Tuesday, August 25, 2009

Nothing to Fear but Fear Itself?

What's your favorite color? Who's your role model? If you could have a superpower, what would it be? What are you most afraid of?

Everything from first-day-of-school icebreakers to internet quizzes ask these sorts of questions in an attempt to have you reveal something about yourself so others can get to know you better. Left for another day is what exactly green or Shaquille O'Neal or invisibility reveals about your personality; today I'm thinking about fears.

Most people when asked to name their greatest fear say something like snakes or spiders: very specific, tangible things which probably do give them the shivers when they encounter them. But very rare are the people who actually have crippling fears of spiders, who spend their nights quaking with fear that tonight will be the night they'll swallow one of the seven spiders the average human apparently unwittingly consumes in his or her sleep.

No offense, but creepy-crawlies and other animals are kind of an immature fear. They prompt basically gut-level evolutionary responses. Very few people honestly have no reaction to snakes, spiders, bees, wasps, mice, rats, sharks, and the like, but most of us don't actually experience real, true, soul-crushing horror at the thought of such things or spend large chunks of our lives in mortal dread of possible stings or bites. Citing a fear of bees, though, is an easy way to admit to a fear without embarrassment. Bugs and such are socially acceptable fears.

Nobody ever mentions the things of which they are really and truly terrified, about which they stay up at night worrying, the thought of which is accompanied by a feeling in the pit of the stomach: the discovery their partner doesn't love them or has never loved them, the death of a child, dementia, nonexistence, humiliation in front of people whose opinion matters, poverty, debilitating illness, running out of money before running out of life, being friendless, failing at something important to them, completely screwing up the raising of their children, being stupid or inadequate...

These are real fears, and so naturally nobody's ever going to mention them as part of a getting-to-know-you exercise. Before you know someone, there's no way you're going to let yourself feel that vulnerable. I'm guessing either these are the sorts of things that just make everyone feel uncomfortable because nobody wants to think about them or that the sharer would fear looking stupid for sounding neurotic. Animal bites and stings are nonthreatening as a fear; nobody mocks you for being scared of wasps because everybody's scared of wasps...and why not? They sting! It hurts! Well, everyone's scared of being unloved and alone, of failure, of death and nonexistence and the unknown, too.

Saturday, August 22, 2009

Health Insurance Reform

Well, it seems that the White House is indeed calling it "health insurance reform." So much for that brilliant idea. (I get the feeling this is kind of recent, though, when they backed down from reforming as much as they wanted to.)

I realized shortly after writing my last post that in my search for the eight principles, I did not actually find the ones I had intended to (which might explain why my post didn't make as much sense as it did in my head). I think I might be excused for this mistake, as I didn't realize Barack Obama came from an alien race with a base eight counting system: everything the White House has published about health care has been in groups of eight. There's the "eight ways reform provides security and stability for those with or without coverage," the "eight common myths about health insurance reform," the "eight reasons we need health insurance reform now," the "set of eight principles for transforming and modernizing America's health care system," and last (at least that I've seen) but not least, those eight I actually intended to post: "health insurance consumer protections: the security you get from health insurance reform":

  • No Discrimination for Pre-Existing Conditions. Insurance companies will be prohibited from refusing you coverage because of your medical history.
  • No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays. Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  • No Cost-Sharing for Preventive Care. Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  • No Dropping of Coverage for Seriously Ill. Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  • No Gender Discrimination. Insurance companies will be prohibited from charging you more because of your gender.
  • No Annual or Lifetime Caps on Coverage. Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  • Extended Coverage for Young Adults. Children would continue to be eligible for family coverage through the age of 26.
  • Guaranteed Insurance Renewal. Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
These are basic reforms that would fix what is horribly unfair and ridiculous (and sneaky) about our insurance system. Though I obviously would prefer something more sweeping and socialized, these protections (minus the extended coverage for young adults) are (or should be) something everyone could agree on as basically fair and what insurance companies should be doing anyway.

Monday, August 17, 2009

Obsessed with Health Care Before It was Cool

I feel like if it were referred to as "health insurance reform" rather than "health care reform," a lot of our problems would go away. "Health care reform" sounds like it could lead to (heaven forbid!) the British National Health Service and all sorts of strange, foreign-sounding, and potentially very unpleasant things. It seems like everything is on the table. "Health insurance reform," on the other hand, sounds like we're reforming a sector of our economy that most people admit the bureaucratic evilness of and cherish a hatred for that is second only to the too-overcompensated CEOs of bailed-out banks.

Seriously, does anyone like health insurance companies? They're just unpleasant to deal with. It's like dealing with your computer manufacturer or your cable provider except they're sneakier, they're more bureaucratic, and (most importantly) health is much more important than your failing laptop battery or the stealthy post–special introductory offer increase in your cable bill. I remember Mom spending hours on the phone trying to force our insurance company (Aetna is evil incarnate, by the way) to cover what it was supposed to, which in retrospect blows my mind, since at that point, we were all perfectly healthy. What were they trying to refuse to pay? A annual physical? A Pap smear? It's not like we were costing them a fortune in radiation treatments or dialysis or anything. We didn't even have broken bones or anything—nothing other than routine care.

I feel like most of the people who are yelling don't even know what they're yelling about. To hear them, you'd think Obama was going to go on a killing spree to take out Trig Palin, Ted Kennedy, and Stephen Hawking after converting our health care system into a socialized, bureaucratic system of meting out health care to those young and healthy citizens who were most likely to contribute to the economy (but who still might have to wait months for any treatments). Obama doesn't want any of that. I won't speak for anyone else, especially as I haven't read any of the proposed bills (hey, don't judge me; nobody else has either), but as far as Obama goes, it's pretty mainstream and reasonalble. How can you really disagree with this?

Obama's stated eight principles for successful and meaningful health care reform:
  1. Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.
  2. Make Health Coverage Affordable. The plan must reduce high administrative costs, unnecessary tests and services, waste, and other inefficiencies that consume money with no added health benefits.
  3. Aim for Universality. The plan must put the United States on a clear path to cover all Americans.
  4. Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.
  5. Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. They should have the option of keeping their employer-based health plan.
  6. Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking — as well as guarantee access to proven preventive treatments.
  7. Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.
  8. Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.
What is so scary about this? Most of it seems, actually, scary only insofar as it makes you realize, Oh, wait, why is it this way in the first place? I mean, obviously everyone, including Republicans, is a fan of number eight, fiscal sustainability. And what about reducing "inefficiencies that consume money with no added health benefits" (number two)? Who isn't for cutting costs in areas that don't lead to cuts in outcome? Preventative care (number six)? Sounds good. (That saying "An ounce of prevention is worth a pound of cure"? Totally applicable. Helping people not get fat is cheaper than paying for their insulin and then foot amputations and eye surgeries and whatever as their diabetes progresses. Plus, you know, then their lives don't suck.)

But the big one for me is number four: portability of coverage. The absolute stupidest part of our health care system in my mind is that it is currently almost entirely linked to one's employer. I assume this will erode, regardless of what happens with this current attempt at reform, as Gen Y ages, since nobody is doing the work-your-whole-life-at-General-Motors kind of thing anymore. We're all changing jobs every year or two or four. (Seriously, who do you know who's working for the same company they plan to be with in five years? I may never get to that point.) If we're all going to be changing jobs every couple of years, especially if there are going to be any gaps between one job and another, the current system simply sucks. Yeah, there's COBRA to cover the gaps, but it's prohibitively expensive. And what about families? Within a period of four years or so (late high school and early college), I changed health insurance plans a ridiculous number of times: from Dad's to the COBRA Dad got after losing his job at the Federal Reserve to Mom's when she started working for the school system to Dad's when he got his new job to Mom's with Grady when Dad got called back to active duty...or something. Dental also changed, but not always in tandem with medical, so I lived in a permanent state of confusion. This is bad because even if people are on top of things and do arrange to have seamless medical coverage, there's only a certain period of time they can actually be covered. When you switch, it takes like a month to get your new card and all your information, and then you have to find a new doctor because your old one isn't covered with this plan, and then you have to wait a month or more for your appointment because new patients always seem to get screwed... So even if you've technically been covered for six months, only half of that time is time that you could actually be seeing a doctor, and that's only if you're on top of things (not like me) in making appointments before you switch insurance again.

And then there's the rest of number four: "No American should be denied coverage because of preexisting conditions." I can understand why health insurance companies developed this rule. Obviously it's not fair for someone to smoke for forty years and never have health insurance, but then when they find out they have lung cancer, the treatment of which is going to be quite expensive, to take out a health insurance policy so they only have to pay the few hundred dollars' of deductible plus a few $20 copays. (Of course, if we require everyone be covered, this can't happen...)

What's even less fair, though, is that people can be booted out of their health insurance when they turn out to have, say, breast cancer, because they didn't report it when they applied for insurance...if they didn't know it themselves at the time. Or that people who develop one of these dreaded conditions must then either stay at that job or find another with similar coverage forever, else they be left unable to purchase insurance on the private market because of this now-preexisting condition.

My mom, for example, would now be unable to purchase insurance on her own because she had a melanoma a few years back. It was entirely isolated, entirely removed, and has nothing to do with anything else that may happen in the future. It was stage zero, entirely contained, and it's been years since then, demonstrating that even if these facts were somehow mistaken, it hasn't spread. Regardless, Mom is now a cancer patient and thus anathema to all insurance providers. I mean, good thing it's something that was simple and self-contained and doesn't affect her ability to work (unlike the chronic diseases that make up most preexisting conditions), so she doesn't really have to worry that much; as long as she has a job, she'll be OK as far as health insurance goes. But for people whose illnesses preclude remaining at work? Sucks to be them.

The worst? That insurers can simply drop people from their plan if their health care becomes too expensive, regardless of whether or not it was a preexisting condition. I didn't even know this was possible until recently (thank you, plethora of indignant health care–related articles), and I am appalled. That's cheating! The whole reason people buy insurance is because they're afraid they'll develop a devastating disease that will bankrupt them. It's not fair to quit covering them when they do after having accepted their premiums for however long. If AIDS is too expensive for you to want to have to worry about, just state straight out that you don't cover AIDS, so then if anyone's worried about it, they can just go to another insurer rather than paying you for years until it becomes an issue and you announce you don't want to deal with it.

Seriously, I don't understand why this is so hard. People shouldn't be bankrupted because they develop a chronic disease. We should help people avoid avoidable chronic diseases. We shouldn't spend money to do stuff that doesn't work or spend money when it's irrelevant (most back MRIs—back surgery is way more of a pain than it's worth in most conditions, so all an MRI does is tell you, "Yep, your back is messed up"...which you knew anyway), spend more money for stuff that doesn't work any better (the new name-brand cholesterol drugs that aren't any more effective than the decades-old ones have been in the news lately), and we should do the cheap things we know do work (like washing hands and following other hygeinic procedures to reduce/eliminate hospital-acquired infections like MRSA). We should all have insurance so taxpayers don't get stuck with the uninsured poor's emergency room visits for what should be primary care issues (or, for that matter, the uninsured poor's bona fide emergencies). Insurance companies should do the duties they ostensibly exist to perform without being evil in order to discourage people and increase their profit margins.

Insurance as it is now sucks. Health care, if not a right (people keep arguing that; I'm not taking a side in this post at least), is certainly one of the more important creature comforts and something any reasonable and humane person or society wouldn't want to be caught denying anyone else. So let's suck it up and be mature grown-ups about this already.

Thursday, August 13, 2009

Reality, or What's Really Real?

A Facebook friend posted a note about how relativism denies individuality today that seemed to me like a bunch of gobbledygook (or I may just be out of practice with my philosophy), but it prompted some general thought about relativism and subjective experience.

Surprisingly enough, I don't think I'm a relativist, or at least not in the strict sense. I do think there is absolute truth, that there is an actual reality out there. Obviously reality cannot differ from person to person: either the sun revolves around the earth, or the earth around the sun, or they both stand still, or they both revolve around something else entirely, or they both just vibrate up and down, or the sun is really a collective hallucination, or...something else. There is a way the universe works. The problem is, however, that none of us actually directly experiences reality, so we don't necessarily all agree on what that is. It's impossible. That's exactly what perception is—the attempt of our brains to interpret signals and form a coherent view of reality. I mean, it's not like reality is in bright, living color. Color is entirely a product of living brains translating wavelengths into visual impressions because, for some reason, sight is the sense we use the most to gain information about our environment. Obviously things do reflect whatever wavelength of light they do whether or not we were looking at them, and if you wanted to, you could define that as color, but the qualia of, say, yellow, requires a human (or some animals, I suppose) brain.

(Incidentally, is this the point people are getting at when they say God can see/experience things much more clearly than us because he isn't limited by our senses? I mean, I assume he still has senses, but that they're different ones, because I don't understand how you can, um, sense reality without senses, unless, of course, you are reality, but that's going a little too out there for my tastes at the moment.)

Anyway, I think it's pretty well established that different people do perceive the physical aspects of reality differently. People have passionate arguments about whether something is navy or black (or maybe it's really dark purple?) or whether a particular shade of blue-green is more blue or more green. Some people hear that noise TVs make, while others of us can't hear that wavelength. Some people think cucumbers have a strong taste while the rest of us don't have the kind of taste bud or the chemical or whatever that makes the bitterness stand out. So obviously in the most fundamental ways, we all perceive reality slightly differently. And at least in most of these examples, it's nonsensical to say that one person is perceiving reality accurately and something's wrong with the other person. (It's much easier to say that if, for example, someone is colorblind, though I would still say that to that person, light at wavelengths of 510 and 650 nanometers are gray, just as they are green or red, respectively, to others.) Does the reality of cucumber have a strong bitter taste or a very mild, nearly flavorless taste? Neither. Obviously it does contain a chemical that makes it bitter to some people and to those of us who can't taste that chemical, it's not bitter. It's not that it is bitter but we're not tasting it or it's not bitter and some people are just making something up; it actually is bitter to some and not to others. Voila, subjective experience.

Now that's all well and good; we already knew we feel temperatures slightly differently and see colors slightly differently and taste and hear things slightly differently and that some smells that are foul to some are fair to others (gas, Sharpies). All that doesn't really matter, though, as you can pretty much average it all out and assume that's close to the truth. And really, what does it matter if some people can hear a sound that others can't? None of this is very important to everyday life (as long as you're not the colorblind one who can't tell what color the traffic light is) and epic truths. We can all be pretty sure that where one of us sees a brown cow, someone else doesn't see a bolt of lightning or a bicycle or a scarf, so as long as we both see a large animal with dark fur, we can be pretty confident that it has some connection to reality, and that's enough for now. (Of course, we could just all be sitting in cold tanks of water in the bowels of the earth with machines activating the parts of our brains that tell us we're seeing large, dark mammals, à la The Matrix, so I suppose agreement doesn't necessitate accuracy, but for simplicity's sake, let's go with it for now.)

So, on to things less immediately tied to direct perception of reality: religion. If there is one real reality, is there any sense in which beliefs can be true for some people and not true for others? I think here, it depends on what kind of truths you're trying to get out of religion.

Can there be one god, and also be many gods, and also be no gods? Can Jesus have died for our sins 2000 years ago, and the Messiah not yet have come, and if there's going to be anyone to save us it's going to be us ourselves? Can God have created the earth and everything on it in seven literal days, and life on earth have evolved over millennia, and us all be perched on the back of a turtle? Um, I can't see how. Some things (particularly specific events) directly conflict and thus cannot all be true.

But can it be true that God's plan for their life gives some people meaning and purpose while others would feel their lives less purposeful if they thought their lives were being controlled by a god? Can the route to communion with God be through traditional rituals for some, through unrestrained emotional expression for others, and be impossible or not to be desired by yet others? I certainly would say so.

Contradictory? I think not. Certain factual claims either have to be true or false. Either God is an old white bearded man or has blue skin or is Jewish-looking or is a plate of flying spaghetti or is something else; he certainly cannot be blue-skinned and white and Jewish and pasta. You can certainly argue, and I think most people do, that God is none of these things and that these are all our representations, which can differ according to what best suits us and what we are best able to worship without affecting the actual nature or existence of God. This nicely removes this entire problem. But to remain in the realm of factual questions of what God actually is or how the earth came into being or whether our consciousnesses will live on after death—when there are contradictions, some options must be right and others wrong. (Of course, my personal feeling is that it's highly unlikely any one religious tradition has it all right. Nevertheless, there is a right that it is theoretically possible to be.)

Pointing to the physical realm as proof of one belief or another often fails, and this goes back to the perception issue. One person looking at nature sees evidence of God's handiwork in creation, while another sees evidence of a struggle for survival resulting in evolution by selection. One person sees healing through prayer where another sees healing through modern medicine with prayer just happening to coincide. One person sees God's hand at work in their life, guiding them to the right decision about a job or relationship where another sees their own decision-making process with different aspects of their consciousness trying to hash it all out. One person sees God bringing a person into their life for a reason while another sees a chance encounter that they may or may not learn from. Each of these could be a reasonable interpretation of the data, but obviously the mindset, belief structure, and past personal history they are being filtered through affect which interpretation is decided on.

Other claims are less coupled to an absolute reality and depend yet more on a person. For example, it is obviously true (at least if people's claims are to be believed) that believing in God makes some people feel as though their lives have meaning, since they are all a part of God's great plan. Equally as true to others, though, is that the only meaning that could comfort them is one devised by themselves rather than imposed from outside; they have no desire to be a cog in some great unknown plan, the devising of which they had nothing to do with. For many atheists, the thought of living under God's thumb is terrifying. Now, obviously these feelings do not change the reality of whether there is or is not a God who has a great plan we are all a part of, but the 'reality' of whether God is nice or good or whether God comforts people can certainly and legitimately vary from person to person. Religion (or God) can give meaning or sap meaning, soothe or agitate, inspire or depress.

Since to me it seems rather difficult to prove any given claim (even God's existence, much less his color or age or gender or habits of creation) to everyone's satisfaction, I feel we're left with relativism. Of course you have to believe what you believe, what your perception of reality causes you to believe, and it's only reasonable that you should accept that others only believe what their perceptions of reality lead them to believe, whether or not you accept the validity of that belief. And really, to a certain extent, if you can't perceive the true reality and have no way to know who is closest, it almost doesn't matter. I mean, if more evidence comes to light that would push you one way or another, you should take it into account, for the truth does matter, but if the truth is actually unknowable, what you believe doesn't.

NB: I know most people who are religious (and, for that matter, most who aren't, I suppose) do say you can know, but since various groups admit as evidence that which other groups aren't disposed to admit as evidence, we seem to be at an impasse. Yes, the Bible says, but to believe what it says, you have to believe it was inspired, so you have to believe in the God who inspired it, which is what the Bible was supposed to be convincing you of. Likewise, I assume to believe in what scientists have to say about origins of life and such, you have to be convinced nothing exists which cannot be measured or sensed, but isn't God exactly such a thing? Presumably one wouldn't want to rule out God at the very beginning of a process one was hoping would reveal evidence for the very same.

Monday, August 3, 2009

Do you think veterans and concentration camp survivors and astronauts and such really self-identify primarily as that thing the rest of their lives? On the one hand, it seems ridiculous for something you did for two years fifty years ago to define you as a person, but on the other hand, some things do completely change you and the way you look at the world.

I keep seeing headlines like this one: "Nazi Concentration Camp Survivor, 90, Found Strangled." To me, to identify someone as a concentration camp survivor in the headline means that's relevant to whatever the significant event is, like if he had been killed by neo-Nazi groups or something. But if someone is attacked and killed apparently at random and as part of a robbery, isn't that equally tragic regardless of what their past is? Do we really need to know he's a concentration camp survivor to make us care? (Well, yes, actually, but that's not the way things should be, right?)

But I always wonder if, for example, before this guy died, you had asked him to describe himself, "Well, you know, I survived a concentration camp" would be the first thing to come to mind. Probably not. I assume what he's done with the rest of the life he managed to save is more important to him.

I've actually been pondering this idea for a long time concerning veterans. On Veterans Day, when people talk about those who fought for our freedoms and how we should respect and honor them, I've always wondered if this sort of recognition seems a little peculiar to any of the veterans themselves. Most veterans, especially the ones drafted for World War II or Vietnam spent two years or so in the military, and probably only half of that actually in the war zone. Not only is it such a small chunk of their lives, but it was when they was very young and barely even the people they are today. Does it ever seem strange to them that their 18- to 20-year-old selves are what has defined their lives? (Who else wants to be defined or even reminded of the things they did when they were 18?)

For Vietnam vets, especially, they may not have even wanted to be "defending our freedoms." (Does that description even make sense regarding anything since World War II, anyway?). If you were drafted to fight in a war you didn't believe in, I imagine once you had returned home, formed a family, developed a career, built a life, and so forth, you would really probably prefer not to be forced to remember on every patriotic and pro-military holiday what you had done for your country, much less be praised for it. Wouldn't you prefer to be praised for the part of your life you actually had a hand in, the kind of person you actually chose to be, than for something that just happened to you?

Even with positive things, like landing on the moon, it seems a bit strange for such a small portion of a man's life to utterly define him to the world. In a recent TIME magazine article, the astronauts' bewilderment of what to do with the rest of their lives and how to relate to the world is evident. A few do craft their lives around their identity as astronauts, whether by writing books, painting space-themed pictures, or giving speeches. Others, however, pursue other careers. After 40 years as a CEO, would you still think of yourself as an astronaut first and foremost? I'm willing to bet there are days on end where that thought would never even cross your mind. When it does, I'd imagine it would be of the "I was in space, for Christ's sake; why do I have to put up with this crap?" variety.

None of this is to say that trauma or fame don't change people. Obviously war and other traumatic events from the Holocaust to rape do have an effect on the person involved, and presumably going to the moon has a pretty profound impact as well. Presumably the person one becomes after such an event is different than who one would have become had that event never happened, but it doesn't necessarily follow that one is (or should be) defined by that event, particularly by others. We all learn from and are formed by our life experiences, but the rest of us aren't forcibly identified by one life experience from early in our lives. If one does identify strongly as a veteran or POW or rape survivor, talking about it all the time or using it to explain why they hold some of the attitudes and opinions they do (McCain comes to mind), of course that's perfectly reasonable, understandable, and natural—I just wonder if they all do. If they don't, it seems somewhat disrespectful for society in general to decide that's who they are. I feel like we're missing the point, like we're using labels (once again) to keep from actually getting to know the individual for what he or she has done with his or her own life.