Massachusetts

Massachusetts! Yes, Massachusetts gave you Scott Brown to defeat Obamacare, President Obama, Harry Reid, et al. It was a clear indicator from a state often called “the bluest of blue” (which I might contest) that people Did Not Want the so-called “Affordable” Care Act.

Instead of “passing” the law as was, in a manner that at least bordered on fraudulent, don’t you wish now, Dems, that you had gone for that “oh man, we BARELY lost by ONE vote, maybe next time” loss?

Massachusetts Did Not Want the law passed, enough to muster the people’s votes against it then. Massachusetts! And you blew it.

Better Than The Nolan Chart

My first thought was that this makes glaring the limited difference between typical republicans (conservatives) and typical democrats (liberals).

SocialStructures

This is from Liberty’s Torch.

My second thoughts involved the naming of the categories, and volunteerism being much less scary-sounding than anarchism, which is what the only truly safe section is. Minarchism may not sound less scary than libertarianism, which is what that part of the chart describes, in strict, traditional terms. Since “classical liberal” is a term I learned meant “libertarian,” I am intrigued by having that matched with “paleo-conservatism,” the next step up, and… mmm… acceptable. I always figure that it matters first what you choose to have government do, then, having decided, doing it right. Towns will run schools? OK, let’s not make them money sinks that do a lousy job, and for goodness sake let’s not let the federal government take de facto control. That kind of thing.

I’m glad the next loop up is modified with “modern,” because it is so not conservatism. Except now it is. Deb sat down as I was working on this and we talked about the names and categories. I came to libertarianism in the seventies, and was heavy into it into the eighties. I learned it as what’s called minarchism here, as I noted. She learned it, later, as what’s called paleo-conservatism here. I learned that as more of a next level, just as shown, where you can’t quite get everyone to agree that, really, these things can be done at least as effectively by the market or private cooperation.

And there’s another thing. It seems to me that this looks at any and all activities at any and all levels of government. In my town, we have a classic example of volunteerism/anarchism, whereby the community runs a gas and electric utility, to benefit the community and keep it tight to the people it serves. Local action. So when we talk roads, are we talking that, yeah, way more efficient for the community to build and maintain them, while maybe a highway that goes long distances and has controlled access, yeah, that could work better or as well done as a privately built road you pay to use.

Which is really just a step up from that decision to assign the right to use force on behalf of everyone to a government entity. Trouble is, another thought I had right away, it’s the very fact you are giving government that power to use force on your behalf that makes it easy for it to use power to coerce you. The idea is projecting it outward. It’s so easy to turn it inward.

And arguably the dangerous transition point is that fifth item up: education. Once the government can not on coerce, but control what is learned, influence attitudes from the beginning, power is well entrenched. Which is why education cannot be controlled by higher levels, but must remain controlled by lower levels of government or community, or be in the hands of the people, or be privately operated and paid.

Entitlement

I’ve been thinking about entitlement as a personal and moral trait that can overlap political beliefs, and relate to the government plural of the same word.

Whether you have been raised to it or come to it otherwise, a strong enough sense of entitlement without moral brakes on it can lead you to steal, which is really just a direct form of seeing that money not yours is spent to your benefit. It can lead you to something like insurance fraud, where you feel entitled to take the insurer for enough money not merely to repair insured damage to your house, but also to rebuild it extensively, shiny and like new. It can make you the person who is demanding beyond all reason at a retailer, or who gives the pharmacy hell for the limits of your prescription coverage that they can’t control. It can make you the person who has an unrealistic concept of what Social Security and Medicare are/should be, and of how far the money you paid in actually extends, even if you are logical and not otherwise mathematically impaired.

You see this as a generality in generations, like the Lucky Few, even when individually they might have political leanings ostensibly disparaging of “entitlements.” I had not been aware there was indeed a distinction until recently, despite it seeming like there was a gap before the Boomers. You see it more specifically in families or how people are raised, and in social classes. A sufficiently strong sense of entitlement is a lopsided thing, where you see only that you want, you deserve, you need. You don’t see where the money is coming from, who you are affecting, or even ethical, legal or philosophical ramifications. Come to think of it, it’s the extreme opposite of feeling entitled to nothing via a low self-esteem or “dog that’s been beat too much” problem, but that strikes me as a digression into another topic.

A gentler form of it is indeed strongly optimistic expectations. Of course you can get a job at the proverbial IBM and retire comfortably after thirty years! Isn’t that what everyone does? Sorry, Lucky Few, it’s 2013. Or 1980, as the case may be.

Anyway, where I am going with this is to cross it over to political leanings or expectations. It seems to me that the same outlook could give make your overriding conviction to be milking the system for what you want for you and yours, without regard or even awareness of consequences or costs. Just as you can ruin your life if you let an inhibition-free sense of entitlement veer into illegal ground, you can ruin the country by voting or promulgating institutionalized theft. There are times when the overhead of entitlement can be absorbed for an extended or even indefinite time. For instance, unionized industries that add cost out of proportion to value. There are times when the party ends. Real estate won’t always go up and up artificially. You were never entitled to an automatic windfall. Government won’t always be able to pay benefits it does now. Not even pensions, if the money wasn’t actually put aside and kept safe and actuarially appropriate.

You are not entitled to whatever you want, any way you can get it. There isn’t an endless trough. It has to come from somewhere. If you’re not creating value for value, if you just want it so you should get it, you’re doing it wrong.

Talking About Basic Nonsense

The often sensible if excessively socially conservative John Hawkins has a bizarre piece at Townhall.com that I just can’t resist going through. It’s long, twenty points, and that may be part of its problem. When you’re trying to come up with that much in the face of a deadline…

(Update: I will update this when I have a chance, to show the gist of each original point, so it will not be imperative to read the original to make sense of this. OK, paraphrase, condensed version or copy of point being addressed is indented above each numbered response.)

People who wish to change sexes should see a shrink. Apparently rather than being allowed to, on a reread of the source.

1. People who wish to change genders were not, last I knew, allowed to do so without the advice of a psychologist. That doesn’t mean it’s good advice. That doesn’t mean there isn’t an industry of enablers, as might also be the case with convincing people they have conditions that allow them not to work, or never to grow up, or to live as professionally needful whiners. “OMG I am crazy and always wanted to be a girl” is no excuse for not having a life and taking some responsibility. Nor is it anyone’s business if you want to invert or extend your parts, even if you will never look feminine, or masculine, so long as you are not a societal leech. You have the right to do it. Others have the right to mock it. Nobody but you has any obligation to pay for it, or your general support.

“Most people who remain poor over the long haul in America stay that way because of their own poor life choices.”

2. That sounds like something one of the Lucky Few Generation might believe, having hit everything just right. It sure helps to make good decisions, but conservatives who dismiss timing and luck as factors and are holier than thou just come acorss as low-credibility cretins. It also helps to learn the skills and principles associated with success and good decisions, which makes parenting a rather overlooked factor.

“Most black Americans are good and decent people, but percentage wise there are more black Americans in jail because percentage wise, black Americans commit a lot more crimes than white Americans.”

3. Maybe. Or maybe the pointless drug war goes after them disproportionately. Driving while black? How about toking while black. In any event, most blacks are good and decent people, some of the best, so no disagreement there. It is unfortunate that the fascist left since FDR has used them as a permanent underclass to gain and maintain power, though I perceive that to be eroding. For that matter, referring back to item 2, poor is the new black.

“As often as not in America, the people claiming to be “victims” are the real bullies and they don’t deserve anyone’s sympathy.”

4. No real comment here, since it only purports to be common, not absolute, and strikes me as true enough. There is an element of bludgeoning the rest of us with need, with a claim to being maligned if the sense of entitlement is denied.

Politicians are shameless liars because people vote what they want to hear, not truths.

5. An actual truth, as I perceive it, though given enough chance and impetus, voters might just surprise you.

We owe less to illegal aliens even than to foreign nationals, because they broke the law.

6. Essentially correct, if you operate on the basis of closed borders, and even if you subscribe to the “two hands, one mouth” theory of what immigrants, legal or not, bring. Since Mexico has an economy and we don’t, these days, it’s less of an issue, and it’s not an inverse issue, since Americans are less inclined to leave their family and walk a thousand miles in search of work most people wouldn’t want to do, out of desparation. Or they could stay home and make good life choices!

“Life begins at conception and having an abortion is no morally different than strangling your baby in the crib.”

7. Do we really want to go there? Having kids made me both more willing to accept abortion, and more appreciative of the little parasites developing to the point of intelligence and personality at some point while still in the womb. Until they are viably separate enough to be raised by someone not the biological mother, though, they are indeed parasites, and about as welcome as illegal aliens are to some folks.

“Most liberals aren’t patriotic and they don’t love their country.”

8. Maybe. Not all, but I certainly know some. Yet they would be first to have the schools use instilled patriotism as doublespeak indoctrination and a mind control tool. (Added thoughts…) It is far more important to love freedom than a given country. The same might be said of hardcore libertarians, who are loyal to positive principles more than to place or political status quo.

Avoid civilian casualties but ultimately lives of our soldiers rank higher.

9. Damn straight. Except we should not be involved in conflicts that make civilian foreign casualties a factor without incredibly good reason, none of which currently exist, even if they did in the last dozen years.

Ignorant, ill-informed rabble shouldn’t vote.

10. Arguably, perhaps, but the same sort of class superiority that makes you look down on the poor, and gives you more in common with the left than with real people. This statement is up there with “if you didn’t vote, you lost the right to complain,” which is one of the most shallowly ignorant sentiments I’ve seen. It never fails to make me see red. So are you going to be the one to decide, Mr. Dictator-in-Waiting? That’s where the sentiment leads.

“The only practical way to make peace between the Israelis and Palestinians is for the Israelis to transfer the Palestinians and take their land.”

11. Ah, Israel. Land that leftist American Jews refuse to support, at least as indicated by voting patterns, if not universally otherwise. Israel, and its annexed lands that the owning countries gave up on and didn’t want the residents back from. The ones who are Jordanians or whatever, but call themselves “Palestinians.” Yeah, keep the land. Evict the people. Even though Arabs live peacefully in Israel proper, and it’s probably the best place for them to be in the greater Middle East and Persia. A friend once told me, probably about 1978, that the solution would be for Israel to become an American state. Never happen, but amusing idea that’s never lost its charm for me.

This is a christian nation dammit!

12. This is a nation of religious freedom and open arms, which has something of a Judeo-Christian tone without being overtly religious. I wouldn’t say that makes it a “Christian nation” with “Christian principles.” I consider those who keep harping otherwise to be somewhere between looney and dangerous. Nor is the presence of “in God we trust” or a national Christmas tree worthy of concern to your average atheist, agnositic or pagan. Especially the latter to the latter, since it’s pagan borrowing.

“Men are just generally better at some things than women, just as women are just generally better at some things than men are.”

13. The most accurate thing yet. Men and women. We are not the same. Nobody is saying women should stay barefoot and pregnant, simply by observing reality. Duh.

Racism was once big deal, now a tool of phonies et al.

14. Another accurate item! “Racism” of late has become a cudgel, even as it’s fading away to nothing in reality.

“Long term, the only way our country can pay its bills is by asking everyone who’s not dirt poor to pay as much in taxes to the government as they’re given in services if they want to continue to receive those services.”

15. And hey, why not make the dirt poor pay and pay too, since that’ll teach ‘em not to make bad decisions. But seriously, this is too brief to be analyzed well, though it’s on the right track. Except… at this point, even that is not going to be enough to pay the bills, assuming we’re not talking about repudiating some or all the national debt that cannot ever be repaid without an explosion of productivity and fiscal sanity. Which, yes, would include people paying for services or not getting them. The more of them privately provided and not within the government sphere at all, the better.

Mother and father better at raising children than singles, gradparents or gay parents.

16. Two parental units are always better than one, unless that “village” is awfully responsive, and not too busy helping with someone else’s much older kids who are far more able to take care of themselves than yours. But… they can’t be gay parents? Seriously? Are you a fucktard? An asshat? Or grandparents?! What’s this, ageism? Does this apply to parents who are old enough to be grandparents? Why mess with the point of “single parents have it harder and are less likely to have great results” by bringing in extraneous prejudices?

Boy Scouts can’t survuve gay scoutmasters because lust trumps all, gay male to young male just as straight to young female.

17. But it’s OK to have a lesbian Girl Scout leader alone with your daughter? I know! Let’s make all Boy Scout leaders lesbians, and all Girl Scout leaders gay men. Problem solved! Or we could try our best simply to have responsible, trustworthy adults who are good examples and would protect and defend but never harm their charges. Naw, never work.

Homeless = mentally ill. Contain or help them in spite of themselves.

18. I missed this one on my original reading, perhaps because my head was spinning with WTF by this point. Not actually out of line, since the homeless problem originated with Reagan’s well-intentioned reduction of the former system for handling the mentally ill. On the other hand, where do we stop with the involuntary “help,” and ho decides “mentally ill”? Didn’t the Soviets used to lock up their “mentally ill”? When I was a kid, this was the stuff of nightmares for me.

“If you have good character, you should feel ashamed of taking food stamps, taking welfare, or being on a school lunch program.”

19. I daresay most people are, but it’s bad when that deters you from bothering at all. Further, what is meant by “school lunch program”? In our town, school lunches are $2.50 and do not serve $2.50 worth of food, and yet it has always been my understanding that even this is subsidized, which is why the feds exert so much control over it and have made it so kids throw so much away as unpalatable. If you are poor for your family size, actually the same guideline as SNAP (food stamps), school lunch is 40 cents, while milk alone is 50 cents either way. That is actually a worthwhile discount, since it costs us somewhat more than that to make a lunch. However, we make lunches half or more of the time, since so much of it is food the kids won’t eat, or can’t due to allergies. As far as I have ever been able to determine, free lunch only goes to kids whose parents are on food stamps. Ironic, since we would qualify, and could use the little bit it would provide, but I gave up on applying after the local food stamp office blacklisted me for rudely expecting them to respond to a renewal application after the one year we received benefits. Luckily, the year we most needed it. Of course, we probably made bad decisions that made us poor, which probably means we have bad character, so why would we have any shame? Glad you feel so superior.

Most immigrants should be well-educated Europeans, not losers from rest of world.

20. Racist! Well, maybe not, but think about it… doesn’t that sound like it? Except it’s not that so much as classism, which has been what much of the list was about.

Mental Health “Reforms”

This is exactly the problem, and it’s a rare thing that could be better with government intervention at various levels… and/or by eliminating negative government intervention. You can’t shut down a set of existing services and institutions without adequately replacing them. Lack of insurance coverage for mental health is also problematic, especially given how much we expect “insurance” to do and cover.

Insurance Games

I work at a large company that provides a health insurance benefit for part time employees who have worked there over 1000 hours, or about a year. We’re drawing toward the end of the second year of that.

There are two plans. Let’s say that one costs $10 a month and has pathetic coverage, a catastrophic plan that is marginal until you have been personally responsible for $5250, after which it pays everything that it covers. That’s over 1/3 of my gross income there, and could easily be half of someone’s income, depending on location and seniority. That’s equivalent to an out of pocket maximum closer to $25,000 on the income I’d need in order to be out the other side of the donut hole. I am up over $3000 of that so far this year. That’s a lot of years of making sure the providers get at least $10 a month to avoid having it sent to collections.

The other plan, which I was on last year, costs five times as much, and covers much more. That year, I only saw a doctor a few times, and for whatever reason I never saw a bill. I’m pretty sure I should have seen bills for a portion of each office visit. I was supposed to have been on the same plan, but the company defaults your choice to the bottom plan, and in a tricksy accident I was not allowed to select the one I wanted. You know that’s a guarantee I’d actually need the coverage for that year. In six more days, I will get to select again, which is a relief.

I am also covered, into the beginning of next year, by the part of RomneyCare called Health Safety Net, which is backstop coverage for people who are poor, but not so poor, and have crappy insurance that they can’t actually afford to use but that satisfies the mandate. I had thought that covered all the things, and that was why I never saw one bill from the doctor last year. However, it covers stuff at hospitals and “community health centers” (what are those? where? who designates them? couldn’t tell you!), but not at regular practices. That would encourage one to hit the ER for something relatively mundane, which makes no sense, given the alleged overuse of ERs by poor people was the driving force behind RomneyCare. I have never done that in my life, and it would never occur to me, unless I had an emergency. The practice I use has after-hours urgent care that’s pretty easy to get into, and they have people on-call for emergency visits. Usually seeing a nurse practitioner, but no need for more for most things. Heck, when middle child broke her arm, we went there, not ER. NP saw her and then our family doctor, who is her boss, stepped in to help put on a cast. We didn’t even have to see the orthopedic people.

As an aside, the wife is on separate insurance, through her employer, and the kids are fully covered by RomneyCare, but we pay a monthly premium for that. Not sure how we’d do it if kids were on an employer plan for probably more additional premium than the state charges, but were not as well covered. I know! We’d magically up our income tens of thousands of dollars to get to the other side of the donut hole. Can I digress like a fiend, or what?

Where was I? The point of this was to discuss my EOB (explanation of benefits) for the 34 hours I spent at the hospital, getting a cardiac catheterization that resulted in two stents, followed by time in a room for observation – otherwise I’d have been home same day.

The cath and stent procedure was free as part of a large study I agreed to participate in for the privilege of it being free, and not having to be transferred to another hospital if they found blockage that could be treated with stents. (Bypass would have required transfer, since there is not a full cardiac unit there – thus the study showing the efficacy of hospitals being able to do stents without full cardiac units.) I thought that was cool, and a worthy goal. Cost didn’t matter so much, since RomneyCare would backstop the hospital charges.

On the EOB, there is no indication that anything about the event was “free.” It may be that there is some tiny portion of the charges that is what they actually meant that is not noticeable in its absence. The hospital billed over $60,000 for the 34 hour stay, plus another $2500 for the hospitalist in charge of me for most of that time. Great guy. Chatted with him twice, briefly. He even gave me his cell number in case I needed anything after I got home and couldn’t reach anyone. Even in the middle of the night… call. Except… his number was nowhere on any of the paperwork. Oops.

About $40,000 of the total on the main bill was “physician” charges. Since the hospitalist was covered elsewhere (and the insurance actually covered all but around $400, after discounting it to about $1600 they’d actually cover), that was all for the excellent cardiologist who did the “free” procedure and presumably the anesthesiologist. I expected the retail on the procedure not to be cheap. Specialized room, team of people, special prep and recovery area, special skills and equipment… but, yeah, don’t think so, especially “free.” The room overnight, amazing nurses, meals, whatever… those were apparently around $4000-5000 of the total charges.

Anyway, insurance denied most of it, either not covered or separately billed items already included elsewhere not being allowed. I maybe should have called this “hospital games,” since the culprit here appears to be the hospital, but I suspect this is what they have been trained to do by the government and insurers, as self-defense. If my old business could only have collected 30% of what we billed our clients, our prices would have gone up accordingly, and every scrap of any billable time or expense would have been included. Like when I’d go to four people to solve minor problems in 15 minutes, that was our minimum increment of .25 hours (which was too low), it could instead have been four minimum charges for four incidents, making it 1 hour.

The part they didn’t deny, but discounted deeply, was the physician charges, implying that those are so large because they already incorporate all the supplies, labs, etc. Net result is almost as low an insurance payment for the 60k as for the 2.5k. The other thing they paid is a tiny indigent care surcharge the state collects.

I was pretty amused by the whole thing. I’d never be able to pay my share of it regardless, so as well for them it’s backstopped. But it makes me wonder what they bill RomneyCare now, and what that coverage allows them to get paid for. Is the 60k thing a ploy to get a ton of state money? Or will the state pay only what the insurer left me for a balance? No idea. What should happen is I will either never see a bill from the hospital, or I will remind them of HSN if I do, and will never see anything else about it.

I was opposed to RomneyCare, and can’t believe I am supporting Mitt for President, not that there’s a choice, but with actual enthusiasm. It has been good to us, though. Not that times should have been this rough. I call myself “pragmatic libertarian, because I’d love to see that pure society, but we have to get there from here. You can’t just snap fingers and make it so. You have to backtrack through the bramble maze. People can’t be left in the lurch as if there is and has always been a free market economy. It’s an interesting question, then, how you backtrack to FDR, undo the effects of wage controls that made health insurance a free perk of employment that could differentiate employers, undo the effects of insurance being for maintenance, not “insurance,” and undo the effects of later adding Medicare/caid in part because of the effects of FDR on the market, making matters vastly worse. You can’t just press Ctrl-Z on entrenched policies and their aftermaths. I hope we can make a start, though, before it gets out of hand.

$63>$5

When I got my stents, they put me on Effient, which is now $63 a month for my copay. At the time, we asked why that versus Plavix, which is $5, and the hospital cardiologist thought it possible, even likely, that my regular cardiologist (a funny description for someone I have seen once) would switch after a month of “and we mean it” treatment at the hands of the newer drug. I understand they have slightly different mechanisms, but the main thing is the result.

It’s been a month. Took my last Effient today, and have to get one or the other today, for morning. I am still waiting for a call back from cardiology. She is not in today, so they were leaving my cardio a message. We are so strapped this week, it borders on being not possible to fill the prescription, but not doing so could be deadly. Lovely situation. And one I’ll have to start planning around, so as not to be in it again.

Even if we get that drug this month, it’s a huge hit to the budget if we can’t switch, which is already hundreds a month in the hole. That’s a big kick in the balls, being worse off in real terms than before we increased our income hundreds per month this year, to the point where we are poised at the edge of the donut hole. Get into the donut hole, and suddenly costs are more than what you make extra, between tax effects and loss of income-based benefits of the sort we’d prefer not to need.

Monday

For some reason, typing “Monday” lodged ELO’s The Diary of Horace Wimp in my head. It always felt applicable to me, and oddly still does. Seems to oversimplify things a bit. Even after I managed the key part in an odd sort of way, I failed totally on the ironic “life” part at the end. Anyway, not what the post was about, though it’d do, since the main point was to post something rather than nothing, given stuff I have to do the rest of today.

Monday is the day I put my pills for a week into my AM/PM pill holder. One in the PM, five in the AM to take with food, and there is one that doesn’t go with the rest, which I have to take half an hour before eating. Just to keep things even more exciting. If I were taking the vitamin D supplements I was supposed to and never got around to buying, that’d be one more.

At least Colcrys, for gout attacks like they one I am having and trying to get by without nuking, is three pills and done, within a 24 hour period. Funny for something that’s been known effective since about 550 AD to be $17 for three pills and not covered by the insurance that covers most of the cost of the other drugs.

If I get a chance later today, I’ll go back to reposting old stuff. I’m on a major set of them that all relate, several posts, and with dead links it has been interesting. When done, I’ll post a link collection and updated thoughts, which tie into Obamacare. Since we kind of cut off the old content by moving it, that gets some of the best of it where it’s easier to find anew and adds activity here, which is one of my jobs of the moment.

We have Comcast coming this afternoon – very promptly – because the do it yourself kit to fire up their service so we can cancel Verizon FiOS was not effective given the lack of signal coming through the wire into the building that was last used somewhere over seven years ago. I will be trying to make the place less messy before then. They probably see it all, but it embarrasses me, hard as it is to keep up with three kids, given our reluctance as housekeepers and distraction by other things. I like cleaning best when nobody is home at all, which brings it down to 2-3 days a week and a few hours of a couple others, during some of which I generally need to make up for sleep I don’t get at night. This week should be interesting, because we have a twice per year increase in volume of as much as 100% that is from one company. That’ll mean some days probably starting at 2 AM instead of 3 AM (we’re winging it tomorrow morning because no idea what volume will be the first day), and working as late as 11 AM. Which is possible, now that the kids are all in school! They didn’t like it much when I had to leave by a certain time some days the last couple times this happened. Though it’s still predicated on the spare car continuing to work.

On that note, coffee gone, breakfast finished, pills taken, delays exhausted, time to get on with the day. Shower, laundry while I clean, and of course cleaning. Hoping the cable modem can be setup in the living room and doesn’t have to go in my room, which is hoarder-like and has the cable buried behind furniture in a corner. That also is logistically better, even though the cable modem would be safer in my room. I’ll miss FiOS, but not the $70 a month we will save, and Verizon’s refusal to let us save money by eliminating our phone service and going internet-only, and Verizon’s prices going inexplicably up and up. It’s a great way to thank your long-time customers for their loyalty. Thirteen years, most of it with DSL or FiOS.

It Gets Better

Well, maybe.

I’ve been thinking that barring the coup scenario, and barring total collapse of the worst kind, there will be economic improvement regardless of who is elected.

Heresy! Right?

Maybe not. Look, it will still be relative, and will still vary depending who and on their specific actions or lack thereof, and on Congress, for that matter. However, we’ve been holding our breath, marking time, holding back, perhaps even actively not wanting to contribute to an economy for Obama to pillage or to reflect well by.

After the election, will we really keep marking time for another four years? To that same degree? Perhaps we’ll not act quite the same as we would in a more rational economy (talking relatively here… when was the last time the American economy was truly rational?), but are we really going to hold as much back?

So yeah, barring further meltdown, which is possible, given quantitative easing gone wild, and the pulling aside the curtain of any pretense of sound money, regime uncertainty will be relieved to some degree and things will improve… to some degree. It is entirely possible that the tax cliff will be averted, if Obama wins, since Congress will have no downside to legislating accordingly. Not that that changes the Obamacare taxes, or the law’s overall economic consequences, and not that we won’t have the same cliff looming in another year.

I guess we’ll find out soon enough.

Stents and Blood Pressure Followup

I finally got around to the story of my two cardiac stents, which was not really so short as intended. Now for some followup adventures, since I went to my primary care doctor for the first post-procedure checkup yesterday.

I have a lengthy history of hypertension. I mean, as early as my teens I would get an idle “your blood pressure’s kind of high” from people checking it, but of course those were one-off, no history being tracked, perhaps chalked up to the white coat factor. I’ve actually been medicated for it off and on since 1993, and would have been over a year sooner had I not lost my job before I could go back to the doctor who wanted to treat it once a course of antibiotics for sinus infection had been completed. (Oddly, I remember the doctor’s name despite having seen him just once.) It was super high then, when I weighed about 205 and got a serious daily workout on the job. By comparison, my highest adult weight was about 308 and my lowest, skeletal-looking adult weight was 178. Give or take 5 lbs, 205 was the stable weight I stopped at for years, until I was unemployed for a year and 14 days (which used to sound impressive, before I was un-and under-employed for, at the most charitable measure, 4 years, 8 months, 25 days and counting as we speak), followed by having desk jobs doing tech support. (Least charitable measure? 13 years, 8 months, 10 days, when it comes right down to it.) (I am awfully parenthetical tonight.)

Anyway, I have tended to ditch the drugs when between some combination of jobs, doctors and insurers, or when the side effects of the drugs became too glaringly a problem. The first doctor to treat me started me on beta blockers. While my boss at the job I’d recently gotten hadn’t wanted to hire me in the first place, and the company culture didn’t approve of my 70 mile commute each way – I shoulda been a local, ultimately I floundered because the beta blockers fried my brain and stole my metabolism and motivation. I couldn’t remember or keep track of things, going all absent-minded. It was so bad. I don’t recall just how well my BP was controlled on that first drug, but I seem to recall that he was no more stressed about getting it perfect than the second doctor to treat me, who was happy if it stayed to around 150 over 90-odd. That doctor rejected beta blockers as not right for me. After he left the practice, I lapsed until I needed dentistry that they wouldn’t do with uncontrolled blood pressure. It was disconcerting when dentists starting checking my blood pressure!

Of course, I can’t imagine it helped that I went something like ten years without dentistry, and apparently for years had an infection in the root of a tooth, which was gradually disintegrating and absorbing into my body. But dentistry is a whole other story, apart from two times it forced me to doctors for blood pressure treatment, most recently to my current doctor of about 12 years. Which happens to be how long I’ve been without dental work, except one emergency extraction. I take a lot of Tylenol as dental surrogate, and have no idea where I’ll get the few grand I expect to need for dentistry sooner or (preferably) later.

Anyway, after lapsing from one relatively long-time doctor, eventually I had a brief stint with a younger, more aggressive doctor at the same practice, whose specialty happened to be hypertension. He was curious, as am I, to know a root cause. As I always say, high blood pressure is a symptom, so what it the cause, and can it be fixed? Under that guy, I did 24 hour urine collections, twice to chase ambiguity, and had an MRI of my kidneys to check for pheochromocytoma. Got to see the kindney pictures. Pretty. Nothing foreign there. Not that it’s the only location for pheochromocytoma. Then I lapsed with that one, probably connected with my insurance expiring. After the last full time job I had, which I never expected could be the last I’d ever have, I maintained COBRA coverage for a year, discovering that the main job of the COBRA administrator was to attempt to get rid of you. Or maybe I just walked away, even with insurance still active. I really don’t remember.

I ended up with my current doctor as a result of needing the tooth removed that had the infected root. I spent a couple months on antibiotics before it was pulled, and had to have a doctor and treatment for my blood pressure. When I’d first showed up at the doctor before my current one, it was something like 180/120 and they flipped. Made me stay in the waiting room until the first meds they gave me on the spot made it come down a bit. When I showed at my current doctor, it was 220/140, but he took it a bit more calmly. The most extreme thing he did was an EKG and sending me to cardiology for an exercise stress test. Cardiology refused to do that because it was too high, so they did some sort of sonogram instead. That showed nothing out of the ordinary, no hardening beyond age-appropriate.

Fast forward. This doctor has kept my blood pressure well controlled. I have sometimes been bad, lapsing my prescriptions, or skipping every few days in an effort to feel more normal. Despite hearing the story of me and beta blockers, this doctor gave me beta blockers as one of my three meds. Somehow that fact escaped me until fairly recently, when I let the whole thing lapse and then found that I could turn on a depressed state and frazzle my brain on cue approximately a week after starting the beta blockers. Unfortunately, or perhaps fortunately, given that I am not sure I could have accepted it or would have wanted it after all, I started back on the beta blockers a week before my last interview for a full time job, with my part time employer of now almost four years. I was furious and demanded never to be on a beta blocker again.

The doctor put me on an entirely new set – well, 2 of 3 different – and it had been working well.

Then the chest pain and associated symptoms and the resulting stents.

That meant a complete change of and addition to meds. Turns out, they brought me down to only two blood pressure meds, including the lisinopril 40 I was already taking. No more diuretic. At the same time, they added baby aspirin, statin and blood thinner.

When I went for my checkup yesterday, I was back up to 150/90, from having been well in control before, and at least as low in the hospital. So the doctor consulted with the cardiologist and put me back on chlorthalidone, the diuretic. This also fit with the weight gain I’d been unhappy with. My more recent low was 229, with a lot of time spent hovering in the 230-something range, and more recently 240-245. When I left the hospital, I was at 242, which was actually a drop. Within a few days I was at 260, which is the highest I’ve been in years. Ugh! I dropped to 255, then went back to 260 after a couple days. Bleck! That, the increased BP, and slight indication of fluid in my ankles meant yet another pill, which at least is harmless.

The beta blocker has not seemed to bother me yet. Maybe it won’t, but I won’t count on it. Not sure what I’ll do then, since it’s for life this time. It apparently relaxes the heart. If it seems to make me depressed, I could try a drug relevant to that or anxiety, as I tried once before with unexpected, positive results. Including lowering my blood pressure more dramatically than any other med ever has.

We never did find a root cause for hypertension, but it strikes me like it’s brain chemistry and a fight or flight response, even if we didn’t catch the signs in urine.

While I was at it, I told the doctor about my problem with needing 8-10 Tums a day. The maximum is, I believe, 10. Maalox is currently not being made, or I’d be on that instead. Ranitidine seems to have lost its effectiveness. I reminded him that many years ago, before his time, I’d had an upper GI and gotten to watch reflux in action when I was diagnosed. I was then on Prilosec for a while, when it was expensive, followed by Prevacid when the insurer twisted the doctor’s arm. Both effective, though the latter just wasn’t quite the same. So I added generic Prilosec in prescription strength to my massive set of pills. Since it has to be taken half an hour before a meal, it doesn’t into either the AM or PM slots. The AM ones have to be taken with food. Getting too complicated.

Anyway, I see my doctor again on October 8, and the cardiologist on October 19, then we go from there. One of my meds may change to a lower cost version, for instance, once it’s been over a month since the stents were installed. I hope the blood pressure meds work properly in the new configuration, so we don’t have to keep messing around.

Stents: The Short Form

Since I can’t seem to get written the lengthy version of the post, including on medical adventures more generally this year, I thought I’d put up something brief.

Early in the summer I admitted chest pain and associated symptoms to my doctor. He got me to cardiology for an exercise stress test, even though to him an EKG looked OK. Cardiologist on duty balked at putting me on a treadmill, despite that I essentially work out for a living, introducing a delay while wrangling approval for the medically induced version of the same thing. Due to a suspicious tech, I ended up having a treadmill test anyway, since nobody could figure out why the original cardiologist ever objected. Getting my heart rate up to 140-odd on the treadmill was actually harder work than most anything I’d ever do at work, and it provoked mild chest pain on cue.

The cardiologist, no longer one that happened to be on duty, but my assigned one, grilled me at the followup, poker-faced, before telling me the pictures from the stress test showed that I looked clear. She was uncomfortable with that, due to family history (which I have since learned was worse than I knew) and an oddness in my EKG. First I’d heard of the EKG being off. She wanted me to go for a cardiac catheterization, so they could get a more definite look, even though it was probably fine. An EKG can, after all, just have an inexplicable oddity. He casualness about it was belied by the fact that she’d have had me in the hospital for it the very next day, had I been able.

So I arranged a Friday and Saturday off from work at the best near-future time for them, which turned out to be the week of Labor Day, when I already had Tuesday off for the holiday, and vacation days Wednesday and Thursday for the first days of school for the kids. Funny way to get the whole week off.

Went in that Friday and about noon was finally getting probed, through an artery in my wrist. Had expected they’d have to use the groin, since I am used to blood being hard to draw through my arms, but I guess there’s no comparison.

When they were done, I had two stents and a room being lined up for the night for observation and recovery.

Turns out my two major coronary arteries that everyone has are absolutely clear. That would explain what the stress test pictures saw. I have an extra artery, which was not, and when it branches smaller, it’s worse. There was a spot that was especially clogged that was too small for a stent or bypass, which can be expected to create its own bypass. One of the stents is apparently quite long.

The cardiologist who did the procedure was mystified. I have never come close to being diabetic, despite that family history in places. My blood sugar tests even better than my cholesterol, and reliably so. The pattern of blockage is typical of what a diabetic might have. He was pretty low key, happy I’d already maintained a 65 lb weight loss for a few years, OK with losing as few as 20 more. Apparently he was shocked when I told him of my grandfather’s first heart attack at 55, but then he lived to months shy of 90. Turns out he had another at 60, then had no more heart attacks or strokes until the end. My grandmother on the other side dropped dead of a massive heart attack at 65. What I didn’t know was that she’d been taking nitroglycerin for years before that, when it was all they could do for angina.

Anyway, stayed a night. Great nurses and a cool roommate. Felt fine after the procedure, but they kept me until 7 PM Saturday, suspicious of levels of an enzyme that could mean they’d caused an MI by putting in the stents. I wasn’t supposed to drive or lift more than 10 lbs through Monday. Between that, 3 AM Tuesday being so close to the cutoff, and dizziness from the new suite of drugs, I called the guy in charge of the place on Monday to arrange Tuesday and, if I’d needed it, Wednesday off from work.

It has made a difference. The day before I went in, walking the girls to school gave me chest pain. It no longer does.

The financial impact of the procedure is less bad than it might have been, since I was included as part of a study, no charge, and things done at the hospital are covered by Health Safety Net, so that’ll take care of the way too much my pathetic insurance won’t cover. Since my last medical bill was up over $1000, before the stress test or hospital, that’s good. The prescriptions we bad, big copays, but one was nitro, which won’t be filled routinely. I’m sad to have to be on beta blockers indefinitely, since they fry my brain. Perhaps with oxygen in my blood now, that won’t be as bad. There’s blood thinner and precautionary statins. Oh well.

Followup with my primary tomorrow. That could be interesting.

American Commodus

I love this!

I should really post about the 47% thing, which I saw somewhere corrected anyway, as far as who is not paying taxes and such, and how it’s not entirely a fair characterization. Thing is, Romney is allowed to use hyperbole and oversimplification in a fundraising speech to supporters. How scary does it sound to people who want Obama defeated and have the bucks to contribute, pointing out that there is a base that will automatically vote for him and that it’s large?

In reality, here in Massachusetts there is much disgust and dismay with Obama and ObamaCare among the working poor. If you could sever Boston and Cambridge from the state, I have little doubt Romney would carry Massachusetts. From here on the ground, I see him having a closer shot at it than you might expect. And not because he was much beloved as a governor, or RomneyCare is such a beloved accomplishment, whoever crossed and dotted the details once he’d padded his wannabepresident credentials with a single term.

So let’s get over the 47% thing already. I know that’s not the job of the press. The job of the press is to get Chavez Obama reelected, even if it’s not in their best interests.

School Lunch Madness

On another school-related note, I am not surprised that there is a parody video regarding the worst first lady ever‘s pet school lunch policy. We’ve watched the school lunches go downhill since our second grader started kindergarten, becoming less likely to be eaten. If your kid won’t buy what they’re serving and takes lunch, well, I suppose that’s a form of freedom from nutritional oppression. Not to mention that if you’re paying full price the meals are overpriced. There have been complaints, albeit not universal, that this school year the meals are smaller and kids are coming home hungrier. Our kids get home about 3:45 PM. Some families are eating supper at 4:00 – 4:30 as a defense against the kids being snack locusts (more than normal) when they get home. Ours almost always wanted to snack on arriving home, but it seems a bit more extreme. Not a lot, but I haven’t correlated that to whether they have bought or brought, what and when their snack was, or whether they (allowed in the elementary school but not kindergarten) bought a snack or ice cream (available 2 days a week) in addition to lunch.

When I saw the policy requiring kids to take a fruit or veggie, I had images of trash cans filled with wasted food. Those poor starving kids in China! Er… or wherever, these days.

Random stuff:

Keep in mind that some of these articles/posts have been open in my browser for the last week, so yes, not only am I behind the times but I have no idea where I found some of them. In any case:

More about the Depression. Like the policy suggestions or not, this lays out the landscape pretty neatly. Ugly freaking landscape, though.

George Takei Wonders What Happened To The Republicans Who Are Against Big Government. Excellent question.

I’m relieved to see that cilantro-hate may not be a character flaw after all. ;-)

I want to write more about this later, but I think I would love to have this fellow as my doctor.

I was wondering how long it would be until Gary Johnson’s presence in the race would start to cause some interesting effects.

Again with the Depression.

And lastly, for the moment, I’d just like to point out that I have a serious crush on UfYH. (This may be NSFW depending on your workplace’s tolerance for strong language and/or employees spending hours tumbling through tumblr.)