Death sneaks in again

It is sometimes tempting to call the workings of our corporate world evil.  A ninety year-old woman, until her recent broken hip fiercely independent, lives out her last days in a bare bones hospital ward where her needs are ignored, though she is kept miserably alive, her tab paid by Medicaid.   There may or may not be a government agency that can help her.  Sekhnet and I lack legal standing to advocate for her, though I got two numbers today that may allow Margaret to advocate for herself.    

The ACA, which right-wing zealots and “Birthers” are still bent on abolishing as an illegitimate “Negro” plan, mandates that low income citizens buy private insurance on their state’s health exchange.  New York State of Health Marketplace was designed by Kafka, during an LSD nightmare.  The agency is run by an unaccountable political appointee director (Donna Frescatore) who has made it her agency’s policy for no worker to divulge her name.   They have no effective method of correcting their many errors, the wait for an “appeal” is months’ long.  

A more vexing collection of useless, low-paid motherfuckers I have never encountered, and I am a veteran of Adult Protective Services, the New York Housing Authority and the Housing Court’s Guardian ad Litem program.  I have seen hideous bureaucracies.   The unaccountable agency entrusted with providing health care to low income citizens in New York State is by far the worst.  

Had a nice chat today with a guy from NYS of Health Marketplace Appeals, Patrick, very patient– though even he had his limits in that regard.   My appeal should be conducted over the phone in a month or two, after that, presumably, I should be allowed to pay only what the law requires and not twice what the law requires, as I have been paying since an erroneous denial in January.

While talking to a social worker at the Department for the Aging, who spoke on the QT since I lacked legal standing to have the conversation on behalf of a mere friend, I had a call from Sekhnet.   Sekhnet has been overwhelmed and tearful lately, in part due to the steroids she’s taking for her breathing troubles.   She has been worried about my potentially dangerous kidney disease, and the fact that virtually my entire vegetarian diet is composed of foods, I learned yesterday,  very bad for compromised kidneys.  She’s been crying because Skaynes, our beloved cat, had test results the other day that showed his one kidney is in trouble, this in addition to a flare up of pancreatitis.  

I broke away from the kind, long-winded social worker, put her on a brief hold, and took Sekhnet’s call.   She was sobbing.   “Liz is dead,” she told me.  I expressed my sorrow, told her who I was talking to and said I’d call her right back.

Liz was the long-time partner of Tony, a gregarious fellow we met while he stood smoking cigarettes in front of Sekhnet’s building.   It emerged that Tony lived on the second floor with a shy, agoraphobic woman named Liz, a lover of cats (they hosted two former strays, Sid and Gus), and that it would be great for us to get together some time.   Tony explained that he’d have to work on Liz, and his work seemed to be a success.  We had dinner, after researching what Liz, a diabetic, could safely eat.   I think it was garbanzo bean pasta we finally made.  (To be strictly accurate, this dinner occurred after we returned from our trip).

Shortly after we first chatted with Liz and Tony, Skaynes began vomiting frequently and rarely coming out of his bed.  We were scheduled to leave for a two week trip to Israel in a few days.   Liz, Tony and our old friends’ son Avram generously stepped in to take care of Skaynes.   They wrangled the cantankerous cat into his carrier and ferried him back and forth to the vet for treatments.   The treatments were daily for a week or more.  Skaynes recovered while we were in Israel, we got their medical updates by email.  Liz and Tony (and the indefatigable Avram) had saved his life, and enabled our long-planned trip to happen, and we felt very grateful.  

We got together with them another couple of times.  Then they were having troubles, Tony had resumed drinking, after years on the wagon and in AA.  Liz had a past that included drug addiction and she could not tolerate this relapse.  There was tension.  Tony moved out, moved back in, was on a job in New Jersey when he had a fatal heart attack.  

Liz affected an air of stoicism, but the tragedy made her no more zealous about checking her diabetes monitor.  She’d been found in a diabetic coma before.  Tony said the beeping of her monitor annoyed her and she’d often turn the machine off rather than do what the beeping was reminding her to do.

After Tony died, Liz lived alone with Sid and Gus, in the apartment owned by her mother.  Her mother lives in Florida and needs money, is in the process of selling Liz’s longtime home.  Packages sat outside Liz’s apartment door for days at a time.   I followed up with Sekhnet who contacted Liz.  She was reassured when Liz finally returned a call, sent her some adorable animal emails (Liz volunteered at a cat shelter) with a funny note and also inquired about Skaynes.     More packages outside her door the other day.  Sekhnet could get no answer from Liz lately.  She convinced a neighbor with the key to have a look today.

The neighbor discovered Liz’s dead body.  One of the cats was sitting next to her dead body.  The cats had not been fed for several days.  The last email from Liz, about a week ago, noted that a dog will sit sadly by their master’s dead body and starve, too depressed to eat.  A cat will do the same, until they get unbearably hungry and start eating the dead master’s face.   The neighbor fed the cats and called Sekhnet.  

When I got off the phone with the social worker I called Sekhnet back and did my best to soothe her, though there is not that much real soothing to be given under terrible circumstances like this.   The world can be a cold and cruel place and one must count oneself fortunate only to be fighting with corporate cocksuckers, while Death, smug and implacable, waits with the infinite patience of one who has never been denied, to snuff out your last breath.

Detention

New York State has a little known legal procedure called Article 78.  Article 78 allows you, once you’ve “exhausted all administrative remedies” with a government agency, to apply to the court for relief if you’ve been deprived of something without a good reason.   The government agency, like most private businesses, which are given tremendous latitude with the profit-based “business judgement rule”, can show virtually any reason for its actions.   As long as there is any reason at all, even a theoretical one, you lose again.   The burden is on you to show that the decision is based on nothing at all, is, in fact, “arbitrary and capricious,” in the words of Article 78.

Presumably if the ruling is simply arbitrary, too bad.  If the decision is capricious, without also being arbitrary, it is upheld and you are, once again, shit out of luck.  You must prove that no evidence to support the decision against you was submitted, that your evidence was ignored, that the agency didn’t follow its own policies, that your opportunity to be heard was utterly devoid of any of the niceties of due process.   Arbitrary and capricious is a low bar, in fact, it’s a bar painted on the ground, almost anything can drag itself over it.   Still, it’s surprising how many bureaucratic decisions are both arbitrary and capricious.  

The punchline, of course, and you know there has to be one in our puckish legal system, is that the statute of limitations to bring an Article 78 proceeding is arbitrarily and capriciously short, either 90 or 120 days, depending, and good luck figuring out which applies to which agency.  Once your SOL is up you are SOL*.  

There is also no requirement that decisions subject to Article 78 review inform you of the existence of Article 78.   That would give people who are arbitrarily and capriciously fucked an unfair advantage, obviously.   The best thing to do, if you know a lawyer who tells you about Article 78, is get your papers ready to file in court before the decision against you is made.   

I am thinking of Article 78 out of the blue, another example of the way our laws are set up, with every appearance of fairness and transparency, but written as compromises with the powerful to favor those powerful entities who like their sex with or without consent.   Many of the indignities suffered by masses of people are covered under the maxim de minimis non curat lex, “the law does not concern itself with trifles.”  I was in court today, on jury duty, and I was reminded of the whole hideous enterprise as I bided my time waiting to be dismissed from service.

At lunchtime I went over to Chinatown, passing under part of the Lower Manhattan Detention Center.   I recall it was still being built in 1991 or ’92 when I took my third grade class from Harlem to Chinatown on the A train.  The parent chaperones didn’t show up on the day of the trip, and against the advice of all of my colleagues, me and about eighteen little Harlemites made our way, on a very hot day,  to amaze the waiters at Hop Kee with the kids’ skill with chopsticks.  It was a great trip.  

On the way back to the A train we passed the Detention Center, then still under construction.   A worker was hosing down the wet cement.  Fatima, looking thirstily at the splashing water, asked me if the man would give them a drink.  I said I had no idea, suggested she go find out.  She asked him and he smiled and patiently held the hose as all the kids drank their fill.   Fatima was delighted with herself and told me happily, her face gleaming with water, “see, Mr. Widaen, it never hurts to ask!”

That detention center was at the time named for Bernie Kerik, a crony of Rudy Giuliani.  Giuliani, a glory seeking, autocratic, former federal prosecutor, was mayor of New York at the time.  He told his cops to take no shit from punks on the street.  Under his watch the city quietly paid millions in police brutality cases, and no doubt saved just as many millions in cases that were never brought, like the ones where all the punks/victims were deported.  Kerik was Giuliani’s friend and enforcer.  

The complex of holding cells by the criminal court was called the Bernard Kerik Detention Center while it was being built and for years, until, in fact, the very day Kerik was sentenced to prison time for being a flagrantly corrupt and lawless asshole.   I saw the next day that the sign had finally been changed.   I think it’s called the Lower Manhattan Detention Center now.  I passed it on the way to and from lunch today.  It got me thinking about detention.  

An abstraction to most Americans, the lock-up is  also brutal reality to millions of Americans.  We have more people locked up here than any nation in the civilized, or even uncivilized, world.  A chart I saw the other day, based on FBI statistics, shows that 46% of the current American federal prison population is locked up for nonviolent drug-related offenses.  This site has some good charts and articles, click through the charts midway down the first page to see some eye-popping statistics.  (“The death of one man is a tragedy, the death of a million is a statistic” — attributed to Stalin).

My point is, in America, for the crime of preferring one recreational drug over another, you can be locked up for a long time.   In 2017, under a law pushed through by Nixon to punish and incapacitate his hated enemies, hippies and blacks, to fuck them up in perpetuity, going on fifty years now.  It’s the law, so be assured there is nothing arbitrary and capricious about it.

The power of state violence is an awesome thing we are all grateful for when it is used to save us from violence, from predation.  Some people are violent criminals and need to be taken off the street.  Forcing a non-violent person, who threatens nobody, to lie on the ground at gunpoint, shackling them, shooting them, locking them down, are not things to be done lightly.  Except that here, increasingly, they are, by militarized police departments for offenses like disrespect and running to escape prison time for the illegal drugs in your pocket. 

I felt like a fish in a frying pan today during seven boring hours on jury duty– the full power of the state and its armed agents ready to slap me down if I did something stupid.   Imagine being locked in a cage, subjected to the violence of the state day after day after day, say the wrong thing and get a crack across the face.  Your word against mine, maggot.   Solitary confinement for you, asshole. Picture being locked up awaiting trial and sentencing to a long term in the slammer because you like to drink scotch rather than bourbon.   USA!  USA!!!!

 

*  Louis Armstrong recorded a tune called SOL Blues, Shit out of Luck Blues.  SOL is also a law student abbreviation for statute of limitations, the timeframe for bringing a legal action.

New York Minute

It was a Friday,  late afternoon.  I’d struck out signing up to get a tax transcript online for my eventual appeal of NY State of Health Marketplace’s mistake, which is currently costing me $220 a month.  “Incorrect phone number” the moronic IRS robot told me before shutting down the session for the fourth time.  I finally gave up and went out for a walk.

Heading up crowded Sixth Avenue in a foul mood it didn’t escape my notice that everyone was out of step.  Three or four across, staring at tiny screens, stopping suddenly, veering, lurching.  After a half mile of this I burst around a small crowd of lollygaggers, hit my foot on an uncommonly high curb cut, and fell loudly on to the sidewalk, on to my palms.   The sudden loud noise was exacerbated by my heavy coat, which I’d been carrying, slamming loudly next to me, books and metal phone chargers slapping the ground.

I was surprised, and embarrassed, but otherwise unhurt.  I saw the feet and legs of people who’d stopped to help.  “I’m OK, I just tripped, I’m fine,” I said calmly as I started to stand.  The woman who’d begun to scream as I went down kept screaming.  “I’m not hurt, I’m all right,” I continued, as the woman continued to scream. 

She screamed like a woman in a horror movie, screamed for all she was worth.  At the time I was thinking “what an asshole…” but now, a week or two later, I realize she was screaming for all of us.

Slice of New York City Life

A friendly guy often stood in front of Sekhnet’s building having a cigarette.  Sekhnet hates the smell of cigarette smoke, and noisily protests whenever a whiff of it rolls over her, but she and I became friendly with this guy who always had a big smile and small talk when we ran into him in the street.  He worked as a contractor of some kind, with only modest financial success, and his hours were odd.  You could run into him smoking out there during the day or at two a.m.  

His girlfriend lived in the building, he lived there too, in fact.  She wouldn’t let him smoke in the apartment, and fair enough, so he went down to the street, stood in front of the building, and cheerfully shot the shit with people coming in and out.   It emerged that his girlfriend, a fairly agoraphobic woman, was deeply involved in the rescue and fostering of unwanted cats.   They had two adopted strays, Sid and Gus.  When our cat, Skaynes, was suddenly very ill– on the eve of a two week trip we had planned— these two lovingly trundled him off to the vet for daily treatment of his newly diagnosed pancreatitis.  Along with the son of old friends, on hand in the apartment to otherwise take care of the cat’s needs, these three literally saved the Baron’s life.[1]

We had dinner with them a couple of times, I read the dark play the guy’s father had written about his life in prison, culminating in a smuggled razor blade, presumably to end his life, tucked somewhere safe as they transported him to another prison, or a death chamber.   Father and son had had a reconciliation before the old man died.  Actually, it was all good, it’s just that the older man had spent much of his life locked up for crimes he claimed he’d never committed.  Lived out the last years of his life a free man.

Now we fast forward a year or so, troubles in the relationship between these new friends of ours.  The man also had untreated heart issues, the occasional pains in the chest, shortness of breath.   He’d been told he had heart issues, but didn’t have insurance so had been reluctant to see a doctor.  He got a stern lecture about smoking every time Sekhnet passed him having a cigarette downstairs.  There was a self-destructive side to him, certainly.  

Then, a phone call.  The woman had been having problems with her phone, when they got fixed she heard the message from the man’s mother.  He was in the hospital in New Jersey.  He had signed a DNR.  They had taken him off life support. “He looked good,” she reported after visiting the young, healthy-looking man lying unresponsive in the hospital bed, disconnected from all life support.   A day or two later he was dead.

 

[1] Among his names is the title Baron Von Doghead

 

Merry Christmas From New York

I was headed downtown to visit friends in from far away.  After a groggy start to Christmas Day, a day that generally fills me with despair,  I was running late, well after the time I’d told my friend I’d aim for.   I had a twenty minute or so southward train ride to get there, then a short walk west.  

As you approach the elevated Number One line at Dyckman Street you can see up the track almost to the next station north.   If you see the southbound train coming around that bend, experience teaches you can catch that train if you run into the station, Metrocard in hand, and make a smart dash straight up the steep steps.  

I went through the turnstile and made my dash smartly, but there was no train.  The one I’d seen, apparently a mirage.  There was no train on the horizon either.  I noticed how winded I was, I’ve run up these stairs many times– this was the most winded I’ve been.  I walked it off.  

At the end of the platform a man was talking on the phone with his back to me.  He had a baby carriage with him.  The baby was also turned away from me, but I noticed how solicitous the man was, walking the baby carriage in little circles to soothe the baby.  I watched them absently for a moment, thinking of the human parent’s instinct, if everything falls right, to comfort their child.  I recall feeling impressed with how this guy was taking care of his baby.

The train came.  The man turned the baby carriage slightly to move his child on to the train.  I could now see that the baby was a full grown beagle, sitting very patiently upright in the baby carriage.   I made a note to tell this story to my friends when I arrived, but as things happened I forgot about it.

We exchanged handshakes, hugs and pleasantries and then my friend said “I have a small gift for you,” as if remembering some trifle.  He went into the other room and returned with the best gift anybody has ever given me, possibly the best gift anyone has ever given anybody.  “It’s really nothing,” he said, handing me a hard-shell ukulele case with the imprint of a palm tree on its shell.

Over the years my friend has mentioned a dream image he has, of himself, sitting on a porch somewhere beautiful at sunset after his work day is done.  His work would be gently but firmly bending wood, plying it, smoothing it, skillfully using tools to turn beautiful wood into a beautiful musical instrument.  In another life, he’d have loved to have been a luthier.  

A few years ago he took a course from a master luthier and made a tenor ukulele, out of beautiful wood, over the course of several weeks.  He sent me photos of it at the time and mildly self-effacing comments about the instrument when it was done.   I opened the case and there was the hand-made ukulele, a very beautiful one.  Everyone I showed it to later could not help stroking it.  It is lovingly detailed, with several unique flourishes, and finished to the texture of perfect skin or something like that.  It is so silky that it’s hard not to pet it if you hold it in your hands.   Everyone who held it did.

It plays beautifully, with a rich tone I haven’t heard from most ukuleles.   He also somehow rigged the lowest string to be in a lower octave, as on a guitar, making this uke a much more useful instrument to play melodies on.  I smiled as I played a little Django ending that had been impossible to play on my other ukes.  Sekhnet could not stop commenting on its beautiful tone, just as I could not stop playing it in the car after we left our friends.  

“What an amazing gift!” Sekhnet said, “I hope you really thanked him.”  I assured her I did.  I think I did, I’m sure I did, I had to have.  Of course, now that I’ve played it for hours, and re-tuned it to concert pitch, I’ll sing its praises some more when I talk to him tomorrow.  He’d looked at the label inside, with his name and the year he made it, 2009, and told me, since he never played it (although he certainly could), that I should have it, since I would play it.  I certainly am playing it.

I played it happily for an hour or so in the background with Sekhet’s family.  Each of them had admiringly held and petted the beautiful instrument, a few even strummed the open chord it plays if you don’t finger the frets.  I then played it all the way back to the city.  When we got back I was concerned that the constantly sleep deprived Sekhnet get some sleep.  I left her and walked to the subway to head uptown.

Being Christmas, it was only natural that the train service would be fucked up.   The high-tech interactive electronic information signs on the subway platform gave random misinformation.   According to the fancy new sign the next A train was a Brooklyn-bound one scheduled to arrive in 46 minutes (average wait is supposed to be about twelve minutes).  There was no information about any uptown trains at all.   “We’re working harder to serve you better,” I said finally to two other sour-faced men waiting for information on the uptown train to take them home Christmas night.

A moment later there was an incomprehensible PA announcement and a Brooklyn-bound A train rumbled in on the downtown platform.   Another announcement began as the Brooklyn-bound train was departing, making a great racket across the station.

The MTA had decided, in its infinite puckishness, to have the crackling, irrelevant, over-driven announcement delivered by the employee with the heaviest and hardest to decipher foreign accent.   I don’t know where this guy was born, but I’m sure the last thing his parents ever dreamed of for him was delivering this incomprehensible message to disgusted New Yorkers over the public address system moments after the end of Christmas Day. I have no idea what he said, but I do recall sincerely muttering something about fucking retards that I do not now feel very proud about having muttered.  

A dirty, smelly beggar was striking out as he made his way toward me on the platform.  He’d start to speak and get waved off.  I saw this happen a few times, found I had a single dollar bill in my pocket and thought “what the fuck?”   When he came toward me I handed him the dollar, which he dropped.  

Before he picked it up, he looked me in the eyes and asked “could you please help me out with two or three more?”  I told him I didn’t have it.  It was true.  My other bills were twenties, and outside of that, I had two pennies.  He continued down the platform and I was reminded of my dislike of people who don’t have the grace to say thanks. 

On the uptown A, which finally arrived, a large man asked “may I sit next to you?”  This is not a question anybody phrases this way on the New York City Subway.  It was the only seat in the car, and I nodded, almost imperceptibly, and without looking up from my book, only because it was the right thing to do.  

Then, because you know what they say about unpunished good deeds, he began humming in a soulful way, and turned his head toward me as I tried to read, which made his humming suddenly way too loud.  He began to sing, in the same manner as his humming, turning his head like a slow moving leslie-speaker to heighten the effect.  

He did that African spiritual-inspired melisma, making every quavering note a long, stylized, if cliched, statement of his soul.   After a few minutes of this I wanted to do something to make him stop. I thought about my vow to remain mild and kept reading.  

A seat opened across the way, and I took it.  I couldn’t hear his fucking singing from over there, and it was a relief.  Suddenly, I smelled ass, dirty feet, filthy clothes.  The smell was coming from the seat behind me, turned out to be a homeless woman.  But the smell wasn’t that bad, it was better than the fucking soul singer.  

The singer got off a few stops later and I went back to where I’d been sitting.  I watched the poor homeless woman, who appeared to be very much insane.  I thought of the almost infinite varieties of suffering in this world, and of God and the mythical baby Jesus weeping over it all, less than an hour after Christmas.  I  took out the ukulele, played a bit of Django’s version of “I’ll See You In My Dreams” and put the lovely instrument into its protective case as the train pulled into Dyckman Street.

As I walked up the hill to my apartment, carrying the perfect tenor ukulele my old friend had made, I thought of the blessings of this life. Those blessings are not the physical things everyone is taught to covet, of course, but what lies behind them, what we might call their spiritual dimension– what they represent in terms of our souls.   If the physical manifestation is also a beautiful thing, that’s ideal.

I thought of my friend’s ancient mother, now well-past ninety and noticeably much older than the last time I saw her, not that long ago.  She made mention tonight of her approaching death.  I’d never heard her speak of death, but when I quickly broached the subject of Trump, during a moment when her son had gone back upstairs to fetch something she’d forgotten, she told me that the only good in it for her is that this would be a good time for her to die.  

I told her that my mother, at the end of her life, had begged me to promise her that Sarah Palin would never be the president.  I made the promise and I’m as sure as it is reasonable to be that Sarah Palin will never be the president of the United States.  There are things as unthinkable as President Sarah Palin, but that’s an imponderable story for another time.

When I put her son’s ukulele in her hands she immediately began stroking it.   She admired it for a long time, and mused about how many other hidden talents her talented son had (he was cooking a delicious smelling dinner at the time).  

Later, sitting around the coffee table, my friend’s mother smiled, and pointed at her son and her grandson, huddled over the young man’s cellphone, looking at photos of some of the grandson’s recent architectural projects, I assume.   To her daughter, with a big smile, she said “kvelling…” This is Yiddish for a parent’s pleasure in seeing their child do something that makes them kvell with pride.  The daughter looked at her blankly and asked “who?”   

“Me,” said the old woman happily, as she pointed to her chest with a gnarled hand.

Protection from Fraud under the Patient Protection and Affordable Care Act

The short answer: there is none.

The longer answer:  

The NYS Department of Financial Services, any health insurance consumer’s logical first stop for answers about Health Insurance Fraud, had a longer than expected hold time (16 minutes).  There was nobody available at their fraud office today, they took my contact information and promised me an eventual call back.  They also have an online complaint form that you can fill out and, presumably, print, fold and insert into a body part exempt from your health insurance coverage.  

The kind woman I spoke to there, Norma, did not know of any place except the U.S Department of Health and Human Services that possibly oversees any aspect of the Patient Protection and Affordable Care Act.  Twenty-nine minutes after I’d placed the call  to her I was dialing 877-696-6775.

There was no wait at the federal agency, though also no option to speak to a human.  The voice prompts were limited, it seemed the best bet was being connected to my state Department of Health and Human Services.   I tapped in the requested information and was connected to the New York State agency.    

Unfortunately, it was the New York State agency that handles temporary or disability assistance.  I could press various numbers to get information about child support and other programs, but none related to health insurance.  

I eventually tried the administrative office options and spoke to a sympathetic woman at the office of legal affairs.  While her sympathy was solid, she did not have unlimited patience or time, and after five or ten minutes commiserating she connected me, without further ado, to the Fraud Hotline.  This number is 877-873-7283.

Sadly for me, it was the Medicaid Fraud Hotline, and as my program is not administered by Medicaid, I had to make a human appeal to an even more sympathetic woman, who, after twenty minutes or so, worked with her supervisors during a short twelve-minute hold, and was able to  give me two more promising, and seemingly self-evidently logical, numbers to call.  

One is the NYS Department of Health, Office of Health Insurance, apparently an unlisted secret number: 800-343-9000.  I surmise that it’s an unlisted help line because it took several long calls, ninety minutes of sleuth work today alone, and almost cat-like patience on my part, to have a supervisor at the Medicaid Fraud office think of searching for this particular number.  

She told me the number used to be on-line but they removed it from the website, presumably too much traffic on that line, too many strangled, inarticulate cries for help, too much rage and despair for New York State’s limited allotment of representatives to handle.

The other number is the New York State Insurance Department, which, while seemingly a logical number to give to someone with a complaint about insurance in New York State, is apparently equally obscure.  This office can, hopefully, be reached at 800-342-3736.

I don’t know why, but barely two hours into the calls now, I suddenly ran out of steam to tell my story to another person who agrees that there ought to be an ombudsperson or help-line to oversee problems with a federal health law administered by the states, particularly one that consumers are mandated to buy on pain of a tax penalty for refusing to participate in.  

Even though health insurance and pharmaceutical companies wrote the PPACA, and their liberal one-sided exemptions therefrom, even as the despicably corrupt right wing Democrat Max Baucus (recipient of millions in contributions from those lobbies — the fucking scion is now Ambassador to China– a little ‘thank you’ from smiling Obama) oversaw the process, even as health insurance/pharma industry lifer Liz Fowler wrote the law, you would think there’d be some oversight involved somewhere.  

You would apparently be wrong to think that.  Nowhere in the 2,700 pages is there any provision for a mechanism to protect patients from fraudulent denial of services under their one-sided contracts with the private corporations.

The last well-meaning woman I spoke to suggested I call Empire Blue Crucifix and talk to their internal complaint department about my accusations of fraud against them.  She assured me there had to be a number on the back of my insurance card for complaints.  I checked.  There was not.  I read her the options.  “Customer Service!” she announced hopefully.  I gently dashed her hopes.

Maybe I am thinking about the condolence call we are going to be making in less than an hour for Sekhnet’s old friend whose mother died the other day and I want to clear my head.  Or something like that.  I certainly do want to clear my head, I can tell you for sure.

And the minute the talented Mr. Obama is a former president, make like Robert De Niro wanted to do with Trump, which he can’t do now, obviously, because of Secret Service Agents and the private security contractor army that surround the new most powerful and important man in the world.

The Patient Protection and Affordable Care Act

The New York Health Exchange, which determines the metallically designated (platinum, gold, silver, bronze)  level of PPACA insurance coverage your income qualifies you to have, has no ombudsperson.   It has no meaningful appeals process to correct things like an error that deprives a patient of health coverage for a few months.   The name of the director of the New York State of Health, if you ask, figuring you will contact that office directly, is none of the public’s business, although the enterprise is a wholly public one.  

It employs practices that fit the definition of “arbitrary and capricious” but would probably not be so deemed in a court of law.   You can hire a lawyer to bring an Article 78 proceeding, under NY State law, if you have a few thousand dollars lying around, but, there is zero chance of recovering any kind of monetary damages, so why go there?    

The Patient Protection and Affordable Care Act could, as accurately, have been called the Health Insurance and Pharmaceutical Industry Profits Preservation Act, but while the name would have been more truthful, it would have been a harder, and more embarrassing sell for the president.

But, let’s leave all that aside for now.    

Now you have health insurance assigned to you and you pay your premium. You liked the doctors you’ve been seeing for years, and were promised you could keep them, but that was not a truthful promise by the president.  No problem, and don’t get all pissy about it.  You find new doctors and you can have medical records sent to them for free by your old doctors, provided you send the proper authorizations to each previous doctor’s office.  Not really much of a problem, as anyone would agree.  

Except when you try to find out who will pay the new doctors for their services.  Then it becomes the patient’s sole responsibility– and you’d better be smart and patient as hell, preferably a trained lawyer, too — to figure out what you have to do so that you won’t be left holding the often shockingly unaffordable bill.

Although there is no requirement in the law that the patient be informed of the price of any medical service until after it is rendered (and therefore, purchased) it turns out to be possible, if not simple or straightforward, to research which services and providers are covered by insurance under the Patient Protection and Affordable Care Act.  

All you need, in the end, is the provider’s NPI number.   You call the provider (in health insurance jargon doctors and hospitals are called ‘providers’) request and write down the ten digit NPI number for that provider. Then you call your insurance company where you can usually speak to a representative within less than twenty minutes, since they are generally busy assisting other “customers”.   You give the person who answers the NPI number and then go back on hold while they connect you to someone who knows what an NPI number is.  

Do not get overwrought when the ads you are listening to while on hold are suddenly in Spanish, or in Mandarin.  You can never be sure, from a marketing point of view, which language ad will be the most ‘impactful’ even if the customer did not oprime el numero dos when given the choice of languages.  It is best to remain free of judgment while on hold.  

One must not be unduly disturbed by the thought that every health-related transaction is driven by the imperative to maximize corporate profit.  It is also important to keep in mind that any aggravation you may experience while on a long hold has nothing to do with any active desire to make things harder for patients trying to get medical treatment.  The health insurance company keeping you on hold to speak to customer service is only trying to keep costs down, for your ultimate benefit.  

“You didn’t get the provider’s NPI number?” the representative may say, throwing up her hands.  If you had the foresight, and got the NPI number, it is only a minute’s work for the insurance company representative to look up the doctor, determine if the provider is “in network”.  If you have not made a prior call to the provider to learn the provider’s NPI number you create additional work for a representative who does not get paid very much to do the patients’ work for them.  

You may learn, to your great surprise, and only 51 minutes into your customer service experience, that one provider may have multiple NPI numbers, each corresponding to a specific office location and associated telephone number.   Call the wrong office, or even the right one picked up at the wrong location, and the NPI number and provider are no longer “in network”– even though it’s the same provider, it’s a totally different NPI number, which should be obvious enough.  

From the insurer’s point of view, why would you expect to have insurance pay for a provider who you think is in network, even if the insurer itself told you so, if you do not have the correct NPI number for the specific service delivery situs you are making an appointment to see that provider at?

I understand that the bottom line in our global economy is corporate profit.  I get that, I really do.  I don’t like it, particularly when applied to health care, but I understand we live in a materialistic world and that corporations are legally constructed psychopaths the Supreme Court has us pretend are living human beings for purposes of their right to have a say in the government that makes and enforces the laws they must “live” by.  I get all that, I do.  

I get that all presidential candidates lie, that all presidents disappoint, that Mr. Obama was no worse than most in either of those areas.  He was better than some recent ones, certainly.  If you’re going to be fleeced by a predatory corporation, or killed by a drone without charges or trial, or have your phone and email records secretly collected, or be denied a Freedom of Information request, or threatened with the death penalty for being a diligent journalist, or anything else Mr. Obama or any other American president might do, you might as well get that treatment from someone who is thoughtful, funny, smooth, cool, calm, who knows how to sound like his heart is always in the right place.

I don’t begrudge B.O. the hundred million in speaking fees he will get in the next couple of years.  He’s brilliant and very talented and deserves the handsome fees much more than most of the famous and infamous speakers who get paid obscene sums to inspire corporate audiences.  God bless America and God bless his freedom to make those hundred million in the next few years.  Couldn’t happen to a nicer guy, as far as I can tell.

That said, I have limited patience for statistics-spouting, blindly partisan defenders of a deeply flawed,  perhaps fatally compromised, solution to a long-standing problem that afflicts millions of our most vulnerable, especially if that partisan defender has had no personal experience with the day to day niceties of the Patient Protection and Affordable Care Act.  

The outgoing president, taking his bows now in a last well-measured victory lap, has to get some of the blame for the many flaws of the monstrously complex, profit-driven health industry-favoring law that bears his name.  

You want to point out that he’s been surrounded from day one by detractors, many of them racists, snarling, unreasonable, petulant obstructionists who have done nothing to fix the flaws in the complicated, problematic law, outside of trying to repeal it countless times?  Fair enough. But the solution the president put on the table at the start of negotiations was designed, before anything else, to ensure that health insurance and pharmaceutical company profits were kept as healthy as possible.    It was drafted, after all, by experts who went back to work for those industries after the bill became law. 

And, as in any zero sum game, the weaker party, regrettably, wound up, inadvertently and completely unintentionally — and we’ll stipulate, out of respect, that it was done with only the best of intentions — burdened, scammed, coerced, unaffordably billed and, in many cases, simply fucked.  

But, hey, would you rather have a preexisting condition?   Or die in an E.R. with the 45,000 other Americans who died every year for lack of health insurance?   Thanks to Obamacare the number of Americans who die in Emergency Rooms for lack of decent preventive health care is certainly much lower now.   Though statistics are hard to find, I’d wager that terrible number has been cut in half.

As the president said when signing the flawed law “don’t let the perfect be the enemy of the good.”  Or, as a patient protected by the PPACA might say, “don’t let the good be the enemy of the fairly crappy.”