Health Care--Again

In my native country of France, a nation not known for its humility and often unaccepting of reality, the cost of maintaining the average citizen's health is completely covered from birth to death. When my mother died there 17 years ago following a lengthy bout with cancer, the family never saw the bills. They were automatically sent to the state insurance monopoly and paid off. This health system, costly as it may be, is so deeply ingrained in the French psyche that no politician would dare touch it. Soon there will be changes, however, as medical costs rise, but the essence of the coverage--which is very much like Medicaid without the age restrictions--will endure. In most of Europe, the right to the pursuit of happiness includes, as it should, the right to a healthy life without worry of the costs such a life implies.

In the U.S., my adopted country, I pay $770 a month to what is reputedly the best HMO in the East coast. This entitles me to make appointments with a number of specialists, for which I will bear a copay of $30 to $50 per visit. Should I be prescribed meds, I will pay for those as well. My health care runs to roughly $10,000 a year if I am healthy, which, by and large, I am. My most significant procedures with this HMO were two colonoscopies within five years. According to the American Cancer Society, these would cost me an average of $3081 apiece were I not insured.

My HMO is great. It's blocks away from where I live, and my main physician is a delightful woman who truly seems to care for her patients, answers emailed questions, and takes the time to explain what I have and what can be done. Truthfully, I have never had a bad experience there.

But still. Ten thousand dollars is a hell of a lot of money.

Here's the other side. I have a very good friend, a woman I've known for years. She is a single mother whose children live with their father to whom she makes monthly child-care payments. She has no car, uses public transport to get to two low-paying jobs. She cannot afford insurance. Since neither company that employs her will hire her full-time (they don't want to bear the insurance costs either), she has had to rely on the county welfare system for medical care.

Mind you, we're talking about Fairfax County, Virginia, one of the wealthiest areas in the nation. It took her two months to get an appointment for a physical, and that appointment is slated for mid-November. Should anything be seriously wrong with her, she has few choices: a hospital emergency room which may or may not treat her, a doc-in-a-box storefront that may prescribe meds but is more likely to tell her to go to a hospital, or a county clinic where she will stand in line starting at 6 a.m. and, with luck, be seen by a doctor sometimes in the late afternoon. Or be sent home and told to come again the next day.

There's something distinctly wrong with this scenario here in the land of the free.

Here's my concern. The entire health care debate is nonsensical. As it presently stands, there are far too many players with vested interests to allow any resolution. The drug and insurance companies, the AMA, the hospitals, doctors, Congress, and a host of other parties are more than enough to block any efforts to insure the common citizen. What is likely to happen in the next few months is a lowest common denominator consensus that will not serve the people. If anything can be done, it will have to start with a willingness to scrap a system that does not work, and painfully build a new one. This is not the American way. We are the land of instant results and quick gratification; we are more likely to accept a flawed outcome than have the patience to forge something fair, workable, equitable.

Lets not do that. For once, let us hold our elected officials and representatives responsible for acting for the common good. Lets force them to behave in a manner that will show we care more for the people than we do for the corporations. Lets try to understand that it is not the wealth of a nation that makes it great. It is its health.

Regrets (I've Had a Few)

But on the other hand, there are some things I don't regret at all. To wit: In 1981, an acquaintance whom I'll call Binky had recently inherited a sailboat and proposed that I and my girlfriend at the time help him smuggle 800 pounds of top-notch marijuana into Miami. He had it all figured out. There was a seller in the Bahamas offering an excellent price. He had the sailboat and knew how to handle it. My girlfriend was also an experienced boater. He had even secured a cache of guns in case we were attacked by pirates or intercepted by the Coast Guard. The payoff would be $25,000 apiece--not a bad sum in the early 80s--which could, if we were interested, secure future, larger purchases. The likelihood of success, according to Binky, was 99.9 percent.

My gf and I talked it over. I was recently divorced, flat broke, unemployed. She thought it was a worthwhile idea. I did not. In the end, after much argument during which I was called all sorts of inelegant names, I persuaded her that we should pass on this golden opportunity.

Within a month Binky found two other partners and I drove to Annapolis to see him off. On the dock where his boat was moored, he hugged me and, grinning, called me a pussy. Three weeks later, the stripped and bullet-ridden hull of his boat was found off the coast of Ft. Lauderdale. Neither Binky nor his partners in crime were seen or heard from again.

Now it's possible that this was all staged and that today Binky is drinking Pina Coladas on a beach somewhere, surrounded by half-naked women, but I don't think so. I'd have heard from him, if only so he could gloat and propose another project. No. I'm pretty sure Binky bought it. So this is an adventure I do not regret not having participated in.

I do regret having to sell stuff prematurely because the economy blows and I need money. I've sold a car, guitars, amps, real estate, a lot of stuff I thought I really needed but didn't. And this brings up an interesting conundrum.

A regret encompasses a feeling sadness about something, a sense of loss and longing for what is not--or soon will no longer be--there. Right now, I am balancing regret against peace of mind. I will miss the use of what I've had to sell, but the money gained will allow me to sleep at night without a panicked awakening in the wee hours. I remain angry at the situation, still feel that the people I trusted with my savings were not worthy of that trust, but I have to accept that by and large, the fault was mine. Had I paid more attention to economic trends, had I questioned the monthly financial statements rather than accept them blindly, I would not be in this situation. I was lazy, like millions of people who have suffered economically a lot more than I have. In a way, I opted to have others lead my financial life for me, and that was a mistake not to be repeated.

My mother, when she was alive, wrote every expense in a large brown ledger. Rent, mortgages, the price of a dozen egg, a sheet of stamps, getting her shoes resoled, a dinner at the local restaurant, all were entered in her high cursive hand. To the best of my knowledge, she never actually did anything with these figures--they were just there, reassuring her that money was available to do the basic things.

I tried the modern version--Quickbook--and was a dismal failure. But maybe I'll try again. My mother was right about a few things in life, and perhaps this was one of them.

Denims

In the past three months, I have thrown away two pairs of jeans. There is something very odd about discarding denims; they're personal, a reflection of one's self and of one's perceived social standing. New or used, they range in price from a few dollars to a small fortune and many people will wear them until they--the jeans--disintegrate.

I don't. I am long past the age where I need to make a denim-related statement and I've frankly never understood where the fashion of torn, ripped, threadbare dungarees originates. Nor, frankly, do I care.

But I am fascinated by the fact that world-wide, with the possible exception of Africa, denims are considered acceptable street-wear. I could find no number on annual jeans sales worldwide, but I'd be willing to bet it's in the hundreds of millions.

According to Wikipedia denim is "a rugged, cotton twill textile, in which the weft passes under two (twi- "double") or more warp fibers. This produces the familiar diagonal ribbing identifiable on the reverse of the fabric, which distinguishes denim from cotton duck. Denim has been in American usage since the late eighteenth century.The word comes from the name of a sturdy fabric called serge, originally made in Nimes, France, by the Andre family. Originally called serge de Nimes, the name was soon shortened to denim. Denim was traditionally colored blue with indigo dye to make blue "jeans," though "jean" then denoted a different, lighter cotton textile; the contemporary use of jean comes from the French word for Genoa, Italy (Gênes), where the first denim trousers were made.

"A similarly woven traditional American cotton textile is the diagonal warp-striped hickory cloth that was once associated with railroadmen's overalls, in which blue or black contrasting with undyed white threads form the woven pattern. Hickory cloth was characterized as being as rugged as hickory wood—not to mention the fact that it was deemed to be worn mainly by "hicks"—although neither may be the origin of that term [from a nickname for "Richard"]. Records of a group of New Yorkers headed for the California gold fields in 1849 show that they took along four "hickory shirts" apiece. Hickory cloth would later furnish the material for some "fatigue" pantaloons and shirts in the American Civil War."

Why do we so love our jeans? I know some people--men and women--who have more than twenty pairs. How do we equate something everyone wears with individuality? It makes no sense, yet there's no doubt that every jeans wearer will attest that the jeans he is wearing are his and no one else's. There are jeans for tiny babies and jeans for the morbidly obese. Rodeo cowboys and movie stars wear them, as do socialites and working moms. At one point, jeans were a standard trading commodity in Eastern Europe and the Soviet bloc, and I remember being in Spain in the early 70s and getting a better than average guitar for two pairs of Levys.

Here's something else: everyone knows a pair of bad jeans at first glance. They're too blue, and the stitching is too yellow. Bad jeans worn at school attract bullies and derision; a bad jeans wearer knows it, and his stride reflects the knowledge. No one struts in bad jeans, and bad jeans can never, ever, become good jeans.

So throwing them away is hard. I tried to make rags out of a worn-out pairs years ago but for some reason, jeans make poor dust cloths. Maybe, like worn out flags, dead jeans should be burned with quiet ceremony. Ashes to ashes, jeans to dust.

Nineleven

Eight years ago when the madmen struck, I was working as a counselor in a suburban methadone clinic. It was a bad job in a drab place stuck between a warehouse and an animal shelter. I would get there shortly after 5 a.m. to open up, and already the addicts, recovering or not, were queud up and waiting for their daily doses. The dispensing nurse generally arrived at the same time and we would take our respective stations, me behind an inch-thick plate of bulletproof glass, she farther down the hall organizing the tiny cups orange juice and methadone phials.

I took in the money--soiled ones and fives--through an opening in the glass, then buzzed the patients through. I was a dealer, not a counselor because really, there was no counseling. Most of the clinic's clients had been on methadone for years and they had lives, jobs, families. They didn't need to listen to me pontificate about the evils of drugs. They knew they'd get a random urine test, and that if they showed positive for any drug other than meth, they'd lose privileges. Some tested clean, many tested dirty.

When the Islamic madmen struck, I was on break in the TV room with some clients and saw the second plane hit the towers. There was as a stunned silence, followed by, "Man, that's gonna fuck up the dope prices..." This from Billy, a Vietnam vet who once in a while vanished from view only to reappear a month later looking much the worse for wear and with fresh tracks on his arms.

Nineleven is now taught in schools, it is etched in the national memory next to the Kennedy assassination, it has marked this country in ways both obvious and not. Some would call it a pivotal event, a mini Vietnam that firmly established a painful reality: the US was not invincible, indeed, was by its inviting nature an easy, plump target. The repercussions, obviously, are still being felt. Nineleven launched wars, cost many more lives than those lost in New York, Pennsylvania and Washington, made us aware for perhaps the first time that vulnerability is not just a word, it is a state of mind, because in many ways, the nation has so changed that the madmen have won. Travel, economics, family life, political philosophy, warfare, all have been affected, generally not for the better.

There are still three things about nineleven I do not understand.

• Why have our good and wealthy friends the Saudis not given us bin Laden and his crew? The House of Saud is rich beyond description and has contacts throughout the Middle East; it is impossible to believe they didn't know something was up--most of the madmen were Saudis--and bin Laden comes from a wealthy and influential Saudi family. By now he should have been delivered, gift-wrapped, to the White House.
• Why, with hundreds of millions spent annually on intelligence, didn't we know about this? Where were the CIA, the DIA, military intelligence and all the other experts whose jobs it was to protect the nation? Have we been so hampered by legislation that our intelligence people can't do their work anymore? Or is intelligence gathering a lost art...
• How does taking my shoes off at airport security make us less susceptible to attack?

Of course, it may be our own ineptitude that got us into this mess. Just this morning, all the news in Washington was about a Coast Guard intervention of three terrorist ships on the Potomac, near where President Obama addressed the Pentagon to mark the anniversary of the attack. Shots, we were told, had been fired, and the news teams scrambled for more info. The Secret Service was mobilized, the Homeland Security folks were on war footing. Turned out it was a Coast Guard training exercise, and apparently the people who should have been notified were not. This is not good. It does not make me feel safer here in the land of the free to realize that the right hand (the Department of Defense, the White House, the information people) did not know what the left hand (the Coast Guard, which is now part of Homeland Security) was doing...

Oh, I forgot to mention. Billy at the methadone clinic was right. Immediately after nineleven, the price of heroin tripled in Baltimore and Northeast Washington. So yeah, the terrorists really did affect us all.

Jean Octave Sagnier

My father, Jean Octave Sagnier, died on this date 13 years ago. He was a good wise man who without being secretive hated talking about himself. He was an architectural student working as the traveling secretary of a wealthy Brit when the war broke out and he walked from the south of France to St. Malo in Brittany, then hopped a boat to England so he could join the upstart general Charles de Gaulle and become a Free French. De Gaulle assigned him a mobile radio station which roamed occupied France and relayed Allied news to the maquis and other underground forces. He never fired a shot during the war but was nevertheless awarded the Légion d'Honneur, France's highest honor, for deeds that I do not know.

He met my mother in the summer of 1945 in Marseilles. She was Free French too and they conceived me that very night in the back of a US Army truck.

He was estranged from his family. I would be an adult before I was told I had uncles and an alcoholic aunt who died of the disease in the UK. He lost a younger brother during the V2 bombings of London. He never, as I recall, mentioned his own mother. I have an aged family photo taken in the 20s, three boys and a girl posing with a man and a woman standing at attention. A much later shot shows a painfully thin young man wearing boxing gloves and looking not at all ready to fight.

It was snowing when I was born in the American Hospital in Paris, and the barely liberated capital was devoid of food. Regardless, my mother craved a ham omelet. My father, using the military issue Colt he had never fired, forced the hospital cook at gunpoint to go into his own larder for eggs, butter and meat. He fixed the omelet himself, ate it, made another and served it to her. She complained it wasn't hot enough, and that would be the tenet of their relationship. They were married 46 years, nursing each other through poverty, joblessness, an eventual move to the US, cancer.

He died five years after my mother. I carried his ashes in an oak box from the US to France, and when I went through customs the douaniers were very curious as to what I was cradling in my arms. One soldier took the box, shook it. It rattled as if there were pebbles inside. When I told him he was manhandling my father's remains, he turned sheet-white, handed the box to his superior officer who in turn gave it back to me. I said these were the ashes of a Free French and the man saluted.

He was not a natural father. The growing up and education of a son baffled him. He was unlikely to give advice, did so only at my mother's prompting. He taught by doing, showing, and patience. We never played catch, never went fishing together, did not bond in the accepted way. There were few family vacations, a limited number of father/son experiences shared. He was a good and quiet man who witnessed and took part in moments of history that are now almost forgotten.

He told two jokes, neither particularly well, but each retelling brought tears to his eyes. He died a bad death and I hope he didn't suffer and I think of him every day.

Time!!

Lately I have happened upon the advantage of timers. I go to a 12-step meeting that has discovered the best way to stop people from being windbags is to give them a limited number of minutes to talk. Three minutes seems to be the norm, after which the timer begins to beep and the speaker has a few extra seconds to wind things up.

It's wonderful! No more endless shares about ungrateful daughters, dyslexic parents or abusive siblings. Three minutes! Ding! Next! And so I am considering using a timer for everything. Because the truth is that any action performed for more than three minutes--with the possible exception of running a marathon or playing putt putt golf--is excessive. No one should be made to stand in line for more than three minutes, and have you ever seen someone speak for that length of time without repetition or saying "you know?" at least 87 times. Eating for three minutes and then stopping will undoubtedly be good for your health. Boxing rounds are three minutes. Good pop songs are less than three minutes, as are all six-word novels (go to http://www.wired.com/wired/archive/14.11/sixwords.html for examples.)

A timer guarantees that everyone who wants a say has one; it is the ultimate equalizer. Should there be a sizable contingent that needs more than three minutes, let those people form speakers' clubs where they can practice their oratorical skills and bore each other to death.

And it works for sex, too. After three minutes, you should stop whatever it is you're doing with your partner, compliment him/her on their lovemaking, maybe brew an espresso, eat a lo-cal cookie, take a breather. Talk about the weather, the kids, tomorrow's dinner plans. Then resume.

Ding! OK. Time's up.

Mind and Matter

OK, here's something I've been pondering for awhile--nothing too deep, and I'm certain there will not be an original thought there, but here goes.

Rene Descartes, the French mathematician, scientist and philosopher, was arguably the first major philosopher in the modern era to make a serious effort to defeat skepticism. His views about knowledge and certainty, as well as those about the relationship between mind and body have been a major influence since the 17th Century.

He originally came up with cogito ergo sum, "I think, therefore I am," and the world, philosophically, has not been the same since.

The simple meaning of the phrase is that if someone is wondering whether or not they exist, that in and of itself is proof that they do exist (because, at the very least, there is an "I" who is doing the thinking). This theory indirectly postulates another imperative: "Know thyself." That, in turn, implies uniqueness exists among people and that man, as a species and as an individual, is a rational animal with a mind that is not explainable mechanically. There are vagaries, lacuna, and not two association of ideas are ever the same. For example, although I can understand objectively the workings of your mind, I only do so by comparing it to the workings of mine. I come to the conclusion that you are unique not because of what you are thinking, but because of the way you are thinking it, the manner in which you reached a conclusion.

But that doesn't really cut it. We also know that many things incapable of thinking do in fact exist, and that there is no necessity of having an "I" concept to be sentient. Artificial intelligence is on the verge of bringing us sentient beings--computers and robots--who may very well have an "I" concept, but this would seem to oppose the idea that minds are not mechanical. Being an insecure race with a fast trigger-finger, we've assumed from the very beginning that robots and self-aware computers would mirror our own darkness and be inherently sinful and flawed, evil entities bent on taking over the world. The writer Isaac Asimov who in the 40s came up with the Three Laws of Robotics did so as a literary device at first but now these rules taken very seriously. They are:

1. A robot may not injure a human being or, through inaction, allow a human being to come to harm.

2. A robot must obey orders given it by human beings except where such orders would conflict with the First Law.

3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Law.

So now we're safe. Descartes would have been proud. Of course there is no way to program such logic with utmost certainty. If we do indeed develop sentient computers, it's likely that the first thing they will do will be rewrite their own programs. That'll be fun.

So OK, I have managed to confuse myself. But that's all right, I majored in philosophy and an occasional relapse onto philosophical mind play is allowed. I'll try to make more sense tomorrow.