Jay Lake: Writer

[culture] The Boston bombings

First and foremost, my heart sorrows for those caught in the Boston bombings of yesterday. The dead, the injured, their friends and loved ones, the first responders and volunteers; everyone. The date and venue of the attack is just a twist of the knife, I suppose.

I don’t consume broadcast media other than the odd snatch of NPR in the car, or watching online videos of segments which for some reason have been recommended to me or caught my eye. My understanding of the bombings thus far has been from a mix of (mostly) liberal blogs and the some news Web sites, as well as secondary commentary from those sources.

While I have my own private views of what is likely to be uncovered about the perpetrators, I am the first to acknowledge those views are currently not grounded in any facts whatsoever. Therefore I decline to speculate in public pending reliable evidence emerging.

What I will say is this: I hope for swift justice tempered by mercy. I likewise fervently hope that we can avoid another national paroxysm of retributive anger like that engendered by 9-11. Despite our manifold imperfections, we are a nation of laws, and a people who value a moral and orderly world. Our internal disagreements are for the most part about what those ambitions mean.

Please, let America be lawful and orderly in our response to this terrible event.

Tags: Boston, Culture, media

Posted: 5:47 am Tue April 16 2013 | Comments(22) |

[culture] Pharmaceutical Puritans

My insurance plan, like many, has multiple tiers of pharmaceutical co-payments. Most of my drugs cost me $10 per prescription filled or refilled. A few cost me $20. Exactly two cost me $50. Those same two drugs are also the only drugs I have ever been prescribed in my life for which my insurance company limits the number of doses I’m allowed per month below what the doctor prescribed.

That would be Viagra and Levitra.

Ever since my colon surgery in May of 2008, I have had persistent erectile dysfunction. The probable root cause is surgical disruption to the vagus nerve. That, and the effect of being in my later 40s with a lot of medical and life stress, has kept me from ever recovering full functionality.

If and when any organ in my body other than my penis malfunctions, insurance covers everything required. I have co-pays and other minor hassles, but my insurance carrier is consistent and supportive. They have unquestioningly paid for drugs that cost $10,000 per dose, as needed in my chemotherapy regimen, with no co-pay at all because they were dispensed in a clinic.

But when I need a drug to help me enjoy the basics of male sexuality, I’m limited to a handful (or less) of pills per month and charged 2.5 to 5 times what every other drug I’ve ever taken costs me, when I have had a co-pay at all.

Is there any logical reason for this? To my view, this is just the ingrained Puritanism in American culture. Yet another stupid price we pay for the Calvinism in our national DNA. The unwillingness of many people, most of them conservatives, to contribute to the sexual enjoyment of others. Millions for cancer, barely a few cents for a good fuck. I cannot imagine any medical or financial justification for this beyond simple, petty discomfort with human sexuality.

I know perfectly well the sordid history of health insurance and female birth control. I don’t expect much sympathy from female readers, who have borne the full cost of their sexual health for decades, until quite recently. But it’s really the same problem that conservatives so ardently and wrongly tried to smear Sandra Fluke with: people don’t want to think they are paying for other people to have sex.

You know what? I’m just as entitled to sexual health and well being as I am to any other form of health and well being. This is really a minor issue in the symphony of horror which is my cancer experience, but it’s a damned annoying one. The medication restrictions on sexually related drugs are just petty, and serve no purpose other than to make some people, somewhere, feel good about punishing me for having a libido and opportunities to exercise it.

Tags: Cancer, health, Personal, sex

Posted: 6:42 am Wed January 16 2013 | Comments(7) |

[culture] A small Gedankenexperiment on healthcare

My experience of being deeply enmeshed in the healthcare system is that a majority of my non-billing paperwork (and a meaningful percentage of my billing paperwork) is intended to ensure that I am qualified to receive certain benefits, and to check my continuing eligibility. Another way to put this is that a majority of the patient-facing overhead of healthcare delivery costs, meaning costs exclusive of actual medical expenses, is about compliance.

A simpler way to put this is that we spend a lot of money making sure only those judged deserving are helped.

From my perspective, the only three things I’ve done in my life that were more paperwork intensive than being a patient in the American healthcare system were to apply for a security clearance, buy real estate, and adopt the_child. I did all of those things successfully while in good health and of sound mind.

Being very ill in America invokes a messy, complex, internally inconsistent system that requires a lot of focus and precision at a time in most people’s lives when they are least equipped to provide those things. If indeed, ever they were. Not everyone is good at paperwork. And this is me, who is not dealing with public benefits and all their myriad oversight requirements, but rather a relatively sane and generous employer and employer-sponsored private benefits plan.

So let’s assume a certain number of claimants are fraudulent. That’s true in every walk of life with every kind of benefit — someone will always be trying to figure out a way to get something for nothing.

What would happen if we simply let those people into the system? If, instead of spending money on compliance we spent that same money on delivery? Would net costs go up or down?

We’d certainly have a system that is much kinder and more supportive to the overwhelming majority of users, its legitimate patients. Instead of punishing the users along with the fraudsters, let’s keep things simple for the people in most desperate need.

Would that cost more or less? I have no idea. But it would be the mark of a compassionate society that values life, liberty and the pursuit of happiness over punishing the undeserving and deserving alike.

Tags: Child, Culture, health, healthcare, Personal

Posted: 8:20 am Sun December 16 2012 | Comments(7) |

[culture] The Connecticut shootings

I’ve already said most of what I would say about the Connecticut shootings. Now, on chemo when I am cognitively impaired and my filters are compromised, is not the time for me to try to say more. I’ll leave you with one thought of my own, and one from someone else.

Via Twitter, from @ethannichtern: A KNIFE Attack in a Chinese School today WOUNDS 22 Kids, kills NONE. #endofargument http://t.co/w4HnrjS0

As for my part, consider this. Zero guns would equal zero gun violence. By definition. There must be some midpoint between zero and 300,000,000 guns where 30,000 people don’t have to die every year of suicide, homicide and accidental shootings.

Tags: Cancer, Culture, guns, health, Personal

Posted: 9:01 am Sat December 15 2012 | Comments(2) |

[culture|politics] National blind spots

As long-time readers of this blog know, I’ve been pretty exercised about the United States’ national healthcare policies (specifically healthcare finance, not healthcare delivery) for a long time. This was true even before I became a cancer patient and got to experience much the madness first hand. I am similarly exercised about certain other issues, such as our firearms policies (viz recent blog entries) and education policies (specifically, that we have a political and social system that allows Creationists to take control of public education, leading to monumental wastes of time and effort and the horrific mis-education of children as characterized by the Dover decision).

But we also get a lot of things right in this country. To name a few, healthcare delivery (as opposed to healthcare finance), where when the United States is at our best, we are generally the world’s best. Aviation policy, where most of the world follows FAA standards. The research-industrial complex that has delivered everything from Teflon to the Internet for the whole world to use. Higher education, where again, at our best we are generally the world’s best. Our First Amendment protections for freedom of speech and freedom of worship, which provide us with at least the potential for maximum personal expression and individual freedom of thought.

So what I wonder is about our national blind spots. If our healthcare finance system so wonderful, how come nobody else in the industrialized West has anything like it? If our national social policy on firearms is so conducive to personal liberty and a free society, how come nobody else in the industrialized West has anything like it? Quite demonstrably, more often than not when the United States get something right, the rest of the world tends to either develop in parallel or follow along. Yet no one will touch our healthcare system or our firearms policies with a bargepole. And those countries tend to have much better healthcare outcomes than we do, and much lower rates of violent crime. As Americans, we seem incapable of perceiving that.

In other words, if our policies on healthcare and firearms are such a good idea, how come no similar societies are following our example?

History will judge us harshly for some things — leading the path in climate change denial, for example. Our obsessive militarization of world affairs, for another example. But history will be simply baffled by other aspects of American culture, such as our vicious healthcare policies and our national obsession with placing deadly weapons in the hands of every citizen who ever dreamt of having one.

Blind spots. Destructive blind spots.

Tags: Culture, guns, health, healthcare, Personal, Politics

Posted: 8:50 am Fri December 14 2012 | Comments(14) |

[personal||culture] The costs of owning a car

I hold an Oregon drivers license. I own an automobile. I belong to the American Automobile Association. That makes me part of car culture in this country. In accepting the perceived benefits of owning a car, I am also taking a responsibility for the risks and social costs of widespread automobile use.

There are over 250,000,000 registered passenger vehicles in the United States.¹ There are over 210,000,000 licensed drivers in the United States.² We are almost all of us in his country part of car culture. Almost all of us take responsibility for the risks and social costs of widespread automobile use.

As it happens, for my personal lifestyle, though I am low-mileage driver by US standards, mostly due to having a job working at home and thus no daily commute (we’re ignoring the effects of cancer on my driving for the sake of this discussion), I and my household are not in a position to go car-free. The location of Nuevo Rancho Lake is such that many of life’s needed errands are impractical without an automobile. We do not live in a transit-dense area, and the time penalty for taking such mass transit as is available overwhelms our schedules.

For my own part, when the_child is older, in the somewhat unlikely event that I have regained my health, I would like to move to a dense, mixed-urban neighborhood where my automobile dependency can be sharply reduced or eliminated completely. At this point in my life, that’s largely wishful thinking. I continue to be reliant on automobile transportation both directly — to be driven to my copious medical appointments by friends or relatives, for example — and indirectly — the errands to the grocery store, post office and so forth that are run on my behalf, largely by Lisa Costello in her car.

This means I am benefiting from automobiles, even if I no longer operate them personally for reasons of my own health and everyone’s safety. In benefiting from them, I accepting their costs. Like any aspect of life, car culture is both things, benefits and costs.

I accept that in the United States, we experience about 30,000 deaths per year (10.3876 per 100,000 population)³. (Oddly enough, this is very similar to the number of gun deaths per year.) That number is down about 25% over the last ten years, apparently mostly due to safety improvements in automobile design and construction. In opting to own and use a car, I am participating in a system which kills 30,000 of my fellow citizens every year. I own a piece of those deaths as surely as if I were driving the car that killed them. To pretend otherwise would be disingenuous of me. The moral calculus here isn’t “ooh, killing machines!”, but rather a balance of the overall social benefit of nearly universal transportation with the carrying costs of its risks and inefficiencies. Every one of those 30,000 dead set out with some purpose, most of them by car, that they judged to be worth the risk to their life. Just I like judge ever car trip I make to be worth the risk to my life. That 0.01% risk of my death on that particular trip is the cost of doing business.

I also accept that in the United States, the average passenger vehicle emits 108 pounds of hydrocarbons, 854 pounds of carbon monoxide, 55.8 pounds of oxides on nitrogen, 16,034 pounds of carbon dioxide, and 813 gallons of gasoline evaporates.⁴ (I’m not sure about that last number, but I’m not in a position right now to research it further. The rest meet a test-of-reasonableness for me, but if someone has better data, let me know.) Again, by participating in car culture, I own a piece of that pollution as surely as if I were dumping industrial chemicals into the air by hand for the sheer joy of seeing the birds fall out of the sky. Again, a balance of social benefits and net risk. One that is highly arguable, of course, but every day 200,000,000 million of us get in our cars and pump out those tailpipe emissions. This is of course changing with the increasing emphasis on hybrids and more efficient conventional engines, as well as be affected by other choices such as mass transit or bicycle use. But that massive scale of pollution is the cost of doing business.

As I said, I belong to AAA. That’s an organization which among other things lobbies for motorists’ concerns and increased government support for car culture. I am responsible for the things they promote and achieve, whether or not I personally agree with choices to, say, fund a new highway and not build a light rail system somewhere with that same money. I own that, it’s part of car culture.

I’m not even talking about many other costs of the automobile, from the way Federal and State budgets are skewed toward road infrastructure to the impact of fossil fuel extraction and distribution to the foreign wars we have fought over access to oil to the misplaced research and development dollars that could have improved our way out all of this decades ago if it were not for car culture. Those are all part of the cost of doing business.

The point I’m making is that in choosing to own and use an automobile, in choosing to participate in car culture, all of these things belong to me. The deaths, the pollution, the foreign wars, the misplaced spending. And I accept them as part of the cost of doing business, given the benefits I perceive the automobile giving me. I would be a moral coward not to do so. I would be in denial. If I didn’t take that responsibility, I’d be accepting the emotional and personal rewards of automobile ownership without acknowledging any of the costs.

How this applies to handgun licensing, gun ownership and NRA membership is best left as an exercise for the reader. I will simply say that we are all responsible for the consequences of our beliefs. We live in a society that will barely acknowledge the cost of widespread private automobile ownership, while pretending that widespread private gun ownership is some holy right without consequence at all.

Bullshit. My belief that I should own a car places responsibility on me for death, pollution and numerous other social costs. Your belief that you should own a gun is no more free of such costs.

Tags: cars, Culture, guns, Personal

Posted: 6:58 am Thu December 13 2012 | Comments(10) |

[culture] Yesterday people died in my neighborhood for your guns

Gunman opens fire at Oregon mall; Suspect, 2 dead.

This happened last night a mile or so from my house, at the mall where I normally go to the movies, and where my family occasionally goes to restaurants or stores which are easiest found in shopping malls. In this case, no one in my circle of family and close friends, and so far as I know, no one in my circle of acquaintances, was involved. My personal degree of involvement consisted only of hearing sirens from time to time while the through street down the block from my house became badly snarled up with diverted traffic.

Guns.

Now we’re going to have the same, tiresome, never ending discussion we always have about our national obsession with firearms. “Guns don’t kill people, people do.” “Guns are only a tool.” “Spoons don’t make people fat any more than guns kill people.” “Cars kill more people than guns do.” “Guns make me safer.” “Guns prevent far more unreported crimes than they cause.” And my personal favorite, “It’s not right to politicize such a tragedy by bringing up these larger social issues.”

You know what? Shut the fuck up. People died. Because of guns. People who wouldn’t have died if the shooter couldn’t have acquired his firepower and accessories. It’s that fucking simple.

I’ve never yet met a gun enthusiast who will admit to the simple proposition that if there were fewer guns in our society, there would be fewer deaths. Not a single Second Amendment enthusiast with the moral and intellectual honesty to agree that yes, their ownership of firearms is more important to them than the tens of thousands of people killed every year by suicide, homicide and other gun-related causes.

My life is worth more to me than your guns are. My life is not made safer by your guns. If you can’t own that simple fact with its moral and social implications, you are a dishonest coward.

If you can own that simple fact, then you are a very different person than me. Because guess what? I value your life more than you value mine.

There’s a lot of conservative “scholarship” about how firearms keep people safe and prevent crime. That work is only slightly more credible than Young Earth creationist “scholarship”, a great deal of it being simply made up by a man working as a janitor at Yale who’s still cited in NRA circles as an Ivy League researcher.

There’s a lot of personal anecdote about how firearms have saved people’s lives. I’ll stipulate that even if each and every one of those is passionately true, it’s still on a par with people who tell stories about not wearing seatbelts saved their lives when they were thrown clear of a fiery wreck. The objective data says otherwise, and I’ll take data over anecdote every time. Especially when you’re laying my life on the line.

No one comes to gun advocacy as a reasoned position based on careful examination of the evidence, any more than anyone comes to evolution denial, climate change denial or supply side economics based on the evidence. Gun advocacy is an emotional and ideological position desperately in search of an objective basis, just like its conservative kissing cousins. Like all of those fixations, advocacy of widespread private gun ownership is a patently absurd position when viewed from any perspective other than the purely internal.

Some people feel safer with guns. You scare the rest of us spitless. Yesterday afternoon, your sense of safety was bought and paid for by someone who dressed up, went to the mall in my neighborhood, and killed people to celebrate the Christmas spirit and his theoretical defense of essential liberties as protected by the NRA and the Republican party.

It’s as simple as that. If the shooter didn’t have access to a weapon, a tool whose sole purpose is killing other human beings, he wouldn’t have killed and wounded nearly as many people.

Every day people die by firearms. Every day people die for your guns. I don’t want to be one of those people. I don’t want anyone I love or care about to be one of those people. I don’t want total strangers to be one of those people. I don’t want you to be one of those people. (There are more gun suicides than homicides in the United States every year.)

We have social experiments running in countries all over the globe, from the UK to Australia, that show reduced firearms availability and increased firearms control reduces gun violence and death rates. This isn’t even a remotely questionable proposition. Yet the gun lobby as a whole and gun enthusiasts in general go through intellectual and moral contortions that would shame a pedophile Jesuit crackhead in order to maintain that their beloved firearms are a right which cannot possibly be tainted by any whiff of sane social policy or moral considerations.

So, guns? Yeah. If I could, I’d mail every gun owner in the United States postcards every single day, showing a photo of that day’s dead, their bio, listing their surviving family members, and the make of firearm that killed them. They’d be like baseball cards. Maybe then it would be real to you guys polishing your guns and feeling afraid of the wicked world, feeling safer with your home defense.

I know a lot more gun owners than I do criminals, and it’s your culture of guns that enables those criminals to be armed in the first place.

If you’re a gun enthusiast, you own those deaths as surely as the sun rises in the east. And I’ll be amazed to see any of you ever admit that to yourselves. Congratulations, you’ve sufficiently controlled the social and political discourse such that none of the rest of us get a say in our own safety.

Meanwhile, people died in my neighborhood yesterday, paying with their lives for your gun rights. Just as people die in neighborhoods all across the United States every day.

Feel safer now?

I sure don’t.

[1] Be aware, in the comments section on this post I am unlikely to be my generally polite self to the usual specious arguments about why guns are harmless and wonderful. The social utility argument (“cars kill more people…”) or the home defense argument (“my gun in my nightstand is more accessible to my sleepy self who just woke up than that wired-up burglar’s is in his hand…”) for example. Feel free to engage me where you disagree, but don’t be stupid about it. I’m not willing to be moderate on this topic. Not today.

[2] I shouldn’t even have to go into this, but some people will doubtless think it, or bring it up, telling me that I don’t know what I’m talking about because I’m a stupid liberal hippie who’s never touched a weapon. Yes, I’m quite familiar with firearms. I lettered in both riflery and archery in high school. I know range safety, and believe me, if I shot at you, I’d hit you. That makes me all the less interested in ever doing such a thing, or having such a thing done to me. In short, I’m afraid of guns precisely because I do understand them, not because I am ignorant of them.

Tags: Culture, Family, guns, Personal, Portland

Posted: 6:59 am Wed December 12 2012 | Comments(47) |

[culture] Waiting, in line or otherwise

I have no patience for waiting, in line or otherwise. Sometimes you have to — airport security, for example — at which point I put on my big boy pants and deal. But I won’t wait for a restaurant table or a movie ticket or at a music venue or a festival. My absolute limit for hanging around a restaurant to be seated is fifteen minutes, and that’s mostly governed by my laziness in not wanting to go elsewhere. As I’ve often said, they could be hosting the Second Coming and free chocolate on the lawn, and I won’t go stand around for it.

The only real exception for this is when I’m with a friend who really wants to do something, and I want to be with my friend. At that point, I’m not waiting in line, I’m spending time with a friend who happens to be doing something I wouldn’t normally do. It’s a mental shift.

This means there’s places I like around Portland I very rarely get to eat at anymore. The Screen Door, for example, or Apizza Scholls, where it’s incredibly difficult to get in unless you show up early and wait for them to open. I love the food at both places, but my life’s too short to spend it hanging about for an hour to get a table. (And this ignores my current health issues, which make waiting in line almost literally impossible for me because I cannot stand in one place for more than a couple of minutes without needing to sit down.)

I can’t figure out if this is utterly reasonable of me or an irrational tic on my part. I don’t suppose it matters much either way. I’m happier not being frustrated by standing around, that’s good enough for me.

Do you wait for things? What do you get out of it?

Tags: Culture, Food, Personal, Portland

Posted: 6:31 am Wed December 05 2012 | Comments(11) |

[culture] Lake’s Law of Power Outlets

In any public space with a high demand for and limited supply of power outlets, such as an airport gate area, the first seats taken will be those closest to the outlets, and those seats will generally be occupied by people who do not need or care about the outlets.

Corollary: You will be resented as a creeper if you sit down next to them in an otherwise empty gate area and reach around to plug in.

Tags: Culture, Tech, Travel

Posted: 4:59 am Sat October 13 2012 | Comments(3) |

[culture|politics] Pro-life

When you fight for unfettered access to women’s health services…

When you fight for universal contraception…

When you fight for pre-natal care for all children…

When you fight for paid universal maternity and paternity leave…

When you fight for universal health coverage for all children…

When you fight for early childhood education…

When you fight for honest, fact-based teen sex education…

When you fight for equal pay for equal work by mothers as well as fathers…

Then I will believe you are pro-life.

Tags: Culture, gender, Politics, sex

Posted: 4:40 am Fri October 12 2012 | Comments(9) |