All across the country every day huge pools of people sit down in cubicles, put on headsets, and straighten the three-ring notebooks in front of them. Most of them are people of color, overweight women, and men who either are not equipped to or not interested in carving a career. They answer questions all day, sometimes about a guarantee, sometimes a complaint, sometimes as customer service for orders and so on, and sometimes to explain government services. Their computers, alongside their answer books, can pull up detailed information about you.
When I worked for the City of Portland, I had the same sort of job but this time answering questions about city codes and regulations, which were recorded in a three-foot row of books with thin paper and fine print. Sometimes they were about bad landlords or a wish to build something. Many were about flood plain regulations, which are based on maps which were hard to interpret. So one quiet afternoon I composed a one-page summary of answers and principles to send to callers. At the top was the legal right to ask for a hearing on their problem. The plans examiner who handled these determinations was a great libertarian and defender of rights, but my inclusion of the right to ask for a hearing set his hair on fire. Visions of endless hearings rose in the smoke. I had to throw my summary away.
No one’s hair is bursting into flame this time around. If I feel it beginning to happen I’ll just run out and stick my head in the snow. But I got up at 4AM this morning, determined to understand what is going on. I’ve prevented further debt, thanks to BigSkyRX, and am not trying to challenge my $450 accrued owed premiums, but trying to understand the whole system. On Friday the library will host “Navigators” who will try to answer as many questions as they can. Every question I asked on my phone call journey sent the operator off for a conference with a supervisor because the question/answer was not in their book.
Somehow in 2011 I was moved from "Level 1" to "Level 4". This reflects one’s relationship to the poverty level, which the lawmakers use as an index. The idea is to measure the depth of your poverty and respond to it by the amount of help provided. But the poverty level doesn’t stay put; it’s redefined according to some formula managed by Social Security. I presume it’s probably involved in taxing as well. You might be gratified to know that very rich people have extra premium payments.
Medicare is closely related to Social Security. There are four plans: Plan A is hospital stays and other serious and usually emergency things. I've never used it. Plan B is the general medical. I mostly use it for my eyes. It’s managed directly by Centers for Medicare and Medicaid Services. I recently changed eye docs because the one I had been using kept pushing for things I didn’t need, esp. cataract surgery. Also, he billed as soon as he prescribed rather than after the tests were delivered, so some of his payments were denied since the service had not been delivered. My eyes are doing very well -- there is no increased diabetes damage though that was how the original diagnosis was made. That same doc referred me to another doc who had been in court for double-billing Medicare. She is no longer in practice.
I don’t use Plan C. Plan D is for drugs and I get two answers about whether it is voluntary -- yes and no.
What I needed to know this morning was the formulas for the four levels, but no one could answer that question. Then I wanted to know why in 2011 I was moved from level one to level four, though my income only changed slightly due to COLAs. So far I’ve talked to Social Security (they’re on the east coast which is why I called them so early), Medicare, Special Help, BigSky RX, and SilverScript. I was interested to realize that CareMark, a pharmacy business, owns SilverScript. (Walmart also owns a Plan D insurance company.) I’m supposed to use a pharmacy in the “CareMark Network” which luckily owns the new ShopKO (previously Pamida) in Shelby. Lucky, because Janet the pharmacist is really good at what she does and absolutely trustworthy.
It strikes me that insurance companies owned by pharmacy chains are a conflict of interest. In fact, the whole thing strikes me as a ball of snakes. The big squeezers. It is evidently the Caremark connection that is sending me all the chiding robocalls, ten-year-old sweet thangs on the phone, and computer letters, urging me to take more drugs. Of course, they’re very persuasive to some nurse-practitioners and docs. At least where I am most people are middle-class enough that our clinics and pharmacy chains are pleasant and clean. But everyone is too unquestioning to suit me.
The most recent blowup over prescribing statins is only one python in the struggle. Stigmatized patients are exposed to low-end providers in shoddy settings “because they’re just scum anyway or they’d get jobs.” There’s a rising unwillingness across the nation to help people who are “not like us.” More and more people are “not like us.” More and more are immigrants, old, homeless, disabled, suffering from PTSD or brain trauma, and so on. Some were here long before anybody else. (Native Americans -- remember them?) Some churches feed on them, offering help and the assurance of prosperity in order to fill the pews with faithful people.
On the hopeful side, I’m reading more and more analysis of society, new ideas, individuals willing to risk by uncovering the struggle, and the realization that nations, even the “democratic” ones, are being replaced by intertwined and international corporations. A few, not so hopeful, are forecasting revolution. There are already demonstrations in the streets. Since so many young people are out of work and poorly educated but somehow idealistic, it is a good use of their time and an inevitable development.