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Photo Credit: An eye for my mind Flickr via Compfight cc

January 18, 2017

I have spent several days of dread since hearing of actions to repeal the Affordable Care Act (A.C.A.). I have attempted to write a letter several times and now I may be calm enough to do so.

I need the protections the A.C.A. provides:

Preexisting conditions

In 1998 I quit working to stay home with my newborn and preschool child. I had been the adult with employer-based insurance. We looked for other coverage while on COBRA. The best plan our insurance broker found was a plan which would cover our family of four for $3000 per month. My husband and I had minor preexisting conditions. That was enough to make our premium so high. I was lucky enough to be able to get group coverage for “only” $900 per month through my professional association. At $3000 per month we were considering having no coverage as it didn’t seem to make much sense. And we still had to pay for those preexisting conditions regardless of premium cost.

 Affordability

Individual insurance has always been expensive. People who complain most about insurance costs, have had the luxury of coverage through their job. They have no idea of the total cost of their insurance coverage. They only know how much they pay through their paycheck. I was a psychiatrist in private practice. My health insurance policy (through the medical association) was about $1500 per month for my family of four in 2013. My deductible was $7000 per year. I could not afford to provide my one or two office staff with health insurance. In my experience employer based insurance is a drain on private businesses. I envied businesses in countries which had universal coverage. This was because I would have liked to have coverage for my employees.

 Chronic Illness

 In 2014 I had to quit working due to worsening asthma. Thanks to the A.C.A. I have been able to maintain continuous coverage. I have not had waiting periods for treatment of my life-threatening preexisting condition. This is especially fortunate since the costs for my medications out of pocket would total over $40,000 per year. If health insurance rules change then I, and many others, will be uninsurable. This could flood the emergency rooms and disability rolls, not to mention the morgues.

In conclusion I would like to add that since my retirement two years ago, my health has improved. This year I have high hopes of being able to work in some capacity on a part time basis. This means that I can contribute more to the country that I love. And that is thanks to the A.C.A. Please allow me to be a productive citizen and to continue to breathe free in every sense. Support universal health coverage.

Thanks for your attention,

Catherine Munson, MD

Psychiatrist, retired

Pop Culture: #zombies4socialjuztiz

A few thoughts

  Some classes in anthropology as an undergraduate have left me with the cultural anthropology addiction. And the phenomena of zombie fanatics, "zombie as metaphor" if you will has nagged at my mind for some time. The most intriguing thing was the wonderful opportunity of having a monster who is ALREADY DEAD!!!!

  

  This morning it finally came to me. When I was a child we had the cartoon like portrayals of hordes of natives (pick your continent, any continent) vs. the white people. Or more finely crafted series where Nazis etc, (pick your favorite worst example of a racial, or ethnic group) were the monster. But now we have zombies. They want my brains!  And we get to kill them! But they could be me! Cool! Because they are already dead! So hey, no guilt!

  Am I crazy? Or is this a sign that we want a monster so preposterous because.. we are maybe, slightly, less,    (racist). Ok I said it. So that is one possibility. But it is probably just like the blob, or irradiated giant ants. It's just fun, scary and silly. 

#zombieBLACKlivesmatter

When black lives matter, all lives matter.

Book: By Light Alone by Adam Roberts

A Few Thoughts

Before I begin properly let me state that my father hated science fiction. He was a scientist and there was no science in science fiction. In honor of my father I henceforth declare the novel By Light Alone to be a fantasy novel. There, now I feel better.

This fantasy novel is set in a world eerily like our own but ostensibly in the future. The basic premise is the optional genetic manipulation of humans so hair can provide sustenance by photosynthesis. Babies can imbibe the mutation through their mother's milk. This procedure was invented with the best of intentions and indeed the world now is free from hunger. And as with so many good intentions we shortly find ourselves in hell.

Class divisions have gone more wildly berserk with the extreme poor having nothing; now they reduced to begging for water. They must get minerals and protein by eating bugs and dirt from time to time. The wealthy meanwhile struggle with ennui and constantly seek sensation. They ostentatiously shave their heads (although they do not have the magical plant-like hair) and dine on carefully crafted delicacies, after skiing on ice cream covered slopes.

The book is really two books. One is a bleak satire on over-consumption and living life in denial of pain and difficulty. Needless to say the characters in this section are not terribly likeable. Unfortunately they are recognizable. The humor makes the underlying despair bearable.

The second book is a call to action on the side of the light eaters. A view into their grim existence, which again, seems disturbingly familiar. Mr. Roberts has few real answers to the problem of how to bridge the gaps between the haves and the have-nots, however while giving away as little as possible there are two moments in the book which seem to provide possibility. They both involve characters in flight, choosing connection. The choice of connection is not based on logic or ideology. It is based on passion, emotion and acknowledgement of biological connection, an acknowledgement of the possibility of love.

As I was pondering the book the following words came to me:

Cold hearted orb that rules the night,
removes the colours from our sight.
Red is grey, and yellow, white,
but we decide which is right,
and which is an illusion.

~ Graeme Edge (Moody Blues)

This book celebrates humanity as much as it deplores where we end up in our humanity. We have enormous inventiveness and creativity. Where we end up depends largely on our vision as we go along. When we create something, what world is envisioned by that creation. Are we creating a fantastic bauble for only a few? Are we creating something "for someone else's good", while allowing the supposed beneficiaries no input into what good they desire? In the end, we decide. It may still turn up pear-shaped, but we do decide.

Anomalisa and Medicine

The Movie: Anomalisa

I was lucky enough to preview the movie Anomalisa early this month. I urge any adult who is interested in how our modern economy changes us to go and see it. Adult because it does have explicit sex scenes albeit with stop-motion animation, nevertheless it is sex that is so honestly portrayed that parents should be cautioned. 

  This movie gave voice to much of my dissatisfaction with modern living. In this case by modern living, I mean dealing with large businesses or organizations and the commodification of friendship. Obviously the big bad they have not been able to bribe or blackmail my actual friends into being false friends. However they have clearly infected every single sales or customer service rep with a virus causing them to imitate friendship. In a similar way casual games have been set up expressly to seduce me into one more level or more disturbingly into one more hidden object scene. There now my ugly secret is revealed.

So go, now, see Anomalisa, do not stop at go, don't wait til you have $200, go now to your local art movie theater and see Anomalisa. While you still can.

And Medicine

  So what has this got to do with medicine? Now that I am no longer a practicing doctor, I can express my dismay about what I will call algorithmic medicine. I was thinking about this quite intensely after seeing the film and attempted to put it all into words. My efforts were not pleasing.

  Then I saw an article in the New England Journal of Medicine (Jan. 14 2016, pp. 109-111). It compared industrial efficiency (aka Cheaper by the Dozen's Taylor) to the push to electronic medical records and a number of other regulations recently imposed on doctors.  Most of the comments about the article were outraged rants about how LEAN and six-sigma efficiency practices had been misrepresented. Yet for those outside of a hospital administrator setting, there is no real opportunity to give feedback, "Hey medicare! This isn't working for me, or for patients x, y and z." I mean there is opportunity, complaints, protests, appearing before committees and so forth, but not immediate, actionable opportunity.

  In brief, this is the message. Efficiency experts and pursuers of lowered health costs are trying to turn physicians and other health professionals into robots who churn through check-lists and algorithms to provide the best care that evidence-based medicine can provide. The problem is that people are not identical, neither physicians nor patients are robots with the same instruction and repair manuals. We are each wonderfully, fearfully made with our own amazing uniqueness as well as our common humanity. Let us never forget that. 

  Now go, see Anomalisa!

TV: Occupied 

A few thoughts -

  My latest binge watch on Netflix is Occupied a Norwegian television series.  I find the basic premise is a bit wobbly: Russia intervenes when Norway's new prime minister stops all petroleum production. That said the questions raised by the scenario resonate with me. Those questions are:

 -when must a nation/state rise up against an intruder or risk surrendering its very identity as well as its sovereignty? 

- to what extent do other nations have a claim on another nation's resources?

- how trustworthy is the new Russia under Putin?

- for that matter how trustworthy is any nation when its national interest (here represented by threat of war and energy security) is threatened?

  While I was relieved that the USA was absent during most of this first season, the above issues obviously could relate as much to the US in the middle east and Persian Gulf as they do to how Russia is portrayed in this fictional TV show. 

  The plot follows 3 Norwegian families, including that of the prime minister as they navigate the new terrain after the soft occupation begins. 

  Other random thoughts in no particular order:

- Norwegian sounds very different from Swedish, who knew?

- It's very odd to hear English automatically spoken with an American accent by actors who are not portraying Americans. I keep thinking where is the British accent (the proper accent)?

- This thing has so many plot twists that I am dizzy. Yet it seems eerily familiar. I must be watching too much television.

Here's an article with more detail.

Poem 1/18/2016

To a mother's eye
To a mother's eye
You are a miracle.

Breath made visible
In a cold morning's sun.
The sharp fine line's
Of a spring beauty's bloom.

To a mother's eye
To a mother's eye
You are a miracle.

In the face of wars
All cruelty and suffering known
No matter your mistakes
No matter how you've roamed

To a mother's eye
To a mother's eye
You remain a miracle.

Each fold of ear
Each lash of eye
Each tear cried
Each laugh that ripped the sky.

To a mother's eye
To a mother's eye
You are a miracle.

Haiku Prompt # 1

Langston Hughes wrote haiku! Sometimes daily. This gave me the idea to use the first 5 syllables of a haiku as a prompt, either for Haiku or for other writing. Here is number one:

Oversleeping I,

In Which I Remember Why I Don't Read Jodi Picoult

I wanted some light reading and picked up Handle with Care at the grocery store. Several hours later I wonder why I bothered.

It is, of course, an important story, a tribute to the sacrifices parents make when their children are chronically ill or cursed with a congenital defect. It is, of course, important that people know about rare conditions such as osteogenesis imperfecta. And she writes well. I care about all the characters even if there seems to be something missing.

I read the first one hundred pages and then decided that I didn't want to wade through the middle of the book. So I skipped about 350 pages to get to the legal part of the book and read from there to the end. Which means I didn't give the middle of the book a fair shake, I know. Then at the end I wanted to throw the book into a sewage canal.

So I won't be picking up her books anymore. Why not, when clearly her intentions as an author seem to be good. Why not when her writing isn't half bad. She even has a sense of humor. This book evoked the feelings I have had in Sunday school, in overly earnest political meetings, and sometimes in settings with Friends (as in Quakers) who are notorious for earnest intensity. Everyone is sincere and intense about everything, even taking a vacation. When they are n't intense, they are guilt ridden and resentful. There is never a let up, there is never current joy, only wistful joy. It is as if the hallmark of humanity is victimization and suffering. Endless, unrelenting suffering followed by guilty realization of how lucky one is to be less victimized than someone else. It becomes more like a voyeuristic journey into sadomasochism to watch everyone suffering and feeling guilty about suffering or not suffering. Why read a book in which every broken bone a sweet 6 year old child endures, through no one's fault, is detailed fervently. "Just imagine the unimaginable pain!" its author seems to cry through page after page after page. Enough already!