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.

Performative empathy and terminal distraction

What I am about to write may mark me, to some, as uncharitable and harsh in my judgments, but see if you’ve had a similar experience.  This might ring a bell and give you a different way of viewing a vexation from your own life.

When someone you know tells you they are sick, badly injured or facing a scary diagnosis, it is customary to say things like “please let me know how it turns out” and “let me know if there’s anything I can do.”  As kids we learn to say these kinds of things from the empathetic adults around us.   If we are involved in the health-challenged person’s life, able to do things for them, and have shown ourselves willing to exert ourselves to follow through, the phrases land as a show of sincere concern and friendship.   If we say these things in a show of concern and never actually follow up, it is performative empathy.  Don’t look at the intention and the history too closely and everybody feels a little better.

Sometimes the performance of empathy is unintentionally feckless.  It is not that they don’t want to help out, it’s just that they are terminally distracted.  They intend to do the compassionate thing, but, goddamn it, there is so much to do, it’s relentless, and, plus, the person they extended the invitation to didn’t seem too grateful, seemed to doubt them, so isn’t there an element of judgment there?   I said the right thing and they judged me as being insincere.  I was sincere, but their silence in response to my offer of help really hurt, made me feel like a bad person.  It was like they didn’t expect me to follow up, as if I said it just to make myself feel like a good person!

Some people always follow up on their offers of support.  Some people rarely, if ever, follow up.  It is better to speak less and do more, given the choice.   For some, speaking in a generous manner is the best they can do.  They are honestly overwhelmed by the million details of their day to day activities, trapped in the rushing cascade of their own highly programmed lives.  When they speak generously they don’t intend not to follow up, it’s just that they are so busy, all the time, that they will not always remember the sincere gasp of concern they emitted when you raised the spectre of a cancer diagnosis.  And it’s not as if you would be there for them.

Along it all rolls, until, for one or the other of us, it stops rolling and all consideration is in the past tense, for everybody else.

Gnawing question?

I had a close friend, for decades, who always said that maintaining healthy friendship takes work.  He was always ready to jump in any time someone needed him, his expertise, his services, his sympathy, his honest counsel.   Then, a few years ago, he started putting up a fence around certain subjects he’d always been candid about, they were no longer up for conversation.  

Something was clearly tormenting him, he was looking increasingly grim and reporting awful moods, agitation and sleeplessness, but he was no longer willing to discuss it.  His walling himself off was a mysterious process.  The unexplained closing down of certain topics was subtle at first, then it began eating at our friendship.  After a relatively simple conflict arose between us, this shutdown of our ability to freely discuss problems devoured what was left of our long, close friendship.  

“No matter what you say, you will never convince me that you have a legitimate point of view,” was his stance on the question of whether I had a right to feel hurt by things he and his wife had done.  That they had both vented at length, while demanding I not mention anything ever again, was my own fault.   “We made MISTAKES, and you want to crucify us, for mistakes, while you…” a knowing look, “what you did was no mistake, which is what makes it so hard to forgive.”   

He’d get indignant if I pressed, or asked “what the fuck?” or looked at him the wrong way.  I had no real idea of what was suddenly making my old friend act with so little friendship.   We were now locked in a zero-sum conflict, familiar as a kick in the nuts from a childhood that had featured a long-running, zero-sum, no-holds-barred conflict with my brilliant, implacable, tragically damaged old man.

At a party a few months back I met a charming, mischievous looking man who told Sekhnet and me a heartwarming story.   Two minutes in I was greeted by someone I hadn’t seen in 35 years, who burst into the little circle to hug me, smile and reminisce, and so I missed the remainder of the man’s anecdote.   Over the course of the next few days it emerged that the charming, mischievous looking man had fairly advanced early onset dementia.  He would stand and sit over and over, uncontrollably.  He would get agitated and cry out.  He was unable to speak.  He was always attended by a kind, attentive young man who steadied him, calmed him, gently got him to stop calling out, directed him back to breathing, helped him reel himself back in.

I think now of my friend’s unwillingness to discuss certain things, the downright silly defenses he made several times over the year of our unsuccessful peace talks, the stubborn irrationality of points he insisted on, and wonder if I missed a similar decline in faculties.  Maybe his change in behavior was not unwillingness to be himself but inability with an organic cause. The charming guy we met at the party was able to put on a front, at first, maybe I was unable to see that my friend’s torment is related to the terror of losing his ability to maintain his personality in the face of a disquieting change in his capacities.  Unable to face what is happening to him, he lashed out at someone who had always reciprocated his care, concern and friendship.  Ironic and terrible, that.

Even if the theory is true, it leaves me with no real option at the moment.  After all, I am the trusted old friend who deliberately, and with depraved indifference, sadistically stuck a dagger into the hearts of these two beloved old friends, for absolutely no reason.  I pressed on when I saw they were upset, and their defensiveness and anger were entirely natural, and 100% caused by me.  I am the kind who does not make mistakes, my hurtful behavior is knowingly malicious and I operate under ruthless principles, justified by the “abuse” I suffered decades back when I was a helpless, angry child, my distorted point of view supported by demonic skills at argumentation and persuasion.

The thing about a traumatic childhood is that when the trauma is reawakened in adult life, as mine was after a long glare of rage was directed at me by a frustrated old friend going through torments she couldn’t openly discuss, the pain is identical to the original.  As an adult you have tools to resolve the pain that are not available to the child, or so you would think.  Another adult may act childishly in response to your need for mercy but, until you see this clearly, you remain locked in the pain of the reopened childhood trauma.  

“I need to talk about what happened,” you say, seeing that the current situation is intolerable.

“You need to shut up about what you think happened, unless you want some more,” is not a response that will cause your roiled emotions to relax. “You brought this all on yourself with your aggressive, threatening, angry reaction to my attempt to be considerate, you vicious prick.  You want to accuse us of being insensitive bastards who don’t know how to treat people.   How dare you, you unforgiving, unloving monster!”

Demented or not, that’s some fucked up shit, Larry.

Sociopathic transgression # 397

We all know that a desperate person with no scruples, feeling cornered and about to lose something they need, is capable of atrocious behavior. Even if the person has some scruples, when badly wounded and in great pain they may become capable of terrible acts.

Donald Trump’s brain, politically speaking, is an apparently very disturbed man named Steve Bannon. Sloppy Steve fancies himself a modern day strategist of international nationalism (which rings like National Socialism), right-wing oligarchic authoritarianism. He speaks of Vladimir Lenin’s “fire hose of mendacity”, the idea of flooding the marketplace of ideas with a constant high-powered flood of incendiary lies, like spraying diarrhea out of a high pressure nozzle. People get so overwhemed, so worn out, so sickened, that they turn away, while many others, less capable critical thinkers, are convinced by the constant stream of verifiable horseshit that comes too fast to fact check.

The transactional Trump was arguably the most corrupt, and one of the most insane, presidents who ever won the Electoral College. He was said to constantly push against the guardrails, as the New York Times styled it “bending and sometimes breaking them. Most of the time he would just take a greasy shit on them, “here are your fucking norms, asshole.

By design, according to Bannon’s Leninist strategy and Trump’s own penchant for chaos, it would take hours to list all of the destructive, corrupt and despicable acts committed by this administration (ask any of the remaining 900+ of the almost 4,000 children seized from asylum seekers who will never see their parents again).

Here’s a disgusting one that just jumped out at me, nicely encapsulating the destructive psychopathy of the GOP’s leader and the moral tone of its lynch mob caucus. I was reminded of it when I saw a photo of the supremely spineless Mike Pence wearing his special Vice President of the United States Covid mask.

Trump tested positive for Covid a day or two before the first 2020 presidential debate, and lied about it, claiming his retest was negative. It would have been a political disaster for him to admit that he was so weak and mortal that he got Covid, the hoax virus that Biden invented to defeat him in a rigged election. So the usually punctual president showed up late for the debate, too late to take the Covid test he’d agreed to take, and immediately took the stage with no mask barking at Biden from close range. Biden was, fortunately, wearing a mask.

Trump mocked Biden’s mask and within a day or two was medevacced to one of the greatest hospitals in the world to have every one of the new million dollar Covid treatments available.

Trump demanded an early release from the hospital and forced his secret service detail to drive around with him in a closed car so he could wave to his fans while his agents contracted Covid from him during his strongman photo op right out of his boyfriend Kim jong-un’s playbook. Then he immediately bragged about how easy it was to defeat Covid, that it was mind over matter, that if you were strong you had nothing to fear from this so-called pandemic.

Then the insane, highly infectious prick skirts the agreement he made to be tested before he took the debate stage. On the honor system the infamous and prolific liar lyingly told the corrupt, sick, dangerous, biased libtard cucks who were running the unfair debate that he had tested negative for Covid. His fucking family sat in the first row hissing and coughing throughout the debate with no masks on. Biden, fortunately, was wearing a mask. Which is probably what saved his life, or at least saved the senior citizen a bad case of a deadly pandemic.

Hard to even untangle the many strands of that transgression. He’d been lying for months about Covid, first claiming it would go away in a few weeks, saying it was the Kung Flu, blaming Hunter Biden, China and corrupt Ukraine for Covid-19, then appointing his imbecile son-in-law to be the czar of Covid, because Jared had done such a wonderful job fixing the opioid crisis and had also successfully brought peace to the Middle East (not including the Palestinians who he called ungrateful idiots).

Now if Biden had died of Covid that he contracted from Trump at that debate, could Trump go to prison for manslaughter based on his demonstrable depraved indifference to human life?

LOL!!!

When the truth bites you in the ass

Sometimes you can’t avoid a truth you would rather not confront. Without looking squarely at the actual situation, and understanding how it works, no solution will ever be possible. So if you are tormented in a relationship you will need to find a way to grasp the dynamic, and assess the damage being done, before you can end the torment.

A parent’s overwhelming need to feel in control and infallible, constantly undermining your own needs is a brutal thing to look at directly. It is natural to make accommodations, learn to accept blame for things you didn’t actually do, flatter the parent when necessary, learn when to withdraw, swallow a response, put on a false smile. These do not really solve anything, but they keep the ongoing harm to a minimum since you avoid fresh conflict with them.

The next step, the painful but freeing one, is understanding that this parent is not capable of behaving any better. They are stuck in unresolved pain from their own earlier life. They may not know how to resolve conflicts peacefully. You may tell everyone that your mother is a goddess, and she may smile, and bask in your admiration, but if you explain that you were calling your mother a goddess only to avoid her rage, she will make you pay for your unappreciated candor.

There are truths we resist because they undermine things we value greatly. At the same time, there is no healthy alternative when you understand the mistreatment you’ve been forced to tolerate. Someone who forces you to tolerate the intolerable does not love you very well.

What is hateful to you do not do unto another” is an excellent and practicable formulation of the Golden Rule. We all know what we hate, we probably know it better than almost anything. So if I am doing something to you that I hate done to me, you will, and should, point this out to me. If my answer is “yeah, you hate it, maybe even I hate it, but fuck you, this is all you deserve and all you’ll ever get from me” you should very much take me at my word.

Every day that you don’t take me at my word, and hope that somehow love will prevail, is a day that the unacknowledged truth (that my final word to you is fuck your fucking feelings, asshole) is taking another giant bite out of your ass. In the end you’ll have no ass left, a very bad way to live.

Truth is hard, sometimes

I recently got a note from somebody telling me he wasn’t interested in taking sides, or even forming an opinion, but in learning the truth about a conflict we are mutually interested in.   The comment reminded me of an essential thing about truth.   It looks different depending on our point of view, how much information we have, our tolerance for cognitive discomfort, our level of self-awareness and honesty, while at the same time, things are objectively more or less true when viewed in light of the facts, and in the context of the situation. Truth can get famously foggy during a moral battle.

There is an eternal debate, among eggheads (old term for intellectuals) about the nature of truth and morality, the nature of reality.   These brainy types like the structure and rigor of science, even when talking about matters of the spirit and the soul.   Two prominent schools of thought are moral relativism and moral absolutism, both terms also used as pejoratives.  Most people simply believe in the truth that confirms their view of things and call it a day.  Academics write books, teach courses and defend their school of thought in the debate over the true nature of cherished, elusive truth.  Some views are closer to the truth than others, alternative facts are not the same as actual facts.   The academic stand-off goes something like this:

Moral relativists believe that truth, and its close cousin morality, are not absolute but change according to culture, social condition and historical epoch.  An example of this lack of universal morality/truth would be leaving a new born baby on a hill top to die.   Many, perhaps most, would recoil from this practice, condemn it as immoral.   But what if the baby’s mother, and the entire community, were starving to death during a drought?   People living in this harsh environment would not judge a mother for exposing her child for a quick death rather than struggling to keep the doomed baby alive, using valuable resources that others with a real chance of survival need.  In fact, in that case, she’s doing the right thing. Sadly, this rare example, though hard to refute, muddies the discussion of universal right and wrong.  If all morality is relative, who’s to say who is moral and who is acting immorally — how do any of us know the best way to act? 

Moral absolutists believe there is a universal morality, an immutable set of truths that apply across all cultures, times and places.   Murder, for example, the willful taking of an innocent life in a malicious or depraved manner — universally evil.   If there are universal truths, and it’s hard to imagine that something like refraining from murder is not a universally valued trait (but, see example above) then laws can be made based on these principles, to combat evil impulses.  Sadly, moral absolutists are often religious hardliners with no tolerance for the viewpoints of those who don’t embrace their religious views.  Their moral absolutism allows them to believe  morally problematic things, like the abortion doctor who was killed outside the clinic is burning in Hell, while the one who shot him gets a wink from Jesus Christ.

Truth can be elusive, though only in academia (and politics) are there only two ways to see it.  Truth is compatible with both of the warring views above, it is not always one thing or the other.   

Facts exist — I punched you in the nose, your nose bled, you called the cops, the cops arrived and told us both to sober up and fuck off.  The truth is that we had a conflict that turned violent, you were threatened enough to call the cops.  We will tell different stories about the facts.  

You will insist the punch was completely unprovoked, that I blindsided you, fooled you into relaxing just before bashing you.  That will be your “truth” and those sympathetic to you will accept it.  My story will have a detailed set-up, the context that came before the blow, the reason you needed to be hit right at that moment, and those who relate to my telling will be certain I was well provoked before I busted you in the head.   

The reflex of many people is to believe that the real truth exists somewhere between those two stories.  Somebody standing close by while the conflict escalated will be better situated to evaluate the stories, we’d think, but they have biases too.   Plus they won’t necessarily know the history, the smug look, repetition of the most hated phrases, and how they predictably ratcheted up the tension.   Context is important, though not always easily discernible. 

You have the classic “one man’s terrorist is another man’s freedom fighter.”  In the case of the more than a thousand angry people who stormed the Capitol after sending 140 cops to the hospital, we can call them insurrectionists, waving a Confederate flag as their belligerently rebellious forebears would have, after sacking the Capitol.   Others call them “patriots” who were engaged in “legitimate political discourse” and are now being held, totally unfairly, as “political prisoners” and martyrs.   Those who blow themselves up for their beliefs are called martyrs, or insane, murderous assholes, depending.

So too in personal life.  Your deepest needs will dictate the truths you believe.   Truth can’t be divorced from opinion, since what we believe to be true forms the basis of our opinions. An opinion based on truth is more legitimate than one based on spin, color, a persuasive, selective  retelling of events that leaves out important facts.   Events and the sequence of how things unfolded, the cause and effect,  how one thing led to another, are the building blocks of truth.  Not everyone is prepared to deal with a truth that is upsetting and potentially destabilizing, like: the peacemaker on his moral high horse has also deployed irritating gas, which had nothing to do with his mission to make peace, in the name of making peace.

The benefit of sharing vexations with others

You can find yourself in a perplexing emotional cul-de-sac, very, very hard to see any way out. You can ruminate, follow theories, compare your situation to others, but the limitation in your point of view is partly that it is only your point of view, uninformed by the views of others.

As soon as you share a perplexing riddle with somebody you trust, you open the door to an insight that might seem obvious once it is expressed out loud but would never otherwise occur to you.

For example, I had an embattled friend who lived in a war zone, who could not help provoking me whenever we got into a conversation. No matter how angry I became, I always restrained myself from bashing this annoying guy in the face, because he was my childhood friend, because I try to conduct myself peacefully, because I don’t bash people in the face. This aggravating cycle continued for several years, until, unable to get him to even acknowledge that he was provoking the shit out of me regularly, I had to walk away from our long friendship.

Recently, I entered a vexatious revolving door dispute with my closest friend. No matter what progress we seemed to make in our peace talks, he regularly became indignant and angry. Each time I exerted myself to reassure him of my friendship and calmed him down. This happened more times than I can recall. He recalls this pattern too.

Talking to an old friend who also knew this guy very well, and has lost contact with him, I described the maddening dynamic. My friend becoming instantly angry, me calming him down. As I described this my friend emitted a knowing chuckle.

Every every time he got mad and you reacted not with anger but with compassion, you were giving him exactly what he’s been looking for, and never received, for his entire life. And you wonder why he couldn’t stop doing it?!”

And it is kind of funny, how easy it is to see, when somebody else points it out. In both of the cases described above, these are people locked in war who lack good impulse control and basic conflict resolution skills. They are both required to hold in enormous amounts of frustration. In each case, when they vent their anger, which they are not generally allowed to do without severe consequences, they were met, in my case, with the mildness of friendship and understanding. Why would either one of them stop doing it? They wouldn’t, they can’t. Until they succeed in killing the thing that is sustaining their belief that they are worthy of love.

Being so patient in a one-sided arrangement like this is not a long-term strategy for friendship or life. Without mutuality, what’s the point of a relationship?

You can ask this question of people who care about you, and you may be surprised by the obvious insights they may have for you.