#and this is like. a patient with insurance and money at what is considered a very high-end facility!

[celiaelise]

I guess I already knew this, but it's always kind of astonishing how little medical providers seem to feel the need to communicate with their patients!

Like, my mom had surgery yesterday, and her doctor hasn't even committed to her getting to stay in the hospital again tonight. Even though she's expressed her desire to do so several times, and to several people, we're still not certain we won't have to take her home today. And it's almost 1pm!

Even disregarding the simple rudeness of that, and the stress the uncertainty could cause for the patient, (which, like. Shouldn't be disregarded.) there's also the logistical issues! Someone else has to take her home, and take care of her! People have jobs, and commitments!! Some people (though luckily neither I nor my brother) have children to take care of!! You can't just expect a whole family to be put on hold indefinitely, and if you DO expect that, you need to clearly communicate that expectation!! (I made sure my schedule was clear for 3 days, but it's the principle.)

And they don't tell her much about her schedule for the day, or anything. The nurses have mostly been very nice and polite, but it's difficult for her to get definitive answers to her questions from them. She hasn't even been told whether it's okay for her to use the shower in her room, even though she's expressed that not having showered is making her uncomfortable. They all act like the decisions are up to someone else, but no one seems to know who the "someone else" is. I mean, I guess it's the doctor, who spent maybe a total of five minutes talking to my mom early this morning. I'm told he mostly said, "we'll have to see how you do", which would be more understandable if he had actually made an appearance since. Like, how are you going to "see how she does" if you haven't even seen her??

I will grant, my mother is very passive and deferential and will not ask follow-up questions, but, like, so are many other people??? That doesn't mean they don't deserve information about their care! And communicating with patients who are reticent to communicate should be a skill and a priority to these providers, not something they can neglect.

Also, she specifically told us before her surgery, "was I nice? I want them to like me so that they are careful with me." She was scared!! They put her under and cut her leg open and apart, and she was nervous about that, and was aware that they would have all the power when it was happening!! She hasn't told anyone here that they're all mispronouncing her last name for the same reason. She doesn't want to ruffle any feathers, because she knows that these people are in a position to, very literally, hurt her if she does.

And, yeah, personally, I don't share these fears. I believe in advocating for myself, and, if I can't trust in my providers' compassion for me or their pride in their own work, I'm willing to put my faith in the power my money has over them, and the power I have to potentially make life more difficult for them in the future. But, like, my mother's not wrong, either!

[mostlysignssomeportents]

Conspiratorialism as a material phenomenon

I'll be in TUCSON, AZ from November 8-10: I'm the GUEST OF HONOR at the TUSCON SCIENCE FICTION CONVENTION.

I think it behooves us to be a little skeptical of stories about AI driving people to believe wrong things and commit ugly actions. Not that I like the AI slop that is filling up our social media, but when we look at the ways that AI is harming us, slop is pretty low on the list.

The real AI harms come from the actual things that AI companies sell AI to do. There's the AI gun-detector gadgets that the credulous Mayor Eric Adams put in NYC subways, which led to 2,749 invasive searches and turned up zero guns:

https://www.cbsnews.com/newyork/news/nycs-subway-weapons-detector-pilot-program-ends/

Any time AI is used to predict crime – predictive policing, bail determinations, Child Protective Services red flags – they magnify the biases already present in these systems, and, even worse, they give this bias the veneer of scientific neutrality. This process is called "empiricism-washing," and you know you're experiencing it when you hear some variation on "it's just math, math can't be racist":

https://pluralistic.net/2020/06/23/cryptocidal-maniacs/#phrenology

When AI is used to replace customer service representatives, it systematically defrauds customers, while providing an "accountability sink" that allows the company to disclaim responsibility for the thefts:

https://pluralistic.net/2024/04/23/maximal-plausibility/#reverse-centaurs

When AI is used to perform high-velocity "decision support" that is supposed to inform a "human in the loop," it quickly overwhelms its human overseer, who takes on the role of "moral crumple zone," pressing the "OK" button as fast as they can. This is bad enough when the sacrificial victim is a human overseeing, say, proctoring software that accuses remote students of cheating on their tests:

https://pluralistic.net/2022/02/16/unauthorized-paper/#cheating-anticheat

But it's potentially lethal when the AI is a transcription engine that doctors have to use to feed notes to a data-hungry electronic health record system that is optimized to commit health insurance fraud by seeking out pretenses to "upcode" a patient's treatment. Those AIs are prone to inventing things the doctor never said, inserting them into the record that the doctor is supposed to review, but remember, the only reason the AI is there at all is that the doctor is being asked to do so much paperwork that they don't have time to treat their patients:

https://apnews.com/article/ai-artificial-intelligence-health-business-90020cdf5fa16c79ca2e5b6c4c9bbb14

My point is that "worrying about AI" is a zero-sum game. When we train our fire on the stuff that isn't important to the AI stock swindlers' business-plans (like creating AI slop), we should remember that the AI companies could halt all of that activity and not lose a dime in revenue. By contrast, when we focus on AI applications that do the most direct harm – policing, health, security, customer service – we also focus on the AI applications that make the most money and drive the most investment.

AI hasn't attracted hundreds of billions in investment capital because investors love AI slop. All the money pouring into the system – from investors, from customers, from easily gulled big-city mayors – is chasing things that AI is objectively very bad at and those things also cause much more harm than AI slop. If you want to be a good AI critic, you should devote the majority of your focus to these applications. Sure, they're not as visually arresting, but discrediting them is financially arresting, and that's what really matters.

All that said: AI slop is real, there is a lot of it, and just because it doesn't warrant priority over the stuff AI companies actually sell, it still has cultural significance and is worth considering.

AI slop has turned Facebook into an anaerobic lagoon of botshit, just the laziest, grossest engagement bait, much of it the product of rise-and-grind spammers who avidly consume get rich quick "courses" and then churn out a torrent of "shrimp Jesus" and fake chainsaw sculptures:

https://www.404media.co/email/1cdf7620-2e2f-4450-9cd9-e041f4f0c27f/

For poor engagement farmers in the global south chasing the fractional pennies that Facebook shells out for successful clickbait, the actual content of the slop is beside the point. These spammers aren't necessarily tuned into the psyche of the wealthy-world Facebook users who represent Meta's top monetization subjects. They're just trying everything and doubling down on anything that moves the needle, A/B splitting their way into weird, hyper-optimized, grotesque crap:

https://www.404media.co/facebook-is-being-overrun-with-stolen-ai-generated-images-that-people-think-are-real/

In other words, Facebook's AI spammers are laying out a banquet of arbitrary possibilities, like the letters on a Ouija board, and the Facebook users' clicks and engagement are a collective ideomotor response, moving the algorithm's planchette to the options that tug hardest at our collective delights (or, more often, disgusts).

So, rather than thinking of AI spammers as creating the ideological and aesthetic trends that drive millions of confused Facebook users into condemning, praising, and arguing about surreal botshit, it's more true to say that spammers are discovering these trends within their subjects' collective yearnings and terrors, and then refining them by exploring endlessly ramified variations in search of unsuspected niches.

(If you know anything about AI, this may remind you of something: a Generative Adversarial Network, in which one bot creates variations on a theme, and another bot ranks how closely the variations approach some ideal. In this case, the spammers are the generators and the Facebook users they evince reactions from are the discriminators)

https://en.wikipedia.org/wiki/Generative_adversarial_network

I got to thinking about this today while reading User Mag, Taylor Lorenz's superb newsletter, and her reporting on a new AI slop trend, "My neighbor’s ridiculous reason for egging my car":

https://www.usermag.co/p/my-neighbors-ridiculous-reason-for

The "egging my car" slop consists of endless variations on a story in which the poster (generally a figure of sympathy, canonically a single mother of newborn twins) complains that her awful neighbor threw dozens of eggs at her car to punish her for parking in a way that blocked his elaborate Hallowe'en display. The text is accompanied by an AI-generated image showing a modest family car that has been absolutely plastered with broken eggs, dozens upon dozens of them.

According to Lorenz, variations on this slop are topping very large Facebook discussion forums totalling millions of users, like "Movie Character…,USA Story, Volleyball Women, Top Trends, Love Style, and God Bless." These posts link to SEO sites laden with programmatic advertising.

The funnel goes:

i. Create outrage and hence broad reach;

ii, A small percentage of those who see the post will click through to the SEO site;

iii. A small fraction of those users will click a low-quality ad;

iv. The ad will pay homeopathic sub-pennies to the spammer.

The revenue per user on this kind of scam is next to nothing, so it only works if it can get very broad reach, which is why the spam is so designed for engagement maximization. The more discussion a post generates, the more users Facebook recommends it to.

These are very effective engagement bait. Almost all AI slop gets some free engagement in the form of arguments between users who don't know they're commenting an AI scam and people hectoring them for falling for the scam. This is like the free square in the middle of a bingo card.

Beyond that, there's multivalent outrage: some users are furious about food wastage; others about the poor, victimized "mother" (some users are furious about both). Not only do users get to voice their fury at both of these imaginary sins, they can also argue with one another about whether, say, food wastage even matters when compared to the petty-minded aggression of the "perpetrator." These discussions also offer lots of opportunity for violent fantasies about the bad guy getting a comeuppance, offers to travel to the imaginary AI-generated suburb to dole out a beating, etc. All in all, the spammers behind this tedious fiction have really figured out how to rope in all kinds of users' attention.

Of course, the spammers don't get much from this. There isn't such a thing as an "attention economy." You can't use attention as a unit of account, a medium of exchange or a store of value. Attention – like everything else that you can't build an economy upon, such as cryptocurrency – must be converted to money before it has economic significance. Hence that tooth-achingly trite high-tech neologism, "monetization."

The monetization of attention is very poor, but AI is heavily subsidized or even free (for now), so the largest venture capital and private equity funds in the world are spending billions in public pension money and rich peoples' savings into CO2 plumes, GPUs, and botshit so that a bunch of hustle-culture weirdos in the Pacific Rim can make a few dollars by tricking people into clicking through engagement bait slop – twice.

The slop isn't the point of this, but the slop does have the useful function of making the collective ideomotor response visible and thus providing a peek into our hopes and fears. What does the "egging my car" slop say about the things that we're thinking about?

Lorenz cites Jamie Cohen, a media scholar at CUNY Queens, who points out that subtext of this slop is "fear and distrust in people about their neighbors." Cohen predicts that "the next trend, is going to be stranger and more violent.”

This feels right to me. The corollary of mistrusting your neighbors, of course, is trusting only yourself and your family. Or, as Margaret Thatcher liked to say, "There is no such thing as society. There are individual men and women and there are families."

We are living in the tail end of a 40 year experiment in structuring our world as though "there is no such thing as society." We've gutted our welfare net, shut down or privatized public services, all but abolished solidaristic institutions like unions.

This isn't mere aesthetics: an atomized society is far more hospitable to extreme wealth inequality than one in which we are all in it together. When your power comes from being a "wise consumer" who "votes with your wallet," then all you can do about the climate emergency is buy a different kind of car – you can't build the public transit system that will make cars obsolete.

When you "vote with your wallet" all you can do about animal cruelty and habitat loss is eat less meat. When you "vote with your wallet" all you can do about high drug prices is "shop around for a bargain." When you vote with your wallet, all you can do when your bank forecloses on your home is "choose your next lender more carefully."

Most importantly, when you vote with your wallet, you cast a ballot in an election that the people with the thickest wallets always win. No wonder those people have spent so long teaching us that we can't trust our neighbors, that there is no such thing as society, that we can't have nice things. That there is no alternative.

The commercial surveillance industry really wants you to believe that they're good at convincing people of things, because that's a good way to sell advertising. But claims of mind-control are pretty goddamned improbable – everyone who ever claimed to have managed the trick was lying, from Rasputin to MK-ULTRA:

https://pluralistic.net/HowToDestroySurveillanceCapitalism

Rather than seeing these platforms as convincing people of things, we should understand them as discovering and reinforcing the ideology that people have been driven to by material conditions. Platforms like Facebook show us to one another, let us form groups that can imperfectly fill in for the solidarity we're desperate for after 40 years of "no such thing as society."

The most interesting thing about "egging my car" slop is that it reveals that so many of us are convinced of two contradictory things: first, that everyone else is a monster who will turn on you for the pettiest of reasons; and second, that we're all the kind of people who would stick up for the victims of those monsters.

Tor Books as just published two new, free LITTLE BROTHER stories: VIGILANT, about creepy surveillance in distance education; and SPILL, about oil pipelines and indigenous landback.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/10/29/hobbesian-slop/#cui-bono

Image: Cryteria (modified) https://commons.wikimedia.org/wiki/File:HAL9000.svg

CC BY 3.0 https://creativecommons.org/licenses/by/3.0/deed.en

[star-daughter]

Whooh boy. Hi everyone! Sorry, It's been a while. But I have quite the post for you all today, because we'll be talking about a webcomic I just finished! ... I will warn you all though, that I do not have the kindest of words to say about it.

You may be aware of this comic, as it has a considerable following, especially here on tumblr, the comic is called Sparklecare. It currently has 4 volumes and is on a short hiatus so the website can finish it's redesign, but the plot summary of the comic from the last available snapshot of the website is as follows:

The comic follows the story of a cat named Barry Ill and his experience of being admitted to the Sparklecare hospital. Despite its glamorous reputation, the hospital is actually a prison that tortures and kills its patients and drains their families of insurance by the corrupt hospital's owner, Dr. Cuddles. Cuddles is a greedy Capitalist scumbag who cares about nothing but money, and so far, everything is working out for him. Any patients who escape or try to speak out against the hospital aren't believed and are written off as crazy. The story follows Barry's journey into uncovering the truth about why this place really is the way it is, and why nobody's talking about it.

From the outside, the comic is very striking and intriguing! From it's prominent art style and art direction, to the concept itself, it sounds like a fun time! ...Right? Well that's where the comic gets you; see just like the in-universe hospital, Sparklecare isn't as inviting and pleasant once you really sink your teeth in. And I'm here to talk about why I think that is.

Before we begin, I'd like to clarify since I've become aware of the community's um... Questionable attitude towards critique, that if you enjoy Sparklecare, that's totally fine! I'm not gonna tell you what you can and can't read, I'm here to express my own thoughts on it.

Now, I won't torture you with this post if it ends up on your dash, so the full post will be under the cut! Please check the reblogs, I may add more there if I run out of space.

Also, CW for bright colours, blood and a whole heaping o' medical mispractice.

Before I get into some of the more serious issues with the comic, I wanna first start off with the thing you're going to first see trying to read it: The art. Here I would say the website, but since it's getting a redesign, I don't feel confident speaking on it. I'll leave one note on it though: it needs serious optimization...

Onto the art: I will say, I found the art quite charming, especially the art in the first 2 volumes. I think the comic has a way with setting mood and tone using it's palette, specifically in the dramatic "blue/red" scenes - I think those look gorgeous!

The style in volume 1 & 2 is also very pleasing to the eye, although it can look off at points. I think the style succeeds extremely well with it's tendency to give characters large, exaggerated expressions - it's very cartoony and I love it. The lineweight is also used very well in my opinion!

However... There's a few big elephants in the room that they are The designs, lettering & panel work.

I'll begin with how the series handles it's lettering, as it's one of the most important parts of a comic. Although it's unique, that does not mean it's good.

In volume 1, it starts off fine enough, it's a simple speech bubble with white/black text.

It sort of flip-flops between having a shadow/glow and not having one, which although confusing and hurts my eyes sometimes, not a deal breaker! The bubbles are all colour coded also so no matter the scene, you understand who is talking. That is very good! I like that! I wish the colours weren't as bright as the backgrounds, but I understand why they are.

Volume 2 introduces what I consider my favorite of the lettering styles, big bold outlines with bubbles that better surround the text!

It's easily the most recognizable lettering style of all the volumes, and it's very readable. It's simple, but lettering is at it's best when it's simple and understandable.

This volume's lettering also introduces colour coded words & different fonts.

Which, I think looks lovely! It adds personality, and since fonts carry different tones with them, it helps with emphasis and how people read the dialogue. However, this isn't to say I think this lettering is perfect.. I'm not a huge fan of the random dots & spots, I think they clutter up the page when there too many characters on screen speaking, which distracted me from focusing on the actual words they were saying.

It also changes mid-way through volume 2! Suddenly, we get character-coded dots & spots... Which, cool in theory, but in practice, as I mentioned, it clutters the page if there's too many characters speaking at once.

Plus, they're used on background characters who do not appear again after their introduction, which is such a waste... If you're going to introduce these character-specific details, they should be used on characters who are important, not character we'll never see again.

When we get to volume 3 & 4, the lettering style almost completely solidifies, the same big bold outlining from volume 2... But now instead of just having personalized dots, we get fully personalized speech bubbles. Which, again, cool in theory! But in practice it's just... So hard to read.

On lettering, I will applaud the use of a custom hand-written font. It looks great! It's fairly clear and adds a nice touch to the comic's overall appearance... But how they use the font is, in my opinion, awful. Characters talk way too much for how much page space there is, which means that there isn't enough space for the bubble to encompass the text, which means text needs to get smaller.

These pages are over 2000 pixels wide and tall, but there's no consideration for how the images & text will look when shrunk down to fit into a normal browser page, which means the text gets tiny and barely readable if there's too much of it - which there often is. I'll get into how I feel about the writing in a moment.

On the panel work, it's fine, it's not super jaw-dropping but it's serviceable. Where the panel work starts to fail though, is it's pacing. See, in comics, pacing is extremely important, good pacing means a better and clearer reading experience, bad pacing can leave the reader confused and force them to reread repeatedly to understand what's going on.

Sparklecare suffers from this heavily, I feel. Take a look to this page below, while not the worst example of it, I think demonstrates a bit what I mean.

There's a lot of text, similar looking shots, and... Very little background to help, well, ground where we are, which made me feel dizzy while reading. There's not a lot of proper flow, because speech bubbles float all over the place, often times out of order in which you are supposed to read them. You tend to dart your eyes all over the page to "properly" read it, which makes for a bad reading experience - the clearer the order is, the better the flow.

On backgrounds, I do not like the near-complete lack of them. Sparklecare gets around backgrounds by filling the colour voids of the panels with dots, specks, lines and patterns - but they don't do the job! It makes the pages feel more cluttered and difficult to look at and read.

Even when they do have backgrounds, they're also filled to the brim with patterning to take your mind off how often strange they look.

Being unable to see what's going on is a reoccurring issue with the comic, and it doesn't just end at the panel work or backgrounds...

The character designs in Sparklecare also contribute to the visual clutter, what with many of them having many small details or otherwise being unpleasant to look at due to their colour palette.

Here's a few examples of characters I think have too much going on or are just eyesores. And see, I get it, they're supposed to be sparkleanimals - designed like a kid on DeviantArt was making them in 2011, but you can get that look without making the designs hurt to look at. Sparklecare both tries to work within a limited palette and tries to have every colour possible on a character and it pulls neither off well. Not to mention, the multitude of small dots & details, adding more to the pile of small dots in the comic.

When a ton of characters are on screen, it tends to make things more confusing to look at - due in part also to the comic's continuity issue. Things or characters that are in one panel or page, will disappear the next, or swap places. Overall, small art issues pile up onto a mess of bright colours and rainbow.

Now here's where we get to the fun point, The writing. Oh boy! For the most part, or at least in volumes 1 & 2, the writing is completely fine. Complicated, a bit odd, but nothing to scream about... Until volumes 3 & 4, because that's when the issues in the writing really starts to show it's rainbow-speckled face.

I'll be direct, I don't like the writing in Sparklecare. The characters are typically unlikable or annoying, and when they do have something interesting going for them, it gets walked back on for plot reasons. Characters also seem to be unable to do wrong, unless they're deliberately out to be the bad one. Characters will do something bad, but get reassured that everything is fine and it isn't their fault even though they did something bad - which is weird the first time, but awful the next 40.

The writing does have it's good points (I liked most of the writing in volume 2, I thought Hemera's struggles with wanting to keep her friends safe was really interesting and I liked the chunklings), but there's prominent issues I can't shove aside.

I namely have issues with the humor, specifically it's uh... Sexual humor. Now, don't get me wrong, I love a good penis joke every now and then, but volume 4 has about 5x the sex jokes of any volume. It was genuinely horrible to sit through because I knew every serious moment would get a joke about stroking it a page or two afterwards.

(One note on that first image there, it happens right after Barry [the green guy] completely belittles and insults Uni [the purple one]...)

The meta humor also felt very, very forced.

It always came out of nowhere, and completely out of place every time it was used. I like meta humor also, but this is supposed to be a more serious comic, yes? I mean, it should be considering the topics at hand, so suddenly throwing in references to this being a comic feels weird to read.

I will say, I do like some of the jokes, specifically these ones:

Let me circle back to the character writing really quick, because there was characters I enjoyed! ... Just not the main ones.

I think, out of everyone, my favorite characters were:

Several background characters with no lines

Dr. Party

Cyn

Jean

Rem

I also really enjoyed how Cuddles was written in volume 1 & 2, he felt very threatening to me.

Outside of these characters though, I found little interest in the main cast and even found myself rooting for the downfall of a few of them due to their poor writing.

Specifically on Barry, there's a small arc in volume 2 where he realizes he needs to stop violently denying that Uni has magic (Which is a stupid plot in my opinion, by the way, considering the worldbuilding has a lot of magic in it. You'd think the smart guy character would know that?) after Uni's magic helps them in the dump. However, right afterwards, in volume 3 & 4, Barry goes right back to verbally assaulting Uni about how magic isn't real! It's not enjoyable to read, and makes no sense to me after what happened in volume 2.

One note, since I don't know where to put this but, I don't like doom. I really don't ... I think I'm supposed to feel bad for him? But I can't! I saw him in volume 1 take glee in having power over the patients, and as the site states:

Doom is not a normal nurse, because he takes on the role of a doctor by harming people alongside regular nurse duties.

He literally tortures people! I'm sorry, I cannot forgive that! No matter how bad he feels about it.

Some more notes on writing before I end this because it's getting too long.. The disability rep in Sparklecare is, questionable sometimes. For the most part I think it's perfectly fine, buuut there are moments I don't think of fondly.. Specifically this moment in volume 2:

Barry starts having a paranoid and panicky moment due to his contamination OCD (Because they're in a literal trash heap) and Uni decides to...

Call it cute??? Genuinely what the hell, who thought this was a good thing to put in here? I haven't read the spin-off AU comic, but I hear it treats it's character with OCD even weirder. Yuck!

On a related note, I hate the cutesy names for disorders. They don't even come up often in-universe, there's little purpose in having them, especially if most of them are just real life, actual disorders. I know it's about an abusive hospital but come on man! You don't have to use baby names for everything! You don't even follow the weird naming pattern for everything! Things like autism don't get a weird cutesy name, but OCD and depression get one? Have some consistency if you're gonna make a weird universe decision.

Alrighty.. This should be the end of it, I'm not sure how to end it because there's still more I want to talk about! I'm super-duper open to talking about anything I've said here or elaborating on why I feel certain ways. This is in no way meant to be a hit-piece of the creator of Sparklecare, I think there's a lot of protentional, and I simply adore some aspects of the comic (Specifically visually). I really do hope this comic will improve over time and that it sees a long life of success.

If you come to this post to disagree, I ask you read through what I say carefully and come at me respectfully, I have no interest in fighting with people over a webcomic about furries.

-Mod Star

[genderqueerdykes]

seeing you're endo posts really got me thinking. why is it so hard for people to realize that the physiciatric system is just as flawed as the health care and justice system? obviously there are many posts about it, but it never seems to be as big an issue for people for some reason? iykwim? or maybe im just not in the right places to see it? thoughts?

you nailed my point dead on: the psychiatric system is extremely flawed, and is just as out for profit as any other part of the modern medical industry. like yes, individual doctors, nurses, assistants, therapists, technicians can all be amazing, wonderful people with compassion who treat their patients right. however, the industry itself does not care about that. at all

the psychiatric industry is literally there for profit. that's it. that's all. it's not there so that we can actually study psychology and learn more about the human brain. it's about making as much money as possible. like i really can't stress that medical studies *have* to allocate funds in order to be conducted. they don't just happen because doctors want them to. there has to be some kind of funding, and if it doesn't seem like it's gonna turn a profit down the road, it's just not gonna get funded.

psychiatric hospitals in specific can be really brutal to people who don't have health insurance, but have been forced into psychiatric care. like i feel like people forget that still, to this day, people can be and are forced into therapy, psychiatric hospital stays, and more, against their will. if someone is considered "a danger to themselves or others," which is an extremely vague concept that can easily be skewed to screw someone over, they can be forced into psychiatric "care" without any stance in the matter. like, y'all, some people are committed to psychiatric facilities for life, whether or not they feel it's necessary. this complex is not our friend.

i'm glad you sent this message because thank you, i'm glad to hear that you understand exactly what i'm trying to put down.

[thehollowwriter]

I hope the conversations around medical insurance companies start to expand to other big companies and industries that harm or kill people because the impact they have is not talked about or challenged enough

E.g:

The medical industry as a whole (not just the insurance) and how its discrimination against women, queer people, poc people, disabled people, fat people and more leads to people dying due to not being believed or taken seriously.

The cigarette and alcohol industries that sell addictive and life ruining products that cause cancer or active harm to those who don't buy them (e.g: second hand smoke inhalation). The advertisement of cigarettes is literally illegal because of the health risk, and yet they can still be sold on mass. It comes with the warning of the risk of cancer and addiction, but nobody questions the billions of dollars made from selling them to addicts. But yeah, weed is the big bad evil. And pain killers and medicine, can't take our seriously sick patients or mentally ill patients seriously (medical industry) because what if they're addicts looking for a handout??? What if meds to treat mental health are addictive???/s

Alcohol and alcohol consumption is still advertised everywhere no matter what and is culturally framed as a must do, something that makes you mature and cool while simultaneously blaming alcholics for their addiction. Just ask anyone who says they don't drink and are called a killjoy or a boring person. Think about the fact that the hero mc of a movie is shown to be dapper, charming, or cool through alcohol, whether it be the way he drinks it or the type of alcohol he's drinking. Hell, cigarettes are used for the same thing, too.

The beauty industry promotes blatantly unhealthy bodies as the standard that should be achieved and promotes medication, surgeries, and more that can be incredibly risky in order to achieve beauty. Cosmetic items like makeup are so poorly regulated that they can cause chemical burns. And yet when I type "can makeup" the first thing that pops up is "can makeup cause pimples." Cause pimples aren't pretty, and that's what should be the concern/s

The "health" industry and how it works with the beauty industry to spread incorrect "medical facts" about health and weight to advertise weight loss pills and diets and so on that encourage or cause eating disorders and general unhealthiness (no matter what you think or what these companies say, suddenly rapidly losing weight is NOT healthy and is NOT a "solution to weight gain").

If I ask whether a certain food or shake or whatever is healthy the first response should not be "it causes weight gain/weight loss" because that is not actually an indicator or how healthy something is. But when people's main concern is avoiding gaining weight because that is viewed as ugly, of course you're gonna tell them "It's healthy, it makes you lose weight, buy my product! Of course I'm concerned about your health now buy my product!"

The gambling industry and how it actively uses psychological tricks to ensure people will stay and continue to gamble. It actively takes advantage of gambling addicts and, through mass advertising and subtle tricks, encourage and worsen their addiction and cause them to lose money and put themselves and their families at risk. Gambling is oh so taboo, but it sure doesn't stop my 7 year old brother from sitting through an unskippable Hollywood Bets ad when he just wanted me to show him funny cat videos.

I can go on but I'm sleepy, so just consider these examples. There's a lotta shit that needs to be challenged and criticised.

[cognitiveleague]

PSA for fellow USAmericans who might be considering their health insurance options (since it’s the time of year for it at time of writing):

If you have ANY other option, I recommend staying as far as possible from any private (non-government administered) plan talking about “reference-based pricing” or “disrupting the health insurance establishment to save you money”.

I hadn’t heard of this type of plan until a couple of months ago, and neither had my colleagues who’ve worked in my field (billing for a private healthcare specialist’s office) much longer than I have, when we all of a sudden had several clients switch to similar plans within a few weeks of each other, so I suspect it’s likely that they’ve been making a push to get a foot in the door this year. I’m sure it’s legally inadvisable to outright call them “scams”, but IMO they are at the VERY least operating on a business model that’s extraordinarily ill-thought out, and at worst (likeliest) it seems to me that they’re misleading and predatory in a way that’s somehow still shocking and infuriating to me after years of working in healthcare billing in the US.

More detailed explanation / further Advice from your Friendly Neighborhood Angry Socialist Healthcare Billing Administrator below the cut, for those who want more information.

So the issue here essentially is that these companies are trying to sell clients (looks like particularly small business owners and HR people looking for plans to offer their employees) on the idea that they’re ~shaking up the corrupt industry~ to improve transparency and costs, and like, if that’s what they were actually doing? I’d be so incredibly for it, you don’t even know. Fuck everything about the established health insurance industry, I want to see them burn as much as the next person.

But what they’re actually doing is deciding it would save THEM a lot of money to just pay doctors / other healthcare providers as little as they want to, and that the problem getting in the way of that is that there are usually contracts establishing how much they’re supposed to pay, and it would be cool to just… not have those! From there, the plan is:

1) telling bosses “hey, we’ll cut your costs by offering you a plan that’s cheaper than conventional ones!”

2) telling workers / clients “hey, you know how your health insurance plan determines what doctors you can see and have insurance pay for it? Fuck that, see whoever you want!”

3) conveniently neglecting to mention that if your brilliant plan to lower costs is “just don’t have contracts with providers, so there’s no agreed-on cost and we can pay them whatever we unilaterally decide is fair!”, that also means there’s no contract obligating the healthcare providers to accept your insurance at all (which is extra bullshit when you consider that they can’t tell you which providers have agreed to take their insurance, on account of how they don’t actually have a list of providers who have agreed to take their insurance, since they decided agreements were unnecessary)

Basically, it ends up saving the bosses and the insurance company a shitload of yachts-and-blackjack money, but then puts You The Patient in a situation where you’ve been told “yeah, see whoever you want, we don’t give a fuck”

So you go to the local clinic or your usual therapist or whatever and say “oh, here’s my new health insurance card, they said I could be seen here,” and hand them a card for a company that

A) they’ve never heard of

B) they have NO contractual obligation to work with, and

C) a brief google search can easily tell them openly intends to pay them significantly less than any of the insurance plans they do work with (besides the few that are allowed to get away with setting their own prices because they’re literally run by federal government-affiliated agencies and using that considerable leverage for the benefit of senior citizens, people on disability benefits, veterans, etc — they essentially plan to use the base pricing THOSE plans use, except… as a private, for-profit company, and without discussing it with the other parties involved.)

All of which is likely to just put the staff at your local clinic or whatever in the awkward position of having to tell you “I’m so sorry, it doesn’t look like that’s actually a plan we work with, we’re going to have to do self-pay for the recent visits / if you’d like to continue,” and put YOU in the awkward situation of having to pay for that shit out of your own pocket.

What do I do if my employer is offering a reference-based pricing plan?

So glad you asked, me.

My recommendation would be to look at what other options they have available if you work for a company that offers multiple options, or to opt out of their plan and look into the options available to you via your state’s health insurance marketplace — open enrollment for most states is November 1 - January 15th, so at the time of this post (November 23rd) it’s ongoing and now’s the time to do something about it!

But that means my work won’t help with payment of my insurance premiums?

Yeah, but in the context of this discussion, we’re weighing the cost of paying your own premium in full against the potential cost of being told you can see whatever providers you want, doing so, and then ending up having to pay them out of pocket at the uninsured rate because your insurance actually does jack shit and fuckall, which can EASILY get a lot worse.

Also, some employers will reimburse a portion of the premium cost if you have outside health insurance, so check with your HR department or your boss (and maybe let them know why you decided not to go with the insurance they’re offering).

Also-also, if you’re in a lower income bracket, the ACA / healthcare marketplace options on your state’s healthcare marketplace website will include Medicaid plans, which are subsidized by the government to help low-income folks afford them.

Ok, I’m looking, but how do I pick the plan that’s right for me?

Oh god I have a whole other post about this but it’s from ages ago and I don’t have the spoons to look for it right now, but the basics boil down to:

A) Look if possible for plans where, if there is a deductible, either it’s as low as possible or it doesn’t apply to services you anticipate needing at least semi-regularly

B) If the difference in monthly premiums for two plans is MORE than the difference in what you can reasonably expect to pay out of pocket in copays during a month, the “cheaper” plan isn’t saving you money.

So like for example, if I’m choosing between two plans and the up-front cost between them is like, $250 / month or $400 / month, and the $250 plan has specialist services I need 4 times a month covered under a deductible while the $400 plan has a flat copay of $20 for those same services, then my numbers will end up looking like “$250 + (4 x $125) = $750, vs “$400 + (4 x $20) = $480), which would make the $400 plan cheaper for me overall, even though the premium is more expensive.

You want the plan where the monthly costs for your premium PLUS expected average monthly out of pocket costs for services you’re likely to need routinely is as low as possible, is what I’m getting at here. No real way around doing the math, unfortunately, though if you DM me during open enrollment I’ll probably be willing to do the math for you out of sheer spite toward our country’s bullshit insurance “system”.

C) If you can’t afford a plan with a higher premium, it’s still worth getting something, but be aware that low-premium plans are typically going to be “catastrophic” health insurance plans, designed primarily to put a (high) cap on how much medical cost you can incur at once if you like, survive a freak accident or something — as a rule, they’re not going to do much to help you with much besides either the super basic preventive care they’re required by law to cover or keeping your total annual costs from an accident or major illness from getting too wildly astronomical. If you need non-emergency specialist care even semi-routinely, I’d encourage trying to avoid this type of plan if possible, and ALWAYS checking in with your plan and your providers’ billing department to figure out how much you need to budget for out of pocket costs when you do need to see a specialist or something, because you do NOT want to be caught off guard by that shit.

What else can I do?

Uhhhhh, advocate for socialized healthcare like every other fucking rich country in the world has had for decades, I guess? We’re not some special case where it would never work, we’ve just got a bunch of craven politicians invested in telling us that because of that sweet sweet insurance company lobbyist money they get in exchange for keeping things the way they are. Fuck ‘em, if that wasn’t clear.

Also, be gay / do crimes / look out for each other on this bitch of an earth / seriously DM me if you want me to help you figure out your options, ok I love you bye ✌️

[preet-01]

K — Detective/Criminal for @witchywitchy19

It was a demotion. Lewis was absolutely sure of it.

How else would he go from undercover stings busting drug rings and mobs to investigating stolen art that he was 90 percent sure the museum was “losing” for the insurance claims? Though there were the benefits of being able to actually spend time with his husband now that he wasn’t always undercover for his job.

“It makes no sense, Seb,” Lewis groans as he rants about the latest developments in his case. The latest development being that there were no developments and Lewis was absolutely losing his mind having to deal with the museum’s art director — Nico Rosberg, a former friendship that had turned sour sometime during their college days.

He’d been able to avoid interactions with Nico and his petty remarks for so long, but with this case he had to deal with Nico everyday.

“Maybe take a step back and talk through the facts,” Sebastian advises. It’s a strategy Lewis knows that Seb loves to use with his patients. “What was stolen?”

“A rare Rembrandt painting that Nico so kindly has emphasized the importance of in every meeting we’ve had,” Lewis replies, cuddling closer to Seb.

“Anything else?” Seb inquires.

“Not according to the museum. Jenson is doing an audit with some of the museum guys to make sure nothing else was stolen,” Lewis says. To the naked eye, only the Rembrandt was missing. But the concern was that a reproduction had been hanging in the gallery as the actual painting was undergoing regularly scheduled maintenance inspections. So it was in the museum archive with a bunch of other stuff that wasn’t on display.

“Signs of breaking and entering?”

“That’s the thing, nothing is out of order. The cameras all worked with the exception of two — one that has been broken for the past three weeks and the one situated above the painting. The locks weren’t tampered with. And the reproduction wasn’t touched at all in the glass case. The thief knew to check the archive.” Lewis rants.

“Huh,” Seb says.

“Huh? What are you thinking of?” Lewis inquires.

“Well, you said the reproduction was hanging, right?” Seb asks as Lewis nods. “The only people who would know a reproduction is hanging in the museum while the original would be the museum staff, right?”

“They would know how to avoid the cameras, which ones worked, which one to tamper. They would have access to the building,” Lewis rambles off as pieces fall into place. There’s still more work to do, but things are starting to make sense and it’s a lead.

_______

“You’re late,” Mark says, “what took so long?”

“My husband was taken off of undercover and moved to robberies,” Sebastian answers with a sigh as he pulls out the Rembrandt that had driven Lewis crazy a month ago. “The Rembrandt robbery was his first case since that move. It requires caution when the detective trying to catch you is sleeping in your bed,” Sebastian adds.

“Considering you and the painting are here, I assume he didn’t crack the case,” Mark states as his guy checks the painting’s authenticity.

“He put away the museum’s art director,” Sebastian reveals.

“What did the art director do?” Mark’s guy — some pale twenty some year old with brown hair and an Australian accent just like Mark 1- asks.

“Nothing recently,” he answers, “years ago? Well that’s a different matter.”

“It’s a Rembrandt,” Mark’s guy tells them.

After making sure the wire transfer goes through, Sebastian returns home. A weight had been lifted from Lewis’ shoulders ever since the Rembrandt case had been closed which meant that Lewis could actually enjoy not being on the undercover unit.

And tonight was date night where he’s sure Lewis will bring up the idea of adopting. The Rembrandt money will help pay for a bigger home and the cost of raising a child. Not that Lewis would know it’s Rembrandt money, no as far as Lewis knew, Seb had a rich distant uncle in Germany that left his money to Seb.

He hadn’t intended for the blame to fall on Nico, but two birds one stone, gift horse, and all of that. The ghost of Nico and their college years couldn’t haunt them with the man locked away in a prison three hours away.

[fvckw4d]

In the US we have many types of doctors offices. If you have insurance, there's a Primary Care Doctor, who can't treat anything that isn't a cold. Their job for most people, especially the chronically ill, is to run blood tests and refer you to a specialist. A specialist is a doctor who went to extra school so they could only solve one specific issue at a time and their wait lists are usually months long because most people don't go to their doctors for colds or anything else you can solve in 15 minutes - the typical amount of time each patient is alloted with their doctor before they become "problem patients" - because doctors are expensive, so they get referred out. These doctors might be next door from your PCP or they might be hours long drives away.

If you don't have insurance or dont have months to wait, there's a Urgent Care, which is an oxymoron because you will not be seen urgently, but more like between 1 and 8 hours depending on your luck. They mostly exist to bridge the gap of PCPs and ERs, to make sure you can be medically neglected no matter what day of the week it is.* They can't prescribe most medications and don't have most equipment that a specialist or ER has, or even that your PCP has, because their real purpose is to prevent the poor or inconveintly-timed sick from clogging up the ER. There are versions of these in some of the bigger pharmacy franchises because making a lot of money selling drugs means you're basically qualified to be a doctors office.

(*most doctors offices are closed on the weekends and before 5pm.)

The ER, or emergency room, is a last resort doctor. Anyone will tell you that, it's for dying people didn't you know, which is why wait times are typically 8 hours. Yes we all know that it's the only place thats open all hours of the day and every day of the week, or has equipment that most doctors dont, or is legally required to see you no matter how insured you are. But if you go there without an emergency, it's because you're selfish and stealing time away from literal dying people, which will be the excuse used whenever you receive subpar care no matter why you went there or who is talking to you. The ER is a really good place to be diagnosed with anxiety and drug addiction by a doctor who isn't a psychiatrist or addiction specialist, no matter what your symptoms are. ERs also cost 10x the amount a PCP or Urgent Care does, but there's not much they can do to make you pay the bill, so this is a common choice for the absolutely destitute.

If you are poor, especially if you have "specialized needs" because you are queer or not white or homeless or have limited transportation, you might go to a wellness center or walk in clinic or what have you. They have a lot of names, but they're basically the same thing. This is the only publically funded healthcare in the US and the only place that will give you free or sliding scale healthcare, one of the only places you can go without needing an appointment (if you are fortunate), and one of the only places that you get care for things like HIV prevention or birth control or HRT. They don't have most of the equipment of even an Urgent Care. Every doctor there is severely overworked and most secretly think you're a junkie. It's a good place to get diagnosed with being high.

If all of this sounds bad to you, you might consider having enough money enough to afford a concierge doctor, which is a pet doctor rich people buy. They work much like how family doctors used to work about 50+ years ago, meaning they are on call at all times and will treat you at home. They're known for being willing to write any prescription you want, no more having to beg and plead and prove you aren't going to abuse your pills and aren't just a little anxious, which is how it works for everyone else.

And that's pretty much it. So many options, right? Tune in next week to hear about the state of mental healthcare in the good ol' US of A.

[shiraishi--kanade]

Wait so you have universal health care and also have huge medical bills??? I'm genuinely confused

Anon, you're probably American and you know what, I'm as confused about how American healthcare works and how therefore you guys imagine universal healthcare works as you are, so I'm not going to hold it against you.

But here's how it works in my country:

1. I have a heart disease. I go to a cardiologist in my city. My cardiologist takes one good look at me and says: "I'm sorry, we have nothing to help you here"- (because they lack the medical equipment, educated staff, or, in more cases than not, both). -"Here's reception contact for our state cardiology clinic, please go there."

2. So I go to the state clinic (that is located a fair distance away). They take a closer look at me, and they would treat about 60% cases that come to them, but then will also say "here's your meds and diagnosis but we don't have the equipment or staff to be 100% sure this is what's wrong. Have you considered..."

And then they refer me to a private hospital. Or a private clinic. Regardless, a private doctor, who charges their patients like everyone else does, and that pay goes up in thousands and tens of thousands for diagnostic processing or monitoring alone. And that's where I actually get my treatment. And my bills. Because regardless if you have universal healthcare or not, healthcare industry exists and will continue to exist.

State-funded healthcare (which we call free but it's not actually free, it's just paid for you by the state) will never be able to compete with the private healthcare industry because 1) the state doesn't receive any profit, and in fact only loses money on providing healthcare, 2) the state therefore does only the bare minimum to keep up with the demand, and usually doesn't necessitate enough funding to provide new technology and equipment or training, if any, 3) the medical staff, who have no equipment or training or pay, says "screw this, I'm out" and goes into the private field, where they actually have a shot at having a decent pay and working conditions.

Therefore the universal healthcare institution grows only weaker.

Is it fucked up? Yeah. Does it bring unnecessary suffering to anyone? Also yeah. But if you're any level of smart in this situation you'd just skip the first two steps and immediately go and pay to get treated properly instead of risk wasting PTO, gas and possibly your pre-existing condition flaring up to go through the routine.

And this is also why medical insurance is starting to get traction in my country with universal healthcare, because universal healthcare doesn't mean that you can get all the medical services free of charge but rather that there are options provided for you. No-one ever said these options have to not suck, especially for someone with a chronic condition. Fun!

Still better than the USA though I will admit to that.

[riverthebooknerd]

OPENING COMMISSIONS, BROKE QUEER 18 Y/O, PLEASE READ <3

Hey everyone!! For those who don't know, I finally got a decent job after months of searching! Unfortunately, I'm still dead broke, and in order to start my job, I need a bunch of training and verification. No biggie, except the verification is, in total, a few hundred dollars… plus I'm still having to pay for gas and phone bills and insurance…

I'm going to be completely transparent with y'all. I'm almost out of savings, and if I'm not able to get some kind of money, I'll have to ask my parents for help. They'd do it, and they've made it clear that they have no issues with lending me money if I need it, but I would REALLY rather not have to ask them. They've already given me way too much, and it's… embarrassing, for me, to be depending on them as much as I am.

Another thing is that I'm trying to save up enough money so that I start going on testosterone. It's basically my dream to start medically transitioning, but with my dwindling bank account, I don't really have the money to spare. This new job pays better than my last couple of ones, and if I budget right, I'll finally be able to afford t without asking my parents for help, since insurance won't cover it.

So, I'm gonna be opening commissions and accepting donations! If you happen to like my work on ao3 even a LITTLE bit, please consider commissioning me! I've never been paid for writing anything, this is a bit of a new experience, so please be patient! I'll have my kofi and my prices down below! I made the prices based off of what I've seen from other people who make similar work, and what I believe is fair for the amount of time it takes to write!

Anyways, don't feel obligated to help! If you can, even if it's just a couple of dollars, that would be AMAZING, but there's absolutely no pressure! Thank you all so much!! <3

kofi- ko-fi.com/riverthebooknerd

ao3- https://archiveofourown.org/users/riverthebooknerd

tiktok- https://www.tiktok.com/@someofusarealiens

(PS- if you can't donate, sharing and reblogging helps a TON <3333)

[financialzero5]

Why CometCare is the best ending (AKA why the public knowing about SparkleCare isn’t possible)

Let’s say, by some insane leak from a government official mad about their paycheck, the events of SparkleCare got leaked to the public, with enough evidence to back all of it up. Hooray right? Everyone knows what the patients and staff went through. Now this is the best ending! Here’s several reasons why this happening would be AWFUL for the Comet family (and nearfamily)

-Staff would be arrested | Imagine that you hear that the hospital you thought was safe and caring for their patients was actually torturing and killing them instead, while siphoning money out of their insurance. What would be your first reaction? The likely answer is get everyone involved imprisoned! And the government, now having to clean up their mess, would likely follow through with this in an attempt to show that they’re not incompetent. Now who do we know that was involved? This does include immoral characters like Sunny and Cuddles, but this also includes ALL the staff, like Boxa, Lovella, and most importantly for the Comets, DOOM, Mood, and Rem. I don’t think I need to explain why DOOM being arrested would be devastating for the Comets.

-EVERYONE finds out | The only person we see in CometCare that knows anything about SparkleCare outside of those involved with it, is Faerie. Faerie has a strained relationship with their parents, ESPECIALLY Boxa, due to him knowing what she did to people. Now imagine how characters like Marco or Cream would react to finding out one of their parents tortured and killed people. It’s stated in DOOM’s Toyhouse page that Marco’s respect means the world to him, and he does everything he can to make sure he doesn’t lose that respect. And Cream is noted for latching onto a bad thing about someone and never being able to move on from it. Needless to say, if DOOM somehow got out of being arrested, this would devastate him just as much. And this also affects the other parents, Uni, Polly, and Barry. A lot of their kids definitely wouldn’t understand why they were lying to them about all of this, and this would harm their relationship with their kids greatly. While this does mainly affect DOOM, I’m pretty sure finding out that their parents kept something like that hidden from them would sour their relationship quite a bit.

-Internet being the internet | Now this is mostly unsupported information, but considering that NO ONE believed the patients that broke into the music festival, covered in their own blood and wounds, it wouldn’t shock me if there were still some Bwitter users that think all of it is a government coverup for something else. Personally I would prefer everyone having mostly forgotten about SparkleCare’s existence, over having a bunch of True Crime podcasts talking about my trauma for money, and seeing a bunch of morons try to prove how all of it was a coverup to raise gas prices by 2%. This would be horrible for all the patients and staff, as well as their kids having to see that. Uni is also somewhat of an influencer online, so I’m sure that info coming out would be very traumatizing to both her and her fans on KneeTube.

While it sucks that all the atrocities that Cuddles committed are locked down in a government database somewhere, forever hidden from the public eye, this is just how it has to be. CometCare is the “best case scenario” for a reason. It’s simply impossible for that info to be public, AND have the victims live normal lives.

[brettdoesdiscourse]

There's so much to unpack here.

Let's knock out just the, "you most likely don't have BPD" thing.

Most likely based on what exactly?

It's estimated that at least 1.4%-1.6% of adult Americans have BPD. Although, researchers believe that number could be even higher. Assuming 1.4% of the adult American population have BPD, that itself is 3616200 people who have it.

That's not even counting how high the number might be. Anyone who is under 18 in America. And it's not even considering everyone else around the world.

Putting that aside, let's move onto the privilege comment.

It's ridiculously privileged to tell people to "just work" to make that money. And I don't know where you're from or what insurance you have, but most people are not going to get diagnosed with BPD for $75.

Even assuming it does cost $75, let's consider a few things.

People who are living literally paycheck to paycheck. At least 60% of Americans are living paycheck to paycheck. When every dollar has to go to something already, how are people meant to save? Being able to save money in itself is an incredibly privileged position.

People who live in areas that do not have mental health resources. In March of 2023 alone, 160 million Americans live in areas where they don't have enough mental health resources. Living in an area where mental health resources are available is an incredibly privileged position.

Assuming you have the money and professionals available to you, are any of those professionals qualified or willing to diagnose/treat BPD? BPD is still a highly stigmatized disorder and that is very prominent in the mental health field. Many professionals are not willing to deal with patients who have BPD or diagnose a patient with BPD. There's so much discrimination against BPD in the field.

Does this person have any trauma surrounding the mental health field or the medical industry in general? Tons of people have had extremely negative, even traumatizing experiences with medical settings. This can be even more increased if a person has BPD which can caused heightened paranoia. Seeking help can be an extremely daunting, even impossible thing, and I'd prefer to have someone self-diagnose rather than put themselves through a retraumatizing experience for....What exactly? What is actually changed by having an official diagnosis? What is the harm of someone self-diagnosing, even incorrectly?

[lesbianhalflifeposting]

Postponing the larger posts like CYIBC indefinitely because I'm feeling like complete shit lately. Girlfriend is leaving town and I won't see her until July, Dysphoria Fatigue is reaching an all-time high, and to top things off, I don't have the money to pay for my own HRT appointment since my insurance won't cover it out of network! Yippee!

Seriously though girls it's been bad out here lately. I'm having trouble even finding motivation to eat, let alone be horny enough to sit and write for hours at a time. What little posts I can muster both here and on my personal, I can promise you I am trying to give my all. I know it may not seem like it considering the volume of posts I used to make here but I am trying. Please be patient with me. I'm still taking asks about anything Half-Life/Portal related, so if you want to get me fired up about something, send an anon about your desires. Otherwise I'll keep posting when I feel up to it, or when this massive wave of despair passes. Pizza!

[mushroomwillow]

so I quit my job. Just texted and said nope. And even with the threat of not having a job in time to cover all my bills, 99.9% of my anxiety has gone away. Yes I’m still anxious. But I don’t feel sick to my stomach about going to work, and not knowing if tomorrow my entire schedule will change. That the “promised” hours will suddenly be gone.

So like, as much as I loved being a caregiver, being one on one with patients, I learned tbh the hard way that I cannot do it. September nailed the head on that coffin. So much was put on me, and no matter how much I asked for help, I was told “just deal with it he won’t be in our care by the end of the month anyway” and my mental health fucking tanked.

Him, his wife, and everyone I came into contact with expected me to find a solution. I had no power to do so. No recourses, and no way to convince them they needed a facility. That that’s all their insurance would cover. Even the nurses and shit expected me to be able to do this. One tried to convince me to start my own business so I could do it, even tho there’s no fucking way, I’m not a nurse, I have no formal education, how the fuck would I be able to do that.

And then talking to my therapist? Really thinking about how their children were boomers and all 3 of them went no contact? The likelyhood of a boomer doing that is slim to none. And it fucking hurts to do that, I’ve done it. So all 3? Something has to have happened that was serious and severe.

So idk. I like taking care of people. I enjoy helping people at the end of their lives. But I won’t ever be a caregiver again.

Now I’m looking for something where I can work with my hands. Something “mindless”. Something where the only thing I’m responsible for is getting one thing to another thing and making sure nothing gets broke or no one gets hurt. Just fuck it all for a while. Eventually I’d like to get into tattooing while I complete my degree, and maybe after the 4 years I’ll have had enough time to really consider what I want to do with it, but above all, I want my mental and physical health to be my priority.

I’ll find something to make extra cash in the meantime. Instacart, dog walking (I have to find the money for the background check first for that one), just something to make sure the bills are paid. We’re just going to have to eat a lot of rice and beans, pasta, and soup for a while. I can make my own bread too so that’s not much of an issue right now.

It sucks. And I’m kind of just venting and getting the thoughts out there. And coming to terms with a lot of stuff about myself. There’s so much right now that idk what’s going to happen. But the feeling of relief I have even with no idea when I’ll get a replacement job is honestly kind of sad. I knew it was messing with me but I didn’t realize how much.

[bisluthq]

How are you doing? Any updates you feel comfortable sharing?

lol okay so I did 5 days in patient and came home and promptly proceeded to like finish most of the Xanaxes I’d been prescribed outpatient (and when I tell you it wasn’t a suicide attempt I really do mean it and the psychs believe me lol because here’s the thing - I have done a bunch of these things so like if I were TRYING to kill myself I’d make more of an effort, it’s just that they had me on new meds and I had like 6 of those old ones left and I was like “wonder what six of these would be like 🤷🏻‍♀️” (ps for anyone considering trying it for science - it’s not worth it, exactly the same as like 3 but just knocks you out for longer). Anyway, the doctors have decided I’m not a danger to myself or others and I don’t have any physical addictions because I don’t exhibit any withdrawal symptoms. That said, obviously I’m not exactly the picture of mental health lol nor sobriety. So now my parents want to send me to this like rehab retreat thing where you live off the land in the mountains and work with the animals (I do like animals and horsies) and they do have wifi there and allow visitors so they think I could use the time to work on a book or a phd. My bf is pretty supportive of the horsie idea. There’s also a free version of that concept where you’re essentially just a farm hand but my problem with that one is it has no wifi and sorry but while the horsies and shit sound really good for me, two months with no wifi does not. My mom wants to try hypnotherapy but my dad and my bf both think that’s a waste of time and money (insurance doesn’t cover hypnotherapy) because the alcohol and the other stuff is a problem on occasion but I’ll find new things lol like I took up a 2 pack a day smoking habit while inpatient first time round so 🤷🏻‍♀️ My bf, in what can only be described as saintly behavior, has said he doesn’t want to break up and he’ll support me with this because well he knew I’m a troubled person going in like that’s what made it fun right at the beginning right is my nuttiness but he’s happy to make lifestyle changes to accommodate for it and if I need to go to live with the horsies for a while that’s fine. I said to him between his insane ass ex wife and me, he really needs to reconsider his taste in women though but yeah 😂🤷🏻‍♀️

[sonicenvy]

I think if there is something that I've learned this year having to deal with a lot of healthcare nonsense it's that many patients (myself included) need to learn our rights, and that there ARE options that we can take when we can't afford payment for drugs or care and when we get rejected by insurance for coverage for something. I wish to god we had a better healthcare system in this country; I do, but for now we have to live with the bullshit we have, and I think people would be served better by getting educated about their options and rights in the now to reduce harm in the now, while we fight for a better system. For now, here are some things that are of interest:

If you do not have health insurance at this time, you can get it through healthcare.gov. It doesn't matter where in the country you live, what your previous claims payment history is or what your current medical conditions are. You can pay for and get ANY plan that is offered on this site. This is defined through ACA Subtitle D, Part I.

When you look at the plans not signed in, they look SUPER expensive. They are not. Create an account and submit your tax information. Once your previous year's tax information is submitted, the site will tell you what your tax-credit reduction is for your monthly premiums. This is the amount of $ that the government will subsidize your premiums for. The less money you make, the more this amount will be. If your income was greater last year than it is this year, when you file your taxes you will get money back that you should have received in reductions on your premiums. If your income is greater, you owe. They give you the choice of how much of the credit to take in the now. If you choose not to use all of it, you get the unused amount back on your taxes.

If you have marketplace plan questions, call the healthcare dot gov help line (1-800-318-2596) and someone will help you. They will answer any questions you have, no matter how dumb they are. You can ask them simple stuff like "What is a premium?" and they helpfully explain it.

No insurance company can raise your premiums based on your claims payment history, your health conditions, your health history or any other form of "evidence of insurability". They cannot deny you a plan for any of these reasons or deny you renewal of a plan for them. You have rights, if your insurance is trying to do this, you can report them to the government. It is illegal for them to discriminate against YOU for any of these reasons. This is all defined either under ACA Subpart I: General Reform, sect 2702, sec 2703, and section 2705.

If you are over 65, you are eligible for medicare, and you should get it. If you have a serious disability, you can get medicare earlier. This will significantly reduce your healthcare costs. You have already paid into it if you have been paying taxes on a W2.

If you are poor, you may qualify for medicaid. If you are unemployed you probably qualify for medicaid. Eligibility requirements vary by state, but if you are below the federal poverty line and under 65, you are almost certainly eligible. Medicaid is low cost and covers most services. If you have children and are poor, you can get CHIP.

Certain services are considered "Essential Health Benefits" under the ACA and ALL plans are required to cover them. These EHBs include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care. If you plan refuses to provide ANY coverage for items and services under these categories, that is illegal and you can report them.

If you visit a non-for-profit hospital for emergency services, and are uninsured or poor, they must provide you with financial assistance, whether that is FREE care or significantly reduced care. This applies even for insured patients who are visiting an emergency room that is not in their network. Talk to their billing department and ask about financial assistance and charity care.

Under the No-Surprises Act, a subsection of the CAA 2021, a provider of emergency services cannot balance bill you (bill you money after you have paid your deductible, copay, coinsurance and your insurance pays out their obligation to make up for costs on the visit from their providers being not in your network). This is something new I didn't know about until my current situation lol.

Certain forms of medical debt CANNOT be reported on your credit report. Additionally, if you apply for an FHA mortgage to purchase a home, the FHA does not consider medical debt when assessing mortgage eligibility. For more information about new rules regarding medical debt as related to creditworthiness here is the general bulletin.

If you are denied coverage for a medically necessary drug or service, you have the right to appeal this. Call your insurance company and ask for an explanation for the denial of coverage. Sometimes, your doctor can provide a letter of medical necessity for the service to get you coverage. The same drugs and services can be billed under different classifications, which may affect coverage. Read through your plans benefits booklet to find if the service you are being denied is covered under a different billing classification (usually called a CPT #). If this is the case, you can work with your provider to reclassify the billing of the drug or service to get coverage. Arm yourself with all the right vocabulary and information by reading through your plan's benefits booklet and by requesting an extended EOB (explanation of benefits) for the claim in question. Note that you cannot get extended EOBs for medication claims, but you can for services. You may also want to enlist your provider in your fight against charges as there is certain information that they can more easily access than you can and that they can do on your behalf.

Many drugs have manufacturer coupons that you can use to reduce your copay. These coupons can be applied WITH your insurance. If a pharmacy employee tells you otherwise, they don't know what the fuck they're talking about. Ask to speak with the head pharmacist about this. You can find many kinds of drug coupons through sites like goodrx or the manufacturer of your drug's website. Sometimes your doctor may also have coupons; ask them. If you have an especially competent pharmacist, they can also help you find coupons or discounts.

Anyhow, I hope someone finds this helpful. Learn your rights and your terminology so that you can get the care you need and deserve!