Category Archives: muttering to myself

45,000 dead Americans

What do you call 45,000 uninsured Americans who die every year for lack of medical care in the wealthiest country on earth?  

The price of freedom.  The cost of doing business in the Free Market, bitch.

At the risk of seeming to pile on the president I voted for twice, a charismatic man beloved by millions even as he killed American citizens by remote control without trial or charges (and gave that power to his unstable successor), even as he repeatedly lied about “transparency” and prosecuted those who exposed government abuses under a draconian law drafted in the hysteria leading up to American entry in World War One, a law designed to crush dissent, even as he did much for the wealthiest among us and little for the rest, while delivering inspiring speeches at every turn– I have to say, I really do hate the motherfucker.  Someone with his intelligence, expressed ideals and talent as an eloquent and convincing salesman should not be such a tool of the status quo— in my opinion.   Yes, I know, half of Congress are not unsympathetic to the Klan and all that, rabid partisanship and racism are off the hook and so on, but, still.

“If you like the doctor you have, you can keep your doctor,” was, of course, POTUS-speak for “I won’t come in your mouth.”  Most of us make promises in the heat of the moment, sometimes it’s hard to keep them, I certainly understand that.   The side-effect of this untruthful statement, for me, the deal sealed by the immensely complicated PPACA drafted by the affiliated American medical industries, is that I’ve had to change doctors several times, pursuant to changes in the ACA in New York State in recent years, though for years I had good doctors I liked and was able to easily see.

Slipping through the cracks the last couple of years, as I’ve been forced to change networks and doctors more than once, and largely my own fault, was a visit to a dermatologist for a skin scan.  I almost saw one a year ago, paid for the visit out of pocket, though I also had insurance.  What scared me were the unforeseeable lab costs and possible follow-up surgery costs.  In hindsight, very stupid.   I’ve already had skin cancers removed from my nose and my arm.  Why am I fucking around?

In less than an hour yesterday I was able to find the names of dermatologists (“providers”) who accept my current QHP (“qualified health plan”) and rule out one who appeared, by the many similar comments about him on the web, to be something of a complete asshole.   A young woman dermatologist in a nearby office seemed like a good bet, nothing good or bad about her on the web.  Clicked on her office to make the appointment, typed in my insurance and was notified:

 

out of network.JPG

After only twenty minutes on the phone with the insurance company I was assured that the doctor is definitely in-network for my QHP.  The woman at the insurance company sounded very confident, offered to call the doctor’s office for me and make an appointment, but it was already after hours.  

I called today to make the appointment.  I gave all my information and when it came to insurance there was a pause.  The doctor is not enrolled in the QHP with that insurance company.   I explained that I’d been referred to the doctor by the insurance company’s provider look-up, verified with the insurance company that the doctor was in the plan.   She asked me to hold and as I did, the Dr. Mengele String Quartet sawing away at an adrenaline-fueled classical piece scored for the highest registers of their instruments, I felt my blood begin to boil.

I calmed myself with the thought that it is truly nothing personal.  45,000 Americans will die this year for lack of medical treatment.  Some are fuck ups who just don’t go to doctors until their symptoms are overwhelming and by then it’s too late.  Some have no health insurance and are scared by doctor and hospital bills.   Some are just fucked.  No reason to take any of it personally.  There is nothing personal here.   I am no more special than any of the other tens of thousands of Americans who will die this year because profit for a few is deemed much more important than the lives of  enough American losers to fill a large stadium.  Fair enough.

The thought didn’t calm me that much, though.   When Melanie came back on the line she told me she’d contact the office that coordinates the dozens of insurance companies and QHPs the provider group currently participates in.   She said it was possible that the doctor had recently been added and that they hadn’t updated the system yet.  

I was relatively restrained in giving Melanie a succinct and dispassionate version of what I have written here.  Melanie was nice, she has offered to call me tomorrow to follow-up.   As I sit in the chair tomorrow on the last day of a multi-visit root canal I will think of Melanie, ready to call her as I stagger from the dentist’s office.  I will keep my fingers crossed that none of these things growing on my skin are anything to worry about.  Then I will continue my search for a participating nephrologist for follow-up about the progress of my kidney disease. 

Repurposing “The Deep State”

Because Americans live, increasingly, in echo chambers where our own views are endlessly confirmed– and there is no overestimating the power of the confirmation bias– the same term can quickly become a weapon for each side.   During the recent presidential election much was made of “Fake News”.  Both sides used calculated untruth and incendiary stories composed largely of bullshit to stir their troops,  though the right seemed to use it more, and to more galvanizing effect.

I saw a stat right after the 2016 election, fake news skewed something like 2:1 right, but that’s still a lot of outright bullshit from the left side.  I couldn’t find the original cite for the statistic, but here’s the Grey Skank and Steve Bannon/Robert Mercer’s own Breitbart on the well-known phenomenon.   I must say, both accounts read well and appear to be, without more research that most news consumers don’t have time to do, plausible.  Let us assume for our purposes today, and to avoid the typical distracting argument, that the left and right were equally guilty of lying during one of the ugliest campaigns in our history.

My point is that Mr. Trump and his people, who set new standards for untruth during the campaign and since (hah, so much for my fairness caveat directly above) , introducing us to “alternative facts” and so forth, quickly co-opted the term “fake news” to increase skepticism toward the corporate mass media.  One should be very skeptical of corporate media driven entirely by advertising dollars and the bottom line of shareholder profits and enormous compensation packages for its executives.  But look how quickly the term “fake news” was pointed back at the exposers of right wing ‘fake news’ and neutralized.   Who owns fake news now, bitches?   Two wrongs do make a right, yo.

Now the same has happened to the term “The Deep State”.   This description of the powerful forces that profit mightily from our globalized “Free Market” and the endless wars we are now embarked on, has been captured by the right.  To the right the Deep State is the liberal-biased intelligence community, fanatically determined to bring the new president down. Trump’s people now openly deplore the “Deep State” and everyone is right to deplore it.

A former long-time Republican government budget analyst, Mike Lofgren, spoke to Bill Moyers a few years back about the Deep State.  The permanent shadow government is not a new thing, the interests it represents go back to our original one percent, the Founding Fathers, but it’s entrenched and protected in ways we couldn’t have imagined generations ago.  Lofgren described The Deep State 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.’  

Lofgren 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.  It operates by 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, a massive conspiracy, but its only deliberate design is to maximize profits for our wealthiest citizens. 

Like the deal-makers in the administration we have now.   Exxon-Mobil was the first company to research the effects of carbon on our planet’s climate.  They made alarming discoveries, decades ago, about what became known as Global Warming and later was re-branded as the less alarming Climate Change.  Exxon scientists learned that carbon emissions, like the ones from burning millions of barrels of fossil fuel, were indeed making the world a less habitable place for human and other life.  

Then Exxon spent decades funding Climate Change Skepticism. To their credit, and against a mountain of evidence from most reputable climate scientists, they created a sizable block of Climate Change Skeptics including, apparently, our current president.

Exxon knew the lucrative product they were selling was choking the earth to death, but they were making too much money to stop.  You know the old dilemma.  It’s easy to be critical, but don’t forget, Exxon is about the most profitable corporation in the history of the world.  Now their CEO is our nation’s Secretary of State.  How’s that for transparency in government?   You’ve got to love these guys we’ve got now.   They will not let the Deep State get any deeper, despite all the fake news to the contrary.

 

 

*   Lofgren describes the Deep State as “the red thread that runs through the war on terrorism and the militarization of foreign policy, the financialization and deindustrialization of the American economy, the rise of a plutocratic social structure that has given us the most unequal society in almost a century, and the political dysfunction that has paralyzed day-to-day governance.”

 

Consumer info for people screwed by The New York State of Health

I post this as a public service for New York State health insurance consumers at the mercy of the merciless New York State of Health Marketplace.  

The identity of the person responsible for the public “marketplace” where otherwise uninsured New York State consumers are mandated to buy health insurance is a closely guarded secret within that public agency.  Representatives of the agency are forbidden to disclose the identity of the executive director they work for.  I have confirmed many times over that this is the actual policy of this public agency.  

The likeliest reason for this policy of secrecy is that she doesn’t want 1,000 overwrought letters a day complaining of the mind boggling, blood boiling, heart attack inducing inefficiency of the bureaucracy she oversees.  And who could blame her?  Would you want your secretary bogged down with an endless tray of badly written complaints?

Fortunately there was a letter to this elusive public official posted on the internet.  Here is the unaccountable political appointee’s contact information:

Ms. Donna Frescatore 
Executive Director 
New York State of Health 
New York State Department of Health 
Corning Tower 

Empire State Plaza Albany, NY 12237

Drop her a line, please give her my best.  

And as they tell you at the New York State of Health Marketplace, after a long call that fixes nothing, thanks for calling and have a nice day!

And as I answered today, through gritted teeth, after a 20 minute exercise in self-control to pronounce the word “yes” to the person in the proper office to confirm that I still wanted the appeal I asked for a month or two back, “it was my pleasure.”

The Constant Sharp-toothed sucking

Frank Zappa had a song called “The Torture Never Stops”, which is about right. Like pugnacious people looking for a reason to punch someone, it’s one of those things that hums along in the background of our enraged, maddening world.  Here’s a seemingly random one, crosswise in the old throat, that I will try to briefly dislodge.  

That’s one of the beauty parts of writing.  Describe it well and experience a moment of relief.  Why am I foaming at the mouth, you ask?  Let me wipe away the foam, like Mr. Hitler delivering a coherent, if amoral, description of effective propaganda in a book otherwise composed of rabid dog spittle, and give myself that momentary illusion of relief.  

The current figurehead of our Deep State, an entitled, irascible and seemingly unhinged reality TV big shot, has promised, among other things, to abolish and replace Obamacare.   That he is the man to provide America with a health care scheme like the one citizens of every other wealthy nation depend on is as ridiculous an idea as his modern day Great Wall of China proposed for our long southern border.  I have critiqued the corporation-friendly, cynically-named Patient Protection and Affordable Care Act at length.  You can click on the Obamacare link stage left (to the right for you pogues) to read the disheartening details.  I am no friend of Obama, a probably good man with a record of accomplishments as shameful as Bill Clinton’s.  Depleted uranium and cluster bombs dropped in Syria?  Not done by Mr. Trump, that was the handiwork of my man the Nobel Peace Prize laureate.  

Anyway, in the last phase of Mr. Obama’s second term, New York State came up with a pay-as-you-go Medicaid plan for New Yorkers living slightly above the poverty line.  It’s called the Essential Plan.  The name turns out to be apt.  You can essentially get the health care you can force someone to provide under the plan.  Based on my income I qualified for this no-frills plan.  In fact, I was forced to enroll, or have no health insurance and pay a fine as a scofflaw come tax time.  

My experience with this “Essential” plan was literally sickening.  I wound up so sickened that my visit to the ER resulted in my being hospitalized for cardiac tests.  Follow-up care was deemed unnecessary, an undue burden, no doubt, on the corporation to which I paid my low monthly premium.  

When I enrolled for health insurance in 2017 I was determined to pay more and get a plan that could provide me with some measure of actual health care.  My subsidy level, and choice of plans, would be determined by my projected 2017 income.  It had to be above a certain level, to allow me to choose anything but the Essential Plan.  My actual 2016 income would have doomed me to the Essential Plan.  Luckily for me I was not asked my actual 2016 income, I was asked to project my 2017 income.  

After hours on the phone I learned what was not available anywhere on the internet– what the income threshold to choose a health plan was, somewhere around $29,000.  Nobody could tell me if this was gross or net income, so I declared my 2017 income to be a robust $32,000, to leave myself a margin for error.  

I instantly received a Notice of Disenrollment.  What I mean is that, this shit popped up on my screen within seconds of clicking in that income number.  I got a document emailed to me at the same time, helpfully labeled Template 09, like all the others, which informed that I was no longer qualified for the Essential Plan.  Good news, I naively thought.  

I will spare you a hundred details and tell you that my Navigator (the website and marketplace are so opaque it literally requires a navigator to help you get around) informed me that my income level qualified me for a subsidy of about half the monthly premium.  Meaning, with the subsidy I’d pay an affordable $230 a month for “Silver level” Obamacare with only a $1,200 out of pocket deductible.   Meaning that’s what I should be paying, under the law.  Except I’d had another notice telling me, erroneously, that I was not entitled to any subsidy.  Fair enough, we have already had vivid illustrations of what contemptible morons the administrators of the complicated and opaque program are.  

It will take about six months to have my appeal heard, my Navigator (also an attorney at a New York non-profit mandated to help consumers) informs me.  In the meantime I will pay $453 a month and have a $2,000 deductible.  Although, once they correct their mistake and reinstate my subsidy I will get a tax refund, some time in the second half of 2018, for the overpayment in 2017.  All I need to do to get an appeal of their clearly mistaken determination is to submit a letter, my 2015 tax return (the last one filed) and a Tax Transcript from the IRS.  

What the fuck is a Tax Transcript, you ask?  No fucking idea.  Click this  shit to learn all about it:  https://www.irs.gov/individuals/get-transcript.

OK, easy enough.  The IRS will send you an electronic one, chop chop.  All you need to do is create a log-in and request one.  They assure you it’s quick to create a log-in, only about 15 minutes.  Easy.  Except that each of the four times I have tried so far, over the course of more than an hour over two days, punctuated with Tourretic outbursts that have terrified, and horrified, Sekhnet, they log me out, sometimes because their system malfunctions, other times informing me it’s done for my own protection, before I can complete the process.  There is no 800 number where you can speak to a human being for assistance.  

So, I can just relax for Presidents’ Day Weekend, since there is nothing to be done at the moment.  Two days in a row, unable to complete this easy log-in business.  No reason to get excited.  Just keep loaning this giant insurance company $230 a month, since I’ll, theoretically, get it back a year and a half from now anyway.  Assuming this Orange Winner does not actually make good on abolishing the whole plan and replacing it with something terrific.  

I feel much better now, thanks, I really do.

Standing on a Phantom Leg — and Ag Gag Laws

The law gives and the law takes away.  Thank God for the laws we have that protect the vulnerable.  These laws are not the rule, but they are something to be very thankful for, to fight to protect.  Between the rule of law and the rule of violence, there is nothing to choose.

One of the most difficult things, as an idealistic young lawyer trying to make a living, was hearing a prospective client’s long, painful recitation of a brutal screwing that raised no legal issue a court could address.   One of the most useful, and terrible, parts of law school is the “issue spotting”  exercise.  You listen to a long detailed complaint looking for issues that may be legally remediable among the many equally, sometimes more horrific, parts of the story that is regarded, in its entirety, as a trifle with which the law does not concern itself.  

“You got royally screwed, no question, and I sympathize 100% with your anger at the sickening ordeal you were put through, I would feel exactly as you do,” I would begin, seeking the words to let the poor sodomized fucker down gently on his tender sphincter.  

“What they did to you was unconscionable, sickening and offensively typical.”  The words do not come easily, you have to give your professional opinion of the person’s odds of getting a case into court, having a meaningful hearing, achieving some victory with the law.   Those odds are zero. 

“This is the worst part of my job, explaining to someone who’s been brutally, deliberately screwed, against his will, that the law regards his screwing as a trifle with which the law does not concern itself.  De minimis non curat lex, as the judges say.   It’s Latin for ‘your client is shit out of luck, asshole.  Next!'” 

The issue spotting exercise is the law student’s training for hearing a layman’s complaint and finding a viable legal theory for bringing the complaint to court.  Often there is no remedy at law.   People who are severely screwed often have a hard time understanding this.

 “You agree that they fucked me up the ass sideways,” the prospective client will protest.  

“I do,” the empathetic young lawyer will say.  

“You agree that it was unconscionable, your own word,” says the prospective client.  

“I do, absolutely,” the lawyer will say.  And so on.  The lawyer knows what the prospective client cannot understand in his particular case yet–  the laws are made by powerful forces that like the idea of non-consensual sex, they like it very, very much.   Unless there is a provision in the law to enforce the rights of those who do not give consent to those powerful people, and other non-human entities, who love a little spontaneous dalliance, consensual or not, well, you have a trifle that the law does not need to concern itself with.

It is very troubling to see a rightfully aggrieved person standing on a phantom leg. There ought to be a law…  well, I agree very much.  Unfortunately the billionaire class, in conjunction with those psychopathic legal fictions called ‘persons’, with their army of well-paid  lobbyists representing the tiny, powerful group whose interests they tirelessly protect, have the most persuasive voice for lawmakers.  

Still, there is the human reflex, felt by many, to stand on a right they strongly believe they SHOULD have.  Brings us, in an odd way, to the narrow electoral college election of this unreasonable fellow we have in office now.  Millions voted for his unconvincing promise to help the little man and cut through law and everything else to get him what he SHOULD have.   A promise ridiculous on its face, as we used to say at law,  but there you have it.  His type essentially says, pretty much irrefutably:

You have no legal right unless you can enforce it in court, asshole.   Even if you have a legal right that a court will enforce, find a lawyer who will work for free or we will bankrupt you.  We will bury you in legal bills!  You really want to fight the power, motherfucker?  We will destroy you!

In this context there is a controversy, sadly non-controversial to most Americans, that is like a fiber of celery caught uncomfortably between my molars.  No floss can remove it, my tongue is constantly playing with the irritating strand every time I’m reminded of it.   I don’t know if Anwar al-Awlaki went all the way over to becoming an active al Q’aeda recruiter, as his accusers claimed when they put him on the secret presidential kill list, and after they turned him into chopped meat with a missile launched by a Predator drone.  I doubt it, but I don’t absolutely know for sure.  Neither did Jeremy Scahill, who researched the issue in depth, but he also strongly doubted that Awlaki was affiliated with terrorists and presented a good case that no evidence whatsoever of terrorist ties was produced before his extrajudicial execution.

I know, at least in the first part of his railing against the American worldwide war against Islam, that Awlaki probably felt he had a right to free speech under the First Amendment.   It’s an argument his lawyer could have made in court, Awlaki’s right to dissent, if he’d been tried, even in absentia.   As an American, Awlaki believed he had an absolute right to express his opinions, to argue against the murderous policies of his government, to appeal in the strongest possible terms to the sense of justice in those he addressed.  

The American president had a different idea and, being a brilliant Constitutional law professor brushed aside all the legal issues raised by the targeted murder of an American citizen for giving speeches the president deemed the dangerous incitement of a deadly enemy combatant.  Brushed aside all legal arguments and zapped the American citizen with a drone-launched missile.  The story forever after would be that Obama wisely and decisively took out a dangerous terrorist leader, the number two man in al Q’aeda and heir apparent to Osama Bin Laden himself, if you believe Obama’s representations about  Awlaki.

I don’t begrudge Obama his accomplishments.  The elimination of the obscene ‘pre-existing condition’ loophole in health insurance was long overdue and something every American should applaud.  At the same time, Obama handed expanded executive prerogatives to the volatile, angry man who succeeded him as president.  

Included in these prerogatives was the absolute right to say who is an enemy combatant and, based on that unappealable status determination, to take any steps necessary to make sure the dangerous terrorist is neutralized.

“Your classic slippery slope, Elie,” said the skeleton of my father.  “You heard about those ALEC introduced Ag Gag laws which call for complete opacity when it it comes to the systematic industry-wide torture of animals raised for slaughter.  In the states where these laws have been passed it is illegal to take unauthorized videotape of violence against farm animals.  

“Violence seems like a ridiculous thing to talk about in connection with animals raised to be meat.  And it is.  The standard for what is acceptable in the animals-for-food-industry, of course, is determined by industry standards.  If ten chickens per square yard of cage means you have to cut the beaks off them to keep them from pecking each other to death, so be it and there’s nothing cruel or unusual about it.  Cruel it might arguably be, but unusual?  I’m afraid not, we all do it, sir.  Industry standard.  Nothing to see here.

“Animals being raised for slaughter and sale as meat certainly have no rights a white man is bound to respect.  But here’s the kicker, Elie.  As you know, these laws allow the State to prosecute vegan activists as ‘terrorists’.  Try that ass hat on for size.   If you’re a PETA activist and you take a video of factory workers beating a cow or pig to death, you are a terrorist under these Ag Gag laws.  What can you do to a terrorist?  Some believe torture is too good for those motherfuckers, you dig?”

“But see, Elie, torture is nothing to worry about either.  That’s because our Constitution protects us against a psychopathic element of the government deciding that, in spite of treaties we’ve signed and prosecutions we’ve successfully waged against torturers from other nations, Americans can legally torture people — if we secretly redefine it and call it something else.  

“We all know Americans don’t torture unless the country’s most powerful skillfully play to the terror of the populace, which will allow such formerly hideous practices to become ‘normalized’.  You know, like if we’re facing an enemy so terrible that all measures must be employed to destroy that enemy.  You know, an enemy that has no hesitation to slaughter as many children as it takes to rid the world of what they perceive as evil.”

OK, dad.  Calm down now.  Life goes on.  

“Not for me it doesn’t,” said the skeleton.  

Not for me either, really, not all the time.

Kudos to the New York Times

The Grey Lady, America’s newspaper of record, reports on the recent accidental killing, by Navy SEALs, of eight year-old Nora al-Awlaki, daughter of the previously executed Anwar al-Awlaki.   Awlaki’s father, Nora’s grandfather, Nasser al-Awlaki, is quoted in the piece:

Nasser al-Awlaki, the girl’s grandfather, gave NBC News a different version of events of what took place. “My granddaughter was staying for a while with her mother, so when the attack came, they were sitting in the house, and a bullet struck her in her neck at 2:30 past midnight. Other children in the same house were killed,” he said. Nora died from her injuries two hours after suffering the gunshot wound, he said. The grandfather went on to say that the SEALs burned the home after raiding it, and that Nora’s mother escaped the raid with only a minor injury. The U.S. has also killed Anwar al-Awlaki’s father and son in previous drone strikes.    source

I know I’m a nitpicky, mean-spirited motherfucker, but the Times concludes the paragraph above by reporting that the man who spoke to NBC news about the recent killing of his granddaughter had been himself killed in the drone strikes of 2011.  

We presume the Times will print a correction, if a reader writes in to point it out.  Who has the time?  Who really cares about such a seemingly insignificant detail?  There are larger issues of accuracy and credibility to concern their editors.

In a larger sense, the Grey Lady may have had it right.  It might very well feel true for Nasser al-Awlaki, that he was already killed by American drones several times over.  His petition to save his son Anwar from Obama’s kill list was thrown out of court.  His son was soon thereafter killed by a drone strike. Two weeks later his 16 year-old grandson Abdulrahim was killed by another American missile strike, also remotely launched from a Predator drone.  

Those two killings may have, metaphorically, killed Nasser al-Awlaki.  One can only imagine how troubling to his dead body the gunshot mutilated little corpse of his eight-year old grand-daughter must be.

But in fairness, and truly, America, who really gives a fuck about some family’s tragedy in far away Yemen?  Anwar al-Awlaki (you will read everywhere but in Scahill’s Dirty Wars) wasn’t a dissenting American citizen forcefully exercising his First Amendment right to oppose government actions he found hateful.   He was a dangerous terrorist, pure and simple, a powerful recruiter for hateful, murdering fanatics, the President said so.   He was very highly placed in al Q’eada when he was put on the Presidential Kill List, you can confirm that with the New York Times and NPR as well as on Fox, CNN, MSNBC.  

Chances are they all hate our freedom over there anyway, isn’t that right?   As for the beautiful little girl bystander left to die slowly in that raid, an American bullet in her spine, without medical treatment, remember that every terrorist was once an adorable eight year-old.  

Move along now, America, nothing to see here.  USA!  USA!!!!

 

 

Obamacare dramatically reduces preventable American DEATHS!

Before the puckishly named Patient Protection and Affordable Care Act became law, 45,000 was generally accepted as the number of Americans who died every year of conditions that would have been curable, had they not been diagnosed too late in an Emergency Room.  Thanks to Mr. Obama’s inspired and innovative health care scheme, that number may now be as low as 25,000 dead Americans a year for lack of health insurance.  Almost half of the 60,000,000 previously uninsured Americans are now covered under the PPACA.  An achievement anybody would be proud of, any way you slice it.   Shoot, 7,300 American veterans take their own lives every year in this country, for Christsake, as the president informed us on Veteran’s Day (20 American veterans take their own lives every day).

Admittedly, the PPACA health insurance system is still not perfect, even in states that adopted it early and eagerly, like New York State.  If you want a wee taste of the PPACA in action, and a very dry little chuckle, read the helpful paragraphs below and click on the link to see the list of providers.  This is from the New York “State of Health” “Marketplace” website.  It is for sure worth a quick click:

On this page, you will see the plans that are available for you to purchase. You can search plans by different criteria such as how much you will pay each month (monthly premium), the category (metal) of the plan you want, and/or the health insurance carrier you prefer. You can search for plans based on their quality ratings.

You can also see the plans that your doctor accepts, or plans that include hospitals or other facilities that you use. Click here to search for doctors and facilities. By clicking on the link, you will be re-directed to the NYS Provider & Health Plan Look-up website. However, this does not guarantee that your doctor accepts the plan. In addition to using the search function, call your doctors hospitals, or other facilities to see what plan they accept.

You can apply for an affordability hardship exemption if you think you cannot afford to purchase health insurance due to your projected income in the coming year. Click on Apply for an Exemption for next steps.

Disclaimer: CMS is conducting additional consumer testing regarding the public display of quality rating information.

Not to be rude, but who the fuck is CMS and when are they going to get their collective head out of their collective ass?

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