Procedure Codes

I suppose one way providers can fight back while being paid 20% of their billed rate for services is by skillfully working the procedure codes. I may be wrong, but I suspect this may be the case. The thought never occurred to me until yesterday when I got the approval from Healthfirst for the minor surgical procedure I had two weeks ago.

I had diagnosed the tiny cancer cell on my nose myself. I had only felt that intermittent slightly stabbing pain twice before. Each other time it had been a basal cell on my nose. The growth was so tiny that neither the dermatologist nor the surgeon she sent me to could actually see it. I pointed to a spot on the bridge of my nose under which the basal cell, its visible part about the size of a pinprick (if the pin is very sharp), was slowly growing. The surgeon told me that since we’d caught it so early there would be no need for a skin graft, just a couple of tiny stitches that would leave no scar.

The surgery was painful, due, according to the red haired surgeon, to the skin sensitivity of people with red or reddish hair (my beard, before turning white, was red). It turns out the surgeon had made a slit the length of my nose, dug out the basal cell from underneath, and left a line of large black stitches about the size of an eyebrow, from my left tear duct to the top of my left nostril. When I first changed the bandage I had a bit of a shock at the size of the incision to remove something smaller than the period at the end of this sentence. Sekhnet, of course, had a theory about why the long cut was the right thing to do.

Tomorrow I go to get the stitches out. Yesterday I received approval from Healthfirst for the procedure, which they informed me would be good between the two dates indicated (first date about four weeks ago, the second date rapidly approaching). They approved five separate procedures:

17311 MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS

17312 MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYL)

13152 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM [1.02362″ TO 2.95276″ –ED]

14060 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS [3.93701″]

14061 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM [3.93701 SQ INCHES TO 11.811 SQ INCHES– ED.]

Could all be on the up and up, I suppose. Until they start digging they don’t know if that tiny tumor will be less than an inch across or the size of 30% of my face. Fair enough. The rest of that stuff, I’m not sure about. Maybe it explains why the incision came so close to my left tear duct, where the stitches start. Maybe I am just so bitter about corporate medicine, and so aware of the psychopathic nature of the corporation, that I just suspect the worst from these “persons”. As for the humans– I think about the surgeon’s failure to provide me with pain medication after a surgery she acknowledged was painful for me, as it would be for her, But why be judgmental?

Still, you know, it makes sense, from the point of view of the provider, being squeezed and nickeled and dimed on their bills by powerful insurance companies, to bill for every possible procedure. The eyelid adjacent stuff may be very lucrative, for all I know. Who am I, who has never run a successful business, never been an entrepreneur, never had to answer to a room full of very wealthy, pissed off shareholders, to opine about anyone’s business practices?

Hopefully there will be little pain tomorrow when I get the stitches out, that I won’t find it necessary to ask the surgeon any pointed questions, and that, true to her word, the long line of stitches will leave no scar. Otherwise I’ll get me an eyepatch, and a parrot, and limp down the street cursing their salty, scurvy wives and unwashed ill-reputed mothers. Arrrgh.

Explanation of Benefits

You’ve got to love the in-your-face shamelessness of the American profit motive. Check this one out, for your health, which is a lucrative commodity in our exceptional economy, even as many continue to die every day for failure to sufficiently monetize their own self-worth. I believe the numbers in this story will blow your mind.

American medical treatment, famously expensive, is generally paid for through private insurance companies or government insurance schemes like the Veteran’s Administration, Medicare and Medicaid. It would be foolish for an American to seek any kind of major health treatment without insurance, it’s a recipe for lifelong debt and/or bankruptcy. With insurance, pay enough every month, and on time, and you’re pretty much covered, much of the time. Like a good patriarchal neighbor, the insurance company will step in and negotiate for you.

After any medical service the insurance company sends you a chart called the Explanation of Benefits, or EOB. The EOB tells you, for the first time, what the medical facility charged you for treatment. The next column informs you what the insurance company agreed to pay, the rate negotiated between the insurance company and the ‘provider’ (or ‘doctor’ to us old fashioned folks). The next column tells you what the insurance company actually paid of this negotiated rate and the amount of that rate applied to the deductible, or MOOP, if applicable, and then what you owe.

As I’ve noted here before, under the Patient Protection Act the doctor or medical facility cannot tell you the price of treatment until everyone gets their EOB. The insurance company cannot tell you the price prior to treatment, because, until they get the bill from the provider, they don’t prepare the EOB. Go to the restaurant, order what you want from a menu without prices, or the specials (waiter can’t tell you the prices), and we’ll bill you for the entire amount a month or two from now, no problem. If you pay monthly meal insurance premiums, we’ll make sure the restaurant doesn’t gouge you too badly. This way everyone makes money!

When I went for my first infusion of rituximab (or rituxan) I learned something cool. I was presented with a contract to sign before I was sent upstairs for treatment. The last section claimed, on my behalf, that I’d been informed of the price of the rituxan treatment I was about to get and that I agreed to pay the full price if insurance refused to pay any part of my bill. I returned to the woman behind the desk, pointed to the language and asked her what the price was. She told me, in a friendly way, that she had no idea, that they’d tell me upstairs.

Here’s the cool thing I learned. I circled the bullshit language about being informed of the price and crossed out the signature line, with the full approval of the woman behind the desk. She smiled, nodded, photocopied the contract and handed me my copy. I went upstairs for treatment. They also had no idea what the price of the treatment was. We’d all heard it’s very expensive, that’s all we knew.

Six weeks after the first infusion I got the EOB. For some weird reason I owe $33.54. A couple of five dollar charges, a twenty, and some change. The total bill for the first of two treatments was $44,129.58 — putting the total for the two infusions at over $88,000. The loose change I owe is the full negotiated price for the injection of methylpredinosone/sodium succinate, billed at $14.38. For some reason insurance won’t pay the negotiated $3.54 for that shit, you know. Why would they? Fuck that shit — you pay it.

Here’s the thing, though. The full retail sticker price for the infusion of rituxan turned out to be $33,730.20. Guess what the insurance company paid? It might be fun to guess, so I’ll hide the Amount Covered by Plan in this footnote, if you’d like to play at home [1]. It gets better, somehow. The chemotherapy administration, intravenous infusion, was billed at $6,910. Play along with us at home, won’t you? The amount I am responsible for is at footnote 2. Take your wildest guess what part of that I owe. [2]

Everyone will tell me, correctly, that I’m lucky to have insurance, fortunate that I paid last month’s premium on time, didn’t get bounced off insurance before they could pick up all but $33 of the more than $40,000 I was billed. This time it was a damned good deal.

The larger question, of course, is what the fuck? What is a fair and reasonable price for the medical treatment I received? Is that question really unanswerable? Is the total mystery of the price really necessary so that everyone makes maximum profit? I don’t get it. The provider was satisfied to get less than 20% of what they billed as full payment for the expensive, possibly life-saving treatment they provided? Pennies on the dollar, as President Trump likes to say about paying to settle something like the fraud case against him for Trump U (“Hey, Trump YOOOO, assbite!”).

They sued then candidate Trump for $40,000,00 and, through the art of the deal, he paid a mere $25,000,000, or pennies on the dollar (a mere 62 pennies on the dollar), to make the problem vanish forever. But one would have to agree, my insurance company did a much, much better, and a far more artful, deal for themselves, and for me (see footnotes).

Look, I get that corporate capitalism is an amoral predator with only one aim– to make money by the bushel, cut any possible corner to make more profit, and have a team of top notch attorneys poised to fight regulators and liability for any expensive harm the entity causes, any fraud it commits, pay as little as possible for any deaths it causes. It’s all understandable. The business of America is business, as America’s wealthiest often say.

The greediest and richest are indisputably entitled to unlimited acquisition, to as many luxury homes, private planes and yachts as they like, while the takers, well, they get what we grudgingly give the fucking parasites. In America every parasite has a cell phone and a refrigerator, and a TV, and they’re all still bitching, and taking drugs, and having children out of wedlock. While the children of billionaires will soon no longer have to worry about being taxed so much as a penny on every dollar of the unimaginable fortunes they will inherit.

Of course, the children of the super-rich deserve every inherited nickel for being natural aristocrats in the land of the free and the home of the new landed gentry. That blessed top 0.2% (two tenths of the wealthiest one percent, that is), the children of our most successful money acquirers and hoarders (“job creators”), is finally on the threshold of liberation from that scourge of the children of the super-rich, the hated Death Tax. If you’re born poor, well, suck it. If the choice is five or ten ‘to die for’ homes for me — and I really need just one or two more, got my heart set on a sweet little pied a terre in Paris — and zero homes for you and your parasite children — is it really a choice?

I’m not going to change any hearts and minds here among the handful who stumble on these words. All I can hope to do (while noting my own monstrous ingratitude for the great medical deal I just got) is set the outrageousness of this set up out as clearly as I can. What the fucking fuck? Is this really the best Americans deserve? In our exceptional nation, the likes of which the world has never known? God shed his grace on thee, motherfucker, and if you don’t believe it, curl up and die somewhere for all the rest of us fucking care. Have a nice day! Have a blessed day!

[1] $7,475.70 of the $33,730.20 billed, every red cent paid by Healthfirst. 22%, baby!

[2] $5. Healthfirst ain’t paying jack for that one, but they got me a pretty sweet deal, I have to say. Knocked the price down from $6,910 — to five bucks. I’ll take it, I guess. Talk about pennies on the dollar… 0.0007 pennies per dollar!!! Suck on that, Don, you fucking loser.

1945

An old friend recently told me of a film called 1945, a production making the rounds in selected cinemas. He said he thought it was available on Nexflix, where I recently saw the 57 minute documentary. [1] He didn’t want to spoil it for me, but told me it’s a remarkable piece of work, as I recall he said it used until recently unknown footage from right after the war, in the summer of 1945. He told me it was well worth checking out.

I preface this short discussion, which I place under the category of Ahimsa, to say that as a guide to one’s own life, there is no more admirable path than non-harm. We don’t need to kill other creatures in order to eat, we don’t need to browbeat those we disagree with, we don’t need to break heads. There are alternatives to each of these things. You can live well on a vegan diet. You can mildly and directly make points in a conversation with somebody you might be tempted to browbeat. You can usually leave the room when the temptation to break somebody’s head is about to become unbearable. I think Ahimsa works beautifully with “what is hateful to you, don’t do to somebody else” the classical Jewish statement of the Golden Rule, formulated by Hillel.

If you are stuck in a room, or a prison, or a camp, or a city, where violence is the rule and your survival is an open question, Ahimsa begins to seem like less of an absolute. If you are starving to death you are as likely as not to eventually kill an animal and eat it (or have someone else kill it, butcher it, and cook it, then you can eat it). Few fellow vegans would be self-righteous enough to fault you for it. If someone slaughters your family, and then comes for you, a Gandhian smile of resignation is probably not the best move. Contrary to what the Great Souled One urged on the Jews in the path of Germany, Nazi-types will never be moved by Soul Force.

In the face of certain brutality, only physical force is useful. Brutes know this instinctively, from having been humiliated enough to become violent. The Nazis did not come to power in Germany on the strength of their ideas– they came to power because they were the most ruthless, determined and disciplined head-breakers in Germany. They knew that many people who feel powerless admire, and will identify, with decisive, brutal action portrayed in a heroic light. As for the rest, only a few heads have to be broken publicly before the rest will fall into line. The Nazis did far more than break heads, they had camps waiting for anyone who opposed them in any way. Many were killed, starved and brutalized in these camps.

One of the Nazi goals was lebensraum, “living room”, defined by google translate as “habitat” which is also a synonym for heimat, which translates to “homeland”, a phrase modern American fascist types adopted after the attacks on 9/11 that apparently changed history forever. Nazis invaded Poland, in a brutal and unprovoked blitzkreig, and enslaved the Poles, taking their best land for ethnic Germans. They also killed most of Poland’s three million Jews while they were there. The Nazis set the standard for ruthless regimes, we compare all such regimes to those murderous, enslaving no-holds-barred motherfuckers.

1945, using film noirshot after the German surrender, in the months immediately after Mr. Hitler poisoned Eva Braun, and his dog, and shot himself in the mouth, documents what the filmmakers call “the largest episode of ethnic cleansing in history.” Twelve million ethnic Germans, we are told, were displaced, very badly treated and up to a quarter of a million killed. Worse ethnic cleansing than the one immediately preceding it? There’s an argument to be made there.

There are films of atrocious conditions for ethnic Germans forced to flee their new homes, after only five years as lords and masters. Thousands died on forced death marches back to the old heimat. As many as 250,000 lost their lives in those terrible post-war months. In a soccer stadium, in front of a huge Czech crowd, German men were forced to remove their shirts. The twenty one men with SS tattoos (the SS were the most fanatical of the Nazis, the elite units personally loyal to the Fuhrer) were brutally beaten to death, sadistically, revived with a bucket of cold salt water to the face, beaten again, revived again, beaten until they were dead. Children were starved. Several of the survivors cry as they recall what they were subjected to by the brutal “victors” of history’s then most brutal war.

I have to say, I watched this all pretty much unmoved. Which surprised me. I couldn’t feel much sympathy for these victims. I wondered, more than once, why no mention was made of the ethnic cleansing so recently undertaken by the German government. There was no mention, by the BBC narrator, of the extermination — or even the existence– of so many Jews, homosexuals, Slavic slave laborers and other untermensch enemy of the state types. [2] There seemed to be no concession to human nature on the part of the filmmakers who describe this brutality as something as abhorrent and incomprehensible as that shown by the Nazis.

I realize I am not a disinterested observer. Nazis marched through the areas where my grandparents on both sides came from. When the German army and the SS were done marching through the Ukraine and Belarus, everyone besides my four grandparents in New York were dead. So beating a few SS men to death for the amusement of a vicious crowd of people recently liberated from Nazi rule does not sound so bestial. I understand it was horrible for the German men standing shirtless in the stadium as the most fit and brutal among them were beaten to death, but I found myself philosophical about it.

The experience of watching the documentary and my reaction to it made me understand something troubling about the human condition. We may be lifelong opponents of torture and sadism, of capital punishment. But show us the perpetrators of our family’s slow death by starvation, torture and finally shooting and we will, if given the chance, fuck those people up. This is one of the horrors of the human condition– this limitation of our powers of empathy that fuels the endless cycle of righteous rage and violent revenge.

I get a chance to ponder this horror several times every day, as our Divider-in-Chief regularly throws bloody meat to his irrational “base” and the shrewd billionaires who put him into office. I don’t generally cheer for the idea of anybody having a painful, prolonged heart attack in the middle of an incoherent world-televised live speech. But if it has to happen…. if you know what I’m sayin’….

[1] Oy yoy yoy! This BBC production is not the movie my friend told me about! I went to check the title for the BBC subtitle (“The Savage Peace”) and found this film, also called 1945, with a Rotten Tomatoes score of 94%, the one my friend urged me to see:

On a summer day in 1945, an Orthodox man and his grown son return to a village in Hungary while the villagers prepare for the wedding of the town clerk’s son. The townspeople – suspicious, remorseful, fearful, and cunning, expect the worst and behave accordingly. The town clerk fears the men may be heirs of the village’s deported Jews and expects them to demand their illegally acquired property back.

Guess I’ll have to go to the Lincoln Plaza Cinema to check it out.

[2] A friend pointed out that the BBC occasionally displays a highly refined, almost irreproachably subtle, version of well-born anti-Semitism.

Mettez le crayon sur le pupitre

My sister and I both took French in school. Any time the subject came up our father would chirp “mettez le crayon sur le pupitre”. Put the pencil on the desk.

Years later, when the subject of French came up in my uncle’s house my uncle immediately chirped “mettez le crayon sur le pupitre.” My sister and I both laughed.

My uncle explained: we had the same French teacher.

Congratulations, Alabama

Alabama seems to have narrowly avoided national shame today by not electing the Ayatollah of Alabama to the U.S. Senate. News of the result in the Alabama special election was a relief with an aftertaste of hope. Negative campaigning and bullying alone may not carry the day right now in American elections. We’ve all had a long look at the results when the most adept at innuendo and insult attain high office. Unaccountable, unqualified people in office, incompetent stewards of our resources and rights, doing a bad job.

Congratulations to Senator-elect Doug Jones, congratulations to the voters of Alabama. Congratulations to the Alabama Election Commission for integrity and to the Alabama Secretary of State for not suppressing the vote to the extent that a fundamentalist Christian thug, twice removed from the bench by his fellow judges in Alabama for flagrant contempt of the Constitution, could be elected to represent you in Washington, D.C.. As I write this, with all 67 counties reporting, the projected margin of victory is less than 2%, currently less than 21,000 votes. This one has been a squeaker. It turns out the GOP was right to try to suppress black and Latino votes: Jones got virtually all of the votes that “minorities” were able to cast in Alabama. Moore had 70% of the white vote, naturally enough.

In a defense related to Moore’s dismissal of accusations by women he creeped out when they were teenagers, and he an adult assistant district attorney, I think Mike Huckabee’s daughter, the press secretary who replaced Sean Spicer, said it all yesterday in her defense of Donald Trump in the face of renewed allegations of unwanted sexual contact brought by now nineteen women. It underscored the Trump/Moore lawless approach to governing and the rule of law. She said, in essence: “y’all voted him into office and the question of if he did or did not years ago grope those women who are accusing him again now is irrelevant.” Following her, eh, logic, I guess the fact that Moore was defeated means those women weren’t lying about his unwanted sexual attention when they were in high school.

I was delighted to find a complete transcript of the recent press conference where this issue was discussed fully provided on whitehouse.gov.

A grateful thank you to the Trump administration for this unexpected and very welcome example of full government transparency. I wish the policies of Obama and Cheney had been anywhere near this transparent:

Francesca.

Q Thank you, Sarah. I wanted to ask you about the women who came forward today against the President. They first were on a television show and then they were at a press conference. And they said that he should resign, and then also that there should be a congressional investigation. And I know that you’ve said that this has already been litigated in the last election, but I wanted to get your specific reaction to this idea that there should be a congressional investigation into this.

MS. SANDERS: Look, the President has addressed these accusations directly and denied all of these allegations. [1] And this took place long before he was elected to be President. [2] And the people of this country, at a decisive election, supported President Trump [3] , and we feel like these allegations have been answered through that process [4].

Kristen.

MS. SANDERS: Sarah, thank you. I want to follow up on that. But first, a little bit of breaking news we just learned about: The Pentagon apparently will now allow transgender people to enlist in the military beginning January 1st. Your reaction to that? And any follow-up action you’re going to take?

MS. SANDERS: Yeah, as of right now, they’re simply complying with a court order and preparing to implement a previous policy to remain in compliance. The Department of Justice is currently reviewing the legal options to ensure that the President’s directive can be implemented. [5]

And for anything further and any specifics on both of those matters, I’d refer you to the Department of Defense and the Department of Justice.

Q Okay, and one follow-up —

MS. SANDERS: Sorry, Mara.

Q One follow-up very quickly on — just very quickly, Sarah.

MS. SANDERS: Sorry, Kristen. Mara, go ahead.

Q Can I just ask you about Nikki Haley’s comments saying that the President —

MS. SANDERS: Mara, go ahead.

Q I’ll pick that up for you, Kristen.

MS. SANDERS: She’s going to pick it up for you.

Q Nikki Haley, as I’m sure you know, said, when asked does the election mean that’s a settled issue — which you’ve been arguing from the podium here — she said, “I know he was elected, but women should always feel comfortable coming forward and we should all be willing to listen to them,” specifically referring to the accusers of the President. Does the President agree with her?

MS. SANDERS: Look, as the President said himself, he thinks it’s a good thing that women are coming forward, but he also feels strongly that a mere allegation shouldn’t determine the course. And, in this case, the President has denied any of these allegations, as have eyewitnesses. And several reports have shown those eyewitnesses also back up the President’s claim in this process. [6]

And again, the American people knew this and voted for the President, and we feel like we’re ready to move forward in that process.

Q But he thinks it’s a good thing that the women who accused him are coming forward now, again?

MS. SANDERS: The President has said that it’s a good thing for women to be able to feel comfortable in coming forward, generally speaking. [7]

Jacqueline.

Q I just want to go off of that, Sarah. But the President told Howard Stern in 2005 that he had walked into a teen beauty pageant dressing room where he said that teen contestants had no clothes on because he could sort of get away with things like that. Is that not an admission of sexual harassmen

MS. SANDERS: Look, the President has spoken about this directly. I don’t have anything further to add on the process.

Q And the American public —

MS. SANDERS: We’re going to do one question today, guys, to move around.

Q Two ISIS attacks in New York City — or ISIS-inspired attacks in New York City just recently. Is the President concerned that there is a growing threat against people inspired by ISIS who have been radicalized online?

[1] Trump responded that all the women telling similar stories about him are liars, threatened to sue all of them in court, claimed he never even met most of them and scoffed that half of the ones he did meet were dogs he’d never dream of trying to stick a finger up, the thought itself being repellant to him.

[2] And that matters why?

[3] An election Trump lost by almost 3,000,000 votes and won by a razor thin 70,000 strategically placed votes in five key states that garnered an Electoral College margin of victory.

[4] Sarah, how does the process of this narrow, brilliantly calculated and executed Electoral College victory have any relation to the question of whether or not Trump did what he boasted of? Nineteen women tell similar stories about a groping, molesting person entirely consistent with the Boor-in-Chief’s public persona. What does his magically narrow Electoral College defeat of an intensely disliked opponent have to do with whether he forced himself on these women?

[5] This item, while offered mainly to change the subject, means that Trump’s petulant, sensationalist tweet about banning transgender persons for the U.S. Armed Forces was just another impulsive presidential tweet and that there will be no change to existing law on the military’s policy of allowing transgender enlistment.

[6] What on earth does this actually mean, Sarah? Was Trump himself the eye witness who corroborates that he didn’t do what the women said he did?

[7] Although all the women who had accused him were, in fact, complete liars trying to cause irreparable harm to his good name, nasty women he promised to sue in court for defamation, plus, he never met them, or if he did, most of them were dogs he wouldn’t molest with a ten foot poll.

Alabama’s Voter ID Law

There is an ongoing federal lawsuit in Alabama, brought by the NAACP and others, over restrictive voter ID laws in the state that the plaintiffs claim are voter suppression measures disproportionately targeting black and Latino citizens. Here is a short description of the lawsuit from the Alabama Public Radio website (in other news, did you know W.C. Handy is known worldwide as the Father of the Blues?)

Here are legal papers from the lawsuit itself, plaintiffs responding to the Alabama Secretary of State’s motion to have the case dismissed for lack of triable issues of fact.

Trial was set for September 11, 2017, according to the APR piece, but it seems the trial is now set for February, 2018. Oh well. Here is a recent op-ed by a guy who heads a church group fighting the Alabama voter suppression measures. He does not even mention Alabama’s closure of more than thirty DMV offices where many voters could have secured the newly required photo IDs. Nor the closure of some voting sites in majority black and hispanic precincts.

Fortunately we live in a land of law, (he said sardonically). Here is one shining example of the Supreme law of the land in the land of law we live in:

When a man has emerged from slavery, and by the aid of beneficent legislation has shaken off the inseparable concomitants of that state, there must be some stage in the progress of his elevation when he takes the rank of a mere citizen, and ceases to be the special favorite of the laws, and when his rights as a citizen, or a man, are to be protected in the ordinary modes by which other men’s rights are protected.

(from the Civil Rights Cases, 1883)

You may have to wait ninety years or so for your taste of justice, as these special favorites of the law had to, starting 18 years after the end of the Civil War, but doesn’t that just make it taste sweeter?

(Rhetorical question, no answer required.)

In a closely contested election, the more votes of your opponent you can cause not to be cast, the better your chance of a narrow victory you can call a mandate. It’s tempting to say, looking at some of the in-your-face racist bullshit that puts on the finery of American law in our great post-racial society, that this country is doomed. Think about it, though. We are probably no more doomed than the rest of the world that the powerful psychopaths at the helm are so heedless about destroying.

They’re doing a hell of a job, Brownie, hell of a job.

Just for Fun

You’ve got to love these top ten lists. America is into rankings, big time. Our entire culture is based on competition and the myth of the big, happy winner and the pathetic, miserable loser. The competition is not always fair, admittedly, and the rankings are not always accurate or verifiable, but let’s play a little game I just thought up (instead of jumping out of my skin, my only other option at the moment.)

Bear in mind that these rankings were reported in that notorious Commie rag Forbes (note how their “rankings” diverge from the alleged source of the article — check out the sad case of Colorado, for example [1]), so take that into consideration when playing, but play the game along with us anyway, it’s fun in a sick way. We’re seeing how the top ten in education and the bottom ten in education cast their votes in the 2016 Electoral College.

Ranking the states for educational attainment, based on some formula you can read about in the linked Forbes piece, you get the top ten (one to ten) according to Forbes: Massachusetts, Maryland, Colorado, Connecticut, Vermont, New Hampshire, Virginia, Minnesota, Washington, New Jersey. Their votes in the Electoral College equal 90.

The bottom ten are (bottom to top): West Virginia, Mississippi, Louisiana, Arkansas, Kentucky, Nevada, Alabama, Tennessee, Texas, Oklahoma. These states represent a total of 104 Electoral College votes, Texas with an outsized 38.

Top ten best educated states? All ninety electors went to that nasty woman, loser Hillary Clinton.

Bottom ten worst educated states? 98 of those 104 Electoral College votes went to America’s greatest winner, and the most popular president in human history, Donald J. Trump.

Only Nevada with its six electors bet against the former casino tycoon, fucking up the wonderful symmetry of this diverting game.

Here’s the 2016 electoral college map, if you want to fill out the rest of the board.

Thanks for playing, y’all.

[1] Colorado is either #3 or #14, depending on whether you believe Forbes or the report by an outfit called Wallethub that its article is based on.

A Note About the Power of Words

This point hardly needs belaboring– what you call something matters, often very much. For example, the phrase “sexual harassment” did not even exist until fairly recently when female lawyers coined it and began advocating for laws against it. Before that time, unless a woman had been raped, or subjected to other forcible sexual contact, in front of witnesses, she had little to no legal recourse for something like a “male chauvinist” boss caressing her ass over her skirt, complimenting her breasts while licking his lips, pressing against her, perhaps even sliding his grubby hand down her shirt and kissing her. Threatening to fire her, or actually firing her, if she objected to him continuing to do all these things, and other things too, wink, wink — no harm, eh, no word for the harm, no foul! LOL!

There was not even a word for these still common little practices, they were, until some time in the late 1970s, 80s or 90s, something the law considered de minimis, and, as we all know, de minimis non curat lex. The law don’t make laws against things we don’t even have a word for, sob sisters. Ah, for them good old days when America was still great.

We can all rattle off phrases that were created at great expense to shape political discourse — if we can apply that term, which implies a reasoned back and forth conversation, to American politics. Death Tax, Death Panels, Right to Life, Tax and Spend, Enhanced Interrogation, Right to Work, States’ Rights, Special Rendition, AUMF, Signature Strike, Collateral Damage, Friendly Fire, Climate Change Skeptic, Intelligent Design, Birtherism, blah blah blah.

Here’s one that just got to me, hearing a discussion about so-called evangelical Christians who support an Alabama bigot running for the Senate in a special election. This candidate claims it was God’s vengeance on American sodomites and blasphemers what caused the attacks of 9/11/01, though he hates Muslims too, and believes his fervor for the teachings of Jesus trumps any direct order of the U.S. Supreme Court, even in executing his duties as an Alabama Supreme Court justice. He was twice removed as Chief Justice of the Alabama Supreme Court, by his fellow Alabama state judges, for unrepentant contempt of court orders. [1] Like the affable idiot Dubya, he takes his orders from a higher father. Law and Order, yo, as he waves his wife’s little gun at a campaign rally and the audience erupts in applause.

Anyway, the word that got to me, as much as the fucking f-word, or the n-word itself (let’s all agree to ban the hateful word, shall we, instead of honestly dealing with its long, ugly history and ongoing American legacy) was Democrat. We now have Republican values and Democrat values, the Republicans are no longer ceding the adjective “democratic” to the party that spawned the Klan while they, the Party of Lincoln, were fighting to abolish the Peculiar Institution.

Note that subtle, but strong, implication of saying “Democrat” values instead of “Democratic”. No more moral high ground for you, motherfuckers. Note that we hardly even notice it at this point, the usage has become ubiquitous. It was not in wide use until fairly recently. There was always the Republican candidate and the Democratic candidate, the latter could also be called the Democrat, as opposed to the Republican. But the D-word’s use has expanded, it seems to me. It is used in its noun form, weaponized as an adjective, in a pejorative sense, often not undeservedly so, mind you. It is generally spoken with a southern inflection, think of George Dubya Bush saying it, leaning derisively on that last syllable, Demo-CRAT. It can be tastefully followed by a well-aimed lunger into the old brass spittoon, for emphasis.

Words matter, sure, but if you say ’em right, you can make a polite word just as potent as a darned fighting word, an ‘invitation to exchange fisticuffs’ as the fancy pants on the Supreme Court styled it. Say the “n-word” with the right emphasis, boy, and it’s as good as using the old one, “nigger”, a word that will get you fired now faster than you can say Jack Robinson. That was another of them politically correct, liberal Democrat triumphs, taking the castrating shears to our cherished vernacular. How you like your damned n-word now, n-word?

Alabama Republicans can only thank the good Lord that nobody has a tape recording or video of Roy Moore saying the “n-word” for real. Y’all would still have to double down and vote for him, but it would be a much harder pull than just against a handful of fifty-something year-old women claiming Moore felt them up when they were teenagers. He said he asked their mamas every time, before he gave ’em a ride in his car and started sweet talkin’ ’em. Plus, how come, if there was any truth to these anti-Christian lies at all, they didn’t start defaming his Honor’s good name with this forty years ago?

He’s the Law and Order candidate, unlike that one the Democrat party is running, Doug Jones. All Jones ever did is prosecute some old men who, when they were young, blew up some little colored girls in a church. If Alabama can keep enough coloreds from voting tomorrow, Moore has a fair shot at becoming Alabama’s next U.S. Senator. The Supreme Court itself said we now live in a post-racial society where coloreds are done being the “special favorites of the law.” [2] No need to enforce the Voting Rights Act down there, Lord no, as the Roberts Court so ruled. Do not insult our honor, sir!

States rights, except when it comes to carrying my concealed handgun in Times Square and all over the liberal states that hate the Second Amendment, to make sure it’s ready to fire at bad guys with guns. And, of course, when it comes to federal action against the most dangerous and evil drug the world has ever known– marijuana. Oh, yeah, and Monsanto selling its toxic agricultural products wherever it wants and fuck the wishes of local fucking hippies.

Don’t forget to vote tomorrow, Alabama. You may be number 44 (out of 50) in educational attainment in the U.S. for 2017, but there are still six states with worse outcomes for students (though five out of the six voted for Trump too). Surprise us, Alabama.

[1] how he crawled back to his Chief Justice post after the first time, I have to check out some time, though I suspect the good, white, Republican Christians of Alabama re-elected him.

[2] This phrase is from a famous 1883 Supreme Court ruling in the mischievously named Civil Rights Cases that decided the former slaves no longer needed federal protection under the Fourteenth Amendment and the legislation passed to enforce it. The 8-1 decision, written by long-winded racist douchebag Justice Joseph P. Bradley, contains this immortal paragraph which was, for the better part of a century, the law of this great nation, back when we were still great:

When a man has emerged from slavery, and by the aid of beneficent legislation has shaken off the inseparable concomitants of that state, there must be some stage in the progress of his elevation when he takes the rank of a mere citizen, and ceases to be the special favorite of the laws, and when his rights as a citizen, or a man, are to be protected in the ordinary modes by which other men’s rights are protected. There were thousands of free colored people in this country before the abolition of slavery, enjoying all the essential rights of life, liberty, and property the same as white citizens; yet no one, at that time, thought that it was any invasion of their personal status as freemen because they were not admitted to all the privileges enjoyed by white citizens, or because they were subjected to discriminations in the enjoyment of accommodations in inns, public conveyances, and places of amusement. Mere discriminations on account of race or color were not regarded as badges of slavery….

read a more detailed account of this immortal piece of jurisprudence, including Justice John Harlan’s forward-looking dissent here

Please continue to hold

‘You would have loved this shit, dad. Now that we all have cell phones, in our pocket or charging next to the bed while we sleep, you get calls around the clock from companies you do business with,’ I told the skeleton of my father.

“That’s the American way, Elie,” said the skeleton brightly. “The business of America is business, and you can take that to the bank.”

Yah, mon, 9:30 a.m. Saturday I got another call from the Internet Service Provider that has a monopoly in my neighborhood. I had two more today, with important news about my internet account.

“Courtesy calls, Elie,” said the skeleton, “Jesus, you’d complain if you were hung with a new rope.”

I know, I know. Anyway, they’ve called six or seven times the last few days. I figured there might be some problem with the robot that processed my most recent payment, plus a ten dollar late fee, not on my bill, that the robot had informed me was imposed.

“A brand new rope, Elie, and here you are bitching…”

It’s my way, dad. Anyway, the folks at Speculum were much faster than the Student Loan people, whose recording thanked me over and over for being such an important customer and read me information about how to pay them while reminding me that all of their representatives were still busy helping other customers.

“Jesus, Elie, the problems of the living are tedious….”

I’m hip. Anyway, it was only five minutes and thirty-nine seconds before the Oklahoma Student Loan servicing corporation put a human on the line.

“You actually timed it, you petty, seconds counting bastard?”

The phone times it automatically, it’s right on the screen while you’re listening to muzak and ads and being thanked for your time and politely reminded to please hold, that all representatives are currently still busy helping other customers.

“The technology truly is amazing,” said the skeleton. “I can’t tell you how fascinating all this is to a dead man.” The skeleton turned to watch two squirrels leaping after each other in the dead leaves.

“At least they didn’t refer to you as a ‘guest’, like at so many retail establishments now.”

I used to say, ‘if I’m a guest how come you’re trying to take money from me? Not a very gracious host, is Bed Bath and Beyond?’. In the beginning it got a smile from the cashier, by now it’s just a stony expression and the predictable, deadpan “credit or debit?”

“May I help the next guest?” said the skeleton.

Yeah, so anyway, the guy at Speculum was quick to pick up. He asked my name, which I spelled.

“A last name unique in the United States, at least as far as Social Security is concerned. That was verified by your uncle Paul Widem, my brother, and long-time Washington D.C. government insider. You can remind your readers that ‘Widaen’ was mistakenly written on my birth certificate, it was an invention coined by a nurse at the hospital with the nodded approval of her collaborator, the illiterate patient, my mother. It became my name, and later our nuclear family name, only once I got into the army.”

Yeah, true. So, anyway, I spell the name for him and he types it in. Then he says ‘do you have an account with Speculum?’

“I have to admit, this is even more interesting than watching the leaves turn color,” the skeleton of my father said, pointing up to the tree over his grave, stretching out limbs and branches bare of leaves.

I read the kid my account number and he tells me…

“That you’ve received a series of courtesy calls, dear guest?”

Close. That because I am such a loyal customer Speculum has been calling me around the clock to reward me with a special promotion.

“Ah!” said the skeleton.

I tell the kid, listen, I don’t have a land line or a television set, so I don’t need phone or cable service. I’d appreciate being taken off the promotions list for these bundles. Then, because I’d just spent ten minutes getting useless and incomplete information about the repeated courtesy calls from the private Student Loan servicing corporation (they hadn’t yet received the payment I sent last week, had no record that I need to immediately re-certify my income to stay on the new income-driven repayment plan), I couldn’t help myself.

“That’s my boy,” said the skeleton, “chip off the old crock.”

I told the kid the CEO of Speculum makes $98,000,000 a year, highest paid CEO in the U.S., and that all of the unionized technicians are still on strike, that Speculum, which has a monopoly in my area, has raised my rates every single year so that I am now paying almost double my “promotional” rate from three years ago, plus a brand new 25% late fee if you pay after a due date that does not appear on your invoice.

“Fair is fair, Elie, they have a monopoly, what are they supposed to do? Give you a break, sucker?”

One of us born every minute, dad. Anyway, the kid tells me he’s sorry for all the calls about the promotion and that he’ll take my name off the promotions list. Then he informs me it will take up to thirty days for the calls and letters to stop.

“Is there no end to this courtesy call, Elie?” the skeleton said.

Yeah, that’s it.

“So this was just a courtesy call?” said the skeleton.

Basically, yeah. No action on your part is required. However, if you wish to take action, we couldn’t care less, knock yourself out, be our guest.

“Action-taking knave,” said the skeleton.

I wouldn’t dream of taking action, dad.

“No you wouldn’t, that’s the last thing you’d dream of,” said the skeleton, “now, if you’ll please excuse me, Elie, I have to take some action — get back to my nap here in my eternal dirt bad.”

Pleasant dreams.

“Zzzzzzz….” said the skeleton, with exaggerated fatigue.

When a Bad Dream Really Sucks

Short answer: when it is too close for comfort, it wakes you and prevents you from getting the rest of your badly needed sleep.

Went to bed tired a few hours ago, quickly fell into a deep sleep, had this dream, that actually woke me, after less than an hour blissfully unconscious. It is two, maybe three, hours later, I haven’t been able to get back to sleep. The dream:

I was in a restaurant, it was late at night. It was a huge place, virtually empty. I ordered a vegetarian steak sandwich. In real life, I haven’t knowingly eaten meat (apologies to the occasional sea creature) in at least seven years (except once, maybe five years back, when politeness obliged me to eat a small amount of chicken in a curry my host had prepared for me — the one pot dinner he made for his family and me that night– there was no avoiding the finely chopped chicken).

The waiter brought the large open-faced sandwich on a platter and left without making eye contact or saying a word. In fact, I never even saw the waiter’s face. I studied the very realistic looking steak, which seemed to be uncooked. It was cool to the touch. The other face of the sandwich was definitely sliced turkey and something that looked like ham. I waited for the waiter, who was nowhere to be seen, so that I could exchange this for what I had ordered.

I eventually wound up carrying the plate around the empty restaurant, unable to get the attention of anyone who worked there. The place was deserted. I scanned a menu looking for what I had actually ordered. There was no vegetarian steak sandwich on the menu. I found another menu, completely different from the first, and began searching it. I saw yet another completely different menu on a nearby counter and began to lose hope.

As I waited with a dish I would not eat, it became clear that I was in the kind of restaurant where you fucking take what they serve you, eat it, pay and shut the fuck up. You also leave a nice tip, if you know what’s good for you.

Waking from that all too realistic dream, in a chilled room, with about 28% of the bed available to me, and unable to get comfortable, the new line of stitches down the side of my nose, covered with a jerry-rigged dressing over a corrosive antibiotic salve (learned how like battery acid it is the hard way, painfully blinded and desperately groping in the shower) starting one millimeter from my left tear duct, on the side of my face usually against the pillow, I couldn’t shake the feeling that I was still in a booth at that accursed restaurant. Rattling the keys here has made me no more optimistic about falling asleep if I manage to secure a bit of the bed when I crawl back in it.

I am wearing fleece pants, socks, slippers, a fleece lined shirt, a hat and a fleece jacket with the hood pulled up. It’s not a matter of being cold at the moment. Though, at the same time, I’m not exactly toasty. Even the Baron was happy to nap under a three or four layer cape today, even wearing Sekhnet’s fake fur vest as a Liberace-style cape for a while. It’s chilly in here, yo. Although, admittedly, it did give the dying cat a bit more pep today, when he was not sleeping on his perch above the radiator or doing his Liberace imitation huddled under a warm pile of capes.

It was too hot for days, sauna-like, and the cat looked wilted, was very sluggish. Now it’s too cold, since the temperature outside dipped into proper winter range just as Sekhnet climbed up on a step ladder and propped a large screen in a window she opened, a window that is behind bars, bars that have a variety of things hanging from them.

Theoretically, I could open that gate, climb up on a ladder and take the large screen out of the upper window, close the window, hang everything back on it, and the room would eventually warm up. But I’d have to turn on the lights, take down everything hanging from the bars, wake Sekhnet in the process, ignore the surgeon’s advice by lifting, and toting, exerting, forcing blood to my face.

Jesus, what am I talking about? I’m still asleep, still in that dream, holding a plate of meat served by a faceless waiter to a vegetarian customer who is left with one choice, eat what’s been served or shut the fuck up about being hungry.

It reminds me of the dilemma of the would-be satirist, living in the Age of Trump and fucking Roger Stone. All roads lead back to these larger than life cocksuckers, no conversation can long avoid at least a mention of our current giant, angry, attention craving two year-old president.

I see fucking Roger Stone’s face, as he promised a reporter recently that if anyone tries to remove Trump from office, for any reason, there will be blood in the streets. Trump’s people have guns, he assures us, as is their God-given right under the Second Amendment, and they will not hesitate to use those guns, if it comes to it. And we all know what the other side is like, fucking animals, and they all have guns too. Stone warns of a blood bath, not that he’s advocating it, mind you, he’s just saying’, just putting it out there.

I watch the psychopathic Stone, as much as any single individual, responsible, along with his former partner Paul Manafort, for the current lobbyist-led negative campaigning black and white wedge issue kick ’em hard in the balls and destroy your opponents nightmare American politics we have today. A political predator, and a psychopath.

I see that fucking smirking, supremely confident face and realize, with a smile that is painful to smile, particularly at this ungodly hour when my eyes are almost crossing with exhaustion, the sun creeping up behind me, that someone just like him owns the fucking restaurant where I am forced to wander endlessly with a plate of cold meat I did not order.

I was prepared to say to the Orthodox Jewish nephrologist the other day, after the third or fourth time he demonstrated he is something of a distracted, imperious putz: Doctor, Ha Shem (God) does not make a person a mensch, it is left up to each of us to be a mensch or not. But as I was holding a plate of human entrails, and a fork, as I sat in his office the other day, with a napkin across my lap, I thought: ah, fuck it, I just won’t leave him the full 20% tip.