A note for those who may be following the travails of my wife’s surgeries.

About three weeks ago, my wife was having some recurrent discomfort with her digestion. Her GI doctor ordered CT scans and thought he saw a condition that needed immediate attention.

She was transfered to Dallas, where an endoscopic procedure found no sign of that condition, but the doctor didn’t think she probed far enough down to see the whole length and scheduled a colonoscopy.

During that procedure, the doctor perforated April’s intestine necessitating immediate surgery to repair the damage. This was done and she spent about two weeks recovering in the hospital.

It is also worth noting that while she was opened up, the doctors found no sign of the condition for which she was being tested in the first place.

So, she comes home with pain meds and anti-nausea drugs to rest. After a few days, she notes that the pain is still very bad, especially after eating.

On Thursday, she noticed that the surgical wound was oozing a nasty puss and, on consulting with the original GI doctor, checked in to the local hospital. It was discovered that the infection was quite bad, perhaps involving several abscesses, and she was ambulanced back to the hospital in Dallas on Friday, to which I am about to drive to see how she is doing and offer such comfort as I can provide.

The need for civility in our discourse has been raised of late by our new Author, Siarlys. I wonder if there is a general case to be made that Conservatives or Liberal are, on the whole, more civil in their discourse or if more outrageous individuals skew the curve.

Since, at Alexandria, we are blessed with Authors who are generally civil, so I must look at The Other Blog for data.

One great big data point, Crustacean – who I am now frankly happy that he has ignored our invitation to join our pleasant band – has presented a most uncivil set of screeds to which I link here, but will not quote.

Out in commercial media, I note that uncivil behavior dominates the airwaves – these boors are known far and wide – Rush Limbaugh, Michael Savage and the lot. Interestingly enough, on the non-profit airwaves, NPR, etc., such boorishness is rarely seen.

One might come to the sad conclusion that boorishness sells.

Once again, Helper Monkeys Amanita, Arugula and Uvula have cornered, captured, and roasted a fine, plump specimen sadly bereft of Linneaen classification deep in the catacombs of Alexandria. This year, our good assistants having followed my admonishment to utilize instruments more selective than their miniguns, there will be even more than enough breast and drumsticks, not to mention necks, for any who want some.

May you feast with joy amidst those you love or at least covet, and may your teams conquer their enemies and drive their foes before them broken and weeping on the field of competition.

May those of you inclined to follow this fine American holiday of fellowship and feasting have a Happy Thanksgiving, one and all.

H. M. Stuart
Alexandria

While trying to solve this puzzle–“The elderly vote. Because of this they have political power out of proportion to their numbers.”–that is, how any voting cohort could possibly have political power out of proportion to their numbers, a recent constellation of multiple posts each by our good Authors Destiny and Scott leads us elliptically but inevitably to questions sure to gnaw at tryptophan induced visits by Morpheus in the near future:

Within the problematic complex of modern mass medical care:

Are there rights? More importantly, could some or all of these rights cost?

We traditionally think of the right to liberty as properly costing the blood of the patriots who liberate us, but within other arenas, and here specifically modern mass medical care, could other rights come to be discovered to have cost tags of their own? Of course, the political costs: one must vote for them.

But beyond that, what if we find that rights within (and, for Scott, without) modern mass medical care irreducibly cost money?

If our good Destiny has a right to have medical care she may need, and if our good Scott has a right to not have medical care he does not want (understanding insurance as a prepayment for medical care), how are we to reconcile these seemingly conflicting rights?

More importantly, if these “rights” come into existence only with the payment of the cash necessary to supply their satisfactions, our Thanksgiving holiday questions can be distilled to:

• Are there rights to–and from–modern mass medical care?
• Do these political rights to–and from–modern mass medical care cost real economic dollars, without which they cannot meaningfully exist?
• Who has a right to these rights?
• Who is compelled to fund the existence of any or all of these putative rights when it may be decided any or all of them should exist?

H. M. Stuart
Alexandria

The Goal Is Freedom: The Mandated Health Insurance Outrage

How can they make us buy coverage?

By Sheldon Richman • Posted November 20, 2009 [tip: The American Conservative]

With the introduction of Senate Majority Leader Harry Reid’s 2,074-page health insurance nationalization bill, we can be thankful for one thing at least. It will most likely be the last bill of its kind introduced this year. Who’d have time to wade through another?

This doesn’t mean there is anything in the bill to be thankful for. Like its Senate predecessors and House counterpart, it should offend any advocate of liberty and good economic sense.

First and foremost among its defects is the individual health insurance mandate: Every individual would be forced to buy government-defined comprehensive medical coverage (or to have it bought by one’s employer). A fine up to $750 awaits anyone who defies the mandate.

As Shikha Dalmia points out in Forbes this week, the individual insurance mandate is the major outrage in the whole “health care reform” scam. I would say it’s the keystone. Remove it and most of the rest crumbles to the ground.

Who do these politicians think they are? Our lives are not theirs to dispose of.

Politicians love to sugarcoat their threats of force. So the Reid bill calls the mandate “shared responsibility.” To those who wonder by what authority the government can make us buy insurance against our will, the bill alludes to the Constitution’s Commerce Clause, which gives Congress the power to “regulate … commerce among the several states.” (For a fuller story on the clause, see this.) The bill says, “The individual responsibility requirement provided for in his section . . .  is commercial and economic in nature, and substantially affects interstate commerce.”

How would an insurance requirement affect interstate commerce? The bill says that since without the requirement people wouldn’t buy insurance until they are sick, it therefore “will minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums. The requirement is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.”

In other words, for the sake of making the insurance market work better, we must be forced to buy coverage. How’s that for a justification?

It’s amazing how many fallacies can be stuffed into one argument.

[More]

A Health-Insurance Criminal Pleads His Case

Why I Will Ignore the Mandate

By James L. Payne • Posted November 16, 2009

If mandatory health insurance goes through, it will turn me into a criminal.  I don’t have health insurance. I don’t want it. And I will refuse to buy it even though I can afford it.* Before they lead me to the cells, perhaps the prisoner may be allowed to say a few words in his defense.

It’s understandable that politicians are eager to eliminate the medically uninsured. For years they’ve been told that we are the flies in the ointment of health care policy. It is said we are either a) wrecking the system by using services we don’t pay for, or b) we are deprived of needed medical care and therefore objects of pity and subsidy.

These points may apply to some uninsured but not to all. Some of us belong in what might be called the “successfully uninsured” category. We are not freeloaders. We believe we have an obligation to pay for the medical care we receive, and we always pay for it. I put no financial burden on doctors, hospitals, or taxpayers, and politicians are wrong to assume I am part of the country’s health care problem.

Politicians are also wrong to assume that I am an object of pity. Like many Americans, I have significant savings and can afford medical expenses out of pocket. (Census Bureau figures for 2000 show that over 18 million households had assets in excess of $250,000).  Our savings make it possible for my wife and me to decline both private insurance and Medicare (we are 70). Those without savings are in a different situation: They probably need insurance, or a subsidy, or charitable help. My point is that if you can handle your own medical bills through savings and personal responsibility, this is a sound approach. Politicians should encourage this state of self-reliance, not make it a crime.

There are many advantages to being insurance-free. [More]

*As will we, who neither can afford it nor wish it if we could; a group of anarchist friends and we are currently drafting peaceful, direct-action methods enabling the chain-reacting nationwide takedown, once signed into law, of any proposed health-care “reform” mandating the purchase of insurance, using seldom-discussed methods entirely legal, which grew out of a draft currently under revision of a method to bring down the entire oligarchic US financial system, also via methods wholly within the letter of the law, loosely adapted from the sovereign precedent of the General Strike familiar from syndicalist doctrine. A link to the published version should appear in a future post. As authentically revolutionary methods adapted from actual historic occasions are seldom discussed at all seriously in or out of the blogosphere, we look forward to lively discussions as we disseminate our ideas in the coming months. Where once the hammer-and-sickle bashed the skull and slashed the throat of Man that the State might conquer all, let the monkey-wrench forged from their blazing wreck loosen its nuts that its calliope might crash to the ground, blinded by the light of liberty, rev(olution)ed up like a Deuce, another runner in the night ferrying fugitives to freedom with the aid of spike-driving, money-laundering Chinamen plying their ancient stain-removing secrets along the new Overground Lairlord.

An earlier version of Payne’s article appeared as “My Body, My Choice“**, The American Conservative, July 16, 2007.

**Mirror, Mirror, up against the wall, Mother Dearest, from which fairest-of-all-weather friends of rights in one’s body against  among the ranks of the faculty of the Bolshevik School of Medicine (and authors: see Rat Poison as Pharmacology) have we heard that selectively-chanted plaint?

Bruce Bartlett, Reagan’s former adviser, continues to write good stuff on true fiscal responsibility. Key quotes….

Recall the situation in 2003. The Bush administration was already projecting the largest deficit in American history–$475 billion in fiscal year 2004, according to the July 2003 mid-session budget review. But a big election was coming up that Bush and his party were desperately fearful of losing. So they decided to win it by buying the votes of America’s seniors by giving them an expensive new program to pay for their prescription drugs.

Recall, too, that Medicare was already broke in every meaningful sense of the term. According to the 2003 Medicare trustees report, spending for Medicare was projected to rise much more rapidly than the payroll tax as the baby boomers retired. Consequently, the rational thing for Congress to do would have been to find ways of cutting its costs. Instead, Republicans voted to vastly increase them–and the federal deficit–by $395 billion between 2004 and 2013.

However, the Bush administration knew this figure was not accurate because Medicare’s chief actuary, Richard Foster, had concluded, well before passage, that the more likely cost would be $534 billion. Tom Scully, a Republican political appointee at the Department of Health and Human Services, threatened to fire him if he dared to make that information public before the vote……..

Just to be clear, the Medicare drug benefit was a pure giveaway with a gross cost greater than either the House or Senate health reform bills how being considered. Together the new bills would cost roughly $900 billion over the next 10 years, while Medicare Part D will cost $1 trillion.

Moreover, there is a critical distinction–the drug benefit had no dedicated financing, no offsets and no revenue-raisers; 100% of the cost simply added to the federal budget deficit, whereas the health reform measures now being debated will be paid for with a combination of spending cuts and tax increases, adding nothing to the deficit over the next 10 years, according to the Congressional Budget Office. (See here for the Senate bill estimate and here for the House bill.)

Maybe Franks isn’t the worst hypocrite I’ve ever come across in Washington, but he’s got to be in the top 10 because he apparently thinks the unfunded drug benefit, which added $15.5 trillion (in present value terms) to our nation’s indebtedness, according to Medicare’s trustees, was worth sacrificing his integrity to enact into law. But legislation expanding health coverage to the uninsured–which is deficit-neutral–somehow or other adds an unacceptable debt burden to future generations. We truly live in a world only George Orwell could comprehend when our elected representatives so easily conflate one with the other.

While the proposed bills fall short of my ideal health reform plan, I am encouraged that the idea of costs is at least on the table. The plans have met the goal of not increasing the debt. They will provide more services. Those services will be paid for, not merely tacked on as new debt. Quite a change.

In the past year or so, there have been referenda in both Maine and California on whether to expand the civil-law definition of marriage. The proposed change would have provided for licensing of same-sex couples. Those disappointed by the outcome have raised loud and outraged voices. Of course we were already familiar with the loud screams of outrage that anyone would even think to propose that same sex couples could marry. It is rumored that some such devout provocateurs marched into San Francisco’s Castro District to strut their stuff, after winning the Proposition 8 vote. It is also rumored that residents of the district loudly voiced their disapproval. But in the wake of some heart-wrenching defeats, advocates of same sex marriage have been doing some name calling and threatening of their own.

Anyone can pontificate “I’m right, you’re wrong, end of story,” but if you live with one other human being, let along 300 million or 6 billion, that doesn’t work. In fact, people with that attitude are totally unfit for marriage. In no marriage do both partners ever agree on everything. Two human beings will never share every single value precisely in common, will never have identical tastes. Partners have to learn, (a) to sacrifice their own deeply held preferences to please the other, and (b) to accept that which their partner will not sacrifice for them. That is one thing which keeps a certain level of tension, even among the most affectionately devoted partners.

The reason we need some rational discussion is that we all, like it or not, have to share this planet. Some hundreds of millions of us have to share this continent, or a portion of this continent. Unless we are prepared to physically liquidate the opposition, we have to talk. I personally find the concept of male to male sex disgusting. Since I’m attracted to women, lesbians are easier for me to understand. How that makes me feel is (in my seldom humble opinion) entirely irrelevant to whether a gay man, or woman, is qualified to hold a job, own property, live next door to me (not in my home, next door), teach in public schools, or walk down the street in safety and security, in peace. Those who would deny these fundamentals to any human being, because they are gay, because they drink alcohol socially, because they are evangelical Christians, because of their skin color, because they are Muslim, because of any irrelevant characteristic you care to fill the blank with, are bigots.

Some of those fighting in “defense of marriage” are no doubt bigots, but everyone who voted against licensing same-sex marriages is not, therefore, ipso facto, a bigot. It is not bigotry to believe that marriage has a definition, that it concerns the relationship of male to female, and that a gay partnership, whatever it may be, whatever merit it may have, however loving and affectionate it is, is not a marriage. Nor is it bigotry to hold a sincere religious belief that homosexuality deviates from divine intention. (At minimum, such beliefs are entitled to the same respect as sincere religious advocacy of temperance, albeit drinking alcohol is legal in this country).

That may deeply disappoint those gay partners who consider their love to be a marriage, and they have a right to say so, but it is not bigotry. An opponent of extending marriage licenses to same-sex couples, that is, one not motivated by sheer bigotry, should have the good grace to recognize, this will deeply hurt some deeply devoted same-sex couples.

In contrast to the bitter words over same sex marriage, it has become pretty well accepted by a substantial majority that what consenting adults do in the privacy of their own home is not the business of the police. Lawrence v. Texas was a valid application of well-established constitutional principles. States have no business imposing criminal penalties on gay couples. Businesses have no rational purpose in discriminating against them. By contrast, denying a marriage license is NOT “using legal power to force others to adhere to your belief.” Lawrence was decided based on the right to privacy, a right most Americans firmly expect of our government, although we sometimes disagree about who is entitled to be left alone as to what.

The claim to same sex marriage as a right is based on equal protection of the laws, and that is a proposition that reasonable men and women may differ about. The only common denominator is “what do gay people want next?” That’s neither a legal nor a moral case for (or against) anything. Some things I want I have a right to. Other things I want I may get, or may not, but they are not rights. What is not a fundamental right, is a matter for legislation, and that requires persuasion. At minimum, it requires a good lobbyist persuading a bored and indifferent legislative majority to come around. At best, it requires persuading a majority of one’s fellow citizens to make it clear that legislators who wish to be re-elected had better support the proposal.

But in the wake of some bitter electoral battles, there have been demands to identify each and every voter, or at least each and every petition signer, to somehow “out” these people to all their neighbors and business associates. George Will, a conservative columnist who has been known to have valuable insight now and then, compares this to the state of Alabama demanding the membership rolls of the NAACP in the 1950s. At a time when the state government and every local police department was interlocked with the Ku Klux Klan, that was a significant threat. Gay marriage advocates have not threatened to hang anyone from the nearest tree. More often they have sent out letters saying “you should know what your neighbor, John Doe, stands for…”

Nobody who seeks to establish a constitutional right should overlook the right to freedom of association, upheld by the Supreme Court in NAACP v. Alabama. Each individual citizen has a right to sign any petition, join any organization for lawful advocacy, make any donation they wish, without their name being posted for all to see and consider. There was a time when the demand for a secret ballot was considered to be “unmanly.” Those who said so were generally employers, intent on telling their employees “don’t report for work tomorrow if you vote for,” e.g., Andrew Jackson for president. No momentary anger can justify trashing such an essential and painfully established common right of all citizens.

Civil discourse doesn’t mean we all agree. It means we have some hard discussion to do, some volatile debates to fight out, but we all want to be standing when its over. Or, as Inman said in the novel Cold Mountain, “We can do this so that twenty years on, we might run into one another in town and take a drink together and remember this dark time and shake our heads over it.” If we don’t kill each other first, we are all going to be neighbors when its over, we are all going to be co-workers when its over, as we are now. Many of us will find ourselves sharing the same churches. Finally, it may never entirely be over. Things change. Keep talking.

Clash of the Bushy-Headed, Best-Selling Metaphorical Eponyms, as Harvard cognitive psychologist Steven Pinker

(The Language Instinct, How the Mind Works, Words and Rules, The Blank Slate, The Stuff of Thought) assays tress-same-made* trendspotting journo Malcolm Gladwell’s

(The Tipping Point, Blink, Outliers) new collection What the Dog Saw in the lead review of last Sunday’s NYTBR:

Readers have much to learn from Gladwell the journalist and essayist. But when it comes to Gladwell the social scientist [More]…

The Pinker-Gladwell brain strain is lighting up the blogs, including Gladwell’s own, with reviewer and reviewed in a rematch on the letters page of the November 29 NYTBR.

Meanwhile, in “Gladwell for Dummies“,  Maureen Tkacik finds herself saying, after many a Gladwellian doctrinal volte-face , “That’s not what you said six months ago.”

*The two ringleteers of their respective three-ring circi maximi have midwifed their twins in our forthcoming, fifth-pleading roman à clef du laboratoire, Tress of the Test-Tubervilles, or, The Pare of the Lock…

Jack’s Mannequin performed its song “Swim” on The Daily Show last night: “Andrew McMahon of Jack’s Mannequin describes his battle with leukemia before performing ‘Swim.’”

If you’ve been watching the news, you may have seen some historic changes in recommendations about cancer prevention.  There have been news releases regarding a change in the recommendations for mammogram screening by the US Preventive Services Task Force (USPSTF). Women in the 40-50 year old age group are now only encouraged to have regular mammograms if they are at increased risk of breast cancer, due to the fact that this test often finds non-existent of unimportant abnormalities in this age group that, on the whole, makes them less, not more, healthy. This will save women thousands of dollars and countless hours of time and energy at a time in their lives when that time and energy is a real gift.

Today I read that the American College of Obstetrics and Gynecology now recommends starting pap smear screening at 21 for most people, and reducing the frequency in that first decade to every 2 years. I have studied evidence based recommendations for pap smears for years, and the formula that makes sense is somewhat more complex than this, but in most cases our standard yearly pap smears are not necessary. This is based on the fact that some of the treatments for abnormal pap smears can make a women less healthy, less fertile, and that the whole process is expensive enough that  honing it down to what is truly necessary makes excellent sense.

Cost is certainly not the only issue here, but diversion of significant money from womens’ health funding in directions where it does no good hurts all of us. Google tells me that a mammogram costs around $100, and may cost as much as $200, and a pap smear runs about the same price. The cost of these tests in terms of comfort and dignity is not insignificant.

Johann Hari has a great piece up that I hope everyone has seen by now in The Independent on ex-Islamists. Key quotes…..

To my surprise, the ex-jihadis said their rage about Western foreign policy – which was real, and burning – emerged only after their identity crises, and as a result of it. They identified with the story of oppressed Muslims abroad because it seemed to mirror the oppressive disorientation they felt in their own minds. Usman Raja, a bluff, buff boxer who begged to become a suicide bomber in the mid-1990s, tells me: “Your inner life is chaotic and you feel under threat the whole time. And then you’re told by Islamists that life for Muslims everywhere is chaotic and under threat. It becomes bigger than you. It’s about the world – and that’s an amazing relief. The answer isn’t inside your confused self. It’s out there in the world.”

But once they had made that leap to identify with the Umma – the global Muslim community – they got angrier the more abusive our foreign policy came. Every one of them said the Bush administration’s response to 9/11 – from Guantanamo to Iraq – made jihadism seem more like an accurate description of the world. Hadiya Masieh, a tiny female former HT organiser, tells me: “You’d see Bush on the television building torture camps and bombing Muslims and you think – anything is justified to stop this. What are we meant to do, just stand still and let him cut our throats?”

But the converse was – they stressed – also true. When they saw ordinary Westerners trying to uphold human rights, their jihadism began to stutter. Almost all of them said that they doubted their Islamism when they saw a million non-Muslims march in London to oppose the Iraq War: “How could we demonise people who obviously opposed aggression against Muslims?” asks Hadiya…….

In Mazratora Prison, Maajid was held in solitary confinement for thee months. It was a bare cell with no bed, no light, and no toilet: just a concrete box. Then he was taken out suddenly and told his trial for “propagation by speech and writing for any banned organisation” was beginning in the Supreme State Emergency Court. But Maajid’s Islamist convictions were about to be challenged from two unexpected directions – the men who murdered Egyptian President Anwar Sadat, and Amnesty International.

HT abandoned Maajid as a “fallen soldier” and barely spoke of him or his case. But when his family were finally allowed to see him, they told him he had a new defender. Although they abhorred his political views, Amnesty International said he had a right to free speech and to peacefully express his views, and publicised his case.

“I was just amazed,” Maajid says. “We’d always seen Amnesty as the soft power tools of colonialism. So, when Amnesty, despite knowing that we hated them, adopted us, I felt – maybe these democratic values aren’t always hypocritical. Maybe some people take them seriously … it was the beginning of my serious doubts.”

For the duration of the trial, he was placed in a cramped cell with 40 of Egypt’s most famous political prisoners. There were row after row of beds with only a thin crack between them to inch through. Maajid was thrilled to discover two of the men who had conspired to murder Anwar Sadat – Omar Bayoumi and Dr Tauriq al Sawah – had recently been moved to this dank cell. “This is like meeting Che Guevara – these great forerunners and ideologues who I can now get the benefit of learning from,” he says. But “they were very fatherly, and they had been spending all these years studying and learning. And they told me I had got my theology wrong”.

After more than 20 years in prison, they had reconsidered their views. They told him he was false to believe there was one definitive, literal way to read the Koran. As they told it, in traditional Islam there were many differing interpretations of sharia, from conservative to liberal – yet there had been consensus around once principle: it was never to be enforced by a central authority. Sharia was a voluntary code, not a state law. “It was always left for people to decide for themselves which interpretation they wanted to follow,” he says.

These one-time assassins taught Maajid that the idea of using state power to force your interpretation of sharia on everyone was a new and un-Islamic idea, smelted by the Wahabis only a century ago. They had made the mistake of muddling up the enduringly relevant decisions Mohamed made as a spiritual leader with those he made as a political ruler, which he intended to be specific to their time and place.

The idea of American ideals triumphing over jihadism’s ideals is one I voice frequently. I think we have seen it borne out over and over. In Iraq, we stopped torturing and al Qaeda did not. The Sunnis chose our side. Bing West noted in his book, The Strongest Tribe, that it was the common decency of our grunts that won over the Iraqis. Petraeus in his mission statements and in his Field Manual emphasized the importance of living our values.

If one takes the view that we are in a long term struggle against fundamentalist Islam, it is a battle between cultures. The jihadists number in the thousands against our 300 million and the strongest military in history. They need to win the battle of ideas. They need to bring in recruits. They need to radicalize moderate Islam. We make that easier when we act against our own principles. Will we be able to convert back the remaining Islamists? No way, but we don’t need to do so. Stop their recruiting and let them fade into oblivion.

Pro-Life Men,

You say abortion hurts women. You say you love women and want to protect them. You say that Planned Parenthood is evil, and you try to stop our government from funding them.

Did I get that right?

Let me begin by saying, I agree with you. Abortion does hurt women, in so many ways. I love the fact that you guys want to protect us from the horrors of abortion and want to protect us from the proverbial wolf in sheep’s clothing that is Planned Parenthood.

In a valiant effort to do that you start up Pregnancy Centers, Outreach Organizations, and Demonstrations all in the name of life. You are brilliant and passionate, and most of all you guys ‘get it.’ All but one part that is…

Many women still need health care. Middle class women, uninsured women; your sisters in the fight, pro-life women just like me. And we don’t only need it when we are pregnant, because when we’re pregnant, if we have to, the government can actually provide us with adequate health care free of charge—when we’re pregnant.

What about at other times, though?

Here, let me give you an example- I know there is something wrong with me right now. As in, right now, right now. As I sit here and type this I know there is something wrong inside of my lady parts, right now. I don’t quite know what it is, but something just isn’t right, and I can tell. Something that very well might affect my ability to have anymore children, or even go on living a productive life at all for that matter. (not very “pro-life”)  And because my husband and I can only afford the insurance premiums for he and our three children, and being as I am a stay at home mom and societally deemed “unemployed,” I have nowhere to go for medical care.

Well, actually, that’s not quite true. There are places I could go.

I could go to the emergency room and spend thousand of dollars having my parts checked out, inevitably wiping out my family for quite some time. I could go to my old OB/GYN and perhaps work out some sort of payment plan, but once again it would be a huge blow to our budget. Or there is always my third option; I could go to Planned Parenthood. I could let an abortionist put his hands on my body and all it would cost me is $77.00…monetarily, that is.

We need health care. Some of your sisters in the battle for life need health care!

If you really want to take the legs out from under Planned Parenthood all you have to do is find a solution to this problem.

No, it is not a little task. It will take massive amounts of unified effort. And the only reason that I, as a pro-life feminist, am putting this burden of responsibility on you, is because unfortunately my fellow womankind see very little problem with the way things are running right now.  Many of them don’t ‘get it.’

I will do my part, and continue in my efforts to wake them up, but you must do your part and start building something that will help us rather than working to tear down something that does help us.

{I was hesitant to post this on here, because A) I’m not looking for an abortion debate on this lovely Thursday, although I’m quite sure I will get one anyway, and B) when I posted this on my blog, all of the comments revolved around the immediate danger my broken vagina was in, instead of the real overlying issue here, my call to action for Pro-Life Men, who deem themselves our protectors and the righters of our wrongs, but who are unfortunately doing more damage than good in some cases, I am afraid.  So, go ahead, be predictable and tell me to get over my bias and go to PP, oh and that abortion is glorious for the following reasons….}

The proposed Senate Health Reform bill will place a tax upon cosmetic surgery. If I am an accurate judge of the character of our Congress critters, I fully expect a boob job exception to be added before the final bill is passed.

Recently I attended a town hall meeting, because that’s what Republicans like to do. Congressman Pete Sessions was discussing the hot topic of health care, also something Republicans like to do. He took his point a step further though by asking everyone with health insurance to please stand up. Suddenly there was a wall of people all around me, standing.

I remained seated, not something many Republicans did.

Sessions made a comment along the lines of ‘wow, what a very blessed community we live in’ and I couldn’t agree more. The residents of my town are abundantly blessed, although I doubt many of them know it; a point proven by what happened next.

This united moment of health care comradery was soon shattered by the voice of an older man who shouted out ‘Why don’t you ask those of us who DON’T have health insurance to stand up?’ I had the same thought, but upon realizing I would personally suffer at the hands of this question, chose to keep my uninsured trap shut.

Before the man even had time to reclaim his seat, one of my fellow Republicans hollered back “Get a job!”

I was astonished. You really think not having insurance means you are some sort of lazy, unemployed bum?

Perhaps someone should have told my gainfully employed husband that. He worked for a small recruiting firm last year and because of their size they were unable to provide insurance benefits to the employees. Instead they gave him a $200 monthly allowance for health insurance. After discussing our options at length with a reputable broker we decided on a plan that would cover my husband (the employee) and our 3 children for $256 a month. Adding me would have upped the price exponentially. Co-pays were $40 a visit and we had a $1,000 deductible. Hardly a steal, but it was what we could afford based on the allowance, plus a bit more. Over the next 6 months our premium raised 3 times. No major injuries or illnesses, just a well baby visit and some vaccinations. But yet, here we were paying a hundred dollars out of pocket on top of my husband’s allowance for insurance that we barely benefited from, all the while our premium’s rising.

I was fed up, but couldn’t shake that voice in my head saying, “You may need it one day, and then you’ll be glad it’s there.”

Two months later our middle child fell and needed stitches. Of course it was on a Friday. Of course it was after 5pm. Of course it was at the end of a very healthy year where we had yet to touch our deductible. Finally we had a need, and was it there? Absolutely not. Our insurance covers cancer. It covers heart attacks. It covers life threatening illnesses and really nothing else. Sometimes I wonder if our money would be better off crammed into an empty coffee can.

At this point, my husband is with a new company and we are considering a health savings account. However this does not change the fact that my generation-young, middle class, WORKING families- are receiving so much less from their insurance coverage all the while paying so much more. And my fellow Conservatives, most of whom grew up during a different era of health coverage, have no clue. To them, being uninsured is the same as being unemployed, because that’s what Republicans like to think. Well, I’m here to tell you otherwise.

I know socialized medicine is not the answer, but ignoring this growing number of uninsured middle class families is not the solution either.

The fact that I am trying to telekinetically focus my bitter health insurance hating energy into the formation of cancerous cells within my body just so I can finally have the last laugh when they are forced to pay for my chemotherapy, is a sad sign of our times.

James Surowiecki has written a concise, readable piece on the toxic effects of debt upon our economy. Key quotes….

The government doesn’t make people go into debt, of course. It just nudges them in that direction. Individuals are able to write off all their mortgage interest, up to a million dollars, and companies can write off all the interest on their debt, but not things like dividend payments. This gives the system what economists call a “debt bias.” It encourages people to make smaller down payments and to borrow more money than they otherwise would, and to tie up more of their wealth in housing than in other investments. Likewise, the system skews the decisions that companies make about how to fund themselves. Companies can raise money by reinvesting profits, raising equity (selling shares), or borrowing. But only when they borrow do they get the benefit of a “tax shield.” Jason Furman, of the National Economic Council, has estimated that tax breaks make corporate debt as much as forty-two per cent cheaper than corporate equity. So it’s not surprising that many companies prefer to pile on the leverage.
There are a couple of peculiar things about these tax breaks—which have been around as long as the federal income tax. The first is that they’re unnecessary. Few people, after all, can save enough to buy a home with cash, so home buyers naturally gravitate toward mortgages. And businesses like debt because it offers them tremendous leverage, making it possible to put down a little money and potentially reap a huge gain. Even in the absence of the deductions, then, there would be plenty of borrowing. The second thing about these breaks is that their social benefits are pretty much nonexistent. Advocates of the mortgage-interest deduction, for instance, claim that it increases homeownership rates. But it doesn’t: in countries where mortgage deductions have been eliminated, homeownership rates haven’t dropped. Instead, the deduction simply inflates house prices. The business-interest deduction, meanwhile, may lower an individual company’s taxes, but it also means that the over-all corporate tax rate is higher, so its real impact is to give companies with lots of debt an unjustified advantage.
If the benefits are illusory, the costs are all too real. Economies work best, generally speaking, when people are making decisions based on economic fundamentals, not on tax considerations. So, as much as possible, the tax system should be neutral between debt and equity, and between housing and other investments. It’s not, and, worse still, as we’ve seen in the past couple of years, debt magnifies risk: if companies or individuals rely on large amounts of leverage, it’s much easier for bad decisions to lead to insolvency, with significant ripple effects in the wider economy.

Adam Smith thought that markets work. Indeed, they are the best method we have for pricing most goods. Now, what happens when we are trying to factor in the value of the huge debt taken on to finance the production of those goods? Debt that made sense only because it was a tax write off? At what point do markets stop providing us accurate information due to our financial distortions? Why do we privilege the costs of homeowning over renting? Are renters less valuable to our society? The subsidizing is also largely offset by the resulting higher costs. Who loses here? Everyone who does not own a home.

As Surowiecki points out, we did away with the deductions for credit card debt. Maybe we can do the same for these other kinds also.

Any discussion of cutting costs in health care must address Medicare. Any attempts to discuss Medicare provokes the demagogues on both sides to incite the elderly against whatever plan is being proposed. It is 100% predictable. It has also been 100% effective. The elderly vote. Because of this they have political power out of proportion to their numbers. One solution would be to get everyone to vote. I do not see that happening. Attempts at expanding the numbers who vote will be actively opposed, especially by Republicans as demographics currently run against them.

My second best solution is to combine our medical systems into one. Tyler Cowen makes this idea the last, and least probable, of his suggestions for health care reform. Mind you I am not saying this need be a single payer system. It just needs to be a unified system, maybe something like the private insurance system of a Switzerland or France, even a Taiwan. As long as the elderly card can be played, I see little chance at effective cost cutting. Cost effectiveness research will be called an attempt to ration. Refusing to subsidize costly care which shows no improvements, will be called rationing. Increasing reimbursements to primary care docs while holding costs steady for specialists, will be called rationing of specialty care.

Putting everyone into one system means that the elderly will then have a stake in keeping the whole system solvent. As it stands now, the Greatest Generation just continues to vote itself the Greatest share possible of health care benefits.

Or, for that matter, about feeling good? Or even doing good in order to feel good? These questions, of course, are directed at the authors and devotees of “Stuff White People Like.” Admittedly, I’ve only read bits and pieces of SWPL itself, mostly as quoted in other people’s blogs. But SWPL is only the most coherent popularization of a strain of thought that has afflicted our culture for nearly a century now. It has its origins in a kind of pop Calvinism that has by now forgotten its origins, but is still basic to the American psyche.

Jean Calvin (no relation to the tiger’s pal), who brought us the Pilgrims and the Presbyterian Church, believed that people are inherently sinful, and can’t “save” themselves by doing good works. We are “saved” if and only if God chooses to save us. We have no way of knowing who is saved and who is damned, and we shouldn’t care. We should, of course, do good, but not to save ourselves from damnation. We should do good purely because that’s what God wants. We must do everything possible to guard against ulterior motives. Doing the right thing for the wrong reason is no better than not doing it at all.

There are, Calvin tells us, lots of wrong reasons. Earthly rewards, like money and status and power. Heavenly rewards, like not going to hell. And psychological rewards, like feeling good about ourselves. Ideally, we should do good as secretly as possible*, and in ever-present uncertainty about our eternal destination. Calvin didn’t, so far as I know, have any helpful advice on how to keep from feeling good about having done good. Presumably, if we are all sinners, awareness of that fact should be enough.

Well, these days, it isn’t. Unlike Calvin and his ideological descendants, today’s Americans believe deeply in their inalienable right to feel good about themselves. We bump up our self-esteem for our skills, our temperaments, and our sheer lovability. As Senator Franken, in his earlier incarnation as Stuart Smalley, used to say, “I’m good enough, I’m smart enough, and—doggone it!—the Minnesota Supreme Court likes me.” Or something like that.

We are entitled to feel good about every aspect of our selves except—oddly enough—our attempts to improve the world we live in and the lot of its inhabitants. Not only are we not allowed to feel good about doing good, we are not allowed to feel good about being good, except in the sense denoting excellence of worldly skills. We still believe we are all sinners. But we also believe that, as Smalley would say, “that’s o-kay.” We don’t need to feel bad about being sinners, we just shouldn’t feel good about being do-gooders. That would imply that we do good for ulterior motives—namely, in order to feel good.

This at least provides us with a solution to the eternal conundrum of how to bad-mouth people we don’t like but about whom we don’t actually know anything discrediting—just say they’re only buying Fair Trade coffee/living in integrated neighborhoods/going to church regularly/sending their children to public schools/buying hybrid cars/etc. to feel good. It’s even neater than calling them hypocrites, which was the ploy before we discovered feelgood.

Admittedly, I come from the Jewish tradition, which is mostly profoundly behaviorist. With some rather esoteric exceptions, we don’t much mind if you do the right thing for the wrong reason—even reasons a lot wronger than mere self-esteem, like looking good to the neighbors, improving the image of your business, impressing eligible members of the opposite sex, or even intimidating potential opponents—so long as you do it. We figure the world will still be a better place than if you don’t do it at all.

For the same reason, we aren’t keen on doing good secretly. If your neighbors don’t know you donate to charity, they may feel they live in a world in which most people don’t donate. This may lead them to stop donating. It may also lead them not to bother asking for help when they really need it, because they don’t know anybody to ask. At the very least, it is likely to lead them to depression and even despair.

Moreover, as St. Augustine figured out a long time ago, it is just about impossible to delete selfish motives from our actions. Nice people feel good about nice things. Nasty people feel good about nasty things. Either we deceive ourselves about our motives, or we get paralyzed into not acting at all. This is not worth the trouble.

So, please, spare me the Stuff White Liberals Who Aspire to a Moral Code Loftier Than Al Capone’s Like. Pat yourself on the back and go on your way. Make the world a better place.

Red Emma

*This was the whole point of Magnificent Obsession, a very popular edifying novel of the 1950s.

Three articles in the most recent New England Journal of Medicine describe more new medical technology, and have made me curl my toes in mental conflict.

1. A pacemaker that goes into both the right and left chambers of the heart, rather than just the right side, preserves heart function better, according to ultrasound tests.  It is a much trickier (read inaccessible, expensive, desirable) procedure than the standard one, and the patients don’t actually feel any better or act any healthier than with the standard kind of pacemaker.

2. Giving an intravenous iron supplement that I’ve never heard of before (new) (they didn’t test the ones I have heard of before) can improve heart function and health in patients who have congestive heart failure and are iron deficient. How odd that they didn’t evaluate oral iron supplements which have been generic since before I was born and are the standard treatment for iron deficiency. Is it just possible that the new product will be the only product approved for treating congestive heart failure in patients with iron deficiency? Is it just possible that it will cost some jaw dropping amount of money?

3. In people who have heart failure so bad that they would need a heart transplant to survive, but they are not well enough to survive a heart transplant, use of a mechanical pump can prolong their life, and can be used somewhat indefinitely. Only 1/4 of these people will live a year with this technology, and 17% of those treated will have a major stroke. The cost of the technology wasn’t mentioned, and quality of life was not addressed.

We continue to move towards technology that is more expensive, more resource consuming and does not seem to improve quality of life, at least in clinical research. Frequently practice follows close on the heels of research. A good journal still publishes studies like the intravenous iron one that may influence practice without any evaluation of possibly equivalent less expensive and resource intensive alternatives.

Whence my internal conflict? Clinical science occasionally barks up the right tree, and contributes to the health and happiness of people.  It also burns money like it is nothing, as if resources were unlimited.

Sullivan linked to this piece by Schneier, and it is well worth reading. Key quotes….

Security theater refers to security measures that make people feel more secure without doing anything to actually improve their security. An example: the photo ID checks that have sprung up in office buildings. No-one has ever explained why verifying that someone has a photo ID provides any actual security, but it looks like security to have a uniformed guard-for-hire looking at ID cards. Airport-security examples include the National Guard troops stationed at US airports in the months after 9/11 — their guns had no bullets. The US colour-coded system of threat levels, the pervasive harassment of photographers, and the metal detectors that are increasingly common in hotels and office buildings since the Mumbai terrorist attacks, are additional examples…..

Unfortunately for politicians, the security measures that work are largely invisible. Such measures include enhancing the intelligence-gathering abilities of the secret services, hiring cultural experts and Arabic translators, building bridges with Islamic communities both nationally and internationally, funding police capabilities — both investigative arms to prevent terrorist attacks, and emergency communications systems for after attacks occur — and arresting terrorist plotters without media fanfare. They do not include expansive new police or spying laws. Our police don’t need any new laws to deal with terrorism; rather, they need apolitical funding. These security measures don’t make good television, and they don’t help, come re-election time. But they work, addressing the reality of security instead of the feeling.
The arrest of the “liquid bombers” in London is an example: they were caught through old-fashioned intelligence and police work. Their choice of target (airplanes) and tactic (liquid explosives) didn’t matter; they would have been arrested regardless.
But even as we do all of this we cannot neglect the feeling of security, because it’s how we collectively overcome the psychological damage that terrorism causes. It’s not security theater we need, it’s direct appeals to our feelings. The best way to help people feel secure is by acting secure around them. Instead of reacting to terrorism with fear, we — and our leaders — need to react with indomitability.
Refuse to Be Terrorized
By not overreacting, by not responding to movie-plot threats, and by not becoming defensive, we demonstrate the resilience of our society, in our laws, our culture, our freedoms. There is a difference between indomitability and arrogant “bring ‘em on” rhetoric. There’s a difference between accepting the inherent risk that comes with a free and open society, and hyping the threats.
We should treat terrorists like common criminals and give them all the benefits of true and open justice — not merely because it demonstrates our indomitability, but because it makes us all safer. Once a society starts circumventing its own laws, the risks to its future stability are much greater than terrorism.

As I have noted before, al Qaeda has had, at most, a few thousand members. They cannot reasonably expect to destroy us. They can hope to incite us into destroying ourselves. At times, it looks as though they are succeeding.

As we age, I think we all understand and, at least begrudgingly, accept the loss of bodily functions that goes with that process. The part which is so hard to face is the loss of mental faculties. I see this all of the time in my demented patients. We see it in our family. We can sort of see it in ourselves, though we mostly joke about it. It is a slow gradual process for most of us. We, and our loved ones, have time to adjust.

I recently had a patient with a large intracranial tumor. In order to take it out and preserve speech function, we were doing this as an awake craniotomy, awake surgery. An important part of this procedure is preparing the patient for what is going to happen. Everyone along the way goes out of their way to explain what will happen to the patient so that they can cooperate and get better results. As I began talking with this patient, he behaved as though he had never heard any of what I was talking about.

I stopped and went back to the chart. Yup, major short term memory loss. His tumor was adjacent to the speech centers, but was also impeding the processing of memory. This makes things much more difficult. However, talking with the wife and neurosurgeon, we thought this was the best chance for the patient to remain viable afterwards. I still went through all of the instructions, in case some of it stuck. As I went through everything, it became clear that he was processing some things into memory. It was also clear that he was missing a lot and he knew his memory was not working the way it should.

This made his odd affect finally understandable. He looked partly bemused, surprised and suspicious. He did not know if should act as though he had talked to me before about all of these issues or if this was all truly new. Over the course of a couple of weeks, he had gone through the kind of memory loss that most of us will undergo over years. All while having some self awareness that it was going on. How must he have felt? Trapped? Scared? Hopeless? Heck, can you forget feelings too?

It was a long and fairly arduous procedure. It was pretty rough in parts, complicated by his memory loss. His response to some drugs was atypical. Still, we made it through. I followed him in the recovery room a bit longer than usual. On my way out I checked one more time. He looked straight at me, and with a big smile said, “I remember you.” I hope he remembers everyone from now on.

Montreal poutine from La Banquise in Montreal

Calvin Trillin (audio; abstract of article in The New Yorker not online) samples a signature French-Canadian dish known to some as a “heart attack on a plate”.

The Pacific Yearly Meeting Advices and Queries for the Eleventh Month (Quakerese for November) are on peace. You can see the advices if you follow the link; I will just reproduce the queries here.

Do I live in the virtue of that life and power that takes away the occasion of all wars?

How do I nourish peace within myself as I work for peace in the world?

Do I confront violence wherever it occurs, even when my personal relationships are involved?

Where there is distrust, injustice, or hatred, how am I an instrument of reconciliation and love?

What are we doing to remove the causes of war and destruction of the planet, and to bring about lasting peace?
Do we reach out to all parties in a conflict with courage and love?

The historic peace churches cover a range from more emphasis on separation from the world (for example, the Amish) to more emphasis on engagement with the world. Quakers tend to be way over at the engagement end of the spectrum, and so our peace testimony, in part, is lived out in activism, from the small silent protest against the Vietnam War, in which I remember the Quaker mother of my grade school best friend taking part, to the relief work of the American Friends Service Committee, to the work of the Quaker United Nations Office, to the legislative activities of the Friends Committee on National Legislation. At the same time, the queries that we consider each year on peace are also directed toward personal relationships, nurturing peace within ourselves, and living in the spirit that takes away the occasion of war; working for peace involves the small scale as well as the large, and inward work as well as outward work.

But it’s FCNL that I want to talk about today, because FCNL has just finished its annual meeting, and this year, something particularly cool happened in our meeting. One of our members asked to represent us at the annual meeting, and his teenaged daughter, the girl I have (following her parents’ Internet usage) called Catgirl, asked to go with him. They have just returned home. While they were away, they both diligently kept us informed about events at the FCNL annual meeting via blog posts and Twitter. Here, for example, is Catgirl’s account of Days One and Two of the FCNL annual meeting. Here, for example, are some of her father’s Tweets from Sunday:

Two testimonies: “We are prisoners of hope” and “I’ve always felt that ‘hope is a thing with feathers.’” #FNCL2009
10:09 PM Nov 15th from TweetDeck

“Why are Americans so willing to accept red/blue labels when there are so many other hues?…The work of the Spirit is to diversify” #FCNL2009
7:27 PM Nov 15th from TweetDeck

Meeting for worship is half from the programmer tradition, w/hymn, reading & speaker, & half in unprogrammed sitting in silence. #FCNL2009
7:07 PM Nov 15th from TweetDeck

Development report: “They say that time is money. This is not true. Time is time, money is money.” (I think he’s an accountant. #FCNL2009
5:53 PM Nov 15th from TweetDeck

An Epistle Encouraging Quaker Engagement with American Muslims: http://fcnl.org/muslim-epistle @EmpressNorton, this one’s for you. #FCNL2009
4:45 PM Nov 15th from TweetDeck

Up next: Meeting for Business, in which we cover the agenda items plus all the stuff that spilled over from yesterday’s meeting. #FCNL2009

I am @EmpressNorton, and the reason the Muslim epistle is directed particularly at me is that I’m one of the point people, in my own local meeting, for Muslim-Quaker dialog. I’ve been leading a Quran study, that meets once a month, where several of us go through sections of the Quran to get a better understanding of Muslim beliefs, I’ve connected with some people at local mosques, we’ve had a Muslim woman come in to talk both to the meeting as a whole and to our First Day School, and (this one I missed due to being in Hawaii) another member of our meeting arranged for a group to visit a mosque as part of an Open Mosque Day in which many local mosques took part. I can think of at least one Quaker in Southern California who has done much more than me, in terms of Muslim-Quaker dialog, and that’s Anthony Manousos. But in Orange County Friends Meeting, I’m the obvious person to get the epistle. Here it is: An Epistle Encouraging Quaker Engagement with American Muslims.

As Quakers we are called to “answer that of God in everyone.” Our work begins with ourselves and our own country. This work must include our embrace of the “other,” in order to replace “tolerance” with understanding, respect, and sustained collaboration on issues of mutual concern. Especially since September 11, 2001, American Muslims have been wrongly stereotyped as foreigners, unbelievers, and terrorist-sympathizers.

The Christian roots of Quakerism bring us Jesus’ answer to “Who is my neighbor?” in his parable of the Good Samaritan [Luke 10: 35-37]. Paul heard this message and worked to open the community of believers to the “other,” regardless of ethnicity, status, or gender. [Gal. 3:28]. Many Quakers have extended their hands to the “other” over the centuries.

If we stand together to practice equality and justice, we can enhance our understanding of American Muslims and theirs of us and raise American Muslim visibility in a positive way, which is of special importance to Muslim youth….

You can follow the link for the whole epistle.

At a more local level, our meeting authorized our clerk to write a letter to the Los Angeles Times, in the wake of the Ft. Hood massacre, cautioning against condemning all Muslims, and relating our own experiences with our local Muslim community. Her letter was published, and can be found here (Dee Abrahamse, Long Beach, clerk of Orange County Friends Meeting).