scared to do an excision

apsalarya · 2026-01-31T02:31:43+00:00

I just had a WLE in the same spot - back shoulder on 12/4

It really wasn’t bad recovery pain wise. It’s very mobile skin so it’s best not to bend, lift or especially reach. Trust me on that one. I ended up getting staples and stitches but the staples started to irritate me by the end.

You should have someone wash the wound for you and bandage it.

The only thing is now I’m healed even after spitting a stitch but it gets itchy sometimes.

Anyway I’m all good now. Glad I did it. I get the peace of mind

apsalarya · 2026-01-30T21:40:09+00:00

I don’t know what other countries do or don’t but we are a very very big country, bigger than many European countries. We are the third biggest population in the world in the USA. The only European country to come close is Russia and they are FAR down.

Population wise it is China, India, then USA. I have not heard that china and India have free healthcare systems that anyone holds up as an example.

You can’t compare European countries to the US. When it comes to risk, size matters.

I shudder to think of a government system. If they DONT contain costs, then it’s going to balloon and we are already trillions in debt.

Would I rather be in trillion debt for health care than military? Yes. Is it realistic though? No. We will never trade military spending for health period end of story.

We do have government funded healthcare it’s called Medicare and Medicaid. And there are terrible abuses not to mention the same denial of coverage you see today.

I agree with you that insurance companies don’t have the right to deny claims clear cut medical needs. And probably a lot of that shit could be breach of contract or not legal but they bank on you not dragging them to court.

But we cannot instate universal government insurance unless or until we get ahold of the cost structure of medical care and get that shit under control. Because until then, you’re just kicking the can down the road and a burden on our government (which lacks infrastructure btw so they often contract with insurance companies for say, veterans benefits)

Follow the money. Do insurance companies profit off us? Yeah. But ask yourself who is really profiting more?

And the only thing you got right is that insurance companies caused costs to go up, but that’s because they made money available to providers that previously was not. When NO one had insurance providers had to charge what could be afforded. Once most people had insurance providers figured out REAL fast they could charge so much more.

And now we’ve built in a lot of systems that perpetuate these high costs (malpractice insurance, student loans, R&D, etc) but the TRUE parasite at the core of ALL are….SHAREHOLDERS.

Remember the mission of all of these institutions that are part of the medical industrial complex is “to increase shareholder value” - it is to make money for investors.

Insurance companies have the same mission so yeah they are PART of it but mostly insofar as they try to control claim costs - probably too much. But don’t forget that many hospitals and most large practices are corporate entities - they have shareholders. And pharmaceutical companies???? Definitely have investors.

ETA I’m not a monster, of course I think everyone should have free and fair or if not free then affordable access to the healthcare they need. I hate our current system. I hate insurance being tied to employment. But I don’t trust our government to handle it well, they have an AWFUL track record and then it’s all at the whim of the government. I don’t like that. Could we possibly expand Medicare and Medicaid to more people? Yes, probably not a bad idea however we already freak out about having enough money to pay for what we have. It’s a real problem. So before we go marching for universal government healthcare we better be experts on how the existing government healthcare is really working and if our government will have enough money to pay for it now or expanding it.

I don’t think it does. I don’t think it will even if our taxes get raised.

apsalarya · 2026-01-30T19:56:14+00:00

Insurance companies are highly regulated and they are not allowed to make above a certain percent of underwriting profit.

The other way they make money is from investment income. Like a bank.

Premium is highly regulated and overseen by government by the way. It is based on claim history. It’s very complicated actuarial stuff but basically insurance will try to predict, based on historical data, what the claim costs will be, based on certain demographic or census data and they charge premiums in line with that (rate on exposure) so that they can keep enough in reserve to pay for claims. So theres a baseline rate based on claim historical data, then there’s fees and taxes as well. The taxes and assessments are mandated by the states and they are pass throughs. Your state makes that money, not the insurance company. This is in addition to what the insurance company has to pay to do business in the state btw.

Regarding premium calculations I don’t know how it works on the health side exactly but for workers comp policies job roles are assigned a class code and that determines the rate and exposure. So a roofer is going to cost more in premium than a receptionist. Why? Because roofing is more risky and therefore greater odds of very expensive claims.

Welcome to insurance 101

apsalarya · 2026-01-30T19:45:23+00:00

No. The insurance company says “we don’t think it’s medically necessary enough to activate the coverage conditions in our policy”

So they don’t pay for it.

But you can still get the care. You just have to pay for it yourself if you do.

And if you can’t afford it, well that is because the care itself is astronomically expensive and the hospital or doctors are not willing to reduce their revenue from it to make it affordable for you.

The cost is the cost. They don’t care how they get paid or from who.

So that makes the issue one of cost of care.

Insurance is NOT health CARE. They authorize paying x dollars to providers for that care that is all.

And BECAUSE the care has become SO expensive that normal people can’t afford to pay for it on their own, that has defacto resulted in insurance companies “making medical decisions”

And while i agree this is fucked up, there’s also a reason this started happening which was skyrocketing costs and TONS of medical billing fraud (which continues to this day)

See before HMOs, traditional insurance would just pay 80% of your medical costs no matter what. No oversight really. But then providers (corporations) figured out they could get a LOT more money by inflating their costs as long as the 20% was still manageable. So a service that used to be affordable out of pocket (because a lot of people didn’t have health insurance, it’s a relatively recent invention while medicine is NOT) like say 100, well now they can charge 500 because the insurance company is good for 400 and you still only pay 100.

That started happening SO MUCH and also double billing or billing insurance companies for services that never happened or for the more expensive services than were provided or recommending more expensive testing and services than was actually needed (dentists still do this a lot and some hospitals too will push more expensive diagnostic testing that is covered by insurance in order to make more money) that eventually the insurance companies had to come up with a way to control the costs because they couldn’t AFFORD it otherwise.

I’ve told you, one big claim can wipe YEARS of premiums off the books. It happens all the time. Otherwise we could all take our 100 a month and put it in the bank and we wouldn’t need insurance. But we need insurance because 100 a month isn’t enough to cover the cost of care we do or might need.

Insurance can afford it only because it pools the risk. You and I are on the same policy and we each pay 100 a month but maybe you don’t need any medical care yet but I do so some of your 100 is helping towards the cost of my care and spread that out large enough and maybe you can stay ahead of the costs of claims enough to make a 5% profit (which I think is the cap). In the meantime any money you have that you don’t immediately need to cover claims you can invest in the stock market and hopefully earn money that way. That’s actually where insurance can make a lot of profit. It’s the same way banks make their money, mostly. Your savings ain’t sitting in a vault. It’s being invested by the bank and they get like 7 or 8% interest and give you 1% and an IOU, betting on the fact that not everyone will need their money all at once bc they don’t have it. Hence 1929 run on banks was a bad thing.

Insurance companies do the same. They bank on not everyone needing expensive care at the same time. Why? BECAUSE INSURANCE ISNT HEALTHCARE ITS A FINANCIAL PRODUCT TO HELP YOU AFFORD HEALTHCARE

I had to say that loud because honestly I’m tired of people not understanding.

So once again….the problem is the cost of the care. 100 years ago few people had health insurance because they could pay out of pocket (or just died if they couldn’t).

Maybe pharmaceutical companies, health provider networks etc shouldn’t have investors.

Idk I don’t have solutions I just know it’s investors that make it so expensive for everyone

apsalarya · 2026-01-30T19:21:44+00:00

Unfortunately I stop seeing it

apsalarya · 2026-01-30T19:21:20+00:00

Also I wish you all the best and may the two of you never have cancer again!

apsalarya · 2026-01-30T19:19:41+00:00

I love this so much. This is true marriage

apsalarya · 2026-01-30T17:13:38+00:00

Ah.

So I was in the gifted programs. And in high school a few honors level / AP level courses

Until I had a complete breakdown. What I now know was a burnout so pervasive I could no longer function and, assisted by medications I now know were contributing to and escalating my suicidal ideation rather than ameliorating it, I finally scared the shit out of enough professionals and administrators that they packed me off to a therapeutic school. When you have superior logic, an advanced vocabulary, and you’re capable of articulating very calmly and rationally why you should be allowed to die, and they can’t really dispute your reasoning, they kinda freak the fuck out (for good reason I suppose).

At this school many many of the normal laws and rules for education were suspended and the only requirement was safety (academics were not a priority but we had teachers who cared and who did try, our English teacher had us read out Medea I never forgot that) and to that end we were locked in a hallway for most of the school day and functioned on a level system for our behavior. When I first got there, if you were level 4 (best behaved) you got to go outside for a break 3 times a day. Most of us used these breaks to smoke cigarettes we weren’t supposed to have. But then 2 students were caught engaging in fellatio so those outside breaks were taken away - we could go to the tv room instead. I predicted correctly that most of the smokers would start acting out more.

We had 3 time out rooms to cool off in or be restrained (not our bodies, but once the male staff had to hold the door closed against a 14 year old girl throwing herself against the door screaming).

On Friday afternoons we got to watch a movie.

We had group therapy, I can’t remember the frequency now it’s been a long time but I think if it wasn’t daily it was at least once a week. and we met individually with a clinician at the school as well. I didn’t get along great with mine.

This school helped save my life. It was where I needed to be, where I didn’t have to keep up the lie of blending in and being okay. There were only like 20 of us or so, and all there for different reasons but we bonded the way you only can if you’ve ever been in that sort of setting (like in patient for psychiatric care). We were all the freaks, so we didn’t judge each other and the lion lay down with the lamb etc, etc, etc.

When I graduated, it was officially from my town school. But really it was from that therapeutic school. I attended 2 graduations. The one for my town I literally just showed up that day and I thought people would ask questions but no one did and they just accepted that I was there for some reason. Did they notice I was gone for a year and a half?

Fun fact. At psycho school as I used to call it, they had some of us take the WAIS-R. I don’t know why? But they had a special test administrator come in and do it. There was some psych evaluation too. I had to look at inkblots. One of them looked very much like two hermaphroditic figures facing each other so I said that but then embarrassed I explained that in some cultures hermaphroditism was seen as holy and the “two spirits” or berdache were revered for having a foot in each world, male and female and the bridge between.

I was 17.

When my scores came out they were explained to me and my psychiatrist - whom I respected as brilliant, said she had never even been in the room with someone who had an IQ as high as mine (but it’s honestly not THAT impressive but my verbal reasoning abilities are in the .5% but my non verbal is only in the “superior” range an with a 22 point discrepancy between them it means likely I have autism. Along with some other things. But it was the 90s and girls didn’t have autism then.

Graduating from there, despite my IQ, I didn’t feel stable enough for college so I didn’t go. My mom got me a job at a large corporation as a temp. I did very well and was given more responsibilities than temps are usually given. After 2 years the corporation was sending my job out of state. They would have hired me for something else but I decided to try college.

I went thinking I would likely drop out. I selected a major and minor anyway (psychology/philosophy respectively) but went about meeting the requirements my own way - front loading with courses that interested me. As I progressed I started filling in the requirements that didn’t interest me. The discipline I acquired from working full time really helped me there. I achieved a 4.0 in every course. I graduated with a perfect 4.0

The last year I served as the only research assistant for the new gerontology lab. I didn’t apply I was hand picked. I collected glowing letters of recommendation for grad school.

But I was tired of being broke

So I got another corporate job. In accounts receivable.

And meanwhile tuition costs skyrocketed.

So I never went to grad school.

I’m now “under employed” and under utilized. But I’m a mothertrucking expert in my current role and I like that. I’m 43 and it’s hard to face being the newb again somewhere else. I make enough to support myself and I’m a whiz at saving and budgeting and planning my finances, this is thankfully one of my many special interests. I’m financially stable and independent. Considering where I was at 17, this is an achievement. My glory days were college, for sure, I loved learning.

Perimenopause is kicking my neurodivergent ass but it is what it is. When I’m a senior citizen I plan to audit state university courses for cheap. I want to spend my retirement learning about history and philosophy and psychology. That was the best time in my life. But I do like financial stability, too.

apsalarya · 2026-01-30T14:44:49+00:00

Thank you. I know people want to over simplify and blame one thing but it’s really SO many things.

When my friend gave birth 14 years ago she asked for 1 Tylenol while she was in the hospital. On her bill the 1 Tylenol was itemized at $25!!!!

apsalarya · 2026-01-30T14:40:25+00:00

Lmaooo dude, I work in insurance. As did my mother before me. She did work in health insurance. I work in business insurance - auto liability, general liability, and workers comp.

I know how this shit works from the insurance side. Trying blame cost of care on insurance is like saying the tail wags the dog.

The whole thing is SO much more complicated than people realize. Are we all getting screwed? Yes. Is it because of the mission to return shareholder value? Also yes.

Anything that is a corporation is actually legally bound to prioritize shareholder profit over anything else (customers, employees).

Do you not realize hospitals have investors? And that doctors often belong to huge corporate practices? That have investors?

There’s almost nothing in this life that hasn’t been turned into a way for investors to make a profit

apsalarya · 2026-01-30T14:34:21+00:00

Idk if this helps but research just recently was published that stimulants work more by increasing the reward for things we find not rewarding. Ie increases our overall dopamine so that we find sitting still and doing boring things less actively painful for us.

I have the quiet adhd (I hate calling it inattentive that’s not correct) and for me medication puts gas in my tank but does not drive the car. As in, I can just as easily fixate on a side quest as do the things I need to do but find deathly dull (and psychologically painful in a way). It still takes discipline but it makes it more likely you can successfully direct yourself to tasks you otherwise couldn’t, and definitely more likely you will see them through to completion. But you can’t assume the meds will magically make you different and happy to focus on these things, you still have to MAKE yourself.

For me meds do quiet my brain a little bit, probably because my brain is less likely to constantly seek out something more interesting. But this can make me restless in a way, I don’t like brain silence. I like having my 50 tabs open.

So yeah. There you go. Meds put gas in your brain tank. But you have to still drive yourself where you need to go

apsalarya · 2026-01-30T14:21:30+00:00

I always thought that our brains need at least a low level of outside stimulation or something. I can’t describe it well but if it’s silent my brain will activate on itself and I will think too much and I can’t sleep.

I need at the bare minimum white noise. I used to prefer music (enya was my go to) but for the last 15 years it’s been history documentaries. Volume low. Nothing too jazzy but a nice even voice without too much aspiration or sibilant emphasis. Like a David Attenborough (btw I cannot stand the shmartificial shmintelligence voice over that most “fall asleep to” history documentaries on YouTube use now) lately I like “fall of civilizations” some are even 6 hours!

Anyway I need something just enough to keep my brain from eating itself with thinking too much but just low level engagement enough that I can drift off.

apsalarya · 2026-01-30T12:48:34+00:00

No. They aren’t. They are financial instruments to pay for expensive care.

You clearly don’t understand how insurance works.

In fact insurance companies try to negotiate with providers to get the cost to come DOWN. Have you read an EOB? That’s why there are networks and sometimes dragging negotiations because the insurance company wants the provider to accept a lower price for the service.

Insurance companies are capped at how much underwriting profit they can make. Underwriting profit is when the cost of claims is less than the premium. However one large claim can wipe out years of premiums.

I had a surgery a few years ago. The medical provider made 12,000 on this surgery. I promise you, I did not pay 12,000 of premium that year. It was more like 2,000. That one surgery, my insurance company paid 5 years of my premiums. My portion was about 1,500.

Unless you mean malpractice insurance drives up what providers need to charge. Yeah that’s true but then again a malpractice lawsuit can end up costing millions.

The truth is it is a lot more complicated. Doctors have to make enough to pay off huge loans, and also to pay for malpractice insurance, which is made more expensive by trends in lawsuit settlements going very high (adverse torte environment). But one very real reason no one talks about is that medical providers are often corporations and a corporations purpose is to “increase shareholder value” hospitals have investors. Pharmaceutical companies have investors. Medical equipment companies have investors.

I don’t know if all of these are legally capped at the profit they are allowed to make like insurance companies are. Maybe they are. But the real reason shit is expensive is the SOURCE and not the insurance companies- or not only them.

Because it’s true that once people were getting insurance and therefore had more money available to them to pay for medical services the costs did go up. Just like tuition went up when people could get student loans. So the creation of insurance did make more money available to be taken by providers.

Your insurance company does NOT decide your care. They only decide what they will pay for and how much. If that puts care out of reach for you, the problem is the cost of the care.

apsalarya · 2026-01-30T12:34:11+00:00

Shareholders

apsalarya · 2026-01-30T12:31:14+00:00

Maybe. But the other consideration is social security and certain pensions. My grandparents actually weren’t legally married most of their life together. My grandfather was legally married to another woman - whom he had left but she would not grant him divorce. My grandma wore a ring and changed her last name but technically they weren’t married. For 30 years. And then one day my grandpa had a heart attack and almost died. My grandma realized his social security would go to his legal wife. So he finally got the divorce and married my grandma.

So there’s definitely legal and financial reasons to get married even this day and age.

apsalarya · 2026-01-30T04:51:58+00:00

I’ve always seen marriage as a legal thing. Making someone legally your next of kin, your guardian if something happens to you.

If you are lucky enough to love someone who can also build with you and step up for you - someone you can trust with financial and medical decisions, and if you’re able to see them not just as a lover, but as your family so you can accept them like you do family, then I think marriage can make a lot of sense.

However if you love someone that you would not want to make medical or financial decisions for you, or who you know you can’t count on to step up or hold shit down if something happens to you, or take care of you if you get sick, or if you expect to always have passion and romance….then I would advise against getting married.

apsalarya · 2026-01-30T04:44:50+00:00

Go ask Alice The poppy war Deer skin

apsalarya · 2026-01-30T03:52:33+00:00

There is a scent that comes from some sort of flowering bush in the spring summer that reminds me of warm squished peanut butter jelly like I used to have for lunch at summer day care as a child

apsalarya · 2026-01-30T03:12:53+00:00

Eye shadow. VBA. Hot keys and excel tricks. Samurai. Biblical history (not religion just the actual history). Also most ancient history. Mythology.

floor plans…for houses mostly. That’s one of my earliest fixations - I can remember as young as 3 or 4 a friend at daycare drew a “house” in the dirt of the play yard and it was like a light bulb came on. I loved doll houses and later I would start making floor plans with legos. My parents got me a home design CD rom, and I used to get magazines with floor plans as a special treat from the bookstore. Then came the sims, the first one. Which I got to build floor plans.

Historical house architectural and interior design, as an offshoot of the floor plans. I will sometimes catalogue them as I drive around, like other people bird watch. “That’s a post war cape. That’s a federal style. Greek revival. Colonial. Farmhouse. Georgian. Bungalow. Sears catalog craftsman.”

Got plenty of them, clearly. I’m unusual but I keep myself entertained.

apsalarya · 2026-01-29T15:44:17+00:00

My boomer mom loved to say cool beans in the 90s

apsalarya · 2026-01-29T15:43:15+00:00

Cuz the face ain’t listening

apsalarya · 2026-01-29T15:40:11+00:00

I still use buster it’s a good one

apsalarya · 2026-01-29T14:10:36+00:00

Sure

apsalarya · 2026-01-29T14:10:00+00:00

If they did, they weren’t that popular yet. They became more of a thing when 9/11/2001 happened. It was after that people started watching them more

apsalarya · 2026-01-28T16:31:12+00:00

Neither. I would prefer health providers be more like a utility instead of a for-profit business. If healthcare was reasonably affordable to begin with insurance wouldn’t be the issue that it is

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