Category Archives: muttering to myself

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.

 

“Trying to suck his own cock”

There is the famous joke that explains much that is unexplainable in human affairs, most strikingly in the area of law.   How, for example, did an evil genius like Antonin Scalia do as much unappealable damage as he did, with no consequence to himself, outside of the eternal love of right wing extremists?  Here is the joke that explains it, an old one I’m sure you know.

“Why does a dog lick his balls?”

Because he can.

Nothing is illegal, absent a law that makes it so.  Things are evil, immoral, unethical, despicable, disgusting, infuriating, wrong, etc. but, unless there is a specific law against the hideous practice  — not illegal.   About these things judges and lawyers look at each other and say “de minimis non curat lex“, “the law does not concern itself with trifles.” 

Speaking of trifles, a frivolous lawsuit was recently brought by a blustering bully who owns a coal mining company.  This bully, named Bob, is a big Trump supporter and is almost as litigious as the man he supports for president.  He filed a lawsuit against a comedian who critically covered Bob’s shady practices and had a man dressed in a squirrel suit holding a sign that said “Eat shit, Bob”.   Here is what the ACLU filed in that case, as a friend of the court.  Scroll down to page two, the table of contents.  It will be the best hundred or so words you read all week.   The rest of the brief is a delight to read as well, Bob.

But I came here not to speak of fucking Bob Murray, CEO of a coal empire and man, from all appearances, bent out of shape from constantly trying to suck his own inconveniently located appendage.   I didn’t even come here to complain about the steep and disgusting decline in civil discourse since crude talking cock-suckers, ass-dickers and pussy-grabbers took over the West Wing, as well as the increasingly inclusive lunatic fringe of one of our two major political parties.  I am here to vent just a tad about a trifle that the law does not concern itself with.  

The law in question is the Patient Protection and Affordable Care Act, everybody’s favorite whipping boy.  It does not provide for very much regulation of the insurance industry, though the regulatory scheme for the consumers it protects is rigorous.  Uninsured consumers who qualify financially, for example, are mandated to participate, and to sign up during a single, very short annual enrollment period.   Insurance companies, on the other hand, can stop participating in the ACA program any time they fear their profits will be adversely impacted.  Like during times of increased profit uncertainty.   Like during times when the current president uses his bully pulpit to fulminate, Birther-style, against his predecessor’s signature law while cutting funding to the ad budget of the ACA and using tax payer money to run ads attacking the government program.   Like, now.  

There is no regulation, of course, of the practices of the state “marketplaces,” the exchanges where qualified people are required to buy their health insurance if their employer does not provide it.   Because the “free market” was given priority over “health care” to Americans (note the estimated 27 million of us still uninsured under the ACA), as an individual without employer subsidized health insurance you either jump through the exacting hoops of the PPACA or wind up without insurance of any kind.    Jump through all the hoops perfectly and you may still wind up screwed, with no recourse but a several months long line for an “appeal” at the marketplace that screwed you in the first place.  No need for state regulation when the marginally competent government agency itself is able to provide all the due process necessary.

My dealings with three different insurance companies, at three different income levels, and my ongoing nightmares with Donna Frescatore’s New York State of Health Go Fuck Yourself Self-serve Marketplace, have demonstrated over and over the need for state regulation.  Today I called a second replacement nephrologist on my health plan, this one recommended to me by a doctor friend (what happened with the prior one, recommended by another well-respected doctor, is yesterday’s news).  Today I learned, once more, that just because the insurance company has the doctor listed as a provider does not mean the doctor is actually a provider.  Strike two, get back in the batter’s box, motherfucker, before we call you out for delay of game…*

Mistakes are made, the passive voice used.   Humans are only humans.  Corporations have feelings too, they are called “profit” and “loss”.   Why am I so judgmental?  Why can’t we all just get along?  Why don’t I just shut the fuck up already instead of venting about this de minimis inconvenience to my hypochondriacal kidneys?   Who do I hope to influence by writing these words?   Why do I insist on seeing the glass of syphilitic piss as half full, instead of half empty?    Why am I not pouring all these incendiary details into my letter to the Attorney General?  Why so many questions?

Anyway, now it’s Friday evening, at long last.   Why is nobody pouring me a cold glass of beer as foamy, and richly golden, as a beaker of my own protein- rich urine?  It’s Miller time, is it not, Mr. Stephen Fucking Miller?  … if that is your name.

 

 

*    Sports fans will note that, under the rules of baseball (where balls and strikes come from) a batter cannot be called out for “delay of game” (in the National Football League it can result in a five yard penalty, a complete non sequitur in baseball).  The footnoted sentence is what’s charitably called a mixed metaphor.  If I told the ump to go fuck himself, that the threat to throw me out for delay of game is ridiculous, and not in the rules of baseball, the ump could call me out for “arguing balls and strikes,” a rule giving ample grounds for my ejection.  As always, de minimis non curat lex, baby.

 

Surviving the American Death Panel

When healthcare is a profit-driven, corporate industry, as it is here in the wealthiest country in the world, competitive companies and some individuals will become very rich participating in it.  Sadly, people also die under such a health care system, which tends to be as expensive as the market will bear.  Those who don’t die often face personal bankruptcy for bills incurred during life-saving medical interventions.   These are, one supposes, the price we all pay for freedom, for the exalted Free Market.   Americans should be free, under our system, to pursue unlimited wealth and damn the torpedoes.   Sick people die, poor people die, not our problem or responsibility, as individuals in the Free Market or as a society.

Part of the corporate structure is hierarchy, in which each level is accountable only to the ones above.   This produces natural caution, a reflex to self-justification and a tendency to ass-covering.  A related side of corporate life is patriarchy, for lack of a better word.  Corporations tend to dictate terms, be rigid, owe no explanation, erect obstacles to information and have procedures to ensure that their policies are inviolable and untouchable by courts of law.  They are not known for flexibility, fairness, even common decency.  They behave this way because they can, because they write the laws that govern them, finance the elections of their bought and paid for candidates.    

What does all this have to do with my own inability, so far, to see either of the two nephrologists recommended to me by a doctor I respect?   I shall tell you as briefly as I can, as I suffer silently with idiopathic kidney disease.

By chance, on the recommendation of an acquaintance of  a friend, who got the doctor’s name from a list, I saw a patriarchal nephrologist, a female patriarch by chance, who dismissed my questions about nutrition, life-style, alternative treatments, supportive therapies, recent studies of my disease I could read.  None of these things would help me, she said.   She urged me, from our first meeting, to immediately begin side-effect rich immunosuppressive therapy.  Months 1, 3 and 5 begin with three consecutive days of IV corticosteroid infusions and it takes off from there.

This immediate immunosuppressive therapy is called for, I eventually learn, only for high-risk patients, those with a high daily proteinuria count and other risk factors.   All other patients are advised to wait, and watch, as a cure without this regime is about as common as a cure with the sometimes devastating immunosuppressive treatment.   The statistics argue for waiting, and rechecking levels every couple of months absent a medical determination that you are in the high risk category.  

This nephrologist assessed me as a high risk patient without ever checking daily proteinuria levels and even though my kidney function is normal.  She did not share her diagnostic findings with me, beyond saying the disease was getting worse and urging me to start with the IV steroids.  She never mentioned a risk category or the reason for the haste.  She told me over and over that I need to start immunosuppressive therapy right away.

I was never told why I am at high risk as I was being pressured into starting the immunosuppressive therapy ASAP.  Patriarchs and corporate types do not owe such explanations.  They offer the service they deem correct.  To this end, I was manipulated into having a medically unnecessary biopsy done.  The necessity of the biopsy was that it is the last part of the protocol before immunosuppressive therapy.  I was told it would show the precise stage the disease has progressed to.  I’ve since learned it cannot really show this with any precision.  

For a long list of reasons, I lost faith in the defensive, argumentative, dismissive nephrologist.  I simply could not trust her, in spite of her strenuously extracted, and meaningless “unconditional apology”.   She was about as sincerely repentant as Trump was about being the nation’s number one Birther.  

I got a recommendation for a senior nephrologist.  As luck would have it, he was in the same practice group as the original patriarchal nephrologist.  I was told the two doctors would have to discuss the switch, as they generally did not see patients of other doctors in their group.  I was told my nephrologist needed to consent to the change and the other doctor had to agree.  

My nephrologist seemed to consent in a terse message: I have instructed my front stuff.   Her front stuff told me, each time I called, that the doctors were still deliberating.  After three weeks of calls to make an appointment I was told that they never, under any circumstances see a former patient of anyone in the group, it was an inviolable rule.   As Jane Fonda’s character in Grace and Frankie said the other night, during a vexing moment: “fuck me in the eye!”

I went to a good deal of trouble and expense to get another recommendation.   Thankfully this doctor was on my health-insurance plan.   I called the number the insurance company had listed for him, to make an appointment.  It was a wrong number.  I called the insurance company and was given two more numbers, not available on their on-line participating providers list.   They connected me to the doctor’s office.  

The doctor’s receptionist informed me that they do not participate in the plan, that Healthfirst has them listed incorrectly.  They only take insurance patients for the private dialysis center they run, but are not participating nephrologists for any other purpose.  This receptionist was knowledgable about insurance law, telling me, for example, that it is a crime to pay a doctor out of pocket if you have insurance coverage.  She referred me to an NYU nephrology group, the same one who had treated me so unethically. She was not all that sympathetic, in my opinion, and after snarling a bit, and cutting me off, hung up on me before I could tell her to fuck off.

Which was just as well, I don’t find it very satisfying or effective to tell unreasonable, nasty people that they are unreasonable or nasty.  In the case of this receptionist, there was really nothing more she could do.  That I had one final , quick question, which would have the same answer as all the others, was nothing compared to her duties to the patients waiting in her office as she was wasting time talking to a non-patient with an attitude problem.

“If you like the doctor you have, you can keep that doctor,” promised President Hope and Change, the former Compromiser-in-chief, while negotiating against himself during the passage of Obamacare.  If you don’t rate him highly on that promise, remember that he never came in America’s mouth.  Not explicitly anyway.  The people we have in there now, hoo boy, talk about death panels and forcers of unwanted touching.

My task now is to figure out how to use this ill-designed system against itself to get the treatment I need for this potentially fatal disease I am up against.  A disease that, thankfully, seems to take a long time to finish you off and that, as mysteriously as it comes, sometimes disappears by itself.  

I don’t know how interesting this has been to read, if at all, but I note that the knot in my chest I woke up with seems to have unloosened itself by a turn or two, and that is a very good thing.

 

The Shoelace

Bukowski’s great poem about the killing nature of the accumulated frustrations we are powerless against captures the accursed essence of our lives here.  It’s that constant swarm of trivialities, culminating in a shoelace that snaps with no time left, that finally breaks a man, sends him to the madhouse.  

“I will not be broken,” he said to nobody.  

Of course you won’t, nor die, either.  

Toilet doesn’t flush.  Call super.  See you between 6 and 7, he says.  At 9:30, after several chats with the lying super, his two underlings arrive.  One shows me how, by forcing the flush plunger inward toward the pipe while pushing it down, you can get the broken device to flush.  This works four or five times after they leave, then, kaput.  Meanwhile, new part ordered for your antique toilet, will take a week.   Super recommends improvising, try not to shit for a week or so, the toilet will eventually be fixed.  

New York City does not have an answer, besides take the landlord to Housing Court.  You look for on-line help.  The help number on their handy PDF on Housing Code Violations connects you to a wrong number.  

Doctor friend provides new information on best practices for treating your idiopathic (“cause unknown”) kidney disease.   The medical journal article she’s copied for me calls for watchful waiting before IV steroid therapy if daily proteinuria level (the amount of unfiltered protein your kidneys pathologically spill into your urine) is below 2 grams.  Doctors have no idea what my daily level is, that requires a 24 hour urine test to determine.   If you think the nephrologist who charged $860 for my first visit would have known to order such a test, you think wrong.  She urged me to have an unneeded, expensive, kidney biopsy instead.  

It’s been complicated hearing back from my primary care doctor on the 24 hour urine, how to get the jug that I will collect 24 hours of urine in.  Only two or three calls to his office so far.  Maybe the third or fourth call will be the charm.

You learn, too late to save the several thousands of wasted dollars, that the so-called Silver level health insurance plan you bought, hoping for better treatment than you had last year on the “Essential Plan”, the plan you are paying almost 900% more for (after the subsidy, restored only seven months after being erroneously removed), gives you coverage identical to what you had last year on pay-as-you-go Medicaid.   I must not think of the more than $4,200 flushed down the toilet– especially now that my toilet doesn’t flush.  

The best things I write these days, I have to pull teeth to get any feedback on. I write these things ’til my forearms ache, and read them aloud to Sekhnet.  She tells me some of the recent ones with the skeleton are excellent overviews of this ambitious, highly speculative project I embarked on almost twenty months ago.   I heard an interview with Aaron Copeland, late in his life, lamenting that so few people heard his new music, wondering how a composer goes on without an audience to hear his work.   I felt bad for him, even as I wondered where he got the temerity to whine about not being as famous as he used to be.

The list goes on and you begin to wonder about the futility of trying to persist.   How long a NYC landlord has to fix a broken toilet, under NYC law, should not be such a mystery.  It is.  You take a bucket and manually flush the toilet, it takes at most two or three buckets full.  The bathtub is right next to the toilet, easy to fill the bucket as many times as you like.

So, shut the fuck up and keep bailing.  You’re lucky you live in a place where there are flush toilets, bountiful running water, sanitation, a medical industry, a semi-functioning government.  You have fucking first world problems, white boy.

“Well, as I always said, Elie, you’d complain if you were hung with a new rope,” said the skeleton of my father.  “With your fertile imagination comes an ability to brood that is beyond the powers of most people.  Not that I envy you, I’m just sayin’.”   

Yeah.   Be careful when you bend over.

More Plain Language

This is the punchline of the decision from NYSOH (one wonders who it is returned to, since the decision itself came from NYSOH) regarding my vast overpayment of premiums since February 1, 2017:

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Meantime, in an effort to get a second opinion on treatment for my kidney disease that does not involve an every other month three day infusion of intravenous steroids during a six month immunosuppressive regime, I found an internist who is also a nutritionist and holistic practitioner.   To get insurance payment for a second opinion from this out-of-network doctor requires prior authorization from the insurance company’s Medical Management Office, the outfit that determines if medical necessity justifies payment to an out-of-network doctor.   The doctor’s office must call to get this prior authorization.  I passed this information on to the doctor’s office and they told me they’d call to get the prior authorization.

Got a call back a short time later from Mary Rose, the office manager.  She was told by the Medical Management Office that my insurance policy does not cover out-of-network medical services under any circumstances.   I called the insurance company and was assured, again, that in a case of medical necessity, my insurance would cover the cost, or some unknowable part of the cost, of seeing an out-of-network doctor.  The doctor just has to call to get prior authorization.  I described what the doctor’s office was told: that I am not eligible for out-of-network coverage.  “That’s because they didn’t get prior authorization,” Jasmine told me unhelpfully.  

I am an attorney.  I am somewhat articulate.  I have long experience in not having strokes, even under brutal and gratuitous pressure.  I described the freedom of insurance companies to commit fraud in a scheme where there is no meaningful government oversight of their activities.  Citizens are mandated to buy private insurance, and are instructed to pursue all grievances about denied services with that private corporation that has denied them service.  It is a perfect cul du sac.  Services can be legally denied for a variety of reasons under the law:  an incorrect NPI number or a transposed CPT code or any other legitimate business reason.  I went on for some time about the lack of remedy for screwed insurance consumers and how tempted I was to put this case in front of a Supreme Court judge under NY State’s Article 78.

Jasmine was very decent about the whole thing.  She told me she’d be extremely frustrated too, in my position.   That human admission was rare, and no small thing.   She spoke to yet another supervisor, a third, called me back and spoke to Mary Rose at the holistic doctor’s office.   She walked Mary Rose through exactly what she needed to say to make my case that this second opinion was a matter of medical necessity for the Medical Management Office.  It was good of her.  In the end we wished each other a very nice day.  

It almost made me forget that my fourth attempt to get an appointment to see the nephrologist highly recommended by Sekhnet’s long-time doctor failed today.   Jinza the office manager still had to speak to the doctor I’d lost confidence in, and to that doctor’s supervisor, the one I’d been urged to see, before she could allow me to make an appointment.   This has only been going on for two weeks, and it is a mere ten days since my former nephrologist emailed to say she’d instructed the front desk to make an appointment for me with her colleague, so why am I being such an angry fucking pussy about it?   That’s the $64,000 question, doc.

Plain Language

When I went to law school, more than twenty years ago, there was a big emphasis on plain language.  Lawyers should write as plainly and clearly as possible.  In the old days, we were told, scriveners, who wrote legal papers for lawyers, were paid by the word and so they laid the words on with a trowel.  This practice led to unplain, exceedingly excessive language, writhing, modifier-laden legalese, language embellished, decorated, complicated and modified, as needed, or sometimes not, according to long custom, by a dozen redundant, recursive, tautologous synonyms encompassing a dozen finely calibrated shades of meaning, foreshadowing, portent, legal significance, modified ambiguity, standard boiler-plate ambiguity, ambiguousness intended and incidental, anything to the contrary notwithstanding.   Reading legalese is generally a huge pain in the ass– take a glance at our Constitution or any on-line contract you must accept before getting web-based services.   “Plain language!” we were told, “the law now requires anything a consumer will be bound by to be written in plain language.”

 That was some precatory, aspirational, academic shit, apparently.  We were also taught to use the female pronoun instead of him and his when speaking of general things.   It was a fairly liberal school, I suppose, even though it had its share of rigid sociopaths on the faculty.   There are, I need not point out, rigid sociopaths on every shade of the political spectrum.    

I am thinking about this because I just got a determination from the New York State of Health appeals unit.  It is seven pages of fairly spare legalese that concludes with the determination that NYSOH must rescind its notice of January 9, 2017 and reconsider my case in accordance with the law.   It does not say, anywhere in its learned pages, anything that someone without a background in the law can understand as a clear, five and a half month belated, reversal of NYSOH’s clear error.   An error, moreover (to use a word beloved of scriveners everywhere) that anyone on the NYSOH website can verify in less than five seconds.  

It was only a four and a half month wait for the appeal and then, a speedy 30 days for the determination to be written up and sent out.  I have only been required to loan a large corporation about $1,250 in that time and I am told it will come back to me some time next year when I file my taxes, since I was entitled to what the decision refers to as the APTC, payable on my behalf towards the monthly premium of the QHP.  The subsidy, in other words.    

Rigid sociopaths are currently dickering about the quickest way to dismantle the conservative think tank-born, health care industry-friendly health insurance plan that bears the hated secret Muslim president’s name.  These are some dangerous, cynical, amoral motherfuckers doing this dickering.   Obamacare is bad in many ways, very bad in some ways, but it is a step forward, although not necessarily in the absolutely right direction since it leaves ravenous foxes to supervise the hen house.  The plan these dickheads are trying to push through will be a disaster for millions.  It has a 12% approval rating among the citizens of this nation of poor bastards, which is why it was initially kept secret and why its advocates are refusing to allow public debate on the punitive details of the new bill.

The Republican plan, in fairness to them, while hurting the poor and lower middle class, will greatly benefit the rich.  Who can blame the rich for trying to get richer?  It’s only natural.  

Like trying to repeal the hated DEATH TAX, another long time dream of America’s greediest.  Check this number out– I don’t know why it is not more widely known.  The so-called DEATH TAX affects the top 0.2% of our great, gullible, lynch-mob republic.   For those of you not good in math, that’s 2 estates out of every 1,000.   I don’t know about you, but that number of people affected by the so-called DEATH TAX, the top 2% of the top 1%, gives me goose bumps.   

Have a groovy fucking day, y’all.

McConnell’s Secret Kick in the Diaper

As despicable as steely-eyed, chinless tortoise Mitch McConnell is, there’s a certain sly irony in him protecting the murderous Trumpcare bill from public scrutiny as zealously as the president he hated and vowed to thwart hid legislation he knew was shameful.  If the public knew the details of this “health care bill” giveaway to the richest at the expense of everybody else there would be massive outrage– supporters of the bill would be primaried and run out of office.    So they do it the principled way that unpopular, troubling laws are always done, in secret.

The shameless McConnell and his ilk keep the details of this punitive (except to the richest among us) proposed American Health Care Law secret while trying to ram the exceedingly ugly bill through in the darkness of night for the president to sign.  Not so different than the way  President Transparency proceeded with the Trans-Pacific Partnership (TPP) flimflam, though, since McConnell and Ryan are playing directly with the daily life and death of millions of citizens, the stakes are even higher.  The result is likely to be serious as preexisting cancer.  

Obama knew there were enough corporate giveaways in the TPP to outrage millions, so he made sure there was less than full transparency about the details.  To be a bit more transparent, Obama made sure there was no transparency or public debate whatsoever prior to his fast track up or down vote.  

McConnell is a corrupt, despicable, hypocritical villain with testicles larger than his head, but Obama doesn’t get a pass from me because he was a great comedian who spoke beautifully, and proudly wore a blue hat, but did the same sickeningly anti-democratic thing whenever circumstances “demanded” it.  

I’ll always hold those drones against him, the ones we know about that killed completely innocent people in the name of the War On Terror.   The missile that killed Mamana Bibi the 67 year-old midwife, and the one that killed innocent 16 year-old American citizen Abdulrahim, a kid who liked hiphop and had not even a suggestion of a capital charge against him.  Obliterated, along with countless other innocents, by the complicated, supremely practical Nobel Peace Prize laureate.   One more reason to keep policies like this as secret as possible, a reasonable politician reasons, reasonably.

That said, these guys in there now, determined to strike down every bit of the legacy of the Negro Democrat they were united in hatred of, are probably the worst guys we’ve ever had in charge of everything.

The Free Market

When politicians talk about our Free Market, many of us realize it is a variation on a glittering phrase like “Freedom is On The March”, spoken over the burnt corpses of those we liberated from a modern-day Hitler while making half of the survivors stateless refugees and leaving the rest in a permanent killing zone.   The Free Market sounds like a great place.  In theory, it’s wonderful.   There is free and sportsmanlike competition, on an even playing field, where the best product, sold for the best price, sets the pace for the race to give people the best of everything at the most affordable price.  Like the best health care in the world, available here in America, to those who can afford it.   Like a delicious and filling meal containing several times the daily sodium, sugar and fat recommended for health, for under $5.   That’s the magic of the Free Market.  How can you beat that?

The “Free Market” is very much like the red and blue fucking baseball hats and the loyal, uncritical thinkers who wear them.   There was a critique of Hillary’s campaign– her message didn’t fit on a baseball hat.   Trump had a great, if ambiguous to the point of sinister, motto: Make America Great Again.  Sekhnet snapped a great shot of a smiling older man at an anti-Trump rally wearing a red Make America Hate Again baseball hat.  Closer to the mark than Trumpie’s motto, but still — just a gotcha.  Sticks and stones can break my bones, but political mantras can never hurt me.  Unless, perhaps, I look like a Muslim to a group of angry guys in red hats.

I’m reminded of this “invisible hand of the Free Market” bullshit, demonstrably stinking bullshit at that, by the pills I receive in the mail from an outfit that mails out my prescription drugs.  One pill is to keep my blood pressure under control, a Herculean task these days.  The other is a statin, because my kidney disease has caused my cholesterol to spike.   Here is a photo of the two pills, greatly magnified, to show one of the tiny wonders of the Free Market.

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This is an example of the Free Market being free.  You see, these wonder drugs were originally developed by big pharmaceutical companies at the cost of many millions of dollars.   Then, after a certain term as a patent protected drug, to pay back the cost of development with a handsome profit as a reward, the drug was allowed to be produced as a “generic”.   Same chemical composition, a fraction of the price.  I get the generic Avapro and the generic Lipitor.  My mother always said, of the latter, “I luuuuuuhv Lipitor.”  She did, apparently.

Luckily for me, I have a magnifier app on my new brilliant phone.  It allows me, when studying a pile of these pills, to separate the 329s from the 10s.   As I do this I wonder how intolerable to the Free Market the government intrusion would be if they mandated “red for blood pressure drugs, green for statins” to the manufacturers of generic drugs taken by tens of millions of Americans.  I know, I know, it stinks of state-controlled Communism.    Seriously, I don’t fucking get it.   Is America really that fucked up?   Are we really this fucking stupid?

I get that Obama had to please those who put him in office, that he was constrained and coerced left and right.  Mostly right, in fact, but also left.  Money, it is said, has no political allegiance, although recent American history may argue that point.  It’s not like anyone with a brain said money has no political allegiance, money said it.  Yes, money talks.  Of course it does.  It told Obama that his signature health insurance plan could not overturn some very, very lucrative practices fundamental to the American Free Market.  Those hungry foxes?  They are the best and most experienced guardians of the hen house.  

Look how well it worked having Goldman Sachs guys in charge of economic recovery from the massive financial fraud they profited from, an intricate scheme of deliberate deception that would have embarrassed Bernie Madoff, and almost sank the boat in 2008.  These experienced foxes know exactly how many hens they need to eat, let them do what they do best.  Don’t let the perfect be the enemy of the continued unnecessary deaths of tens of thousands of Americans a year.   Those dead Americans are patriots, in a way, dying for the Free Market we all love and defend to the death.  Those preventable American deaths are the price the rest of us pay to live in a Free Market, and don’t you ever forget that.

I’m harsh on Obama because I actually believed the poetry he recited while campaigning.    Sad to say, my man was mostly saying whatever he needed to say to get into power, like they all do.  Sad to say, the alternative, both times, was seemingly much worse.  Now we’ve got a wobbly, over-confident scary clown for a commander-in-chief, thanks in part to my man Barack “Raking in Some Serious Tubmans” Obama.  People can only hear so much polished, meaningless bullshit coming from a bullshit artist, even a genius of the art, before they shut down.  

You like the Free Market so much?   Let the private health insurance industry compete with Medicare for all.  Let the best entity win, as it is written by the invisible hand of the Free Market.  “That was never in the cards,” say those in blue hats who still believe Obama had no choice.   Tacitly, they add with a silent sigh “super lucrative business interests and very well-paid, in-the-loop, revolving-door lobbyists are too powerful here in the Free Market to allow that massive incursion into their market share.  No matter how much better virtually everyone agrees a public option would be.”

Amy Goodman:

(After writing that meteorologists need to constantly explain that the latest catastrophic climate event is related to the pattern of increasingly disastrous global climate change)

How else will people understand the connection between disparate weather events, from dust-bowl conditions in the Midwest, to epic wildfires in the Northwest, and record-breaking cold in the Northeast?  Scientists tell us that climate change played a role in at least half the droughts, floods and storms in 2014.  The National Aeronautics and Space Administration (NASA), on its global climate change website, states that “multiple studies published in peer-reviewed scientific journals show that 97 percent or more of actively publishing climate scientists agree: Climate-warming trends over the past century are very likely due to human activities.  In addition, most of the leading scientific organizations worldwide have issued public statements endorsing this position.” In Europe and other parts of the world there are debates on what to do about climate change.  But in the United States, we have debates on whether it exists at all, or if humans have contributed to it.   It’s as if every time we talked about the earth being round, we interviewed a member of the Flat Earth Society for “balance”.  (Democracy Now! p. 213)

The idiotic American debate on whether climate change even exists has been underwritten, at a cost of billions over several decades, by the industries that profit the most from the ultimate destruction of life on the planet.   Those industries are simply too lucrative, and too powerful, to let themselves wither and die just because the earth is being destroyed by the fossil products they extract and refine. 

The Secretary of State we have now knows this better than anybody, he was until recently the CEO of Exxon.  Exxon’s scientists were among the first to discover, in the 1970s,  the connection between burning fossil fuel, increased CO2 in the atmosphere and rising global temperatures.  The corporation published these findings, then spent the next few decades funding studies that would obfuscate those findings, cast them into doubt, create a debate between Alarmists and Skeptics.  Who are you going to believe, a hysterical Alarmist or a cool, calm skeptic?  Let the debate continue.  Meanwhile, CAH-ching!  Fossil fuel.  Good to the last drop.

What is the lesson of all this brouhaha over global warming for a leading voice of the Flat Earth Society, former loudest, unrepentant “Birther” voice?  Simple. Shut down NASA’s fucking website.  DUH!

Free Market, baby.  Like Justice, you get all the Freedom you can afford to pay for.  If you are poor, you know, you can’t afford much of either.  Probably best to shut the fuck up and keep your head down while the best and the brightest Make America Great Again.  Freedom, as always, is on the march, taking flight in the skies over your hovel.   Ask any ten year-old in Mosul, Waziristan or Raqqa. 

The Campaign for Critical Thinking

This campaign, which I am officially launching, though nonchalantly, will likely meet with the same fate as my undeniably innovative and, I’m sure, verifiably effective, program for team problem-solving, the student-run animation workshop.   A good idea, no matter how good, is not enough, of course.  If the idea is not self-monetizing and irresistible to angel investors, one needs funding, or, at minimum, a large network of enthusiasts.   In our culture, money speaks, and spreads the word, and makes or breaks.  One billionaire backer makes all the difference.

Even in the case of genius, great skill, luck and complementary genius is often necessary before an idea can get huge, become a force in society.  The Beatles would quite possibly never have become the worldwide phenomenon they became without the public relations genius of Brian Epstein.   The president we have now would not be the president without the genius of those who helped promote him, target his message, data-mine voting patterns to pinpoint the exact number of districts he needed to win the Electoral College, an anti-democratic mechanism created by the framers of the Constitution that can only be understood in connection to protecting the rights of slaveholders, who were a tiny minority of the population.  In some cases these poor slaveholders lived in states where they were also part of the racial minority!  Can you imagine the pressures on them?!

The certainty of failure must not deter the pursuit of a needed idea.   I heard Chris Hedges couch this in terms of his Christian belief– the duty to intervene on the side of righteousness does not depend on your chances of success.  In fact, you could argue that the duty becomes greater as the abuse escalates and the odds of failure increase. 

A simple idea then.  Reserve opinion, and advocacy, until you have as many facts as you can get.   Facts, you will say, are slippery.  There are now also “alternative facts” and facts invented for profit.   Many of the unverifiable facts that influenced the outcome of our recent election were dreamed up by industrious young capitalists, creating a market-driven product for which there was a huge demand.  

Millions hated Hillary, it was simply shrewd business to create another incendiary reason to hate her.   Make it wild enough you could get millions of monetized clicks.  How about a factual account of a child-sex ring she was involved with, located in the basement of a pizza place that has no basement?  They got millions of hits on that one, each one sounding a distinct “cah-ching!”. The story was repeated over and over among those who hated Hillary, each time it was liked, more profit for the “content creators”.  A guy with a gun finally went to investigate, to free the child sex slaves that Hillary and her people had locked up in that basement.   Hard to blame the guy, in a way.  

The same cynical genius, or a similar nonpartisan businessman, also came up with the Trump and Sheldon Adelson gang-raping the under-aged girl story.  CAH-ching!  Much of this fake news was created by highly successful content creators who wrote the fake news of the right and of the left.   They had no dog in the fight, did not even like dog fights, maybe, but there sure is money in the right dog fight.

Critical thinking is harder than reflexive thinking, for sure.  It is harder than many things.   The confirmation bias is one factor, we tend to believe new things that conform to what we already believe.   This has been greatly exacerbated by that tsunami of capitalist genius, Facebook.   Most people get their news from their friends on there, and algorithms track the news and send them more like-minded well-liked stories (and related ads).  Everybody wins.  Except for critical thinking. 

There has been a deliberate campaign against critical thinking in the United States, accelerated since the days of Reagan when political debate began to be reduced to “I Know You Are, but What am I?”  That anti-intellectual ideology is now personified in a party “intellectual” like Paul Ryan whose political credo was forged while reading a really long novel by a supremely opinionated Russian anti-communist named Ayn Rand.  Paul Ryan considers this poet, a rationalist, a self-proclaimed Objectivist, who believed that the “Invisible Hand” of the “Free Market” would free mankind from the tyranny of altruism, a profound political philosopher.

In Ayn Rand’s gigantic allegories about the evils of Communism she makes her case that the remarkable man will always be considered an enemy of the State, hated by the herd.  The titanic struggle of the remarkable visionary protagonist of her books inspires readers to admire persecuted individual genius and to value it far above the craven needs of the masses, who are lazy, corrupt and indifferent to evil.   Her novels also hammer home the message that it is no virtue to want to help others.  

Paul Ryan is considered a Republican intellectual because his political epiphany came while reading a really, really long book.  Take a quick, mocking look at the philosophy of Ayn Rand.   Here is the visionary herself, explaining to Phil Donahue why wanting to do good in the world is not a virtue.   If you have the stamina, toward the end of her presentation, you can hear Ayn Rand’s attack on public education, which she says creates a class of brainwashed slaves to government tyranny.  She also states that she would never vote for a woman for U.S. president.  A female commander-in-chief of the Army, she said, is “unspeakable”.

I am not using this despicable example simply to bash Republicans and Libertarians.   Democrats may be arguably likelier to critically debate policy positions, at least during the primaries, but they are hardly great advocates of critical thinking.  They defend their own indefensible inconsistencies as doggedly as their colleagues across the aisle.  

Any time you have only two positions to choose from, you are probably leaving important considerations and options off the table, not thinking very critically.   And critical thinking is now more critical than ever, as vast areas of the inhabited earth will soon be uninhabitable, as we pass a climactic tipping point while false arguments are forcefully presented, at great expense, by those who profit handsomely by the destruction of the planet. 

Critical thinking.  The Campaign for Critical Thinking.  Hastag don’t be a fucking asshole.

Institutional Personality

This is not the time to write this, but I want to jot it down right quick before I forget.  Institutions actually have personalities.   It is related to the legal fiction that a corporation is a person under American law, but much more tangible.   To be direct: a corporation is a “person” with only one consideration– maximizing profit to itself and its shareholders.  The corporation, as a person, is essentially a very powerful psychopath, a constantly advancing predator incapable of anything but feeding.   Institutions, in contrast to the stark personality type that is the modern corporate “person”, actually have distinct personalities.  These institutional personalities are expressed in how they treat the people they deal with.

I give one example, then I’m out of here.  Two hospitals, both with fine doctors (and asshole doctors) both with considerate support staff (and inconsiderate support staff).   This is about their institutional personalities.

Columbia has a hospital, it’s corporate identity has changed a few times in recent years, it was called Columbia Presbyterian for many years, it’s now New York-Presbyterian, apparently.  The hospital has no Patient Advocate or ombudsperson.  Its billing is done by a third party.  The bills they send are non-negotiable.  Sometimes the bills turn out to have been sent in error, but in all cases they are the responsibility of the patient to pay or make excuses to the third party billing service until they can be straightened out with the insurance company. There is no discount offered, the fee is the fee and it is not negotiable.  If you are indigent, and can prove it at an off-site office, charity may pay your outstanding bill.  Otherwise, have a nice day, you will get collection letters from our attorneys if you do not remit.  

From time to time the Columbia hospital non-profit corporation sends, amid collection letters from their lawyers, solicitation letters touting their generous service to the community and seeking your tax deductible donation.  This institutional personality is what’s known as an asshole.  The personality likely reflects that of the wealthy, supremely talented twat who accepts his multi-million dollar salary to captain the charitable ship of the hospital he’s so rightfully proud of.

NYU hospital, next door to Bellevue, is another large, non-profit operation.  I had a problem recently getting medical records.  One call to a very nice woman at the Patient Advocate’s office quickly resolved the problem.   I’d been informed two weeks earlier, that I owed $2,100 out of pocket, an advance payment, before they’d perform the renal biopsy the following day.   When I expressed dismay and asked about financial assistance, I was given the number of an office that quickly relieved me of the $2,100 copay, based on my income and the large payment my insurance was making on my behalf.   I had a letter confirming the waiver two days later.  When I got NYU’s solicitation letter the other day, I did not feel bitter at all.  

It would not surprise me at all if the board members and executives of Columbia and NYU eat dinner together every week at the same exclusive club, frequent the same high class house of prostitution, support draconian economic policies that only benefit them and indulge in every other refined behavior that goes with being in the 1%.  I only know what I have experienced of the personality of the two institutions.  I prefer the one that is not the asshole.