Category Archives: History and Politics

Your voice in Democracy & American Exceptionalism

The Electoral College was created to ensure that no foul demagogue, appealing to the lowest impulses and rages of the populace, would ever be elected president. Alexander Hamilton crowed about this ingenious safeguard of our democracy in Federalist Paper No. 68, if memory serves.  He wrote it pseudonymously, under the name of Schmuck, if I recall correctly, and his crowing sure came back to bite him in the posthumous ass, didn’t it?

“Well, I don’t know that Hamilton or any of the founding fathers really gave a shit one way or the other.  This guy who lost the popular vote this time by a fairly impressive three million votes, and eked out Electoral College victories in a few key states by under 100,000 votes total, is a member of that eternal ruling class, born ‘booted and spurred’ in the famous phrase stolen by the eloquent and erudite Thomas Jefferson, also born booted and spurred, to ride the saddled masses of mankind.  You can ask Jeeves about the man who, as he stood about to be executed in the 1680s, uttered the words now ascribed to The Author of Liberty.  

“You know, democracy is the worst form of government in the world, as Churchill said, except for every other form.  American Exceptionalism means that we can have as the Author of Liberty a visionary genius who held 300 humans as chattel, even after his death, although he eloquently argued against the soul-destroying evils of slavery.   American Exceptionalism, as you know, means we can drive the original inhabitants off the land in order to possess it, to the profit of a few privileged speculators, guys like the populist psychopath Andrew Jackson, who will become unimaginably wealthy.   We get to do these kinds of things because we are exceptional, Elie, you understand that, right?” The skeleton fixed me with a look.  

Oh, believe me, dad, I get it.

“So for those who complain that a candidate who got 3,000,000 more votes than her opponent deserves to be the president over a compulsive liar and snake oil salesmen who appealed to every prejudice and hatred imaginable I have two words: American Exceptionalism.   You want a voice in democracy?  Simple solution. Money equals speech, as Scalia and his buddies unappealably ruled.  Just get a lot of money and speak as freely as you like.  Like in the halls of justice, you get the justice you can afford to pay for.  If you are poor, bend over and shut the fuck up.  No whimpering!

“Look, you’ve had a nice taste of being poor, though you’ve never actually been close to poor.  I have hand it to you, though, you’ve managed to live like a poor person, I’ll give you that.  So your income last year, what you actually lived on, was 167% above the arbitrarily low U.S. poverty line.  If they set a realistic poverty line, more than 50% of the country would be living in poverty.  That would be unthinkable.  So we keep the line artificially low and the percentage of the country living in poverty becomes about right.  In the richest country in the history of the world it would not do to have a 50% poverty rate.  25% sounds much better, I’m sure you’d agree.

“So, dig, you eke out your modest lifestyle on 167% of the federal poverty level.  In 2015 that meant a 50% subsidy for your mandated health insurance.  You paid an affordable rate of about $250 a month for mediocre but adequate health insurance.  The care you got was not what a well-to-do person gets, but there was no major nightmare attached to it either.  Then, in 2016, New York State came up with a new innovation called the ‘Essential Plan’ that was virtually free to poor consumers.  At the poverty line you qualify for Medicaid.  Between 101% and 249% of the poverty line you get assigned this new plan, the ‘Essential Plan’.  You pay about $60 a month for your premium, $15-50 every time you see a doctor and have an out-of-pocket annual deductible of $1,500.  Fair enough, right?”

It took me a while to understand why it was called the Essential Plan until I had it for a while.  You essentially get whatever health care you can force them to pay for.

“Hey, you want to live like a poor bitch, make sure you do it under the poverty line.  Then you can have all those fancy programs they give to poor people, live out your days sucking luxuriously at the tit provided by your wealthier tax-paying fellow citizens.  Give ’em the punchline, Elie, I’m not feeling up to chatting much more today.  I’m suddenly remembering I’m dead and the thought is exhausting me.”

OK, in November, after a long bout of numbness in both arms and tightness in my chest,  I went to the Emergency Room on the advice of my doctor, just like in the days before Obamacare.  I’d been waiting only three months by then to see a cardiologist to discuss my dilated left atrium.  To my shock, the ER doctor admitted me to the hospital for tests.   I passed the tests and was released the next afternoon.  

My insurance carrier, fucking Anthem/Empire, the nation’s largest health insurance conglomerate and indefatigable provider of assdicking to marginally poor people, referred me to a cardiologist.  The doctor’s office confirmed I was good to go insurance-wise.  The cardiologist, ten minutes into the Q & A part of my consultation, had second thoughts and sent me away, telling me my insurance had informed his office that he was out of network.  

“So, basically, the cardiologist was a dick who had hypocritically taken his Hippocratic oath,” said the skeleton.  

Basically.  Anyway, this and related fuck-ups had me call the mega-corporation I was paying my premium to every month.  Hours of maddening calls, a long letter to the New York State Attorney General’s office and hours of snarling at inanimate objects around me later I eventually found myself talking to a rep at Anthem/Empire named Jamie.  

I realized that for purposes of any kind of legal action I needed to create the paper trail to support any further complaint I had against this massive engine of fraud I was paying premiums to every month for the ‘Essential Plan’.   My question for Jamie was simple: where do I mail my written complaint, since the website which allows Bronze, Silver, Gold and Platinum level customers to file on-line complaints does not seem to have any on-line complaint form for the Essential Plan.  

Jamie was a good guy.  He diligently looked through his on-line manuals, found the pertinent passage and read it aloud to me, with a tone of disbelief, and though I shared his disbelief, I also laughed the bitter, knowing laugh of a man who had just been handed the golden spike for his arguments to the Attorney General. It’s written in red, he told me, the way I wrote it for the complaint and to the AG, but WordPress doesn’t seem to let me have it appear in red.  Picture, then, these words in a beautiful shade of red.

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 12-14-15 at 7:56 a.m.

“They may ALSO contact… you got to love that, Elie,” said the skeleton.  

I love it so much it’s hard to describe.  

“Reminds me of Chief Justice Roger Taney’s great line about Negroes having ‘no rights a white man is bound to respect’, from Dred Scott, one of the final straws before the so-called Civil War, though we can all agree that war was anything but civil,” said the skeleton.  

Heh, reminds me of Taney’s infamous bit of honesty too, dad.

Rewrite of To Whom it May Go Fuck Yourself

I came to realize the previous draft was lacking in at least two ways.  It was focused on the mind-fucking Patient Protection and Affordable Charismatic Presidential Candidate Legacy Enhancement Act, for one thing.  The focus on the soon-to-be repealed PPACA gave the whole letter a sour overlay of mootness.  

Equally important, the letter as written probably wouldn’t have inspired the A.G. to take any action and didn’t set forth the specific action I was seeking.   This one, I think, does better in those areas.

Here’s the rewrite, which is about as good as I can get it at the moment,  After I post it I will go back to gnawing at my ankle:

January 4, 2017

Office of the Attorney General
The Capitol
Albany, NY 12224-0341

Honorable Attorney General Schneiderman,

I’m writing to alert you to a massive consumer protection failure in New York State and to encourage you to take action.   There is no New York State agency where a citizen can pursue a claim of fraudulent denial of medical service against a health insurance company.

The need for state oversight is more important now than ever, with an incoming administration committed to dismantling government regulation in many areas.

I’ve admired the courageous and proactive steps your office has taken against the perpetrators of various frauds and urge you to consider this letter in the context of systemic healthcare-related fraud against a large class of vulnerable low-income and senior citizens of New York State.

Uncertainty about health care, lack of information about costs and the routine denial of medical services without explanation are all stressful. They negatively affect the health and quality of life of those mandated to participate in income-based “bronze” level health insurance plans in New York State.   As detailed below, NYS health insurance buyers are denied any protection against the practices of private health insurance companies, even when the denial of necessary service appears to be utterly fraudulent.    

This consumer protection emergency transcends the current health care scheme under the Patient Protection and Affordable Care Act (“PPACA”).   The president-elect’s threatened repeal of the PPACA makes it all the more essential for New York State to regulate private insurance companies.   The replacement for the PPACA, whatever it might be, will not eliminate the need for protection of vulnerable older and low-income consumers, the need will likely become even more pronounced.

 In googling your mailing address to mail this letter I came across the New York State Health Care Bureau, a couple of layers down on your office’s website. While that office no doubt provides a welcome shoulder to cry on, the citizens of New York State sorely need a regulatory apparatus that can make timely and binding determinations on when insurance companies cross the line into actual fraud against their mandated customers.  

 Of course, the creation of a regulatory agency is a matter for the legislature. A fraud investigation by your office into practices such as the ones described below would highlight the need for state regulation, and give momentum to the legislative process.  

As stated above, defrauded health insurance consumers (patients) in New York State have no forum where complaints can be resolved, outside of the NYS Department of Financial Services, which, it turns out, does not hear such complaints.

The fraud investigator there 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 many 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 some 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.

 As for the PPACA, I understand that it was drafted by Liz Fowler, a career health industry insider who went on to a senior executive position with Johnson & Johnson immediately after her work on the PPACA was done. I‘ve witnessed the many attempts to repeal the law and thwart its implementation, rather than fix any of its original flaws, as most other complicated laws are tweaked and improved over time. Even so, the lack of any provision for oversight of corporations participating in the PPACA by New York State is grotesque. To a sixty year-old cardiac patient unable to see a cardiologist now for many months, the lack of oversight may also be deadly.

Although the situation I’m complaining of is personal and extremely aggravating, it is sadly typical. I’ve commiserated with many others who suffer under similar insurance coverage.  Erroneous bills are a common, if relatively innocuous, theme.

I receive bills that there is no way to resolve, most recently an invoice for $1,324 for a fully covered sonogram I had in August. The x-ray and kidney sonogram I also had that day were fully covered, the sonogram of another body part was not.   The billing issue was resolved with the insurance company (Empire Blue Cross) and the provider to a zero balance in October. Two months later, the full bill for $1,342 was sent to me again in a Third Notice.  

Nobody at Empire could give me the reason the provider had sent that bill, although the representative, who checked my account and called the provider again, informed me that, this time, it was my responsibility to pay it in full.   She offered to send a consumer handbook for my plan that would fully explain the reason, which she claimed was clearly set forth there, though she could not state it.

There is nobody in New York State to adjudicate this billing matter, outside of a judge on some court one must file an actual lawsuit to appear before, assuming one could find a cause of action.

Empire recently sent me an email warning of termination of my insurance for non-payment of December’s premium two weeks after their email confirmation of my payment for December and January.

More ominously, a patient can be denied medical service without explanation (site-specific provider NPI numbers and proper CPT pre-authorization codes notwithstanding), and there is nobody in New York State you can appeal to, except to the company itself.   Empire Blue Cross “Health Plus” recently sent me to two providers for needed medical services, a cardiologist and a physical therapy facility. Neither provided me with any service. 

I received the site-specific NPI number for the cardiologist, scanned and emailed the back and front of my insurance card, got pre-approval from his office. The consultation was halted ten minutes in and I was informed that my insurance would not cover the visit.   When I arrived at the nearby ‘physical therapy facility’ Empire had referred me to, it was a nursing home.  The director told me the facility offers PT, but only to residents.

The circuit of government agencies I have contacted in vain came full circle with the “consumer help line” the NYS Department of Financial Services Fraud Unit investigator had me call, which I immediately recognized as the very first number I’d called.   Here is a summary of that cul du sac:

NYS Department of Financial Services referred me initially to the US Dept of Health and Human Services 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.  

The NYS Department of Financial Services, one learns, has sole responsibility for oversight of health insurance companies, as well as all fraud investigations related to consumer fraud against insurance companies, and complaints about the practices of banks and brokers.   Everything but, according to John Marconi, a fraud investigator for the Department of Financial Services, investigations of colorable fraud committed by insurance companies against mandated health-care “consumers” in New York State.

My political and legal conclusions are beside the point. Whatever the reasons, the fact remains that in New York State in 2017, even under the PPACA, citizens whose health is menaced by private insurance company denials are denied any legal process to have these vexing, sometimes life-threatening situations resolved.  

Outside of a possible Article 78 (which government agency would you sue for relief, the Department of Financial Services?) or a class action under a private attorney general or qui tam statute, what is a patient trying to get an appointment to see a cardiologist since August to do under the Patient Protection Act in New York State?   At minimum an ombudsperson, or a few hundred of them, would be a good start.

As I stated above, I’ve followed your career from the start and have admired your principled engagement in the fight against injustice.   To have a legal right that cannot be enforced is to have no legal right.   While certain widespread injustice is accounted by some as a kind of ‘externality’, the lack of legal recourse for denial of purchased health care must not be allowed to stand in New York State.

I will be glad to do what I can to help your office take the first steps towards sorely needed due process for denial of health care for some of the State’s most vulnerable citizens.  I am open to being a plaintiff in any lawsuit the State might want to bring and to testifying in any proceeding.   I look forward to hearing from your office and stand ready to give any other details or assistance your office might require.

 Yours sincerely,

 B.B. Rebozo

 * teachable moment!  The previous draft had idiotically read “discreet”, an error imperceptible to homophone-deaf smell check

discreet:  having or showing discernment or good judgment in conduct and especially in speech :  prudent; especially :  capable of preserving prudent silence

discrete: separate

 

Letter to Whom It May Go Fuck Yourself

Office of the Attorney General
The Capitol
Albany, NY 12224-0341

Honorable Attorney General Schneiderman:

I am writing to enlist your efforts to remedy the lack of state oversight of health insurance companies under the Patient Protection and Affordable Care Act (“PPACA”).

I have admired the courageous and proactive steps your office has taken against the perpetrators of various frauds and urge you to consider this letter in the context of systemic healthcare-related fraud against a large class of vulnerable citizens of New York State.

Defrauded health insurance consumers in New York State have no forum where complaints can be resolved, outside of the NYS Department of Financial Services, which, it turns out, does not hear such complaints.

 The fraud department investigator there could not find a word other than fraud to describe what I detailed, but urged me to call the NY State Department of Financial Services Consumer Services Hotline. He assured me that they were the specialists in this area. The answering machine at the hotline, which I recognized from my first call, offers no option for resolving issues with health insurance companies regulated by the ACA, or otherwise.

 On my original call, 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 some 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.

 I understand that the PPACA was drafted by Liz Fowler, a career health industry insider who went on to an executive position with Johnson & Johnson immediately after her work on the PPACA was done. I have witnessed the many attempts to repeal the law, rather than fix any of its original flaws, as most other complicated laws are tweaked and improved over time. Even so, the lack of any provision for oversight of ACA programs by New York State is grotesque. As a cardiac patient unable to see a cardiologist now for many months, the lack of oversight may also be deadly.

Although the situation I’m complaining of is personal and extremely aggravating, it is typical.  I’ve commiserated with others who suffer under similar insurance coverage. Erroneous bills are a common, if relatively innocuous, theme.

I receive bills that there is no way to resolve, most recently an invoice for $1,324 for a fully covered sonogram I had in August. It was resolved with the insurance company (Empire) and the provider to a zero balance in October. Two months later, the full bill for $1,342 was sent to me again in a Third Notice.   Nobody at Empire could give me the reason the provider had sent that bill, although the representative, who checked my account and called the provider again, informed me that, this time, it was my responsibility to pay it in full.  

Empire recently sent me an email warning of termination of my insurance for non-payment of December’s premium two weeks after their email confirmation of my payment for December and January.

More ominously, you can be denied medical service without explanation (provider NPI numbers and CPT codes notwithstanding), and there is nobody in New York State you can appeal to, except to the company itself.  Empire Blue Cross “Health Plus” recently sent me to two providers for needed medical services, a cardiologist and a physical therapy facility. Neither provided me with any service. 

I received the site-specific NPI number for the cardiologist, scanned and emailed the back and front of my insurance card, got pre-approval from his office. The consultation was halted ten minutes in and I was informed that my insurance would not cover the visit.   When I arrived at the nearby ‘physical therapy facility’ Empire had referred me to, it was a nursing home. They offer PT, but only to residents.

The circuit of government agencies I have contacted in vain came full circle with the “consumer help line” the NYS Department of Financial Services Fraud Unit investigator had me call, which I immediately recognized as the very first number I’d called.   Here is a summary of that cul du sac:

NYS Department of Financial Services referred me initially to the US Dept of Health and Human Services which connected me to NYS Health and Human Services, although 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 the NYS Banking Department.

The NYS Department of Financial services, it appears, conducts all oversight of health insurance, as well as all fraud investigations related to consumer fraud against insurance companies, and complaints about the practices of banks and brokers. Everything but, according to John Marconi, a fraud investigator there, apparent fraud committed by insurance companies against mandated health-care “consumers” in New York State.

My political and legal conclusions are beside the point. Whatever the reasons, the fact remains that in New York State in 2017, even under the PPACA, citizens whose health is menaced by private insurance company denials have no redress.  

Outside of a possible Article 78 (which government agency would you sue for relief?  The Department of Financial Services?) or a class action under a private attorney general or qui tam statute, what is a patient trying to get an appointment to see a cardiologist since August to do under the Patient Protection Act in New York State?   At minimum an ombudsperson, or a few hundred of them, would be a good start.

As I stated above, I’ve followed your career from the start and have admired your principled engagement in the fight against injustice.   To have a legal right that cannot be enforced is to have no legal right.   While certain injustice is accounted “the price of freedom”, the lack of legal recourse for denial of health care must not be allowed to stand in New York State.

I look forward to hearing from your office and stand ready to give any other details needed.

 Yours sincerely,

A. Schicklegruber

Freedom from Want– the difficulty of that freedom

“Well, you know, Elie, there have always been two sets of laws– one for wealthy transgressors and the other for everybody else.  The poor get their own subset of laws which were established thousands of years ago under the ancient principle that translates to ‘go fuck yourself, asshole.’  None of this is at all surprising, once you’ve been around a few years, every society reeks of this double standard.  You get the justice you can afford to pay for.

“It’s a very galling state of affairs, of course, but it’s nothing new.  You’re waiting for a call back from some ‘supervisor’ named ‘Julie’ at the ‘NY Call Center’ of the health insurance company that’s committed fraud against you on at least two recent occasions.  I can hear them now ‘sir, fraud is such a judgmental word, and it’s a legal conclusion.  Can you make a firm legal conclusion before you’ve read all 2,700 pages of the PPACA?  You seem completely unaware of the third footnote to amendment three in Appendix Two of your plan-specific consumer handbook.’

Oh, now that you mention it, I remember that footnote.  It stipulates that external body parts, the outside of ears, noses, breasts and so forth, are not ‘body parts’ for purposes of diagnostic testing.   Kidney?  Totally enclosed, body part, sonogram fully paid for.  Testicles, which hang outside of the body proper, are therefore clearly exempt from insurance payment for all diagnostic procedures.  

“Well, you make a joke out of it, but I notice you’re not smiling.   Why would you smile?  You remember Dubya smiling like a baby with gas every time he talked about something horrible? One thing I could always say about you, Elie, you never had an inappropriate smile about things like people jumping off tall buildings and the horrors of war.

“Of course, a chat with the skeleton of your dear old dad is not what kindly old Doctor Mengele ordered today.  You’re distracted because your balls are caught in a vise and your heart may be slowly killing you.  We learned last time, in only ninety minutes, that in addition to the site-specific NPI number for each provider there is the additional complication of the precise CPT code required from that provider to pre-authorize certain service referrals.  

“There is nothing complicated in this.  Fail to verify the NPI number?  You, not the insurance company is responsible to pay the provider. Provider submits wrong CPT code?  Same deal. ‘Read the law, motherfucker! Read the law!'” the skeleton grinned broadly and grotesquely.

Excuse me, dad, just had a call from a robot at the insurance company with a surveybot asking about my recent customer service experience.  They wanted to make sure I was completely happy with the service I received from “Julie”, the “supervisor” at the “NY Call Center” of “Empire” that I was connected to after less than an hour the other day.  “Julie” was going to research the issues, since she had not a single answer to four separate questions about fraud and radically changing answers to seemingly simple billing questions, and call me with answers today, now.  The placatory, friendly “supervisor” Julie, who gave neither last name nor ID # (‘I’m the only Julie in the NY Call Center’ she assured me brightly– although it turns out nobody at Empire, or anywhere else in the world, can connect you to that call center) proves to be completely unreachable.  ‘Press one if you were the person who placed the customer service call, bitch-ass motherfucker.’

“Well, you know from your own experience in the Housing Court, Elie, that the rules for poor people are very strict.  When that obese Brooklynite, a house-bound diabetic amputee, got a letter scheduling an appointment and did not make it to her mandated face-to-face meeting at Section 8 two days later she lost her rent subsidy and all other government benefits.  You went to court 13 times on her behalf, over more than a year, before finally figuring out how to haul the director of Section 8 into court and instantly resolve an insoluble bureaucratic problem– and pay almost two years’ worth of rent arrears.  The law is clear: one notice for poor motherfuckers, failure to jump through the indicated arbitrary hoop: immediate termination of all benefits.

“You want health insurance, bitch?  They could have rolling admissions very easily, submit on the anniversary of your first premium, or your birthday, or within 90 days of some arbitrary date.  Wait, here’s a better idea for poor motherfuckers:  you have the ten days before Christmas, and the ten days immediately after New Years to submit all your paperwork, be assigned your level of insurance coverage, and choose a company to provide your health care on the marketplace for the following year.  Failure to wait on endless hold, exercise superhuman patience with non-working websites, servers that crash because thousands of desperados are submitting and resubmitting their required documentation within that short window of business days, with offices closed for several legal holidays during that window, and Christmas parties, and hangovers:  no health coverage for at least sixty days.  Hey, you want health insurance, you low-income cunt?  Come and get it.  If you can, bitch.  Please have a very nice day and continue to hold.”

God must have loved poor people, he made so many of them, as some poor wit once observed.  God, it must also pointed out, long ago became severely demented after centuries of despair watching the abusiveness and cruelty of the creature he fashioned in his own image.  

“Leave God out of this, Elie, hasn’t he suffered enough?   The present conversation with Ashanti D. at the Empire Blue Baboon’s Asshole Health Insurance Syndicate should give you fodder enough without bringing God into it.  You’ve only been on hold for less than 50% of the so far 39:42 you’ve been speaking to Ashanti D. and she’s been trying very hard to find you answers, answers she doesn’t have, but she’s concerned that you’re having a good experience with her, outside of the fact that nobody at that criminal syndicate has any answers for you.  

“Good for you getting her ID # and the specific call reference number for your call, that will really help you going forward … oh, look, Elie, it’s ringing now.  Maybe this is the NY Call Center.”

It rang three times and then the call terminated. Typical.  These motherfuckers aren’t accountable to anyone because — you’ll be shocked, dad, when I tell you that when Obama’s PPACA went into effect they abolished the NYS Department of Health’s Office of Health Insurance.  The New York State Insurance Department was also abolished, its functions subsumed by the New York State Department of Financial Sevices, along with all banking, as you know.  I have a map of hours of calls to offices that could not help and my futile conversations with corporate employees who were not authorized to help.  

I was able to consult that list just now and verify that the fraud and complaint hotline number Ashanti gave me was the fourth call I made that day, the Medicaid Inspector General, an office that, while very sympathetic, could not help me.  I told Ashanti as much.  She told me she was sorry then tried to connect me, via an internal number, to the NY Call Center.  There is no consumer number to reach Julie, the possible supervisor, of that office.  After a bit of a hold the phone rang three times, at the NY Call Center, presumably, then the line went dead.

 Now, there’s nothing left for me to do.   I’ve got to go write my fucking complaint to the Attorney General, make it short, snappy and effective.  I’ll post it up here, as I rein in the impulse to say something cruel about the charismatic, hilarious architect of this vast empire of perfectly legal health insurance fraud.  Or smash his smug, perfectly composed, handsome, fucking soon-to-be billionaire speaker/performer face.  

“Now, now, Elie, don’t be so bitter.  You have it much better than 99% of the Third World and even most Americans.”  

Yeah, and don’t I know it, pops?

Don’t Torture Yourself

President Obama, a man who can be counted on to deliver an inspirational speech, made an unambiguous admission about the systematic brutality visited on Muslims who fell into American hands after the invasions of Afghanistan and Iraq.   He left no ambiguity about the “enhanced interrogation techniques”.  In one of the most regrettable phrases the great speechmaker ever uttered he made it clear that “we tortured some folks.”  

That was in the summer of 2014, and the remark was prefaced by “after 9/11 we did a lot of good things, but…”  His legal training was on display in the way he buried that terrible admission in the second half of a sentence that began reminding us of all the correct things we did after 9/11.

Great rhetorical speaking often calls for a stirring generality that can unite listeners and make the bitter medicine go down easier.  Obama did not disappoint, making the larger, more abstract and more palatable point that “one of the strengths that makes America exceptional is our willingness to openly confront our past, face our imperfections, make changes and do better.”  Keep that remark in mind, we’ll get back to it in the punchline.

His high-minded (to give him the benefit of the doubt) decision not to prosecute anyone for these war crimes, American crimes, flagrant violations of international treaties, etc. fails to account for one dependable human tendency.  If you admit what your country did was abhorrent and then vow to look forward, without any accountability for those who ordered the savage, illegal acts committed, it’s not hard to imagine what will happen the next time you and other good people feel pushed into a desperate corner, surrounded by implacable, murderous enemies who hate your freedom.  

This guy we have coming into office loves tough talk and loves the idea of inflicting maximum pain on our enemies.  Waterboarding is not enough for him, he boasted, he’d do really bad shit, much worse than just controlled drowning over and over as you’re strapped to a board upside down, between punches in the face as you vomit and gag for air, at the very edge of cardiac arrest (which is why they always had a doctor by the waterboard– how about that for a post 9-11 turn on the Hippocratic Oath?)

I have whined about all this torture done in our names since I heard the U.S. had secretly “legalized” torture during the Cheney-Addington-Bush years.   I was glad to hear, even as I winced at the grotesque nonchalance of the expression, an American president admit “we tortured some folks”.  It was like hearing Bill Clinton say what no other American president had ever said: slavery was an atrocity and America should apologize for it.  Another great moment of national healing that should have made folks feel much better.

Why am I whinging about this today of all days? Last week there was some debate, way in the background, about the fate of the 6,700 page Senate Torture Report.   Although the Obama Administration has kept the report top secret since its release, it appears that the full scope of the torture program is laid out in its pages, specific atrocities are described in detail, it contains the testimony of the torturers themselves about gaining no useful intel from the torture, details the eventual insistence of the torturers and their bosses that the program be stopped because it did far more harm than good, and so on.  

The full report is apparently a ringing slap in the face to tough talking guys like Dick Cheney, who continue to insist that torture works, that we got plenty of good intel from it, that those we tortured fucking deserved it, and worse, and that countless American lives were saved by torture, even if many of those tortured were wrongfully imprisoned detainees who had no connection to terrorist activities and were eventually released from indefinite detention.

When Republicans regained control of the Senate in 2015, Republican Senator Richard Burr, the new chairman of the Senate Select Committee on Intelligence, the committee responsible for the Senate Torture Report, apparently sought to collect all copies of the report that had been distributed so that the report could be classified and/or destroyed once and for all.  

It seems mad to destroy the report, erase its still classified findings, but, that’s partisan politics, I suppose.   Objection to torture is seen as largely a liberal tic in current American politics. Why that would be the case is hard for me to understand, I am certain that many conservative people also abhor torture, which has long been considered antithetical to American values, but there it is:  torture  is now another snarling partisan issue in our Divided States of America, like abortion, global warming, full rights of citizenship for homosexuals.

Obama took decisive action the other day to preserve the Senate Torture Report.  He’s including a copy in his presidential library.  He has been praised for this action.   He has also classified the report for the maximum twelve years under the Presidential Records Act.   Nobody, including, presumably, the incoming president and his administration, who are unlikely to consult it in any case, will be able to have access to the report until 2029, at the earliest.  

The cliche about the unlearned lessons of history comes to mind.  Along with this stirring epitaph about American Exceptionalism: “one of the strengths that makes America exceptional is our willingness to openly confront our past, face our imperfections, make changes and do better.”  We can start to do that on the subject of torture in a mere twelve years, maybe.

May I Vent a Bit Here, Mr. Obamacare?

I’m having a stressful day so far, as I wait for President-Elect Fuckhead’s latest publicity stunt to hit the wires.  I can’t keep it to myself.  Poor Sekhnet was bawling uncontrollably just now at my frustration before I could calm her enough to let her off the phone.   I need to vent, so if you’re not up for it, I understand, click away, click very away.

I went to an accountant who made a few minor errors on my taxes.  The first would have cost me almost $300, the second a little less than $500 in tax liability I apparently didn’t have.   I don’t hold this against her, going forward it won’t happen again, and, fortunately, I avoided both of those costs, as far as I know.   She told me to wait for the IRS to bill me on another matter, and I waited, and they billed me.

I paid this bill to the IRS.   Then two weeks later I received two certified letters from the IRS, threatening me with a levy or garnishment to satisfy the debt to them they claimed I hadn’t paid.  Their threatening certified letters were dated 12/12/16.  The payments to them were made on 12/5/16, confirmed on date of posting and the backs of both cancelled checks.   I wonder what their next letter will say.

But that’s nothing to get upset about, it’s easily resolved.  Just print out the images of checks, front and back, put stamps on their fucking IRS mailer and enclose the proof of payment with their certified mailed notice that they will begin collection efforts against me for a debt already paid.  Or better still, just wait for their next letter.

What I’m upset about is the Obama news conference I made the mistake of listening to just now, in the context of my ongoing horrors with his signature program, Obamacare.  

It’s true he’s killing people with drone-launched missiles in at least seven countries, off of a secret kill list.  Many of these people might be terrorists, no doubt, and hopefully few are innocent children and old women, or innocent men, for that matter.  His successor will have the same top-secret kill-lists presented to him for his approval.  

It’s also true that Obama has reserved, for himself and any future president, the right to kill American citizens without the need for any sort of process at all, with or without charges.   Tidying up afterwards is just book-keeping, most Americans are not paying attention, seriously.   Just pose with Kanye West or Kim Kardashian until the news cycle is over, done.    

I have plenty of beefs with Obama, who I voted for twice, but let me just give you the details of one I know better, and more personally, than anybody else I know.  Most people I know are comfortably middle class and work jobs where their health insurance is not at the mercy of the industry-written compromise called the Patient Protection and Affordable Care Act.  

You are assigned a level of health insurance based on your income as reported on your tax return.  If you don’t file tax, no Obamacare.  Fine, fair enough– the State Health Insurance Marketplace automatically gets all your proof of income statements anyway.  Submit your income numbers, get the level of insurance coverage your income entitles you to.  Choose any participating company to provide your care, at the assigned level, and start paying your premiums.  

I had a diagnosis of a slightly dilated left atrium over the summer.  The left atrium is one of the four chambers of the heart.  I asked my doctor how serious this was and he pantomimed a strong man pose, the healthy atrium muscle flexing, and then a limp armed pose, the same atrium, only flabby and weak.  He promised to refer me to a cardiologist, one who was joining his practice any day.  That was in August.

In September I began having pains in my chest when I did a strenuous bike ride.   I discontinued riding and kept following up to find out about the cardiology referral.  By November 17th I still had no referral and the doctor, returning my late night call about chest pains, agreed it might be best if I went to the E.R. to rule out a possible heart attack.  

Reclining on a bed in the Emergency Room, I learned the medical jargon meaning of “a good story”.  My EKGs had come back fine, my blood work was clear of markers for recent heart events, but as I was taking medication for hypertension, high cholesterol, and was 60– I had three of the five major risk factors and was, thus, “a good story.”  

I smiled, relieved, ready to go home, until the doctor explained that a “good story” was a bad thing, not a good thing.  I was a good story for possible heart disease and they’d better admit me to the hospital to rule out some deadly event that might soon befall me.

More out of shape than I’ve ever been, since I’d done no aerobic exercise in a few months since the chest pains while biking, I did OK on the stress test and was given a clean bill of heart health, cleared for all activities, though I was also diagnosed with an abnormality in one of my ventricles as well.

After payment for my visit to a neprhologist was denied as out-of-network since I had not pre-submitted the referred doctor’s location-specific NPI number and made sure he was in my plan at that location, I called Empire Blue Crucifix to make sure the next specialist I saw was in network.  

Empire gave me the name of a cardiologist and his office address.   I took pains to read back the site-specific NPI number for the provider and send his office the front and back of my insurance card.   I verified the doctor’s NPI number and was told by Maria at his office that we were good to go.   Ten minutes into my interview with the cardiologist’s assistant she was called away.  It annoyed me that she left the room mid-sentence, cutting me off without saying so much as “excuse me”.  

That annoyance would turn out to be a rather trivial.  Ten minutes later I was called back out of the consult room to the front desk.   The cardiologist himself was sitting at reception, very apologetic. He literally couldn’t have been nicer.  He told me that unfortunately the insurance company had informed his office that he was out-of-network.  We spoke for a few minutes, and I thought this was a person I could be good friends with, if circumstances were different.

I mentioned the importance of restraint as a musician and he raised his eyebrows.  “I should write that down: ‘restraint’…” he said, and we went on to talk about a master of that subtle and indispensable art, George Harrison.   The doctor gave me a print-out of all the materials from the hospital visit, with the intimate details and scientific names for my two or three heart irregularities.  We shook hands.  

My right hand, which has regained much of its strength six months after I injured it in a fall, is still stiff.  The P/T I began in November made it feel immediately better.  When I returned for my second appointment I was told that, unfortunately, I was out of network.  

I got a referral from my insurance company, complete with site-specific NPI provider number, for another P/T provider two blocks from the cardiologist.  I walked over with my referral form after my aborted visit to the cardiologist to set up an appointment to resume P/T.

I was surprised that I’d walked into what looked like an Old Age Home.  I checked the address, I was in the right place.   The receptionist was surprised that I was there for outpatient P/T.  She wasn’t aware they offered that.   The director, over the phone, told me they did offer P/T, but only if I checked into the nursing home as an inpatient.

I walked home 0 for 2 on referrals given to me by my insurance company.  I thought of the third notice of a $1,324 medical bill I’d received the day before for a sonogram I’d had months earlier.  I’d had an x-ray of my hand and two sonograms that day.  The x-ray and one sonogram were both covered, the other was not.  $1,324, please.

 After the second notice demanding $1,324 I straightened things out, on October 19th, with the insurance company and the provider, it took less than an hour.  Daniel at the provider told me I’d been billed in error and actually only owed a $25 co-pay.  I told him I’d pay it when they billed me.  Then, six weeks later, I got the third notice to pay $1,324.    

This time, I was told by the insurance company, that I was responsible to have read all of the fine print in my contract and that it was clearly spelled out which body parts were not eligible for coverage.  She was not able to explain the reason for this, but assured me it was the law, all described clearly in the contract.  She then called the provider and confirmed that I owed the entire $1,324.  Daniel had no recollection of having spoken to me, on October 19th or any other day, she said.  

It was a purely futile conversation and there was no supervisor available for me to whine to.  Empire’s position was that it was my responsibility to familiarize myself with the arbitrary and random bodily exclusions from coverage under the specific policy I had under the newly-created Essential Plan.

Tired of making Sekhnet cry, I thought outside the box just now and had a very pleasant twenty-five minute chat with a thoughtful and intelligent man named David at 311, the NYC information hotline.  

David had only one number for complaints about medical insurance, the New York State Department of Financial Services, naturally.   You can reach them Monday to Friday from nine to five at 212-480-6400.   He doesn’t know if they investigate medical insurance fraud, or oversee any agency responsible for assigning and administering health care in New York State, but it was the only thing he could find, though he searched long and hard.   He recommended I contact a local politician for help, they usually know how to do these kinds of things.

He agreed that the new norm of corporate opacity in government is very troubling.  I told him how the New York State Health Marketplace would not divulge contact information for its director, when I was erroneously denied health insurance for two months earlier this year and called many times trying to get the error corrected and have my health insurance reinstated.  

“Sir, we are not required to provide you that information,” one of the New York State of Health representatives told me from their call center in Albany.  

“Why is that?  Are you a private corporation?” I asked.  

She admitted that they are a public agency, but reiterated that  a member of the public is not entitled to know the identity of the director. They have specific instructions not to provide their boss’s contact information.  Their supervisor will not provide that information either, nobody will.   As for an ombudsperson, or someone available to help distressed customers, they are not required to have one under the Patient Protection and Affordable Care Act.  

They have an appeals process for all disputes.  I initiated an appeal and was told I’d hear within two weeks.  I heard nothing, nobody could give me an explanation for the delay.  Two months later my health insurance was back in effect and I began paying my premiums.

Two months after that I had a call from an appeals ‘hearing officer’.  He asked me if I was ready for my appeal over the phone.  I asked him why I’d received no notice of the hearing.  He told me a notice had been sent to me thirty days earlier. He directed me to where I could find it on line.  

There was no notice there.  He saw it on his end, he told me.  I pointed out that if the person who is entitled to notice doesn’t receive any notice it really doesn’t matter if a form was prepared or not.  

He was not the sharpest knife in the drawer, and had a shit job, no doubt,  but he was on point, I’ll say that for him.  No matter what I said he returned to his single question: are you prepared to go forward with your appeal or do you wish to abandon your appeal?

I explained, in vain, as it turned out, that since I had been appealing a denial of benefits for January and February, and it was now May, that we would need a time machine in order to have a meaningful appeal of the wrong I had appealed.  

“Do you want to abandon your appeal or go forward, you have to tell me one thing or the other, sir,” he said.  

I went out on a limb and used a word many people mis-correct as “mute”.  I told him it was academic, since the controversy was now moot — the harm was done and could not be corrected any more due to the passage of time.  He asked his single question again.   I explained the concept of mootness to him.  I might have been explaining it to my own sonogram-exempt body part.

Obama was surrounded by organized, determined, ruthless enemies, no doubt.  He had very wealthy donors in the industry that, in fairness, he had to consider as well as the public his law was designed to protect.   However you slice it, Barack Obama is the Obama of Obamacare, and I hope he will not be too offended if I point out again that he’s a sell-out and a bit of a dick.

Commie Bastard

“Basically, you’re a commie bastard, Elie,” said the skeleton of my father, with very little judgment.  “You know, you’re animated by that ancient, hard to extinguish Jewish spark of longing for Justice.  A CEO in Japan makes 11 times what the average Japanese worker does, in Britain and Canada it’s 20 times.  Here in the ‘USA! USA!’, as you call it, the average CEO makes 435 times more than the average worker, because, fair is fair.  You know, you’ve always had a rage against this kind of logic.”  

Well, in fairness to the CEO class, I had the same reaction when Cheney and Dubya started torturing people in my name, when Obama, years later admitted that “we tortured some folks” and, historically, when my family was lined up by that ravine in Vishnevitz, or simply disappeared without a trace two hundred miles north.  

“You don’t really expect those who live on a million dollars a week to suddenly have to make due with only a few hundred thousand, do you?” said the skeleton, his facial expression matched perfectly with his words.

“The super wealthy are not like you, Elie.  They go to bed dreaming about wealth and they wake up thinking about it.  You are a… how to put this in a way that won’t hurt your feelings?… a fucking idiot swimming against the prevailing tide of your time.  Is any of this confusing to you?  America is run by wealthy people and the lucrative interests they own.

“Much of history is interpretation, as we’ve discussed, but certain lines can be drawn between events– causes and effects shown with reasonable reliability.  A doddering, beleaguered, probably senile Ronald Reagan, oversaw the abolition of the Fairness Doctrine in 1987.  Why allow opposing views to be presented to the public when the free market can best decide what views the masses of Americans will see?  

“So you have, in short order, the rise of Rush Limbaugh, FOX TV and the rest of the well-oiled Right Wing echo chamber.  If they are laughable nuts to some, they are also the voice of America to wide swaths of our population who get all their information from these avowedly fair and balanced sources.   Whose interests does the end of the Fairness Doctrine serve in the end?  It doesn’t take a PhD in the History of the Fairness Doctrine to figure that one out.

“When Obama became the first presidential candidate in decades to opt out of public election financing he was able to outspend John McCain two to one.   He was charismatic, a great campaigner, McCain had to run on the dismal record of his party during eight terrible years, etc. but the 2:1 spending didn’t hurt either.

 “All of those twenty dollar internet contributions Obama had quickly multiplied when the big money started pouring in from the financial services, fossil fuel, health insurance and pharmaceutical industries.

“Then, you know, when crafting the Affordable Care Act, fair is fair, take the only effective solution—the public option—off the table from the start and let the private health insurance industry write the law. 

“In the Patient Protection and Affordable Care Act, as you’re fond of calling it, the mandate is all one-sided, the consumer is forced to pay for health insurance, in exchange for CEOs holding the line at their seven and eight digit annual compensation packets and giving the insurance companies the option to opt out at any time if their profits are adversely affected by the new law.  

“The pernicious myth of the ‘free market’ is so pervasive that the alternative to any profit-driven enterprise is unthinkable, downright un-American. That said, your critique of this rogue form of bare knuckles capitalism makes you, and let’s be honest about this, Elie, a fucking commie.”

One reason Trump is President-elect, why most Americans hate their government, and why they hate others, as well

I voted for Barack Obama twice, holding my nose the second time. “All presidents disappoint”, Bill Moyers reminded his viewers during the euphoria (for many) when Obama was elected the first time.  Moyers’ reminder was one of the most sobering, and prophetic, I can recall.  Obama, smooth, thoughtful, droll, sensitive, has disappointed more than any other president in my lifetime.  

For but one example of my disappointment, let’s have a peek at his signature achievement, The Patient Protection and Affordable Care Act, popularly known as Obamacare, the program the president-elect has vowed to repeal as soon as he’s inaugurated.  

I am the only person I know who is directly affected by the outgoing president’s masterful compromise with the massive health care corporations who need to remain as lucrative as ever.    I speak of the workings of the PPACA with bitter personal familiarity unmixed with statistical satisfaction of any kind about things like the possible long-term altering of medical care cost vectors.  

The law was a hasty compromise with what was sorely needed to prevent tens of thousands of preventable American deaths every year.  It was written, by industry insiders, to ensure, above all else, that the private insurance and drug industries would remain as healthily profitable as possible.  

Written by wealthy health industry lifer Elizabeth Fowler (check out the great five minute Bill Moyers clip at the bottom of the link) who worked, during a brief sabbatical in ‘public service’, for the most handsomely paid (by the Health Insurance and Pharmaceutical industries) man in government, Montana Senator Max Fucking Baucus.  

Baucus apparently admitted never having read the bill, stating that it would have been a “waste of time” to do so, because only an expert could understand its 2,700 pages (NOTE: the author of the linked Washington Post article, no friend of Mr. Obama’s, is a professor at the ‘Antonin Scalia Law School’ whatever the devil that infernal place is).   A somewhat less biased account of Baucus, with a passing note on his ambivalent role in the crafting and passage of the PPACA, is here.

One learns from the Grey Lady article that Baucus is the scion of a “prominent and mostly Republican” Montana ranching dynasty who always “marched to his own drummer” as he did, one assumes, when accepting Obama’s appointment as ambassador to China rather than face sure defeat in a re-election bid as Montana Senator after three and half decades on the job.  

Baucus took over the lead role shepherding through the PPACA when Ted Kennedy died.  Baucus is known (albeit not well) for these right-wing, business-pleasing votes, as well as for taking millions in campaign contributions from concerned health industry lobbyists:

In 2001 Mr. Baucus defied Tom Daschle, then the Senate Democratic leader, by co-writing President George W. Bush’s tax cuts, setting off screaming matches between the two Democrats. In 2003, Mr. Baucus broke ranks to support a Medicare prescription drug benefit that Democrats viewed as a giveaway to drug companies.  (source)

You can google either of these characters, Baucus or Fowler, to read their sordid bios.  One can admire the way Ms. Fowler danced through the revolving doors, and made millions while serving her fellow health industry executives, without applauding, or even cracking a smile about, the sickening health care law she lovingly crafted for Mr. Obama’s signature.

Anyway, I’m just worked up because I got “an important notice” from the New York State of Health in the wee hours of the morning. It arrived at 3 a.m., certainly the most effective hour to send such crucial health insurance-related news that likely impacts a patient’s immediate health insurance coverage.  It read: 

A notice has been sent to your inbox in your account. This notice tells you important information you need to know about your health coverage for you and/or your family.

You must log into your account on the NY State of Health website to read the notice.

The careless motherfuckers at New York’s Obamacare “marketplace”, The New York State of Health, contacted me last year, with an almost Josef Goebbels-like sense of mischief, on Christmas Eve and Christmas Day to inform me I would be ineligible for health insurance until March 1, 2016, at the earliest, and gave me seven (7) days to provide all tax forms and a full, written explanation of why I should be given health insurance at all.

 

Almost lost in my inbox, I took a moment just now to log into the accursed site and read this:

Screen shot 2016-12-04 at 3.04.34 PM.png

IMPORTANT NOTICE:   Today is December 4th, please come back AFTER December 15th to keep your insurance up-to-date and in place for 2017.  On, or just after, December 15th you will then have up to 24 hours — provided our servers, often overloaded just before our short, arbitrary registration deadlines, do not crash– to provide all required updates within that short window in those leisurely days before Christmas, or lose your insurance coverage until, the earliest, March 1, 2017.  

Or maybe not.  Nobody you speak to at New York State of Health, after a wait of no more than 25 minutes, will have the definitive word on what’s what.  The only thing you can rely on regarding the New York State of Health is not getting reliable information.  Take heed, though, and take that to the bank, bitch.

I’ll be eagerly following Barack Obama’s career as a private sector public speaker.  I am confident that my man will break all existing earning records for corporate speaking.  He’s that good.

The Fairness Doctrine is Ancient History

“Well, how bout this one, Elie– we have the votes, let’s abolish the fucking Fairness Doctrine and get the old show on the road,” said the skeleton.

For the benefit of those who have no idea what the Fairness Doctrine was, a bit of, eh, history.   Starting in 1949, when television was in its infancy, the FCC came up with a requirement for broadcasters, licensees who used the limited public airways built and maintained by We The People, when presenting public interest content, to give both sides of any contentious public controversy equal opportunity to influence public opinion.  

“If you gave air time to a spokesman for everyone’s irrefutable constitutional right to as many guns as they want and the freedom to take them everywhere they go and use them freely anywhere if they feel threatened, or even just a bit paranoid, well, a spokesman for people who are not insane had to be given a chance to present their side and rebut that opinion.  It was called The Fairness Doctrine, a quaint idea today.  

“The FCC apparently abandoned the doctrine during the Reagan Administration, when the votes lined up to begin consolidating media and getting rid of anachronistic, idealistic, safeguards against the mass media becoming a propaganda machine for one side or the other.  

“Which makes sense, since the Reagan Administration can be seen as a kind of fork in the road, making the right wing cool.  And as Yogi is reputed to have said ‘when you come to a fork in the road, take it.’  

“Under the Fairness Doctrine if a licensee down south ran segregationist programming and censored all national news about the civil rights movement, the public in its broadcast area had a right to also hear a non-racist point of view and the broadcaster was obliged to air it.   They actually yanked the license of at least one broadcasting outfit who refused to give what were then quaintly called ‘nigger-lovers’ a chance to rebut the network’s view.   You can imagine how many righteous souls that decision pissed off.  

“And, of course, if you want to influence partisans and maintain your political power, the main thing you need is a powerful echo chamber.  You don’t want the other point of view considered, or even heard, it must be vilified and ridiculed so it can be dismissed reflexively.  If you chant your slogan you don’t want the other side to get even sixty seconds to state all the reasons your slogan is pure idiocy.  

“I used to get a kick out of listening to Rush Limbaugh, as you recall, the massive, cast iron balls of that whacked out right wing drug addict used to give me a kind of kick of adrenaline.  

“Over time you have not one Rush Limbaugh, who reminded me of Father Coughlin, the old populist anti-Semite who ranted on the radio about ousting that cunning old Jew Franklin Delano Roosevelt from office, but dozens, hundreds of Rush Limbaughs.  Scroll through the radio dial, and between legal disclaimers about the views expressed, you will hear the passionate partisan stylings of countless rabid dogs.  Most of them right wing, many of them very well-paid.  Advertisers love them.  And why not, hatred has always been a winning business model.  

“Since the demise of the Fairness Doctrine, with the government no longer having any requirement over broadcasters to present any nuance at all, you get calm acceptance of things like the government proscription of showing the caskets of dead Americans returning from wars that are only explained in the most idiotically partisan terms.  ‘Freedom is on the March’ and ‘Support our Troops’ is all you need to say over and over to get people waving American flags and wearing them on their lapels.  American flags made in China, of course.  

“There need be no actual discussion of any of this, mercifully, unless you happen to listen to some fringe pirate station not owned and controlled by a giant profit-seeking corporation.  And everyone knows those people are just crackpots.  Why would you want to show a parade of American coffins coming back from anywhere anyway, you sick bastard?  

“We don’t have much conversation in the mass media, not that there ever was a long supply of that, but people talking past each other and partisan false equivalencies are the rule now, everything reduced to an over-simplified either/or.   As you say, people who wear blue hats support the charismatic guy or lady with the blue hat on, same for red hats.  It’s not about the actual issues, it’s if the person is on our team or not.  A sad day for America, but, if you look back to the beginning, it’s always been a sad day for Americans with little power over their lives.   Two sets of laws has always been the case here.  

“You heard that guy, Mike Lofgren, interviewed by Bill Moyers about the Deep State.  The permanent shadow government is not a new thing, the interests it represents go back to the Founding Fathers, but it’s entrenched and protected in ways we couldn’t have imagined generations ago.  He described it as ‘a hybrid association of key elements of government and parts of top-level finance and industry that is effectively able to govern the United States with only limited reference to the consent of the governed as normally expressed through elections.’  

“He set out the workings of our current deep state, now organized largely around, and justified by, the so-called War on Terror, that bold war against fear itself: deregulation, privatization, deindustrialization, financialization of the economy, Wall Street as the only casino in town, widening wealth disparity,  permanent war, surveillance state, etc.  It all takes on the air of the inevitable, but… well, you know, it’s by deliberate design, to maximize profits. 

“When Henry Wallace was the popular people’s choice to succeed the ailing FDR, and he had massive support at the 1944 Democratic convention, right wing business and political leaders got busy talking to the DNC.  Wallace was an anti-imperialist, anti-colonialist, non-racist, egalitarian who had been FDR’s Vice President through the war, and before that a very capable and savvy Secretary of Agriculture, to the left of FDR, throughout the New Deal.  

“When Henry Wallace gave a speech about the post-World War Two era being the Century of the Common Man, it excited millions of common men and women in America and gave hope to enslaved people worldwide.  He advocated federal regulations to guarantee equal pay for equal work, for men, women, people of all races.   He supported the right to collective bargaining and a right to arbitration for all workers in disputes with their employers. The status quo could not tolerate this sort of shit, it stood to lose trillions of dollars.   The Commies hated our freedom and, literally, wanted to take everything the rich and their grandparents had worked for generations to acquire.

“Harry Truman was a senator of limited experience and influence, perfect for the uses of the Democratic party machine and the powerful forces they represented.  Within 24 hours they’d brought support for Truman as FDR’s V.P. from around 2% up to a robust 90% or so on the third vote, and all it took was an overnight adjournment of the convention vote and the granting of a few hundred political appointments.  

“After that third ballot Truman would be the next president, Wallace was done, the Cold War started, Civil Rights legislation and Equal Pay legislation, and the rights of labor, put off for a generation.  Then, after a few fitful years of modest progress on each of these things, shoved off for another couple of generations.

 “The Fairness Doctrine would not apply to cable TV stations, or the internet, but the abolition of it, in hindsight, was just another sign of which way the wind was blowing.   Who needs Fairness when it’s Morning in America, Elie, or when we’re Making America Great Again?  You dig?”  The skeleton beamed, a slightly mad glint shining in the eye sockets.  

“Consider this, though, Elie, which one of us is the madder, the guy who is dead and buried or the one putting words in his mouth almost twelve years later?  Hmmmmmm?”

The Patient Protection and Affordable Care Act

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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