Fucked Up Health Insurance Priorities

Community Health Plan advertisement for soccer event

My “non-profit” Medicaid health insurer (all the others in WA are for-profit!) doesn’t cover all kinds of providers, facilities, treatments, and medical devices. It requires prior authorization for lots of things rich people get automatically. Their nurse advice line must be contracted out, because the call center is in Texas (CHPW headquarters is a block from me). They don’t cover my sleep doctor, the orthopedist I was referred to, the version of diabetes medication I was recently prescribed, EMDR, or the blood glucose meter I have that requires a minimum of blood, to cite a few examples off the top of my head. They don’t let me see ANY specialist without a referral from my primary care doctor.

But they can somehow afford to spend money organizing and advertising a free event with professional athletes in Columbia City. I’ve gotten email, Facebook postings, and maybe even paper mail promoting it. This is a blatant waste of money. Estimates on marketing and administration costs in the US health system range widely from about 5% to 50%. Administration of some kind will always be necessary, but we could greatly reduce it in part by simplifying the system. Isn’t Medicare’s administration cost around 3%? In the short term, Medicaid should simply be absorbed into Medicare–economies of scale there, less cost for states, and better health care for the poor. Marketing health care or insurance or other products (PILLS!) is pure evil. We are patients, not consumers. Advertising has absolutely no justifiable place in health care. This money is pure waste that drives up demand for expensive and unnecessary products and overall health spending. And for a non-profit insurer covering poor people, I find it totally unjust and unconscionable that they prioritize spending for this kind of bullshit over health care for people who need it.

Email to Crazy Russian Psychiatrist

She got flustered with my texts, some of which I’ll post here in screenshot form, so I tried to lay everything out by email. For your car crash viewing pleasure:

Last year I went without klonopin for a month because you and my pharmacy couldn’t get it together. I went through awful withdrawal symptoms the whole time. You and they blamed each other while I suffered. 
 
You’ve criticized my eyebrows and mischaracterized my and [my old therapist]’s words. You say you’ll check your notes, but I’ve never seen evidence that you do. 
 
You are always late which costs me extra time and bus fare. Then you criticize me the ONE time I’m late. 
 
You’ve not filled out or returned any of my necessary forms. 
 
I’ve repeatedly told you I take too many pills and need fewer. You ignore me or change the mix but never reduce them. You seem to think the answer to everything is more pills. It’s not. They’re not working. They’ve made my life worse. 
 
You speculated that I might have sleep apnea when I was diagnosed with it 8 years ago and put it on my intake paperwork on my first visit. You similarly asked what the news was with diabetes. The only news was your forgetting my 2008 diagnosis–or not checking your file on me. 
 
You’ve refused to help me get PTSD treatment, dishonestly saying EMDR is the only treatment for it and using the flimsy excuse that it’s not your specialty and not what I came to you for. But you can’t tell me what I did come to you for, and you’re the MD plugged into the mental health establishment–I’m the patient. Why is it that when I know exactly what I need, and ask for it repeatedly, I can’t get it? Is it any wonder so many people kill themselves??
 
Based on the time stamps of your Facebook activity, you are using Facebook during patient appointments. Meanwhile you criticize the times when I use Facebook even though you have no way of seeing me there. 
 
You’ve accused me of laziness and sabotaging myself. These are totally false and inappropriate things for you to say to a patient. You don’t even remember anything about me from one appointment to the next and routinely confuse me with other patients and their issues. You see so many patients that you can’t keep them straight. 
 
You ignore most of my emails–that’s why I text. And why I contacted [my old therapist] first when I was seeing her. 
 
Is any of this going to change? Will you complete and return my disability paperwork? Will you make any effort to get me some PTSD treatment? Otherwise this all seems like more trouble than it’s worth. I hate going to Bellevue for surreal visits that don’t help and make no sense; the rules and priorities change every time. 

Russian Tourism Guide Nails US Culture

Acting romantic only gets you in trouble with American women. And our extreme optimism bias means we have to hide and keep secret all our problems, embarrassments, insecurities, etc. My inability to do this has gotten me in lots of trouble and lost me lots of “friends” on Facebook. We don’t allow people to be realistic or clear-eyed; only enforced optimism is allowed. Which is really phony, misleading, and dangerous.

“ON TALKING TO AMERICAN WOMEN
The short version: American women are a little uptight. They might call the cops if you look at them too long. And don’t be gallant, that creeps them out.

…ON AMERICAN OPTIMISM
Short Version: These people do not stop smiling. Also, they don’t want to hear your problems because it interrupts their smiling. ‘Surviving’ makes you a hero over there. Here it just means you were unlucky, but not unlucky enough to have died.”

Russian Travel Tips for Visiting America

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Lethally Ill, Impossible to Get Treatment

I told my crazy Russian psychiatrist at my August, June, and April visits that I need to be treated for PTSD. She said I should get EMDR, but Medicaid doesn’t cover that. I told her this, but she just said “Hm”, and kept typing.

Now my psychologist aunt changes her position a second time (my friend reminds me that most people don’t remember as well as I do) to say that I have PTSD, not borderline personality disorder, and that’s what I should seek treatment for. She was “always” doubtful about both the Borderline diagnosis and the DBT recommendation (except that I gave my last therapist permission to discuss me with my aunt, after which my aunt emailed me saying she liked my therapist and agreed with the diagnosis and recommended treatment–now conveniently forgotten). So now she treats me like it’s my fault that I followed her advice/blessing. She also criticizes me harshly for “ranting” which is “an instrument of alienation” — glossing over her repeated rants to me about the horrible M family she married into (and which I never chose and hardly have any connection to; it’s not like any of them communicate with me), although I’ve been quite sympathetic to them.

I emailed and texted my psychiatrist repeatedly, to get a response, saying I desperately need treatment for PTSD, and she again told me to get EMDR. She said everyone does it (except her)! I told her what Harborview told me, which is that no one in the UW/Harborview network does EMDR. “Oh”, she said. She claims there is no other treatment for PTSD except EMDR. This is obviously false. And a great example of how America treats its people.

Sexism Hurts Men, Too. Why Won’t We Address it?

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Look up bigorexia. I’ve been warning since college, where I was by far the most prominent male feminist activist, that if feminism didn’t address the legitimate concerns men hold, men otherwise sympathetic to the cause would avoid the movement and join harmful right-wing ones like the men’s rights movement. Feminism in the last 15 years has studiously refused to address any men’s concerns (case in point: Jezebel.com), and men have done exactly as I warned.

Look at the seduction/pickup community. Rape culture (women leading men on by saying yes when they mean no. Women on OK Cupid usually say in answers to personality questions that being drunk is an excuse for bad behavior, that men should head their households, that it’s unacceptable for men to stay at home raising their kids, that when they say no to being asked out, their ‘no’ really means ‘keep trying’, that men shouldn’t have long hair or wear makeup, that chivalrous men are preferable–the list is endless). Fraternities and hazing. The glorification of inherently sexist chivalry (because equality can’t be romantic!). The proliferation of the phrase “man up”, as if responsibility or maturity are male traits, or only men need to grow. The continued if not increasing refusal of straight women to ask men out or pay their share on dates (even though studies have shown that when men do all the asking and paying, they have all the power which leads to a higher incidence of rape). Man caves. The suicides of young boys who are bullied for liking “feminine” toys like Barbie or Care Bears, or painting their fingernails, wearing makeup, etc.

Recently a non-gendered Meetup group I belong to offered a class on makeup tips. You had to sign up for the event to get the location emailed to you. I signed up and heard nothing until I said something after the event. The organizer ASSUMED that only women could or should be interested in makeup. I guess she hasn’t been on Capitol Hill. Someone in my neighborhood Facebook group posted a question about where to get good manicures and pedicures, but directed the question only to women. No one can tell me why umbrellas, alcoholic drinks, or bathrooms should be gendered (I’ve been mocked by men AND women for drinking “girly” drinks). Studies, again, show that women prefer to date sexist men over feminist ones. If you wanted to make men more feminist, wouldn’t you want to reward the feminist ones and punish the sexist ones? In sex and dating, men are the demand, and women are the supply. Sorry, I wish it weren’t true, but it is. Women have a great deal of power they aren’t using. Simple behaviorist psychology says you’ll get more of the behaviors you reward, and vice-versa. Yet women WANT men to be jealous, “protective”, and violent. They take no interest in men who express emotions–especially weakness–or ever need emotional support. They want men who are sensitive TO THEM, not who are sensitive people on the whole. The personal insult hurled at me for opposing war and guns is that I’m a pussy. “REAL men do X” because men constantly have to “prove” their masculinity based on behaviors that have nothing to do with gender. If you don’t fit the outdated, sexist, 1950s prescription of what a man is supposed to be, you’re a fake man. 

You can’t create equality between two groups of people when you only have buy-in from one of them. Feminists should be exploiting the ways sexism harms men to address those concerns, and attract male support for a movement that truly helps everyone and improves all our lives. They should not ignore, dismiss, demean, or belittle men when they raise these issues (a favorite tactic of mine is when they classify these concerns as personal and thus irrelevant or unimportant, so conveniently forgetting that “the personal is political” was a rallying cry of 2nd wave feminism). But the sad truth, as Warren Farrell said, is that no one really wants equality. They want immediate, short-term self-interest. So that’s what we’ve got. And most women and some men continue having the cost forcibly extracted from them.

US Forces Poor to Subsidize Rich

The mortgage interest deduction is regressive, ineffective, wasteful, distorts the housing market (although worshippers of density and housing supply never admit it), and comes at the cost of denying 76% of eligible Americans the housing help they’re entitled to–under current law; not what they actually need. People are literally going homeless because we’d rather spend money on tax breaks for the rich than affordable housing–even if we need the affordable housing and construction jobs it would create more. The mortgage interest deduction must be ABOLISHED.

But what makes overhaul of this tax subsidy especially urgent is the current nationwide housing crisis in the United States, where 76 percent of the 19 million people who qualify for housing assistance from the U.S. Department of Housing and Urban Development cannot obtain it because not enough federal funds have been made available to help them. The $70 billion to $100 billion that this country annually sacrifices for the MID dwarfs HUD’s $46 billion budget, the primary means of housing assistance for moderate and low-income people.

Mortgage interest deduction fuels inequality