A simplified explanation of why we need a public healthcare option

Thanks to my friend Nathan for passing it on!

(Video link)

The middle of the race

Yesterday was a tumultuous but decisive day... I made the decision to move back to Portland, sooner rather than later. No fall classes at UNLV. It's time. The decision was based on a lot of practical issues, but my difficulty in finding someone to join me for happy hour in Vegas underscored the decision. While I spent the evening calling, texting, emailing, and chatting with friends in San Francisco, Los Angeles, and Portland, I just couldn't find anyone to do anything with locally.

I ended up watching Revolutionary Road last night (here's an excellent review, which I may think is excellent since Ebert uses the same word I used to describe the movie: "devastating").

I was texting with a friend about it this morning. He thought the acting was superb, though the ending "somewhat predictable." I completely agree about the acting: Kate Winslet and Leonardo DiCaprio were amazing. But his comment spurred this thought:

I think I'll appreciate it a little more with some distance. If the ending was predictable, I think it's because endings are. No matter how close we fly to the sun, it's pretty obvious what will happen in the end.

And in reference to our mutual confusion as we make our navigate our way across the landscape of urban gay life:

As for us and confusion and convention... it seems oddly connected to the movie. Or perhaps I'm just seeing that because it's where I am right now. Life is often a mystery. And random. And its unpredictableness--especially in the face of its ultimate predictability--is the source of much of its beauty.

Right now life seems its most confusing. And for the first time I'm seeing a somewhat obvious reason for that. I'm reminded of a day 25 years ago when I was running in a cross country meet hosted by my high school. It was our own course, so you'd think that I'd know my way across it. But halfway through I was in the lead, which in itself was unusual. I had to stop because I got lost and didn't know which was to go... I had always had someone ahead of me to follow.

I'm roughly halfway through my life right now. I have neither the starting line nor the finish line in view, no clear landmarks of where I started or where I'm going to end up, and no one ahead of me to show the way. I'm just out here in the middle, making my own way, trying to find my path.

I know how it's going to end up, after all. I just have to figure out what to do with the time between now and then.

Song of the afternoon

Queen's "These Are the Days of Our Lives"

(Video link)

The lyrics:

Sometimes I get to feelin'
I was back in the old days - long ago
When we were kids when we were young
Thing seemed so perfect - you know
The days were endless we were crazy we were young
The sun was always shinin' - we just lived for fun
Sometimes it seems like lately - I just don't know
The rest of my lifes been just a show

Those were the days of our lives
The bad things in life were so few
Those days are all gone now but one thing is true
When I look and I find I still love you

You can't turn back the clock you can't turn back the tide
Ain't that a shame
I'd like to go back one time on a roller coaster ride
When life was just a game
No use in sitting and thinkin' on what you did
When you can lay back and enjoy it through your kids
Sometimes it seems like lately - I just don't know
Better sit back and go with the flow

Cos these are the days of our lives
They've flown in the swiftness of time
These days are all gone now but some things remain
When I look and I find no change

Those were the days of our lives - yeah
The bad things in life were so few
Those days are all gone now but one thing's still true
When I look and I find
I still love you

I still love you

Leaving Las Vegas

Two years and a day ago I arrived in Las Vegas. I had been living in San Francisco, had muddled through a depressing spring and early summer, and then had met Victor while he was living in San Diego. He invited me to move to Vegas with him. I agreed.

I arrived that first day with excitement and hope for a new start, a feeling that was quickly tempered a few days later when I caught him in a lie... unfortunately the first of many. But somehow we made it through a year and a half, and when we split up, I thought that I'd stick around and make a life in Vegas. I was in school, working on my pre-reqs for a physician assistant program, and sticking to that path seemed like the way to go. (One great thing about moving to Vegas has been starting school and figuring out what to do with the rest of my life, no small thing.)

That was eight and a half months ago. While I've had some good times here, I've also spent a lot of time on my own, doing my own thing, unsure of where this path was leading. I've ran off to San Francisco for many a weekend; I was spending time with my old circle instead of building a network here. There have definitely been opportunities to do so in Vegas, and too often I've chosen to let them slide by. I'm feeling that now: missed opportunities.

It's been hard to invest the time and energy into being a good friend here when I've been so uncertain as to how long I was staying. That's been a mistake, because while I was here I could have just been here. And I've come to see how much I do need the support of friends, especially as I navigate my way towards a new career. I'm feeling the call of established ties and the desire to be close to those who know me well already.

San Francisco, of course, will always be home, but it can be a bit too much sometimes--too many things to do, too many friends with tempting offers--and I'm hesitant to try to be a student there, lol.

Portland is home, too, and a bit more low key and easier to manage. And since my top choice for school is there anyway, it seems like the way to go.

Today I'm just trying to decide when: do I stay and complete another semester at UNLV, or do I move sooner?

Either way, I'm leaving Las Vegas in 2009. It's just a matter of when.

Song of the morning

Grace Jones... "La Vie en Rose"... one of my favorite morning songs.

(Video link)

Song of the day

Howie Day's "Collide"

(Video link)

Then, again, now, and when

Hmm. Today is a strange nexus of my childhood, my young adult life, where I am now, and where I'm going.

I returned last night from a weekend in San Francisco and at the Russian River. So many memories of so many days and nights gone by. I was at the River from Saturday until Monday; Sundance was on Sunday. It was always one of my parties; there are few things I love more than dancing in the sun surrounded by good friends and beautiful men.

At one point early on on the dancefloor Sunday afternoon I was dancing within fifteen feet of my college boyfriend Lance, my first post-college bf James, my ex-husband and current wingman Tommy, and the two men I dated when I returned to SF from Portland, Anthony and Justin.

I was also surrounded by friends who I've danced with for over fifteen years, and the DJ, Phil B, told my friend April that he loved how we were all out together after all these years.

The mid-nineties: the best of times... one of those magical moments when you make a circle friends that last forever.

But there were new good times over the weekend as well, though reality sank in back in Vegas. Classes have started at UNLV: do I stay here for another semester, or do I move on to Portland where new opportunities are waiting? And when and how do I start cleaning up all of the messes I've made?

And childhood... how does that fit in? Driving home from UNLV, on a 100 degree day, planning a Friday happy hour with my friend Ricky, I was ready for a beer. I remembered being a kid and watching Dallas and noticing that when JR came home from Ewing Oil, he'd make himself a drink. And I thought, "When I'm grown up, that's what I'm going to do. Come home and mix myself a cocktail."

But while I love them, somehow a drink has never become part of my post-work routine.

(This Heineken sure is good right now, though! :-)

Song of the weekend

A classic tea dance song that always reminds me of Sundance... "Perfect Day" by Indigo.

(Video link)

Correction

Whoops. My dad just informed me that I probably meant "constitution" rather than "prostitution" in this post. He is correct.

At least I know he's reading!

Here's a question: how big should I be?

How organisms know how large to grow remains a mystery:

But here’s the thing. While we know quite a bit about the forces that cause animals to change size, we know rather little about how an animal’s body “knows” what size it is supposed to be. Let me show you what I mean.

Take a salamander. Let’s say it’s a certain size, and it has a certain number of cells. Suppose you double the size of the cells. Do you get a salamander that is twice as big? No. You get a salamander that’s the same size as it was before. But it has half the number of cells. Somehow, the salamander’s body can measure how big it is and stops growing when it gets to the right size.

(These animals look like regular salamanders, and are perfectly healthy. However, they are a bit stupid, apparently because they have half the number of brain cells. They’re less good than regular salamanders at solving mazes.)

And how about the diversity of life:

But the animal that really captivated me was the pygmy shrew. It was tiny! Smaller than my little finger. It weighs only a few grams (less than a quarter of an ounce), and is smaller than some insects. The Goliath beetle, for example, can weigh more than 100g (3.5 ounces), and can be as big as my palm.

I contemplated the pygmy shrew, imagining it burrowing through grasses, capturing small insects, perhaps engaging in an epic battle with an earthworm. I thought about its heart beating at 1,200 beats a minute, and about the fact that some species of shrew are so small that they can run on water.

And then I thought how remarkable: the shrew is a mammal, and the blue whale is a mammal. Yet the blue whale is the largest animal ever to have lived. The biggest ones — which, by the way, are females — can grow to be as long as 30 meters (about 100 feet) and can weigh over 120 metric tonnes (118 tons). One of the most massive blue whales ever put on the scales was 190 metric tonnes (187 tons).

Now for the next question: how do you put a blue whale on the scales???

The Times of Harvey Milk

If you've never seen this amazing documentary about the life of gay trailblazer Harvey Milk, it's now available on the web. The opening footage with Dianne Feinstein still gives me the chills... and often brings me to tears.

Watch The Times of Harvey Milk here.

Language and thoughts

Here's a short, interesting article on that notion that language constrains the thoughts that we can have.

Strange bedfellows

Ted Olson, the conservative lawyer who argued Bush's case in Bush v. Gore, is now leading the legal fight against proposition 8 which amended California's prostitution constitution to ban gay marriage. Here's the story of how he got there.

While Mr. Olson came to the case by a serendipitous route that began late last year with Rob Reiner, a Hollywood director widely known for his Democratic activism, he said his support of same-sex marriage stemmed from longstanding personal and legal conviction. He sees nothing inconsistent with that stance and his devotion to conservative legal causes: The same antipathy toward government discrimination, he said, inspired him to take up another cause that many on the right applauded — a lengthy campaign to dismantle affirmative action programs.

A hearing in the marriage case, filed on behalf of two gay couples, is scheduled for Wednesday in federal court in San Francisco. Practicing his opening argument recently, Mr. Olson declared that California’s ban is “utterly without justification” and stigmatizes gay men and lesbians as “second-class and unworthy.”

“This case,” he said afterward, “could involve the rights and happiness and equal treatment of millions of people.”

Song of the day

"Zero" by the Yeah Yeah Yeahs. Watch and listen here.

Whole Foods and healthcare reform

I had heard that there was a boycott movement going on with regard to Whole Foods... I saw this piece in the New York Times and got the background. It's worth a read because it ultimately led Ezra Klein to make some interesting observations about healthcare reform when looked at from the model of how we deal with food and people who are hungry. (Or you can just skip the Times post and go straight to Ezra :-)

Obama: The time is now for healthcare reform

Obama has an op-ed in Sunday's New York Times. He lists the main reasons why the proposed reforms will address issues in our healthcare system:

First, if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family — coverage that will stay with you whether you move, change your job or lose your job.

Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.

Third, by making Medicare more efficient, we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies. This will not only help provide today’s seniors with the benefits they’ve been promised; it will also ensure the long-term health of Medicare for tomorrow’s seniors. And our reforms will also reduce the amount our seniors pay for their prescription drugs.

Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable. A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition. The companies either refused to cover the person, refused to cover a specific illness or condition or charged a higher premium.

He encourages debate but urges Americans to keep it civil:

The long and vigorous debate about health care that’s been taking place over the past few months is a good thing. It’s what America’s all about.

But let’s make sure that we talk with one another, and not over one another. We are bound to disagree, but let’s disagree over issues that are real, and not wild misrepresentations that bear no resemblance to anything that anyone has actually proposed. This is a complicated and critical issue, and it deserves a serious debate.

And he warns us to not be frightened away from reform by the scare tactics of those opposed to change:

In the coming weeks, the cynics and the naysayers will continue to exploit fear and concerns for political gain. But for all the scare tactics out there, what’s truly scary — truly risky — is the prospect of doing nothing. If we maintain the status quo, we will continue to see 14,000 Americans lose their health insurance every day. Premiums will continue to skyrocket. Our deficit will continue to grow. And insurance companies will continue to profit by discriminating against sick people.

That is not a future I want for my children, or for yours. And that is not a future I want for the United States of America.

In the end, this isn’t about politics. This is about people’s lives and livelihoods. This is about people’s businesses. This is about America’s future, and whether we will be able to look back years from now and say that this was the moment when we made the changes we needed, and gave our children a better life. I believe we can, and I believe we will.

Christmas in August

Here's the Trey Parker / Matt Stone video Christmas card that inspired South Park.

(Video link)

Typical conservative grandstanding

The Senate Finance Committee health insurance reform bill had a provision that would give patients the right to speak to a counselor about end-of-life issues. Many Republicans threw a fit and claimed that this was putting us on "a treacherous path toward government-encouraged euthanasia" (in the words of House Minority Whip John Boehner).

Only problem is, many of those same Republicans voted for just such a provision in 2003. And President George W. Bush signed it into law.

Hmm.

More here.

Bill Clinton on DADT and DOMA

President Clinton was interrupted during a speech yesterday at Netroots Nation by a heckler asking about Don't Ask Don't Tell and Clinton's signing of the Defense of Marriage Act.

Bill took the time to explain his reasoning for what he did back in the 90s. A lot of it I'd never heard articulated before. And after a rough year on the campaign trail for Hillary, he finally sounded like the old Bill to me. Definitely worth a watch. The transcript and more on the story can be found on Towleroad.

(Video link)

Quote for the day

To argue with a man who has renounced the use and authority of reason is like administering medicine to the dead.

-- Thomas Paine

So you know you live in Vegas...

When you go to bed, set the thermostat at 80, and still feel cool under the covers. :-)

Ezra Klein on the healthcare shouting match

Ezra's take on the hullaballoo here. He thinks it the state of our political and media landscape rather than the issue at hand or the occupant of the White House.

Better (and less expensive) healthcare

Lost in much of the current healthcare debate is discussion about ways to actually improve patient care while lowering costs. Instead the crazies focus on "death panels" and taxes and the government taking over healthcare, while those supporting reform have gotten dragged down into defending against those arguments.

Atul Gawande and three other doctors have been looking at communities around the country that already provide great care at a cost much lower than the national average:

Yet in studying communities all over America, not just a few unusual corners, we have found evidence that more effective, lower-cost care is possible.

To find models of success, we searched among our country’s 306 Hospital Referral Regions, as defined by the Dartmouth Atlas of Health Care, for “positive outliers.” Our criteria were simple: find regions with per capita Medicare costs that are low or markedly declining in rank and where federal measures of quality are above average. In the end, 74 regions passed our test.

So we invited physicians, hospital executives and local leaders from 10 of these regions to a meeting in Washington so they could explain how they do what they do. They came from towns big and small, urban and rural, North and South, East and West. Here’s the list: Asheville, N.C.; Cedar Rapids, Iowa; Everett, Wash.; La Crosse, Wis.; Portland, Me.; Richmond, Va.; Sacramento; Sayre, Pa.; Temple, Tex.; and Tallahassee, Fla., which, despite not ranking above the 50th percentile in terms of quality, has made such great recent strides in both costs and quality that we thought it had something to teach us.

If the rest of America could achieve the performances of regions like these, our health care cost crisis would be over. Their quality scores are well above average. Yet they spend more than $1,500 (16 percent) less per Medicare patient than the national average and have a slower real annual growth rate (3 percent versus 3.5 percent nationwide).

The op-ed can be found here. Gawande also wrote a great article on this topic for The New Yorker which I blogged about here.

ONE DOCTOR RESPONDED to a conversation taking place over on The Daily Dish; he points out that in our current system, there are no incentives to keep costs down even while taking excellent care of patients:

The story of $15,000 for a needle in a thigh touches a nerve with me. As a surgeon, I'd have tried to find it using local anesthetic, in my office, before escalating to an operating room. With luck -- and since it was an insulin needle it couldn't have been very deep and would have been near the entry hole -- it'd have been a couple hundred bucks or so, including my fee and the use of a few sterile instruments. It's possible, of course, that it would end up requiring xray guidance; even then, it's hard to figure where the $15,000 went.

But here's the thing: no one would have recognized the savings, or even cared, much less rewarded me for it in any way....

Likewise, when I did breast biopsies in my office, with local anesthesia and comfortable patients, happy at not having to go through the hassles of surgery at a hospital or surgery center, I saved thousands of dollars each of the many hundreds of times I did it. Again: no recognition, no reward. I just did it because it seems right.

This is part of what gets lost in the screaming rhetoric of the right, the death panels of Palin. Some doctors know how to save the system lots of money, and do so, every day. Establishing a means to discover them and to spread their wisdom is central, as I understand it anyway, to Obama's plan. Not rationing. Discovering why some methods are more successful and less expensive than others. Hard to understand, maybe; and very easy to demagogue. Which is exactly the problem.

His comments appeared in this post; he was responding, as did many others, to this one.

FINALLY, ON THE SUBJECT OF THE SO-CALLED DEATH PANEL: Obviously creating such a body would be a bad idea. Yet Americans do need to have a rationale conversation about what makes sense in terms of taking care of those we love at the end of their lives.

If you had a contractor scheduled to install $5,000 of new tile in your upstairs bathroom, you might just tell him not to bother if most of the first floor was on fire.

And if you rolled back the clock to when most of our grandparents were children, they probably had a much healthier relationship with the idea of death. Going back even further, it was pretty likely that people were raised in homes with multiple generations living (and dying) under one roof. Birth, death, and everything in between: it was all part of experiencing life.

Now we live mostly on our own--single people, couples, or parents and kids defining the household. Death happens, more often now, at a distance. And I think one factor that underlies people's willingness to do anything--and spend any amount--when a loved one, especially a parent, is dying may be a sense of guilt that we weren't there for them earlier. I'm painting with a very broad brush, and everyone's story is different. But it just makes no sense to me when people want to put Grandma through some difficult treatment that is unlikely to significantly extend her life and just may make her more uncomfortable during the time she has left.

The conversation isn't about whether someone else should be deciding on when to pull the plug on Grandma. The conversation should be one with Grandma... finding out just what she wants. And now, while she's still relatively healthy.

The conversation should be about what the incentives in our healthcare system should be, because right now they're set up to reward doctors and facilities that order more tests and perform more procedures rather than those who provide their patients with a higher quality of life.

And I want a way to have my personal preference--which is to not have extraordinary measures taken to keep me alive for a mere few months--mean something when it comes to the cost of my own health insurance. If I don't want replacement value insurance coverage on my car, I don't have to pay for it. I want the ability to buy a health insurance policy that will take care of me while I'm alive, not to keep me breathing indefinitely in my deathbed.

A few months ago, there was a great program on Fresh Air about this topic; you can listen here and read my earlier comments here.

Oddities of our legislature

Here's a good New York Times article with links to several essays and columns about the odd composition of the U.S. legislature. While House representation is based on a state's population, each state gets two Senators. As the states now vary widely in size, we're left with an arguably undemocratic result when it comes to passing laws that would benefit--and are supported by--the majority of the American people.

The Times piece includes a couple of excerpts from an essay by Alec MacGillis:

Why, for example, have even Democratic senators been resistant on health-care reform? It might be because so many of the key players represent so few of the voters who carried Obama to victory — and so few of the nation’s uninsured. The Senate Finance Committee’s “Gang of Six” that is drafting health-care legislation that may shape the final deal — without a public insurance option — represents six states that are among the least populous in the country: Montana, Wyoming, North Dakota, Maine, New Mexico and Iowa.

Between them, those six states hold 8.4 million people — less than New Jersey — and represent 3 percent of the U.S. population. North Dakota and Wyoming each have fewer than 80,000 uninsured people, in a country where about 47 million lack insurance. In the House, those six states have 13 seats out of 435, 3 percent of the whole. In the Senate, those six members are crafting what may well be the blueprint for reform.

And a historical explanation for the Senate's design:

The idea was to safeguard states’ rights at a time when the former colonies were still trying to get used to this new country of theirs. But the big/small divide was nothing like what we have today. Virginia, the biggest of the original 13 states, had 538,000 people in 1780, or 12 times as many people as the smallest state, Delaware.

Today, California is 70 times as large as the smallest state, Wyoming, whose population of 533,000 is smaller than that of the average congressional district, and, yes, smaller than that of Washington D.C., which has zero votes in Congress to Wyoming’s three. The 10 largest states are home to more than half the people in the country, yet have only a fifth of the votes in the Senate. The 21 smallest states together hold fewer people than California’s 36.7 million — which means there are 42 senators who together represent fewer constituents than Barbara Boxer and Dianne Feinstein. And under Senate rules, of course, those 42 senators — representing barely more than a tenth of the country’s population — can mount a filibuster.

And Hendrik Hertzberg at The New Yorker weighs in on the filibuster and the byzantine committee structure that water down the meaning of our elections:

For us, an election is only the opening broadside in a series of protracted political battles of heavy artillery and hand-to-hand fighting. A President may fancy that he has a mandate (and, morally, he may well have one), but the two separately elected, differently constituted, independent legislatures whose acquiescence he needs are under no compulsion to agree. Within those legislatures, a system of overlapping committees dominated by powerful chairmen creates a plethora of veto points where well-organized special interests can smother or distort a bill meant to benefit a large but amorphous public. In the smaller of the two legislatures—which is even more heavily weighted toward conservative rural interests than is the larger one, and where one member may represent as little as one-seventieth as many people as the member in the next seat—an arcane and patently unconstitutional rule, the filibuster, allows a minority of members to block almost any action.

Molly Ringwald on John Hughes

John Hughes directed two of my favorite movies from the 80s, Sixteen Candles and Weird Science. He died last week, and Molly Ringwald reflects on growing up and her work with Hughes here.

(Video link)

Flashbacks at the gym

Tonight at the gym they played Brownsville Station's "Smokin' in the Boys Room." When I was seven, maybe eight, my family was out shopping one evening, and my mom asked me if I wanted a 45rpm record for my collection.

I think my asking for this particular song may have been the first time that I shocked her. :-)

Song of the day

Sometimes I am still amazed how easy it is to find things on the Internet. I loved this song my senior year of high school.

(Video link)

The song is "Tonight is What it Means to Be Young" and it was in the movie Streets of Fire. (And I love the fact that the scene was posted from a dubbed version of the movie, lol.)

Healthcare insanity

The whole system is insane. Not to mention the debate.

Case in point with respect to the former: I recently needed to refill a simple prescription, but my doctor's office said I'd need to come in for a visit since I hadn't seen him in a year. So I went in, and the doctor ordered a treadmill test, an echocardiogram, etc. The experience was frustrating and highly annoying... I mean, this is a huge part of why healthcare in America is so expensive. (More on that in a recent post here.)

And on the latter issue, I am torn between disbelief and a deep sense of unease about the tone that the healthcare reform debate has taken on at town halls across the people. I listened to a report on NPR today in which one interviewee said that Hitler wanted socialism (huh?) and implied Obama did as well. And then I read a New York Times article about a town hall that Senator Arlen Specter held. I have to ask, what kind of world is the person described below living in? It's such a different reality than mine that it's frightening:

Hoping to avoid similar unrest, Senator Specter tried to control the event from the very beginning, imposing a rigid format. Only the the first 30 people who wanted to speak were given cards allowing them to ask questions. He allotted 90 minutes for the meeting and was careful to let people speak their piece. He gave succinct answers before quickly moving on to the next question. At his request the Capitol police sent three extra officers to the meeting.

In addition, he and his staff controlled the microphones. And he stood face-to-face with his questioners, often only a foot or two away, a move he said later in an interview he had hoped might make it harder for people to scream at him.

But for all his efforts, tempers boiled over 15 minutes into the meeting. Standing two feet from the senator, Craig Anthony Miller, 59, shouted into his face, “You are trampling on our Constitution!” A half-dozen security people quickly swarmed in on Mr. Miller but refrained from touching him as Mr. Specter, raising his voice, said sternly, “Wait a minute! Wait a minute!” He said the man had the right to leave.

Mr. Miller, shaking, stood his ground. He said he was furious that the Senator’s staff had limited the questioning to those with cards. “One day,” he said to loud applause, “God is going to stand before you and he’s going to judge you!”

Mr. Specter shouted into his microphone that demonstrators disrupting the proceedings would be thrown out.

Just for the record, screaming at your opponents was a Nazi tactic. (And there, I've just reinforced the validity of Godwin's Law. :-)

Quote for the day

The beauty of the world has two edges, one of laughter, one of anguish, cutting the heart asunder.

--Virginia Woolf