These blog posts started months ago, with me questioning why exactly Universal Health Care was innately bad on Facebook and proceeding with me reading various analyses and articles on the issue. So the following blog posts are a summarization of my understanding of the issues at stake and an overview of the solutions that have made the most sense to me in my readings. I’m writing this for my benefit as well as anyone who would like a bigger picture view of the system and it’s flaws. I am organizing the posts so that I explore all the flaws first, and then some potential solutions that make sense to me, and I am trying to keep the posts to bite-sized chunks. I am of course, always open to discussion.
The Healthcare System
There are two main critiques of the healthcare system that we are supposed to be solving with whatever bill emerges. The first is that there are millions of uninsured people in America who either can’t obtain care because of “pre-existing conditions” or are unable to afford healthcare but don’t qualify for the existing government programs. Secondly, there is the issue of excess, fraud, and inflation in healthcare – estimates are that about 30% of all medical services provided are unneeded, but are still covered by insurance thus contributing to the rising costs. Because of these unneeded services, healthcare costs are rising faster than the GDP or the average American’s income.
It would seem that the two problems are directly linked – as healthcare costs rise yearly, insurers must be more careful about who they cover and what issues they cover, leaving millions of people uninsured with no hope for coverage that is reasonably priced.
This is the simple version though – and as I’ve read what I’ve had time to read and parsed the sometimes overwhelming amount of information, my frustration has risen at the amount of people who take this simplification at face value and assume that this is the totality of our problem and that’s why a simple solution is needed. This is the American way though – we boil something down so simple that it’s seemingly a straw man, and then we just fix the straw man. But the devil is in the details, and healthcare is all about the details so that is why I’m writing these posts.
The Complications
The Healthcare system as it stands now is not a free market system. Politically minded people want us to believe that the choice is between our free market status quo and Obama’s socialistic plan. This is not the case, and it is confusing a lot of people. Right now as a consumer of insurance, my best bet for obtaining coverage is through an employer based group plan. That plan is provided by a Insurer that can only operate in the state I live in, meaning that in every state in the US insurance works differently and has different main players. To provide coverage in each market, each insurer must negotiate with each Healthcare provider to decide on rates and coverage for each service provided – and the rates that the Healthcare provider and Insurer decide on in no way change the rates that another insurer might get with the same healthcare provider.
Because of these problems, we work in a very monopolistic market, where each state is dominated by two or three major insurers. Those insurers are the only choices employers have for providing insurance, and anyone who cannot join group coverage is faced with the exorbitant costs of premiums that come with individual coverage. They have no real choices because there are only two or three major providers and these insurers have any incentive to compete with each other on individual plans because their main consumers are businesses who obtain group coverage.
I should note – the laws right now do not allow insurers to provide coverage across state lines, this is a legal hindrance and not a choice on the part of insurers. Because of this, each state is a unique market in healthcare and prices fluctuate from state to state (and often city to city within states) because there is no actual open market that guides pricing.
Pricing in the healthcare industry is yet another confusing, non-free-market system. Every hospital sets the prices for what it thinks the services it offers are worth. This is probably not completely arbitrary, but it can vary a great deal within a city. No hospital is required to publish a price list and there is no free market pressure to reduce prices as each hospital usually is only competing for business from a few major players (the main insurers in that market). Consumers have no knowledge up front of the cost of their medical procedures and thus are unable to make economically-minded decisions about healthcare. That point will be revisited.
For an insurer to provide coverage at any specific healthcare provider, the insurance company has to actually go to that healthcare provider and negotiate rates for all the services they provide. If a hospital says that a certain test costs $1000, the insurance provider will negotiate how much they have to pay for all the people they cover if those people receive the test, and it will typically be a drastically reduced rate (like say, $300-400). But EVERY insurance provider has to do this negotiation, and all of them will get different rates. It used to be (until a decade or so ago) that hospitals were the losers in this battle, because they were the small dog at the negotiating table.
A decade or so ago, coinciding with the rise of the HMO’s, hospitals began banding together into networks, increasing their negotiating power with insurance providers. Because the insurers goal is to have as many choices for the people they cover, when hospitals banded together, insurers had more incentive to come to an agreeable deal with the hospital networks so that their insurees had more options. Before the hospitals banded together, the insurer always had the option of saying due to unreasonable rates, we will not provide coverage at your hospital to the thousands of people in your market. The hospitals banding together into large networks removed this threat because an insurer couldn’t risk not providing coverage for so many hospitals in a certain market.
This move on the hospital’s part, and the increased power on their part at the negotiation table meant that rates started rising – insurance providers could no longer lowball. But the combination of state line limits on insurance providers with the new hospital networks means that in each state the size of the insurance provider dictates the rates they receive – the hospital networks didn’t just even the scales, in many cases they tipped the scales in the hospital’s favor. If an insurer in a specific state doesn’t have a lot of clout (meaning a large amount of people that they cover in a given hospital network’s area), they cannot negotiate lower rates. This only increases the monopolistic market of insurance, as only the biggest insurers can negotiate lower rates with more healthcare providers so that their premiums don’t rise as fast. The smaller providers are stuck with higher rates that they must pass on to the consumer.
In view of this control and the conflicts of interest that permeate the enterprise, it is not surprising that industry-sponsored trials published in medical journals consistently favor sponsors’ drugs—largely because negative results are not published, positive results are repeatedly published in slightly different forms, and a positive spin is put on even negative results. A review of seventy-four clinical trials of antidepressants, for example, found that thirty-seven of thirty-eight positive studies were published.[8]But of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome. It is not unusual for a published paper to shift the focus from the drug’s intended effect to a secondary effect that seems more favorable.
This article from the New York Review of Books about how the doctors who lead medical tests on new drugs from big Pharma companies is particularly damning. I’m especially worried about how the medical doctors don’t seem to recognize that these are conflicts of interest – the fact that they receive thousands if not millions each year from the companies that produce the drugs they are supposed to be scientifically (read: without bias) testing. Yet another hole in our current medical system.
For anyone who might read this blog regularly I am preparing a series of posts on the information I’ve gained in the past few months about the US healthcare system. Nothing groundbreaking or revolutionary, but just trying to compile and sort out all the information in my head. I hope to start posting them over the weekend, once I get the drafts for every post completed.
“Here’s to the crazy ones. The misfits. The rebels. The trouble-makers. The round heads in the square holes. The ones who see things differently. They’re not fond of rules, and they have no respect for the status-quo. You can quote them, disagree with them, glorify, or vilify them. But the only thing you can’t do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.”
-Jack Kerouac
This has always been, and most likely will always be my favorite ad campaign ever. There are lots of reasons why it works as excellent advertising, but I love the way it works as inspiration. Seeing these great faces and hearing Kerouac’s quote is inspiring. This commercial (and the posters that were part of the campaign as well) reminds that mankind is capable of truly awesome inventions and art, and it is not necessarily the smartest of us who create them, it is the bravest. Those who step out and do think different.
I’m in no mood to write a review, so this is a scattershot meditation on Spike Jonze’ film that came out today. Freya and I couldn’t wait any more to see it, so we braved the midnight showing here in Nashville.
This film is a child-view examination of the life that we live in constant tension. The wild things are ferocious and more than capable of crushing or eating Max, but they also want him to lead them and all have their own problems that they think he solve.
There is no attempt to simplify life or hollywoodize a moral out of a wandering story, rather the film is simply concerned with what does it mean to be a child, what does it mean to have emotions that are stronger than we care to admit, what can imagination and escape do for us, and yet to simplify the film to these questions offends the power and beauty of it. Spike, and co-writer Dave Eggers have attempted to remove the wisdom we get as adults and simply capture the volatility and wonder of being nine years old, of trying to understand why good things happen and why bad things happen.
The film is beautiful. That’s really all I have to say about it right now. I can’t wait to see it again, to enter back into the world where the wild things are, to see the reign of King Max, who will be a good king. This movie is devoid of nostalgia about childhood, and in stripping that away, we remember the world as it was before we built up our defenses and coping mechanisms. And that world, as scary and volatile as it was, is worth revisiting.
Darnielle, of the Mountain Goats, reviewed some of his favorite Christian and religious albums for emusic, on the occasion of the release of his new album, on which every song is inspired in some part by a scripture verse. Here, he recommends “The World as Best I Remember It, Vol. 1″ as the album to check out from Rich Mullins:
It’s hard not to go with Songs, the first greatest hits collection — it’s more solid end-to-end. But the title of this one comes from “Jacob & Two Women”, which is one of the best Christian songs of the past thirty or forty years by anybody and an incredible song by any measure. (My favorite version of it is Carolyn Arends’s graceful reading on Awesome God: A Tribute to Rich Mullins.) It’s a song that shows Mullins at his best: witty; clever; open; doubting; playful; faithful; wistful; in touch with the sorrow & the loss & the hope & the wonder that lies underneath all spiritual seeking, and all housed in one flesh-and-blood, wholly unpretentious person. There’s also “Step by Step” and “Calling Out Your Name” here — both clear evidence of how truly great a songwriter Mullins was and how much the music world lost when he died.
Over on Tiny Mix Tapes, Darnielle is given the full interview treatment, and this question is illuminating, heartbreaking, and worth swallowing any immediate reaction you have to consider what he says for awhile.
Let’s turn to the album. Religion always seemed hinted at in your music, but it’s never been so blatant as it is on The Life of the World to Come, even without the song titles. Is there any reason for this explicitness? Religion is treated here in a similar way as subjects like love or family on past albums.
For sure: religion’s explicitly personal for me, for a bunch of reasons. My early school experiences were in Catholic school, and some of the early Sisters who taught me were real heroes to me: they nurtured me, treated me with love and respect; they meant so much to me. Experiences like those, at a parochial school, can really cement one’s ideas about God and bind them with one’s ideas about self-worth and feeling welcomed and at-home.
And then my parents divorced, and church became something we only did when we (my sister and I) would go to stay with my dad, and he wasn’t Catholic any more at that point, so I’d get exposed to the weird world of protestant services, which had their own warmth for me. And then I renounced God and raged against religion for years, as I still will, often, given all the damage that Christians (not fake Christians, that’s a cop out: real ones do all kinds of harm) will do. But down in my gut, I want to believe so badly. I can’t stand the idea that Christian virtues are mainly humans celebrating their indwelling natural goodness; it’s probably true, but I want transcendence. That’s personal. And some of my friends are dead, but I feel that what they left in this world persists: and that’s spiritual. So, yes. Spiritual stuff, way personal for me.
Thursday afternoon Freya and I are our skidaddling out of Nashville towards the similar sounding city of Asheville for our one year anniversary trip. We’re a week early so technically it’s a 51 week anniversary but we’ll take it.
The cabin has a hot tub on a deck and a skylight-lit loft area and acres of woods surrounding it, followed by mountains and forests surrounding those.
I’m taking my typewriter with a fresh ribbon, a stack of blank pages, a notebook or four, 5 New Yorkers, 1 Wired Magazine, 3 books of poetry, one book of non-fiction and possibly a novel.
I think Freya’s list of items to bring is similar in length but decidedly more visual arts themed.
We’ll be taking two cameras, one digital SLR, one polaroid.
At the Greenlife grocery in Asheville we’ll be buying ingredients for homemade chicken salad and homemade butternut squash bisque and any other recipes we find that strike our fancy.
We are making no plans except for maybe a picnic drive up the Blue Ridge Parkway, and on Monday we’ll be visiting the Biltmore.
Otherwise we will spend our days creating and reading and enjoying the hot tub and the complimentary bottle of champagne and most of all the company of each other.
And Thursday cannot, absolutely cannot come soon enough.
The National Library of Congress has a site with a poem a day for American Highschoolers. Why foreign highschoolers can’t enjoy them either I have no clue, but either way it’s a cool site. Poetry 180 is the name of the site, and here’s poem number seven:
“Do You Have Any Advice For Those of Us Just Starting Out?”
Ron Koertge
Give up sitting dutifully at your desk. Leave
your house or apartment. Go out into the world.
It’s all right to carry a notebook but a cheap
one is best, with pages the color of weak tea
and on the front a kitten or a space ship.
Avoid any enclosed space where more than
three people are wearing turtlenecks. Beware
any snow-covered chalet with deer tracks
across the muffled tennis courts.
Not surprisingly, libraries are a good place to write.
And the perfect place in a library is near an aisle
where a child a year or two old is playing as his
mother browses the ranks of the dead.
Often he will pull books from the bottom shelf.
The title, the author’s name, the brooding photo
on the flap mean nothing. Red book on black, gray
book on brown, he builds a tower. And the higher
it gets, the wider he grins.
You who asked for advice, listen: When the tower
falls, be like that child. Laugh so loud everybody
in the world frowns and says, “Shhhh.”
The wife and I saw The Decemberists in concert at the Ryman on Sunday night. The timing could not have been better as every time I go see a good concert I inevitably listen to the band on heavy rotation for the next few weeks. And the very day that they played their show the first true day of Autumn decided to sweep into Tennessee.
So I’m at work right now, storyboarding for a new video that I conceptualized, helped write, and am now animating, and who should be providing the soundtrack in my headphones but The Decemberists. I put on The Crane Wife, their album of a few years ago that was pretty excellent. I listened to 9 of the 11 songs before I really paid attention, but as soon as track 10 came on – The Crane Wife 1 & 2 – I had to stop and be a little sentimental.
There are songs attached to memories, song attached to emotions, songs attached to periods in our life or times when we were erasing the preceding period of our life. But this song is something else. As this digital copy of a recording of Colin Meloy’s voice begins to play, I am transported to an unknown place and time in a very concrete season.
The acoustic guitar is the lapping of a bonfire, and as the organ slowly rises in the background I feel the heat from the cup of hot chocolate I’m holding and the fire on my legs. The lyrics are small at first; so is the circle nearby that the fire illuminates and as the lalala’s build at the end I see all the stars above and the blackness around. But most of all, the rhythm of the song, the slow, melancholy tone that it is sung in makes me feel the cold of winter, the dead of the world as it hibernates and holds still for a season.
The return of the crisp, cool air in the evenings this week has been wonderful. Sunday after the concert we walked with some friends to the Walking Bridge and took in downtown Nashville. Last night we sat on our deck with good friends and drank hot chocolate and smoked pipes and enjoyed that we were chilly, reveling in the way the night air actually caused us to shiver and bundle and appreciate the warmth of the house.
After the new year, a few months from now, the winter chill will be at its worst and the grayness of the world will be crushing and every breath will be cut short because of the way your lungs freeze. Then we will once again long for spring, for warmth, for specks of green in a world of browns, and sometime after that those things will arrive.
But this week, right now, there is the first arrival of Autumn and after the lethargy of late summer and the monsoons of the past few weeks the cool air in my lungs is more entrancing than the very best fireworks display on our national birthday. And the Decemberists are doing their part to excite me about the impending chills.
As you can see below, I saw some (all?) of the works of Shakespeare last night in the park. A few weeks ago I had the pleasure of seeing the same three actors plus a bevy of amateurs perform The Taming of the Shrew in its full form.
I subscribe to The New Yorker and Wired, and while they are far different types of writing and the topics rarely overlap, each issue is filled with excellent writers writing about interesting subjects. I read about 80% of all long-form articles in the New Yorker and typically read Wired cover to cover.
And it turns out that reading all of this – plus the books and quarterlies and blogs that I occasionally manage to fit in – has a detrimental impact on my confidence as a writer. It might be that I have the ability to write, it might be that I could say something of value in a manner that isn’t blatantly amateurish in quality, but the bevy of good literature I read becomes an obstacle to overcome.
True I learn and the words I do write are immensely improved simply by the quality of literature I regularly expose myself to.
But that’s just it – I read lots of incredibly good literature. Just like with films (and my wife and friends will tell you that I’m a big film snob), if given a choice I will avoid any and all bad writing because there is so much good writing that I’ve never even read. And that really bothers me.
But this snobbish choice of mine – to avoid bad writing so I can explore more of the good – serves to cripple my fingers when presented with a blank page, an open document or a blank blog entry box. I just cannot bring myself to create bad writing.
These days my only strength as a writer is my complete willingness to throw a sentence out. Except I throw EVERY sentence out. I start down one path, then a few paragraphs in decide it’s cliché. So I try from a different point of view. But it’s cliché too.
Cliché, I am increasingly being forced to admit, is simply a blindness to the fact that you are not revolutionary. Yes, what I am doing has been done before. Yes, what I am writing resembles other people’s writing – it turns out English sentences have only so many forms that actually make grammatical sense. No, my name is not David Foster Wallace. Or Flannery O’Connor. Or whomever the author is that I am excited about at the time.
And if I could grasp this glimmer of wisdom like an umbrella, open it up and step under it, I would find that it just might protect me from this insidious desire to be a genius.
But no, no, why would I embrace wisdom? My response is a synthesis of resignation and frustration – a tendency to spew sarcasm and snarkiness and cynicism. So I twitter a lot of smart aleck remarks and push peoples buttons with my blog posts and facebook statuses but meanwhile, have no body of work that actually tests the idea that I have an ability to write. Thus my epiphany.
I have become a really pretentious troll. And frankly, I am ashamed.
My modus operandi in “real life” is happiness, exuberance, passion, and a constant curiosity. And if you’ve found that in my online persona, well I applaud you because obviously you’re reading between the lines of what I say into, wait, no. I don’t applaud you. Rather I’m worried about you because you are obviously crazy.
Will this change now? I hope so. I really do. The thing is, and this is ultimately what I was getting at with the title of this post – I want to write well, and when I write now I am not well, and thus what i write is not good.
Here’s hoping that changes. Blogging is hard, but I think what is even harder – and what has kept me from doing it the most is how finding worthwhile, interesting subjects I can write about in a constructive, interesting manner is much harder than being a sarcastic cynic.
I know I’ll never be Shakespeare, and I have no long-term goal of writing in the New Yorker or Wired or really even being published at all, but my intention with this blog is attempting to add to the bevy of good writing that is available for you to read so that should you decide to read it, your time at wnstn.com might be worthwhile.
The wife and I went to see the Nashville Shakespeare Festival’s production of The Complete Works of Shakespeare Abridged in Centennial Park tonight. It was rollicking good fun. I was crying from laughing so hard – pretty much the whole way through.
On our way there, driving down Eastland passing RosePepper and Ugly Mugs we were confronted with this glorious sight, so I had to get out and stand in the road and take a picture!
Sunset
And then after parking, the Parthenon was looking quite glorious so I had to capture that as well, all before the show even began.
The Parthenon at Dusk
Only three actors were involved in the production.
Bradley Brown (As a humble narrator)
Christopher Campbell (As Julius Caesar? It was hard to keep track)
Benjamin Reed (Giving the second most famous speech from Hamlet)
There was a great deal of cross-dressing, editing liberties, misinformation, more editing liberties, some choice dialogue from across the Bard’s plays, and all the comedies condensed into one section because as we all found out, the Tragedies are much more comedic than the comedies.
For the full set of pictures, hop on over to my Flickr, where I uploaded 12 more pictures of the actors performing their wonderful trade.
Bradley Brown (As a humble narrator)
Christopher Campbell (As Julius Caesar? It was hard to keep track)
Benjamin Reed (Giving the second most famous speech from Hamlet)