“Yeah, tell me about it,” said Jackson. “Let me guess: it’s not one bill, it’s dozens, right? Going on for fifteen pages, from every little radiologist and every little lab. And that ‘EOB’ thing!”
“Explanation of Benefits – or lack of benefits, more like it. It’s byzantine.”
“Carol does the paperwork for Flicka, and I’m so grateful I could cry.”
“What kills me is how near-impossible it is to figure out what you owe. Before I brought in an accountant, I used to do the books at Knack myself, and I’m no slouch in that department. But it took me hours to sort out what to send in and where.”
“Fucking hell, you’d think they’d make it easy to give them money,” said Jackson. “Still, I think it’s deliberate. The blizzard of paper, all the numbers and codes. It’s a smoke screen. Behind which you get charged three hundred dollars for a Band-Aid and you don’t notice.”
Jackson shot a ritually despairing glance down the avenue. He missed the old Park Slope – a few failing pizza joints, coffee shops that didn’t charge four bucks a pop, hardware stores with barrels of screws instead of little packets of four all wrapped in plastic. “Gentrified” – though he was hard pressed to see how an army of whiny Barnard grads plowing them into the gutter with strollers the size of troop transporters qualified as “gentry” – it was all yoga parlors, organic smoothie bars, and pet therapists.
“And, you know, what Carol mentioned?” said Shep. “But I didn’t understand at the time. This World Wellness Group. They cover procedures according to prices that are ‘reasonable and customary’ in your area. In other words, what the fee should be, and not what it actually is.”
“This stuff is news to you, pal?” Jackson felt a surge of pitying condescension.
“I did some digging online. The outfit that generates this ‘reasonable and customary’ figure? It’s another unit of the same company. They’re under no legal obligation to tell you how they arrived at it. And it’s in both outfits’ interests for that figure to be as low as possible. As far as I can tell, they could be making it up.”
“Here’s how it works,” Jackson explained benevolently. “We’re going on a trip, and it’s your car, so I’ve agreed to pay for gas. We stop at a station, you fill up the tank, tell me the gas was fifty bucks, hold out your hand. With an expression on my face like I’m doing you a big favor, I hand you a twenty. You say, what’s this? I say, but that’s what a tank of gas should cost – since that’s what it cost when I was twelve. Basically, the insurers live in a fantasy world, and we Mugs are stuck in the real one.”
Shep shook his head. “Glynis and I have always kept to a tight budget. Trying to build that nest egg for The Afterlife. We’ve waited for the two-for-one offer on shampoo. Bought toilet paper in the economy size of twelve rolls, single ply. Got the special on turkey burgers even if we were more in the mood for steak. Now it’s five hundred for this, five thousand for that … And they never tell you in advance what it costs. It’s like going on a spree, piling all this shit on the counter, and none of it has any price tags. We only pick up twenty percent in co-insurance, but that’s after the five-K deductible. One single lab bill – that’s a hell of a lot of toilet paper.”
“Double-ply,” said Jackson.
“I’m thinking, why did we ever eat turkey burgers? And then I remember that I’m not supposed to care. Ultimately, I don’t care. All that matters is Glynis.”
“That’s what they’re counting on, bud. That’s the whole scam in a nutshell. Same with Flicka. It’s your kid, right? So what are you gonna say, no we’re not going to treat her pneumonia – again – cause we want the kind of DVD that records? And, friend … I hate to say it, but for you this is just the beginning.”
“I know,” said Shep quietly, as they hung a left on Ninth Street and headed for Prospect Park. “Even to cover the last stack of bills … Well, you know I’ve kept this other account, where I put the proceeds of the sale of Knack once I paid off the feds. It’s earmarked for The Afterlife, and I’ve never touched it. But there wasn’t enough in our joint checking, so I had to tap the Merrill Lynch. I’d never written a single check on it. Number 101 went for the CAT scan.”
“My guess is you’re already on 115. Take my advice, and order another checkbook pronto.”
“Signing that first one was strangely emotional. Even if it’s ‘only’ money, as my father would say.”
“Yeah, ‘only’ the proceeds from over twenty years building your own business. ‘Only’ eight years of humiliation with Randy Pogatchnik.”
“It doesn’t matter. I just didn’t realize at the time what I was really saving for.”
“You ever think about it? Pemba?”
“No,” said Shep, and changed the subject. “I guess we’re lucky, though. We live in the States. Hey, we get the best medical care in the world.”
“Think again, pal. In comparison to all the other rich countries like England, Australia … Canada … I don’t remember the rest. Look at all the statistics that matter – infant mortality, cancer survival, you name it? We come in last. And we pay twice as much.”
“Yeah, well. At least we don’t have socialized medicine.”
Jackson guffawed. Shep wasn’t stupid, but he could be painfully cooperative. That “socialized medicine” bogyman went all the way back to the 1940s, when Harry Truman had wanted to bring in a national health service, just like the Brits. Nervous that doctors wouldn’t keep raking it in, the American Medical Association concocted this inspired cold war buzz phrase, which had struck terror in the hearts of their countrymen ever since. A genius stroke of labeling. Like when supermarkets came out with that “no frills” line, packaging a perfectly standard, decent product in stark, ugly-ass black-and-white, thus ensuring that no one with any class would buy it, at half the brand-name price. It worked. Even Jackson’s cash-strapped mother hadn’t wanted to be caught dead with no-frills tissues in her cart.
“You realize fortysomething percent of this country is either on Medicaid or Medicare?” said Jackson; history lessons always put Shep to sleep. “All this ooh-ooh about how we don’t want ‘socialized medicine.’ Well, we got socialized medicine, for nearly half the population. So the other half is paying twice. Your Mugs are paying for your Mooches’ CAT scans with confiscatory taxes” – confiscatory was a wonderful word Jackson had learned only about a year ago, and he used it at every opportunity – “and a second time for their own damn scans.”
“You sound so down on Medicare and Medicaid. But you’re not saying that you wish old and poor people didn’t have access to health care.”
Jackson sighed. That line was so predictable. Shep was a class-A Mug. For the ranks of complacent dupes to which, alas, Jackson also belonged, Shep Knacker could be the mascot. “No, I’m not saying that. My point is, guys with health benefits don’t think they’re paying their own medical bills. They cling to their precious employee health insurance as if it’s this great freebie. It’s not free! They don’t understand they’d be getting, like, fifteen grand more in salary if it weren’t for the damned health benefit! It’s fucking sad, man.”
“Money’s gotta come from somewhere, Jacks. Some big national thing would send taxes through the roof. There goes your fifteen grand. Worse, if you earn a decent living.”
“It seems like it’s all the same dough, but it’s not. Think about it. Every piece of paper that just landed in your mailbox cost money. Some officious twit was paid to fill in all those codes, and tick the boxes, and fire off copies to five other places. Thirty percent of the money spent on medical care in this country goes to so-called ‘administration.’ Fact is, there’s a wholly fatty layer of for-profit insurance companies larded between Glynis and