Category Archives: current events

Here we go, the ACA, in a nutshell

Haven’t discovered how to enforce my right not to receive apparently fraudulent bills from health care providers (so far I’ve had a few hundred dollars for duplicative demands for payment dismissed, after calls to billers).  But part of the difficulty with the law is put in context by the following:

The Patient Protection and Affordable Care Act (PPACA), codified as amended at scattered sections of the Internal Revenue Code and in 42 U.S.C. commonly called the Affordable Care Act (ACA) or “ObamaCare“, is a United Statesfederal statute signed into law by President Barack Obama on March 23, 2010.  (Wikipedia)

When I wrote the other day that it was written by the health insurance and pharmaceutical industry to benefit those industries, I was lacking the name of the author of the ACA.  A friend found it for me in remarkably short order.   Her name is Elizabeth Fowler and she worked closely with former Senator Max Baucus between three separate stints in the industry.

Here’s a good article about Elizabeth Fowler, health industry insider and primary author of the PPACA, now back working for Johnson & Johnson — with a very worthwhile five minute video editorial by Bill Moyers at the end of the article.

(Thanks to JDS for sending link to article on Liz Fowler and her stinking ilk)

If you prefer an article in the New York Times, read this.

A bit more about Ms. Fowler and her former boss, Mr. Baucus:

Fowler’s career in Washington stretches back more than a decade, when she first left a private sector hospital group in Minnesota in 2000 to join the Health Care Financing Administration, a federal agency now known as the Centers for Medicare & Medicaid Services (CMS).

By the following year, Fowler had landed at the powerful Senate Finance Committee, working on health care issues for Montana Democrat Max Baucus. Lobbying records show that Fowler stayed until 2006, when she departed for a two-year stint at health insurance company WellPoint, only to return to the Senate in 2008, again working on health policy for Baucus.

When it comes to health care, and health lobbyists, Baucus isn’t just any senator. Since 1998, he has collected more than $5.1 million in campaign contributions from the insurance, pharmaceutical and nursing industries, making him one of the health care sector’s most heavily backed lawmakers.

 (the rest of the article is here —->)  yawn, yawn 

Obamacare 101

If you receive health insurance under the Affordable Care Act (“ACA”), Obamacare, you already know that it has all of the elements of a corporate scam.  If not, the jury would seem to still be out.   I’m here to tell you that the verdict is in.

I have a politically progressive friend who reads the Wall Street Journal every day.  He argues that the ACA has been a great step forward.  It covers millions more uninsured Americans than ever before and is beginning to rein in runaway medical costs.   As a participant in the ACA, and no fan of the Wall Street Journal, I can tell you from direct experience how closely Obamacare resembles an insurance industry scam.  

On the plus side first, it can’t be denied that eliminating the loophole of “pre-existing conditions”, the term that enabled American health insurance companies to deny insurance if you were ever sick with a particular disease, was welcome, and long-overdue.   There are other good features, no doubt. The perfect should never become the enemy of the good, as the president has said, but for the most part the ACA, that great free market compromise with comprehensive health care reform written primarily by and for the insurance industry, profits mainly that industry.   Like many other boons applauded by the Wall Street Journal, it involves large profits for the canny few at the expense of the clueless many.  

The opacity of the 900 page ACA is one of its most notable features.  If your rights and remedies are hard to discover, most people pay the bills they are sent and kiss their rights and remedies goodbye.

New York State set up a Health Care Marketplace at the earliest possible date.   We were all in for Obamacare.  Visit the New York State of Health website and you will marvel at the opacity of the consumer-friendly system.  From the difficulty of signing in (that’s called Get Started, by the way, no matter how many times you’ve already gotten started), to the lack of easily navigable plan details, to the absence of a clear statement of what the ACA is, or what it guarantees, to the almost completely useless help number (“we are experiencing more than the usual volume of callers, your business is very important to us”) you will see enough to discourage the casual seeker of health insurance from persisting there.  Also, enough to deter anyone looking for the rights guaranteed by the law in clear, unequivocal language.

“Preventative services are 100% covered,” the helpful woman at the NYS of Health assures me, after only 35 minutes on hold.  I ask her where I can see a list of these covered services, since I’ve already paid $150 in co-pays towards my recent colonoscopy and am being dunned, and threatened with collection letters, for an additional $281 connected with this preventative service.   She isn’t sure where I can find that language, the NYS of Health Marketplace only sells the plans, they don’t actually administer them or oversee the individual insurance companies.  

This particular woman is great, sympathetic, smart.  I kick myself that I did not get her name.  We look together for language that says I’m entitled to have my colonoscopy paid for 100% under the ACA, for my $471 monthly premium.  I find, several screens later, in only 4 or 5 clicks, this page, under Resources, and on the pull-down menu there’s a link for Using Your Plan, that eventually takes me to this, at the bottom of that page:    

Sep 26, 2013

Covered Benefits and Out-of-Pocket Costs for 2014 Standard Health Plans

And I read, under What Are Essential Health Benefits, number 9, the closest I will find to any kind of confirmation of this seemingly simple yes or no fact that preventive services are not subject to any deductible, to wit:  

Prevention & wellness services and long-lasting disease management

“You are entitled to be repaid that $150 you already paid for a covered service.  If your insurance company is making you pay any fee in connection with a colonoscopy they are not in compliance with the ACA and you should hold their feet to the fire,” this bright woman, a former health insurance industry appeals expert, tells me firmly.  

She informs me, in answer to my question, that the Department of Financial Services (“DFS”) is the state agency that holds insurance companies accountable for compliance issues.  She gives me their 800 number (800-842-3736  M-F 8:30-4:30).   I ask why there is no information about that on the NYS of Health webpage. They are discouraging frivolous complaints, she explains, since so many people are having problems with the ACA.  Not publishing the complaint number reduces the amount of angry callers making unfounded complaints before they have followed up with their individual insurance plans to make sure the insurers are out of compliance before calling DFS to lodge a complaint.

Makes me think of President Obama’s laudable campaign promises about transparency in government, protection of whistle blowers, and robust protections for consumers. Clear knowledge of one’s rights, after all, is a precondition to exercising them.   Few things are more important to the proper functioning of a just and accountable democratic republic than government transparency.   Few things are more useful to exploiters, despots and profiteers than the secret concealment of devilish details that might galvanize righteous opposition.

I recall the president’s campaign rhetoric and think of the Obama administration, the most opaque in our history, whatever else one might say about it, and my jaws clench. And I have to say, between Obama and Bush, dealing with the latter is much less soul crushing to an idealistic citizen than listening to the glib eloquence of the Equivocator in Chief, great lover of justice and defender of the common citizen that he is.

 

 

Priapic Corporatism

The corporation, American jurisprudence holds, is a person.   It is a sort of idealized rugged individual type person, having no need for anything but profit.  It also has an insatiable, if impersonal, sexual appetite, with the legally constructed and indefatigable organs to sustain this voraciousness endlessly.  

What makes me think of this today?   A call from a female robot, threatening to cut off my health insurance if full payment is not made by January 30.   This was especially aggravating since I’d made full payment on January 21 and had the email confirming payment.   I snarled the command to connect me to a representative and then was put on the queue as if I’d called the 800 number.

If you are an Anthem customer or member of the Freelancer’s Guild, press one, if you are a health care provider, press two, oprime el tres si no entiendes ingles, then muzak interrupted by the standard, sincere, reminders about how important my business is and urging me to stay on the line.

My blood began to simmer as the ten second muzak loop continued to blare.  Welcome to America, land of the bottom line– our only business is business.  You powerless cocksuckers will wait on hold to be placed on hold while the corporation gives you the chance to find out why you were threatened with cancellation of a policy you have already paid the premium for.

In only ten minutes Mark is on the line, apparently having a hard time making out the spelling of my name.   That D, he asks if it is a G.  “D as in dog,” I say and he hears E.  D as in David works.   Then I go through a similar exercise with my first name, he reads back an Aleutian name instead of the one on my policy.  In a moment he sees the same confirmation of payment I am looking at.  He asks me to please hold for just a few minutes while he checks something.  

“I’m not going to hold, I’m going to get a call back from a human being apologizing for this aggravating error by the corporation you work for,” I tell him and he agrees.  “Do you have my callback number?” I ask him and he says he does, reads me back the number of the robot who called fifteen minutes earlier to inform me that my health insurance is about to be terminated for nonpayment of the January premium.  I give him the correct number, he promises to call back in a minute, and I begin shoveling a cubic ton of snow, snarling as I do.

In a moment he calls back.  Empire generated bills for two month cycles in 2015, this one was for January and February.   Presumably for corporate convenience, saves money on billing, like using robots to call customers and nag them for payments, instead of wasting humans who have to be paid to make these calls.  Since I’d only been required to pay January’s $471 and not the $942 that would have paid for my excellent Obamacare health insurance through March 1, I’d paid only half of the bill, the half I was legally required to pay.   You get the math here?  Pretty straightforward.  

I thought of the ungodly mechanical sexual apparatus of the American corporation, and how it thrusts endlessly onward, upward, downward, sideways, relentless and insatiable.  And I saw another American president, this one very articulate, witty and smooth, smiling next to it, admiring the vigor of the machine that makes him an obscenely wealthy and powerful man.

Game for Suckers

Here is a snapshot of the rules of this game for suckers.  

Put your savings in a bank, the way one was encouraged to do for generations by thrifty adults.  Your savings will nowadays earn less than 1% interest and you will get a 1099 at the end of the year with this interest ‘income’ on it.  This interest gets added to your taxable income and you will pay the same rate on it as you do on the rest of your income.

Keep your money in a diversified portfolio, as people who are more successful, or simply luckier economically, do, let a financial manager take care of the tricky details and earn an average, over time, of 7-10% annually.  Leave the money grow, it will come in handy later on.  The interest on this money will be taxed at a substantially lower rate than the rest of your income, if at all.

Game for suckers?  That’s so harsh.  As my father often reminded me, JFK famously said “life’s unfair.”  Dig it.

 

Heartbreaking

Heartbreaking

 

 

What about this picture is not heartbreaking?   This little girl lived in a remote rural area where, from out of the sky, a Hellfire missile, launched from a circling remote control plane, killed everyone around her.  

The intelligence may or may not have been good that there were bad guys there, but the fragments of the missile found after the attack, falsely claimed by the cynical president of Yemen as launched by his government, were plainly identifiable as American-made.

Does it break your heart less to think that this little orphan girl will grow up hating the Americans who sent the drone to kill her loved ones, become a terrorist and deserve whatever fate a future administration may decide for her?

Rationales versus Reasons

Now, admittedly, I am a foolish idealist.  I don’t say this to be cute, only to underscore that living in a world with concrete, monetizable values that override fairness, and what was once quaintly thought of as common decency, it seems foolish to me, over and over, to keep dreaming of a more merciful and equitable society.  It would be different, perhaps, if I had great wealth to hire a talented team to help me market my fond ideals, but that’s a pointless thought.

In the decade before the Civil War, an unprecedented carnage not eclipsed for more than fifty years, when machine guns, aerial assault and poison gas were added to the atrocities of trench warfare, our countrymen were poised to kill each other.   We are again now.    Violence is the default setting in our violent nation and when one people holds another under their dirty boot long enough the only answer becomes murder.  Justifiable homicide, each injured party believes righteously.   

We now have a culture where each side feels, once again, as though it has been held under the other’s dirty boot for long enough.  This feeling is amplified by the mass media, which does whatever it can to get people to tune in.   Billions of dollars hang in the balance and truth, a slippery thing in any case, is reconciled only in the corporate bottom line.

So instead of serious discussions, and an honest search for the real reasons for our problems and possible solutions, we get rationales and overheated partisan rhetoric.  Talented talking head pundits make millions of dollars to pontificate, deliver talking points and push a party line, their demographic choir lustily nodding their agreement, shuddering in disgust, pumping their fists.  My foolish idealism believes, like Anne Frank, before the Nazis killed her, that all people are basically good.  If they had the facts, and a bit of honesty, just a little….

Right, Dave.

I offer just two rationales, instead of reasons, that merely state a good enough excuse to do something truly inexcusable.  In fairness, let me qualify that.   The displacement of millions of people, the violent deaths of tens or hundreds of thousands– not necessarily inexcusable, fair enough.  But to be fair, and in the context of an unprovoked attack on a country ruled by a tyrant and massive destruction in the name of freeing them, it seems a bit hard to excuse.

Rationale for the war in Iraq: 

Why Iraq?  Because we and many others (Democrats too) thought he had WMD’s and because we could use a strong country in the Middle East that was sympathetic to us for their liberation.

This rationale leaves out the oft trumpeted connection between Saddam and al Qaeda, which turned out to be as false as the WMD rationale.   That the CIA and many foreign intelligence sources knew the reports of this connection and the WMDs were false was not seen as an impediment to the invasion of a country that would be sympathetic to us even if we inadvertently destroyed its infrastructure, displaced millions, killed many thousands, subjected it to more than a decade of mayhem, explosions, assassinations and so on, in the name of freedom and democracy… well, such are the costs of war, the price of freedom, one might rationalize.

And I am tortured by torture, as I keep saying.   It makes my skin crawl that so many Americans are so nonchalant about what our government has been doing in our names.  I was proud of John McCain for this speech.  Here is a rationale for torture, you will notice how different it is from a good reason to torture, something that, outside of doing it to inflict maximum pain on someone you hate, I have never heard:

I don’t justify torture…water boarding isn’t torture…it’s used in the training of our troops.  And we only water-boarded three people.  And the times then called for enhanced interrogation methods so that 9/11 could never happen again.

A person saying this, you might think, well, you, Sir, have set up a straw man to try to prove your point.   This is an actual answer to the question “how do you justify Americans torturing people?”.  It seems unfair to suggest that if we grabbed this woman, shoved a bag over her head, rushed her, shackled and diapered, to a dark, coffin-sized cell and locked her in there for a few weeks she would say the same thing at the end of her little adventure.  Even if we did not strip her naked, kept her cell at a comfortable temperature, left her in silence and never put a gag in her mouth, tilted her upside down on a board and poured water into the gag until the doctor monitoring the procedure told us we were about to accidentally kill her.

As for me, I just wish I had something productive to keep me busy enough not to think of these things.   I sometimes envy people I know who are running at high speed all day, far too busy to ponder, more than momentarily, things so sickening, and so futile and depressing to ponder.

Yemeni girl004

photograph from Jeremy Scahill’s Dirty Wars: The World is A Battlefield.

 

Knee Jerk

It was only a matter of time, I suppose, after the recent slaughter of two policemen by a gun wielding maniac who dashed into the subway after the murders and blew himself away, until someone on the political right would place these deaths squarely where they belong: on Hamas, angry Muslim antisemites, race-baiters and the progressives who embrace them.

Like most people, I was sickened by the news of the killings. Only in the mind of an enraged and suicidal killer could the murders of two policemen in their patrol car innocently eating lunch be justified.   Nobody with any sense of decency could relate to the senseless and brutal act as anything but a senseless and brutal act, an atrocity.  It has been denounced by everyone with a microphone, including the mother of Eric Garner, the man killed after being placed in a police choke hold on Staten Island.  

I will say this for the extreme right, they never lose an opportunity to connect the dots, to exploit every horror to show that progressives are deluded apologists responsible for every terrible thing that befalls us here in the land of the free and the home of the brave.   I had an email forwarded to me just now that sits in my craw like a hairball.  I kick myself for reading it.  It makes the point, in the right’s typically assured way, that liberals, by caving in to their abiding guilt, forced the NYPD to stop surveilling Muslims and thus lost the opportunity to know that this killer had made reference, on Facebook, to Al-Farooq, which is a Brooklyn mosque allegedly well-known to have ties to radical Islam and terrorist plots, where, if he went there, he may well have received instructions to murder those policemen directly from Hamas.

Case closed, as they say.

Why torture tortures me

I should, I know, not be tormented by the arguable torture that has been done in my name.   Who am I to expect to have any say in what’s done in my name, and for my own good, anyway?  I am not on the battle field, after all.  I have not been directly hurt by the fanatics intent on cutting my throat.   Still, something just seems wrong with this picture:

It seems wrong to me, naive though it may sound, to torture a guy until he snaps and then say “see, he was just waiting to snap, faking his moderate stance but look, torture the angry fanatic just a little, not even two years locked up without charges, and the prick will go on the internet and preach jihad for no reason except that he hates our freedom, resents our ability to do whatever we want to Muslim extremists anywhere on the earth.  YOU’RE DEAD, fucker!” 
 
And then, boom, death from the sky, 500 pound Tomahawk missile, poof!  There go your fiery sermons, bitch– go deflower 72 virgins, asshole.   In two weeks we’ll wipe out your DNA in the form of your long-haired American son and the guys he’s having lunch with.   How dare you call us murderous infidels!
 
And I feel a bit insane to be thinking about this at all, but more insane to think about it and not write about it.  In the context of the latest tortured torture semi-revelations it seems timely to note that even just locking someone in a tiny cell without charges or access to anyone in the outside world is torture.  No need for the $81,000,000 in consultant’s fees and all the tortured secret legal opinions– just lock someone in the dark for nine months, that will do it.  Then, when it’s done, and they start to scream, kill ’em for screaming.   It’s perfect, yo, don’t you see?

Unsung American Heroes

There are so many unsung American heroes out there, but let us sing of just two today: James Elmer Mitchell and Bruce Jessen.  Selflessly these two psychologists, awarded a government grant of $180 million dollars to help the nation in the desperate times after 9/11, charged only $81,000,000. These two men were the brains behind the coercive interrogation program that some, including them, claim kept us safe in the years after the hellacious attacks of September 11, 2001.  

Mitchell and Jessen, given pseudonyms in the Congressional report, reverse engineered the SERE program, a grueling series of tortures used to train our own special forces to resist enemy torture.  Mitchell and Jessen’s work allowed enemy prisoners to be interrogated in ways that would otherwise have been regarded as torture, wink, wink.   Having psychologists and doctors in the room when prisoners are being subjected to things that can cause death makes all the difference between brutality and civilization, some argue.  Mitchell and Jessen’s key roles as designers of “enhanced interrogation” are detailed in the recently completed five year, $40,000,000,  6,700 page, almost 8% public, report on America’s use of torture in the decade after 9/11.

I will let Vanity Fair contributor Katherine Eban take the wheel:

As the report makes clear, some of the worst corrosion occurred in the ranks of America’s psychologists, who, like many medical professionals, are charged with doing no harm. It was two C.I.A. contract psychologists with no experience with real-life interrogations. Instead, as described in the report, they promoted the tactics to the C.I.A., employed them indiscriminately, earned money to do so, and lied about their effectiveness.

I was the first reporter to enumerate the roles of the two key psychologists, James Elmer Mitchell and Bruce Jessen, as architects of the coercive interrogation tactics, in a 2007 story inVanity Fair. The pair had previously been Air Force trainers in a program called SERE (Survival Evasion Resistance Escape), which subjected military members to mock interrogations—interrogations that ironically had been used by the Communist Chinese against American servicemen during the Korean war in order to produce false confessions.

Historically, the C.I.A. knew the tactics would not be useful. In 1989, the C.I.A. informed Congress that “inhumane physical or psychological techniques are counterproductive because they do not produce intelligence and will probably result in false answers.” In the desperate months after 9/11, the C.I.A. willfully ignored its own findings.

source

As the president recently admitted, to the horror of those who support rough treatment of possibly evil bastards, “we tortured some folks.”  Although unsung American heroes James Elmer Mitchell and Bruce Jessen, now very wealthy men, might beg to differ with Mr. Obama’s characterization of what was done to those folks.

Bankrupt Democracy

The air is toxic in this sweaty mine shaft where we scratch for the ore democracy used to be made of, my fine feathered friends.  The federal government, once a defender of human rights (as when, a century belatedly, it battled the Klan) and keeper of many valuable public institutions (schools high on that list) and much of the nation’s infrastructure, keeps begging these days to be drowned in a bathtub.  The Free Market, the private sector, is constantly held up (by those with the money to know best) as the best arbiter of what is important and what is worth drowning in a bathtub.  After all, mustn’t we all admit that it’s the extremely wealthy and successful who have the expertise and proven success to tell the rest of us the best thing to do in every sector of  life?

A few days before Christmas, when lines in the post office can be an hour or more long, I got a nice symbol, in my mailbox, of our tax dollars at work.  A large envelope from the post office, with a clear plastic window on one side, showing me the partially mangled envelope I’d sent to my landlord with my rent check for December a week or two earlier.  My landlord’s printed address clearly visible through the window, as is my return address.  The stamp has been cancelled.   The reason my landlord did not cash my rent check this month is that the U.S. Post Office was keeping it, after it was partially ruffled in a government machine, to considerately return to me with this important message on the back:

postal

So, this citizen will spend perhaps $15 on Monday to let Fed Ex do, overnight, the work a 45 cent stamp, and the full faith and credit of our U.S. Postal Service, could not accomplish in two weeks.  And resist the foolish, if understandable, urge to do anything whatsoever to respond to the moronic government robot that signs itself, with sincere regret, after an appropriately Newspeak arbeit macht frei taken directly from the Free Market best practices book,  my postmaster.