Just got off the phone with another callback from the Seattle office of CMS of HHS. They are continuing to research my case, but have made no progress. The gal really is nice, very sensitive, and you can hear the beep from the recording throughout. It’s a struggle to work her slowly through the understanding of the law – she apparently has been with some sort of health system for thirty years, but it’s very clear that she does not understand the ACA very well. As usual, when dealing with federal employees all the way up to the Senate, I know more about the ACA than they do. Man is that frustrating. Why can’t we find anyone in the federal government who understands the laws they pass? I’ve even asked that of USCP and FLETC, but they are cowardly little shits and remain silent on the subject. Fucking little bitches – enforcing laws they do not understand, enforcing laws even the legislators and the architects of our laws do not understand – how the hell are we supposed to be compliant when neither the legislators nor the enforcers can understand the law? The law is too complicated for effective society – period.
And all I want to do is be able to do things like call a reasonably priced skin doctor and ask if this bump and that bump will go away and what we would be looking at if we wanted some sort of cosmetic adjustment, as well as basic skin care education. That’s it – but that is legally impractical for me, because of the inability of the government to explain it’s health care law.
Another morning shot to shit due to health care legislation – good lord, it’s the middle of May, it’s my dead mother’s birthday today. The hell we went through dealing with bureaucratic health care, trying to cater to her end of life here in america – egads – what an absolutely horrible health care system. It wasn’t a matter of coverage, it wasn’t a matter of payment, it was a matter of the freedom to care for her and nurture her to the end of her life as she nurtured us. The obstacle – very clearly, the legal mindset of insurance driven health care. As long as insurance is the mainstay of our health care system the system will remain broken. Furthermore, our capacity as americans to find creative solutions to our health care woes has been shut down by the affordable care act – which has paralyzed us.
Personally, I believe that all health care law should be thrown out and a health care amendment be made to the constitution – one paragraph. That shall be the end of the federal involvement in health care – it is the state’s requirement to manage the health care of the citizens, and if it is a smart state, it will delegate that to some ensemble of organizations with smaller constituencies. All federal health care programs should be abolished and all federal health care taxes should be collected and managed by the state. The feds have demonstrated an incompetence to govern the health care industry, and they should now step away from the table.
But who the hell knows what’s going to happen. I just want to know how to achieve the same stability, certainty, access, and coverage that I had before. I do not want to pay the bureaucratic price of Obamacare. I do not want to be on Medicaid. I want to waive my right to medical malpractice except in egregious cases (like leaving instruments in bodies after surgery, or faking a medical degree) – and I want insurance and lawyers removed from the picture. In that world, I would cost $20 to talk to a skin doctor for a while about skin – I would be able to stop by the pharmacy when I’ve got the sniffles, and pick up some antibiotics – based on someone with something like a “physician’s assistant” licensure – i don’t need to see a doctor to manage my health for the most part, except that the government – you, my fellow americans – do not give me that choice nor do you respect the individual sovereignty that is part and parcel of my personal identity and my right to life, liberty, and the pursuit of happiness. In terms you money grubbing bastards will understand, I “own” my body – that is individual sovereignty.
So – it was an hour and 19 minutes on the phone that I patiently educated the government and helped them work through the law that they passed, are enforcing, and are still trying to figure out. They are not willing to admit to a “list of insurance policies” maintained by the …..
I call, right at that point and discuss this with the gal at CMS/HHS – about thirty minutes, but I need to make sure she understands one point. I need her to document, to me, that there is no way for me to document, to the government, my compliance with the law in any way but registration with one of the government approved health care providers. I have to register my “health management contract” with the government, which maintains the list of acceptable health care management contracts. This means that my individual sovereignty, my right to govern the interstices of my life, the community of cells that is me, is governed by a list of government approved oversight committees – the cabal of insurers and insurance companies whose collective policy limitations effectively define the envelope of my legally compliant physical and mental life.
I claim that it is more than a tax – it is a direct threat to the american ability to define what it is to be a person. A corporation is a person, but I have effectively lost the right to individual sovereignty! I say effectively because it is definitely possible for a government to construct such obstacles as to make it unrealistic for a reasonable citizen to do other than as instructed. While not specifically disallowed, the right to individual sovereignty has effectively been granted to the top financial echelons of society – as they are the only people with the free and available liquid capital to pay exorbitant united states costs to manage their own health care. Individual sovereignty is a right in theory, but is effectively available only to the aristocracy. This is not american.
Now – you could fix that by simplifying the damn ACA and opening the field. Stop defining micro-cases of rights and stick to the defense of broad and easy to understand rights. It is the right of an american, and indeed of all of the citizens of the planet, to live in a society capable of providing for their health and well being, and it is the responsibility of the american, and indeed of all of the citizens of the planet, to maintain a society capable of sustaining the health and wellbeing of the global constituency. Insurance-driven, for-profit health care with exceptional bureaucratic overhead is not an acceptable part of such a society. The ACA has entrenched and exceptionally poor solution to the british commons of problem of health care.
Where is the vehicle by which I can document my compliance with the law – what I’ve been told, over and over, is that this is the responsibility of government operated corporations or the government itself. I no longer have a way to document my compliance with the law except by accepting a health management contract which requires specialists to understand. Nope – not acceptable Barry, just not acceptable. And shame on you Merkley for getting that out – but as your staff made it clear, you have no idea what’s really in that law – and as the USCP/FLETC have indicated, we should never expect our legislators to actually understand what they do. Nope – fuck you all for the ACA – you done gone and fucked up my health care in a huge way, and you are demanding an awful lot of my time and energy to try to cope with this.
You could have just told the truth instead. And if you were just confused, then you must understand my confusion. You may make restitution in terms of a tax credit at my state’s minimum wage for the 3000 hours I’ve spent dealing with your shit. We’ll ignore the other costs and the physical damage you’ve done to me – but a 30,000 tax credit by way of your apologizing for your incompetence would be a step in the right direction. Our you could give that equivalent to some charity in my name – how about an organization dedicated to overhauling and rebuilding the american legal system – maybe commongood.org, or give it to them to dispense. That way you can’t accuse me of profiteering, but you will demonstrate your acknowledgement of your incompetence with the ACA the only way that is unambiguous to americans – with money.
seriously…. when I began, last October, looking for a way to document my compliance I heard a lot of shit – bald lies really – that it had something to do with “10 essential health benefits” and “minimum required coverage” – but it does not. It is defined in terms of “MEC”, and MEC is defined by an effective list of “acceptable management contracts”. There is no way for me, as a citizen, to find any unique way to cover my health care, nor to choose care that is sensible or appropriate. You have effectively removed my access to health care, and you have done so in the name of granting access. For basic carcass mechanics, like picking up antibiotics or a muscle relaxant for a pinched nerve you have entrenched the least efficient, least flexible, most expensive, least patient controlled solution – you are so afraid of granting freedoms that you have implemented an expensive micromanagement in the name of freedom and rights. Argh – you infuriate me so much – i want my damn freedom back, and it is clear to me that you just do not understand what that word means anymore.
So – 4 hours, and I’ve taken a bunch of extra blood pressure medications, as my hands are shaking with frustration – i’m upset and struggling to focus on work. I’ve had the energy of my day sapped – I had a good day yesterday, got some work done – but the ACA done come and fuck me again today. Egads I’m fucking tired of this shit.
Thing is, I have very little faith that the person I’m chatting with will provide any help. She’s just struggling to keep up – but today I think she came away with a good understanding of the two questions I’m trying to answer. Maybe, in the next round she’ll come up with something useful – i think the key is to understand the question, and that understanding poses a significant problem for her – because she’s coping with the details of the law for the first time. I do think she now understands two questions well enough to ask them at the level I need answers – one is one half of a question I’ve asked government officials maybe 400 times already, and the other is a more complex question required to plan – what kind of freedom do I have in providing for my health care and is it possible for me to meet the requirements of the law in some novel way and document that solution – or is that just non MEC compliant by definition?
The penalty is assessed as an all or nothing thing, which is either capped at $300 for a low-income scenario, or the national average of a bronze plan. What is that amount? What is my tax liability? – meanwhile, I am paying a few hundred a month for health insurance, there are no available insurance plans that fit my situation exactly, and I’m stuck on Medicaid against my will and wishes under some sort of confusing situation. Man the health care system in the united states needs reform – too bad the ACA is not a viable solution – they worked so hard on it, they worked so hard to carefully define the little bubble in which I am allowed to pretend I have individual sovereignty.
God damn motherfuckers – why is the government so fucking focused on getting up in everyone’s business – this is the fucking united states of america – once great nation, once the land of the free, the home of the brave, the kind of people who fought for civil rights and went to the moon because it was hard, with great institutions like Teach for America, and the Peace Corps. What the fuck happened to this place – it’s a damn over regulated military camp govern by fear and idiocy, and worst of all – we can no longer trust them – in my life they’ve lied flat out too many times – we invaded a country on a lie, now we lost our health care on a lie. Fuck you washington – just fuck you, your priorities are too fucked up and you can no longer claim that you are operating with integrity or in our best interests. As my kid would say, “Fail!”
So get the fuck out and let us start over. Admit that you suck and you fucked up, and use the power of that admission to re-invigorate a state-led government, opening the field of states rights so that we, as americans, can watch our collective diversity solve the problems of the 21st century. You have demonstrated that you are not the institutions to do that – and the proof is this health care debacle.