Vive Le Healthcare II

Maybe I should have titled this post Kill Bill 2.  Just when you thought the GOP healthcare bill was dead, it has begun to exhale sulfurous vapors again, its glowing red eyes blinking open, its sharp claws twitching in anticipation of wreaking more mischief.  It’s as scary as any horror story by Stephen King.

Despite essentially every healthcare organization and the majority of the population coming out against it, the House birthed a malformed Repeal and Replace bill which, you have heard many times, would increase the number of uninsured by 22 million, take away protections for pre-existing conditions, and worse.  After behind-closed-doors tinkering in the Senate, Repeal and Replace emerged more fully developed but equally grotesque.  It would cause 15 million people to lose coverage within a year, and again, 22 million by 2026, as well as water down the quality of health coverage.  When four Republican senators jumped sides and put any hope of passing this horrible bill out of reach, the relieved majority of citizens (remember them?) in this country celebrated.  The bill had been killed- or so we thought.

But then President Trump’s response was to “let Obamacare fail… I won’t own it,” without any regard to the cost to his citizens- he’s only concerned about a “win” for himself, and has been actively sabotaging Obamacare for months.  That would leave no healthcare plan, but who cares?  He, the President, won’t own it, and a win’s a win, never mind where the buck stops.  In a strikingly similar vein, Sen. McConnell- backed by Trump, of course- plotted a move to Repeal And Not Replace, even though 32 million people would be left out in the cold.  So once again, the GOP healthcare agenda stirred ominously back to life.  Do any of these elected officials ever consider the people who voted them in?

Then came another bright spot in the GOP (following Sen. Collins):  when Sen. Capito announced that she had “not come to Washington to hurt people,” I thought that would surely be a stake driven into the heart of the beast.  Congress would come to its senses (unless they had come to Washington to hurt people… )  And when 50% of those polled said they were in favor of Obamacare, versus 24% for the GOP plan, I was sure the struggle was finally over.  But no, no, here it comes again, still staggering among the undead:  McConnell wants to open floor debate on healthcare next week, in the faint hope that the GOP bill can somehow be rewritten on the fly- perhaps garnering just enough votes to squeak by?  Remember, repeal efforts have been going on for seven years, and yet the GOP doesn’t have a realistic plan to offer.  This healthcare zombie won’t go away, no matter how badly scared the people get:  already six long months into the Trump Administration, it needs a win at any cost!

If the GOP gets its way, I might have to adjust my sci-fi novel Fourth World:  the average life expectancy in 2197, I wrote, is 107.  But now I might dial that down; it seems that only GOP healthcare bills live that long!

 

Vive Le Healthcare!

Start stockpiling those pills.  Republicans in the Senate have just released their latest revised healthcare bill, and it does not look promising.  Despite a few tweaks, for example to planned tax cuts for the rich and lower-cost options for buying insurance (eliminating benefits considered essential under the Affordable Care Act, such as maternity care), several huge, ugly bugs remain in the system:  deep cuts to Medicaid resulting in loss of coverage for millions (the CBO, which predicted a loss of 22 million for the previous version, will weigh in next week- hopefully before the Senate vote), loss of guaranteed protection for pre-existing conditions, etc.  On this eve of Bastille Day, the current political turmoil- including Healthcare, the Trump/Russia investigation, Paris Accord, Muslim travel ban, and so much more- brings to mind the storming of a prison or fortress by a population which has reached the end of its rope.

The people demand liberty, including freedom of the press, speech and assembly.  To me, liberty also includes- within reasonable limits- freedom from fear:  fear of hunger, oppression, deportation, terrorism, global warming, pollution- and also illness.  Access to healthcare should be part of our daily expectations, but a GOP-controlled Congress doesn’t agree.  As Joel Baden, at the Yale School of Divinity, recently pointed out:  Republicans like to quote from the Book of Proverbs, wherein the righteous are consistently rewarded and the wicked are punished; in this worldview, it follows that the successful (i.e. rich) must be more righteous than those who struggle (the poor).  Mo Brooks (R-Alabama) said the poor should pay more for healthcare, because “those people who live good lives, they’re healthy.”  He must not have read Ecclesiastes 9: 11-12:  “the race is not to the swift, nor the battle to the strong, nor bread to the wise, nor riches to the intelligent, nor favor to the skillful; but time and chance happen to them all.”

They demand equality:  equal pay and treatment in the workplace, social and environmental justice, educational and employment opportunity.  And, as you might expect, equal access to healthcare!  The proposed bill would throw millions of people off Medicaid, while providing tax breaks for the wealthy.  Everyone understands that if the entire country had health insurance, pooling the risk would enable equal treatment of the whole spectrum of medical conditions, from the worried-well to the chronically and severely ill.  Not requiring health insurance, Speaker Paul Ryan says, would give people the freedom not to buy something they don’t want.  So he wants to give them freedom, not healthcare.  That has the callous, unthinking feel of “Let them eat cake!”

Although deeply divided, the people need fraternity as well.  Cross the aisle.  End mindless, tribal partisanship.  Talk amongst yourselves.  One bright spot:  Susan Collins (R-Maine), in rejecting the proposed GOP bill, says she is ready to work with Democrats on improving the Affordable Care Act- imagine that!  Improve Obamacare?  Not “repeal and replace?”  Not “lock ‘er up,” “murderers and rapists,” fake news, witch hunts and chaos?  Yes:  a return to sanity, mutual respect and the realization that dominance-based politics destroys fraternity, equality and liberty.

Wishing all of you out there a happy and healthy Bastille Day!

Just Act Natural, If You Can

In my early practice, I used to have a patient- a handsome, urbane Chinese man in his thirties- who had appeared in a number of car commercials.  He seemed successful, and yet at every doctor’s visit, even before mentioning his health, he would complain about the lack of acting roles for Asian actors.  It was more important to him, he said, than his blood pressure!  This turned out to be a widespread frustration which has resulted in activism, educational endeavors, signed petitions and quasi-political gatherings across the country.  George Takei (Mr. Sulu) has been particularly outspoken on the topic.

In the 1930s, the Chinese stereotype depicted in movies ranged from the super-smart, respectful and submissive Charlie Chan to the super-smart, evil and insidious Dr. Fu Manchu.  These were two Chinese extremes, and yet, as Asian activists love to point out, Charlie Chan was played by a Swedish actor, Warner Oland, and Fu Manchu by another Caucasian actor (I forget his name) in yellowface.

Another stereotype is the martial artist, and here at least, we see Bruce Lee, Jet Li, Jackie Chan and other Chinese actors in kung fu movies.  And who can forget Michelle Yeoh and Zhang Ziyi in Crouching Tiger, Hidden Dragon?  All fighting with hands, feet, sticks and swords.  But where is the Asian Meryl Streep, Harrison Ford, Tommy Lee Jones, or even Woody Allen?  Maybe there won’t ever be one.  Does the necessary depth of character and experience lie beyond what Hollywood expects from such actors, based on Asian stereotypes?  Now Daniel Dae Kim and Grace Park are departing from the cast of Hawaii Five-O, allegedly because of unequal treatment and pay.  The show is based in an Asian-dominant environment, and yet the Asian actors are considered secondary.

When I wrote the sci-fi novel Fourth World, I chose a Chinese youth- Benn Marr- as the protagonist, the hero/anti-hero.  True, I was motivated by concern over the exploitation of post-colonial Third World countries; the European nations’ intolerance of their colonial subjects, now transplanted minorities in the homeland; and- part of the autobiographical element in Fourth World- the difficulty finding acceptance when coming in from the outside.  I wanted Benn to wrestle with not-belonging, and to crystallize these types of issues.  But it’s also true that, in thinking about my long-ago former patient, I wanted to create a leading role for a Chinese actor (John Cho?), in case Fourth World ever becomes a movie!  I know, dream on…

What I Tasted On My Summer Vacation

Just kidding:  retired doctors don’t take vacations!  But we did just return from a week in Madrid and San Sebastian, followed by a week visiting chateaus in Bordeaux.  Although there were lots of great-tasting solids (jamon iberico de bellota, foie gras, Charolais beef, raw-milk Epoisses, mmm), this posting is going to be about Bordeaux wines.  If you have no interest at all in wine, my apologies; this would be a good place to exit- thanks!

Tasting barrel samples of 2016 red Bordeaux was fabulous; the vintage really does live up to all the hype.  If you have a wine collection, I would recommend buying some 2016s: even at $25 or less, some wines are already very appealing (Chateau Potensac from the Medoc, for example) and have the potential to develop well for five to fifteen years.  At the other end of the spectrum, wines such as Ch. Mouton-Rothschild or Ch. Margaux lie in the stratosphere, with regard to quality and price, and can age for decades.  Ch. Leoville-Las-Cases, for me, was their equal in quality for half the price.  If you have a special event to commemorate yearly, such as a wedding in 2016, you’re in luck!

One good thing about this vintage is that the wines reflected their respective communes:  that is, a wine from St. Julien had the typical taste and style of that commune, and not, say, Pomerol or St. Emilion.  In my opinion, this typicity doesn’t happen every year.  To generalize:  a typical red from St. Estephe tends to be heavy-ish, somewhat monolithic, linear and powerful.  A Pauillac tends to be more nuanced, although still sturdy, with graphite notes (think pencil shavings) and tobacco, like a cigar box.  Pauillac’s immediate neighbor to the south, St. Julien, makes wines quite similar, but more supple and round, and I find India ink notes, as well as overt fruitiness, in St. Juliens more than in Pauillacs- both in the nose and flavor.  Wines from Margaux tend to be more delicate/elegant, with a famous floral (violets) aroma.  Graves often have a mineral, smoky character.  St. Emilions and Pomerols are often fleshy, plump and rich from a high percentage of Merlot; whether they are grown on limestone (St. Emilion) or clay/gravel (Pomerol) affects the flavor.  From years of comparing these, it becomes possible to identify the commune, or even the producer, in a blind tasting, which is a pretty good bar trick.  But I’ve only listed general tendencies; there can be huge differences in style between two chateaus located in the same commune.

By the way, these taste characteristics are not the same as the spurious and fanciful descriptions often provided by wine writers, who might argue with one another as follows:  “I taste mangoes!”  “Mangoes?  You’re crazy; it’s pineapple.”  “That’s right, pineapple!  And coconut!”  “Yeah, just like the pina colada I had before dinner!”

In science fiction, it can get even more obscure.  Here’s an excerpt from Fourth World, in which Benn Marr attends a wine tasting at Mellon College:

And so it went, for four other wines.  Dr. Neelin described esthetic and geologic elements: earthy forest or mushroom; the smell of rain falling on hot stones; delicate floral scents; the tang of iron, like a bloody nose; roasted coffee beans, licorice, chocolate, berries of various colors; the mineral effect of a steep, rocky slope; a summer plagued by hailstorms; or a long hot spell before harvest.  And, though it seemed far-fetched, even as Dr. Neelin described the historical context of each wine- the influence of an ancient monastic order, or the personality of an eccentric winemaker- Benn detected traces of each element.  He imagined some sort of ambient energy field interacting with the water content, imprinting all of this data into the structure- the hexagonal, square and triangular formations- of each wine.  It was like the electronic translation of sound or sight into a recording (not so different from the volumes of data previously recorded in ancient tapes, plastic phonograph records, or metal discs; and now the micro-crystalline core of his datadisc) which could be heard or seen again, and replayed endlessly, if only one had the diamond-tipped needle, the laser, the ability to translate the data in reverse.

China On The Rise

Last night, Harvard Prof. Graham Allison gave a talk, moderated by former Rep. Ellen Tauscher, at the Commonwealth Club in SF.  The topic was his new book, Destined for War:  Can America and China Escape Thucydides’s Trap?  Five centuries BC, Thucydides noted that the threat from a rising power, Athens, as perceived by Sparta- the ruling power in ancient Greece- led to the Peloponnesian War.  He drew a parallel with US/China relations- acknowledging some of the shortcomings of such a comparison, which have been amply pointed out in various reviews of the book.  China, he said, has caught up with the US in every major parameter, and surpassed it in some.  For example, when Reagan was president, China’s GDP was 10% that of the US, and now it is 110%.  In many aspects of technology, China is taking the lead:  social media, AI, robotics, clean energy, electric vehicles etc.  The US still leads by far in the military arena, but China may not care as much as we suppose (Allison reminded us that, when US and South Korean troops once pushed back a North Korean invasion almost to the Chinese border, China used conventional weapons to fight the sole nuclear power on Earth, all the way down to the 38th parallel).  Economic “warfare” is just as important these days, and as the US withdraws from the world stage (see TPP), you have to wonder:  which country now represents Sparta, and which Athens?  Sharing common interests- such as avoiding nuclear holocaust and preventing global warming- lowers the risk of war, but then having a belligerent and unpredictable president who denigrates NATO and pulls out of the Paris Accord weakens those commonalities.  It seems to me that under our Chaos President, fear of “Mutual Assured Destruction” (MAD) and climate change may not be enough to prevent war.  Also, the strong chauvinism and national fervor among Chinese- not mentioned in the talk- may tilt the balance towards war when a crisis erupts, for example on the Korean Peninsula or South China Sea.  As I pointed out in an earlier blog (A Day Without Women), the world is a lot more complicated now, but Thucydides may be right after all.

Here’s an excerpt from my sci-fi novel Fourth World, in which Chou Xia-Yu, leader of the world government in 2196, ponders the fate of expatriate anomaly Benn Marr:  will he have to be destroyed?

Chou silently nodded his satisfaction at the inherent justice of it all:  descendants of the American colonists on Mars had paid a steep price to atone for the imperialist policies of their ancestors.  And now, he speculated, this Benn Marr represented another level of reward for years of experimentation.  The ability to read and to project thoughts was similar to what Chinese monks (particularly in the Tibetan District) had been practicing for a thousand years.  The difference was that Eunigen had given Benn his abilities by modifying his genes, so that they could be passed on to future generations in large numbers:  the hypothetical implications for the PWE were staggering!  Unfortunately, Benn Marr, although of Chinese descent, had lost touch with his ethnic roots on Mars, and had no understanding of his rich cultural heritage.  As with all traditional Chinese, Leader Chou harbored the conviction that the Chinese civilization had greater value- it was simply superior- and should be promoted above all others; Benn was unlikely to feel such loyalty.

Looking Good, Mate!

Is it more important to look good, or be good?  Here’s an excerpt from Fourth World, in which Benn Marr unravels a knotted debate over the use of recombinant genes purely for cosmetic purposes:

When the crowd noise had settled, Dr. Neelin shook his head and said, “I confess, I would never have thought of applying the principle of Natural Selection.”  He sighed at the sea of vacant faces and added, “For those unfamiliar, it’s the passing down of genes which increase survivability, for the good of the species.  For a thousand years, outward appearance has replaced survivability as the driving criterion in choosing a mate, has it not?  What did you so aptly call it, Benn- “Unnatural De-selection”?  Thanks to cosmetic procedures, Mr. Marr is telling us, genes that weaken the species are just as likely to be passed along as genes that promote survival of the fittest.  It’s hardly better for the human species than, say, choosing mates by the attractiveness of their clothing!”

Richard Prum, an ornithologist and evolutionary biologist at Yale, argues that female birds choose their mates (a process called sexual selection) based on beauty- not because an attractive appearance reflects underlying health and fitness, but for the sake of beauty itself.  This is a challenge to the mainstream understanding of natural selection.  As proposed by Darwin, good genes encoding beneficial physical traits, such as speed and strength, increase survival and are therefore more likely to be passed on to the next generation.  It seems to me that selecting mates by their beauty, which does not help birds fly faster, hunt more successfully or detect predators better, may actually dilute survival of the fittest.  On the other hand, among humans, an expensive suit and large blond comb-over may attract potential First Ladies, so cosmetic appearance can be a Darwinian advantage!

As we evolve in the Information Age, survivability becomes further and further removed from what our genomes dictate.  With the aid of prostheses (eyeglasses are an early example), medical advances, internet avatars of ourselves (no, not just online dating services), and of course robots, survival is now vastly multifactorial.  And we’re just talking about surviving to childbearing age.  Our physical deficiencies have become less crucial to our chances of having offspring, whereas a nearsighted, clubfooted caveman would not have survived long enough to attend the Junior Prom.

In light of this departure from Darwin, perhaps my characters in Fourth World are too humanoid.  In 2196, people may be closer to moles on wheels:  inarticulate, nearly blind, not beautiful in any sense, hybridized with cybernetic parts, texting one another with tiny hands but massively hypertrophied thumbs.  Bizarre, maybe- but still having kids!

 

Another Day, Another Dolor

When does it stop?  I mentioned earlier that reading and blogging about these daily outrages has become quite exhausting, and now the increasing abuse of journalists is in all the news, including the NYT and NPR this morning.  Ben Jacobs, grabbed by the neck and body-slammed to the floor by Montana GOP candidate Greg Gianforte for asking him a question about the Republican health plan.  And Gianforte still won the election!  John Donnelly, pinned against a wall by security men for trying to ask FCC Commissioner Michael O’Rielly a question.  Dan Heyman, jailed for shouting a question to HHS Secretary Tom Price about pre-existing conditions under the House healthcare bill.  Never seen a reporter shout a question, in a noisy room?  Journalists harassed by Trump supporters, shoved and punched, pepper-sprayed, verbally abused and arrested for doing their jobs.  Are we to accept this as normal now?  Well, Heyman did raise his voice…

There’s the well-known Reporters Committee for Freedom of the Press, which works to protect First Amendment rights.  But, in the face of all this violence, reporters may need to be more concerned about protecting their Second Amendment rights.  That might seem self-evident when they are assigned to cover news in the heart of Trump Country, but apparently even government buildings in Washington DC can’t be considered safe zones for the press.  You can’t blame one person for the entire toxic environment, but our Chaos President has been blowing mightily on that dog whistle, for example calling the press the “enemy of the people,” and there has been a trickle-down effect.  Under Trump, the range of options that pop into the minds of erstwhile public servants when approached by a journalist has widened to include physical assault.

By the way, I was gratified to hear that, as a sort of olive branch to the press, the White House is looking for flight attendants to take special care of the Press Corps aboard Air Force One.  A long process, but why drag it out:  can’t United Airlines spare a few?