Reflections on Health Care

Some things I think about health care in America:

Our system of employer-based medical insurance makes no sense. It’s an accident of history that should be scraped. It places American businesses at a competitive disadvantage. Moreover, it impedes mobility, puts a drag on the labor market and simply makes no logical sense.

Treating health care as a partisan issue makes no sense either. Disease and death don’t respect party affiliations, ideology, race or wealth. Neither should our health care system.

It’s not a matter of entitlement. No one is owed anything. Rather, it’s a matter of what’s right and just. We’re a rich country. America’s brand of capitalism and democracy has allowed many of us to accumulate vast personal wealth. But it’s a system that is poor at ensuring a fair and just allocation of the fruits the system produces. It’s not that we don’t have the money. We spend more on weapons than the next seven countries combined. It’s an issue of priorities. We can afford to ensure no citizen is denied access to treatment and care because of the inequities built into our economic system.

No child, grandparent or other person should die, languish untreated or be compelled to go bankrupt because they weren’t fortunate enough to be born to the right parents, be free of the inherited diseases or conditions that plague some, be well connected, or have the abilities or desire to land a lucrative position. It’s not right that something as basic and precious as health care is rationed on the basis of parentage, personal income or wealth.

Americans are their own worst enemy when it comes to our health. We haven’t adjusted our diets to our sedentary lifestyles. Our habits, propelled by individualistic and materialistic cultural values, are notoriously harmful, yielding high incidences of obesity, high blood pressure, diabetes, stress-induced chronic conditions, emotional and mental conditions, avoidable cancers and drug addictions. Moreover, our over-reliance on chemicals (we call them medicines) and our fear of death also lead us to spend obscene amounts of money to compensate for self-destructive habits and to extend life, regardless of quality or the impact on the community or family. But it is what it is. The health care system must accommodate these realities.

Insurers and monopolists (pharmaceutical companies) walk away with huge profits at the expense of sick and dying people and the country as a whole. Privileged positions afforded by laws passed by elected officials (from both parties) who do the bidding of their donors/masters (insurers and big pharma) need to be rescinded. Patent laws should be changed, and insurance processing should be moved to the public sector or profits capped. Further consolidation among insurers should be blocked and greater competition encouraged and fostered.

Allow citizens to buy their medicines from Canada and Mexico, countries who are more committed to the provision of affordable heath care for their citizens than we are. End protectionist policies that serve the needs of the rich at the expense of the poor and middle class.

Stop protecting the wealth of doctors by excluding well-qualified immigrant professionals. Health care, like education and other systems, abhors competition. Moats are erected to protect the status quo and wealth of its incumbents. Get rid of those moats. Use government regulation to ensure quality and safety, not to protect the incomes of the rich.

Incentives matter. If the system allows for — indeed, encourages — excessive profit-taking, over use, inefficiency and waste, that’s what we’ll get. Indeed, that’s what we get. Design the system to encourage and reward affordable, quality health care for everyone.

Require radical transparency, so patients can compare providers and hospitals by cost and outcomes.

Republicans need to get over Obama. Their guy is president now. And they control both houses of Congress. Own it. Take responsibility.

And come on, Mr. Trump, man up! Honor the promise you made to the American people during the campaign. Chose honor and virtue. Show America what true leaders look like. You have the power to make things better. Stop all the whining and excuse making. Lives and personal well-being of our citizens are at stake. Think about someone other than yourself. Do something that is good for America and Americans.

American can afford affordable, quality health care for all.

The only question is, do we want it?

 

I Hope You Will Be Treated Unfairly

“From time to time in the years to come, I hope you will be treated unfairly, so that you will come to know the value of justice.

I hope that you will suffer betrayal, because that will teach you the importance of loyalty.

Sorry to say, but I hope you will be lonely from time to time, so that you don’t take friends for granted.

I wish you bad luck, again from time to time, so you will be conscious of the role of chance in life, and understand that your success is not completely deserved, and that the failure of others is not completely, deserved, either.

And when you lose, as you will from time to time, I hope every now and then your opponent will gloat over your failure. It is a way for you to understand the importance of sportsmanship.

I hope you will be ignored, so you know the importance of listening to others. And I hope you will have just enough pain to learn compassion.

Whether I wish these things or not, they are going to happen, and whether you benefit from them or not will depend upon your ability to see the message in your misfortunes.”

These are the words of the Chief Justice of the Supreme Court, John Roberts, delivered this month at the commencement of Cardigan Mountain School.

They speak for themselves.

Expecting Life To Be Fair Leads to Persistent Unhappiness

Shane Parrish recently wrote, “Expecting life to be fair leads to persistent unhappiness.” I think he’s right. The unfairness of life is difficult for some of us to deal with.

I don’t know why I think life should be fair. My theory is it’s because of my upbringing in Christian churches. Hearing about the Gospel of Jesus. Always thinking about how people should live, how the world should be. Could be.

Churches do their kids a disservice by talking so much about the shoulds. They should talk more about the way things really are and how one is to navigate a cruel and dangerous world.

Better yet, they should talk less and put more effort into showing by doing. Seeing someone live a happy, loving live while embracing noble and honorable values goes further than listening, especially when deductions of hypocrisy are inevitable when observing the gaps between words and actions.

There is a lot of unfairness and cruelty in the world. You even encounter it a lot among churchgoers. Perhaps it’s an essential element of being human.

Martyrdom is one answer of course. And the church talks a lot about its martyrs. But most people aren’t martyrs. Most of us don’t have what it takes. Church should talk more about the ways the rest of us are to navigate an angry and selfish world without allowing it to get us down.

Some religious folk deal with this by hanging out primarily with their own. Take the Amish. Or Bruderhof. Or Mormons.

That works for some, but others either don’t have that option or haven’t realized the risks associated with living in the midst of rampantly individualistic capitalists who have no pretense of fairness or common good.

The problem isn’t them. The problem is us, that is, if we think they should behave as we’d like them to behave: fairly and with respect and concern for the community and others.

If I had life to live over, I’d try to have no expectation or illusion of fairness. I’d try harder to accept the world for the way it is and not the way I (or anyone else) think it should be or how we want it to be.

That doesn’t mean I’d forfeit fairness as a value. Rather, it means I’d forfeit expectations of fairness.

Why? It’s simple and selfish: greater happiness.

I think Shane is right.

Avoiding Terror

I’ve never been the subject of a criminal investigation. But I know people who have been — who lived in fear of being prosecuted and imprisoned. In a few cases, their worst nightmares came to fruition: they had to serve time.

One thing I’ve observed: when you’re the target of a criminal investigation and live with the fear of going to prison and having your life turned completely upside down, it instills pure terror. Even men who normally walk with a swagger and play the role of the strongest chimpanzee in the jungle melt into a puddle of fear. Terror works that way.

You might think this is an odd point to make to one’s granddaughter. But I learned something else along the way: the terror that I reference has visited sons and daughters from good families. One never knows who might cross the line.

There’s a lot of pressure to cross the lines these days. I know people in the business world who have crossed more than one line. Some were discovered by law enforcement. Most weren’t.

The pressure to “succeed” in America is intense. And the fear of losing one’s job can be pretty intense, too. It causes people to do stupid stuff — stuff that could land them in jail.

So I no longer think the terror of criminal prosecution is restricted to those who live on “the other side of the track.” I’ve learned that the odds of the getting caught and prosecuted are greater over there, but I’ve also discovered there is more criminality on the “good side” of the tracks than most people imagine.

Personally, I think it’s foolish to cross the line, to subject oneself to possible prosecution. But many people don’t share my concern. Many people are willing to take a lot of risk. I’ve kept some of these people from being prosecuted and from going to jail. But I’ve also visited some of them in prison.

Recently, we learned that our president is under criminal investigation (or at least that’s what he says). Based on what I know about his actions, he has reason to be concerned. Whether his concern has blossomed into terror yet, I don’t know.

It’s obvious, though, that his life and well-being are being affected. Unfortunately, when our president is under the spotlight like this, all of our lives will be affected.

I have no idea how any of this will turn out. I’ve gotten people out of worse predicaments than the president seems to be in, but, of course, I don’t have all the facts. Some of those facts may be helpful. Some may be damning. In any case, the spotlight that’s shining on this matter is unlike any normal case. Bright lights have a way of exposing dark corners.

If I could advise Mr. Trump, I’d tell him several things. First, stop tweeting. Second, stop digging. Third, stop acting so damn guilty.

People who make stupid decisions often make the situation worse by digging the hole even deeper. The president has been digging a lot lately. He needs to stop.

One way people often dig their holes deeper is by lying. It’s rarely a successful strategy. Indeed, it’s often the very thing that ensures things will turn out poorly. The president needs to stop lying. Unfortunately, it may not be possible for this man to do that. Lying has become who he is. This, combined with a deep-rooted insecurity, is usually a recipe for disaster.

As I’m sitting here this morning, Vera, I can’t imagine you would ever do anything that could put you into legal jeopardy. That said, I’m sure many, many parents and grandparents of future felons thought the same thing.

It’s quite possible you may feel the pressure to do the wrong thing at some point in your life. You may feel your job is at stake. Or your financial survival. Whatever fear or pressure may be present, my hope is that you will be strong and courageous and take the high road. Never approach, let alone cross, the line. Do nothing that unfairly injures another person or institution. Never put yourself into a position similar to the one our president has created for himself.

Terror is real. Keep it at bay.

Place Matters: Today I Became A Hoosier

At the risk of laying claim to a derogatory term, today I embrace Hoosierism. Well, maybe.

What’s inarguable, however, is that, today, I became a Hoosier. We closed on the purchase of a house in Carmel, Indiana this morning.

But part of me knows that I’ve always been and always will be a Pennsylvanian. It’s the land of my and my family’s roots. Every time I think I’ve shaken it, I return home to the Commonwealth to visit friends and relatives and realize it’s not something one can shake. It’s in my bones.

But on the surface, I am now a Hoosier.

I came here after living the past five years in a blue state: Colorado. Indiana is a red state. I take a tiny bit of solace in knowing it’s just a bit less red today than it was yesterday.

Hoosiers are friendly people I’m told. However, I’ve learned over the years that friendly comes in different packages, some more authentic than others. I hope Hoosiers are authentic people. I find authenticity to be far more valuable than friendliness.

Regardless, I am so lucky to be here. We came here to be near you, Vera. That’s the power you possess. Try not to let it go to your head. Or to take advantage of your grandparents.

There are collateral benefits of course. We’re near your parents, too. And nearer to the rest of our family (sans your uncle on the west coast).

And we finally live at a place that’s within walking distance of just about everything we need in life. And we’re a stone’s throw away from a trail that will take us, by bike or foot, to downtown Indy or north into the countryside.

My goal is to burn as little gas as possible. And to walk, hike and bike as much as possible.

So now we go about the business of nurturing place.

Place is something that resides in our subconsciousness more than our consciousness, which is odd considering how important it is.

When I was younger, I didn’t appreciate the importance of place. I lived not in a place but in a cutthroat world — a world of competition, domination, discontent and violence — primarily violence against oneself and one’s soul.

I now think place is paramount.

The place we envision will be an enclave of love, peace and grace. Our home will be your home, Vera. And your parents and uncle’s home. And a home for friends and family to commune. A place to laugh. A place to cry. A place where precious memories are created.

Outside, your grandmother will take the lead in creating a tribute to nature and humanity’s connectedness to the earth. She will play in the dirt, as angels are inclined to do. It will be a place of peace and tranquility. And of beauty. I’m looking forward to seeing it unfold. It will be glorious.

Beyond the borders of what we naively think of as “our property” will be the larger place. My place in that place is yet to be defined. I’m counting on the rhythms of life to show me the way. Some people call it “the hand of God.” I’m no longer sure I believe that. But I don’t disbelieve it either.

I try not to delude myself however. I know that, for many, place is hell. Daily, some are forced to walk into or through the valley of death. It’s hard to create place when confronted by harsh realities.

Perhaps my place will nudge me forward, to hold their hands, to carry their loads, to help create place in the midst of pain and suffering. Perhaps my place will go with me wherever I may go.

Place can do that. Place has incredible power. But only if we allow it. Only if we allow place to thrive and become a living force within us.

On my journey, I have been blessed to live within the beauty and grandeur of Pennsylvania, Virginia, Colorado and, now, Indiana. I have absolutely no idea where my journey may take me in the years yet to be lived. But, for now, I am attending to important work. Holy work. I am allowing place to do its work.

Violence

A U.S. Congressman was shot yesterday. It should go without saying that it’s a tragedy. It always is, when a human being is shot, that is.

Shooting another person is such a barbaric act. Yet it happens every day. It’s confirmation we are not nearly as civilized as we think we are.

There are all kinds of justification for shootings and killings, of course. Personally, I don’t find any of them to be persuasive.

When I was in college, I toured the prison in central Pennsylvania where state-sponsored executions were carried out. Actually, the execution room had been inactive for a while until the Supreme Court could finally resolve the issue, but the room stood ready for action. The electric chair was in the middle of the room. A large exhaust fan was positioned in the ceiling above the chair, ready to suck the fumes from the room as the flesh and organs fried. I wondered how anyone could participate in the intentional, well-planned killing of another human being. I still wonder.

I also wonder why so many people are willing to fight rich people’s wars. That’s what wars usually entail: fighting over resources or other strategic advantages that bear on the ability of rich and powerful people to maintain or build their wealth. It’s said that money is the root of all evil. The older I’ve gotten, the more I’ve come to realize it’s true.

Some people think we need to be armed in order to protect our liberty. Hence, you can walk into a Starbucks in Cheyenne, Wyoming and encounter a customer with an assault rifle slung over his shoulder. Some people simply don’t understand what nurtures and protects liberty. They put too much faith in instruments of death. In the power of violence.

I don’t own a gun, Vera. And I suspect I never will. I did borrow one years ago when we lived in Pittsburgh. I was involved in the defense of a client in the trash hauling business, and there had been some assaults and one murder on the fringes of the case. Borrowing the gun was probably an over-reaction, yet when you have a wife and small kids, over-reactions aren’t uncommon. You become very protective.

I returned the gun and haven’t had one in the house anytime since. That said, I’d probably resort to violence in self-defense or in defense of a loved one. But the odds of the need for such action are very, very low.

I’m lucky. For people in my socio-economic status, violence is usually something that lives in the distance. But not all people are so fortunate. It’s just one of the many daily reminders of the role luck and parentage play in one’s life. You’re a very lucky girl, too.

I don’t mean to suggest violence only comes to us in the form of guns. In fact, violence takes many forms. Sometimes it’s delivered by a fist. Or needle. Or mental or emotional assault. Or some act of self-destruction.

Usually (but not always), violence is accompanied by fear, anger, greed, hate or desperation. If we thought and talked more about those things, perhaps there would be less violence.

I wonder if humans will ever develop to the stage of finding violence to be barbaric and unacceptable. That would be nice, but it’s probably just a pipe dream.

In the meantime, the struggle between violence and peace will continue. It’s a struggle that takes place not only in society. It also plays out within every human being’s heart.

Peace be with you, my dear Vera. May love, courage and hope hold violence at bay in your life.

Walk

Looking back, I realize I didn’t walk enough. I should have walked more.

We chose our new house primarily because we can walk. To many things. Stores. Coffee shops and restaurants. The post office. Doctors and dentists’ offices. Barber. Parks. Farmers market. Entertainment venues. A trail that runs from downtown Indy far into the northern suburbs.

My goal is to use the car as little as possible. And to walk or ride my bike just about everywhere I go (locally).

For most of my life, I spent too much time in a car, especially commuting to work. What a waste of time. If I had to do it over, I’d live within walking distance of my work. Or biking distance. Or at least live where my commute was as short as practicable.

Walking is a healthy endeavor. Sitting in a car isn’t. Plus, it’s the time. I can’t imagine many worse ways of spending my time than sitting in traffic. Or spending an hour or two a day commuting. Or more (as many people do).

Do the math. It adds up. I wish I could have those hours back. I wish I’d spent them differently.

I walk more today than I have at any time in my life. Rarely a week goes by that we don’t take quite a few long walks or hikes. Or long bike rides. Usually, a day doesn’t go by without a walk or ride.

It’s possible because I have more control over my time at this point in my life. But it’s also because it’s something I want to do. And because I value my time more than I used to. And because it’s important if one is to age gracefully and try to forestall physical decline. And because outside is simply a more wonderful place to be.

I realize my body eventually will fail. And that it may shrivel up before succumbing. I’ll get shorter. And weaker. But I have no intention of cooperating. In fact, I plan on resisting. Walking is resistance.

There is a reason there are fewer obese people in Colorado than most places we’ve lived. People walk and hike more. And ride bikes. I suspect they have healthier diets, too. I plan on taking a bit of Colorado with me to Indiana.

One thing that concerned me about moving to Indiana is the way people back East hibernate in the winter. I don’t want to revert to that lifestyle. I can’t import Colorado’s sun to Indiana, but I can ensure I don’t hibernate.

If it requires spending some winter months in Florida or Arizona, so be it. Or some summer months in the Rockies.

Yesterday, we took three walks, Vera. You initiated one or two of them. That’s an encouraging sign. Keep it up. Don’t stop walking.

Cars aren’t inherently bad. They’re only bad when they’re overused. Try not to overuse yours, Vera.

Keep on truckin’.