Category Archives: Obamacare

Corporate Social Safety Net — Medicare edition

Medicare, the health care partnership between private insurance companies, pharmaceutical manufacturers and the government to protect the health of people over 65 (or with certain disabilities) is promoted as the solution to health care coverage for Americans of all ages. At 69, and dealing with Medicare now for a few years, I find this idea appalling, especially since the only solution to protecting the health of the old and the sick is a single payer system that cuts out all the parasitic middle men who profit off disease and our legitimate fear of death.

Citizens of a democracy deserve decent health care as a right of citizenship, like in every other wealthy economy (and formerly Iraq, Libya and other third world “shitholes”). But, lest I forget, America is exceptional.

Every year, between October 15 and December 7 (a day that always lives in infamy now, thanks to Medicare) purchasers of Medicare insurance are urged to shop on the marketplace and find the best suited plans for themselves. You can compare prices and, in some cases, actual coverage. It is no fun navigating the website, shopping for the best “deal” that should be provided to you automatically as a lifelong tax payer. Each of us should get the best deal available from our government, the one we fund, the one that is supposed to watch out for our best interests.

The economic reality is that, in a consumer society, if you need a few pills, you will pay 50 cents each. If you buy a billion pills, the price is 3 cents each. This is simple capitalism, economy of scale. The more you buy, the less each one will cost you [1]. Medicare buys a trillion pills a year, but is prevented, by a right wing/corporate law signed by Dubya, from negotiating prices with pharmaceutical companies based on that economy of scale leverage.

And so old people are forced to enter this kind of virtual mall, after October 15th of each year, where you can search for the best deals before the annual December 7th final deadline comes crashing down and you can choose nothing until the following October 15th rolls around because, fair is fair and rules are rules.

Part D of the alphabet soup that is Medicare is the prescription drug plan and every Medicare recipient must choose a Part D plan (or get it included in the problematic, loophole-ridden, insurance company sponsored Medicare plans known as Medicare Advantage). Prices for Part D vary wildly. In 2024 I chose the cheapest drug plan available, Aetna Silverscript, for $31 a month. Then:

You see profit margins here that would make Jeff Bezos and Elon Musk insanely jealous. Over 100% price increase in 2025 and then, a tic below another 100% price increase the following year. All perfectly legal here in the land of the free and the home of the brave, as long as you get a letter from that corporation informing you that your premiums will double and you will get only slightly less coverage.

A billionaire named Mark Cuban set up a company called CostPlus that will mail you prescription drugs, at 15% above cost plus handling and mailing. You can calculate the approximate cost on their website. The four generic prescription drugs I take will cost under $100 every three months, less than $400 for the year. No deductible, no insurance, just the prescriptions. I signed up online. There is a form for my doctor to submit to them, and the drugs will be shipped to me every ninety days.

I called Aetna to cancel my Part D with them, after visiting the marketplace and seeing annual prices, under our American “freedom of choice”, from $1,000 to $3,000 for the identical drugs (cost of drug copays plus premiums). My once modest $31/month plan was now up there with some of the most expensive. The woman I spoke to at Aetna was lovely, but she was not a trained disenrollment specialist, she explained, and so couldn’t take my cancellation order. She gave me another number to call to speak to a “Medicare disenrollment specialist”, and after checking, at my request, confirmed it is a 24/7 number.

In the wee hours of the morning I decided to make the last aggravating December 7th related call of the year and get that particular pile of steaming scats off my plate. When I called the 800 number it came up like so:

Who the fuck is Valley Organized Physicians? Fuck if I know, but they answer the phone “Medicare”. The person I spoke to patched me through to a disenrollment specialist named Kevin. Kevin and I wound up talking for almost an hour. He somehow had instant access to every prescription drug I’d bought in the last three years. His job, apparently, was to sell me a Part D plan, as I learned when he read me the complete list, suggesting that some, if not many, would be hard to get without insurance.

Kevin warned me that unless I enrolled in a Part D program with creditable coverage that met the minimum standards of Medicare, I’d be subject to a potentially large lifetime monthly fine that would add several dollars, or even a hundred or more, to my monthly premium in perpetuity should I need Part D coverage in the future.

I told Kevin I had no idea what “creditable” meant in that context and he explained. If the prescription drug program you enroll in is not recognized by Medicare, it’s not creditable and you will pay a monthly fine for the rest of your life if you cancel a creditable plan at any time during your years on Medicare. Way to watch out for the old and vulnerable, you fucking corporate psychopaths, I thought. But since Kevin was being so nice, we continued to amiably bat the ball back and forth.

Kevin laid out the worst case scenario to make me understand the risk I was taking by going with a non-creditable plan. Say in five years you decide you need Part D, for some expensive medication, let’s say (which, admittedly, Part D might not cover, but exceptions can sometimes be made for medical necessity). Well, currently the penalty is 39 cents a month times twelve (since you can only fix this once a year). That penalty number keeps going up. So in five years time, Kevin told me, I could be looking at a penalty of maybe $50 a month, maybe $100.

I pointed out that if I realized it was a mistake to opt for CostPlus and bought a Part D plan at the next available date (October 15, 2026) I’d pay $4 a month penalty for the rest of my life. Meantime, Aetna had increased their premium price for their basic plan 100% one year and 100% the following year. I asked him how it was possible that an insurance company can double its rate year after year with no regulation by Medicare.

Kevin had an answer worthy of a Republican congressman speaking to a FOX audience, there are many factors, market forces, which are impossible to regulate, or predict, or even consider, he told me. In other words it’s hard to say and above our pay grades to understand or do anything about. I told him it was not hard to say that costs for Aetna had not increased 200% in two years.

I expressed dismay that Medicare imposed no regulations on what private insurance companies could charge. He agreed that it was not unreasonable for me to be dismayed, but that there was a reason, somehow, beyond our feeble human understanding, apparently, that corporations can’t be regulated but consumers must be charged lifetime penalties for not buying creditable plans from approved insurance companies providing benefits consistent with the minimum standards of Medicare Part D.

Kevin told me to look for a zero cost Part D plan, then checked and said there were none available in my area. He tried to sell me a $35 a month plan, from Healthspring Assurance, which, with the drugs, would cost me only about $720 a year. He agreed there was no guarantee that Healthspring wouldn’t double its premium next year, but that’s why there is a period to compare prices once a year and the requirement of a letter informing the customer that the price was about to double.

He was trying to help me out, he said, after explaining he could have disenrolled me as soon as I called, but he was warning me of the potentially dire consequences of uncreditable disenrollment. I said that in dollars and cents, the difference between $300-400 a year for generic prescriptions, and even the bargain price of $720, would seem to more than offset the penalty for a year or two.

Eventually, after a long chat, he told me he would disenroll me. There was no confirmation number, no proof we’d ever had a conversation of almost an hour (except on my phone, but again, who the hell is Valley Organized Physicians?), I’d get a letter from Aetna confirming I’d been disenrolled, he told me. We bid each other a polite goodnight.

We got off the phone, it was now 4 a.m., and my head immediately fucking exploded. Every narcissist I’ve ever known has told me I’m too sensitive. Maybe the despicable freaks are right about that. I was unable to tune down my outrage enough to get to sleep, the pill I took at 5:00 allowed me to finally drift off around 6:30 a.m. for a few hours of sleep. I’m too sensitive, goddamn it, and it’s messing with my health.

[1]

Healthcare, USA style

A very strong case can be made that we live in an extremely toxic culture here in the land of the free and the home of the brave. Our culture is so insanely poisoned that the regular slaughter of school children and their teachers by insane “gunmen” is considered, by a powerful, immovable minority, the non-negotiable price for American freedom, somehow.   Our toxic culture is the only one in the world that allows the regular mass murder of our children.  Number one cause of death for children one to eighteen years old — gunshot.

How toxic is our culture? A candidate for the American presidency can tell this colossal, hateful lie, pulled directly out of his own floridly insane imagination, (in a manner that even Hitler might have hesitated to voice in public) gain millions of likes and as many votes, become president again:

He’s angry about a fact that he just made up, young American girls being raped, sodomized and murdered by these illegals…. the dark brown, scary, violent, pet eating ones who are poisoning the blood of our country like the vermin enemy within (folks like me and Mike Pence)…

Just to be clear, this imagined rampage of rapes of young girls by dark-skinned “illegals” (listen to the evocative way the mad fuck pronounces that word), in the mind of this asshole’s diehard fans, means that, blessedly, (for the ones who wear crosses), even more rapists’ children must be born, because that is how Jesus wants it. Fetuses are clearly infinitely more sacred and precious than kindergarten children.

The public’s reaction to the cold blooded murder of a wealthy health insurance CEO has been, largely, to treat the man who killed him as an avenging folk hero. When I told a friend someone had quipped that there are 50,000,000 Americans with a motive to shoot him, his response was “only 50,000,000?” Another friend questioned whether the gunshots were actually the cause of death, isn’t it likely the dead man had many comorbidities?

What did this CEO do to inspire someone to kill him?  He simply did his job, vastly increasing the profitability of his health insurance company by using AI to deny 99% of all claims.   He noted that far less than 1% of those denied health care by his insurance company ever appealed the denial of claims by his bots.  A fucking genius innovator, this guy.  His company, the largest health insurance giant in the world, took in $260,000,000,000 (with a B) last year [1].  They were doing great, more profitable than ever, and the CEO was raking in piles of money for himself.

Did he deserve to be murdered?   Arguably, nobody does.  The public reaction seems to underscore the feeling that in an age when well-connected psychopaths are constantly rewarded, their crimes excused, where no accountability for powerful white men shitting on the world seems to exist, some will argue that this is exactly the kind of exception to the rule that we need right now. 

These CEOs will now all be accompanied at all times by armed guards, ready to maim anyone who might threaten the boss.  Nobody wins this kind of war.  In fact, American fascists are spoiling for exactly this kind of war.  Newly minted acting Minister of Treason General Michael “Q-Anon” Flynn will be empowered with the discretion to create death squads to counter the violent enemy within, particularly in anarchist jurisdictions, where these enemies proliferate like insects.

The point about the brutality of the American health insurance system remains, though.  The United States is the only wealthy country where health care is not a right, where buying health insurance is the best anyone can do when it comes to paying for our own health care.  Who put these parasitic middle men into the loop?

Why are there so many Medicare Advantage and Medigap plans?  Because the gold standard of American health care (health insurance, actually) only covers 80% of covered procedures, while dental, vision and other crucial elements of health care are excluded entirely.  Who benefits from this system?  A company that had revenues of $260,000,000,000 (with a B) last year.   That’s a shit ton of incentive to keep things just the way they are.

No matter who has to fucking die or be killed.

Nothing ever happened to any of the murderously incompetent idiots who willfully allowed twice as many Americans to die of Covid-19 than died anywhere else. The angry moron who oversaw that shitshow of televised carnival barker-led carnage is back in charge again, with loyalty oaths to ensure nobody ever contradicts him again. What a country! Pay your health insurance premiums or die, don’t tread on me!

[1] Forbes

Concierge medical care

America is rapidly becoming, if you have the money and you want responsive medical care, the land of concierge doctors and nurses.

The number one hospital for orthopedic surgery, HSS, where I had my left knee replaced almost 600 days ago, boasts on huge banners all over its grounds that it has been the top hospital for orthopedics fourteen years in a row. That doesn’t mean they provide aftercare, and they don’t claim to. If you have a problem, pain, stiffness, difficulty walking, sleeping, whatever, when the x-rays show a perfect mechanical result, it’s not their problem, since the operation was 100% successful, even if you can’t walk more than a block 18 months after surgery.

They don’t claim to be the number one hospital for follow-up care, as you learn when they provide zero aftercare, can’t get you in to see their physical therapists for post-surgical evaluation and offer no solution (other than another operation, a 50/50 coinflip) to a not uncommon, foreseeable but difficult to fix chronic disability they did not help you avoid.

Corporate medicine increasingly works this way in the United States. Health care is an enormously profitable sector and vampire entrepreneurs are increasingly getting in on this lucrative growth industry. More and more doctors work for corporations that take care of all the business aspects of medical care. The bottom line is probably better for all of them and it’s easier to be a doctor in our country if you don’t have to compete with giant medical corporations that have the wealth and infrastructure to put you out of business.

The only casualty is the patient, sometimes. In the event of a good result, there’s no problem. In the event of a problem, complication, need for follow-up, corporate medicine has an answer — concierge follow up, done by telephone, billed as a regular doctor visit, sometimes 100% paid by insurance, or in the case of someone over 65, if you have purchased supplemental insurance for your 20% Medicare copay.

I had a call from my new urologist’s office the other day. These folks are hard to reach or get a return call from on a good day and I’m not optimistic about reaching anyone there if something goes wrong with my upcoming procedure. The caller, a likable guy named Tony, called to offer me a direct number to call and talk to a dedicated nurse any time after my upcoming surgical procedure.

We wound up speaking for a while and it emerged he was not affiliated, nor did he know, the medical practice he was calling from. Somehow, through corporate wizardry, his call appeared to be coming from the difficult to reach office with an offer to give me a direct after care line. Tony worked for a third party selling concierge assurance to rightfully nervous patients.

He agreed it was crazy that he couldn’t tell me the price I’d have to pay for one of these follow up calls billed as a doctor visit. He was with me when I pointed out the madness of healthcare being the only store in America where they can’t tell you the price of anything before you buy it. The standard line is that the doctor has to wait for insurance to bill them before they can tell you the price. My standard reply is to ask if I’m the first patient who ever came to them with this insurance that they take every day. Their standard reply is some kind of smile reflecting an attempt to be civil. None of these folks have any control of anything, and it’s pointless to antagonize them with questions there are no reasonable answers to. Tony and I parted as friends, our call recorded, and by midway through he was no longer trying to sell me a service he could not tell me the price of, but one I’d definitely be on the hook to pay 20% of.

America the beautiful. Exceptional. About to become even more exceptional. I’m keeping my fingers crossed it won’t become too much more exceptional. It’s already much more exceptional than is healthy for almost every American.

American Exceptionalism: Health care for seniors, episode 71

Medicare for all, baby.  

Just spent 45 minutes on the phone with a very nice receptionist at Medicare who reviewed my last few payments.  I’d made all of them, had not missed one.  I was calling to find out why they had threatened to cancel my Medicare health insurance with a delinquent premium notice and why I’d been billed an additional $510 (that I promptly paid, just to be safe) when the record showed I had paid it already, three months ago.   

The woman was very nice, but helpless.  She confirmed that I hadn’t missed a payment and that I shouldn’t have been sent a delinquent account notice, but, after placing me on hold several times, was unable to verify that the delinquent account notice had been sent in error, though from what she and I could tell, based on my payment record, it certainly had been.  Mistakes happen.  In 7-10 business days I’ll hear back from Medicare, if not, I should call again, and have a very nice day.

Need a colonoscopy, old man?    The Medicare.gov website tells you everything you need to know, or need to find out, or need ask your doctor, or research with a competent financial advisor who is schooled in the intricacies of the gold standard of American health insurance (not healthcare, that’s for godless commies and people in less exceptional nations) for old people who don’t have better health insurance.  Here you go, from Medicare.gov:

Medicare covers screening colonoscopies once every 24 months if you’re at high risk for colorectal cancer. If you aren’t at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There’s a minimum age requirement of 45.  (note, Medicare does not cover anyone under 65, does it?)

If your doctor or other qualified health care provider accepts assignment, you pay nothing for this test. However, if your doctor finds and removes a polyp or other tissue during the colonoscopy, you pay 15% of the Medicare-Approved Amount for your doctors’ services. In a hospital outpatient setting, you also pay the hospital a 15% coinsurance. The Part B deductible doesn’t apply. If you initially have a non-invasive stool-based screening test (fecal occult blood tests or multi-target stool DNA test) and receive a positive result, Medicare also covers a follow-up colonoscopy as a screening test

Note: To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

Other insurance you may have

How much your doctor charges

If your doctor accepts assignment

The type of facility where you get your test, item, or service

Note: Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs.

Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

More on Medicare for All

Like its equally well-intentioned cousin Obamacare, The Patient Protection and Affordable Care Act, Medicare is not set up to tell you how much you will have to pay before you go for medical care.  Medicare has to wait for the doctor’s bill to see how much you owe.   The “provider” bills you directly and then, sometimes months later, you get what the insurance industry calls an Explanation of Benefits.  The EOB sets out what the doctor charged, how much Medicare agreed to pay, how much they actually paid, how much you owe to the provider as your 20% or “out-of-pocket copay”.   Only in America, boys and girls.

How this odd arrangement jives with the Patient Protection part of Obamacare, where the patient may be billed several times for an amount that is unknown until the EOB eventually arrives, is hard to work out, except that it is an improvement over being disqualified for health insurance by the proverbial “pre-existing condition” and things like that.   Don’t let the fairly shitty but better than the past thing be the enemy of…

Under the gold standard of American health insurance, you instantly get a bill, like this one.   

You will get it repeatedly until the EOB arrives.  If you ignore it until the EOB gets there, certain providers will turn the billing over to collections attorneys who threaten you with debt collection techniques to get their client’s dough.  When the EOB comes you are finally informed of you how much you legally owe.   It is often less than the initial bill you receive from the doctor.   

When you’re talking a trillion or two annually for the U.S. health insurance/medical industry, why quibble over a few hundred extra bucks a hungry corporation is trying to get from you for your medical care?   Everybody’s got to eat, especially hungry cannibals. 

It’s not like affordable health care is any kind of human right, or right of citizenship in the wealthiest, freest (that free-est doesn’t look spelled right) country in the world, you hateful communist.  What next, a whine that your record low student loan interest rate (3.75%) is 375 times higher than the interest banks now pay customers, almost 40 times higher than the highest rate wealthy corporations pay to borrow money? Commies, always carping, never satisfied with a status quo that’s pretty good for people living the dream. Lah dee dah…

If you live long enough America treats you to the gold standard of go fuck yourself

Though this is an old man’s complaint, I never forget that the young have been severely, severely fucked by the previous generations. There are countless examples, but any one will do, really. Concerted action on slowing climate catastrophe, even if taken as late as the first Earth Day in June of 1970 (I went there on one of my first “dates”), would have prevented the steep precipice life on earth stands at now, in the gathering tide of regular, ever more destructive Acts of God, floods, famine, wild fires, drought, record cold, extinctions, earthquakes, tsunamis, hurricanes, tornadoes, record heat, avalanches of ice and rock, the warming and desalinization of the oceans, rising sea level, poisoned water and all the rest of the apocalyptic changes.

The most extreme Christian fundamentalists may regard the end of life on earth philosophically, some rejoicing at the hastening of the Rapture, after the battle of Armageddon between the armies of God and Satan, the final defeat of Evil, raising of the faithful to heaven and the casting of everybody else into the eternal torments of hell. Oh, happy day! l’ve got nothing nice to say about such true believers, so let us say no more about those God-fearing proselytizers. I have to assume that most Christians, certainly the most Christlike among them, must weep when they consider the criminal stewardship of nature by man, to whom God gave dominion over all life and the sacred trust of protecting God’s miraculous creation, according to their beliefs.

The righteous of all nations, heaven-bound or otherwise, suffer the same earthly uninhabitability of our beautiful home planet. Greta Thunberg and people her age are 100% right to be furious at the blah, blah, blah of the powerful bullshit artists of the present, equivocating in a dozen languages about their inaction and worse, while gorging themselves on the profits of those lucrative industries that are wantonly destroying everything as they spread lies, darkness and a series of toxic rationales. Fuck them, seriously.

So not to take anything away from the horrors facing the young, who the most idealistic of us all put most of our faith in. The young have every right to be fucking mad as hell at their hedonistic, shallow, asshole forebears. The future is a huge burning bag of radioactive dog shit we are handing to the next generations. How unfair is that? In a just world, we’d have all been fined every penny we are hoarding to clean up the mess we made.

But we don’t live in a just world, boys and girls, and so if you live to be old enough, and go on the American Gold Standard of government subsidized health insurance, Medicare, at least, theoretically, you don’t have to worry about the cost of your health care, not as long as you can prepay the premium of about $600 several times a year, 80% of your medical worries, as far as what you will have to pay on top of that, are theoretically taken care of. The US Gold Standard that is a rallying cry of progressive Democrats “Medicare for All”. It is certainly the least a nation can do for its people, and I’m here to explain, as succinctly as I am able, why it is certainly the least.

It leaves the final decision on the care you receive in the hands of private corporations. It ensures the vast profits of several lucrative health related industries. The insurance it provides covers a generous 80% of regular medical expenses, or sometimes none. You have to work it out with the corporations that will, or won’t pay for, say, a vaccine.

So I made my reservation for pneumonia and a shingles vaccine online, both recommended for people my age. My Medicare insurance was accepted, I got a confirmation email from the pharmacy, my t-shirt sleeve was rolled up, my right deltoid swabbed with cool alcohol, the pharmacist held the syringe of Shingrex in her hand and told me that it might cost another $200 or more for the required second shot (I’d been told a few minutes earlier that $200 would cover both), she really couldn’t say, and the pneumonia vaccine was new and could be very expensive, the one they had was the new one, a one shot deal, my insurance didn’t cover it, but she thought that if I spoke to the pharmaceutical insurance corporation (Medicare Part D, I think, you have to buy it separately if you want pharmaceuticals as part of your medical treatment) they might pay for it at another pharmacy chain, in a different form perhaps.

My only move at that point, learning that these highly recommended shots might cost me hundreds of dollars, was to put my shirt on, make sure the $200 credit card charge was reversed, and get the fuck out of there.

I have to say, as much progress as I may have made when an individual acts like an asshole, corporations and psychopaths still have the power to ruin an entire day for me. The pharmacist informed me that she would have to throw away the shingles vaccine that she’d been ready to inject in my arm. Which makes perfect sense in fucking America, if the guy doesn’t want to pay for $500 or more so his American Gold Standard government/private insurance doesn’t have to pay, well fuck him, we’ll throw the fucking expensive shot away rather than administer it. Which makes perfect sense in a nation that throws away millions of its most vulnerable citizens on an hourly basis. Fucking nation of fucking shills.

Mixing unregulated capitalism with democracy causes trouble

Part One is here.

My embrace of democracy does not make my recent experiences with losing government-provided health insurance three times in the last eighteen months any less bitter. The first time my health insurance was cancelled, and I lost the corporate internal appeal at the insurance company, it turned out my insurance had been cancelled illegally.

An on-line complaint to the NYS Department of Finance resulted in the corporation instantly reversing its irreversible decision, restoring my health insurance. I even got an apology for their “mistake,” unlike the probably tens of thousands of others who lose their health insurance every year in the same “unappealable” scam all insurance companies routinely use to cull their lowest paying, most expensive customers.

The supremely maddening part of that first gratuitous fucking is that, even as a long-time lawyer who spent weeks in research, speaking and writing to every expert in the state and federal bureaucracy, I was unable (as was every expert) to find the law the company had clearly violated. Not part of the “Patient Protection (and Affordable Care) Act”. Not discoverable in New York State Insurance Law or in any administrative code. Makes me angry just thinking about it now. No agency I spoke to was even aware of the existence (let alone amazing efficiency) of the Department of Finance online complaint form [1].

If a law that protects a low-income Americans from the illegal act of a corporation providing affordable health care, under the Patient Protection Act, cannot be found, even by determined lawyers, there is no fucking law.

The opacity and unfariness of that burns me to this day, even as a learned, well-meaning former friend kept assuring me I was wrong to be so angry, that I should just be happy I got lucky and saved my own healthcare. As for those with limited English proficiency, struggling to get by, who’d had their ACA insurance illegally cancelled in this manner? Fuck ’em, not your problem, pal (spoken by this dick head like the Great Communicator himself).

The second time my insurance was abruptly terminated (during the second month of the pandemic, which raged uncontrolled in NYC), it was a matter of one document I’d “failed” to upload to a website in a timely manner. There was no actual notice to me of this failure, or its hard consequence, (and fixing it on-line took about three minutes, once I knew about it), my insurance was legally cancelled, according to New York State Law, for my failure to timely provide the document I wasn’t told needed to be provided.

During the window of time we are required to re-apply for ACA insurance in NYS this tax document is not yet available. A reminder email would have been nice (and I had numerous survey emails from this same agency), but is apparently not required under unappealable NYS law. Although NYS informed my insurance company of this fatal failure of mine, with enough time for me to fix the problem, neither entity had any obligation to inform me that my insurance was in jeopardy, until after it was irrevocably cancelled. This time there was no appeal, I had to wait a month to be insured again, trying not to inhale too deeply any time I left the house.

Then we have Medicare, the Great Society program that is the American gold standard for health insurance. “Medicare for All”, is the rallying cry of liberals and socialists alike. I recently turned 65 and learned, over the course of several months, how complicated the public-private Medicare partnership actually is. Do this first or irrevocably lose the right to that, and so forth.

Accepted by virtually all doctors and hospitals, Medicare leaves a potentially gigantic bill for the patient to pay, as 20% of medical visits is not covered. One can, of course, spend thousands a year on private insurance “Medicare Advantage” (there are many plans of all different prices in our “Free Market”), to avoid these possibly huge bills falling on the old person who gets sick. Medicare is infinitely better than no Medicare, but, again, complex and not without tremendous problems, at least based on my initial experiences.

Fortunately, the law gives a person six months, three before the 65th birthday and three after, to learn about this complicated program and sign up (though you will get no communication from Medicare itself and Medicare itself cannot help you in any way until you are officially on Medicare). I was finally able to speak to a knowledgeable volunteer (at the NYC Department for the Aging) who spent over an hour warning me of pitfalls and giving me important information. She found me a prescription drug plan for $8 a month (or something like that) among many that are ten times or more that price. You see, that’s part of our freedom here in the USA — the right to choose!

Two weeks before my 65th birthday I got a notice from my insurance company informing me that ACA insurance ends when you turn 65. Goodbye three month window to apply for Medicare after you turn 65, you will be uninsured until you apply and get approved for Medicare.

Here my beef is not as much with “government” (a legal requirement for actual notice, with enough time to act before your health plan is terminated, would be good) as with how thoroughly corporate “culture” has affected the workings of government. This adoption of corporate practices stems from the idiotic and frequently disproven 40 year myth about the superiority of “private enterprise” over “government”, a big talking point of right-wingers like Louie DeJoy and other “Free Market” defenders.

Part of corporate culture is the thorough segmentation of the “corporate brain” such that one side of it cannot communicate with the other. You cannot get information you need from the consumer side, because they have no way to interact with the provider side — which can answer the question– for example.

We also now commonly see “third parties” with contracts to do government work, like collecting debt, sending bills, providing “notice” and so forth. If I requested something a month ago that is typically available in five business days, and call weeks later to find out the status, I am as likely to get a bored, underpaid, bitter “third party” subcontractor giving me a surly answer pulled directly from his ass as I am to talk to a well-informed government agent ready, willing and able to solve my problem.

In the case of Medicare, I was assured when I applied on June 17 (after a ten business day delay to get a new PIN sent to me by US Mail when I was unable to log-in) that everything was in order, that my application would be approved within two weeks or so and that my Medicare, whenever officially granted, would be effective July 1.

You can’t reach anyone on the phone to find out why it is now three weeks later and the website shows the same 2/3 on the status bar. You read that your application is in process, but there has been no discernible movement in three weeks.

For most people, you read, this review takes 2 to 4 weeks. For you, asshole? Hah!

The first three times you call you are subjected to an endless loop of “Thank you for holding. We appreciate your patience, we’re currently assisting other people and will help you as soon as we possibly can.” The loop about helping you plays until your call is eventually cut off. This is a universal corporate trick that enhances the bottom line, why hire extra workers to answer phones when you can simply play this recorded loop until the call is automatically terminated?

My fourth call was the charm, I was connected to a woman who assured me I simply had to wait, everything was in order, everything that could be done was being done. The Social Security Administration website continued to tell another story.

My next call, a few days later, also got through, this time the guy impatiently told me to forget what the website said, the review ALWAYS takes 60 to 90 days to complete and I’m only slowing it down by trying to call all the time. And, yes, the recording says that if your need is crucial you can schedule a face-to-face meeting (NYC branches of federal government offices are apparently still closed for the pandemic), but merely being uninsured does not qualify as crucial and there are no face-to-face meetings because … Covid. You just have to be patient, asshole.

My next couple of calls put me in that endless loop of thanking me for my patience and eventually disconnecting my call. When I got through next, just the other day, Ms. Estevez was very helpful. The guy who told me 60 to 90 days? He had no idea what he was talking about, he was completely wrong, said Ms. Estevez with great disgust. She looked over my stalled application, found no reason it was being held up. Approved it on the spot.

The next day, with only two or three hours of work, I was able to get my Medicare ID number read to me over the phone. Now, the only things I have to worry about is getting this cancer scare checked out before September, and how much 20% of my doctor’s bill will be (it will certainly be far less than the full retail $885, excluding tests, I was scheduled to pay “out of pocket” in September).

Say it with me, boys and girls:

USA! USA!!!

[1]

I received a notice from the Department of Finance, after my complaint was successfully resolved by their intervention, that my low-cost health insurance did not allow me to use the Department of Finance’s website, that I’d have to lodge any future complaints with Andrew Cuomo’s incompetent political appointee at Medicaid (also in charge of all ACA programs in NYS). Medicaid’s website contains no on-line form, you have to wait for someone who can help you, possibly, to pick up the phone there, you indigent piece of shit.

Note: this letter from the Department of Finance did not stop them from filing my next online complaint against the insurance company, though that one led to nothing, as current New York State law required.

In Defense of our Flawed Democracy

Thank you for holding. We appreciate your patience, we’re currently assisting other people and will help you as soon as we possibly can.

(repeated every 40 seconds, at 7 minutes into a short loop of insipid hold muzak with the Social Security Administration, at 16 minutes and finally, one last time, at 26 minutes, when I belatedly pulled the plug on holding for these lying, pseudo-corporate bureaucrat pricks)

Theoretically the American people are the government and the government is intended to work for us (particularly if we are in the social class for whom the benefits of life, liberty and the pursuit of whatever were guaranteed by our Founders). The experiment in democracy these wealthy white men designed in the waning decades of the Eighteenth century was revolutionary, at the time every other place on earth was ruled by a monarch who sat on the throne by Divine Right (compare: Manifest Destiny). Anyone who questioned why God would put a vicious inbred hereditary imbecile on the throne could be considered a blasphemer and subjected to the usual time-honored remedies for this sort of impiety (not to mention treason).

The Founding Fathers risked their lives, committed open treason against the world’s most powerful king, to change a system that placed a king’s arbitrary will over all of them, giving them little or no say in the conditions of their own lives. “No taxation without representation” was a rallying cry of the colonists, since there was, by then, a bicameral representative council in England below the king (House of Lords and House of powerless fucking chumps) that had a say in government policy.

It was the radical idea of representative government, based on the radical notion of the right to self-determination, that gave rise to all sorts of radical ideas (including representative democracy) during the Age of Enlightenment when discerning minds began to use Reason to question long held beliefs, practices, customs and superstitions.

We’ve come full circle, in many parts of the world, to the pre-Enlightenment vision of religious faith in an all-powerful individual leader, chosen as part of an unknowable God’s all-loving, all-knowing plan, a “strongman” who exercises unlimited personal power paternalistically, to ensure what he deems is in the best interest of citizens. Thus, even in our democracy, you can have a mentally-ill sadist, ordained by God, doing what he needs to do to rid us of hated enemies and promote his loyal followers to head every important government office to advance his vision of truth, justice and the American way.

In the US that includes, obviously, the Social Security Administration, the Internal Revenue Service, the US Postal Service, the Department of Defense, the Department of Justice, etc. If that leader surfs to power on a wave of churning emotion, exploiting fear and hatred of an unfair, corrupt, inefficient, abusive government, well, the more unfair, corrupt, inefficient and abusive his government is, the more it proves the point that he’s the only person who can save us! Don’t worry about the argument making sense, it doesn’t need to. It just needs to keep making you angry as hell.

So we have “debates” in our deadlocked, non-functioning Congress about things like increasing the budget for IRS enforcement against wealthy tax cheats (to pay for programs to literally begin trying to save the world from accelerating climate catastrophe). Is it American, patriotic, decent, honest, to cheat on your taxes? Here is the opposition party’s position in the debate:

WHO ARE YOU TO FUCKING SAY??!!! FUCK YOU, WASSHOLE! TRYING TO TAX THE RICH, THE JOB CREATORS, IS PUNISHING SUCCESS, JUST COMMUNISM, RADICAL ANTI-FASCISM or FACISM, TAKE YOUR PICK!!!

This is literally the quality of political “debate” in a nation run by, and for the benefit of, sociopaths and unprincipled careerists. Here’s a great snarky take on that from Sarah Lazarus at Crooked Media:

Rep. Bennie Thompson (D-MS) confirmed this week that he plans to investigate Donald Trump as part of the probe, and is prepared to depose senior Trump administration officials and members of Congress who might have played a role in the insurrection—like, say, the two seditionist Jims that McCarthy tried to put on the other side of the table. Thompson also indicated that the committee is very interested in learning more about McCarthy’s panicky phone call to Trump as the attack unfolded, which probably has nothing to do with McCarthy’s panicky efforts to thwart the investigation.

Nothing to fucking see here! You’d do the same if you had supported a maniac’s insane right to send a mob to the Capitol to violently stop the constitutionally mandated certification of an election he honestly refused to accept that he lost since he is history’s greatest winner. You’d do the exact same fucking thing if you were in McCarthy’s position!!!! Repeat everything you’re told to say and pretend you love the taste of the delusional Big Guy’s crusty hindquarters.

Anyway, I believe in government, in spite of the sickening frailties of the one we have now. Democracy is better than any alternative form of government, but we need to fix ours. Several radical, common sense reforms will be needed to restore our experiment in democracy to a representative government.

No more dark money in politics (at least say your fucking name, Charles, Rupert, Robert Mercer) funding the most extreme reactionary candidates in primaries to ensure the extremist political outcomes the 1% desires (part of the proffered protection of the public in the disastrous Citizens United ruling was that unlimited funding of political campaigns would be done transparently, a transparent bit of purely transactional bullshit, as it turned out).

No more right-wing fraternity vetting and choosing lifetime federal court judges to rule, whenever legally possible, according to that fraternity’s stated far right ideology. No more (currently entirely permissible, per 6-3 Supreme Court) partisan gerrymandering and no more restrictive, partisan voting laws — whether or not “race” is intentionally implicated in these moves (the Supreme Court’s brand new standard for overturning voter suppression laws, opponents have to prove they were intended to be deliberately racist, whatever the actual impact of the on different “races” the law causes).

The Supreme Court, a 6-3 right wing juggernaut whose majority was appointed by two presidents who lost the popular vote, straight from the Federalist Fraternity’s list, must be balanced with a handful of even-handed, non-“ideological” judges. Abolish the fucking Electoral College, that vestige of slavery, while we’re at it.

Everyone who works deserves a living wage, $7.25/hr, current federal minimum wage has not been raised since 2008, adjusted for inflation (since it was instituted) it should be $24/hr. Giant corporations must not be allowed to pay workers so poorly they qualify for Medicaid, health insurance for indigents. Taxes on vast, untaxable hereditary wealth and massive corporate windfall profits could go a long way to paying for vitally important programs we needed to have started decades ago, including the preservation of a habitable planet.

There’s a pretty short list of the essential things that are broken, and need to be fixed.

So I don’t write this in any way to attack our need for government programs and agencies that help our fellow citizens. We need those things that only a determined, responsive, well-functioning federal government can do. Think of the immediate improvement in American vaccination under a new president who didn’t regard the pandemic as a Communist/BLM-antifa hoax engineered to personally hurt him. Another example: the federal government took its time about it, to be sure, but in the end it was the intervention of the federal government, enforcing federal law, that ended the custom of lynching in many parts of the country that were determined to uphold this hateful tradition. FEMA is who you call when a killer storm destroys your town. Protection of voters’ rights in federal elections also falls to the federal government, under the 14th Amendment, and so forth.

Here are a few basic human needs the federal government has to attend to in a democracy, none of which seem controversial to me:

Disabled people should get help from the government. Children should not be subjected to malnutrition and the other ravages of poverty. Decent health care should be a right of citizenship, Americans should not have to die for lack of health “insurance”. Workers should be able to afford a place to live, food, clothing, days off, a bit of security. People who retire should be able to live in dignity and at least modest comfort. All citizens should have easy access to voting. Victims of killer storms should be rescued, helped to rebuild their lives. Corporations should be prevented from poisoning the water, air and ground. None of this is controversial, until you get down to the details, which are dictated by the agenda of a tiny, powerful elite of the hereditary super-wealthy, a group that has other priorities.

For example, if a law that protects a low-income Americans from the illegal act of a corporation providing affordable health care, under the Patient Protection Act, cannot be found, even by determined lawyers, there is no fucking law.

Details HERE

No skin off my nose, pal

As the narrator of this tale, or the plaintiff in a related medical malpractice nuisance suit, I have the great advantage that you won’t need to squint or strain to see the fingernail sized permanent divot on the bridge of my nose. You can see what I’m peeved about at a glance, even in low light.

This lifetime scar gives me instant credibility as the teller of this particular story, and a bit of pathos too. Juries like pathos, if they shudder to imagine having been subjected to the same thing the plaintiff was forced to undergo.

It’s always a mistake, of course, to believe that a gratuitous scar on one’s face, inflicted by a doctor who has not performed the medical procedure he prescribed, the one authorized by insurance, is a legally cognizable injury.

Let the lawyers fight it out, I say.

“Is this scar going to fill in?” I asked the confident doctor three weeks after the surgery, a single gouge deep into the bridge of my nose, to remove a basal cell invisible to the naked eye, a large round wound which was then cauterized instead of stitched.

“No, that’s about as good as it’s going to look,” he said, with admirable candor.

My next question was based on the four or five previous Mohs surgeries I’d had to remove much more visible, deeper, more advanced basal cells (the most benign form of skin cancer). Each of these surgeries had taken several hours, as opposed to the 30 minute procedure his surgeon had done on my nose.

“I was supposed to have Mohs surgery, which removes one thin layer at a time to preserve as much healthy tissue as possible and minimize scarring. Your surgeon basically took a small, sharp ice cream scoop and scooped out all the surrounding tissue in one pass, down to the cartilage,” I said.

“Yes,” said the doctor. In that moment I didn’t have the presence of mind to say anything more. I suppose my psychic efforts were focused on not cauterizing the good doctor’s nose right then.

The doctor’s attitude about the prominent scar in the middle of my face was a slightly impatient “no skin off my nose, pal.” His body language said “are we done here? Any more rhetorical questions?” He thought for a moment then told me about a powerful prescription cream that reduces scarring.

“But your insurance won’t pay for it,” he told me a moment later. The kindly doc then sent his nurse off to find a few of the free sample tubes the pharmaceutical company rep had left him a case of. The cream, which came with no instructions except his nurse’s “apply in a very thin layer”, seemed to irritate the scar which became increasingly uncomfortable until I stopped using the stuff.

In the debate over “socialized” medicine we often hear the critique about the “rationing” of medical care not provided on a competitive, profit-driven “free market” basis. Healthcare, in Communist nations like Great Britain, Canada, Japan, France, etc. is rationed, we are told, because everyone is presumed to be equal when it comes to health care and so there is often a line for some procedures. While it’s true that the wealthy can skip the lines, even in those countries, by going to a private doctor, health care for most is still “rationed”. Here, under our system, the level of care you are “entitled” to is rationed by your ability to pay a monthly health insurance premium. The more you pay, the higher the quality of care you are entitled to, the less rationing you will be subject to.

Here in America every doctor, even the kind orthopedist I’ve visited a couple of times for the arthritis in my knees, knows exactly the level of your insurance coverage as you sit discussing medical options. “Unfortunately, your insurance won’t pay for it, though it works very well to keep the knee pain-free for six months or so while you strengthen the surrounding muscles,” she said of an injection she proposed. She nodded when I told her I’d be on Medicare soon, hopefully. Medicare will absolutely pay for the shot, she told me with a smile.

A cardiologist, who revealed himself as a mask-shunning Trumpist during the pandemic, billed almost $12,000 for each of the four procedures I had on veins in my calves. He’d told me confidently “your insurance will cover it.” My insurance paid him almost half. Not a bad hour’s work for those first three veins. I had a mirthless laugh when I got my “Explanation of Benefits” for the fourth and final venous ablation. He’d billed $12,000 and received zero. His office, apparently, had failed to renew the authorization to be paid. I guess their lawyers will have to fight it out, and good for them both.

A doctor working for a patient with low-cost health insurance (dictated under the ACA according to your declared income, the only choice a low-income patient has is to accept the offered insurance or reject it — and have none), knows exactly how much of the amount his office bills will be paid by the insurance company. This dermatologist motherfucker had every incentive, based on the small fraction of his billed Mohs surgery fee he’d receive, to get me in and out of his office as quickly as possible. Thus incentivized, I was in and out quickly. Even though the surgeon couldn’t see the tiny spot he was supposed to remove.

He called in the dermatologist for a quick consultation, they looked at the photos of the two biopsies (the second had been necessary because the first was done in haste) and concluded it was there, just next to that broken blood vessel. I had a strong reflex to hesitate, as if in a moment of precognition.

“If you can’t see it clearly, I’d rather wait a few months until it’s visible,” I said with mild panic, knowing that these slowly growing cells can be there for a long time with no terrible effect. The confident dermatologist told me that they concurred, knew exactly where the basal cell was and that there was no need to put off the surgery. Like a schmuck, I sat back and let the surgeon hurry to gouge out the entire surrounding area, taking out a circle of healthy tissue to ensure he got the basal cell.

I was in and out of the office in just over a half hour, less time than even the first phase of Mohs surgery usually takes, as I know from experience, having had the procedure now five times out of six. Cah-ching.

As for Dr. “No Skin off My Nose”, what are the odds that a patient with a scarred face, given one more small scar for good measure (and to maximize the good doctor’s billable hours) will have the ability to coherently make a case that a doctor who prescribed surgery A, had that surgery (as well as a skin graft to minimize the scar) authorized by the patient’s insurance and then provides surgery B, including the burning of the flesh around the unnecessarily large wound, deserves a little shit, from his medical ethics board and a payment from his malpractice insurance carrier for the nuisance he inflicted (I have pain at the site of the surgery months later, in addition to the small crater) to the guy whose nose he brutalized?

It may take me a little while longer, but this slick, confident operator needs his smug fucking face cauterized too, just a little. No? After all, it is really no skin off my nose.

American Healthcare under the unamended, serially challenged ACA

I got a notice on Sunday from the New York State of Health, the state entity that administers the Affordable Care Act Marketplace in NYS, selling various plans and being the final arbiter of all things health insurance for millions of otherwise uninsured New Yorkers. It has been run, since its inception, by a marginally competent and apparently energetic Cuomo appointee named Donna Frescatore. Under her stewardship, you can get the New York State of Health to fix their own errors (if they result in denial of coverage or denial of the subsidy the law says your income provides for) only after arbitration, a process that takes just three months or so. I’ve had to do this twice over the years (while having no health insurance the second time). Fair is fair. Frescatore has been promoted for her excellent work at the NYS of Health and now also runs New York State Medicaid, because, why not? Albany is known as a corrupt town and Cuomo is suddenly looking every bit as obnoxious and autocratic as many of us long felt he is.

Anyway, because the New York State of Health gave me no notice last March that I needed to upload a document I’d forgotten to maintain my insurance coverage (though they sent a timely notice to my insurance company, informing them to cancel my insurance effective April 1) I found myself without affordable health care during the first full month of the pandemic’s initial surge in New York City, where I live.

I found out when a doctor’s office called me to tell me there was a problem with my upcoming visit, my insurance had been rejected. In disbelief, since I’d paid premiums for the entire year, I contacted my insurance company and learned it was true. This time, they informed me with regret, NYS had cancelled it. The insurance company apparently has no legal obligation to pass on such notice to the consumer under the PPACA. So sorry!

Infuriating, yes, scary too, particularly during a massive public health emergency that has now killed about 525, 000 Americans. Fortunately for me, I didn’t need to seek arbitration last April, and since I learned my insurance had been cancelled a few days before the deadline for getting it back in May, I was able to complete the ten minute on-line fix before the April 15 deadline for coverage in May. A friend advised me to go the the NY State of Health website and see why I’d be terminated. I uploaded the document they’d requested, the whole thing took a few minutes. If I’d had notice (NYS of Health claimed, falsely, that I had) I would have done this the day my insurance company was ordered by NYS of Health to cancel my insurance in 20 days. Last year my insurance was restored effective May 1. Slight harm, slight foul. I was glad to have health insurance again during lockdown.

When I went to renew my plan for 2021, in the weeks between Thanksgiving and Christmas, when all New Yorkers are required to re-enroll, I was surprised to learn that my renewal was not due until May 1, 2021 (or April 15th, I guess). I verified this, paid my first six months’ premiums and have had no problem with services under my insurance since.

I’ve often questioned why the overwhelmed NYS of Health makes everyone re-certify in these hectic weeks at the end of the year, when phone lines are jammed, mistakes are routinely made, the website crashes, instead of on a rolling basis, say, by birthdate which would allow everyone to be better served. One characteristic of a great, unaccountable bureaucrat is inviolable rigidity.

I had a notice from NY State of Health on Sunday night, in their typical opaque bureaurcratese it notified me:

I suspected it had to do with my obligation to re-certify before the fifteenth of the month prior to the first month of coverage, on pain of losing health insurance with likely arbitration looming if I wanted help paying for ongoing health care. The arbitration is great, by the way, after only a month or two wait, you get a formal hearing over the phone, where a lawyer/arbitrator grills you and you present your side of the story complete with all evidence you may want to submit. A few weeks later you receive an arbitrator’s decision in the mail. I’m two for two in these, although, in fairness to everyone, I practiced law for fifteen years or so.

I keep thinking of the tens of thousands of poor bastards who lose insurance or premium subsidies every year who may not be up to putting on a legal showing of NYS of Health’s errors resulted in their loss of affordable health care. An experienced lawyer who doggedly searched the law for months, calling every state and federal (and NYC) office I could fine, spending hours on-line, I never found the law my insurance company had violated when they’d illegally terminated my insurance the previous (and instantly restored it when I filed an on-line complaint at the NYS Department of Finance– of course it was DOF!). I think, what chance does the average low-income New Yorker stand against the opaque Patient Protection Act?

Typical of all fucking notices from the NY State of Health, they bury the lede, (after informing the reader in the annual notice of notice email that the customer may have received the message in error). The notice is usually many pages long, and what you need to do is often set out on page eight or ten, like they want to make sure to fuck your brain good and proper before coming to the point, informing you of your inviolable obligation. Of course, this could be succinctly stated at the top of the notice, but… what the hey? I assume Donna Frescatore (who does not allow her subordinates at NYS of Health to give out her name) has something to do with this oppressive approach to informing low-income citizens of their rights and obligations. What you need to do to keep your health insurance could be up top, on page one of the important notice, but, you know, fuck it.

Much as I despise her type, Donna probably had nothing to do with this next bit, which is surely part of the Patient Protection Act itself (the communist inspired one passed on a party-line vote by the last illegitimate president before the present illegitimate one, inserted after massive, obvious but unprovable fraud — the very worst, most insidious kind of fraud!!):

IMPORTANT: When you end coverage with one plan and start a new one in the same year, all
of your cost-sharing responsibilities start over. For example, any payments that went toward the
annual deductible for your old plan will not apply to the new plan. This is true even if the new
plan is with the same company.

Which only stands to reason, you know, because, why not? Corporations are people too.

I remind all Americans that this shit is an exclusively American sickness– advertising medications — “ask your doetor!”, excluding eyes and teeth from the definition of “health care”, buying health insurance rather than health care itself, a trillion dollar industry with a million wealthy middle men demanding Americans pay way more for health care than citizens of any other civilized, wealthy nation in the world. Every “moderate” Democrat in Congress will defend each of these self-evident things as right, just as ordained by Jesus Christ Himself.

Medicare, the popular health insurance program for Americans over 65, had many problems when it was first passed under LBJ. Those problems were addressed and many were fixed over the next few years. In contrast, the ACA, a highly conservative plan (brainchild of the Heritage Foundation — deniers of climate science, promoters of the myth of voter fraud and so forth) that left the profits of large health corporations intact, has been attacked by angry Republicans since its passage, many attempts to repeal it launched (recall, it was only the dying John McCain’s dramatic thumbs down that saved it under Trumpie) and so all of its original warts and infirmities remain. When it works, it’s fine. When you hit any kind of snag, you’re pretty much fucked, patient protections or no.

Now I’m going to go back to read the rest of the fucking thing, the informative and entirely reasonable gem above was on page three or four.

Whew, further down the notice we learn:

Please Note: Changing your coverage is different than ending your coverage. If you want to switch
plans and do not want to make any other changes to your account, call NY State of Health to find out if
you are eligible to switch plans and to pick a different plan. Enrollment in Child Health Plus and the
Essential Plan can be changed at any time during the year.

I just read all seven pages of this important notice (that may have been sent to me in error), doesn’t seem to be any action I need to take at this time. Here are just some of the other languages one can request this important document in:

Getting Help in a Language Other than English

This is an important document. If you need help to understand it, please call 1-855-355-5777. We can
give you an interpreter for free in the language you speak.

Español (Spanish)
Este es un documento importante. Si necesita ayuda para entenderlo, llame al 1-855-355-5777. Podemos proporcionarle gratuitamente un intérprete en el idioma que habla.

繁體中文 (Traditional Chinese)
這是一份重要文件。如果您在理解這份文件上需要幫助，請撥打電話：1-855-355-5777。 我們可為您免費
提供一名會講您的語言的口譯人員。


简体中文 (Simplified Chinese)
这是一份重要文件。如果您在理解这份文件上需要帮助，请拨打电话：1-855-355-5777。 我们可为您免费
提供一名会讲您的语言的口译人员。


Русский (Russian)
Это важный документ. Если вам нужна помощь, чтобы понять его, позвоните по телефону
1-855-355-5777. Мы можем бесплатно предоставить вам переводчика на ваш родной язык.

Kreyòl Ayisyen (Haitian Creole)
Sa a se yon dokiman enpòtan. Si ou bezwen èd pou w konprann li, tanpri rele 1-855-355-5777. Nou ka
ba ou yon entèprèt gratis nan lang ou pale a.

বাংলা (Bengali)
এ􀎜ট এক􀎜ট গুরুত্বপূণ ন􀎺িথ। যিদ এ􀎜ট বুঝেত আপনার সাহােয􀒝র প্রেয়াজন হয় তেব অনুগ্রহ কের 1-855-355-5777
এ কল করুন। আপিন􀎭য ভাষায় কথা বেলন আমরা আপনােক িবনামূেল􀒝􀎭স ভাষায়􀎭দাভাষী প্রদান করেত পাির।

اللغة العربية (Arabic(
هذه الوثيقة مهمة. وإذا كنت بحاجة إلى مساعدة لفهم الوثيقة، يُرجى الاتصال على الرقم 5777-355-855-1 .ويمكننا أن
نوفر لك مترجمًا فوريًا باللغة التي تتحدثها مجانًا.

한국어 (Korean)
중요 문서입니다. 이해하는 데 도움이 필요하시면, 1-855-355-5777번으로 전화하십시오. 귀하가 사용하는
언어의 무료 통역사를 제공해드릴 수 있습니다.

Français (French)
Ceci est un document important. Si vous avez besoin d’aide pour le comprendre, appelez le
1-855-355-5777. Nous pouvons vous offrir gratuitement les services d’un interprète qui parle votre
langue.


Polski (Polish)
Ten dokument jest ważny. Jeśli potrzebuje Pan(i) pomocy w jego zrozumieniu, proszę zadzwonić pod
numer 1-855-355-5777. Możemy zapewnić bezpłatne usługi tłumacza w Pana(i) języku.

􁤖हन्दी (Hindi)
यह एक महत्वपूण􁭅दस्तावेज ह।ै य􁳰द आपको इसेसमझनेकेिलए सहायता क􁳱आवश्यकता हो, तो कृपया 1-855-355-5777 पर
कॉल कर􁱶। हम आपको आप जो भाषा (􁳲हदी) बोलतेह􁱹उसम􁱶िनःशुल्क दभु ािषया सेवा प्रदान कर सकतेह।􁱹

اردو (Urdu(
یہ اہم دستاویز ہے۔ اگر آپ کو اسے سمجھنے میں مدد درکار ہے، تو براہِ کرم 5777-355-855-1پر کال کریں۔ ہم آپ کو
آپ کی زبان میں مُفت ترجمان فراہم کر سکتے ہیں

And I think to myself, what a wonderful world! It really is amazing how varied and adaptable we brilliant (and sometimes irrational and brutal) wise apes are. Can you say that in Urdu?