It’s not a “health care” debate

~ ianrandalstrock ~ Leave a comment

One of the big topics related to the government right now is the ongoing debate over “health care.” Specifically, allowing the Affordable Care Act subsidies to expire, finding a better way to pay for health care, and blaming the other side for the mess we’re in (well, that last is pretty standard for every issue at the federal level). As a person who tries to use words precisely, to best communicate my thoughts to you, I cringe every time a politician or pundit says “health care,” because that’s never what they mean.

Health care is when I go to the doctor and say “this hurts.” The doctor checks me out, diagnoses what is causing the hurt, and treats it (or tells me what to do) so that it stops hurting. That’s health care. And in that respect, health care in the United States is great. We have excellent doctors and nurses and physician assistants and therapists and… a whole slew of people who do remarkable things to make us feel better and keep us healthy, along with the equipment and medications and more. And none of that is what they mean when the politicians and reporters talk about health care.

No, what they’re talking about is “health insurance”: a system of paying for the health care we get that keeps us going. And health insurance in the United States is a disaster, falling apart and falling fast. And none of the tweaks they keep proposing at each other are going to fix the health insurance industry, because we’ve been misusing it and expecting far more from it than it can ever possibly provide.

The thing is, health insurance isn’t some unending pool of money which pays for our every smallest medical need. Health insurance—indeed, any form of “insurance” (except the half-wager when you’re playing blackjack and the dealer has an ace showing)—is a collection of people betting on something they hope won’t happen.

Start with something slightly less controversial: car insurance. You pay a small amount every year to someone managing the money (the insurance company), against the (hopefully very small) chance of being in a crash and requiring a lot of money to repair your car (or one your actions damaged). This only works if there are a lot of people paying in for this insurance and very few of them actually get in crashes requiring large pay outs. In the ideal world, if you had enough money to cover those potential expenses, you wouldn’t bother buying insurance; you’d just pay the repair/replacement costs yourself if you ever needed to (I’m ignoring your responsibility for the other guy’s car, and why states require car insurance). What this all means is that most people pay for car insurance and don’t ever get any money from it, because the entire group of people is funding the expenses of the one or two people who will wind up actually needing it. It only works because relatively few people need it, and no one knows if they are going to be that one person who does. So everybody pays a little, and most never get anything but peace of mind from it.

Health insurance is similar to car insurance. At least, it used to be. You would pay a small amount every year against the (statistically) small chance of having a catastrophic illness or injury that would be very expensive to treat. And the few people who did have such needs would have their expenses paid for by the insurance company (again, in an ideal world), while everyone else in the insurance pool would wipe the sweat from their brows and say “I’m glad I wasn’t the one who needed the money.”

But health care has evolved. Most people used to only see a doctor when they had a major injury or illness. As we’ve developed more of the concept of wellness care, more and more of us go for regular check-ups, low-level medical treatments to prevent (or earlier detect) major problems, and so forth.

And while these are (theoretically) inexpensive health care events, we now expect “insurance” to pay for them all. (Admittedly, the costs of those inexpensive events have been rising, too. And if our politicians were serious about this whole debate, that is where they would be focusing: why does it cost hundreds of dollars for a regular check-up?) But as we expect most people to have those regular check-ups and those preventative treatments, we’re over-stressing the ability of health insurance to cover the catastrophic costs it was designed for. That’s not a fault of insurance; it isn’t a money-multiplier. Way back when, if everyone paid $100 a month for insurance, it was against the fear that one person in a hundred would have a medical problem this year that might cost $100,000 to treat. At those numbers, the insurance pool was sufficient.

But today, we’ve gotten to the stage where, instead of everyone paying in against the rare major need, everyone is paying in their $100 a month… and everyone is expecting insurance to pay the doctor $400 for our “see me in six months” regular check-ups, and we’re expecting insurance to pay for the $25-a-month prescription medicine, and suddenly there’s no money in the insurance pool for the $5,000 the emergency room is going to charge to treat your broken leg, and that $100,000 expense will be enough to bankrupt the insurance company.

The failure is that we’ve spent a couple of generations teaching people that medical treatment is health care, and it’s not just for emergencies, but that everyone should seek it out continually as a preventative. Medically, that’s a good thing. But financially, it may be ruinous. Our methods of paying for it have not kept up.

The recently signed discharge petition means the House of Representatives is going to vote on an extension of the Affordable Care Act subsidies sometime in January. Even if it passes, it’s not going to fix anything, because the entire concept of health insurance is broken. I readily admit that I don’t have the solution, either. But someone smarter than all of us is going to have to figure it out. Because if it’s something we expect most people to use, then the only way to pay for it is individually. And the costs have risen so far so fast that most people simply can not afford to pay for it.

The president’s proposed fix—“we’ll just give everyone $2,000, rather than paying the insurance companies”—is naive at best. Where is the government getting the money to give everyone $2,000? The same place the government gets all its money: from the people. It’s a non-starter.

Indeed, the whole debate has become the Second Law of Thermodynamics for finance: if everyone is paying for insurance, but everyone expects to use it, then insurance is nothing more than a drain on everyone’s wallet.

Blackjack table image by Frerk Meyer, shared under Creative Commons Attribution-Share Alike 2.0. https://upload.wikimedia.org/wikipedia/commons/thumb/7/7e/Blurry_blackjack_table.jpg/640px-Blurry_blackjack_table.jpg

Compliment and addition from Samuel Delany

~ ianrandalstrock ~ Leave a comment

I just got some very nice praise, and more information, from Samuel Delany about my latest book. He writes:

I recently enjoyed your book, Punctilious Punctuation, very much. One of the things you didn’t mention, however, is that anyone who has ever studied Greek (as I did in my youth) who learns to speak it (as I did in my time in Greece), realizes that the semicolon functions, in Greek, as a question mark. There is no mention of this in your otherwise remarkably thorough treatment of those jots and tittles.

Wow, thanks, Chip!

(And here’s a picture of the two of us from several years ago.)

WotF Podcast #358

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I am the guest on the newest podcast episode of the Writers & Illustrators of the Future podcast, episode #358, which is now available at https://writersofthefuture.com/podcast/episode-358/ .

The main topic of discussion is my new book, Punctilious Punctuation, but we also go into punctuation and communication in general as well as writing clearly. Several things mentioned during the episode may have you seeking more information, so here’s a list (in the order in which they were mentioned):
Analog Science Fiction & Fact magazine: https://analogsf.com/
Asimov’s Science Fiction magazine: https://asimovs.com/
Gray Rabbit Publications / Fantastic Books: https://www.fantasticbooks.biz/
DragonCon: https://www.dragoncon.org/
Punctilious Punctuation: https://www.fantasticbooks.biz/product-page/punctilious-punctuation-by-ian-randal-strock
AP Stylebook: https://www.apstylebook.com/
Victor Borge’s spoken punctuation: https://www.youtube.com/watch?v=TIf3IfHCoiE
Eats, Shoots & Leaves by Lynne Truss: https://www.lynnetruss.com/eats-shoots-leaves

The person behind the curtain?

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MSNOW’s Morning Joe just wrapped up—as it frequently does—interviewing an actor. Today, it was Simu Liu talking about the science fictional ideas behind his new series, The Copenhagen Test. He did well, talking about the nature of privacy and hacking and trusting our own sense. But as he was talking, I wondered why they weren’t interviewing the writer who came up with the idea for the show. After all, their focus was on the concept underpinning it, so wouldn’t the best interview be the person who created that?

Intellectually, I know, they interview actors because viewers know the actors and don’t know the writers. But if they’re talking about the ideas, it occurred to me, they ought to be talking with the people whose ideas they are.

The Communal Nature of Television

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I’m home alone, all by myself. And White Christmas is on BBC America right now (one of my favorite musicals). I didn’t call it up from some on-demand service; I stumbled across it while flipping channels.

And watching a movie, “live,” as it were, has a very different feeling than on-demand would. I don’t quite understand it. There’s something in the knowledge that other people are watching the same thing at the same time, seeing and reacting to the same things.

I don’t know who they are, don’t know where they are, will never interact with them. And yet… yet I still find watching on television more appealing, more of a communal feeling, than on-demand or on DVD or VHS or whatever. Not communal like sitting in a movie theatre (which I think I’ve done once in the last six years), nor even with a few friends or family members in the living room. But still, there’s that hint of doing something as a group rather than all by my lonesome. Does that make any sense to you?

 

Bad coin design

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I just sent the following email to the US Mint (at inquires@usmint.treas.gov).

Please, PLEASE tell us the obverse design of the “Enduring Liberty Half Dollar” is NOT final, and that it will be improved. Specifically, the point on the Statue of Liberty’s crown that comes out from behind her nose makes her look like Pinnochio telling a lie. Please move the tine away from the nose.

The image of next year’s half dollar (look at it small, or almost life-sized, on 
https://www.usmint.gov/news/media-kit/semiq-resources#accordion-ff8bbe2a7a-item-a383a9f54d ) is:


Saul Rubinek playing Saul Rubinek playing Shylock

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I had an odd theatrical experience this past Tuesday. I went to a show, and while I’m still not sure if I liked it, I am still thinking about it, so in that respect, it was good.

The show is Playing Shylock, starring Saul Rubinek (the original version was written by Mark Leiren-Young; this was apparently an updated, modified script). It was in the Polonsky Shakespeare Center, a little theatre in Brooklyn, and the show is closing tomorrow, so at this point, I can’t really urge you to see it yourself.

The conceit is that the audience is actually there to see a production of William Shakespeare’s The Merchant of Venice. [Aside: I’d never read the play before, though I knew bits of the story, so Monday night, I watched a film version from 2004.] A voice-over tells us the second act will be delayed due to technical difficulties, and eventually, Saul Rubinek comes on stage—in costume as Shylock—to tell the audience that they will not be performing the second half of the play, because the cast accidentally learned during this intermission that the theatre has cancelled the remainder of the run, making tonight’s performance the last.

What follows is a nearly two hour-long monologue/discussion of artistic freedom, antisemitism, and virtue signaling. But also, the concepts of freedom, security, and memory; the Jewish experience in surviving (or not) the Concentration Camps in Nazi Germany; and honoring our parents as we live the better lives they worked for us to have. Thrown in are digressions about the nature of representation, artistry and artistic credit, and the never-ending debate over who actually wrote the plays of William Shakespeare. As with all of the best questions, there were no hard-and-fast answers. It was all there to make us think.

Playing on nothing more than his own memories, the script, and the all-too-limited audience reactions, Rubinek is wonderfully emotive, and incredibly moving. And with such heavy concepts and weighty thoughts, there is just the right touch of levity to keep the show from being crushingly depressing… even though he and we know that the depression has a very strong foundation, and holding back the tide of the antisemitism, the repression, and the outright hatred may not be possible.

One of the unintended sources of discomfort, for me, was his interactions with the audience. I’ve been in theatres my whole life, sometimes on the stage, more often in the audience. And in all that time, I’ve learned that the audience’s role is to watch, but not to interact. (There is, of course, the allowed interaction during lectures, which are a different animal, perhaps because the “actor” is not playing some fictitious character, but is merely himself.) But in Playing Shylock, Rubinek is playing himself—or an alternate universe version of himself—in which he is still in costume from the interrupted performance of The Merchant of Venice, except that there was no actual interrupted performance of the play, so is he actually just Saul Rubinek, or is he a fictitious Saul Rubinek? At any rate, several times he asked the audience for commentary, for responses, and I truly didn’t know if I was supposed to supply the other side of that conversation, or if those were rhetorical questions, part of the script. I suppose that added discomfort may actually have been intended, to show that the comfortable world we hope we live in is not really so scripted and easy.

Yes, I guess I did like it. Not in the “that was a lot of fun; I want to do it again” way of liking something, but in the “that made me think” way. Yes, it was an evening well spent. Bravo, Saul Rubinek, and playwright Mark Leiren-Young.

 

A Talent to Amuse publication day

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If you weren’t with us at Philcon this weekend, today is your first chance to get a copy of Daniel M. Kimmel’s fantastic new novel, A Talent to Amuse. It’s a funny, fantastical, romantic look at the concepts of creation and inspiration.

What happens when a struggling writer falls in love with an unemployed Muse? Only the Fates know…

Writers have spent centuries praising and cursing the Muses, as their artistic talents have waxed and waned. But it’s a rare writer indeed who can attract not only the attention of a Muse, but her love, too.

Meet Sherman Biberman, a fair-to-middlin’ writer who actually meets his Muse in the park. You thought there were only nine? Where have you been? Sherman and Komikós (the Muse of Humorous Genre Fiction) are parting ways, but Komikós knows another, out-of-work Muse, who just might be good for Sherman, and vice versa.

That begins Sherman’s relationship with Vinteokaséta, the erstwhile Muse of Blockbuster Video stores. She’s currently unemployed, and looking for some inspiration herself.

Hugo Award-finalist, Skylark Award winner, and Cable Center Book Award winner Daniel M. Kimmel showcases his wide range of writing talents in A Talent to Amuse, introducing us to Muses greater and lesser, offering tales in myriad genres, and topping it all with heaping dollops of the humor and pathos that has made him such a beloved writer.

The book is available hardcover, trade paperback, and electronic formats, in all the usual outlets.

What brings you joy?

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I’m planning to go to a Mensa gathering this evening, just some people getting together in a restaurant/bar for conversation. The last time this particular gathering gathered, it was fascinating. I met several new people, including some from other countries, who knew and talked about things I didn’t know, so I learned. It was a good time.

But there was one woman present who I’d only known from online interactions. Unfortunately, in person, she was the same: always complaining, angry, and put upon. Nothing was right, and everything needed to be corrected to her standards. Thinking about tonight’s gathering, I’m anticipating the good, but I’m wondering what I might say if I find myself in proximity to this woman, to short-circuit her kvetching. I think I’ll ask her what brings her joy.

That, however, makes me think she might turn the question back on me: what brings me joy? So I’ve been thinking about that.

I try to find some joy in every day: whether it’s talking with my family, hearing a new song or joke (well, new jokes are rare these days), or learning and playing games with friends, but those are little things, small joys (mind you, that doesn’t make them any less important or less cherished). But there are bigger joys, too: being on stage (thinking of the talk I gave last weekend, about punctuation and my new book), selling a story or essay, or experiencing something genuinely new, like visiting a new place.

Most of those, however, rely on other people. But there are also the joys that don’t require other people’s efforts: writing, for me, is one of those joys, whether I’m at the keyboard or out walking and the right turn of phrase comes to me. Selling what I’ve written adds another level of joy, but even without the selling, I enjoy my time choosing precisely the correct word, and ordering those correct words. My wood carving is another one of those joys; one I get to experience too seldom, especially in the colder months, since there’s no place to do it in the house. And there are a few cherished movies I’ll rewatch when I need a lift, a pick-me-up, because they always make me smile (although movies, by their very nature, require other people to have done a great deal to get them to me). It’s a similar thing with reading an especially good passage or engrossing story, when not only am I enjoying what I’m reading, but I’m trying to figure out how the writer did it, to see if I can learn from it to improve my own writing.

Anyway, that’s a short answer to the question I may ask of others this evening, but I’ll ask you, too: what brings you joy?

 

Science Fiction Convention (10th of 2025)

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It’s another science fiction convention weekend, this time with an over-stuffed Saturday! This weekend, I’ll be at the Doubletree in Cherry Hill, New Jersey, for Philcon.

As always, you can find me in the Dealers’ Room, open Friday, 4:00–7:00 pm; Saturday 10:00 am–6:00 pm; and Sunday 10:00 am–3:00 pm.

You can also find me on programming:

Saturday at 12:00N in Plaza 3: “Meet More Editors!” with Danielle Ackley-McPhail, Michael D. Pederson, Alex Shvartsman, and Ann Stolinsky

Saturday at 3:00PM in Plaza 4: “How Do I Get Publishers to Notice Me?” with Aaron Rosenberg, Neil Clarke, and Michael A. Ventrella

Saturday from 6:00 pm to 7:30 pm in the Con Suite: book launch party for Daniel M. Kimmel’s A Talent to Amuse, as well as Dragonwell Publishing’s new book by Bernie Mojzes.

Saturday at 8:00PM in the Grand Ballroom: I’ll be emceeing the Masquerade.

Sunday at 11:00AM in Plaza 3: “Assembling an Anthology” with Danielle Ackley-McPhail, Neil Clarke, Alex Shvartsman, and Michael A. Ventrella

If you read that schedule closely, you’ll notice I have to be in the dealers’ room and the con suite and the masquerade Saturday afternoon/evening, probably all three at the same time, so I don’t really know where I’ll be: setting up for the launch party in the con suite before 6:00; closing the table in the dealers’ room at 6:00; and preparing for the masquerade before 8:00. You, however, as an attendee, will be able to do all three with no overlap.

Dan’s book, A Talent to Amuse, is a wonderful romantasy. In it, a professional writer is looking for the inspiration to take his writing to the next level. He meets an out-of-work Muse, who is looking for some inspiration of her own. And together, they may find something even more.

I hope to see y’all at the convention!