WAITING
Ask, and let your words diminish your asking
As your journal has diminished your days,
With the next day’s vanity drying your blood,
The words you have lost in your notebooks.
Ask — do not be afraid. Praise Him for His silence.
What I love to ask is what I know,
Old thoughts that fit like a boot.
What I would hazard clings in my skull:
Pride intervenes, like an eyelid.
All sound slows down to a monstrous slow repetition,
Your times of reflection become a dark shop-window,
Your face up against your face.
You kneel, you see yourself see yourself kneel,
Revile your own looking down at your looking up;
Before the words form in the back of your head
You have said them over and answered, lives before.
O saints, more rollicking sunbeams, more birds about your heads!
Catherine, more Catherine wheels!
Sic transit gloria mundi,
The quick flax, the swollen globe of water.
Sic transit John’s coronation, mortal in celluloid.
Underground roots and wires burn under us.
John outlives the Journal’s 4-color outsize portrait
Suitable for Framing, flapping, no color,
No love, in the rain on the side of the paper-shed.
Into Thy Hands, O Lord, I commit my soul.
All Venice is sinking.
Let us dance on the head of a pin
And praise principalities!
Life is a joke and all things show it!
Let us praise the night sounds in Connecticut,
Whistling Idiot, Idiot!
The moon’s disk singes a bucketing cloud
Lit by the sun lit by a burning sword
Pointing us out of the Garden.
Turn your back on the dark reflecting glass
Fogged up with the breath of old words:
You will not be forgiven if you ignore
The pillar of slow insistent snow
Framing the angel at the door
Who will not speak and will not go,
Numbering our hairs, our bright blue feathers.
— Jean Valentine, Dream Barker, Yale University Press, New Haven, 1965
December 8
The switch to good flannel and a down comforter has really helped my sleeping, I think. The new feather bed is back ordered and won't arrive until early January. Bebop is finally getting comfortable enough to sleep up towards the head of the bed. She hasn't quite made it to being cuddly, but, for the first time, I have some hopes that she will be more of a full-service cat.
I have an old wool blanket that is thread-bare, if one is being generous. This has been floating around for 60 years or do. And, with my ridiculous sentimentality, and my common-sense-defying compulsion to save or re-use everything, I hadn't quite gotten it out of the house. Having unearthed some baskets also on their way to the "great beyond," I thought maybe I should make a cat basket, having been searching desultorily for a cat bed, I thought to give the concept a trial run.
 |
| McCoy in the basket. |
The minor bummer there is that Vera who is normally the chief bedcat has taken a liking to it as well. Hopefully, the extra warmth exuded by this human and the luxe comfort of down will lure her back here as the weather gets colder. I can't really blame her for abandoning me. I often have this iPad in my lap where she deserves to be or I toss and turn more often because of sciatica and arthritis.
I did get up to make it to my Saturday morning yoga gathering. I had not been in a month. While I was very comfortably asleep, it was a sunny morning and Sonia was teaching. Had I not gone, it would have been a squandered opportunity as the cold weather is a-coming and Sonia might not be available if she is tending to her mother. I often remark that I miss Kava, our old yoga studio, and I desperately need to practice more myself. Sometimes, I don't like to go as I feel unable to keep up with the group (I am quite a bit older), but I did a reasonable job.
As I practice and teach, I am constantly struck by how hard it is to move around safely and properly. Given that my classes are comprised of mostly older students, and many beginners, I spend quite a bit of time on balance and general mobility...
(Bebop has moved closer and is making biscuits on my foot. I believe she will settle down to sleep against me, which is a first. Bebop wasn't a cat that I particularly wanted but one that came to me through the Universal Cat Distribution System. Although she loves and gets along with the other kitties, particularly Vera Paris, who is The Mother and The Destroyer, her skittiness and wariness of humans meant that days might go by when I didn't even try to pet her. I am quite pleased she is warming up to me. I also got her to purr for the first time.)
Most of us heedlessly and precariously hurtle through space. At this point, I don't really think I teach yoga as much as body awareness. In my early years of practice, I was utterly unaware of what I was doing out there in moving-around-land also known as proprioception. I could teach yoga, but I have become so obsessed with the nuances of muscle movement that in my classes we more toward asanas and only occasionally practice vinyasa,
For someone who was lousy at sports and did not, in general, like exercise, this new me surprises me. I apologize if this tangent is boring.
Later
I never thought of dismay as an "arrow" kind of emotion, not piercing but more "like a slow-moving cold front" (h/t John Hiatt, Icy Blue Heart). Despair, of course, is an arrow "straight to your heart like a cannonball" (h/t Van Morrison), but dismay, to me, has been a sad settling of the shoulders and slow shakes of the head.
Today, dismay was an arrow, a weapon of mass destruction, as I merely overheard some of the comments that the Orangeshitgibbondumpsterfire made on Meet the Press, as he disgustingly ascends like Apollo on his day's journey. I was struck, not head-shaking, head down, shoulder shrugging, but a fierce and penetrating blow to my heart.
And here's the thing about some of those feelings: once they take you over, they are very hard to get rid of. And you are stuck in your aloneness, your singular meat-suit with no obvious way out as the bees of terror continue to buzz more loudly in your being.
COLD BLOOD AND YOU’RE LAUGHING?
What the death of a health-insurance C.E.O. means to America.
By Jia Tolentino
December 7, 2024
Photograph by Anthony Behar / Sipa USA / Reuters
As you know, the C.E.O. of UnitedHealthcare, fifty-year-old Brian Thompson, was murdered on the street in midtown Manhattan, on Wednesday morning, twenty minutes before sunrise. He was in town for an investors’ convention, and had worked for UnitedHealthcare for more than two decades—a company that is part of UnitedHealth Group, a health-insurance conglomerate valued at five hundred and sixty billion dollars. UnitedHealthcare had two hundred and eighty-one billion dollars in revenue in 2023, and Thompson, who became C.E.O. in 2021, had raised annual profits from twelve billion dollars to sixteen billion dollars during his tenure. He received more than ten million dollars in compensation last year. Andrew Witty, the C.E.O. of UnitedHealth Group, remembered Thompson in a video message to employees as a “truly extraordinary person who touched the lives of countless people throughout our organization and far beyond.” Thompson lived in a suburb of Minneapolis, where UnitedHealthcare is based, and he is survived by his wife and two sons.
The particulars of this murder are strange and remarkable: it occurred in public; the suspected shooter went to Starbucks beforehand; he got away from the scene via bicycle; he has not yet been found. But the public reaction has been even wilder, even more lawless. The jokes came streaming in on every social-media platform, in the comments underneath every news article. “I’m sorry, prior authorization is required for thoughts and prayers,” someone commented on TikTok, a response that got more than fifteen thousand likes. “Does he have a history of shootings? Denied coverage,” another person wrote, under an Instagram post from CNN. On X, someone posted, with the caption “My official response to the UHC CEO’s murder,” an infographic comparing wealth distribution in late eighteenth-century France to wealth distribution in present-day America. The whiff of populist anarchy in the air is salty, unprecedented, and notably across the aisle. New York Post comment sections are full of critiques of capitalism as well as self-enriching executives and politicians (like “Biden and his crime family”). On LinkedIn, where users post with their real names and employment histories, UnitedHealth Group had to turn off comments on its post about Thompson’s death—thousands of people were liking and hearting it, with a few even giving it the “clapping” reaction. The company also turned off comments on Facebook, where, as of midday Thursday, a post about Thompson had received more than thirty-six thousand “laugh” reactions.
What on earth, some people must be asking, is happening to our country? Are we really so divided, so used to dehumanizing one another, that people are out here openly celebrating the cold-blooded murder of a hardworking family man? That people are making jokes about how the assassin could’ve won the Timothée Chalamet look-alike contest in Washington Square Park? That when a journalist at the American Prospect called an eighty-eight-year-old woman who was aggravated by her poor Medicare Advantage coverage for comment, she wisecracked that she wasn’t the killer—she can’t even ride a bike?
There had been prior threats against Thompson, his wife told NBC News, motivated, she said, by, “I don’t know, a lack of coverage? . . . I just know that he said there were some people that had been threatening him.” There had been protests at the UnitedHealthcare headquarters, in Minnesota, in April and July; during the latter, eleven people were arrested. The group responsible for the protests, People’s Action, also confronted Witty, the UnitedHealth Group C.E.O., at a Senate hearing in May. In a statement, People’s Action leaders referenced endless hours on the phone trying to get medical care covered, and denials of coverage for lifesaving medication and surgery. A recent statement from the group, in response to Thompson’s death, read, “We know there is a crisis of gun violence in America. There is also a crisis of denials of care by private health insurance corporations including UnitedHealth.” They urged political leaders to “act on both.” UnitedHealthcare has the highest claim-denial rate of any private insurance company: at thirty-two per cent, it is double the industry average. And, though the shooter’s motive remains unknown, shell casings found on the scene had the words “deny,” “delay,” and possibly “depose” written on them, echoing the title of a 2010 book by Jay M. Feinman, “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It,” which by Thursday had leapt up one of Amazon’s best-seller charts.
To most Americans, a company like UnitedHealth represents less the provision of medical care than an active obstacle to receiving it. UnitedHealthcare insures almost a third of the patients enrolled in Medicare Advantage, a government-funded program facilitated by private insurance companies, which receive a flat fee for each patient they cover and then produce their own profits by minimizing each patient’s care costs. Reporting in the Wall Street Journal has found that these private insurance companies, which cover more than a third of American seniors on Medicare, collect hundreds of billions of dollars from the government annually and overbill Medicare to the tune of around ten billion dollars per year; UnitedHealthcare has used litigation to fight its obligation to repay fees that were overpaid. In 2020, UnitedHealth acquired a company called NaviHealth, whose software provides algorithmic care recommendations for sick patients, and which is now used to help manage its Medicare Advantage program. A 2023 class-action lawsuit alleges that the NaviHealth algorithm has a “known error rate” of ninety per cent and cites appalling patient stories: one man in Tennessee broke his back, was hospitalized for six days, was moved to a nursing home for eleven days, and then was informed by UnitedHealth that his care would be cut off in two days. (UnitedHealth says the lawsuit is unmerited.) After a couple rounds of appeals and reversals, the man left the nursing home and died four days later. The company has denied requests to release the analyses behind NaviHealth’s conclusions to patients and doctors, stating that the information is proprietary
At the same time that news was breaking about the NaviHealth algorithm, the company was fighting—ultimately unsuccessfully—a court decision that it had acted “arbitrarily and capriciously” in repeatedly denying coverage of long-term residential treatment to a middle-school-age girl who repeatedly attempted suicide, and has since died by suicide. Several years ago, government investigators found that UnitedHealth had used algorithms to identify mental-health-care providers who they believed were treating patients too often; these identified therapists would typically receive a call from a company “care advocate” who would question them and then cut off reimbursements. Though some states have ruled this practice illegal, it remains in play across the country. There is no single regulator for a private health-insurance company, even when it is found to be violating the law. For United’s practices to be curbed, mental-health advocates told ProPublica, every single jurisdiction in which it operates would have to successfully bring a case against it.
Thompson’s murder is one symptom of the American appetite for violence; his line of work is another. Denied health-insurance claims are not broadly understood this way, in part because people in consequential positions at health-insurance companies, and those in their social circles, are likely to have experienced denied claims mainly as a matter of extreme annoyance at worst: hours on the phone, maybe; a bunch of extra paperwork; maybe money spent that could’ve gone to next year’s vacation. For people who do not have money or social connections at hospitals or the ability to spend weeks at a time on the phone, a denied health-insurance claim can instantly bend the trajectory of a life toward bankruptcy and misery and death. Maybe everyone knows this, anyway, and structural violence—another term for it is “social injustice”—is simply, at this point, the structure of American life, and it is treated as normal, whether we attach that particular name to it or not.
The Norwegian sociologist Johan Galtung coined the term “structural violence” in 1969, in a paperthat offers a taxonomy of violence—ways to distinguish between the forms that violence can take. It can be physical or psychological. It can be positive, enacted through active reward, or negative, enacted through punishment. It can hurt an object, or not; this object can be human, or not. There is either—Galtung notes that this is the most important distinction—a person who acts to commit the violence or there is not. Violence can be intended or unintended. It can be manifest, or latent. Traditionally, our society fixates on only one version of this: direct physical violence committed by a person intending harm. The pretty girl killed by a boyfriend, the C.E.O. shot on the street, the subway dancer strangled by the ex-marine. You don’t even need a human object—people are generally more troubled by the Zoomers throwing soup at paintings in a weird bid to raise attention about climate change than by the more than ten thousand farmers in India who die by suicide every year in part because of the way erratic and extreme weather renders their debts insurmountable. If one were to, hypothetically, blow up an unoccupied private jet in protest of the fact that the wealthiest one per cent of the global population accounts for more carbon emissions than the poorest sixty-six per cent, this would be seen by many people—like Thompson’s murder, and unlike the tens of thousands of human deaths per year already caused by climate change—as a sign of profoundly alarming social decay.
On this point, though, everyone’s really in agreement. It’s just a matter of where you locate the decay—in the killing, or in the response to it, or in what led us here. The only way to end up in a situation where a C.E.O. of a health-insurance company is reflexively viewed as a dictatorial purveyor of suffering is through a history of socially sanctioned death. A person who posted on Reddit’s r/nurses forum, whose profile describes her as an I.C.U. nurse, wrote, “Honestly, I’m not wishing anyone harm, but when you’ve spent so much time and made so much money by increasing the suffering of the humanity around you, it’s hard for me to summon empathy that you died. I’m sure someone somewhere is sad about this. I am following his lead of indifference.” Reading this, I thought about the statistic, from 2018, that health-care workers account for seventy-three per cent of all nonfatal workplace injuries due to violence. Nurses, residents, aides, specialists—they are asked to absorb the rage and panic induced by the American health-care system, whose private insurers generate billions of dollars in profit and pay executives eight figures not despite but because of the fact that they routinely deny care to desperate people in need.
Of course, the solution, in the end, can’t be indifference—not indifference to the death of the C.E.O., and not the celebration of it, either. But who’s going to drop their indifference first? At this point, it’s not going to be the people, who have a lifetime of evidence that health-insurance C.E.O.s do not care about their well-being. Can the C.E.O. class drop its indifference to the suffering and death of ordinary people? Is it possible to do so while achieving record quarterly profits for your stakeholders, in perpetuity?
Thompson’s death resurfaced some unsavory details about his industry. We learned, for instance, that Thompson was one of several UnitedHealth executives under investigation by the D.O.J. for accusations of insider trading. (He had sold more than fifteen million dollars’ worth of company stock in February, shortly before it became public that the Department of Justice was investigating the company for antitrust violations, which caused the stock price to drop.) A new policy from Anthem Blue Cross Blue Shield also went viral: the company had announced that, in certain states, starting in 2025, it would no longer pay for anesthesia if a surgery passed a pre-allotted time limit. The cost of the “extra” anesthesia would be passed from Anthem—whose year-over-year net income was reported, in June, to have increased by more than twenty-four per cent, to $2.3 billion—to the patient. On Thursday, the company withdrew the change in response to the public outrage, if only in Connecticut, for now. It’s hard not to be curious about what, if anything, might happen to UnitedHealthcare’s claim-denial rates. I was at a show in midtown Manhattan on Thursday night, and when the comedians onstage cracked a joke about the shooter the entire place erupted in cheers. ♦︎
Jia Tolentino is a staff writer at The New Yorker. In 2023, she won a National Magazine Award for her columns and essays on abortion. Her first book, the essay collection “Trick Mirror,” was published in 2019.
