Category Archives: History and Politics

Death by American Healthcare (part 3 of 22,000,000)

I was lucky enough, after more than two months in the wilderness, to get an appointment with a nephrologist who seemed to be very well-liked by his patients.   Sekhnet located this doctor for me, by persistence and almost pure chance.  He was not listed as a participating provider in my health plan, but Sekhnet’s call to his office confirmed that he accepted my insurance.  The only bad news was that his next available appointment was September 19th, almost four months after the biopsy confirming my progressing kidney disease.   I had a call back from his office Tuesday, could I come in Thursday? On Wednesday, the next time my primary care doctor was available, I neglected to get a new nephrology referral, something that is the patient’s sole responsibility.    

Thursday I found myself at the nephrologist’s office without a referral.  My fault, though somewhat understandable, due to the last minute nature of the changed appointment.   I called my doctor’s office and spoke to his service, who informed me he was off on Thursdays.   She promised me a call back, but as I ‘d never had a call back from him, I had my doubts.  Ten minutes later I had a call back from someone in his office, offering to try to get the referral faxed over.  Problem solved, or possibly not.

The problem was, my insurance company requires an Emdeon electronic referral, according to the new doctor’s receptionist.   A faxed paper referral won’t be accepted, she told me, though it had been accepted by the prior nephrologist’s office.  There was a discussion of back-dating the referral, something I’ve been told is insurance fraud.

“Just to be safe,” the receptionist told me, “let’s have you sign this, to avoid a surprise bill.”  The form she gave me stated that the nephrologist did not participate in my plan, was out-of-network, and that therefore I was responsible for paying the full cost of the visit.  

I asked what the cost of the visit was and the receptionist told me she had no idea.  They cannot tell you the price of any medical service, under Obamacare, until after the service is rendered.   It’s a menu with no prices next to anything, the waiter just keeps smiling and tells you not to worry, that you will be billed in thirty days.  It’s fucking insane.  “Just to be safe,” I thought, and then told her I couldn’t sign a paper saying the doctor wasn’t in-network when he was.  I pointed out to Sekhnet, who assured me that she would pay for the visit, if it came down to it, that by signing this, agreeing to pay “whatever”, I was waiving any defense under the recent Surprise Bill amendment to Obamacare.  Even though the bill would, indeed, be a surprise.

The receptionist had another idea.   Call my insurance company and make the doctor my primary care doctor, he was an internist as well as a nephrologist.  This way I wouldn’t need a referral.  The call to my insurance company lasted for 29 minutes.  There were a series of hurdles and I was placed on hold several times, listening to muzak, the last patient of the day, waiting in the doctor’s empty waiting room, earphones in my ears.  Toward the end of this endless call the doctor passed by and I asked if he had any IV valium.  He smiled and told me not to worry, he was in no rush.  

There followed a discussion of his office location.  I told Karen, at the insurance company, that I was at 161 Madison Avenue.  She told me I could only see the doctor at his East 88th Street office.  I repeated this out loud and the receptionist, who by this point had already hugged Sekhnet twice, nodded emphatically that it was no problem.   “Tell her you’re at 88th Street,” she said.   I have a hard time with an outright lie, so I said “88th Street, fine.”

I was now at the last hurdle: a three question questionnaire about my reason for switching primary care doctors.   The last question was about convenience.

“Is the location of this doctor’s office more convenient for you?” Karen asked me kindly.   Not really, I told her.  I explained that the doctor I’d been seeing was half a block from my house and that this doctor was located about an hour from my home, but that I wanted to switch anyway.

“Is the location of this doctor’s office more convenient for you?” Karen asked me again, prompting me.  I repeated Karen’s question out loud for the receptionist and Sekhnet, both now actively coaching me, nodding like two mad women.  

“Yes,” I told Karen, “much, much, much more convenient.  Thank you.”  She thanked me, the transfer was done, I was able to see the nephrologist.    

When the nurse began taking my vitals I heard Sekhnet’s agitated entreaty from the waiting room.  “Don’t take his blood pressure yet, he just got off the phone with the insurance company!”  I told them both it was OK.  My pulse was 57, blood pressure 122/82.   I told them I’d become so used to being screwed around by the insurance company that it rolled off me like water off a duck’s back.

The young doctor smiled again when I apologized for being late (it was now an hour after my original appointment time).  We discussed my idiopathic membranous nephropathy and he told me candidly that the reason there is not more recent research on the disease, which is not as rare as the lack of research might suggest, is that there is no pharmaceutical in development.  The drugs used to treat the disease have been around for a long time.   When a new pharmaceutical is in development that drives research.  “Death by American Healthcare,” I thought, but nodded thoughtfully instead.

He was indeed a very likable doctor.  The upshot was roughly the same as at the previous nephrologist, my best bet was medicine’s only bet: immunosuppressive therapy.   He would refer me to the doctor he trained under, who specializes in glomerular (a word I still can’t pronounce– definition below*) diseases like mine.   There was no immediate rush to begin treatment, he said, as the disease progresses slowly, but his senior colleague was the expert and would fully inform me of everything I needed to know.  We shook hands and bid each other goodbye.   Sekhnet was beaming from ear to ear.  

“You should keep this doctor,” she told me, “even though it’s inconvenient to get to his office.”  I told her I’d think about it.  This morning at 9 a.m. he called to discuss the results of yesterday’s blood test.  We’ve been playing phone tag since, but it was impressive to hear back from him so soon.

 

*      glomerulus:  a cluster of capillaries around the end of a kidney tubule, where waste products are filtered from the blood.

Writing to Survive

Leaving aside my increasing need to make a few copeks from writing, somehow, I have been writing recently to survive.    I’ve been writing out, as clearly as I can,  what I need to try to digest in order to keep my frustrations from crushing me.  There is something to be said for closely studying a hideous monster, setting the monstrousness out on a page as plainly as possible.   It is preferable, in my view, to squeezing the eyes shut and groaning “no… fucking no…. arrghhh….”  

So on that theory, and to keep my writing pencil sharp, I tap out these words every day.  It feels like a psychic necessity.  I have two things I need to write, two things I’ve been too preoccupied to tend to as I worry about the long difficulty of finding a nephrologist, as I struggle against Death by American Healthcare.  I have an appointment with a nephrologist tomorrow, so I am once again thinking of the future. 

One thing I need to write is my long-planned letter to NYS Attorney General Eric Schneiderman.  He is one of the few AGs who proposes legislation and advocates for it.  I wrote an untenably long letter to him in January that  I never sent.   I need to write a short, persuasive letter, with many attachments.    It needs to proffer a kiss or two for his activism against creeps and corporate malefactors.  It needs to alert him to the need for a NYS regulatory agency to intervene in the epidemic of frauds committed by health insurance companies in NYS, corporations not presently regulated in any way in New York State, except in the most cursory regard.  

Sounds like a simple enough letter.  Its last paragraph would set out what the attachments are, as in a legal brief.   #1 sets out the useless cul de sac of helpline numbers NYS consumers currently have access to.   #2  is a series of examples of seemingly fraudulent practices I can testify to.   #3  is a description of the dysfunctional practices of the NYS of Health Marketplace.   Just writing it out this way makes me feel that the project, though important and proposing sorely needed oversight that could help thousands presently screwed, is also mad.

The other thing I need to write is a note to Jeremy Scahill, both as a letter of introduction and to have him confirm something that has been gnawing at me since the extra-judicial execution of the American Muslim Anwar al-Awlaki.   Everywhere but in Scahill’s detailed discussion in Dirty Wars, Awlaki is referred to as a top al Qu’aeda leader and the organization’s number one English-speaking recruiter.   When I say everywhere I mean: NY Times, PBS, NPR, Fox News, CNN, Washington Post, Wikipedia, any other source you can turn to for information on the first American citizen killed by the US president as an enemy that must be “killed or captured”.  

Scahill describes an initially non-political American imam targeted for blackmail by the FBI, fleeing with his family to Yemen, locked up in Yemen, at the request of America, and held in solitary for a year or more, a man increasingly outraged by the worldwide war against Islam unleashed by his own country after 9/11.  Scahill reports that there was no proof of Awlaki’s involvement with al Qua’eda and no charges against him at the time of his murder by drone launched missile.

No charges against this dangerous al Qua’eda leader?   US Government agencies involved in the killing refuse to comment on whether there were charges against him at the time of his killing.   You can read that everywhere too, right next to the claim that he was a supremely dangerous terrorist leader.   We had to kill him because he hated our freedom and inspired other terrorists to hate us, goes the official story.  No need for a showing of any kind in any court, there is no appeal once placed on the new Presidential Kill List.  Appeal denied.  End of story.  Freedom on the march, nothing to see here.

The history of the world, of American Empire, is written in the blood of people whose deaths were used to tell one story or another.   I think of the widely disseminated lie about the death of American hero Pat Tillman.  The heroic legend Bush and Cheney’s people concocted about Tillman makes anyone who learns the real story want to vomit.   Tillman was killed by Rumsfeld’s inept handling of the war in Afghanistan, a victim of an idiotic policy, shot in the face by a guy in his own platoon.  

His uniform and journals were burned before his mostly headless body was flown back to the US for a hero’s funeral. The journals were burned, presumably, to get rid of the evidence of how critical he’d become of America’s misguided and mismanaged “War on Terror”.  Tillman’s family doggedly pursued the truth, eventually got it, put it out there.   Jon Krakauer wrote a powerful book about Tillman, that’s how I know.  Most people don’t give a rat’s ass.  Something is wrong, something smells bad, better spray some Febreze.  Ah, that’s better. 

I cannot turn my eyes away, some how.   If you can kill an American citizen without trial, without charges, even — what the fuck?   Why isn’t everybody fucking angry?  An idealistic American hero, killed by the ineptitude of the Secretary of Defense, his death lied about before his burial as a martyr to American Exceptionalism?   What?  Oh, wait, America’s Got Talent just started, got to get ready to vote.  Thank God I recorded Dancing With the Stars, though, regrettably, I won’t be able to vote.   Sucks to watch the show with absolutely no say on who advances to the next round…

Civil Suit proceeds to trial against torture psychologists Jessen and Mitchell

The two psychologists pictured below were paid over $80,000,000 by the Bush administration to design a torture program for use against captured terrorism suspects.  The torture program was called “enhanced interrogation” to give the torture and inhumane treatment a fig leaf of legal deniability, just in case anyone later decided to follow up on the systematic violation of American and international law.   Nobody successfully did, until this ACLU lawsuit on behalf of two living and one murdered torture victim.  

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from a Spokane paper, Quackenbush is the District Court judge in the case:

In the last hearing, defense attorney Brian Paszamant argued that his clients only provided the CIA with a list of potential interrogation techniques.

“The problem is my clients were involved in drafting the guidelines (for the CIA) and didn’t know they were going to be applied at” CIA black-site prisons, Paszamant said. “There is a huge disconnect.”

Quackenbush asked Paszamant about the treatment of Rahman, who was placed in a diaper before he died on a cold floor. Evidence suggested that Jessen helped interrogate Rahman but it only included one slap to his face.

“I’m not sure a single slap to the face would constitute torture under international law,” Paszamant said last month.

Quackenbush replied: “He was tortured.”

Paszamant pointed out that Rahman died of exposure … “none of which my clients had anything to do with. I’m not at a position to acknowledge (Rahman) was subjected to torture.”

The judge then added: “That’s why we have juries.”

In his written findings, Quackenbush noted that the defense attorneys made “several unconvincing arguments” that there was no connection between developing the interrogation techniques and those applied to Sulieman and Ben Soud.    

source

Lawyers for these two psychologists also argued that the defendants could not be held accountable for their work because the scientists who invented Zyklon-B, the poison used in Nazi gas chambers, were not prosecuted at Nuremberg.   The judge rejected that argument as well.  He ruled yesterday that the case against these two will proceed to trial.  

The Politics of Rage

I, like many Americans, spend much of my psychic energy every day trying to keep the top of my head from blowing off.   This happens when a person is placed in a psychological pressure cooker of one kind of another.  In my case the present pressure cooker, primarily, is the near impossibility of seeing a recommended doctor to treat my serious kidney disease– an eventually life-threatening difficulty I’ve been stuck in for two months now as unknown damage may or may not be occurring in a vital organ/organs.  

Solving this vexing health problem would only relieve so much stress, of course.  I would still face the many frustrations of living in a competitive pressure-cooker of a society where people are pitted against each other in a zero sum war, while ugly partisan battles rage daily and the earth itself is becoming uninhabitable due to the incomprehensible greed of a few already immensely wealthy people.  We watch problems that should be intelligently discussed and solved go unaddressed, except for the televised bickering of well-dressed two year-olds spouting talking points, talking past each other to score meaningless points with those who support them, year after year.

The result of enforced powerlessness is resignation and rage.  These things sound at first like opposite reactions, but they are not mutually exclusive, they are two sides of a coin.  You feel hopeless and resigned, you brood about why you are in the situation you are in and you feel rage.   Your rage leaves you hopeless again, but it is building in the background for the next wave.  The rage and hatred at least provide a surge of energy, a phantom feeling of some kind of power.

In my case, I find myself hating frequently deadly American Corporate Health Care and the culture of personal greed that justifies countless preventable deaths as an acceptable cost of doing supremely profitable business.   When corporate medical providers and corporate insurance companies blame each other for the medical predicament I find myself in, I turn my hatred to the corporate “person”.   I understand that this legally created person is a psychopath, it exhibits every one of the DSM’s characteristics of the psychopath.  Callous unconcern for the feelings of others, reckless disregard for the safety of others, deceitfulness, repeated lying and conniving against others for profit, incapacity to experience guilt, etc.    

I can defend my hatred with countless examples.  It doesn’t help me solve the immediate problem, avoiding death by American health care, but critically analyzing the faceless entity that is nonchalantly and impersonally trying to kill me offers momentary relief from the feeling of being sodomized.  The confirmation bias comes into play.   Every time I see another example of corporate psychopathy, and there are many, I am confirmed in my view that the practices of these poisonous institutions should be tightly regulated instead of corporations being the omnipotent rulers of the “Free Market” that is the democratic world order.   I dismiss ads by Koch Industries that tout the wonderful, creative, life-sustaining, people-friendly company they are as the work of an amoral public relations agency making a shit load of money putting a good face on the hell-bent moral equivalents of Nazis.

Here’s the larger point, though:  

We live in the stubbornly gridlocked political dysfunction of a divided nation of self-interested partisans, bigots and haters of bigots, barking past each other, each side howling catch phrases to its base.  This hideous farce is currently presided over by the personification of unearned privilege and the idiocy that is marketed to Americans as success.   This “winner” was born rich, sought endless attention, finally attained it as an abrasive, wildly popular ‘reality-TV star’, and, through an aggressive, divisive campaign narrowly won the Electoral College (designed to protect slavery from the whims of the democratic voters) and took on his dream role of the most powerful man in the world.   His presidency is a symptom of the miasma of rage most Americans live in.

Everything I have said above about my hatred of the corporation can be said, in one form or another, by anyone who hates.   We do not believe anything without being able to justify it 100%.  As I can make my case against corporate psychopaths, someone who hates immigrants can make their case, someone who hates Muslims, or Jews, Blacks or homosexuals can make a case as tight as a noose.  The analysis may not be as convincing in each case, but a case is made and an undying belief confirmed.  

Trump appealed to the rage that millions and millions of white Americans feel, having been told over and over they are “privileged,” as they watch brown and yellow people, many who don’t even speak English, pushy women, transsexuals, foreign-born secret Muslim presidents, etc, moving ahead and “winning” while they are not, and worse, as they lose they are being held guilty for wrongs done long ago, wrongs they had nothing, personally, to do with.    It’s not hard to understand why many white people would be angry, watching the American Dream slipping away from them.

It’s hard to dispute that most Americans are worse off than we were a generation or two ago.  Certainly in terms of hope for a better life for the next generation.   Adjusting to that reality is maddening.  As the super-wealthy increase their wealth, the vast majority of Americans grow more economically insecure in our casino capitalist system while a government of millionaires performs disgusting theatre in a pay-to-play system that does not act in the interests of the screwed majority who voted them  into office.  

The candidates in the recent presidential elections spoke to that injustice to varying degrees.  Millions, particularly the young and most directly screwed, supported Bernie Sanders, who analyzes the situation astutely, speaks plainly and proposes humane solutions based on crucial systemic changes.   Millions who hated Trump did not bother voting for Hillary Clinton, the second most hated political brand in America, because she spoke the language of a corrupt insider, promising incremental change, the rising tide that lifts all boats, and empowering little girls to grow up to be rich, powerful women.  Trump, meanwhile, spoke nakedly to hatred and rage, making an emotional appeal to a mythical past when everyone knew their place, demonizing immigrants and angry minorities, and promising things he had no intention of delivering to suckers he correctly said would have supported him if he shot someone on Fifth Avenue.

Not all analysis is equal, of course, but the confirmation bias means we will select data that supports our thesis, ignore data that contradicts it.  Particularly, and this is worth noting again, when we are angry.  When we are angry, we feel perfectly right to be angry, there is no question abut that. Virtually everyone who voted for Trump still believes they were right to vote for him, that he is doing his level best to carry out his promise to Make America Great Again, in spite of being surrounded by traitors, liars, leakers and other cowards.  Trump is regularly throwing red meat to them, directly to their phones, confirming over and over that he is their man, working for them, no matter what.

Consider this example.   Black kid sneers at cop, or menaces him,  cop shoots black kid to death.   There is a big difference, legally and morally, if the cop felt disrespected or was in actual danger, or protecting others from imminent danger, but that is a question for a jury of one’s peers.  That is, if you can get a Grand Jury to indict a police officer who kills in the course of his duty to protect and serve.  Depending on who the jury is, we will have two very different outcomes.  

A jury of poor blacks will know other families who have lost a son to an angry cop, may have their own experience being treated badly by the police.  A jury of policeman will know other cops who have been killed because they hesitated to defend themselves with deadly force.  Conviction or acquittal, in a system based on ‘reasonable doubt’, will come down to where the trial is held and the composition of the jury.  Lawyers are paid big bucks to get the right venue for trial and pick the best jury.

That is not to say, of course, that everything is relative and depends on your point of view.  Something happened right before Michael Brown was shot to death in Ferguson, Mo.    Cop told him to “get the fuck out of the street.”  Brown may have said “back atcha, you fucking racist cunt.”  Brown may have moved menacingly toward the cop, punched him and made a violent move to reach into the car to grab the officer’s gun, as the cop said, justifying the six shots that killed the young man.   Just because we will never know exactly what happened does not change the fact that something objectively happened.  Here is one account  trying to piece together what actually happened.

If the officer had been wearing a body camera, and it had not been switched off, the entire incident could be viewed.   That video could have exonerated the policeman in short order, if the kid actually did reach into the car to grab his gun.

There will be Americans who sincerely believe that an angry black kid who curses back at a cop deserves whatever he gets.   Death sentence is fine with them.  They will be outraged that a black person would respond to “get the fuck out of the street” by cursing the cop, or making a menacing move toward him.  Unthinkable that anyone could curse at a police officer,  no matter what the cop may have done to the citizen, let alone shove or punch a cop.   I suspect  Trump got the vote of virtually every American who feels that way.  

We live in a culture of systematic manipulation, driven by the profit-motive, which never sleeps.  It is no surprise that the most toxic notions in the world are routinely sold here in America.  Millions here believe “Climate Change” is a hoax dreamed up by prosperity-hating commies like propagandist Al Gore.  No amount of evidence can change a view that is baked in and confirmed by everyone they trust.

A psychopath has no limitations on what he will say or do to get his way. That’s the liberating beauty of being a psychopath, or a corporation, for that matter.  If you truly have no regard for others, outside of taking their money, and no shame, you have a great advantage in a society that teaches there is only one measure of success:  unlimited fame and vast fortune.  

As for me, I continue to try not to let my powerlessness and hatred destroy me, and to keep the top of my head from blowing off.

Death by American Healthcare

Richest country in the world, blah, blah, blah.  Only wealthy country that lets thousands of its citizens die every year, deaths that would have been prevented but for lack of access to affordable health care.  Only country in the world where basic medical services are a commodity, administered on a profit-based model by corporations whose sole mandate is to increase profits for shareholders.  Blah, blah, blah.    The Devil, as always, is in the details.   Death by American healthcare is not always as straight-forward as it seems.

 I vented to Sekhnet’s long-time doctor about American Corporate Medicine, and the externality that, to keep profits as handsome as they are, 50,000 Americans dying preventable deaths every year is reckoned an acceptable ‘cost of doing business.’  

“Where did you get that number?” the doctor asked.  

“The number I always hear is 45,000, but I’m hopped up because I haven’t been able to see a new nephrologist for my progressive kidney disease, so I added 5,000.”

“You can add a lot more than 5,000.  Those statistics are deaths based on documented ER visits when the disease is discovered in its final stage.   Many more Americans than that die preventable deaths every year.   You can probably multiply that 45,000 by some factor to get the actual number of Americans who die for lack of access to affordable basic health care.   How many more die without ever getting to an Emergency Room?  Those dead Americans don’t even get to be statistics,”  the doctor said.    I don’t dispute the good doctor’s point.    

As a man who has now had to change nephrologists so far three times (in less than a year), and is currently without care for my kidney disease as I look for a fourth nephrologist,  as a result of Obamacare’s immensely complicated private insurance scheme, I take Obama’s famous “if you like the doctor you have, you can keep your doctor” lie personally.  That poised, principled, hilarious, smooth-talking bitch looked me sincerely in the eye and lied to my face.  

I’d have liked to have stayed with the second nephrologist very much, instead I was forced, by income-based insurance laws, to visit one who was arrogant, defensive, insecure and argumentative.  As a result of her healthcare inexpertise, and the intricacies of the government-private insurance partnership, I am now more than two months without medical care for my progressive kidney disease, kidney disease the final nephrologist labeled an emergency case.  My kidney disease is of unknown origin, though all studies seem to agree that stress makes it worse.

“You mustn’t take these things personally,” says a random anal sphincter, passing by.  

Of course, it is absurd to think that Mr. Obama lied to me personally, offensive for me to refer to him with the gender insensitive “bitch” rather than as a dick or corporate shill.   He did his best to make positive change, President Hope and Change.   Mr. Obama was certainly a much better president than his predecessor, a limited man run by a cabal of psychopaths, and his successor, a man who needs no introduction.  

By the same math, of course, Mr. Mussolini was much better than Mr. Hitler and Mr. Stalin.   That is just hyperbole talking, a gratuitous rhetorical flourish, snapping snappishly.   Nobody is comparing any American president to these maniacs, it is a grave national insult to do so and it removes history and morality from the equation.  These were dictators, for one thing, our leader is democratically elected.   The tens of thousands, perhaps as many as a million, killed by the three most recent American presidents are not comparable to the millions killed by brutal dictators like Hitler and Stalin.  Collateral damage deaths in war zones are not the same as deliberately mass murdered civilians, even when they are the direct result of an errant smart bomb or a mistaken “signature” drone strike, or they are children who die as a result of an embargo of food and medical supplies.   A fine point to the families of the dead civilians, perhaps, but a discussion for another time.

The problem with assessing the real world effects of our presidents is that we don’t even have the language to talk about it.  Without a frame for the discussion, it is hard to understand how someone like Obama, who spoke eloquently from his heart on many matters of great public importance, at the same time steadily supported the powerful forces that run our pernicious status quo and ensured that any change proposed would be incremental, at best.  

Obama campaigned on “Hope and Change” with a slogan of “Yes We Can!”.   Campaigns and their tag-lines are pretty much PR bullshit, we all know that.   Reagan used “Make America Great Again” along with “Morning in America” and a bunch of other glittering, meaningless phrases.  Anyone who voted for Obama truly hoping for the advertised hope and change was clinging sadly to hopes inspired by a very successful marketing strategy.  Obama himself repeatedly told the people who voted for him that it was their responsibility to push him to keep his promises, though he phrased it more flatteringly to himself. 

Let’s take a glance at Obama’s presidency.  Before he was in office very long he was awarded the Nobel Peace Prize, for things he said as a candidate, presumably. When he accepted the prize he spoke eloquently about war, poverty, racism, but asked us to recognize that while he stood on Martin Luther King’s shoulders, his hands were somewhat tied.  As president, he reminded us, he would have to authorize the ongoing war on Terror, order extrajudicial killing by weaponized drones and engage in other violent policies Reverend King might not have approved of.   He humbly asked us to remember that there is only so much an American president can do about the institutional violence of militarism, racism and poverty.

“Everyone knows you don’t mess with the American war machine.   War is deadly serious bucks, man, it’s a powerful, lucrative industry with unlimited clout and, truly, if we’re completely honest about it, you cannot separate the American war machine from racism and poverty, and if I tried to, particularly as the first black president, I’d be a dead man, I promise you,” is something he didn’t need to add.

The reason my disgust for Obama exceeds my disgust for Dubya is that I expected nothing from the strikingly incurious Dubya and I expected something from Obama.  Obama might have come into office and turned the page back towards a world order based on international law, as most of the world was keeping its fingers crossed he would, for example.   This was the direction international law was headed when Mr. Bush took office in 2000, pursuant to a one-off Supreme Court decision declaring him the winner of a close and disputed election.  The Bush administration went on to flout international law, create a novel doctrine called Preemptive War, commit war crimes (with full preemptive legal immunity for the perpetrators), and serially violate the Geneva Conventions and other international treaties against torture and inhumane treatment.  

Obama took the high road, promising to look forward, not backwards, refusing to hold anyone accountable for the atrocious state policies carried out in our name.  Eventually he had the personal courage to publicly acknowledge that, in those confusing days after 9/11, and with the best of protective intentions, “we tortured some folks.”   Good speech, bro.

The term we are searching for is neoliberal.   Bill Clinton was a neoliberal. He was liberal on social issues: a woman’s right to choose, freedom from discrimination, protection of civil rights and the social safety net, proactive policies on Climate Change and environmental protection, gay rights, pubic education, access to affordable health care, freedom of speech and expression, etc.  He was neoliberal when it came to economic policies that disfavored corporate power– he took action during his presidency to ensure that large financial interests prospered.  He smiled as he reported great economic growth on his watch and claimed that a rising tide lifts all boats.  

He also signed several key pieces of right-wing legislation that did a lot of harm to the poor and swelled the bloated U.S. prison population, disproportionately with people of color.   He had the charisma to carry it off and to be remembered as a popular liberal president.    Until Obama, many called Clinton our “first black president”.   He was a neoliberal, a social liberal capable of forming alliances with the extreme right in the interest of promoting the continued growth of the “Free Market”.

President Bush didn’t have much to do, from an economic point of view, when he took over in 2001.   He cut taxes for the very rich, as anyone in his position would have, but Wall Street was humming, as it had been under Clinton.  Clinton signed off on the repeal of Glass-Steagall, which freed the biggest financial institutions to make risky, highly leveraged bets, backed by federally guaranteed money.  This led directly to the great scam that ended in the multi-gazillion dollar losses to Americans in concerted, industry-wide fraud by businesses too big to fail and the bailout of these crooked institutions by those same taxpayers.  

Obama presided over the aftermath of this, but nobody was ever prosecuted for the massive, coordinated fraud, the vast transfer of wealth to the wealthiest.   No serious policy changes were instituted to prevent a repeat, as Wall Street stabilized itself.   Obama’s financial brain trust was from Goldman-Sachs and the other top beneficiaries of the taxpayer bailouts.  Everybody who really mattered did very well under Obama, who also continued most of Cheney’s secretive policies, while giving moving speeches about the need for government transparency in a true democracy. The disgruntled masses who got a little poorer?  They are always belly-aching.

Neoliberalism, in matters of basic profit-making by corporations, the entities that are said to create all wealth in the “Free Market,” is identical to neoconservatism.    Their interests meet in their central belief that corporate freedom to thrive in a Free Market is essential to our way of life. For the market to remain free, government policy must give these corporations many protections, such as subsidies to oil companies, payments for agribusiness not to grow certain crops, no-bid emergency contracts, tax incentives, right to unlimited campaign contributions, a revolving door between industry and government to influence policy, financial bail-outs when their scams go south and so forth.  

Why is it called the “Free Market” if the government has to play such a key role in its operation?  

Because, if we told you the truth, the whole truth and nothing but the truth, it would make you want to rise up and smash our faces.  It really would.  

That’s why.

Insidious detail

Count on the New York Times to zero in on the big story, as it gives its sober, measured take on sometimes outrageous things.   Its piece detailing how the current president is doing everything in his considerable power to undermine and destroy Obamacare (and in fairness to him, Obama, a secret Muslim, was not even born in this country, SAD!) so that it can “implode,” contained this nugget:

The Department of Health and Human Services, which is in charge of administering the Affordable Care Act, has also been circulating bad news about the program.

I love that this is an aside, it reminds me of that throwaway line in the Bible about Onan’s brother: “the Lord slew him, also.”  The new administration is using taxpayer money to fund a campaign against the law passed by the previous administration.  Kudos to the Grey Skank for bringing this out!  

The rest of the short article is quite detailed in describing this quiet horror-in-progress, you can check it out here.

 

Informed Consent

We live in an imperfect world, a point that needs no belaboring.  We like to believe that Reason governs human affairs, but most often we can trace the behavior of societies, groups and individuals, to fear, hatred, hopelessness, greed and other mostly non-rational impulses.  The great democracy we live in, for example, is currently presided over by a person who is not a clown as much as a menace.  He was put into office by the galvanized forces of fear, hatred, hopelessness and greed.  He cannot seem to control his impulse to lie.  Here’s Amy on a recent presidential lie the White House just admitted was a lie.  

You can go mad watching the news, dominated by this stubborn attention seeker, unless you believe, as up to 33% of our voting populace seems to, that we live in a time when minorities and poor people are completely out of control, rich job creators are being tortured by our government, the media lies constantly and that only good old fashioned law and order can “Make America Great Again.”  

Going mad is not the best option, at least not as far as I can see.  I’ve made it my daily practice to try not to go mad, no matter how tempting it may be to go there.   One form of this daily practice is writing, in detail, to make whatever I am dealing with as clear as possible, to myself and to anyone reading.  

Transparency, and its deliberate denial, has long been a big issue with me.  It comes from a childhood where blame was shifted on to the children for the problems of adults.  Perhaps my father was incapable of answering my anguished question about what happened to grandma and pop’s twelve siblings (shot in the neck in a ravine, as it turned out) but it was wrong of him to blame me for being anxious about it.   If Reason is to guide us in trying to live reasonable lives, we have to have the information we need to consider things fully and make reasoned choices.  

We have that great phrase from the Author of Liberty, about ideal government: “deriving their just powers from the consent of the governed.” That has been changed slightly in practice, if not rhetorically.  A more accurate statement in 2017 would be “deriving their indisputable powers from the acquiescence of the systematically manipulated.”   Our elections are decided by a plurality of voters casting votes after watching fantastically expensive advertising campaigns.  The winning product is the one with the most effective attack ads on the rival product.  The government that results from this process hardly amounts to one ‘deriving its just powers from the consent of the governed’.  

It is a mark of patriarchy to rest on its right to simply be right.  No discussion is required, if one party has all the power and the other party has none, when the powerful party declares “because I said so.”  You cannot give informed consent if you are not informed.  There is nothing mysterious about this formula.  

As in the larger society, so it goes in individual interactions. If patriarchy is the final word, from top to bottom, and you have a problem with that, you are the one with the problem.   The impulse to be right is a powerful one, and we are all conditioned to argue that we are right whenever we feel challenged.   There is a more merciful orientation, true, and the world would be better if more people operated under it, but that is not the problem of patriarchs.

I called the National Kidney Foundation’s helpline.  Marjorie was great, though, in her own words, not very knowledgable about anything but the basics.  She’d never heard of my idiopathic kidney disease, for example.  She was pleasantly surprised to learn that up to 40% experience a spontaneous remission from this disease of unknown cause.   She told me that most nephrologists, going by what she hears every day, are arrogant jerks.  She said the profession apparently attracts these types.  I told her my experience did not contradict this.  

Here is my problem with the insecure, defensive, arrogant jerk who was treating me, until two months ago.  She did not feel the need to answer questions, was dismissive, manipulative, untruthful, incapable of sincere apology.   Aside from those things, which tend to increase a patient’s stress level, I’m sure she is an excellent doctor.  My biggest problem, now that I have learned much more about this disease and proposed treatments, is her refusal to give me the information I needed to make an informed choice about a side effect-rich course of IV steroids and toxic agents designed to shut down my immune system.  This therapy is recommended only for high risk patients, all others are treated with supportive therapy and counseled about diet and exercise and watched for signs the disease has progressed or begun to wane.

I wrote this, earlier, to send to this gender-neutral asshole nephrologist, for my physician friend’s feedback:

You seem to have concluded that I am a high risk idiopathic membranous nephropathy patient and that therefore immediate immunosuppressive therapy is necessary.   I’d appreciate if you could set out the factors you considered to determine that I am in this high risk category, as these were not explained to me in any detail.

Thank you

Full transparency, which would have called for a “Fuck you” instead of “Thank you” at the end, must sometimes be sacrificed for the greater good.  In this case, I need to know what tests and other factors she considered, in the absence of the standard 24-hour urine test, to determine that I need to begin a chemotherapy regime immediately. 

We all tend to phrase things in terms of our own concerns.  I don’t mean to keep harping about my kidney disease, although it is on my mind.  It serves as a perfect metaphor for many killing situations that are just part of the status quo in our competitive, materialistic USA! USA!!!   If you are not afflicted by a serious disease, the many problems of Obamacare, the calls for its repeal, are abstractions, troubling though they may also be.  If you are unable to get treatment from any of the highly recommended nephrologists you’ve been referred to, doctors allegedly in your insurance network, you are, as they say: fucked. 

Republican Health Care Plan

I inadvertently gave myself a nice taste of the shit sandwich that is the proposed Republican Health Care Plan, Trumpcare, as far as I can tell from the details I’ve learned.  I heard an interview last night that laid out the main differences between Obamacare and Birthercare and realized– fuck, I did it to myself in 2017!  The Republican plan would greatly increase premiums, co-pays and deductibles on older Americans, an age-based pricing scheme not currently allowed under the ACA.  I’ve had a taste of that in 2017, hoping for better care than I had in 2016 I am paying 600% more for the same coverage I had last year.  You don’t need me to tell you what a shit sandwich tastes like.

Obamacare, basically Romneycare, which was in part based on the Heritage Foundation’s conservative plan to keep private industry in charge of American health care, had two or three major improvements over what came before.  In exchange for the mandate that would force younger, healthier people, on pain of a tax penalty, to buy insurance, thereby funding the pool for older, sicker citizens, American patients were freed from the industry’s “pre-existing condition” loophole and ensured delivery of what are deemed essential medical services.   It used to be possible to sell insurance with serious limitations on, say, preventative services.  No more, under Obamacare.

The details of the secret Republican plan, the culmination of a seven year partisan battle against Obama’s health care law, a law they’ve called “worse than slavery”, probably worse than any holocaust, were to be revealed a week before the up or down vote.  No debate was planned because Republicans, being in the majority, believed, at first, that they could pass the law on a strict party-line vote.  When some of the details were revealed, including the CBO report that 22,000,000 Americans would lose health insurance under the proposed law, the deal quickly went south.  It’s hard to cast a principled vote for something with a 12% public approval rating.  Even in today’s lockstep party-line political environment.

There were tremendous tax breaks to the wealthiest Americans as part of the Republican plan.  This would fulfill one promise the current president made to his wealthy friends and more than reverse the tax hike Obama instituted to help fund Obamacare.   Part of the Republican plan shifted more of the cost to older, sicker customers.  Another part removed the mandate but instituted an alternative punishment, a six month waiting period for enrolling if you allowed your prior coverage to lapse.  Under the Republican plan the customer would pay a higher percentage of the cost of medical care, from Obamacare’s 70/30 split to something much fairer to insurance companies, like 58/42.  A sixty-four year old with an income of $26,000, currently paying $1,700 a year under Obamacare, would see the cost of health care increase to more than $6,500 in premiums.   That number does not include increased co-payments and out-of-pocket expenses, devilish little details that could add up to another quarter of that person’s income.

Fatefully, the Republican plan would eliminate millions from the Medicaid Expansion roles.   Obamacare increased the threshold for Medicaid type coverage to people up to 150% above the artificially low poverty guideline and provided subsidies for people living on up to 400% over the poverty line.  11,000,000 to 14,000,000 Americans now have low cost health insurance that is virtually Medicaid.  

The costs of Medicaid Expansion are paid mostly by the federal government, the federal contribution is currently at 95%.  The Republican bill scales it back 5% a year from 2021 to 2014, until it makes the program impossible for states to continue.  States, under the Republican plan, would also be able to get waivers for in-state insurers to opt out of Medicaid expansion programs and offer less than the Essential Benefits mandated under the ACA. The Republican plan would allow patients currently receiving Medicaid Expansion benefits to be grandfathered in, but it is also still famously easy to be chucked off insurance, and once chucked, it’s chuck chuck bo-buck banana fana fo fuck to you for the rest of your earthly lifetime, under the Republican proposal.  The proposed bill also slashes funding for Planned Parenthood.  USA!   USA!!!!

I’ve written critically of Obamacare, which sucks in many ways, especially its fundamental deal to keep the foxes in charge of the sickening American health care henhouse.   That said, there is no question that it is more decent than the unfettered, bare knuckles medical insurance scheme that preceeded it.  People who receive coverage under the ACA, whatever our many frustrations with the idiosyncrasies  of the industry-written plan, prefer it to the way things were before.  Most Americans, it seems, agree.  

Is there still a serious debate over the “pre-existing condition” loophole that saved insurance companies billions while condemning countless sick Americans to death?  Even Mitch McConnell’s bill doesn’t restore an insurance company’s right to refuse to sell insurance to somebody because they once suffered from an expensive medical condition.

It seems apparent that a big part of the motivation for this Repeal and Replace mania is a vicious partisan hatred of this nation’s first mulatto president.   There’s greed by the wealthiest, sure, you always expect a certain amount of that from wealthy materialists obsessed with getting every government advantage to help them become wealthier.  There’s the old partisan bickering that has become a larger and larger feature of our political landscape since Reagan.  

To understand the Republican jihad to repeal Obamacare we must not discount hatred, pure and simple, of the well-spoken half black man for whom the bill is named.  He comported himself with dignity even as Mitch McConnell announced that the Republicans were dedicated to making sure everything the president proposed failed and a coyly racist movement known as Birthers publicly, continually and counter-factually attacked Obama’s legitimacy to be president.  The highest profile “birther” was the celebrity brand who is the president now.

 “Birthers” spoke the lingua franca of millions of Americans, and said it loud and proud: “this man is a nigger and we do not have to have a nigger president of the United States.  We will simply not allow ourselves to be ruled by a nigger.”  If you doubt this widely shared sentiment, look at a large part of the current president’s base.  Millions of readers of websites like The Stormer, named in homage to the Nazis infamous Der Sturmer, whether affiliated with a hate group or not (and these mothercuckers have proliferated wildly since Obama’s election) will have no problem endorsing this view.  I guarantee that not one of these neo-nazi fucks will ever use the politically correct “n-word” to refer to our former president, except perhaps in gleeful air quotes.  These angry young white men, and their fathers, and grandfathers, voted overwhelmingly for the race-baiting panderer-in-chief, an unrepentant leader of the Birthers.

Are we living in Germany 1938?  I’d like to think not. On the other hand, on the eve of Hitler becoming the full-blown Hitler history remembers, the New York Times opined that the institutions of German democracy were too robust, the German people too cultured and sober, to allow the crass little shit-snot Mr. Hitler to run amok.  Run amok the crass little shit-snot Mr. Hitler did.  I’m not comparing this genius of audacious self-branding to any other would-be tyrant.  I’m just sayin’.   The proposed repeal and replacement of Obamacare would be a giant step toward the final victory of America’s crass little shit-snot-in-chief and the third of the nation on which his legitimacy stands.  

Would it not?