When the courts do hospitals' dirty work - Libby Watson

 

When the courts do hospitals' dirty work

Libby Watson

The story that drove me most insane in the last week was a USA Today piece about Hertz’s practice of filing police reports for cars that are not stolen, more information about which emerged in the proceedings of an ongoing lawsuit this week. Sometimes the cars are simply lost, or ‘missing’ in the system because someone extended a reservation by phone. This practice of filing police reports—which it does an average of 3,365 times per year, or about nine a day—has led to the 230 plaintiffs currently seeking justice in the lawsuit spending 2,742 collective days in jail. People interviewed by the paper have lost jobs or homes because of these false charges. This is not a healthcare story, but it does highlight an inescapable fact of American life that is horribly relevant to healthcare: The profitable partnership of massive corporations and the criminal justice system, holding hands to stamp on the faces of the poor.  

The story reminded me immediately of two others. First, this New York Times story from 2018, which revealed how huge corporations like Walmart “employ aggressive legal tactics and take advantage of loosely written state laws” to demand money from people they accused of shoplifting, even if those accusations were false. Those retailers often “do not have to return the money they collect if the cases are ultimately dismissed or the people are cleared.” In one instance, a woman accused of stealing $25 worth of CDs alleged that “two police officers ‘threw’ her on a couch, handcuffed her and took her to jail.” The charges were later dropped, but not until after Walmart’s lawyers demanded money from her and threatened her with a lawsuit. 

 Second, in 2019, ProPublica wrote about the practice of jailing people who fail to appear in court for medical debt cases, which became especially profitable for one collection attorney in Kansas. The story provided harrowing examples, like the cancer patient who was “hauled away from home in her pajamas in front of her three children; too weak to climb the stairs to the women’s area of the jail, she spent the night in a men’s mental health unit where an inmate smeared feces on the wall.” Not long before that piece came out, a story from Kaiser Health News detailed the University of Virginia’s practice of taking patients to court for unpaid medical bills, for as little as $13.91. Together, these pieces tell a powerful tale about how hospitals can use the justice system to threaten and extract payment from patients—all possible because we make patients ultimately responsible for the individual costs of their healthcare. The charges the patients owe money for are, of course, completely arbitrary and wildly inflated, but they don’t have to justify the fees to sue the patient over them. 

These are stories from three different sectors of the American economy—car rentals, retail, and healthcare—but they have an important aspect in common. In all of these stories, huge, profitable institutions are able to use the full might of the state, with all the consequences this has for their victims’ lives, to obtain mostly meaningless amounts of money—to them, that is. To the people whose lives they’re ruining, these sums can be life-changing, or life-ruining. The cops and the courts act on behalf of the corporation, no matter how egregiously wrong or aggressive they might be, to insure them against any little loss of profit. 

I write about healthcare, not criminal justice or American history, so I don’t feel like I can adequately diagnose or explain how the American justice system got so eager to help corporations like this. I can’t explain why a judge in Virginia might have told a woman in her 70s, who arrived at hospital “bleeding and in pain” from uterine cancer, that her payment agreement with the hospital was not too vague to be enforced, because she always had “the ability to decline the surgery” that led to her $23,849 bill. I guess she could have gathered up her bloody clothes and tottered along to the next hospital, which would have had exactly the same clause “you owe us whatever we say you do” in its contract and might have charged her twice as much anyway (neither could have told her the cost beforehand, of course). I can’t explain how the debt collector in Coffeyville lives with himself. I can’t explain why Walmart goes to such lengths to pursue people for such stupidly small amounts of money, which must itself cost them a lot in legal fees.

I can’t explain any of it, but I do know that all over this country, there are frightening and arbitrary schemes put in place by corporations to ensnare regular people, extract their little bits of money, and toss them aside, into jail or financial ruin, or both. The criminal justice system opens its arms and welcomes the worst fucking snakes in America and happily lets them use it, with its gun-toting cops itching to humiliate people and its horrific, dangerous jails, to chop up the meager finances of the poor and turn them into snake food.

And I know that there are many, many hospitals that are no better in this way than Hertz or Walmart.

Thousands and thousands of lawsuits are filed by hospitals against their patients every year; some kept doing it during the pandemic, including New York’s Northwell Health. According to Axios, the Mayo Clinic Saint Mary’s Campus sought $4 million in 904 lawsuits against patients between January 2018 and July 2020; the Mayo Clinic’s total revenue just in 2019 was $13.82 billion. Those lawsuits over two and a half years represent 0.02 percent of the organization’s revenue in one of those years. 0.02 percent of a normal person’s yearly income is like what you might spend on lunch. Could they perhaps have foregone their lunch to not ruin 904 people’s lives? 

Cops and judges arrested and jailed people who had not stolen a car to help out Hertz. They humiliated people who had not stolen stuff to help out Walmart. They jailed cancer patients for being unable to afford the made-up price a hospital charged them to stay alive, to help out the hospital. (I didn’t even mention the judges who sign off on landlords’ arrest warrants for unpaid rent.) The reverse of this—for ordinary people to use the legal system to obtain justice from large corporations—is absurdly difficult, thanks to neat things like arbitration clauses and ‘needing money to get a lawyer.’

The truth of American inequality is not just that some people have a lot of money and a lot more have very little, in some sad natural accident. The rich are rich because other people are poor. The wealthy elite extracts their riches from the poor through schemes like this, or underpaying workers, or pure wage theft. It’s a transfer, and the logic of capitalism and ever-increasing profits dictates that they must always use every possible avenue to expand this transfer. And sitting right there is the criminal justice system, already primed to oppress the powerless and vulnerable, with the legal authority to take people’s money. It’s a loaded gun, literally.

Maybe you expect this of Walmart. But hospitals? If a hospital is just as willing to engage in this behavior as Big Evil Corp., and the legal system is willing to enforce the complete fiction that hospital prices are real, we don’t really have a healthcare system—and we certainly don’t have justice, let alone a right to healthcare. We just have another type of greedy fuckers making money however they can, who just happen to sell healthcare instead of cars.

Josh Steich on Voter Education

 Josh Steich on voters: 
Voters have always been "vibe based" rather than deeply engaged, policy literate rational actors. And the folks (older homeowners) who have traditionally been the most deeply engaged are the ones who tend to advocate for policies that end up benefiting them while screwing the rest of us.

There are two ways to fight this (and both are probably needed): First, the most popular liberal establishment answer, and the most popular among college-educated folks overrepresented in political discourse, is to do better civic education and work on getting normies more politically literate. It's the "the answer to bad speech is more speech" option, and counts on most people engaging with politics the way that educated liberals generally do: through a mix of research, debate and mainstream credible sources.

Second, to work on better vibes for liberals, progressives and Dems. The general complaint from the right that Obama voters just thought he was cool and didn't really think much about his policies? That's probably correct, at least to a significant extent. It's probably true about Biden too. And Trump voters are almost comically politically illiterate, and entirely voting based on negative partisanship vibes. This is something that Republicans excel at — partly because they have to, because when you describe their policies accurately, they're really unpopular! Only something like 15% of the public wants abortion laws like Texas, and even most Republican voters want to see higher taxes on the rich. So it's all based on provoking an emotional, fear based response, where scary Democrats are going to eat your babies.

It's really hard for mainstream liberals and progressives to answer that, because they try to get back by grounding the discussion in rational debate — basically like trying to reason with shitposters. It can be even worse on the left, because a lot of people with status on the left got that status by being able to argue more forcefully with people who generally agree with them — that's the wrong skill for convincing people who don't agree, and leads to what I think of as "Fugazi politics." Fugazi is a great punk band who intentionally staked out a career whose goal wasn't to be financially successful, but to be purists about their music. Which, again, is pretty great. But that can make their fans really snobbish about music like Taylor Swift, who is widely loved by all sorts of people. If you want to win elections, you want to win over the Taylor Swift fans, not the Fugazi fans, because there just aren't enough Fugazi fans and there never will be.

And maintaining political power — which is the goal, in order to get preferred policies passed — means winning over people who will never really want to be engaged, never be interested in wrestling with whether this abstruse zoning rule will have a downstream effect on housing, etc. It means getting them engaged because of vibes. Because it's cool, it's fun, whatever.

The good news is that the best way to do this is for you, reader, to talk to your friends and family NOW about how you're voting for Dems in the fall. Not as a fight, not as an argument, but just, like, a thing you're doing because you're a normal person, and it's a normal thing to do. Don't make people feel attacked, don't make them feel scared or angry, shrug off any bullshit and just be public about voting for Dems. You gotta start now, though, because this shit TAKES LOTS OF TIME AND REPETITION. Save the arguments for people who you already agree with, make them about the best way to get policies you both agree with, etc.

Ethan Grey on the pandemic through a caste lens

 

You’ve no doubt mused at some point why the logic of “If we all just got vaccinated, the pandemic would be over. We wouldn’t have to wear masks anymore!” didn’t work with Trump’s base. For starters, you’re projecting your rational desire to see the pandemic end onto them.

The most important thing to Trump’s base is not ending the pandemic. The most important thing is ensuring the pandemic cannot be used as a pretext to alter the rules of society, and this is based on an awareness of who COVID-19 significantly affects. The moment that it was understood that COVID-19 disproportionately affects communities of color, the immunocompromised, and other vulnerable populations, Donald Trump’s base decided that the viral pandemic was acceptable.

Donald Trump himself best channeled how his base views the pandemic when he said this: “if you take the blue states out, we’re at a level that I don’t think anybody in the world would be at.” From Adam Serwer’s book “The Cruelty is the Point.”

Donald Trump did not see himself as being under an obligation to act as a President for all Americans, and his base was with him that regard. In him, they saw their own desire to ignore the issue if they perceived it was just Democrats being significantly impacted.

Obviously, wanting to conceive of the pandemic as a Democratic problem is not rational. But this calculation to not take the pandemic seriously was not being made with rational considerations in mind. It was made with notions of caste in mind.

The reality: Donald Trump’s base has a sense of occupying the dominant caste, they want to think of COVID-19 as a lower caste issue, and the dominant caste being forced to go out of its way to protect people perceived as lower in caste is a supreme violation of caste rules.

All subsequent discussion of how caste intersects with the pandemic will be based on this summary of the temperament of dominant caste behavior from Isabel Wilkerson’s book “Caste: The Origins of Our Discontents.”

These two paragraphs make no mention of the viral pandemic, and yet I contend that they contain everything you need to explain the behavior of Donald Trump’s base throughout the viral pandemic.

Bear in mind the priorities of the dominant caste as you read ahead: to see itself as most correct. To refuse instruction from people outside of it. To ensure it has the power to put people in their places. To deny shared basic human experiences with anyone perceived as lower.

When the pandemic started taking off, the most heated debate was over having to wear masks. Why was there a debate? See this through the lens of caste: the dominant caste was being told to wear masks to protect themselves and potentially people outside of their caste. But according to caste rules, the dominant caste does not get told what to do. Not when it comes to protecting themselves, and most *definitely* not when it comes to protecting people perceived as beneath their station.

You’ve been rationally approaching the pandemic as a threat to your health & to the health of the people you care about. Trump’s base has approached the pandemic with a paranoid suspicion that the pandemic will be used as a pretext to upset a caste order that privileges them. For if those perceived as occupying the dominant caste are forced to go out of their way to protect people perceived as being outside of it, then their sense of dominance is a lie and their humiliation as seen through the lens of caste is complete.

We’ve also had debates over social distancing measures, suspending large indoor events, temporarily closing down indoor dining, etc. to control the spread of the virus. Why did Donald Trump’s base freak out when these were proposed?

See this through the lens of caste: the dominant caste, viewing itself as the zenith of society, is the one endowed with the power to put people in their places. To decide where people can go. Nobody is allowed to usurp this power from the dominant caste for any reason. What you see as rational measures to control the spread of the virus, they see as people outside the dominant caste attempting to seize their sense of power with respect to being able to put other people in their place.

Donald Trump recklessly holding rallies throughout the viral pandemic was precisely what they wanted. Because it was about reasserting the power that comes with being in the dominant caste: you can go where you want, do what you want, and behave how you want without consequences.

Their sense of identity is tied to being able to impose upon others and celebrating invulnerability from being imposed upon. That is why they view everyone who is laser-focused on following measures to reduce the spread of the virus as beneath their station.

When they speak of “freedom”, they speak of the “freedom” to not bear any responsibility in controlling the spread of the virus. Any responsibility to act better. The virus is beneath them. Therefore, the people who care about the virus are automatically viewed as beneath them. …

Furthermore, the dominant caste will immediately find the idea that people among other castes have the correct strategy for dealing with COVID-19 to be absurd. To view yourself as a member of the dominant caste is to view yourself as unassailable in knowing what should be done. …

Not acknowledging shared human experiences is the entire point of caste. Not acknowledging shared vulnerabilities is the entire point of caste. Because shared vulnerability ruins the entire point of feeling invincible, unassailable, compared to other human beings.

So let’s name the precise reason the pandemic has played out as it has: it’s because a society that responds to the viral pandemic with an earnest desire to protect the most vulnerable is a threat to caste, and that alarmed Trump’s base way more than the threat of the virus.

That’s the calculation Trump supporters made, and you know what it ultimately means: they chose caste over their own lives. They chose caste over the lives of their own children. They chose caste over your lives and the lives of your own children.

So that’s it. No more wondering what’s ultimately driving the behavior of Trump’s base during the viral pandemic. Their behavior during the pandemic is completely synonymous with their behavior before the pandemic. They are upholding America's caste system: white male supremacy.

Why I've Lost Respect For My Republican Friends by John Pavlovitz

 Why I’ve Lost Respect For My Republican Friends

John Pavlovitz

I’ve spent much of my life pastoring in predominately white churches in the South. Before that, I was raised in a family with many Conservatives. I’ve always been surrounded by Republican voters, and until very recently I could respect their positions, even when I disagreed with them. Despite our differences, I still saw them as inherently well-intentioned people.

That is becoming nearly impossible, because I now realize something about them that grieves me.

I used to think this was all about education. I’ve spent the last few years trying to make them aware of the ugliness they are tethered to, the criminality of the politicians they support, the irreparable damage they are doing to our nation’s sacred systems. I operated under the false assumption that if I could only make them aware of the malevolence of their party, that their better angels would certainly move them to fully reject it.

It’s only very recently that I realized that they already are aware:

They know their party tried to violently overthrow the Government and overturn an election, and is still actively perpetuating the big lie.

They know they are willfully prolonging the pandemic by shunning safeguards and opposing vaccines and peddling disinformation.

They know they’re gerrymandering and suppressing votes and installing corrupt electors because they can’t win elections any other way.

They know their party is fully infected with Proud Boy, KKK white supremacist domestic terrorism.

They know it is filled with unqualified, unstable sociopaths like Lauren Boebert, Matt Gaetz, Madison Cawthorn, and Marjorie Taylor Greene.

They know Donald Trump is a lying, vile, incompetent, traitorous monster who hasn’t had a noble instinct in his lifetime.

They know that their party is on balance, anti-immigrant, anti-Muslim, anti-LGBT, anti-Semitic, and anti-women.

They know all these things.

They just don’t care.

Worse than that, they’re happy about it.

They are “winning,” in whatever way they define that, and so the intoxicating ends justifies the sickening, violent, shameful means.

They no longer have a need to weigh the morality of the people they are in bed with, no longer worry about abiding the teachings of Jesus, no longer have to do the uncomfortable work of examining their own hearts.

The victory trumps decency.

Over the past five years, they have seen the absolutely unfathomable criminality of Donald Trump and the Republicans—and despite knowing the depths of their misdeeds and the human collateral damage and the economic toll and the national disfigurement—they will vote Republican again without a moment’s deliberation. I can’t get over that.

I try to imagine how I’d have responded if the roles were reversed, I wonder if I too might be able to set aside my convictions if offered such a political bounty—but I know the answer.

I’d never have voted for a traitorous ignoramus like Donald Trump had he been the Democratic nominee.

If my party was populated by such open hostility to Science and diversity and equity, I’d have left it long ago.

If a Democratic president had dehumanized them the way Trump has dehumanized so many, I’d have defended them.

If Joe Biden and the Democrats tried to engineer a violent coup, I’d never consent to it and I damn sure wouldn’t defend it afterward.

And that’s the simple difference: I would not be capable of embracing the horrible things they have been able to, and that is now a barrier to us that may be insurmountable.

Most of our once passionate exchanges and spirited debates have been replaced by cold, surface conversations or uneasy silence. I no longer have the desire to give them more information or help them understand the urgency of these days or wake them from some slumber so that they comprehend the inhumanity of their public servants—because I know that won’t make a difference.

Worst of all, I no longer see them as people I can truly respect, because that is saved for those who can admit their mistakes given evidence of them, people who can be swayed by facts and data, people who are willing to change in order to do what is right, even if it means them losing something.

This isn’t about comparing differing political ideologies or debating the merits of particular legislation, and it isn’t about theological dissonance or arguing over what benefits the common good. All those things I am able and willing to participate in.

This is simply a matter of them seeing the way to accrue power, becoming hopelessly addicted to it, and being fully resistant to relinquish it.

I still interact with many of these people on social media, I run into them at the grocery store, I see them at family reunions. Yet, I’ve lost the energy to argue with them and so I simply share space with them, doing my best to be decent and to have our time together be as short as possible.

I still love these people, I still affirm their humanity, I still fight for their civil and human rights—I just no longer respect them in the way I once did.