PDD: July 2012

It was a matter of two pain doc days this month. The first came right before my wife's trip to Boston and was a SNAFU even by chronic pain treatment care. In fact, it was so bad that I didn't want to write about it in such stark terms and possibly scare people away from treatment that they need. The second appointment was yesterday and it was as smooth as good glass.

The first visit included the following fun features:

• After being told it was just an appointment for prescription pickups, I had to wait and be seen.
• The doctor who saw me (one I like if I may say so) didn't have a clue about the course of treatment I've been on for the past half year.
• I was left frazzled almost to the point of being unable to walk but that's nothing unusual.
• In my frazzled state, I forgot to bring up one of my prescriptions.
• In a followup call, I was told that I had been taken off two prescriptions including one they had actually filled that day and the one I forgot to bring up.
• Melissa backed up my memory that no such conversation had taken place and/or message delivered.
• I ran out of the one prescription on July 4th. On July 5th (the day before Melissa left for Boston), my calls about it led to me being told it (and one they had given me a prescription for) had been cancelled. I was also told about the non-existent conversation.
• A nurse at the practice had to perform a service above and beyond the call of duty in order to get me through the 28 days. She collected me enough samples and stayed late after the office closed to give Melissa the meds in the parking lot. I hope this was legal but it sure was the right thing to do and I do not identify doctors and nurses for such reasons.

In comparison, the second visit was pretty normal except for the fact that I felt horrible going in and demanded some answers.

• I saw my regular doctor and received all my regular prescriptions.
• I was feeling extra paranoid about the drug testing due to the other problems from the first visit. Therefore, I had taken extensive notes on what meds I had taken when. When I dared my doctor to test me and confirm or deny those results, I was told that I had passed the previous drug test just fine.
• My doctor found no indication that any conversation had taken place about taking me off any meds.
• My doctor continued me on all current medications including one where I found a need to adjust how I go about taking it.

Unfortunately, things continued to be normal after I got home. I had been in so much pain during the visit that I fell asleep exhausted for a few hours afterward. Normally, I meditate which always includes some dozing but this was full sleep. As usual, I was unable to do anything serious like writing or game playing. During the evening, I was happy to be able to be upright.

My doctor asked me to give it another 30 days before making any medication changes. This made sense to me because most of my remaining options are on the extreme side. One that I had been worried was my only option is all but ruled out. Others were put on the board as potential changes. As I put it, I plan to live a long life and tolerance makes treatments less effective over time no matter what. Therefore, I need to change things as slowly as I can stand. She reminded me that my back was not truly against the wall. I'm glad she did because I'm not immune to the tendency toward doing stupid things when I think my back is against the wall.

Even at their worst, the practice pulled together and took care of me. Let's just make sure we note that. It was a little shaky but we held it together. That's we as in the whole practice of receptionists, nurses, techs, doctors and me. We're a team and I've always seen it that way. If I didn't, I don't believe my results would be this positive overall.

To justify my existence...

Hopefully none of you actually use those words on a regular basis. I'm trained to look at my thoughts and actions carefully because I used to be suicidal. If I need to do something in order to justify my existence, it's a trap. If I fail, that means my existence is unjustified and then there's the next layer of defense. If I have no justification for my existence, then I shouldn't exist. Right? Wrong! We all exist and have no need to justify that existence.

What can we use to replace those words? It isn't always easy to know these things so I'll give you my best try. For today, I'm trying to fight the feeling that I'm a total impostor as a writer so I'm embracing that part of my identity. I'm not writing to justify my existence but to try to add something of value to the world. It's my legacy. When I'm dead and gone, I can only hope that someone reads my combined works of fiction, blog posts, the journal entries backed up on my hard drive and my private journal. Then, I have to hope that it adds something important to their lives.

There are days when I feel trapped. I'm unable to produce anything new and I'm tired and I end up hoping the pain will come to help me justify my lack of production. Just in case you feel something similar, let me break down that logic for me. If I'm tired, it's often because I'm trying too hard to create something. The creative juices won't stop flowing even when my body betrays me and demands rest. Being tired is just part of being sick and so I can't need to justify the rest that my body is demanding. Otherwise, I realized that I make myself sicker just to have the excuse to rest.

I don't know if any of this makes sense to you. It certainly makes little logical sense in the course of my life. I have been putting out dozens of pages of new material per relatively healthy day recently. This is a pace I would have probably said was worth getting sick when I was healthier and dumber. In those days, I felt that just making great strides on, or God forbid, finishing projects would justify my existence and let me rest. There's the other problem with that belief. It's like a drug where you need bigger and bigger hits to get the same high/relief. I'm approaching a hundred pages of new material in my "Twice in a Lifetime" project over the course of a couple weeks. I feel ready to purchase and christen a notebook for nothing but notes and an outline for my ongoing fantasy project. That's not true. I feel ready to stop working on the preliminary short stories and go straight for the novel.

This is months of work for me at my normal pace. Why am I feeling like an impostor now? I do not have an agent for my first novel much less the rest of this work. I do not see a path forward toward getting my novel about life and love and learning to ignore the siren song of suicide. It's done according to the current definition of done but I won't feel like a success until it is published for money. My inner critic tells me that anyone can write novels but only the best get published. The fact that I see hundreds of copies of dreck out there does not help deter this belief.

I bled real metaphorical blood along with the far more real sweat and tears for my baby and its less ready siblings. The reality that these early novels might never see the light of day bothers the hell out of me. It's a drag on my current work which I've written for an intentionally broader audience. How can I justify myself by adding something of quality to the world if so few people will ever see it? And we're back to square one.

In my dreams, I'm able to use my non-existent fame and fortune for Chiari awareness. I'm able to tell people that the difference between a success like me and your average failure is that I got a lucky break when I needed one. Right now, I'm feeling the frustration compete with the need to write. I need to finish this project and put a stamp on it somewhere in my mind that says "completed first draft." That's when my coping skills will come into play for real because the distance between "completed first draft" and completed novel is at least as long as the distance between idea jotted down on paper and that completed draft.

Just remember this, fellow Zipperheads and others who live with the pain. Bon Jovi sang it a long time ago. "You live for the fight when it's all that you got!" I continue the struggle so that's my answer when things get bad enough for me to want to justify my existence. With respect to victims of actual violence, I hope it's clear that I'm talking about something else when I strap on my armor and go out there for one more fight. If I should fall today, I'm going to take as many of the bastards as I can with me.

Those bastards are merely the obstacles both external and internal that stand in my way but that's no fun. I'm like the comic who wants to go out there and kill his audience. If I were to be literal, I want "them" to publish my novels and another set of "them" to buy them in massive numbers and, obviously, I need them to be alive. Put on your highest SPF (snark protection factor) gear for this last sentence: I do need them to be alive literally so that they can buy my next book.

A Day In the Life

There will be some serious topics coming but I try to maintain my devotion to fairness even when things upset me. For instance, things could have gone better at my last Pain Doc appointment. Instead of reporting on what was likely mere confusion caused by me and my problem of serious time constraints, I realized that my 28 day appointment cycle makes July a rare but regular two appointment month. After my next appointment, I hope to have plenty of positives to report.

Also, Melissa went on a brief vacation with her side of the family but without me. This was by my choice. Their goal was to see a show I would have hated and travel is just plain bad for me. Unfortunately, I learned there's some truth to calling Melissa my better half. I was hopelessly dysfunctional without her to the point where an extended trip probably would have killed me from the sheer neglect I'd have put myself through. How to do better surviving on my own is a topic all disabled people should take seriously.

In addition to those serious topics, I have kept myself very busy. Was I doing something too important to sit down and write something that might help someone else survive better? No. I was keeping myself very busy because the broken chair makes it nearly impossible to relax comfortably while out of bed. If you think that frustrates me, you should see how Maddie the cat reacts to not having lap time for her naps. That got coupled with the great flea invasion of 2012 so that it seemed the world was conspiring against my favorite grey kitty.

Then there were days like yesterday. Melissa was off yesterday and we had a whole day's worth of agenda to complete after Melissa's fourth straight closing shift. Unfortunately, my reversed sleep schedule took a day off on Wednesday. I'd hoped to sleep Wednesday night but it didn't happen. By the time she woke up (very early for her) on Thursday, I was at the end of my rope. My goal was to make a quick trip out that accomplished one or two things but I had a severe headache, extreme touch sensitivity and I was twitching like a madman.

While I was no longer up for a productive trip, I hoped that Melissa would get us some breakfast before I could get worse. Then I might feel better enough to take a little trip and knock one thing off my list somewhere. The cat is out of the bag about the Barnes and Noble "Nook" e-reader that the in-laws bought me. I had tried to keep this information away from them but it never worked worth a damn. The ratio of hours spent on the phone with customer service to hours spent reading was approaching 1:1 and I am very bad on the phone.

This leaked to them with the expected bad feelings but they actally felt guilty about it. As I had snapped to a tech on the phone, my in-laws don't have money to burn. It was very impressive that they had purchased this thing that is relatively easy on the arm muscles to use. I'm trying to get over the guilt associated with someone deciding to make buying me something a priority and move on with life. They were kind and kindness should not bite you on the ass. Melissa and I decided that the way to make this gesture work was to exchange the Nook for an upgraded version that didn't suffer from early adopter bugs and pay the upgrade costs ourselves.

While we were at the bookstore doing this, I was going to spend as much time as I could stand checking out a variety of books that I wouldn't normally consider buying. My interests are already what you'd have to consider eclectic but I'm always interested in broadening those horizons. I never thought that I'd be a tea drinker or someone who listens to symphonic music so I wanted to give poetry reading a try. I'm old and mature enough to no longer be afraid of being that guy who reads poetry and all so why not?

Unfortunately, Melissa doesn't go from zero to full speed in two seconds flat on her days off. While she put way too much thought into the concept of breakfast, it became lunch time. She revealed a hidden agenda of wanting to get me out of the house which I opposed with an asterisk. The asterisk is the always available "do it because you love me and trust me" exception. She invoked that quietly and we ended up at Arby's which is, in fact, "good mood food."

It was a very busy store and I used up the very last of my energy for the day without realizing it. By the time we left, I was barely able to walk and carry an orange cream milkshake at the same time. (It was such a good milkshake.) I couldn't be that close to the "Staples" office supply store without certain feelings emerging. Since I looked up fetish in the dictionary and learned it is not a dirty word by definition, I have admitted to my office supply fetish. She talked me into waiting for an upcoming sale at her store but I reminded her that my favorite pen in the whole world is sold at "Staples" and not her store. She went in and bought me a 12-pack obligingly after she realized that we wanted the same thing. She wanted to keep me out of what might as well be the Heroin Emporium for me and I didn't want to take another step.

When we got home, she found an old school primer. I don't know what age group it was intended for but there was an essay justifying the study of literature even for those who planned careers with nothing to do with the subject. That makes my guess high school since it was printed in 1966 before college was so nearly universal. I found the section on poetry and was genuinely delighted. Yes, the textbook aspects were as annoying as the editors suggested they might be but the poetry was delightful. I read a poem about cherry blossoms that was short, pleasant on the tongue and revealing of a small part of human nature.

I'd never enjoyed lyric poetry before with my admittedly limited efforts linked exclusively to the narrative form. Why am I interested in poetry? There has always been an all but forbidden link to the romantic in poetry for me. I think of sitting close to a certain someone (aka Melissa but I had the image before I knew her) reading aloud so that the words helped form some sort of mood. I don't care if your minds are in the gutter because I know my image doesn't change whether I'm too sick to react to a thousand mostly naked dancing girls or if my mind is in the gutter with you. Romance, comfort and solace have always been linked very closely for me.

It only took a few short poems before my eyes were closing and I was worried about dropping a hardback book on Maddie who was asleep on my lap. She seemed to like it when I read to her. I went upstairs to take a short nap to escape the pain and then Melissa awakened me at 8 PM. It was too late to do more than the barest exchange at the bookstore so I told her the truth. I wanted to sleep more than anything. By 2AM, I was stiff from lying in bed for too long. Our mattress is too hard or something so that my hips and the sides of my gut feel bruised after so many hours in bed.

The beginning of yesterday didn't really fit in the beginning of the story like it should so I'm going to put it here. After hours of trying to get to sleep, I reached a point where I suspected (correctly as you know) that I had lost the chance to sleep and have a productive day. Therefore, I spent some more time working on my latest novel effort with the working title "Twice in a Lifetime." My last writing session broke off suddenly when the story went to a place so dark you would think it had to be the product of an evil imagination but it was inspired by a number of stories I'd been told in confidence. Even blended together so that I doubted the actual people could recognize the tiny fragments of their own lives, the story was too hard to write.

As I've done recently, I took some inspiration from Stephanie Meyer when my own life experience failed me. Instead of vampires, I used my knowledge of military matters to create a corporate paramilitary team. Instead of my protagonist having to watch helplessly while the second love of his life struggled with horrors he could not help, I made them external. The "bad guy" became a physical threat and so Peter the protagonist called in the cavalry. As the now outgunned potential threat of an unmarked van (that could have been harmless) fled, the couple was whisked away in armored black SUVs. As Melissa put it, "is there really any other color for them?"

It was quite the breakthrough for me because I've been writing a lot lately of what I thought a friend had called dumb girly stuff back in high school. It turns out he had said boy'n'girly stuff at the time but I had taken note of something Melissa had said far more recently. As I complained about "Twilight" movies leaving the novel plots behind to include pointless violence, she noted that there had to be something in it for the boys. She explained that I'm unusual in my long held preference for character development with little action. Throwing in a little action that will integral to the story and not tacked on will expand my potential readership.

That writing was fun but it used up a little too much energy. I got to use the other side of my brain as I picked the perfect weapons mixture for a covert team that wants to use weapons that will minimize collateral damage if there's a fight but will intimidate their way out of the fight in the first place. If you're a Stargate fan, you might recognize the P-90 but you might not realize that it's a real gun. I'm sure the show used it because it looks cool but police and some military units use it because it won't shoot through people and walls to kill the wrong people so easily.

I'm getting far afield here but there is a point. Even a bad day like yesterday with crippling pain and dizziness that kept me in bed can have all sorts of high points. I got to eat roast beef, curly fries and drink Diet Dr. Pepper. I am no longer using my very last good pen and frantic about its potential loss. Maddie left a nice warm bed to come downstairs and sit on my lap in yet another show of affection for me. Now, I'm going to post this and try to fill today with as much good as I can.

Belgian Independence Day is approaching and there's a beer sale. What can I say? I know what I like.

The Second Time

One of my many oft shared observations about life is that it is relatively easy to declare your intention to start a new habit and then to have a good first day. The second time around is the first real test. Obviously, some things just won't work so they will blow up in your face from day one no matter what you do. Then there are those important things that just have to go well no matter what. I look at my first trip up to New York to see Melissa and me in-laws to be as an example of this. Everyone was on their best behavior (especially me) and I was willing to devote every resource I had to this including every last dollar I owned since I was still living with my parents.

The second time around was much harder. The second time, I was trying to do the job more efficiently so that I could continue it into the future. Judy, my mother-in-law, didn't hesitate to delay my travel for a day so that she could "clean up for me." (I've never had a problem with her housekeeping either then or now but that's what she said was going on.) My father didn't hesitate to fill that day with as much yard work as he could find so that I was exhausted as I left.

I guess instead of placing my importance on the second time being more difficult, it should be on how much more important it is. You cannot establish habits (good or bad) in a single day, you cannot know a trend from a single event and you cannot claim to have a routine if it only lasts one day. Therefore, I got out of bed at about 6 AM despite a bad night's sleep to take out the trash and take a walk. This time, it was only one bag of trash but much heavier and I decided to make the whole loop that my car odometer once called seven tenths of a mile. I'm calling it half a mile with the whole pedestrians on the sidewalk or the left side of the road which would be the inside of the loop. It's better to claim a lesser distance than to get cocky and fall flat on your face if someone tests you.

Now, I'm sucking down water as quickly as I can drink it comfortably in preparation for the rest of the day. The weather looks very much like one of those days when it will start raining and not stop for a couple of days but the forecast is calling for triple digit temperatures. If it clears up, I'm going to try to hit the pool again today. If it's raining, I don't plan to risk it. We live next to an airport so it's not easy to pick out thunder from all the jet noise. (Okay. The airport is down the road maybe a couple miles away but you get my point.)

The pool visit didn't go quite like I had hoped with laps being a problem. It was less my stamina than the degraded muscle memory making it hard to swim. My movements were uncoordinated so my strokes lacked all power. My instinct to keep my head above water was difficult to overcome as well so my bottom half was too far underwater for kicking to help much. Therefore, I couldn't do more than one lap at a time yet even that was physically and mentally draining.

Late Update (6/20: Things didn't go as planned or even close to it. I was exhausted after my bad night's sleep and half mile walk. I couldn't stay up until my planned nap time and slept until close to midnight. The excessive heat warning begins at 1 PM and I think I'll adjust to it a little for the rest of the day. I did complete my mile walk but it's humid out there and so I was ready to drop afterward. I'm planning to sleep early today because I'm wiped out after my walk. I might be ready to go to the pool near closing time because there's an adult swim afterward. I qualify as an adult.)

Productive Overreaching

I slept too late yesterday and forgot to take my bedtime meds last night so it was an all-nighter. I managed to take two bags of trash out to the dumpster which inspired me to do more. Actually, the first thing I did was clear off the nice couch taking all the junk from that and putting in the disintegrating chairs. I had been getting frustrated at my inability to get comfortable in either chair for a while now.

You have your choice of hazards between the two chairs now. On the left side, you have a back that disconnects on one side. It's not quite as dangerous as it sounds since the back doesn't come all the way off but it doesn't lean back at all. On the right side, you have the chair that exploded. Apparently, one too many screws came loose on that side so the foot rest is not actually connected to anything. If you attempt to recline the right side, you end up with a pile of metal bars and other assorted pieces at your feet.

It isn't that these weren't nice chairs (a divided loveseat actually) but they weren't designed for the sort of wear they got. I fall a lot and sitting is involuntary a frightening amount of the time. These things aren't designed to have the weight of a full grown man flopping down into them for years. It also didn't help that I tended to live in my chair eating and even sleeping there for major parts of several years. It didn't seem possible at first but the collective impact actually bent major pieces on each side giving the poor thing a decided list outward on both sides.

Someone needs to design furniture with people in mind who are overweight and crash land a lot. They also need to make it comfortable and dirt cheap. Right now would be kinda nice since moving the junk from the couch into the chairs is a de facto burial. They are officially dead and I hope to get all the forks out of them before dumping them somewhere. (It's a pun but I did eat several thousand meals in them.) Who would have thought I'd get a chance to make two fork puns before noon?!?!

The moving of the junk is what inspired the dumpster trips but most of that junk is not actual trash. There are several comfortable blankets and what seems like about a dozen pillows in that pile. (What is it with women and decorative pillows?) The dumpster trip inspired the next part of my day. I took an additional short walk to check out the neighborhood pool. I'm glad I did because it doesn't open until noon and I had assumed that would be much earlier. If not for that sign, people would be calling the police right now to report a great white whale that somehow beached itself outside the fence.

In case you haven't guessed, I'm explaining what I meant by productive overreaching. I've done more (just counting the productive/practical stuff) before 10 AM than I normally accomplish in a day. There will likely be consequences later on. I'm feeling a fair amount of stiffness and soreness already. I've overdone it again but things needed to be (over) done. There was also writing, a change to my car insurance policy and lots of gaming but the last one doesn't count for anything except mental wear and tear. There's no guarantee that I've gone too far already but it's close to certain so I might as well take the full plunge.

Speaking of plunges, I've decided to risk going to the pool today despite the remaining scabs on my burns. Hopefully, they won't bar me from getting in and I'll try not to leave anything gross behind. My reasoning is something from Ocean City. I slept so well down there and even on a regular schedule but lost that when I returned home. One of the theories is that I was out and about in Ocean City. It wasn't much exercise but I was moving around getting in and out of the car or walking down to the beach. If that helped me so much, I'm hoping to combine that with the theory of having a routine and take a daily swim. In order to take a daily swim, I have to start with a day so that shall be today.

I was considerably healthier after a week when most of my exercise involved walking in and out of restaurants so I'm wondering what a healthy routine might do. If I replace my rounds of beer (not that I'm swearing off beer - just can't afford to drink like I did that week very often), with laps in a pool, there might be some real improvement that my PCP could appreciate. When this many lines from different graphs intersect in one place, I see something you might call a "sweet spot."

Obviously, I won't be doing any Michael Phelps impressions out there. Laps may end up being a real stretch but moving around instead of sitting or lying down is an improvement. When dealing with chronic conditions, improvement is all we can ask for without being silly. I'll take a full recovery if someone is offering but I have my doubts about that. As for immediate results, I'll take getting away with overreaching this much with no extended periods of agony. That would be good enough.

Starting at the Bottom

Philosophy and ideas are important. When I'm writing entries like the last one, my head may seem stuck way up in the clouds but I assure you my feet are on the ground. (Well, let's make that carpet on the second floor but you get the idea.) Those of us who are in pain can end up needing so much help that we don't know exactly what we need at times. In my case, I needed to start from the ground up. I tend to feel better if I have something approaching a normal sleep schedule.

Therefore, I managed to get to sleep last night at a reasonable hour by my standards and then I wrestled myself out of bed before 11 AM. That's a little later than I'd like to sleep but it's a shift in the right direction. Waking up at a "reasonable hour" has put my whole day on schedule more or less. It's funny to think that my first issue with getting out of bed was wondering what I'd do with my day once I was up. It's funny because, one cup of coffee later, I read through my email and did my easy activism for the day. That made me want to write.

My last entry came the day before I read a fascinating article on the lack of ideas in this country right now. Everyone is so fixated on the specifics of things that there is no time for philosophy. Actually, most people fail to pay attention as usual but those who pay attention are focused on specifics. (Remember, politics is a dirty word in this country.) Big ideas are important because they lead to specifics that make sense from that point of view. Everyone has heard of the "big idea" called trickle down economics. Nevermind that it makes very little sense. It leads to certain specific policies which also don't make sense except within the context of the big idea. I think a lot of people believe in it solely because it is the only big idea that gets that sort of promotion.

Today's big idea is that we all need help. I'm writing about disabled people in particular but it applies to everyone else too. Helping people who need or could use a hand is the biggest part of a society based on social justice. A lot of us don't have money to spare for causes we support whether they are political or just going out to see live music at a local club. You get music/food/drink out of the deal, the club gets money to stay open and the band gets their money plus exposure plus the experience that is valuable beyond measure. Some of us don't have money to spend on a lot of different things but it's good to maximize the value of what you do spend.

For a lot of people, the help they need involves that most valuable of all resources, time. Spending time with someone whether listening to them or helping a kid learn to throw a good change-up, is the ultimate hand up. I am trying to spend more time with people whether in person or online. You never know who you're going to meet in this crazy online universe. When I was growing up, I never would have guessed that I'd have a good friend from South Africa much less the dozens of people in the Netherlands who were once such a big part of my life. "Scarey" from South Africa came to mind because I she told me that I'd once saved a bad day for her because I wrote about what a good time I had hanging out with her on the game called "Ancient Anguish." (Also called AA but that can be confusing at first.)

In any case, it's good to recognize that you need help instead of trying to deny it or be embarrassed about it. I'm not exactly the poster child for letting people help me with my history of arguing with nurses about my desire to be independent but I am getting better at letting people do things for me. The little things matter as much as the big things in proportion anyway.

There are people out there who are screaming bloody murder at the idea of people getting help. They claim to be self sufficient in theory and wonder why they should ever have to pay a dime in taxes. I don't have any time for these people who don't realize just how much this society has given them. I don't understand how anyone could claim such ignorance until I remember how shy my side of the political aisle is about beliefs. If people only knew what good government had already done in their lives, they might not be so wrong headed. Then again, they might just be looking for something to be angry about and government serves them in that capacity.

Health Care Vs. Health Insurance

One of the problems we have with our health care system in the United States is that it's based on an outdated insurance model. Insurance is something you buy in case something goes wrong. You are required by every state I know of to purchase something called liability insurance for your car. Liability insurance actually covers those people in the other car of a theoretical accident in which you are deemed to be at fault. Since a split second mistake behind the wheel can cost someone an entire lifetime of income in addition to medical expenses, you are advised to carry enough liability insurance to cover all of your assets. This means that your insurance would pay all of a claim (minus deductible) if you are sued for all that you own.

You are not required to carry collision insurance which covers damage done to your own car or comprehensive insurance which covers damage done to your car while it is parked. The main reason is that you're not going to sue yourself for those damages. There are also some technical reasons why various degrees of collision and/or comprehensive insurance are recommended for some people. Melissa has to park her car in a busy lot at work where it is vulnerable to hit and run drivers or vandalism. Then there was the day that someone smashed one of the car windows while it was sitting in our driveway. It is considered statistically impossible to live your life without being involved in auto accidents.

Car insurance does not cover things like preventative maintenance because it is a hedge against bad things happen. That sort of maintenance is another hedge against disaster since most insurance doesn't actually cover mechanical breakdowns even if you've had your car maintained. Therefore, it is likely that the average person will file less than a dozen claims over their lifetime and I'm trying to guess high. Deductibles and large uncovered areas of your car make it certain that you will never consider filing an insurance claim to be a good thing.

Health insurance is a completely different matter. The vast majority of health insurance claims filed are for basic preventative maintenance. You get immunized as a child, get your teeth cleaned and checked and get screened for various diseases as you get older. A true insurance system would not cover these costs because there is no way to hedge against the risk. On the other hand, our car insurance system requires periodic inspections of your car so that you are less likely to have a malfunction that ends up hurting someone else. Our health insurance system does not require you to get those awkward symptoms checked out and the result is one of those "bugs" that runs its way through the workplace as employees expose their peers to risks through a system that requires them to do so.

Here's another difference between a health insurance system and a car insurance system: a badly damaged vehicle will most likely be "totalled" by your insurance company. This means that the cost of repairing the car exceeds the total current value of that car. In such a case, the insurance company pays you the listed value of your car to put toward buying a new one.

What happens when our bodies sustain catastrophic damage due to injury or illness? Thankfully, there is no legal way to set a price on your body. They can't "total" you and pay less than the total cost to repair you, right? Actually, they can. All of us who are disabled go through a process where our doctors prescribe a treatment and the insurance company refuses to pay for it. They have committees set up to decide what treatments are covered and what is not covered. They also have the ability to decide that a treatment should only cost a small portion of the actual cost. There are entire departments devoted to avoiding payment on claims. Sometimes, the doctor is under contract to absorb the rest of the real cost but some patient will be covering the rest of the true cost. Otherwise, the doctor would lose money doing the job society needs them to do. Do we really need to pay for the denial department of the insurance company as well?

When you start to look at the system based on some sort of social justice, you will see that it is hopelessly broken. Patients deserve the medical care that will get them the best standard of life possible which I'm defining as having as much freedom from pain and other unpleasant conditions as possible. Doctors spend decades racking up debts while working absurdly hard in schools, internships and residencies. They deserve a relatively high standard of living which I'm defining as the ability to afford the nice things in life in addition to paying off all those debts. Insurance companies are in the business of making money and have stockholders who deserve to be represented by people who will try to maximize the value of their investments. One of these things does not belong here if you'll permit me to paraphrase "Sesame Street."

The very idea of health insurance makes no sense because holding down costs and raising profits does not maximize health results. We need to take on health care as a societal responsibility. Even big business would benefit from a better approach because every one of those workplace "plagues" cuts productivity. I don't have the numbers to back this up but I'm venturing a guess. If you add in the possibility of a serious epidemic, it would be obviously in the best interest of each business to avoid punishing employees for taking sick days. In this growing world of 24 hour/7 day a week over 365 days a year business, there has to be room for some increased schedule flexibility.

Disability insurance needs to play a greater role in all of this. Despite the massive zipper scar on the back of my head from brain surgery, I had trouble qualifying for the private long term disability that I bought. Then, like most people, I was rejected by Social Security Disability but I was lucky. My private disability insurance hired me a lawyer to represent me in my third try. In my case, the judge who handled my hearing in the third stage was fair and the doctor working for Social Security knew what he was seeing. I never had to testify through my case of the twitches because that doctor read up on my case, saw my symptoms for himself and made my points for me.

Lucky as I was, that delay cost me late fees on my rent and kept my money out of the economy for months. Multiply that by a couple of million people with varying degrees of the same problem and the system meant to keep out freeloaders costs the economy many times what letting a few bad apples get through would cost. From the social justice point of view, subjecting those who already suffer to all that difficulty is a crime.

I don't pretend to have all the answers but I will suggest a few here and there. The main point would be taking health care out of the insurance system and putting into something new. This new something would examine health care from a social justice point of view. Where there is social justice, society benefits.