The Oak Desk

I recently made the decision that it’s past time to get rid of the roll top desk that sits under the window in our bedroom.  A roll top was something I’d always wanted.  I suppose I pictured myself sitting at that desk like some latter day Mark Twain; sipping expensive bourbon from a heavy crystal rocks glass, dipping pen in inkwell and writing the next great American novel.

When Things Fall Apart

I’ve achieved a new personal record as we runners like to say.  I now have a small collection of little amber pill jars; 3 actually.  That’s the most I’ve ever had at one time.  My previous personal best in pill jar collecting was two and it usually came after oral surgery; antibiotics and the ever popular Vicodin. 

Dis-HEART-ened

It’s Tuesday the 8^th and I’m in bed by 7:30.  On a normal evening I would be relaxing after dinner and feeling good about the day’s run.  It’s not a normal evening.  My heart is doing its version of the Macarena or the Rhumba.  It’s pretty much a middle-aged white guy version of one of those dances; or any dance for that matter.  You see, middle aged white guys are supposed to be notorious for not having rhythm; I’m a prime example.  And so that about describes what my heart is doing; it’s beating to no particular beat; out of rhythm.  It’s a condition known as atrial fibrillation.  Those of us with a more intimate knowledge of the disease refer to it contemptuously as a-fib.

America Heal Thyself IV

Final Part

People over Money 

This is the last post of four dealing with healthcare in America.  Before commencing I should point out some important facts about myself to provide perspective.  I’ve always had health insurance through an employer and still do.  I’ve never complained about the premiums or copays.  I would not flinch if my rates or taxes were increased to provide healthcare for each and every citizen.  There are always personal sacrifices that we can make for the good of all.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

From The Declaration of Independence.

Of the thirty-three developed nations, thirty two have universal healthcare.  The lone exception is the United States.  How could that be?  In 1776, when America was just a concept a group of patriots signed a document that established as unalienable rights, life, liberty and the pursuit of happiness.  Integral to two of those rights, life and the pursuit of happiness is good health; or at the very least the opportunity for good health. And yet we find ourselves mired in a cantankerous debate over whether we should have universal health care anchored by a robust government system.  If we were a truly civilized society, we would have long ago figured out how to accomplish this. 

Nearly 50 years ago America experienced a similar debate about healthcare.  It was a time when the elderly were tied to their children for survival.  There was no healthcare system in place for the elderly to turn to.  In 1959, George Reedy, the man who 5 years later would become Lyndon Johnson’s press secretary summed up the status of America’s elderly; “Somehow the problem must be dramatized in some way so that Americans will know that the problem of the aging amounts to a collective responsibility.  America is no longer a nation in which grandmother and grandfather can spend their declining years in a log cabin doing odd jobs and taking care of the grandchildren.” Johnson took on the challenge and in 1965, Medicare became a reality.  Oh there was a hue and cry and the alarm of creeping socialism.  Said Ronald Reagan; “If you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”  Well I’m closing in on the sunset years and I still don’t have a portrait of Joe Stalin on the wall and contrary to Reagan’s dire warning Medicare was actually liberating.  America isn’t bound by the shackles of despotic Socialism but the elderly are no longer tied to their children.  They live longer more productive lives on their own, assured that their medical needs are taken care of. Young families no longer have to wonder what to do with the grandparents when planning the family vacation.  They no longer have to choose between saving for their children’s college education and keeping granny healthy.

Once again we’re in a healthcare debate; this time over universal coverage.  We’re told by conservative pundits that if it’s a government program, it’s bound to fail.  Nothing that the government does ever turns out right.  These are words that come from the self-same individuals who will regale us with the greatness of America; a nation that can accomplish whatever it sets its collective mind to. The nation that sponsored the exploration and opening of the West in the 19^th century, facilitated the carving of a canal in Panama, spearheaded the downfall of Axis tyranny, built the Federal Highway System, funded science research that is second to none, possesses the most powerful military ever known, landed a man on the moon and for decades operated a successful space shuttle.  We did all of these things yet we can’t find a way to make healthcare for everyone a reality? When it’s convenient to make their case, the Palin’s and Limbuagh’s will always decry the incompetence of American government.

At the heart of the debate is money; the rising costs of healthcare; an aging population putting pressure on funding and medical resources; the impact on the deficit.  We’ve been told that to have government sponsored healthcare is not sustainable; that it’s impossible.  I have to believe that finding the means to fund universal healthcare is possible.  This country spends mountains of money on programs that nobody bats an eyelash over.  Consider a military budget that dwarfs the rest of the world.  Our two “potential military opponents” Russia and China have combined military budgets of 142.5 billion dollars a figure that is dwarfed by our budget of 739.3 billion dollars.  And while Mitt Romney is ready to add another two trillion dollars to the defense budget he finds that we can’t afford medical care for the citizenry. 

Investing in the health of Americans is a positive investment but if you're looking for investments to fume over there are plenty out there.  How about Pakistan?  Why did we never have a contentious national argument over doling out some 20 billion dollars to Pakistan? Over the last 10 years we poured money into a nation that not only gave aid and comfort to insurgents fighting against us in the Afghan war, it pretended not to notice a tall Arab terrorist hooked to a dialysis machine living next door to their military academy; and then they were outraged when we killed the man.  But Pakistan was Bin Laden’s friend years before he was on our radar.  That was a time when the Soviets had left Afghanistan and we poured countless millions and more millions into Pakistan while it supported Bin Laden and the precursors to the Taliban. Where was the outrage over giving money to a nation playing us for fools?  We can support a rogue nation that works against our own interests but we’re pennywise and pound foolish with healthcare for our own.    

Over the course of three posts, I’ve not discussed the debate over money.  I’ve not delved into the minutiae over the funding of universal healthcare and I certainly won’t begin here.  That’s because at its very core it is not a money issue, it is a moral issue.  And yet the two, money and morality, have become tragically intertwined.  We’ve come to a hell of a situation in which people cannot afford to get sick. Consider that:

     Crushing hospital and medical bills are the cause of most personal bankruptcies. The results of a 2007 study by the American Medical Association states: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001. The study also found that; The share of bankruptcies attributable to medical problems rose by 50% between 2001 and 2007.

      People put off medical care until such time that they can afford it. US News reported that a woman in New Jersey had a 51 pound tumor removed.  The tumor was not only malignant; it was putting pressure on her interior vena cava which returns blood to the heart.  The tumor grew to its appalling size not because the woman was obese and didn’t know it was there or because she was chronically stupid.  No she was forced to wait until Medicare kicked in before she could have the required surgery. What would have happened to her if she were not on the cusp of Medicare?

     
And then there are those not as lucky as the New Jersey woman; the ones that simply die; something that Mitt Romney assures us doesn’t happen; “We don’t have people that become ill, who die in their apartment because they don’t have insurance.”  Well according to a Harvard Medical School study, some 45000 people a year die due to lack of medical insurance.  The study also found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

     I imagine that someone could try to make the argument that the study is flawed; the numbers inflated.  Okay let’s grant that the numbers are inflated. From what? 35,000?  20,000?  10,000?  Is there a point where the figure becomes acceptable? If there is then please go to the comments section and fill in the blank.
 

Beware the sanctimonious hypocrites; the so called God fearing folks, Huckabee, Santorum and their apostles, the Tea Party.  Phony Christians and blustering humbugs; they claim a franchise on the defense of life and bloviate about the moral decay of America while their actions and policies expose their meanness and cruelty caring not one fig for a family on the edge of poverty that suffers a parent with untreated high blood pressure or a child with autism and no recourse but to simply soldier on.  It doesn’t touch the souls of these "Christian soldiers" that over 35% of uninsured children go a year or more without seeing a doctor. Carrying a Bible in one hand and a bludgeon in the other their twisted creed distorts Christian charity as creeping Socialism.  An inbreeding of right wing ideology, tub thumping evangelical Protestantism and unbridled paranoia seeks to marginalize “the least of these” as Christ called them.

“Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

“They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

“He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’

The Book of Matthew; Chapter 25; 41 – 45.

In my first post on healthcare I quoted a man’s response to an article on healthcare. He said; “if u want insurance buy it, if not pay Cash..if not, go Die..”  As loathsome as I find that sentiment I have to say that I’ve more respect for this fellow than those that choose to remain behind a veil. 

I’ve long ago grown weary of the whiners on social media bitching about Obamacare and how its going to raise their insurance rates and lighten their bank accounts.  Tough shit. I have someone close to me with type 1 diabetes.  She did nothing wrong except sit by while her pancreas decided to short circuit.  I’ve a wife who’s gone toe to toe with cancer three times, won each time and shown more courage and character than some pudknocker sniveling over having to cut back on his Coors ration because my wife deserves coverage as much as he does.  I’ve a friend with a child who has a heart condition.  I’ve another friend with a quirky thyroid that requires medication.  One with a history of spinal surgeries.  These people are all a job loss away from possibly losing health coverage and losing a chance to thrive, to be productive members of society to love and be loved by their families and of losing those unalienable rights of life and the pursuit of happiness.

And so to those whiners I have a challenge and a parting sentiment.

Your challenge is to become courageous and honest and stand up for your view to the people who would be most affected. Your challenge is to go to a friend with some affliction; you must know somebody; we all do.  Look that person in the eye and say these words; "You know if you ever lose your health insurance I guess it sucks for you.”

And my parting sentiment?  I don’t give a good goddamn about your fucking bank account.   

America; Heal Thyself III

 Third Part in a Series

"Just go to an emergency room"

“People have access to health care in America.  After all just go to an emergency room.”  George W. Bush

Mitt Romney recently echoed Mr. Bush in a 60 Minutes interview. If you have a heart attack “you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital.”

“Just go to the emergency room” is a great plan if you have a heart attack, break a limb, have a stroke or get shot. That’s what every rational person does because the emergency room is there for critical conditions that require immediate attention. 

America; Heal Thy Self I

 First Part in a Series
The Rhetoric

“We are the only industrialized country in the world that does not have national health insurance. We are the richest in wealth and the poorest in health of all the industrial nations.”  ~ Studs Terkel

“If they would rather die they had better do it, and decrease the surplus population.”  ~ Ebenezer Scrooge speaking of the poor. 

Countries with universal healthcare: Norway, New Zealand, Japan, Germany, Belgium, United Kingdom, Kuwait, Sweden, Bahrain, Brunei, Canada, Netherlands, Austria, UAE, Finland, Slovenia, Denmark, Luxembourg, France, Australia, Ireland, Italy, Portugal, Cyprus, Greece, Spain, South Korea, Iceland, Hong Kong, Singapore, Switzerland, Israel. 

 

Richie Batra’s comment was chilling, “if u want insurance buy it, if not pay Cash..if not, go Die..im not worried about anyone but myself and nobody should worry about me either(sic)."  Mr. Batra’s remark was a comment in a thread responding to an article last December in Think Progress covering then presidential candidate Rick Santorum’s Q & A with a group of high school students.

Why We Ride: John

It was hard to hold a conversation.  He would speak a few words and then be interrupted by a cough; a wet, relentless cough, releasing a malicious fluid that gurgled up from deep within his failing lungs; a cough that convulsed his entire, now frail, body for what seemed minutes at a time.  The coughing seizures seemed to last for minutes and left him spent beyond the exhaustion brought on by the illness itself.  I was visiting John at Kaiser Hospital in Oakland.  John was dying.  I knew it, his friends knew it, his family knew it and John knew it.  By this point John was philosophical about it all.  John was dying of lung cancer.

31 Forgotten - and Remembered

There’s a saying, “It’s always the simple things that change our lives.”  For us maybe it’s the simple things that define our lives.

It’s the 7^th inning and the Giants are working hard at dropping a Sunday get away game to the visiting Oakland A’s.  Cora comes into the room and for some reason I remember that I should be remembering something.  That’s kind of how it works when you start getting up in age; you have to jog your memory to jog your memory; sort of a mental double clutching.

Another Giant looks at called strike three and then it comes to me.  I'm not even sure why it comes to me at this particular moment but I look at the date on my watch and then at Cora, “Uh, isn’t it our anniversary today?”

“May 20.”  It registers with her.  “Yeah; 31 years.”

“Happy anniversary,” I deadpan.

“Happy anniversary,” as she looks back at the score.
She starts to go back to what she was doing and I settle back to watch another Giant futility . 

Life's Awful Curve

My last post, Dad;Reconnecting inspired some responses that merit not just a reply but an entire post.

In my original, I touched on my dad’s final years and his – our, mine and my wife and childrens’ – battle with dementia and my regrets over how badly I handled it.  In conversation with a couple of acquaintances I found that they also felt regrets over the way in which they dealt with parents suffering dementia.  A high school friend of mine, Susan, left a touching, heartfelt comment and our mutual high school friend, Craig left a kind and comforting response of his own. 

Susan wrote:  “My mom, like your dad, began suffering from dementia a very short time after my dad died. She was such a strong person that she lived too many years with it before finally succumbing. I, too, am filled with regret for the way I handled her illness. I, too, am not proud of the way I handled her situation. I don't have a lot of regrets in my life, but I wish I could have a do-over on that one.”

Craig’s response: “Never regret how you dealt with a parent's dementia. I deal with dementia on a daily basis. Some days I will see each stage of dementia - early silly confusion, one's undeniable fear and trepidation as they realize the harpoon is set, the early failings, the argumentative phase, the wandering phase, the incontinence phase, the placement phase. I no longer see the zombie/coma phase, as I do not do nursing homes any longer. There is no instruction booklet for the process. I see families struggling to 'do the right thing' neither knowing what that is or how to do it. That's because there are no rights and wrongs, strong players and inadequate players - we are all just regular folk shlepping though life who get thrown an awful curve-ball. You take your best swing! That's it. Neither of you did a bad job - there is no such thing. Remember too, that as you felt your inadequacies mount, as the disease progressed, the shell that personified your loved-one lack the insight and memory to either know or recall that they were treated badly. In fact they were not. When your fathers hug you at The Pearly Gates, neither will even mention it. If you apologize, "Poppa I'm sorry I let you down there at the end", your going to make him frown and then smile and wink at you and confess, "You did a great job - a hell-of-a-lot better than I did with my old man. So give us another hug." I will brook no more regret over this ugly, diabolical illness which is impossible to 'handle' well. 'Nuf said!”

In her response to Craig, Susan summed up my feelings, again better than I could express:  “Craig, you brought a tear to my eye with your kind comments! When we're young and in a different place in our lives, we make choices we wouldn't necessarily make later on. (I had a similar conversation with my daughter just a few weeks ago on choices made and possible regrets later.) I don't know how much I would have done differently if my parent was facing dementia today. I know there would be some things done differently, but you're right. We do the best we can at the time, with the knowledge and abilities we have at that time. I can't say I won't continue to have some regrets, but it helps to know I'm not alone when it comes to simply being human and making good decisions and not-so-good ones. Thanks Craig, and Paul, for helping me better understand that I'm not alone.”

As I read their comments again in writing this post the emotions welled up again.  I don’t always respond to comments, though I should, but theirs particularly warrant a response and this post is in part my response.  I’d already planned on writing a post on this topic and I even had some version of, “there’s no instruction book that covers this,” all ready to go but Craig beat me to it and said it all so much better than I could.  While he didn’t say as much, I’m certain that Craig’s daily encounters with dementia come through his work as a physician. 

I’m 58, about the age my dad was when he was starting to forget things and become flustered.  I’ve reached that point at which I ask myself, how will I age?  It’s a question that we baby boomers have to face.  And that question comes with its own myriad subset of questions.  Will we be self-sufficient?  Will we be physically able to take care of ourselves?  What will become of our mental faculties?  Will we be financially able?  One of the acquaintances that I spoke with told me that her husband has a real and tangible fear of the same dementia that plagued the aunt he had to care for.  In a comment to my post, Scott wrote; “I find myself getting a little lump in the throat whenever I do something that is a mental slip, thinking about how it must have been for him and wondering if it is something I'll be dealing with in the not so distant future.” 

And then there is the question that haunts those of us with children, making their way with families of their own; will we be a burden on our children?  After having difficulties with my maternal grandmother, my parents suggested to me that they would never be a burden.  Which of course begs its own question; how can you make that suggestion?  There’s the strong potential that the option will not be one that we can control; which is just the reason that I’ve not made that suggestion to my own children.  I do what I can to avoid that circumstance by keeping both physically and mentally active.  And while my future independence isn’t the motivation it is a hopeful byproduct that I keep in the back of my still able mind.

I have two wonderful children who’ve expressed that they would of course take care of my wife and me when we’re doddering.  They make that statement with the same certainty that they would have in saying the sun will rise in the morning and while I don’t doubt their sincerity and have every faith in their love for us I have to wonder if they realize the full import of the baggage that comes with a dependent parent.  Every generation, every young family potentially has to face the quandaries.  Dealing with everything from deciding whether or not to take the old boy out to dinner with the family, to is he going to be okay at home, to is he going to wander out of the house, to how in the hell do we take our family vacation which all boil down to the question of “how do we just have a normal family life?”   

With the large boomer generation transitioning into late middle and old age this shouldn’t be just a question within the domestic circle.  A big segment of this nation is going to be losing its collective marbles and we, those of us that are aging and our families, should be wondering how this nation is going to deal with it.  From the Alzheimer’s Association website are just a few of the many sobering facts:

·         5.4 million Americans are living with Alzheimer's disease.

·         One in eight older Americans has Alzheimer's disease.

·         Alzheimer's disease is the sixth-leading cause of death in the United States and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed.

·         More than 15 million Americans provide unpaid care valued at $210 billion for persons with Alzheimer's and other dementias. 

·         Payments for care are estimated to be $200 billion in the United States in 2012.

•        Today, 5.4 million Americans are living with Alzheimer’s disease – 5.2 million aged 65 and over, and 200,000 under the age of 65. By 2050, up to 16 million will have the disease.

•     Of Americans aged 65 and over, 1 in 8 has Alzheimer’s, and nearly half of people aged 85 and             

       older have the disease.

•     Another American develops Alzheimer’s disease every 68 seconds. In 2050, an American will develop the disease every 33 seconds.

This country has faced up to major crises in the past with large measures of success and some of these have included finding many cures.  On the other hand, as I’m reminded every time I fill up the tank, we’ve had a history of kicking the can down the road.  I suppose that I could transition this into a commentary about the debate over nationalized health care and the rising costs of health care.  I’ll leave that for another time and just keep hoping that one of the cans that we kick down the national road won’t be full of those lost marbles. 

Just this past week a co-worker’s mother had a heart attack that put her in hospice care.  The mother has been suffering from dementia for ten years now.  In conversation another co-worker commented that he couldn’t imagine what it would be like to have a loved one “not know who I am.”  I told him that I went through that for nearly 10 years myself and he sadly shook his head and allowed that he was sorry.  The woman whose mother is now in hospice said to me that there will be no heroic efforts from here on out; “It’s been 10 years now; its time.”  Of course I felt the same way when my father passed; hell it was past time.  And he would have agreed.  Had he been able to have a half day of lucidity and figured out a way to end it himself he would have.  I know I would; sit in front of the TV, watch the Three Stooges with a nice sedative or ten and a bottle of Maker’s Mark.  Yeah I know it would horrify some of the family and friends and the local Catholic prelate; “my son how can you disrespect God’s gift?”  Look I got an electric pizza cooker as a wedding gift but at a certain point it gave up the ghost and the pizzas came out half-baked and it was about time to toss it.  When my thought processes start coming out half-baked it’s time to realize that the gift is about wore out.  I don’t want to deal with 5 years of putting the can of shaving cream in the oven and a quart of milk in the toolbox; or worse.  

And so thank you to Susan and to Scott and those who I spoke with over the last week or so.  It was somewhat reassuring to know that there are others who went through the same experience of trying to do right and in the end feeling like the job got badly botched at times.  And thank you to Craig who reminded us with some of the most eloquent words that I’ve ever read that “…we are all just regular folk shlepping though life who get thrown an awful curve-ball. You take your best swing! That's it.”

And a final note:  Susan, Scott and Craig are three of my oldest friends.  I went to high school and junior college with Susan and Craig and we were best of friends who went our separate ways.  We reconnected through Facebook but have not yet reunited.  I’d say it’s time.  I met Scott after graduating college.  We spent some years sharing living quarters and some great memories, many that are lost in a fog of varied substances.  He was the best man at my wedding and we still get together at times, although not often enough.  They are three of the finest people that I’m proud to know. 

Comments are greatly appreciated and encouraged and may be left in the comments section below.  While I don’t always respond to them (and I admit to it being bad manners) I do read them.  Unrepentant spam will be deleted and sent to spam hell.