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…

Perfect shills

shamelessness is a virtue
2024? 2024? USA! USA!!!

Barr’s core premise, absolute protection of a “transactional” far-right useful idiot president from all charges, no matter how much evidence of guilt, is untenable — unless you are the top law enforcement officer in the nation who gets to decide what is “tenable”. The lowest circle of hell is reserved for pious, bullying fucks like Barr, now on a sad-faced rehab tour trying to shill for his book on how he was right all along and the real threat facing our nation comes from Commies, anti-fascists, racist Blacks and goddamned hippies intent on forcing their perverted version of “equal justice” on reactionary white people who are the real victims.

Be audacious!

Just four great hits from his tenure as top enabler, and saucy, obliging gunsel (in the Dashiell Hammett sense of the word) of an insane two year old Unitary Executive — there is no institutional racism in law enforcement and Blacks better shape the fuck up and show some goddamned respect if they want protection from the totally non-racist criminal justice system; a peaceful protest may be broken up by force if an insane president demands “domination” of the streets; that massive voter fraud from mail-in ballots during a pandemic would occur was ‘obvious”; the lies that an insane Trump loyalist pled guilty to, twice, were “immaterial”. You know what’s immaterial, Bagpiper? You and your fucking mother. Here’s Glenn Kirschner on our less than perfect shill of the day, Bill Barr:

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.

Insight vs. a punch in the face

Gaining insight is hard, delivering a punch in the face, when provoked, is pretty straightforward.   Not to say you might not pay a price for the punch, you can break your thumb, bruise your knuckles, have the shit beat out of you, even get shot or stabbed, but the reflex to lash out when angry is pretty basic.  It’s simple, primitive, sometimes effective in dealing with a real or imagined threat.   Those who train to deliver a punch effectively learn to harden their hands, protect their fingers from damage, turn the fist just so right before impact for maximum effect. Everybody else is free to let fly, with real or metaphorical fists, like a hurtful series of words you can never take back.

Insight, on the other hand, is hard to come by, often painful.   You need to learn to see things from a perspective not your own, feel things that may never have happened to you directly, learn to study the broken pieces calmly, detached from your ingrained reactions.  Insight allows you to make connections on a more thoughtful level than our world consistently operates on.   

The level our world operates on is a well-deserved punch in the face.   More specifically, a punch in the smug, fucking face.  Insight allows you to understand the operation of life on a less reflexive level.  Gain enough insight and almost everybody may want to punch you in the face, if you’re not insightful enough to be cool about your path toward insight.

I give the example of my own attempts to not replicate what I experienced from my parents in my youth.  That is, I try to follow Hillel’s formulation of the Golden Rule.  I try not to do things to others that I hate being done to me.   All we can do is try, but trying is a step in the right direction, every time.  I hated being unfairly accused of things I hadn’t done, painted in an ugly light, I still do, as does everybody else, of course.  In my parents’ house I was constantly confronted, always portrayed as coming home from the hospital two days old angry and ready to fight, usually blamed for the anger that was always exploding all around me, and always required to fight.   I fought, and got pretty good at it, even as I understood how tragically ridiculous the nonsensical war I was drafted into was.

I have made it a long project to make myself less susceptible to my anger, less ready to react with rage.  Reading about Gandhi’s philosophy of satyagraha (not in detail, mind you) I began trying to practice ahimsa, non-harm, as a first principle.  A difficult stance, in our violent world, particularly without a religious framework and a community of fellow non-harmers, but I have found the goal very worthwhile. Trying to keep the principle of non-harm in mind has made my life better, even if I am far from serene.

If you come from a mindset of not harming others, of being straight in expressing what you need, being direct and patient, it seems to me your life will improve, particularly if you were raised in a senseless war where everybody had to fight all the time for no real reason. 

It turns out even a straightforward insight like this is very shaky in the real world.  Certain old friends will insist that you’re deluding yourself, that you may have become a tiny bit better at DELAYING the arrival of your famous fucking anger, but you are actually just kidding yourself, propped on a flimsy moral pedestal that with only a few hours of determined kicking I can topple, proving that your rage is very real and present, you fucking superior fucking asshole.  In the end, I will make you want to punch me in the face, Ahimsa-boy, proving that I and the brutal real world are right and your ahimsa pose is just gas, self-righteous fumes, no matter how much you may think you’ve improved in overcoming your reflex to respond with anger.

To me, resisting the impulse to react with anger is a net good, no matter how incremental the improvement. If in the past you would have been angry a minute into an aggravating situation, you now find you are able to go for an hour before the anger starts sapping your will to remain peaceful.   In one sense it is a huge step forward, you will find yourself doing better in many situations that would have turned to shit instantly in the past.   It is a useful skill in our world, to refrain from striking others with words or fists. 

On the other hand, to someone intent on proving that you, like them, are a piece of shit beyond redemption, beyond the possibility of meaningful change of any kind, well, in the end they will be able to grind you down.   You are not a bodhisattva, you are just trying to do better, and in the end you will reach your limit and get that look on your face that will prove their triumphant point.

Been there, done that, showing great patience with people who demonstrated that insight was not for them, that a punch in the fucking face was much more to their taste (even if beyond the limits of their physical courage), and that I, actually, rather than being less angry and provocative with my so-called insight and ahimsa was even more of a piece of shit for trying to be better than them.  Of course, and I say this just between us, I was already better than them, in terms of treating people the way I would like to be treated myself, but my goal was to be better than myself, not anybody else.  I’m not in competition, in any field you can name, except to make myself better.

Insight is the only way out of pain, outside of the usual painkillers.  It is not a magic door you can walk through, of course, it is a path you take, a goal you aspire to.  Much easier than pausing to gather yourself and trying to develop understanding is staying on the treadmill, running until your heart gives out.  Hard to blame people who recoil from introspection.  People don’t like things that cause them pain, unless they are masochists. 

Think of it this way, though — you can repeat the same tragedy over and over in your life, with minor variations, or you can learn from the way you play your part in the tragedy and do it a little bit less tragically next time.  Or, you know, you can just punch me in the fucking face, it’ll probably feel better, at least until the adrenaline and cortisol rush wears off.

The KKK Act

The Ku Klux Klan Act of 1871 was one of several laws passed to enforce the 14th and 15th Amendments. Those amendments guaranteed equal rights for all citizens and the vote for all male citizens of voting age. The Klan and other white terrorist groups were using unspeakable terror to prevent the exercise of these rights. The newly created Department of Justice sent federal prosecutors and law enforcement down south and quickly (and all too briefly) shut down the Klan and their fellow travelers using a law designed for that purpose.

At the time it was passed, the law was intended to protect Black people and members of Congress from being terrorized by the KKK. The KKK had particularly been known to use threats, assaults and destruction to influence elections and intimidate White Republicans who were attempting to participate in the reunited National Congress. The group also sought to reverse and block Reconstruction-era activities in the South that gave Black people political power and civil rights.

https://www.cnn.com/2021/02/17/politics/ku-klux-klan-act-lawsuit-trump/index.html

The post-January 6th case against Trump by members of Congress under the Ku Klux Klan Act continues, the judge ruling recently that Trumpie is a proper party to haul into court under the KKK Act. Fitting, and also, proper. If the klu (klux) fits, wear it, orange boy.

In related news, the Emmett Till Anti-lyncing Act will become law, now that Rand Paul, who apparently staged a one man filibuster the last time the bill was brought up for debate, has joined a unanimous Senate vote to send the bill to Joe Biden for signature.  Who says incremental change isn’t just the fucking greatest?  Sarah Lazurus puts it in perspective:

Congress has given final approval to the Emmett Till Anti-Lynching Act, which will make lynching a federal hate crime after only 200 other attempts.

The Girl Can’t Help It

I really don’t understand the Grey Lady, outside of as a floridly schizzophrenic purveyor of important investigative journalism and a reality shaping distortion lense.

Desperate Dems, in disarray, failing, turn to unpopular Biden for salvation. You read it in the paper of record, it must be true. Fuck me.

On the other hand, the predictable betrayal by corporate Democrats of policies to solve problems most people in the country share, based on polling, right-wing talking points and fundraising from wealthy donors, is not something that can be whitewashed, no matter how many fearful white people show up with buckets of white paint, or however plainly the influential Grey Lady paints it.

Bagpiper blows

Heather Cox Richardson, in a post describing the mounting evidence of an extensive seditious conspiracy and an insurrection to keep Trumpie in power highlighted the increased determination of the Republican Party to turn the clock all the way back to pre-Fourteenth and Fifteenth Amendment days with the so-called Independent state Legislature Doctrine. This doctrine is a variation on the old slavers’ states’ rights argument, publicly embraced by four of the Trump Six so far. The theory would allow Republican-controlled state legislatures to throw out any votes they didn’t like and send their own electors in 2024. They’d use this legal theory, codified in state law, instead of staging a series of frivolous lawsuits and launching a desperate riot. Here’s the fucking religiously and politically zealous bagpiper, William Pelham Barr:

Trump’s attorney general William Barr has just published a book detailing how Trump lied about the election and threatened democracy. And yet, on a tour to sell the book, Barr on Monday told NBC’s Savannah Guthrie that he would nonetheless vote for Trump if he were the Republican nominee in 2024. “Because I believe that the greatest threat to the country is the progressive agenda being pushed by the Democratic Party, it’s inconceivable to me that I wouldn’t vote for the Republican nominee,” he said.

Watchful Waiting

When my father was diagnosed with prostate cancer, late in his life, his doctor told him that most men who live to be eighty will develop prostate cancer but that it grows very slowly at that age and they will generally die of causes other than prostate cancer.  His doctor recommended “watchful waiting”, keeping an eye on the slow, inexorable advance of this common cancer in older men.  Sure enough, something else killed my father, undiagnosed liver cancer, though saying it that way is a bit unfair to the several highly regarded specialists he saw regularly in the last two years of his life, it actually was diagnosed, in the ER, six days before he died.   

A few decades later, I myself watchfully waiting, in this case for the results of an MRI on my prostate, an MRI done because my prostate specific antigen levels were quite high.   The test results were quickly emailed to me, along with a bill for $162 (thank you, Medicare… the US Gold Standard…) for the short visit with my urologist to set up the MRI (bill for that to follow).  I have learned that reading medical test results without knowledge can be needlessly stressful, so I am watchfully waiting for the call from my doctor to tell me what the MRI results mean for my immediate futire.

In this waiting mode you can invent stories, more or less likely, that may or may not explain the delay in hearing from the doctor — though we have no idea about any of these theories.   If it was good news, the MRI showed everything nice and benign on the old prostate, the doctor would have immediately called to tell me, no?   Since it’s not good news, next step biopsy to confirm cancer suspicion from MRI, he’s waiting to have a few minutes to talk to me since the discussion is longer than “good news, it was benign”.   If it was bad news, another theory goes, he’d have called right away.   No, wait, he’d give me a day or two in my preferred fool’s paradise before dropping the bad news that I need to have a long needle repeatedly inserted up my ass and jammed into my prostate, likely followed by cancer treatment of some kind.  Or any other story I can imagine, including a list of stories involving complications in the doctor’s own life that have caused him to fall behind in updating anxious patients.   Since each theory is equally plausible, and equally implausible, I put the whole theorizing out of mind now that I’ve emailed my doctor telling him I have my fingers crossed until he tells me what the MRI results mean.  Figure of speech, “fingers crossed”, since I am clearly typing with uncrossed fingers.

I think, philosophically, that everybody has to die of something.   I also recall the foamy urine I was seeing five years ago, foam that got so thick it looked like the head on a well-pulled pint of Guinness, foam you could piss deep holes in as you went.  Ending with a smiley face in the foam was always fun.   That foamy urine, with the swelling of the legs, turned out to be symptoms of a rare kidney disease that taught me a new word — “idiopathic”.   What does idiopathic mean?   It means we don’t know what causes it, as to the pathology of this disease we are, as they say, idiots.  As to the cure?  33% of the time a short course of chemotherapy (at around $25,000 a bag) knocks it out, and I was in that lucky 33%, and lucky too that Obamacare hadn’t been repealed.

That constant itch on the inside of my left scapula?   A dermatologist told me the name several years ago but I never retained it.  It’s neurological, not topical, I recall that — put what you like on the skin, the itch is caused by a signal sent from a nerve, so nothing will really help with the itch, outside of a good scratch, which I was advised only makes it worse.  In the Age of Surveillance Capitalism we live in, I was discussing this itch with Sekhnet, as she scratched it, and soon had videos about Notalgia Paresthetica sent to me, for my edification, or shopping pleasure.

Fucked though so much of this world is, designed by the greediest for the benefit of the greediest, with applause and hero worship for the most successfully greedy, the mass of humanity not only viciously screwed but driven mad by deliberate lies that benefit the worst people alive at any given time, spread with increasingly ridiculous ease by those paid to do it, for the enormous profits of selected far-sighted tech billionaires … we don’t want to leave it.  This miraculous world is not the problem, the problem is that we must all leave it one day.  The only consistently useful practice available to most of us is taking care of ourselves and our loved ones as well as we can, and watchful waiting.