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mostlysignssomeportents · 3 years

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Dead, broke

Of all the moving, wrenching accounts of death during the pandemic, Molly McGhee’s “America’s Dead Souls,” for The Paris Review stands out: haunting, furious and sad, an rude awakening of the status quo that denies any possibility of inaction.

https://www.theparisreview.org/blog/2021/05/17/americas-dead-souls/

I’ve known McGhee a long time, since she worked on my book INFORMATION DOESN’T WANT TO BE FREE from McSweeneys, a professional association we renewed when she landed at Tor.

During the pandemic crisis, I’ve had two different connections to her: on the one hand, the consummate professionalism of her emails as we published my novel ATTACK SURFACE in the middle of the lockdown.

On the other hand, I knew her through her wrenching and deeply personal Twitter account of the personal tragedies she’s endured over the same period. Her Paris Review essay brings those tragedies into sharp focus and uses them to pin a huge and heretofore ill-defined feeling.

McGhee’s mother died during the crisis, but the death was the culmination of years of hardship: “[earning] less than $10,000 a year. Suffering from debilitating depression while caring for her aging parents…chronically unemployed, undermedicated, and overstressed.”

Her mother’s debts were on public display through searchable databases, and her life was haunted by both con artists and bill collectors who carpet-bombed her with calls, letters and emails.

She was too poor to fight back: her wages were garnished by the IRS “for back taxes calculated from a years-old misfiling they refused to correct.” McGhee sent her months of her salary, but it wasn’t enough.

She had no answer for her mother’s rhetorical questions, “Why are these people harassing me? What good does it do them?”

Because the answer is obvious and insufficient: “The people in power don’t care if we live or die, as long as they get paid.”

It only took two days after McGhee’s mother died for her creditors to begin harassing her for her mother’s debts. The state of Tennessee seized the house, but Wells Fargo expected her to make good on the mortgage.

The hospital where McGhee’s mother died wanted a quarter of a million dollars. McGhee, not even 26, was staring down the barrel of the weapon that had been trained on her mother, the inheritor of nothing but debt.

The debt-machine is efficient. Bill collectors found out about McGhee’s mother’s death before McGhee’s own family got word. And they’re remorseless, immune to McGhee’s “pleading, bargaining, reasoning, denying, uploading, scanning, begging, faxing, and crying.”

McGhee compares it to Gogol’s “Dead Souls,” a surreal tale of a grifter named Chichikov who buys dead serfs’ souls to sell for profit.

It’s only surreal if you’ve never been in the debt system’s crosshairs, “where one day of lost wages can compound into houselessness.”

We live in a system of winners and losers. The winners’ winnings come from debt, shielded from the system’s cruelty by “professionalism and bureaucracy” that insulate them — and their functionaries — from “feelings of culpability, not to mention empathy or curiosity.”

Poor people have less money, but the system is firmly focused poor people, because people with money can defend themselves. When McGhee went into debt to hire a lawyer, a single letter on official letterhead instantly reduced all that debt by 90% — more than $250k, poof.

It’s expensive to be poor. Take Community Health Systems, one of the largest hospital chains in America. It sues the shit out of poor people. When those people can afford lawyers, CHS loses, because it is chasing debts it is not entitled to collect.

https://pluralistic.net/2021/05/18/unhealthy-balance-sheet/#health-usury

CHS itself owes $7.6 billion. It turned its first profit in 2020, thanks to hundreds of millions of dollars in state and federal subsidies, and its executives pocketed millions in “performance bonuses” for a performance that consisted of getting bailed out by the public.

The Trump stimulus handed trillions to the richest people and biggest companies in America. Those companies “leveraged up” their handouts to raise trillions more and went on spending sprees, buying up struggling businesses.

https://pluralistic.net/2020/09/17/divi-recaps/#graebers-ghost

They loaded these companies up with debt, declared “divi recaps” (where you take out a loan on a company you bought on credit and put that money in your own pocket as a “special dividend”) and crashed the companies, destroying jobs and communities.

Plutes know there are three kinds of debt: workers’ debts (which must be repaid), owners’ debts (to be “restructured” away) and government debt (not debt at all, but still handy for terrifying normies with stories of “mortgaging our kids’ futures”).

https://pluralistic.net/2021/05/17/disgracenote/#false-consciousness

Forty years of this approach has turned the economy into a shambling zombie, dependent on the fiction that “consumer” debts — repackaged as bonds through financialization — will be repaid, somehow.

https://pluralistic.net/2021/04/02/innovation-unlocks-markets/#digital-arm-breakers

As an ever-larger share of the world’s wealth has shifted from the workers’ side of the balance sheet to the owners’, the ability of workers to buy things to keep businesses afloat as vehicles for debt-leveraging has only declined.

Wage-theft and stagnation, unions in retreat, monopoly, monopsony, tax-preferencing for home-owners over renters, for capital gains over wages, spiraling housing, health and education costs, worker misclassification — wages are annihilated before they’re even deposited.

With no wages left over to fund consumption, there’s only debt, and as Michael Hudson says, “Debts that can’t be repaid, won’t be repaid.” CHS can comfortably carry billions in debts, but the sick people it sues for $201 have to choose between rent and medical debt.

Every loan-shark knows how this works. The chump with $500 who owes you $500 and owes the bank $500 needs an incentive to pay you ahead of the bank. To assert the primacy of your claims, you need an arm-breaker.

The digital world has given us all kinds of fantastic new arm-breakers: digital repo men who can brick your car or your phone. It’s automated the once rare practice of evictions, creating eviction mills that run with devastating efficiency.

https://pluralistic.net/2021/04/02/innovation-unlocks-markets/#digital-arm-breakers

Creating a debt-instrument — a bond grounded in the payments from other peoples’ debts — requires that you convince investors and bond-rating agencies that your arm-breaker will terrorize the debtors into paying you instead of child-support or grocery bills.

“The cruelty is the point” isn’t ideology, it’s pure description. The system — an artificial life-form constituted as immortal colony organism that uses us as gut flora — runs on competing claims to your debt, and victory consists of terrorizing you more than any rival.

The financiers who practice leveraged buyouts destroy real businesses, ruin lives and hollow out communities. They are feted as “job creators.” The workers who must borrow to close the gap they leave are “deadbeats.” Leveraged buyouts are back, baby.

https://pluralistic.net/2021/05/14/billionaire-class-solidarity/#club-deals

If you fret that forgiving student loans and making college free will “saddle our kids with debt,” then you’ve been suckered.

Look. Replacing a system that starts all but the richest children with unserviceable debt with one that doesn’t is liberation, not bondage.

Since Reagan, we’ve been hiking tuition, killing deductions for interest, and shielding student debt from bankruptcy.That’s how you can borrow $79k, pay $190k, still owe $236k, and have 25% taken from every paycheck AND Social Security until you die.

https://pluralistic.net/2020/12/04/kawaski-trawick/#strike-debt

Debts that can’t be paid, won’t be paid. Student debts do get forgiven, but only for those highly educated, (potentially) highly productive people who can prove that they have been so thoroughly destroyed by debt that they have no future.

https://pluralistic.net/2020/11/20/sovkitsch/#student-debt

And as McGhee reminds us, the tragedy isn’t merely that we educate people on the pretense of betting on America’s future, but really, the principle use that the system makes of the educated is as collateral for securitized loans.

If the arm-breakers who chased her mother wanted to understand that woman’s humanity, McGhee says they should start here:

“Her humor and her rage were unmatched. In the evenings, against the setting Tennessee sun, she liked to drink red can Cokes in the garden while snuffing cigarettes out against the yard’s ant colonies. She could reckon with anyone just by looking them in the eye. Men were terrified of her, rightfully so. She was sweet. In the last week of her life, when she couldn’t understand where she was or who she was talking to, she greeted everyone the same: ‘Hi, pal. Hope you’re doing okay. When can you come pick me up?’”

Take a second. Re-read that.

#pluralistic

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rosecierraw · 7 years

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Republicans Move to Grant Immunity for Medical Malpractice

Yes, a real case. Yes, the x-ray hangs in my office.

Well, this comes as no surprise. With Republicans now controlling the Senate, House and White House, they have decided that they didn’t really mean what they said about states’ rights. And they didn’t really mean what they said about personal responsibility.

Out of the House of Representatives, courtesy of Rep. Steve King of Iowa, comes a bill (H.R. 1215) to grant immunity to doctors and hospitals if they negligently injury someone.

Given that 210,000 to 440,000 are estimated to die each year from medical malpractice — a number that dwarfs the 30,000+ killed by guns — you should care about the subject.

Cynically named as a bill to “improve patient access to health care services” by “reducing the excessive burden the liability system,” the King bill slams an artificial cap on awards for pain and suffering at $250,000 in both federal and state cases, among many other things.

Did the hospital negligently operate on the good leg instead of the bad one? 250K.

Did you lose the good leg? The same 250K.

Did you also lose your previously bad leg because they operated on the wrong one? The same 250K.

And it comes as no surprise to anyone that lawyers won’t actively jump at the chance to spend hundreds of hours and tens of thousands of dollars on a suit that is so artificially limited. Thus, de facto immunity for most pain and suffering causes of action from medical malpractice.

How does King go all federal on this, going deep into what is most often a state cause of action? By stating that it will apply to anyone that receives health care through a “federal program, subsidy, or tax benefit.” [Copy Of Bill] That means anyone who uses Medicaid, Medicare, veterans health plans or Obamacare.

And by “tax benefit,” it may mean anyone who has a deduction for healthcare of any kind. Essentially, the idea is to make sure that no one, anywhere in the country, can ever bring a meaningful action for medical malpractice.

The losers in this, of course, are the patients and their families who have already been injured once. And the taxpayers, who are now forced to pick up the tab for the rest of the loss.

King’s bill is based on a faulty premise, that doctors and hospitals order unnecessary tests to protect against malpractice claims. This is the “defensive medicine” theory of why medical costs go up.

But that theory was tested in Texas, and found to fail. As I noted in 2011, the $250,000 Texas cap didn’t stop medical increases. In fact, costs went up faster in Texas than in states that didn’t have a cap.

While doctors may have saved money with fewer suits, and insurance companies may have made buckets more money, it didn’t stop health care costs from rising.

The Texas Experiment also was also supposed to bring more doctors to Texas and more to rural counties. It didn’t work. Even noted tort reformer Ted Frank wrote, in 2012, that the data from Texas “substantially undermines the empirical case for the conventional wisdom that Texas’s 2003 reforms against medical malpractice lawsuits attracted more doctors to Texas.” Ouch.

Frank went on to conclude:

I, for one, am going to stop claiming that Texas tort reform increased doctor supply without better data demonstrating that.

The real kicker to the artificial caps, of course, is that the taxpayers then get saddled with the costs of the injured person instead of the ones that negligently caused the injury. That’s right, saddling the taxpayers with the costs is a form of socialism. And it is being promoted by alleged conservatives.

The myth that tort “reform” reduces costs was debunked awhile ago. As Steven Cohen noted in Forbes two years ago regarding additional studies, there was no reduction in the expensive tests from states with caps:

That myth was dispatched by the recent publication of a major study in the New England Journal of Medicine. A team of five doctors and public health experts found that tort reform measures passed in three states – specifically designed to insulate emergency room doctors from lawsuits — did nothing to reduce the number of expensive tests and procedures those ER doctors prescribed.

Cohen went on to summarize that none of the “expected” reductions in health care costs came to fruition:

This latest study follows numerous others that deflated other tort reform myths: that making it harder for victims to file medical malpractice lawsuits would reduce the number of “frivolous” suits that “clog the courts;” that imposing caps on the damages victims could receive would reign in “out of control” juries that were awarding lottery-size sums to plaintiffs; and that malpractice insurance premiums would fall, thereby reversing a doctor shortage caused by specialists “fleeing the profession.”

Trump is now on the bandwagon also, or at least whoever wrote this portion of his speech last night:

“Fourthly, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance — and work to bring down the artificially high price of drugs, and bring them down immediately.”

This oblique reference — Trump never deals in details — was presumably put there by his staff, as I know of no other Trump comment on the subject of medical malpractice.

But wait, there’s more! Tort “reform,” you see, has never saved a life. But has it ever killed anyone? Answer, yes!

I addressed that subject a few year back by pointing to plunging payouts at Columbia Presbyterian Hosptial / Cornell Weill Medical Center. A study found that “instituting a comprehensive obstetric patient safety program decreased compensation payments and sentinel events resulting in immediate and significant savings.”

How much did they save by instituting new safety procedures — in pure dollars and cents leaving aside the human misery of injury? “The 2009 compensation payment total constituted a 99.1% drop from the average 2003-2006 payments (from $27,591,610 to $ 250,000).”

You read that right: 99.1% drop. Based on a safety program, not tort “reform.”

Now if Congress wants to take away the incentive for safety, and just give immunity, you can expect continued deaths. The results should have been screamed from the rooftops:

Safety improvements = fewer malpractice payments and healthier patients.

Tort reform = more patient deaths.

Now let’s return to politics, shall we? I just want to close by asking conservatives a few questions, and do so with the knowledge that medical protectionism has already been a proven failure in reducing health care costs:

1. Do you believe in limited government?

2. Is giving immunity your idea of limited government?

3. Do you believe in states rights? Would federal tort “reform” legislation that limits the state-run civil justice systems run contrary to that concept?

4. Do you believe in personal responsibility?

5. Do you want to limit the responsibility of negligent parties and shift the burden to taxpayers?

6. If you believe in having the taxpayers pay for injuries inflicted by others, how much extra in taxes are you willing to authorize to cover those costs?

7. Is shifting the cost of injuries away from those responsible, and on to the general public, a form of socialism?

Elsewhere:

Congress Moves To Punish Anyone Using The ACA And Medicare (Doroshow @ Huffington Post), which lists other “features” of the bill

Statement of the Honorable John Conyers, Jr. In Opposition to H.R. 1215, the So-Called “Protecting Access to Care Act of 2017”

Republicans Move to Grant Immunity for Medical Malpractice published first on http://fergusonlaw.blogspot.com

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