Sartorial statements and other rants

Sometime before 2004, I used to encounter this guy--New Yorker by accent and attitude--outside the local hardware store. If I happened to have picked up my Red Sox hat on the way out the door, he'd invariably sing out "so how about those Sox?" This of course happened more often when the Sox record was unimpressive.

Eventually he said it once too often and I snapped back, "it's a hat."

My daughter brought me back a U of Texas t-shirt as a souvenir of her cross-country auto trip some years back. I gave up wearing it after hearing a number of actual U of T grads wish me "hook 'em, horns," or make the horns gesture. I figured out eventually that it was a social gesture, not an insult.

For some years, as part of my defence against the Beast, I have worn hoodies for most of the cold months. Now I learn that because I wear a hoodie, I must be a gangsta and therefore it's fair for any white guy packing to shoot me on sight.
This insight is of course courtesy of Geraldo Rivera. In media packed with entertainers playing journalists, Rivera has long stood alone in his idiocy. There was a slight window for doubt that he's a total doofus, but he has now slammed that shut. Even Fox must find him hard to stomach.

Speaking of idiot media: as I write, the Trayvon Martin backlash pack is in full cry. I'm not the first to wonder a) how it is that Mr. Zimmerman's alleged injuries at the hands of Mr. Martin did not come up until a month after the fact? and b) how it might be that the "stand your ground" defence wouldn't apply to someone armed with Skittles and Ice Tea confronted by a stranger packing heat? And oh so many other things. Note to the lawyers. If Mr. Z had his head pounded on the sidewalk by the vic, and there are (conveniently) no superficial wounds a month later, such trauma would likely leave brain lesions that will be detectable for quite some time yet. Evidence is extremely helpful.

The most remarkable feature of the health care pissing contest is the way that Republicans in general, and the TP in particular, fly passionately to the defence of people after something for nothing. Their darlings are people who can afford health care but don't buy it. They prefer to take their troubles to the nearest Emergency Department (ED) and plead lack of coverage to avoid paying most, or all, of their bill.

The availability of free coverage today (such as it is) was meant to provide care
to those who genuinely can't afford it, not to small business people suffering from Stage 4 cheaps, who won't even cover themselves for fear of cutting into their margin. Reactionaries have a word they like to apply to people they think are after something for nothing, when those people are poor, or old, or not them: freeloaders. It seems to fit the case here. We have private health insuorance, and one reason (the main one) that it costs so much is that we're paying not only for ourselves, and for the system capacity that goes to the indigent, but also for this sort of freeloader. Of course, the same rule is true for government subsidies to, say, oil companies. It's not freeloading when Republicans do it.

Speaking of freeloading, I've spent the last couple of days trying to get a MBTA senior discount pass. In theory, I'm eligible for this because I just had my 65th birthday.

In practice, well.... I went online to see what I could do to expedite the process. The answer is nothing. The T in its wisdom has merged the processes for senior cards and TAP cards (the latter being for people with disabilities). In doing so, any opportunity for an older, non-disabled person to fill out paperwork in advance has vanished. So yesterday I followed the instructions to Back Bay Station to fill out forms and file in person. A helpful T person inside the turnstiles directed me to the office, which is outside the turnstiles. There, a less helpful person said "the-system-is-down-call-tomorrow." Tomorrow is today, and I don't have enough time off to do that. I'll call next Monday, and I'm betting on the same thing happening. (I'm also betting the office still won't inform any T employee on the platform, so that people can turn around without paying a second fare.) The Monday after that I'm booked; the one after that is Patriot's Day, so they'll be closed. Come April 23, I wonder if "the system" will still be down.

Massachusetts residents are well aware of the MBTA's budget shortfall, and that the cuts the T will make to close the gap will be announced next week. Being more than a little paranoid, I have to wonder whether this is an unannounced part of the plan: simply stop enrolling new riders in the discount plans. That surely would meet Republican approval. Tough cookies if some senior has to go without their cat food dinner to ride the T, or if someone in a wheelchair has to ride their own two wheels from Lynn to Boston. There will be a later report.

Social Security and the age thing

In theory, I think raising the Social Security retirement age is one good and logical step toward getting our house in order. After all, anyone my age already reaches full retirement age at 66, not 65. (It is a constant surprise how many younger people don't know that.) In practice, I have reservations, to wit:

1) Can we trust the lap-dogs of the people who have spent the last 30 years cheating--yes, cheating--their workers out of the pensions that they relied on for their retirement? Any tinkering with Social Security has to come with defences against this sort of thing. Putting Congress on Social Security is a good place to start, but it may need more. I've worked for the very rich. I know how they think, and in general they have no problem with older Americans dying by the roadside, as long as someone sweeps up the corpses so they don't frighten the horses. Cut the deck before starting this reform.

2) Living until 90 is a statistical construct, subject to many variables. Depriving the older poor of retirement income and health care is one of those variables. The more the reactionaries get their way, the more likely it is that "years left to live" (a more accurate statistical term than life expectancy) will decline, not increase. Don't make changes based solely upon this one, vulnerable measurement.

3) During my time of un- and under-employment, it has become clear that in the near future most "careers" will run from age 25 to 45. Age bigotry is entrenched in corporate America. If present mindsets are allowed to persist, the nation will have an entire generation greeting customers at Walmart between 45 and retirement age. This just at the time we have made the retirement age a moving target. This too introduces a factor that is likely to cause life expectancy to decline. What if anything will reform do to adjust corporate attitudes and keep people over 45 working?

4) Finally, remember that all those jolly age projections may work for the elite and professional classes, but they aren't realistic for the working class, now. For anyone in the sort of physical occupation praised in TV truck commercials, 66 is a stretch now. Age 90, for men at least, is absurd. I see this every day I work. Time to get out and see how the other half lives before dicking around with anything in the social safety net.

I'll save Keynesian rants about the benefits of deficits for some other time.

Adventures in defensive medicine

Nearly two weeks ago my right shin began to hurt. I manned up, decided it was only a shin splint, and toughed it out. I chose poorly, for several reasons.

Last Saturday I slipped just a bit on the back stairs and came down hard on my right leg, which objected loudly. After spending the rest of the day on ice and ibuprofen, and not sleeping much at all, I dropped on my PCP Sunday morning.
It was the duty physician--no slouch, one of the founders of the practice--who suggested compartment syndrome. He had me doing more ice, more elevation, and as much Ibuprofen as I could tolerate. If, said he, the leg is still uncomfortable in two days, go directly to the ER.

It was and (reluctantly) I did, not without wondering why we didn't instead try an orthopedist. Emergency Departments always have an element of black comedy about them. In my view they are places to avoid unless one is actually bleeding out, has about six fractures, or both. People with mystery issues should stay away, House notwithstanding.

The sole bit of good luck this visit was that it wasn't very busy when I got there. Dr. S's hint of compartment syndrome was enough to get me through registration and triage fairly quickly. But EDs, like the military, operate on the "hurry up and wait" principle. Having hurried through the first two steps, I waited. I had brief visits with an RN, a PA (who dosed me with Vicodin), and a very young physician, and waited some more. The cubicle TV was set to Dr. Phil, and he was the only doctor over 25 within ten feet of me all day.

The upshot of all this was to send me for ultrasound. Dr. S had already ruled out fracture by palpation, and by the fact that while I could only put weight on the limb with pain, I could put weight on it. I'm not endorsing this Dx, just reporting it. The limb only swelled when I tried to use it. I had been in cold storage for nearly an hour when Doogie Howser saw me, so the swelling was reduced. With all this my position on the triage scale was degrading, and it was some time before the transport person arrived to schlep me to Radiology.

I'm not remarkably tall, but my feet hung over the end of the gurney (cost cutting?). If you've ever made a gurney trip in a hospital, you know that transporters usually open doors by ramming them with the gurney. The prospect didn't appeal, and I tucked my legs up after the first near miss. We did make it to radiology without incident, where I--wait for it--waited some more. I figured by this time that my triage status was worse than that of a dog with a cold nose.

When the rad tech did show up, he was friendly and cooperative, indulging my professional curiosity by angling the ultrasound screen enough for me to watch. We looked, as it happened, he looked in detail everywhere but where the pain centred. Techs aren't supposed to diagnose, but this one said he saw neither clots nor vascular compression. Again, I'm just reporting here. He finished, we shook hands, and he wheeled me to the corridor...to wait for the return trip.

Through much of this, everybody I encountered was worried that I was cold. Actually, the temperature was very pleasant. What I was was bored...and hungry. Wanting to be ready for anything, I hadn't had breakfast. It was midday by this time, and we had arrived at the ED before 9. This got to be a preoccupation, because medical staff with lunch were strolling past the gurney.

The transporter eventually showed up. I hauled in my feet and he wheeled me back to my cubicle: only to find it wasn't mine anymore. There was a moment of confusion, whereupon the nurse said, "take him to 7 1/2."

Room 7 1/2 is, in that ED, a stretch of corridor wall between Room 7 and the john. I took this as a measure of how far my triage status had fallen. Eventually the RN dropped by to say that I was awaiting the radiologist's interpretation. Note the word "wait."

In a perhaps misguided bit of humanity, the staff went out and fetched my wife. "Room 7 1/2" had no chair. She had had breakfast but not lunch, and so was beginning to share my preoccupation.

Located just inside the trauma entry to the ED, "Room 71/2" made up for its lack of amenities with a considerable amount of traffic. One reader has commented elsewhere about the one thing that modern hospitals lack: peace and quiet. He was in a room: try it in a hallway. Actually, I thought it fairly peaceful as hospitals go. Had I not been obliged to carry on domestic conversation, I would have dozed off.

Eventually, the RN showed up with the radiologist's interpretation. I know a little bit about the nuances of medspeak. I observed that the interpretation carefully avoided anything resembling a declarative statement. After six hours in the toils of emergency medicine, the closest thing we had to a diagnosis was my own. Thank you, Einstein. But I was free to go, clutching my Vicodin scrip.

On my health plan, the co-pay for all this theatre is $50. The Vicodin does what Vicodin does best: blunts pain, rather than relieving it, and adds its side effects to the amusements.

We'll figure it out eventually, right? House always does, after four or five false starts. Heh.

Nobody reads it all

Just one more about the reform bill and then I'll move on.

Those of us who have made our livings writing operating manuals, online help, or even those little bits of paper that come with whatever new gadget you buy, all learnt at the start of our careers that little sentence in the title: "nobody reads it all." As soon as I moved into writing about health care, I discovered that this principle applies to major legislation*. That's why legislators have aides. Everyone in an office reads something and summarises it, then someone else stitches together all the summaries to make an overall summary for the legislator. That is what she or he reads, along with some particularly ripe sections that she or he finds from directions in the summary.

So I noticed, amongst the barrage of hypocrisy thrown at health care reform, the taunt of "have you read it?" Those who threw it knew, of course, the dictum. They believed that their ranting followers did not. A number of people in public life have noticed that many of the people with the loudest voices** have never been involved in political action before; some have never voted before, and it's reasonable to think that many are mostly acquainted with books from the outside. Thus, the puppeteers could be sure that they wouldn't know that none of their legislators have read all of most major pieces of legislation.

Nor is this one all that long as health care legislation goes. At 2400 pages or so, it is a masterpiece of laconic presentation compared with two annual pieces of legislation that run Medicare, and secondarily define the direction of almost all American care for just one year. These documents (one for inpatient care, one for outpatient care) often reach 2000 pages... each; per year: plus a few hundred pages of quarterly amendments. You get my drift.

So the next time a republican shouts "have you read it?" remember that he or she hasn't, either.

---------------------------------------------------------------------------
* One health care lobbyist I know does read all of those annual pieces of legislation I mentioned, and usually in one long weekend for each, but that's an unusual performance.

**Congress needs a New England Town Moderator to keep the tea bags in line. A few years back a contentious local issue had brought hundreds of similar loudmouths to the local Town Meeting for the first time. They were shocked to learn that they had to wait their turn to speak, stick to the point, sit down when the Moderator told them they were done, and that they could be removed and even arrested if they did not do as they were told.

The elusive genius of compromise

We are in danger of earthquakes touched off by the whines and bleats from the shills of the health insurance industry—oh sorry, the republican party—but equally high decibel complaints from what passes for a left wing* in this country. One knows why the republicans complain: first, health care was their last stand and they have, by their own definitions, lost. Second, they're paid to complain.

America's stand-in left complains because health insurance reform isn't perfect. This idea has brought a host of historical and literary reflections pouring into my mind. Richard Armour provided the literary one:

The bride, white of hair, is stooped over her cane
Her faltering footsteps need guiding.
While down the church aisle, with wan toothless smile,
The groom in a wheelchair comes riding.
And who is this elderly couple you ask?
You'll find, when you've closely explored it,
That here is that rare, most conservative pair,
Who waited 'til they could afford it.

We've waited over 100 years, and it's time to get something out there, perfect or not.

The historical ones come in order. The USA had its start only after a compromise, distasteful to nearly half the Continental Congress, sidestepped slavery, already the elephant in the room. The nation's Constitution was accepted, then ratified, only after a host of compromises. The slavery question was at least contained by a further succession of compromises, which put off an all but inevitable civil war until the nation was large enough to sustain such a trauma and survive.

Then my generation came along and, in its moment of greatest stupidity, declared that compromise is evil and got that destructive idea embedded in the national psyche.

Then there's the matter of emancipation. The preliminary Emancipation Proclamation is a fair equivalent of this health care reform legislation. I quote Bruce Catton (not because I think he's the be-all on the subject, but because that's the book at hand):

This proclamation was nothing much.... It declared slavery extinct in precisely the areas where the Federal government lacked all power to enforce its decrees....If the President was going to declare himself on slavery, this...was just about the least he could say.

Yet it...locked the Confederacy in with the anachronism that was [its] dreadful, fatal burden.... An ideal that might be humanly unattainable had been riveted in so that it could never, in all the years to come, be abandoned.

Your history classes probably never taught you that emancipation was, in its time, the most universally despised action ever taken by an American president. The government had to take active measures to ensure that the Federal army (much of it encamped within a day's march of Washington) would not rise, revolt, and take over the country. Much of the Federal union was not reconciled to the idea until nearly the end of the war. Jefferson Davis spoke for the whole white South when he called emancipation "the most exercrable measure recorded in the history of guilty man." (Nod if you think that sounds a bit like McCain's pandering sound bite today.)

The parallels just keep coming. It is interesting how much progressive scorn for this legislation and for the President sounds so much like that of extreme abolitionists toward Lincoln for most of his presidency.

This nation looks most like a nation when its people and politicians recall the compromises that created it and that have lighted many of its most significant moments. It looks least like one when public and elected officials become so carried away with their rhetoric and extreme politics that they forget to look for achievable objectives.

It may be that some republican angst is motivated by an understanding of how Catton's description applies here. They have allowed themselves to become a one-trick pony, locked in with the anachronism of capitalist health care. This least, hobbling, almost insignificant, piece of legislation is far short of perfect, but it is enough to turn the page, and perhaps begin the process that will prevent our own health care from ruining the nation.

We can now argue how we will manage to join the rest of the developed world, decades late, in recognising health care for all as both a right and as good economics. We can no longer argue whether we should. Because so many of the features with immediate benefits (to children and small businesses, amongst others) begin when the President's pen touches the paper, republican talk of repeal seems little short of delusional. Let them try. As David Axelrod said tonight on the News Hour, let them campaign on the promise of taking away the benefits this law, this slow-moving, minimal law, will have already provided by November. They will not only make many people very unhappy with them; they will find that this ideal too cannot ever be abandoned.

---------------------------------------------
* So far has discord gone that it's necessary to offer several disclaimers. The first is that scorn for a disorganised, just left-of-centre political party and for "leftists" about five degrees to the left of that does not mean the author is a conservative: Quite the contrary. There is a lot of underpopulated political real estate to the left of the conventional positions. Some of it (hallelujah) is occupied by pragmatists who want to keep the ball rolling.

Second, I consider all ideologies to be troubled substitutes for rational thinking. If you are an ideologue, you can get treatment.

Third, as a British-American, I have to wonder whether it might have been better if that first compromise (over independence and slavery) had failed. This land would still have become independent, just a bit later. It would now have universal health care without all this delay. It would have a parliamentary form of government, with all the incentives that form of government has for getting things done (like elected representatives keeping their jobs only when they deliver). It would have achieved emancipation without killing half a million people. And the beer would be better.

Ready for the streets

I was disappointed on Friday last when even a proportion of WGBH's Beat the Press simply did not get it regarding Republican mob politics to oppose health care. Mob rule: good lord, Alexander Hamilton is spinning in his grave.

Whatever his other credentials, it was clear that Emerson's Paul Niwa flunked American history when he compared the reactionary Republican mobs disrupting healthcare town meetings to the Sons of Liberty. Paul, there were such groups, true, but they weren't the Sons of Liberty: they were Loyalist (Tory) mobs; like today's mobs, they existed to defend the status quo and to prevent change.

Paul Sciacca trotted out what must be the Herald party line. He doesn't do that often, so shame on him. He argued that the press would not call a demonstration by union members an angry mob.

Well, no, they wouldn't. Because union demonstrators would fly their true colours, a principle republicans seem to have abandoned. Good journalism demands that one would call them by their identity. However, when republican sneaks paid off by health insurance interests hire and deploy an angry mob under no colours at all, they have no reason to object when it is called an angry mob.

I've ignored the emails asking me to show up for Obama at this event or that. While I am not best pleased with how the administration has handled this business, that isn't the reason. I am not there because I am furious, I am feeling very revolutionary, and I would test the value of some reactionary clown's health insurance. The world is better off with my sweet self on the sidelines.

But back to the journalists. so-called. Most now seem to be clear on the concept that these are paid thugs. I grant that GMA among others is still without a clue, and none of them can figure out the ones demanding that Obama "keep the gummint outta my Medicare." Health care providers have been rolling on the floor over that one for years. One said to me the other day that we'd have emergency room overcrowding fixed overnight if we could find a cure for stupid. Beat the Press should have been asking, "where was the critical faculty?" What terminal flaw is it that prevents broadcast journalists from ever questioning the source and nature of the story? That flaw is, I submit, that they are not journalists at all, that they do not work for news media. They are entertainers, and their employers are simply circuses in the Roman sense, who gull the mass audience into blind acceptance.