Life as Crisis Management: The American Health Care Merry-Go-Round Kiada

 

Like so much else in the United States health care and medicine, a service industry similar to another once upon a time service bureaucracy in the US, America's universities, has been, and particularly so since the late 1970s, corporatised and McDonaldised. 

I am actually old enough to remember when it was different. My General Practitioner (GP) when I had the unfortunate experience of moving to a state that, it turned out, had only recently emerged from the ideological stone age only to shortly return to it again by the 1990s, Indiana, was independent. He was his own man He was own employer and living the American dream. And he had his office in a house near the county run hospital in that litte Hooser town that I had moved to from Big Tex.

I had, of course, been to doctors before but only rarely. When I was young, for instance, I rode my bike into a brick stairway and almost tore off my nose, something which required the doctor to come to our house and stitch it up. Think of that, doctor house visits! How backward!

In 1967 everything changed in terms of my health life and my life in general. One day while running track I could not breath. Eventually, after some false starts—including the idiotic your mother did it to you or it is psychosomatic diagnoses—I was informed that I had asthma. 

Between 1967, when my asthma issues first appeared and introduced me to the joys of the need fir constant medical attention and visits to medical specialists, I was taken, after seeing my GP, to see an allergy and asthma specialist at the Methodist Hospital in the Oak Cliff section of Dallas, the Dallas neighourhood in which I and my family lived. My asthma doctor initially put me on cortisone which had the usual side effects which forced me off of it and on nebulisers.  

When I moved to Indiana my GP replaced the largely ineffective nebuliser treatments with Kenalog, which at first was great despite requiring periodic hospitalisations, and which eventually proved ineffective or of limited help in the long run as well. Because of the declining effectiveness of Kenalog my parents took me to see a Internal Medicinist at a health care clinic south of Fort Wayne. He put me on several pills, including Theopylline, Albuterol, and Prednisone, which I remained on, with limited effectiveness but a lot of nervousness, until the 1990s. 

Around 1993 or so I was put on Advair and Singular by an asthma doctor in Albany, New York. This regimen served me well, so well that I was able to do all my doctoring with my GP. Sometime in the 2000s the physician group I went to became part of St. Peter’s Health Partners—St. Peter’s is a large and increasingly sprawling hospital and health care centre in Albany--and eventually  Trinity Health, a Catholic non-profit health care corporation. They also decided to move up the medical status ladder to Internal Medicine physicians. 

Both of these moves—corporatisation and specialisation--point up something that has increasingly happening in American health care and in American medicine since the so-called Reagan Revolution. This processes was aided and abetted by the religious revival of neo-liberalism and its key utopian notion and symbol that the market was and is god. Deus ex machina! As a consequence the practise of medicine in the US has changed and changed, in my opinion, for the worse in many instances. 

Since around 2020 when I started having stomach and bowel issues the doctors—and I mean doctors plural--I increasingly saw and continue to see in the Capital region of New York, are not independents. Instead they, whether GP or specialist like the heart specialist, the pulmonologists, the allergist and gastro-intestinal specialist I now see--work for corporations like the non-profit Catholic Trinity Health, the apparently non-profit Community Care Physicians (CCP), and, Albany Medical College and Medical Centre, the physician and medical testing arms of the non-profit Albany Medical College and Albany Medical Centre  Like the modern and postmodern Western world in general all of these apparently non-profit corporations are private bureaucracies, modern bureaucracies, which, as Max Weber noted, are the dominant organisation in that putatively best of all possible worlds, the West. By the way, the last independent doctor I went to retired and passed his cases on to Certified Allergy Consultants, which has five locations in the Capital region and which I can find no historical information about. Welcome to the postmodern Western world, a world without history.

What these corporations do in the United States is mimic each other. Albany Med, for instance, has an MRI. So does Saint Peter’s Health Care Physicians, which is part of Trinity Health, and so does CCP. Each of these corporations, of course, and for financial reasons, want you to use their MRI, use their testing labs, use their physicians, and use their own portals, so they can keep, or at least try, to keep the monies from insurance—the private for-profit bureaucracies that really run health care and medicine in the US-Medicare, and the information they gather through health care visits and their patient portals— information, of course, is central to the postmodern core nation economy--in house, in the corporation. By the way, another portal, a physicians only portal, has been developed in Albany to allow said physicians and techs from the various corporations to see what their patient has been treated for by other corporations but this is not mandatory and chance is a factor in whether the various corporations put that important information up on the shared portal. Bureaucracy breeding more bureaucracies because of inherent irrationalities and inefficiencies in the already existing bureaucracies. 

Despite all the bureaucratisation that has come with corporatisation, however, efficiency and effectiveness, which bureaucracies and their new digital aids are supposed to be good at, aren’t always either efficient or effective.  I, for example, recently got a new phone number and set up a new email account and managed to get all these changed in my medical portals—there are four== portal accounts or so I thought. When I was asked to review the health information in my ENT portal I found they still had the old and now outdated information in health information despite having the new information in my accounts page. Redundancies are costly and perhaps unnecessary. Waiting times to see specialists can be and sometimes are long. It took me several months to get into see a skin specialist and Gastro, for instance. And just last week Albany Med's Gastro liver specialists wrote me a prescription for a medicine my G-I "generalist" had already given me, something I took the time to note in my  permanent portal record on Albany Med’s brand spanking “new” and “improved” portal—another bureaucratic tendency the celebration of the ever new and improved--and which had proven ineffective save at making me dizzy and loopy.

And many wonder why “consumers” are so cynical and skeptical these best of all possible worlds utopian days. Next customer, err, patient please. Ding.

Hosanna Hey-Sanna: God I Love the Neo-Liberal University and College

 

Everybody knows that old proverb about money making the world go around by now I assume even if they have not seen Cabaret. And unlike a lot of the more sentimental and melodramatic proverbs out there in our disneyfornicated world it is actually kind of true particularly in a world where the idea of the free market is now a sacrosanct article of metaphysical faith which, if someone has the temerity to question, is categorised as a commie, nazi, adolescent heretical alien loon.

This theological platitude—the free market is the best of all possible economic worlds, the capitalist version of the Bolshevik notion that they and they alone knew the direction of history because they numbered among nature’s chosen-- can even be found in bureaucracies where you would not have expected to find it forty or fifty years ago. You can find the money makes the world go around attitude, for example, in corporatised doctor’s offices with their increasing number of nurse practitioners and physicians assistants who are in some ways a kind of medical bureaucracy version of the higher education adjunct in the US. What Hippocratic Oath? You can find it in corporatised American dental offices. You can find in in the corporatised law offices of the United States. And you can even find it in the ostensibly non-profit world of corporatised and bureaucratised world of American higher education. What devotion to learning for learning’s sake?

There are a number of reasons for the corporatisation of what used to be public service oriented educational bureaucracies whether of the public or private sort. Most importantly, perhaps, there is the cultural religious like notion that the free market is nature’s or god’s economy, that the free market conception of modern capitalism is the only viable and true (note the theocratic nature of this faith) economic theory non-theory. There is the increasing prominence of political groups, mostly on the conservative and right wing populist parts of the ideological spectrum and particularly in the historically racist Dixie and the historically nativist West. There is the decrease in relative terms of national and state support for higher education in the US. There is the culture war between American universities and the wider world over books, the curriculum, classes or courses themselves, and administration, for instance. There is the need, a need others like Thorstein Veblen and Upton Sinclair recognised at the turn of the last century, to appoint hardly radical or even progressive business interests to their boards, and the power of these boards—they are the actual powers that have the authority to run universities and colleges—and faculties really have little means at their disposal to block or even ameliorate them. And there is the increasing notion among those with dreams of well paying academic jobs dancing before their eyes, that the American university and college is a way to advance one’s bureaucratic and financial career.

Quite a number of intellectuals regardless of political persuasion have not been particularly fond of the neo-liberalisation of American higher education large, medium, or small. But gee, what’s not to love about the neo-conservative university and college? I mean who doesn’t love the 200% plus increase in administrative bureaucrats in American universities and colleges between 1979 and 2008? Who doesn’t love the 60% increase in administrative bureaucrats in American universities and colleges between 1993 and 2009? Who doesn’t love the corporatisation and professionalisation of particularly male college football and basketball programmes on America’s university campuses and the use of student fees to build sporting facilities for the privileged few who “play” these childhood games at these universities?  Sis Boom Bah! Who doesn’t love the increasing retailistion of America’s universities and colleges with their customer oriented mentality and their customer service bureaucratic operations with their keep the customer satisfied attitudes, their grade inflation, their dumbing down of the curriculum, their speech codes, and their consequent and often selective curtailment of free speech? Who doesn’t love the increase in part-time yearly contract faculty, the lumpen academitariat, the cheap labour counterpart in American academia of cheap labour in the exploited peripheral world? Who doesn’t love the kowtowing of the university and college to big business, big business “practicality”, and big business spin doctoring? And who doesn’t love the increase in student fees to not only compensate for lost public support at public universities and colleges but to raise monies for the institution as well.

So, dear readers, let us raise our voices in praise for what is happening at Columbia University. Let’s praise what is happening at Indiana University. Let’s praise what is happening at the University of Southern California where that retailversity, showing its commitment to image over free speech, shut down its Facebook page at the end of the week to those who did not already like the USC page and, in some cases, to only the chosen, for obvious reasons and with obvious happy faced consequences. Let’s praise what is happening at the University of Michigan. Let’s praise what is happening at Yale and NYU. Let’s praise Columbia and USC for shutting down their FaceBook pages to public comment pointing up their real commitment to free speech (translate where “freedom” to spin doctor trumps freedom of speech every time). Let’s praise what is happening to public universities in theocratic and authoritarian parts of the United States (you know where they are who they are). What’s not to love, after all, about the public relations conscious and let’s raise monies from the economic elite for the postmodern American megaretailversity? Isn’t it the best of all possible academic worlds after all? And doesn’t building the best of all possible world mean that Orwellian language must be used to curtail free speech on university and college campuses if we are to remain the nation that we imagine in our myths and epic tales--myths and tales undergirded by power realities—we  are? Hosanna, hey-sanna, sanna sanna, hosanna he-sanna hosannah!

Life as Crisis Management: The SNAP or Food Stamp Kiada

 

I am retired and living on a fixed income of around $20,000 dollars a year. Even with a $400 dollar car payment—I bought a car before I was forced into retirement by vampire capitalist SUNY—I was doing OK. Then I got sick.

My sickness started when I took a generic version of Advair. After taking it I immediately struggled for breath and subsequently I developed stomach tightness and consequent deep breathing difficulties and bowel problems. I went to the doctor and have now been sent to a heart doctor, a pulmonologist, two allergists, an ear nose and throat specialist, and a Gastro-Intestinal specialist, including recently a GI liver specialist since I have liver and kidney cysts,  My doctor now wants to send me back to an allergist and to a urologist while the liver GI specialist is sending me back to the GI generalist. 

Needless to say, this merry-go-round that seemingly never stops is costing me monies even though I have Medicare and New York state retiree health insurance. As I told me GP after I brought this up when she wanted to send me to more specialists the copays of $25 dollars, $50 dollars—trips to an urgent clinic—and $100 dollars—three trips to the accident and emergency—not to mention three CT scans and two MRI’s, add up. And this is why, along with car issues, my savings are almost gone.

Because of the decline in my savings I decided, after looking at the qualifications—which I met--to apply for SNAP or food stamps through New York state, the state in which I live. I went to the online website and filled out the forms and provided pictures of my Medicare, NY state retirement income,  Ny state driver’s licence, and a host of other necessary documentation they demanded. About a month or so later I got a letter from food stamps saying they needed information about my pension. I assumed they meant my TIAA CREF “pension” of $70 dollars since they didn’t specify what they meant and I had already provided them with a picture of my NY state retirement income. So I sent it to them. In fact, I sent them the original since I no longer own a printer and wanted to get the documentation in as quickly as possible. Why they could not have asked me to send a picture of this online as I did the earlier ones is beyond me.

Several months later my application was denied. They said that I did not send them the requisite information. Did the post office lose the letter with document I returned four days after I received it? Did the SNAP office lose it? Was this intentional so that roadblocks where put in the way of applicants again and again hoping that the applicant would simply, at some point, give up? I immediately appealed the ruling by writing, calling, and emailing. 

Recently I received a call from the Albany County Government, the public bureaucracy that handles food stamp applications in Albany County, and which I assumed was related to my food stamp application given the timing. Though my phone is working and I had it near me I apparently missed the call. Is it one of those bots that lets the number ring once or twice and no more? I missed it again while at the doctor’s office. I tried to call and tell them when I would be home but got no response after I left a message. So here I am stuck in the hard place that one is always stuck in in a Kafkaesque and Voinovichian bureaucratic world.

Boo Hoo Hoo: Musings on Trauma and Free Speech

Ah, traumas and free speech. The one never seems to come up anymore without the other in modern Boo Hoo Hoo America anymore. Apparently many don’t grasp that free speech is different from action, I can say, for example, and traumatise many in the process by doing so, that god gave this land—Judea and Samaria, the land from not so shining sea to not so shining river—to me and mine. However, if I start to go out and engage in violence to make it so (shout out to Jean-Luc) extralegally—war doesn’t fall into that category oddly since most humans seem to have coded it as legalised murder if selectively—well there are laws as they say.

As to feelings the putative feelings of the traumatised they are, as the song says, nothing more than feelings. And many of those who have them faiil to have to provide evidence of physical violence to back up your traumas, something everyone has for a variety of reasons. Some of us apparently are able to kind of deal with those traumas—traumas we all feel and can hence sympathise and empathise with if some of us only selectively due to parochial political and ideological correctness--whether they be jealousies or some other form of human stupidity--something it is impossible to stop as history shows--thanks to Freud and his children and other coping mechanisms such as Buddhism or the serenity prayer or whatever. We have to if we want to continue slogging our way through the crap and pain that often is life. Life is not and never can be flower child bliss even with the assistance of psychedelics.

In reality, of course, in a world of rationality rather than emotions, calling for death to anyone whether it is theocratic Zionist Jews calling for the cleansing of Palestinians from Judea and Samaria, Palestinians calling for the cleansing Israelis from Palestine, or the formulaic "I am going to kill you” one hears all the time on American winkly TV shows, is speech and, in the case of the TV cop shows, is also usually a McGuffin or a red herring (hmm, interesting) form of speech. It is not an act of physical bodily harm or the killing of someone and thus is not a crime save in the boo hoo hoo fantasies of some of those many humans doped up on certain versions or variations of political and ideological correctness. That so many, including students at supposedly elite retaiversities like Columbia and Michigan and overrated retailversities like USC, have not comprehended this obvious distinction. is not surprising. Moreover, many claiming to be traumatised and thus in need of free speech are lying for their lord and using it as leverage in order to gain power and control in a culture war that has been going on in the United States even before there was a United States. These polemicists, regardless of the reasons for why they are pushing for the criminalisation of some speech, seem not to have grasped the historical fact that it wasn’t even possible to criminalise speech in places like Saudi Arabia, apartheid era South Africa, the old USSR, Israel, or the USofA (shades of prohibition) in the long run even in periods of inquisition and executions, and it will not be possible to do so, in the long run, in America's retaiversites even with their very limited commitments to freedom of speech and academic freedom either. And we should not forget that even if it were somehow possible to criminalise selective forms of speech such criminalisation would necessitate that the state or private corporations build a lot more gaols/jails than the US has now in order to warehouse these linguistic heretics since they would be filled to the gills with language convicts given that humans are first rate at one thing, uttering emotional and fantastical nonsense.

Before I end this post I should take note of the commitment, or better lack of commitment, of those supposedly traumatised by free speech to free speech, you know that little thing that is guaranteed in the US Constitution. Hypocrisy on a general scale about this is not surprising. Just look around at those right wingers who proclaim free speech out of the gilded side of their gobs and violate it out of the others when it is not their politically and ideologically correct speech at every turn.

An addendum. Now we know, thanks to news coverage, who the real purveyors of physical violence and bullying are during the recent protests, those who oppose the free speech of those on American campuses whose free speech they don’t like. Now that is the real America, the America which talks the talk on freedom of speech but doesn’t walk the walk on freedom of speech. By the way, I hear similar minded people are not only attacking Palestinians in the West Bank but food convoys heading to Gaza to relieve hunger as well. Meanwhile some US officially condemns the breaking up of protests by authorities in the nation of Georgia while other American officials urge the need to send in the flics to break up protests at home. Doesn’t all this make you so proud of the human species?

The TIAA-Cref Kiada: Part Three, the Bureaucratic Cyclops

 

Bureaucracies, unlike suicide at least according to the M*A*S*H* myth, are definitely painful. I know because I have had several painful experiences mostly with private bureaucracies including three painful experiences with TIAA-CREF, a private financial service bureaucracy based in America’s Dixie. 

The first painful experience occurred sometime in the early 21st century, precisely when I don’t recall and, to be honest, I don’t care to recall as it is not really important to me. Anyway back to the tale: I had taken a job with the Research Foundation, SUNY, the State University of New York, a research arm of an educational system that is larger and substantially more mediocre than the demographically larger state of California. The Research Foundation decided to close my TIAA-CREF account rather arbitrarily, something bureaucracies, like monarchs, do constantly, of course. It took me three days of a painful series of emails and telephone calls, and associated headaches in order for me to have the monies accrued—a couple of hundred dollars at most, if memory serves-- from the Research Foundation SUNY account folded into another TIAA-CREF account I had taken out, this one with another SUNY bureaucracy, the State University of New York with which the Research Foundation, SUNY twain did not, and intentionally so, meet. 

After I retired from SUNY in 2021—a forced retirement since SUNY was not going to give me two classes and the health care that came along with those two classes--I decided to close my TIAA-CREF SUNY account a year later in 2022. I called the labyrinthian bot based TIAA-CREF number and was eventually transferred to the relevant bureaucratic department and bureaucrat. I was told I could close my account that day via the phone if I wanted to. I, however, decided to do it via a form which I assumed TIAA-CREf would ultimately need anyway. Moreover, I did not feel well, something that has become quite common in my retirement. I was sent the form and closed the account taking mental note that in the period between the phone call and the time it took the form to reach me and for it to reach them my account went down in value. But then that is what happens with modern capitalist stock markets. They go up up up thanks largely to casino capitalist speculation, and they go down down down thanks again largely to casino capitalist speculation, which is what happened to my no more than $3000 dollar account in the short interim.

2021 was also the year 1 I took a part-time job at the Albany College of Pharmacy Library. In retrospect I wish I hadn’t done this since ACP was one of the worst paternalistic and adolescent bureaucracies I have encountered in 69 years of life. I also—stupidity at work here again--took out another TIAA-CREF account when I took the job at ACP thinking that I would work at the college for more than three months I did before I quit because I could not stand the paternalistic nature of those administrative bureaucrats who ran the place.

In March 2024 I decided to close the ACP account, an account kept open in case I wanted to put more monies in it for me or my son. So I did what I did before but only after trying to do it via my online accoun—I also needed to update my email and phone number--an account which I had not used more than once or twice since I set it up and which would not accept my user ID and password, despite the fact that I had not only written down both and had saved my user id and password in my computer saved passwords page. Needless to say this is just one more of the many banes of life in the brave new digital pain in the arse age in which we are all now forced to live. So, I called the TIAA-CREF number, waded through the press x's for the y’s. When I got to an actual human I asked to be transferred to the account closing bureaucracy. My request was denied. When I asked for a form to be sent to me at the address they had on file so I could close my account that request was also denied too. I was, miracle of miracles, provided with an address that I could write to in order to request the account close form. And that is what I did. I even sent this request on one of the original pages of my quarterly earnings report to them requesting the form so I could close my account thinking that might help.

Long story short it has been awhile and I have still not received a response from this Orwellian meets Three Stooges bureaucracy even after sending a second letter. As a consequence I am now proceeding to the next step. I am going to contact the New York Attorney Generals’s office and contact a lawyer though paying my lawyer really to contact them probably isn’t worth the $72 bucks in my account as of the end of March or the hassle. Hiring a lawyer to deal with the absurd TIAA-CREF bureaucracy would no doubt set me back much more than what is in my account. But hey, $72 smackers is $72 smackers and I am retired on a limited monthly income from Medicare and the pension fund of the state of New York. Hmm, I really probably should rethink that last shouldn’t I?

The Books of My Life: A History of New Zealand (Sinclair)

 

Though many historians, caught up as they are in their parochial historical boxes, parochial historical boxes that often provide the scaffolding for various civil, civic, public national faiths, it is essential, if we are to understand the history and culture of the United States, Canada, Australia, or New Zealand, to compare and contrast those national and far too often mythic histories, with the history and culture of other similar English and British settler societies. Given this it is necessary and essential for historians of the United States, Canada, Australia, and New Zealand to read the history of each of these other English and British settler societies lest they play into and validate the myths of exceptionalism that are at the heart of the civil religions of each of those new nation-states. Some scholars, of course, Louis Hartz, Thomas Bender, James Belich and others, have attempted to do just that over the years. Nevertheless, despite these comparative histories of these comparative historians, the comparative history of English and British settler societies remains very much in its infancy and very much a marginal practise within the social sciences even today, to, I would argue, their detriment.

Keith Sinclair, one of the second generation of professional Kiwi historians, while punctuating his history of New Zealand with comparisons between New Zealand with the United States, Canada, Australia, and, of course, Great Britain, has written a book on New Zealand history that, since it first appeared in 1959, has acquired the status of a classic among histories of New Zealand. In A History of New Zealand (Auckland: Penguin, revised edition, 2000) Sinclair takes readers on a journey from the settlement of New Zealand by those who we now know as the Maori to the late 1990s.Along the way he touches on the high points of Kiwi political, economic, and demographic history, as any good history should do, and on New Zealand cultural and identity history, the last an exploration that was somewhat novel in 1959.

There is much in A History of New Zealand that should be grist for the comparative English and British settler society mill. Comparative English and British settler society historians will find much of interest in the history of European interactions with the Maori, in the attempt by the British to learn from their treatment of indigenes in what became the United States, Canada, and Australia and apply these lessons to Aotearoa. They can learn much from the impact of utopian ideas that originated in Europe and in how they played themselves out in New Zealand. They historians can learn much from the role capitalist land speculation played in the colonisation of New Zealand. They can learn much from the impact of World War I on New Zealand identity. They can learn much from the impact of depressions on New Zealand. They can learn much from the difficulties associated with an export based economy which NZ was and is almost from the very beginning of European colonisation. They can learn much from the delayed adoption of the Westminster Statute in Aotearoa compared to Canada. They can learn much from the movement of New Zealand out of the orbit of Imperial Britain and into that of Imperial America, particularly in the wake of World War II. They can learn much from the increasing ethnic diversification of New Zealand. They can learn much from the development of the welfare state in 19th and 20th century New Zealand, a welfare state, some argue, that was a leader in progressive and neoliberal reforms thanks particulafrly to the Labour party. And they can learn much from the integration of core nation New Zealand into the modern global economy dominated by the United States in the wake of WWII. 

Highly recommended for anyone interested in the basics of New Zealand history.