Under It All

All heroes most sojourn in the underworld, and we are all heroes in this story.

Once upon a time, there was a 1-800 number. It could have been any 1-800 number. But this 1-800 number was a health care number. What the number didn’t know is that it was really just a portal to hell. But like any portal to hell, it was also a gateway toward actualization and liberation for those heroes brave enough to keep walking.

I spent the better part of the day back and forth between my healthcare and my medical provider to see if my Doctor — or rather, my doctor’s medical group which is not my medical provider — is, in fact, accepting new patients, even if I am not a new patient. With me still? I know it’s a looking glass rabbit hole without the fun hallucination.

I like to think of the whole repeat experience as the telephone equivalent of being stuck in a roundabout while listening to a record you hate stuck in a groove. What I concluded when I recovered from the spins from three hours of the run around is that it’s all fuckin’ nuts.

We get sold the system. A system we are told that works. We are reminded to trust the system, feel relief that we are safe in the system, then realize the system is a little broken. Maybe skews to those with means a little more - even though it is supposedly designed for those without, but regardless, one starts to sense in ones toes that the system in question does not actually do what it says it does. Or more importantly, what we need it to. Then we feel tricked, betrayed, and then learn that the whole thing is maybe a little more than a little broken. Or maybe it is not broken it all, and is working exactly the way it is designed.

I might be wrong, but I think it is this moment of awakening, when one goes, ‘oh well fuck,’ when the pain takes root and drives many of our fellow Americas to make decisions that don’t serve their best interests as they look for someone to blame, and a way out of the suck hole. And then they gets ads driven by algorithms with pictures that reinforce that belief. Even if it is a false belief, not based on any fact. Not any fact other than the system was broken back when health care was privatized under Nixon and it takes some time to mend it. Especially when it can’t just power down completely and must somehow bring the worst of corporate power into compromise with the rusty machinery of legislation that can only be greased by pork fat.

The level of absurdity we encounter when we need to buy insurance starts out like a fugue; a simple melody that then layers over itself. And it’s always preluded by I’d be happy to assist you. Eventually, they learn they can’t assist you. Then they pass you over. If you’re lucky, you end up being transferred to the right number, but often, as was my case today, you are transferred back to where you started, navigating an automated system. It is the first ditto mark that sends you back to the beginning of the fugue. Except now as you navigate the same melodies, measure by measure, round and round, there is the echo of discordant complexity.

I try to treat the whole thing like a game. Let me be nice. As we look at the menu of HMOs and PPOS and POSs as if they are super-sized value meal options. Maybe Steve at Covered California, who is really doing his best, will also help me get a side of ranch.

But what we do not see in our list of meal menu options is that the medical groups that provide us with care have open or closed panels. And many of those groups close panels to those who are on a budget. So you often end up purchasing insurance that is not really in network for your chosen medical provider. Even though it says it is.

And why is that? M-O-N-E-Y.

It is a simple lesson in you get what you pay for. If one wants to avoid the clinic, you have to pay a little extra. And sometimes, a LOT extra.

Enrollment may be open, information sent to Covered California says your doctors are in network, Steve and Tasha and Jocelyn, and Kindle, and Jessa may say it shows up, but the panels will often be closed.

How can you check if they aren’t closed?

—By signing up.

Ok. But how do I know I’m signing up for the right provider if I don’t know if that provider will be covered under this group?

—Exactly.

It’s a dizzying experience. Like a carnival ride. But not like a family friendly amusement park ride that is up to code; more like the one that you don’t quite know is going to actually work. And smells of puke and flop sweat.

But this vertigo machine is an improvement. It really is. But that improvement is not good enough. Not for those of us who are neither poor or rich. And it is certainly not good enough for those, like myself, who work freelance and a variety of gigs in a gig economy, and by definition, have multiple employers.

When I was on hold on my fourth call, I finally learned I was not connecting with my actual provider, but somehow a different external broker who bought and sold insurance licensed to the provider. You see, it may all be under the window of LACARES or CARNIVAL INSURANCE, but each of these options have so many other subsets, besides gold, silver, or bronze. And it was then, as I was finally learning who I actually paid my premium to, that I had my moment of awakening.

It’s all the same. Whether it is car insurance, disaster insurance, health insurance, life insurance. This is the reason that the only companies that still buy up TV ads are insurance companies. It is the same reason they are the ones that have their names on many skyscrapers and on top of basketball or football stadiums. And how they can do that? By putting the onus for qualification or coverage, the idea of proof, on us— the consumer. And it leaves one asking, what am I really pay for?

Regardless of any existential quandaries, in practicality, if you want to survive within this system, you have to be nimble and speak so many languages to advocate within and between these various entities that make up the three headed hydra known as the health care industry.

The thing that makes me sad is that imagine doing so when you are in crisis? If your home has been destroyed by a once in a lifetime hurricane that shoes up every year. Or — you have cancer, and your husband or wife is the one who usually handles these things. What if you are elderly and only have a flip phone? And don’t speak English very well. etc.

The system is broken and cruel. It is repairing, yes, even if it is not quick enough and must fight a wave of blow-back wanting to undo it, reverse it, gut it. But despite these facts, there are many individuals within its fissures and fractures that are good and kind. And want to be helpful. They remind me of Robert DeNiro’s character Archibald Harry Tuttle in Terry Gilliam’s BRAZIL. These saint customer service technicians know how to reach behind the walls and connect all these invisible tubes, click boxes, uncheck things, and help look still exist in a flawed and unnecessary system we seem to be stuck in till someone comes up with a better idea.

But back to my original point, the thing that I am alchemizing from this particular field of fucks is that one can connect this very personal (and often shared) frustration with the resentment that fuels desperation and victim blaming that is at the root of these kerosene times. People are angry, confused, lost, and feel alone. Powerless. And then someone comes along and says, ‘blame these people. And I will fix it.’ And the whole thing repeats itself.

What I walk away with is we are on our own. No cavalry is coming. Which is why we must have each other. What I have learned from navigating “a qualifying life event” that created a “gap in coverage” is that if you are dogged, you can navigate the fugue, look behind the panels of health care groups and find good people at providers and somehow get there. But you must be your own Harry Tuttle (pictured below from BRAZIL). The only weakness in the system, whether you are fighting airlines for a rebate, or Amazon, or a hospital, or a governmental thing, is that the automation is all the same. Once you crack the code, you are now like Neo in the Matrix. And you can see it for what it is. A corporate shell game.

We all need Sir Archibold Harry Tuttle in Brazil