I am scheduled to have the first of two five hour infusions of a drug called Rituximab on Friday.  This drug is usually used for lymphoma patients, as far as I can tell, after a visit to the manufacturer’s website.  Nephrologists have recently found Rituximab is often helpful in curing the kidney disease I have, membranous nephropathy.  I am resigned to being hooked up to a slow dripping bag of this miracle drug, which seems to have a fraction of the side-effects of the steroid-based chemo regime I was being pressured into a few months back.   My current nephrologist recommended three vaccines before I start, as the Rituximab will suppress my immune system.  

I had a flu shot, and a pneumonia shot.  I’ve spent the last ten days or so trying to get the third — an immunization against shingles.  From everything I’ve heard, shingles is something to be avoided.    I am prone to skin troubles, I am over sixty, I have an auto-immune disease, had chicken pox:  I am a good candidate for this potential side effect of the immunosuppressive regime.  

My primary care doctor, for whatever bureaucratic reason, could not order the pneumonia and shingles vaccines.  He gave me a prescription to fill.  The pneumonia vaccine was easy to find, the shingles vaccine, not easy.  I have been to seven pharmacies so far.  My local pharmacy, for whatever reason, could not order the vaccine.  Two chain pharmacies had the vaccine, RiteAid ordered and quickly procured it, and DuaneReade had it in stock, but they do not accept my insurance.    

It costs about $300, if I wanted to plunk down my credit card.   Four pharmacies that accept my insurance, CVS branches, did not have the shingles vaccine. The CVS closest to my apartment has been waiting months for it to come in. The pharmacist at the last place, the one that had the vaccine, but doesn’t accept my health insurance, suggested I call Healthfirst, the corporate gatekeeper of my health care.

It was not a terrible suggestion, but past experience whispers now that I should not have made the call.   For one thing, the inviolable policies of corporations are not something mere mortals can question, let alone contest. For another, there is the psychological angle — I cannot separate the practices of one homicidal legally-created psychopath from those of another homicidal legally-created psychopath, and I hate them all.  

“Homicidal” sounds so judgmental, I know, but do the math.  I live in the USA, where tens of thousands die every year for lack of affordable access to adequate health care.  It’s a cost of doing business here in the Land of the Free and the Home of the Bankrupted by Cancer.  We don’t bat an eye about the annual preventable deaths, more than tenfold the death toll of September 11, 2001, every year.  We have reality TV, social media, a big American Dream, evil people to hate– so people die here, like the tens of thousands of Americans who died of oxycodone and heroin overdoses last year, what’s your point?  Your little problem?  Fuck you, asshole.  Get a better life, make enough money to buy whatever you want, including good health care, and shut the fuck up about ‘injustice’, boner breath.

In fairness, and we should always strive to be fair, insurance companies do not make money paying out claims, the profit is in paying out as little as possible.   In a nation that was not insane, stoned beyond reason on “free market” kool-aid, it would not be a patient’s problem to figure out how to get a needed inoculation paid for by the insurance company he pays a premium to every month.  

My trouble is that I can’t separate the frustration and the indignity from the injustice any more.  I get angry, though I control my language, and I cannot help but remind the helpless representative, reduced to meaningless apologies, that she works for a corporation, something we pretend is a “person”, but is the kind of person incapable of conscience, empathy or anything but naked self-interest.   This does not sit well with some of the reps.   They are not being paid enough to listen to this kind of shit from someone who is angry that he has to keep calling a murderous psychopath for help with healthcare.  Murderous psychopaths do not give a fuck, what kind of idiot does not know that?  What kind of moron tries to argue with representatives of an artificial “person” who is also, by definition, a murderous psychopath?

By the end of yesterday’s marathon 40 minute chat with an excessively polite woman named Ilene, the obstacles escalated considerably.  Not only, did she inform me, (after two long holds for consults on how to deal with an insane raging asshole, and a sickeningly articulate one), would Healthfirst not pay for a shingles vaccine administered in a pharmacy, assuming I could even find the drug anywhere, the shot must be given by your doctor, in his office, after he receives pre-authorization from Healthfirst.   

As for how long that pre-authorization might take, nobody has any idea. Could be fast, could be very slow.  Ilene, after all, is on the membership side of Healthfirst’s corporate brain.  Pre-authorizations come from the provider side.  These two sides have no way to communicate with each other.  I have experienced this before.  It was a kind of last straw yesterday.  I remarked that it was handy, for an artificial “person” without conscience,  to have a divided corporate brain that could not communicate between the halves in order to answer a simple question.  Before I could utter a stream of horrible curses nobody would be able to unhear, I thanked Ilene in an acid tone and wished her a good day.

The pharmacist in Sekhnetville, who has ordered the vaccine, assured me that they give shots to Healthcare customers all the time, that it should be no problem, once the vaccine comes in, to shoot me up right there.  In hindsight, I suspect that Ilene, being a polite and hardworking girl, probably from the mid-west, had found a way to tell an insane asshole to go fucking fuck himself, in the politest, most vicious possible terms.

The latest call to the pharmacist in Sekhnetville, who promised the vaccine would be in today, revealed that… oops, the manufacturer does not seem to be currently shipping the vaccine.   It appears to be on back order.  Could be weeks, or even months.  So, sorry.   Have a very nice day.  Unexplained is why RiteAid was able to procure the drug within a couple of days, or why the shot was available at DuaneReade.

Looks like I’d better reach for my credit card and just have the fucking shot at one of the “out-of-plan” pharmacies that currently have the shit.

USA! USA!!!!  Nice work, Barack, rocking that big, lucrative corporate boat as gently as possible while making some small, long-overdue improvements for more folks who couldn’t previously afford health care.  Good luck with your book sales and paid speaking tours, my man.