We have a family tradition that at certain holiday meals and birthday celebrations we go around the table and ask everyone to say what they’re thankful for.
I also had no idea about healthcare until moving abroad and understanding what a strange system we have in the US. (As a teacher in Massachusetts, my health insurance was pretty good.) I can get behind this initiative, David!
I have struggled with the story of Job my whole life and I have yet to hear an adequate explanation for Job's original wife and children. They were expendable, collateral damage and could simply be replaced with equivalents. I imagine the old wife and children were sad to die and did not like their suffering, but the story does not consder them in its press to make the bigger point.
A large share of religious stories really only make sense in the total context of their faith / in a supernatural world where the facts of earthly life aren’t the only facts. A traditional believer’s answer might say: their lives and souls had their own stories and recompenses, or purposes and resolutions, that aren’t part of the written story of Job.
I remember being in a class where Gandhi’s argument that the Jewish people should have willingly offered themselves to the slaughter during the Holocaust appalled many students. “Maybe it would have aroused sympathy, but what about them, what about their lives?” To the extent that he believed in reincarnation and karma, of course, it adds up: this life isn’t the only end; but to the extent that we don’t, it doesn’t make nearly so much sense.
Myths often trouble me because I worry about the minor characters and how the bigger point plays out in their lives. Sometimes I do not know where to put my gaze.
My point was that the myth of Job, and the standard reading with its non-consideration of the minor characters is David's essay in miniature. With his consideration of new information and in this essay, he is pointing to the wife and children in the Job story.
Same, absolutely. And yes for sure! I didn’t mean to seem like I was pushing back, it’s just an issue that’s concerned me with Job specially too, so I thought I’d share what I’d come across as a possible answer; couldn’t agree more about its application here!
I attended a Baptist service in a poor part of Baltimore and the sermon was about Job. The entire emphasis was on Job's comeback. When I've heard it discussed as part of Jewish theology, the ending has almost no emphasis. The god of Judaism can be mercurial and cruel.
Which is why we Goyim became so very fond of Yeshua bin Miriam. An incomprehensibly loving Jewish man, whom our priestly class elevated to Godhood. But his Loving approach to life was not ontologically sufficient to our Hierophants, who deeply embraced the "fire and brimstone" facets of Judaism.
I’ve struggled both for their struggles but also if my life was destroyed and my husband and children were killed “bygod” to “test my faith”. Sorry they are not just casually replaceable by another set!
I attended a Baptist service in a poor part of Baltimore and the sermon was about Job. The entire emphasis was on Job's comeback. When I've heard it discussed as part of Jewish theology, the ending has almost no emphasis. The god of Judaism can be me
I recall hearing the story as a child in Catholic school. The emphasis was on how mightily he suffered. I remember the nun describing the sores on his palms with pus coming out of them. Geez. I wonder what the pedagogical intent there was.
There is arguably tons of value in transformative approaches to pain and suffering. But training young children to willingly embrace any sort of warrior ethos is a sell. Especially if there's not a clear roadmap with incentives. Pus-oozing-sores as a selling point?
Perhaps I go too far the other way, but I never discuss with anyone outside my immediate family (ie Mrs Freedman) what I do for charity or community organisations. I think its unseemly. I remember a member of my then community always giving £2000 in the annual collection, a fact that was loudly proclaimed to everyone, leaving the rest of us feeling that we wished we could do more, and him looking very proud. Anonymous giving would have been much better. Both the Jewish and Christian traditions support this. Maimonedes (https://aish.com/48893902/) and Jesus (https://reflectivebiblestudy.com/gospeladventure/giving-anonymously-matthew-6-1-4/). I also tend to express gratitude privately most of the time, because otherwise, as you suggest, it can be performative, or seem so.
Still, I think the ultimate criterion is WHY perform acts of charity or expressions of gratitude. If it's to make oneself look good, I believe that that in some indefinable way pollutes it.
As I am multitasking and about to race out, I may not have expressed myself well, so I just want to say that I am by no means suggesting that I think your acts of kindness/expressions of gratitude are merely performative!
I’m with you on this one Terry, at least partially, but I do think context matters. I tend to think it’s best not to talk about it unless the circumstances allow for a discussion that is not self-serving or self-congratulatory (like this one, I suppose).
I've got a friend who gets one the wrong side of this one all the time. We'll get a text from him telling us how many homeless he fed last night, and maybe we should get involved? Well piss off, I think, I am involved ... I'm just not sharing it with you.
Motivation informs perception. A sociopathic can publicly imitate the conduct of a Mother Theresa. While privately doing the unspeakable.
The primary Buddhist formula for altruism is relevant here: do/think/say good--and abstain from the opposite, because it *feels* good, and sets the stage for journey into deeper mysteries.
Absolutely, Nubby. Unfortunately I know at least 5 people like that. I have as little to do with them as possible. If nothing else, I actually feel a little polluted for having been in their presence.
It could be difficult, if not impossible, to fully know what their motives--or mixtures of motives--truly are.
From a Buddhist perspective, Mudita ("empathetic joy") would have one feel yummy-ness over whatever good they are accomplishing. But also Upekkha ("equanimity") would inform emotional response if any of their motivations were performative or unsavory. Mudita and Upekkha being 2 of the four ideal (spiritually mature?) emotional responses to every relational interaction.
I was on a train when I read your original comment, and when I arrived home I realised that I'd only seen the first part, which is what I responded to. I don't know an awful lot about Buddhism, so I find your comments interesting. I suppose the ideal state would be to be so spiritually developed that you would always say, do and feel the right things for the right reasons.
I wondered/worried if by writing about narcissism and complacency when it came to our giving whether I was "getting on the wrong side" of the subject as Tom put it. I think I did a bit as the highest form would be to remain silent as Terry mentioned but in writing personal essays I'm going to inevitably cross some lines.
The highest form of giving according to Maimonides is to give someone a livelihood. On an individual level that is "systemic." You're right that anonymity was very important and ranks high as well. In our modern world, it's an interesting question as to when not being anonymous ever is preferable. There's also an interesting distinction between "looking good" and "feeling good.'
The second (?) leading cause of personal bankruptcy is medical debt.
Our current multi-tiered system is extremely inefficient, providing roughly half the benefit at twice the cost, compared to every other industrial society. But its bloat and waste is defended by key stakeholders in our financial sector, despite the fact that such a GDP drain renders us uncompetitive with our greatest competitor: China.
You are my favorite wealthy person ever ! I have the odd but not unusual perspective of the well educated, hardworking but poor. I grew up pretty poor because my mom had to raise me alone after divorce. Even working three jobs most of the time she barely made it. I went to a very good school and did very well in my first career but some serious health problems hit in my early forties and I haven’t quite dug out from the fall out of not being able to work full time for years while trying to support my aging mother. I’ve gone without necessary healthcare for years. I live in a dangerous neighborhood that I cannot yet afford to move out of. I struggle to pay the basic expenses. It’s hard for me to be around people who throw money around like it’s nothing or who don’t understand why I can’t afford a new reliable car and don’t have any overseas vacations to talk about. Life is just different for those of us one emergency away from eviction. Fortunately I’m incredibly good at navigating systems - once I got 10k in medical debt written off because I qualified for charity care and I spent hours pursuing it. But most people don’t have those skills and going to the hospital for one night could destroy them. I’d love to start a nonprofit to help others who don’t have those skills navigate the systems and rescue their families. I’ve been on Medicaid too and was once denied a full course of antibiotics for a respiratory infection so I had to go into my food money to pay for the rest of the medicine. Most people wouldn’t know how important it is to finish the course of antibiotics but I have a masters in public health and I do. And I consider myself fortunate to have been able to come up with the $25. I love how you think about wealth and that you are conscious of the issues you write about. I’m sure you tip well. No matter what I always tip well if I have to take a cab or something because I know how much even two extra dollars means to those of us who count every penny. All the best to you and your family.
Hi, April. There are lots of well-educated, hardworking poor people out there, actually! I know many. Your antibiotic story is demoralizing. Why would we accept a system that would do such a thing to people?
Hi April -- regarding your wish to start a nonprofit to help families navigate healthcare bills. Are you familiar with https://dollarfor.org/ and https://unduemedicaldebt.org/ ? These two nonprofits both help families navigate and negotiate medical bills and medical debt.
April, your experience with the antibiotics illuminates the problem. It's a barbaric system that would have people in such a wealthy country make the choice you had to make. I do tip well because of the asymmetry of the effect of the tip. Thanks for your comment.
Why not put your philanthropic efforts into creating a new system of healthcare, one that ideally incorporates the best of the mainly European systems with our American love of laissez-faire? And that most existing stakeholders could buy into.
A Single Payer system with luxury tier care options for the 1% and 10% might be a good start.
I always tip in cash--even if I pay by credit card. The person receiving does not have to declare it and it is theirs for whatever they need. Servers aren't top tier millionaires, after all. Neither am I.
As I’ve noted before, Australia has Medicare - free basic medical care for all. It comes with its pitfalls but is a sound base premise for healthcare. I was horrified when I realised how American healthcare worked. I wish you all the best in trying to help change your system to a more equitable setup. Good luck.
No system is going to be without its pitfalls as you write. There's a lot of propaganda floating around about how awful all the other wealthy countries' systems are. Endless waits, etc.
Most Europeans are shocked when they learn about the US system. There are many different systems and the National Health Service (NHS) has its problems, but the principle that we all have a right to healthcare is deeply ingrained.
I haven't been grateful for insurance for the last 20 years. Deductibles are so high that I have to pay both my insurance and my doctor bill. Insurance literally takes money out of my hands that I don't get back. We were better off with a $500 deductible and 80/20 coverage.
I loved Obama as president but ObamaCare is the first time I went without insurance since I was 18. I can explain my reasons if you want to get into it, but I actually have come to mind that insurance just needs to go. Maybe a little capitalism will bring hospital prices down. I think maybe government protections for the people and maybe a rebate program would need to be in place but mostly, the disturbing thing about insurance has been their interference in healthcare. It has gotten to the point where doctors have quit doctoring. Again, I can get more into my own personal experience if you want to discuss but what we need is a total disruption in the whole process. Health care providers need to recruit people who are attracted to the science. Doctors need to be free to do the doctoring. Clinical studies need to be backed out of curiosity and innovation instead of backed by pharmaceutical corporations. Actually if I was in your position finding ways to back clinical studies and getting other people on board with it is where I would look. As for Insurance, it needs to get back to paying the bills and get out of doctoring. They also need to go back to single payer and move away from employee group plans. If President Obama had stuck with his original idea for insurance it'd probably wouldn't be as contentious.
Actually I had an idea a few years back that I just remembered. Take the HSA cards that we have now and just by-pass insurance all together. Or maybe insurance would become more like AFLAC and cover your paycheck when out of work, or have Emergency Room insurance... Anyway, the HSA card would be yours, so if you changed jobs you don't have to worry about losing it, or spending all the money right away.
The structure is already in place. Paycheck deductions already happen, we are used to the money coming out of our checks. We are already used to automatic deposits. Then also there are the employer expenses that could now be applied to the employee, either in a matching program like the 401K or for padding new accounts.
This way whatever is not spent, can roll over into the next year. Now patient care is between the patient and the doctor. Now when a doctor writes a prescription you can actually go get it filled without going home and fighting the insurance company first. Plus those prescriptions will have to come down in price because pharmaceutical companies can't charge all willy nilly just because insurance will cover it. Same for any other medical care, X-Ray, or test.
You could have a family card or each member of the family has their own card that they can carry with them into adulthood. Now generational wealth is created. This would also set those kids up for maternity expenses to be covered when they're starting out in life and wages are at their lowest. I'm sure there will be some reckless spenders out there but the idea would be to build that account for end of life expenses.
The card is yours, at your bank, at whatever bank you choose. Which should help the local economy. Since the bank is using that money and turning it back into the community you also earn interest on that money.
As for employees of the insurance companies, they'd probably find work at the banks to keep the parameters of spending to medical expenses, or find work at malpractice insurance companies or whatever new industry crops up from this. move because it isn't a fully fleshed out thought. Anyway, that is my bright idea. Hope I didn't deviate from the topic too much. lol
Fully agree that we need to fix the health system. My son was diagnosed with type one diabetes at age 13. We had good insurance and the means to drive him to appointments and hour and a half away because there wasn’t a pediatric endocrinologist in our town.. but I remember thinking how hard it must be for those who don’t have adequate insurance and can’t take a day off every 6 weeks or so to learn how to manage this condition… I remember arguing with the pharmacy to get more test strips so my son could stay on top of his blood sugar… and I’m a mama bear and educated about health etc.. imagine someone trying to do this who is timid and not understanding of the importance? He now has a CGM and is doing well.. but having a family member get a chronic illness who is dependent on insulin to live and knowing there are others who have died rationing their medication is beyond infuriating… this is something we all need to get behind.
Thanks for the comment, MM. It's true that even when you have the tools to deal with a tough and complicated health issue, you realize how much time, resources, and education you need to handle it and wonder how others less fortunate can possibly get a good result.
I remember when the great George Michael died aged just 53 (that one really hurt), it was revealed that throughout his life, he anonymously volunteered in homeless shelters and gave millions of pounds to charities and less fortunate individuals without them knowing who the donor was. He helped so many people, and nobody knew how much he did for others or about the vast sums of money he secretly donated until he was gone. I loved him as an artist in life, but when I heard about his selflessness and extraordinary generosity after his death, I think of him as a saint. That's what I call a legacy!
Keanu Reeves gives away lot as well. My favorite story is of Zack Galifinacas who early in his career befriended a homeless woman, found an apt for her and paid her rent while he was just a struggling stand up. A few years ago he brought her as his plus 1 to an awards ceremony.
Healthcare here is awful, why would anyone n o t think it's a right, and not a privilege?
To that extent, I mean to understand why things stay here as they are, I read many answers a few years ago, that roughly divided onto "but I have it good" (?? strange way to look into societal issues. also, today you happen to have it good -what about tomorrow?) and "the State has a habit of ruining things when it runs it" (slightly more relatable, because the State does; but maybe if to change the whole outlook it would ruin less. After all many states do succeed, mostly).
Now what's left is to change the outlook. I won't go into my own experiences, suffice to say it's maddenning, and I know about that much more than I'd ever care to.
Ah, and the better the doctor is, I noticed -the more time they spend on dealing with insurances pleading about this or that, instead, you know, doing what they're trained to do.
As for story of Job -I'd summarize it differently; but thank you for mentioning it, as it is indeed one of the best ones.
Thanks Chen for the comment. As for Job, it's a puzzle of a story that has fascinated many great thinkers. I was going for brevity and forsaking all the philosophical and theological questions it raises.
American individualism is at the root of most societal ills. It fuels an economic system that allows a handful of individuals to amass incalculable wealth, more than one person/family could use in a lifetime. It's obscene that in the United States people don't have enough food to eat, a place to live, excellent public education, and healthcare when they are sick, and yet an individual can amass billions of dollars. There is a mindset that we are not interconnected as human beings. Billionaires (and multimillionaires) truly believe that they "earned" their wealth, when in reality they've just been able to manipulate public systems to their advantage. The legacy of colonialism and slavery needs to be addressed and reparations made. America prospered because it committed a genocide against native peoples and built an economic system based on free slave labor. Legalized racism prevented Black people from buying government subsidized houses and participating in the GI Bill post WWII after they fought in the war. The first step is acknowledging that the reason some people have so much is because others have so little.
Thanks Amy for the comment. I'm not yet at the point where I'd call American individualism wholly toxic. That said, our social safety net and our tax system are out of joint with other countries and with basic decency.
I look forward to your posts on the topic of healthcare and encourage you to explore the root causes of the various problem statements and the outcomes that result. I am fortunate both with my health and with working for the US division of a Danish company (they offer several good options for health benefits). However, I was previously self-employed for about 10 years and the cost of insurance became too much of a financial concern. One of the outcomes of our current system in the US is that people who might not be happy or satisfied with their work may continue at a company because of the healthcare benefits.
Oh. So ripe . I can’t resist. Tradition in my family . Around holiday season. What we are thankful for. Most sincere . Others. Pass the sweet potatoes. Yesterday, speaking with my sister she casually mentioned the whole family , 22 total. 5 children, grands , she and husband going on their annual trip to Maui after Xmas “ we’ve told the adult kids no Christmas gifts for them. Just grandkids .” First class all the way. Each get suites . I chuckled under my breath . The trip would help give our son and daughter a down payment on a home. Am I envious? Nope. It’s just another vacation in the lives of upper 1 percent. Eat. Drink and be genuine.
I also had no idea about healthcare until moving abroad and understanding what a strange system we have in the US. (As a teacher in Massachusetts, my health insurance was pretty good.) I can get behind this initiative, David!
I have struggled with the story of Job my whole life and I have yet to hear an adequate explanation for Job's original wife and children. They were expendable, collateral damage and could simply be replaced with equivalents. I imagine the old wife and children were sad to die and did not like their suffering, but the story does not consder them in its press to make the bigger point.
A large share of religious stories really only make sense in the total context of their faith / in a supernatural world where the facts of earthly life aren’t the only facts. A traditional believer’s answer might say: their lives and souls had their own stories and recompenses, or purposes and resolutions, that aren’t part of the written story of Job.
I remember being in a class where Gandhi’s argument that the Jewish people should have willingly offered themselves to the slaughter during the Holocaust appalled many students. “Maybe it would have aroused sympathy, but what about them, what about their lives?” To the extent that he believed in reincarnation and karma, of course, it adds up: this life isn’t the only end; but to the extent that we don’t, it doesn’t make nearly so much sense.
One possible answer, anyway!
Myths often trouble me because I worry about the minor characters and how the bigger point plays out in their lives. Sometimes I do not know where to put my gaze.
My point was that the myth of Job, and the standard reading with its non-consideration of the minor characters is David's essay in miniature. With his consideration of new information and in this essay, he is pointing to the wife and children in the Job story.
Same, absolutely. And yes for sure! I didn’t mean to seem like I was pushing back, it’s just an issue that’s concerned me with Job specially too, so I thought I’d share what I’d come across as a possible answer; couldn’t agree more about its application here!
I did not feel you were pushing back. I anguished over my tone, and failed, alas. I am glad to find a fellow worrier about the wrong characters.
I think we’ve succeeded as much as two people can through these text boxes! You seem thoughtful and cool to me.
Mutual.
Mary and Mills,
I attended a Baptist service in a poor part of Baltimore and the sermon was about Job. The entire emphasis was on Job's comeback. When I've heard it discussed as part of Jewish theology, the ending has almost no emphasis. The god of Judaism can be mercurial and cruel.
Which is why we Goyim became so very fond of Yeshua bin Miriam. An incomprehensibly loving Jewish man, whom our priestly class elevated to Godhood. But his Loving approach to life was not ontologically sufficient to our Hierophants, who deeply embraced the "fire and brimstone" facets of Judaism.
Correction: Job’s wife is the only one to survive.
Kind of makes you wonder who the intended audience back when this story was told as an oral tradition.
Also, please note that this is the only mention of the Devil in the Old Testament. The mythology is Zoroastrianism, not Judaic.
In that vein, I think history can be viewed as an expansion of who we tell stories for.
The Buddhist tradition has Buddha and Mara talking together, too. I always wished to hear those conversations, as well as this one.
Thank you for the correction.
Smartest thing thing I’ve heard all day; can I restack a Comment?
Please do.
Thank you for the compliment.
Good correction. Thanks.
I’ve struggled both for their struggles but also if my life was destroyed and my husband and children were killed “bygod” to “test my faith”. Sorry they are not just casually replaceable by another set!
Agree! it's a horrible story.
An intrinsic part of why I became a Buddhist.
Mary and Mills,
I attended a Baptist service in a poor part of Baltimore and the sermon was about Job. The entire emphasis was on Job's comeback. When I've heard it discussed as part of Jewish theology, the ending has almost no emphasis. The god of Judaism can be me
mercurial and cruel.
I recall hearing the story as a child in Catholic school. The emphasis was on how mightily he suffered. I remember the nun describing the sores on his palms with pus coming out of them. Geez. I wonder what the pedagogical intent there was.
There is arguably tons of value in transformative approaches to pain and suffering. But training young children to willingly embrace any sort of warrior ethos is a sell. Especially if there's not a clear roadmap with incentives. Pus-oozing-sores as a selling point?
Perhaps I go too far the other way, but I never discuss with anyone outside my immediate family (ie Mrs Freedman) what I do for charity or community organisations. I think its unseemly. I remember a member of my then community always giving £2000 in the annual collection, a fact that was loudly proclaimed to everyone, leaving the rest of us feeling that we wished we could do more, and him looking very proud. Anonymous giving would have been much better. Both the Jewish and Christian traditions support this. Maimonedes (https://aish.com/48893902/) and Jesus (https://reflectivebiblestudy.com/gospeladventure/giving-anonymously-matthew-6-1-4/). I also tend to express gratitude privately most of the time, because otherwise, as you suggest, it can be performative, or seem so.
Still, I think the ultimate criterion is WHY perform acts of charity or expressions of gratitude. If it's to make oneself look good, I believe that that in some indefinable way pollutes it.
As I am multitasking and about to race out, I may not have expressed myself well, so I just want to say that I am by no means suggesting that I think your acts of kindness/expressions of gratitude are merely performative!
I’m with you on this one Terry, at least partially, but I do think context matters. I tend to think it’s best not to talk about it unless the circumstances allow for a discussion that is not self-serving or self-congratulatory (like this one, I suppose).
Thanks, Tom. Yes I agree, context is key I think.
I've got a friend who gets one the wrong side of this one all the time. We'll get a text from him telling us how many homeless he fed last night, and maybe we should get involved? Well piss off, I think, I am involved ... I'm just not sharing it with you.
Well, exactly.
This.
Motivation informs perception. A sociopathic can publicly imitate the conduct of a Mother Theresa. While privately doing the unspeakable.
The primary Buddhist formula for altruism is relevant here: do/think/say good--and abstain from the opposite, because it *feels* good, and sets the stage for journey into deeper mysteries.
Absolutely, Nubby. Unfortunately I know at least 5 people like that. I have as little to do with them as possible. If nothing else, I actually feel a little polluted for having been in their presence.
It could be difficult, if not impossible, to fully know what their motives--or mixtures of motives--truly are.
From a Buddhist perspective, Mudita ("empathetic joy") would have one feel yummy-ness over whatever good they are accomplishing. But also Upekkha ("equanimity") would inform emotional response if any of their motivations were performative or unsavory. Mudita and Upekkha being 2 of the four ideal (spiritually mature?) emotional responses to every relational interaction.
I was on a train when I read your original comment, and when I arrived home I realised that I'd only seen the first part, which is what I responded to. I don't know an awful lot about Buddhism, so I find your comments interesting. I suppose the ideal state would be to be so spiritually developed that you would always say, do and feel the right things for the right reasons.
I wondered/worried if by writing about narcissism and complacency when it came to our giving whether I was "getting on the wrong side" of the subject as Tom put it. I think I did a bit as the highest form would be to remain silent as Terry mentioned but in writing personal essays I'm going to inevitably cross some lines.
It's an unavoidable paradox if one is going to write about such topics. As others here have said, much depends on context and motive I think.
The highest form of giving according to Maimonides is to give someone a livelihood. On an individual level that is "systemic." You're right that anonymity was very important and ranks high as well. In our modern world, it's an interesting question as to when not being anonymous ever is preferable. There's also an interesting distinction between "looking good" and "feeling good.'
Indeed.
Thx 👍👍
Single payer health care would indeed slow the growing wealth disparities in America.
The second (?) leading cause of personal bankruptcy is medical debt.
Our current multi-tiered system is extremely inefficient, providing roughly half the benefit at twice the cost, compared to every other industrial society. But its bloat and waste is defended by key stakeholders in our financial sector, despite the fact that such a GDP drain renders us uncompetitive with our greatest competitor: China.
You are my favorite wealthy person ever ! I have the odd but not unusual perspective of the well educated, hardworking but poor. I grew up pretty poor because my mom had to raise me alone after divorce. Even working three jobs most of the time she barely made it. I went to a very good school and did very well in my first career but some serious health problems hit in my early forties and I haven’t quite dug out from the fall out of not being able to work full time for years while trying to support my aging mother. I’ve gone without necessary healthcare for years. I live in a dangerous neighborhood that I cannot yet afford to move out of. I struggle to pay the basic expenses. It’s hard for me to be around people who throw money around like it’s nothing or who don’t understand why I can’t afford a new reliable car and don’t have any overseas vacations to talk about. Life is just different for those of us one emergency away from eviction. Fortunately I’m incredibly good at navigating systems - once I got 10k in medical debt written off because I qualified for charity care and I spent hours pursuing it. But most people don’t have those skills and going to the hospital for one night could destroy them. I’d love to start a nonprofit to help others who don’t have those skills navigate the systems and rescue their families. I’ve been on Medicaid too and was once denied a full course of antibiotics for a respiratory infection so I had to go into my food money to pay for the rest of the medicine. Most people wouldn’t know how important it is to finish the course of antibiotics but I have a masters in public health and I do. And I consider myself fortunate to have been able to come up with the $25. I love how you think about wealth and that you are conscious of the issues you write about. I’m sure you tip well. No matter what I always tip well if I have to take a cab or something because I know how much even two extra dollars means to those of us who count every penny. All the best to you and your family.
Hi, April. There are lots of well-educated, hardworking poor people out there, actually! I know many. Your antibiotic story is demoralizing. Why would we accept a system that would do such a thing to people?
Hi April -- regarding your wish to start a nonprofit to help families navigate healthcare bills. Are you familiar with https://dollarfor.org/ and https://unduemedicaldebt.org/ ? These two nonprofits both help families navigate and negotiate medical bills and medical debt.
April, your experience with the antibiotics illuminates the problem. It's a barbaric system that would have people in such a wealthy country make the choice you had to make. I do tip well because of the asymmetry of the effect of the tip. Thanks for your comment.
Why not put your philanthropic efforts into creating a new system of healthcare, one that ideally incorporates the best of the mainly European systems with our American love of laissez-faire? And that most existing stakeholders could buy into.
A Single Payer system with luxury tier care options for the 1% and 10% might be a good start.
I always tip in cash--even if I pay by credit card. The person receiving does not have to declare it and it is theirs for whatever they need. Servers aren't top tier millionaires, after all. Neither am I.
As I’ve noted before, Australia has Medicare - free basic medical care for all. It comes with its pitfalls but is a sound base premise for healthcare. I was horrified when I realised how American healthcare worked. I wish you all the best in trying to help change your system to a more equitable setup. Good luck.
No system is going to be without its pitfalls as you write. There's a lot of propaganda floating around about how awful all the other wealthy countries' systems are. Endless waits, etc.
Thank you for your openness, transparency, and willingness to explore potentially fraught issues.
Most Europeans are shocked when they learn about the US system. There are many different systems and the National Health Service (NHS) has its problems, but the principle that we all have a right to healthcare is deeply ingrained.
I'd imagine that America seems barbaric in this regard.
Yup. That word is not unknown in the context.
I haven't been grateful for insurance for the last 20 years. Deductibles are so high that I have to pay both my insurance and my doctor bill. Insurance literally takes money out of my hands that I don't get back. We were better off with a $500 deductible and 80/20 coverage.
I loved Obama as president but ObamaCare is the first time I went without insurance since I was 18. I can explain my reasons if you want to get into it, but I actually have come to mind that insurance just needs to go. Maybe a little capitalism will bring hospital prices down. I think maybe government protections for the people and maybe a rebate program would need to be in place but mostly, the disturbing thing about insurance has been their interference in healthcare. It has gotten to the point where doctors have quit doctoring. Again, I can get more into my own personal experience if you want to discuss but what we need is a total disruption in the whole process. Health care providers need to recruit people who are attracted to the science. Doctors need to be free to do the doctoring. Clinical studies need to be backed out of curiosity and innovation instead of backed by pharmaceutical corporations. Actually if I was in your position finding ways to back clinical studies and getting other people on board with it is where I would look. As for Insurance, it needs to get back to paying the bills and get out of doctoring. They also need to go back to single payer and move away from employee group plans. If President Obama had stuck with his original idea for insurance it'd probably wouldn't be as contentious.
Thanks April for the comment and the suggestion about clinical studies as a focus.
Actually I had an idea a few years back that I just remembered. Take the HSA cards that we have now and just by-pass insurance all together. Or maybe insurance would become more like AFLAC and cover your paycheck when out of work, or have Emergency Room insurance... Anyway, the HSA card would be yours, so if you changed jobs you don't have to worry about losing it, or spending all the money right away.
The structure is already in place. Paycheck deductions already happen, we are used to the money coming out of our checks. We are already used to automatic deposits. Then also there are the employer expenses that could now be applied to the employee, either in a matching program like the 401K or for padding new accounts.
This way whatever is not spent, can roll over into the next year. Now patient care is between the patient and the doctor. Now when a doctor writes a prescription you can actually go get it filled without going home and fighting the insurance company first. Plus those prescriptions will have to come down in price because pharmaceutical companies can't charge all willy nilly just because insurance will cover it. Same for any other medical care, X-Ray, or test.
You could have a family card or each member of the family has their own card that they can carry with them into adulthood. Now generational wealth is created. This would also set those kids up for maternity expenses to be covered when they're starting out in life and wages are at their lowest. I'm sure there will be some reckless spenders out there but the idea would be to build that account for end of life expenses.
The card is yours, at your bank, at whatever bank you choose. Which should help the local economy. Since the bank is using that money and turning it back into the community you also earn interest on that money.
As for employees of the insurance companies, they'd probably find work at the banks to keep the parameters of spending to medical expenses, or find work at malpractice insurance companies or whatever new industry crops up from this. move because it isn't a fully fleshed out thought. Anyway, that is my bright idea. Hope I didn't deviate from the topic too much. lol
Fully agree that we need to fix the health system. My son was diagnosed with type one diabetes at age 13. We had good insurance and the means to drive him to appointments and hour and a half away because there wasn’t a pediatric endocrinologist in our town.. but I remember thinking how hard it must be for those who don’t have adequate insurance and can’t take a day off every 6 weeks or so to learn how to manage this condition… I remember arguing with the pharmacy to get more test strips so my son could stay on top of his blood sugar… and I’m a mama bear and educated about health etc.. imagine someone trying to do this who is timid and not understanding of the importance? He now has a CGM and is doing well.. but having a family member get a chronic illness who is dependent on insulin to live and knowing there are others who have died rationing their medication is beyond infuriating… this is something we all need to get behind.
Thanks for the comment, MM. It's true that even when you have the tools to deal with a tough and complicated health issue, you realize how much time, resources, and education you need to handle it and wonder how others less fortunate can possibly get a good result.
I remember when the great George Michael died aged just 53 (that one really hurt), it was revealed that throughout his life, he anonymously volunteered in homeless shelters and gave millions of pounds to charities and less fortunate individuals without them knowing who the donor was. He helped so many people, and nobody knew how much he did for others or about the vast sums of money he secretly donated until he was gone. I loved him as an artist in life, but when I heard about his selflessness and extraordinary generosity after his death, I think of him as a saint. That's what I call a legacy!
I never knew that about him. Thanks Petra for the comment.
Keanu Reeves gives away lot as well. My favorite story is of Zack Galifinacas who early in his career befriended a homeless woman, found an apt for her and paid her rent while he was just a struggling stand up. A few years ago he brought her as his plus 1 to an awards ceremony.
The owner of Little Caesars (Mike Ilitch) quietly paid the rent for Rosa Parks from 1994 until she died in 2005.
Healthcare here is awful, why would anyone n o t think it's a right, and not a privilege?
To that extent, I mean to understand why things stay here as they are, I read many answers a few years ago, that roughly divided onto "but I have it good" (?? strange way to look into societal issues. also, today you happen to have it good -what about tomorrow?) and "the State has a habit of ruining things when it runs it" (slightly more relatable, because the State does; but maybe if to change the whole outlook it would ruin less. After all many states do succeed, mostly).
Now what's left is to change the outlook. I won't go into my own experiences, suffice to say it's maddenning, and I know about that much more than I'd ever care to.
Ah, and the better the doctor is, I noticed -the more time they spend on dealing with insurances pleading about this or that, instead, you know, doing what they're trained to do.
As for story of Job -I'd summarize it differently; but thank you for mentioning it, as it is indeed one of the best ones.
Thank you for the essay, as always, David
Thanks Chen for the comment. As for Job, it's a puzzle of a story that has fascinated many great thinkers. I was going for brevity and forsaking all the philosophical and theological questions it raises.
American individualism is at the root of most societal ills. It fuels an economic system that allows a handful of individuals to amass incalculable wealth, more than one person/family could use in a lifetime. It's obscene that in the United States people don't have enough food to eat, a place to live, excellent public education, and healthcare when they are sick, and yet an individual can amass billions of dollars. There is a mindset that we are not interconnected as human beings. Billionaires (and multimillionaires) truly believe that they "earned" their wealth, when in reality they've just been able to manipulate public systems to their advantage. The legacy of colonialism and slavery needs to be addressed and reparations made. America prospered because it committed a genocide against native peoples and built an economic system based on free slave labor. Legalized racism prevented Black people from buying government subsidized houses and participating in the GI Bill post WWII after they fought in the war. The first step is acknowledging that the reason some people have so much is because others have so little.
Thanks Amy for the comment. I'm not yet at the point where I'd call American individualism wholly toxic. That said, our social safety net and our tax system are out of joint with other countries and with basic decency.
I look forward to your posts on the topic of healthcare and encourage you to explore the root causes of the various problem statements and the outcomes that result. I am fortunate both with my health and with working for the US division of a Danish company (they offer several good options for health benefits). However, I was previously self-employed for about 10 years and the cost of insurance became too much of a financial concern. One of the outcomes of our current system in the US is that people who might not be happy or satisfied with their work may continue at a company because of the healthcare benefits.
I believe this is hinders one our greatest strengths as Americans - Entrepreneurialism
That's an excellent point.
It is strange and illogical that having adequate healthcare should be tied to where you happen to work. Thanks Jeanne for the comment.
Oh. So ripe . I can’t resist. Tradition in my family . Around holiday season. What we are thankful for. Most sincere . Others. Pass the sweet potatoes. Yesterday, speaking with my sister she casually mentioned the whole family , 22 total. 5 children, grands , she and husband going on their annual trip to Maui after Xmas “ we’ve told the adult kids no Christmas gifts for them. Just grandkids .” First class all the way. Each get suites . I chuckled under my breath . The trip would help give our son and daughter a down payment on a home. Am I envious? Nope. It’s just another vacation in the lives of upper 1 percent. Eat. Drink and be genuine.
Jennifer, that anecdote raises performative gratitude to a whole new level!