Don’t bother saving the world

In the grand scheme of things, worlds, suns, and other fabulous celestial bodies come and go all the time, so the loss of one more wouldn’t really make any difference at all, so you can relax. And, the Earth isn’t really under any serious existential threat at the moment, anyway. I mean, it’s getting warmer, but planets do that from time to time. It quite literally is not the end of the world. Hear George Carlin explain here.

The world will go on for some time, I would imagine, unless it collides with something or some other heretofore unimagined accident occurs. I mean, I guess it is possible the Earth will spontaneously break up into tiny particles and become another ring around Saturn, but the chances of that seem infinitesimally small.

But you’re still worried about the state of the world (aren’t you?) because you’re selfish. Only you don’t think you’re being selfish. You’re just worried about all the pretty flowers, the coral reefs, the poor people in other countries, and the cute animals that will disappear, severely affecting your enjoyment of travel documentaries. To be fair, if the plants and animals on the Earth are capable of wishing anything about you at all, I’m sure they do wish you would either go away or at least clean up your mess, so the anti-litter campaign is probably well received by the non-human inhabitants of the planet.

Somewhere deep down, you must fear that if the world ends, or even just changes slightly, you might also end and leave the world to fight for itself, which it could certainly do better without you, anyway. So, let’s face it, you’re really just fighting for your own survival. Don’t worry, you’ve got this. Humans always seem to find a solution to every problem.

Most inhabitants of the Earth are congregated near large bodies of water such as oceans. If the sea levels rise, you’re thinking you may have to move further inland. It might help a little. The folks who already live inland will most likely welcome you with open arms and give you plenty of food and fresh water as most people have already proven to be extremely concerned about the plight of immigrants and refugees.

Your arrival in the new place isn’t likely to cause too much disruption. They may have to expand the hospital a little, but it shouldn’t take too long. Tax revenue is sure to be increasing, so building more roads, schools, power plants, water processing centers, and so on will be easy enough.

As people like yourself travel around, you will carry germs with you. Things you may have become accustomed to may or may not cause problems for your new neighbors. It’s possible everyone will stay healthy. Of course, animals will also be moving and changing their migration patterns, but that should be all right. It’s not like anyone has ever gotten a serious disease from animals. I mean, whoever heard of bird flu or pig flu or anything like that? It’s absurd.

And no one worries about plagues, anymore, because they haven’t happened in a long time. The viruses that caused great epidemics in the past are long dormant. Who could imagine them being reintroduced into human society as a result of thawing ice or something? Preposterous. New bacteria aren’t likely to emerge, either, as we’ve already dealt with them. Scientists these days develop vaccines and new antibiotics at the drop of a hat. Infectious diseases are simply no longer a matter of concern. It’s hard to imagine a pandemic wiping out billions of people, certainly. That kind of thing doesn’t happen where you’ll be living.

As you travel, you may meet fellow travelers moving away from wildfires, drought, inland flooding, failed crops, and so on. Everyone will be understanding and work together to divide the available food as equitably as possible. The police and military might be called in to help smooth over any disagreements. You may see a few skirmishes crossing borders and so forth, but new drones and fortified structures will offer substantial protection to the good immigrants, like yourself. The people who die in conflict should have been more careful.

It’s possible extreme conditions could lead to occasional power failures, which might impact travel and communication. Some flights may be grounded. Some traffic signals might not work as expected. I guess there is a slight chance it will affect rail transportation. Navigation might be a little difficult. If you have a good signal, you can upload a funny meme about it. I mean, really, global warming shouldn’t affect satellite communication, should it? It’s not like airport runways could get too hot for planes to land, rail could warp under extreme heat, or roads could become impassable from melting or buckling. That kind of thing only happens in movies.

So don’t worry about the old Earth. She’ll keep spinning as long as she is destined to, with or without you. And don’t be too concerned about yourself, either. You’ve survived this far. Surely your good luck will continue. It’s a shame about the animals going extinct, though, and the poor people who have lost their homes. And you’ll always have your memories of how things were.

 

Democracy Died (#poem)

woman holding protest sign
Photo by Rosemary Ketchum on Pexels.com

Democracy died in the Senate chamber
When Supreme Court justice was never heard
Through a guileless force of legal obstruction.
Respect for law fell like old holiday garland.
A complacent nation did not demur,
Thinking true fascism could not recur,
Power transferred to a political poseur.
A complacent nation watched it’s legal destruction
And Democracy died.
They quickly forgot what they once were,
A nation of laws designed to deter
A tyrant seeking freedom’s complete destruction.
As the confident joked about his linguistic aberrations,
They let the unthinkable occur
And Democracy died.

Things People Know About Marxism (#poem #NaPoWriMo)

marx_head_3The prompt for Day 9 of NaPoWriMo is to write a list poem. I decided to write a list of things people know about Marxism.

Most people seem to know
That Marxism has something
To do with seizing
The means of production.

They seem unclear about
Who seizes it or what they
Do with it once seized,
But I guess it’s a start.

Oh, and they know
That Marxism means
Taking according to ability
And giving according to need.

Most people assume that
Means taking from good people
Like themselves and giving
To the undeserving poor.

They forget, I suppose,
That they may have needs
As well and that life is luck,
But what can you do?

Oh, and finally, people know
That Marxism means gulags
For their type, so they are
Afraid of democratic socialists.

Growing Demons in the Garden (#poem)

They hate him but everyday say his name.trump rally

The insults and mocking are more powerful

Than the most potent growth hormones.

As he grows, he bellows, drawing

Minion demons near, frightening the herd.

Luckily, it seems, the demons are weak

And easily defeated, but each

Lopped off head seems to summon

Ten, 100, or 1000 more automata

Bringing the battle to their betters.

Perhaps someone should have built a wall.

Perhaps someone should have built an entire house.

While flailing at a dust devil in the desert,

The hordes, who previously had little to do,

Were stirred to action—to destruction.

Perhaps it is time to turn away from spectacle

And focus on preservation or even flourishing.

The jokes have grown repetitive, anyway,

And the audience is weary of laughing desperation.

Just say you want to do good, you know what is good,

And you love the others.

Set your shoulder to the stone,

Dig in your heels,

And push.

If Sisyphus can do it,

I’m sure you will be at the crest soon.

The Kids are Proper Communists (#poem)

(Note: This poem is about the younger generation in general and not about specific individuals.)

I’ve always supported freedom and equalityScreenshot 2019-02-18 at 09.28.18

I wanted minorities to have equal opportunity.

I believed in promoting a liberal social order,

Showing non-aggression and peace at the border.

I wanted to teach the world to live in perfect harmony,

So that our new Utopia would all be down to me,

But my kids are proper communists,

They want to overthrow the state.

They will give everyone what they need,

And take whatever the wealthy can pay.

Workers will take the means of production,

And profit will be a thing of the past.

Even if there’s no greed reduction,

The billionaire power will never last.

They’ve declared private property a lie,

And reliance on investment income will die.

The worker and his value no longer alienated.

The greed of the bourgeoisie no longer sated.

My kids are proper communists,

Syndicalism will arrive any day.

My kids are proper communists.

You better get the hell out of the way.

Own the Libs Boycott (poem)

Whatever the liberals do,

You’re against it.Screenshot 2018-10-29 at 11.34.22

You’d destroy their position,

If you could understand it.

You bought an expensive coffee pot

Just to destroy in some boycott.

But liberals have done something new,

So you have to set fire to your shoes.

 

Corporatocracy and Me

The East India Company was the first modern corporation,

And it is credited with introducing the world to markets that are free,

But it brought the free market enforced by the world’s largest standing army.

It was the beginning of colonialism, imperialism, and Corporatocracy.

The EIC introduced the world to spices, tea, and global slavery.

Some in the United States rebelled with a giant tea party,

It set off a revolution but didn’t bring down corporate rule,

The robber baron bosses soon controlled trade, news, and even schools.

We may think their practices went against the principles of enlightenment.

But the EIC employed such men as John Locke, JS Mill, and Jeremy Bentham.

So the first corporation took control of public attitudes and education.

Promulgating equality for all European, land-owning men.

While denying rights to all those considered less than human.

When the US tried to recognise non-white men with an amendment

Giving them equal protection from abuse and harassment,

The railroad said, “Hey, corporations are people, too,”

And the courts went along as they always do.

 

Well, what’s past is past, and now it’s all good.

We’ve grown used to the idea of corporate personhood.

Citizens United taught us money is speech

You have a voice, but Exxon’s has more reach.

And Monsanto, now Bayer, wants to feed the entire globe,

By controlling food, seeds, farming, drugs, and microbes.

You have no other choice than to just trust them,

As manufacturers lead us on a race to the bottom.

Apple computers are built in factories with suicide nets.

Because conditions are so bad workers prefer death.

Our clothes are made in sweatshops where workers burn.

We’ve no choice to buy them is all that we’ve learned.

In 2007, the financial sector destroyed the economy,

But workers bailed them out with hard-earned money.

Now we’ve cut funding for public education.

Replacing it with the public/private partnership.

Giving business control of science, arts, and research.

IF you want unbiased info, you’re left in the lurch.

But what about corporations great philanthropy?

Don’t They give developmental aid from sense of charity?

No, They buy up or steal resources and flood markets with free food,

Destroying the economy and local businesses for good.

You can scream about Trump or any other entity,

But corporations are your true enemy.

 

In US, Illness is Financial Anxiety

In August 2016, I moved from Texas to the northwest of England. Last summer, I while walking in the local park I slipped on a stepping stone and sprained my ankle. As the pain pulsed through my body and my ankle began to swell, I began to wonder whether I needed an ambulance, an x-ray, or possibly even surgery.

I did not think about the cost of an ambulance or whether my insurance might refuse to pay for it, the cost of an x-ray if needed, the price of surgery, or even co-pays for medication or any possible treatments. I was worried only about my condition and getting better.

I enjoy hiking, cycling, dirt bike riding and other sports with risk of injury, so I’m not unaccustomed to dealing with the occasional injury. With similar injuries in the United States, though, I always thought immediately of the cost. Mind you, I was never uninsured, but even with insurance proved by the college where I taught, a shattered tibial plateau in 2001 that required two surgeries and months of physical therapy left me with surmountable but daunting bills long after I had recovered. Since 2001, prices have risen dramatically along with higher deductibles, narrower networks, and higher copays for treatment.

In the United States, illness or injury means an immediate calculation of costs and threats to financial security even for working people securely in the middle class. For others, the situation is much worse. Of course, long-term illness or injury can throw middle-class workers out of work, which means they will lose their insurance, unless they can afford COBRA payments to maintain their insurance for a limited time after employment. In my experience, COBRA payments are much higher than people expect or are able to pay.

As a student in medical humanities, I read many narratives of illness. They all focused on suffering from the condition, facing mortality, finding or making meaning in the face of prolonged pain, but not so much about what truly horrifies Americans when they fall ill. Illness or injury should be a time to focus on healing, if possible, or confronting or preparing for prolonged pain in the case of a chronic condition, or to prepare for death in the case of terminal illnesses. It should not be a time to worry about financial ruin for oneself and one’s family.

The study of medical ethics offers many opportunities to contemplate challenging philosophical problems with rich and varied intellectual interest. However, access to healthcare is by far the most pressing problem in the United States. Anyone concerned about illness, suffering, and medicine must assume the obligation to relieve the suffering created by unaffordable healthcare.

 

 

Illness as Financial Ruin (US only)

Every human who has drawn a breath has faced illness, injury, and death. The universal experience of illness creates vulnerability, loss of identity, anxiety, diminished autonomy, and fear. The inescapable battle between health and illness defines human experience and shapes our personalities, our worldviews, and spiritual depth.

For most of the developed world, though, it does not mean financial ruin. In the United States, alone among developed nations, even a relatively minor injury such as broken bones or illness requiring a brief hospital stay can lead to economic disaster. As a result, when we in the US get sick, we don’t think about how we can recover, how we can endure the pain, or the spiritual significance of our pain; rather, we think of how we will pay for our bills.

poorunclesam-800pxAs we face our anxiety over possible diagnoses, we must constantly be prepared to battle with insurance companies, aggressive hospital billing agents, and doctors exhausted from dealing with insurance paperwork. Few things in life create as much anxiety as financial insecurity, and illness always brings the threat of insecurity to US residents. When people have serious accidents, they balk at calling an ambulance because they fear the bills—they worry over whether the ride will be covered and whether the ambulance will take them to a hospital that is in-network. As a result, many people suffering medical emergencies drive themselves to the hospital.

When it isn’t an emergency, Americans often forgo treatment altogether. A Gallup poll in 2014 found that one-third of Americans skip needed medical treatment because of cost concerns, even when they have insurance.  According to the report, “Some 34% of Americans with private health insurance say they’ve skipped out on care because it was too expensive, up from 25% last year. Additionally, 28% of households that earn $75,000 or more report that family members have delayed care, up from just 17% last year.” The Affordable Care Act succeeded in insuring more people, but it also created greater financial burdens for middle-income families through higher deductibles and co-pays. Many people who have been accustomed to being able to afford healthcare now find that it is out of reach.

While healthcare inflation has slowed a bit in recent years,  catastrophic medical events put the costs incurred out of the reach of most of us. The United States alone finds medical fundraisers to be normal and routine. According to an article in Journal News, the number of GoFundMe contributions for medical expenses “was up more than 293 percent in 2014, when more than 600,000 medical campaigns were launched, compared to just over 158,000 in 2013.”  Families with or without insurance cannot afford their medical bills. A serious accident or illness such as cancer creates an existential crisis while forcing people suffering from illness and their families to scramble to avoid destitution.

I don’t write this impersonally, my wife and I buy our insurance through the healthcare exchanges. We pay $682 per month ($8,184 per year) with a $4,000 deductible per person. The out-of-pocket limit on expenses is $13,700 per year. Balance-billed charges do not apply to the out-of-pocket limits, so there really is no upper limit to possible charges. Ignoring balance billing, my costs could easily exceed $20,000 per year.

I often hear the argument that universal healthcare coverage is too expensive and will require raising taxes on the middle class. As I see it, I would still benefit from a tax rise of $15,000 or even $20,000 each year. It is true that others are not in my position, but all Americans should realize they are at risk. No one stays young and healthy. Eventually, everyone will be at greater risk for catastrophic illness, but even those who are currently young and healthy can face illness and injury, though we may not like to think about it. Further, everyone’s income is subject to great variability. Those who have employer-provided health insurance may not want to pay in to a national system, but employer-provided insurance is never guaranteed. Employers may cut benefits, employees lose jobs through layoffs and termination, or illness can end employees’ ability to work.

The same is true for business owners. The tides of fortune shift. When the Affordable Care Act was passed, Mary Brown brought a lawsuit against it, saying she did not want to be compelled to purchase health insurance. Mary Brown owned an auto repair shop that went under due to the pressure of economic recession and the Gulf oil spill in 2010. Of note, her bankruptcy filing listed “among the couple’s unsecured creditors several providers of medical care – a hospital and a physician group in Florida; an anesthesiology group based in Mississippi; and an eye care center in Alabama.” https://newrepublic.com/article/98145/affordable-care-act-mandate-lawsuit-nfib-mary-brown-bankruptcy-court-standing

Like many people, when she was doing well, Mary Brown thought that guaranteed universal access to healthcare was something the government was providing to other people. It didn’t occur to her that she might ever be in a position where she could not pay for her own medical care, but that is exactly what happened. I recently had the opportunity to speak to a Swedish citizen about Sweden’s healthcare system. He was a middle-aged man who explained that healthcare was paid through higher taxes. He said he didn’t mind the taxes, though, because you never know when you will be the one needing care.

It seems many Americans are not able to make this basic calculation of risk. Most people, even those who consider themselves well off, are not immune from the financial ruin that illness and injury can bring. Once people realize their own vulnerability, they support universal coverage for healthcare. The time for a more sober and accurate assessment of risk is well past due. We must wake up to the fact that the US healthcare system is not sustainable, that it leaves us at risk of financial failure, that it makes the experience of illness exponentially more stressful, and that we can do better.

It will not be easy. The US spends far more than other developed nations on healthcare. Each excess dollar we spend is profit for an insurance company, hospital, testing facility, pharmaceutical company, biotechnology company, or other player in the healthcare industry. Many people profit from the dangerous, expensive, and inefficient system we have in the United States. Every reduction in healthcare spending will be a reduction in profit for someone, and each person (or business) facing a loss of income will argue vehemently and vociferously that such a loss of income is a horrible tragedy and an impossible feat.

We will be told that reducing healthcare spending will reduce the quality of care. We will be told it will reduce our choices and control. We will be told it is impossible. We already have little choice or control, and we already have higher mortality rates than the rest of the industrialized world, so we have nothing to lose and everything to gain. We have plenty of ideas on how to improve the system. What we lack is political will, but I think the will is growing. If we want universal coverage, we must demand it, and the time to demand it is now.

 

Medicare at 50: Our Moral Imperative

Last year, on the 49th anniversary of Medicare, I wrote a post advocating the expansion of Medicare to ensure that everyone in the United States can have access to basic healthcare. In the past year, I have read and heard many arguments against the expansion of Medicare and, in fact, single-payer systems in general. As I read the arguments, I realize that in a sense “Medicare for All” and “single-payer” have become a shorthand way of saying we need to guarantee “universal access to healthcare,” but I still think Medicare for All is the way to go in the United States.

I happily admit, though, that my commitment is to universal access to healthcare, not Medicare. The first step, in my opinion, is to declare that we will provide access to medicare for allhealthcare to all United States citizens. Take this simple idea, and make it law: We will provide healthcare to every citizen of the United States. Once that law is passed, we can have extended debates about whether Medicare can fulfill the purpose of guaranteeing that all citizens will have access to healthcare (my repetition is intentional).

Here are some of the objections I’ve heard and read to expanding Medicare along with my replies:

I don’t want to pay for healthcare for people who are too lazy to work.

Many people I talk to are extremely optimistic about their ability to pay for their healthcare in the case of extreme illness or injury. The fact that you’ve made it so far only means you’ve been lucky, not self-sufficient. Mary Brown, who sued the government over the Affordable Care Act because she didn’t want to purchase insurance, went bankrupt and was unable to pay her bills. In response to her own bankruptcy, Brown reportedly said, “”I believe that anyone has unforeseen things that happen to them that are beyond their control.”  Yes, and the Affordable Care Act was designed to reduce the impact of unforeseen illness and injury. Unlike Mary Brown, many people who become medically bankrupt had insurance but weren’t able to cover their medical bills, anyway. A study in 2007 found that three-fourths of people who were medially bankrupt had insurance.  A study by NerdWallet Health found in 2013 that “Despite having year-round insurance coverage, 10 million insured Americans ages 19-64 will face bills they are unable to pay.”

For people who do have insurance, most get it through their employers. Too many people seem to forget that when they face unforeseen illness or injury, they will also be unable to work and are likely to lose their employer-provided insurance. If not immediately, it will happen sometime further down the road. Whether the road is long or short, it leads to bankruptcy. While some are rich enough to be impervious to mounting medical debt, most of us are not. A few hundred thousand dollars may sound like a safe cushion against medical disaster, but many life-saving treatments exceed that amount quickly. Selling your house and other assets to pay your medical bills may not be a solution. In fact it probably is not a solution.

The fact is that supporting a national program to guarantee access to healthcare free from the risk of burdensome medical debt is not something you should do only for other people. It is something you should do for yourself. And it is something we should do for our country.

As a nation, we share many burdens: national defense, national safety, public health, personal security. Like infrastructure and security, we are not talking about items we can choose to forgo in leaner times. These are basic human needs. Any society that does not meet the basic needs of its citizens will falter. If we can share the cost of providing a strong military, food inspectors, fire fighters, and police, we can share the cost of providing health services. The financial life you save may be your own.

Most countries don’t have a true single-payer system.

The argument here is that many countries that do guarantee universal access to healthcare do not use a “true” single-payer system. I am willing to concede that even Medicare for All might technically require the use of more than one payer. What is important, really, is that the payers are not invested in fleecing their clients, which often seems to be the case with for-profit insurance companies. In fact, if we had a single for-profit insurance monopoly, we might find our processes somewhat more efficient but not beneficial for consumers, so it matters who the single payer is as well. Just to repeat: we must have a system that guarantees access to healthcare without the risk of bankruptcy.

Medicare is fraught with fraud and abuse.

No one can deny that fraud and abuse exist within the current Medicare system. We need greater transparency, oversight, and regulation of the system and of the providers. Also, Medicare must have the ability to negotiate prices, unlike the disastrous Medicare Part D that currently exists for prescription drugs.

Corporations will game the system.

It is true that for-profit providers, whether they are pharmaceutical companies, for-profit hospitals, biotechnology companies, medical equipment suppliers or food vendors, will strive to earn as much profit as is humanly possible. This is why we need a system that empowers taxpayers to hold bad actors accountable and demand transparency regarding pricing and profit. Corporations will serve the common good only when common people demand that they do. Fatalism is an excuse to avoid the hard work of diligence.

We need price controls.

Again, simply removing all but one payer will not, on its own, lower prices. If Medicare simply sent checks to providers for whatever charges they submitted, the United States would continue to have the costliest healthcare system in the world. Medicare must have the ability to negotiate prices and set limits on unchecked profits.

We must limit unnecessary tests and treatments.

In a pay-for-service system, hospitals, labs, equipment manufacturers, and others make money every time someone is tested or treated for anything at all. More and more studies are finding that many tests lead to unnecessary treatment, waste money, and (even worse) cause more injury and death than they prevent. Unfortunately, limiting the number of tests and treatments available to patients is likely to be perceived as (shriek) rationing.

With our current system, we trust insurance companies to refuse payments for useless or harmful tests and treatments, but we know this does not always happen. When it does, clients fear they are being denied necessary tests and treatments. They fear this largely because it is sometimes true. Whether Medicare is expanded or not, we need better ways to evaluate what tests and treatments are beneficial, and we need better ways of educating patients on what is and is not beneficial.

Movements toward paying providers for results, not services, may reduce unnecessary and harmful services greatly. It may also force patients to become more responsible for their own health.

Finally

The only real imperative here is that we, as a nation, must decide whether we will provide access to healthcare for all our citizens. Once we agree that we will, we can begin to work out the most efficient and cost-effective means for achieving our goals. Almost no one in the United States is immune from the possibility of medical disaster and bankruptcy. This is a matter of caring for our fellow citizens, but it is also a matter of caring for ourselves.

On the 50th anniversary of Medicare, take a stand for healthcare justice.