Book Club: An American Sickness

The U.S. healthcare system is a hot mess. Even people who know things are convoluted and expensive might not realize the extent: we pay far more for just about all aspects of healthcare here than anywhere else, and our outcomes are worse pretty much across the board (see this article from the Commonwealth Fund for details).  As tempting as it is to implicitly trust that you’ll get the best care in the world right here, the facts would suggest otherwise. Every other major developed economny in the world as some form of universal access. So why do Americans cling to the idea that our healthcare market is somehow sacred, and that a market-based approach is the answer? I’ve talked about why healthcare is not just another commodity before, but it’s still true.

Elisabeth Rosenthal, a physician turned journalist who has worked for the NYT and Kaiser Health News, wrote a book last year. In it, she exposes a lot of the causes and effects of the major malfunctions in our healthcare system. Much of this is illuminating— examples about hospital conglomerates and pharmaceutical pricing are spot-on. But what seems to lack punch is the explanation for why this upside-down, losing system persists. When healthcare is treated like every other business, greed drives, incentives are bonkers, and lobbyists shape policy. When healthcare is considered as a public service, things are different. But once powerful people are making obscene amounts of money, it’s nigh impossible to unring that bell. Are there market failures? Big time. Can the people affected muster enough influence to combat the big-money lobbying of professions and industry that have become accustomed to fat-cat money? Fat chance.

Aother quibble: Rosenthal is mercelessly physician-centric. She doesn’t consider the unique added value of team-based healthcare or other professional expertise, choosing instead to lump unique professions like NPs and PAs together as “extenders”. Barf. Dr. Rosenthal, I wish you’d take a broader view of health.

That said, give it a read. It’s interesting/depressing. And you might pick up some useful tips for your nex hospital visit, knock on wood.

The Badass Female Project: the Woman who hates Men who hate Women

I’m starting with Lisbeth Salander because she’s the one who got me thinking about this. I liked the idea of working more with female creators as well as female characters, and I still do, but I love Lisbeth so much that I can’t leave her waiting. It took me years to start reading this series, because it seemed like a fad, like a throw-away thriller. . . but no, no, no. They’re  action-packed, yes, but also smart, creative, and thought-provoking. (There are movies, too— a Swedish triology, and an American version. They’re all pretty good, but read the books first. I’m just a book person, OK?).

First, a little background (but no spoilers): Lisbeth Salander is the protagonist of Swedish writer Stieg Larsson’s “Millenium” series, the first and most well-known of which is called The Girl With the Dragon Tattoo in English. The translation of the original title, however, is Men Who Hate Women. They should have kept it, because it’s the heart of what makes Lisbeth a badass. Not her boxing, hacking skills, tattoos, or motorbike (but those are all pretty dope). Lisbeth Salander has a solid internal moral code, and she is not cowed by anyone or anything. She will not excuse men who hate women, and she has plenty of material to work with.

Continue reading

Delicious, yet malicious: Reading Salt, Sugar, Fat

No one, as far as I know, will be surprised to find out that highly processed, manufactured food isn’t the healthiest option. No, what’s compelling about Michael Moss’s Sugar, Salt, Fat isn’t some surprising revelation. Rather, it’s the breadth and depth of an issue we kind of already knew about, laid bare. And it ain’t pretty. Here are the take aways, in the cliff’s notes version:


  • Food companies are not interested in your well being. They’re interested in their bottom line. They will make things healthier if and only if it helps them sell more. They are for-profit companies in a cutthroat competitive market. Capitalism, folks!
  • The executives and scientists who make processed food and drinks generally don’t partake of the products they design and sell. Make of that what you will.
  • The copy on food packages is disingenuous. The only information about a food’s
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    keeping supremecourt.gov fly.

    nutritional value is on the actual nutrition facts and ingredients labeling.

  • The history of the government’s dietary guidelines is apalling— this isn’t a conspiracy theory, it’s pretty blatent. The department of agriculture steers the ship— and this department’s primary mission is not, in fact, health. RBG knows— Moss wrote of Ginsberg’s opnion in a 2005 case about the checkoff program for beef marketing that the USDA was simultaneusly promoting beef (advertising paid for by the government program) and telling people to eat less meat (in the USDA guidelines). She couldn’t square that circle, and neither can I: these folks have a texas-sized conflict of interest.

Bottom line: if you want to eat healthy, you have to pay attention, and it’s up to you because neither the food industry nor the government has your back. Bon appetit!

On Choosing

I recently read Marie Kondo’s now-classic The Life Changing Magic of Tyding Up. Underlying the advice about how to fold your clothes and the batty-seeming suggestion to talk to your stuff was a solid truth: we can choose our lives, but unless we decide to do so deliberately, we will not— and we will often not even be aware that this is happening. Kondo demonstrates this easily in reference to possessions: we keep unused gifts and promotional throw-aways and things that came in the mail even when we don’t like them, want them, or have any use for them. They become part of our stuff without our ever having chosen them. They show up, we let them in, and then bam! They’re ours. This happens with stuff, with people, with habits, with jobs, with whole careers, with whole lives. When zoomed out to these macro things, asking “does it spark joy?” somehow seems more important.

If we do not make deliberate choices about the elements of our lives, they will be decided for us by circumstance, chance, and others’ interests.

Woah.
Of course, sponteneity can bring joy, serendipity, the unexpected, the delightful, the life-changing, in its own right. I don’t mean to suggest we can’t open ourselves to things that come along– but when they do, ask ourselves why we are letting them be part of our lives. There are two benefits to this approach: first, we aren’t cluttered with things that don’t serve us, and second, we can truly value the things that do.
Identifying our values through sorting our stuff? OK, I’m sold. As a healthcare provider, I’m keenly interested in identifying what people value.

Happiness: When Thinking Fast Steers Us Wrong

I read a lot of books last year— among them The Undoing Project, by Michael Lewis, which led me to Thinking Fast and Slow, by the behavioral psychologist Daniel Kahneman. In Thinking Fast and Slow, Kahneman proposes that the “fast” system of thinking, or system 1, is the efficient and rapid way of processing information and taking action— it’s a heuristic-reliant process and always looks for the shortest path to an answer. It’s helpful, unless it isn’t. System 1 makes mistakes— and one of them is answering the wrong question. Politicians are aces at this one— answer the question you have the ready answer for, and hope the questioner doesn’t notice. And in the brain, often, it doesn’t.
What does this have to do with happiness or goal-setting?

We might ask ourselves “what do I want?”. There are lots of ways to answer that question, and the answer we’re after is sometimes complicated. It might be scary to admit, it might freak us out that there’s no clear way to achieve it, it might look like an insurmountable amount of work to get there, we might think it’s silly. We might be subconsiously blocking the real question for these reasons. Or we might not have really figured out how to listen to ourselves. So when we ask ourselves what we want, sometimes we get a system-one sleight-of-hand. What would make me comfortable right now? What do others expect of me? What would be easiest? What do I already know how to do? What would impress people? And system 1 will answer that question for us before we realize that it’s not really what we wanted to know.

Where does that leave us? I believe that self-reflection is a necessarily slow process. That’s not to say that we can’t have bursts of insight that hit like lightnening and change everything, but those aren’t enough on their own. We hear a lot about goal setting this time of year, and there’s a booming business for planners, self-help books, journals, programs, and “goal getter” t-shirts. All of this is fine, but none of it is going to help us unless we can take dedicated time thinking slow about what we want.

dealing with death.

 

In Tucson each November, there is an event called the All Souls’ Procession. It’s a relative of the Mexican holiday Dia de los Muertos, but it’s a distinct and unique experience. People come together and walk through the city with floats, puppets, photos, banners. They dance, chant, drum. They paint their faces and wear costumes. There’s a giant urn. There’s a celbratory aspect, but also a solemnity. There’s a shared sense of loss and solidarity. It’s moving and remarkable.

In most of America, anxiety around death is rampant. There are huge silicon valley projects dedicated to promoting longevity. We talk about “not giving up” and “fighting.” We put 85-year-old people with failing organs on ventilators and tube feeds at great expense, both in finances and in human suffering. We use euphamisms like “passed on”.  We generally don’t think and talk about the fact that death is a presupposition of life— the thing that, by oppostion, defines it, and the place that it ends. Life and death are in this way inseperable. It’s a strain on our society, I think, to stick our fingers in our ears and ignore this.

Of course there are people who resist this tendancy to avoid thee idea death. Continue reading