fattypatties

I'm impressed with Master Chef, Julie Goodwin. I guess the early reports that she turned down a quarter of a million dollars from Jenny Craig was innaccurate. No figure was apparently discussed, but the person leaving the job was paid a rumored $900K, so I'm sure it was a big pile of money from which she walked away.

I especially liked why she walked away:

"I am less concerned about my weight than about the fact that one in seven people do not have enough food to eat each day and that is why I wanted to be an ambassador for Oxfam Grow" (source: Daily Telegraph)

Yeah I know that she later reassured everyone that she watches what she eats and she didn't think all weight loss was bad and all the other disclaimers about it being her life and her choices, but she's still a hero in my eyes because she walked away from the money and she is doing something more important with her life.

I want to celebrate her decision because as things developed last week regarding Jess Weiner (look it up because I'm over linking to her or providing her with search engine optimization through net attention), I became profoundly disappointed in how contrived and base it all seemed. She was a shill for Dove and now she is going to be a shill for weight loss. Too bad, so sad, and frankly, boring.

The contrast to between Jess and Julie is profound and holds important lessons about self-love and priorities. Julie is okay with being herself, so her priorities can lead her elsewhere. It is her own heart and not money that rules her decisions.

So I just want to give Julie Goodwin a great big shout out for loving her self and loveing others and keeping her priorities straight. If you're on FaceBook, you might go by her page and letting her know you appreciate her. Or better yet, support OxFam in her honor, which I'm sure she'd appreciate.

I've had a few people ask me if I can reveal more about what happened. I will give you an update, but there is an investigation and I am in the process of small claims so at the moment I cannot reveal all.

The scam was a local mobile mechanic who claims to be licensed and insured but is not. He came to my home to look at my van. I described the repair work that had been done. He told me that something needed to be done that I found out later was just another way of saying what had already been done. He asked for cash up front. I paid. He removed a part from my van to be rebuilt. Then he disappeared for 9 days giving me all kinds of lame excuses as to why he could not come back.

I became suspicious and finally confronted him and told him if he didn't come and fix my van by noon the next day, I would be calling my lawyer and then whoever the lawyer suggested.

He showed up at 2p the next day and installed what turned out to be the same thing he took off only spray painted with a non-fuel-resistent paint sprayed OVER dirt (it was gritty). He didn't even put it back together correctly because it didn't work and it was working before. The van was running when he started work on it and he left it not running and demanding that I pay him more money to redo a repair that I had already told him had been done.

He didn't count on the fact that I knew more about cars than most laypersons (especially most women), though I obviously didn't know enough and got scammed anyway. He left saying I had to redo a repair that only had 5K miles on it or he wouldn't honor the "warranty." There was no warranty I have a receipt.

Now that I know what he did, he is insisting that because I had someone else clean up his mess that he cannot give me my money back because he cannot honor the warranty. Again, what warranty? He claims it was rebuilt by a "specialist" and he cannot get his money back, but, of course, he's not offering me the difference between what he claims to have paid for the rebuild and what he charged me for the installation. He has offered no proof that this specialist exists or offered to do anything to make this right.

I have reported him to the DMV investigative division(in Nevada, all mechanic and garage fraud cases are investigated by the DMV) and it turns out they have a case file on him already. From what I can gather from the net, he preys on stranded motorists, women and disabled persons. I have a disabled tag on my van.

I think his scam is to do a series of repairs with the last one fixing the vehicle and the person usually paying many times more than they should for the thing that needed to be done. Not knowing they have been duped, they write glowing reports about him on the net (of course some of those reports could be written by him and his friends). I think I messed him up by calling him on it before he could fix it finally.

I gave him $470 to do the spray paint job on something that didn't need fixing. Because he re-assembled it incorrectly, I had to pay another $135 to fix what he did. So I'm suing him for $605. Not much in some people's world but that's about 2/3of the extra money I made this semester that I set aside to have the van repaired. So to me it was a lot of money and summer is THE worst time to have a set back as I do not have any work right now and can't draw unemployment as a summer break teacher. (Subject for another rant.)

So once I am done with the legal entanglements with this guy I will definitely (if I'm allowed to do so) tell everyone his name. Hopefully, though, when all this is over he will be behind bars where he belongs. At the very least, he will not be out on the road taking advantage of vulnerable people.

By the way, on the emotional side of this, as soon as I heard from the DMV that they knew him and were investigating him, I felt vindicated. I know that if someone like me could be taken in by this guy (and he is a smooth talker until you call him on his shit, then he is a mean sonofabitch), that almost anyone could be taken. I couldn't sit back and let him keep doing this.

I've moved from embarrassed and feeling stupid to kick-ass mad-as-hell. Oh, and it feels a lot better.

======================
If you live in southern Nevada (or northwest AZ or southeast CA) and are considering a mobile mechanic, please email me and I will let you know who he is and also give you a recommendation for the guy who helped me fix this mess and get my van to pass smog and get back on the road.

I should have known better.

I think this what anyone who has ever been scammed by another person thinks.

The feeling is an overwhelming sense of shame and anger. Shame because surely if I had been smarter, paid more attention, checked out more things, etc. then I wouldn't have been taken. Anger because the disruption and damage hurt. Anger, also, because the world is a little tougher and I'm a little more jaded each time this happens.

The "confidence" man (or woman, I've been scammed by both genders) counts on the fear and shame. I don't like people who take things for granted about me. They hope that I will be too naive to understand that I've taken. Failing that, they hope I will be too embarrassed to report them.

I've been recently scammed and this one hurt badly. I was vulnerable and I think this guy saw that vulnerability and took advantage. Yes, I should have known better. I should have looked things up. I should have checked things out. I've got the knowledge. I've got the resources. But I thought I could trust. I shouldn't have.

Essentially I've lost an amount that might not be a lot for many people, but represents a large amount for me. I've lost it at the worst time of the year to lose it. And it is a set-back that happened when I thought I might be actually recovering from the last set-back (which, btw, also began with a scam).

Let me be clear. I'm doing what I should do at this point. I'm talking with my prepaid lawyer about it. I'm collecting evidence. I'm taking it one step at a time. I am determined not to just let it go because I believe this person is targeting vulnerable people and he needs to be stopped.

What I'm not doing is coping well with it emotionally. I'm trying. After all I feel worse after each breakdown, like he's winning again, making me more vulnerable. I also feel ungrateful to the people who are helping me survive this. But I am crying. A lot. I have this feeling of having been socked in the gut. I'm a little nervous, anxious, jumpy. And just about anything can trigger tears.

I'm also withdrawing. Being civil to people is hard to do right now. I'm wishing I could run far away from humans. I'm feeling disgusted with the whole human race.

I'm also fighting to not let this change me. I'm basically an optimistic person who believes that people should just be straight with each other. Okay, I know most people are not and I have healthy skepticism. But one of the reasons I'm vulnerable is the my first inclination is to trust, to believe. I hate, hate, hate that people don't respect that. I hate, hate, hate that now I have to distrust, check out, test people. I hate, hate, hate that now I have to build a taller wall and keep more people out in order to stay safe.

I also hate the insecurity of the loss. I worked hard this past semester, taking on an extra course. Basically I've lost 3/4 of what I made on the extra course. This was supposed to be money that would cushion the summer months, making it an easier time. Now it is going to be one of the worst summers yet. I really don't need another bad time. I've survived so many. I want a break. I deserve a break.

A part of me believes that I must have been a monster in my previous life because it feels like I'm punished over and over again. Bad karma.

I probably shouldn't write about this in public, but doing so affirms my desire to remain a basically open and honest person. So here it is, raw.

I have been through scams and set-backs and hard times so often that I know I will survive. But the emotions are still real.

I also write in the hope that writing will make it better. Sometimes things stated out loud lose their power.

Finally I write because others may feel the same thing. I want you to know that the feelings do not prohibit taking action. You can do all the right things and still feel these feelings.

I'd like to say it is all better now, but it is not. I'm still anxious and on the verge of tears and overwhelmed. But it did help. At least I know I'm not defeated. Something important to remember.

A friend of mine gave me a card that still sits on the fridge. On the front it says "dare to be naive." Over the years I've contemplated a myriad of meanings for the card. This is the meaning I'm contemplating tonight.

The world is absurd, and yet, I am naive enough to want to find its meaning.

I naively think that when people say they want freedom, they know what that means, that trying to contain or control the chaos usually results in less freedom.

I naively think that people will take me at face value. But a false dichotomy grips this land called America. "If you're not for us, then you're agin' us." Can't I just be "for" something without having to take up a whole side. I don't fit. I don't want to fit into this neat box. I like fractals.



I naively think that in order there is chaos and in chaos there is order.

I naively think that I am a free person and that holding an idea that overlaps with one side of this artificial, false divide does not limit me from holding an idea that overlaps with the other side. I am free to have my own side, as I see it.

I naively think that my having a brain is a good thing. Apparently, the world sees it as an inconvenience.

I hold little power. I have no money. My opinion does not count and is not sought. Others decide for me. I am constructed by others and then made to suffer the consequences of the construction as if it were my own doing. I am naive enough to believe I might get to have say in my own identity.

This culture, this place, this 235 year old experiment is falling apart because of this false divide. Turns out that a house divided against itself just collapses.
I am naive enough to think something better might emerge from the implosion (maybe that's just what Vegas taught me).

You may be wondering what triggered this contemplation and its underlying anger, disgust and sadness.

Nothing and everything.

I'm naive enough to speculate and wait around to see what's next. I am naive enough to believe that there has to be a better way.

This month, I am participating in a ReVolution! -- Every Monday in January I plan to write a blog post here about my life and how Health at Every Size℠ has changed my life for better. This is the fifth and final installment of five.

IDENTITY, STIGMA AND HEALTH AT EVERY SIZE℠

Erving Goffman is said to have looked through newspapers and magazines every day, clipping items that helped him shape his ideas about how people interact with each other. Several key elements emerged in his writing.

First, he noted that people anticipate how others will view them and seek to manage that view through action, gesture, dress and facial expression. He called this "impression management." He suggested that this thing we call our "self" is actually a multitude of "selves" that are created in the moment of interaction with other people who are also presenting their "selves" in an attempt to manage our impression of them. In essence we play parts like in a play and we change our behavior and our presentation based upon who we are with and how intimate we are with that person. Questions of trust, authenticity, desire and control inevitably become part of the mix.

It is this background that helped Goffman develop his ideas about social stigma. He defined social stigma as a "spoiled identity." He suggested that those who are stigmatized by others are limited in their ability to manage impressions. When we are stigmatized, those who would view us through a single lens do not let us show them multiple layers of abilities, character traits, desires, etc. To stigmatize is to control another and to prevent them from having a useful and fulfilling social relationship.

Here's how it works. If I am stigmatized and I do something that fits the stereotype of my stigmatized social identity, I am used to prove the truth of the stigma. If I do something that is different from the stigma I am regarded as being inauthentic, faking it or trying too hard. I cannot escape the stigma and show my authentic self, or manage impressions that move away from the stigma.

Most of what has been done about stigma since Goffman has missed the point. Efforts are made to help individuals who are part of stigmatized populations to cope with the stigma and rise above it. This usually only serves to reify the stigma not end it. If stigma is to end, it must be ended by those who are stigmatizing. It is telling that English is so convoluted at this point. We do not really have a word for those who stigmatize. Bigot, maybe, but that can evoke a history that one might not want to evoke. Stigma is often regarded as the "right" attitude to have.

For example, there is a kind of reasoning that suggests that stigmatizing fat is correct because fatness is a result of laziness and a lack of self-control on the part of the person who is deemed fat. Fat people are placed into a cardboard, flat group that assumes all individuals deemed a part of the group are alike and, indeed are lazy and lacking in control. These are the only things that matter about the fat person. A fat singer, a fat Ph.D., a fat scientist, a fat physician, a fat athlete and so forth cannot exist as just a singer, Ph.D., scientist, physician, athlete. The word fat as an adjective changes the identity of the noun into something less than human.

But most people do not regard this as bigotry. This stigma is regarded as not only good but as necessary to help the fat person become thin. The stigmatizer is seen as "caring" about the "health" of the fat person.

But the stigma translates into a self-fulfilling prophecy with discrimination leading to reinforcement of the stereotypes. Fat people are insured less often and therefore put off going to doctors and getting health care, which leads to them become sicker. Fat people earn less money, making it harder for them to adequately acquire clothing and other symbols that suggest competency or diligence. Fat people are pushed to social backstage, which leads other to assume that they are unhappy with their bodies. And, of course, almost all fat people have tried to get thinner, which reinforces this belief as well.

Here's the problem. Stigma limits the life chances of human beings. It doesn't improve health. It makes it worse.

Stigma creates stress and stress creates imbalances in our physical and emotional well-being. There is ample evidence that stigma is a predictor of ill-health and there is growing evidence that this may have to do with a physiological change that surprise, surprise, leads to all those conditions that are associated with and are supposedly caused by being fat.

So I could sit here and make a health argument at this point, citing articles and studies. But I want to make a different point with this post.

Stigma is also a bad things to do to another human being. It is controlling and limiting the freedom of people. It shuns and shames people. In a word, it is just ain't right.

So I'd like to suggest in this last installment that the reason to embrace Health at Every Size℠ is because it is a stigma-free approach. Instead of treating a person as being less than human because of their size (and by the way, this happens to people on the thin end of the spectrum as well, not too mention people are considered too short or too tall), HAES℠ celebrates all bodies. Instead of dividing humans into acceptable bodies and unacceptable bodies, HAES℠ opens the door to people being judged on what they do, not what they look like.

To me, this is the most important reason to embrace HAES℠. Health is relative and there can be much debate on what is and is not good for a person. But dignity, empathy and diversity are not debatable. So often fat people, even fat activists, get caught up in justifying their existence by outlining how healthy one can be and still be fat. But that is not the issue. The issue is that weight-focused health care is stigmatized health care.

My favorite slogan, which has been co-opted from the disabilities movement is "nothing about us without us." A real test of public health policy as well as personal health care is the extent to which the voice of the patient is heard. Fat people are silenced by medicalization of their natural variation.


So listen up world. We do not need help. We do not need a cure. We do not need to be changed. We are that perfection. We have dignity. We are human. It really is that simple.

And that, to me is the essence of Health at Every Size℠.

Well the stupid embed code was messed up on the Colbert Report Word segment. So you will have to go see it here.

I have to admit there is something appealing to an exodus of tv pundits to their own country.

I have a lot of thoughts about Ayn Rand, government and the current state of affairs in our culture that I will save for future posts, but I find it interesting that there is a renewed interest in Rand's work.

I had other thoughts about an earlier work by Rand that might be of interest.

The Obamas are following the Clintons down the road of Health Care Reform and while I had hopes that it was not true this time and I've been impressed with how much further they have gotten, I'm have a feeling of deja vu all over again. I fear that if the stalled health insurance reform does ever get restarted again, it will end up being exactly what the monied interest in health care want: mandatory purchase of health care without or with few restrictions on profit-making at the expense of our health.

But what really is giving me the willies is last week's "Let's Move" campaign "targeting childhood obesity." Does anyone remember the timing of the "Shape Up America"? There stood Hilary Clinton standing behind C. Everett Koop near the end of 1994 while he announced that what America's health care needed the most was for doctors to tell their patients to lose weight like no doctor before 1994 had ever suggested to a patient that weight loss was a good idea. Wait. 1994! Hilary Clinton! Could it be that this was a smoke screen to take the focus off her and her husband's failure to fight the monied interest and give Americans a universal health care system?

Now we have a stalled health care reform that has been watered down to create the same racket we have with car insurance, except that living is something we have a right to and driving a car is a privilege (remember the Declaration of Independence? LIFE, liberty and the pursuit of happiness). So either way, I smell smoke and I see mirrors -- don't look over here where deals have been made with the profiteers. Let us misdirect your attention to the horrors of fatness. Except this time, we'll add the good old, "do it for the kids" line and that way you don't have to worry about the fact that after 16 years of telling Americans to diet and most Americans trying to diet, we still have fat people. What's worse, we managed to kill a bunch of people from the drugs and surgeries in the name of losing that fat along the way.

My more liberal friends are taking a gentle approach. They see something well-meaning-ed in Michelle Obama's motherhood and are gently asking her to consider alternatives. I'm not so inclined to let her off that easily. There's too much data and too much history and too much context to just assume that she is miguided. This is the same ole, same ole and I think it's time to shout from the roof tops: "The Emperor and (the Emperess, in this case) have NO CLOTHES!"

But I don't want to stop there. I do not like negative politics and I do not want to echo the Nopublicans in their negativity about everything these days. So on the off chance that Michelle Obama is sincere in her desire to make life better for the next generation and the generations to come, let me put 7 practical and feasible alternatives on the table that would be better at improving the lives of our children than putting them on a diet and making them exercise to the point that they forget how much fun it is to just play:

7 PRACTICAL IDEAS THAT WOULD MAKE LIFE BETTER FOR GENERATIONS TO COME

1. SAFER FOOD AND DRUGS

Our food system is superior in many ways, but the ever growing greed in food production is leading to more and more mishaps from contaminated food to preservatives that are bad for us to frankenfood to the lack of basic foods in poorer neighborhoods with less nutritious foods in their place. In fact, I suspect that many of the sins laid on the doorsteps of "obesity" have more to do with safety of our food than it does with how much we are consuming of it. In addition, more and more people are dying from their medications, including children. Reform at the FDA is needed and I haven't heard one word out of the administration regarding this.

2. SAFER PLAYGROUNDS AND STREETS

Children still grow up in areas where staying at home and watching television helps them live longer than being out in a playground or playing in the streets near where they live because it is dangerous to be in the streets. (Last time I checked, gunshot wounds or being assaulted were not good for your health.) Schools are closing earlier and earlier. In a world where ecommuting and working at home is more possible than ever, we are still insisting that the 9 to 5 work day is optimal and thus we have latchkey kids with no place to go and no safe adults to be near. This is not a matter of playing police. This is a matter of it takes a village to raise a child. Our communities are not child-oriented. They are profit-oriented. If we wanted to create a village where children could move, they would move. Children do not need to be told to play. When they are safe to do so, they move. And by the way, targeting fat kids is going to make this worse, not better. Bullying kids that are different is one of the ways that the streets are unsafe. Blaming fat kids for their health problems is going to fuel those differences and give ammunition to those bullies. In fact, it turns the federal government into one of those bullies.

3. STOP POSTPONING PAYING THE BILLS UNTIL THEY GROW UP

Deficit spending is putting a burden on the next generation and the ones after that. I'm not just talking about government debt. We had a major meltdown of the "credit industry" 2 years ago and our response was to patch it up and keep it. We have been sold a pack of lies about credit, especially long-term debt. Debt used to be something we entered into until the crops were harvested and then we paid it back with an eye on savings in bumper crop years. Now we are told it is okay to buy our toys on credit. The wake up call is that some day it has to be paid. We hit the snooze button instead of making the hard decisions. That has delayed the collapse of an unsustainable system, not fixed it or bailed it out. All of these things means that it is just going to be a bigger problem for our children. If we really loved our children we'd be re-examining this entire economic system and making some deep and abiding changes in our economy.

4. SPEAKING OF DEBT, GET RID OF BORROWING FOR STUDENTS

Nothing screams "I hate my kids" more than student debt. We put pressure on kids to go to school. We design jobs so that a high school education isn't good enough. Then we make it impossible for them to pay for that schooling without first putting themselves in debt. They leave the starting gate with a burden to carry. This burden makes them wage slaves, pure and simple. Now we are adding to this burden by making it impossible for them to finish the "4-year" degree in 4 years. Overcrowding and cutting back on teaching continues to create a system where students will have to borrow more to finish that degree.

5. SPEAKING OF EDUCATION, MAYBE TEACHING SOMETHING OF VALUE

Student debt isn't even the biggest problem in education. With the "No Child Left Behind" legislation we have made schools less about learning and more about test-taking. Our educational system is creating automaton sheeple, not critical thinking citizenry who question systems in order to improve them. If we really wanted life to be better for our kids we'd teach them how to think about their lives and the social systems within which they live so that they could improve things. Nothing belies the fear that adults have of their kids' brains than the way we do education and nothing points out the lie of "doing it for the children" than this fear. If we truly want them to have a better life than we have, then we should prepare them to be reflective thinkers instead of sheeple.

6. STOP STARVING THE CHILDREN

The real tragedy of the "Let's Move" campaign is the extent to which America's children still are suffering from malnutrition, starvation and lack of food security. Children are dying from lack of food and we are emphasizing starving the ones who have food? How crazy is that?!?

7. REAL UNIVERSAL HEALTH CARE

It is long past the time for America to provide health care to its citizens. Children growing up under the "for-profit" health care system are not going to be as health as they would be if they were able to see a doctor without fear of breaking the family bank. There are plenty of preventative measures that will ensure they grow up health that have nothing to do with the size of their bodies that need to be available universally. The hodgepodge, committee-fied bills that are being "reconciled" in committee right now are not going to cut it without a public option. As long as health care is a "for-profit" enterprise, money is going to be more important than our children.

Let's be clear about some things:

I voted for Obama. I did not vote in 2000 or 2004 presidential elections because I saw no viable candidates for whom to cast my vote. I liked Obama's message of change and wanted to give him a try. I had hope that he might be different and I think there are some ways that he has been different.

But I am not as pleased as I hoped I would be and this latest campaign weakens my hope even more. This is nothing new. This is business as usual in Washington and all those things he said in his campaign about continuing down the path of business as usual will come true, even if it is cloaked in the language of change.

We pay a price for those things we believe that are not true. Taking public resources and emphasizing weight loss for children is going to have a heavy price tag. We are going to raise a generation who fear their own bodies, who stigmatize fatness and fat people and who will spend their adulthoods sorting out food issues instead of solving more important challenges. In addition, spending these public resources on this means that we take away resources from more important challenges facing us now. We pay now. They pay later.

We do need a change. The "Let's Move" campaign is not change.

Wendell Potter is my new hero. I saw him on PBS with Bill Moyer and now he has been featured on a NY Times OpEd. If you believe our current system works and that a public option isn't necessary, I suggest you read about Wendell Potter and also Linda Peeno.

Both of these whistle blowers tell eerily similar stories about the insurance industry. We are currently at the mercy of these megacompanies and their policies.

Here's a taste of their stories:

I just saw this posted in a forum (I will refrain from attribution because I don't want to debate the person, but the ideas):

GOVERNMENT RUN HEALTH CARE:
The compassion of the IRS
the efficiency of the Post Office,
at Pentagon prices.

Without pointing out the immediate fallacy (no one is advocating "government run" care -- oops, pointed it out anyway) this is my response:

CURRENT AMERICAN HEALTHCARE:
The compassion of Wall Street,
the efficiency of American Auto Makers,
at Hollywood Blockbuster production costs

Medicine is never going to be a free market because the knowledge and care needed at the worst possible times in our lives is complex. Those charging for these services are always going to have the upper hand. Free markets allow for buyers to shop, to refuse to buy, to obtain the best knowledge. Without consumer protection and a power player in the market that evens the playing field, we are at the mercy of the sellers in the worst way -- the consequences of not buying is death, disease and disability.

I happen to believe that it should be universally and singularly funded so that we have one representative for the people who negotiates the purchase of services for all humans (this is the Canadian system and having been a part of it for several years, I found it to be working fairly well). But I'm a realist and I don't believe that such a system would be possible at this time. Too many stakeholders with too much to lose.

What is a close second is what is being proposed by Obama and is being semi-fulfilled by the various bills being considered in Congress: make one of the players in the market a force to level the playing field.

What I find most disconcerting is that many of the criticisms that are being leveled and fears being expressed about government involvement in health care already occur in our system, just through the private sector.

This is my top seven list of misconceptions:

1. Everybody pays for their own health care.

If you have insurance, you are paying for everyone else in the insurance system -- the concept of pooling funds to cover the risk for a few is the basic concept of insurance. Excluding millions of people from the pool isn't very smart unless the people you exclude from the pool are the ones most at risk, thus, insurance companies do not want you in the pool if you are a child, if you are an older adult, if you have a pre-existing condition, if you have are at-risk because of family history or personal behavior, and, increasingly, if you get sick.

2. No one should have to pay for those who do not qualify for insurance.

One of the reasons that health care entities charge so high is they have to cover the visitors to emergency rooms and facilities who do not pay either through bankruptcy or through simply not paying all or most of the bill. This not only costs the entity the money spent on the time and equipment to provide the service, but also the staff time on social services or collection services at attempting to get the bill paid. The net result of this is that those who have insurance pay more than they would otherwise because they are paying for these overhead costs.

3. Doctors and nurses should decide on care, not bureaucracies.

This ship sailed in the mid-80s. Your medical decisions are being directed by nameless, faceless decision-makers who "qualify" your care through your insurance company. If they refuse to pay, you most likely will not receive care. The job of the decision-maker is to find whatever reason possible to deny care in order to maximize profits. Most the reasons they find are NOT medical reasons. They look for some little thing in your application that they can use to cancel you policy (btw, they do NOT refund your premiums when they "discover" these discrepancies). The number one complaint that most medical professionals have regarding the current system is that they cannot spend the time or provide the best care to their patients under the current system. This is why nurses, especially, are solidly for health care reform. They see the results of this system every single day.

4. If the government becomes a major player, we will lose the efficiency of the free market.

We currently have the most inefficient and costly system in the developed world. Fully 25% of our health care "costs" are due to the enormous administrative burden of going through the qualification process the each insurance company has. Most doctors offices now employ at least one staff member who does nothing but paperwork and sit on the phone all day working through the bureaucratic mess of private insurance.

Our emergency rooms are places of the biggest medical mistakes because they are clogged with people who have no where else to turn for care. In inner cities, airborne communicative diseases spread faster because of these centralized places for the working poor to gather when they are sick to sit for hours and hours of exposure. We are one big disaster away from the whole thing breaking down.

The current system is extremely inefficient and is getting worse. We are starting to see the results. A recent book asserts that medical professionals are misdiagnosing about 15% of the time.

5. The current system allows the freedom to get medical care without interference from bureaucrats.

This one is especially used by those who would scare older persons with the so-called death clause. Well, every single HMO that I've studied or been a part of has "end of life counseling" already. I'm asked every time I go to the doctor or hospital about whether I've set up a living will. The current profit motive is going to push and push us to consider opting out of their paying for care at every turn. This is not a medical issue. This is not a moral issue (you know, care for your loved ones by planning ahead, it is the right thing to do), this is a profit issue (tell your doctor to turn off the machines so we can collect from you and never have to pay out). Personally, I'd rather have this be a matter between you and your attorney and not be asked when I'm sick, but if people are sure that this is a government thing, they need to pay attention to this long-standing practice by the HMO.

This does raise another issue that I think is more important. Does universal health care mean anybody can get any medical service they want covered. The answer is "no" and has to be "no" because otherwise we will be giving free reign to medical providers to invent crappy medical interventions. Oh yeah, we already have that -- its called "fee for service" and only a government player in the system is going to push for an incentive that doesn't include keeping us sick in order to get more money out of us. In truth, this may be the only thing HMOs have been good for in the past 30 or so years, but because of their own profit motives, they found out that they like us being sick too -- that way they can refuse us coverage when the moment comes while keeping our premiums.

6. The current system is good for business

It is plainly not. Some of the business failures we have seen in the past few years have been in part due to the rising costs of health care coverage for employees and pensioners. The only business that the current system is good for is the HMO/insurance industry and the pharmaceutical industry. I mentioned in a comment on an earlier post, it is my belief that if we continue with the current system, we are going to see the United States lose ground in the world economy (and may be seeing this already). Outsourcing from other countries, moving of factories to other countries and brain drain exits of college graduates to other countries are all motivated in part by the rising costs of health care.

7. Our system is the best in the world, why mess with it?

Yes, we have more bells and whistles than most places. We do love our technologies. However, most of the time our technology drives up costs without producing much in the way of improved health. The fact is that we rank out of the top 10 in a number of health indicators such as life expectancy and infant mortality. When put in a per dollar perspective, we really suck. We spend more, receive less. We are not the best in the world and the best in the world are systems that have their governments involved in some way.

Carl has a list of books he'll never write which includes one called the "Mononarrative," which would be about the trend in American public discourse that has been going on for 20 or 30 years. The idea seems to be that we should all be repeating the same narrative and that composing a text or subtext that doesn't confirm to this one, true narrative is unacceptable. It's not that everyone agrees upon the content of the mononarrative, but everyone seems to agree that there should be a mononarrative.

"Since coming up with the term, I've seen the expression 'monomind' in my readings," explains Carl, "and it parallels what I've been thinking very well."

Of late, Carl has been suggesting that there is a new discourse afoot -- he has called it the "No-No Narrative." Those in power no longer want anyone talking, including themselves. They just want to shut down discourse.

"The motto of the 80s and 90s was 'You're not supposed to say that,'" Carl further elaborates, "while the motto in this decade has been 'NO talking.'"

I couldn't help notice over the weekend how eerily similar the "spontaneous protests" popping up at town hall meetings on health care were to the "Brooks Brothers Riot" from the 2000 election. I went looking on YouTube for videos of both events and found that Rachel Haddow beat me to the proverbial punch:




I agree with Rachel's take at the end. The best way to fight this stupid form of shouting down politics is to point it out for the orchestrated power mongering that it is and make it so obvious that no one will want to do it again. Shouting down is not debate and shouting back isn't the way to create a debate. We must fight the no-no narrative by telling our own stories and by unmarking and taking away the incentive for this kind of government by riot.

I've been amused and frustrated at the discussion about last week's Paul Campos interview over at Alas, a Blog and I've thought about several responses.

I could get in on the discussion about the politics of fatness. Personally, I don't think any mainstream political perspective is doing right by fat people. Liberals blame so-called "Big Agriculture" or "Big Food" for fatness, which is essentially painting fat people as mega-consumers, who mindlessly obey their mental and physical impulses. This paternalistic attitude fundamentally sees fatness as an illness, or at least, a social ill. The fact that they don't directly blame fat people is irrelevant. We are still stigmatized and flawed for being fat. That is not fat acceptance. Conservatives are perfectly happy to ignore the health and well-being of fat people while using us to support opposition to the liberals, specifically, staying in the pockets of Big Ag, Big Food, Big Pharm and Big Insurance, by suggesting that our being fat is all our fault -- "personal responsibility versus public interest." So fat people will cost too much for the health care system, so let's not reform health care. Libertarians have questioned some of the methodologies for demonizing fat and have even provided forums for fat acceptance writers to share their points of view, but in the end, the stance of the Libertarian is not usually fat acceptance but rather that the government has no business telling us to not be fat. They still mark fat people as being flawed, they just support our right to be flawed.

I could join in the discussion about what is and isn't fat acceptance. Personally, I believe fat acceptance is fundamentally the belief that people come in diverse sizes and that fat, in and of itself, is not a sign of illness, mental deficiency, moral deficiency or lack of fortitude (will-power). Fat is fat. Some human beings have more than others. It is a physical characteristic and shouldn't be debated or discussed any more than we would if we were talking about eye color. Fat should not be the basis for discrimination as much as any other physical characteristic should not be the basis. Just treatment of people involves not judging on the basis of the how they look, period. Thus, deciding that whether people who look one way will cost the system more than "beautiful people" is a basically unjust discussion.

But I haven't posted these thoughts there because I can't get past one little aspect of the whole discussion: Debating costs is a smoke screen.

While we continue to debate the questions of cost, we continue to pretend that cost is immutable, fixed objectively without any room for scrutiny. That it is just is. After all, people in the medical system have to be paid, don't they?

The BILL for my little surgery in June has grown to around $4500. This is what I'm being BILLED, NOT what it COST. Why was the hospital emergency room the only place this could be addressed? Why did I have to see several doctors to have it addressed? Why did I have to come back to the hospital to have the bandages changed and see a burn unit nurse twice? Why did my just stepping into a hospital mean I was going to be billed over $1000?

When we have discussions about health care costs, we keep confusing billings with cost. Right now hospitals bill whatever they want (as do clinics, doctors, pharmaceutical companies, laboratories, testing centers, and so forth). They often do not get what they bill because the HMO, insurance company or government program says, this is what it should cost and pay only that. Then the hospital tries to get the difference from the patient. Sometimes they do, more often they do not. That is part of the why the bill is so high in the first place.

You people who have health care coverage think you are paying for your own care only? You are already paying for all the people who can't afford it and you are doing it in a system that allows the medical provider to decide how much they want to charge in the first place. You already subsidize others, you are just doing it in the most inefficient and costly way possible and making the health care oligopoly rich in the meantime.

Let's be clear. No market forces are going on in health care. A market requires the ability for consumers to walk away. When you or your loved ones are sick, you cannot shop around. You aren't able to pick and choose. You can't decide to delay purchase until later. You can't buy low. If you can't get the health care that you need at a doctor's office or clinic, you head down to the emergency room where you know that you most likely will not be turned away. The hospital knows this as well and that is why they charge $4500 to lance an infection. They know that I'm there because I have no where else to go. This is a decided advantage of which they take are only too happy to take. In any other economic circumstances, we would label this "price gouging" and make it illegal. This is why traditionally health care providers have only been too happy to have a number us not have access to funding. We are the reason they can price gouge. We are desperate enough that they can charge what they want.

I heard someone say one intelligent thing the other day in the health care "debate": In all other instances in the Western world where health care reform has occurred, it historically had to be done in spite of the cost. Once it was done, the costs were reduced BECAUSE of the reform. There used to be a time in this country when government or public control of natural monopolies was a good thing. Health care is a natural monopoly and it can and should be regulated just like electricity, gas and water used to be.

But one part of the health care reform debate to remember is that discussions of "costs" always have to be tempered with the knowledge that what we call "costs" are essentially price gouging. The best way to reduce those costs is to regulate the market so that those who are in a position to gouge will not be allowed to do so.

Okay, I have to admit some vanity here. I hesitated to post this because, well it is gross and there is a stigma around having these things, but every once in a while I get a staph infection called a "boil" in one of the hair follicles along my neck. This runs in my family. My father frequently had them. My brother frequently has them. In the last few years, I've gotten one or two a year. Warm water, antibiotic cream, a few days of pain and they are gone. It is basically like having an atomic zit.

Well in June, I got a really bad one and it abscessed. It grew in the matter of three days to be the size of a golf ball (4cm x 4 cm) and it was hard as a rock and not showing any signs of healing. The placement was right at the base of the neck, which basically meant right on a bunch of nerves that went throughout my body. I was in tremendous pain. So I went to my doctor. He sent me directly to the emergency room and 5 hours later I was on morphine and ativan having my neck operated on.

I bring all this up because what happens next is what is wrong with the US. Because of the nature of the infection and its proximity to my brain and my spine, it was important to rid myself of it as quickly as possible. It was also important that I not have the wound seal over the infection before it drained completely. So not only did I have to go to the hospital to have it removed, I had to return to the burn unit twice to have it dressed. The burn unit was the best place because preventing infection in severe burn wounds is extremely important so they have the right tools and techniques.

Cost for this? Well I don't think I have all the bills yet, but so far it is $3500.

Now I know there are some unusual costs involved, but lets face it, with the exception of the drugs, most of what was done was a sophisticated version of what mom's do all the time. $500 I could accept, but $3500 is outrageous.

Why so high?

I have some speculations.

1. I'm not going to be able to pay this amount, so it is a high charge to cover people like me who can't pay. The next person with an atomic zit will have an insurance company pay the atomic price and it will cover my costs as well.

2. Because they can. There is no regulation of costs only some negotiations with Medicare and HMOs. If you are going into negotiations on price, you put your bid high so that the resultant final offer is higher.

3. Technological necessity. My guess is that there were instruments at the doctor's office that could have accomplished pretty much the same effect but the fancier stuff was at the hospital. Okay, this may not be as pertinent in this case as it often is, but I still think this was a little bit of overkill.

4. Regulation by the threat of malpractice suits. My doctor would not touch the thing, other than to measure it. His stated reason: potential infection means someone more qualified than him needed to address the wound. Translation: "I'm afraid if I open it up and treat it and you get a more severe infection of the brain or spine, I will be sued." In fact, when I called and asked if I could avoid the $230 per visit follow-up to the burn unit (yes you read right, I am being billed nearly $500 for having my wound redressed twice -- this was a clean it out, drain it and re-bandage it procedure that took 10 minutes. Of course, it was 3 hours of my time because I had to admitted to the hospital.)

This is a mess and a $3500 bill for this minor problem is a perfect example of why it is a mess. US emergency rooms are the current health care program in the United States. My problem was only one of dozens of people who didn't have emergencies but had problems that a local clinic would have taken care of in Canada in less time, for less money with probably better results because the 5 hours of exposure to other people's diseases would not be part of the bargain.

I'm so tired of the damn "debate" going on in Washington.

The opposition says that we should have choices. There were no choices for most of the people in that room. Even the ones with insurance were stuck with being exposed to every respiratory ailment prevelant in the city.

The opposition says that we should not have to supplement other people's health care. The bills are high because those who are insured or on Medicare are supplementing those of us who are not insured and will either be a deadbeat, file bankruptcy or turn to a charity that will only be required to cover a fifth of the bill.

The opposition says that it is a question of quality. This is not high quality care. This is care by fear. Fear of the HMO. Fear of the deadbeat. Fear of the lawsuit. Quantity is not quality. US emergency rooms are full of people who cannot afford to go to a doctor and full of people who are sent there because doctors are afraid to practice. Hospitals are not the best place for health care. A large amount of sick people in small places equals breeding ground for major communicable diseases. We are one major flu epidemic away from breaking down the US health care system and the ER will be a primary place for that epidemic to spread.

The only thing that is keeping US healthcare from being universal and being of the highest quality is greed.

HR676 has been introduced in the US House of Representatives every year since 2005, including Jan 2009. It is an elegant bill that is only 30 some odd pages long (current debates are over a bill that is around 870 pages long), but it would revolutionize our health and well-being. AND it will never pass unless our politicians find political will because its passage would get rid of insurance companies and HMOs and would curtail the obscene profits of pharmaceuticals. The reason that the bill that will be considered is so much longer than HR676 is simple: the bigger bill is hiding greed in the form of political compromises.

HR676 would turn the Federal government into a single payer of health care for all Americans, including anyone living in the United States at a given time. Instead of having 25% of phyisician's practices and hospital administration being devoted to sorting out all the different plans that patients use to pay for health care, the billing process will be streamlined. Huge savings would be seen on a system level. One system of payment = one process to administrate.

Current versions of "healthcare reform" are trying to set up "also payers," making the government a player in the market place. This is inefficient and expensive. Efforts to not step on the profitable toes of HMOs will lesson opposition to the bill, but it will be doomed to fail. It will be one more system that every doctor's office and hospital adminstration will have to learn to bill. It is doomed to add expense.

The problem is that health care has to be addressed as a public issue. But it is thought of as personal choice in the United States with little regard for the big picture. This is a spiraling mess and 870 pages of more spiraling mess is not going to fix it.

Only a radical change of heart will make this mess go away. I'm not sure I'm going to live to see that day in the United States.

23 Days to Go

So I'm starting to freak out a bit.

I had a line on a job, but get this fat fans, the company booked the flight to the interview on Southwest Airlines. Knowing that the airlines probably would insist I buy a second seat and knowing that I didn't have the money for a second seat, I called the potential employer and told them that there could be a problem. They cancelled the flight rather than buy the second seat and now I'm in limbo. ARRRGGHHH!!!

I'm trying to get my taxes done. (An irony, I know, since I'm working 40-45 hours a week preparing other people's taxes.) Today I found out that I'm going to be forced to file an extension for reasons I can't publicly disclose. So adding to my work worries is tax worries.

Carl has been sick for over 3 weeks now. I'm deeply worried about him. He is not proned to long illnesses and we're heading into "something-more-than-a-cold" territory.

I have some positive things going on. I may start learning how to drum. I've joined a convenant group at a local Unitarian church and I'm actively searching for a literary agent. And a dear, sweet friend spent over an hour on Sunday listening to me cry and I have to tell you that was more needed than I knew until I did it.

I still cry every morning and I still feel more lonely than I've felt in years, but I haven't lost hope. I guess the words of the poet really describes what I'm going through right now the best:

I'd have a nervous breakdown,
only
I've been through
this too many
times to be
nervous.