If you’re in a position to do so I could use your support through all of this. If not that’s ok hope you’re staying safe.
In every disaster or apocalypse movie there’s always a character that is meant to be the stand in for capitalism who remains motivated by profit long after it seems reasonable. Everyone else by this point is panicking or fortifying things or dying or killing but this type of guy is still dreaming about the potential windfall at hand for the company or packing briefcases of cash or jewels or whatever instead of supplies and we all think look at this vile weenie and we hate him so much. In the movie the guy gets owned almost instantly after that and we all cheer but of course it doesn’t work that way in real life.
Another thing about movies about the end of the world is we’re always sort of skeptical that things could go to all hell as quickly as they do and you think ah come on the army (?) or whoever would have gotten control of this by now wouldn’t they but of course it doesn’t work that way in real life.
I just went outside at 6:30 am to sit on the porch and look at the sky and it was a beautiful pink and orange not the most beautiful pink and orange I’ve ever seen but nice enough to look at for a minute anyway and then I heard someone yell my name and I looked down and it was my neighbor the retired veteran who mercifully for our ability to talk about things hates the president’s fucking guts and he said something like the fucking guy finally started taking it seriously last night and I said he’s been dragging his heels on it for a month and he said I know. I said it would be pretty funny if he got it and he was about to agree with me but he caught himself and he said well I don’t wish death on him I’m a Catholic and I’m on my way to mass and I said well you’re a better person than me please pray for me and he said he would so I should be covered for today anyway vis a vis the maintenance of my eternal soul.
A weird thing about being a scumbag addict or drinker is that it’s hard to ever know if you’re coming down with a cold or the flu or whatever because you just generally always feel this way.
I forget if I’ve shared this Auden poem in here before I probably have since it’s one of my favorites ever but it’s worth reading again either way.
The Fall of Rome
(for Cyril Connolly)
The piers are pummelled by the waves;
In a lonely field the rain
Lashes an abandoned train;
Outlaws fill the mountain caves.
Fantastic grow the evening gowns;
Agents of the Fisc pursue
Absconding tax-defaulters through
The sewers of provincial towns.
Private rites of magic send
The temple prostitutes to sleep;
All the literati keep
An imaginary friend.
Cerebrotonic Cato may
Extol the Ancient Disciplines,
But the muscle-bound Marines
Mutiny for food and pay.
Caesar's double-bed is warm
As an unimportant clerk
Writes I DO NOT LIKE MY WORK
On a pink official form.
Unendowed with wealth or pity,
Little birds with scarlet legs,
Sitting on their speckled eggs,
Eye each flu-infected city.
Altogether elsewhere, vast
Herds of reindeer move across
Miles and miles of golden moss,
Silently and very fast.
Look I don’t know anything about coronavirus or anything else in the world but one thing I do know is that you cannot underestimate how many people have been getting all of their information about it from sports talk media morons who are apoplectic about games and entire seasons being postponed or canceled because canceling shit is for girls I guess? You know Jordan balled out against the Jazz in game 5 of the 1997 finals with the flu so I’m not sure why these millennials of nowadays can’t etc. etc.
I saw that Robert Redfield the director of the Center for Disease Control said yesterday that they weren’t planning on setting up drive through testing centers because “We're trying to maintain the relationship between individuals and their healthcare providers.”
Another thing I saw is that secretary of the USDA Sonny Perdue said that they are still planning to go ahead with the reduction in SNAP benefits and tightening of restrictions for some 700,000 people despite the encroaching impact of the coronavirus.
Something I think about a lot and I'm not projecting this will be the time is the idea of the final joke. Like we'll all obviously joke online through almost everything no matter how bad but someday there might be a thing where we don't want to anymore. Whatever the last joke is going to be it won’t be funny.
Some random food magazine asked me if I wanted to write about the history of lemonade stands in America and I was like uh then they said they’d pay me a good sum and I said can I be political and they said ok and so I said ok and so I was doing my little research and writing my cute little jokes and japes and so on and the line I wanted to draw was from how lemonade stands are this iconic American thing that are supposed to teach children about running a business and the glories of capitalism and so on and I wanted to get up to the era we’re in now where kids are starting lemonade stands to help pay off their classmates’ school lunch debt and their mommies’ cancer bills and then I came across this post and the whole overarching metaphor basically wrote itself.
Right around 9 pm last night just as former vice presidential candidate Sarah Palin was finishing up singing Baby Got Back in a pink bear costume on an inexplicably popular game show the president came on TV to reassure the country about our approach to the virus and fucked up like three things instantly that his people had to walk back. You could actually watch the transition as it happened and I don’t think I could write anything in here that more accurately summarizes the place we are in in 2020.
One thing Trump said was that travel from Europe but not the UK for some reason would be halted and also shipments and cargo would be halted but I guess once the stock market guys or whoever heard that they got pissed off so then they came out and said ah just kidding cargo is ok but all the same Americans in Europe freaked out and dropped what they were doing and got to the airport where they found crazy lines and general panic.
Here look at this here’s a primary care provider in Pennsylvania posting a Twitter poll about the virus that’s obviously inspired by what has been up until basically today the entire right wing Fox News and Trump administration framing of it which is that it’s a political hoax and also a Chinese plot being weaponized to hurt Trump by the nasty media. I would… not feel great if this was my doctor but then again it would be nice to have a dedicated doctor in the first place so what do I know.
I don’t really feel like talking about the primary today which some of you may take as a mercy except for this real quick:
Joe Biden just cannot stop telling voters to suck his fucking dick you almost have to respect it in a way. A lot of people are like man what is this guy’s deal is he losing his mind or what but I have seen directly into Biden Brain it’s that feeling when you’re thirteen beers drunk and you’re convinced you could beat anyone’s ass and you forget what you said one minute ago almost instantly except it’s a permanent personality and his brain is just stuck that way.
It’s probably a bad time to have pathological onychophagia but the fingernails taste too good to stop. Another thing that happens in zombie movies is there is always a guy who’s like trying to save his obviously sick wife long after it’s clear that she’s done for and we all watch and say come on man because you know he’s gonna fuck it up for everyone else and I was thinking about that yesterday and I had one of those bad day nightmares that your brain shoots off into sometimes like a parallel timeline opens up and you follow it and get shivers and you actually have to say no! to make your brain stop thinking it but anyway the point is I decided I would do that shit I would probably endanger the entire world if it meant saving my wife so I’m sorry in advance if I ever do that. I would drive my zombie wife to the hospital then she would bite my fucking neck and not in the good way.
Here’s another one by Auden.
Jumbled in the common box
Of their dark stupidity,
Orchid, swan, and Caesar lie;
Time that tires of everyone
Has corroded all the locks,
Thrown away the key for fun.
In its cleft the torrent mocks
Prophets who in days gone by
Made a profit on each cry,
Persona grata now with none;
And a jackass language shocks
Poets who can only pun.
Silence settles on the clocks;
Nursing mothers point a sly
Index finger at a sky,
Crimson with the setting sun;
In the valley of the fox
Gleams the barrel of a gun.
Once we could have made the docks,
Now it is too late to fly;
Once too often you and I
Did what we should not have done;
Round the rampant rugged rocks
Rude and ragged rascals run.
About thirteen years ago when we were first moving into this apartment I was having trouble getting the mattress and boxspring up the narrow stairs so I rigged some sort of half-dicked rope system by which I was going to hoist them up over the second story back porch and get them in that way and I was struggling with it it was just me and Michelle and her mother and I guess it probably looked like I was going to fly off the side of the porch to my certain doom — unless I happened to land perfectly on the mattress just so — and the neighbor next door the retired veteran who hates Trump and loves the Red Sox but also hates them sprang into action and came over and saved the day. I was thinking about that because it looks like we’ve found a house to move into fingers crossed and we’ve been trying to throw out all the shit we’ve accumulated over the years week by week and I’m starting to get nervous about the fucking mattress because I am far weaker and a lot less fearless than I was back then. I get weaker and less fearless every single day and I guess it just goes on like that forever.
The thing I’ve been doing when it comes to going through my old shit and deciding what to throw away or not is to make like Orpheus and just don’t look back. You can’t look back or the spell will be broken. Throw it all away.
I wrote about this process when it comes to cleaning out your old shit leftover at your parents’ house last year for Boston Magazine and it’s a pretty good one if you never read it.
Every year, around the start of spring, I get a call from my mother asking me to come contend with the entire history of my youth, which has been jammed into this room for almost 20 years. It’s like the persistent alerts you get on your phone saying you’re running out of photo space and it’s time to upgrade your iCloud storage, but even phones don’t (yet) have the power to guilt you into action like mothers do. And so finally, this year, I gave in. I was in the neighborhood already to celebrate the March birthdays of my niece and sister, two people at various stages of object accumulation. I trudged up the alarmingly steep and uneven staircase, the wood having warped under the pressure of centuries.
Inside, the bedroom was a mess. I discovered box after box filled with the detritus of youth: old comic books my mother insisted must be worth some money; projects dating back to elementary school; high school and college essays; and morbid poems, including some in an unrecognizable scrawl that I’d bound together into a book with a flowery wallpaper covering. I must have recently read Emily Dickinson’s “Because I Could Not Stop for Death” for the first time, because one verse was clearly a rip-off, and I laughed, because at least it was proof to me that I’ve remained consistent in my miserable, brooding identity. I also found a treasure trove of cassette tapes, some I’d even listen to right now—Dinosaur Jr., Liz Phair, Alice in Chains—and some I wouldn’t, such as a Hootie & the Blowfish live bootleg from 1992. I don’t know what to tell you, man, the ’90s were weird.
There were also postcards from girls I no longer remember and long, desperate letters from ones I do. Pictures of friends whose names are lost to me and pictures of friends who I still see all the time; posters of concerts I’d been to by bands that haven’t existed in decades; and posters of Keanu Reeves looking beautiful with great hair—evidence that at least some things never change. There were Boy Scout badges, and photos of me and my friends looking like we were in a ’90s boy band, and photos of my dead friend, who actually was in a ’90s boy band, and photos of people I’d thought at the time would be in my life forever and, of course, would not. I found my old shit, in other words, which feels like an appropriate term because I found it all foul.
By coincidence, I wasn’t the only person staring down a personal history. A former high school classmate came to visit me while I was going through my old things—I’d found a mixtape he’d made me in the pile—and he showed me his latest project: thousands of archived emails that our group of friends had sent, beginning in 1996. At first I was thrilled about the prospect of being able to read what we were talking about back then, and I jumped into the messages, but the excitement didn’t last long. Here was someone writing under my name in a voice that no longer exists, and what was worse, speaking at length and with no shortage of emotional conviction about things I no longer remember caring about. I felt the same way about the dusty boxes of memories, a strange dissociative feeling like none of this had ever happened, or had happened to someone else, someone who wasn’t me. Reading some of the old letters felt like eavesdropping on conversations that I wasn’t meant to hear. It all engendered a sense of revulsion.
Throw it all away, I told my mother. I don’t want any of it. It’s not mine, I said, which hurt her feelings—something I seem to be very good at doing, much as I don’t want to. Why wouldn’t I want to dig through it all for hours and pick out the things I want? she asked. The honest answer is, I don’t know. At least not yet.
The repugnance I felt for my belongings seemed off to me. Based on what I gather from Marie Kondo’s famous Netflix show about organizing, which I haven’t seen but have read roughly 10,000 posts about so therefore am an expert on, it’s supposed to be hard for people to let go of their sentimental clutter, right? I asked around.
Read the rest here if you want I don’t know.
Find another working class apologist
I am not your shill
God wrath on rich hypocrites
A prophecy fulfilled
No time for compromise
Feels like end times
Clairvoyant fatal vision; a prophecy fulfilled
Walls scrawled with blood. I've got trouble in mind
As you know sometimes people send me their stories of what it’s like living in Hell World and here are three I got this week.
I read your blog and it fills me with a deep visceral rage, especially the recent one from the nurse who worked at the ghoul orthopedist office. I’m a nurse and have some horror stories involving insurance, heart failure/transplant, and critical care medicine
My ICU deals with a lot of cases of advanced heart failure, given that we’re a transplant center. We’re also the only nonprofit transplant center in the state and in addition to that we take a lot of patients with comorbidities that other centers won’t touch. One of the most horrifying instances of the faceless, soulless insurance industry murdering a person was this guy who came to us in distress because of a heart failure exacerbation. He was about to die so we had to make the emergent decision to put him on ECMO. ECMO stands for extra corporeal membrane oxygenation, and it’s basically a pump and artificial lung that pulls blood from a vein and returns it to the aorta. This dude’s heart was shot and our doctors putting him on the device emergently had no idea what his insurance situation was. Turns out the guy had insurance but his “tier” wouldn’t cover a heart transplant. He ends up recovering but we’re unable to wean him off the device because his heart is too far gone. He’s going to need a transplant.
So our financial coordinators start working on getting his insurance upgraded and after they do that, they can put him on the transplant list. Great, problem solved, right? Not exactly. Turns out that having two garden hoses in your body with a bunch of non-biologic material increases your chances for all kinds of funky complications, especially clots. Our coordinators worked their magic and had him approved to upgrade. It would take the insurance company 2 days to do whatever stupid paperwork they had to do to upgrade him so we could list him for the transplant and he threw a big clot to his brain and stroked out. The fun thing about insurance is you can’t upgrade your plan and then retroactively bill them because they don’t work like that because the purpose of insurance isn’t actually to give you healthcare. He had been physically ready for a transplant for a week. Would a heart have become available in those 5 previous days? Maybe, maybe not. We’ll never know.
If a patient showed up to our ER and the doctors refused to treat them before they got the correct paperwork filled out and the patient died, the doctor would be in violation of their Hippocratic oath, but the only oath insurance companies take is to their shareholders and it turns out that treating everyone isn’t the most profitable path. In any good faith system, we could have transplanted the guy and retroactively billed them, but we don’t live in a good faith system because insurance fights us tooth-and-nail on EVERYTHING.
I also get to sit in on the multidisciplinary meetings where we go over cases for heart transplants and those are super fun too because the most common reason we deny people, after medical noncompliance, is for financial/insurance reasons. Now, I don’t blame my hospital for this. We’re a nonprofit and do a lot of objective good, but we have to play the game that everyone else plays and if we just put hearts in everyone, we’d go under and couldn’t help anyone else. But it’s hard not to leave these meetings feeling emotionally drained. I remember when Obamacare was passed and the conservatives were screaming about “death panels.” Well the death panels exist anyway and I sit in them once a week because having them is the only way for hospitals like mine to survive and do whatever bit of good they can in a broken system. It’s probably cynical to call them death panels because I really do believe that my hospital does a lot of good, way more than the for-profit HCA hospital in town, but we’re kneecapped by the system we’re forced to work in.
Just last week we had an incident in this meeting that made me instantly harken back to Pete Ratboy Buttigieg’s argument about “not taking away peoples’ choice.” Our heart failure doctors have been seeing a guy for years with an LVAD (left ventricular assist device), which is a pump they implant in the heart for people who have left sided heart failure. This guy is now eligible for a transplant, which is great news, but his insurance has a non-compete clause with the other transplant center in town, which is not great news because if he wants to get a transplant now then he has to leave his doctors who know him intimately and whom he likes and he has to go to the hospital across town. This is the fucking “choice” that all these ‘moderates’ want to preserve. They talk out the side of their mouths about choice when it’s a blatant lie. In other circumstances, people who shill for systems that kill people are labeled “extremists,” but for some reason preserving the insurance industry is the “moderate” position.
Because my hospital is a nonprofit we do occasionally use our charity fund to give an uninsured patient a transplant, but it’s a massive financial undertaking and it’s just not practical to do it for everyone. It makes me feel warm and fuzzy but it doesn’t make up for the massive amount of patients who we can’t afford to sponsor. Those patients die. Not because we can’t do it, but because of money. And I get that my hospital can’t just give everybody free medicine but this I signed up for nursing to care for people, hard stop. The entire concept of for-profit healthcare is morally abhorrent.
Hey Luke. Long time reader, first time caller? Or writer? Whatever. I know that you often tell stories about what a nightmare the healthcare system is in our country, often focusing on people who have befallen some sort of medical emergency. My story isn't one of those. It's not even really Hell World as much as Heck World or Purgatory World or some other poorly thought out twist on your schtick's name, but I think it clearly illustrates that this system is horribly broken, even for those that are doing pretty well.
On November 4, 2019, I started working full time as the senior editor at [A Magazine]. (Please don't name them if you write or tweet about this, I can't risk losing the gig). It's really the editor-in-chief gig as I'm in charge of the entire magazine, but they didn't want to pay me anywhere near that kind of money so they claimed they don't have an EIC. I'd worked here previously for a spell of 4-5 years, I know the folks, it was a comfortable place to return to. I'd been the web editor before, a much lower position, but I started out at the exact same salary I was making there in 2016. But I didn't care. Freelance writing is a goddamn nightmare (as you know), and the hustle of not only chasing the next job but also chasing for all of the various paychecks I was due got to be too much. The opportunity for a steady paycheck and benefits was too good to pass up. I happily started on November 4.
I keep repeating the date because it factors into the story. Since they were paying me below market and wouldn't give me my actual title, I was hoping they would budge and let me sign up for their health insurance right away. They wouldn't budge and I had to wait 3 months. Fine.
February 4 rolls around and I hit up the accountant asking about the health insurance. Do I need to sign up or do I just get opted in? How much will they deduct from my check for it? I knew they only paid $250 a month towards it, but it couldn't be that bad. This was the first roadblock. By their math I had only worked there 2 months... it was 3 full months. So even though I started on November 4, a Monday, I would have to wait until March 1 to sign up for insurance. I missed one working day of the month of November, but that didn't count as a full month. Fine. By the letter of the law they are correct.
During the last week of February I hit up the accountant to once again grovel for health insurance. She finally sends me the paperwork on February 28. It lists all of the different plans that Aetna offers and breaks down what each one offers, but with a catch. There are no prices to be seen. When I inquired about the cost I was told that the accountant would have to check the numbers after I filled out the necessary paperwork. So I got to choose blindly. I used the same system my girlfriend does when picking tequila: I chose the second worst one. I figured it would be affordable and not the worst. Sent in the paperwork and heard nothing else.
Today I checked to make sure they got the paperwork and met another roadblock. They didn't have prices for me because they decided to change insurance company, but they had paperwork for me to fill out from AmeriHealth. There was no longer a choice of program, just the one that they picked for me. The cost of it breaks down to about $500 minus what the company is covering. So $250 per pay cycle. My take home pay is roughly $1300. I'm losing a big chunk of cash, but it's doable. Then I looked at what the plan covered.
If I go to my PCP, that's $80 a visit. A specialist? $160. Any trip to urgent care? $160. If I have the audacity to go the emergency room it'll be $500. Out of pocket. Just for walking in the door.
I'm of Irish stock, so I have pale skin that gets sunburned even when I wear SPF Infinity. When I get a new mole I know that skin cancer is a very real possibility. I have one on my back that we've been worried about for over a year. I couldn't afford to go while freelancing, I was barely making enough to cover rent. I live in Jersey City, so things are expensive, but I figured once I got insurance through my employer that my problems were solved. Then, right before I wrote this to you, I did the math. A visit to my PCP to determine I needed to go to a specialist (a requirement in this system, even though it's fucking obvious I need to see a dermatologist) is $80. An appointment with the dermatologist to remove the mole is $160. A followup to make sure I don't have cancer and maybe checkout other new moles is $160. If by some miracle I can get all of this done in two weeks, so it's all coming from one check, that will be a combined $650 spent on insurance and doctors. After taking out a prorated half month's worth of rent and bills, I'd have roughly $200 for food/transportation to work/misc. It would clean me out. And this is one of the easiest medical procedures imaginable. I'd be spending under an hour in the doctor's offices with all three appointments combined, assuming the doctor was running on time.
As I figured this out, I cried. This isn't putting me back together after a horrible accent, this isn't surgery for a new kidney. It's simply removing a growth smaller than a dime to make sure it's not a ticking time bomb waiting to kill me. What if it is cancer? May as well throw me in debtor's prison now, the “affordable” co-pays will wreck me.
And I have a good job! I make decent money, we're not talking minimum wage. I'm not even paying full price thanks to the “generous” $250 a month my employer chips in. I thought I was a success! I'm running a major magazine! This was my dream. And now I know that if I were to get mildly sick it would completely bankrupt me. I'll be 40 this year and, fuck. Add in the last couple of days of politics (I'm heartbroken that Warren won't be the nominee, but goddamn I hope she is Majority Leader for a Sanders White House) and it's too fucking much. I'm getting paid to write and living in my second favorite place on Earth, I should be able to look at my life and say that I'm happy. But instead I live in constant peril that a slip and fall or a nasty case of coronavirus will surely kill me financially, likely put undue stress on my relationship, and possibly actually kill me. Cool.
I know my story isn't overly interesting or remotely unique, but I needed to tell it to someone today. And my poor girlfriend hears too many of my problems already. I love what you're doing, the newsletter is amazing. Thanks for listening...
I thought I’d treat you to a UK-healthcare anecdote given the amount of shit you guys have to deal with: Sister was feeling unwell last week on Friday with swollen glands and saw her GP later that day. Was feeling much worse on Sunday and after calling the non-emergency healthcare number (same NHS/nationalised service provider), they told her to go to a different nearby health centre. Doctor prescribed some meds (they were free for her as she was pregnant under 12 months ago, would have been £9 if not, like all prescriptions, regardless of the actual drugs or number of drugs the doc has told you to take) but said it could be mumps.
All kids get the MMR (measles, mumps and rubella) vaccine at the age of 1. She was born between 1985 and 1990 when there was a temp pause on them (she’s forgotten if she had it anyway). Her foreign-born husband took the following work day off sick (paid leave), called the GP, got himself vaccinated the same day. Their (few days short of 1 year old) son was due for his vaccine next week but they were able to get that pushed earlier to Tuesday. And money...never came up. Ever. Just like it’s never come up for me and my doc/hospital visits. And this is despite our NHS being underfunded by quasi-fascist conservatives for a decade now. Yet boomers over there seem even more hellbent on killing everyone than the ones here. So. Fucking. Dumb.
“Co-pay”? “Deductible”? Either fully nationalised (and have private health for any super rich assholes, sure, whatever) or single-payer. It’s not that complicated yet Americans want the “choice” in...how much quicker they want to die? Okay cool!!
Anyway, you’re still rad. Loved your book. Told someone else to buy it as well when I finished. Keep writing! And hope you stay safe man.
In the land where the gods are dead
I can still hear their stations
As the radio towers bend
To their voices replaying
And they speak through the static now
Just like ghosts in their cages
While the children still lie awake
And the faithless are praying
And they speak softly, as they are fading
We are all ageless, we are all human
But in the twilight, as sun is wasting
I lose my words and I lose my patience