Thursday, August 20, 2009

New Poem

I posted last year the eulogy I wrote for my grandma, Louise Evans. It says many of the good things I'm thinking about today. This year, I thought I'd write her a poem.


No clothesline held my weight when I was small.
I learned to swing from a metal T
we bent slightly the afternoon I couldn’t do pull-ups.

It takes nine long steps to cross the backyard
and stay just wide of wet snouts poking through the fence
next door. Always,

someone I love has understood better how to care
for the living things around me. In the kitchen, frozen bacon fat

loosens the skin of salted onions and fresh beans.
A fryer chicken defrosts in the sink.
A freezer full of meat and butter seals itself against the summer heat

of another city, a different state,
small and improbable as a hummingbird boring the wood
of a cellar I’ll never again open from within.

Monday, August 17, 2009

Why I Support Something That Doesn't Yet Exist, or, Me And Obamacare

I have been surprised by the crude language and lies being put forth to attack "Obamacare," the as-yet unnamed and undefined amalgam of no less than five separate bills in the House and Senate that may or may not ultimately provide universal health coverage to most Americans, depending on what it looks like when it comes out of committee and gets voted on, with or without various amendments that may further water it down, if it gets voted on before next year's mid-term elections.

Whatever is currently happening in American politics, America itself is not poised on the precipice of great reform. Health care in America is not going to substantially change any time soon. But you wouldn't know that from watching television:

or reading various newspaper accounts of Obama's "dishonest," "judgment"-ridden program menacing America with roving "death panels" managing euthanistic, abortion-happy "death lists."

Excepting the New York Times' excellent work uncovering the outrageous and opportunistic roots of said "death panels," I've felt frustrated with the national reaction to the wild spectrum of anti-Obama rhetoric informing this "debate."

First, President Obama has not written any bill. His office supports no individual plan. Instead, Obama has set out a series of broad principles that he'd like to see Congress enact, however it best sees fit.

As has been widely reported, Obama learned a lesson from watching President Clinton fail to pass universal health care, and has instead requested that Congress create, debate, revise, and vote on its own variety of bills. Various bills still exist in various stages throughout Congress; there has been no formal vote on one bill in both houses of Congress. When the various current proposals eventually reach the intra-Congress committee, there will be further debate, revision, creation, and voting, after which one (or more) bill(s) will reach both floors of Congress, where there will be further debate and, finally, a vote.

In other words, Congress is doing its job as the legislative branch of our government. It is writing bills.

And Obama is sitting back, offering advice, working behind the scenes. He will eventually either sign or veto whatever bill does reach him, if one does at all.

Presidents and their staffs no doubt work the backroom scene, cajoling and glad-handing with the intention of influencing the various legislative acts. So do lobbyists. There are currently 6 health-care-specific lobbyists for every 1 member of Congress in Washington, D.C.

Think about that for a second: 6 to 1. For each state, that's one basketball team per Senate pair. For New York, that's an entire NBA conference of lobbyists working House members.

Americans should be concerned that so much corporate lobbying influence will dilute the final bills that come out of the Congress.

Instead, it seems, somehow, the outrage is directed at the Congressional members who, it is often implied, hate freedom and conspire in secret to somehow take away government health care coverage from some by extending it to all Americans:

or who conspire to empower Nazis:

or who look to hurt the elderly while giving young girls free abortions:

or who look to deny health care to Americans who need it:

or who want to kill any and all of the above:

To whom is this misinformation and fearmongering helpful? How does it add constructively to the important national debate that we should be having?

I should practice what I preach, right? Okay, here goes:

I'm 32 years old. I was born with bicuspid aortic stenosis. That means that my aortic valve doesn't work properly. Instead of three healthy valve flaps, it has two imperfect ones. Over time, that valve continues to narrow and work less well. As it does so, the aorta compensates by swelling in size. As the valve narrows and the aorta swells, my heart will work less well. Eventually, I'll have to have open heart surgery, at least once in my life (depending on the longevity of the artificial valve they put in to replace the original, and the little sleeve of fabric they use to reinforce my aorta).

Since birth, I have seen a cardiologist at least annually, often semi-annually. Last week, I visited my cardiologist, Dr. Hunt, a rock star Stanford Cardiology doctor who's one of the best in her field. I feel incredibly lucky to have Dr. Hunt currently overseeing my care. I get to see Dr. Hunt because I work at Stanford and I have HMO health insurance through Stanford, for which I pay about $300/month. I bring my records since childhood. She orders some tests, interprets them, and we talk about my long-term prognosis (so far, so good). My condition requires biannual check-ups with expensive tests that include echocardiograms and stress test echos. In the past, with health care that required me to pay 10% of my visits, the bill ran $800-$1,400 as my portion per visit. Expensive stuff.

I cannot get individual health care in America. Likewise, I can't get individual life insurance. I don't quality for either, because I have a pre-existing condition. That I was born with. I didn't develop it and I can't control its progression. All the same, call Blue Cross, Anthem, Kaiser, et al, ask for a health insurance policy and then say, "oh by the way, I have congenital aortic stenosis." No dice.

I'm well-educated and I'm good at finding jobs with group health coverage. When I needed to take some personal time two years ago, I was able to pay for COBRA coverage to extend the time until I got back on my feet.

The things that bugs me, personally, is that I can't imagine what someone in my situation, who doesn't work at Stanford, and/or who doesn't have health care coverage, and/or who has poor coverage, would do. Probably get really sick and then either die or cost a city hospital millions in lost expenses to do dangerous, end-of-life surgery from which s/he may not recover. That someone can be born in America with a condition that requires so much attention, and not be able to get it because s/he can't afford it, strikes me as unfair and short-sighted.

Regular check-ups are expensive, time-intensive, and require meticulous follow-up. Open-heart surgery is very complicated and expensive. It requires a lot of recovery time and follow-up, as well as medications and regular check-ups to make sure everything is working okay, and continues to work okay. And, ideally, you want someone really good at heart surgery to, you know, cut open your chest and tinker with your heart.

I believe in the potential of my country to solve problems, from work programs to social security to veterans' benefits to institutional care for the long-term unwell. Health care costs are a short-term problem, and in the long-term so is the staggering absence of a health care safety net for those who need it most. Having many uninsured Americans who do not treat small problems leads to many uninsured Americans who must treat big problems. It's like the story of the guy who busts his arm, doesn't get it fixed, eats lots of Advil, damages his liver, and ends up in the hospital looking for a donor, a surgeon, a nutritionist, and a welfare officer. All on the government dime. Small problems, left untreated, get big.

Let's have a real debate about real issues. I'm a big Obama fan, and I trust my president to make good decisions as the chief executive. At the same time, I appreciate and understand that others may not. So, let's hash out the issues, rather than score cheap political points:

And let's not get mired down in the muck of hypothetically intellectualizing the real issues we face today, so much so that we grind to a halt and get nothing done. In the words of a great American president, FDR, "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little."

Thursday, August 13, 2009

David Axelrod Counters the Lies and Rumors About Obama's Much-Needed Healthcare Reform

The following is from an email from White House Senior Advisor David Axelrod:

Dear Friend,

This is probably one of the longest emails I've ever sent, but it could be the most important.

Across the country we are seeing vigorous debate about health insurance reform. Unfortunately, some of the old tactics we know so well are back -- even the viral emails that fly unchecked and under the radar, spreading all sorts of lies and distortions.

As President Obama said at the town hall in New Hampshire, "where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed."

So let's start a chain email of our own. At the end of my email, you'll find a lot of information about health insurance reform, distilled into 8 ways reform provides security and stability to those with or without coverage, 8 common myths about reform and 8 reasons we need health insurance reform now.

Right now, someone you know probably has a question about reform that could be answered by what's below. So what are you waiting for? Forward this email.


David Axelrod
Senior Adviser to the President

P.S. We launched this week to knock down the rumors and lies that are floating around the internet. You can find the information below, and much more, there. For example, we've just added a video of Nancy-Ann DeParle from our Health Reform Office tackling a viral email head on. Check it out:

8 ways reform provides security and stability to those with or without coverage

1.Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

2.Ends 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.

3.Ends 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.

4.Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

5.Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

6.Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

7.Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
Guarantees 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.

Learn more and get details:

8 common myths about health insurance reform

1.Reform will stop "rationing" - not increase it: It's a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.

2.We can't afford reform: It's the status quo we can't afford. It's a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.

3.Reform would encourage "euthanasia": It does not. It's a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.

4.Vets' health care is safe and sound: It's a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.

5.Reform will benefit small business - not burden it: It's a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.

6.Your Medicare is safe, and stronger with reform: It's myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.

7.You can keep your own insurance: It's myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.

8.No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you - and the same rules of privacy will apply as they do for all other electronic payments that people make.

Learn more and get details:

8 Reasons We Need Health Insurance Reform Now

1.Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults - 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market - were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more:

2.Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more:

3.Roadblocks to Care for Women: Women's reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more:

4.Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more:

5.Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured - 13 million people - are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more:

6.The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more:

7.Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more:

8.The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform.

Learn more:

Tuesday, August 4, 2009


In the fall of 2002, Katie called me from work to say that a co-worker was looking to give away two kittens and did I want her to bring one home? We had been talking pets for a few months and while my loyalties at the time leaned dog, the practicality and self-sufficiency of cats made them a better choice for our urban Chicago Uptown digs. Actually, Katie suggested we get the apartment ready and she bring home a kitten two days later but I was undeterred: bring both home at the end of your workday (on the orange line "El," from the end of the line all the way north to red-line Montrose) and I'll make sure they come home to a cat-ready apartment! I took the bus to Petco and bought cat litter, two litter boxes, cat food, cat climbing toys, cat treats, cat nip, food and water dishes, a play toy that consisted of a long wand with a furry thing at the end, and little furry round things filled with catnip. I took a cab home.

Katie arrived home with tiny kittens in a big white pillow case. They were no bigger than the palms of our hands (here's a 2002 photo of our holding the kitties, upon their arrival). One was wiry, aggressive, and loud. Assuming she was a boy, we named her "Chet" after Chet Atkins, one of our favorite country-western guys. The other was quiet, reserved, larger, and covered in incredibly soft white fur. We named her "Lucy" in honor of Lucinda Williams, whose Car Wheels On A Gravel Road was a staple of our CD playlist that summer.

Chet and Lucy were a big part of our lives for the next five years. They moved with us from Chicago to Miami, and on to Romania. We went through the many stages of animal care, from delousing to fixing to litter box location, to some play (they were, after all, cats) to brushing to let-us-be-cats-and-you-know-more-or-less-leave-us-alone. Truth be told, they were easy kittens. Lucy, in particular, had a kind of Ben "Big Baby" Davis quality: big and athletic, she could clear an easy four feet leaping into the air after said dangly cat toy. She took the lead batting at and hiding catnip-filled mice. Lucy was a quiet alpha cat who suffered no grief from Chet. Every few weeks Chet would test, unsuccessfully, the natural order, trying to claim Lucy's favorite spot in Chicago on top of the computer monitor, under the desk lamp; in front of the big sliding glass door in Miami; on top of the yellow leather chair in Romania. Lucy didn't like to be picked up or pet all that much, and unlike Chet she never let anyone put her on her back. But she would sidle up to the bed and sleep near my head, or stretch out under the lamp while I wrote in Indy, resting the pads of her feet against my arm. Lucy was affectionate on her own terms, which I always respected. The last few months, she got in the habit of waking us up in the mornings to go turn on the tub faucet, so that she could drink from it (a habit that followed her to every apartment where she lived). Then, she would return to the bed and climb up on top of my chest and sit there, purring, while I slept.

I wonder, now, if her climbing up on my chest was comforting to her because she had internal pain. Or, worse, if she was doing her best to communicate, in "cat", to us that something was wrong. However it developed, Lucy died of liver failure last Sunday. Cait and I came home to find her nearly-catatonic, unwilling to move too much, and the wonderful, sympathetic Dr. Wong at San Francisco Veterinary Specialists confirmed confirmed our worst fears. Dr. Wong was kind to give us as much time as we wanted to say goodbye; I've said this a few times in emails to friends and family, but it surprised me how much I had to say to Lucy, how much I wanted to communicate as best, and probably ineffectively, as I could. Cait and I cried a bunch. The vet let me hold Lucy as she died, which meant a lot to me.

For me, pet eulogies have always ranked up there with paeans to old cars and invocations of fertility deities at dinnertime. Truth is, Lucy was one of my best friends. I really miss her. I'm shocked that she's not sleeping on the red chair in the next room, or wandering in to mew and get a quick chin scratch. Lucy lived with me in five cities, on two continents, for seven years. In that time, she was a great comfort in all sorts of situations. Just knowing she was there, and would be there, gave a kind of continuity to a life that featured some unexpected transitions. More than that, I liked Lucy. She was easygoing, friendly, independent. She made cute noises when she yawned. Most of the time, she looked at me with this kind of "Really, what?" look on her face. If a stranger came over, or if there was a storm, she'd hide under the bed or in Cait's closet, in a shoebox. Unlike Chet, she didn't give Cait a hard time when she moved in and she made immediate friends with Cait's sister, Jilly.

I've been listening to Death Cab for Cutie's "Scientist Studies" a lot these last two days. Especially, the first two lines get me: "What ghosts exist behind these attic walls? There's got to be a simpler explanation." Strangely, Chet seems generally unfazed by Lucy's absence, though I think in the long haul, it's going to be a transition for her. So, keep both of my kitties in your thoughts. And, here's a poor recording of what otherwise sounds like a great live version of the song (drunken setting aside):