America's Exceptional Medical Care

Is anybody else getting sick of hearing how America's medical care is the best in the world? Does anyone still believe that it is? Yes to the former means you're paying attention. Yes to the latter means you believe all of the American Exceptionalism lies that are still going around. Don't get me wrong, I love America, and there was a time, within human memory, within my own memory, when America was the most exceptional country in the world. The best! The best by far in almost every category. That time, unfortunately, has passed. America has been overtaken by events. The democracy, the rule of law, the standard of living, and yes, the standard of medical care, have all been overtaken by most of the developed world and quite a bit of the developing world as well.

Here's an example from today's New York Times:

Some guy is mowing his lawn, wearing shorts. He feels a sting of some kind on his right foreleg, front side. When he looks down, he can see the puncture wound. He finishes up the lawn and goes inside to clean up. Before long there's a red area around the puncture. It doesn't hurt, so he puts on some Neosporin and forgets about it.

After a couple of days, it does start to hurt, and the red area is larger. Guy goes to “the doctor,” which today is some kind of clinic or “medical center” or something. Something corporate, where all of the care providers are underpaid employees.

Ooooops! No doc today! So he is seen by a nurse-practitioner. I love those people, but they're not doctors. She gives him a bottom rung antibiotic. His symptoms worsen.

Second visit! Ah! There's a doctor here today. Well, a resident, anyway. An internist! By now the red mark is large and has bumps in it, and there's a line running up his leg. He goes home with more antibiotics.

Third visit! This time he is seen by a real doctor, but this doc is also an internist. Forgive me, but doesn't “internal medicine” still carry its traditional meaning? What the hell is “internal” about an angry skin rash? This doctor, like those others before him, has no idea what he is looking at, and is considering a course of one of the strongest of our current antibiotics. Luckily he got a brainstorm. I'll see who else is here today! By total coincidence, there's a real dermatologist leading a bunch of residents around, trying to teach them something.

The real dermo takes one look at the guys legs (it's bilateral now, did I mention that?), and asks, “are you using a triple-antibiotic-ointment on it?” Like Neosporin for instance. Guy says yeah. Case fucking closed! Dermo doc says, “you're having an allergic reaction to the ointment. It rubbed off onto the other leg while you were sleeping.” (Turns to his resident assholes and says, “this is Allergic Contact Dermatitis.”)

Guy discontinues Neosporin, it all clears up, and thank sweet baby Jesus in the manger the guy doesn't get his legs cut off because some internist is sure that it's the fucking flesh-eating virus.

I get better care than this in Thailand. And when I ask to see a dermo, without an appointment by the way, I'll see a dermo, and I'll be sitting with a real dermo within twenty minutes or so. These are most often experienced doctors who know what they're doing. They get out the big light and have a good look around, and generally they get right to the point. Then, if they're not busy, they like to chat a bit and practice their English. It's all very chummy.

I have no idea what they charged that poor guy with the bee sting, or whatever it was, but it was three visits with two Rx's for antibiotics. My one dermo visit would cost me, for the visit alone, about $35. I don't have outpatient insurance, so that's the full charge. They like to prescribe things here too, but I discourage them, or refuse antibiotics all together. They all like to write scripts, wherever you live. They make money on it, let's face it. They do the same thing in America. Usually, even with scripts, I get out for $60 or $70 bucks.

My doctors are as good as yours, and my providers are for-profit hospitals. Mostly, anyway, I keep a working relationship with the best government hospital in case I need something expensive, like open-heart-surgery. Want to laugh? Two years ago I had an angioplasty with two stents installed at my local, “expensive” hospital. The bill was under $10,000, my junk insurance paid one third of that, and my doctor had an MD and post-doctoral angio training in America. His English was as good as mine. (The bill included one night in the cardiac ICU.)

So, how's that “Shining City on the Hill” thing working for you?

Alfie

1967, by Burt Bacharach and Hal David, and a great job here by Dionne Warwick. 

Would this be a strange lullaby to sing to an infant? Putting an infant to sleep requires a routine. You can't just surprise them with "that's it! down you go! lights out!" There must be a series of events, culminating in sleep. You program them, in other words. For my second child, the last step in the routine was me singing two songs to him. The light were out, just me and him, my hand on his back, and I sang the same two songs every night for at least a year. 

First I sang, "Silhouettes on the Shade," by the Rays. Then I sang, "Alfie." By the time I was done, he was fast asleep. I still love these songs, and that memory. 

Locate The Exits, And Plan An Escape Route

Only one friend of mine has a “bug out” bag. We live overseas, and he's the cautious type. His bag is small, just an extra t-shirt, a couple of underwear and pairs of socks. Plus the essentials. Passport, dollars, baht, ringit Malaysia, chargers, a small tablet computer. Maybe a small, folding umbrella. I'd add a very light jacket, for emergencies. Like when you're wet, and sleeping outdoors, waiting for a bus, or a smuggler, or something. Keep the money in different pockets/ compartments, so that no one can ever see how much there is. I do not anticipate any need for emergency exits, not unless things take a sudden turn for the much worse. My friend is just the cautious type. He has always had a bug-out bag, and we, his friends, have teased him about it. I'm starting to think that it's a good idea though, at least for anyone who is young enough to walk as far as becomes necessary and smart enough to get across borders without losing their shirt. Not owning anything larger than a computer helps.

Disclaimer! Anyone who takes advice from me does so at their own peril. I am neither your lawyer, nor your confessor. I'm just wondering how much caution is prudent under our current circumstances. Call it risk evaluation. It seems that our world is now subject to a limitless range of dangerous possibilities. Things change overnight. I would say that a Zombie apocalypse is probably out of the question, but almost anything else is on the table.

I'm planning for some weird contingencies myself. At least for contingencies that would have been considered weird four or five years ago. I will be weathering whatever comes in place. Neither I nor my wife are capable of that much running around and that much rough living. I am, however, trying to make flexible contingency plans to meet situations that would have seemed impossible until very recently.

Things have certainly gotten weird in a short time. Every day now we are treated to spectacles of all kinds, political, social, biological, ecological, psychological, meteorological, and a long list of et ceteras. We've become numb, admit it, you're numb too. There's even a popular new saying, “it's the new normal!” We can no longer count on anything, and we're being told to learn to live with it. I should be fine, except for a slightly heightened anxiety level. I live in a country that has handled the COVID crisis very well, and that has handled more economic crises than most. We're lucky here. The weather is good; there's plenty of domestic food production; people tend to be cooperative. I feel bad for the people who are up against the hard times in America. That's my country, although it's been a long time since I lived there. Those hard-timers were already losing their balance before the last few years put everything on boil. The many people who were already standing at the bleeding edge of the void will now begin to spin off into space in increasing numbers. And that's in America! The Shining City on the Hill! The many folks that were famously one paycheck away from destitution. Well, welcome to destitution, y'all! And with barely a “fare thee well!” from our cold-hearted government. COVID and climate change and greed and corruption are pushing many entire countries over the edge. Imagine the poor wretches suffering on third world flood plains! The penniless refugees from wars, brutal criminal gangs, or dead, sun-blasted farmlands! The people whose bug-out bag contains only an ID card and a bottle of dirty water! I can imagine how they feel, but I don't like to think about it. The anger must be coming off of them in waves.

I would suggest that everyone in America make “flexible contingency plans to meet situations that would have seemed impossible until very recently.” May I remind you that we are living in the new normal. Oh? You feel safe? Property? Money in the bank? A salary, or a pension, or Social Security? Good insurance? Medicare? Well don't forget, all of those old-time measures of financial security rest entirely on the fiduciary responsibility of the scum that are now in charge of all of the institutions that should be insuring them. Politicians, bankers, “businessmen,” judges, congressmen. You trust that crowd? Think again. They've been robbing you for years, and they've got big plans to get the rest. There's a kleptocracy backed by a police state coming into focus right in front of our eyes and nobody seems to care, or even notice. People hear, “eliminate the payroll tax!” and they think, great! Trump is cutting my taxes! That's your Social Security, you idiots! Are you collecting Social Security now? That's your money that they're giving away to their friends! Do you rely on Medicare? They are saying out loud that they want to get rid of Social Security and Medicare. People should really learn to pay attention.

When I was young, I trusted that the people in charge, as crooked and self-serving as I believed them to be, were compelled by circumstance to allow the prosperity of the middle-class to continue. That was, after all, the basis of their own prosperity, being whatever they could skim off for themselves. We've seen how that worked out.

When I was thinking those things, there were about 220,000,000 people in America. There was a thriving middle-class. There were politicians that were capable of compromise on important issues. And as far as the rich went, one hundred million dollars was an almost unheard of amount of money. That was Rockefeller money. Most rich people had a lot less than that. Hell, $500,000 was “fuck-you” money. With that, you could buy a fabulous home, three good sized apartment buildings for income, and still have $200,000 in the bank. Things are a little different now. With 340,000,000 people, no middle class, thousands of billionaires, topping out at over 200 billion dollars for ONE GUY, one hundred million now being around the buy-in for “rich,” politicians that only want to keep their mouths firmly wrapped around the tits of the super-rich, and “fuck-you” money at about $50,000,000, I'd say that things have changed a lot.

Fella, they don't need you anymore! Forget security! You don't have anything that they can't steal in a heartbeat. And that's what they're planning to do. And that's what our stupid electorate is about to hand them. We hear talk about “Joe has this one sewed up,” and 63% of the voters think that Trump botched the COVID thing, and “bringing back better” or some damn slogan, but it's all premature. All of these tiresome jokes from comedy TV shows, all of this “get out the vote” talk, it just creates the illusion that the Democrats have a chance. People can't seem to wake up from the dream that Trump is the problem, and it'll all snap back to fine-and-dandy when he's gone. People can't seem to get it through their heads that the old institutions have lost their power to help us.

I've said it since the beginning: Trump is just the headache; the Republican party is the brain cancer that's killing us. Trump is a tool, and a dull tool at that, but he's done a great job of distracting us while those other gangsters have been moving all of the furniture out of the house. Trump was a God-send! The Republicans had been doing remarkably well, considering the bunch of stiffs they ran in every election after Reagan. Even the couple that managed to win, or steal, the presidency were unpopular. Trump really put some wind in their sails! He has enabled the Republicans to steal the keys to the kingdom. They'd love to have him back for another term, and who's going to stop them from stealing this election? The DNC? Government watchdogs? Sleepy Joe? UN observers? The House of Representatives? Trump-appointed judges? The (gasp!) Supreme Court? You? The Democrats have had four years to “get out the vote,” get people registered, set up transportation networks to get their voters to the now far-away polls, but they didn't lift a finger. Even if the Democrats managed to pull a win out of the fire, is there anyone so naive as to believe that that would change our political fortunes? The Republicans' creeping coup d'etat progressed nicely during the eight years of Clinton and another eight years of Obama. It will continue next year whatever the outcome of the election. Jeez-Louise, some days I wish the Army would take over. We'd probably be better off.

So yeah, my advice is to smell the coffee and plan for extreme danger. Don't just wait around to see what happens. The money power is getting out of dollars, driving up the prices of stocks and gold. Diversify, brothers and sisters. Look for the exits, and plan your escape. And vote, I suppose. Hold your nose and vote for Biden. That would at least delay the now inevitable downfall. No sense in rushing into a Gestapo dungeon by next summer. A vote for Biden might seem a bit sad, but a vote for Trump is a knife in your own neck.

In a few hundred years, I'll bet that the academics of the future will blame the Twenty-First Century collapse of civilization on climate change. That'll look like the smart money, the safe bet. They'll be wrong, though. It will have been due to stupidity and greed, in roughly equal measure.

Pablo Picasso - John Cale

I love a good cover. This is a nice version of a very good song that brings subtle touches of its own to a well produced original. I like it. 

I also love the way it illustrates the wheel of influences in music. The Velvet Underground heavily influenced the Modern Lovers, Jonathan Richman's early 1970s punkish band. Their version of Richman's Pablo Picasso, produced by John Cale in 1972, appeared on a Modern Lovers LP. John Cale, of the Velvet Underground, thought enough of the song to include his own version of it on his Helen of Troy LP. 

Music is a highly creative endeavor, but with a lot of borrowing involved. 

ROLLING STONES: Country Honk (Early Version)

Rock bands often follow a similar story arc. They start out with great enthusiasm, hungry to grab some business and make some money. Their music is often full of energy and fun at the beginning. They turn it way up and make a beautiful, impudent mess. Then at some point, if they are "lucky," they make some money. There are many ways for the story to go after that. Very often towards caution; often enough downhill. 

The Rolling Stones stayed in the beautiful, loud, impudent period for much longer than most; they stayed there long after they had started to make money. They stayed in that period of high-quality productivity until something like the mid-1970s. That's over ten years! Almost unheard of, and still rare. Even in their later period of mostly coasting, they have remained generally interesting, with flashes of very good. 

Even though they made themselves into a great arena band, I will always think of them as one of the greatest bar-bands in history. At their best, to this day, they sound like FUN. 

Another Birthday

“What would you like for your birthday?”

Waking up in my own bed would be nice. Nothing hurting; breathing clearly. Having had a good night's sleep would be the icing on the cake. Check, check, check, check.

I had no plans for today. Nothing on the schedule is my idea of a perfect day. Everything at my discretion. Some reading, some writing, some conversation, some Netflix. No company on this COVID birthday, but we did call for a pizza delivery. I ordered a Caesar Salad to be delivered with the pizza. We'll have that for dinner later. We have a smallish banana bread from the convenience store, and we'll put a candle in it and sing the song. Don't tell anyone! The owners of the rights to “Happy Birthday” are real bastards. We won't be singing it! I was only kidding!

Facebook will be announcing my birthday one of these days. I forget what date I told them. Lots of very nice people will say nice things, and I will be gracious about it. I enjoy that, to a certain extent. I have always hated drawing attention to myself, hated becoming the center of attention. I have no desire to be the leading man. No, not even the best friend. I'm happy being “crewman number 8,” the one who gets killed in the second act. As long as I get a couple of lines, I'm happy. I'll get on the credits, and I'll stay in the union.

All year I watch my friends on Facebook share the events of their birthdays. Many of them are real friends or family members, but most are Facebook friends. I like them all, or else I'd get rid of them, and I enjoy their birthday smiles. Many of them have children that call them all the time, and some have grandchildren that they see frequently and have genuine relationships with. I'm jealous, it's true, but I try not to get worked up about it. After all, pretty soon we'll be dead, and then it all comes to nothing anyway.

I have no bucket-list. There is nowhere that I really need to see. Nowhere that I want to go. There is nothing that I need; I have everything that I really need. I have access to medical and dental care that is pretty good. If you think that yours is better than “pretty good,” you are almost certainly wrong. I still have a job that I enjoy, one which does not overtax my diminishing reserve of energy. My second wife is a lovely woman who appreciates my good points while effortlessly overlooking my shortcomings. We have saved each other from lives of loneliness, and each of us works hard to make the other happy every day. I have nothing to complain about, although I like complaining so much that I do it frequently. Old habit.

You can write it on my tombstone: He was happy. No sense in scaring the children with the truth.

GOIN' DOWN SLOW HOWLIN' WOLF

Our lists are different, but I know what the brother means. I was never one for self-deprivation while shit was around at affordable prices and I knew the right people. My life in the perfumed garden made up in intensity what it may have lacked in variety. My experience in the arts of life and nature have been deep and wide. I've been around. If I go suddenly, don't cry for me, Argentina. I'm satisfied.