Sunday, October 15, 2017


I have an Imp in my life. She is the right size, though the bleached blonde hair and dancing blue eyes, instead of bat wings and tiny horns, tend to mask her Impish nature. However, when it comes to mischief and the determination to being the center of attention, no Imp is her better. Which makes perfect sense. Why shouldn’t a near endless flurry of pure joy, boundless curiosity, and fearless adventurism be the center of attention? A touch of the mischief just comes with the territory.

A couple of weeks ago, a small lump appeared in the middle of my Imp’s little tummy. It was coy, sometimes noticeable and sometimes not. Every adult in her life immediately moved right up to the edge of panic and hovered there. Her Doctor insisted there was no real reason to worry. Our Imp was eating and sleeping well, never complaining of feeling bad, or showing any sign of being in pain. Still, he couldn’t say what the lump was was, only what is wasn’t. And what it wasn’t was a (rather common place) hernia. He scheduled an ultrasound for several days later, allowing that it could be canceled depending on what he learned from further research and conferring with other doctors.

Ultrasounds are moderately expensive tests on toddlers, and the Imp is among the many in our country whose family can only afford health insurance that comes with a crippling high deductible. Which puts one in a weird state of mind, hoping that any looming medical bills remain as “out of pocket” expenses. Such could easily drive us into a financial hole so deep that climbing out would take several years, as happened with a cancer scare a few years ago. (One of the contributing factors to us being in Bradenton these last two summers.) But chewing through the deductible to actually get insurance support would mean entering that place from where the panic wells. Perhaps the Doctor would come up with something, and the ultrasound could be canceled.

The several days passed and the Doctor could not find any explanation for the lump that would negate the need for an ultrasound. So the Imp, accompanied by Mom, headed off to the hospital. Apparently ultrasounds are common procedures for those who ended up having reason to fear the worst. My little Imp was the healthiest one in the room. It was a thought that brought a deep ache to the heart and allowed the panic to edge in a bit closer. Why should fate smile upon those I love when so many, so deeply loved by others, dwell in the valley of the Shadow?

At the end of the test, the technician was nothing but encouraging. According to him, had the test shown anything of real concern, the radiologist overseeing the procedure would have admitted the Imp to the hospital forthwith. That she was sent home to await the diagnosis was a a positive omen. But, once again, though they got a bunch of “good” pictures no one would say for sure what this thing was, or even what it wasn’t. The panic edged away a bit, but it didn’t disappear.

Two days later came word, and the panic died. The Imp has a hernia after all, it just isn’t a very common one. Surprisingly, while spreading the good news to family, we found out my Sister was born with the exact same kind of hernia and has had it all of her life. Surgery was never required nor has the condition done her any harm. Good news made even better, but it seems there is still some room for debate. Word has it general anesthesia and invasive surgery have already been broached by the professionals.

When one climbs aboard an airplane the professionalism of those flying is assumed. There is good reason for the assumption since the crew, as the saying goes “will be the first ones in the hole.” They have skin in the game, and those in the back of the plane ride along on the crews determination to end the day in one piece. But it is difficult to make that assumption of the medical profession in the US.

Our medical industry is a profit center, not a health center. It would be far more lucrative for that industry if the Imp undergoes surgery rather than just going about her life. A stay in the hospital, specialists and drugs, doctors and nurses…what do you guess - $10,000 - $20,000? And the thing is, if something goes terribly wrong, no one in the operating room “will be the first one in the hole”. In fact, they will get paid anyway. Will they “feel bad?" Sure. They are human beings after all. But they have likely “felt bad” before, and will “feel bad” again. In the mean time they have student loans to pay off, mortgages to meet, and dinner to put on the table. American’s ratio of health care returned for dollars spent is the worst in the first world. Ours is also the only one based on making a profit rather than making people well. Are the two connected? Many insist not. Indeed, some insist that "market forces" will make for the best health care. I suspect (if you will forgive the pun) they are whistling past the grave yard.

It would be nice to think that we, as a people, have earned better than that. Maybe, much like a chain can be no stronger than its weakest link, a nation can’t rise above the level of its average collective wisdom. It is starting to look like this is the best we can do, the wisest we will ever be. This generation of America is never going to fix its health care system. We have reached the limit of our collective wisdom.

My hope is that such is a generational thing. There is a whole new generation of Imps out there. One of them owns a big part of my heart. She is fine. And my belief is she, and they, are going to be much wiser than we.

Assuming we let them live that long.


Sheri Gallic said...

Hugs,,from the sister

Marc Tjaden said...

It is good to hear your "Imp" is okay and you are right our medical system is a for profit only which makes it a little on the sucky side.

TJ said...

That sad thing Marc, is that it doesn't have to be this way. Hell, we don't even have to invent some kind of new system, just borrow one from pretty much any of the first world nations who figured out health care years ago. I don't know if their politicians are just slightly less corrupted than ours or if their citizens are (collectively) just a little smarter than us. It isn't even that we are stuck in place, we are actually going backwards when it comes to healthcare. Then again, "backwards" seems to be the general direction the country is taking when it comes to a lot of issues.

pfrymier1 said...

Well, I have to agree with your statement that perhaps this is as "good as it gets". The documents that define our basic rights were at once cleverly and frustratingly vague. I don't think we have the system of governance to optimize quality of life above a certain level. The founding principles in the Declaration were unalienable rights to life, liberty and the pursuit of happiness. The country was founded (well, actually the land was mostly stolen, but let's not quibble) by people with a strong sense of self-sufficiency. There are pluses and minuses. I've done well, for the most part. I am nearly perfectly insulated from people I don't like or who make me uncomfortable whenever I like. I have managed to get myself to a a place where there is virtually no one to whom I answer either in my personal or professional life. I am the perfect example of the American Dream, in some ways, free to fail spectacularly or succeed gloriously. At this point, it if virtually impossible for me to fail. I'm insured against nearly every catastrophe, real or imagined. The worst thing that could happen perhaps is that I would die and leave my heirs with a pile of money so large they'd have a hard time spending it all. Partly by virtue of birth and partly because I like to do things other people don't or can't, I've managed to be considerably more toward the later than the former.

I believe some countries manage to do a better job at securing a better quality of life for their population, but often the circumstances make it difficult to replicate here. For example, some of the smaller European countries appear to be virtual paradises on first blush. The streets are so clean and the homes and buildings in the entire country so well maintained, it is hard to believe they exist in the same world as, for example, Haiti. However, often the populous is extremely xenophobic and becoming a citizen if not born there is impossible. Immigration is extremely tightly regulated. In the US, by comparison, we have built our entire civilization on looting the rest of the world for the best and brightest. Although perhaps change is in the wind, we have been historically, to many, that shining beacon on the hill with unlimited potential for economic benefit for the educated and/or ambitious. People will leave everything they'd ever known and risk all just to get here. However, our very strength through our diversity to some extent limits the ability to get along and function to some higher goal of quality of life. Where we succeed, on average (with a massive standard deviation), with quantity of life, we struggle with mean quality of life. There is always some group to scapegoat as taking advantage of the system or gold-bricking that politicians can use to their benefit to divide the population and gain power.

pfrymier1 said...


It may simply be the nature of the beast. I think all developed cultures become more progressive over time, but it is awfully hard to say. There are certainly short term fluctuations that make it difficult to see a trend in a mere 200 years or so. Anyway, the US is where I live and work and it is better than many places I've been although maybe to my taste, not as progressive as I'd like. It is a big place that struggles with figuring out how to deal with big issues that require national level organization and resources. We often fall back on the rugged individualism that built the early US and forget those exploited in the process. The continual struggle between federal, state, and individual rights is perhaps the tension that defines the US for all time. Perhaps we are asymptotically approaching a local maximum while forever prohibited from finding the global maximum by our nature, if one exists.

It is difficult for me to keep my perspective. I have health insurance that is the envy of the free world. I'd probably pay less for a case of good beer than for an ultra-sound. The disparity is mind-boggling. We are certainly a nation of contrasts.

But these are just some thoughts. Anyway, certainly glad things turned out for the better in this case. I hope those with the intelligence to solve big problems are brought to bear on the problem of health care. In the most simple sense, it looks trivial: We have the infrastructure and the expertise to solve so many medical problems. It is a matter of bringing them together. On a system that requires a profit, money is always going to get siphoned off to bring the solutions to the problems. If this adds value and solves the most problems, then it works. But the system is only as good as its rules; for every smart person out there burning the midnight oil to be the best radiologist in the world, there are two figuring out how to get the most money out of the process of bringing together the problems and the solutions.

Marc Tjaden said...

TJ you are so absolutely correct

TJ said...

Interesting thoughts pfrymier, thanks. My basic view is that we, as a people, have (or perhaps had) such huge potential. Civil rights, human rights, liberty, peace, compassion, responsible living, the pursuit of knowledge and understanding; these were (or had the potential to be) our national focus. That is mostly lost now, and I see little hope it can be regained.

I don't actually think that federal or states have any rights...they exist only to protect, expand, and balance the rights of citizens. The balance is the hardest part. I am an atheist and (for example) regard marriage as a personal choice sanctioned by the legal system. Gay people have every right to make that personal choice and enjoy the sanctioning of the legal system offered to all citizens. But no religious organization should be required to marry gay people if they think that offends their god. (And none that I know of are suggesting that they be so required.) They certainly shouldn't be forced to attend gay weddings. (None that I know of are suggesting that either.) But if they make wedding cakes for a living, should they be required to make a cake for a gay wedding? Kosher shops are not required to sell bacon, but they can't refuse to sell chicken to a Muslim or a Christian. Would we let a Nazi wedding cake maker refuse to service African American citizens? Should we? After all, it wasn't that long ago that we let American Christians refuse service to other American Christians, all in the name of religious freedom.

Balance. For me, IF your company's business to provide wedding services, and if you think your god will be horribly offended and likely send you to hell for providing such services to gay people, you should have the right to refuse; along with refusing service to everyone whose beliefs you regard as offensive to your god...Muslims, Jews, Christians, whatever sect or cult you think lives in "sin". Is that fair to gay people? Not at all and I would never patronize such a place even though I am not gay. But "fair" is not always attainable and is never available at the beginning of social change. Progressive social evolution is about moving toward "fair."

In any case, I think the system set up by the Constitution had a lot of weak points, places where the system could be (and has been) gamed to the point of failure. Late stage, corrupted, predatory capitalism being the final nail in the coffin. What happens next is anyone't guess.

pfrymier1 said...

On the subject of fairness, I was listening to the program "On Being", which is syndicated on NPR stations, today. The host was interviewing Jonathan Haidt, who is the Thomas Cooley Professor of Ethical Leadership at NYU's Stern School of Business. Much of the discussion centered around what could be done to inject civility into political discourse, which Dr. Haidt is a proponent of. There were a lot of interesting discussion points, but there were two things he said that stuck with me. First this: "People who are liberal and conservative, he says, value two of these in common, compassion and fairness. But conservatives simultaneously juggle three other moral values — of loyalty, authority, and sanctity."

And then this: " one study that I did with my former graduate student, Jesse Graham, we asked liberals and conservatives to fill out our main surveys, pretending to be the other, and also as themselves, for different people. What we found is that conservatives and moderates were very accurate at filling it out as though they were liberals. But liberals were not accurate filling it out as though they were conservatives, because they just couldn’t get their mind into the idea that authority is somehow related to morality; they think it’s just oppression."

If you are interested and have the time, you can read the transcript or listen at:

TJ said...

pfrymier, thanks again, I will have to check that one out. You can count me in as one of those who doesn't get the idea that authority is somehow related to morality, though I'm not sure I buy the idea that it is "just" oppression. Some authority structure is usually required when any group of people try to work together. What that has to do with morality is vague. Sometime people work together to help themselves and others. Sometimes they work together to help themselves without much thought to others. And sometimes they work together with the explicit purpose of doing as much harm to others as they can.