Celebrating Diversity, Wondering about Equality

Earlier in the day, the Supreme Court had announced its decision paving the way for same gender marriage throughout the US. The energy of the happy-hour crowd was euphoric. Smile, hugs, "happy marriage day" messages. A definite day of significant progress. Among the crowd were men who clearly had lived through much of the long-struggle for gay rights mixed in with the young generation that will largely benefit from the struggle. I wondered how much the latter appreciated the work of the former or, as we see with the HIV/AIDS pandemic, how much of this will simply be taken for granted, just as my generation did not fully appreciate the struggles of the depression of my grandparents. Also among the crowd were some lonely figures, some of whom will no-doubt join the countless other people in the world - gay and straight - who can legally marry in wondering if and perhaps hoping for the "right one" to come along.  And, this being DC, no doubt many of the celebrants are among the rich and powerful - the already well-to-do.

As I left the noisy, celebratory scene and walked out onto the street, it was back to reality. Among this reality scene were many people who continue to live on the fringes of society - people who sleep on the streets, ask for donations, perhaps suffer from the neglect of a society that often seems to place greater value on acquisition of wants instead of helping meet each others' needs.  I don't say this with smugness. I, too partake in this to some extent. I think I do better every year, but I still have a long way to go.

This is why, to me, the ruling the day before basically keeping the Affordable Healthcare Act in tact, was more significant.  This was one of the few rulings in the past few years that addressed the biggest inequity that we continue to ignore - economic inequality (as did the Fair Housing ruling earlier in the week that was a reminder of how institutional our racist/classist policies still are). This was the program that Obama promised when he was running for President, and the one that he spent enormous political capital on when he knew he had it, and he has paid the price for since then in three House election cycles.  Now, the Supreme Court has solidified this, helping to ensure income inequality is less a factor in accessing healthcare.  Given other Supreme Court decisions removing voting rights and anti-discrimination protections that are routinely used against the poorest among us, this was huge.

So, while I absolutely celebrate and understand the significance of the marriage ruling, I cringe to think that the celebrations of this are deluding us from getting the real work done for justice. I cringe to think how many gays and lesbians will indulge in spending sprees on costly weddings and unneeded gifts, sending a message that "we have arrived", when the reality is we have a long way to go.

Missing from the Healthcare debate...

In the spring of 2011, I fell off my bike and broke my arm.  No cast was needed, but I did have x-rays taken 3 times and had 3 office visits to confirm that my arm was broken and was healing.  I would have been fine with just getting the information after the first or second session, since I was not getting any treatment such as a cast.  Instead, my insurance got billed for almost $2000.

In the spring of 2012, I was experiencing some shoulder pain when I worked out, especially doing a few exercises.  I went back to the same arm guy, had x-rays, was told I have tendinitis, and was sent to physical therapy for 12 sessions.  The majority of the sessions consisted of using exercise equipment, doing stretching exercises and putting a heating pad on.  I could have just as easily done these at home or at the gym.  Each of these sessions was billed to my insurance at about $90/pop, and my out-of-pocket expenses were roughly 50%.  This doesn't include the initial assessment.  I am supposed to go back to the arm doc for a follow-up, but I don't want to pay anymore or have my health insurance plan have to pay any more just to be told I'm good.  

Both of these are examples of what I consider to be an aspect of our broken and costly healthcare system that is ignored but is perhaps an area that we could all agree on: while we do need a safety net for covering the basics and the vitals, there is a strong element in the system that over-prescribes and exploits minor ailments in order to "feed the beast."  In this system, we the consumer are often not very informed about things, and blindly do what we are told.  I'm no exception.  I did just what the doctor ordered.  But here's how I would like it to have gone, and perhaps would like to see it go in the future: a frank discussion about the diagnosis, and then a more thorough look at options.  For example, I would have been fine with the initial doctor saying I have tendinitis, and getting a recommendation to meet with a physical therapist to learn about exercises and a bit more about tendinitis.  After that, it's up to me.  I'm in my 50's, am not a lefty (except when I eat).  I can live with tendinitis; I have had shin splints since high school, and have learned to accommodate.  I broke my knee, and have arthritis there, but still do ok.  I can handle this.  It was really not necessary to have the system milk me and my insurance.

This is one of the fundamental problems that I think also needs to be addressed, and I think that universal healthcare is one way to bring it forward.  There are others, but we don't seem to use them.  I did question some orders for blood tests from an MD once, stating I didn't want to pay for them since I wasn't really willing to do the treatment.  Drove him nuts, but I think we need to move to a serious conversation not just about comprehensive healthcare but also informed consumerism.  My priority is to get my HIV treatment.  Beyond that, I'll live with the aches and pains.  If I have something I need a diagnosis and perhaps some recommendations, I'd like that as well.  It's the unnecessary and costly visits that trouble me, but that's what you get when you have people whose livelihood is dependent on people having maladies.  I think that if we are to have a sustainable system, we need to become equal partners with our physicians and insurance companies, not just pegs moved around for financial gain.

Beware the Common Enemy

What do Stalin, Saddam Hossein, and the Taliban all have in common? Each one, at one point in our history, was an ally of the US. It was not that these people were at one time fundamentally different in character than what we now know them to be, but it was that we shared a common enemy; with Stalin, it was Hitler; with Hossein it was Iran, and with the Taliban in Afghanistan, it was Russia. In the latter two cases, there was much more to it than just the common enemy. There were also issues of corporate greed, and the desire to control oil that was the underpinnings of the US economy that was dependent on the auto and housing industry. As Franklin Roosevelt said about a mid-20th century Nicaraguan ruthless dictator, "Somoza may be a son-of-a-bitch, but he's our son-of-a-bitch". (Note: there is some question about whether Roosevelt said this, but there is no doubt that he was a strong supporter of this corrupt, greed-driven dictator because he was against communism)

What does all this have to do with current events? Beyond international policy practices that still continue, this phenomenon of "my enemy's enemy is my friend" has reared its head in the healthcare debate as well. The "enemy", in this case, is Obama. For some, it is his policies, including a proposal for a single-payer option in healthcare. There is certainly room for debate here, as there are legitimate concerns about funding a program like this. (I personally have two concerns about the healthcare issue: the first is that we expect too much from healthcare, and the second is that government is an institution that is way too slow and bureaucratic to really get anything done, but I welcome the discussion).

For the fiscal conservatives who have legitimate concerns about either the financing of a program or merely have concerns about the role that government might play in healthcare (keeping in mind that Medicare, Medicaid, and the VA are already in place), having your issues heard is currently being drowned out by other "anti-Obama" allies who have more insidious motivations. Among the allies include a colllusion of: corporate greed folks, the Republican leadership that is looking for any opening to regain some power, a right-leaning media looking for viewership, and blatant racists who simply cannot believe that a black man is President. Here's how, to me, it seems to be playing out: The more corporate folks (Dick Armey, healthcare corporations, Fox News) whip people into an emotional frenzy that then comes out in the form of fear of communism, fascism, government killing old people, loss of gun rights. The racism gets thinly veiled by comments about the country being taken over by Muslims. The success of this movement is dependent on keeping people's fears heightened, and calling these fear "patriotism".

For the benefit of all of us, it would be great if we could all take a deep breath, relax, listen, and re-engage the frontal lobes. If we could open up dialog with real exploratory questions, and seek common solutions, we would all benefit. But for those who really have concerns about any government expansion in the role of healthcare, it is important to pull apart from those who are dependent on polarizing effect of "my enemy's enemy is my friend" approach. The blatant racists, partisans looking merely for power, and corporate greed folks are exploiting you for their personal agenda and care little for your real concerns. In fact, they don't want you to think. They just want you to be angry.

Healthcare, living well and letting go

Last week I was going through the mail during my few days at home and, among the many pieces were a few bills for a medical appointment I had in the spring. The total out-of-pocket expenses for this one appointment: nearly $1000. Granted, this includes the $750 deductible, but given the salary I make, it's still alot (considering that on top of this there is an additional $60/month for the co-pays of medication). As I perused the bills, I looked through the labwork that was done and it was filled with things I have no clue about.

At the same time, I was listening to the radio and the on-going debate about healthcare. No doubt we have a broken healthcare system and we need to do more to see that people have access to healthcare, especially preventive medicine. But looking through my own bills, and reflecting on my own recent interactions with my doctor (whose biggest concern seemed to be that I was rejecting the idea of pursuing elective cosmetic surgery to fill out my cheeks that have thinned out as a result of the HIV-progression or treatment).

What I am noticing that seems to be completely absent from the debate about healthcare is that not only should all people have access to healthcare, but perhaps we should also be having a national dialog about what we expect from healthcare and why. I suspect, based on my own bills, that my MD is milking me for billable services. I know that he needs to be monitoring certain things because of new medications, but I also know that in some cases, if something were off, the prescribed course of action is more medication. Do I really need to know that certain levels of something are off, if I am going to refuse the treatment?

That very week, the woman (Hilda) whose house I am living in died. She was in a nursing home for the past 2 years and had not been out of bed for that time, but on Sunday night she got out of bed and fell, breaking her leg and hitting her head. My friend Marilyn (the woman's guardian) got a call at 6:30 in the morning asking whether she wanted to have brain surgery performed on Hilda. She was told she needed to make the decision immediately, not for the patient's sake, but because this was when the operating room was available. Marilyn was told that the surgery was to remove a clot (for a woman who had been basically comatose for a few months). Marilyn was not told about the broken leg. It all smacked of a healthcare decision trying to milk this woman's estate before she died.

Basically, I think we need to open up the national dialog to include a frank discussion that, yes, we are all on the same train progressing to one common end result. We want to use healthcare to help us get there as safely, happily, healthily and productively as possible. But we perhaps should depend less on healthcare for the quality of life things, and focus on some of the basics, while we also commit to healthier living. I don't know that statistics, but have heard about the high proportion of healthcare dollars spent on the last month of life. A part of this makes sense - trying to extend lives is costly. But we should know that all we are doing is extending life, not saving it.