Category Archives: History and Politics

Transparency is Crucial to Understanding

The lack of transparency, so prevalent in our unapologetic, commercial win-at-any-cost culture, is a bone crosswise in my throat.   It comes up again and again, from the secret “dark money” that decides our elections, to secret national killing policies, to toxic family relations rooted in shameful secrets, and it gets to me every time.   Shameful secrets shamefully kept usually create more shame, lack of trust and other serious ills.  Doubt this at your peril.   

Without transparency we do not have enough information to make informed decisions, our conversations are about what we suspect is the case, rather than what we can actually see and understand.  Without a truthful report of the actual, verifiable facts, all we know are the rumors we suspect are most likely true.  We then act accordingly.

I offer a petty but recent example to stand in for the damnable reflex toward opacity, which is also a reflex toward small-mindedness and obstinate certainty.   The certainty of the lynch mob.

A baseball player, born in Cuba, hits a home run off a top pitcher in the World Series.  The pitcher is of Japanese/Iranian ancestry and grew up in Japan.  The hitter circles the bases, gets back to the dugout, flushed and laughing, and, sitting on the bench makes a ‘racially insensitive gesture’ which instantly becomes national news and results in the player’s five game suspension (longer than the usual suspension if he’d literally charged the mound and tried to punch the pitcher in the face).   

After the game Yu Darvish, the pitcher who gave up the home run (and was knocked out of the big game not long after) and then was victimized again by racism, was surrounded by reporters after the game, under bright lights.  He had just pitched terribly in the biggest game of his career.   The reporters wanted to know how he was feeling about the racist gesture.   Through an interpreter he made an admirable reply, under great pressure:

“Including him and I, nobody’s perfect. Everybody’s different. We’ve just got to learn from it. He made a mistake, and we’ve just got to learn from it. We are all human beings. It’s just learn from it, and we’ve got to move forward.”

Remarkably mature comment, I thought, particularly under the pressure he was under at the moment.  The Cuban player apologized immediately, expressed great respect for Darvish, said he could never get a hit off him, regretted what he had done after the home run.  He released this statement:

Screen Shot 2017-10-30 at 1.37.00 PM.png

 

I did a search to find a video of the racially insensitive gesture.  I found it immediately.  I had to scroll through the video to find the gesture, two talking heads were clucking at length over how terrible what we are about to see was.   As though they were preparing us for grainy footage of a klansman tying up a terrified child he was about to string up in a tree.   Trigger warning:  please be advised, what you are about to see may really, really hurt. 

Then, I saw it.

The player is on the bench, smiling from ear to ear, excited after his World Series home run.   He appears to be sitting by himself on the bench, there is no other player in the shot.  He turns his head, shakes his ridiculous hair-do, lifts his forefingers to the sides of his eyes, laughs.   The micro-gesture takes a nano-second, literally.   

Luckily, since this happened during an internationally televised sporting event, we have multiple camera angles and slow-motion so we can get a good long look.  Let’s slow it down and show it from the left, look, Bob, both hands.  He used both hands, yeah, you see that left forefinger?  Definitely a two handed racially motivated attack on the Japanese pitcher.  I did see that, Kyle, both hands, yeah, he used two hands, definitely.    The fingers didn’t actually touch the eyes, Bob, but you could see the intent there, clear as day, here, let’s see it from another angle.  Yep, it’s racially insensitive, all right, Oh my Lord, yes it is.

I watched as it was replayed several times in slow motion thinking “what the fuck?”   It was unlikely that Darvish, the intended victim, even saw the gesture, unless he was staring, unblinking, at the Houston bench instead of pitching.  The full mockery was done and over, based on the video which showed the same horrible gesture over and over, in the matter of perhaps three quarters of a second.   Then the mob of reporters investigate, put Darvish on the spot to act like a mensch after the worst outing in a big spot in his distinguished professional career, shelled and out of the game in less than two innings.   The new baseball commissioner later gets big praise for a prompt Solomonic decision:  the racially insensitive player will be suspended for five games, without pay, next season, but will be able to play the remainder of the World Series.   

I sent the video clip to a friend who wrote back, with characteristic slyness:

I was triggered by that gesture, so I’ve been in my safe space. I may come out tomorrow.

I sent the clip to another friend a few hours later.   He emailed me back that the clip was unavailable.  It had apparently been taken down by the copyright holder, or the account terminated by youTube, or both.   See for yourself.

So we are left, without the ability to judge the offensive act itself, with the instructive moral lesson that we do not tolerate racial insensitivity in our great nation.   Which, of course, is true, self-evident, in fact.  America is a land of exceptional equality where race is never a factor in anyone’s behavior.  The proof is our president, if you need proof.   Never a less racist person in that Oval Office, except, arguably, Woodrow Wilson, maybe. 

Seriously, how about we make the author of that racially insensitive gesture do a sincere public service announcement about how hurtful racism is, show it during baseball games.   The lost five games of salary that is part of his punishment, let’s put those tens of thousands of dollars to good use by donating it to an organization that fights racism.   How about something meaningful?  Instead of this pious fucking feel good bullshit.

Those Americans killed earlier this month in Niger, what’s the deal with them?  They are part of the now thousand American force initially placed in Niger as advisors in the War on TERROR by… oh, gosh, Barack Obama.   We never heard about that.   We never heard about the drone strikes in Yemen, until disloyal Americans like Jeremy Scahill investigated and revealed that American, not Yemeni, drones had launched those murderous, if mistaken, strikes.   How many countries are we doing that in?  Top secret, commie.  Campaign donors who give more than $5,000 to a political non-profit are granted anonymity in the exercise of their First Amendment right to political self-expression.  They’ve earned it.   

Well, we have to take our symbolic victories where we can.  Thankfully, that fucking racially insensitive Cuban motherfucker got what was coming to him.

NOTE:

Gurriel will lose $322,581 of his $12 million salary next year, which the Astros will donate to charitable causes. He also will be required to undergo sensitivity training during the offseason.

Darvish said he couldn’t decide whether Gurriel’s suspension was appropriate, but he said that he understood why commissioner Rob Manfred didn’t impose it during the World Series.

Darvish said a Dodgers employee informed him about Gurriel’s gesture, which was caught on television, after Game 3.

“I didn’t think it was going to be this big of a deal,” Darvish said. “But to me I wasn’t that frustrated at that point when I saw it the first time.”

 

source

Insightful discussion of drug addiction and the destructive “war on drugs”

This guy, Johann Hari, wrote an excellent, comprehensive and very readable book called Chasing The Scream, about the almost unimaginable horrors of the misguided century-long WAR ON DRUGS.  His book lays out what he learned about the nature of drug addiction and the best policies to help addicts.  He contrasts these successful programs with the endless War on Drugs which winds up killing addicts, and many others.   Here he delivers a talk that distills the book (which I highly recommend) into a smart 14:42.   

Mala in se vs. mala prohibita

I was once friends with a judge, a very smart man, who hipped me to this important distinction, which goes back to to the roots of Common Law– the principles our legal code is based on.   There are two kinds of crime: the malum in se— a common sense crime that is morally wrong and hideous in and of itself (cutting the limbs off a healthy baby only to cause agony comes to mind) and the malum prohibita, a crime that is a crime only because a law makes it so.   

It is a distinction most people never even consider.   For purposes of sometimes racist law enforcement in America, for example, by those who cry out for “Law and Order!”, no distinction is visible between these two very different kinds of law.   It is part of the ignorance and self-righteousness of fucking racists who rail against criminals and it’s the driving force behind America’s world leadership in mass incarceration and criminalization of the poor.

In 1925 in America it was illegal to buy or consume whiskey or beer.  That was Prohibition, when the Constitution was actually amended to make that the law of the land.   The experiment went badly and was abandoned about 13 unlucky years later when the Constitution was amended again to repeal that disastrous attempt to “legislate morality.”   

What was the moral issue being legislated?    Not that it was wrong to have a drink of alcohol once in a while, but that it was a grave social ill for masses of poor men to spend all of their pay getting drunk, starving their family and beating them.  There had been a widespread epidemic of drunkenness and violence among mobs of underpaid American working men in the decades before there were any labor laws in the country.  It was a massive social problem, the unfortunate synergy of hard work, poverty and alcohol. 

It turned out not be a crisis that could be cured by banning alcohol and locking up people who wanted to drink it.  After a bloody criminal reign of terror that made millionaires of criminals who organized into national syndicates to circumvent the law, and a social problem only made worse by an ill-designed law that criminalized a popular form of recreation and punished everyone (while causing millions of Americans to hold the law itself in contempt), the nation came to its senses and the law was changed.

During Nixon’s first term as president he needed a harsh law to enforce against a generation that hated him.   Nixon is on tape referring to his many enemies by words I shouldn’t write here unless I put them in quotes: “fags”, “homos”, “kykes”, “niggers”, “spics”, etc.   Nixon could not make a law to imprison these despised minorities directly, so he targeted something many of his more outspoken enemies enjoyed: marijuana.   The Controlled Substances Act criminalized the use of certain drugs according to their “dangerousness”.  Marijuana was placed in the most dangerous category of drug: highly addictive and with absolutely no medicinal value.  It remains there today, in spite of its many known medicinal uses and a wide consensus that it is no more harmful, is even far less harmful, than alcohol.  The Controlled Substances Act, enforced strictly, allows the police to arrest people en masse, under a federal law, if they are smoking pot, say, during an otherwise lawful political protest.

Remember mala in se and mala prohibita.   If you criminalize something, like marijuana, it gives you license to stop and frisk someone you suspect might be carrying it.  If they resist a search, a policeman can legally use a bit of force.  If things escalate, and the suspect (suspected of a malum prohibitum) tries to run, rarely, if ever, will a cop be prosecuted for shooting the fucking defiant criminal in the back.  

I am thinking of this in context of the current president’s most recent noise about doing something about the opioid crisis in the United States.  The crisis was created largely by overprescription of deceptively marketed, highly addictive prescription opioids sold in a lying, multibillion dollar pharmaceutical scam orchestrated by a very rich executive of dubious morality, a person who will never be held accountable anywhere, a scumbag named Richard Sackler.   Trump spoke of the opioid crisis, during his campaign, to audiences in poor areas where hopeless people were turning to opioids in despair, and they cheered, because the lying Reality TV superstar was promising people in the rust belt and coal country that he’d give them their shit jobs back when he was president.   

Tens of thousands died of opioid overdoses last year, about 150 Americans are dying opioid caused deaths daily now, according to the CDC.   Trump signed an executive order in March, scrawling his name bigly on an order creating a commission to study how to best end this crisis.  We heard little more about it (the super-qualified Jared Kushner was at one point tasked with ending the crisis, remember) until he once again rightly called it a National Emergency in an August speech, and promised, with his usual sincerity, to take immediate steps to deal with it.

The other day he ordered his Health Secretary to get busy fixing the opioid crisis, calling the crisis a National Public Health Emergency.  A man with a shaky grasp of nuance, the president may or may not have known that the funding for a National Emergency (which his own commission urged him to declare in July) can tap into billions, while funding for a Public Health Emergency can tap into a fund of only $57,000, at present.   You can read about that here, if you have the stomach for a short article.

Here is the official position of the Trump administration on our nation’s overall drug crisis, voiced by Jeff Sessions, a man deemed too racist to be confirmed as a federal judge (imagine how fucking racist you have to be not to hop over that bar):

AMY GOODMAN: Earlier this year, Attorney General Jeff Sessions vowed a major revival of the so-called war on drugs. This is Sessions speaking at the Department of Justice headquarters as he rescinded two Obama-era memos that encourage prosecutors to avoid seeking inordinately harsh sentences for low-level drug offenses.

ATTORNEY GENERAL JEFF SESSIONS: Going forward, I have empowered our prosecutors to charge and pursue the most serious offense, as I believe the law requires, most serious, readily provable offense. It means that we’re going to meet our responsibility to enforce the law with judgment and fairness. It is simply the right and moral thing to do. … And we know that drugs and crime go hand in hand. They just do. The facts prove that so. Drug trafficking is an inherently dangerous and violent business. If you want to collect a drug debt, you can’t file a lawsuit in court. You collect it with the barrel of a gun.

(the rest of an excellent discussion  is here)

Now let’s parse Sessions’ statement for just the ten seconds it deserves.  We have laws that allow us to punish people for a legislatively created crime.  Let us harshly punish these criminals who are, by definition, committing crimes, and often deadly crimes in furtherance of their other crimes.  “It is simply the right and moral thing to do,” says the moral dwarf, simply, citing irrefutably circular logic based in an unamended Nixon era law. 

I’ve often thought the proper term to refer to an outspoken homophobe is, simply, “fucking homo,” though I know it would not be politically correct to do so — as well as offensive to my gay siblings.  Think about it, though.   A loud anti-Semite should be publicly referred to (by Jews, of course, only by Jews, yo) as often as possible as a “fucking kyke”, I think.    What would hurt these hateful types more than constantly being referred to as what they hate? 

Tempting as it is to call the racist Attorney General, our nation’s top law enforcement official, a “nigger” (and what could be a crueler blow to the pride of this prissy, racist bitch of the southland?) I’ll refrain in the interests of not alienating anyone who would be offended by the objectively offensive term.   What would be the point of my giving such offense, suh?  It would simply not be the right and moral thing to do. 

Then again, right and moral are such problematic terms, as we see every day.   And mala in se and mala prohibita are often two very, very different things, the latter often driven by political calculation, preservation of privilege and perpetuation of lack of same.   Look at our prison population for a moment, and see the disproportionate lock down and disenfranchisement (another desired outcome by the Sessions crowd) of minority criminals who pled guilty to selectively enforced mala prohibita involving randomly criminalized substances. 

Makes me wanna holler.

USA! USA!!!

I got a kind solicitation from a bot/person recently who wrote, of a fairly incoherent first draft of an ambitious recent post on this blahg:  

Would it be OK if I cross-posted this article to WriterBeat.com? Therev is no fee; I’m simply trying to add more content diversity for our community and thought this was insightful. I’ll be sure to give you complete credit as the author. If “OK” please let me know via email.

I visited the site, and read this insightful piece:

How to debate the subject of inequality with liberals

by Ari Silverstein Oct 2, 2017 – 8:22am

Of all the issues that separate liberals from conservatives, I’d argue inequality is the one where the two sides are the furthest apart on.  Typically liberals vent about the pay of corporate CEOs or bankers and compare their salaries to minimum wage workers, teachers or anyone that gets paid less.  Then they advocate for higher taxes on the rich or higher minimum wages as the means to fix inequality.  Conservatives usually counter with something along the lines of “the free market should decide what we make for what we do.”  Many than add “In America we promise equal opportunity not equality of outcome.”

If you’re a conservative, never say something like that!

It’s impossible to have equal opportunity for all.  The rich will send their children to the best schools, their children will then exit without the burden of debt and be handed a good paying job from a successful relative.  In other words, opportunity to succeed for the wealthy is bound to be far superior to the opportunity of success for the poor.

My advice to all Republicans/conservatives is to embrace inequality as being something completely healthy and natural within any capitalist system.  Only under socialist governance is the liberal dream of equality possible and we all know what socialism does to economic growth.  Of course liberals will counter by saying that “inequality has gotten worse” but they’ll fail to count the increase in food stamps, unemployment, housing assistance, EITC payments.   But now we’re into the weeds, stick with the concept that equality isn’t something to be celebrated and there is no such thing as equality of opportunity.

Good point, avoid the specifics and stick to the fact that some people just have to be brutally fucked so that others can have obscene wealth in a society whose laws are written by their paid hacks.   Made me hope Ari isn’t Jewish, reading this, though, his name suggests otherwise.   We Jews have enough trouble being a light unto the nations without this kind of insight.  (I’m only glad he didn’t get paid for the article).

I’m also hoping the philanthropic Sackler motherfuckers who have profited so handsomely from the opioid addiction/overdose crisis are not Jewish.  I guess I may have to read the rest of this article. 

Oh fuck:

Arthur and his brothers, the children of Jewish immigrants from Galicia and Poland, grew up in Brooklyn during the Depression

Oy yoy yoy…

In 1997, Arthur was posthumously inducted into the Medical Advertising Hall of Fame, and a citation praised his achievement in “bringing the full power of advertising and promotion to pharmaceutical marketing.” Allen Frances put it differently: “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”

Snapshot of a Complete Asshole

I should not let myself be distracted, I should not let myself be distracted…

A couple of weeks ago four U.S. servicemen were killed in Niger.  Two were named Johnson, one black, one white.  One was named Black; he was white.  Why they were killed in an unarmored vehicle in Niger, although the military is still actively investigating the weeks’ old the incident,  is obvious — fighting a secret worldwide war on TERROR.  Duh!  

We must, we are told, wage a relentless and borderless war against TERROR and be eternally vigilant until we have killed all of those violent extremists who hate us enough to resort to TERROR.  Our leaders have kept us all aware of this terrible, uh, fact since the World Trade Towers came down and the Pentagon took a hit in the fall of 2001.  

The WAR ON TERROR, although plainly impossible to win with military force alone, has been used as the excuse for a lot of inexcusable mischief, mayhem, murder and manipulation, but that is another story for another time.

The body of one of the four dead Americans, Sgt. La David Johnson, was apparently not found until 48 hours or so after the ambush.   When the four dead Americans were eventually sent back to the U.S., their coffins draped in American flags, the widows, at least in the case of La David Johnson’s wife, Myeshia, were not allowed to see the dead bodies inside the coffins.   Maybe it was because they were beyond recognition, I don’t know.    La David Johnson’s widow cried that she was prevented from seeing so much as his hand, to be sure it was really him in the box.

Our president called the widow of La David Johnson.  A condolence call, of a certain style.  The widow was apparently not consoled by the call.   Our president called the widow a liar, claiming angrily that he had fucking consoled her.  (In fairness to the president, he claimed only that he’d been very respectful, that she was lying about him not remembering her husband’s name and that a “wacky” congresswoman who’d SECRETLY listened in on the call was a fucking liar). *

He had his four star general Chief-of-Staff John Kelly make a long televised speech, during which Kelly lamented the lost dignity of our society, the mistreatment of women included, how nothing is sacred anymore.  Kelly then surrendered the shaky moral high ground he was shifting on, claiming that the self-aggrandizing Democratic politician listening in to the president’s call to the widow had been eavesdropping, that the nosy Representative had deliberately distorted the president’s words of condolence (Kelly neglected to mention that the widow and the representative were in a car together, or that the call was on the widow’s speakerphone, creating the impression that the Florida representative had a sinister ability to wiretap at will), was an “empty barrel”, talking shit, a lying partisan viciously trying to politicize a tragedy, someone who had falsely claimed credit for securing funding for a new FBI headquarters in South Florida.   

(Although, in fairness to everybody, and not that it’s a gigantic detail in the overall hideous picture — except coming from the mouth of a general speaking in the context of respect for the fallen, and perhaps to the family and colleagues of Jerry Dove — the second murdered FBI agent referenced by Kelly was named Jerry Dove, not Duke as Kelly said.  You’d think somebody on the general’s staff could have hit Google to fact-check the speech before Kelly gave it, wrote the correct names of the two dead heroes on a card for him.  No attention to detail in President ADHD’s post-reality administration. SAD!). [1] [2]

The widow was interviewed shortly after Kelly’s news conference.  She explained that the congresswoman, a long time mentor to the family, had been in the car when Trump called and had reported the president’s remarks accurately.   

Our thin-skinned, bottomlessly needy president attacked Myeshia Johnson vigorously on Twitter for not being grateful for something that had been very difficult for him.   He might as well have called her a lying cunt.   We would expect no less from the man, but still.

 

* Screen Shot 2017-10-26 at 12.53.42 PM.png

Adroitly done, Lyin’ Don. 

Facts?

Politics in America

Americans, it is said, are like children when it comes to politics.   We are not really children, we are consumers continually sold snappy, brand-name products, including politicians.  We are marketed to around the clock, from the cradle to the grave, and our political system reflects this.  There are powerful reasons for this sad state of affairs.

I was often critical of President Barack Obama, a genius on the campaign trail, a perfect political product, a man I voted for twice.   I criticized him, in part, because I’ve been personally victimized, many times, by his compromise that left rabid corporate foxes in charge of the healthcare henhouse– not to mention many millions still uncovered by health insurance, and the tens of thousands who continue to die preventable deaths each year in the wealthiest nation on earth.   

Obama, like all presidents, did many bad things, quietly, as he gave inspiring speeches about our values.   Tragically, he lulled much of progressive America to sleep with his beautiful oratory, giving stirring speeches that often directly contradicted his actions; like when he told the correspondents at the annual dinner that they had been his partners in transparency, in keeping American democracy well-informed and robust.   We know, if we look at all, that Obama’s administration was not transparent; it was as opaque as the secretive, aptly named, Dick Cheney’s.   

That said, Obama was one of the better presidents of my lifetime, perhaps the best, sad to say.  A friend with a brilliant talent for argument beat me down thoroughly in a long comparison of the presidents of our lifetime.  He drove the point home.  Sure, Obama did some fucked up, inexcusable things; massive secret “signature strike” drone killing in multiple countries, repeated use of the 1917 Espionage Act to punish “traitors” who revealed shameful government practices, the secrecy about the actual terms of the Trans-Pacific Partnership, but on the whole, may have done less harm, and attempted to do more good, than many of his predecessors.  The scale of presidential atrocity is now being re-calibrated by an insane idiot, as he scrambles to dismantle everything positive that Obama managed to accomplish, in the face of massive, organized obstruction.  All future presidential comparisons will be skewed by this petulant outlier we have in there now.     

The first test for an American presidential contender is one that should disqualify them:  that he or she truly believes they should be the most powerful person in the world.   They must secure massive financial backing and sell that sincere, if grandiose, self-belief to voters on television (and, increasingly, via social media) while at the same time assuring the most powerful entities in America that they will do nothing to affect the bottom line.   This process self-selects a certain egotistical, telegenic, born politician.  Branding and marketing, and skillfully deployed soundbites, will decide the battle.

The successful American presidential candidate must be prepared, and demonstrate a willingness, to do unspeakable things.   I’ve often thought there is a psychopath test for any serious American presidential contender.  Maybe  it’s a kid, strapped to a chair in some secret room, that the candidate has to kill, in front of the most powerful CEOs in the nation, to demonstrate he or she has what it takes, won’t hesitate to do what must be done.  

Presidential candidate Bill Clinton rushed back to Arkansas to oversee the execution of a brain-damaged death row inmate.  Candidate Dubya mocked the final plea of the brain-damaged Born Again death row inmate he famously refused to pardon.  They had to, politically.   America needs its president to be tough.  Look how many kudos Trump got, from everyone, when he made himself “presidential” by launching tons of senseless missiles at a Syrian airfield, or when he dropped the Mother of All Bombs in Afghanistan.  How jealous Saddam would have been!   Imagine how presidential Trump will be if he gets to drop nukes on Little Rocket Man’s people.

The world is dangerous, mobs of people are maniacs, murder is rampant all over the place.  As sea levels rise and natural disasters grow dramatically more devastating, the danger from and for humans is getting worse.  Maybe we need a president who can kill, who will not flinch, when the situation demands it.  But let’s look for a moment at the rest of the picture.  

Obama’s winning personality, clear intelligence, gift for the felicitous phrase, encouraged those of us who voted for him to believe he was a decent person, a man of conscience.  He played one on TV, and perhaps he truly is.   He came off as thoughtful and fairly honest, to those of us who didn’t hate him, telling us early on that we have to push him to accomplish the hope and change he promised.  We can’t expect any elected official to do the right thing unless we push him relentlessly, he pointed out.  On the one side some people quietly tried to push, on the other side a few very powerful “persons” representing gigantic market forces generally prevailed.   Good, individually powerless people didn’t band together into a mass movement and push hard enough, Obama chided us when he was criticized from the left, while the people with all the power paid powerful experts who pushed harder to influence public policy.  

There is a sickening truth to this lack of American political will, except among extreme right-wing zealots, it seems.  We, who don’t share their values, have been reduced to a nation of handwringing spectators, waiting for our leaders to do the right thing.  Historically, this hopeful passivity has not been a good bet.  There were literally thousands of labor strikes during FDR’s first and second terms, when an uncommonly bold president seized the momentum for change to create a social safety net to save the country from Communism.   

Frederick Douglass hit the nail on the head in 1857:   

Power concedes nothing without a demand. It never did and it never will. Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong which will be imposed upon them, and these will continue till they are resisted with either words or blows, or with both. 

A century and a half later our first “post-racial” president presided over a nation as divided as on the eve of the Civil War, surrounded by in your-face racists intent on rendering him powerless, while membership in white supremacist hate groups rose dramatically and, mobilized, carried the president we have now into office.  With all of the threats we currently face, as a nation and a planet, are we still really watching wealthy talking heads argue over whether racism is bad and whether men and women are really equal?  While a global climate catastrophe gathers steam, no less.

Americans are trained from our earliest days to be consumers, to consume politics and culture as well as everything else.  We are trained to want, to feel a stimulated need, to buy, to binge.  Imagination and creativity is the realm of a small group of professionals who make huge sums to create the content we are all the audience for.   We are numbed now when it comes to our own powers, and overwhelmed with monetized distractions.  We leave the heavy lifting to the professionals, that’s why they get paid the monster bucks.

There is a deep sense of futility in America.  We have an opioid crisis that kills tens of thousands a year, Americans overwhelmed by hopelessness.  One person with a powerful argument, a hundred people, a thousand, a million, are often outmatched by a single billionaire who can spend whatever it takes to have their free speech heard everywhere.  We watch the results time after time and it beats us down.   Not only can’t you fight City Hall, you can’t fight one very rich asshole with a giant twenty or fifty million dollar megaphone and a skillful top-shelf media team.  Free speech, baby, take all you can afford to buy.

Yet we have Bernie Sanders, energizing millions with a real critique of the  indefensible status quo here in a wealthy nation that leads the world in death by gun violence, incarceration,  military spending, health care spending and annual preventable deaths by citizens too poor to afford the world’s most expensive health care.   With his average campaign contribution of, chant it with me, crowd, “$27”, Sanders reached millions and made himself a legitimate presidential contender.  

He did this based largely on his vision of a better, more fair America, as opposed to promising incremental change as the best we can hope for, or idiotically vowing to turn the clock back to the days when America was great, when you could openly wish everyone a Merry Christmas, when women were not so disgusting, when you could call an assertive black person a “nigger” without fear of losing your job for not being politically correct, where traumatic brain injuries to football players was not an issue, they knew what they signed up for and should be allowed to hit and be hit as hard as possible, where military widows respectfully shut the fuck up, etc. 

I don’t really fault this piece of shit we have in the Oval Office now, in a way.  I fault myself.   I fault everyone else who is addicted to the opiate of American celebrity.  What is this spoiled man-child in the White House celebrated for?  Being a born-rich, vulgar, relentlessly self-promoting jackass who made 185 million dollars producing a long-running “reality TV” show where he fired people every week.   That show was his only purely successful business venture, in a long, public career of mostly fuck ups, but it was more than enough to create his brand. 

He became a celebrity mega-brand as he decanted gallons of toxic kool-aid during the presidency of Obama, insisting, to the end, with no evidence whatsoever, that Obama was an illegitimate president, born in Kenya, a secret Muslim and a liar.  Today we’ve got the 1% president our system deserves, America’s racist, self-regarding, entitled chickens coming home to roost.  

The percentage that put him into power, and continues support him in spite of his performance in a job he is completely overmatched by, seems to be around 39%.   Like their president, they know only how to “double down”.  In my recollection 39% was also the high-water mark for German voter support of the energetic, no-holds-barred Nazi party.  Of course, once they had that 39% in Germany, the rest, as they say, is history.  It was 100% soon after that, no matter how many Germans may have opposed it.  

We need to get off our couches now and back into the streets.   We must be vigilant and take nothing for granted in the Age of Trump.  American political arguments are not won with logic, they are won by masses of people doing the hard work.

You sound a bit… insane, sir

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.

 

 

 

Attachments for the letter to the A.G.

Attachments to this letter.

#1  The NYS Health insurance Consumer helpline cul du sac

In an attempt to resolve problems with my health insurance I contacted a circuit of government agencies in vain last December.  Here is a summary of that healthcare consumer help cul du sac:

The NYS Department of Financial Services helpline (from dfs.ny.gov) referred me initially to the US Department of Health and Human Services (877-696-6775) which, supposedly, connected me to NYS Health and Human Services, although to an incorrect branch of that agency, the pertinent branch apparently having been merged into the NYS Department of Financial Services which took over all functions of the former NYS Insurance Department as well as oversight of banking and several other discrete and seemingly unrelated areas.  (When I called this number today, it gave me an option, unavailable last time, to press 6 for “consumer problems with the ACA”, and offered a call back in five business days from a representative.)

The New York State Insurance Department, along with other agencies related to healthcare in New York State, was merged into the Department of Financial Services when New York adopted the Patient Protection and Affordable Care Act (“PPACA”).  The New York State Department of Financial Services, it turns out, does not hear consumer fraud complaints against health insurance companies.

I entered this administrative cul du sac in December 2016 after Empire Blue Cross “Health Plus” sent me to two in-network providers for needed medical services, a cardiologist (for follow-up care after a hospitalization for cardiac issues) and a physical therapy facility.  Neither provided me with any service. 

The fraud investigator I eventually spoke to at the NYS Department of Financial Services, at the end of a long chain of calls, could not find a word other than ‘fraud’ to describe the facts I set forth, but urged me to call the NY State Department of Financial Services Consumer Services Hotline.  He assured me that they were the specialists in the area of health insurance.  The recorded menu at the hotline, which I recognized from my first call hours earlier, offers no option for resolving issues with insurance companies of any kind.  

On my original call to the Department of Financial Services, a long wait to speak to a representative yielded the number of the proper federal agency to contact.   Calls to the U.S Department of Health and Human Services are robotically routed to a NY State number that is, sadly, the office of Temporary and Disability Assistance, where a helpful party connects you to a fraud hotline, which turns out to be at the office of the Medicaid Inspector General, where the office of legal affairs is also sympathetic, but unable to help, and so forth.

#2 Permissible grounds for routine denials of purchased healthcare benefits in NYS and limited “appeal” of denials available to New Yorkers

More ominous than the many billing irregularities consumers are left to resolve with the billing parties, a patient can be denied needed medical service without explanation.  Permissible corporate reasons for denying service are things like incorrect site-specific provider NPI number and improper CPT pre-authorization codes.  These valid grounds for denial are unrelated to an individual consumer’s MOOP, which comes into play more for billing.  There is nobody in New York State a patient can appeal these denials of service to, except to the insurance company itself.  

Immediately before I was diagnosed with a serious kidney disease, in January 2017, I attempted to resolve some issues I’d been having with my then insurance provider, Empire Blue Cross. This was before I switched to Healthfirst, which has a series of nephrologists I’d been referred to, listed as ‘in network” who, it turned out, were not.   Here is the slightly overwrought grievance I wrote when I was a customer of Anthem/Empire.  It reflects the frustration of someone caught in this ‘regulatory’ vacuum:

Grievances – Anthem/Empire Blue Cross Blue Shield “Health Plus”

Grievance 1:  lack of internal complaint procedure for aggrieved customers

After being chided by an Empire representative for never filing a written complaint about any of the grievances detailed below, I attempted to do so on-line.  Logged in automatically under my former bronze plan ID there was an on-line complaint form, easily located.  I was unable to update my member ID info.  A web support representative at Empire walked me through changing the new log-in.  On the website for the “Essential” plan there is no complaint form.

I was also told by web-support/claims representative Laurisha that there is no internal mailing address for submitting a written complaint to Empire and that company policy was not to divulge the name or contact information of company executives.   The rep told me she could take my complaint orally over the phone.   I decided to try my luck with the original claims person I’d just spoken to for an hour.  Nobody was able to connect me to her.

Someone at claims found this answer for me, while looking for the physical mailing address to send a complaint directly to Anthem/Empire.  He told me it was printed in red, as I will reproduce it here:

Essential Plan members do not have a right to file complaint appeal (sic).  If they need assistance filing a grievance or appeal, they may also contact the state independent consumer assistance program at:  Community Health Advocates, 105 E. 22nd Street, NY NY 10010 or 888-614-5400 or email at cha@cssny.org

source:  Anthem’s National Contact Center Document under NY market tab for “Essential” plan updated as of 12-14-16 at 7:56 a.m.

Grievance 2:   unresolvable bill

8/17/16 I went to Madison Avenue Radiology for an x-ray and two sonograms.  I had referrals for all of them.  I got a bill from Madison Avenue for $1,324 for one of the sonograms.   

On 10/19/16 I spoke to a representative at Empire who spoke to the provider, to a person she told me was named Daniel.   I then spoke to Daniel who agreed the $1,342 had been billed in error and told me I’d receive a corrected invoice for the $25 co-pay.  

The next invoice I had, in December, was a third notice from Madison Avenue Radiology that I owed $1,342.  This time Ty at Empire told me she called the provider, who denied ever speaking with me, and that I owed the entire amount, for reasons I could find in the Essential Plan handbook she offered to send me.  She herself did not know the reason a kidney sonogram was covered and a pelvic sonogram was not.  She told me I was responsible to pay the $1,342.  When I asked to speak to a supervisor she told me no supervisor was available.  

(Months later this bill was eventually reduced to a $25 copay)

Grievance 3:   fraudulent referral to cardiologist

I was referred, by Empire, to a cardiologist named David Sahar.  I was given his site-specific NPI number to see him at his 3050 Corlear Avenue office, I sent front and back of my insurance card to his receptionist who confirmed that we were good to go for a December 15 follow-up to my November 18 Emergency Room visit/hospitalization.   Ten minutes into the consultation the nurse who was interviewing me was called away and when she returned she told me Empire had refused to cover the visit. The doctor explained he could not risk not being paid by Empire.

Grievance 4:   fraudulent referral to physical therapy

I was referred by Empire to a facility to continue the Physical Therapy I had begun on 11/1/16 at a facility that treated me once and then informed me that they do not accept the Empire Essential Plan.  I made several calls to Empire to find out how to get them in network, as Empire told me they could enroll by calling 800-454-3730.  After a few weeks calling the PT facility and Empire I gave up.   I requested an in-network PT provider and Empire sent me to an address that turned out to be a nursing home.  It did not offer PT to outpatients.

Grievance 5:   incorrect information; false promises of help from customer service

I called on 12/30/16 in an attempt to resolve these issues, the bill and the two denials of coverage from providers I’d been referred to by Empire. I was told by Joan that the “service not covered” code came up at the cardiologist’s because, likely, an incorrect CPT number had been called in, or possibly the doctor’s office had failed to obtain a prior authorization from Empire’s medical management office, both the fault of the doctor’s office. Empire, I was told, had done nothing wrong.   Joan had no explanation for why I was sent to a nursing home for PT or why the kidney sonogram had been covered and the other one not covered.   She offered to send me the handbook so that I could read it and find out for myself why one body part is covered and another is exempt from coverage for the same diagnostic procedure.  

Joan transferred me to someone who said she was a supervisor.  She identified herself as Julie, at the New York Call Center, assured me she was the only Julie there and that I’d have no trouble finding her.  She noted that I’d never filed a formal complaint about any of these issues and promised to research and get back to me with the answers on Tuesday, 1/3/17 when the office reopened.   Regarding the PT, she gave me a number for a third party vendor called Orthonet.  She incorrectly informed me that they could answer any and all PT-related questions.  When I called Orthonet the receptionist there told me Orthonet’s only role is to authorize services for PT once a provider makes a request to treat a patient.  

When I got no call from Julie at the NY Call Center I attempted to reach her.  Ashanti D, user ID AF09740, was very helpful, even giving me the conversation reference number I52146704.   She told me that without a last initial or employee ID number it would be impossible to look Julie up.  The NY Call Center could not be reached directly by Empire customers, it was an internal number and Ashanti looked it up and transferred me to it.  After a long hold the phone rang three times, then the line went dead.

Grievance 6:  improper billing practices

I received confirmation of my payment for December and January two weeks before this arrived:

Screen Shot 2017-10-11 at 5.07.10 PM.png

Grievance 7:  instead of promised return call, customer service survey

Attempted Customer Happiness surveys asking about each of these “customer service” experiences, by telephone and email.

To show that the corporation is not without a certain sardonic sense of humor, I had a solicitation call from an Empire representative, on 1/4/17, thanking me for my business and offering her assistance in renewing me with Empire so there would be no interruption of insurance for my health care.     

#3 The New York State of Health Marketplace

Errors are not easy to resolve at the New York State of Health (”NYSOH”). Answers to routine questions vary from representative to representative. There is a wait of several months to have even the most simple mathematical mistake by the NYSOH corrected, and one must go through a quasi-legal appeal process before NYSOH will correct its error.  Attached is a recent decision by a hearing officer that ordered NYSOH to correct an easily detectable mathematical error they had committed months earlier.   

Note that any employee of NYSOH could have used the online calculator on their website to instantly verify their error, generated automatically by their website (it is easy to instantly lose insurance coverage at NYSOH, hard to regain it), a mistake that took months to have corrected and resulted in the customer being forced to overpay by almost 100% until they did.

Compounding the aggravation of resolving problems with NYSOH is the policy of its director, Donna Frescatore. Representatives are specifically instructed not to divulge the director’s identity or any way of reaching her office. I have confirmed this policy many times, with many different NYSOH representatives.

#4 Common healthcare billing irregularities in New York State

The PPACA, whose primary drafter, Liz Fowler, went back to work in the health industry after her legislative work was done, apparently contains no provision that the cost of a medical service must be divulged to the patient before the medical service is performed.  

The doctor’s office or hospital cannot tell you the fee until the insurance company sends them a statement.  The insurance company cannot predict the fee until they get the provider’s bill.  The insurance company then eventually sends the patient an Explanation of Benefits, (“EOB”), detailing all charges, payments made and the patient’s responsibility for whatever part of the negotiated rate insurance has not paid.   It is like eating at a restaurant with no prices on the menu, and being sent a bill for the meal weeks later.  Except, of course, that it is not a meal at a restaurant, it is often a matter of life or death, or, at least, of health-related stress.

My kidney biopsy, for example, may cost the patient anywhere between zero and many thousands of dollars.  Simply no way to determine the cost prior to delivery of the service, under current law.  I had the procedure on May 26, I got the most recent EOB related to the procedure on September 28.  In the intervening four months, I got many bills from the hospital.

Though there is probably nothing your office can do about this particular practice, I offer it as an illustration of the scope of the challenges facing New York healthcare consumers.  I provide the following letter to the CEO of Healthfirst as a snapshot of the general billing madness under our current ‘regulatory’ scheme.   

Pat Wang
CEO  
Healthfirst
100 Church Street
New York, NY 10007

pwang@healthfirst.org

September 26, 2017

Dr. Ms. Wang:

I appreciate that you allow your reps to give out your contact information to customers who can’t otherwise resolve issues with your staff.   This encourages me to think that you might be helpful in resolving an aggravating billing situation that has been ongoing for months.    I applaud your willingness to be contacted, it shows integrity and is in stark contrast to the policy of Donna Frescatore, director of the “New York State of Health” (NYSOH) ordering her reps not to divulge her name to callers.

I request a corrected bill and an accounting showing my remaining credit toward premium payments.  The credit situation is described below.

During an August 25th call to Healthfirst to try to resolve the issue of incorrect bills being sent to me, my “case” was assigned an “escalation number” (347-79-923).  I was promised an accounting, showing payment history and current credit toward future premiums.   I received instead a notice, dated September 8 and signed by Christopher A. DiMarco, threatening me with cancellation of my health insurance for a claimed past due balance of $28.   

On September 19 I called Healthfirst and was assured that credit had been applied and my September premium paid in full.  I was also informed during that call that “finance” had included no notes on my account.   I could not be sent a simple receipt for payment or anything indicating my remaining credit.  I was assured by an extremely sympathetic rep that my account was paid through October, with credit remaining toward November’s premium.

Attached is the invoice I received on September 25.   It seeks payment of $482 for October (plus a past due amount), nonpayment of which will result in losing my health insurance (as I begin treatments for kidney disease and skin cancer).   It has been mailed to me in error.   I have a credit of several hundred dollars due to overpayments made as a result of NYSOH’s error.   NYSOH incorrectly denied my subsidy for 2017.   It took months, and a ruling by a hearing officer, before NYSOH was ordered to retroactively restore the subsidy, about fifty percent of the premium.  

As a result of NYSOH’s error, I was required to pay Healthfirst the full premium from February through June.  When I got a bill for July, I called Healthfirst and learned that a credit had been applied for my overpayment.  After payment of July’s premium the rep calculated my remaining credit at $876.

Since then it has been a health insurance headache every month.  In another context, it would be tempting to characterize the attached invoice demanding payment for a premium I have already paid as an attempt at fraud.  I am sure it was sent to me in error.    Please have somebody update my account and send me an accurate statement of my payments and remaining credit.

(invoice attached here)

Thanks,

 

A short time later, after a call from one of Ms. Wang’s assistants, I got a corrected bill that demanded payment of -$183 on or before October 1.

A Little History

640px-Colfax_Riot_sign_IMG_2401.jpeg

                                                                                                              (photo credit)

As we learn, words matter very much.   What we call something frames the conversation and removes certain aspects completely from the discussion. Most of us recognize that there is a more truthful description of an actual incident and a less truthful one.  Those who would manipulate public opinion seize the selected description that serves them best.   We can see this daily in the asinine pronouncements of President Pantload and the often convoluted defense of these remarks by his loyalists.   It is an old ploy: call the thing something else and we are no longer talking about the thing that concerns you the most.

Look at the thirty-four words on this marker about an event that took place on April 13, 1873, Easter Sunday that year.  A beautiful example of this.

Context:  this incident took place less than a decade after the end of the Civil War, a war that grew out of a peculiar form of commerce, institutionalized racism and a region’s military defense of chattel slavery based on that racism and commerce.   It is an American war that continues to rage, as a glance around today will confirm.  

The side that lost America’s bloodiest war was forced by the winners to ratify constitutional amendments that would give full citizenship to a race that had until a few years earlier been mostly enslaved.   The former Confederate states were not happy about being forced to do this, but they were compelled to sign so they could get Federal funds to restore the destroyed infrastructure of the South.

After the election of 1872 local whites were enraged that former slaves were again attempting to vote and, worse, were intent on trying to enforce the results of an election their candidate had won.   An armed garrison of blacks guarded the courthouse at the county seat of Grant Parish, to ensure that their candidate was sworn into office.  Local whites, heavily armed, most on horseback, with at least one cannon, besieged the former slaves guarding the voting box.   After the surviving outnumbered blacks surrendered they were taken prisoner.   Dozens of these unarmed prisoners were summarily executed by the mob over the next few hours.

Riot or massacre?  You decide.

Note that three white men were killed.   In a riot.  Then 150 blacks were killed, probably while running amok.  “You know how those people are…” is presumed here, I can almost hear the demur, lowered voice, almost apologetic.  

The passive voice “were slain” is another great touch.  You know, shit happens in a riot.  It is so much more tasteful than “were butchered” or “shot point blank by members of a mob who also tortured many before killing them”.

Then the historical marker concludes, like an incompetent president doubling down, with the punchline, of sorts.

“This event on April 13, 1873 marked the end of carpetbag misrule in the South.”

It is amazing in its bluntness and accuracy, to cite only two ways it is amazing.  Once local mobs could kill blacks with impunity there was no way the former slaves could hope to enjoy the rights of citizenship.   It was probably the Supreme Court decision on the case a few years later, freeing all the white perpetrators/victims of the riot, that marked the end of so-called carpetbag rule, and the compromise that settled the 1876 presidential election, and removed federal troops, that led to the end of enforcement of the new federal laws in the South, the return of “home rule”, but that is a trifle. 

The carpetbaggers were unscrupulous northerners who came down to plunder the helpless south after the war.  There were a bunch of them, no doubt, and some enriched themselves in the manner of ticks gorging on the blood of a noble animal too weakened to resist.  But the “carpetbag misrule” on that plaque refers to the efforts of the Federal government to enforce the constitutional amendments preventing slavery, extending full citizenship and the vote to former slaves.   This “misrule”, enforced with troops and often called “bayonet rule”, included making the former Confederacy do everything it had gone to long and bloody war to prevent:  treat its blacks as equal citizens.  “Misrule” because it is so unfair for the victor of a war to impose its will on those who lost, no matter who fired the first shots.

The fucking issue is still being bitterly fought.  The racism behind it is deeply baked into our society.   Calling it by another name?   Just more of the same.

Bravo, by the way, to the creators of that historical marker.  Making America great again.

Edited letter to the A.G.

Dear Mr. Attorney General:

I am appealing to you for assistance, on behalf of many thousands of New Yorkers caught in a sometimes life-threatening situation regarding their healthcare.  As described more fully below, citizens of our state have no government agency that intervenes in cases where patients are mistreated by the corporations we buy health insurance from.   This is true even in cases of apparent fraud.  

I urge you to propose legislation to correct this grave oversight.  The need for state regulation of health insurance grows ever more acute in light of the current federal administration’s determination to gut all regulation.

I’ve followed your career and admire the principled and proactive steps your office has taken against the powerful perpetrators of various frauds.  Leaving politics aside, as one must in a letter like this, it is gratifying to see someone in office holding powerful entities responsible for their bad acts.  Your office is well-suited to fix what I believe is a healthcare emergency affecting the lives of countless New Yorkers who purchase private health insurance, particularly older citizens and those living just above the “poverty line.”

As frustrating as my healthcare-related ordeals have been, a 61 year-old currently trying to get treatment for kidney disease and skin cancer, I have the benefits of fluency in English, computer literacy, legal skills.  It is hard to imagine the life-shortening stress that is inflicted on the elderly and other vulnerable New Yorkers unable to get so much as a hearing for often unappealable denials of health care.

It has been a challenge to put the many healthcare-related issues I’ve been forced to navigate into a streamlined letter.  I’ve attempted to keep this letter short and dispassionate.  To that end I provide some of the devilish details in a series of attachments.  I have confirmed many times that my experience as a consumer who buys health insurance on the New York State of Health Marketplace (“NYSOH”) is representative of the experiences of countless others.  

Attachment # 1 is a detailed description of the “consumer help” cul du sac that desperate NYS residents can spend a few hours in, looking in vain for help with health insurance-related troubles.  Anyone in your office can retrace the useless steps.  Creating a healthcare ombudsman position would be a good first step here.    

Corporate “persons” are without conscience and motivated only by a zeal for profit.  When left unregulated, it is no surprise such “persons” act as they see fit.  In the case of health insurance companies, they are free, for example, to repeatedly refer patients to “in-network” doctors who are not actually in-network.  They are also relatively unrestrained when refusing to provide services, under a variety of corporate rationales, in spite of what the Patient Protection and Affordable Care Act (“PPACA”) may have to say about it.   There is no penalty for these common business practices and they are well aware of it.  Regulations to address these things, with an enforcement arm, would be a good start.  (see #2)

Those mandated by the PPACA to purchase health insurance from the New York State of Health Marketplace may find themselves with a host of new problems during the short holiday season window for purchasing insurance. A consumer advocate or ombudsperson on site at NYSOH would greatly aid in resolving problems, including simple mathematical errors, that presently can only be addressed by a lengthy appeals process.  (See  #3)

Billing irregularities, including improper bills, which are to be expected in a law as complicated as the PPACA, are probably the most common form of immediate stress most of us are regularly subjected to.   The rep at your office’s consumer help desk offered help with billing problems, problems I suspect are legion.   I offer a short overview of the larger problem and one recent snapshot as #4.

Thank you for your time.  I am available to amplify anything written here and to testify anywhere you may require.

Yours sincerely,

 

From attachment 4:  

The PPACA, whose primary drafter, Liz Fowler, went back to work in the health industry after her legislative work was done, apparently contains no provision that the cost of a medical service must be divulged to the patient before the medical service is performed.  

The doctor’s office or hospital cannot tell you the fee until the insurance company sends them a statement.  The insurance company cannot predict the fee until they get the provider’s bill.  The insurance company then eventually sends the patient an Explanation of Benefits, (“EOB”), detailing all charges, payments made and the patient’s responsibility for whatever part of the negotiated rate insurance has not paid.

My kidney biopsy, for example, may cost the patient anywhere between zero and many thousands of dollars.  Simply no way to determine the cost prior to delivery of the service, under current law.  I had the procedure on May 26, I got the most recent EOB related to the procedure on September 28.  In the intervening four months, I got many bills from the hospital.

Though there is probably nothing your office can do about this particular practice, I offer it as an illustration of the scope of the challenges facing New York healthcare consumers.  I provide the following (obviously minus preamble, dear reader)  as a snapshot of the general billing madness under our current regulatory scheme.   I compare it to eating at a restaurant with no prices on the menu, and being sent a bill for the meal weeks later.  Except, of course, that it is not a meal at a restaurant, it is often a matter of life or death.