The Camel, the Straw, and the Broken Back

I have been thinking and thinking about how to say this, and here is what I want to say: 

If the last straw had been the first, it alone would not have broken the camel’s back, but each and every straw the camel was asked to carry would have contributed its weight to the final result. 

Poem: "Watched Kettle"

Watched Kettle

Watched kettle resisting boiling point,

Toaster refusing to relinquish

       Or crisp the still-soft bread it holds,

Silent, stared-at telephone,

Cloudless, rain-withholding sky,

Bobber motionless on sun-struck water

Over baited hook awaiting fish—

All these stubborn deserts of waiting

       Stretch on day by day,

       While meanwhile

The children grow up overnight.

- P. J. Grath

November 3, 2012

Why Is American Medicine So Costly?

I read with interest the other day praise by a fellow bookman for libertarian politics. I became a big Ayn Rand fan at the age of 17 and clung to Objectivist certainties until my late 20s, when life experience, broader reading, deeper critical thinking, and subsequent gradual disillusionment intervened. The main charge made in the short piece that got me thinking about this stuff again was the writer’s contention that it is government interference in health care that has sent medical costs soaring. I want to examine that claim.

Certainly a statistical correlation can be found between programs such as Medicare and rising costs since World War II, but other, equally available correlations are left out of such a narrow focus. Three come instantly to my mind.

(1) First there has been the rise of the for-profit hospital. Hospitals used to be owned and run by communities and churches. They were not expected to “make” money but to provide care when needed. These hospitals were not free, but neither were their charges governed by the “free” market. Schools, libraries, hospitals—these were seen as necessary provisions of civilized communities for their members. For-profit hospitals have changed the landscape utterly. Younger people can be forgiven for not remembering a history they did not live through. My generation has no such excuse.

Along with for-profit came (2) more and more health and practice liability insurance "products." Insurance is not in itself a necessarily bad idea. In fact, the pooling of economic risk and sharing of economic benefits are (does this astonish you?) basically a socialist principle. But does anyone not realize that private insurance companies exist to make money? As much money as possible for shareholders and investors. The more you buy—and the less they have to pay out—the more money they make. As for liability insurance for physicians, can a doctor even without malpractice insurance in a for-profit hospital? (Any hospital?) Lawsuits would certainly put profits at risk, and reducing risk to the company is what actuarial calculations are all about.

Also in the postwar period came (3) advances in medical science. These have brought Americans more and more expensive testing and treatment options, and they have also made equipment more expensive to hospitals. Not only are more people kept alive longer (some of them only "alive"), but because more and more new tests and procedures and treatments and equipment all the time come to be regarded as “ordinary care,” the cost of ordinary health insurance continues to go up correspondingly. 

Put it all together and look at the expanded picture again. For every case of a Medicare patient costing big bucks, there is a corresponding case of a healthy person with private insurance whose physician has ordered a dozen expensive, often unnecessary tests, "just to be on the safe side”; a man or woman “suffering” from the usual effects of aging and taking prescription medication to hold those “symptoms” at bay; or a comatose patient in a hospital bed being kept “alive” as long as private insurance is footing the bills.

Americans want to live forever, they want to stay young forever, and those who can afford to pay top dollar in their futile search for the Fountain of Youth make it almost impossible for those of us who would be content with basic care to find no-frills providers and institutions. It’s like looking for simple, basic dental care, when the way dentists make money these days is with expensive cosmetic procedures. Who wants to serve the lower end of the market? That won’t pay off medical school debt or help meet malpractice insurance bills!

My point is that private insurance companies, for-profit hospitals, scientific advances, and the race to the top of the medical market all fit perfectly well into the free-market, libertarian model. Why is American medicine so expensive? Blaming government interference is simplistic, narrow thinking. But it’s got “sound bytes” working for it.

It's Far From Over

Anyone who thinks fall color is over is walking around with eyes closed--or, more likely, driving around with eyes closed, which is even scarier. 

Question varies, answer remains the same

Answer: It varies from year to year.

Question could be any of the following:

What’s winter like here?

How much snow do you get?

When do the cherry trees blossom?

How hot is it in summer?

What’s the best week to catch fall color?

Predicting Election Results

Please, someone tell me what is wrong with my nonexpert analysis of predictions of election results based on probability:

Probability cannot foretell the outcome of a specific event—say, any particular flip of a coin—but can only be assigned in percentages to a range of possibilities. Weather is more predictable than coin flips, human actions more complicated than horse races, but for any prediction on a specific event’s outcome based on probability, no outcome will or can show the prediction to have been "wrong." The person having made the prediction need not even acknowledge having left out relevant factors. Picture the careless shrug and casual statement to the effect that a “less likely outcome” prevailed. What I’m saying is that anyone can criticize a prediction for not taking everything relevant into account but that no one can ever say, regardless of outcome, that the prediction was “wrong.” 

Am I right that such a prediction cannot be wrong? If so, tell me again why we should give a rip what anyone predicts? If not, please explain.

Rumblings Around Leelanau

Thunder rumbling is what we need. Well, rain is what we really need. The rumblings, however, are coming mostly from agricultural machinery. Old orchards are coming out, and land is being cleared for new trees. That’s the noise from the south end of the township.

Up at the north end, a young bear has been sighted several times, in different places. The hairy youth has caused no problems so far, but dog walkers are being careful where they wander.

It’s summer’s end and fall’s begining, and that spells fruit flies Up North. One thing that can be said for fruit flies is that they’re quiet. They arrive, they annoy, they die—and all without a sound!

They Just. Don’t. Get It! (Sigh!)

Back a few years ago, our local, county-wide bank was bought by a large, out-of-state bank, and one of the first thing “Corporate” did was to install those chrome stands you see in movie theatres, the kind with thick, velvet-covered ropes or chains, to indicate where customers should line up for tellers at the counter. Cries of outrage greeted the innovation. We are not livestock! We don’t need to be herded through cattle chutes! We know how to wait our turn! Things reverted to the way they were before, and everyone calmed down. This year “Corporate,” guided by “Marketing,” has made many more changes, most of them pointless, some of them downright irritating.

For starters, work by local artists was banished from the walls and replaced by promotional posters for the bank. (Why all the strenuous effort to sell what people are already buying?) All branch offices were painted in tones of beige and green, a new logo appeared on the outside of the bank, and the doors sprouted new green Lucite handles. When I went to the bank in Leland one morning, I was asked, “Do you feel like you’re in Northport? Because that’s the aim.” The aim of all this branding and homogenizing, I guess: make every branch feel like every other branch. Well, let’s get something straight. When I’m in Northport, I want to know I’m in Northport. When I’m in Leland, I want the feeling of being in Leland. And if I’m in Traverse City or Empire, I want to be clear about that, too. Each of these towns is unique, and that’s the way we like it Up North. Big box banks? Not appealing at all, folks!

My husband says that when he goes to the bank these days, he is annoyed the minute he sees the green door handles. Well, I can live with those, and if I were a teller, I’d probably be okay with the new uniforms: they are attractive, and employees have a choice of colors and coordinating articles of clothing. (Less figuring out “what to wear” every morning would have appealed to me back when I worked in offices.) The free pens have been a big hit. I’m told (and this surprised me) that the new 24-hour grace period before overdraft charges netted the bank a nice number of new customers. Twenty-four hours does not seem like a big deal to me before an overdraft charge of over $30 per check is assessed (I do not overdraw and so do not keep current on the penalty figure), and I wouldn’t have guessed that such a short grace period would bring in new customers, but hey—whatever!

What I find most—no, what I found most annoying, until a few days ago, is the new video display on the wall behind the tellers. It’s like a big, wide-screen TV, constantly in motion, and I have to hold a hand up over my eyes to block it from my view. When I’m talking to a teller, I want to be paying attention to the teller, not being distracted by a video display of the bank logo (who cares?) and “products” the bank is trying to sell me. In my case--and I suspect I am not alone in this--the annoyance of the distraction makes me, if anything, less likely to consider deepening my relationship to the corporation.

What makes local banking attractive in the first place? (1) The bank is here. (2) The workers, people we know, are friendly and courteous. (3) The staff knows the bank’s procedures and are helpful to customers. That’s it. That’s all we care about. The free pens are nice, but we lived without them for years and could live without them again. We just want the bank to be here and for the employees to do their jobs and be pleasant. If another bank bought up the current bank, we would switch “allegiance” without hesitation, as long as the bank was here and the employees—our friends and neighbors--pleasant and efficient. “Brand loyalty”? There is no such thing in today’s world. I can’t believe the marketing wonks haven’t heard the news.

And how much has all this “branding” nonsense cost? Because, no, there is one more thing bank customers would appreciate and that would be better interest rates, so instead of wasting customers’ money on such unnecessary and annoying changes, how about if “Corporate” just upped the interest rates a noodge? We would appreciate that!

Ah, but the changes weren’t over yet--and maybe they still aren’t, which is a scary thought—because just the other day, turning my gaze from the offensive video display to the clock on the wall, I saw—the clock was gone! Up there on the wall all alone was a silly double outlet, too high to be useful for anything, nothing plugged into it. Where was the clock? Can you guess? Ah, yes! “Marketing,” those chipper, eager, bright-eyed youngsters down at “Corporate,” decided it would be better not to have a clock in sight. People might time how long they were waiting in line. I’m not kidding. At least, this was the only rationale anyone could come up with.

Corporate, Marketing—get a clue! These branch banks are in small towns! We hardly ever have to wait in line, and when we do, no one minds, because we use the time to visit with one another. It's a break in the day for us! The occasional impatient person, usually a tourist off a yacht in the harbor, doesn’t understand small town life, either, and clearly doesn’t know how to be on vacation, the point of which is to slow down. Please don't gear our life to their ways!

Clearly, the marketing people are city people, and no doubt they’re very young. To their credit, they want to earn their salaries. So they come up with ways to change things. But if we wanted to live at a city pace, in anonymous city surroundings, we wouldn’t be here in Northport. Many of us, however, are still working for a living, and we do need to keep track of the time, so please put the clock back! Is that so much to ask?

More Fun with Mom and Pop

Mom and Pop and the Mouse

Mom (in kitchen, finding mouse in trap) to mouse: I’m sorry. We wouldn’t have tried to kill you if you’d stayed outside.

Pop, appearing from bedroom door: I have to pee.

Mom: There’s a mouse in the trap. Shall we throw out the trap?

Pop: I’ll get it.

Mom hands Pop a paper towel to use to pick up the trap. He throws it in the garbage and removes the bag from the can, taking it out to the porch. He comes back in and looks at the clock.

Pop: It’s really early!

Mom: No, it isn’t.

Pop: It’s seven-thirty!

Mom: That isn’t really early. Five-thirty is really early.

Pop (sarcastically): One o’clock in the morning is really early.

Mom (stubbornly): No, that’s the middle of the night.

Pop: You’re crazy.

Mom pours herself a cup of coffee, and Pop goes back to bed.

 Mom and Pop Look for Their Glasses

Pop: I can’t find my glasses.

Mom: Did you leave them in the bathroom?

Pop: No, they aren’t there. Do you see them on the table?

Mom: Here they are, on the kitchen counter.

Short silence. Then—

Mom: Where are my glasses?

Mom Does Yard Maintenance

Mom, shutting off riding mower: There! The big part’s all done!

Pop: You did a good job. How was it?

Mom: Not bad. But this front part, around the trees and gardens, I’ll have to do with the electric mower. Is there enough gas for that mower, too?

Pop (astonished): Are you crazy? You don’t need gas for the electric mower! It runs on electricity!

Mom and Pop stare at each other for a moment in silence, then both burst into laughter. Mom’s laughter is a bit hysterical.

Homonym of the Day

Rain falls from the sky.

To rein in a horse--or, by extension, one's enthusiasm--means to hold it back. Giving "free rein," on the other hand, means letting it go.

Monarchs reign from thrones.

These words are homonyms. They sound the same but have very different meanings. Since horses are no longer part of everyday life for most English speakers, there is great confusion over rein and reign. Here's another case where Matthew's recommended study of Latin would help out a lot. Journalists, take note.

[This was originally and mistakenly posted on Books in Northport. I meant to post it here.]

Greening

Chives and sorrel

Parsley

Rhubarb, strawberries, the odd weed and last year's straw bales

Just Call Me "Nobody"

As in --

"Nobody reads books any more." (I do.)

"Nobody writes real letters any more." (I do.)

"Nobody uses e-mail any more." (They do everything through their "social networks"? Not me.)

So e-mail, send me a letter, or write me a book. I'll get the message.

Be Careful What You Sign Up For

When my son was still very young, imagining convivial meetings where persons of similar interests would gather to listen to and discuss their favorite music, he signed up for a certain “record club,” which shall not herein be further identified. What a rude disappointment when he discovered that the only activities of the club were to be his receiving and paying for the monthly selection! “The club isn’t nearly as much fun as I thought it would be,” he observed sadly.

Years later my husband reached the age when he was eligible to join a very large, well-known and powerful association promising many discounts to its members. The unwelcome consequence was a flood of junk mail stuffing the post office box day after day.

Not long ago someone suggested that I join a certain online organization because I would find the discussions interesting. Well, unhappily for me, this group does not conduct conversation on a website but via e-mail, and the majority of these e-mails seem to be conducted in “reply all” mode, with all previous correspondence on the subject still attached. Help! I’m drowning! I need to unsubscribe asap—if only I can figure out how!

There are times when un-joining a club is much more exciting than joining. The thing is, relinquishing membership usually takes a lot longer. Sigh!

And one more thing--

One STANDS on a PODIUM. One places lecture notes, sermon, book, etc. on a LECTERN. If you're trying to stand on a lectern, you're riding for a fall, and if you try to rest your arms on a podium while you're speaking, you'll be lying on the stage floor, and you'll look pretty funny.

Glimpses Near Home

There are beautiful things happening in my front yard if you look close 

...and looking closely in the woods yields surprises, too.

Along with the new, however, there is still the old from last year,

beautiful in its own way.

And all these could have gone on my photo blog, if I didn't have

something else going on there today....

My Winter Garments of Repentance

Begin with a warm coat. Forget the ski jacket. You want a coat that goes at least down to your knees, and it must have a lining. Pockets are essential--

the deeper the better.

Heavy barn coat with warm lining and deep pockets

But on the coldest days even a long coat isn't enough. 

You need leggings 

(over cozy, drawstring exercise pants 

over your jeans over your tights).

Leggings

Keeping hands warm is important. 

You can't keep your hands in your pockets outdoors and get very far, 

so good, heavy, lined gloves are a must.

Gloves

Then there are the days when a little cap isn't enough--

not if you're going to stay outdoors any length of time at all. 

That's when you throw all concern for fashion out the window and-- 

dress like a lumberjack! 

This wool helmet is fleece lined and has earflaps and a fold-down forehead visor.

Wool helmet and warm scarf

Face mask

David thinks my face mask looks scary.
Doesn't it appear to be smiling?
There are days outdoors when I would not be smiling without it!

The "Outfit"!

And there you have it--at least from head to knees....

Boots--ESSENTIAL!

But don't forget boots, and they must be lined, waterproof, and warm! 

If head, hands, and feet are warm, you'll be fine.

Options for warmer days

Of course not every winter day is an Arctic day,

and on warmer days a light cap and less bulky mittens will do,

especially in the sun.

Not pictured here are the warm socks or underlayers for body and legs.

The rest of my outdoor kit included 

a folding beach chair (carried in its own case with shoulder strap),

binoculars,

sketchbook,

pen, pencils, eraser, and pencil sharpener.

Cold Medicine

This is the kind of cold medicine I believe in. Real chicken to make a rich broth and lots of garlic in the broth. Onions and carrots. A spring of fresh rosemary. Simmer it all very slowly for hours. Do not boil, or you will turn the broth cloudy.
For dessert, fresh oranges and hot tea with honey.

Has My Mind Been Blank Lately?

Comfort in Trees

Word came last night of the son of friends, dead at age 27. We could not take it in. We recalled the boy as an infant and a toddler, his first birthday, friends cheering as he crossed the room with lurching baby steps and a big grin. “If he falls down, will he cry?” I asked. Our friend, answered, “He never falls. We always catch him.” David speaks on the phone with his old friend. The parents are stunned, hardly yet comprehending. Will they ever? How can anyone?

At three a.m. I wake in the dark, the place where death and loss begin to take shape. I remember this from other times and know that what I feel is the palest reflection of the pain that stabs our friends. As they come out of numbness, their minds will begin to thrash about the cell of grief, seeking escape. 

Two things come to me--and this is only for me, not a recommendation: First, images of trees, both outdoors, in the snow, and on the pages of the drawing books I pored over before going to bed. Dead or alive, trees do not try to explain anything: they simply are. Ritual words and words of wisdom come, too, but not as explanation—only as formulae, to be chanted silently over and over.

 ...Sancta Maria, ora pro nobis.

The Tao that can be told is not the eternal Tao....

These phrases repeat themselves over and over in my head, a disjointed litany spoken against the branches of trees.