Less Human Than Human

My line of work is medical appeals. I work on the administrative end of outsourced case file reviews. Despite what you may think, it’s endlessly more fascinating than it sounds. What I do is facilitate utilization management (perhaps the most Orwellian health care term coined since “health care”) for internal or external appeals of carrier (insurance company) denials. I, along with more qualified medical professionals, examine these case files for content that may determine whether a treatment is/ was/ is going to be medically necessary or appropriate.

The final decision, you’ll be glad to know, does not rest with a faceless bureaucrat like me, but with a board-certified doctor in the same or similar specialty as the providing doctor requesting coverage for the treatment. These are tough decisions, sometimes life and death decisions. Even though our determinations ultimately only affect coverage by insurance, it’d be naïve to argue that it is anything other than that which keeps us alive. What insurance we can get, how well we can be covered, and how much we’ll be screwed if for some reason we’re not covered is all dependent on capital, that which aerates our lungs with breath, especially the sickest among us, on a day-to-day basis

The paperwork industrial complex behind modern medicine is massive. Any single case that crosses my desk can range from a prescription slip to a thousand or so pages of historical hospitalization records. From a clinical standpoint, my company is required to consider every single slip of recycled tree, every X-ray, every blurry photograph, every radiological impression, every indecipherable scribbled note, every bizarre semiotic gesture and shorthand. Suffice to say, individual words make a huge difference and overworked, underpaid doctors are notorious for lousy copyediting.

To make their judgments, doctors want to see cold, hard clinical facts. Therefore, one of the most glossed-over documents in these case packets is the letter of appeal from the individual whose care is being denied. Since these “members” of a health plan (the preferred terminology- like they’re a part of a special club) are not doctors themselves, and therefore not as acute diagnosticians as their treating providers are, the patient’s words don’t hold nearly as much stock as the words of the clinical professionals.

Yet, what’s lost in the hard science of objective rationality is the human drama on display in these letters. Every story is a tragedy, though some are more dismal and pathetic than others (the girl who wanted orthotic surgery so she could wear normal shoes like the rest of her friends).

The letters of appeal can range from sensible to desperate to rightfully agitated and bloodthirsty. In the fallacious game of doctors versus insurance company, where each side tries to persuade the same objective science to serve the needs of either the marketplace or the human OS, the sideline observer- a bureaucrat like me- can find the abject antihumanist rhetorics to be as pathological as the patient’s workup. It’s hard not to sympathize then solely with the patient, he or she trapped in a feedback control loop, not only biologically damaged but emotionally and institutionally powerless. In these letters, you can find the debilitating, dehumanizing, and quite possibly pathogenic/carcinogenic results of an anguish economy strengthened by human suffering. All of this paperwork serves to weaken human functionalism, which would, under normal circumstances, resist a cybernetic parasite/ vampiric ideology seeking to strengthen itself through the subservience of its host creators.

One of the most common phrases I see in these letters of appeal is the expression “I finally felt human”, as in “after I had that surgery, I finally felt human” or “I’ve been taking experimental drug Y for a month now and this is the first time I’ve felt human in a long time.” There’s no reason to mistake these statements for hyperbole or metaphor. Ask any one who has ever been really sick how his or her identity becomes appropriated by disease. Better yet, think of the last time you had a bad head cold or flu and how it made the world around you seem like a hypnagogic blur. Now imagine going through the world this way, making important decisions and struggling through once-rote tasks. Imagine the disgust of being unable to celebrate when celebration is in order or forcing those you care about to stress when they should be relaxing. Between the everyday mediation of the id and the superego, between the common conflict of cultural norms and bestial naturalism, between the schizophrenic quotidian cognitive dialectic that tries to reconcile the way things are and the way things ought to be, now lies disease first and foremost, destroying the body and then taking down the mind.

A sick person in America is a bit like an automaton. It’s no mistake that automatonism in medicine is a condition in which someone will forget they took pills and reflexively take them again, often resulting in overdose. When not constantly looking for a baseline, your every biological move is not only bound to the chemistry of a drug or the rehabilitation schedule of a procedure, but also particularly to the parties that make the decisions as to what treatment you’ll be permitted to get. Your sense of identity becomes buried under a sea of distress and paperwork.

Hostages of insurance jargon are no less dehumanized than Gitmo inmates, stripped of their integrity, assigned a number, and made to endure preventable physical and psychological harm for irrational aims. Thankfully, most people get well or stay well and don’t have to deal with this cycle. Others don’t even have the luxury of being a part of this cruel medical experiment (about ¼ of the population according to recent studies. As job creation declines and a bunch of rich experts with jobs and health insurance say that the economy is getting better, one has to wonder if our schizophrenic health care system would have even registered as a political issue had it not begun to affect the upper middle class (the caste system from which I descend).

If these sick people, these fractured and distorted people, are not really people at all- less human than human- what does that make them? Mutants? Robots? Zombies? Aliens? Or just depersonalized non-humans? If you were to aggregate all of the people that felt less than human in a culture than makes money corrupting the corporeal and creating the new flesh, wouldn’t it be the humans themselves who were the minority? Take all the sick whose bodies don’t feel right. Add those whose jobs make them feel 2/5 a slave. Combine with those whose consent to slavery has rewarded them with financial ruin, foreclosed homes, exorbitant medical bills, and mountainous credit card debt. Couple those with the ones who, as Andy Warhol famously quipped, feel more like they are watching television than living life. Integrate with those whose legality, love, or overall legitimacy is constantly called into question. Throw in those who are indentured to passive addictions or impervious to active addictions. Incorporate those who are constantly left out of the network or chronically lost in the paperwork. Remember those who cry invisible tears and die invisible deaths. The grand sum of all this dispiriting and dehumanizing is trillions of dollars in capital and a febrile nation who’s been forced out of the mammalian gene pool.

None of these people feel human, because they’re not. The disease has transformed us into mere carrier cells, operating solely to propagate our disease. To not do so would be to lose insurance and invite more disease. To resist insurance is to boycott our health. The only alternative to the current system is death. Make no mistake, the goal of the parasite of capital is the elimination of the human race and the replacement of the species with viral agents of toxic dissemination.

It’s important than to ignore the pleas of those who can still feel their humanity rush in, such as those writing the letters of appeal. Focus on the objective data. Language never lies and the dogma of written word can only serve one master, eh?

To be human is a privilege, not a right. Put somebody in a room and beat them with sticks and they’ll begin to fight back. Prolonged mistreatment though only breeds lower expectations. So after considerable privation, the hand comes around to throw us a few scraps. We thank the hand and watch it as it pats itself on the back for practicing bipartisanship when we should be biting that fucking hand right the fuck off. It’s not cannibalism. It’s non-human self-preservation.

Without proper health care, the survival of the species is at stake. To disguise this fact from us, the parasites on our backs have mutated us into something less human than human, uncaring and unfeeling, distracted and distraught, unable to resist for fear of death. Yet it’s death that approaches. Humans and non-humans. Covered or not. The hour draws nearer.