Thursday, December 9, 2010


In REPUBLICANS 101: TEA PARTIES, I pointed out that the good ol' boys who represent the Republican establishment in Congress appear to have no clue about the Tea Party movement, the reasons for it, and its underlying constitutionalist philosophy. Though they would benefit from the movement and be handed a huge victory on November 2nd, they would be unable to understand their mandate. This was always the danger---that the conservative groundswell would vault Republicans into power but they wouldn't understand the need to change their modus operandi. At that point, the howling would begin. Now, a mere five weeks after the election, and before the new Congress has even been seated, the howling has begun.

The tax rates in effect for the last eight years are due to expire on January 1, and unless something changes, we will all soon experience the largest tax increase in American history. So it was that President Obama entered a closed room with several (still-unnamed) Republican leaders and emerged on Monday with a deal: 1) the existing tax rates would remain in effect for two more years, 2) the estate tax rate, which is currently 0%, would increase to 35% on large estates, and 3) unemployment benefits (originally 26 weeks, then extended to 99 weeks) would now last for 155 weeks.

The Democrats had eighteen months to do whatever they wanted with these tax rates, of course, because they controlled everything. They did nothing, however, and now the political backdrop has changed. The Republicans cannot pass anything, but they can block legislation in the Senate, so this gives them some veto power over legislation introduced by the Democrats. And what they have made clear is that the only bill they won't block is one that extends all the current tax rates. Obama and the Democrats thus have only two choices: 1) extend all the current rates, or 2) impose enormous tax increases on the American people in the midst of a horrific recession. These political realities are what make the Republican acceptance of the current deal so difficult to understand.

First, because of the relentless propaganda about the “Bush tax cuts for the rich,” it is easy to forget that the 2002 tax bill was primarily designed to benefit lower-income tax payers. In fact, the biggest beneficiaries were those in the lowest bracket, which was reduced from 15% to 10%. If nothing happens in Congress, in other words, the rate on the poorest of the working poor will rise by 50% on January 1. Realistically, what is the chance the Democrats would allow this to happen? Obama, with his back to the wall, desperately needed cooperation from the Republicans. If they had simply demanded that all tax rates be extended permanently, the Democrats would, sometime in the next three weeks, have agreed.

Secondly, the agreement to raise the death tax on large estates from 0% to 35% is not only a capitulation to Obama's tired, dreary, class-warfare demagoguery, it is a violation of the Pledge To America that Republicans unveiled on September 22. In that document, they vowed to eliminate the practice of combining disparate pieces of legislation in the same bill. Pet projects that could never be passed on their own routinely get hidden away on page 822 of popular legislation that is certain to enacted, and the Pledge promised to put an end to it.

The extension of unemployment benefits also violates this provision of the Pledge since it too has nothing to do with marginal tax rates. In addition, the Pledge promised to “prevent... the expansion of unfunded liabilities,” but there has been no suggestion of how an additional year of unemployment benefits will be paid for. I guess we just print some more money, or borrow it from the Chinese.

In short, the deal is a betrayal by Republican leaders. It's a terrible deal, and the worst thing about it may be the way it was done. Last week, all the big guns in the Republican Party were publicly promising they would insist on a permanent extension of the tax rates. Then over the weekend, the big boys go into a room somewhere and come out with this monstrosity. The process stinks, and the message to the tea partiers and all the folks who voted for Republicans on November 2nd is that nothing has changed.

Every Republican who votes for this, and who faces election in 2012, will face a primary. The campaign ads are being written today. “Mr. X, five weeks after the 2008 election, voted for a huge increase in the death tax, voted to spend billions on unemployment benefits without paying for them, and voted to allow tax rates to go up in 2012.”


Thursday, December 2, 2010


December 1, 2010

To: Al C.
From: Michael K.
Re: My injury
Claim Number PA 103511230001
Visit to City Line Family Medicine

First let me tell you about the office. You get off the elevator on the first floor of the nondescript office building at 301 City Ave. and confront a seemingly endless array of identical, unmarked, wooden doors. After a while, unconsciously, you find you are walking more slowly and cautiously, half-expecting that at any moment, one of them will fly open and a claw will reach out, grasping your shirtfront and dragging you into a scene of unspeakable horror. Why all these doors? And why don't they have any names on them? What do they do here, you begin to wonder. What's behind this door? Is this where they slaughter the goats? And how about this one? Is there a gorilla behind it, and if so, what is he doing?

Eventually you find the “Suite 100” sign and you realize the truth is more prosaic. The entire floor is Suite 100 and there's only one entrance to the office, so the setup is designed to discourage you from wandering into a room where they don't want you to wander. It works, I guess.

The real entrance, once you find it, leads you into a waiting area with about thirty chairs and a 25-foot impenetrable counter with four receptionists seated behind it like ticketing agents at an airline terminal. Behind them is the records area, with five narrow aisles of floor-to-ceiling shelves, all filled with paper files in white folders---row after row, shelf after shelf of them. Other files were stacked on the floor in several locations. There's probably a room just like it down in City Hall where they keep the land records from the 1840's, but you just don't see a file room like this anymore.

To one side of the long counter was a large white hutch, with glass doors, that was stuffed with medical equipment and drugs of various kinds, with an overflow pile on the floor in front of it. At one point, a doctor appeared and asked one of the receptionists to find him a box of something-or-other, and she went over to the hutch, got down on her knees and fished through the pile with her hands until she pulled up whatever it was the doc wanted.

I put my name on the Dr. Angeloni sign-in sheet, filled out a form or two, and within minutes was face-to-face with the man himself in his examining room. He quizzed me briefly on the events surrounding the unpleasantness in my groin muscles, then put me on the table, moved my leg around a bit and asked what hurt. He was a fast worker, this Dr. Angeloni, and when he sat back down, he immediately started writing out referrals.

“First of all, you need a week off---no physical work or lifting. Next Wednesday is the 8th, so that's what I'll tell Argus. You can go back on the 8th. Next, I want you to see a physical therapist---there's one right here on this floor and we can make an appointment at the desk before you leave.”

“OK,” I said.

“Finally, I want you to see an orthopedist because only an orthopedist can identify precisely the source of your pain. Once that is done, they can sometimes direct a painless injection to specific cells causing the problem. Space age stuff. I'm referring you to an office near here with some great doctors in it. You'll like them. They work on the 76ers.”

And that was where he lost me. “The 76ers,” I thought. How very groovy. Excuse me, doc, BUT DO YOU THINK I'M TEN YEARS OLD? Maybe I'm slow, but suddenly the airline counter and the spooky doors and the files and the drug samples on the floor all came together and I began to see how this grind operated. I was now a Workers Comp Case. I had a number and everything. And above all, I had a solvent company behind me that was going to pay for some stuff and all I had to do was put myself in the hands of the comp docs. The week off, with pay, is what sells it. Who doesn't want a week off? I sure do. The deal is a simple one---I submit to whatever they come up with that they can bill my employer for. All I have to do is go along for the ride.

And how unpleasant could it be? A few physical therapy sessions with an amiable young woman massaging my thigh? A visit to the snazzy offices of some Main Line Orthopedists-To-The-Stars? Maybe Andre Iguodala would be sitting next to me in the waiting room and I could give him some tips on how to deal with LeBron. By the end of it, my leg might even feel better, and it's not like they would amputate it by accident. Once you sign up for the party, the leg itself is pretty much irrelevant to the whole process. And it's all free!

I declined his offer to set up an appointment with Elton Brand's groin man, but I agreed to a physical therapy appointment. So it was that I reported at 3:25 this afternoon for a 3:30 appointment with Dynamic Rehabilitation, which is in the same office.

They didn't have a sign-in sheet for the physical therapists, but one of the receptionists walked me down a hallway to the right area, where I introduced myself to a woman who appeared to be a therapist. She asked me to wait back in the reception area. I did so.

An hour passed. Nothing happened. Nobody asked me to fill out forms, nobody came to say hello, nobody offered me a coffee, nothing. I began to suspect that nothing would ever happen, no matter how long I sat there, and that no matter how serious my injury, my leg would almost certainly heal long before anyone from Dynamic Rehabilitation would find the time or inclination to examine it. Perhaps, I thought, this is an innovation that this tiny band of medical revolutionaries is introducing to the science of physical rehabilitation---just let the patient chill in the waiting room until he gets better on his own. There's probably something to be said for it, and in my case, it would probably work. My leg will heal on its own, eventually, though other types of injuries might not. I was glad I didn't have a gunshot wound, for example.

At 4:30, I spoke to one of the ladies at the reception desk and politely asked whether someone from Dynamic Rehabilitation might be roused to address my situation. At that moment, as luck would have it, a Dynamic Rehabilitation person appeared and my receptionist called her over. “Mr. Kubacki has a 3:30 appointment,” she explained.

“Oh,” replied the Dynamic Rehabilitation person. Then: “I'll be back in a minute.”

Ten minutes later, she returned with a small pile of forms and a clipboard. Sign here, fill in this part, initial here, etc. etc. I went to work. I was happy to. It seemed we were making progress. Drug addict? No. Diabetes? No. Birthday? Yes, I have one of those. I raced through the stack, flipped to the last page, and then settled in for a long read.

It was a legalistic sort of thing consisting of one sentence that stretched on for about ten lines of text, and I had to read it a couple times to get the meat out of it, but the gist was that they wanted me to agree (there was a signature line at the bottom) to be financially responsible for my treatment in the event that a long list of people and entities (my employer, insurance companies, the UN, Lady Gaga, etc.) refused to pay. It was the sort of crap I've signed a hundred times in a hundred different situations. We all have. (“It's just one of our requirements. Everyone has to sign it. Don't worry about it.”) This time, I just wasn't in the mood. I had had my taste of Dr. Angeloni the previous day, and I had been steaming for an hour already while these guys forgot about me, and I wasn't having any more of it. I wanted somebody to show some goddamn interest in my goddamn leg, or at least pretend to. That's what they're supposed to do, isn't it? That's why they become doctors and nurses and therapists, isn't it? I know it's also about the money, of course. I know everything's about the money, partly. But there's got to be more to it than that, doesn't there? I mean, I've been in strip clubs that were less “about the money” than this joint. I called the Dynamic Rehabilitation person over.

“I have a problem with this form,” I said. “Isn't Argus going to pay for this?”

“Oh yes,” she said. “We spoke to your HR department and they're going to pay for it.”

“But you think Argus may not be good for it?” I asked.

“But everyone has to sign this,” she said. “Nobody's ever objected before.”

“Well, I'm sorry, but I won't sign it. It's nice of Argus to send me here and pay for this, but if I'm going to bear any financial responsibility or even potential financial responsibility, I'm going to choose my own doctors, and I wouldn't necessarily come here.” It was a silly objection, I guess, and there's no way I would ever wind up paying for this circus, but I had to assert myself in some fashion or I would simply become a cog in this dirty little medical/legal underworld. I had come to the conclusion that, in the long run, that would hurt more than my leg did.

“Give me a couple minutes,” she said finally, scooping up my forms and disappearing into the labyrinth of offices and cubbyholes that is City Line Family Medicine. I never saw her again.

At 5:10, I gathered up my things and walked back to the office where I had first introduced myself, the one with “Dynamic Rehabilitation” on the door. I knocked, and the woman who I still think is a therapist opened the door. “I'm Michael Kubacki,” I said. “I'm your 3:30 appointment, but an hour and a half is enough for me. I'm leaving.” She looked very surprised.

I went home.

Thus ends, I hope, my career as a “Workers Comp Case.” Dr. Angeloni examined me, and I assume you have his report for your files, and that is sufficient. There will be no further reports from physical therapists, orthopedists, psychiatrists, nutritionists, nurse-practitioners, thoracic surgeons or gynecologists because I don't want to be a Workers Comp Case anymore. I'd rather limp. In fact, if I am ever again injured at Argus, I hereby authorize you to throw me in the cardboard baler and push the button. You will be doing me a favor, and it will be simpler for all concerned.