NYC: no place on earth so governed by paradox. Every cliché holds true and falls bankrupt; it is the best of all possible worlds, and certainly also the worst. It sprints at the future but is hopelessly mired in the most antiquated thinking west of Rome. It is sleek and modern and clean; it is run-down, ruggedly beat up, beautiful only when the lights are out and no one's home. Beautiful: it can be beautiful. Unexpectedly so, because who counts on beauty in a place so large and loud and hulking. There is wealth here truly beyond an ordinary man's imagining. And there is poverty as grim and hopeless as any on earth. It is a thrilling place of coincidence and calamity and sex and surprise — and, yes, also a dullish place of relentless numbing routine, the soulkilling grind of day-in and day-out. It cherishes its routines. It also cherishes its eccentrics, which can seem, on some days, everyone, all the time: not a single normal step in all the millions, everyone a weirdo to his own idiosyncratic degree.
Why should its people be any different? They are not. They're crass, rude, insolent and unfeeling. They are soulless, money-grubbing, worshippers of the deal. Size matters here; your money is your life. They are cocky beyond all justification. They are more bark than bite, they are in fact the bark that disguises the bite's mediocrity — and yet. They work miracles. They get things done, enormous things, things others wouldn't dare to dream. They are restless. They are arrogant, but not complacent. They stay out late at night because they are afraid, afraid, afraid there is someone somewhere, even everyone everywhere, getting more of life than they are, making more of it, and if they could only keep their eyes open until the right moment it would all be theirs forever. They are bold and brash and they take what they want. They pride themselves on takvng what they want — it's a religion with them, a thing they practice at home in front of mirrors. But they want you to take what you want too. They don't mind getting in line, though they have appearances to keep up and so must pretend they do. It's all a game to them, this thing they are, this thing they are always becoming. They are always becoming. They're on the move. Work hard, play hard, fuck the rules. What are the rules? We make the rules.
And they can be kind. They can be gentle and humble and sweet. They are kids from Queens, sons and daughters and moms and pops who know and remember what that means. They can love you. You will not believe it but they can love you. They are just guys with jobs, they are girls who want to have fun, they are boys who want to make time with pretty girls, or pretty boys. They want to fall in love like anyone else. They are a woman pushing her baby. They are a man reading his paper. They drink their coffee in the mornings, watch their televisions at night. They go to sleep decent hours; they have to get up early, catch the subway, go to work.
You come here to be somebody. You also come here to be nobody. The nobodies and the somebodies stand next to one another, neither acknowledging the other, for reasons that are worlds apart but still relative. The myth is all around you and you can hate it but you can't ignore it: what this place is, what it stands for. The famous come and go; so do those no one cares about, or remembers. Possibility is an endless river. Not everyone, though, will get their chance to swim. The knowledge of this is maddening. It is a taunt, a threat, a jibe that punctures your field of vision in every walk down every street. And at the same time there is the joy of being in a place where apologies are almost never required. Whatever your neurosis, your obsession, your weird little habit, you can feel free here to indulge it — just so long as it doesn't require touching (though even this: there are people who wait to hug you — you; anyone; for free — in Washington Square Park, any given weekday). Can't stand walking slow? Walk as fast as you can. Can't stand walking fast? Go at a snail's pace. And no, you needn't bother getting over to one side; people will find a way around. Don't like sitting in the third seat from the left? Get up and move. The truth is that no one will notice, much less reproach you. There is a refreshing capitulation to reality here. The city's favorite saying may well be "It is what it is." You'll hear this ten, twenty times a day. It means exactly what it says, which is a lot. It means we cannot live in a land of wish. It means we live in the world, and the world is real, and reality must be dealt with, congenial or not. The truth may be ugly, but it is the truth. It cannot be escaped.
And there's beauty in that.
July 30, 2005
June 11, 2005
Ensurance
A Thanksgiving story for you, as we verge on July. While visiting a friend's house for a group cook-a-thon last November 25, I sliced my finger. It was the index finger of my left hand. The offending instrument was a serrated bread knife in outstanding condition, long and mean. Not uncommon: get a group together, open wine, start cutting; eventually blood will be spilled. In this case the blood was copious, as was the attendant pain. Nonetheless, I wasn't overly concerned. But when the usual home remedies — thorough washing, direct pressure — failed to mitigate either pain or bleeding, and after a quick uncomfortable look at the wound, we decided to drive to a local ER.
This wasn't a decision I labored over. At the time I was covered by a more-than-adequate insurance policy. Deductibles were low. Because it was a COBRA plan, I'd been paying full premiums myself for nearly six months, and they were substantial, and I had yet to use the policy for so much as an aspirin. What was all the expense for if not peace of mind — the knowledge that if and when I did need medical attention, I could easily get it?
The hospital wasn't far from my friend's house in Brooklyn. (It's even closer — 2 blocks — to my own. At the time I viewed this as a pleasant discovery.) We arrived in early evening, around the traditional Thanksgiving dinner hour, and the ER was thus empty. A TV blared in the lounge. A man sprawled over an armchair in a state of restless unconsciousness, ignored by the skeleton crew. I was taken in by the triage nurse, who asked a few clipped questions before hustling me to an exam room.
Here is your first clue: these days, the first thing that happens when you're hustled to an exam room in emergency medicine is that you are visited by the insurance fairy. In my case the insurance fairy was a woman in navy scrubs pushing a loaded cart. Loaded: with computers, I mean, and other unidentified filing and machinery. Not mechanisms of health care in the traditional sense — you need them, yes, but they won't do a damn thing for you by themselves — these are the tools by which the insurance fairy plies her trade, which is verification of coverage. She is spectacularly thorough. I spent no less than twenty minutes going over every possible personal and demographic detail while she patiently, doggedly typed into the top of the cart. There were questions I wouldn't've been asked by a banker (I'd recently applied for a mortgage; I knew). There were questions I was sure my attorney would've advised against. I answered them all. It wasn't that I feared the insurance fairy, exactly — I had insurance, after all. I'd whipped out the card and thrust it at her like van Helsing with his crucifix. But the finger continued to bleed, and to hurt.
And here it's worth noting that, during the insurance fairy's interrogation, no actual medical care was being dispensed. If all you've done is slice a finger, that's not such a big deal. But what if that's not all you've done? What happens if half your head's caved in? I'm sure there's an answer to this, and I'm sure I don't want to ever need to know it. But the fact that the question even occurs should tell you something about just how sick we've become.
I was given a small cup of betadine and told to soak the finger in it. The attending or resident or whatever — the truth is she didn't really say, and I didn't really ask — took a look at the wound. She advised more soaking. A few minutes later she looked at the wound again. This time she told me I could have stitches, or I could try the glue. I'd heard about the glue. I'd heard, for example, that the glue was more or less the same thing as superglue — that it had been developed during the Korean war, or maybe the Vietnam war, for treatment of battlefield injuries. Whatever. It sounded less traumatic than stitches. Let's do the glue, I said; and we did. She glued me together. They sent us home.
That's the uneventful part of the story.
Several weeks later, I recieved a notice from my insurance carrier. The claim — a bill for slightly more than $200 — had been denied, and I would be held responsible. This was, to my way of thinking, given all the checks I'd written, an outrage; and, outraged, I took the statement to the company through which I'd subscribed, and for which I still did freelance work. My understanding, I told the HR director there, was that emergency room visits were fully covered. My understanding was that I shouldn't be paying a thing.
I don't know what I expected; another bureacratic fobbing off, I guess — a reading of the policy fine print in which it was stipulated that yes, emergency visits were covered, EXCEPT, followed by a description of the exact circumstances under which I'd gone. Instead the HR director agreed with me, emphatically. Yes, yes, she said, seeming more outraged still. Absolutely, fully, yes. Phone calls were made. Wheels were set in motion. I'd responded to bureaucracy with bureaucracy, and it seemed, so far, to have worked.
Several days later we got an answer from the carrier. The problem, they said, was that the bill had come from the doctor, not from the hospital. The doctor was not a member of their provider network; the hospital was. Therefore they'd refused to pay.
We — the HR director and myself, now in a Vulcan mindmeld of entitlement — pointed out that, (1), I had entered the hospital emergency room, not the doctor's office, with the intent of (2) seeing whomever happened to be on duty, not of seeing this particular physician or any other. We further pointed out that, (3), the policy provides coverage of out-of-network physicians anyway, just at a higher copay level, so under no circumstances should there have been a complete denial.
They said they'd look into it.
Around this time I got a bill myself, and it was indeed from the doctor. (Who wasn't a doctor, for what it's worth, but an NP — not that under the circumstances it really matters.) I took it in to the HR director. Yes, yes, everyone said. Now we've got it. It's the hospital's fault. Because we haven't yet received a bill from them, we can't verify it as a legitimate emergency room visit; thus we can't pay. We'll just have to wait for the hospital to issue their bill. Then the doctor's bill will be legitimate, and all will fall into place.
It's yet another sign of cultural illness and decay that this made, in some warped, bureaucratic, utterly logicless way, a kind of sense. But it did. And so we sat back to wait.
Weeks passed. Having set the various corporate chains in motion, I assumed the engine would eventually reach speed. Surely the hospital wanted to get paid, and so surely they'd send a bill. But I am also a cynical type, and I began, as such, to wonder several things. Was it possible the doctors were engaged in some kind of side-billing scam, for example? Hoping, I mean, that I would simply pay the denied claim at face value, thus sparing them the insurance company's negotiation? Or had the hospital, for similar reasons, worked out some kind of weird subcontractor relationship with the physicians, leasing facilities rather than employing them outright, to diffuse responsibility and costs? Just what new twist in the already byzantine dance of American healthcare was this?
The insurance rep, by his own account — which seemed genuine — made multiple attempts to reach the hospital with requests for their bill. For weeks, neither calls nor emails were returned. Finally he got through, and reported that the bill had been sent; the claim would be resubmitted; and he had marked it to be paid. A week or two after this I received another statement from the insurance company; this time, the claim, it reported, had been paid in full. This notice was dated May 6, 2005 — not quite six months after the inury itself, and the superglue that fixed it.
All's well that ends well, yes? And so I thought. Yet just this week, two more pieces of mail on the subject of my hacked finger (which has healed, but uglily; and the nerves are askew to this day). The first was a letter from an attorney, demanding payment for the doctor's bill that had been denied so long ago. The attorney's letter was dated May 29, a full three weeks after all contention had ceased and the check had, presumably, been sent. I replied with a copy of the insurance statement. This might or might not take care of it. It won't surprise me if there are more letters to be exchanged, more representatives whose opinions must be sought, more threats to trade before everyone agrees to call it done.
But the last was worst. There was yet a third Explanation of Benefits statement from the insurance company; in this one, I was informed I'd have to pay a $50 deductible. More shocking, though, was everything else on the statement — all the stuff I wasn't having to pay for because the insurance company was. There were four line items, ranging in associated cost from $60 to $400. The total bill was $897.00. All line items were marked with the hospital's name and "Specialty Room." That's it; no variation, just "Specialty Room," four times, and next to each an amount. This meant that, with the previous bill, the total charge for my visit was more than $1,100.00.
This was stupefying. It had to be, I figured, a mistake, or — worse? better? just different? — a scam. I'd been there thirty minutes, maybe forty-five if you included the perfunctory triage interview and the insurance fairy's visit. The skill level involved in every step was minimal, by medical standards or any others: a student could have treated me in exactly the same way, in the same amount of time. A gym teacher could have, almost. The most sophisticated equipment deploying during the entire episode was that on the insurance fairy's cart. There were no x-rays, no ultrasounds, no CAT scans or MRIs. There was scarcely any palpitation. She took a couple of long glances and shifted some skin around — with her fingers. Supplies-wise, we used 1 plastic cup; about 1/4 cup of betadine; four or five drops of the glue; some gauze, and assorted dressings and bandages. Dinner at Otto uses greater amounts of more expensive stuff.
I called the insurance company immediately. They'd been snowed, I figured. I would do them a favor. I would let them know what had really gone down. I would do my part to rein in the spiraling costs of US healthcare.
You know what happened next. It has probably happened to you. Statistically speaking, it must have happened to some of you. The woman on the other end of the line — my ally, I'd expected — received my indignant whistleblowing as though I'd come over the line in Martian.
Do you realize this was a trivial thing? I asked, my incredulousness running over.
Oh, yes, she replied.
Do you realize the total amount they're charging for this trivial thing?
Oh, yes. They do that all the time.
This is normal?
Oh yes.
For something like this — to cost so much?
Oh yes.
They bill you for the doctor, she said, and they bill you for the room, and they bill you for the equipment and the supplies. They bill you for everything. It adds up.
This is, I said, the most ridiculous thing I've ever seen in my life.
Is there anything else I can do for you today? she said.
There was not.
It's funny. Except that it's not funny. It's what passes for your healthcare system. It has severed all ties to reason; even to call it a "system" implies logic, and that's nearly impossible to uncover in such a mess. It costs more than any comparable system on the face of the earth and its efficiencies dwindle every day. How could they not, when an episode like this is not an exception but the norm? Forget about where the money's going; let's assume it's going several places. Let's assume there's not just one set of pockets being lined by all that cash but a number of them, in several professions and industries. The drug companies. The equipment manufacturers. The administrators of the corporations that own the hospitals, and the administrators of the corporations that insure us. Does it make any difference? We currently have forty million uninsured in this nation, many of them children; the number does not decrease every year, ladies and gentlemen, it increases. Soon we'll have fifty million, and after that sixty million, seventy, a hundred. That's one in three. Things are getting worse. And no one is doing anything about it. It is, to borrow a phrase from the Republicans who adore this so-called system, and who defend it nearly with their lives, and certainly with their pocketbooks (which it has, of course, considerably fattened), a moral outrage.
The nature of that outrage is a subject for other, deeper, angrier and even more confusing meditations. In the meantime, if you happen to slice your finger, consider the following regimen: wash it in cold running water ($0). Apply direct pressure with some sterile gauze ($3.99), and keep the hand elevated above the level of your heart to help ease the flow of blood ($0 — and yes, it's quite possible this is an old wives' tale. Your guess is as good as mine). Once the bleeding has abated, rinse it with some hydrogen peroxide ($0.99) and clean the nearby surfaces with rubbing alcohol (also $0.99). Attach the separate ends with a butterfly bandage ($4.99), or, if you're really feeling the need, with an over-the-counter version of the medical glue, which you'll find these days right next to the bandaids at your local pharmacy ($9.99). Wrap the whole business in more sterile gauze (from the same package as before, so $0), and/or put some appropriately sized bandaids around it, tightly but not so tightly you cut off circulation. Change dressings every day, twice a day if you need to, and avoid getting it wet for a week or two (wrap a plastic bag — $2.29 — around your hand if it helps, and seal it with a not-too-tight rubber band). Of course I'm not a doctor or an NP, or any other kind of licensed medical practitioner, so I can't charge you for this list; I also can't guarantee it will work. You'll have to attempt at your own risk. But then, there'd be no guarantees if you went to the hospital and they told you pretty much the same thing. And the bill in that case would be approximately $1025.00 more.
This wasn't a decision I labored over. At the time I was covered by a more-than-adequate insurance policy. Deductibles were low. Because it was a COBRA plan, I'd been paying full premiums myself for nearly six months, and they were substantial, and I had yet to use the policy for so much as an aspirin. What was all the expense for if not peace of mind — the knowledge that if and when I did need medical attention, I could easily get it?
The hospital wasn't far from my friend's house in Brooklyn. (It's even closer — 2 blocks — to my own. At the time I viewed this as a pleasant discovery.) We arrived in early evening, around the traditional Thanksgiving dinner hour, and the ER was thus empty. A TV blared in the lounge. A man sprawled over an armchair in a state of restless unconsciousness, ignored by the skeleton crew. I was taken in by the triage nurse, who asked a few clipped questions before hustling me to an exam room.
Here is your first clue: these days, the first thing that happens when you're hustled to an exam room in emergency medicine is that you are visited by the insurance fairy. In my case the insurance fairy was a woman in navy scrubs pushing a loaded cart. Loaded: with computers, I mean, and other unidentified filing and machinery. Not mechanisms of health care in the traditional sense — you need them, yes, but they won't do a damn thing for you by themselves — these are the tools by which the insurance fairy plies her trade, which is verification of coverage. She is spectacularly thorough. I spent no less than twenty minutes going over every possible personal and demographic detail while she patiently, doggedly typed into the top of the cart. There were questions I wouldn't've been asked by a banker (I'd recently applied for a mortgage; I knew). There were questions I was sure my attorney would've advised against. I answered them all. It wasn't that I feared the insurance fairy, exactly — I had insurance, after all. I'd whipped out the card and thrust it at her like van Helsing with his crucifix. But the finger continued to bleed, and to hurt.
And here it's worth noting that, during the insurance fairy's interrogation, no actual medical care was being dispensed. If all you've done is slice a finger, that's not such a big deal. But what if that's not all you've done? What happens if half your head's caved in? I'm sure there's an answer to this, and I'm sure I don't want to ever need to know it. But the fact that the question even occurs should tell you something about just how sick we've become.
I was given a small cup of betadine and told to soak the finger in it. The attending or resident or whatever — the truth is she didn't really say, and I didn't really ask — took a look at the wound. She advised more soaking. A few minutes later she looked at the wound again. This time she told me I could have stitches, or I could try the glue. I'd heard about the glue. I'd heard, for example, that the glue was more or less the same thing as superglue — that it had been developed during the Korean war, or maybe the Vietnam war, for treatment of battlefield injuries. Whatever. It sounded less traumatic than stitches. Let's do the glue, I said; and we did. She glued me together. They sent us home.
That's the uneventful part of the story.
Several weeks later, I recieved a notice from my insurance carrier. The claim — a bill for slightly more than $200 — had been denied, and I would be held responsible. This was, to my way of thinking, given all the checks I'd written, an outrage; and, outraged, I took the statement to the company through which I'd subscribed, and for which I still did freelance work. My understanding, I told the HR director there, was that emergency room visits were fully covered. My understanding was that I shouldn't be paying a thing.
I don't know what I expected; another bureacratic fobbing off, I guess — a reading of the policy fine print in which it was stipulated that yes, emergency visits were covered, EXCEPT, followed by a description of the exact circumstances under which I'd gone. Instead the HR director agreed with me, emphatically. Yes, yes, she said, seeming more outraged still. Absolutely, fully, yes. Phone calls were made. Wheels were set in motion. I'd responded to bureaucracy with bureaucracy, and it seemed, so far, to have worked.
Several days later we got an answer from the carrier. The problem, they said, was that the bill had come from the doctor, not from the hospital. The doctor was not a member of their provider network; the hospital was. Therefore they'd refused to pay.
We — the HR director and myself, now in a Vulcan mindmeld of entitlement — pointed out that, (1), I had entered the hospital emergency room, not the doctor's office, with the intent of (2) seeing whomever happened to be on duty, not of seeing this particular physician or any other. We further pointed out that, (3), the policy provides coverage of out-of-network physicians anyway, just at a higher copay level, so under no circumstances should there have been a complete denial.
They said they'd look into it.
Around this time I got a bill myself, and it was indeed from the doctor. (Who wasn't a doctor, for what it's worth, but an NP — not that under the circumstances it really matters.) I took it in to the HR director. Yes, yes, everyone said. Now we've got it. It's the hospital's fault. Because we haven't yet received a bill from them, we can't verify it as a legitimate emergency room visit; thus we can't pay. We'll just have to wait for the hospital to issue their bill. Then the doctor's bill will be legitimate, and all will fall into place.
It's yet another sign of cultural illness and decay that this made, in some warped, bureaucratic, utterly logicless way, a kind of sense. But it did. And so we sat back to wait.
Weeks passed. Having set the various corporate chains in motion, I assumed the engine would eventually reach speed. Surely the hospital wanted to get paid, and so surely they'd send a bill. But I am also a cynical type, and I began, as such, to wonder several things. Was it possible the doctors were engaged in some kind of side-billing scam, for example? Hoping, I mean, that I would simply pay the denied claim at face value, thus sparing them the insurance company's negotiation? Or had the hospital, for similar reasons, worked out some kind of weird subcontractor relationship with the physicians, leasing facilities rather than employing them outright, to diffuse responsibility and costs? Just what new twist in the already byzantine dance of American healthcare was this?
The insurance rep, by his own account — which seemed genuine — made multiple attempts to reach the hospital with requests for their bill. For weeks, neither calls nor emails were returned. Finally he got through, and reported that the bill had been sent; the claim would be resubmitted; and he had marked it to be paid. A week or two after this I received another statement from the insurance company; this time, the claim, it reported, had been paid in full. This notice was dated May 6, 2005 — not quite six months after the inury itself, and the superglue that fixed it.
All's well that ends well, yes? And so I thought. Yet just this week, two more pieces of mail on the subject of my hacked finger (which has healed, but uglily; and the nerves are askew to this day). The first was a letter from an attorney, demanding payment for the doctor's bill that had been denied so long ago. The attorney's letter was dated May 29, a full three weeks after all contention had ceased and the check had, presumably, been sent. I replied with a copy of the insurance statement. This might or might not take care of it. It won't surprise me if there are more letters to be exchanged, more representatives whose opinions must be sought, more threats to trade before everyone agrees to call it done.
But the last was worst. There was yet a third Explanation of Benefits statement from the insurance company; in this one, I was informed I'd have to pay a $50 deductible. More shocking, though, was everything else on the statement — all the stuff I wasn't having to pay for because the insurance company was. There were four line items, ranging in associated cost from $60 to $400. The total bill was $897.00. All line items were marked with the hospital's name and "Specialty Room." That's it; no variation, just "Specialty Room," four times, and next to each an amount. This meant that, with the previous bill, the total charge for my visit was more than $1,100.00.
This was stupefying. It had to be, I figured, a mistake, or — worse? better? just different? — a scam. I'd been there thirty minutes, maybe forty-five if you included the perfunctory triage interview and the insurance fairy's visit. The skill level involved in every step was minimal, by medical standards or any others: a student could have treated me in exactly the same way, in the same amount of time. A gym teacher could have, almost. The most sophisticated equipment deploying during the entire episode was that on the insurance fairy's cart. There were no x-rays, no ultrasounds, no CAT scans or MRIs. There was scarcely any palpitation. She took a couple of long glances and shifted some skin around — with her fingers. Supplies-wise, we used 1 plastic cup; about 1/4 cup of betadine; four or five drops of the glue; some gauze, and assorted dressings and bandages. Dinner at Otto uses greater amounts of more expensive stuff.
I called the insurance company immediately. They'd been snowed, I figured. I would do them a favor. I would let them know what had really gone down. I would do my part to rein in the spiraling costs of US healthcare.
You know what happened next. It has probably happened to you. Statistically speaking, it must have happened to some of you. The woman on the other end of the line — my ally, I'd expected — received my indignant whistleblowing as though I'd come over the line in Martian.
Do you realize this was a trivial thing? I asked, my incredulousness running over.
Oh, yes, she replied.
Do you realize the total amount they're charging for this trivial thing?
Oh, yes. They do that all the time.
This is normal?
Oh yes.
For something like this — to cost so much?
Oh yes.
They bill you for the doctor, she said, and they bill you for the room, and they bill you for the equipment and the supplies. They bill you for everything. It adds up.
This is, I said, the most ridiculous thing I've ever seen in my life.
Is there anything else I can do for you today? she said.
There was not.
It's funny. Except that it's not funny. It's what passes for your healthcare system. It has severed all ties to reason; even to call it a "system" implies logic, and that's nearly impossible to uncover in such a mess. It costs more than any comparable system on the face of the earth and its efficiencies dwindle every day. How could they not, when an episode like this is not an exception but the norm? Forget about where the money's going; let's assume it's going several places. Let's assume there's not just one set of pockets being lined by all that cash but a number of them, in several professions and industries. The drug companies. The equipment manufacturers. The administrators of the corporations that own the hospitals, and the administrators of the corporations that insure us. Does it make any difference? We currently have forty million uninsured in this nation, many of them children; the number does not decrease every year, ladies and gentlemen, it increases. Soon we'll have fifty million, and after that sixty million, seventy, a hundred. That's one in three. Things are getting worse. And no one is doing anything about it. It is, to borrow a phrase from the Republicans who adore this so-called system, and who defend it nearly with their lives, and certainly with their pocketbooks (which it has, of course, considerably fattened), a moral outrage.
The nature of that outrage is a subject for other, deeper, angrier and even more confusing meditations. In the meantime, if you happen to slice your finger, consider the following regimen: wash it in cold running water ($0). Apply direct pressure with some sterile gauze ($3.99), and keep the hand elevated above the level of your heart to help ease the flow of blood ($0 — and yes, it's quite possible this is an old wives' tale. Your guess is as good as mine). Once the bleeding has abated, rinse it with some hydrogen peroxide ($0.99) and clean the nearby surfaces with rubbing alcohol (also $0.99). Attach the separate ends with a butterfly bandage ($4.99), or, if you're really feeling the need, with an over-the-counter version of the medical glue, which you'll find these days right next to the bandaids at your local pharmacy ($9.99). Wrap the whole business in more sterile gauze (from the same package as before, so $0), and/or put some appropriately sized bandaids around it, tightly but not so tightly you cut off circulation. Change dressings every day, twice a day if you need to, and avoid getting it wet for a week or two (wrap a plastic bag — $2.29 — around your hand if it helps, and seal it with a not-too-tight rubber band). Of course I'm not a doctor or an NP, or any other kind of licensed medical practitioner, so I can't charge you for this list; I also can't guarantee it will work. You'll have to attempt at your own risk. But then, there'd be no guarantees if you went to the hospital and they told you pretty much the same thing. And the bill in that case would be approximately $1025.00 more.
June 09, 2005
Getting It
If you are, like me, one of those people who've assumed that the spasms of fervor rolling out of Christian corners since last November are nothing more than the latest media darling, the socio-political equivalent of Britney's navel or J-Lo's ass, you may want to reconsider. Yes, these folks have certainly been getting coverage disproportionate to their numbers, to their representativeness in American culture, and to the sway they lent our last election. Yes, radically conservative religious sects have been a fixture of American culture since colonial days, and though they've sunk beneath the surface of popular consciousness for long stretches they've also had a habit of coming back up for noisy air. You have to keep in mind that less than a hundred years ago it was illegal to sell or purchase alcohol in this nation; it wasn't atheists who hacked the taps. We got over that, of course. (We were even bequeathed a mainstay of American cultural mythology for our trouble: the gangster, a massive thumb in the eye of pious assurance and a figure that would, you'd think, give pause to anyone who presumes the darker impulses of human nature can be legislated away.)
Still, there are a couple of differences in the current uproar. The first is the movement's ambition. The second is its connections. For insight into both I'd point anyone interested — and you should all be interested, especially those of you in blue America, literally or figuratively — to the May 2005 issue of Harper's. A double feature therein tries to grapple with two of the most significant faces of the fundamentalist Christian political movement, and it makes for some creepy reading.
Why creepy? Maybe because of all the rhetorical antecedents from 1950s America, under McCarthyism, and 1930s Germany, during the late adolescence of National Socialism. Maybe because there's not even any real attempt to conceal the desire for a theocratic — well, revolution: that's really the only word. And maybe most of all because the rhetoric coming from Colorado Springs and Orange County — the settings of the two reports — is not just militant, it's militant in a Taliban kind of way as opposed to, say, a Malcolm X kind of way. These guys are shaping up to be some kind of domestic Hezbollah. They talk about "training camps"; they talk about "bombs" and "explosions"; they pass out maps of New York City with "targets" marked. Toward the end of the first piece, the author runs into a local fellow. The author explains he's from New York. The local fellow's response is to say, simply, "Ka-boom"; and frankly by this time it's not a surprise. It's more like a culmination.
Interesting to note that both authors — Jeff Sharlet in the first piece, about Colorado Springs and the New Life Church; Chris Hedges in the second, about the National Religious Broadcasters conference in Orange County, CA — fall into different but similar forms of breakdown by the ends of their pieces. I imagine they, too, expected something more innocuous, more akin to a purportedly disenfranchised group demanding its place at the national table, claiming a corner of public dialogue and calling for an end to past neglect. This is, after all, the common public face of the fundamentalist movement. We've been put down, picked on, shut out; and we're not going to take it any more — making America safe for Christians and all that, as if anyone had ever contended it shouldn't be. From the inside these movements look like quite something else. And how could they not? The claims of persecution have always been specious. Christians are the most powerful coalition of organized interest groups in the United States. They have been since Jamestown. The only way to see them as persecuted is to understand persecution as the denial of their desire — in their eyes, their right — to hold dominion over every square inch of earth and everything that moves, breathes, or thinks within it. Which is precisely what Sharlet and Hedges, in their research, found the groups gearing up for. If they were Islmamists, we'd be calling their plans a "jihad." We'd be calling them terrorists-in-the-making, or at least extremists, militants, hardline factions. But they're not Islamists, so I guess we just call it going to Sunday worship. Nonetheless, the intensity of their fervor, the anger and hatred and intolerance for difference that fuel it, seem to take both writers by surprise — and to drive them, frankly, in the end, a little mad. Pay attenion: we may all be driven a little mad before this is over.
Every time I start trying to write about these people, I find I don't want to do it. Something in me resists — feels it shouldn't be necessary, really; even to broach the subject is to lend it a credibility, a legitimacy it doesn't deserve. We are rational folk. It is 2005. Creationism? Outlawing the teaching of evolution? To a certain extent, it's a discussion that offends the intellect by its very existence.
They are right about me, you see. I want to dismiss them. More than that: I do dismiss them. I don't "get it"; I am utterly baffled by "it" in fact — it; them; the whole fanatical program. It is, in some sense, difficult for me to take such a worldview seriously on an intellectual level. I don't feel this way about all religious folk, only about the literalists: the ones who assign every word its face value, every recounting the merit of eyewitness news, every precept the crack of a military command. Those whose approach to religion involves the sublime — who view it as mystery, something utterly beyond them, inexplicable and unknowable but potent nonetheless, and moving, and present: these I respect. These I even understand, though I don't share. I take love as a simplistic analogy: it defies logic, yet it's essential. Others look into the darkness and call it God; I look in and call it Stuff I Don't Know.
Fundamentalisms take a different tack altogether. To these people, there are no mysteries. There are no metaphors. Theirs is a dry world of proscription and detail in which ecstasy, such as it is, comes not from encounters with the sublime but from the competitive, condescending joys of being in the club. Because the Bible is God's word, and because God's word is literal and complete, there is nothing to interpret; nothing's been left out or unsaid. There are no meanings to decrypt or contemplate, nothing to wonder at or about. It is what it is. It means what it says. Either God pronounced it or he didn't; and if he didn't there's no reason for us to take it up — except to convert it, silence it, exile it or have it killed.
Such a construction of the universe is binary, of course, even Manichean. The divisions are dull and predictable, all flowing from the base duality of God and Satan. Even this is simple: if a thing is not God, it must be Satan. One is right, therefore, or one is wrong; one is just or one is evil; one is saved or damned.
Like all binary systems, one side is only knowable with reference to the other. If you, like me, find yourself in a state of perpetual wonder at how fundamentalists can muster the time and energy to care what you do with yourself all day (and all night), here's your answer: you're the other side of their duality's coin. Robbed of the fertile terrain of an inner life — what's the point, when God's done all the thinking for you? — their gaze must turn outward. To be real to themselves, then, they must look at you.
How else to explain their claims that they're threatened by what you do? Threatened. Take the marriage example: that the marriages of straight men and women are tormented, even "damaged" (and yes, this is the language), by same-sex unions. They're serious about this, and they don't mean that gay couples come to their houses waving weapons and making demands. What they mean is that they understand themselves by what they are not, and that when the boundaries between what they are and what they are not get blurred — say, when gay couples are allowed to call themselves "married" under the law — then their understanding of what they themselves are gets eroded. Such an understanding of self comes from without, not from within; thus it really is fragile, and it really is dependent on who you are and what you do. Wittingly or not, you can become an affliction to people you've never met.
Most of us tend to view this as their problem. We don't care what they do, after all, regardless of how disagreeable we might find it — as long as they keep it amongst themselves and don't get imperial about it. As long as they don't make their problem, that is, our problem. But perhaps the point is that they've now decided to do just that. And this, too, when you consider it, is natural enough: we couldn't have expected a solution to come from within.
Here, too, may lie an explanation for why fundamentalists so often feel hurt and outraged by those who don't share their worldview. It is not easy to be a person of faith, especially a person of this kind of faith. It must be exhausting, in fact. It requires constant policing of the self, constant policing of others. It requires absolute devotion to the evangelical hierarchy, which is for all intents and purposes feudal: God as king; church leaders as vassals; everyone else as more or less serfs, doing the grunt work and paying the dues, avoiding question of the higher-ups. Even if they didn't believe those outside the fundamentalist community were against them as a matter of course, your everyday fundamentalist would pretty much have to build up a rich store of resentment toward those who exempt themselves from the hierarchy. If they must suffer, so must we all; and as in any kind of hazing, the most vigorous are always the ones who got it worst themselves. What does President Bush say about the Islamists — that "they hate is for our freedom"? Indeed.
But perhaps there's more subtle psychological interplay as well. Faith of such a severe sort is not only materially difficult to sustain, it is imaginatively difficult. It requires a repression of human impulses toward curiosity and inquisition. It requires the abandonment of logic. It requires the suspension, often, of sense. So as a nonbeliever, or even a different believer, you are a catalyst for cognitive dissonance. You challenge the fundamental presumption by your presence alone. You are a trial, and trials — even if a routine part of the life of faith — require energy to overcome. No one likes to face constant ontological threat. If there is only one truth, and if that truth is perfect, comprehensive, total, then on one level the person of severe faith must ask himself how anyone could stand outside it. I suppose there are ready answers for this — God gave man free will; a long history of infidels; tests of faith, etc. But these explanations don't really suffice. They make the almighty seem a petty trickster, playing games with humans as a cat might with mice. Such free will is an illusion, after all: to use it in pursuit of any program aside from God's is to be damned, and that's hardly a viable option. Free will thus understood looks more like a trick: choose correctly, all is well; choose poorly, you die. Is this really, to put it in earthly terms, how one wants to think of the Supreme Being spending His almighty time? Has He really nothing better going on? Is His idea of conducting the universe truly as petty as an adolescent boy's? And if it's not, why doesn't he just call a halt to the circus and employ His almighty authority in a giant shove to push everyone into line?
It's always tempting to wade into the waters of theological debate. But in this case they're beside the point. The debate we should be having now is not about theology but about political life, civic life, social existence and national cohabitation. The debate we should be having is about why not one politician in America would dare pronounce himself a skeptic, let alone an atheist, in the public space — not one. We should be talking about climates of fear and retribution, about the rhetoric of militant assault. We should be talking about whether we're willing, as a culture, to allow tolerance and pluralism — the concepts, the practices — to be debased, discouraged, even criminalized. We should be talking about whether the sadness of September 11 arose from the fact that New York, a representation of America, itself a representation of all these things — tolerance; pluralism; mutual respect in the public sphere; acceptance of difference, and a determination to coexist within it; the primacy of the will of the people (which is the meaning of democracy, after all); and the rule of impartial laws that enforce the above but do no more — if sadness arose from the fact that it was these things that were attacked, or from the fact that it was Islamist Arabs who did the attacking. Because it's looking more and more like it wasn't only radical Islamists on the streets of Palestine and Pakistan who might have been cheering the towers' fall.
Still, there are a couple of differences in the current uproar. The first is the movement's ambition. The second is its connections. For insight into both I'd point anyone interested — and you should all be interested, especially those of you in blue America, literally or figuratively — to the May 2005 issue of Harper's. A double feature therein tries to grapple with two of the most significant faces of the fundamentalist Christian political movement, and it makes for some creepy reading.
Why creepy? Maybe because of all the rhetorical antecedents from 1950s America, under McCarthyism, and 1930s Germany, during the late adolescence of National Socialism. Maybe because there's not even any real attempt to conceal the desire for a theocratic — well, revolution: that's really the only word. And maybe most of all because the rhetoric coming from Colorado Springs and Orange County — the settings of the two reports — is not just militant, it's militant in a Taliban kind of way as opposed to, say, a Malcolm X kind of way. These guys are shaping up to be some kind of domestic Hezbollah. They talk about "training camps"; they talk about "bombs" and "explosions"; they pass out maps of New York City with "targets" marked. Toward the end of the first piece, the author runs into a local fellow. The author explains he's from New York. The local fellow's response is to say, simply, "Ka-boom"; and frankly by this time it's not a surprise. It's more like a culmination.
Interesting to note that both authors — Jeff Sharlet in the first piece, about Colorado Springs and the New Life Church; Chris Hedges in the second, about the National Religious Broadcasters conference in Orange County, CA — fall into different but similar forms of breakdown by the ends of their pieces. I imagine they, too, expected something more innocuous, more akin to a purportedly disenfranchised group demanding its place at the national table, claiming a corner of public dialogue and calling for an end to past neglect. This is, after all, the common public face of the fundamentalist movement. We've been put down, picked on, shut out; and we're not going to take it any more — making America safe for Christians and all that, as if anyone had ever contended it shouldn't be. From the inside these movements look like quite something else. And how could they not? The claims of persecution have always been specious. Christians are the most powerful coalition of organized interest groups in the United States. They have been since Jamestown. The only way to see them as persecuted is to understand persecution as the denial of their desire — in their eyes, their right — to hold dominion over every square inch of earth and everything that moves, breathes, or thinks within it. Which is precisely what Sharlet and Hedges, in their research, found the groups gearing up for. If they were Islmamists, we'd be calling their plans a "jihad." We'd be calling them terrorists-in-the-making, or at least extremists, militants, hardline factions. But they're not Islamists, so I guess we just call it going to Sunday worship. Nonetheless, the intensity of their fervor, the anger and hatred and intolerance for difference that fuel it, seem to take both writers by surprise — and to drive them, frankly, in the end, a little mad. Pay attenion: we may all be driven a little mad before this is over.
Every time I start trying to write about these people, I find I don't want to do it. Something in me resists — feels it shouldn't be necessary, really; even to broach the subject is to lend it a credibility, a legitimacy it doesn't deserve. We are rational folk. It is 2005. Creationism? Outlawing the teaching of evolution? To a certain extent, it's a discussion that offends the intellect by its very existence.
They are right about me, you see. I want to dismiss them. More than that: I do dismiss them. I don't "get it"; I am utterly baffled by "it" in fact — it; them; the whole fanatical program. It is, in some sense, difficult for me to take such a worldview seriously on an intellectual level. I don't feel this way about all religious folk, only about the literalists: the ones who assign every word its face value, every recounting the merit of eyewitness news, every precept the crack of a military command. Those whose approach to religion involves the sublime — who view it as mystery, something utterly beyond them, inexplicable and unknowable but potent nonetheless, and moving, and present: these I respect. These I even understand, though I don't share. I take love as a simplistic analogy: it defies logic, yet it's essential. Others look into the darkness and call it God; I look in and call it Stuff I Don't Know.
Fundamentalisms take a different tack altogether. To these people, there are no mysteries. There are no metaphors. Theirs is a dry world of proscription and detail in which ecstasy, such as it is, comes not from encounters with the sublime but from the competitive, condescending joys of being in the club. Because the Bible is God's word, and because God's word is literal and complete, there is nothing to interpret; nothing's been left out or unsaid. There are no meanings to decrypt or contemplate, nothing to wonder at or about. It is what it is. It means what it says. Either God pronounced it or he didn't; and if he didn't there's no reason for us to take it up — except to convert it, silence it, exile it or have it killed.
Such a construction of the universe is binary, of course, even Manichean. The divisions are dull and predictable, all flowing from the base duality of God and Satan. Even this is simple: if a thing is not God, it must be Satan. One is right, therefore, or one is wrong; one is just or one is evil; one is saved or damned.
Like all binary systems, one side is only knowable with reference to the other. If you, like me, find yourself in a state of perpetual wonder at how fundamentalists can muster the time and energy to care what you do with yourself all day (and all night), here's your answer: you're the other side of their duality's coin. Robbed of the fertile terrain of an inner life — what's the point, when God's done all the thinking for you? — their gaze must turn outward. To be real to themselves, then, they must look at you.
How else to explain their claims that they're threatened by what you do? Threatened. Take the marriage example: that the marriages of straight men and women are tormented, even "damaged" (and yes, this is the language), by same-sex unions. They're serious about this, and they don't mean that gay couples come to their houses waving weapons and making demands. What they mean is that they understand themselves by what they are not, and that when the boundaries between what they are and what they are not get blurred — say, when gay couples are allowed to call themselves "married" under the law — then their understanding of what they themselves are gets eroded. Such an understanding of self comes from without, not from within; thus it really is fragile, and it really is dependent on who you are and what you do. Wittingly or not, you can become an affliction to people you've never met.
Most of us tend to view this as their problem. We don't care what they do, after all, regardless of how disagreeable we might find it — as long as they keep it amongst themselves and don't get imperial about it. As long as they don't make their problem, that is, our problem. But perhaps the point is that they've now decided to do just that. And this, too, when you consider it, is natural enough: we couldn't have expected a solution to come from within.
Here, too, may lie an explanation for why fundamentalists so often feel hurt and outraged by those who don't share their worldview. It is not easy to be a person of faith, especially a person of this kind of faith. It must be exhausting, in fact. It requires constant policing of the self, constant policing of others. It requires absolute devotion to the evangelical hierarchy, which is for all intents and purposes feudal: God as king; church leaders as vassals; everyone else as more or less serfs, doing the grunt work and paying the dues, avoiding question of the higher-ups. Even if they didn't believe those outside the fundamentalist community were against them as a matter of course, your everyday fundamentalist would pretty much have to build up a rich store of resentment toward those who exempt themselves from the hierarchy. If they must suffer, so must we all; and as in any kind of hazing, the most vigorous are always the ones who got it worst themselves. What does President Bush say about the Islamists — that "they hate is for our freedom"? Indeed.
But perhaps there's more subtle psychological interplay as well. Faith of such a severe sort is not only materially difficult to sustain, it is imaginatively difficult. It requires a repression of human impulses toward curiosity and inquisition. It requires the abandonment of logic. It requires the suspension, often, of sense. So as a nonbeliever, or even a different believer, you are a catalyst for cognitive dissonance. You challenge the fundamental presumption by your presence alone. You are a trial, and trials — even if a routine part of the life of faith — require energy to overcome. No one likes to face constant ontological threat. If there is only one truth, and if that truth is perfect, comprehensive, total, then on one level the person of severe faith must ask himself how anyone could stand outside it. I suppose there are ready answers for this — God gave man free will; a long history of infidels; tests of faith, etc. But these explanations don't really suffice. They make the almighty seem a petty trickster, playing games with humans as a cat might with mice. Such free will is an illusion, after all: to use it in pursuit of any program aside from God's is to be damned, and that's hardly a viable option. Free will thus understood looks more like a trick: choose correctly, all is well; choose poorly, you die. Is this really, to put it in earthly terms, how one wants to think of the Supreme Being spending His almighty time? Has He really nothing better going on? Is His idea of conducting the universe truly as petty as an adolescent boy's? And if it's not, why doesn't he just call a halt to the circus and employ His almighty authority in a giant shove to push everyone into line?
It's always tempting to wade into the waters of theological debate. But in this case they're beside the point. The debate we should be having now is not about theology but about political life, civic life, social existence and national cohabitation. The debate we should be having is about why not one politician in America would dare pronounce himself a skeptic, let alone an atheist, in the public space — not one. We should be talking about climates of fear and retribution, about the rhetoric of militant assault. We should be talking about whether we're willing, as a culture, to allow tolerance and pluralism — the concepts, the practices — to be debased, discouraged, even criminalized. We should be talking about whether the sadness of September 11 arose from the fact that New York, a representation of America, itself a representation of all these things — tolerance; pluralism; mutual respect in the public sphere; acceptance of difference, and a determination to coexist within it; the primacy of the will of the people (which is the meaning of democracy, after all); and the rule of impartial laws that enforce the above but do no more — if sadness arose from the fact that it was these things that were attacked, or from the fact that it was Islamist Arabs who did the attacking. Because it's looking more and more like it wasn't only radical Islamists on the streets of Palestine and Pakistan who might have been cheering the towers' fall.
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