10 December »
Let me start by apologizing that this post is too ‘bah humbug’. In fact, the first draft was so bad I scrapped it, but then two things happened:
1) Abigail practically begged me to write it for this month’s PFAM.
2) I got food poisoning.
So, really, what choice did I have?
The first point above is self-explanatory. On the second: end of last week, I developed sudden, intense stomach cramps, and had to leave work early to go moan. Nothing was moving in my system, which is Bad News in people who have had a lot of gut surgery. Fortunately, things opened right before bed time — I was glad for diarrhea — but in the meantime I was pretty sure I was dying.
As I was planning my funeral, my primary beneficiary asked what might have caused it. I said, “well, I had pumpkin pie for breakfast”. “Why did you eat that pie?” she asked me, “It’s way too old.” Since I’m already doing lists, let me itemize my responses:
2a) “When were you going to tell me the pie was unsafe?”
2b) “Why was it still in the fridge?”
2c) “What am I supposed to do: not eat pie, like a Communist?”
2d) “Why did we make more pie than we could eat before it spoiled?”
None of these questions had good answers, in my opinion. On 2d), let me point out that nobody else in our family took home leftovers, so we got stuck with the extra pie. On Thanksgiving Day, everybody was oh-so-thankful for all that food; 48 hours later it was radioactive, so we took it, and I got sick. So, uh… thanks?
Don’t get me wrong: I want to enjoy the holidays. I spent my whole childhood learning to enjoying the holidays. I have put a lot of effort into planning, preparing, shopping, cooking, baking, and traveling in anticipation of enjoying the holidays.
But the older I get, the more of a problem the holidays are. Another list, just because it’s a thing now:
I) Holidays destroy my routine. This is generally true, but especially when it comes to meals and food.
I have the same thing for breakfast every day. I like it that way; I look forward to my breakfast. I like eating things knowing they are not going to make me sick. The holidays wreck that for me: they throw temptations like pies and cookies and sweets at me, and disrupt my entire regimen.
Refined sugars especially wreak havoc on my digestive tract: too much and my guts become a burbling mess. It does not help that I have a sharp sweet tooth, as if my tongue was trying to punish my gut. So when we start baking pies and cookies and buying candy, I’m ruined. It takes me a couple weeks after Christmas to level back out, to get my system back to normal regulation.
Then there are the actual holiday meals, which for some reason happen in the middle of the afternoon. I have to be very careful about when I eat, about timing my meals — especially dinner. On a normal day, this means I eat nothing in the afternoon from 2pm to 7pm or so. With this schedule, I can usually make it through the night without having to use the toilet.
So when a holiday meal is served mid-afternoon, it wrecks my schedule — especially because I have no better guarantee of total bowel destruction than a too-large meal full of rich foods. So not only is the timing bad, but I can’t eat much. I end up with about three tablespoons of each dish: three tablespoons of stuffing, three tablespoons of sweet potatoes, three tablespoons of green beans, et cetera — and everybody trying to bully me into eating more.
II) Holidays are work. They require a lot of energy — not just physical, but also emotional. You have all these people together and you’re trying to be friendly and nice and happy, and it’s f—ing exhaaaauuusting.
When I go home for the holidays, I also have to see all of my relatives who live nearby (= 2hrs away). That means I have to budget at least one day just to make the rounds — drive across the state, visit the folks who need visiting. I love ‘em and want to see them, but I also sometimes need a break.
It used to be the case, when I worked a job with regular hours, that Christmas was the only actual vacation I would get: often unpaid, because I had maxed out my sick leave and vacation time on health-related absences. But instead of rest and respite, I had all the emotional stresses of the holidays and a lot of driving and visiting to do. It got to the point where I was actually glad that none of my high school friends were around anymore, so I didn’t have to owe anybody my free time.
For similar reasons, I twice had to schedule major surgeries over the Christmas break, either because of school or work schedules. So the holidays also have some baggage where my health is concerned.
It’s better lately — I’m stronger, more resilient — but then just a couple days after Thanksgiving this year, my family went out to dinner and somehow decided to have an hour-long conversation about genocide. It had been a busy weekend, so I was spent already: finding appropriate affect for a conversation about genocide was beyond me. After half an hour, I was totally ready for genocide — as victim, perpetrator, spectator, whatever. And it kept. going. on. for. ever.
III) The holidays are in winter. I hate winter. I don’t like being cold — which I am now, all the time. In Australia, Christmas is in early summer: everybody goes to the beach. That sounds awesome to me. It is widely accepted by scholars and theologians that Jesus was not born in the dead of winter, so I don’t see why we can’t pick a more realistically warm day to celebrate.
This year, I might spend Christmas alone. My work schedule is a little weird, and I don’t have enough time off to go anywhere. For most people, that would be a bad thing. For me, it holds some appeal. I would rather have a week off to spend with family, but on the other hand I get to wake up whenever I want Christmas Day, eat my same breakfast as always, crank the thermostat to 84*, enjoy a little solitude, and I don’t have to drive anywhere.
And I don’t have to worry about bringing home leftovers. So this might end up being a good Christmas, after all.
6 December »
This week’s Crossmas classic movie:
I have a theory about Love, Actually : Richard Curtis, the writer behind the Cross family favorite Britcom Black Adder, was asked to write a feature-length romantic comedy. He thought about it for a millisecond, and realized that most rom-com plots have have enough comedic tension to sustain maybe fifteen minutes worth of jokes — which sucks if you’re most famous for a show in which nearly every line of dialogue was a good joke.
So what to do? He decided to make not one rom-com, but all of them: every single rom-com plot ever, at once parodying the genre and demonstrating his absolute mastery thereof. Every single rom-com plot ever, woven together in a single movie that is way funnier and way more romantic than anything prior.
And then he figured, just to f— with the hacks who write rom-coms, to make it one of the best Christmas movies ever. So that’s what he did.
Love, Actually is — well, you’ve seen it, right? Hasn’t everyone? You should — put it on your list. It’s brilliant. I know some people think it is too saccharine, but I promise you Curtis is having some fun at the genre’s expense. I hate saccharine, and I think Love, Actually is great.
The film follows a web of romantic relationships in London, every one of them a solid rom-com plot in their own right: Hugh Grant is a prime minister in love with his secretary; Emma Thompson is a housewife with a cheating husband; Laura Linney is a thirty-something with a secret; Keira Knightley is gorgeous; and Bill Nighy is just fantastic as a washed up rocker. Nighy steals the show — and I haven’t even told you about Colin Firth, Martin Freeman, or Liam Neesons.
Love, Actually is the perfect movie to watch with your significant other this time of year — in fact, it’s the only movie you have to watch. It’s all there: love, Christmas, sharp comedy, British accents, Laura Linney. You can’t ask for more from a film.
I may be a burned-out husk of humanity, but Love, Actually is one of the few movies that genuinely warms my cold heart. It is definitely a Crossmas classic.
5 December »
I posted my views of the ACA as policy. Now I want to talk about Healthcare.gov, as a patient and customer.
I live in a state whose leaders decided the Federal government is so awful, they were going to give it all its uninsured sick people to look after. (Good job, grown-ups!) I don’t need Medicaid, so Healthcare.gov is my best option for buying health insurance.
I was up at 4am the day the Healthcare.gov exchanges went live: I have insomnia, nothing else going on that early, so I figured ‘what the heck — I’ll give it a try’. I was totally locked out. Nothing. Not even a beach ball.
A week later I got as far as the part that sends me an email confirming my account: that email never arrived. When I tried to log on again, the system did not recognize my password. I clicked the link for ‘forgot my password’ which — and this is important — sent an email to the correct email address, with a link that promised to reset my password. When I clicked on that link, I was returned to the Healthcare.gov page, only to get an error message. I tried again a half dozen times.
A week ago, I finally called their phone number, and explained that I wanted my password reset. This is a very ordinary tech-support type problem. The operator asked for my social security number (for a password reset!), and then spent ten minutes humming and mumbling until finally conceding defeat. She told me my problem had been forwarded to the appropriate corner, and that my password should work in a few days.
Today I tried one last time — it didn’t work — and finally gave up. I started a new account under a different email address. At long last, I was able to shop for health insurance.
Now that I have a chance to use it, I can say that the eligibility and demographic part of the website is easy and friendly — all very painless. I skipped the whole ‘subsidy’ eligibility part, and finished the rest in a couple of minutes, which is a lot less hassle than most of the preliminary stuff I have had to do for employer-provided benefits. There were some weird questions intended to verify my identity, but other than that it was a good user experience.
The problem came when it was time to actually pick a plan to enroll in. I have issues, so I quickly honed in on the ‘platinum’ level plans, which are supposed to provide customers with 90% coverage of their costs. For these plans, the premiums were quoted at around $400 — which is just amazing. For all of my adult life, decent health insurance has been my Golden Fleece and Holy Grail and One-Ring-To-Rule-Them-All: to think that I could be $400 a month away from that goal gives me goosebumps. And that’s without any subsidy.
The Healthcare.gov site has a helpful comparison shopping tool to show you what various plans cost and cover. I picked the two platinum plans I was eligible for, and easily decided that the “CareFirst BlueChoice, Inc. HealthyBlue Platinum $0” offered a better value. Again, this was way easier than any time I have tried to comparison shop for employer-provided insurance plans.
Unfortunately, my major health expense is not listed in the comparison tool: namely, ‘durable medical equipment’. That’s okay, because you can click through to a Blue Cross document (PDF) that gives a more complete summary of benefits, and it shows that this plan would cover my appliance needs with a 20% (an total out-of-pocket expenses of $2000, which is not great but manageable).
However, that document also shows some discrepancies between what Healthcare.gov advertises and what Blue Cross says it covers. For example, the Healthcare.gov summary shows for outpatient mental health services: “$30 In-Network; $30 Copay after deductible Out-of-Network”, but also “Limits and Exclusions Apply” So you click on that link to open up the same Blue Cross document, which says “no charge” for participating providers for outpatient mental health services. In this case, the discrepancy works in my favor, because outpatient mental health is another major expense.
But that’s not the only discrepancy: infertility treatments are reported on the Healthcare.gov as: “$30 In-Network; $100 Copay after deductible Out-of-Network; Limits and Exclusions Apply” — which document lists infertility treatment under “Services Your Plan Does NOT Cover”. I don’t care that much about infertility (I am probably obliged to Nature and Nature’s God not to reproduce) but I would be seriously upset if I thought I was buying a plan that covered those treatments, and then learned it didn’t. That seems like a pretty big exclusion, damn rough fine print. For the record, DuncanCross.net offers the benefit of getting everyone who reads it the best sex of their lives; limits and exclusions apply*.
The Blue Cross provided summary says, “If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.carefirst.com, or by calling 1-855-258-6518″. Since I did not want to spend the next half-hour yelling ‘operator’ into my phone, I clicked on the link, which just takes you to their front page. You have to search for the ‘policy or plan document’, and this is the best I could find: something called the “Healthy Blue 2.0 / Healthy Blue Advantage CareFirst Blue Cross Inc your member handbook (also PDF).
I am still not sure this is the right document (and it doesn’t say jack about infertility or durable medical goods), but in any case it says in bold print on page 1: “However, this isn’t a contract. A detailed description of specific terms, as well as the conditions and limitations of your coverage, is included in your Evidence of Coverage/Agreement.” So even if I memorized the “your member handbook”, I still couldn’t be sure what I was getting until I actually bought it.
At which point I decided my little experiment was over. If I needed insurance — if I was still paying $600 a month for COBRA — I would go ahead and buy the HealthyBlue Platinum plan. But I don’t need insurance, and the plan I’m married to is a bit better than what I can get through the exchange.
So this ends up mostly an exercise in satisfying my own curiosity, but it illustrates both the promise and problem of the Affordable Health Care Act. Up until a couple years ago, if you had told me there was a website I could go to buy good insurance for $400 a month, I would have thought I was being Rick-rolled as a best-case scenario. That would have sounded like a delusional fantasy to me. So the fact that there is such a place, even if it has some bumps, is totally amazeballs. It’s like Candyland for the chronically ill; I can barely believe that with a few more clicks, I would have bought actual, decent health insurance.
That’s the promise of the ACA — and lets be clear, it’s not just the Healthcare.gov website, but also the fact that I can’t be barred for pre-existing conditions and can’t be charged a million dollars for my premiums. These are all pretty significant accomplishments in health care reform.
Where Candyland gets bitter is that I am still buying insurance from a health insurance company. I am giving Blue Cross a ton of shit in this post, but they are also my current insurer and do a pretty good job. Blue Cross is one of the more responsible companies out there, in my experience, and still their documentation is contradictory, confusing, and difficult. They have a vested interest, as a business model, in not being definite or transparent about the benefits they offer and what they will cover, and that’s probably more true for other insurers as well. And to the extent that the ACA leaves sick people like me dependent on insurers, it still kinda sucks. I wish we had found a way out of that — for example, the public option.
If you do not have health insurance, or are paying too much money for your insurance, you should get started on Healthcare.gov (or your state exchange) right this minute. But keep in mind that what you’re buying is health insurance, and keep your eyes open. Healthcare.gov is a huge step forward for our health care system, but limits and exclusions apply.
*Sex is in no way a benefit of reading this blog, and this blog does nothing to improve your sex life.
3 December »
Lots of hullabaloo about the President’s pledge — then broken, now remade — that health reform will let you keep your insurance plan and your physician, if you like them. Do you like your physician enough that it matters? Maybe you shouldn’t.
I love my primary care physician. He is probably the best physician I have ever had. He’s one of the first to be younger than me, but from day 1 he was a model of courtesy, respect, and professionalism. He is friendly, patient, an excellent listener, and always spends more time with me than I think I deserve.
A few years ago, I tried to schedule an appointment with him, and was told he was not seeing patients. I freaked out — had a panic attack and everything. The rest of my life was kind of a mess, and now I had this other thing to worry about, and it was just too much. I tracked down his personal email address and wrote him a desperate plea, which he answered courteously and professionally despite it being pretty creepy on my part. It turned out that his staff was misinformed; he was on vacation or at a conference or something, but still very much seeing patients, and was happy to schedule me in. I was embarrassed.
After that settled down, I wondered about my reaction, and my attachment to my PCP. A few years before that episode, I had been in an NIH protocol administered by a young female physician. The study was pretty demanding of my time — about 10 to 16 hours per week — much of it spent with this physician. I was sick, so I didn’t have much of a social life elsewhere, which meant I wasn’t dating, wasn’t spending time meeting young women, et cetera. And over the course of the study, I developed a crush on this lady. I kept at it, even though I knew the medicine was not working and I was getting worse, just because I didn’t want her out of my life. And when I finally understood what was happening, I knew I had to drop out of the study at once.
After my PCP-induced meltdown, I realized I have a little man-crush on my physician. I really, really like him: I’d invite him to parties, if he didn’t know a lot of humiliating stuff about me. And I realized, this is not a healthy level of attachment to my physician. I’m to the point where I generally know whether a physician is doing a good job or not, but if I let my fondness for a physician blind me to that, I could be in serious trouble. So as much as I like my physician, I have to constantly remind myself that this is a professional — not a personal — relationship, and it is properly focused on my care.
It also occurs to me that there is nothing special about this physician — at least not innately. The stuff he does well is stuff that any physician could be trained to do well. The fact that physicians are not all well-trained is probably as big a problem for our healthcare system as anything to do with insurance reform. But in rough terms, any doctor should be able to do what he does, even if lacking his sterling bedside manner.
So I think it’s great when patients love their doctors, but I also worry it’s unhealthy. If you are that dependent on one person, on a single provider, you are incredibly vulnerable and powerless. That sort of co-dependency should be strongly discouraged in our health system; medical care should help patients be empowered, autonomous, and independent. If you love your doctor, that might actually be a problem.
This is not to justify or defend anything the Administration has done; it is simply to say that maybe protecting patient-physician co-dependency is not a priority in a functioning healthcare system. If nothing else, every time I see folks angry about whether or not they get to keep their doctor, it makes me cringe. I have a hard time believing that sort of passion reflects a healthy relationship.
I wonder if they need to step back a little, set that doctor free — and free themselves, too.
2 December »
I am proud to present the first installment in my regular series, Underground Ambulance, sharing the stories of courageous physicians who escaped the slavery of Obamacare for freedom and opportunity elsewhere. I am a staunch supporter of the Underground Ambulance.
Lord, lord, lord. I’ve been working these emergency rooms since I was a young man.
Diagnosing . . . medicating . . . binding and stitching. Mind-numbing work, sunup to sundown. But I wouldn’t be a PCP for nothing. These lazy patients won’t even get up to go across the room to get a drink of water. A nurse has to bring it to them.
I went to medical school in Kentucky when I was barely old enough to drive. I can still remember my mother running out of the big house, begging me to be a lawyer, or a car salesman. The all-wheel-drive kicked up a great cloud of dust, her cries faded, and that was the last time I ever saw my mother until Thanksgiving.
Some time ago, I showed a God-given talent for organic chemistry. The university let me try my hand at proctology and colorectal-surgery, and I began to dream of using my skills to buy my freedom, like I heard of some med students doing. The practice who hired me told me that a skilled surgeon is worth a lot of money in the Deep South.
And then the government took over healthcare.
I cannot bear the thought of snipping polyps for the rest of my life in Mississippi. By my reckoning, I am almost 29 years old.
Obamacare made me a slave.
But I do not intend to die one.
It is dark, and I am on the edge of a parking lot.
After the lights went out in the hospital, I slipped out of my ward, pretending to use the necessary. Years ago an old nurse told me that there are other places, places where government spending on healthcare is less than in the US, places where a physician can live free: Myanmar, Liberia, Suriname. So I find my Star Alliance card and start running.
The old nurse told me there are folks in Texas who can help me. I know my chances are slim. Anybody spots a surgeon on his own will know he’s a runaway. I’ve seen captured physicians forced to accept Medicaid patients until they can barely afford lease payments on their Acuras. But so what? I’ve got the student loan debt to prove you don’t have to try escaping in order to go broke.
As day breaks, I can see the 747s landing at Dallas-Ft. Worth. They will show me the way. But in the distance I hear pagers beeping. Can they have discovered me missing already? Or is it just a car salesman? I have no idea how far I’ve come during the night, but I can’t take the chance — I stop at the airport Applebee’s eat a couple hamburgers before catching my flight.
This is how I live for I don’t know how long.
It has taken weeks, but I have arrived in Georgia — the Republic of, not the state.
For the past two weeks I traveled across Europe like a spy — skirting through the bistros, hiding in three-star hotels, wearing novelty hats.
This is a beautiful country — Black Sea coastline, mountainous backbone. There is deep culture and history here. The food is excellent – chicken satsivi and katchapuri and homemade wine.
Best of all, in Georgia the government accounts for less than 20% of healthcare spending. It is one of the most free healthcare systems in the world. I am amazed to see with my own eyes physicians out from under the jackboot of government bean-counters.
Of course, most hospitals lack basic diagnostic equipment. Some of my colleagues bought their degrees online and bribed their way to licensure. A quarter of them cannot “properly diagnose the symptoms of a heart attack”, so my patients are dropping like flies. But how can you put a price tag on freedom?
I do not know what the future holds for me in Georgia.
But I do know this . . . I will not die a slave. I will die a free man.
Probably from a heart attack.
The Underground Ambulance is devoted to freeing innocent physicians from the unspeakable evil of slavery. If you know of a physician yearning to loose the shackles of Obamacare, please let them know about our important work. Apologies to Scholastic.
2 December »
So… I have body issues. I kinda hate my body. It has done some terrible things to me, and it rarely does well the things I wish it would. Undressed, it looks like Dr. Frankenstein’s practice corpse.
But mostly, I’m too skinny and weak for an actual living human being. In 2012, the last time I had surgery, I went from over 140 lbs to under 120 lbs in two weeks. I know what you’re thinking, and no: you really don’t want to lose any amount of weight the way I did. I’ve gained some of that weight back, but a lot of the time I feel like a cardboard skeleton — like a stiff breeze would knock me over.
When I lose weight, a lot of it is muscle. And the thing about muscle is, it’s important. You need at least some muscles for a surprising range of everyday activities: standing, walking, sitting, breathing, etc. If you don’t have enough muscle, you have a hard time doing these things, and you get tired more easily and are more prone to injury.
So part of my never-ending recuperation is going to the gym to exercise, every now and then — but mostly then. Aerobic exercise is great for stress and helps me sleep and perks up my lousy appetite and helps get the blood flowing into my hands and feet (which are always cold), but it isn’t enough to get back the muscle I’ve lost. I also need to lift weights.
I was always small growing up, so the weights room at my high school was kind of a scary place. Some of those guys were big, and I learned to avoid them and their dumb ideas of fun. The coach who taught the weightlifting portion of PE called me ‘big guy’, and I think he meant well — but I still flinched every time he touched me. I thought he was going to crush me up and stuff me in a trash can.
When I do go to the gym, I try to time it so no one else is there, and I never go to gyms with serious lifters hanging around. I can’t relax and focus with those guys in the same room. I also assume they’re judging me, maybe laughing at my skinny ass when they’re not making ugly faces at themselves in the mirror.
I get by at my local gym — it’s pretty low-key — but a couple years ago, I realized I had forgotten everything I learned about weightlifting in high school and was just making it up as I went along. I think most guys at the gym probably are in the same ballpark; if you hid the machine placards, there would be chaos.
So I started looking for a handy reference to help me plan workouts and mix up my routine. Of course, there were plenty of body-building books for men. But every single one of them had a crazy ripped guy on the cover, and all the models were similarly beefed — kinda gross looking, actually, and it reminded me of all the really strong guys I have known who were also really big douchebags. The correlation on that is about 98%, as a rough guess.
Worse, I couldn’t believe any of the models were steroid-free, and that seems like false advertising: that kind of book can’t possible deliver those kinds of results. Like you just open the book, and instead of pages, there’s a big cut-out hole with a syringe and vials of HGH. Even if a mere book could get me those results, I don’t want to look all gross and ‘roidy — I like it when people assume I have normal-sized testes — so I put those books right back on the shelf.
That left me with basically one option: the Women’s Health Big Book of Exercises (Rodale 2010). At first it seemed like a weird idea, using a ‘women’s’ book — but the more I thought about it, the more sense it made.
First of all, the models are cute — not sexed up or salacious, but they keep my attention pretty good. In fact, I have kind of thing for the Quads & Calves lady, who looks almost exactly like my primary policyholder with my contacts out.
And because women are evidently not as interested in maximum bulk, there is a wider variety of exercises. I finally understand what the medicine balls, bosu, kettlebells, and various other devices are supposed to do for you, which is great: I have a much broader variety of exercises at my command.
In particular, this helps because the exercises you do when you’re recuperating are very different from the exercises you do when you’re injecting horse semen into your veins. For example, I have trouble with my knees, which is due largely to lack of strength in the surrounding muscles, and the WHBBE has lots of good low-impact options to help me work through that.
Also, the WHBBE — though written by a dude — maintains a friendly, accessible tone. It’s not all about getting jacked and pumped: it’s about exercising and being healthy, and presents useful information very clearly and sensibly. It’s not the least bit intimidating. There’s some anatomical information, some nutritional stuff, great step-by-step instructions for the exercises, and some canned workout routines.
Once I got over the whole “Wo” part, I realized the Women’s Health Big Book of Exercises is exactly what I was looking for. I imagine for any women out there reading this, you’re already sold — and, alas, there aren’t that many alternatives for women.
The surprise is that the WHBBE is also a great book for men, especially men who don’t aspire to use steroids. For men who just want to be relatively fit, navigate the gym safely, and plan out some solid circuits, the WHBBE is a great choice. You don’t need to have body issues, but it doesn’t hurt if you do.
29 November »
Every year around this time we get inundated with Christmas movies, mostly the same old saccharine crap year after year. This year, I want to celebrate movies that manage to make Christmas actually fun. This week:
In Bruges (2008) is one of my favorite films, Christmas or not. In fact, it’s barely a Christmas film, and then only for narrative reasons which I will get to. Really, it’s film-noir, a black comedy with well-drawn characters and searing dialogue, and it is almost perfect.
The story finds Ray (Colin Farrell), a young gangster, banished to Bruges (it’s in Belgium) after accidentally shooting a boy. Farrell is really magnificent in this one — and I’m not usually a fan of him. His Ray is twitchy, mopey, angry, just exactly the basket case you’d expect from someone who just shot a kid, and also sarcastic and manic.
Ray hates Bruges, and the quiet of the place leaves him stewing in his own head. I mean, Ray really, really hates Bruges. The film has such a terrific, relentlessly hostile sense of place that you wonder what happened to writer/director Martin McDonagh in Bruges, to inspire such animosity. It must have been hell, whatever it was.
Ray is meanwhile being babysat by Ken (Brendan Gleeson), an older gangster who quite likes the architecture and history Bruges has to offer. And it turns out that, in fact, Ray has been sent to Bruges to die — and Ken is going to kill him. Their boss has a very strict rule: you don’t kill kids, accident or not. So Bruges — much as Ray hates it — is meant to be a pleasant last stop before he dies.
Ray doesn’t know this for a while, so he makes the best of his time in Bruges. He follows Ken through the city, falls in love with a Belgian girl who tries to rob him, and gets stoned with a racist
midget dwarf. Bruges is a shit-hole, but Ray starts to get the hang of it — at least until he finds out why he’s there.
Enough about the plot, and back to Christmas and narrative: the thing about this movie is that it is almost perfectly put together. The only reason it’s set at Christmas is that all the hotel rooms have to be booked — not that it’s obvious, or anything you realize until later viewings, the same way it’s only Christmas in Die Hard to keep a handful of people in the Nakamoto Building. The Christmas stuff is definitely there, but only just so — not imposing, not distracting, not suffocating. So you can tell yourself you’re watching a Christmas movie, but really it’s just an excellent movie that happens to be set at Christmas.
In fact, everything in In Bruges is doing work for the ending: Christmas, the fat Americans, the Vietnamese — everything works in this movie. Watch it a second time and you begin to realize how solid the story is, how there’s nothing irrelevant or gratuitous going on. It is seamless — incredibly well put-together, a testament to McDonagh’s ability to tell a story — carefully paced towards a hilarious and deeply satisfying ending. I have seen a lot of movies since In Bruges came out, and a lot with bigger budgets or more famous directors, but I can’t think of any film with tighter story-telling or more narrative integrity. Not all of it makes sense at first, but by the end it all comes together and McDonagh has you primed for one of the best endings ever put to film.
For what it is, In Bruges is perfect: as taut and efficient as clockwork, beautiful as a gem, funny as hell. The film isn’t really about anything substantial — it would be a masterpiece — but it is fun: dark, crazy, hilarious fun.
26 November »
I am on-record as not being a huge fan of the ACA (ie Obamacare), and I will explain why in a minute, but I have to admit that I have been remiss in not paying that much attention to the law since it was passed. I was recently asked what I thought of it, and I realized that I had never bothered to formulate an informed opinion.
So it was well nigh time for me to take a look and figure out what the law actually does for someone in my circumstances. The point of this post is not to crow or navel-gaze, but to see if it actually helps me and people like me. It may not be anywhere near perfect, but I do think it is a positive reform for the sick and disabled in this country.
First a little demographic info: I’m in my 30s, semi-unemployed, married to a great insurance plan, and I have a rather serious chronic health condition. The employer-provided insurance we have is not too expensive, and is pretty comprehensive. That means that not a lot is going to change for me, but there are still some important benefits from the ACA:
– I can never again be denied coverage for a pre-existing condition. Even some good employer-based plans had a six-month exclusion for pre-existing conditions. I had to wait out one of those plans once, but fortunately I was being treated by NIH at the time. Some plans also had a pre-existing exclusion if you did not have insurance prior to joining the plan; when I studied overseas for a year, this meant I had to maintain expensive COBRA coverage even though I had insurance (NHS) through the University where I was in school.
– There is no lifetime maximum to my benefits. I go through at least $20,000 a year in benefits — and that’s a good year. Bad years can be five times that, easily. If my plan still had a million dollar limit, I would probably be a tenth of the way there already, at least — and I’ve only had this insurance for four good years. It’s a relief knowing that I won’t max out, ever.
–Mental health parity is a big plus: read this blog a bit deeper and tell me you want this mind untreated, loose among the general public. I have been getting occasional counseling the last few years, but it is expensive and poorly covered by my — otherwise excellent — health insurance plan.
– If my primary beneficiary loses her job, we can find insurance right away. While most people will get their coverage through open enrollment, an exemption for people with ‘life changes’ allows them to sign up anytime. That’s a reassuring, even though it will probably never be needed. We might never pay COBRA again, which is awesome.
– I have the promise of self-determination. In my life, whoever pays for my insurance owns me. First my parents, then my employers, now my primary beneficiary. I don’t mean ‘own’ in the sense of slavery, but there is always that incredible sense of obligation to whomever pays the premiums. As a young man, I realized there was a lot of stuff I couldn’t get away with, lest I antagonize my parents and they kick me off their insurance. They would not have done so, but the fact that I was afraid of it changed our relationship. The same is true to some extent with my primary beneficiary. Was a time, if she kicked me out I was a dead man. Today, maybe I won’t do the dishes after all.
These are all pretty big benefits, but there are still some problems:
– I have to get insurance through an insurer. While that insurer is required to cover certain things, it’s not clear to me whether the law provides any redress if they balk at something I need. From long experience dealing with these companies, I am not thrilled to continue that association. I wanted the public option — would have been first in line — but one thing the reforms might have done is provide a clearer, fairer mechanism to resolve this sort of problem.
– I haven’t had any luck signing up for Healthcare.gov. My first try was at 4am the morning it opened, but I got nothing. I’ve since gone back and opened an account, but I am stuck at a certain point. Since this is only for my own edification, I have not put a lot of thought into it — but I am curious to see what a plan comparable to ours would cost on the exchange. To be clear, this is a problem in execution, not in principle. I’ll have a separate post on that process, but it really is inexcusable.
– The whole process of getting the ACA passed seemed to ignore patients and their needs. This is a little abstract, but it has always felt to me like the Administration was solving a government problem, not a healthcare-access problem. By not making this foremost about the lives of the sick and injured, I think Obama has lost the high ground and framed the reforms in a way that is incredibly vulnerable to the right-wing. I formed this opinion around the time he abandoned the public option, and that disappointment has kept me from taking the law seriously until now. I should have paid more attention, but I still feel like the whole process was never really about my particular brand of troubles.
That said, I don’t see any of the many alleged evils of the ACA coming to pass. Our premiums have not spiked, my medications and supplies aren’t more expensive, my tax burden isn’t suffocating, and my employer-in-law is not going to drop insurance any time soon. Granted, there is still time for awful things to happen, but I am not holding my breath.
Granted this all seems a little tepid — but again, very little changes for me in the short term. However, it so happens that I was diagnosed with IBD in 1994, just as the Clinton-era healthcare reforms collapsed. I can’t help but look back to see how the ACA might have affected my life back then:
– I could have delayed my first year of college. At the time, the only way I could stay on my parents’ insurance was to enroll in a school. I got diagnosed my senior year, and spent that year dealing with my illness instead of thinking about college. I wound up in a school I hated (though I ultimately transferred to somewhere much better). Still, I almost killed myself that first year of college, so I can’t help but thinking that taking a year off would have been a better choice.
– I could have done something worthwhile after college. I worked through most of college, had some money saved up, and wanted to see a bit of the world when I graduated. I was able to stay on my parents insurance through college, but once I graduated (at 22) I had to buy COBRA for a while until I found a job with benefits. Had something like the ACA passed in 1994, I could have stayed on my parents’ insurance for another four years, maybe done something fun with that time.
– I could have started a business, or chosen self-employment. I have had some inclinations in that direction, but the problem of health insurance has always kept me looking for an employer with benefits. I can do that now, sure, but I had more energy for it when I was younger.
On the downside, the ACA apparently still allows schools to offer shitty health plans to their students, if the school is self-insured, which is too bad — but I never took out a student insurance policy, anyway.
So the more I think about, the more I think I would be ecstatic if the ACA had been approved in 1994. I can’t imagine how different my life would be. If I’m less enthusiastic now, it’s probably because I don’t see any immediate changes — even though there are some key benefits I will enjoy.
The ACA isn’t everything I hoped for from healthcare reform, but it does look like a net win for me. At the very least, I hope it’s the start of a process that will push us towards a fairer, more efficient health care system.
Note: I found a few Q&A pages helpful in putting this together: one from ThinkProgress, one from Wonkblog,. and one from Kaiser Family Foundation.
24 November »
Coronado Biosciences, which was running a clinical trial of TSO, has shut it down for not being effective enough. The one comment on that link points out that the TRUST studies only ran for 12 weeks, while Dr. Weinstock’s initial study ran for 24. Twelve weeks — three months — just isn’t a long time in IBD land. I was on Humira for six months before my doctor decided it was doing more harm than good.
Still, this probably means Coronado is going to bail on IBD. An earlier study — also 12 weeks — concluded no significant benefit from the treatment, and sent Coronado’s stock into the basement. It seems unlikely that TSO will be available for IBD patients in the near future, though we might be able to get it off-label if it is approved for other diseases.
This is very discouraging for anyone with IBD: helminths were the next big thing, a cheap and safe answer to our prayers. Weinstock’s results seemed too good to be true — I mean, 79% remission! — and maybe they were, but I think we’d all love see what happened if these studies went for the full 24 weeks.
18 November »
We all know that the most important thing about the Internet is winning at comments. There is no greater glory, no greater good, than totally pwning a post you disagree with.
Here, then, is a foolproof strategy for winning at comments:
1. Restate the original post in as unfriendly a way as possible. You want to grab hold of the reins early, and turn the debate in your favor immediately.
OP: I like cats.
COMMENT: So you are saying government should force all people to own cats? How do you intend to pay for all those cats?
2. Set traps for the author. Most people who write things you disagree with will stumble right in.
OP: I just like cats. I know some people like dogs, but I like cats.
COMMENT: If you think cats are better than dogs, do you also think white people are better than black people? How are you not a racist?
3. Ask impossible or needlessly quibblesome questions.
OP: I like it when cats purr, and how they stretch out in the sunshine.
COMMENT: Your biases are stretching the English language to breaking point. Before I ask you to clarify your argument, you need to define
just so we know we’re on the same page.
4. Accusations make the best questions. Don’t let them wriggle away.
OP: I’m just saying I think cats are cool
COMMENT: Why do you refuse to give an intellectually honest answer to the question? What are you hiding?
5. Always be ready to go farther than the OP. Internet comments is a game of stamina, endurance, and attrition. Give the OP more to deal with than they could possibly ever address.
OP: The only point here is that I like cats.
COMMENT: So are you just ignorant about toxoplasmosis, or do you want everyone else to get it to? And what about feral cats, and all the birds they kill? Would you have us exterminate all dogs? Your radical cat agenda would leave blind people without seeing-eye dogs. Is that what you want? Answer the question!!! Do you want blind people to not have seeing-eye dogs? Or are you prepared to invest your time and money in training seeing-eye cats? Like that would ever work!
6. Always get the last word. You win when nobody else has anything left to say. The King of the Internet is whomever put up the last comment.
COMMENT: Why are you refusing to answer my question? Hello? Hello?