soon, to sell these little darlings like the adorable hookers they’re supposed to be, in the Free Market.  After all, any craft unsold is just a fucking hobby (he added, with gratuitous bitterness).

Today I made an appointment for screening of my skin for more possible cancer, long overdue in part because I’ve had to find three new sets of doctors in the last three years thanks to my man Obama’s beautiful compromise with the perfect, which disabled my ability to see the dermatologist I’d been seeing for years, a doctor I liked.  The earliest appointment for a new patient I could get today is for August 31, at 2:30 pm.  I took it.  I’m also on the waiting list for any earlier appointment that might pop up.  If I’d done this three months ago, instead of being discouraged when nobody I called accepted my new Silver level insurance, I’d have an appointment for next week.  Of course, I’m free to call as many other dermatologists as are on my insurance company’s list, in the meantime. This is America, after all.  In the meantime, I fucking write.

I’m being pressured to begin immunosuppressive therapy for my kidney disease.   This therapy includes three months of steroid treatment, in alternating months (chemotherapy type agents are administered every other month) each month beginning with three days of IV infusion of steroids.   I am trying to educate myself about the disease before committing to this pharmaceutical blunderbuss approach.   I read this just now, from the Mayo Clinic:

Membranous nephropathy (MEM-bruh-nus nuh-FROP-uh-thee) occurs when the small blood vessels in the kidney (glomeruli), which filter wastes from the blood, become inflamed and thickened. As a result, proteins leak from the damaged blood vessels into the urine (proteinuria). For many, loss of these proteins eventually causes signs and symptoms known as nephrotic syndrome.

In mild cases, membranous nephropathy may get better on its own, without any treatment. As protein leakage increases, so does the risk of long-term kidney damage. In many, the disease ultimately leads to kidney failure. There’s no absolute cure for membranous nephropathy, but successful treatment can lead to remission of proteinuria and a good long-term outlook.

You have to admire the candor of “in many, the disease ultimately leads to kidney failure.”   Regardless, I have my life to live, and a nice box of chocolates to buy for a 95 year-old birthday girl, who I have to dash off to see after a shave and a shower.    

I feel so much better having taken this little break to practice my word arrangement.  Thank you, Diary Dear.

Extracting an Unconditional Apology

I don’t know if the exercise is really worth it, but, under certain conditions, with sufficient detachment, moral suasion, carnivore cunning and mild-mannered treachery, an unconditional apology can be extracted, even from a doctor or a lawyer.

The nephrologist had her receptionist call me after I sent her a summary of my recent attempts to get the update she’d promised on my recent biopsy.   This neutral summary was what lawyers call “making a record”.  Making a record is done to prepare the grounds for argument in the legal case– anything you write, like a memo, could be used as evidence.  

It’s like Trump’s lawyer Marc Kasowitz making a record that there is no evidence whatsoever that the president ever used anything beyond precatory, non-legally binding, aspirational language, when he had FBI-director Comey alone in a room and expressed his hope  that Comey would dummy up about Flynn [1] and lay off the investigation into the good guy’s possible problematic entanglements.  Therefore, as a matter of law, based on the explicitly precatory language all parties agree was used, no direct order was given and therefore there can be no obstruction of justice.  Plus, of course, Kasowitz added, although nothing he said implicated his client in anything, Comey was lying his ass off under oath while the president is always truthful.

My note to the nephrologist, which became part of my permanent medical record at the hospital once I hit ‘send’, presented the facts without editorial comment, but in a pretty dim light for the nephrologist.  Her actions did look pretty bad laid out end to end, the lack of communication was clearly one-sided.  It would look pretty bad to any department chair reading it by the time I ended asking  “am I missing something?” and signed it Eliot.   I also called the Patient Advocate at the hospital to express my concerns and find out why nobody was forwarding the medical records I’d requested.  

The nephrologist’s receptionist called me few moments later, to tell me the doctor herself would be calling me and that they would be forwarding the medical records I’d requested.  A short time later the receptionist called back to ask me to hold while she connected me to the doctor.  This transfer took just under two full minutes, which, while annoying, was not comparable in its effect to her previous behavior and attitude.  She began to remedy that as soon as she picked up the phone.   After a moment of silence she asked what I wanted.  

“I want the update on what the biopsy showed about the progression of my kidney disease,” I said, and things went quickly downhill from there.   I was soon told that I have unreasonable expectations, am a very nervous patient, smart but also nervous and with unreasonable expectations.   I told her I expect people to do what they promise to do — until I learn what it is unreasonable to expect from a particular individual.   I stop expecting what experience teaches me to stop expecting.  I disputed that I have unreasonable expectations, took exception every time she mentioned it, but since it came up several times, it got me to wondering about the phrase.  

There were several attempted if-pologies (tip of the tam o’shanter to Harry Shearer) for how I apparently felt as a result of our mutual miscommunication.  I rejected each of these pseudo-apologies forcefully, explained what was objectionable about such false, conditional, self-serving apologies.  She was not taking responsibility for her actions and inactions, she wasn’t apologizing for how those actions and inactions effected me, she was apologizing about my unreasonable expectations, fears, excessive nervousness that made me see monsters where there were only puppy dogs and kittens.  (detailed anatomy of an if-pology here)

In the end, seeing the folly of having a conversation with such a desperately defensive person, and sick of having to raise my voice to cut in whenever she cut me off and talked over me, I told her she was a good person and wished her a good day.  Then I took a few deep breaths, muttered politically poisonous words that should not be printed, took a few more breaths and called the kind woman at Patient Relations at the hospital.

I thanked her for her earlier kindness and gave her a report of what had happened since she made her call to the nephrology department.   When I reported to her that the doctor told me that I had “unreasonable expectations” and was a “very nervous patient” Joann seemed genuinely offended that a doctor would say those things to a patient she’d been ignoring.  I asked Joann for the only actions I could think of — to inquire about a waiver of my $237 out-of-pocket payment for my next office visit and a recommendation for a less combative in-network nephrologist.  (Thank God I have Obamacare, Romneycare, Patient Protection and Affordable Private Corporate Health Insurance Out of Pocket Deductible Care, Lobbyistcare,  VultureCapitalistcare, HealthInsuranceandPharmaceuticalindustrycare,  Corporatepsychopathcare, is all I can say.  Can you imagine how prohibitively expensive and stressful the visit might be without health insurance?)

I then spent the next few minutes trying to figure out how not to seethe.  I went to the post office.  Not generally the best cure for a need to seethe, but today at 4:00 the place was virtually empty.  I joked with the guy behind the window and we both had a few laughs.  The guy at the next window got in on it, and another patron did too.  We were all laughing together on a Friday afternoon.  All the sweeter that we were like the United Nations, representatives of four continents.

The guy helping me, the representative of Asia, was gone for a long time, came back with my stamps then stood there, looking down, seemingly texting for a long time, while I stood there waiting to pay him for the stamps that were right next to him.   I watched him bemusedly, as he regarded his phone with a pleasant smile, tapped away, seemingly got a funny text in response, paused to savor it, tapped his reply.  It went on for a few minutes. I just looked at him, somewhat in awe.  Then he asked for my credit card, which I gave him.  When he handed me back the card I asked if I needed to swipe it.  He smiled, shook his head and held up the small device that he’d been tapping into.  I started to laugh.

“Oh, man,” I said to him “that whole time I thought you were texting.” He laughed. 

“No, really, I was fascinated, I was admiring how brazen you were, how you seemed to be taking your time, really enjoying each text that was coming back from your friend.  I figured you were typing ‘place is empty, one hour to weekend, one asshole customer waiting, just standing there, not doing anything, blank face, stupid expression, LOL!'”

We had a last yuk and I headed back up the hill to my apartment, 40 U.S. stamps and 2 stamps good for Europe in my shirt pocket.  Plan to drop a note to Macron, just to tell him his name is hilarious and ridiculous.

I sat down and watched the mirthful, merciless late night comedians on youTube, all of them with millions of hits, slowly turning POTUS over a slow fire, slathering on the barbecue sauce (for all the good any of it does). I was finally beginning to feel a little relaxed, after more than a week’s escalating, endless battle with a stubborn jackass of a nephrologist.  My phone rang.  

It was the nephrologist, she felt terrible, she’s not that kind of person, not malicious.  

“I never said you were malicious.  I don’t think you’re malicious.”  

“I’m calling to tell you I feel terrible about our conversation.  I don’t sleep at night after a conversation like that, I’m not that kind of person, I do feel very bad about our miscommunication.”  

“Don’t feel bad about that,” I said, ” it wasn’t really ‘our miscommunication’ anyway.  If you want to feel bad about something, feel bad about not doing the empathetic thing, the thing you’d want me to do if our places were reversed.  Feel bad about telling me I have ‘unreasonable expectations’ and that I’m a ‘very nervous patient.'”  

“I never said you had unreasonable expectations and  I don’t say nervous in a bad way, I’m very nervous myself…” she said quickly and with utter conviction.

“You repeated several times that I have unreasonable expectations for expecting to hear back on test results, but I don’t even care about that right now.  If you want to apologize, at least know what you did that you should feel bad about, what you’re actually apologizing for.”  

“I apologize if you feel that I was neglectful of…”  she began.

“No,” I said, “I don’t accept your conditional apology,  forget it.  You cannot apologize  for how I may have felt.  You can only apologize for what you did.  It’s no apology if you condition being sorry on what I may or may not have subjectively felt.”

“You apologize for what you did, that you understand now was wrong.  ‘My actions hurt you.  I was wrong.  I am sorry that I hurt you.’ “

“It’s no apology to say I’m sorry if you were hurt.  You have to acknowledge that what you did was hurtful, would have hurt you too, or anyone else.  That there was nothing unreasonable about being hurt by the hurtful thing I am so sorry I did to you.  Then you have to promise to try hard not to do it again.  That’s an apology.”

“I apologize without conditions,” she said.  

I thanked her for that, and happily accepted her apology, although with conditions.

God must have been smiling down on me in that moment, for the call from her cell phone dropped, she texted that I had suddenly stopped talking, that we seemed to have lost connection.   I texted back that she must have gone out of range, I was still sitting at my desk.  I ended thanking her for the call, and the apology, and wishing her a good weekend.

But do I really?

 

[1]  The greatest accomplishment of Flynn’s military career was revolutionizing the way that the clandestine arm of the military, the Joint Special Operations Command (jsoc), undertook the killing and capture of suspected terrorists and insurgents in war zones. Stanley McChrystal, Flynn’s mentor, had tapped him for the job.  source

 

 

 

 

American healers

The first example is a veterinarian with a thriving West Village practice.   He informed us last week that, sadly, the second set of blood tests confirms that the cat has a terminal kidney condition.   We can hope to extend his life, have him around a bit longer, he said, if we learn to give him subcutaneous hydration and do it daily.  

We immediately make plans to visit his office, to learn how to apply this liquid through a line and a needle  under the flexible skin and fur on his back. We also have a few questions for the vet.  A young technician gives us the demo.   The doctor does not so much as stick his head in the room, nor does his colleague, another vet who sent some interactive and empathetic emails to Sekhnet.

The following day at home Sekhnet expertly applies the needle, I wrangle the cat, run the line, squeeze the bag to hasten the flow of the liquid.   The Baron tolerates it reasonably well.   I wind up emailing my questions to the vet.

One is about stopping the fight to give him a hated, foul tasting phosphorous binder by syringe forced into his mouth.   Although it’s a primary weapon in slowing feline kidney deterioration, it makes the Baron furious and bitter and we’ve decided to stop forcing it on him.   I ask about an alternative powder form we may be able to mix into his wet food or treats somehow.   I also ask how far along the downward slope of the chronic, deadly disease Skaynes is, in terms of kidney function now vs. end stage kidney function.  I express our disappointment at not having been given a moment to bounce these things off him in person when we were at his office to see him the other day.

He writes, helpfully and sympathetically:

He does have what is termed chronic renal failure, meaning he.s losing his ability to filter and eliminate fluid waste, conserve water and control electrolytes.  It does tend to be progressive at a very individual rate.  They can be around for six months to a couple years, is my experience.  His blood pressure result was 165, which is normal.  He should get the low protein diet daily, with fluids.  I.m not crazy about the aluminum hydroxide either.  If he is becoming intolerant, then I say stop it.  Try the epakitin and we.ll check his blood again in three months.

Then, addressing my human concern, as a human who just brought a fatally ill animal he loves to a doctor for beloved animals and was disappointed not to get a moment of the doctor’s time:

I usually have technicians provide fluid demos and do blood pressures.  Let me know in the future if you have concerns I specifically need to address.

I can read this now, four or five days later, in a neutral light.   He is telling me his ordinary procedure for these demos and letting me know that in the future I should not hesitate to make my concerns known to him if they were not addressed by his technician.  He was probably taking care of his day’s correspondence and didn’t pause to realize he was writing this to a person with all the concerns of someone bringing a dying long-time pet to the doctor (plus, unbeknownst to the vet, anxious about impending news on his own kidney disease).  In a better world, where he would have had the time and sensitivity to look over the email before sending, he could have done much better.  Reading it now, I hardly see what infuriated me so much when I first got his reply.

At the time I got it, ten minutes after I wrote him, it hit me like poison.   I read his email shortly after the first time we gave the Baron the fluids, and I decided we were done torturing him by forcing the aluminum hydroxide down his snarling mouth.  I read the vet’s last lines as:  you should have told me if you had concerns, not really my fault, kind of your’s, that you didn’t get to express your worries to me.   Kind of odd for a person who had specific questions while he was in my office, to be whining about not asking them a day later.

It was a slap in the face, piss down the back of my leg, a knee in the privacy (as a kid in Harlem once said).   I felt, in light of my deep surge of righteous indignation, that I’d been admirably restrained in writing an email that, in the cooler light of a fresh read a few days later, I’m glad I didn’t send.  I wrote:

Thanks for this update.  Glad to hear his blood pressure was normal.   We’re discontinuing aluminum hydroxide and ordering Epakitin.

As far as your last sentence, why would somebody bringing a beloved pet with a recent diagnosis of a fatal disease need to alert the vet to having concerns?  In your experience, is there anybody in that situation who does not have at least a couple of concerns?

An apology, no matter how mild, for not giving us a minute or two the other day, would have worked a lot better than citing your usual policy of having technicians conduct the demo in how to prolong a chronically ill cat’s life.

Eliot

I would have been within my rights, perhaps, but I’d be making things snide with a busy, caring vet who arguably hadn’t written the most sensitive sentence he could have come up with to address our feelings.  Assuming he was even capable of writing a more compassionate sentence.   Coming up with a sentence like that is not within the repertoire of most people, even highly decorated poets of public relations struggle over perfectly calibrated expressions of professional/personal sentiment.  

My reply, though superficially polite, would have hurt the feelings of someone who most likely hadn’t meant to hurt Sekhnet’s and mine at all.  On the contrary, he’d just answered all of our questions in a reassuring tone, what the hell was I chastising him about?  It would have confused him, struck him as completely unfair, insane, even, and it would have pissed him off.  It would have done nothing good for me, Sekhnet or Skaynes either, or any of our future meetings at the vet’s office.

My friend’s father’s father collected wise little sayings that he wrote, in a meticulous hand, on small cards.  They were written in Hebrew, and the small stack of words to live by were read by my friend after his grandfather passed away.  One said: all delay is for the best.   The meaning was, if you feel you must act, it is better to pause first, to consider, to calm down, if needed, turn the planned action over in your hand another time.

 

Example Two

I caught myself this afternoon ready to punch out the fucking nephrologist.  It took very few text and email exchanges before it got out of hand and, once it did, I stopped myself from writing back.   To be sure,  I did unleash a nice, clean, snapping punch to her fucking smug, self-justifying, bureaucratic, inhumane, insecure face.  I left it in my drafts folder, it laid her on the canvas groaning.  But I did not send it.  

Flashes of her worst traits, her more hideous assertions, flew out at me unbidden all evening. She is now demanding I pay her another $237 out of pocket, and visit her office, any Friday I choose, for the results of my May 26th biopsy, results she’d started giving me over the phone last week, results she promised to phone me about as soon as they came in.

The results came in, possibly days ago, these were the only medical records so far not sent directly to me, the patient.   Then I was treated to no reply, insistence and unrepentance, all of the highest order.  Thoughts of her overbearing insecurity and shabbily slapped together legalistic attack on a patient, anxious and aggravated after 12 days (thirteen now) with no news on his kidney biopsy results, enraged me anew each time I thought of this distasteful creature’s behavior.

I have been diagnosed with a kidney disease called idiopathic membranous nephropathy.     At least I hope it’s idiopathic, meaning they don’t know the cause and it’s not secondary to some other more systemic autoimmune disease like Lupus, MS, or some kinds of cancer.  The disease is a progressive autoimmune disease that ends, if not cured first, with dialysis or a kidney transplant, or, if those options are unavailable, death.  

It is obviously important to know what stage the disease has progressed to when deciding on treatment options, most of which involve long regimens of intravenous steroids and immuno-supressant drugs, similar to the cocktails used in chemotherapy.  A biopsy is the most accurate way to determine what stage the disease is at.   So I had the biopsy, thirteen days ago.  

When this nephrologist first tested me in April, to see if I was among the approximately 33% of membranous nephropathy patients who undergo spontaneous remission, I got test results emailed to me by a corporate third party.  I contacted the doctor’s office, since the most crucial test for this disease, the ratio of creatinine and protein in the urine, had no standard range I could compare my numbers to.  The test result/billing/appointment bot suggested I call the doctor.  I did.  I called again.  I wrote.  

The last thing I wrote used “unconscionable” to describe incomprehensible test results sent by marketing/billing/medical record bots to anxious patients without medical interpretation attached.  It was, in the end, five days before she called to say, after apologizing for the terrible delay in getting back to me, that my numbers were slightly worse than in the January test.  I was not experiencing any kind of remission, the disease was progressing.  

When the numbers were retested in May she wrote preemptively to tell me she had strep, had gone to the Emergency Room, and couldn’t talk on the phone.  She promised to call with the results, as soon as she could talk on the phone.   I wished her a speedy recovery, not bothering to point out that strep had no effect on her ability to type.  Again it was five days with uninterpretable test results before I heard from her.  Again the test showed the disease was progressing.  She thanked me for my concern with her strep, in place of an apology for once again keeping me hanging for five days.  

So I had a biopsy, thirteen days ago.  This biopsy would show, I was told, exactly what stage my membranous nephropathy was at.   Based on the stage, it would be more or less urgent to begin steroid-heavy immunosuppressive treatment, the only option in American corporate medicine, immediately.  

I had a call from her as soon as she got the preliminary results, a few days after the biopsy.  There was some good news, no scarring on the kidney.  This means once the underlying disease is cured, if it’s cured, the kidneys should be as good as new.  She promised to get back to me soon with the rest of the report.  I never heard another peep from her.  On day eleven I emailed:  

It’s now eleven days since my kidney biopsy. Any news?

On day twelve I wrote: 

Twelve days with no results from my kidney biopsy.  Any idea what the delay is?  Are they growing a culture?  Your insight will be appreciated.  

After a few more hours with no insight, or anything else, from her I texted her on her cellphone, a number she’d given me to follow up on the biopsy results.   Immediately after my text she made an appointment for me, two days later, on a day I’d already told her was impossible for me to come in.  She acknowledged in a text that I was anxious and then said she truly believed we had discussed the date for the appointment she made and offered no word on the results of the biopsy.  She got very shitty when I told her to put herself in my position, waiting for this news, and getting only silence and bureaucratic non-replies.   Clearly her feelings were hurt.  She wrote:

Dear Mr. Widaen,
We had preliminary conversation about your renal biopsy result over the phone (the week of 6/29/2017) and discussed that appointment 2 weeks after biopsy would be adequate time
to receive a full result that we would discuss once you come in.
I am sorry but I do not remember that you said this Friday was not good (I remember last Friday was not good) and I truly believe we set the time to meet this Friday.
However, it is not an emergency and if this Friday is not good for you I can meet with you at your earliest convenience next week or the following week.
I understand that you are anxious but I was not able to reply immediately.
For further communication, please use my chart and you may call office to leave an urgent verbal message.
Please let me know when you would like to come for an appointment.

>I replied, insula aglow:

This is very similar to your previous replies. Last Friday was not good because it was the day of my renal biopsy, as you could probably know because you were there [this was a low blow, and an inaccurate, emotional blunder, my biopsy was actually two weeks ago Friday-ed.]. I am anxious about the results, which should come as no surprise, and it is neither professional, nor humane, to respond in this bureaucratic fashion. Imagine how you would feel in my situation, twelve days after a kidney biopsy, if you can.

Then it was her turn to be the tough guy, doubling down on the bureaucratic prerogative:

Mr. Widaen,
Your renal biopsy was on 5/26; 2 weeks after biopsy would be this coming Friday and that is what I had on my schedule.
Despite “lack of communication” I do remember about you and remember to reserve an appointment spot for you.
Again, I am sorry for assuming that you are coming this Friday and we would have a full discussion as planned.
Please let me know when you would like to come in for an appointment.

Fool me three times, go fuck yourself.  I was angry at this point.  She’d promised me a follow-up telephone call as soon as she had results.  She promised me this again when she called with the preliminary results about the lack of scarring a week earlier.   Instead, she claims to understand that I am anxious, equivocates about a “lack of communication”, corrects me on my stupid error about the date of the previous Friday, claims to have never forgotten about me, even as, coincidentally, she remembered my case immediately after my third reminder text, apologizes for an incorrect assumption, gives no further information on renal biopsy and the status of my disease and stands by her previous offer, to have me come in and pay her $237 out of pocket once again to find out what the biopsy showed.

You can picture how many new assholes my terse email response ripped in every part of this poor woman.  I, thankfully didn’t send it.  Brooded for hours longer, then finally calmed down enough to remember that you don’t win a fight with somebody like this.  This morning I sent her a secure reply:

Please send the biopsy report to my primary care doctor, so and so, here is his fax number (…) his telephone number is (….).  Thanks.

Now, with my metrocard, on to the subway to see the sights!  Up, up the motherfucking high road, pirates!

Obama/Romneycare Update

Finally had my appeal at the New York State of Health (NYSOH).  It was done over the phone by an Administrative Law Judge who identified himself only as “Steve”.   Only five months after the determination that I do not qualify for the subsidy on my premium, called “the tax credit”, even though my income clearly does qualify.   These things are complicated, as everybody knows.  It’s not as if anybody at NYSOH can punch in my projected 2017 income and see the exact amount of the subsidy the law entitles me to within three to five seconds.  Oh, actually, they can.

Here was the problem.  There is apparently a regulation, at NYSOH, not necessarily unpublished, but virtually impossible to find or even learn about.  It could be part of some other administrative code, possibly the CFR or some New York State code, also not easily accessible, but nonetheless on the books and available to extremely tenacious members of the public.  This reg allows NYSOH, in the case of a citizen who files a tax extension and files a return after the 4/15 deadline, to disqualify an otherwise qualified citizen from receiving a future tax credit he is otherwise eligible for.   Nothing arbitrary or capricious about that, obviously.

If one knows this is the reason, they can provide a copy of the tax return, and something called a tax transcript (and beware, there are several kinds, and only one will work– also, they cannot be requested on-line, or over the phone, the IRS is very, very busy), and, technically, the disqualification should be “cured” and the tax credit retroactively restored.  

That’s not how it works in Donna Frescatore’s nominally public agency.  If I were an employee of NYSOH I’d be violating their strict stated policy by revealing the name of the public agency’s director, but… luckily, I don’t work for her.   I am sure, by the way, that she is lovely and highly qualified, and very concerned.  I’d be the last person to suggest that she is an uninvolved, disinterested and unaccountable political appointee.

So, anyway, I was disqualified from the tax credit I’m eligible for, for a reason that was never disclosed to me, and not notified of my ability to “cure” the disqualifying event.  Relatively straight-forward, if you have a lawyer to research it and explain it all to you.   I “cured” the situation in February.  Nobody at NYSOH looked at the uploaded documents or made any kind of reassessment based on them, I was already scheduled for an appeal, which would be held within three to six months.

Steve was very professional, unlike the previous Appeals officer, who called two months after my vexing problem was behind me (being kicked off health insurance for two full months because of an error a telephone rep made while “helping me” against my strenuous objections) who could not grasp the concept of “mootness” (too late for the court to do anything about something that already happened, did it’s damage and was already fixed to the extent it can be).  Steve promised me his written decision.  In terms of a timeline, he answered that the law gives him ninety days.  He suggested it would be sooner than that.

I say call Obamacare by it’s correct name, Romneycare.  Romney is a very rich man whose wealth, we hear, is largely based on what some judgmental people call “Vulture Capitalism”.  These vulture entrepreneurs look for lucrative companies which they can strip down to bare bones, making them “lean” and sexy for resale.  They get rid of “fat”, employees, employee benefits, services offered by the company, things like that.  Once they’ve trimmed down a company for sale at a discount price, they sell it to the highest bidder.  It’s like flipping a house, but on a huge scale that effects many more people. 

Let’s call Obama what he was, is, will always be.  Sekhnet urged me to make no reference to what Bill Maher recklessly called himself the other day.   Fine.   Yeah, Obama was hated by entrenched racist fucks in both houses of Congress, as well as by a significant portion of the American people, many of whom still believe he is a Kenyan Muslim.   Many Americas, as shown by our last election, would rather have an unabashed  sexual predator with a tenuous relationship to facts as president than someone with 50% African genes, or even someone endorsed by such a person.  Let’s leave his race out of it then.   Yes, he was constrained in what he could accomplish, as all presidents are.   Let me, therefore, just call him what he also is:  a smarter, hipper, better looking, better speechifying, more charismatic Mitt Romney.   You read it here first, in the fake, liberal wordpress. 

 

 

 

 

 

Redraft of letter to Whom it May Go Fuck Yourself

It all feels too big today, as the rain pisses down. Concentration may be hard to come by.

The police department sealed what was until the other day Liz’s apartment.  I passed the green sticker on the door, took a blurry photo of it.   Her cats, brothers Sid and Gus, were taken to another apartment where they will get fed every day and have their litter boxes kept clean, until they can hopefully be adopted.  

Time marches on, rushes on, like the cold rain that is pelting down outside right now.   I am going to attempt to finish the letter to the progressive, publicity-hungry Attorney General of New York, per the imagined suggestion of my dead father.

Dear Mr. Attorney General,

I am writing to alert you to a massive consumer protection failure in New York State, regarding routine denials of purchased health care by health insurance companies.  I urge your office to investigate this unchecked, widespread fraud and propose legislation to correct it.  

There is no New York State agency meaningfully overseeing the practices of private corporations providing health care insurance in the state of New York, as I will detail below.   Even apparent outright fraud by a health insurance company cannot be redressed, except through an appeal to the insurance company itself.  This letter lays out the state’s current non-functional regulatory apparatus, such as it is.  I urge you to propose legislation to remedy this intolerable situation.

In January I drafted a long letter to you about this lack of regulation by New York State.  The health care emergency described in that letter (and here), with consumers at the mercy of an industry rich in temptations to deny services to increase profits, is even more acute under an administration intent on dismantling all regulatory schemes.  My own medical issues prevented finalizing that letter.

Since writing that draft I learned that your office proposes legislation and advocates for it.   I am writing to convince you to propose a bill creating state oversight, on behalf of consumers, of the medical industries that do business in New York State.  Widespread, colorable fraud is routinely committed against mandated ACA consumers/patients and no state agency oversees it.    

While there are hotline numbers for aggrieved health care consumers, none of these provide any help.   Alleged fraud against consumers by corporations is not something the New York State Department of Financial Services (“DFS”) is set up to investigate.   The oversight functions of the Departments of Health and Insurance, you may recall, were merged into the DFS for all insurance-related  purposes when New York State adopted the ACA.  There is no state agency, outside of DFS, that has jurisdiction over such frauds.

New York State needs an agency to oversee routine denials of approved medical services by insurance companies and to act as an Ombudsman for the many difficulties endemic to a complicated public/private health insurance scheme.   

I also urge you to call for creation of an ombudsman’s office for the New York State of Health Marketplace (“NYSOH”).   I can tell you from an unfortunate wealth of experience that the NYSOH is the most intractable bureaucracy I have ever dealt with (this includes New York City’s overwhelmed Adult Protective Services and the NYC Housing Authority). The current waiting time to have an “appeal” to correct a simple clerical error by NYSOH is, at minimum,  four months.  NYSOH’s policy is not to divulge the identity of its director, Donna Frescatore, and I no longer wonder at that policy, with the thousands of complaints they are currently attempting to handle.

Under the ACA, in New York State, a patient is expected to resolve all issues with the corporation he pays premiums to for health insurance.  I will lay out the cul du sac of non-help a NYS citizen experiences in the State of New York.   It is a seemingly robust system, with numbers for consumer help hotlines.  An hour’s investigation reveals that it is not even a fig leaf of a regulatory system.   Presumably the only action a New Yorker can take for denial of service, after calling all of these numbers,  is an Article 78, assuming one could find the legal grounds to not have it dismissed.

The health insurance company may deny services for any number of plausibly innocent-sounding reasons.  Claims are denied for: errant CPT code, two numbers transposed on the NPI, wrong NPI, incorrect service code specified, something related to customer MOOP.   (The PPACA is a treasure trove of acronyms).

What follows is a map of the regulatory cul du sac and some examples of this widespread silent profit-driven campaign against the most vulnerable of New York State’s health care recipients.   It is my hope that your office will propose legislation to make corporations accountable for the worst of these practices.

blah blah blah…

for some reason I can’t focus much on this hideous, but important, task today.  

Maybe it’s the image of a group of grinning elected white male imbeciles in suits, in a White House garden photo op yesterday, celebrating their impressive two vote “victory” in the House, passing a secret bill to abolish Obamacare.

The bill was never debated, its text wasn’t circulated before the vote, its economic impact was not scored by the CBO, but it satisfied the most implacably right wing members of the House.   An actual 1930 lynch mob could not have looked more delighted, posing under a swinging corpse.   The president laughed, asked playfully “can you believe it?” about him being the president.  Then he set off, three hours late, to meet the prime minister of Australia and tell him that Australia’s health care system (public) is much better than America’s.

USA!   USA!!!!

As for moving America back toward the 45,000 annual preventable deaths due to lack of affordable health care, I guess this president hasn’t had time to staff the CDC and pull down its website, as he’s already had his people do with Civil Rights and science-based Environmental information on government sites.  Visit The Center for Disease Control’s site while you can.

You can read for yourself Harvard Medical School’s dire accounting of uninsured Americans’ greatly increased chance of death here.   Thousands more will die, if the Republicans in the Senate can only change the rules so their 52% can pass the long-awaited law to wipe Obama’s signature legislation off the books.  On the other hand, and to be fair, the incredibly rich will get richer.   

We live in a country that accepts the preventable deaths of tens of thousands of its citizens a year as part of the price of freedom– the freedom of talented health insurance CEO-investor types, like Jared Kushner’s equally well-born younger brother, Joshua, who has much of his $1,500,000,000 investment fund invested in health-insurer Oscar, to reap unlimited financial rewards for their selfless service.  

USA!   USA!!!

I’ll hope to finish my letter to the A.G. in a few days.  I have to put on my rain clothes and pedal my bike through the dirty rivulets of lower Manhattan.

Happy Day for Motherfuckers

It’s pouring outside, rain gurgling merrily in the air shaft, a perfect day to do a little writing.  I’m working on a book about my father I’ve been neglecting recently and I thought of a great little chapter about his generosity.  I am also working on a book proposal for a much easier to complete book that I have more than half-written.    I’m also working on a letter to the New York State Attorney General, to convince him to propose legislation to regulate the out-of-control fraud of unregulated health insurance companies who do their lucrative business, sometimes enhanced by sharp practices they are not accountable for, in our state.  

But first, I needed to make two key medical appointments.  These having been hanging over me for months; in the case of the dermatologist, for three or four years.  The new kidney doctor (the excellent one I saw a few months ago is not on any QHP I could find) needs to tell me if my membranous nephropathy has yielded to my low-sodium diet and ban on non-steroidal anti-inflammatory drugs (ibuprofen) or if I need to go on an auto-immune drug regimen to avoid the worst case scenarios of dialysis or a kidney transplant.   The skin doctor needs to look at a variety of odd things growing on my skin and tell me which, if any, I have to worry about.  

A nurse friend found me a nephrologist the other day and in a relatively short time today I was able to make an appointment.  I’ll see the new doctor in a few weeks.  Thank God for friends in the field.  

I have the number of a young dermatologist I’ve been trying to make an appointment with the last few days.  I was referred to her by my current insurance company.  I am paying literally ten times what I was last year, for a “higher” level of medical insurance and better care than I was able to get last year.   This doctor’s name came up, and as I found nothing bad about her on-line, I’ve been calling her office to make an appointment.   Although she’s listed as in-network on the “provider” list for my specific silver-level QH fucking P, her office doesn’t think she’s in-network.  They were going to get back to me, but you know how that goes.  When I called yesterday Melanie had no update for me, so today I asked Norma, an extremely nice woman at Healthfirst, to make the appointment for me.  

Norma laughed when I asked if she could put me on hold without the Dr. Mengele String Quartet, and she was able to do so.  I heard only a few notes of their infernal nerve-jangling sawing.  We soon had another receptionist at the dermatologist’s office on the line.   We learned, about 40 seconds in, that the dermatologist was not able to see new patients because she didn’t have an NPI number yet.

If you live in the cocksucking United States of America, and do not have insurance through work, or enough money to buy an expensive but good private plan, and sign up for the PPACA’s mandated product, you quickly learn about things like NPI numbers, which are site specific (the doctor with multiple offices apparently has multiple NPI numbers, or maybe not) and CPT codes, which, if not perfectly transcribed, prevent treatment.  Wrong NPI number?  You pay.   Incorrect CPT code?  No service.  

You want to call someone to fix this?  Call your insurance company, baby, they work for you.   New York State, is there any state agency I can call to get this straightened out?   Uh, no, first work this out with your insurance company, everything’s going to be fine.  Or call this 800 number for the New York State Department of Financial Services which puts you into a cul du sac from the hell our smiling former commander-in-chief, and our glowering present one, for that matter, ought to be frying in.

“Norma, I’m sorry to be venting like this to you…” but Norma was fine, so many customers are experiencing similar horrors.   She worries for her kids, living in an out of control plutocracy with two working parents, a country where it’s no national scandal that tens of thousands die every year for lack of decent medical options, while billionaires compare taxation to Auschwitz.  She worries about the increasingly demonstrative boa constrictor that is life for working people in our great nation.  She is fine with my complaints, interested in my analysis.  But it helps neither of us, helps nobody.  

When I venture my opinion on the precedent, created by our recent two-term chief executive, of killing American citizens without trial or charges, passed on to this angry, unstable fellow occupying the oval office now, she becomes quiet.  It is horrible, she agrees.  Then I cross the line, as one ranting and venting while caught in a chafing trap often does.  

“When we droned a sixteen year-old American citizen, not charged with anything, and the press secretary said, in response to a question at a televised news conference,  ‘he should have been more careful about who his father was’, the proper response for the reporter was to break the press secretary’s nose.  To show that unaccountable violence by the State, in our names, is an unacceptable answer– wipe up your blood and try again.  The American people will no longer accept that kind of crap… our government is not a reality TV show where anything flies that makes people tune in and the cash registers cah-ching.”

Now Norma was silent, and I didn’t blame her at all.  A patient and empathetic woman, she’d been wonderful throughout a long, frustrating chat.  This was more than she was being paid for.  I told her as much, thanked her for her kindness.  She told me, gently, that it had been her pleasure, wished me luck and I sat down to type.  I figured that was as good an option as going to fuck myself.  

I’m going to call my nurse friend and ask her to get me a recommendation for a dermatologist.  If I have to travel an hour from my place to get my skin scanned, as I will to see this nephrologist to have my urine and blood re-tested, so be it.  Now just sit back and enjoy the rain, it’s another happy day for motherfuckers.

 

 

45,000 dead Americans

What do you call 45,000 uninsured Americans who die every year for lack of medical care in the wealthiest country on earth?  

The price of freedom.  The cost of doing business in the Free Market, bitch.

At the risk of seeming to pile on the president I voted for twice, a charismatic man beloved by millions even as he killed American citizens by remote control without trial or charges (and gave that power to his unstable successor), even as he repeatedly lied about “transparency” and prosecuted those who exposed government abuses under a draconian law drafted in the hysteria leading up to American entry in World War One, a law designed to crush dissent, even as he did much for the wealthiest among us and little for the rest, while delivering inspiring speeches at every turn– I have to say, I really do hate the motherfucker.  Someone with his intelligence, expressed ideals and talent as an eloquent and convincing salesman should not be such a tool of the status quo— in my opinion.   Yes, I know, half of Congress are not unsympathetic to the Klan and all that, rabid partisanship and racism are off the hook and so on, but, still.

“If you like the doctor you have, you can keep your doctor,” was, of course, POTUS-speak for “I won’t come in your mouth.”  Most of us make promises in the heat of the moment, sometimes it’s hard to keep them, I certainly understand that.   The side-effect of this untruthful statement, for me, the deal sealed by the immensely complicated PPACA drafted by the affiliated American medical industries, is that I’ve had to change doctors several times, pursuant to changes in the ACA in New York State in recent years, though for years I had good doctors I liked and was able to easily see.

Slipping through the cracks the last couple of years, as I’ve been forced to change networks and doctors more than once, and largely my own fault, was a visit to a dermatologist for a skin scan.  I almost saw one a year ago, paid for the visit out of pocket, though I also had insurance.  What scared me were the unforeseeable lab costs and possible follow-up surgery costs.  In hindsight, very stupid.   I’ve already had skin cancers removed from my nose and my arm.  Why am I fucking around?

In less than an hour yesterday I was able to find the names of dermatologists (“providers”) who accept my current QHP (“qualified health plan”) and rule out one who appeared, by the many similar comments about him on the web, to be something of a complete asshole.   A young woman dermatologist in a nearby office seemed like a good bet, nothing good or bad about her on the web.  Clicked on her office to make the appointment, typed in my insurance and was notified:

 

out of network.JPG

After only twenty minutes on the phone with the insurance company I was assured that the doctor is definitely in-network for my QHP.  The woman at the insurance company sounded very confident, offered to call the doctor’s office for me and make an appointment, but it was already after hours.  

I called today to make the appointment.  I gave all my information and when it came to insurance there was a pause.  The doctor is not enrolled in the QHP with that insurance company.   I explained that I’d been referred to the doctor by the insurance company’s provider look-up, verified with the insurance company that the doctor was in the plan.   She asked me to hold and as I did, the Dr. Mengele String Quartet sawing away at an adrenaline-fueled classical piece scored for the highest registers of their instruments, I felt my blood begin to boil.

I calmed myself with the thought that it is truly nothing personal.  45,000 Americans will die this year for lack of medical treatment.  Some are fuck ups who just don’t go to doctors until their symptoms are overwhelming and by then it’s too late.  Some have no health insurance and are scared by doctor and hospital bills.   Some are just fucked.  No reason to take any of it personally.  There is nothing personal here.   I am no more special than any of the other tens of thousands of Americans who will die this year because profit for a few is deemed much more important than the lives of  enough American losers to fill a large stadium.  Fair enough.

The thought didn’t calm me that much, though.   When Melanie came back on the line she told me she’d contact the office that coordinates the dozens of insurance companies and QHPs the provider group currently participates in.   She said it was possible that the doctor had recently been added and that they hadn’t updated the system yet.  

I was relatively restrained in giving Melanie a succinct and dispassionate version of what I have written here.  Melanie was nice, she has offered to call me tomorrow to follow-up.   As I sit in the chair tomorrow on the last day of a multi-visit root canal I will think of Melanie, ready to call her as I stagger from the dentist’s office.  I will keep my fingers crossed that none of these things growing on my skin are anything to worry about.  Then I will continue my search for a participating nephrologist for follow-up about the progress of my kidney disease.