RIP

Please pray for the repose of the soul of Shelly McKinney.

Thanks.

 

RE: ‘climate change’

I’m a sorry linker, when it comes to WSJ articles .  But anyway, the other day* , after I posted about the beetles, the journal’s “The Numbers Guy” column was on climate models.  Long discussion about how these models are inaccurate, unreliable, not good for making policy, etc. But then there was this graph.  A very eye-catching graph.

–> Which showed, to my slightly-trained eye, that sure enough, over the past century the average global temperature (that’s got to be fun to measure) has been steadily increasing. Plenty of up-n-down blips, but the overall trend was mighty obvious.

Now what to do with that data another question entirely.  I’m not persuaded it’s a man-made phenomenon, though I can certainly see why someone might think so — industrial revolution, all that.  But as I think about Romans-to-Renaissance industrial ebb and flow, and then ponder the climate variations that went alongside, I just don’t see the connection.

It could be that my memory is poor — it’s not like I’ve got 2,000 years of ecomic and weather data neatly filed here at my  hand.  I’m just going off of bits and pieces pasted together from various reading over the years.  So if someone has a nice readable [short, if we could] article fitting that slightly longer-term data into the current climate-change theory, do post.  I really am not at all decided one way or another.

 

*That’s a technical citation, meaning “it is in my mulch box, no longer in the living room”.  Which is how we date newspaper articles here.

 

Pine Beetles and Climate Change

Listened to Marketplace last night on NPR.  I almost never listen to the radio anymore, as it is difficult to hear an entire story with small children present, and I don’t think the part where I yell at the kids not to interrupt is all that healthy.  So mostly I read.

But last night I happened to catch (most) of an article about how pine trees were dying in Montana due to global warming.  I was stunned — are temperatures really getting so high that pine trees are perishing in the heat??  Maybe I should take this problem more seriously.

No no, it’s that pine beetles are eating them.

Ah.  So, er, what do pine beetles have to do with global warming?  Well, our reporters contend that the 1.something degree rise in global temperature over the past fifty years has suddenly made the pine beetles not get killed off by winter freezes, and hence the attack.

Now if I lived in Montana, I might buy this.  But as it happens, I’m rather familiar with the *southern* pine beetle, which has been on a feeding frenzy for quite awhile now.  (Note to Montana: Start chopping.  Do not leave those dead trees standing there.)  And the thing is, the southeastern US hasn’t had a Montana-style winter in quite a while.  [Thousands of years? Millions? Some geologist please quick speak up.]  So apparently *our* pine beetles are much slower on the uptake than Montana’s . . .  Or else no one is blaming our beetles on global warming, and it’s just a coincidence that Montana gets climate-change beetles, while ours are extra hungry for some other reason.

My reaction?  Linking the pine beetle infestation to global warming is lousy science.  We may or may not be experiencing some kind of human-induced climate-warming.  Or maybe human activity is causing wider swings in weather patterns than in the past (hence, warming and cooling both.)  I’m doubtful, but it could be — I won’t dismiss the possibility out of hand.   But claiming anything and everything just must be due to global warming is silly, and ruins the credibility both of the scientists who make these claims, and the journalists who report on them.

That said, as I mentioned, I live with small children, and there’s a chance I missed some pivotal moment in the report when the Marketplace journalists displayed their healthy skepticism.  In which case, good for them.

 

Depression & Creativity

Essay in the Journal this morning, in the weekend section, about the connection between mental illness and creative genius.  I try not to pay too much attention to the WSJ’s Saturday essays, and my mental health is the better for it.  But I thought today’s page W3 piece by Jeannette Winterson (“In Praise of the Crack-Up”) wanted a little reply.

[For a very thorough, sometimes too thorough, exploration of this topic, see Peter D. Kramer's Against Depression.  But my thoughts, different from his, are what follows.]

No one extols the virtues of depressed Pizza Guys. Read an essay like Winterson’s, you’d get the idea that writers and artists were the only moody people out there.  Perhaps artsy people don’t have a very wide circle of acquaintance.  So let me assure you: mental illness, including but not limited to depression, knows no professional barriers.  Accountants, Wal-Mart Managers, Engineering Professors — keep an ear out and you’ll quickly discover these people, too, can suffer mood disorders.

The difference being, of course, that your average laboratory technician doesn’t get asked to write an op-ed about the experience.  And no one pores through the details of the billing-clerk’s private life, in order to write a riveting biography about the “real story” behind that face we know so well.  Thus we never ask ourselves, “But what would interstate commerce come to, if we didn’t have depressed truck drivers??”  [Who would cover those long-haul routes without the work of those who long for solitude?  Mmn, I suppose the guys who are so fond of CB radios, and, these days, cellphones.]

But in fairness, the nature of literature and art does mislead.  I was struck the other month reading through a collection medieval poetry: it’s 98% about love, death, and combinations of love-n-death.  And pretty  much that seems to hold true through the centuries.   As much as *I* like to write about exciting topics like doing the dishes, or changing diapers, apparently themes with a little more drama tend to be more enduring.

–> So whereas the janitor has little to gain, professionally, by letting his personal agony shine through in his work, a writer or painter can use the depths of despair or psychosis as raw material for a riveting masterpiece.   Of course ordinary grief and heartbreak are plenty dark for those purposes, and most of us will get to enjoy a fair bit of both by the time we’re old enough to write decently;  but sure, if you happen to have episodes of mental illness to draw on, that works too.

And it *is* consoling for other suffering readers to know they are not alone in their experiences. So not such a bad contribution to the art, if you go in for that type of reading.

Which leads to a final point: Writing about difficult experiences is helpful to the writer. Or painting for the painter, and so on, I imagine.  (The other arts are beyond my skill, so I can’t be sure.)   Though honestly, most of us, when we work through our feelings this way, end up with a piece that is dreadfully boring — ‘maddening’ you might say; it takes true genius to be able to write about the experience of  mental illness without causing it to become contagious.   For the average depressed person, best to keep those feelings in the personal journal, far, far, from an editor’s desk.

But none of that makes it necessary to keep around the assorted mental illnesses just for literature’s sake.  Any more than we need to keep around cancer because it has produced so many great works of art (I like this one), or encourage warfare in the Mediterranean that we might get another Iliad in the process.   Given effective, no-obnoxious-side-effects cures for mental illness, there will still be plenty to write about.

 

Health Care and the Living Wage

So when I started writing about the Just Wages, I intentionally left health care out of the picture.  Why?  Because health care is a virtually unlimited need.

I have no qualms about telling you that a person only truly needs so much living space, this much food, that much clothing, and so on.  It is important that we not make an impossible wreck of a straightforward moral teaching, by trying to tack on burdensome ‘extras’, as if love of neighbor were synonymous with ‘upper-middle class 21st century American’.

But how much health care does a just wage pay for?  Not so easy to define.   Set aside all the debates about which care is most helpful, and which is not helpful at all — those are medical debates.  Pretend you know what the useful stuff is, and focus on just the question of ‘how much’.

It can’t be nothing, we are certain of that.  But does the requirement extend to providing every care that might possibly help the worker-patient?  We have an arsenal of extraordinarily expensive tests, procedures and medicines that will extend life a few months or a few years; we have treatments that, in the event they work, will give back the recipient a nearly-normal lifespan, but for which the probability of sucess is quite low.

Those rescued months and years, those chances of success, are absolutely priceless.  I am easily persuaded that, as a society, we should value the medical progress that cutting-edge technology offers.  We should choose legal structures that encourage both doing the research, and making new forms of care more widely available.

But should every business owner consider it a normal cost of business, to provide wages that will cover high-cost-low-expected-return medical treatments?

I think that we need to fall back on the same pragmatic approach used for discerning just wages in other areas:

1) Remedy gross injustices. Keeping in mind that, say, access to a safe water supply remains a significant health problem for many workers around the world.  Employers should begin there.  I’m reminded of my friend Jenn Labit, whose factory in Egypt includes such basic amenities as a safe way to store lunches.  Sounds self-evident, but it was not the standard local business practice.

2) Use the love-neighbor-as-self standard. If senior management and members of the board are willing to accept a given level of health care, it is reasonable to assume the company is making an honest effort at providing a just wage for health care.

Beyond that?  We want to set up laws and regulations that make it possible for employers to efficiently provide a good health-care wage to workers.   We can disagree over the details — I’m not convinced the current legislation coming out of Congress is going to be an efficient and effective fix.   On the other hand, I’m entirely in love with my local water company, and do think that providing clean water is an appropriate use of community — read: local government — power.   Assuming it is done well, as it is where I live.

–> The imperative to pay a just wage works both ways.  On the one hand, it is up to local governments to set up community structures in a way that makes it affordable for businesses to pay a fair wage.  Think: utilities, transportation, policing, insurance regulations, medical safety standards.  On the other hand, the requirement to pay a just wage ought to spur businesses to use their importance in the community to push for change when the local government has fallen short of its mandate.

 

Well as you can imagine, every time I read something about the health care package about to emerge, my head gets that much closer to exploding. Said by a person who thinks our health care system does need some serious attention.   Just mostly not the kind that is coming out of Congress lately.

But I promise the relative quiet here is not me storming off sulkily.  I suppose my absence is healthcare-related though — we’ve a perky little GI virus hopping about the family.  Not a bad little guy, mild, short-lived, even agrees to appear in the early hours, before interested siblings are up and about and interfering with clean-up and quarantine efforts.  No complaints here.

Meanwhile, registration is open for the Catholic Writer’s Conference.  Highly recommended: It is free, and there are helpful people who will work with you regardless of your skill-level.   You can participate as much or as little as you want, and then purchase the transcript of the proceedings so that you can sit-in on missed classes at your leisure.    SuperHusband insists I go, even though I’ve done virtually no writing since I left off on my project from last year’s conference.  So I will.  A wife doesn’t argue about these things.

 

An MS suicide, and the cost of accomodations

William Peace has two posts up that fit together eerily well.

An MS suicide.  MS can be a discouraging, depressing illness.  And depression & discouragement can lead to suicidal thoughts much more easily than many people realize.   But when someone steps up to the ledge of a building, what kind of monster stands beside and gives advice on the best way to jump?

And why are disabling illnesses so discouraging?  In part because we all know that our society just isn’t all that concerned about accessibility.

The noise about cost is, in my opinion, a pretty weak excuse.  You’ve got to put a door on the building, it really isn’t that much more expensive to have slightly more door and slightly less wall.   There’s nothing magical about stairs that makes them so dramatically cheaper to build than a ramp.  And most buildings that require an elevator for wheelchair access really won’t function efficiently unless you have an elevator for freight & furniture access.

Visited our local county historical museum with the homeschooling group the other day.  Was appalled by the complete lack of wheelchair access to any of the buildings.  (Well, except this one barn.)  Outdoors was okay, if you can do gently sloping grassy terrain.

Now there are often good reasons historic buildings are inaccessible.  For example, sometimes the only way to improve access to a building would be to make significant architectural alterations to a building that is being preserved precisely for its architecture.  But I assure you, though the buildings we visited were authentically old, a well-placed ramp or lift would not have marred the educational and aesthetic value of these particular buildings.  Nor were the curators especially concerned about that problem, seeing as they didn’t mind putting a honking big HVAC unit outside one of the buildings, in a visible-to-visitors location.

Which is the second point: Cost was not the concern.  No one had any worries about the cost (let alone authenticity) of putting modern HVAC, plumbing, and electrical wiring into these historic buildings.  Even though, being historic buildings that had been steadily used for over a century prior to the availability of those conveniences, they were actually designed to function quite well without modern amenities.

–> What it comes down to, is that people are perfectly willing to spend and accommodate for items that provide comfort and convenience for “ordinary” visitors and workers.  But somehow, taking the time and energy to plan an installation so that it is workable for those-other-people-not-like-us* just isn’t a priority.

Which of course makes the prospect of future disability so dreadful, because you know that wider society has been built in a way that excludes your disabled self.

_________________

*This particular museum, which I will not name, apparently specializes in ‘those-people-not-like-us’.  Witness the way we were all assumed to be able to imagine ourselves as white 19th century southern farm-owners, but when a bit of Native American technology was mentioned, it was “those people”.  Not an intentional slight — I expect the volunteer-docent meant no harm, and was probably unaware of the shift in his point of view.  But it was cringe-worthy all the same.  [In double fairness, my guess is that our docent actually grew up on just the kind of farm, with just the kind of ethnic heritage, that he was presenting as the assumed "us".  So for him, us-v.-them might have been more accurate than not.  But for the rest of us, not so.]

 

MS & The Dreadfulness of Being

So in my very sporadic reading lately, MS & assisted suicide seem to be frequent partners.   Take a look here, for example.  Ironic, since multiple scelrosis is not a terminal illness, and people who are in favor of assisted suicide and euthanasia usually use ‘terminal illness’ as the excuse for their position.

Which got me to thinking . . . what is it that makes MS dreadfuller-than-average?  Not worse, necessarily, but more dreaded?  A few brainstorms:

It won’t kill you. Not usually, anyway.  Catch a nice case of terminal cancer, and you can be dead in short order, without having to a lift a finger.  Come down with MS, and you’ll probably live about as long as previously planned.   So if you develop a death-wish, your disease won’t fulfill that desire for you.

MS is very unpredictable.  Will you develop horrid symptoms?  Which horrid symptoms?  Nobody knows.  Until diagnosis, you had a life map all planned out.  Now it isn’t just a matter of changing plans, but of not even knowing how to make your new plans.  Losing the illusion of control is very stressful, and stress can be depression-inducing.   Depression, of course, being what leads people to suicide.

The unpredictability can be very discouraging.  Unlike once-and-for-all disabilities, with MS you never know what is coming next.  Which makes it hard to know what rehab efforts will turn out to be worthwhile.   Your right hand is acting up — do you learn to write left-handed? What if your left hand goes next?  So you decide to try a nice dictation software — but what if your speech becomes affected?  And yet you feel a tad silly preparing to blink as your attendant points to a letterboard, when so far all you’ve got are some numb fingers . . .  It isn’t that the disabilities associated with MS are impossible, of course they aren’t.  People manage just fine with equally disabling non-MS conditions.  It’s that it is discouraging to work crazy hard to adapt to the current symptoms, knowing that at any moment all that work might come to naught, and you have to start over from the beginning again.

–> Curiously, people without MS-type conditions are also prone to having all their hard work wiped out in an instant.  It’s just that they enjoy a more insistent illusion of control than a person with a known dreadful disease.  No one says, “Darling, are you sure you want to take up archery?  What if you lose both your hands to that nasty strain of meningitis tomorrow?”

The unpredictability is hard on bystanders, too. The family members in particular who may have to provide care, pick up slack, and spend financial resources, also lack that pleasing notion of predictability.  There’s no getting into a comfortable routine, confidently determining that x,y & z are going to be needed, how can we provide for x, y & z in the most efficient, family-friendly way possible?

(And of course, your loved one *isn’t* likely to die soon, so you can count on this unpredictability to go on indefinitely, with none of that desperate emotional force of caring for a person actually on their death bed.  It is wearying.)

MS happens to adults.  Which means the raw parental passion isn’t there to fight desperately for the sick person.  Sordid truth: parents will fight to the bitter end on behalf of a sick or disabled child, in order to give that child every possible chance at life, to help that child thrive and live life to the fullest, despite whatever obstacles.  That’s how parenthood is.  (Not actually due to the disease in question — parents generally work crazy hard for all their children, regardless of health status.)   But by the time you develop MS, you usually don’t have Mom and Dad there to clear the path at every turn.   And there just aren’t many good substitutes for good ol’ Mom & Dad, when it comes to being a sick person.

And then of course, there’s the actual suffering.  MS has a deservedly bad reputation — it can be a truly vile illness.  Kinda like polio: a lotta people are exposed to the polio virus and are none the worse for wear; but if it decides get you, it can get you good.   Depending on your luck, patient and loved ones might actually have a hard time of it with MS, with the all the difficulties that come with any disabling injury or nasty illness.  Not all cases turn out to benign, or painless, or something-I-was-ready-to-deal-with.

So in all, it is a recipe for stress and discouragement.  This for the person with MS — who already is prone to depression just as a symptom of the disease, aside from everything else.  And then also for the near family members, the people who, when the depressed patient begins to think about suicide, are *supposed to be* the ones who help the patient get treatment for the depression.  Except that if you, the caregiving family member, are yourself suffering from situational depression, you are hardly in a position to think clearly on matters of life and death.

And hence MS shows up in the news, wound up in the politics of suicide and euthanasia.   Not because it is a terminal illness — precisely because it is *not* a terminal illness.

Killing People Is Not The Solution. Emotional support, social support, practical help with day-to-day problems: *these* are actual solutions to the problems related to MS.  [Hey, living wages, real health care reform, and accessible community design would be useful here! Hint hint.]   Treatment for depression, for whichever members of the family are suffering from depression, is essential.  A strong legal framework that protects vulnerable people from the temptation to suicide and euthanasia is part of the package, too.

–> Legislators, judges, and medical professionals who encourage death as the solution to discouraging medical problems are, frankly, a bunch of cowards.  Wicked evil cowards.   Deal with the actual problem, don’t try to sweep it under the tombstone.

 

Nice economics link here.  Haven’t read the article cited, just the blog post.  But it looks promising.

 

Why a sliding scale matters (health care costs)

So.  Months ago I started this health-care cost topic.  We started off on the topic of routine costs.

And to summarize the main point of that post: Routine health care — all those preventative check-ups, and the care and treatment of run-of-the-mill colds and flu and stubbed toes is not something we actually “insure”.   These are planned expenses.

Insurance is the means of having everyone contribute a modest amount to a funding pool, so that the few who suffer the unlikely catastrophe are not devasted by the enormous costs.    So, we insure against a car wreck — many drivers will never be in one.  But gasoline and oil changes are part of our routine costs — costs every driver will incur, no matter how careful you are.

When we say we have “insurance” to cover routine health care costs, what we really have is a pre-payment plan.

(The same can be said of larger unplanned-but-still-expected expenses.  Sprained ankle, the weird stomach thing that felt like a heart-attack but you went to the ER and it turned out you were okay, the  routine delivery of a healthy baby.   You might not know exactly when and what expenses are coming your way, but come on, you knew something was bound to happen.  You set aside an “emergency fund” of cash to cover these odds and ends.)

***

On the other end of the health care spectrum are insurable costs.  Not everyone will get cancer, or suffer massive injuries in a car wreck, or contract some other equally expensive ailment.   Insurance to cover the cost of treatment makes sense.   We all contribute a modest amount towards paying those expenses, and if you are the unlucky one, the pool of funding is there to help pay your enormous bills.

–> Now it should be observed that as with home insurance or car insurance, there are factors that affect how likely you are to suffer the big disaster.   Within reason, it makes sense to allow the health-care corrollary to safe-driver and good-homeowner discounts.  Recognizing, however, that unlike obeying the speed limit or installing a sprinker system, a significant chunk of a person’s health is not within their control.  Like being male & under 25, slightly elevated rates are understandable, but it isn’t fair to price a guy completely off the streets for something he can’t control.

But here’s where health insurance differs entirely from car and home insurance: You can’t buy a cheaper body.

If my budget is tight, I can choose to live in a small home and drive an inexpensive, easily-repaired, fuel-efficient used car.    My insurance rates will, correspondingly, be lower.  Likewise, my routine maintenance costs will be lower.

(Indeed, how do we measure a living wage?  We aren’t looking for a wage that will pay for a mansion and a cadillac.  We look at whether it will cover such basic needs as modest housing and frugal transportation.)

With health care, we aren’t so lucky.  If I take a big pay cut, I can’t go sell my McMansion body and rent a modest little apartment of a body instead.  I can’t take my late-model BMW body to Car Max, and come home with a cute little ‘92 Civic in exhange.   I can’t even park my gas-guzzler body in the driveway and take public transit for all my bodily needs instead.  Indeed, for the most part I never got to choose whether I wanted an expensive body or frugal one to begin with.  I’m stuck with whatever body I was given, and bodies aren’t given out according to income.

What does this mean for health insurance?

It means that the point where health care becomes unaffordable depends on your income.   Partly a living-wage problem, of course.   But let’s imagine a worker earning enough to cover routine appointments and modest amount of emergency health-care besides.  The illness that is an inconvenience and a bit of a strain to a wealthier family is something that would be absolutely unaffordable to a person of more modest means.

(Check out the wheelchair world for a specific example: Some people can just go out and buy the chair that suits them best, even though it costs something in between a high-end racing bike and a quality new car, depending on their needs.  Other people have to hope someone, anyone, is willing to fund a chair approximating what they need to function in a healthy manner.)

It also means that the ability to afford insurance premiums varies.  How much of your monthly budget can you set aside?

***

Two very obvious points, I know.  And hence the importance of sliding-scale charges for health care.  If we mean to have a fair health care system, it is reasonable to give discounts to people who cannot afford as much.   Kind of the way we have student discounts for opera tickets.

Does that mean we have to go with a tax-funded, nationalized health-care system?  Not necessarily.  Physicians could be allowed to post discounted prices.    Insurance companies could be allowed to issue policies where the premiums and deductibles are percentages-of-income rather than flat rates.   Employers that offer health insurance benefits could be allowed to vary the “employee’s share” of the expense according the employee’s income.   If we are creative enough to think up double-coupons, Sam’s Club, and Early Bird Specials, we can figure this out, too.