Vive Le Healthcare (a.k.a. Kill Bill 3)

Ding dong, the bill is dead!  The “skinny repeal” bill died in a close final vote last night, a surprise attack at 2 AM as Sen. Mitch McConnell tried to ram it through on short notice.  It was killed by unified Democrats and three brave Republicans, to the great relief of nearly everyone, including many Republican senators who had voted to destroy health coverage for millions of their constituents for the sake of party unity.  But is the zombie GOP healthcare bill truly dead (see my post from last week, Vive Le Healthcare II, in which Repeal and Replace first passed the House, morphed and died in the Senate, then came back as Repeal Only, was killed again, then struggled back to life under the guise of Opening Debate on Healthcare).  Well, it soon died again, then- guess what- rose from the dead as Skinny Repeal, which would have deprived 16 million people of health insurance and raised premiums by removing the individual coverage mandate.

And now that, too, has died, and McConnell has finally said it’s time to move on.  Nothing more to see, folks.  I’m reminded of the classic horror movie ending:  ominous music plays as funeral mourners head back to their cars, sniffling with heads bowed under gray skies.  Behind them, the freshly-turned earth on the grave begins to shift.  Terrified movie-goers scream as a claw-like hand suddenly reaches up through the soil!

Just as insurers and exchanges can now look forward to a stabilized market and resume setting rates not artificially raised due to uncertainty (“just in case” the GOP bill had passed), our Chaos President tweets “let Obamacare fail, then deal!”  Even a GOP-owned Congress sees that as a catastrophic option, but Trump wants to win so badly, he’ll force his opponents (and with them, the American people) to their knees.  He’ll “win,” for example, by weakening enforcement of the individual mandate or increasing uncertainty regarding cost-sharing subsidies.  The President will breathe life back into the moribund Repeal and Replace agenda by sabotaging his own nation’s healthcare.  Say… did you see the earth on that grave shifting just now?  No?

In Fourth World Nation, the second novel in my science fiction trilogy, I offer a tongue-in-cheek view of healthcare in a dystopian future.  By the way, I’m doing a final rewrite on the finished book, so you can expect a notice on this blog very soon!  Here’s an excerpt:

True, at each patient’s initial visit, the mobile AI units did all of the diagnostics and prescribed treatments.  And inevitably, some of those treatments would fail; in those cases, according to DOW policy, the second visit would be scheduled with a human provider.  “For the human touch,” said a DOW brochure.  Lora barely felt human at this point, but when the green light flashed above the door, she always took ten seconds to clear her frazzled mind before putting on a smile and heading into the exam room- especially with cases of treatment failure, who tended to be hostile from the outset.  Taking a full ten seconds was actually self-indulgent, comprising over eight percent of the two minutes allotted for the diagnostic phase of each visit.  The patient, seated in a chair which entered the Intake Room through a sliding door on the left and slowly moved along a conveyor belt toward the Probot chamber on the right, had exactly six minutes with the physician before the exit door slid shut.  Yes, spending ten seconds to gather herself was generous, she admitted; but then again, when providing the human touch, good bedside manner was important, wasn’t it?

Six minutes would seem to be plenty of time to take a history, show the appropriate level of concern, perform whatever physical examination was rarely required, assess the psychosocial peculiarities of the patients (“each to be treated respectfully as an individual,” she recalled the admonition from her early days in medical school), and then wish them wellness as they disappeared into the domain of the Probot, where the real work was done.  But those six minutes, Lora had discovered, flew by much faster than expected.  Some patients insisted on elaborating on the history, reporting new symptoms or irrelevant details about family members at the last second:

“Oh, by the way, did I mention that I have triple-vision?  And I can’t feel anything below the waist?  Great-uncle Leo had the same problem when he was my age.  Should I worry?”

Fortunately the patients were belted to their seats for safety’s sake, as a number of them had tried to get up in order to show her some physical finding, such as a fungus on the foot or a growth in the groin.  Completely unnecessary, she would hastily reassure them:  the Probot would diagnose all of these imperfections much better than she could.

To my readers, stay tuned, in good health!



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, the battered GOP needs a win at any cost!

If Republicans in the Senate get their way, I might have to make an adjustment to my science fiction novel, Fourth World:  the average life expectancy in 2197, I wrote, is 107.  But now, if access to health insurance dwindles, I might dial that down; it seems that only GOP Repeal and Replace bills can 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…

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!


Gimme A Vowel

My ambition, as Author, my point, I would go so far as to say my fixation, my constant fixation, was primarily to concoct an artifact as original as it was illuminating, an artifact that would, or just possibly might, act as a stimulant on notions of construction, of narration, of plotting, of action, a stimulant, in a word, on fiction-writing today.

Postscript from A Void, by Georges Perec


Deconstruction rules in cuisine, but sometimes in writing, too.  This morning, while lying in bed, I thought of the following; it just popped into my mind.  Georges Perec wrote his entire novel without once using the letter E (in his other book of this type, Perec dismissed the very first letter, which rhymes with Eh, like I did in this blog post).  It seems incredible, like it would be impossibly complex, but in truth it’s not difficult.  You keep your eye focused on the big theme or motif; find the guilty letter (glowing red on its Pilgrim outfit) within your prim sentences; ruthlessly remove it wherever found; then come up with synonyms for the words involved.  The process works pretty well, if you don’t mind relinquishing control over whole sets of key words- some of the most powerful concepts, too.

“He’s going nuts,” you suggest (I know, your intent is humorously innocent).  Losing sleep over these kinds of thoughts is, I suppose, one weird effect- one huge price- of being unemployed, i.e. retired from Medicine, with excess time to spend on such things.  Plus, I suspect this sort of nervous pre-sunrise exercise is brought on by the Trump News:  the numerous eye-popping events of this fortnight.  Now Trump is fleeing the country on his religious World Tour- well, good luck World, we’ll genuflect for you when he gets to Rome!

In the context of the sinking presidency, it seems I’m experiencing the urgent need to deconstruct, to expel specific offensive thoughts, even chunks of memory.  I’ve cut out the first letter, the first vowel.  Oh, if only it were possible to reverse history, to possess such fine control over life!

Sanctuary III

Meantime the “Big Ditch” is alive with teams and scrapers, and the canyon resounds with blasting.  It awes me to see how big this scheme is….  The finished section, so far hardly more than a half mile, eighty feet wide at the top, fifty at the bottom.  The twelve-foot banks slope back at the “angle of repose,” which means the angle at which dirt and pebbles stop rolling.

– Wallace Stegner, Angle of Repose

At our Immigrant Sanctuary meeting last night, we heard about the 700-1,000 new arrivals per year in Alameda County, the terrifying situations they are forced to flee in their home countries, deep traumas compounded by their abysmal living conditions now, and the unshakable anxiety with which their days pass.  Either because of government restrictions or their own fear of deportation, these immigrants receive no cash aid, food, housing or education.  They do have access to medical care, but, unwilling to reveal their illegal status and risk being torn away from their families, they will avoid showing up at a public clinic until illness has progressed to a desperate stage, often beyond treatment.  The safety net for them is thin, and in many cases, nonexistent.

The ramped-up detention and deportation aimed at these people by ICE and our Chaos President is based on the perceived threat that they pose to our national security.  So ICE is cleared to blast away, and let the rocks fall where they may.  Their bosses in Washington are willing to risk the pain and suffering these immigrant families will go through:  when the dust clears and the pebbles stop rolling, they say as objectively as a canal engineer, we’ll just see what angle of repose results from all our blasting.

In a way, the President is performing the same operation in Washington DC:  the explosive developments in just the past eight days have sent dirt and debris flying in all directions.  Not a day goes by without some new, spectacular revelation, and it’s exhausting just to write about them.  Suspicious firings, false and contradictory explanations from the White House, mis-directions via the Justice Department, threats of “tapes,” attempts to obstruct justice, and on and on:  it awes me to see how big this scheme is.  What will be the angle of repose?  The news has been jaw-dropping, really.  And how ironic is it that those poor immigrants are seen to pose some sort of threat to national security, when, the day after firing the FBI director who is investigating his campaign’s links to Russia, the Chaos President is spilling national secrets to known Russian spies right in the Oval Office?

Excuse me, I dropped my jaw in the other room- be back soon.