#or had the money to turn to private healthcare
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Cigna’s nopeinator
I'm touring my new, nationally bestselling novel The Bezzle! Catch me THURSDAY (May 2) in WINNIPEG, then Calgary (May 3), Vancouver (May 4), Tartu, Estonia, and beyond!
Cigna – like all private health insurers – has two contradictory imperatives:
To keep its customers healthy; and
To make as much money for its shareholders as is possible.
Now, there's a hypothetical way to resolve these contradictions, a story much beloved by advocates of America's wasteful, cruel, inefficient private health industry: "If health is a "market," then a health insurer that fails to keep its customers healthy will lose those customers and thus make less for its shareholders." In this thought-experiment, Cigna will "find an equilibrium" between spending money to keep its customers healthy, thus retaining their business, and also "seeking efficiencies" to create a standard of care that's cost-effective.
But health care isn't a market. Most of us get our health-care through our employers, who offer small handful of options that nevertheless manage to be so complex in their particulars that they're impossible to directly compare, and somehow all end up not covering the things we need them for. Oh, and you can only change insurers once or twice per year, and doing so incurs savage switching costs, like losing access to your family doctor and specialists providers.
Cigna – like other health insurers – is "too big to care." It doesn't have to worry about losing your business, so it grows progressively less interested in even pretending to keep you healthy.
The most important way for an insurer to protect its profits at the expense of your health is to deny care that your doctor believes you need. Cigna has transformed itself into a care-denying assembly line.
Dr Debby Day is a Cigna whistleblower. Dr Day was a Cigna medical director, charged with reviewing denied cases, a job she held for 20 years. In 2022, she was forced out by Cigna. Writing for Propublica and The Capitol Forum, Patrick Rucker and David Armstrong tell her story, revealing the true "equilibrium" that Cigna has found:
https://www.propublica.org/article/cigna-medical-director-doctor-patient-preapproval-denials-insurance
Dr Day took her job seriously. Early in her career, she discovered a pattern of claims from doctors for an expensive therapy called intravenous immunoglobulin in cases where this made no medical sense. Dr Day reviewed the scientific literature on IVIG and developed a Cigna-wide policy for its use that saved the company millions of dollars.
This is how it's supposed to work: insurers (whether private or public) should permit all the medically necessary interventions and deny interventions that aren't supported by evidence, and they should determine the difference through internal reviewers who are treated as independent experts.
But as the competitive landscape for US healthcare dwindled – and as Cigna bought out more parts of its supply chain and merged with more of its major rivals – the company became uniquely focused on denying claims, irrespective of their medical merit.
In Dr Day's story, the turning point came when Cinga outsourced pre-approvals to registered nurses in the Philippines. Legally, a nurse can approve a claim, but only an MD can deny a claim. So Dr Day and her colleagues would have to sign off when a nurse deemed a procedure, therapy or drug to be medically unnecessary.
This is a complex determination to make, even under ideal circumstances, but Cigna's Filipino outsource partners were far from ideal. Dr Day found that nurses were "sloppy" – they'd confuse a mother with her newborn baby and deny care on that grounds, or confuse an injured hip with an injured neck and deny permission for an ultrasound. Dr Day reviewed a claim for a test that was denied because STI tests weren't "medically necessary" – but the patient's doctor had applied for a test to diagnose a toenail fungus, not an STI.
Even if the nurses' evaluations had been careful, Dr Day wanted to conduct her own, thorough investigation before overriding another doctor's judgment about the care that doctor's patient warranted. When a nurse recommended denying care "for a cancer patient or a sick baby," Dr Day would research medical guidelines, read studies and review the patient's record before signing off on the recommendation.
This was how the claims denial process is said to work, but it's not how it was supposed to work. Dr Day was markedly slower than her peers, who would "click and close" claims by pasting the nurses' own rationale for denying the claim into the relevant form, acting as a rubber-stamp rather than a skilled reviewer.
Dr Day knew she was slower than her peers. Cigna made sure of that, producing a "productivity dashboard" that scored doctors based on "handle time," which Cigna describes as the average time its doctors spend on different kinds of claims. But Dr Day and other Cigna sources say that this was a maximum, not an average – a way of disciplining doctors.
These were not long times. If a doctor asked Cigna not to discharge their patient from hospital care and a nurse denied that claim, the doctor reviewing that claim was supposed to spend not more than 4.5 minutes on their review. Other timelines were even more aggressive: many denials of prescription drugs were meant to be resolved in fever than two minutes.
Cigna told Propublica and The Capitol Forum that its productivity scores weren't based on a simple calculation about whether its MD reviewers were hitting these brutal processing time targets, describing the scores as a proprietary mix of factors that reflected a nuanced view of care. But when Propublica and The Capitol Forum created a crude algorithm to generate scores by comparing a doctor's performance relative to the company's targets, they found the results fit very neatly into the actual scores that Cigna assigned to its docs:
The newsrooms’ formula accurately reproduced the scores of 87% of the Cigna doctors listed; the scores of all but one of the rest fell within 1 to 2 percentage points of the number generated by this formula. When asked about this formula, Cigna said it may be inaccurate but didn’t elaborate.
As Dr Day slipped lower on the productivity chart, her bosses pressured her bring her score up (Day recorded her phone calls and saved her emails, and the reporters verified them). Among other things, Dr Day's boss made it clear that her annual bonus and stock options were contingent on her making quota.
Cigna denies all of this. They smeared Dr Day as a "disgruntled former employee" (as though that has any bearing on the truthfulness of her account), and declined to explain the discrepancies between Dr Day's accusations and Cigna's bland denials.
This isn't new for Cigna. Last year, Propublica and Capitol Forum revealed the existence of an algorithmic claims denial system that allowed its doctors to bulk-deny claims in as little as 1.2 seconds:
https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
Cigna insisted that this was a mischaracterization, saying the system existed to speed up the approval of claims, despite the first-hand accounts of Cigna's own doctors and the doctors whose care recommendations were blocked by the system. One Cigna doctor used this system to "review" and deny 60,000 claims in one month.
Beyond serving as an indictment of the US for-profit health industry, and of Cigna's business practices, this is also a cautionary tale about the idea that critical AI applications can be resolved with "humans in the loop."
AI pitchmen claim that even unreliable AI can be fixed by adding a "human in the loop" that reviews the AI's judgments:
https://pluralistic.net/2024/04/23/maximal-plausibility/#reverse-centaurs
In this world, the AI is an assistant to the human. For example, a radiologist might have an AI double-check their assessments of chest X-rays, and revisit those X-rays where the AI's assessment didn't match their own. This robot-assisted-human configuration is called a "centaur."
In reality, "human in the loop" is almost always a reverse-centaur. If the hospital buys an AI, fires half its radiologists and orders the remainder to review the AI's superhuman assessments of chest X-rays, that's not an AI assisted radiologist, that's a radiologist-assisted AI. Accuracy goes down, but so do costs. That's the bet that AI investors are making.
Many AI applications turn out not to even be "AI" – they're just low-waged workers in an overseas call-center pretending to be an algorithm (some Indian techies joke that AI stands for "absent Indians"). That was the case with Amazon's Grab and Go stores where, supposedly, AI-enabled cameras counted up all the things you put in your shopping basket and automatically billed you for them. In reality, the cameras were connected to Indian call-centers where low-waged workers made those assessments:
https://pluralistic.net/2024/01/29/pay-no-attention/#to-the-little-man-behind-the-curtain
This Potemkin AI represents an intermediate step between outsourcing and AI. Over the past three decades, the growth of cheap telecommunications and logistics systems let corporations outsource customer service to low-waged offshore workers. The corporations used the excuse that these subcontractors were far from the firm and its customers to deny them any agency, giving them rigid scripts and procedures to follow.
This was a very usefully dysfunctional system. As a customer with a complaint, you would call the customer service line, wait for a long time on hold, spend an interminable time working through a proscribed claims-handling process with a rep who was prohibited from diverging from that process. That process nearly always ended with you being told that nothing could be done.
At that point, a large number of customers would have given up on getting a refund, exchange or credit. The money paid out to the few customers who were stubborn or angry enough to karen their way to a supervisor and get something out of the company amounted to pennies, relative to the sums the company reaped by ripping off the rest.
The Amazon Grab and Go workers were humans in robot suits, but these customer service reps were robots in human suits. The software told them what to say, and they said it, and all they were allowed to say was what appeared on their screens. They were reverse centaurs, serving as the human faces of the intransigent robots programmed by monopolists that were too big to care.
AI is the final stage of this progression: robots without the human suits. The AI turns its "human in the loop" into a "moral crumple zone," which Madeleine Clare Elish describes as "a component that bears the brunt of the moral and legal responsibilities when the overall system malfunctions":
https://estsjournal.org/index.php/ests/article/view/260
The Filipino nurses in the Cigna system are an avoidable expense. As Cigna's own dabbling in algorithmic claim-denial shows, they can be jettisoned in favor of a system that uses productivity dashboards and other bossware to push doctors to robosign hundreds or thousands of denials per day, on the pretense that these denials were "reviewed" by a licensed physician.
If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
https://pluralistic.net/2024/04/29/what-part-of-no/#dont-you-understand
#pluralistic#cigna#computer says no#bossware#moral crumple zones#medicare for all#m4a#whistleblowers#dr debby day#Madeleine Clare Elish#automation#ai#outsourcing#human in the loop#humans in the loop
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million dollar man | lance stroll x fem! reader
summary; in the world of her million dollar man, y/n can’t help but feel like a lost puppy and stick out like a sore thumb leading to mess of jumbled feelings.
warnings; insecurities esp around money, reader is mentioned to be a healthcare worker/nurse
word count; 1.2k
taglist; @namgification @louvrepool @locelscs @thehufflepuffavenger1 @minseok-smaus @goldenmclaren @ollieshifts @lavisenri @graciewrote @xoscar03
note; i can’t tell yall the amount of times i’ve thought of this fic ever since i started the born to die series 😭😭😭😭 but i rlly let out my obsession w these luxuries out here 🫣🫣
‘born to die’ series masterlist.
masterlist !
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“Why don’t you wear your new necklace? The one that your fiancé got you.”
Y/n could hear the smile in Lance’s voice as she stood in the bathroom adding the finishing touches to her makeup. “Yeah, because a Serpent around my neck would match the floral look.” She snorted, referring to the Bulgari necklace he had gotten her the week prior.
“I mean, you haven’t worn it yet. Where else would you showcase it for the first time other than your own engagement party?”
“Because it doesn’t match.”
What she said was partially the truth. The serpent necklace didn’t match her 3 thousand-dollar Oscar De La Renta dress.
It didn’t match with the gold Rolex on her left wrist or the diamond-encrusted Cartier love bangle, Juste un Clou, and the Van Cleef bracelet on her right wrist. Nor did it match the giant diamond engagement ring adorning her ring finger.
It didn’t match her white Louboutin heels nor did it go with the 20-motif Van Cleef Alhambra necklace.
It didn’t match her and that was her issue.
Y/n never even dreamt of the lifestyle she had been living ever since dating Lance. It was something so unattainable. The expensive bags, jewelry, cars, and private jets, she never even dared to dream of.
She grew up middle class, her parents having enough to be able to put food on the table, and have decent clothes, but not enough to earn them all the luxuries she has now. Sure, her nursing job earned her a decent amount of money, but the necklace her boyfriend had gotten her cost more than her yearly salary and that said enough.
She remembered the look on the faces of Lance’s extended family when they found out she did not come from another rich family and was just a regular pediatric nurse. They immediately assumed she was just with him for money. They talked and talked.
The gossip would become worse whenever Y/n would show up with a new bag or bracelet. She hated it.
She remembered when Lance decided to throw her a huge birthday party. He paid for most of it even if she protested. Not to mention, he gifted her not one but two Hermes mini Kelly’s. She remembered the looks on his aunt's face as she held a rare picnic mini Kelly.
“One for the money, two for the show, right?” He joked, chuckling at her shocked face, and pressed a kiss against her cheek. “I love you, honey.”
“You’re unbelievable, Lance. I love you.”
The same picnic Kelly bag he gifted her was the one she decided to wear with her floral dress. A springtime engagement called for a floral theme engagement party, hence the dress.
Y/n stares at herself in the mirror after applying her Dior lipgloss. She looked like a million-dollar man. She looked so strange like she was unrecognizable. She had the dream life of so many but had no idea why she felt so upset or heartbroken.
She was so lost in her thoughts that she didn’t realize Lance had been calling her. “Honey, what’s the matter?” He asked, concern in his voice as he walked into the bathroom all dressed in an expensive suit.
“I hope you’re not getting cold feet before our engagement part.” He joked but his smile immediately fell at her silence. “Are you?”
“No! No!” Y/n quickly exclaimed, turning around and settling her hand on his shoulder. “I’m not getting cold feet, Lance. I want to marry you and I will marry you. It’s just…” Her voice trailed off and she sighed. “It’s stupid.”
“It’s not stupid if it’s bothering you.” He mumbled, grasping her hands. His dark eyes were filled with concern as his thick brows furrowed up. She still seemed hesitant to tell him what was on her mind. “Hey, I won’t judge you for what’s on your mind.”
Y/n sighed again as Lance gave her hands a gentle squeeze. “You know I didn’t grow up with this. All of these luxuries, expensive jewelry, even more expensive cars and bags. My nursing job can only cover so much. It can’t cover a quarter of what you give me.”
“And I don’t care!” He exclaimed, “You’re my fiancée. I want to spoil you. It’s my duty to spoil you. I don’t care what they think, I-”
“But I’ve seen the way your aunts stare at me.” She mumbled, looking down at her Louboutins. “I’ve heard their whispers. They just think I’m a gold digger who is only marrying you to have this lifestyle but I couldn’t give two shits about all of this! We could be struggling with money and I’d still want to be with you.”
She sighed as she let go of his hands. She turned around to look at herself through the mirror. “I see a stranger when I’m dressed up like this. I stick out whenever I’m with your family and they all know it. They never try to hide their whispers and they’re right. I don’t fit into this world, Lance. I look like a million dollar man but why does my heart still feel broken?”
“Y’know what I see?” Lance asked as he took a step closer to her, placing his hand on her waist. “I see the most gorgeous woman. Someone so unique and special that she’s like an exotic flower.” He chuckled, running his finger over the strap of her floral dress.
“I see someone who is so brilliant she used her brain to study to help children in need. I see someone with a heart so big, that she works extra shifts just to spend time with her patients no matter how tiring the week has been.” He continued, gently fixing a strand of her hair which made her let out a soft chuckle. “I see my fiancée, the woman I want to spend the rest of my life with despite not growing up in ‘my world’.”
Lance leaned over and kissed Y/n’s cheek. “I see the woman who has always been by my side. I see the woman who will be the mother of my children. I see the woman who has stolen my heart from the day I bumped into her in that cafe.”
He spun her around so she was facing him. She rested her hands on his shoulder once again for stability as his hands held onto her waist. “I don’t see someone strange. I see you.”
She takes a deep breath, her pink lips curled into a smile as her eyes fill with tears. “You always know how to take a girl's breath away, don’t you?”
“Just yours.”
Y/n leaned up and pulled him close to kiss him, not caring if they were going to be made to their own engagement party. “I love you so much, Lance.”
“I love you so much, Y/n. More than anything else in this world.”
She leaned back down with a wide smile on her lips. She takes a deep breath and quickly glances in the mirror to ensure her makeup is still intact.
“Well, we can’t be late to our own engagement party.” Y/n chuckled, grabbing her bag and turning back to Lance. “Shall we go, my million dollar man?”
He kisses the top of her head as a smile matching hers appears on his lips. “Let’s go, my honey.”
#formula one x reader#f1 x reader#f1 scenario#formula one scenarios#f1 imagine#formula one imagines#formula one imagine#f1 scenarios#lance stroll scenarios#lance stroll x reader#lance stroll imagine
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All Or Nothing
A/n: All mistakes are my own. Written on my phone.
Pre-Stucky x Reader, pre-Bucky x reader, Stucky, Steve x reader
AU: Bucky wants his boyfriend back, but his boyfriend is your husband now. And the father of your child.
Warnings: angst, eventual smut, 18 plus only please, fluff, implied cheating (but not really) mob!Bucky, mob!Steve, presumed unrequited love, polyamory, MMF, bisexual Stucky.
I hope that’s everything!
Part One
You wanted for nothing.
There was a tall Brooklyn Brownstone, a Manhattan Penthouse, a sprawling Hampton Mansion. Further afield was the Aspen Ski Lodge, the Montana Ranch. Overseas was the Mediterranean Villa, the Irish Cottage and the Romanian Castle.
Yes, he owned a castle.
James Buchanan “Bucky” Barnes was the only male heir to three very successful brothers who built themselves an empire. He and his three sisters had been given the keys to the kingdom when his father, the youngest of the three and the last surviving brother, died.
The first thing Bucky did after securing his position was to track down the only person he wanted to share his life with. Trouble was, that man Bucky was in love with was your husband.
You met Steve Rogers five years ago. He ended up in a bar fight defending a woman getting unwanted attention from a group of guys. Feeling lucky you joined in, cracking a bottle over the head of one of the pricks. You had been together ever since.
Steve talked about Bucky to you, he kept no secrets and you knew he had ran to save his life. When you discovered you were pregnant Steve proposed.
“I love you so much honey,” Steve had promised as you hesitated. “You’re mine. And I’m yours.”
Three days later, you were wed.
You wanted for nothing.
There were private planes, helicopters, luxury SUV’s, sports cars, motorcycles, a yacht and other various pleasure boats.
Steve loved anything with an engine that gathered speed, and Bucky was happy to indulge Steve’s whims. Money was no object, and you soon found that Bucky had been loyally taking care of Steve’s ill mother whilst he was on the run, getting her the best healthcare.
Bucky adored your precious Belle, the apple of Steve’s eye. She looked just like her father and had that stubborn streak of bravery just like he had too. You had never seen love at first sight until you saw Bucky meet Belle. Her face lit up and his eyes gentled and an instant bond was formed that terrified you.
Your wedding band meant nothing. Bucky belonged to this family, slotted in perfectly by charming your husband and delighting your daughter.
You had hung back, nodding in greeting and watching your family slip away.
So here you stood, in a designer dress and heels wearing jewellery worth more than you had ever earned watching Steve and Bucky waltz around the vast ballroom with Belle between them, her squealing with delight.
You wanted for nothing except the days before Bucky Barnes turned your life on its head.
Part 2
#stucky x y/n#stucky x you#stucky x reader#bucky barnes x reader#bucky barnes x you#bucky barnes x female reader#steve rogers x reader#steve rogers x you#steve rogers x female reader#steve rogers x reader x bucky barnes#mob!stucky x reader
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Now I'm thinking too hard about some of the surgeons and my personal headcanons for them again, god fucking help me.
Thinking about Hawkeye raised in a rural community with Daniel being more of a horse-and-buggy doctor who made house calls just as often as he saw people in his office or his home. Thinking about Hawk who was a child when he was first needed to hold pressure on a belly wound, not yet a teenager when he became the only person who could assist if someone made it to the Pierce house in the middle of the night and needed emergency care. Thinking about how money never even occurred to him because Daniel's been getting paid more often in eggs and bread and fresh crops and delicious fish and services in turn for as long as Hawk's been alive. A man who walked into medical school already having seen and experienced far, far more of the visceral parts of surgery than anybody else there, who got mistaken for a prodigy, who never thought to correct them but instead expected them all to keep up.
Thinking about Trapper growing up in the thick of Boston slums where it was so much harder to get adequate healthcare, just a kid hearing about how almost all of his friends were supposed to have a baby sibling on the way, but now they're not. How often the men in his area—physical laborers—would be laid off after they lost a limb, how it would pull his friends out of school one by one once they completed their requisite education because they needed to work when their parents no longer could. How many times he had to see someone sick or injured and having nowhere to go for care because they couldn't afford it, coughing on the side of the road, bleeding in an alley. A man who walked into medical school with more fucking determination than anyone else there, gritted teeth, fire in his chest, because he'd be damned if he watched that cycle continue.
Thinking about BJ in a fine home, expensive neighborhood, upper class, parents determined to tick their way up the ladder into new money by marrying their kids into wealthier families so that by extension, they can experience the height of luxury. His grandfather's legacy which led to his father's excellent private practice, high prices, tied up neatly in a bow of how disdainfully he'd often speak of his patients or colleagues at home. The Depression hitting and wiping out his father's and grandfather's money—stored in banks, in stocks, in bonds—instantaneously, and how his father had to pivot to barely making anything because there was so little that his patients could give, and how cold it made him because why should he be a surgeon if he doesn't even get paid for his work? Why should he help anybody at all when he'd receive so little personal benefit? A full eighteen years immersed in his father's bitterness, every minute spent distancing himself from him. A man who walked into medical school having already cut them off cleanly, a mission in his chest, the drive to provide care out of compassion, his principles already firmly locked in place, his desire to be the best out of anybody else around him so that no one ever has to feel like they need to beg him so that he would deign to save their life.
I'm unwell about the surgeons. I don't know if y'all knew this or not.
#charles and i are still on less than great speaking terms so he is not telling me his motivations#we'll get there when he's ready#god do i wanna put this in the main tags#only doing so so i can find this on my blog later#these are for MY personal iterations of them#if you disagree with my thoughts then please go make your own post where you can expound to your heart's content#because it's an incredible delight for me to hear how everyone else headcanons the characters#hawkeye pierce#trapper john mcintyre#bj hunnicutt#my writing
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May not by your wheelhouse, but regarding ever-increasing college tuition, where does the money go? Why is college so much more expensive than it was a few decades ago?
I have indeed written several posts about the college affordability crisis, which are probably to be found in my "ronald reagan burn in hell" tag. This is because, as with most of the batfuckery of the American economy since the 1980s, it is indeed Ronald Reagan's fault. The overall causes of college skyrocketing in cost include, but are not limited to:
1) Huge tax cuts for corporations and the wealthy, gutting the funding that public education systems/public universities previously received from the government;
2) This in turn increased the costs at private universities, which had always been more expensive than public universities anyway, and besides, they were now free to put up their prices as far as they wanted;
3) The "unregulated free market trickle-down capitalism for everyone!!" Reagan-era mentality led to the explosion of costs in healthcare, housing, education, etc etc., and drastically widened the level of income inequality between rich and poor;
4) The replacement of grants (which you don't have to pay back) with loans (which you do), which incentivized unscrupulous loan companies to increase the burden of debt on students and for colleges to charge more and more tuition in the form of loans;
5) A bachelor's degree was once supposed to guarantee you a job, and now does nothing of the sort, and because the market has become so crowded and oversaturated with generally unsatisfactory and unstable job options, you are expected to pay for multiple degrees and go even DEEPER into debt;
6) Obviously, because of this total rejiggering of the economic landscape, everything costs a fuckton more than it used to 40 years ago, so colleges can't return to their 1970s-era fee structure;
7) As an academic, I can promise you that very little of this money is actually going to faculty salaries or the development/sustainment of new programs. Yes, obviously it costs money to run a quality educational institution, and I also obviously want all universities to be funded properly and for academics to be paid what they deserve. But the actual distribution of this money is... less clear.
8) Schools with giant well-known Division I sports programs tend to get all or most of the money that comes into their institutions, leaving relatively little for academic or faculty development;
9) For example: I work at a large, fairly prestigious, private university with very high research activity/classification, and we don’t even have a football team sucking up the money. But still, every single quarter, my department has to go through the budget with a magnifying glass, cut low-enrolled courses, argue constantly with the dean about which courses we do get to teach, etc. Our adjuncts also get paid literal peanuts for taking on a lot of work, and because we're so low on core faculty and just had to cancel another faculty search because of budget reasons, probably 50% of our schedule in the upcoming quarter is being taught by adjuncts. This is... not ideal.
10) Student debt is now such a lucrative part of the American commodities market, is so embedded in the financial system, and constitutes (at last glance) up to $1.8 trillion of outstanding debt, that when Biden tried to cancel even some of it, the Republicans immediately lost their minds and sued him to stop it. As of now, that case is still pending before SCOTUS, and because they're the literal worst, nobody hold your breath for a good outcome.
In short: college is one of the areas that has suffered the most from unregulated Reagonomics over the last 40 years, has been repeatedly incentivized to become and to stay extremely expensive and to represent a long-term burden of debt, and while you would hope that the money was being responsibly reinvested into actual faculty hiring/retention/academic program development etc, that is... not usually the case. The big Division I universities that serve as farm team training programs for the NFL, with a little academics on the side, also tend to have tons of investment in sports and not nearly as much in the classroom. But I'm sure this is fine!
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so I keep learning about The Horrors™️ of American healthcare and I keep hearing Americans talk abt this shit like it’s totally fine and let me tell y’all. It’s not. Apparently and ADHD or Autism test costs like 500$ for you guys? And then when you do get diagnosed you gotta think abt shit like “okay but do I actually need meds?” Bc apparently that’s a financial decision? But it,,, it shouldn’t be right? Right okay bc
I live in Europe, specifically Austria, and this is how healthcare works here: if you have a job you have healthcare. Your employer pays for it. They have to. It’s absolutely illegal and unheard of not to. They do take about 20% out of your pay-check every month to pay for that and other legal things that I don’t quite understand (my dad explained it to me once but I’m 20 so I still don’t get it bc I don’t really have to but every cent they take out benefits me I think so it’s fine).
Now irl this is a lot more complicated but basically, you have public healthcare and private healthcare and then just stuff that’s up to the government (like ambulance rides, I think. Even if you don’t have insurance u don’t pay for that. I know this bc an American friend of mine didn’t and had to go to the hospital and called a cab and when they told me I was like “??? BRO WHY NO AMBULANCE” this is also how I found out that Americans have to pay for ambulance rides. wtf.)
Basically your insurance covers all medical expenses from doctors who are in your network (public practice). This is your GP, hospitals, and pretty much all specialised docs (dentist, internists, cardiologists, etc.). However, the public offices are much busier than the private ones (obvi) so if you’re in a rush, want special treatment, or just be a little fancy you can CHOOSE to pay for private doctors. And even then you can hand in those bills to your insurance and you get part of the money back (abt 30% which you receive abt 4 months after handing the bill in).
If you keep your bills for private care doctors you can hand them in to,,, someone somewhere somehow (idk man) and get a bigger tax return. (bc we don’t calculate our taxes ourselves. it just gets taken out of your pay-check by your employer every month and then at the end of the,,, fiscal year??? I guess?? Idk man idk how shit works — you get any money that was like,,, extra (????) back)
Now you might ask yourself: “phi, why would I pay for doc if I can go to free doc?” Which is an excellent question. Again, for most people it’s about waiting times but there is one field where it just really makes more sense: mental health services. Private practitioners have less clients and more high quality care than public ones because they choose their own funding, which, surprise surprise, is better than public funding.
I will now take you through my own personal journey so you can have a practical example of how good healthcare CAN AND SHOULD BE (keep in mind here I have parents who after messing me up and being terrible but learning their lessen once I became an adult and told them how horrible they were are very supportive of me pursing my mental health)
When I was about to turn 20 I went to my GP and had a conversation with her about how I think I might have ADHD. She asked me about my complaints and agreed there definitely are symptoms indicating it. She wrote me a referral to a Psychiatrist. When I got to my Psychiatrist she tested me and because of the referral she could tell the insurance company that this test was necessary and not elective, meaning insurance payed for it in full and I never even saw that bill.
Now I had a diagnosis all but a week later. I spoke to my parents who agreed to support me in finding private care. My Psychiatrist charges 160€ (insurance returns 48€) per appointment which my mum graciously pays for. I see him once every couple of months to check in on my use of medication and how I’m responding and to see if my dosis needs adjustment. If and when I need a refill, I only have to write him an email. Before he could put me on medication I needed a blood draw and cardiac test, to ensure that I qualified for a stimulant, since they can be harmful in some cases. He wrote me referrals and I went to my GP and a public cardiologist for those tests, which were all free of ANY charge.
I was then cleared to take my meds within a few weeks (cardiologist had a bit of a waiting list). I was prescribed Ritalin and some sleeping pills by my psychiatrist. He gives me the prescriptions and a letter to the insurance company asking them to cover the cost, as I have a diagnosis which he confirmed again in his initial assessment of me. Now that I’ve gotten approved, all I pay for is the prescription, not the actual medication. Which is about 6-7€ for the Ritalin and 4-5€ for the sleeping pills (monthly supply each).
My Therapist is also a private doctor. She charges 120€ per session and I go twice a month, which is 240€ per month. My dad contributes 100€ and my mum contributes 30€, which means I’m down to 110€ per month. Insurance pays 30€ per session (so 60€ per month) so I pay a grand total of 50€ or 25€ per session.
So my medical treatment each month costs me just about 62€ AT MOST (since I don’t always need my sleeping pills refilled).
Now, just for fun, let’s assume my parents don’t support me and I see both my therapist and my psychiatrist in the same month and need both my meds refilled. This would come to just about 304€ (because of insurance deductions).
But you have to consider that I DON’T see my psychiatrist every month, so the more realistic monthly cost would be 187€. And should I decide I can’t pay for that I can still get on a waiting list for public mental health practitioners, in which case the only thing I’d ever need to pay for are the prescription costs for my medication which would still be up to 7€ for the Ritalin and up to 5€ for the sleeping pills putting the grand total at 12€ PER MONTH.
My family and I simply chose the quicker, more efficient option, but no one twisted our arm into paying this amount of money FOR BASIC CARE.
And yes, it’s a lot of bureaucracy (it took me WAY too long to spell that) and paperwork, but I’d much rather that than have to decide between mental well-being or being broke.
So, my conclusion: Cancel America, move to Europe, OR just tell the American People In Charge Men that it is that easy and they really should try a little harder and you citizens shouldn’t settle for the shit you have to put up with right now because wtf
if you wanna cry a little it’s okay lemme know I’ll come sit with you and offer a hug but you can say no if that’s not your thing
anyways love ya
phi
#I also found out that giving birth at the hospital could literally cost you your baby’s college fund#to which I have to say both hospitals and college are FREE here so#idk why people still live in America#I feel like it’s just politicians hating their citizens at this point#or some elaborate science experiment to see how much oppression and bullshit and classicism and ableism humans can take before they snap#and burn the world down#so#yeah#sorry America#</3#healthcare#rant#tw mental health#tw health#tw healthcare#idk what to tw here so if you want me to add something dm me or comment ig#America#politics#Europe
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so medicine and healthcare in star wars
if youve ever had even a passing interest in medicine go on the wookieepedia page for bacta to make yourself incredibly angry
because all sci fi is fantasy but much greyer, and SFF writers would not be where they are in life (rock bottom) if they went to medical school, the way medicine is represented in star wars is the standard for the genre. just sort of a goo that fixes everything.
bacta is described as a slightly warm liquid that is a combination of 2 bacteria, and it has its uses in emergency and non emergency situations, so it can instantly heal a wound or fix your ingrown nail. it can fix broken bones, internal bleeding and hypothermia as well, which begs the question how the fuck does it get inside your body. i would love to see our brave boys get a spinal injection or something but thats too adult for the franchise that only canonised sex like a month ago
for the sake of my sanity im going to assume that the overuse of bacta is due to the fact that the main pieces of the star wars franchise take place during various armed conflicts where there is no time for more sophisticated medicine. bacta is probably very expensive and anakin can only treat it like a disposable toothbrush the way he does with clones because the republic loves throwing money at him to see what he does with it. if you as a regular citizen of fucking like, devaron, go to the hospital because you dislocated your shoulder they will relocate it for you and tell you to take it easy for a couple weeks instead of slapping bacta on it
dealing with illnesses is a similar situation with the major examples being that one really bad series of episodes in the clone wars (save for the really swag teenager they meet on that one planet and the fucking angel who shows up for One scene and then is never mentioned again. guys there are angels in star wars ask me about the angels) and the rakhghoul disease in kotor, both of which can be solved by a vaccine and/or the power of anakin skywalker being really horny. while i assume medicine is a lot more advanced i think they still havent found a cure for the common cold, just cause i think thats really funny. on a serious note i think probably the major problem they deal with are not bacteria and viruses but spores instead. fungi keep growing in people's lungs and they cant figure out why, ships need to be throughroughly infected before and after going to any planet outside of the expansion rim because those planets still have spores that can be deadly to certain species along with completely unidentified species of fungi and sarlacc spores (can we talk about the sarlacc again i would love to talk about the sarlacc again)
as for structural healthcare, the only hospital we see i think like, ever, is in the first season of the clone wars and its a hospital for the army so it doesn't really give much insight into the workings of healthcare in the new republic
i think on coruscant, while public healthcare exists its wildly horrible with wait times being months or even years in some cases and clinics and hospitals gradually lessening on the lower levels. private companies are preying on the people who are desperate enough to turn to them, and the emergency responders have long been combined with the branch of the sanitation department responsible for transporting corpses because oftentimes thats what they arrive for. i also think they fill the role of doctors and whatnot in many districts, because getting an appointment is nigh impossible but the ambulance is going to arrive at some point, so theyre the most well funded branch of public healthcare on the planet but its still not nearly enough to meet the impossibly high demand. a speeding ambulance shuffle on the airways is probably as common a sight as anakin skywalker jumping out of a window
there probably exist a couple of mega hospitals in each district, the size of several housing blocks, housing everything from emergency care to permanent homes for chronically ill people and so on, also probably placed close to the necropolis districts ive talked about. there are also clinics throughout the city specializing in specific species (bad sentence im not rewording it) the older ones of which have attracted enough permanent residents of that species living near them that thats just their area now. specialized athmosphere established in a districts of the 45th level? the first clinic to ever treat Kel Dor was established there 300 years ago and so many of them moved there since that oxygen is basically redundant.
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hi can u tell me more about Koi and ur ocs i think they’re really cool !!
yeah absolutely!! now that u have background knowledge i can tell you more about his backstory.
Koi is not a human. he thought he was, as did most people around him. the only people who really knew was his mom (Clarissa Riverson), his dad (Samuel Riverson, he’s dead now but we’ll get into that later), a private medical staff (to be fair they never knew much about it, they just knew he definitely wasn’t normal), and the D.A. later on. also Astir Bettencourt (i’ll talk abt him some other time if someone asks) but that was his own personal conspiracy theory and he told himself that there was no way that was even plausible (it was!)
koi’s actually a dreamwalker (don’t know if i’ll keep the name, but that’s what it’s been for years so), which is basically a shapeshifting being able to see into and alter the dreams and thoughts of others. in the beta version they could also take over someone’s body and possess it (with the drawback being that their natural form would be asleep while doing this), but i don’t know if i’ll keep that. if i do, it’ll only be for much more experienced ones. Dreamwalkers come from the Void and have very specific and strict customs and practices and have a very spiritual culture, considering themselves descended directly from their gods. Among one of these customs is letting their young develop their own forms free from anything else’s influence by keeping them in isolation for a number of years until they’re fully developed. somewhere along the timeline there was a massive doomsday event which lead to a mass extinction or something i don’t know the dreamwalkers have had a ton of rewrites i kind of lost track of what exactly happened. i need to rewrite them again too so a lot of this is bound to change. but yeah, most of them are dead. somehow koi’s bio. parents managed to like toss him out of the dimension or something seriously i don’t know i need to rewrite stuff desperately but i’m doing things in chunks and that’s not what i’m worried abt rn.
so yeah, koi’s form original is basically an amalgamation of random things he saw as a tiny guy, resulting in a primarily humanoid form. this has some interesting results though when you take into account that these were mainly just outside appearances with makeup and such, not to mention the fact that there were no internal organs that made sense with the regular human’s anatomy because, well, he didn’t ever see anything like that.
Along comes Clarissa, a wealthy businesswoman/CEO of a quickly growing tech company. She sees a random kiddo who seems to look less human the more she looks at it? that’s her son now. yeah no questions asked. that’s clarissa for you. she doesn’t question the strange or abnormal and welcomes it with open arms. For his own safety, she raised him as a normal kid and put in an effort to help keep his form consistent enough that it wouldn’t be questioned. before she knew for sure that he was, well, abnormal, he still had normal public healthcare. this turned out to be a terrible idea. fortunately, most people are very susceptible to hush money!
Koi’s dad, Samuel, was a pretty generic guy. i don’t know how else to describe him. Koi didn’t ever know him that well, but he worked with Clarissa under her company. One night during a fundraiser she was hosting, he had to leave early for whatever reason. He didn’t return home. A few days later, his car and body was found in the woods, heavily damaged. Many of the wounds he suffered didn’t quite make sense, but nothing came of it during investigation. After that, Clarissa became much more protective of Koi. She never really had him in the public eye to begin with, but after that, she was even more careful about it. In the following years after her husband’s death, she gave him a lot of attention. Unfortunately, work picked up again and she was forced to focus more on her career than him, pretty much removing her from his life with the exception of a few occasional visits and check ins.
Koi grew up pretty lonely. his personality was considered overwhelming to a lot of people and he had a tendency to ramble about stuff nobody seemed to ever care about. He did, however, manage to make one notable friend. Juniper. Juniper’s mainly rewritten already so most of this is up to date. She also struggled a lot with making friends and had very overbearing parents who barley even let her leave the house other than for school. The two quickly became inseparable and started dating in their freshman year of high school. In their junior year (maybe sophomore, haven’t decided yet), Juniper became friends with a girl named Eshima, who quickly joined their little friend group. Eshima’s got her own silly plot line and had a major crush on Juniper in high school, but that fizzled out over time (mostly!). Koi barely graduated, considering the fact that he struggled to ever pay attention or understand what was being taught and even ditched class pretty often. Juniper on the other hand was kind of known to be a straight A student due to a lot of academic pressure from her parents. She helped him a bit (a lot). Juniper was looking yo go to a college for astrophysics and managed to get a pretty good scholarship, Eshima attended law school because her dad wanted her to (but dropped out after a few years, which stirred up a bit of family drama), and Koi… Well, considering everything, it was obvious he wouldn’t get a scholarship or anything. Hell, he probably wouldn’t even get accepted into a college.
until that letter showed up. it advertised a new experience, one that would be far more interactive and still provide a proper education. it sounded perfect.
you know what happens from there! ish.
anyways here’s some general facts about him!!
- he was 17 when he graduated and just about 18 when he joined the D.A.
- clarissa used to take him literally everywhere with her. like he was not allowed to leave her side.
- he really likes the super sugary smoothies and energy drinks. he just has a major sweet tooth in general
- He was ~22 when he got out of the D.A. and is 23-24 in present time (this may change)
- I don’t know how this works considering species but he may have ADHD and obviously CPTSD
- He’s pansexual
- technically, he doesn’t have a gender assigned from birth. whether that makes him trans or not is up for interpretation imo because dreamwalkers don’t really have genders. bliss just goes by she/her because it works better for communication but she’s agender
- While he’s not polyam himself, he’s alright with open relationships
- He’s a big sci-fi nerd and before the D.A. was absolutely obsessed with Star Wars and Star Trek too. i like to think that he and Juniper would just hang out and watch stuff together. He’d reference it to no end. He also probably collected dvds and such.
- Due to the burn marks on his arms, he always either wears arm warmers, thick bracelets, or long sleeved shirts and hoodies.
- In beta, he had a much more feminine fashion style. i decided it doesn’t fit his character though. i mainly just did it because it was easiest for royale high which is where i used him a lot LOL
- His canonical friends include Kate (somehow. i don’t know how yet. in fact there’s no reason they should be friends.), Ophelia (surprisingly), Eshima (it’s a bit complicated. eshima thinks he just cut them off completely and he’s not ready to tell her what happened yet.), and That One Guy Who I’m Not Sure If I Should Re-name Or Not Because Of Silly Stuff
if u want me to go into depth for any other characters just lmk i love talking about these silly guys
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My uncle is a diabetic with heart problems. His heart works at around 30% capacity. Last time he was at the hospital, his haemoglobin levels were at around 3.5. His skin was close to transparent. He was dying. This doctor (a general surgeon I think), who is also a member of our parlaiment, saw my mother beg him to take him in, only for this man to turn his back to chat with a nurse. His surname, which I'm not going to drop here for obvious reasons, is really ironic, as its etymological root is the word "dobro", which means "good".
And this idea of goodness and the medical field is something I want to dissect here. When I see people glorify medical professionals or associate them with kindness, I get furious, on a deeply personal level, as well as a cognitive one. There is nothing inherently kind about working in the medical field or healing. A construction worker creates housing and a baker creates food, but we don't glorify these professions for their "kindness" for creating goods that are seen as necessities, do we?
That is because, in a capitalist society, when a baker makes bread, they operate on the premise that not everyone will be able to afford the bread. They may be the working class, but they get their wage for both creating the good and making sure that the good of the capitalist that employs them makes profit. All professions that provide similar services function like this.
A medical professional is no different, regardless of whether they work in private or public healthcare. They provide healthcare on the premise that either you're going to pay them, or that you are on some form of health insurance/healthcare program or whatever system is in place. If you don't have money to pay for the service or you are not insured/on a healthcare program or not in the system, well. You might as well die. I have experienced this as an immigrant in Slovenia, as I don't have a right to insurance (I only have one from my country that covers emergencies), and I needed medication to stop menstrual bleeding which lasted for almost two months, after I ran out of the staah I brought from home. Instead of getting the medicine (which costs 1.5 euros in MNE, with no perscription), I got a 20min lecture on how those are hOrmOnEs and shit, and because I was not in the system or had a perscription from a doctor, I could not get it (something I wasn't aware of as the situation is very different back home, and also up to the fact that up until recently my gynecologist didn't take me seriously and refused to perscribe me medication for PCOS or even diagnose it). It was during the summer, and were it up to her, I could have bled out to death.
The medical field is awful in this regard, because of the prestige the profession gets. A medical professional is typically paid very well (while the working class is typically poor and exploited). They are providing a service just like any other employed person in a capitalist society. They are not saving lives out of the goodness of their hearts (and more often than not they're not saving anyone really), but for a wage. They are not volunteers. They have a significant amount of power, as they have a certain amount of "control" over whether a person in their care lives or dies. And if it never crossed your mind that having such power is open to all kinds of abuse, then you are painfully naive. Doctors, depending on whether they are in a country with privatised healthcare or public healthcare, are either capitalists or agents of the state.
#this was inspired by the sasuke as a healer trope#it is god awful#but i reblogged a post about it that dissects it pretty well already
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Last night, a news outlet was calling some narcotraffic crimes "terrorism." I asked my grandma why they were using that word. What was what they were doing terrorism for. Turns out they were attacking each other, in plain street, which is not with the objective of terrorizing "civilians" but to fight among gangs. And they were stopping cars at gunpoint and asking them to hand over money for right of passage, which is awful, but also daylight robbery, not an act of terrorism. There was no real ideology motivating the attacks, only money. I said to my grandma, "it sounds irresponsible to call this terrorism."
Of course, one of the current members of the government immediately was on the news like "we need more money for police, we need to fund more police". And shortly after there was a a segment that posed the question whether a hitman job against a Nicaraguan activist that happened recently in our country could be the fault of Nicaraguan organized crime. The ex minister of security was on screen saying no, it's more likely whoever organized the murder used Costa Ricans, but my grandma, who was only half listening and half playing with her tablet, said around, pensively "Nicaraguans fight so much, maybe..."
I tried to explain to her, how this right wing modeling works. How they build up the idea that now, suddenly, the enemy is so tangible all of our problems could be solved with more police arresting the problems. How they keep mentioning the debt our social security system has is impossible to maintain because the current government wants to privatize healthcare ("privatizing is bad?" she asked, honestly). I told her they'll always try to lie to her to convince her. "They'll tell you that they're trying to get things back to the way they were before," I said. "But things can never go back to the way they were before. It's impossible." She made a very pained face. I told her "things CAN get better. But they can never go back. Don't trust the lie of nostalgia."
She doesn't like it when I speak that way. She didn't like that I pointed out that theyll always blame immigrants for the problem ( "they'll always say it's the Nicaraguans or the Venezuelans or whoever," I said. "they only ever talk about the criminal Nicaraguans. When someone is achieving good things, they never mention the person is Nicaraguan.") just as the USA blames their immigrants. I told her to be smart. To be suspicious. If they say something, ask herself why they are saying it. I asked her to think, among the people who wronged her, among the people who wronged her family, who among them had ever been anything but Costa Rican. And yet she never believed Costa Ricans were a social problem.
I could see her thinking, I could see her trying to understand, trying to process, trying to find a way to refute. I could see that the propaganda of many years, her whole life, had cut deep. And I could see how the news worked in her so easily. Because that night she had greeted me saying "did you see, Wen, that we now have terrorists in Costa Rica?"
I really fucking hate the way buzzwords are used. The way they generate outrage by misuse. I can only hope this ends with this fucking government. I hope people fucking learn.
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hey, how would you explain neoliberalism to a baby poli sci major? i’ve always struggled with understanding the term because i haven’t been assigned anything to read about it yet
yeah no worries it’s a complicated concept! when people use the word they’re generally referring to one of two things - the process of neoliberalism itself, or the cultural/societal response to, and reinforcement of, neoliberalism as a way of thinking about the world. Sorry this is gonna be long lol but neoliberalism is a weird term that describes a bunch of complicated things that I think are best explained with examples and a bit of history.
the most useful definition of neoliberalism I’ve heard is that it’s an economic process whereby you privatise the public sphere; the free market is offered as the solution to various social problems. Before I describe it more in detail there is a bit of policy history that is important to know. It obviously didn’t arise out of nowhere; neoliberalism is a response to the post-WWII social welfare policies (sometimes referred to as the Keynesian welfare state) where a lot of stuff was nationalised, meaning that that service is now administered by the national (or sometimes regional) government. I’m Canadian so I’m not as familiar with US policy history, but this is when Canada nationalised its healthcare system for example, and iirc this is also around the same time when we got a national pension fund. Social housing (ie housing that isn’t sold on a market) and other social goods were also offered to people at low or no cost (payment for these services coming from taxes). Basically think of like, what if education, healthcare, and housing were offered to you as a public utility and not a product that is bought and sold to each individual person on a private market. This wasn’t universal by any means, like private housing and other privatised services were still dominant, but (again, at least in Canada) things like social housing were much more normalised and weren’t considered to be “housing for poor people” like it is now.
so that’s the policy stage on which neoliberalism arrives. the neoliberal “turn” in western states happened sometime between the late 1960s-90s depending on what country you’re looking at. This meant that a lot of things became privatised again. The process of doing this is usually to first decentralise or “download” the service to smaller regional or local governments (this is why today, cities each have things like their own separate housing policies), reducing federal/national funding streams to those social programs, and then finally defunding them completely. This is also coupled with lowering taxes and flattening progressive tax rates (im not a tax person so this is very simplified, but this means everyone pays similar amounts of taxes as opposed to being taxed relative to your income - this had the almost immediate effect of widening economic inequality). Because cities and states/provinces have less money than the national government, and because they were now receiving even less money due to lower taxes and reduced national funding, it’s a lot harder to run these programs, and so usually they eventually stop paying for them too, or they’ll partner with non-profits or charities who then administer those services (or they’ll sell them to private companies to run). This is why today, non-profits and other charitable organisations have such a large presence in providing services like homeless shelters, addiction recovery, mental health services, disability services, social services for other marginalised groups, etc. they effectively replace “the public realm” by administering basic social utilities to people, except now they’re not run by a single government, they’re run by individual charities with their own funding streams, standards of care, and policies.
And this had a huge effect on the way people think about themselves and other people! More and more aspects of your life were now framed as products you could choose to either buy or not buy. Social services are very often discussed as parts of the government that aren’t “profitable”, the obvious implication being that profit is the primary motive to offering, like, public transit, as opposed it being a public good that helps society function better by letting people move around more freely. You’ll also see these services framed as “handouts” for lazy people who don’t work hard - again, framing basic aspects of everyday life as things you must earn by constant participation in the market, first as a worker and then as a consumer. This is partially a neoliberal conception of public life.
I’ve seen it argued (by Greg Suttor if you want a specific citation lol) that ideologically, neoliberalism is about hiding the presence of the state from people. Society needs things like roads and water and housing and food and education and medical care to run effectively, but running them as a utility is expensive, and it’s basically become a unanimous agreement between all major political parties that spending money on government services is bad (for lots of complicated reasons, one of them being that capitalist interests are fundamentally opposed to paying for services that don’t generate profit), so instead you hand the responsibility off to private companies to do it, who then run it not as a utility for the benefit of the public but as a way for them to make money, turning the utility into a product. This doesn’t make the problem of, say, every person in your country needing a house go away, but now the burden is on each individual to access or not access that via the private market, and that access is dictated by the amount of money you have. It’s a way of de-collectivising mass social needs, and as a consequence it encourages people to think of themselves as individuals disconnected from a larger whole.
A good example to illustrate the cultural effects of neoliberalism is the rise of the concept of self-care, which is essentially pathologising and marketising leisure time - you work hard, you have a bad mental health day, you deserve to treat yourself by buying an expensive coffee, or a new hat, or going to the movies after work. The act of self care allows you to “responsibly” spend your money on things that aren’t absolutely necessary (like food, rent, and clothing) by framing those purchases as a mental health support. And I’m not criticising this rationalisation people do btw, I also do this lol, but this example illustrates that people have such deep anxiety on spending money on “frivolous” things that you need to justify a starbucks latte as a thing that will improve your mental health (+ therefore make you more productive at work).
Anyway this has gotten away from me a bit but I hope that’s helpful lol. I’m not a political theory person so this explanation is policy heavy, not because that’s the only thing that is important but because that is the part I’m most familiar with. Neoliberalism is something that has been happening for decades by now and is very mature. It’s a particular way of conceptualising state responsibility as limited and narrow - public needs are to be handled by the market, and the state handles things like police and border security (notably the only two ‘public services’ that have seen any substantial increase in funding). It’s also a way of understanding the world as a series of private individual interactions between a consumer and the market, often framed as democratic (“the freer the market, the freer the people”, “vote with your dollar”, etc), but what’s on the market are basic necessities you need to stay alive, so “not voting” is not really an option.
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Day One
Sweet Pt. 2
I read the address scrawled across my palm one last time. Yeah, this is the place, but it looks more like a luxury hotel than a medical clinic. The outside is solid brownstone with sleek steel and glass accents. As I step through the automatic, frosted glass doors, I see that the inside is all marble and dark wood. An ornate woodwork desk is in the center of a spacious entryway, and a smiling woman in pastel pink scrubs sits behind it.
“Hi!” she chirps. “May I help you?”
“I umm… I have an appointment with Dr. Astrid. I’m Sparrow Winchester.”
“Ahh, Ms. Winchester! Yes, of course! Follow me. You’ll be in Dr. Astrid’s private waiting room until she’s done with her current patient.” She stands from behind the desk and leads me to a set of frosted double doors, where she slides a key card and motions me to go forward. I do so, and she steps right behind me, leading me down the long marble hallway to a spacious, carpeted room with a large couch and several leather chairs.
“Have a seat. Someone will be with you in a moment. May I offer you some sort of refreshment?”
“Oh, no. Thank you.” I’m a bit nervous. This is unlike any medical center that I’ve been to before. Of course, I’ve only ever been to the ER and the health department, well, and my mother’s psychiatric facility, of course. We’ve never had the money for healthcare. But still, I can tell that these people are striving to make their patients feel like they’re at a resort. There’s soft lighting, classical music playing low in the background, and sleek furniture. Underneath the air of wealth and privilege, there’s the underlying, almost cloying smell of antiseptic. It’s really the only clue to what this building functions as. I must be lost in my own thoughts, because when I hear my name being called, I almost jump out of my seat. I jerk my head up to see a middle-aged woman with chestnut hair pulled elegantly away from her face. Her blue eyes seem kind, and she’s smiling at me.
“Sparrow?” she questions again. I nod and stand up rapidly.
“Uh, yeah. That’s me. Sparrow Winchester.” Again, she smiles.
“Sparrow, I’m Dr. Astrid. Follow me, and we’ll see if we can’t get you all sorted.” I follow her down another marble hallway to an open room with a medical table in the corner.
“There’s a gown in that wardrobe over there. I’d like you to remove your clothes and slip it on. I’ll be back in a moment.” With that, she slips from the room, and I glance around nervously. Something tells me that this process is not going to be fun, but I need the money, and with any luck, in a few months, I can leave this all behind and be secure enough to pay my mom’s bills and provide for myself without breaking my neck to do so.
͠
Three hours later, I’m leaving the medical center with a clean bill of health and a new prescription for birth control. I notice a sleek black car parked close to the entrance when I leave, but I don’t pay it much mind. Afterall, it fits in a hell of a lot better here than I do. I’m coming down the stairs leading to the parking lot when I hear “Sparrow!” being shouted. Immediately, my defenses go up. I’ve lived in NYC long enough to know that if you don’t fight, you die. But as I turn, I see that it’s Collin, and I ease up a little. I walk to his car and stand a few feet from him.
“Hi,” I greet lamely with a limp wave.
“Hello, Sweetheart,” he replies with a smile.
“So, uhh…What are you doing here?”
“I’m here to pick you up. We have some shopping to do, remember?”
“The phone. Yeah, I remember.”
“Not just that. I’ve been invited to a New Year’s Eve party, and you’ll need an outfit.”
“A party? I don’t really party. Well, not anymore.”
“It’ll be fun. There will be people your age there.” That’s when it hits me harder than ever. He is older than me. Much older than me. And maybe that’ll be a problem. He seems to have a distaste for people “my age”, if the look on his face is anything to go by. But then why bother making this arrangement with me? I’m sure there are older sugar babies. Sugar women? Either way, I hope that it’s not an issue. If so, it’s going to be a long few months.
҈
I watch as Sparrow searches the racks for something that suits her tastes. She seems lost in her own world, and I can’t help but admire her. She’s wearing jeans that are frayed at the bottom and an old Led Zeppelin t-shirt. Her pants hang low on her hips, and her shirt slips down one shoulder a bit. Looking around at the other women in the store, I realize how out of place poor Sparrow must feel. With their highlighted and stacked hair; designer bags; and fake, bleached smiles, they look at Sparrow in disgust. Like they are somehow better than her. I feel the anger boils lightly in my veins. No one is better than my Sparrow, least of all these pathetic housewives.
“Uhh, Collin…” Sparrow says, waving her hand at me, obviously having done this a few times before I noticed.
“Yes, Sweetheart?” I reply, ignoring the other women as I stride over to Sparrow.
“I think I found some options. I was gonna go try them on, and well, I… I didn’t know if you wanted to come or not.” I smile. She really is a sweet girl.
“Of course. I’d love to, if you wouldn’t mind.” She shrugs and heads to the back of the store. I follow, stooping under the curtain as she holds it up. I can tell she’s nervous. I’m about to speak, when she beats me to it.
“It’s not you. Well, not entirely,” she says, crouching to untie her shoes. “Making me nervous, that is. It’s dressing rooms. I hate them. They make my skin crawl. I hate all the mirrors. And the curtains. And the fact that anybody could just stroll in. it’s all… quite frankly, it’s all bullshit,” she concludes, taking a deep breath.
“I see. Well, I’ll make sure no one comes in. I’ll block the curtain. How’s this?” I ask, stepping between her and the curtain. She gives me a shy smile.
“Thanks, now, just do the same with the mirror so I don’t have to see myself,” she says in a joking tone, though I can tell it’s no joke to her.
“I would never block such beauty,” I answer truthfully. She lets out an uneasy giggle before sliding her pants down her hips and stepping out of them. She leaves them on the floor and tosses her shirt onto the bench. And I’m shocked at the number of tattoos covering her skin. Under her breasts, a delicate fan of roses and a spiky purple flower surround a triskele. Her thigh is covered by a large peacock feather, with the word “dream” woven in. and a sparrow sits on each hip, while a tree of life is perched between her shoulder blades. I must be studying her for longer than acceptable, because she clears her throat just as I catch sight of the “Be brave” tattoo on the outside of her forearm. She has other words near her elbow, but I feel like I’ve stared longer than I should, so I look up to meet her eyes.
“I…my friend is a tattoo artist. He was apprenticing, and he needed practice. And now he needs to fill his portfolio. I let him eat free on Meatloaf Tuesdays, and he gives me ink.” She shrugs and rubs the back of her neck. “You hate them, don’t you?” she asks, not meeting my eyes. “Is this a deal breaker?” she questions.
“What?! No, of course not! May I…”
“You can look,” she says, moving her arms to her sides.
I step forward, taking her forearm into my hand. The words “But Darling, what if you fly?” are scrawled in elegant script on her delicate arm. I study her closely, making a circle around her, pausing as I catch the tiny moon behind her right ear. I also notice the large, raised scars on her arms, but the look in her eyes tells me not to question it. I give her a smile and gently kiss her cheek.
“They’re very nice. Your friend did a good job. Tell me, what are these flowers?” I stroke over the only colored ink on her body.
“Sheep’s Bit. They’re pretty big in Ireland. Before we came here, my mom let me press one in a book. I still have it. I like to look at it sometimes and remember home.”
“Well, that’s beautiful. I’m glad you have something left of there. Believe it or not, I know how it is to miss home.” She nods at my words, giving me a shy smile and looking down at her feet.
“Now, you have dresses to try on.”
҈
After dinner at a nice Mexican place, Collin leads me to his place. It’s a loft on the 29th floor of one of the glass and steel buildings in Manhattan. I’m reminded how rich he actually is as we take his private elevator to the top floor. Of course, everything looks expensive, but surprisingly, it also looks homey. I can tell that he likes to be comfortable at home, and he’s added his own touches to the otherwise impersonal space.
“This place is just temporary. I’m looking for something I like better. I have a house in Texas that I love, but the work brings me here. Make yourself at home. I’m going to go change.” He walks toward what I assume is his bedroom, and I take a careful seat on his black leather sofa. The view from his window wall is amazing. I can see the twinkling lights of the city, and I remember that I do love New York. It’s as much home as Ireland. And while I wasn’t born here, I like being a New Yorker.
When Collin emerges, he’s in faded jeans and a white t-shirt. “That view’s great, ain’t it?” he chirps.
“Yeah, it’s beautiful.” He takes a seat next to me and studies me for a few seconds.
“What?” I ask. I’m not used to people looking at me so closely.
“You’re a beautiful girl, Sparrow.” He scoots closer as cups my cheek. His hand is large and warm against me, and I soak in the feeling of having someone appreciate me. When he leans in to kiss me, I follow, and let his lips brush mine. When his tongue pushes against my lips, I open my mouth to let it in.
҈
After making out with Sparrow for long enough to harden my cock and wet her panties, I pull away and ask, “Can Daddy make you feel good, Baby?” She nods dazedly before her eyes widen and she blushes.
“I’ve…I’ve never…you know,” she stutters, looking down. Oh, she’s a virgin. Something about that fills me with pride.
“That’s alright, Babygirl. I can still make you feel good,” I say as I crouch down in front of her and reach for the button on her pants. She lifts her hips long enough for me to slide the jeans out of the way, but her hand immediately darts down, covering the black fabric of her panties.
“Nobody can like see in, right?” she questions, looking fearfully at the windows. I chuckle.
“No, Love. It’s one-way glass. You’re safe here with me. Ok? I’m going to take good care of you.” She nods and moves her hands away, allowing me to remove her panties and toss them with her jeans.
I nip her thigh before spreading soft, warm, slow kisses up her thighs to her core. I bury my nose in her damp skin and flick her clit with my tongue. Her hips dart off of the sofa, and I smile. She’s easy to rile up. Holding her hips down with my hands, I dive in, knowing that I’m about to have her screaming my name.
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I had an MRI of my back done recently.
They had to do my entire back because they aren’t sure what’s causing my symptoms (my DO does but no one listens to how compression in the cranium can affect positional problems for other parts of your body but that’s not the point of this.)
They charged my insurance $21,000. For an hour and a half worth of MRI scans.
To put this into perspective, Medicare apparently has found that it costs $75,000 on average to run an MRI machine facility for a month. This includes electricity/utilities, machine upkeep, and staffing. Theoretically, they apparently thought they could meet those operating costs and turn a profit with just three patients like me. Thankfully, these money grubbing scumbags were not able to do so.
In the end, the hospital imaging system that did my MRI got $600. With three segments of spine at $200 a pop, this aligns with the Medicare average of $200–$500 per scan depending on the part of the human body you’re scanning.
Before you say, “See!! Socialized medicine would fix this!!” Imma have to stop you right there.
Socialized medicine is just another monopolized, inefficient system. See: the NHS having over 600k outstanding primary care requests last year, the largest amount they’ve ever had. The French going back to offering private healthcare—which is better and is what my family members have opted into now that they’ve moved back—to ease the systemic burden. The Netherlands considering getting rid of their nationalized health system because they’re drowning in debt.
None of this is going to get better until we remove the monopoly created by the insurance companies and health system administrators colluding with each other to get rich off the suffering of others. We currently have a monopoly on healthcare in the US because of this system. Nationalized healthcare is just another abused monopoly.
If we can get back to healthcare markets that have more freedom—with appropriate oversight—then some of this should stop. None of that can happen until the greediest among us face justice.
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would you all like to know. collei's background in my head. as in before the archon residue. because i have thoughts
collei as a child very quickly learned her place in life. cursed. doomed. touched by the div. afflicted with demonic energy, fated to die, something that will not survive, a walking corpse; Dead. her family is poor. for all that sumeru's healthcare can provide there are things that will always remain out of your grasp when you're poor. and although she's just 5 she can feel it in the way her parents carry themselves when they think she's out of sight, in the way they cry when they assume they're alone, in the way the kids avoid her on the few occasions she's able to venture out of the house: she's different. and whatever's making her different is also making her a burden. such is the weight that a corpse leaves behind.
when sumeru's healthcare inevitably fails her, and when her parents feel like there is no other alternative, the fatui arrive in gilded chariots like miracles descended from the archons themselves. but, of course, it's too good to be true; it always is with the fatui. her parents aren't stupid: they know the risks that come alongside experimental treatment. they know that this is exceedingly dangerous. anyone in their right mind would refuse; anyone who could afford a privately hired physician directly from the amurta darshan would refuse. anyone who had enough money to seek help anywhere else would refuse...
they didn't know they would lose custody of her. they didn't know they were only going to be allowed brief, unconvincing reports of her health mailed every odd month as the only proof that she was still alive. they weren't even privy to what the experimental treatment was, just that it was "proceeding as expected," whatever the hell that meant. unable to even track down the facility without concerted effort, because they kept switching locations, all they knew now was that they needed their daughter back. all that they could hope for now was that it wasn't too late.
collei is frightened. she's terrified beyond any words that could possibly exist in an 8 year old's vocabulary. she constantly wants to throw up, she wants to scream, she wants to run back home... but she can't. in the first place, her body won't let her. she was so used to relinquishing control of her body to others that when it was under an external threat for the first time, there was no defense system in place. collei has never had any control over her own body. as far back as she could remember, it was always someone else; whether it was out of a misguided love or an attempt to cure the sin that was her very existence. it didn't matter if she could control her body or not; she knew that it had already died a long time ago.
at some point the fear turned into anger. it was scary at first, feeling herself turn into flames, but it took away the hammering in her heart for just an instant. it let her mind experience blissfully raging silence for the first time in her life. even if it burned out just as quickly, she was finally in control of something. and so, the newly lit flame was flailed wildly in every single direction: at her parents for abandoning her, at her physicians for abusing her, at her kidnappers for desecrating her corpse, at her colleagues for betraying her; and most definitively, at herself, for being powerless to stop any of it.
there are no words to describe the moment that the dead god nestled itself into collei's soul. there are not enough words in any human language to describe the sheer depth of disgust and hatred felt at the violation of her very constitution. something went wrong. something went very, very wrong. but sometimes these things shouldn't be described.
it's funny though. she had heard the phrases "cursed child" and "demonic child" all her life. looking back they almost seem like premonitions for this very moment. an inhuman presence was nesting itself deep within her veins, staking a claim on her chest, and all collei could do was scream in terror as she felt the ghost of something much more ancient than her lock her heart in chokehold. though, more than that, there was something else that frightened her on a much more instinctual, human level.
the presence. it felt familiar. as if it liked what it saw. as if it had found its home in her, found the small flame she had just figured out how to light and scoffed, saying "this is what you call a fire? i can show you something so much brighter."
the only thing that collei remembered next was flames.
#so this . ended up going in a very different direction than i thought it was going when i first wrote this post#ended up being . i dont evne know. its formatted in bullet points#(not really theyre still paragraphs) but whatever. i have thoughts. theyre kind of embarassing. sorry#ramblings
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Stupid HSA tricks. OR, "Give me my money"
I've had this email sitting in my inbox for a while now, reminding me that I have a balance in my Health Savings Account.
Now, for non-Americans, a Health Savings Account - HSA - is one of those half-assed compromises to make our hellscape of a healthcare system very slightly more tolerable. The idea is, some of your own income is deducted from your paycheck before taxes, and you may use that money exclusively for medical care without paying income tax on it.
Of course, this can't just be handled by the government. No sense in doing that. When this income is deducted from your paycheck, it is graciously held by a private company which will kindly dole it out to you when you submit acceptable requests. In the interim, of course, they will hold onto your money and invest it as they see fit, garner the profits from it.
If this sounds like a scam, it totally is. In fact, when this was first introduced these companies also had "policies" such that if you didn't use your HSA money before the end of the year, they just got to keep anything you had left. I believe the laws were changed to put a stop to THAT.
However, my previous experiences with this scam informed my general feeling on the entire system. One of my previous employers had an HSA such that we had these debit cards with which ostensibly we could make any medical purchase directly. However, if there was a dispute regarding any payment, they would lock the accounts for everyone in our company. And, this HSA denied Every. Single. Claim. No matter how obviously it was qualified, the first couple of times you submitted a claim, it would be denied as unauthorized. Which meant everyone had their accounts locked all the time.
So, anyway. With my current employer there's an HSA. As a matter of personal policy I don't participate - even if they're a legit, ethically-run service, the reality is I'm only saving a pittance in income tax for a huge pain in the ass. But somehow it turns out I have $500 in my HSA, which has rolled over year after year.
I tried to pull it out for some dental work, um, back in 2020. And that never resulted in me getting a check or anything. At the time I was busy and just shrugged and went on with my life.
Today, having blown the cost of a small car on four teeth, I decided to get that $500 out of the account. And thus ensued...
First, I did not recall the password to my account. And I did not write it down, because I had zero intention of using that account once I got my money out. No problem, reset password.
They send me a password link. The link also tells me the text of the security question. I vaguely recall their security questions were off-the-wall stuff I don't have any sort of answer for. (I do not give my mother's actual maiden name for that kind of question, but I do have a specific answer I give for it.) But this was a "Uh, what?". And bear in mind, there was clearly an answer in their system.
So I'm trying to come up with the security question, and figured it out on the third try. So I get the password reset and...
They're sending me an authorization code. Right.
I get the auth code and finally I'm actually in.
First, I look at the old claim and it's just listed as "unpaid". Why was it unpaid? No reason! It just wasn't paid. Not denied, not unauthorized or not qualified. They just didn't pay! Gosh, I wish it worked like that with my own bills!
So, come to find out after much digging, they've got "Request reimbursement" and "Add a claim". The former is - supposedly - the one where you get money from them. The latter is a "courtesy" to help you track your medical bills. So adding a claim has no bearing on the money you have in your HSA, it's just you writing stuff down. In spite of being identical to the reimbursement section.
Okay. Now I think I need to request reimbursement on this claim.
Denied. No authorized account for that claim. They rolled the money over and now I can only get paid for stuff which happens during this calendar year. Fine. I have a current medical bill where I blew WAY more than $500 out of pocket.
I put that in, and request reimbursement. No, wait, I don't. Because first you have to put the request in and save it. THEN you go into the request and tell the system you want paid. Because, apparently, people will put in a request but NOT want paid. Sure, that makes sense.
I request reimbursement. And I want them to mail me a paper check, thank you. Yes, I know it will incur a fee. And no, I will not "pwetty pwease let us have access to your bank account it's faster and easier and we're totally secure and definitely don't use this as a means to collect even more saleable information on you."
I request a check. And within thirty seconds I get an email telling me the funds have been "returned" because they tried to make a payment and it did not work. Which is really fucking fast for delivering a check, let me tell you.
And there is no further guidance on what to do. The website says the request is "not approved" but no information on what that means. I request to contact a representative. Which involved navigating a chatbot and repeatedly telling it that, no, it has not identified my problem and DO NOT redirect me to a page which talks about something else.
I finally get a human on the chat function. Who tells me that from their end everything looks fine, they just need to review the request and I'll get the check in 7-10 business days. Which would be GREAT except i have nothing official to indicate that. The rep claims the system is mistakenly telling people requests are being denied and IT is aware. Which is kind of suspicion in an industry which routinely denies valid requests anyway. So of course their system "mistakenly" says requests are denied.
Since I trust this exactly not at all, I ask for something official, as a chat in the company's website is not a legally actionable record. But of course there's no way to do this. I can download or copy and past the chat, which is equivalent to me writing out a text file.
So, I'm probably not ever getting my money.
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Time is the currency of life, not money
In today’s world, if you’re lucky enough to achieve even basic financial security in your 60s then you’ve probably won in life. And, most likely, there is little difference in quality of life between you and, say, Jeff Bezos.
Or, so goes the recurring thread. It goes onto suggest that free-time, health, relationships, diet, exercise, and family then really become the yardstick you should use.
Financial security is, in this famous internet question that comes around every few years, is defined as “a coupla mill stashed away, mortgage-free house, and a nice car”.
Does this still stack-up? And are more of us reaching this lofty but maybe modest goal? And where does the increasingly distorted mirror of social media figure in this, if all?
Those familiar with Maslow’s “Hierarchy of Needs” will no doubt recognise some of the themes: house, car, and money fills the lower two rungs (physiological and safety) whilst relationships and family the next layer (belonging and love). So, despite Maslow never actually creating his oft quoted pyramid, there seems to be some basis for this - at least at the lower levels.
So, really all we need to do is a) define the local requirements to meet the lower levels (they will be different in sub-Saharan Africa vs Singapore), and b) understand what constitutes the higher levels.
But, if “2-3 mill plus a paid-off house and nice car” only meets the lower levels then the original statement is false as there is so much more to life; esteem, accomplishments, learning, self-discovery, and enlightenment.
But this is where the argument gets nuanced. Maslow states that the motivation to achieve higher layers is not fully developed until the lower levels are met. So, does that mean individuals who have no interest in the higher levels are deficient in some lower levels? Or have too high expectations at the lower levels?
And where does the internet age/social media fit in? Ostensively, social media should be about belonging, relationships, esteem, dignity, respect, and a greater sense of self. But mostly it is corrupted via opinion polarisation, aggression, dysmorphia, insecurities, hubris, and the false sense of safety from operating in a virtual world.
But going back to the original premise: “a few million and other stuff … makes you as happy as Jeff from Amazon” only then holds true for the lower, physiological needs and doesn’t address the more significant (or less important today? Ed) higher-level needs.
More to the point: do you stay trapped and unfulfilled if you don’t have a few quid and a mortgage-free house with a Porsche on the drive? What happens if the expected esteem from social media turns to e-hating? Or, if your respect evaporates in the face of online reputational damage?
I suppose the answers are to a) strive for the basic needs, but keep the bar as modest (low) as possible, b) strive to do something worthwhile that others respect and appreciate, c) self-learning and discovery is best done away from the public and social media eye, d) gloating or inflating yourself could see you being stripped back to the basics - where a few mill, house, and car could feel very hollow - I’m looking at you Michelle Mone, Philip Green, and all the greedy assholes who sacrificed their chance for self-actualisation on the insecure altar of greed.
And to finish off, we have to quote “no one lies on their deathbed wishing they had worked more”. Except …
Just maybe, if you had worked more and earned more and transcended those lower levels of Maslow’s pyramid then you’d live a decade or two longer. Or if you took the time to learn about health and nutrition, could afford to spend quality time in relationships, afford private preemptive healthcare, saved to retire early … the list goes on and it’s no surprise that wealth, education, and social standing are all positively correlated with longer lifespans and increased quality of life.
Time is indeed the currency of life, yet you’d be surprised how much time a “few mill stashed away” when linked to modest physiological needs and a smaller life, not driven by social media, brings.
Happy hunting, but know when to stop and don’t get fat.
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