One additional suggestion for federal health policy reform efforts: to ensure that these efforts are successful, the government ought to establish a ten-year committee to analyze the problem.
The committee will issue 2 reports at five-year intervals. It will be evenly bipartisan and should reflect the perspective of every stakeholder (doctor, nurse, worker, consumer, for-profit business owner, administrator, policymaker, family member, etc.)
The first five year report will serve as a Mid-Term Report, and provide hints about the contours of the second, final report. The Final Report may also recommend an additional ten-year period, which could itself be extended. Each report should be drafted by the same unpaid intern.
Questions to be addressed include: What is every possible angle on the problem? Is there a problem? Is a solution necessary? If it will always be broke, should we fix it?
7.09.2009
6.28.2009
mower
We got our mower on craigslist for 10 bucks. It's electric and it takes two outdoor extension cords to cover the yard. The trick is working out a pattern on the grass that doesn't involve constant danger of running them over. That kills the whole process and feels kind of dangerous, like, you can picture the cord spraying electricity, like the tentacle of a pissed off octopus.
The whole thing is rusted through, like an abandoned boat or one littered with the skeletons of erstwhile explorers. One of the wheels wobbles and the handle is missing a bolt halfway down. Easily fixable with electrical tape. When we bought it the motor didn't work, but that was easily fixable too with a soldering iron and a voltmeter.
I mowed the back, then the front, skirting the tangle of rose bushes (project for other day). It was looking pretty good, only trouble was that now my grass was shorter than the neighbors' grass on either side. I ran down to the hardware store for a couple of extra extension cords, came back and did the Green's front yard and back yard. Mowed Rose's yard while her dog barked through the French doors. The across the street neighbors' yards as well.
I was happy with myself, like I was making a contribution as opposed to town vampire. Looking down the block in either direction, you could see a symmetric plane of grass, albeit one that still grew higher two houses down in either direction. I went back to the hardware store and bought as many cords as I could carry.
They kept getting snagged on people's fences, on their porches and hedges. I knocked over a bird bath, and some kids kept messing up the chain playing double dutch. I went back to the house, got another glass of water, and put on work gloves.
It was starting to get late but I finished the Egan's yard, then the yard on the other side of Rose's house, people I haven't met but who waved through their front window. I could picture in my mind a sea of grass waiting to be mowed, through the town and out across the state. It would be easier to see it all from the air, then again the height of the grass would be less apparent.
My legs get tired and I start thinking about dinner. I realize I've plum forgotten about the edging. It'll only take a couple minutes.
The whole thing is rusted through, like an abandoned boat or one littered with the skeletons of erstwhile explorers. One of the wheels wobbles and the handle is missing a bolt halfway down. Easily fixable with electrical tape. When we bought it the motor didn't work, but that was easily fixable too with a soldering iron and a voltmeter.
I mowed the back, then the front, skirting the tangle of rose bushes (project for other day). It was looking pretty good, only trouble was that now my grass was shorter than the neighbors' grass on either side. I ran down to the hardware store for a couple of extra extension cords, came back and did the Green's front yard and back yard. Mowed Rose's yard while her dog barked through the French doors. The across the street neighbors' yards as well.
I was happy with myself, like I was making a contribution as opposed to town vampire. Looking down the block in either direction, you could see a symmetric plane of grass, albeit one that still grew higher two houses down in either direction. I went back to the hardware store and bought as many cords as I could carry.
They kept getting snagged on people's fences, on their porches and hedges. I knocked over a bird bath, and some kids kept messing up the chain playing double dutch. I went back to the house, got another glass of water, and put on work gloves.
It was starting to get late but I finished the Egan's yard, then the yard on the other side of Rose's house, people I haven't met but who waved through their front window. I could picture in my mind a sea of grass waiting to be mowed, through the town and out across the state. It would be easier to see it all from the air, then again the height of the grass would be less apparent.
My legs get tired and I start thinking about dinner. I realize I've plum forgotten about the edging. It'll only take a couple minutes.
6.26.2009
storm summer
The clouds come every evening in dark black and blue clusters of soft still-setting paper-mâché in darkening swirls thickening under gravity the rain is too liquid violent fragmenting blue light in torrents of electricity and breath and the birds have all flown somewhere else until this all blows over the mornings are quiet waiting that fans out from the porches into the air that hangs from the branches on the tip of everyone's tongues that echoes from the ground to the reflective glass of antique windows painted futile shut against the sneaky whims of air that people notice and watch their backs against as if to make sure that as they walk the whole town isn't disappearing behind them a void of space a retreating of form back to empty essence.
The cats grow restless on window ledges hemmed by screens if the mystery were small they could hunt it kill it and bring it back surrendered to their masters but it's
everywhere filling the town and seems bigger worth bowing to in the pecking order not attacking to kill outright wait until it really sleeps no one knows entirely what the quiet means besides storm has passed another on its way.
The flowers are still hungover are justifying the next gallons as hair of the dog stoic in the manner of a man backed into a corner the ground will stand its ground the sun shines ignoring the required retreating of light ignoring what it and everything around it knows must change only the lonely roots smile to themselves snaking everywhere underground to and fro preparing for the banquet feast a swelling to the point of nearly touching in the wet dirt.
Rain it rained so hard and on the road I almost lost control of the car a truck was passing on my left and shooting water all across the windshield of the dumb small car I had the little one in the back and I couldn't see anything but water covering too much the whole car it actually occurred to me maybe the river had gone to higher ground and we were plowing under water my hands kept the wheel shaky or straight all long enough that I knew I was still on the road but had no control at all.
Then I could see again and he was still asleep, safe in the back of the car. I know you trust me but what if I fuck it up and fail you.
The cats grow restless on window ledges hemmed by screens if the mystery were small they could hunt it kill it and bring it back surrendered to their masters but it's
everywhere filling the town and seems bigger worth bowing to in the pecking order not attacking to kill outright wait until it really sleeps no one knows entirely what the quiet means besides storm has passed another on its way.
The flowers are still hungover are justifying the next gallons as hair of the dog stoic in the manner of a man backed into a corner the ground will stand its ground the sun shines ignoring the required retreating of light ignoring what it and everything around it knows must change only the lonely roots smile to themselves snaking everywhere underground to and fro preparing for the banquet feast a swelling to the point of nearly touching in the wet dirt.
Rain it rained so hard and on the road I almost lost control of the car a truck was passing on my left and shooting water all across the windshield of the dumb small car I had the little one in the back and I couldn't see anything but water covering too much the whole car it actually occurred to me maybe the river had gone to higher ground and we were plowing under water my hands kept the wheel shaky or straight all long enough that I knew I was still on the road but had no control at all.
Then I could see again and he was still asleep, safe in the back of the car. I know you trust me but what if I fuck it up and fail you.
6.25.2009
health reform that works
America spends far more on health care than other industrialized nations, yet lags persistently behind in health outcomes. With quality widely considered by experts to be a lost cause, successful health reform will focus exclusively on cutting costs, killing the poor, and maximizing profit for doctors and private industry.
In that spirit, a 13-point plan to destroy America's health care system:
1. Require doctors and all care providers to adopt a Patriot version of the Hippocratic Oath on which unanimous bipartisan agreement has be reached.
2. Ensure that the public makes informed decisions about pharmaceuticals, by requiring medical journals and scientific trials to operate under the full editorial control of the drug companies that produce them. Disallow the sale and manufacture of a given pharmaceutical when its patent expires after 7 years, requiring replacement with new brands. Outlaw generics and the export of drugs to the developing world.
3. Create Altria Wellness Centers in communities and schools, promoting Kraft and Phillip Morris products to remedy common ailments.
4. Require a license for exercising more than 10 minutes per day, to be maintained by unsubsidized weekly fees, and policed by randomized steroid, human growth hormone, and drug testing. Disallow exercise for high risk patients.
5. Increase the use of paper records; where possible incorporate scrap paper. Prescriptions should be written in crayon, or using human feces and an improvised wooden utensil.
6. Health reform needs a public option: an option for the public to purchase private insurance at inflated prices. Eliminate Medicaid, Medicare, and CHIP.
7. Require drug and device manufacturers to provide payments and incentives to providers and physicians, with a zero tolerance policy regarding transparency.
8. Strengthen existing incentives for tests and procedures; eliminate all documentation of primary care outcomes.
9. Increase the prevalence of C-sections, reduce the use of doulas, and eliminate the education of women about the risks and benefits of obstetric procedures. Create special, more lenient laws concerning the murder of abortion providers.
10. The number of uninsured Americans under 65 has increased more than 10 million since 1999, or an increase of little more than 1 million per year. Increase premium costs and coverage restrictions to magnify this trend and further reduce costs.
11. Appoint Princeton University's Peter Singer as Czar for Life of the U.S. Department of Health and Human Services, giving him broad discretion on policy decisions.
12. Close all free clinics, and require insurance coverage for care in all provider settings. Enact legislation banning the un-insured and under-insured from stepping within 500 feet of all provider settings.
13. Bomb France. And Cuba. And Scandinavia as a whole. More wars = more patients.
(For SE.)
In that spirit, a 13-point plan to destroy America's health care system:
1. Require doctors and all care providers to adopt a Patriot version of the Hippocratic Oath on which unanimous bipartisan agreement has be reached.
2. Ensure that the public makes informed decisions about pharmaceuticals, by requiring medical journals and scientific trials to operate under the full editorial control of the drug companies that produce them. Disallow the sale and manufacture of a given pharmaceutical when its patent expires after 7 years, requiring replacement with new brands. Outlaw generics and the export of drugs to the developing world.
3. Create Altria Wellness Centers in communities and schools, promoting Kraft and Phillip Morris products to remedy common ailments.
4. Require a license for exercising more than 10 minutes per day, to be maintained by unsubsidized weekly fees, and policed by randomized steroid, human growth hormone, and drug testing. Disallow exercise for high risk patients.
5. Increase the use of paper records; where possible incorporate scrap paper. Prescriptions should be written in crayon, or using human feces and an improvised wooden utensil.
6. Health reform needs a public option: an option for the public to purchase private insurance at inflated prices. Eliminate Medicaid, Medicare, and CHIP.
7. Require drug and device manufacturers to provide payments and incentives to providers and physicians, with a zero tolerance policy regarding transparency.
8. Strengthen existing incentives for tests and procedures; eliminate all documentation of primary care outcomes.
9. Increase the prevalence of C-sections, reduce the use of doulas, and eliminate the education of women about the risks and benefits of obstetric procedures. Create special, more lenient laws concerning the murder of abortion providers.
10. The number of uninsured Americans under 65 has increased more than 10 million since 1999, or an increase of little more than 1 million per year. Increase premium costs and coverage restrictions to magnify this trend and further reduce costs.
11. Appoint Princeton University's Peter Singer as Czar for Life of the U.S. Department of Health and Human Services, giving him broad discretion on policy decisions.
12. Close all free clinics, and require insurance coverage for care in all provider settings. Enact legislation banning the un-insured and under-insured from stepping within 500 feet of all provider settings.
13. Bomb France. And Cuba. And Scandinavia as a whole. More wars = more patients.
(For SE.)
24-hour news cycle
In the basement of the Fermi National Accelerator laboratory, scientists have set up a large maze, home to a continuous experiment. At one end, typically at the start of a given day, they release a rat. At the other is a blue button, and when the rat reaches and pushes the button a cube of delicious cheese drops onto a small red plate positioned in front of the button. The maze spans the entire 3.9 mi. facility, from the Tevatron to the Main Injector, and under ideal circumstances it takes the rat a full day to complete.
When the button is depressed, an action impetus is also broadcast via satellite into the brains of the editors in chief and station directors who lead our nation's noble information infrastructure. An internal chemical reaction forces them to tire of whatever subject they were covering nonstop and to seize instantly on whatever next topic comes to mind.
Sometimes the test rat gets lost or dies, corresponding to news events we will later consider to have been major, such as a hurricane or the marital strife of vague celebrities. The next day, scientists send in an additional rat. On rare occasions (9-11, etc.) the second rat also gets lost or dies, and a third must be released into the maze. If for some reason a fourth fails to reach the goal, a technician presses the button, the maze is checked for obstructions and cleansed of missing rats, and a new rat is released the following day.
Rats completing the maze successfully are repatriated to New York City.
When the button is depressed, an action impetus is also broadcast via satellite into the brains of the editors in chief and station directors who lead our nation's noble information infrastructure. An internal chemical reaction forces them to tire of whatever subject they were covering nonstop and to seize instantly on whatever next topic comes to mind.
Sometimes the test rat gets lost or dies, corresponding to news events we will later consider to have been major, such as a hurricane or the marital strife of vague celebrities. The next day, scientists send in an additional rat. On rare occasions (9-11, etc.) the second rat also gets lost or dies, and a third must be released into the maze. If for some reason a fourth fails to reach the goal, a technician presses the button, the maze is checked for obstructions and cleansed of missing rats, and a new rat is released the following day.
Rats completing the maze successfully are repatriated to New York City.
6.24.2009
cautery
Burning bridges give you even more than burning airlines. Because eventually they can send other planes, whereas a bridge takes time. If you want to be alone, start with the bridges. To burn a friendship fast throw insults, piss on the outstretched hand. To burn a friendship slow ignore it. When your friend drives past, turn off the lights so they can see you hide. Ignore the doorbell. To burn a relationship heap emotional abuse until you've chased the person out of town. Now call her every night and tell her how much you love her. (Tell her you're sorry, tell her you need your baby). Burn away your potential for sorrow, for kinship, for hope for anything beyond a sports score or a boatload of cash. Burn away love so the only other death you ever have to face is your own. Reach out just enough to maintain a perfunctory variable sex life. Burn away potential for emotion as a kind of cautery. Only keep hate, you need that as fuel. The others simply aren't cost effective. There are a lot of ways to burn memories. One technique is burn as you go-- pay no attention to anything that happens and you don't have to worry.
Father's Day night L. and I got a sitter and saw Up. I couldn't stop crying for the whole movie. I was happy to, it's been years since I was able to outside of being maudlin wasted. Part of being able to cry was that it was a beautiful movie, economically edited, exquisitely written, and wonderfully drawn. Another part was what parenthood has done, loving the little one without the slightest hesitation. Part of it is being more open than maybe ever, to the way I feel, the way other people feel. Part of it is that I wasn't eating popcorn or drinking a big fat soda. There was only the movie, and L and I holding hands, and our lives here.
Father's Day night L. and I got a sitter and saw Up. I couldn't stop crying for the whole movie. I was happy to, it's been years since I was able to outside of being maudlin wasted. Part of being able to cry was that it was a beautiful movie, economically edited, exquisitely written, and wonderfully drawn. Another part was what parenthood has done, loving the little one without the slightest hesitation. Part of it is being more open than maybe ever, to the way I feel, the way other people feel. Part of it is that I wasn't eating popcorn or drinking a big fat soda. There was only the movie, and L and I holding hands, and our lives here.
6.23.2009
metronome
I messed up my ears hanging out with guitarists. Nothing angers a guitarist like the keyboard player asking him to turn down. Then I was 30 and half deaf too.
Bands are a good place to learn that god hates you, that only rarely does man understand his fellow man. Most bands are amateur hour, without measure or law, a battle of myopic painters to see who can pitch the most neon onto a canvas too small to share, while the drummer runs forward to smear logs of fresh shit over everything in the manner of an expressive gibbon. Silence and space banished to un-imaginability.
To aid me in my solo project, to be completed by 2025 at the absolute latest, I've procured a hearing aid with a metronome implanted in it. A small remote adjusts volume, tempo, and tone. The presets include Classic (faux pendulum metronome, Digital Madness (treble-bound octaves of any note), and Dom DeLuise (in which the late actor exhorts one to 'prac-tice' repeatedly in a number of time signatures and languages).
The metronome keeps me out of trouble. A sense of time curving, stretching and contracting is a narcotic for me, and prior to the installation I would go to great and reprehensible lengths to achieve it. The metronome is handy late at night, when cartons of ice cream would otherwise go emptied, or at my desk at work, when productivity might slip for a second, or an hour, or a day. It's handy in dull social settings. The metronome adds order, dividing the world into manageable, symmetric packets, provides information I know I can trust as valid and precise.
Early on, my mother and father urged me to success, to earn, if not a position as the conductor of an elite institution such as the All South Jersey Orchestra, then at least a modicum of rhythmic dignity and respectability in whatever profession I chose. Rare to consensus in all else, they insisted on the metronome as a unified voice. Practice is useless without it, Man needeth but food, sleep, and a metronome, etc.
But if my mother ran an errand and the mood struck him, my dad would quietly lock the swinging bar of the metronome in place and leave me to practice on my own, with my own sense of time. The notes carried me out to sea, into the depths and currents of feeling. When she returned, it always took me by surprise and I would back quickly away from the piano, as if it were a man just knifed in the back.
For a while when I lived on my own, I was happy to do without a metronome. But I see now that that was a foolish waste of time. That a man with his feet on the ground is to be admired and respected, that a man at sea is in trouble, whether he knows it or not.
Bands are a good place to learn that god hates you, that only rarely does man understand his fellow man. Most bands are amateur hour, without measure or law, a battle of myopic painters to see who can pitch the most neon onto a canvas too small to share, while the drummer runs forward to smear logs of fresh shit over everything in the manner of an expressive gibbon. Silence and space banished to un-imaginability.
To aid me in my solo project, to be completed by 2025 at the absolute latest, I've procured a hearing aid with a metronome implanted in it. A small remote adjusts volume, tempo, and tone. The presets include Classic (faux pendulum metronome, Digital Madness (treble-bound octaves of any note), and Dom DeLuise (in which the late actor exhorts one to 'prac-tice' repeatedly in a number of time signatures and languages).
The metronome keeps me out of trouble. A sense of time curving, stretching and contracting is a narcotic for me, and prior to the installation I would go to great and reprehensible lengths to achieve it. The metronome is handy late at night, when cartons of ice cream would otherwise go emptied, or at my desk at work, when productivity might slip for a second, or an hour, or a day. It's handy in dull social settings. The metronome adds order, dividing the world into manageable, symmetric packets, provides information I know I can trust as valid and precise.
Early on, my mother and father urged me to success, to earn, if not a position as the conductor of an elite institution such as the All South Jersey Orchestra, then at least a modicum of rhythmic dignity and respectability in whatever profession I chose. Rare to consensus in all else, they insisted on the metronome as a unified voice. Practice is useless without it, Man needeth but food, sleep, and a metronome, etc.
But if my mother ran an errand and the mood struck him, my dad would quietly lock the swinging bar of the metronome in place and leave me to practice on my own, with my own sense of time. The notes carried me out to sea, into the depths and currents of feeling. When she returned, it always took me by surprise and I would back quickly away from the piano, as if it were a man just knifed in the back.
For a while when I lived on my own, I was happy to do without a metronome. But I see now that that was a foolish waste of time. That a man with his feet on the ground is to be admired and respected, that a man at sea is in trouble, whether he knows it or not.
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