I have never spoken to let alone met my doctor

"Call your doctor"?

This piece below appears in my new book Lockdown In Hell World.

I just saw an argument on Twitter in which someone trotted out the dreaded “people don’t like their insurance, they like their doctor” line which made me want to share this chapter all over again. There’s also a lot of “call your doctor to find out when you are eligible for a covid vaccine” going on right now and as this piece illustrates so many people even those with insurance even those with a doctor do not actually “have a doctor.” I have no fucking clue when I’m eligible for the vaccine do you? Is “my doctor” going to let me know? Who is to say.

Some of you will have read a version of this piece earlier in the summer and if so feel free to skip it. If that’s the case and you still want to read something else below I’ve included an interview with me done by a nice journalist about Hell World that was supposed to be appear in a fine magazine before the pandemic hit and it got bumped so many times for more pressing matters he finally said fuck it and published it himself here.

“It’s no longer an aspiration of mine to be a journalist in the way that we understand the term,” I told him. “I think something happens to a person once they get on these tenure-track Beltway jobs. They lose all sense of their humanity and it becomes a game show to them. Especially on cable news, but also in the higher paying prestige jobs. That’s not to say that there aren’t vital journalists doing real work at small newspapers around the country, but I think that on the higher end of the scale — I’m sure they’re all nice people, or whatever — the job precludes you from expressing the fury that’s necessary if you’re a feeling person at this time.”

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It’s March and it’s sunny and quiet in my old neighborhood. Too quiet except for the birds. It feels like there’s a blizzard outside that you can’t see.

Toward the end of February which is the first time as best I can tell I personally acknowledged the existence of the coronavirus I sent out a tweet that went viral: “I like how the experts on TV say if you think you have coronavirus call your doctor ok lol let me just get my doctor on the phone the thing you can do.”

It’s July and around fifty million Americans have donated to a crowdfunding campaign for medical bills or treatment according to a survey by the National Opinion Research Center at the University of Chicago. This may or may not be related to any problems we’re experiencing at the moment as 5.4 million people have lost their job-provided health care insurance last I checked. The survey also found that “an estimated eight million Americans had started a campaign for themselves or someone in their household and more than twelve million Americans had started a campaign for someone else.”

“Although more people gained insurance coverage with the Affordable Care Act,” they wrote, “crowdfunding for health care expenses is becoming more common because Americans still cannot afford their out-of-pocket costs— deductibles, copays, or coinsurance—their coverage notwithstanding. Medical bills remain the number one reason Americans file for personal bankruptcy, according to a 2019 City University of New York-Harvard study. When asked who is responsible for paying for care for those who cannot afford it, a majority of Americans (60 percent) believe the government should as opposed to health care providers, charities, and family and friends.”

In late July the Democrats’ platform committee voted against including support for Medicare for All.

I’m so fucking sick of being told people like me and presumably you if you are reading this book are too angry about healthcare. If anything we aren’t yet angry enough.

A recent study from Yale researchers says we’ll actually save money—and lives—under Medicare for All.

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care,” they write. “By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services.”

Not only would it literally cost less than what we pay now but “ensuring health-care access for all Americans would save more than 68,000 lives and 1.73 million life-years every year compared with the status quo.”

Just as the pandemic was kicking off I spoke with a former nurse who worked for years in Texas and California because she genuinely wanted to help people. What she found instead was an insurance bureaucracy dedicated to extracting wealth from the bodies of the injured and the sick and even more exasperating for her doctors who were willing to manipulate that system to enrich themselves. After working for a particularly malicious surgeon she decided she could no longer in good conscience be a part of that system.

“Nurses are truly nurturers,” she told me. “I don’t think we would be nurses if we weren’t, but the healthcare industry does something to you. It’s become a black void of greed and corporate shills who have no regards for the sanctity of life. I could no longer do a job I loved because I believe in compassion, selflessness, and solidarity with my fellow humans, you know?”

“I’ve told a patient who had just been diagnosed with terminal lung cancer that their insurance company would not pay for treatment because they themselves were not deemed viable,” she told me. “I’ve told women with breast cancer their insurance has denied a second mammogram for being medically unnecessary. I’ve told parents who were barely hanging on to hope that their insurance was not in-network so we would be sending their child six hours away to another, less qualified facility.”

Despite personally living a life that could be destroyed instantly with a bad healthcare break like most of you I also live the relative life of a king compared to millions in this country. It’s simply unjust and it disgusts me that people doing ok like me seem to care more about the millions being crushed today as we speak than the people who are doing very well like all of the rich cable news personalities and untouched Democrats who think better healthcare is akin to installing a Communist dictatorship. Not only before the pandemic they still think that right now!

Dealing with the right is one thing but it’s real fucking grim and demoralizing having to contend with so many “on the left” who don’t think better things are possible and don’t seem to even want to try. I get that coming from the rich TV people they have their own class interests to protect but I don’t understand the average person who goes to bat for the status quo.

The thing that bothers me the most just as the pandemic has made evident the evils of our current system is this: You can literally just say you want the best and most just outcome for whatever issue at any time. A lot of people don’t seem to get that. It’s free! You do not as an individual have a limited reserve of justice aspiration coupons to redeem. You’re not managing a fantasy football team or whatever where you can only draft one tight end. You can ask for the fucking moon or you can simply ask that our country accept a little bit more social democracy. You don’t have to think Well how will we pay for it? you don’t have to think Hmm will the other side be mad at me for wanting this? you don’t have to think about what the voters of a lawmaker in a purple state might want you can just say THIS IS FUCKING CRAZY AND WE NEED TO MAKE THINGS BETTER. You can say it ten thousand times in a row. And then when enough of us are saying it the politicians will have to listen or it’s their ass.

Countless hours of watching cable news pundits has convinced the average person they have to think like a savvy politics insider who knows how the game is played and that always means hamstringing our aspirations for progress before we even get to the bargaining table. You don’t have to do that shit man. It’s not your job to worry about that shit. You don’t have to see Chuck and Nancy caving in to the Republicans’ demands on unemployment insurance in the middle of a historic devastating plague with millions out of work and millions infected and say ah well they are doing their best.

The only conclusion I can draw from people who aren’t demanding that things can and should be better is that they don’t particularly care if things get better or not because things are already fine enough for them.

But maybe there are other ways to improve healthcare (or whatever) people will say maybe we just need to go a little slower and not make such radical leaps all at once they say and to them I say “more likely to work” and reasonable process arguments are always always always a way of forestalling progress. It’s a condescending appeal to fake reasonability and a lie that says we’ll get to your shit eventually just hold on and to that I say no go fuck your mother. It’s also how we end up with a mostly invisible candidate in the form of Joe Biden at a time when we are uniquely situated for real change.

I’ve said this before but as a reminder all of you fucking worms who aren’t all in on eliminating the predatory health insurance industry today are going to lie and pretend you were all along at some point when retrospect makes it seem insane.

Whether it’s climate change or healthcare or the pandemic or any of the other dozens of crises we’re facing there are always going to be people who are paid very well to tell you that we just have to chill out and let progress wind its slow meandering course. They’ll say it’s too expensive or that the rules must be followed and the choice we have is whether to stand there over a dying man’s body afraid to do anything to help because it might cost too much of a rich person’s money to do so or to fucking take what we want because it’s already ours.

Ok wait I lied the first time I tweeted about the virus was the day before the doctor one. I said this: “I will never contract nor die from the famous virus COVID-19 better known colloquially as the coronavirus.” Back then it seemed ok to joke about.

Shortly before that Alex Azar the U.S. Secretary of Health and Human Services and a former pharmaceutical lobbyist and the vice president of Eli Lilly & Co. was at a hearing refusing to commit to Congress that any vaccine eventually developed for the virus would be made affordable for all Americans. “We would want to ensure that we work to make it affordable,” he said. “But we can’t control that price because we need the private sector to invest.”

After the tweet about calling your doctor took off dozens of readers wrote in to me to confirm the absurdity of it. Here is a sampling of what they said.

  • I don't have a doctor. I have an urgent care clinic I can sit in for 5 hours coughing till I see a nurse practitioner who tells me to go home and drink fluids.

  • I haven’t had a “my doctor” since I was last able to qualify under my mother's workplace insurance so that would be some 15+ years ago. Frankly the idea of having a doctor you regularly see is an alien concept at this point.

  • If you can't get the dr on the phone, just take a helicopter to your family's wing at the local hospital.

  • I adore my PCP but do we ever speak on the phone? Lolz no. It’s either make an appointment or have what would amount to a 3-minute call take 5 hours because we must only communicate via the nurse and she sometimes can’t answer my questions and has to get back to me.

  • Might as well use a toy phone lol.

  • This is why I just love it when people are like “we can't have medicare for all because other countries have to wait forever to see a doctor!” I had to wait 6 months last time I wanted to see my PCP for insomnia and when I did her literal words were “I don't know. Try chamomile.”

  • My last doctor was my pediatrician soooo....dial them up or is that weird?

  • “My” doctor? Not sure I've ever seen the same doctor twice in a row.

A lot of people talked about telehealth like you can get on a video call with a doctor now I guess and that reminded me of this robotic shit from a Hell World from last year.

  • Please, I couldn’t get my doctors on the phone when I was miscarrying, when I had a staph infection, when I had a bad reaction to medications...what the hell good is calling about coronavirus gonna do?

  • The idea that all of us have a doctor… I haven’t had a doctor since I had a pediatrician. Like, hi, no healthcare means no doctor and the last time I went was for a job physical to make sure I wasn’t taking drugs.

  • For most of us it’s “call your nurse line and get referred to an emergency room.”  Having a doctor you can call seems like a fucking myth.

  • Thank you for calling but the first available appointment is November 13th, 2024.

  • Lol people have doctors?

  • I have literally never met my primary care doc, have always seen a nurse prac when I've gone (and they are wonderful and helpful for everything I need! but still).

  • lmao I haven’t been to a real doctor in AT LEAST 5 years. I just see a nurse practitioner & a surgeon at my gyno, which I pay for largely out of pocket since they are out of network & I’ve changed insurance so many times…

  • When I went into urgent care for bronchitis, the nurse practitioner told me “after you finish the round of antibiotics, follow up with your PCP.” 

    “You.... you are my PCP.”

  • I’ve been to my doctor’s office 4 times in the last year and have not seen my doctor. I think he might have died and the staff is covering it up.

  • I can ask the ornery front desk lady to take a note to give to my doctor’s technician’s scheduling assistant. They can call me back tomorrow to let me know if the note was written or not.

  • The last time I tried to call my doctor I was transferred to three different people, eventually had to leave a message, and she didn’t call me back. She’s nice in an appointment but the woman does not have time to talk on the phone.

  • lol I have to leave a message with the front office who will leave a message with the nurse who will leave a message with my doctor who will tell my nurse to call me back 3 days later.

  • Your pcp is just a random name you pick off your insurer’s website to list on your application, not a real person right?

  • I have “good” insurance and every time I try the list of doctors that insurance covers, I'm told they already have too many patients and I can schedule a well visit for a month out. Twice I've been bumped. I haven’t had a PCP since my pediatrician. We need #MedicareForAll

  • Scheduled an appointment once that was actually very serious and it was a year wait LMAOOOO talk to my doctor......

  • Laughing because I have never spoken to LET ALONE met my doctor. I have one and they just send me nurses when I make appts. This shit is COMICAL.

  • I can't even call the office with the system in my area. All calls are routed to a central call center, out of area, that can ONLY make appointments or collect bills.  You literally can't talk to anyone.

  • I can email my doctor through an app owned by a shady company that I’m pretty sure steals my data and they’ll get back to me maybe in a week. If they don’t get back to me, a receptionist will tell me to make an appointment.

  • It took me a WEEK to get my kids’ pediatrician on the phone to discuss a significant issue my child was having and I was happy when I got to have a 5-minute, real conversation with her about it. That shows you where the bar is in our healthcare: I was HAPPY with that result.

  • I don’t even know who my doctor is.

  • I once called my primary doctor 15 times over three days because my ear infection had gotten so bad my eardrums had ruptured to release fluid. No one called me back. My husband once called about some hemorrhaging. They scheduled an appointment for 8 months later.

  • lol I can't even see my doctor with a regular appointment gotta get that a month in advance so basically if I have any issue that needs seeing then I go to urgent care and hope they can help.

  • I have some of the best employer-provided private insurance in the US, and I could never get my Dr on the phone. I can call their office and talk to staff/advice nurse, but getting an appt for even a routine annual exam has taken 3 months’ wait. They’d tell me to go to an ER.

  • I can message my doctor through a secure internet site. At any point, I can get charged money for doing this. (Up to the full cost of an office visit). I cannot send images or voice. This is considered rather good compared to other clinics.

  • I haven't had an answer to “who's your doctor?” since Bill Clinton was president.

  • Our pediatrician recently started charging an annual fee for people who want to just call the office with questions, like that's premium doctoring or something.

  • My former PCP (very sweaty weirdo who always talked about his divorce) once offered me his “concierge service” in which for $50/month I was able to call him.

  • Literally just to send an IM to my doctor on their stupid website costs 40 dollars.

  • And is your doctor a doctor? Mine is a Nurse Practitioner. And she's great, but I have no proof that the doctor on my insurance card even exists.

And as always there were the people from other countries aghast at how fucked our healthcare system is.

From Japan:

  • I am always confused reading things like this. Kinda makes me happy to live where I live. Going to see a doctor when I need one, or even calling them, is like a normal thing here.

From Peru:

  • I’m 9 days into being treated for a serious medical situation in Peru and I’ve been telling the doctors what it was like in the USA and there’s a nurse who worked for a bit in the States and she’s had to back me up and confirm I’m not lying. 

From the UK:

  • Every time I see an American talk about their health service I'm reminded how much we take ours for granted.

  • US medicine is wild. My doctor lets patients dial in for advice every day at 11am, and I think at 3pm. The various practice GPs take turns to cover the phone for that period.

From Jamaica:

  • Wait what? Bro, I have my doctor's personal and office numbers [and] their personal and office emails.

From Ireland:

  • Seriously how are Americans still alive? Every day I learn of a new horror of the American healthcare system.

From Slovakia:

  • Everyday I learn something new and terrible about America

From Mexico:

  • I was today years old when I found out that the gringos struggle even to call their private doctors. [I’m] shocked.

From Canada:

  • I could realistically call and see my doctor in Toronto today. But also tyranny and Venezuela and postmodernist Marxism and death panels and no freedom so joke’s on me really.

From Italy:

  • So you guys can't even talk to your doctor on the phone in America? I know there are a lot of uninsured people. I just thought that once you have an insurance, it works pretty much as it does in most of Europe. But it doesn't seem so. Where do people get this conviction that your health care system is the best???

Back in February when I still had hope I went to a number of Bernie Sanders rallies and at one in New Hampshire I stood there with my hand raised like a nerd for a half hour because I wanted to ask him something along the lines of: When we all hear these stories about people’s lives being crushed under the weight of the predatory for-profit healthcare industry in this country the very natural response at least for me is that that is fucked and we have to stop it. So many other people see it and think Eh that’s not my problem. You cannot legislate empathy I wanted to say. So how at long last do we convince anyone to care about other people? I never got a chance to ask though. No one else since then has come up with an answer.

I’ll probably be ground into dirt myself before too long: An interview with Luke O’Neil

by Daniel Tovrov

Before the world blew up, I interviewed Luke O’Neil, author of the Welcome to Hell World newsletter, about the then still-recent anthology of his work. The piece was supposed to run in February in a fairly popular magazine, but for various reasons it was pushed until March, at which point the world changed forever. Now, almost a full year since we talked, Luke has a new book out — “Lockdown in Hell World,” a collection of his newsletters about the pandemic — and I’m finally publishing this interview here because however much things change they stay the same, and I think Luke’s points are more relevant and worth your consideration than ever.

Below, you will find my original, unedited introduction to the interview, followed by the interview itself, which has been slightly edited for clarity but nothing else. Thanks for reading.

— —

When I asked Luke O’Neil what term he wanted me to use to refer to the writing in Welcome to Hell World, his daily newsletter that has recently been turned into a 500-page epic of American misery, he shrugged away the question, uninterested in categorizing the work into which he seems to pour every last drop of his heart and soul. The non-answer was a bit of modesty on his part, just as the question was a bit of sycophantry on mine, but behind his aloofness was the essence of O’Neil’s project of imagining new, uncharted approaches to journalism that can be more useful and, in his opinion, more honest than what we have now.

O’Neil is approaching twenty years in the newspaper business. In a way that might not be possible anymore, he worked his way up from alt weeklies to theBoston Globe and the Washington Post and online outlets like ViceSlate, and the Guardian, landing along the way at Esquire as an Writer-at-Large, which “came with a title and everything official but still payed me as a freelancer,” he told me. Hell World is very much the culmination of those two decades of experience in that it breaks every single convention that the journalism industry has held as gospel for the last hundred years. Unrestricted by editors or house style, and with a DIY ethic from time spent in the punk rock scene, O’Neil merges disciplines and forms, creating a voice-driven collage of outrage as far from objectivity as he can manage.

Writing like that shouldn’t work at all. A typical Hell World post careens from topic to topic with a violent disregard for transitions, and almost every sentence is a run-on. One early entry, for example, begins at a Trump rally in Montana then swings to a photo shoot with an adderall-addled, pre-Proud Boys Gavin McInnes, then jumps to American-trained jailers of women in Saudi Arabia, brutality in Nicaragua, back to Trump, then El Salvador, and finally comes to rest on a personal anecdote about the magnets on his fridge announcing marriages that have since ended in divorce. It works like magic, for reasons O’Neil and I discussed at length, engaging and enraging readers — more than 17,000, enough of whom pay for subscriptions that O’Neil no longer has to write for publications that pull his articles when he jokes about waiters pissing in Kirstjen Nielsen’s food — in a way that straight reporting cannot.

As he told me on the phone one Tuesday morning in February, O’Neil believes that journalism, which may or may not be breathing its dying breaths, isn’t doing a good enough job empathizing with the victims of capitalism. Hell World is about people, and while O’Neil features prominently in the work, he writes like he’s reaching out to each individual reader. By O’Neil’s own admission, it’s not writing that should replace journalism, but instead the piece missing from the “what the hell just happened” media puzzle that we started assembling in November 2016.

So much of my own energy these days is spent either throwing my hands up in the air or clumsily screaming at my friends about their Amazon deliveries. Hell World, like all great editorial writing, puts my frustrations and feelings into words, thereby making them real and something I can begin to manage. It also gives me something persuasive to send to my friends without the usual fear that they’ll finally cut me out of their lives. Now anthologized by OR Books as Welcome to Hell World: Dispatches from the American Dystopia, Luke O’Neil’s work is literature that all Americans should read, especially those who think that civility works or that humanity has been lost, and especially those who mistakenly think civility and humanity are the same thing.

— —

DAN TOVROV: What have you been up to this morning?

LUKE O’NEIL: I just got off the phone with my health insurance company. I needed them to explain this bullshit bill I just got. Which is, you know, very Hell World-y. It’s not a catastrophic bill; it’s like $600. But $600 is still a lot of money that I don’t want to pay on top of the hundreds I pay for the insurance every month. So I call and they tell me that because I had this procedure done in a hospital instead of a regular doctor’s office, it was something like a $250 copay instead of $25. But while I was on hold, they had this lovely orchestral piece, which I figured out was Handel’s “Water Music.” And I started reading up on that, so it was an educational call. I got some culture.

DT: Have you written the next newsletter yet?

LO: I’m working on it today. I might write a little bit about the bill, and I’m going to talk to a friend of mine who is really getting fucked. He just received a bill for $120,000 for a pretty serious surgery that he had.

DT: Is he insured?

LO: Yeah, he’s insured. He believes they’re going to pay half of it. So he’ll only have to pay $60,000. But we gotta name for the place we live, you know?

DT: Let’s talk about it. A thing that Hell World readers are really drawn to is the discursive, stream of consciousness style of your writing. Is it that you write the newsletter in a kind of fugue state?

LO: The first time I did it, maybe, I remember I was watching the Iraq War documentary, with that photo. I was writing about it right at the time when the John McCain funeral was on TV. Do you remember how long that was? It was on TV for like a week.

I was bowled over by the cognitive dissonance. And angry. When you’re angry, you don’t choose your words carefully. You’re communicating emotionally. And when I was writing it, I found that I was naturally writing in that way. Just writing and writing and writing. That isn’t the way I’d been writing most of my career as a journalist, where you have to be thoughtful and clear in what you’re saying and how you say it, not because it’s necessarily better, but because that’s what they make you do at mainstream publications.

So the style was an accident. It was a confluence of anger and the emotional response to the news. It’s visceral. It’s the best that I can do to translate my disgust into the written word.

DT: What I’ve been surprised while reading the book is how much the topic jumping still works. I don’t quite understand why.

LO: In a way, [the essays] approximate what I feel when I’m looking at Twitter. It’s a cascade of disparate emotions. A bomb went off here, and you feel horror, and here’s a football highlight, and Trump did something stupid, and here’s somebody telling a dumb dick joke, here’s a mass shooting, here’s a rape. And we have to process all of those things in the span of two minutes.

My approach is to take that and slow it down a little. So that it’s not every five seconds you’re getting pummeled by a different emotional response, and you get a little bit of time to sit with the one particular item before moving on to the next.

DT: I hate admitting it, but I almost never read news articles all the way to the end anymore. But I almost always get to the end of Hell World. Does that style you described have anything to do with that?

LO: It’s very rare to read an article that captivates you to the point where you can’t think about anything else. You might read half of it then start thinking about, “oh my back kind of hurts” or “I’m pretty hungover,” or you might check your email in the middle. And that’s the kind of experience I’ve replicated in my writing. None of us have the focus to spend time on anything, so why not accurately convey what I’m thinking in the middle of writing? Your mind is going to wander anyway when you’re reading it, so why not take the initiative and help it wander for you?

DT: One way you do that is by injecting yourself into the work. I can’t think of anyone who puts themselves in their work in such close proximity to their reportage. Can you talk about this?

LO: It’s all a reaction to spending, like, 15 years in the journalism industry, and increasingly the content industry. I hate both equally, the prestigious “News From Nowhere” shit and the 800 words about whatever stupid horse shit we’re talking about on Twitter that day. When I set out to do this, I wanted to be as different from that as possible. One way to fight back against the radical neutrality of the mainstream press, where you’re supposed to be this opinionless automaton reporting the facts, is to say exactly what you mean and what you think about any given topic.

To pretend that we don’t have visceral reactions to the news is a type of lying. The neutrality that’s forced on reporters is an offensive fucking lie to me. That’s part of what makes reading the news hard for me now, too. You know these people aren’t dispassionate arbiters, they’re just taking all of that out. It’s an enemy of clarity.

I think that’s what readers respond to. To just pop in in the middle of relaying some horrific story to highlight how grotesque it is — that’s how people feel when they’re reading. You can read better reporting and better writing than you’ll get from me in wherever — the New Yorkerthe Washington Post — but you don’t get the writer saying, “are you seeing this the way I’m seeing this? Because this is fucking crazy, right?”

DT: You also write a lot about your own mental and physical health.

LO: Yeah, right. I don’t know why. Everything sort of feeds into each other. The run up to the [2016] election happened to coincide with me injuring myself really badly after years of obsessive exercising. It derailed my life and mental health in a way led to self-medicating with alcohol. And both things are all part of the same hole, personally. Politics broke my back, literally and metaphorically. My therapist talks about how you can internalize agitation and frustration, and they’ll manifest in your body. I don’t know if that’s true or not, but it’s true enough as a frame for the writing. So it feels natural to think about all those things at the same time.

DT: As a reader, when you put in the personal stuff about, say, addiction or trauma, the first thing it does is make me trust you. And, as you’re saying, trust can be hard to find, because with the internet even the casual observer is now so aware of how journalism is made. The second thing it does is it makes me think about what I’m going through — and helps me accept it. Is self-reflection on the reader’s part political?

LO: It’s no big revelation but our bodies are the places where the violence of politics is played out. One thing I hear people say is that what I write humanizes the casualties of capitalism. If you internalize that humanization and look at these systems, you realize: if they haven’t fucked you up yet, at any minute they could.

Most people whose lives are untouched by pain or illness or suffering are aware of these things, but they don’t think enough about how these things are going on around us constantly. And it’s not an accident that it’s happening. These are things that are being done to us because of decisions that were made — political, systemic decisions. This friend with the $60,000 bill — that’s not shitty luck, that’s a decision that a series of people made to destroy his life. I’d like people to make that connection. A lot of people go through life with their fingers crossed hoping that nothing bad happens to them. I’d like us to prevent those bad things from happening in the first place.

DT: People forget that politics is always life or death.

LO: That’s why I get so angry! I can’t become the type of person who can’t be friends with someone because they aren’t a radical socialist or I’ll end up with no fucking friends in the world. But I do wonder: Are you that comfortable that you don’t understand that tens of millions of people’s lives are being ground into the mud every day?

DT: Do you think that traditional journalism has an empathy problem?

LO: It’s no longer an aspiration of mine to be a journalist in the way that we understand the term. I think something happens to a person once they get on these tenure-track Beltway jobs. They lose all sense of their humanity and it becomes a game show to them. Especially on cable news, but also in the higher paying prestige jobs. That’s not to say that there aren’t vital journalists doing real work at small newspapers around the country, but I think that on the higher end of the scale — I’m sure they’re all nice people, or whatever — the job precludes you from expressing the fury that’s necessary if you’re a feeling person at this time.

Part of that is, they’re prevented by where they work to express how they really feel. After a certain amount of time of being that system, the institutional norms start to seem normal to you. I’ve always had trouble staying employed. I was constantly getting reprimanded for my tweets at Esquire, where I was a writer at large. And there was the thing with the Boston Globe. I’ve basically been talked to at every mainstream publication that I’ve written for. “Can you tone it down with the tweets?” No, I can’t.

Through my twenties, I thought, “I want to be a New York Times reporter. I want to write for the New Yorker.” None of that means anything to me anymore. After you see the type of fucking morons that get to those types of positions, the soulless ambition vampires, you see it’s nothing. I don’t want it.

DT: One thing that a mainstream outlet has — or once had — is a fact checker. And there are values to having an editor. Do you worry about that?

LO: While I talk a lot of shit about the traditional standards of professional journalism being a lie, I obviously hold onto a lot of the rules. I certainly don’t want to get anything wrong or lie. Not having an editor means I might occasionally fuck up, but if I do I correct myself instantly and admit my mistake. It’s really very easy to say, “Ah I fucked up there, gonna try to not make that mistake again.”

DT: Is there a staff job you’d say yes to right now?

LO: No. Well, maybe if the Times was like, “We’ll fire Brett Stevens and let you write whatever you want,” I’d give it a try. I’d like to run a five minute mile, too.

DT: So, what’s the solution?

LO: I don’t know, man. Taking advertising money out of journalism would be a big help. But look at NPR. They’ll have a story and say, “this bad policy is about to take place and here’s why it’s bad,” then say, “OK, here’s the evil mastermind behind the policy to explain himself.” So even taking advertising money out of it still leaves a problem. We need to continue to chip away at the false idea of neutrality.

Another solution I talk about as a joke but I also kind of mean is: with every person who goes on CNN, there should be a graphic with how much money they make, how much they’re worth, how much their parents are worth. It would be like listing an athlete’s stats during the game. When you watch the game, they tell you where the player went to college years ago, but they don’t do that for pundits. Wouldn’t it be interesting to see for everyone on an MSNBC panel? Harvard, Harvard, Princeton, Yale, Harvard.

DT: Or how much Aetna stock they have in their mutual funds.

LO: Exactly. I think we’re constantly being lied to. Not in the sense that people are making things up. CNN’s not making things up. The New York Times doesn’t make things up. They want to be accurate. But what the fuck do I know? I’m just a newsletter writer. It’s quite possible that I’m wrong and that I’m the asshole. But…

DT: But in the meantime, you’ve opted out.

LO: Yes. It could all be naught. It probably will be. I’m not the first guy to say “the system sucksman.” I’ll probably be ground into dirt myself before too long. I could get canceled tomorrow and everyone will stop reading. But in the meantime, this stuff that I’m writing seems ok. It seems to be making people feel a certain way. I’ll keep on doing it as long as I can. It’s a fucking magic trick, making a living in this business.

DT: I want to ask a big personal question right now. How do you define yourself, or think of yourself? How does Hell World fit into your idea of how you exist in the world?

LO: I don’t think I’m anything. I’m nothing. If I stop doing this, there would be a week where people go “what the fuck” and then I’m gone. That drives me, in a way, to keep trying. I don’t want to disappear. But I don’t like the thing writers do when they talk about “imposter syndrome.” I don’t like the diagnostication of a regular human emotion. It’s not unique to feel like you don’t belong. I’m not under the impression that I’m some great man of letters, but, at the same time, I think I’m pretty good. I do a pretty good job. Not the best writer, not the funniest guy, not the best reporter, not the smartest, but I do them all well enough, in the right combination, to make it feel like it’s something. I’m proud of that. I don’t think I’m going to change the world, but I do think I’m going to change a few people.

DT: What about Richard Munslow, the last sin-eater? In one of the earlier chapters in the book, you talk about Munslow’s funeral, and at the end of the piece, you write:

“Sometimes I think, like the sin-eaters with no other options, I behold the grief of the world without respite because I have no other choice. … We’ve been driven mad with grief, and we know nothing else but to continue to compound it in a gluttonous feast. We gorge ourselves on the sins of others until it sickens us, hoping, without any sort of reliable proof, that in the end it might help someone, but knowing nonetheless that it won’t.”

How does that fit in?

LO: The thrust of that essay is reporters keeping their eye on the prize — to translate the pain of the world. That might be a calling for some people but it’s also a profession, and happens to be the one that I’ve, through a series of missteps, found myself in. If that’s what I’m gonna do, then I’m happy to do it. Well, maybe not happy, but I’m gonna.

Since I wrote that, it’s taken on a new connotation. People write to me with their own things now, and that’s something I struggle with. People are telling me their sad stories, their failures, their addiction stories, the ways they’ve been fucked over. I feel, right now, that it’s my responsibility to handle those as carefully as possible. But I also feel this immense responsibility not to influence people in the wrong way. My personal way of dealing with mental health stuff, addiction stuff, is dark humor and irony, but I’m aware I can’t joke about that stuff the way I might otherwise without fucking with somebody. But as I said in a newsletter, I’m not anyone’s therapist. Please don’t take my advice on any of this.

DT: Let’s go back to the book. The book starts with Samar Hassan, the Iraqi girl who was with her parents when they were shot to death by an American serviceman, and then the next two chapters are intensely personal essays that cover your grandmother, your drug use, fear, meditations on the past, a confederate flag–adorned bar in Prague. Then the following chapter gets very political again with Kirstjen Nielsen’s “baby jails.” Were you going for anything in how you ordered the pieces or what you chose to include?

LO: I spent a lot of time as a musician, making records, and I thought about the book that way. I thought, the first [essay] is short and punchy and gives you an idea of what you’re getting into, like how with the first song on an album you want to grab someone’s attention. And then, once you have someone interested, you can be more indulgent.

I also didn’t want people to think, “Oh, this is a political book about how the military is bad.” I wanted people to think, “This is weird; what’s going on here?” The whole idea of the newsletter and the book is to throw people off balance. To make them feel a little uneasy. So I thought, going back and forth between things that are straight, things are more political reporting, and things that are more broadly focused or that are about me would do that.

DT: Does the work feel different in book form?

LO: It really is exciting. It all happened quickly. I didn’t have designs on making it a book. The folks at OR Books really encouraged me and let me do it how I wanted to do it. I love the package that it became. It’s everything you’re not supposed to do. It’s super fucking long; the chapter titles don’t tell you what anything means; it’s hard to read, in terms of the lack of punctuation; it’s aggressive and off-putting topics. There are so many books that nobody cares about — I happen to think there are too many books — so why not try to do everything you’re not supposed to do and see if it works?

DT: I told a friend I was interviewing you, and he asked me to ask you to tell him what the word “patriotism” is and has become, and your feelings about that.

LO: I have zero sense of patriotism. I don’t understand it. I think it’s one of the most corrosive and corrupting forces throughout the entirety of human history. Patriotism, tribalism. It’s the cause of all the wars, all the suffering. I don’t give a fuck. Fuck all of it. Fuck America. Fuck Donald Trump. Fuck Barack Obama. That sounds like impetuous, punk rock, teenager shit, but I think we’re conditioned to lose that feeling by associating it with teenage rebellion. We should keep that inside of us all the time. Why should I give a fuck about America? I care about the people who live here, but not more than I care about the people who live anywhere else — Mexico, China, wherever. I think it’s a destructive force meant for the people who want us to be patriotic, who don’t have our best interest at heart, because it gets in the way of their ability to make money.

DT: You watched the Super Bowl, with the intro with the troops and all that?

LO: It’s insane. Fuck the troops. No, I don’t hate this young man personally. I’m sure he had a life like anyone else’s that brought him to where he enlisted in the military. But at the end of the day, who are the people who carry out atrocities on our behalf? Soldiers don’t make the decisions, but they’re out there killing people. The spectacle, the extravagance, the jingoism — that’s all paid for! The military uses our tax dollars to sell the military back to us.

It sounds so stupid to say out loud. It feels embarrassing to be this obvious and earnest. But then things don’t get better so maybe we keep saying them until they do. That’s a tagline for the book right there.

DT: Last question: I just saw on Twitter some photos you posted of you as a young man meeting John Kerry and Bill Clinton. What did you glean anything shaking hands with guys like that?

LO: I thought I wanted to be in politics when I was young. I interned at the White House in college. I got fired from it, because I had to show up every day and sit there, then photocopy a thousand pages, and I walked out. I came back to college and I got D+’s the rest of the semester because I walked out of my White House internship. That’s a pretty good origin story for Luke O’Neil. I had this great career-making opportunity and I thought it sucked and told them to go to hell. So what did I learn? I learned that everyone sucks in all the ways we know they do. I was 18 and hadn’t seen it for myself yet.

There’s one more photo of me and Ted Kennedy that I can’t find. I like that. I’m not a big Kennedy fan anymore, but being a young aspiring democrat from Massachusetts that was very exciting.

Daniel Tovrov is a journalist and award-winning fiction writer. You can follow him on Twitter.