Taxes are not a one-way transaction

We all complain about taxes and we all would like to pay less taxes or none at all.

But what happens when we pay less taxes?

We won’t have the public streets and highways that we want to be in pot-holeless condition.

We wont’t have fire departments coming to put out our house-fires or the neighbors’ house-fires that might expand to our house.  Does that give you a clue why tax supported fire departments are a good idea?  If not, consider how safe your house would be if you were the only one on your block who paid the fire department.

The same holds for police and snowplowing and street cleaning and …  Would you want to be responsible for clearing the snow from the street in front of your house?

And the irony of ironies is that the “conservatives” who complain the loudest about taxes for things they don’t like want to to throw money at the military, especially if it means a military base in their district.

Oh, yes!  If you can read this, thank a teacher.  If you're rich, maybe your daddy paid the teacher.  If you're not rich, hundreds and thousands of tax-paying citizens paid the teacher.  Or, the poor kid whose education you helped pay for in your middle-age may be the doctor that saves your life in your old age.

Modern medical care precludes a “free market”

One of the latest to call for a free market in health care is Bert Stephens, one of the New York Times “conservative” columnists.  His latest column, “A Price for the G.O.P.’s Health Care Insanity”. https://www.nytimes.com/2017/06/30/opinion/congress-health-savings-accounts.html  He takes on Obama for creating the mess and the Republicans for making matters worse with their “fixes”.

He blames it as the “third party problem”; the consumer of health care does not shop around for the best deal but depends on an insurance company to pay the bills.

There may still be a free market in dentistry, but there cannot be a free market in health care.  Why?  What is one of the criteria for a “free market”: many sellers.  We have long ago lost many of our independent doctors: they are mostly in large clinic/hospital complexes.

In Duluth, Minnesota, we have two choices: Essentia Health or St. Luke’s.  It may still be that if you have company-provided health insurance, then your only choice may be a given clinic.  I know that we have switched clinics when we switched jobs.

Oh, sure, if we can’t get into one of these clinics or decide an out-of-town clinic is a better choice, we can drive a few hours or stay overnight to visit other clinics.  My wife couldn’t get into a dermatologist in Duluth and so drove to the Twin Cities.  We have had several friends who have stayed in Rochester to use the services of the Mayo Clinic.

There are certain specialties that are available outside the clinics, such as eye care.

A clinic may give you a choice of doctors, but you are often limited to those who have current openings in their schedule.  If your doctor leaves the clinic, the clinic may assign you to the next available doctor  I don’t remember if I chose my first cardiologist, but I know I was assigned to another when my then current cardiologist went elsewhere.  When my cardiologist decided that I needed heart surgery, I was assigned all the subsequent surgeons.

Another consideration is our knowledge of the available doctors.  Do we know who is available?  Do we know their credentials and reputations?  A free market includes having all the information to make a decision.  Very few of us will take the time to get the information, or, if we get it, have enough knowledge to make a decision.

Government too big or too little? Make up your mind!

Republicans seem to be at the forefront in complaining about "big government".  Then they turn around and complain about the Federal government not doing enough.

The attack ads and phone calls from Republicans are overwhelming about the overreach of the Affordable Care Act (Obamacare),  Among their statements are the Federal government should not be between you and your doctor.

Now Republicans in Congress are complaining that the Federal government is not doing enough about ebola.  In other words, the Federal government should get between ebola patients and their doctors.

See "Congress Scrutinizes Handling of Ebola Cases in Texas", New York Times, 2014-10-16.

The Impatient Outpatient

In mid-January I visited my primary physician for my annual physical.  Because my PSA shot up above 7, he recommended I see a urologist.   I had to wait until early March to see the urologist I've seen before.

When I saw him, he decided he wanted to take 20 biopsy samples, which means it would be done with anesthesia in a hospital rather than in his office.  So, that was scheduled in late March, at 5:45 in the morning.  But then he wanted me to see my primary physician for a pre-op.  I scheduled that for a few days before the biopsy surgery.  When I saw my primary physician, he didn't think there would be any problem.

But then he thought about it and because I have a heart valve blockage he thought I should see a cardiologist.  This was about two days before the scheduled surgery.  I couldn't see my cardiologist until the following week.  I notified the urologist's scheduler and she supposedly notified the hospital.

I think the hospital called a day or two before the surgery and I informed them of the delay.  At 6:15 of the morning of the original scheduled surgery, the hospital called asking why I wasn't there!

I saw the cardiologist the following Thursday.  He didn't see any reason I couldn't have the biopsy.  The risk of surgery to open my artery was greater than the risk of the biopsy.

I called urology scheduling and she "penciled" me in for April 10th.  At least this time I wouldn't miss a class. "Penciled" probably means entered in the computer system with a provisional note.  Surgery called me back a few days later and said I was scheduled for 8 in the morning.  A much more civilized time.

So no alcohol 24 hours before and 24 hours after.  I like my wine but I could give it up for a couple of days.  No breakfast on the day of surgery.  Now, that is hard to give up.  Only coffee, water, and clear juice.  At least I get a jolt of glucose with clear apple juice.

Off we go on Wednesday morning with my wife to keep me company and drive me home.

We get whisked into a small room with a hospital bed and a woman working on a computer in the other half of the room.  Hm!  Are they getting crowded for office space?  I'm given a gown, a robe, support hose, and cloth socks with sticky bottoms.  My wife looked at the last and said she should have brought those $125 socks from home; that's what was on the bill for her surgery a couple of years ago.

So, I'm just about ready to be trundled off to surgery.  We sit and wait.  My wife has a book, but I can't get into reading much.  I just sit quietly on the edge of the bed (gurney).  And we wait.  It's nine o'clock.  We hear there has been an emergency surgery.  That's certainly more important than my biopsy.  And we wait.

A guy is brought in on a gurney to recover from his surgery.  The woman working on a computer is his girl friend trying to catch up on work while waiting.

I play with words in my head and come up with "The impatient outpatient".  I tell it to a nurse and she just about cracks up.  She was my best audience; others smiled or shrugged.  Maybe they took it as a serious criticism.

Finally about ten o'clock I'm trundled out of the room in my bed.  I watch the ceiling lights flash by and chat with the nurse pushing me.  She places me in a curtained alcove.  The urologist comes by to check on me; his beaming face is a relaxant.  The anesthesiologist comes by and I ask him his name.  It's Muzzi.  "Parlai italiano?"  Boy, does he!  Not exactly like a native, but better conversation than I could make.  And he spoke slowly enough that we understood every word.  He learned it from his "nonna" (grandmother).  Next comes an anesthesiology nurse who heard some of the previous conversation and said he was "German" and asked me to use some German phrases.  In the course of these comings and goings, I rattled off a few phrases in other languages.  Was I entertaining the staff or were they distracting me?  While this last conversation is going on, the nurse puts an I.V. in me and starts a saline drip.  No big deal except the tube irritates the crook of my elbow a few times.

The surgery space becomes available and I'm moved two or three curtained spaces.  Daphne, another anesthesiology nurse, starts the drip of Propofol.  Hoo boy!  My arm feels like somebody is squeezing it everywhere.  Then somebody says, "Melvyn, wake up!"

I feel really tense and stretch everything I can.  But otherwise I am content to just lie there.  After a few minutes I again watch the lights flash overhead but I don't chat as much.  Back in the room.  Goodness, it's two o'clock.

I'm offered beverages and I choose water and apple juice, the latter again for the energy.  I feel better and better.  My bladder says its time to go down the hall.  I manage mostly on my own, but slowly and with a nurse at my elbow.

At about three I get permission to get dressed and go home.  The staff gives my wife time to bring our car to the front door and escorts me out.  Home we go and life returns to normal, sort of.

I was told I would learn the results in a couple of days.  Well, those couple of days were thrown into turmoil by the weather.  Duluth was hit by a heavy, wet snow fall and many activities were cancelled.  As of Sunday I have not been given a result.   My attitude is that I'm positive the results are negative.

Meanwhile, I've moved a lot of snow and slept well.  The worst side effect was a sore throat from the breathing tube that was put in my throat so I could breathe properly.  Today I feel I have some of my singing ability (whatever that means) back.

For the follow-up, see "I was right to be positive about a negative".

Salt of the girth

When we came back in 1974 from six years of living in Europe, we were struck by how salty much of American food was.  Thirty-six years later, we still think most American food is too salty.

We bought some roast turkey from a deli for tonight's supper.  My wife decided not to eat it because it was too salty; she opted for her own brown rice and black bean concoction instead.  So I'll have her turkey tomorrow and she'll have my brown rice and black beans.

She is fussy about where we have pizza; a couple of pizzerias are off her list because their pizzas are too salty.

One day a week I used to have a three-egg omelet, home-made muffins, plus breakfast sausage from the local supermarket.  Then the sausage seemed a lot saltier.  I mentioned it to the meat cutters, but the salt content seemed to stay the same.  Now I just have the omelet and muffins.  I put no salt on the omelet and my wife says that she makes the muffins 24 at a time with a half teaspoon of salt for the batch.

For several years I've said that excess salt belongs in two places - on the rim of a margarita glass and on pretzels.  I can't even remember the last margarita I had, but I like to have some pretzels with wine before dinner.  Also olives.

A couple of weeks ago I had one leg swell up to a third larger than the other.  I didn't hurt much but it was an anomaly.  My wife called the nurse online who recommended I go into urgent care the next day, a Saturday.  In the morning the swelling had subsided and I decided to just watch it.  The following week it swelled up again, and I called for an appointment with my regular doctor.  By the time I saw him the swelling had gone down again.

I thought it might be excessive salt and mentioned it to him.  I said I had the wine, pretzels, and olives most nights.  He couldn't find anything abnormal, but recommended that I get an ultrasound.  He also said watch the salt.

The ultrasound was negative.  Total charge: $690!

I started thinking about my activity or lack thereof.  I have been very involved in family history research and just get carried away sitting in front of the computer looking at record after record, finding new stuff or confirming old stuff.  Maybe I'm just cutting off my circulation.  I also have the chair rather high because my computer is on a rather high table.  I've lowered the chair and try to get up more frequently.  The swelling has not come back in a big way.

I also decided to check my salt intake.  For the most part, we eat very few processed foods.  I won't bore you with a list of the salt content of various foods that I do eat, but for what I could find of sodium content for the foods I do eat, my intake was 96% of the daily value.

The sodium percentages were surprising.  For olives and pretzels, no.  But 1/2 cup of low-fat yoghurt was 3%; a few "baby" carrots, 3%.  The big surprise was a 2-1/2 inch slice of French bread was 14%!!!

If I eat French bread, I often have two servings, 28% of the daily value for sodium.  But I don't eat French bread very often, and so that gets me down to 82% of the daily value of sodium.  And my doctor wants me to watch my salt?!?

Joan D. Vinge wrote a series of science fiction novels starting with "The Winter Queen".  A persistent theme in some of the later values is when a distant super computer is asked for information, it responds with, "Ask the right question."

And that theme is something for a different blog entry.