Archives for category: Health

 

I thought I would discuss this Atlantic article in the context of political love languages, but there are so many other problems with Conor Friedersdorf’s Take the Shutdown Skeptics Seriously that I’m just going to get into it as a political discussion.

Friedersdorf argues several points:

  • That the discussion isn’t as clear-cut as pro-human and pro-economy. However, he goes on to argue the pro-economy stance much of the way through.
  • That because we don’t know how long a solution will take, or if we will reach a solution, “Americans should carefully consider the potential costs of prolonged shutdowns lest they cause more deaths or harm to the vulnerable than they spare.”
  • That supply chain interruptions and a prolonged depression are equally great risks to life and not to be discounted.
  • That crashed healthcare and education systems are also hard to recover.

He cites Michael Klare’s warning in The Nation that “Even where supply chains remain intact, many poor countries lack the funds to pay for imported food,” he explained. “This has long been a problem for the least-developed countries, which often depend on international food aid” This is not new. Starvation and poor access  to food has always been a hazard because of (among other things) how international trade and exploitation are arranged now and have been since the admitted colonial times. (These places are still colonies – of multinationals now, not other countries, but still.) When we talk about developing/developed countries, there’s often the assumption of dependence on foreign assistance. The problem here is that there are so many internal and external forces at play that keep such countries in the ’not developed’ column. Using this as an excuse not to work on those issues is just a continuance of the problem.

And note the absence of discussion of the plague of locusts in Africa – no global locust watch dashboards but the problem still exists, and people will starve because of it.

Note, too, that there’s currently enough food gin the US supply chain if we’re processing it carefully and not sending it to China. The web of trade can’t be brought back but government stimulus – paying a fair wage for fair work harvesting the food that’s rotting on the vine right now and planting for the next season will feed more people. But again, it seems to be a matter in American politics and the US media that dividing people works in some folks’ favour, and bringing people together to support the effort and each other runs counter to that. This might be a dream that free people will do manual labor in the absence of other labor to do, or in the interest of the country not going underfed in a land of plenty.

The part of the article that really got my blood boiling is the assertion that this crashing economy won’t leave the healthcare systems standing, sourced to Esther O’Reilly’s Arc Digital article Economic Costs Are Human Costs. In the West, this is mostly a problem in the US where a large portion of the economy rests on a fragile but very lucrative system of people paying large sums of money to insurance companies on the slim chance those companies will take care of them in the event of catastrophe. Those companies have a bottom line dependent on not covering care in the event of catastrophe. This is the big hole in how the US economy works that Obama and many before him were trying to fix and now we’re seeing how that affects the rest of society. In the context of the pandemic, we find that we had an opportunity to meet the disaster head on by working with manufacturers to build up the stockpiles of ventilators and PPE that were going to be necessary. See above about the ease of dividing people rather than bringing together to meet the challenge.

Healthcare systems running out of cash on hand is one of the symptoms of poorly run healthcare (and a poorly run country, in my opinion) – or healthcare run on a for-profit basis. We can fight the virus and put the economy on hold if the money we’re borrowing to shore up the economy goes into fighting the disaster and to the people it needs to help. It’s the same with giving tax breaks at the top rather than minimum wage increases at the bottom. That wage increase gets plugged right back into the economy. But a few more people are fed first.

Stimulus works a lot better when it’s effectively directed as well. Hospitals (nursing homes, prisons, food processing plants), three months into this disaster, should have all the PPE they need. There were hundreds of ways to reconfigure our manufacturing base temporarily to address the situation in testing as well as equipment. We (the executive branch of the US government) simply didn’t and made excuses for not doing so. And continues to. Gracious, DJT. You can’t blame the system for that – you can, but we saw disaster on the horizon and decided not to prepare and identified who we’d sacrifice and which corporations would reap the benefit of stimulus packages that should have supported humans in need.

A final point in the article that made me scratch my head was this: ‘The shuttering of auto manufacturing plants led to an 85 percent increase in opioid overdose deaths in the surrounding counties over seven years, according to a recent study.’ (The referenced article by Heather Mac Donald in The Spectator – https://spectator.us/consider-costs-coronavirus/ doesn’t cite a source for this statistic.) Friedersdorf is trying to argue about the social costs of a depression should this shutdown last too long. There’s a leap of logic here that I can’t fathom. Opioid deaths are also associated with the companies pushing the opioids, other healthcare issues associated with manufacturing and the holes in our healthcare system and the generally accepted disposability of workers in general in the US. Topic for another blog

And finally, I found this related sentiment on Facebook, but am having a time sourcing the original tweet:

medically-informed

We absolutely can do much better.

Karl Marx was being somewhat reductionist when he said that history repeats itself, first and tragedy, then as farce. And I won’t be the first person to suggest that the Corvid-19 tragedy in the US is a repeat of the AIDS crisis of the 1980s. The earlier was (for those of us in the West) a great tragedy, and what’s affecting us now surely isn’t farce – it’s a tragedy on a larger, faster scale. One of the reasons it’s such a tragedy is that many people learned from the AIDS crisis, President Trump just isn’t one of them.

This probably isn’t the first time I’ve mentioned on this blog the travesty of the Reagan administration in not acknowledging the toll AIDS was taking on a couple of communities in the United States, even when it took the life of his friend Rock Hudson. He refused even to name the disease until well into his second term. That the hardest hit communities were the gays and the intravenous drug users might have had something to do with this. I initially wrote that Reagan was handily reelected even with ACT-UP protests in the capital, but ACT-UP wasn’t formed until 1987. As long as the communities were demonized, though, there was no need to worry. It didn’t hurt Reagan that his opponent in ‘84 was the relatively uncharismatic Walter Mondale.

But the fact is that over the first 20 years of the epidemic, 774,467 people in the US were diagnosed with HIV. 448,060 died of its related ailments. (HIV is still the cause of approximately 1 million deaths per year, mostly in sub-Saharan Africa and Asia.)

The disease wasn’t discussed in US political circles, except in reference to the innocent victims. Remember the Ryan White Act? Innocent meaning not gay, not a drug user. Comics used it as a punch line. Sometimes the entertainment industry stepped up (Philadelphia), generally not. But eventually there was movement in the research and the disease became less of a death sentence, at least in the West. Africa? Still a different story. Standard Precautions also evolved out of the AIDS epidemic. Previously there had been precautions associated with whatever diagnosed illness the patient presented with. First Universal Precautions (1986 or so), which referred specifically to blood and blood-related bodily fluids, and then Standard Precautions superseded those with a set of practices for all those who had patient (and especially body fluid) contact and weren’t dependent on the patient presenting symptoms. When I was working in healthcare in the 90s (as a secretary in home health for a major HMO), I had to be familiar with these, even though it wasn’t in my daily routine to practice them.

Read that WHO doc on standard precautions, or this one from the CDC. That’s okay. I’ll wait.

Did you note the bits about cough safety and hand washing? Yeah, those ring bells because we’re coughing into our elbows now and washing our hands eighteen times a day. What about PPE, sterilization, and infection prevention? Yeah. We’ve had rules in place about those things for decades.

Which brings us to the current repetition.

We know just about when this outbreak came to the US. And we’ve listened to the president and his cohort lie, cheat, steal, brag, and generally screw over those most in need: those suffering from this dreadful flu and the health professionals doing their utmost to help those patients. If the AIDS crisis was itself a tragedy, what can we say about the sheer numbers of this pandemic and the madness of the federal response?

In United States of America, from Jan 20 to 2:00am CEST, 15 April 2020, there have been 578,268 confirmed cases of COVID-19 with 23,476 deaths. (https://covid19.who.int/region/amro/country/us)

I’m not really sure how to address this. In less than a week, we will see the number of cases of COVID-19 in the US in three months exceed the number of AIDS cases recorded in 20 years. And we knew how to prevent the outbreak, or at least lessen its effects, and we knew what was needed to safely take care of those suffering. (In fairness, we knew how to do those things relatively early on in the AIDS crisis, too.) And we didn’t. Not only were we as a nation unable to meet this crisis in a unified way, we were undermined from the outset by the avarice of those who should have been setting sane policy.

In Illness as Metaphor, Susan Sontag discusses the different ways in which tuberculosis and cancer were treated by the medical profession and by family members of those suffering those diseases. TB had an odd romance about it, but in both cases, even the mention of the disease was thought to add another burden to the patient. One of several dozen key points she makes is that, ‘All this lying to and by cancer patients is a measure of how much harder it has become in advanced industrial societies to come to terms with death. (Ch. 1)’

This speaks volumes to how much we as a society really want to believe that getting back to normal, opening the markets, and so forth is preferable to addressing the massive numbers of suffering on our doorsteps. I’ll be honest, I’ve only finished two chapters of Illness and haven’t gotten to the second volume, AIDS and Its Metaphors. But I think Sontag will have a lot to say that speaks to our current condition.

The main reason I’m bringing Sontag’s points into this discussion is that we don’t have the time to be either romantic or blithely quiet about COVID-19. We should be studying and learning and financing the science and the health to get to the other side of this. And doing the work to protect one another. But instead we have the anti-science coming out of the White House and folks like the protesters in Michigan demanding society be reopened so they can shop and have their hair done.

I grieve.

I know that I’m extraordinarily blessed in that I live in a country with a safety net and that my health insurance costs are capped by law. There are a lot of complaints about Dutch medical care, and I’m sure that if I delved deeply enough, I’d find some horror stories. However, in the Netherlands, and in most of Europe, catastrophic illness doesn’t bankrupt the insured. Note that no one here is uninsured – the benefits system is such that a person in straits for whatever reason is still covered. If you’re not in straits, the system requires each person to pay for a basic level of coverage. At the moment, that basic level costs something like EUR 110 per month. (I don’t know the precise number because I take advantage of a higher level.

I don’t know how to address things like GoFundMe pages for people who suffer catastrophic illnesses or emergencies or simply get blindsided by insurance companies that cover ambulance company X, but not ambulance company Y. Too bad that company Y was sent when you called 911. No, it’s not that I don’t know how to address these things, it’s the fact that we’re still stuck in the situation that people aren’t covered for illness by default. When the Clintons tried to work out some kind of universal health coverage in the US in the 90s, they were beaten back by the insurance industry. When Obama tried the same thing, he was beaten almost from the get-go. The fact that he managed to eke some success out of all that political capital, and all that bloody opposition is a credit to the man.

I worked in healthcare for several years in the 90s. My mother was a medical secretary and my stepdad was an EKG tech before he moved into fundraising at the same hospital. So I’ve always had some input and insight as to how these systems work. For an idea, see the history section of the Wikipedia article on health insurance in the US.

Because Franklin Roosevelt sidestepped the issue at the time he was pushing for various reforms in social policy, the medical industries were able to consolidate their efforts against any kind of socialized medicine. By the time Truman took up the gauntlet in 1949, the AMA was prepared. And for 80 years they and the various for-profit healthcare organizations have fought tooth and nail to prevent any kind of socialized care in the US. And because everyone with full-time employment in the US has an insurance option through one of these plans, the money keeps flowing up to the healthcare industry. Woe be to you if you have to work multiple part time jobs to make ends meet, because it’s unlikely any of them will provide you with a company-subsidized option. So no matter what you do, you’re in deep to the industry should you need care. Of course, those who are uninsured or underinsured will hesitate to go to the doctor when there’s something seriously wrong. Heaven forbid the coronavirus gain a foothold in the US, but even without it, those at greatest risk for spreading communicable illnesses are those least able to take the time to get care for them. Even in my office (software company, generous work from home options), I have colleagues who feel compelled for whatever reason to come into the office when they’re seriously ill. (I shared a crowded train with one a couple of weeks ago – he’d been home for a few days, and was obviously still sick, coughing into his hands and rubbing his eyes. Alas, the drug store was all out of hand sanitizer because of the latest rush on the stuff.)

So not a week goes by that I don’t see a GoFundMe call on Facebook from someone whose friend is needing money for catastrophic healthcare costs. One level of compassion is to give something to each of those. This is reasonable, but also ridiculous, given how much money should be in the system but isn’t. Ridiculous because it’s somehow easier and better for those with little enough money already to help each other than for the obscenely wealthy to ease up on the greed in the system. It’s another version of the rich guy, working class guy, and immigrant/poor guy looking at a plate of cookies. As the rich guy takes all but one, he says, ‘Look out, the immigrant’s gonna take your cookie.’

I honestly don’t know what to say anymore about this situation. For several years now, I’ve seen the comment that this is the point at which the French started building guillotines. I think on a gut level we know that in France politics suddenly became bloodsport and didn’t stop until the engineers of the Reign of Terror were themselves sent to the scaffold. We also seem to have sufficient bloodsport/bread/circuses/entertainment to keep us looking the other way as the things we deserve as members of this society, as contributors to the social contract are taken away.

It’s not a just matter of someone less fortunate than we are taking our cookie, it’s that along with all of the other basics that are part of surviving and thriving together, compassion calls on us to fund as individuals what should be funded by society as a whole.


Edited to add this link, posted to cbsnews.com the same day I posted this entry:

“You wouldn’t think you’d go to jail over medical bills”: County in rural Kansas is jailing people over unpaid medical debt

In the dream, I wake from a dream of swimming thinking of the story as I walk down streets paved with large rocks. It’s one of those dreams in which I’m in wide canals as the water gets higher and the current and waves throw me in the air and I come back into the water and float or swim some more. In this revery, I’m walking through the boulders thinking of another story about swimming. Both the town in the dream and the town I wake in have old crooked buildings. But the town I wake into is hotter and arid. I look at a ceramic display on a street corner with words from prayers in Hebrew and English and possibly other languages, and continue walking towards my flat thinking of writing about swimming, about learning to swim, and about water.

Canal-Walk-Foot-BridgeA man, thin, wizened, about 55, stops me and asks if I have money. He wears shorts that are a little baggy on him and a faded t-shirt, though he doesn’t seem like a bum. I think of the small wallet in my pocket which contains maybe 40 euros. He speaks to me immediately in English, which is odd. Tells me I’m brave for admitting about the money, and ask if I mind talking with him. The small avenues are paved like something out of Gaudi or Hundertwasser. As I would in waking life, I do talk to him even though I’d rather be walking home and thinking about writing and thinking about swimming.

We sit on a bench for a bit and he tells me that he makes naambords (signs that go next to the front door of Dutch houses with the family name and house number) – that he makes them just with street names and post codes for the city. He shows me a catalogue printed in colour on cheap paper. In it there’s a picture of very young him – maybe 20 wearing big glasses with plastic frames. It looks like an early 1980s photo of a radio shack geek. His parents encouraged him to do woodwork, as he had a passion for it. I tell him we’ve only this year bought a naambord, and I think of the slate one we actually have. He tells me it doesn’t matter. His name is something like Garry Barr.

I walk back home, thinking I want to write this story down. About the swimming dream and learning to swim and about meeting Garry Barr. The place I arrive at has a cave-like entrance that reminds me now of Tim Dedopulos’ place up from Nerudova (near Prague Castle). There’s a shop just inside and I ask after some chocolates, half-distracted because I want to go inside and write. I’m thinking of a ream of paper I’ve recently bought and of my typewriter. The shop is tiny and I ask if he has chocolate – the proprietor takes down a shoebox from a high shelf – there are white kit-kat bars that come in double packs with eight sticks. I know I don’t want that many, but they’re only a euro so I buy one. Whatever I’m carrying is bulky and I pass Jeff Rubinoff (an American friend of mine from Prague) who asks after the chocolate and I point him to the shopkeeper, instead of giving him half of what I’ve just bought. Even in my dreams, I’m greedy.

I’m a little anxious to start writing – I don’t want to lose the content of the dream and the discussion with Garry Barr. I have images still of swimming down wide canals with waves that toss me in the air and make me fear just a little bit breaking my legs as I hit the bottom, but that never happens in these dreams – the water is never too cold, and I never fear drowning more than just a little – it’s too exhilarating.

Down a short low corridor that feels a little like a cave, I enter a very small apartment, ready to eat a little of my chocolate bar and start typing. The room I enter is small, crowded and dark. My wife is ironing, and points to a bed on top of which a skinny girl of indeterminate age sleeps, wearing only a pair of panties. I’m disappointed because the noise of getting out the typewriter and the paper, even though I know where they are, will wake the girl. At this moment, I wake myself, needing to write.

Often you hear people say that suicide is never the answer – that there are always other ways out, that no problem is so huge that it can’t be talked out, that solutions are available. I’ve had periods of black depression, but what I call black depression is some people’s brightest day. And otherwise it hasn’t come that close to me – friends and colleagues of people I know, primarily. That’s not entirely true: My first wife’s father committed suicide a couple of months before she was born. This had many effects on her life and on our relationship. 

For some, death is the only logical move forward. Oliver Sacks wrote recently for the New Yorker about writer and actor Spalding Gray’s last couple of years. Being in Gray’s head must have been harrowing, and having read Sacks’ account, I don’t at all begrudge Gray that release. (In short, an auto accident left him with some brain damage that severely affected his ability to write and concentrate.) Is Gray’s case extreme? No way to tell. Every such death is different. 

Knowing of Ian Curtis’ epilepsy makes his suicide a little easier to understand, but I can also guess that a 60s/70s upbringing in working-class Manchester didn’t offer a person much respect for that kind of inner torment. (Curtis was the main writer and lead singer of Joy Division. in 1980, he committed suicide on the eve of the band’s first US tour.)
I just offer two possible examples. 

Most Western societies, it seems, condemn and stigmatise suicide in a number of ways – the term ‘cowardly’ comes up a lot. On the other hand, communities in general don’t seem to offer a lot of support. 

I hate the place I have to go to to write about this, so I’m not going to write much more, but I just want to say that if you have suicidal thoughts because of a relationship, or money issues, or because many of the facts of existence just weigh on you, or any other reason, please find some people to talk to. There is help, even if it seems too far away or too little or too late. Please try again. There’s more hope than you may think. 

UK: http://www.samaritans.org/how-we-can-help-you 

US: http://www.suicidepreventionlifeline.org 

Netherlands: https://www.113online.nl/113online-english-version