Sunday, October 23, 2016

I'm an Early Voter

It's been 3 weeks since I've published a post here. My brain has been reeling from observing the life around me. So much so, that I decided to vote early which is possible in my state. It was wonderful. No lines. Fast. I declined the photo opportunity after dropping my ballot in the ballot box. I left the early voting station feeling elated and relieved. Now I no longer felt obligated to watch what's going on with the various political campaigns swirling around the country right now.

Ha. Ha.

Just when I thought it couldn't get any more outrageous and horrifying, a video leaks into our lives of Donald Trump and Billy Bush yucking it up and boasting about sexually assaulting women. At the third debate, Trump allowed that he hadn't done what he bragged about doing, but that seems to be at odds with the women now coming forward with their stories about him sexually assaulting them. There seems no doubt at this point that Trump disrespects women, and that he's a misogynist. Trump cannot let go of anything, even when the truth is up close and personal in his face. Wow. I grew up in the home of a sociopath and narcissist. Let me say from my experience, Trump exhibits the behavior, speech, and beliefs of a sociopath and narcissist.

A friend commented that watching the debates has reminded him of being in elementary school. And Clinton just rises above it all which isn't too difficult, actually. No doubt of who is the adult in this year's election campaign. In addition, Trump makes no effort to educate himself about the job description for a US President, about the limits and checks on the power of the Executive Branch of our federal government led by the President, and about how the judicial system works in our country. For example, as President, Trump would not be able to put Clinton in jail. He does not have that power. Only a dictator has that kind of power. Electing an outsider is one thing, if that outsider is mature, educated, experienced, and intelligent. It's quite another when that outsider is immature, inexperienced, criminal in his business dealings, ignorant, and autocratic.

And then there's the notion that American men are intensely uncomfortable with a woman in power. The reason given for Clinton's lack of support among men, especially men who haven't been to college. I don't know whether to laugh or groan. I wonder if it has something to do with not successfully detaching from their mothers and maturing as adult men? After all, mothers are the most powerful women in men's lives.  Or perhaps it's closer to racism in this country as we've experienced in the last 8 years of Obama's presidency and how he's been treated.

Women have been fighting for over 60 years for equality under the law, for social equality, for employment equality, and economic equality. Isn't it about time men realized that maybe they need to change their core beliefs about women, as well as their core beliefs about men in our society? It really looks like the men just never got the message back in the early 1970's that if they wanted good relationships with women, that they needed to change their thinking and behavior too? We still have a long way to go, as each generation works to replace the old, misogynistic beliefs with those of acceptance, respect, and equality.

So, women have a long way yet to go, and now it's about helping men learn how to be in a world in which men and women are equal human beings -- not a world where men rule and treat women as dependent children that must be kept under control. Trump truly represents the past.  Where's Melania? Why hasn't she been stumping for him on the campaign trail? She's done very little compared to other candidate spouses in the past and present. Perhaps she has no desire to support her husband in that way. Or perhaps she's had no say in the matter.

This is the first time in my lifetime that a candidate running for president thinks he's smart if he can break the law and not get caught, or get caught and either buy his way out or bully his way out of punishment. And then blame it all on the lawyers and prosecutors because of course he hasn't done anything wrong. Our country does not need this person setting foreign policy, meeting with foreign leaders, or having access to the nuclear codes. This person has neither the skills nor the abilities to govern, to work with Congress, to represent the entire country, to compromise and build consensus. This person knows nothing about leading in a democratic system.

This is also the first time in my lifetime that a foreign country has tried to undermine our democratic process. I suppose it's much easier to do now with the internet being essentially borderless and hacking becoming an acceptable method in the world of espionage. And then to have a presidential candidate deny that the hacking has come from a foreign source? I should think a presidential candidate would be concerned about his own data and want to work with security experts to insure that his own data was protected, and cooperate with security experts regarding any information he or his campaign might have about the cyber-intrusions. If he's not concerned, why not? Does he know something the rest of us don't?

And finally, this is the first time in my lifetime a presidential candidate has begun claiming that our democratic processes are rigged, corrupt, and set up to favor his opponent. That there will be election fraud. He does not know what he's talking about, and what is especially sad and scary is that he makes no effort to educate himself about the processes and why fraud does not occur in this country as it does in a truly corrupt and undemocratic system.  Commentators have explained that his claims of a rigged election is preparation for him losing which was underscored at the last debate when Trump refused to say that he would accept the results of the election. Or, another possibility -- it's his way of encouraging his supporters to try to commit election fraud or intimidate voters (both illegal). When I voted early, I could see no way to rig the process in favor of one candidate or another. The voter's identity is checked three times against the information the voter provides, and the voter signs off on the ballot under the scrutiny of an election judge. Any deviation from the process would be noticed immediately and stopped.

In psychology there's a concept called "projection" in which a patient projects onto others beliefs, speech, and behavior that he himself has and has done. Sociopaths are particularly adept at projection. The layperson knows it as "blaming everyone and everything else for a mistake, problem, etc." They do not take responsibility for their thoughts, beliefs, feelings, and behavior but see themselves as always being right. Another way of interpreting projection is the sociopath revealing his profound sense of powerlessness to effect anything in his world because everyone else does and he is under their power.

I'm going to be so glad when this election is over....

Monday, October 3, 2016

Here We Go Again...and Again

It's that time of year!  Time to look at medical insurance coverage if you buy your own and decide if you want to continue with your current company or shop for different insurance. Here in Minnesota, that means shopping on the MNSure insurance marketplace website, or, if you can afford it, going to each company's website to check out their plans on offer.  Man, I wish I could afford to buy whatever I need and not have to go through the exercise of figuring out my 2017 income, checking drug formularies, checking in-network providers, and on and on. Last year, I used a Navigator to help me. Not sure how I'll proceed this year. There are reasons for my uncertainty.

Reason 1

MNSure operations sent me a letter last week, alerting me to the possibility that I may have to prove my eligibility again for my medical insurance coverage provided by the state. I appreciated the heads up, but I'm not looking forward to going through that process again. Of course, maybe I won't have to prove my eligibility, but I doubt that. They required me for this year to provide explanations for how I had estimated my income for this year. I expect they'll be interested to know what I'll be earning next year.  So will I.

Reason 2 

A couple days after the MNSure letter, I received notification from the insurance company that administers the state plan I'm on. They are making changes in their drug formulary, i.e. the drugs that they will cover. As a result, two of my medications will no longer be on their formulary. While I appreciated the notification, I'm definitely not thrilled that I will now need to request two different doctors to submit prior authorization requests for these medications. These two medications are for my dry eye and dry mouth. I've been taking them since 2008. They are working very well for me. The insurance company suggested a different medication on their formulary instead of the dry mouth med I'm taking now. For the dry eye medication, their suggestion was "CHECK WITH YOUR DOCTOR." They suggested that, of course, because there is no alternative to that medication. Not on their formulary, not anywhere.

In addition, this company also outsources its review of medical necessity. I was very upset when I learned this. When I told my doctor, he was not at all surprised. Now I'm very, very curious to know the cost benefit or risk of outsourcing that particular task vs. doing it in-house. But, of course, there is no way any of us will ever see an insurance company's balance sheet, is there? I doubt they'd want us to know just how much money they have in their excess fund, or how much they spend on marketing and advertising. I think drug companies are the same.

Reason 3

I've been on a job search for the last few months. What if I find my ideal job? What if they offer it to me and I accept? How does that affect my medical insurance? This job search business is full of uncertainty, and it affects so much in my life.  It would be a very different situation for me to be a fulltime employee with employer provided medical insurance. I would not need to purchase my own individual plan. However, what would the coverage be with the employer provided insurance? I could end up with higher medical expenses because the employer provided insurance only covered 70% of drug and medical expenses.

For the Working Poor

While my state offers good medical insurance for the working poor like me at the moment, I suspect there's a segment of workers who are really struggling with the medical insurance issue because they make enough annually through work, but maybe they have insurance through their employer that's inadequate to their needs, or maybe their employer doesn't offer insurance and they still must buy their own. Or they are self-employed, making enough money each year to buy their own insurance, but then run into issues of coverage.

When the ACA was passed, I was ecstatic. I thought that I'd be able to get off the state's high risk pool insurance that was costing almost as much as my monthly apartment rent and qualify for the premium subsidy. Yes, I did qualify for the premium subsidy, but my premium costs continued to increase each year. I began to wonder if that was the purpose of the ACA -- to make insurance just as expensive as it was before it went into effect and increasingly unaffordable for people like me.  Insurance companies are working hard to make that the case, or they are choosing just not to participate. So there are lots of insurance plans to choose from out there, but the number on state ACA marketplaces online have dwindled. Good luck if you need platinum coverage finding a platinum plan from anyone!

So, thanks to the insurance industry, if you aren't already a member of the Working Poor, you may end up there because of insurance costs.

Sunday, September 25, 2016

The Successful Patient: Being Mortal

My father
Years ago, when my father was diagnosed with prostate cancer, we had no idea what was about to happen. He already had severe heart disease and carried nitroglycerin pills all the time (and used them). Because of his heart disease, surgery to treat the cancer wasn't an option. He had chemo which was actually taking estrogen. He didn't like that. He thought it would make him a woman with breasts. I never found out if anyone explained to him that it was more complicated than that. He knew the cancer was serious and got his affairs in order. We knew that he wanted to die at home. That was really all we knew for a while.

Being a successful patient means educating yourself about your body, about the health issues you have. It's also about knowing yourself, what kind of life you want, and how to live when you're dying. Well, technically, we are dying from the moment we are born. But after about age 50, mortality starts to become much more of a subject for thought and for planning. We live in a society that focuses on youth and good health. As a result, we don't know how to talk about dying or how to live in the face of our mortality, i.e. the last months of living in old age or when terminally ill.

Since my lung illness last year, I've been thinking more about mortality. But like anyone, I really didn't want to think seriously about it. I still don't. I'd heard about a surgeon who writes interesting books about his work and was curious to read his books. His name is Atul Gawande and he's a general surgeon in Boston. The first book of his that I found was Being Mortal: Medicine and What Matters in the End. I borrowed it from the library. Reading the front inside cover copy, I wasn't sure I'd picked the right book. But then I decided to read it anyway.

I'm glad I did. Dr. Gawande writes about what medicine does right and what it does wrong when doctors treat elderly people or those who are terminally ill. He writes about how he was trained to heal, to cure, to treat, and to be informative so that patients could choose treatments. He wasn't trained to help the elderly and terminally ill to make choices of how to live in their final months. Describing cases from his own medical practice, he writes honestly about his own feelings of inadequacy, frustration, and confusion about what was expected of him and what he should do. His tone is real, human, warm and personal, and I found it hard to put this book down, even when a story brought tears to my eyes.

Dr. Gawande searched for answers for other doctors and for us. I'm grateful that he wrote this book and shared his hard-won wisdom. It has helped me to think about my own mortality and my own wishes. Dr. Gawande learned that it was necessary to ask patients questions about what they wanted in their lives, no matter how sick they were. It wasn't about medical treatment, but about living well when sick, failing in health, and dying.  He sums it all up:
"We've been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?"

There is one thing any adult can do as a first step in this process: do an Advanced Directive (find an example here). This is a legal document that spells out your wishes on paper so that if you are ever incapacitated and cannot speak for yourself, it provides medical professionals, family and friends with a legal record of your wishes. It also provides the names of at least 2 people whom you'd trust speaking for you. I've done one. It takes some time, but it's worth the effort. I spoke with my Primary Doctor about the technical medical details. I asked two people I know will honor my wishes to be my medical proxies, and gave them copies of my Advanced Directive.

Doing the Advanced Directive forced me to think about my beliefs about living, dying, and medical care. It is a tool for starting conversations among family members about end-of-life decisions. It is a huge step toward answering the questions Dr. Gawande wrote in his book. As a successful patient, I've found that being prepared gives me the power and the control that I need when dealing with doctors, nurses, and other medical professionals.

My father didn't have an Advanced Directive. At that time, in the mid-1980's, there really wasn't a document like that that an individual could fill out, sign and notarize. My father told us what he wanted. Even then, it wasn't enough because he could not have anticipated everything that was going to occur. Fortunately, Hospice provided my mother with much needed relief by sending a volunteer to stay with my father, take him on drives, and help out. My mother hired a part-time nurse also during the final months. What would have been especially helpful? To know exactly what happens to the body in the final weeks and days before death. I think this would have helped us immensely. But it's hard to ask that kind of question, and we really didn't know whom to ask.

Thanks to Dr. Gawande and his book, I now have a much better idea of what to expect and how I want to live out my last days. I highly recommend it for everyone.

Tuesday, August 30, 2016

Let's Talk About "Consent"

Photo: Pioneer Press: Scott Takushi
Last evening, I heard on the local news that the freshman class at the University of Minnesota-Twin Cities was moving into dorm rooms this week. In the next 10 days, each and every one of the freshman class must complete satisfactorily an online class from the University about sexual violence, consent, and drinking. While I was heartened to hear that freshmen needed to complete this online class, I wondered why the other classes weren't require to repeat it each year also.

This morning came the news that Brock Turner, the Stanford University student convicted of felony rape this past March will be released from jail this week after only 3 months of a measly 6-month sentence. He could have received a sentence of 14 years in prison. The judge in this case, Aaron Persky, revealed his sympathy for Turner which really horrified me. Where was his impartiality? What about the young woman Turner raped? She must live with that violation and trauma for the rest of her life. It will color her sexuality and her sexual life for the rest of her life. Didn't Judge Persky care about that? Also, does Stanford University have an online class about sexual violence, consent, and drinking that its students must complete at the beginning of each year?

Brock Turner (Photo: Santa Clara County Sheriff via AP)

Yesterday, I also happened to read a blog post by Doug Muder at The Weekly Sift this past June 13. The post is a round-up of news from the previous week, and Muder addresses the Brock Turner case, "and that rape case," about two-thirds of the way through the post. I really liked Muder's thinking, and he states much more clearly than anyone else I've heard or read what consent is in any situation.  He begins:

"At the trial, Turner claimed the woman consented, which seems hard to square with her being unconscious."
Then Muder writes that when we talk about sex, consent becomes tricky. However, I was taught, as are most women I'd guess, that if we say "No" or if we say "stop" at any time during a romantic or sexual encounter, the guy should stop. If he doesn't stop, then it's rape. In the last few years, we've seen more and more cases of young men, often in college, who use alcohol or Rohypnol, the tranquilizer also called "Roofie" or the date rape drug, to incapacitate young women so they cannot say no or stop. In other words, these young men have learned that in order to be able to have sex with a young woman, the young woman needs to be pliable and under their control. If she's passed out, asleep, or unconscious, so much the better. The whole notion of "consent" doesn't seem to enter into the equation for these young men only to have power over the young women so they can have sex. In other words, they don't seem to know, comprehend or understand that in order to have sex with another human being, the other human being must, must, give consent to it. No exceptions.

Where did these young men learn this? Where did they get the sense of entitlement that they could do as they wished with the body of another human being without the other person's consent? And that it was OK to incapacitate a young woman in order to have sex without her consent?

I love what Muder writes next in his post, because he talks about consent in terms of a financial transaction:

"For example, imagine I ask you for money and you say no. If I then take your wallet, I’m a thief. It doesn’t matter at all whether you’ve given me money in the past, or if you’ve been giving money to lots of other guys. Maybe your jeans are so tight that the wallet in your pocket is totally obvious, leaving nothing to my imagination. Maybe hundred dollar bills are hanging out of your blouse pocket. Maybe we’re both drunk and you pass out before you get done turning me down. None of that matters. If you never said “Here, take my money” I’m a thief."
Do you suppose that young men today would understand consent better if put in those terms?  In other words, it's not consent if the other person is unconscious and cannot say no or stop.  The transaction for sex needs to occur with both parties able to understand what they are doing, and what the consequences are, and able to actually say "yes" or "no." Both sides.

I wonder if Judge Persky understands that himself? I certainly do not understand how he could be so much more sympathetic for Brock Turner over the young woman he raped. I wonder if Judge Persky understands that this could quite possibly be the reason that reasonable people have been outraged by the sentence he handed Turner. Persky in effect told Turner what he did was no big deal, that there are no major consequences to his actions, in spite of the law.

Personally, I'd like to see an online class about what sexual violence is, consent, and drinking for seniors in high school. And I'd like to see parents teaching their kids to respect each other from an early age, no matter gender or sexual orientation. When kids are brought up to feel entitled, which seems to be the case for males still in American society, when they are in fact not entitled, that sets those kids up for something terrible when they enter the world as young adults. 

Parents are the primary teachers of morality and behavior, right? Schools and churches and society reinforce what parents teach. According to a letter Turner's father wrote to the court in defense of his son, he wrote, "His life will never be the one that he dreamed about and worked so hard to achieve.... That is a steep price to pay for 20 minutes of action out of his 20 plus years of life.” Wow. Why wasn't Mr. Turner talking about his son's terrible judgment, his terrible choice, and how they were going to affect another human being for the rest of her life? That his 20-minute action has serious consequences? That he's not terribly happy with that 20-minute action?  Mr. Turner demonstrated in his letter where his son's poor judgment and choice came from. But that shouldn't excuse Brock Turner from the consequences of being convicted of felony rape and sentenced to 14 years in prison like anyone else convicted of the same charge.

I would like all parents and teens to read the victim's statement that she read in court to her assailant, Brock Turner. It should be part of any class about sexual assault, consent, and drinking. This is what happens to a victim of sexual assault. The assault is not only physical, but also psychological, emotional, and spiritual. 

Rape has been, and continues to be, a huge social issue in our society despite some progress in establishing women's rights as human beings. Clearly more needs to be done. Will the online class at the University of Minnesota-Twin Cities be enough?

Friday, August 26, 2016

"The Doctor Blake Mysteries"

My Aussie friends in Melbourne and Adelaide would probably chortle at my recent obsession with the TV mystery series The Doctor Blake Mysteries, set in Ballarat, Victoria, and produced there. The Public Broadcasting System has made a smart move by importing this series (and another, Miss Fisher's Murder Mysteries) from Australia. They definitely spice up the programming schedule of my local PBS TV station.

It doesn't bother me that none of the actors are familiar names or faces. Or that the series is set in the late 1950's. I love that it's a "period" piece, set in a time long before personal computers, cell phones, and blockbuster anything. These mysteries pit a doctor, a "police surgeon," against the murderer and his or her methods, flaws, mistakes, and pain. The police help or hinder depending on who's in charge -- there's been one Chief Superintendent whose handsomeness hid a black heart -- and always provide the authority Dr. Lucien Blake requires to catch the villain. These mysteries proceed quietly, slowly, penetrating the social strata of Ballarat and the surrounding area with some of the most haunting music you will hear on television.

Dr. Blake, the son of a beloved doctor in Ballarat, returns after years spent abroad. His background story seeps through each mystery episode, revealing his flaws and his pain, as well as his character as a person. He takes up residence in his father's house and office, and asks his father's housekeeper, Mrs. Jean Beazley, to stay and work for him. He takes in a district nurse as well as a young police constable or two as boarders. His medical practice would be that of a general practitioner at the time, supplemented by his work with the police. The nature of the show, of course, means that it actually seems like his police work is his major practice.

Craig MacLachlan, as Blake, brings a real presence to the role, a thoughtfulness as well as a kind of reckless drive to solve each mystery. I love that the medical forensics are so early in their development and use -- no DNA profiling here. We learn that a suspect can have the same blood type as that found on a murder weapon or at the murder scene. Poison seems to be a preferred method of murder in Australia, however, in stark contrast to what would be preferred in America, i.e. shooting with guns. Psychology is also in use by the police and Blake, although they don't ascribe to its use. They depend on their knowledge of and experience with human behavior. And so far, the writing has been original and imaginative, giving the actors opportunities to develop their characters as well as making interesting, sometimes twisty, stories.

Two subplots have been threading their way through all the stories, at least so far. One is the politics of the police in Victoria, and how Blake's work with Ballarat's police has shone too bright a spotlight from Melbourne on them. At times, it looks as if Blake will lose his job. At other times, it looks like he could end up in prison. How this subplot plays out is just as suspenseful as each of the mysteries, as complicated, and as full of nastiness as you can imagine. It makes office politics look tame.

The second subplot involves Blake and his housekeeper, Jean Beazley. Over time, the two actors do a masterful job of showing the gradual romantic attraction growing between these two characters. It has been fascinating to watch their reservation, their restraint, the way the social norms of the time govern their behavior, and so on. They are both middle-aged with grown children, and this is especially refreshing to see. They have problems, pain in their pasts, and have each lost a spouse in war. Will they get together?

Jean and Lucien (Not what it looks like)

What's been especially fascinating to me has been seeing Australian culture and a moment in Australian history after World War Two. They were an ally of the Americans in the Pacific Theater and have their own war stories to tell. I grew up hearing mostly about the European Theater of that war despite my father's service in New Guinea which he rarely talked about and then not in detail. Australia had its own struggle with Communism and prejudices, corruption and vice. I feel like with each episode I'm experiencing this time in Australia through these characters and their stories.

I'm almost finished with the fourth season and have been excited to learn that there will be a fifth. If you're looking for something different and you love mysteries, request (demand) your local PBS station to air it (if they aren't already)!