The health industry’s invisible hand is a fist
On June 21, I'm doing an ONLINE READING for the LOCUS AWARDS at 16hPT. On June 22, I'll be in OAKLAND, CA for a panel and a keynote at the LOCUS AWARDS.
The US has the rich world's most expensive health care system, and that system delivers the worst health outcomes of any country in the rich world. Also, the US is unique in relying on market forces as the primary regulator of its health care system. All of these facts are related!
Capitalism's most dogmatic zealots have a mystical belief in the power of markets to "efficiently allocate" goods and services. For them, the process by which goods and services are offered and purchased performs a kind of vast, distributed computation that "discovers the price" of everything. Our decisions to accept or refuse prices are the data that feeds this distributed computer, and the signals these decisions send about our desires triggers investment decisions by sellers, which guides the whole system to "equilibrium" in which we are all better off.
There's some truth to this: when demand for something exceeds the supply, prices tend to go up. These higher prices tempt new sellers into the market, until demand is met and prices fall and production is stabilized at the level that meets demand.
But this elegant, self-regulating system rarely survives contact with reality. It's the kind of simplified model that works when we're hypothesizing about perfectly spherical cows of uniform density on a frictionless surface, but ceases to be useful when it encounters a messy world of imperfect rationality, imperfect information, monopolization, regulatory capture, and other unavoidable properties of reality.
For members of the "efficient market" cult, reality's stubborn refusal to behave the way it does in their thought experiments is a personal affront. Panged by cognitive dissonance, the cult members insist that any market failures in the real world are illusions caused by not doing capitalism hard enough. When deregulation and markets fail, the answer is always more deregulation and more markets.
That's the story of the American health industry in a nutshell. Rather than accepting that people won't shop for the best emergency room while unconscious in an ambulance, or that the "clearing price" of "not dying of cancer" is "infinity," the cult insists that America's worst-in-class, most expensive health system just needs more capitalism to turn it into a world leader.
In the 1980s, Reagan's court sorcerers decreed that they could fix health care with something called "Prospective Payment Systems," which would pay hospitals a lump sum for treating conditions, rather than reimbursing them for each procedure, using competition and profit motives to drive "efficiency." The hospital system responded by "upcoding' patients: if you showed up with a broken leg and a history of coronary disease, they would code you as a heart patient and someone who needed a cast. They'd collect both lump sums, slap a cast on you, and wheel you out the door:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195137/
As Robert Kuttner writes for The American Prospect, this kind of abuse was predictable from the outset, especially since Health and Human Services is starved of budget for auditors and can only hand out "slaps on the wrist" when they catch a hospital ripping off the system:
https://prospect.org/economy/2024-06-13-fantasyland-general/
Upcoding isn't limited to Medicare fraud, either. Hospitals and insurers are locked in a death-battle over payments, and hospitals' favorite scam is sending everyone to the ER, even when they don't have emergencies (some hospitals literally lock all the doors except for the ER entrance). That way, a normal, uncomplicated childbirth can be transformed into a "Level 5" emergency treatment (the highest severity of emergency) and generate a surprise bill of over $2,700:
https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given
The US health industry is bad enough to generate a constant degree of political will for change, but the industry (and its captured politicians and regulators) is also canny enough to dream up an endless procession of useless gimmicks designed to temporarily bleed off the pressure for change. In 2018, HHS passed a rule requiring hospitals to publish their prices.
Hospitals responded to this with a shrewd gambit: they simply ignored the rule. So in 2021, HHS made another rule, creating penalties for ignoring the first rule:
https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/hospitals
The theory here was that publishing prices would create "market discipline." Again, this isn't wholly nonsensical. To the extent that patients have nonurgent conditions and the free time to shop around, being able to access prices will help them. Indeed, if the prices are in a standards-defined, machine-readable form, patients and their advocates could automatically import them, create price-comparison sites, leaderboards, etc. None of this addresses the core problem that health-care is a) a human right and b) not a discretionary expense, but it could help at the margins.
But there's another wrinkle here. The same people who claim that prices can solve all of our problems also insist that monopolies are impossible. They've presided over a decades-long assault on antitrust law that has seen hospitals, pharma companies, insurers, and a menagerie of obscure middlemen merge into gigantic companies that are too big to fail and too big to jail. When a single hospital system is responsible for the majority of care in a city or even a county, how much punishment can regulators realistically subject it to?
Not much, as it turns out. Kuttner describes how Mass Gen Brigham cornered the market on health-care in Boston, allowing it to flout the rules on pricing. In addition to standard tricks – like charging self-pay patients vastly more than insured payments (because individuals don't have the bargaining power of insurers), Mass Gen Brigham's price data is a sick joke.
See for yourself! The portal will send you giant, unstructured, ZIPped text files filled with cryptic garbage like:
ADJUSTABLE C TAPER NECK PLUS|1|UNITED HEALTHCARE [1016]|HB CH UNITED HMO / PPO / INDEMNITY [34]|UNITED HEALTHCARE HMO [101604]|75|Inv Loc: 1004203; from OR location 1004203|52.02|Inpatient PAF; 69.36% Billed|75|Inv Loc: 1004203; from OR location 1004203|56.87|Outpatient PAF; 75.83% Billed
https://www.massgeneralbrigham.org/en/patient-care/patient-visitor-information/billing/cms-required-hospital-charge-data
These files have tens of thousands of rows. As a patient, you are meant to parse through these in order to decide whether you're getting ripped off on that HIP STEM 16X203MM SIZE 4 FEMORAL PRESS FIT NEUTRAL REVISION TITANIUM you're in the market for (as it happens, I have two of these in my body).
Kuttner describes the surreal lengths he had to go through to prevent his mother from getting ripped off by Mass Gen through an upcoding hustle. By coding her as "admitted for observation," Mass Gen was able to turn her into an outpatient, with a 20% co-pay (this is down to a GW Bush policy that punishes hospitals that charge Medicare for inpatient care when they could be treated as outpatients – hospitals reflexively game the system to make every patient an outpatient, even if they have overnight hospital stays).
Kuttner's an expert on this: he was national policy correspondent for the New England Journal of Medicine and covers the health beat for the Prospect. Even so, it took him ten hours of phone calls to two doctors' offices and Blue Cross to resolve the discrepancy. The average person is not qualified to do this – indeed, the average person won't even know they've been upcoded.
Needless to say that people in other countries – countries where health care is cheaper and the outcomes are better – are baffled by this. Canadians, Britons, Australians, Germans, Finns, etc do not have to price-shop for their care. They don't have to hawkishly monitor their admission paperwork for sneaky upcodes. They don't have to spend ten hours on the phone arguing about esoteric billing practices.
In a rational world, we'd compare the American system to the rest of the world and say, "Well, they've figured it out, we should do what they're doing." But in good old U-S-A! U-S-A! U-S-A!, the answer to this is more prices, more commercialization, more market forces. Just rub some capitalism on it!
That's where companies like Multiplan come in: this is a middleman that serves other middlemen. Multiplan negotiates prices on behalf of insurers, and splits the difference between the list price and the negotiated price with them:
https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html
But – as the Arm and a Leg podcast points out – this provides the perverse incentive for Multiplan to drive list prices up. If the list price quintuples, and then Multiplan drives it back down to, say, double the old price, they collect more money. Meanwhile, your insurer sticks you with the bill, over and above your deductible and co-pay:
https://armandalegshow.com/episode/multiplan/
The Multiplan layer doesn't just allow insurers to rip you off (though boy does it allow insurers to rip you off), it also makes it literally impossible to know what the price is going to be before you get your procedure. As with any proposition bet, the added complexity is there to make it impossible for you to calculate the odds and figure out if you're getting robbed:
https://pluralistic.net/2022/05/04/house-always-wins/#are-you-on-drugs
Multiplan is the purest expression of market dynamics brainworms I've yet encountered: solving the inefficiencies created by the complexity of a system with too many middlemen by adding another middle-man who is even more complex.
No matter what the problem is with America's health industry, the answer is always the same: more markets! Are older voters getting pissed off at politicians for slashing Medicare? No problem: just create Medicare Advantage, where old people can surrender their right to government care and place themselves in the loving hands of a giant corporation that makes more money by denying them care.
The US health industry is a perfect parable about the dangers of trusting shareholder accountable markets to do the work of democratically accountable governments. Shareholders love monopolies, so they drove monopolization throughout the health supply chain. As David Dayen writes in his 2020 book Monopolized the pharma industry monopolized first, and put the screws to hospitals:
https://pluralistic.net/2021/01/29/fractal-bullshit/#dayenu
Hospitals formed regional monopolies to counter the seller power of consolidated Big Pharma. That's Mass Gen's story: tapping the capital markets to buy other hospitals in the region until it became too big to fail and too big to jail (and too big to care). Consolidated hospitals, in turn, put the screws to insurers, so they also consolidated, fighting Big Hospital's pricing power.
Monopoly at any point in a supply chain leads to monopoly throughout the supply chain. But patients can't consolidate (that's what governments are for – representing the diffuse interests of people). Neither can health workers (that's what unions are for). So the system screwed everyone: patients paid more for worse care. Health workers put in longer hours under worse conditions and got paid less.
Kuttner describes how his eye doctor races from patient to patient "as if he was on roller skates." When Kuttner wrote him a letter questioning the quality of care, the eye doctor answered that he understood that he was giving his patients short shrift, but explained that he had to, because his pay was half what he needed, relegating him to a small apartment and an old car. The hospital – which skims the payments he gets for care – sets his caseload, and he can't turn down patients.
The answers to this are obvious: get markets out of health care. Unionize health workers. Give regulators the budgets and power to hold health corporations to account.
But for market cultists, all of that can't work. Instead, we have to create more esoteric middlemen like "pharmacy benefit managers" and Multiplan. We need more prices to shovel into the market computer's data-hopper. If we just capitalism hard enough, surely the system will finally work…someday.
If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled
239 notes
·
View notes
A Hum of Time. Toshinori Yagi x Reader
Part 5
Summary: An innocent relationship between two workaholics could not possibly be that eventful. Just two individuals finding comfort within each other's company and the occasional cup of coffee. What happens when a secret that could ruin both of their careers brings the whole thing crashing down? In a heart wrenching decision, you must do what is best for all three of you and brave the future alone. Will you ever tell the truth? You might not have a choice.
Part 1 Part 2 Part 3 Part 4
8081-word count
It's happier I promise :)
It has been six years since the incident. Any blog or post related to you had long ago been swept away into the ever-changing sea of media, buried far below, never to resurface. The name Siren was long forgotten.
Following being discharged after over two months of recovery you had changed your names and moved to the opposing coast. The opportunity for another fresh start alighted new found hope for the future. The saved money from your time as a hero and life insurance payout David had carefully pulled allowed the two of you the luxury of ease and into a mundane title of stay at home mom.
Despite everything that happened, every sacrifice made, and every sleepless night it was all well worth their price at being present to watch your boy grow. You loved him more than you had ever thought possible. A mother’s love is a force of nature, boundless and unconditional.
Even if he could be a pain at times.
Admittedly handling a four-year-old who’s temper tantrums could burst your eardrums had been one of your toughest battles. Thankful that he had inherited something of yours but also woeful for both yourself and the neighbors; He had manifested your vocal quirk.
After many replaced windows, pitiable apologize, and endless pep talks he had finally learned to somewhat control it. With his quirk and gaining of maturity came questions. He could faintly remember you as a hero all those years ago, fortunately however not much. Just that you wore an ‘awesome’ costume and got hurt.
You never told him the truth. Instead opting to lie whenever his bubbling curiosity peaked. Stating that back in the day you were simply a sidekick to some one off low tier hero. Nothing special. Just scratching the surface of heroism, that you had thrown in the towel after getting hurt all those years ago.
Not a complete lie.
Yet far from the whole truth.
This still fascinated him.
Late at night as you tucked the restless child to bed, he would beg for stories, pictures, anything from back then. Occasionally after seemingly endless hours of impetration you’d buckle to his demands, telling a watered down tale of the past. Even as you regaled the simplest of petty robberies, he looked to you like you had hung the stars in the night sky, as if you were the reason that rain fell. Big blue fascinated eyes with a wide smile filled with astonishment chanted your praises in complete and utter admiration.
“Momma is the coolest!” “Momma is the best hero!” “Momma is my hero!”
‘Momma is my hero.’
Oh, how your heart melted at his words. The giddy childlike wonder pushed any nightmarish trauma to the back recesses of your mind. Though, that did not mean it disappeared.
Haunting memories of the past always found a way to resurface.
As he grew older, near the age of six, he discovered how to use the home computer. Spending hours watching videos online of other heroes, it was only a matter of time until he inevitably stumbled upon a video of All Might. Despite your parental controls blocking the tag. Where there's a will there's a way, this kid was stubborn. Since the discovery he could not stop watching, completely enamored. The daunting words “I am here” blaring from the computer's speakers echoed with your son's delightful laughter bounced off the walls of your shared home.
Over and over.
Taunting.
Mocking.
It stung the deepest depths of your faulty heart to hear his voice day in and day out.
To watch your son fall in love with a man who too used to hold your heart…
Yet you did not have the heart nor the courage to demand he turn it off.
A particular moment replayed in your mind.
You had just come home from a quick trip to the market. Nearing the age of elven you entrusted him to stay home alone for short periods of time especially when, if provoked, he could scream loud enough for anyone clear across the city to hear. Yet when he did not meet you at the door or answer your call your stomach dropped. As you began to call for him again your words suctioned themselves to the back of your throat. A cold sweat of fear beaded on your brow.
The bathroom door was open, the light on, and a shadow moved from the door frame. The figure almost too tall to be completely seen. The shape of it alone made you shiver.
Two long strands of hair sticking up in an iconic V shape shadowed onto the hallway wall.
“All Might?” your voice quivered, graveled and raw. Foreboding dread balled into a tight knot threatening to suck you into dissociation, as if at any moment you would melt into the floor. Slowly wobbly legs moved, approaching just enough to allow a peak over in.
“That is right! FOR I AM HERE!” Your son stood atop of the bathroom counter, his fist raised and a triumphant snaggle toothed smile stretched across red blushing cheeks. A bottle of hair gel spilled out on the counter and an old relic of the past wrapped around his shoulders. The overhead light casted a deceiving shadow.
“I…” Trailing off a wide range of emotions spanning from solace to fear hinted disappointment flooded all at once. Eyes watered, yet never spilled over. The breath you held deflated.
“Don’t I look cool mom?! I look just like him! I look just like All Might!” He beamed. Turning back to the mirror to flex his small arms, striking another one of All Might's signature poses. “I can’t believe you have this! Is this really his?” His hands gripped at the fabric of the cape. The material swallowed him completely, flowing from his tiny shoulders to the floor. You had not seen it in years, not since the move.
“You...” Swallowing the lump in your throat and blinking away unshed tears, you approached. Standing behind him, your heart pounded against your chest, ragged and unsteady beats. Struggling to find words, mouth opening and closing yet no sound escaped. Voice cutting out, crackling into a depressing croak.
An everlasting symptom of that treacherous day reared its head once more. When overly emotional or speaking for too long strain on the scarred vocal cords caused them to lock up, trapping words within. Akeno’s brows furrowed, joy faltering.
“Momma?” Seeing his shifting mood sour hands quickly adjusted, signing in boisterous movements
‘You look so totally awesome, Akeno!’ His eyes stared at the signs reflected in the mirror before going wide with exhilaration, smile returning brighter than before. In one swoop your arms wrapped around his tiny waist in a tight hug. The little boy giggled in delight. With what little strength you retained you held him off of the counter, flying him around the air. Despite the burn of strain inside your abdomen and the sting within your decaying forearm muscles; you could not help but laugh with him.
After laying him to bed for the night you quickly checked under your bed for a certain set of boxes. Thankfully only one had been disturbed. Looking inside the now empty package you could still smell a faint hint of Toshinori’s cologne stained into the cardboard.
You did not have the heart to throw nor give away his cape once realizing it had accidentally been packed in your hasty retreat. The tears you had wiped away earlier returned, unabashedly spilling as stifled nostalgic memories resurfaced.
“Sorry I’m late dear. You know how it is.” Shuffled footsteps trudged through a darkened bedroom. Flipping over your met with the silhouetted figure of Toshinori, thinned fingers unclasping his cape before, In vain reaching for the zipper. Losing it in the folds of loose fabric. A small chuckle roused from your drowsy form.
“Here, let me get it.” Moving to the edge of your shared bed he turned, allowing you to unzip and undress the hefty costume from his thinning frame. Warm hands roamed the now exposed skin of his back, massaging the taught muscles beneath. Letting an exasperated groan his stiffened shoulder relaxed under nimble fingers.
“Thank you.” Humming in response digits curved upward, smoothing over protruding bones of his ribs, noting his subtle weight loss. Leaning forward to rest your forehead into the center of his back, the delectable scent of cologne still lingered on sweat slicked skin. If you had an ounce more of energy you’d fuss for him to shower, however as he turned to face you, and a hand delicately held your face within its palm all thoughts of reprimanding faded. His calloused thumb stroked at your cheek.
“Let’s go to bed.”
Together the two lovers laid within each other's arms.
‘ Maybe,
maybe I should tell him that I’m- No.
This… this was the only way.
It was the right choice. For both of them.’
Yearning for something that could never be again you stuffed the thoughts away, curling into yourself alone atop frigid sheets the phrase repeating itself.
‘This was the right choice.’
Yet it offered no reassurance.
You lied once more when your son awoke. Telling him that the cape unfortunately was not actually one of All Might’s. Instead, it was a surprise birthday gift you had bought him from a local shop. That he could keep playing with it if he was good. A bit disappointed that it was not real, Akeno still loved it, promising to be on his best behavior. He even slept with it like a blanket. Never questioning the fact that his birthday was over four months away.
Now nearing the age of fifteen Akeno had blossomed into such a handsome young man. Though, the older he became the more of him appeared. From the moment he was born with an almost translucent tuft of blonde hair you knew he would lean towards resembling his father. However, as he aged, face thinning over prominent cheekbones and jawline defining; he became the spitting image of Toshinori. A deep void of melancholy, yet also strangely a bit of pride surfaced at this realization.
As the years passed it was clear, he had chosen his path.
Just as his father and you had chosen, your child too dreamed of becoming a hero.
It scared you.
Terrified you even.
You were not the first nor would you be the last to be ‘killed’ in action. He saw the scars. How your voice crackled into stained tones, disappearing into nothingness. The endless hours of futile rehabilitation therapy. The way your body thinned from lack of fully functioning organs.
He saw the possible dangers, yet still dreamed of it.
And if this is what he truly wanted you would support him no matter what.
‘It’s what good mothers do.’
So, when on the verge of graduating middle school, and he came to you with a flyer from an all too familiar school you had to swallow your fear and agree to let him at least try.
“I like this kid's style. Just like me when I was that age!” Present Mic gushed, watching as this year's group of contestants fought through the first wave of robotic opponents. Only five minutes into the entrance exam and already Akeno had hit the ground running. Screeching his way through metallic foes in hopes of scoring enough points, he had already landed himself on the leaderboard.
All Might watched from his swivel chair, remaining silent, focused on his own protege. His new coworkers banter lost on inattentive ears.
“Looks like Mic’s got a favorite already.” Midnight laughed, her hands held up and over her head as she too watched. “He’s doing well so far, may even have a shot at passing. Though not sure any of us could handle two screaming blondes.” Now this snagged a bit of the symbol's attention.
His eyes flitted away from Midoriya’s screen, glancing to the other. Watching with bated interest until a small spark of familiarity struck within him.
‘Odd.’ He could not quite put his finger on it nor shake the sensation. ‘Have we met before? Perhaps on the train or maybe at a grocery store?’ No no, it was not that. If not that then where? What was it about this boy that stuck out to him?
Maybe it was the vibrant blond hair? It was not an uncommon thing, in fact some of the other contestants had wildly outlandish colored hair. Had he saved him before? Had he met him at a meet and greet?
He would have to ponder this another time. For now, his main concern was Midoriya’s lack of points. Retreating to refocus on his successor the test continued.
In the end your son had placed fairly high on the exam, landing him a guaranteed spot at UA. The decision was final.
You are going back to Japan.
“I’m not a child anymore mom.”
“I know I know, you're a perfectly capable young man. But I'm not about to let you move across the world by yourself.” Finished packing the last of your boxes, now awaiting for the international movers to arrive. Akeno leaned against the doorframe. “Besides, you’ll be living in student housing, so you’ll have plenty of alone time.” Turning to the disgruntled boy and bringing a hand up, you ruffled the top of his head. “But remember, I’ll always be just a short drive away!”
He sighed in defeat, eyes turned away from your hopeful smile. It’s not that he did not want you there, but that he needed to be sure his boundaries were set. He needed space to grow.
The entire flight you could not help but fidget with the hemline of your sleeved shirt. It’s been fifteen years since you’ve been back…
Would people recognize you?
You were in a different neighborhood, far away from your old house and even farther than the shared apartment. Yet Japan was only so big, hence the move in the first place, but surely after so long you would have nothing to worry about. Last time you were here you were in your mid twenties, now you are on the doorstep of fifty. With patches of gray, new wrinkles, more than a few scars, and gaunt thinning your appearance had become almost unrecognizable. But wha-
“Are you excited to be back?” Akeno had noticed your nervous movements, nothing lost to such attentive eyes. Taking out one of his headphones he turned to you. “I know it’s been a while.”
“Yes of course I am.” reaching a hand over, you placed it over his atop the armrest, squeezing the larger palm.
“Care if I listen too?” You could hear the cello thump as the beginning of Madame Butterfly chimed through his headphones. He smiled back, even if he could sense the unwavering unease and the blatant fake smile, he said nothing, handing over the removed bud.
The two of you hummed quietly to music until the moon overtook the sun. His head lolled down atop your shoulder as sleep overtook him.
No matter how old he got or how grown up he was he would always be your sweet boy.
“There, this should last you the week.” Packing the last of the homemade bento boxes into the fridge you had made sure to wrap each one in your signature bunny eared bow. A significant downscale compared to your usual outlandishly adorable packaging. “I made your favorite.”
“You do know that they have a cafeteria, right?” Scoffing at Akeno’s remark and standing from bent within the refrigerator your eyes steeled.
“Oh, so you don’t like your mothers cooking anymore huh? Guess I’ll have to eat this all myself.” Reaching back, you began taking the packages out.
“NO! Please! I was kidding! I love your cooking mom. Please leave it.” Panicked eyes widened and a bottom lip quivered in a desperate plea. A hardy laugh pushed through teasingly smirked lips.
“I suppose I’ll let you keep it.”
“Thank you!” Your son's voice returned to its natural cheery tone. Though higher in pitch, alighted with excitement. “Mom there’s something I have to tell you”
Your eyebrows rouse, quickly leave the small kitchenette to join him on the couch. His eyes locked onto yours, swimming with childlike admiration.
“All Might is going to be one of my teachers!” He beamed a wide toothy grin, almost a mirror of the aforementioned hero. You mentally felt yourself deflate like a popped balloon, exhaling as if all the wind had been knocked free. “ Isn’t that awesome?! ” He let out a boisterous laugh.
The smile, the laugh, the hair and those big blue eyes. He truly was the spitting image of that man. You felt weak, hands wet and clammy, stomach turning with queasiness, heart thumping against your chest.
“Mom? Are you okay?” Snapping out of your daze you quickly put on a brave face once again, taking a deep breath and nodding.
“Of course I am! I’m so happy for you ho-'' Your voice chipped and shattered, becoming a harsh croak. Moving to sign the remaining. ‘I am very happy for you! Tell the big man I said hi!’ His eyes tracked each symbol, smile never faltering, used to the use of sign language throughout the years he rejoiced at your admiration with a laugh. Joining him in his laughter, even though yours was nothing more than rushed air and out of nervousness.
“I’m finally going to meet him!”
Today was the day. Akeno's first day of school. Though you weren't there to see him off you made sure to send him a lengthy text of encouragement.
Mom: Have an amazing first day of school my baby! High school is a journey filled with excitement, challenges, and countless opportunities. Please remember no matter what happens I’ll always be here for you! Remember to be yourself and have fun! Send me pictures in uniform!
In response all he had sent back was a thumbs up.
All Might stood behind a corner of a building, watching the first year students endure Mr. Aizawa’s quirk assessment test. Again, fearing for young Midoriya, he knew the boy had little to know control of the quirk he had bestowed upon him. Yet he remained hopeful.
What he had not expected was to find himself staring at another boy from the class.
It was the screeching kid that Mic and Midnight made comments about during the entrance exam that once again nagged at his curiosity. He felt something indescribable when looking at the boy. The familiar feeling from before returned with a vengeance. Scrambling through hazed memories, he again tried to place the boy within the vast archive.
“Akeno, it’s your turn.” Aizawa instructed the class to throw the ball as far as they could using their quirks. Simple enough, several other students had already gone, one even managed to score an infinite. Picking it up, Akeno wound his arm back and launched it. Quite average in all sense of the word, yet midair at its peak his mouth opened, and the sheer wind power behind his yell propelled the ball soaring through the air; Higher and higher until the sound waves could no longer carry it.
‘Oh’…
A shiver ran cold down his wide muscular back. The pitch entered his ears yet sank like a rock in his stomach.
‘Just like her.’
God Damit he could not do this right now.
These ridiculous thoughts brought him nothing but heartache and were quickly shoved into the overflowing filing cabinets inside his mind. Hopefully lost within the jumbled mess forever. It had taken the better half of three years to finally put a lid on the pandora's box that once was you. To backslide now was out of the question.
Rationalize.
Quickly erasing the correlation from his mind with the same cold hard truth he had to continually tell himself anytime a memory of you resurfaced; You were dead .
‘Vocal quirks are not a rare occurrence. This boy was not you. In fact, he looks more like…OH! Stop it Toshinori’ He mentally slapped himself. ‘Focus.’
It was Izuku’s turn to throw the ball. A perfect distraction and an opportunity for his ludicrous mind to get a grip.
Amazed by his pupils' success, the threat of his psyche collapsing was stabilized.
Lunch time had finally arrived, overworked and exhausted from their first half of the day each kid flooded the bustling halls. The first week finally reaching its midpoint.
“Can I sit with you guys?” Akeno stood before the trio, bento box in hand, admittedly he was a bit bashful at the thought of his classmates seeing the cutesy bow tied cloth covering yet his need for socializing trumped all.
“Yeah, for sure!”
“Absolutely!” Midoriya and Ururaka ever the kind and social souls smiled, scooting over to allow him to sit. Iida smiled and greeted his classmate from across the table.
The group made small talk, the main three discussing the woes of upcoming exams and the prompts of Mr. Present Mics writing assignments. Proclaiming that it was far too early to be assigning such tasks. Being the kind soul Akeno had grown into, he offered his assistance with the English class. Seeing as he was exempt from taking it due to already being fluent.
“Oh yeah, I almost forgot that you are an exchange student, your Japanese is almost perfect!” Uraraka proclaimed, eyes gleaming with curiosity.
“Yeah! For only living here for less than a month, your Japanese is amazing. I can barely even hear an ascent!” Izuku added, praising his friend. Questions of the states filled his mind. His mentor had made his debut in America, based all of his costumes and merchandise around their flag and even named all of his moves after its states. He too dreamed of one day traveling and experiencing its wonders. Storing his curiosity, he made a mental note to ask later.
“Well, my mom is originally from Japan. She’s been teaching me Japanese since I first started talking. It’s like second nature.” Akeno chuckled, a shy hand brushing down the spiky blond tips on his neck. Refocused on the topic of travel the group buzzed with excitement.
However as soon as Akeno unwrapped the ribbon and unboxed his bento the conversation steered in a much different direction. A mouth watering scent filled the surrounding area.
“That's so cute! Did you make it yourself? It smells so good! How did you get the fruit into such perfect stars?” Uraraka gushed at the culinary work of art that was her new friend's lunch. Even the grandeur that was offered via the cafeteria paled in comparison, nothing could beat a mother's love.
Again, you had toned down the cuteness of his lunches considerably since he was a child. However, that did not stop you from arranging it with as much passion as you could. It was simple, yet had protein, light carbs, healthy sugars and lots of veggies!
Akeno felt his cheeks redden. Not that he was ashamed, he was grateful to have a mother so caring however he’s a grown man now! And grown men don’t need bows or ribbons or star shaped fruit.
“My mom made it for me.” He mumbled, shying away from their surely scrutinizing gaze, they’ll think he's a sniffling little ‘mommas' boy.’
“Truly moving to see such a loving display!” Iida’s chest swelled with pride for his fellow classmate.
“Maybe your mom could make me one of those!” Uraraka laughed along with Midoriya
“She’s right, it does look amazing!” He agreed. Shocked, Akeno took note of his new friend's approval. He may have to ask a favor of you later.
Akeno loved each day of class, he thrived and excelled. His passion growing stronger yet. With the announcement of the UA sports festival on the horizon he readied himself to go beyond, ‘ plus ultra ’ as his idle, now teacher, would say. As the bell rang and Mr. Aizawa dismissed the class, he gathered his belongings and waited for his friend.
Himself, Iida, Uraraka, and Izuku had grown quite close. Always sticking together when it came to field exercises, study sessions and relaxing at lunch. Your son always came home boasting about how amazing each and every one of his friends were. It brought your motherly heart such joy to see him thriving.
As the halls emptied due to the final bell chiming the group chatted in a more serious tone. Uraraka had confessed that she wanted to be a hero for profit. Initially seeming slightly selfish, as she delved deeper into the reasoning the notion was rectified. Quickly reassuring her that she was noble for wanting to help her family, the group divulged their own causes.
“What about you Akeno, why do you want to be a hero?” Midoriya asked, curious as ever.
“My mom was almost killed by a villain; she was a hero too. I don’t remember much since I was just a little kid, but I know the pain she went through. The years of suffering she had to endure. It’s my life mission to never allow something like that to happen to anyone else!” The young man wore a face of pure determination, his chest swelled with righteousness and a smile stretched across his face.
“That’s an amazing reason Akeno!” Uraraka beamed, her cheeks swelled with pink, and eyes shined with admiration.
“Truly an exceptional motive, you have my commendation!” Iida bowed, truly inspired. Proud to be the class representative of such a dedicated and selfless individual. Izuku simply stared as the blond laughed and kicked out a thumbs up. Green eyes widening at the action.
“When you do that face you kind of look like All Might!” Uraraka chuckled, taking the words straight from Izuku’s imagination. Inside her mind images of the two blondes striking various poses together managed to tint her cheeks darker. ‘So cute!’
“She’s right! Could’ve fooled me” Midoriya laughed, though a hint of nervousness laced the chuckle. The more he looked at his friend the more he could see his mentor in him. A flitting image sparked in his mind, though was overshadowed. ‘Strange.’
Akeno simply laughed with them, happy to be compared to his idol.
“Today we will be practicing search and rescue to prepare you for your visit to the USJ simulation. Just the basics as we’ve discussed over the week.” The under enthused tone of Mr. Aizawa droned to the antsy group of young heroes before him. Laid out before them was a near perfect replica of Jaku City. However, the once proud standing skyscraper lay in disarray. Debris and rubble littered the streets. “Scattered around the city you will find several victims; your goal is to safely remove them from the situation without traumatizing them.” shooting a glare toward his most bain student the simulation commenced.
Racing into the disaster the trainees began implementing their teachings. All without a hitch until a young boy was discovered. Screaming and flailing away from any physical contact he laid inconsolable.
“Hey little guy, it's okay. Everything will be fine, com-” As Deku attempted to approach he again cried out slinking away as a gloved hand reached for him.
“I don’t know what's wrong, he won't respond to anything we say.” Confused and afraid of failing, Momo began to panic. Running to the group, Akeno assessed the situation.
While inspecting the child from a distance his eyes landed on his hands. Small nubbed pointer fingers extended and repeatedly jabbed together. Recognition flashed through his mind. Crouching before the boy, making no attempt to touch him, he waved. Red puffy eyes looked at him and again fingers jabbed together. Akeno’s gloved hand raised, his pointer finger zig zagged in the air and replicated the child’s jabbing motion, ‘where does it hurt?’ Recognizing the signs the boy pointed to his leg. With one palm flat and the other in a thumbs up position atop it Akeno moved it towards the child, ‘let me help you.’ Sucking up his sniffles the child nodded, arms extended out, allowing the hero to pick him up.
His fellow classmates watched in confused awe.
“What was that?” Ururaka inquired as the bell chimed, signaling the end of the simulation.
“He was signing ‘pain’. I just asked him where he was hurt and that I wanted to help him.”
“You know sign language too?”
“Ha yeah, another thing my mom taught me.”
The young man had a surprise for his friends.
You had agreed to make them lunch! How could you resist such an offer?
‘It's what a good mom would do.’
Though it came at a cost. Defiantly holding the bundle of boxes above your head your face held determination.
“If you want it, make me give it to you.”
“Mom! You know I'm not good at this”
“Only way you're going to get better is if you practice, ya know it took me years to perfect it!” You countered, if he had inherited your quirk, it was almost for certain he too could use ‘the command’. Just had to concentrate. Besides, if he truly did not want to try, he towered over you, making it easy to simply take it.
Staring at the bag he focused, breathing in deeply his first attempt a near whisper.
“Did you even activate your quirk? Try again.”
“ Hand me the bag .” Loud sound waves nearly had you dropping it, not out of command but from sheer force pummeling your ear canal as he screamed it.
“Nuh uh, that's cheating. Look at me, focus. Take in the surroundings, feel the air move through your vocal cords, find the right pitch and push the sound into my ears. Again.”
“ Hand me th e bag” Fog overtook your vision for a few seconds, regaining full consciousness you saw both hands extended towards him. Yet the bag still remained firmly in your grip.
“Close enough! Good job Akeno” Dropping the package into expecting hands the boy scurried off. One day he’d master the ability, just needed time and practice.
As the lunch bell rang Akeno called out to the trio, having the group gather around his desk. Reaching into his backpack he pulled out the treasure.
“NO WAY!” Uraraka held her own personalized bento box in hand, your son had mentioned her favor of pink, and you couldn’t help but run with it. An adorable checkered pink fabric covered the box with an elegantly tied bow.
“Thank you so much, please tell your mom I said thank you!” Midoriya’s was of course wrapped in green.
“From me as well!” Iida’s was a beautiful shade of blue.
As the group happily strolled to the cafeteria a looming figure waited before pouncing out from behind a corner.
“Young Midoriya! Would you like to have lunch with me?”
“Uh well, thank you All Might but I-” A firm punch to his arm cut the nervous boy off. Akeno stared at his friend, an eyebrow raised and eyes wide.
“You cannot pass up an opportunity to have lunch with All Might!” He forcefully whispered.
“But your mom-”
“Don’t worry about it!” Sighing in dejection he agreed before rushing to his mentor's side and waving goodbye to his friends. He’d have to properly apologize for missing such a special lunch afterwards.
Sitting across from his pupil All Might skeptically eyed the elegantly tied box. As Midoriya began unwrapping it Toshinori felt a deep pang of nostalgia. From the layout to the smell, even to the encouraging message on the sticky note it felt all too familiar.
“Hey! You forgot your lunch, so I thought I’d swing by to drop it off.” Standing in the doorway of your once shared office with a wrapped box of bento you stared over the mountainous stacks of paper to your beloved blond. “I was wondering if you’d like to share it with me?”
Darkened hues glanced up from their sheet, only for a few seconds before returning to his work.
“Thank you, but I’m a little busy right now.” Not yet defeated, you approached the desk.
“I could help you out if you want, I don’t mind.”
“No, it’s fine. Besides I think Mei is all caught up with your work, no need to stay here all day.” Mei, a name you had come to regard with disdain. The woman he had hired to help ‘ease your workload’ brought a bitter taste to your tongue.
“I could wait until you’re done.”
“I won’t be done for a while, please go back home love. I’ll be back later tonight.”
With lips drawn tight and eyes swimming with animosity you exited, not another word shared.
An agonizing growl of hunger hours later finally forced himself away from the still looming stack. Opening the box and bristling in delight at its aroma he scarfed down as much as his decayed stomach could hold. Placing the lid back atop the container his heart ached at seeing the message scribed sticky note attached.
‘Don’t work too hard! I love you! ’
Truth be told Toshinori did not want you to leave, longing for nothing more than to enjoy the meal together. Yet the ever surging rate of crime due to his limited time left him breakless, charging full steam ahead into his work. Darring a glance to his computer's clock, more time than he had anticipated flew by, 11:42pm.
‘I’ll make it up to her.’
He never was able to.
“Where did you get that?” His voice low and graveled, baritone edging into a bass. Shadows darkening overhead, concealing steeled blue.
He knew it was foolish to relish in such nostalgia however, if he must be plagued, he was at least grateful it is of happier times.
“Oh, Akeno’s mom made it for me. She made all of us lunch!”
‘Akeno’s mom?’ The older man pondered. ‘ Who is she? What does Midoriya know about this woman? What is her name? W- STOP. This is pathetic. It’s just a bento box. Anyone can cook katsu.’ Clearing his throat he nodded.
“That was nice of her.”
Folding a freshly dried pile of clothes you sat within your living room, absentmindedly listening to the local news reporter drone on about the most recent activity within the city. However, the flash and sudden switch to a different reporter piqued your interest. Placing the shirt down and adjusting the volume, pure horror sparked as realization of the man’s words took hold.
“Breaking News: There is said to be an active villain attack at UA’s training facility the U.S.J, Class 1-A students are trapped inside!”
Teleported via warp gate Akeno found himself plummeting into the ocean biome. With only a brief second to grasp the situation he inhaled and braced for impact before diving into the treacherous waters.
The sting of salt blurred his vision yet through the blur he managed to catch the movement of a finned fist, miraculously dodging he struggled to notate his surroundings. Spotting a green blob floating just below, he hoped his assumptions were correct on who it was. Propelled by sound waves he pushes the foe away and himself closer to his classmate. Grabbing ahold of him Akeno releases another shriek thrusting them further away from the swarming thugs.
He cannot keep this up.
Lack of oxygen was beginning to take hold; dots spotted his vision. Despite the burn within his chest, he pushed himself to go further. Finally reaching something solid and using the last gusts of air within his lungs he again propelled them. Rushing upward, they broke the water's surface.
Crashing down onto the hardwood deck Akeno hacked, choking on air, desperate to soothe the burn deep within his chest. However, the gurgle of trapped water prevented any mediation. Even with air all around him, It felt as though he was drowning. His chest felt encumbered. Panicked Midoriya gripped his shoulders and turned his friend onto his side. Rubbing and pounding at his back, finally liquid sputtered out with each cough.
“Is he okay?” Tsuyu emerged from the water, leaping onto the ship, tongue wrapped around a squirming Mineta.
“We need to get out of here, he needs a doctor.” Listening to his friends' short shallow breaths sent Izuku’s mind ablaze. Though he had successfully forced most of the water out, residual liquid still crackled within.
Scared for not only his but also his friends' lives, they needed a plan.
“The pros will save us! Right? They’ll come and beat these guys up and we’ll all be safe.” Mineta panicked, the weight of the situation finally dawning on the perverse trainee. Conversing over exactly what had been said during the initial attack coupled with the situation, Tsu and Deku both knew waiting for the pro’s was not an option.
“We have to stop whatever these bad guys are planning!”
Realizing the flaw in the villain's thwarted plan Midoriya formulated a course of action. Wrapped within Tsu’s tongue and flung through the air via the force of Midoriya’s flick, the group managed to fool and evade the attackers.
Following the shore to avoid the peering eyes of foes swimming closer to the main plaza the exit was within sight. Akeno’s body trembled within his classmate's grasp, struggling to stand, and barely holding onto consciousness. Mr. Aizawa’s battle raged on, their teachers' struggle growing louder as the group approached.
How much longer would he hold out?
A sickening crunch echoed as a monstrous beast's fists crashed down onto their teacher's defeated body, his arms twisting into splintered fractures. Fear spiraled down their spines as the young students could do nothing but observe.
“I can't watch this anymore.” Tears streamed down Mineta’s face as he clutched both hands over his mouth, trying not to puke at the gruesome sight. “We should be getting out of here super fast shouldn’t we?”
Horrified Midoriya glanced from his beaten teacher to his half conscious friend. The once confident persona adopted for escaping the ship now shattered. Internal conflict had him paralyzed.
‘To be a hero you have to put others above yourself.’
The mantra repeated itself over and over within his head. Though, what was he to do now? Two people needed him: Akeno and Mr. Aizawa. They were both in life threatening condition.
Yet… he could not bring himself to choose which one to try to save.
“Oh, before we leave. Let's make sure the symbol of peace is broken.” In an instant the main villain lunged, barreling straight towards their group. “Let's make this hurt! You look too much like him, disgusting. Don’t worry I can fix that.” With a palm extended he advanced, mere centimeters away from Akeno’s face. The group's breaths stalled within their chest, unable to move...
Yet, he stopped, halting dead in his tracks.
His once hate filled eyes glossed over, the red hue now dull and empty.
Mouth agape in shock Midoriya looked to the boy that clung to him.
Akeno’s head was up, his eyes staring towards the villain, mouth moving yet the words inaudible.
“Leave us alone.”
Hushed whispers rushed through the air, directly to their target. Forced in and demanding obedience the command took hold.
Backing away the villain retreated, up the stairs in a disconnected stupor until reuniting with the warp gate.
“What the hell was that!” As Shigaraki’s senses returned, anger boiled within his voice, eyes wide and fingers digging into the skin of his throat. Nails raked over the bloodied irritated skin. “No, no,no,n-” The slam of once sealed doors drew his attention away.
The man they had been waiting for finally arrived.
“Have no fear students. Why? Because I Am Here.”
Faster than the puny thugs could process, All Might swung into action. At last, the young heroes' fears came to rest as they watched the world symbol of peace dispatch of each and every evil doer within his path. Crossing the battle field within seconds he swiftly scooped a beaten Aizawa within his arms and grabbed the group of frightened children. The jarring motion of being flung around sent Akeno into a fit of hacking. His body heaved against the muscular arm, blood splattering against the white button up.
Seeing his colleague and student so injured fueled Toshinori’s already raging inferno. Gritted into a tight frown, his teeth ground together.
‘I should have been here; I should have protected them.’
“Everybody back to the entrance, take Aizawa and Akeno with you. They don’t have much time.” Again, plagued by indecision Izuku again looked between the injured men then back to his mentor. His intuition screamed for him to stay and help All Might, to fight by his side. Based on what Thirteen had indicated before training All Might must be near his limit, leaving him vulnerable. Yet his heart yearned to get them to safety.
Once again, the decision was left in his hands, who does he try to save? Taking notice of his prodigy's indecision, All Might addressed him.
“Young Midoriya! I got this!”
“Right.” At his master's words, Izuku tightened his grip around his classmate while Tsu held Mr. Aizawa, they ran away. Not fully assured the nagging thought of being the soul bearer of All Might’s limit and the danger truly at hand made up his mind. Seeing other classmates racing down to the exit he laid Akeno down.
“Tsu and Mineta, take Mr. Aizawa and Akeno to the entrance, I have to go back.”
“What? Are you crazy? We can't hold both of them! Besides All Might has this handled, we have to go!” Before the grape themed trainees' words even registered, Deku ran past them and back to the ensuing fight.
The battle with the monstrous ‘Nomu’ had the man exhausted. Barely clinging onto his mighty form, All Might’s body trembled in exhaustion. All he had to do was stall and keep up the mirage.
Shots firing and the overly jovial voice of principal Nezu signaled his relief had finally arrived.
“I'm sorry ma’am but I can't let you in. The school is under strict lockdown procedures!” The police standing guard in front of the gates had attempted several times to reassure the grief stricken woman into leaving. Yet you refused.
‘You have to! My son was in the attack! He could be hurt.’ hands quickly signed, yet they could not understand nor make an attempt to. Growing agitated they ordered you to back away. Even when attempting to mouth words of reason their resolve stood firm.
The crackle of a speaker and flicker of a screen caught their attention. A small mouse-like creature's face lit the device. Principal Nezu’s beady eyes and smile stared down to them. His paws placed one over the other, a steaming cup of tea sat atop his desk. Analyzing the situation with a sip of his beverage, he addressed them.
“You must be Akeno’s mother. Please come in.” Metal unlocked and the screech of a singular entrance opening rattled through the once impenetrable wall of steel, an elderly woman stood within its threshold. Her wrinkled features offered a warm smile, as she ushered you in. Despite her cheery attitude the cloud of despair that formulated upon hearing the news refused to dissipate.
You needed to see him, to know that he was okay.
“Right this way dear,” Leading you down the winding corridors, her syringe shaped cane clacked against the tiled floor. Its steady rhythm a direct contrast to the thunderous beat of your heart. Stopping just outside a door labeled as the infirmary your anxiety overflowed. Eyes watered as tears gathered on the rims and a few slipping by.
Gesturing for you to wait she sighed, “I healed him as much as I could, but the boy needs rest. He almost drowned today.” Wiping away the tears you nodded, attempting a brave face yet your mind swam with regrets.
‘He almost drowned? Almost died?! … We've been here less than two months and already he's had a brush with death. Was allowing him to come here truly for the best? What kind of mother am I for willingly putting him in danger? I knew the risks. How could I allow this? How could I…’
“Come.”
Half of the room had been sectioned off by drawn curtains, blocking the other patients from view. Light whispers shared between the two males fell silent once you had entered.
Upon seeing Akeno false bravery slid away and tears fell once more.
Rimmed with darkness his eyes remained closed with heavy breaths as he slept within the white sheeted hospital bed.
‘My baby’
Toshinori and Izuku laid beyond the thin curtain wall, both watching as the silhouetted woman stood before her son.
A shadowed hand reached for the boy, tenderly stroking his cheek before her head bowed to rest against his. Rushed breaths and sniffles indicated her distress as she wept.
An endless pit of anguish at both the situation and himself opened within the older man's heart. Sighing he looked away from the scene, up towards the white ceiling, and an unbandaged arm fell over his eyes. Afflicted by guilt any curiosity regarding the young man's mother vanquished, weighed down with the burden of responsibility.
“I should have been there sooner.” His voice barely above a breathed whisper, more so a taunt to himself. Yet within the otherwise silent room it carried through.
Your sobs stalled for a mere millisecond as recognition sparked fear into your aching heart.
You could recognize Toshinori’s voice anywhere.
‘Not here. Please not here. He can't be here. Not now.’
Trying to muffle the ragged sobs your body struggled to stand. Hunched and breaking you held your son's hand, squeezing it tightly to stay grounded. Heartaching for both the man beyond the curtain and your beloved child, your mind felt hazy, far too many emotions swarmed within.
“Ma’am?” An unfamiliar voice called out to you.
Peeking his head out from behind the curtain walls, Izuku had forgone Recovery Girl’s orders. Saddened and riddled with his own guilt he felt compelled to speak to the grieving woman. Your back remained turned towards him, yet your head lifted slightly in acknowledgment. “Akeno saved my life. He protected me and our classmates. You should be proud of him.”
‘Proud that my son almost got himself killed? Proud that I allowed him into this lethal field? Proud that my son… saved people?’
For a split second your head turned, facing the boy. ‘Akeno risked his life to save him?’ A bittersweet smile splayed across quivering lips. Izuku’s eyes widened, recollection though brief flashed within his mind.
You looked familiar…
Mouthing the words ‘Thank you.’ you turned back.
“I thought I said rest!” Recovery Girl had returned. Infuriated to see her patient in direct violation of her orders, her cane raised ready to wallop. Slinging the curtain back into place Izuku rushed back into his bed, though his mind swirled in confusion at what he had seen, or at least what he thought he saw. Recalling his stockpile of memories in an attempt to place exactly where he recognized that woman from, However, the after effects of Recovery Girl's quirk had his eyelids heavy. Dropping down, mind clouded and unclear sleep took hold before he could reminisce further.
Sitting beside your son's bed you awaited his awakening despite the ever looming presence of a man you had vowed to forsaken mere feet away. Azure eyes opened, hazed and confused they glanced around the unfamiliar room before locking onto you. His mouth opened yet only strained groans escaped. Blond brows furrowed as he continued to struggle, croaking crackled words. Quickly raising your hand you signed;
‘Don’t speak, you’re hurt.’ Nodding his own hands rose from under the sheets.
‘Did we win?’ A silent airy laugh escaped your lips, tears long since dried out. Rubbing his forearm with a soothing hand you comforted him with a nod.
Though the lighthearted mood soon turned stern.
‘You almost died, Akeno.’ Eyes downdrawn he stared at the white bedding. Hands fidgeting for a few moments, desperately trying to find the right words, until they steadied. Blond brows furrowed and lips drew into a tight line.
‘I did what I had to. To protect my friends.’ Sighing, you bent down, kissing the top of his forehead and ruffling a hand through his wild blond locks. Wrapping his arms around his mother the two embraced.
‘I know and I’m proud of you.’
49 notes
·
View notes