“It’s a typical situation in these typical times
too many choices…
Oh, everybody’s happy
we’ll keep the big door open
everyone’ll come around.
Why are you different?
Why are you that way?
If you don’t get in line, we’ll lock you away…”
-Dave Matthews Band, “Typical Situation”
I need a doctor.
Maybe I’ve been watching too much of the new “Doctor Who” lately, just starting on season 5 now in the progression, after growing up with the original series as perhaps my absolute favorite show. Tom Baker is still the best, but it was hard to see David Tennant go, especially under the phrase “I don’t want to go!” Of course, that reminded me just a tiny bit too much of the big hug I got from Marcel Miranda in May 2009 when I left Glide after three years. He cried in my office a little and said “I don’t want you to go!” He passed away that December.
I can pick between ten or eleven doctors, which the iconic British show has offered me, and narrow it down to at least two, and probably one if I had to. What I am struggling to do is choose from the large printed book that Blue Cross and Blue Shield of Louisiana sent me a couple weeks ago, detailing all my possible options for primary care provider under my newly regained health insurance. The book is 402 pages.
The existence of such a tome and its delivery to me, free of charge, is supposedly what’s great about health care in America. Obamacare advocates would claim it as a victory and its detractors would say this is the kind of excellent private health coverage that is about to be taken away. Louisiana in particular has been playing out this struggle – it’s one of the Medicare refusal states and a state with unbelievably runaway insurance costs of all sorts. It actually has the highest car insurance rates in the nation (sorry, Jersey, I’ve been able to do some pretty direct comparison shopping) and is one of those weirdly shaded states on the map where health care premiums have still been skyrocketing after the ACA. I don’t even want to think about what the book and its upkeep costs, let alone what it gets billed as in the modern ever-growing health care industry. Especially when it could be a website, but that would limit access, because we somehow stubbornly cling to the belief that the Internet should be doled out like a private luxury instead of the public good that it clearly is. If you wonder why I believe in radical change over gradualism, it tends to be this kind of spiraling frustration that it’s hard to find one thing that this society does efficiently and/or with the people of the country in mind. The really sounds like an exaggeration until I start pulling the loose thread of any given problem.
This book has single-handedly prevented me from going to the doctor for two weeks. And it may yet do the same for a few more. Even though I really need a doctor, mostly because I have been without health insurance for about half a year and there is an ominous growing patch of discolored skin on my upper back that is almost certainly not cancer, but you never know. Most friends who I’ve discussed this issue with find it hard to believe that I waited for health insurance at all to discuss this issue with a certified medical professional (and of course WebMD has already given me just weeks to live), but I’m not fond of doctor’s visits when I’m swimming in health care, let alone when it must be paid out of pocket. I learned that lesson real fast in a 2003 emergency room visit in Berkeley and have never really lived it down for myself. I’m sure I could find the link in Introspection, but I really don’t feel like combing the year 2002-2003 for the record right now.
I believe I have what they call “analysis-paralysis”. Not on my back. That’s probably called something else, hopefully not an astrological term involving an admittedly ornery-looking crustacean. With the healthcare and the 402-page book and the need for a doctor. I have too many choices. Way too many choices. I miss Kaiser Permanente, who just picked a doctor for me. Yes, sometimes the doctor was obsessed with medication and I hate medication, sometimes the doctor wanted to put me on mind-altering drugs for migraines, sometimes I had to wait a week for an appointment. But at least I was utilizing the health care system. At the rate I’m going with Blue Cross and Blue Shield, I’m not sure I’ll ever start.
I guess if I grew up here, I would feel more qualified to make the decision, having logged time and preferences and references and prior visits. The problem is that the decision could matter, theoretically – there are philosophical and quality differences between doctors, to be sure. But researching the decision in order to make an effective one is a ridiculous proposition with the time allotted. Frankly, it would be a ridiculous proposition with the time I used to have back when I lacked health insurance. I think someone could make it their full-time job to pick a doctor (under the premise that the choice matters) for me, because, probably, there are 2 or 3 really excellent matches with everything I feel about the delivery of health care.
But obviously, undertaking more than a cursory random-noise search is impossible. Alex said she confronts these decisions (she, after all, had health care months ago) by picking someone (a) a woman with (b) flexible hours who is (c) close to home. I don’t really have a gender preference in my medicine, but the latter two factors seem to make sense, though they have very little to do with what actually makes a doctor more likely to deliver me health care in the way that I want it. And, admittedly, maybe finding out things about whether they believe in off-label use of anti-depressants to treat migraines or back lesions or any of my other ailments is not really something even the book and the power of Internet research could tell me. Maybe I should just pull some names within 2 miles and throw a dart or a pick a unique-sounding name.
But I’m haunted by the idea that this could matter, that everything in our society tells me that doctors are very different and being able to have agency in selecting a personal doctor is one of my supreme God-given rights. I certainly don’t have a right to housing or food, but doctor choice – now we’re talking! And so this rhetoric has prevented me from sincerely getting out the darts, even though I already would have a diagnosis on what’s troubling me if I’d just freaking picked already. It’s hard not to feel like I’m a big metaphor for the bloat in our system, though I know my results are hardly ever typical of how people approach health or its care.
What is altogether too typical is the preliminary sparring in the 2016 Presidential race, one for which I’d like to make a quiz if I can ever remember how I made 128+-answer quizzes while holding down a day job and living life all at the same time. And what society tells me is important here is that the dream deferred of Clinton-v-Bush, round 2, is being threatened by an e-mail scandal. Hillary Clinton was, apparently, very naughty with her e-mail accounts.
I strongly dislike Hillary Clinton. I dislike her policies and I dislike her as a person. I think it would be a horrific precedent to set that the first woman President of the United States was first a First Lady, that her initial qualification for politics was being married to a popular President. I am terrified of 4-8 years of her policies when she has clearly expressed that she thinks the biggest impediment to electing women is the wide perception that they would be less likely to bomb people than men, and would dedicate her Presidency to proving that theory wrong. I find her sense of entitlement, a true Clinton legacy, disturbing in the utmost. I do not want you to vote for her.
That said, this e-mail “scandal” is stupid. I really dislike Hillary, can’t stand the Democrats (or Republicans), but not voting for her because of these e-mails is ridiculous.
Like, yes, I guess there’s theoretically some minor chance that her personal e-mails would be more likely to be hacked or read by an employee of the private company with whom she sent e-mails. And I guess the surveillance state finds it terrifying that there would be some balance in the transparency of everything, see also Snowden, Edward. But, really? Mrs. Clinton is 67 years old. She doesn’t know the intricacies of technology. You find me a 67-year-old politician or statesperson who understands these things. Who never threatens the absolute security of their documents by making some technological blunder, by leaving a printout lying around, by forwarding the top-secret attachment to their home account so they can print it, by logging in to the CIA server from the ski lodge wifi. Really? People sneak machetes and pepper spray and small arms into airplanes all the time. We’re worried that HRC’s top-secret not-yet-leaked correspondence with leaders she was trying to intimidate were on GMail? All the secrets of the world are on GMail! Thankfully it’s too much data for Google to quickly mine and distill for purposes other than using advertising to creep you out.
But mostly people aren’t even rumbling about security. They’re rumbling about appropriateness. Or, mostly, they’re rumbling about BS. They’re using the opportunity of a couple media people and politicians taking this scandal Very Seriously to join the chorus in the hopes that something like this could actually fell the momentum of the presumed President-elect.
The problem here, of course, is that there are basically no real choices for President. In a theoretically wide-open field of candidates, with no incumbent on either side of the aisle, it’s been known for over a year who most of America thinks will win the Presidency in 2016. And it’s certainly been known for a while that the person will come from one of the two major parties and that there are only a handful of people from each party that could seriously be considered for this job.
And it’s not that there aren’t a few more qualifications for President than there are to be a certified medical professional in greater New Orleans. But with those qualifications and the commensurate responsibility should come at least a modicum of flexibility in who we consider. After all, it’s not like the people we’ve been dealing with are getting us anywhere. Congress continues to pass functionally no legislation while carrying an approval rating well below freezing. And yet the quantity and scope of our choices remains extremely limited.
How have we generated a society that offers a 402-page book for who you want to discuss aches and pains with, but can’t come up with more than a small handful of choices for who is going to make the majority of decisions about the operations of the entire nation for four years?
The illusion of choice is pervasive in our world. We are, as Americans, completely obsessed with choice as a concept. Choices of products, choices of companies, choices of jobs, choices of schools. The ability to make these choices is a badge of wealth and privilege that we like to pretend represents neither. But the ability to choose between 402 pages of doctors belies the fact that the alternative choice is among 0 doctors, or crippling debt to wander into an office. Our college admissions process cloaks the fact that many people had insufficient opportunities to learn before college and are faced with no acceptances, or cutthroat for-profits masquerading as educators. Job offers and rigged unemployment numbers mask the fact that so many people have no jobs to choose from at all, or are being squashed into a shadow labor-market as “independent consultants” who work below the already dizzyingly low minimum wage.
But no amount of status and class can buy you a real choice for the Presidency. Well, even that might not be true. If you have enough zeroes behind those digits in your bank account, I guess you can buy yourself a candidate to your liking.
Can someone buy me a real leftist?
Or at least someone who can help me pick a doctor?