Two days

The first day

If the number of hours that the average believer prays for himself and his loved ones was stacked-up against the time spent praying for world peace and an end to hunger, which stack would be higher? It was a funny question to wake up to, but it’s the one I had after a horrific night last night, a night spent, frankly, looking forward to death. I thought I would have beaten this broken back problem by now—just as I once thought I would beat my shoulder problems—but this is the two month anniversary of my fall, and Im nowhere near well, and it scares me so much that I’ve shed tears over it, this being the first time in my life that I cried because I was afraid.

In America, at least, when you complain of pain to whomever you see before you see your doctor, you’re asked to rate it on a scale of one to ten with ten being the worst pain imaginable and none of the other numbers being defined. If you ask your questioner to define the difference between, say, a pain level of four and a pain level of six, what do you think she (it’s always a she) will say? “Well, six is two points worse than four.” The query becomes a game in which the patient tries to guess which number he needs to give in order to have his problem taken seriously while avoiding any suspicion on the doctor’s part that he might be exaggerating. I realized last night that I’m no longer going to answer the question because it’s bullshit, and I’m sick of bullshit. I put up with way more of it than would seem necessary, and I’m sure you do too.

I prayed last night—my situation being that desperate—not to some supernatural entity but to a place within myself that I used to visit when I needed guidance, but the existence of which I have come to doubt. My prayer went, “Wisdom be in my head, and in my understanding. Wisdom be in my eyes, and in my seeing. Wisdom be in my mouth and in my speaking. Wisdom be in my heart and in my thinking. Wisdom be at my death, and at my departing,” these being close to the words that I loved when Father Hale said them every Sunday at Redeemer Episcopal forty years ago. Last night, they came from my lips like a stillborn baby so decayed that it disintegrated in the hands of the midwife. I was shocked, even horrified. I had expected little of good from the ancient words—a momentary connection with peace, youth, health, safety, community, idealism, and the beauty of morning light through stained glass, perhaps—but I didn’t foresee disgust, and it hurt me to realize how hardened Ive become. I’ve tried to hold, at least metaphorically, to that which I once found beautiful, while gently letting go of the ugliness, but I have failed.

Then a song about heaven (from my fundamentalist childhood) came to mind, but I can’t remember which one. Christian music touches me more than spoken prayers, even really old and quaint spoken prayers like the one I had just said. Who wouldn’t want to go to a place where everyday is a picnic with your loved ones in resplendent surroundings? Singing holy, holy, holy forever-and-ever-and-ever might sound like a complete bore, but having your every dream realized would be okay, or at least I thought so when I was a child who loved to run for joy well past dark and had no desire whatsoever to “get things done.” Like the pain scale, church is a game with serious overtones, or at least it became that way for me. As for how it affects other people, I can only take their words and compare them to their actions, and on that basis, church appears to do more harm than good.

Of course, that is religion. God is another matter. I don’t know why I think about God more, I suspect, than almost anyone who believes in God. I have often said that I too would like to believe in God, and so here I stand, ripe for conversion, so convert me. Show me the error of my ways, so that I too can hold a happy view, a view that gives meaning to a life of pain, a life from which I will be extricated within twenty years or so as if I had never lived, all this pain for nothing, and with the sure knowledge that nothing I did in life will have mattered except to a very few people who will also be dead soon if they’re not already dead. Like the believer, I would like to wake up in the morning to see God peeping lovingly through my window, instead of awakening to a universe of insensate matter and energy that rumbles through the hallways of time and space, knocking against one another for no reason while creating and destroying an endless succession of worlds in the cold, dark void of space. All I ask is that you make your God consistent with the facts. Not a perfect God who nonetheless created an imperfect universe and was forced to die so that he could forgive its imperfection, but a God who provides answers rather than provocations, a God who is both worthy of worship and consistent—as opposed to oxymoronic—with reality. 

The next day

Yesterday, I became so desperate to escape the pain and fear that I put on a great big Fentanyl patch (big for Fentanyl is about an inch square), and it left me wide awake and deliriously happy last night, not every moment of the night, but most moments of the night. How am I to wrap my mind around the fact that the things that I think make me happy or sad have no power except inasmuch as they stimulate various parts of my brain, and that no person or event can stimulate those parts quite so profoundly as drugs? I love nothing and no one like I love Peggy, yet even my happiest moments with her are accompanied by the crushing knowledge that, before too many more years, one of us will die and leave the other alone. After enough Fentanyl, I can say with the apostle:

“Where, O death, is your victory? Where, O death, is your sting?”

Drugs make the universe into a toy that was put here for my pleasure. Why then, am I not an addict? I don’t think I have any choice in the matter. Flip one chromosomal switch, and I’m one way; flip another, and I’m the opposite. Maybe this is why 5% of people are atheists, but even if we’re right about the irrationality of theism, how much credit can we take for our insight? 

Brewsky was behind me as I finished this post, so I took his picture. As you can see, he is sitting on a small ladder, and, yes, I have been using that ladder as well as the ladder that I fell from two months ago. I re-floored and repainted this room just before my fall.

How like Nigeria

I know a former missionary to Nigeria, a country infamous for its Internet scams. She describes it as a land in which honor is nonexistent, money counts for everything, and people learn to cheat one another from the cradle. I didn’t believe her because, as I imagined, societal cohesion depends upon trust more than law, so if you create an environment in which no one can trust anyone, you destroy the possibility of a cohesive society. She stood her ground, saying that the kind of greed and manipulation that people in this country associate with the worst of the worst—Wall Street bankers and hedge fund managers—is status quo in Nigeria where to be honest is to be a sucker. I’ve since come to wonder how different America is from Nigeria. I’ll outline the reasons for my concern by sharing a few news items and personal experiences from the past couple of weeks.

1) The number of people imprisoned in the US has risen by 800% in the past 30 years making us the world’s leader in locking up our own people. One reason for the increase is that US prisons have increasingly come under private management, and before a company will agree to manage a prison, the government must agree to maintain an occupancy rate of 90%. Rehabilitation hell! We need people in prisons, or at least Prison, Inc. and the government officials who negotiate the contracts do, and they’re the ones in charge. Why else would 60% of the prison population have been locked away for non-violent crimes?

2) Next month, I’ll be eligible for Medicare, which is government-run health insurance for people who are old or disabled (taxpayers pay into the system throughout their working lives in order to benefit from it when they need it). Because Medicare isn’t sufficient to keep a person from going bankrupt due to medical expenses, the government works with private insurers whose job it is step in where Medicare leaves off. There are dozens of these insurers, and they offer dozens of different plans that cover various things and include various extras. Determining which insurer and which plan is best is impossible unless you have a staff of lawyers who are versed in alphabet soup and willing to read through one 150-page policy book after another, each of which is meant to defy comprehension. Why, if the goal is to provide health care to those whose minds and bodies are growing weaker due to age and/or disability, doesn’t the government create a simple system under which the policies of these private insurers can be easily understood and compared or, better yet, eliminated altogether? My guess is that such a system would defeat the goal, which is to make money for private insurers.

“But why, you might ask, does the government care about making money for private insurers?” Because those insurers provide politicians with massive campaign contributions, expensive gifts, and private sector sinecures. But why does selling incomprehensible insurance policies to Medicare recipients enable insurance companies to make more money?” Because it eliminates cost-versus-quality competition. It’s like when you go to buy a mattress, and every store has a different name for the same product. By making it impossible for customers to compare prices, stores can compete on the basis of window-dressing rather than cost or quality, and this means more money for everyone, except the consumer. What makes this obfuscation especially immoral in the case of Medicare—and keeping people in prison—is that it harms those who are the least able to protect themselves—the ignorant, the impoverished, the mentally challenged, and the taxpayer.

3) There was a time when only loan sharks charged 30% interest, but the fools didn’t know enough to buy the government so that they could do it legally. Who do you turn to when you can’t pay your medical bills or you’re facing foreclosure? Chase and Citibank are there for you when you think things can’t get any worse, but what happens when things do get worse, when the medical bills keep coming, the bank keeps threatening your home, and you can no longer use your credit cards to juggle your bills because you can no longer afford the minimum monthly payments? Maybe it’s the time to remind yourself that America is “the land of opportunity,” the land that every politician calls the fairest, the most generous, and the most compassionate nation on earth?

4) When the bills came in for my latest round of physical therapy, I noticed that I had never once received what I was charged for—entire series of 15-minute ultrasound sessions, 15-minute manual manipulation sessions, 15-minute exercise sessions, and 15-minute cervical traction sessions. When I finally found someone other than the therapist to complain to, he responded as follows about Oregon Medical Group’s billing policy: “…the Physical Therapist can provide anywhere from 8 minutes to 22 minutes and bill for 15 minutes of therapy.” No session ever ran over 8 minutes.
5) Reminisce Magazine. Its writers receive no compensation for their stories and photos, and the company that owns Reminisce owns a slew of other quaint publications. Peggy likes Reminisce because it takes her back to the ‘50s when she believed her parents could protect her from serious harm, when—as she remembers it—people were kind and noble, and America was admirable. I want Peggy to have a magazine that brings her such joy, and I wish in retrospect that I had kept its ugly little secret to myself, its secret being that, as soon as you subscribe—and Reminisce encourages its readers to subscribe for years at a time—it starts sending renewal notices that begin with “This is your last chance to keep Reminisce coming…” but don’t give you a clue as to when your current subscription expires. Like most cheats, Reminisce preys on a vulnerable population. 

6) But what of the rest of us? Is it even possible to be an ethical American? I’ve focused on those who get rich by hurting people, but what of the millions who work as cogs in the rich people’s wheels, the ones who staff the magazine subscription centers; who administer the “Medicare Advantage Plans;” who work in the prisons; who turn people away because they can’t afford medical care; who, in order to have a secure retirement, invest in companies whose policy is profit before all; all these plus the 300-million people whose taxes finance America’s wars and war crimes, its profit-driven destruction of our environment, its arrogance, its greed?

That which I wondered about Nigeria, I now wonder about my own country. What cohesion binds a nation of people who equate morality with doing the legal minimum, who elect conservative politicians for the purpose of abolishing such legal protections as still stand between big business and the consumer, and between the patient and the healthcare industry? How far do we have to go before we’re like Nigeria, and what will be the cost when we are? I think Peggy is right about the old days in that, despite some significant human rights gains, too many of the gains America has made have been technological, and too many of the losses have been in such areas as trust, idealism, and community. Pay attention to the news and current culture. Look at the filth that is on TV; observe the isolation of people on cellphones; note the abuse that is commonplace in Internet discussion forums; listen to the venom of talk radio. Things which once would have been unspeakably rude, tacky, vulgar, trashy, mean-spirited, greedy, self-abasing, and self-centered, are now the norm. The biggest difference between today and much of my life is that Americans used to be optimists. Even during the darkest days of the ‘60s, the feeling was that positive change could and would come. When was the last time you heard anyone but a politician say that? 

I know that this post proves nothing, but for those of us who remember an era when houses were seldom locked and bicycles didn't even have locks, experience means a lot, and twenty years of dropping crime rates matters but little. I pity those who have never known this country to be any way but what it now is because, despite its former faults, there was a time when I could say with a straight face that America stood for that which was good.

My doctor, my friend?

“Don’t you feel violated?” Peggy asked when she saw the bill, $250 of it for glancing up my nose.

I feel violated every time a doctor’s bill comes, but $250 for a ten second glance up the old snoot does give the phrase pay through the nose a whole new meaning. The average medical specialist makes more money for the few minutes that he spends with the average patient than a minimum wage worker makes all week, and more than what most everyone else earns all day. American doctors make nearly twice as much as doctors in other “developed nations” (see first graph), and their fees are increasing at seven times the overall cost of living, yet America is falling further and further behind in life expectancy (see second graph) and nearly every other measure of quality care. Over the past several weeks, I’ve felt cheated by six doctors and a dentist (I paid $520 last week for two small fillings that took 25 minutes total), and it doesn’t set well. In fact, I’m enraged. I mostly get along well with doctors, but it isn’t because I respect them, but because I want to get the best service for the least aggravation. Besides, they would charge me for the time I spent complaining that they overcharge.

Doctors argue that they deserve their inflated salaries and more too* because they went to school for a long time, but doctors in other countries go to school for a long time without feeling the need to charge so much that millions of people (most of whom have insurance) can’t afford them (“In 2013, 37% of U.S. adults went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs, compared with as few as 4 percent to 6 percent in the United Kingdom and Sweden. **) “Only in America, land of opportunity…”  Yes, only in America, a nation that considers it no more immoral to deny someone medical care than to deny her a yacht.

Regardless of what a few politicians might say, under the value system by which America lives, whatever you can afford, you have a right to, and whatever you can’t afford, you don’t have a right to. For example, millions of Americans oppose abortion on the grounds that life is sacred, yet those same people--and the country itself--base one’s post-birth right to life on personal wealth. It is for this reason that, when we refer to a person’s worth, we follow the word with a dollar sign. Mitt Romney is worth $250-million”; Joe Blow is worth $500.

Do you ever wonder why the number of years a person goes to school should be the determinant of his or her income? Why not pay the most for the jobs that are the dirtiest, or most dangerous, or most boring, or the hardest on a person’s body? Watch a carpet installer crawl around on a floor, breathing filth from the carpet he’s taking up, and dust and formaldehyde from the carpet he’s putting down by kicking a stretcher with his knees; and ask yourself how long anyone’s body can survive such work, and reflect on the reality that, when his body gives out, he’ll be facing decades of pain and disability without adequate medical care.

What follows is a further sampling of my problem with doctors. They provide an essential service, but they don’t compete cost-wise, and if you can’t afford insurance, they charge you more because you lack the clout to negotiate their fees. With or without insurance, a doctor won’t see you without charging you hundreds of dollars, and you can’t decide if a particular doctor is right for you without paying it. To make matters worse, it can take months to get in to see a specialist, only to find him in such a hurry to get you out again (20% of physicians see more than 100 patients a week***) that it destroys any hope you might have had that he would care about your welfare. If worse comes to worse, and you mistrust your doctor to the point of wanting another, you have to start the wait--and pay the hundreds of dollars--all over again, and that’s assuming that every area specialist of the type you need doesn’t work in the same clinic, in which case, they won’t allow you to see another doctor because they care a great deal about their egos and little about your health. In short, a patient’s relationship with a doctor is one in which the doctor holds all the power and comes out richer no matter what, while the patient, more often than not, receives inferior care and is forced to pay through the nose for it. 

It’s not by accident that when a person’s independence, self-confidence, and bank account, are assaulted by bodily failure, they are also assaulted by the very people he or she turns to for help. It serves doctors well for their patients to regard themselves as beaten, helpless, compliant, ignorant, out of their league, and dependent upon their betters, because such patients will accept rudeness, arrogance, and substandard care as just the way things are, and pay their bills without complaint. I know from experience that it gets ever harder to fight the system when your days are filled with pain, you’re unable to work, your mind is increasingly befuddled by drugs, and your life savings are being poured into the pockets of people who don’t need them. My greatest problem with every serious health problem I’ve ever had wasn’t the problem itself, but my impotent rage at my supposed caregivers. Considering that I’ve been through, that’s quite a statement, but the truth of the matter is that an injury or an illness isn’t rude, pompous, greedy, or callous, and it won’t betray me for money. 

As bad as it sounds, the truth of the matter is that every time I hear of some mass murderer shooting shoppers, theatergoers, or school children, I wish the dead had been doctors because their greed has put blood on their hands, and their callousness constitutes a betrayal of their medical oath. According to the first-person accounts I’ve read, even doctors come to hate doctors when they are ones who have a severe enough problem that they’re able to get an outsider’s view of what a nightmare it is to profoundly need someone only to find that his or her main concern is with running up a bill. Yet, the situation wasn’t always this bad. $5 to $10 for an unhurried doctor’s appointment might have represented a lot of money when I was a young man making a buck-ninety an hour (30-cents above minimum wage at the time), but it was nowhere close to the $350 quickies that I’ve been paying for recently. Specialists in America make twice as much**** as general practice doctors. They also look down upon them nearly as much as they look down upon their patients, and they dump as much of the low paying work on them as possible. This is why most of my complaints are about specialists. They are to other doctors what a rabid wolf is to a Pekingese.

For reasons that completely escape me, when the already exorbitant and ever-exploding costs of medical care are discussed, doctors rarely receive any of the blame. Liberals blame Big Pharma and Big Insurance (“The U.S. spent the most on insurance…$606 per person, compared to $277 in France and $266 in Switzerland, the next-highest countries.”*****); conservatives think that everyone should make all the money possible by any means possible so that some of their wealth will trickle down to the little people (meaning leprechauns, I suppose); and doctors are perpetually rated by both groups as belonging to the most respected of professions. What the hell is there to respect?

Call me a damn fool (it wouldn’t be the first time), but I think we need universal medical care or, at the very least, price controls. If the government has an obligation to cap what the utility industry can charge for an essential service, surely it has an equal obligation to control the medical industry, but to do so, it must rid itself of the notion that those who can't afford the cost have no more of a moral right to healthcare than Donald Trump has to another  mansion. 
Here are two more links.